WB LLC (All State Const) Northampton CPR WE 5.21.22I,
WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE
ln 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 payr,,J: records must be submitted either by regular mail or by e-mail
to the awarding authorit. Oner ;ollected, 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 famish weekly and within 15-tlays---a fter eompletion
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
Chifan Huang Payroll Professional
(Name of signatory party) do hereby state: (Title)
That I pay or supervise the payment of the persons employed by
All States Construction, Inc. on the WB, LLC Job #212241: Northampton, MA: RS-1 D & A
(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 Payroll Professional DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2ND FLOOR, BOSTON, MA. 02114
MASSACHUSETTS WEEKLY CERTIFIED PAYROLL REP ORT FORM
!Company's Name Address Phone No. !Payroll No.All States Construction, Inc.PO Box 91 Sunderland, MA 01375 413-665-7021 I 1
Employer's Signature tnt1e �Contract No. Tax Payer ID No. !Work Week Ending
Chifan Huang � -Payroll Professional 220174-04-2216868 5/21/2022
!Awarding Authority's Name Public Works Project Name
City of Northampton, MA WB, LLC Job #212241: Northampton, MA: RS-1 D & A
General TPrime-Contractor's Name iSu6contractor's Name
Ludlow Construction All States Construction, Inc.
HOURS WORKED
Public Works Project Location IMin Wage Rate Sheet No.
WB, LLC Job#212241: Northampton, MA: I 20210606-002 RS-1 D &A
"Employer" Hourly Fringe Benefit Contributions
-·· --
(B+C+D+E) (AxF) .. Project
Hours Hourly illllllllJ ERM Total Gross Wages
IAI Base ....... ,... ._I Hourly IGI Employee is I Appr OSHA Rate I 1 1 , , I , I All M I
Project I.... -ther Wage ....... ,.. ....... PrevWage Total Gross l Check No
(Cj-!Employee
Maillet, Ronald J
22 Mechanic Street
Orange.MA 01364
Work Classification I Certified (?) (%) I Sun I Mon Tuel Wed
Distributor
10043 0 Thu Fri
3.50
Sat I Hours
3.50
,---1---1---1---,-t -t---t--1 -----'I
_,,
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.
(B)
72.09
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8.31
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-SI
,,.
(DJ (E) ' (F) Wanes IHI
2.72 0.00' 65.56 252.311 2022052716
2,194.52
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YES I I NO I I <
No apprentices are identified above I V I
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 1
Date received by awarding authority
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