WB, LLC Job #212241 Northampton CPR WE 5.21.22I,
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 has been printed on the reverse of this page 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 also 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
5/25/2022
Janet R. Delisle Senior Payroll Professional
(Name of signatory party) do hereby state: (Title)
That I pay or supervise the payment of the persons employed by
Warner Bros., LLC on the Ludlow Construction/Paving Lower Pleasant St, Northampton
(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
�(z<gL,�Senior Payroll Professional
DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2ND FLOOR, BOSTON, MA. 02114
.,
MASSACHUSETTS WEEKLY CERTIFIED PAYROLL REPORT FORM
� Company's Name !Address Phone No. Payroll No. -- -�)j Warner Bros., LLC PO Box 91 Sunderland, MA 01375 413-665-4055 1 9♦ '
Employer's Signature Title Contract No. Tax Payer ID No. Work Week Ending_
Janet R. Delisle� I<. Ve,�Senior Payroll Professional 212241-22-3921149 5/21/2022
�warding Authority's Name Public Works Project Name -· Public Works Project Location Min Wage Rate Sheet No.
City of Northampton Ludlow Construction/Paving Lower Pleasant St, Ludlow Construction/Paving Lower 20210606-002Northampton Pleasant St, Northampton
K3eneral I Prime Contractor's Name Subcontractor's Name "Employer'' Hourly Fringe Benefit Contributions
Ludlow Construction Warner Bros., LLC
Project HOURS WORKED Hours Employee is Appr !Al OSHA Rate Allvmer Employee Work Classification Certified(?) (%) Sun Mon Tue Wed Thu Fri Sat Hours
DeMaria, Vincent D Laborer 0 8.00 4.50 12.50
19 Cleveland Street 0.50 0.50
Greenfield, MA 01301 1�7i'i/'
Dixon, Michael J Laborer 0 8.00 4.50 12.50
3 Rocky Ledge Ct 0.50 0.50
Vernon, VT 05354 1� 1
Fuller, Steven B 8.00 4.50 12.50 Laborer 0 131 Amherst Road 0.50 0.50
Pelham, MA 01002 1007/i/'
Kelley Ill, John S 4&5Axle 0 2.25 105 Stock Bridge Street 2.25 Equipment Hadley, MA 01035 ,�,� -----
LaFlam, Christopher J Paver (Class 2) 0 8.00 4.50 12.50 n en 0.50 532 Franklin Road
Vernon, VT 05354 1�
Are all apprentice employees identified above currently registered with the MA DLS's Division of Apprentice Standards?
For all apprentices performing work during the reporting period, attach a copy of the apprentice identification card issued
by the Massachusetts Department of Labor Standards/ Division of Apprentice Standards.
�-�v'i" I
(B+C+O+E) (Ax F) I ' Project Hour1y I HIIIIII& ERIIA Total Gross Wages Base ' ..... Pnlclll Supp Hourty {GI Wage ' Nll'IICil Plall u-. PrevWage Total Gross Check No
(B) I R:(D) (E) (F)Wanes IHI
32.50 10.15 14.01 0.00 56.66 732.63 2022052716 48.75
1,538.86
•_•.· ..
32.50 1tHS 14.ti·-0.0()' 56.66 732.63 2022052716 48.75 ·; -.·· .. -.�
' 1,538.86
' 10.15 14.01 0.00 56.66 732.63 2022052716 32.5048.75 ,. ..
1,561.64
80.96 0.05 3.12 0.00 65.56 182.15 2022052716
1,675.12
36.7 4 12.89 15.45 0.00 65.08 841.06 2022052716 55.11
2,210.96
YES NO
No apprentices are identified above ✓
NOTE: Pursuant to MGL c. 149, s. 278, every contractor and subcontractor is required to submit a true and accurate copy of their certified weekly payroll records to the awarding
authority by first-class mail or e-mail. In addition, each weekly payroll must be accompanied by a statement of compliance signed by the employer. Failure to comply may result in the
commencement of a criminal action or the issuance of a civil citation.
Page 1 of 3
Date received by awarding authority
I I
and
5/25/2022
Janet R. Delisle Senior Payroll Professional
(Name
Warner Bros., LLC on the
Senior Payroll Professional
__ MASSACHUSETTS WEEKLY CERT�FIED PAYROLL REPORT FORM_ _ ;f-·� Company's Name �ddress Phone No. Payroll No. (t -;:�Warner Bros., LLC PO Box 91 Sunderland, MA 01375 413-665-4055 1 �;}'
Employer's Signature Title Contract No. Tax Payer ID No. Work Week Ending
JanetR. Delisle� !<Be� Senior Payroll Professional 212241-22-3921149 5/21/2022
Awarding Authority's Name Public Works Project Name · -Public Works Project Location Min Wage Rate Sheet No.
City of Northampton Ludlow Construction/Paving Lower Pleasant St, Ludlow Construction/Paving Lower 20210606-002Northampton Pleasant St, Northampton
General I Prime Contractor's Name Subcontractor's Name "Employer'' Hourly Fringe Benefit Contributions
·=---...-·----·-
Ludlow Construction Warner Bros., LLC
,. (B+C+D+E) (Ax F)
Project ' . Project . HOURS WORKED Houns Hour1y ' Heallh & ERSIA Total Gross Wages Employee IS Appr (A) Base . ..... Penllan -Hour1y {Gl . . O�HA Rate All vmer Wage lnlurace Plan U-.,. Prev Wage Total Gross Check No Employee Work Classification Certified (?) (%) Sun Mon Tue Wed Thu Fri Sat Houns (B) (C) (D)ii!» (F)waaes !Hl
14 Gould Road Equipment ✓ Maiers, Michael T 4 & 5 Axle [2) 2.75 1.00 3.75 51.20 . 1 __ 1.l!Q . i;Se 0.00 65.56 245.85 2022052716
Ware.MA 01082 11$SSS i \Y;?;i? . -·.. 1,808 .17
10 Old Greenfield Road ✓ 1---+---+------.1----+---· --+--+---+---+----+---.......... --+---t----t-----t--------t
McBride. Brian C 2 Axle Equipment [2) 1 50 o.5o o.5o 1_50 .
37 o355 55 ' · 12:eS .J$A5 0.00 65.37 116.00 2022052716
Shelburne, MA 01370 11� ·,, j 2,269.30
McBride, Brian c Roller (Class 3A) [2) 8 'ii°50 4-5 0 1250050 37 0\555 12.89 15.45 0.00 65.37 844.90 2022052716
10 Old Greenfield Road ✓ 1---+---t------,1----+---· --+--+---+---+----t----+----+-----t---t-----r-------1
Shelburne, MA 01370 11� 2,269.30
Rougeau, James D 4 & 5 Axle [2) 2-75 1-00 3.75 56-35 6.41 2.81 0.00 65.56 245 .86 2022052716
68 Kendall Street Equipment ✓ Granby, MA 01033 11� 1,878 .68 � ...
24 Shelburne Center Road ✓ Tobin, Ryan P Laborer [2) 8�0"" 4-50 12500 5 0 32504875 10.15 14.01 0.00 56.66 732.63 2022052716
Shelburne Falls, MA 01370 11$'� 1,538 .86
Are all apprentice employees identified above currently registered with the MA DLS's Division of Apprentice Standards? For all apprentices performing work during the reporting period, attach a copy of the apprentice identification card issued by the Massachusetts Department of Labor Standards/ Division of Apprentice Standards. YES NO
No apprentices are identified above ✓
NOTE: Pursuant to MGL c. 149, s. 27B, every contractor and subcontractor is required to submit a true and accurate copy of their certified weekly payroll records to the awarding authority by first-class mail or e-mail. In addition, each weekly payroll must be accompanied by a statement of compliance signed by the employer. Failure to comply may result in the commencement of a criminal action or the issuance of a civil citation.
Page 2 of 3
Date received by awarding authority
I I
and
5/25/2022
Janet R. Delisle Senior Payroll Professional
(Name of signatory party) (Title)
Warner Bros., LLC on the
(Contractor, subcontractor or public body) (Building or project)
Senior Payroll Professional
MASSACHUSETTS WEEKLY CERTIFIED PAYROLL REPO�!_FORM � 1Company's Name ddress Phone No. Payroll No.
� -;) Warner Bros., LLC PO Box 91 Sunderland, MA 01375 413-665-4055 1 \ .. ,'�J
Employer's Signature ·fnt1e
Janet R. Delisle fl-J' R Be.-� I Senior Payroll Professional
Contract No.
212241-
ITax Payer ID No. !Work Week Ending_
22-3921149 I 5/21/2022
!Awarding Authority's Name Public Works Project Name Public Works Project Location Min Wage Rate Sheet No.
City of Northampton Ludlow Construction/Paving Lower Pleasant St,
Northampton
Ludlow Construction/Paving Lower
Pleasant St, Northampton 20210606-002
General !Prime Contractor's Name
Ludlow Construction
!Employee
Welch, Chad W
509 Hampden Street
Holyoke, MA 01040
Williams, Timothy J
1109 Conway Road Apt 2C
Ashfield, MA 01330
Work Classification
Laborer
1�
Roller (Class 3A)
�
Employee is OSHA Certified (?)
f2]
f2]
Subcontractor's Name
Warner Bros., LLC
HOURS WORKED Project
Appr A
I Hou� I��j I Sun I Mon I Tue I Wed I Thu I Fri I Sat A=:
a.oo I 4.50 I 1 ,2.so
QSO QSO
8.00
0.50
5.50 13.50 0.50
Are all apprentice employees identified above currently registered with the MA DLS's Division of Apprentice Standards?
For all apprentices performing work during the reporting period, attach a copy of the apprentice identification card issued
by the Massachusetts Department of Labor Standards/ Division of Apprentice Standards.
Hour1y Base Wage
(B)
32.50 48.75
35.91 53.87
"Employer'' Hourly FringeBenefifContributions
Htllllt & l ERIIA ..... ,._. T;.·:.
1 llf-X2i;or,
i�(tf{.,_. ::r
8upp u..., (E)
0.00
12.89ff r15fflS< o,<W)
YES
(B+C+O+E) (Ax F) Total Hourly PrevWage (F)
56.66
64.25
NO
Project Gross Wages (G) Total Gross I Check No
Waim. (Hl 732.631 2022052716
1,538.86
894.311 2022052716
1,696.78
No apprentices are identified above ✓
NOTE: Pursuant to MGL c. 149, s. 278, every contractor and subcontractor is required to submit a true and accurate copy of their certified weekly payroll records to the awarding
authority by first-class mail or e-mail. In addition, each weekly payroll must be accompanied by a statement of compliance signed by the employer. Failure to comply may result in the
commencement of a criminal action or the issuance of a civil citation.
Page 3 of 3
Date received by awarding authority
I I