Certified Payroll - Alaska Department Of Labor & Workforce Development (Page 2 of 2) in pdf

STATEMENT OF COMPLIANCE

CERTIFIED PAYROLL

DO NOT LIST SSN ON PAYROLLS

Contractors & Subcontractors Please Note!!

FORM 07-6058

8 AAC 30.020 CERTIFIED PAYROLL. (a) All Contractors (including owner/operators) who perform work on a public construction contract for the state or political subdivision of the state shall file with the

Department a certified payroll (Form 07-6058) before Friday of every second week that covers the preceding two weeks.

(b) The certified payroll shall be submitted to the Department’s regional office in which the work is performed (addresses shown at the end of this page).

In lieu of submitting Form 07-6058, contractors may submit his/her payroll form IF THE FORM DOES NOT CONTAIN SOCIAL SECURITY NUMBERS. However, the payroll record must contain the same

information required on this form.

Sec 36.05.040 requires that all contractors or subcontractors who perform work on a public construction contract for the state or a political subdivision of the state shall, BEFORE FRIDAY OF EVERY SECOND

WEEK, file with the Department of Labor and Workforce Development (DOLWD), a sworn affidavit for the previous two weeks, setting out in detail the number of workers employed, wages paid each week, job

classification of each employee, hours worked each day and week, and other information which the DOLWD requires.

CONTRACTORS WHO DISREGARD THEIR OBLIGATIONS TO THEIR EMPLOYEES, INCLUDING PAYMENT OF THE APPROPRIATE PREVAILING RATES OF PAY, UNCONDITIONAL PAYMENT,

AND PAYMENT NOT LESS THAN ONCE A WEEK MAY BE DEBARRED FROM PUBLIC CONSTRUCTION.

Date:_________________________

(2) That ____________________________________

(Contractor/Subcontractor)

this payroll has been paid, as indicated on the payroll, an

I, ______________________, ________________ do hereby

amount not less than the sum of this applicable basic hourly

is in full compliance with the provisions set forth in AS 36.10,

(Name of Signatory Party)

(Title)

wage rate plus the amount of the required fringe benefits as

which requires employment preference for Alaska residents as

currently published by DOLWD, except as noted in Section

state:

outlined in AS 36.95.010; and

6(d).

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

(3) That any payrolls otherwise under this contract required

(d) Exceptions: (List other exceptions on a separate sheet

to be submitted for the above period are correct and complete;

of paper if necessary.)

that the wage rates for laborers, mechanics or field surveyors

Exception (Craft)

Explanation

_______________________________________________on the

contained herein are not less than the current applicable wage

(Contractor/Subcontractor)

rates established by DOLWD; that the classification set forth

Remarks

therein for each laborer, mechanic or field surveyor conforms

____________________________________; that during the

with the work performed; and

(Building or Work)

(4) That any apprentices employed in the above period are

duly registered in a bona fide apprenticeship program

payroll period commencing on _____________ and ending

Signature (original signature required)

registered with the State apprenticeship agency recognized by

(date)

the Bureau of Apprenticeship and Training, United States

on_________, all persons employed on said project have been

Department of Labor, or if no such agency exists in the State,

(date)

Name & Title (Print or type)

are registered with the Bureau of Apprenticeship and Training,

paid full weekly wages earned, that no rebates have been or will

United States Department of Labor; or

be made either directly or indirectly to or on behalf of said

(5) That I am a bona fide owner/operator and that my

The willful falsification of any of the above information may

_______________________________________________

contract amount meets or exceeds the prevailing wage for each

subject the contractor or subcontractor to civil or criminal

(Contractor/Subcontractor)

hour I have worked. My last progress payment was

prosecution. See Section 1001 of Title 18 and Section 231 of

from the full weekly wages earned by any person, and that no

the United States Code. Also see AS 36.05.060.

received on ___________ for $ ___________________.

deductions have been made either directly or indirectly from the

(6) That where fringe benefits are paid to approved plans,

Region 1, North of N63°

Region IIA, Southeast

full wages earned by any person, other than permissible

funds or programs: (check all applicable items)

Labor Standards & Safety Div.

Alaska (from Yakutat south)

deductions, on projects covered by Alaska Statute 36 as defined in

(a) In addition to the basic hourly wage rates paid to each

DOLWD

Labor Standards & Safety Div.

regulations issued by the Commissioner of Labor; or on Federal

laborer, mechanic or field surveyor listed on this payroll,

Projects as defined in Regulations, Part 3 (29 CFR Subtitle A),

Regional State Office Building

DOLWD

payments of fringe benefits as currently published by DOLWD

issued by the Secretary of Labor under the Copeland Act, as

675 7

Avenue, Station J-1

1111 W. 8

, Rm. 302

have been or will be made to a union trust.

amended (48 Stat. 948; 63 Stat. 108; 72 Stat. 967; 76 Stat. 357; 40

Fairbanks, AK 99701-4593

Juneau, AK 99801

(b) In addition to the basic hourly wage rates paid to each

USC 276 (c), and described below:

(907) 451-2886

(907) 465-4842

laborer, mechanic or field surveyor listed on this payroll,

Fax (907) 451-2885

Fax (907) 465-3584

payments of fringe benefits as currently published by DOLWD

Region II, South of N63°

_______________________________________________

have been or will be made to the appropriate programs for the

Labor Standards & Safety Div.

benefit of such workers, except as noted in Section 6(d) below.

DOLWD

__________________________________________ and

Fringe benefit payments will be made at least quarterly to an

3301 Eagle Street Suite 301

approved plan. The name of the plan

Anchorage, AK 99503-4149

Bi-Weekly Form pg. 2 – Effective 7/1/2003

Rev. April 2004

(907) 269-4900 Fax (907) 269-4915

is _____________________________________________

Certified Payroll - Alaska Department Of Labor & Workforce Development Page 2

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