Laurel St. Improv.-N'hampton Stmnt of Compliance 5-14-220/14
WEEKLY PAYROLL RECORDS REPORT
& STATEMENT OF COMPLIANCE
In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must
be kept of all persons employed on the public works project for which the enclosed rates have been
provided. A Payroll Form is available from the Department of Labor Standards (DLS) at
www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor
or subcontractor is required to keep these records and preserve them for a period of three years from
the date of completion of the contract.
On a weekly basis, every contractor and subcontractor is required to submit a certified copy of
their weekly payroll records to the awarding authority; this includes the payroll forms and the
Statement of Compliance form. The certified payroll records must be submitted either by regular mail
or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve
those records for three years from the date of completion of the project.
Each such contractor and subcontractor shall furnish weekly and within 15 days after
completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a
statement, executed by the contractor, subcontractor or by any authorized officer thereof who
supervised the payment of wages, this form, accompanied by their payroll:
STATEMENT OF COMPLIANCE
_______________, 20_______
I,___________________________________,___________________________________
(Name of signatory party) (Title)
do hereby state:
That I pay or supervise the payment of the persons employed by
___________________________________ on the ______________________________
(Contractor, subcontractor or public body) (Building or project)
and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on
said project have been paid in accordance with wages determined under the provisions of
sections twenty-six and twenty-seven of chapter one hundred and forty nine of the
General Laws.
Signature _________________________
Title _____________________________ PresidenW
President JaVRQ LaURchelle
JL ConVWUXcWion CoUS
MD\ 20 22
LaXrel SW. ImproYemenWV - NorWhampWon