Fillable Dd Form 879 - Statement Of Compliance printable pdf download

Form Approved

STATEMENT OF COMPLIANCE

OMB No. 1215-0149

Expires June 30, 2000

The public reporting burden for this collection of information is estimated to average 16 minutes per response, including the time for reviewing instructions, searching existing data sources,

gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection

of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (1215-0149). Respondents should be aware

that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB

control number.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER.

1. PAYROLL NUMBER

2. PAYROLL PAYMENT DATE

3. CONTRACT NUMBER

4. DATE

(YYYYMMDD)

do hereby state

(Name of signatory party)

(Title)

(1) That I pay or supervise the payment of the persons employed by

(Contractor or subcontractor)

on the

; that during the payroll period commencing on the

day of

(Building or work)

, and ending the

day of

, all persons employed

on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on

behalf of said

from the full weekly wages earned by any person

(Contractor or subcontractor)

and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible

deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended

(48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below:

(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the

wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination

incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed.

(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State

apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such

recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.

(4) That:

(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS

- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of

fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,

except as noted in Section 4(c) below.

(b) WHERE FRINGE BENEFITS ARE PAID IN CASH

- Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less

than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,

except as noted in Section 4(c) below.

EXCEPTION (Craft)

EXPLANATION

5. REMARKS

6. NAME (Last, First, Middle Initial)

7. TITLE

8. SIGNATURE

The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution.

See Section 1001 of Title 18 and Section 3729 of Title 31 of the United States Code.

DD FORM 879, APR 1998

PREVIOUS EDITION MAY BE USED.

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Dd Form 879 - Statement Of Compliance

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