Certified Payroll - Alaska Department Of Labor & Workforce

CONTRACTS & SUBCONTRACTORS

STATEMENT OF COMPLIANCE

PLEASE NOTE!!

I, ___________________________________, _________________________

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

(Name of Signatory Party)

(Title)

(check all applicable items)

8 AAC 30.020 CERTIFIED PAYROLL. (a) All Contractors who perform work on

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

do hereby state:

a public construction contract for the state or political subdivision of the state

mechanic or field surveyor listed on this payroll, payments of fringe benefits as

(including owner/operators) shall file with the Department a certified payroll

currently published by the Alaska Department of Labor have been or will be

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

(Form 07-6058) before Friday of each week that covers the preceding week.

made to a union trust.

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

_________________________________________________________ on the

(b) The certified payroll shall be submitted to the Department’s regional office

mechanic or field surveyor listed on this payroll, payments of fringe benefits as

(Contractor/Subcontractor)

in the region in which the work is performed.

currently published by the Alaska Department of Labor have been or will be

made to the appropriate programs for the benefit of such workers, except as

__________________________________________________________ ; that

Region I, North of N63°

noted in Section 6(d) below. Fringe benefit payments will be made at least

(Building or Work)

Labor Standards & Safety Division

quarterly to an approved plan. The name of the plan is _________________

during the payroll period commencing on ___________________ and ending

ALASKA DEPARTMENT OF LABOR

____________________________________________________________

Regional State Office Building

on ____________________, all persons employed on said project have been

675 7th Avenue, Station J-1

been paid, as indicated on the payroll, an amount not less than the sum of the

(date)

Fairbanks, AK 99701-4593

applicable basic hourly wage rate plus the amount of the required fringe

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

(907) 451-2886

Fax (907) 451-2885

benefits as currently published by the Alaska Department of Labor, except as

either directly or indirectly to or on behalf of said

noted in Section 6(d).

Region II, South of N63°

(d) Exceptions:

______________________________________________________________

Labor Standards & Safety Division

(Contractor/Subcontractor)

ALASKA DEPARTMENT OF LABOR

Exception (Craft)

Explanation

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

3301 Eagle Street, Suite 301

been made either directly or indirectly from the full wages earned by any

Anchorage, AK 99503-4149

person, other than permissible deductions, or projects covered by Alaska

(907) 269-4900

Fax (907) 269-4915

Statute 36 as defined in regulations issued by the Commissioner of Labor; or

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

Remarks

Region IIA, Southeast Alaska (from Yakutat south)

issued by the Secretary of Labor under the Copeland Act, as amended (48

Labor Standards & Safety Division

Stat. 948; 63 Stat. 108; 72 Stat. 967; Stat. 357; 40 USC 276(c) , and described

ALASKA DEPARTMENT OF LABOR

below:

1111 W. 8

, Suite 302

______________________________________________________________

Juneau, AK 99801

(907) 465-4842

Fax (907) 465-3584

___________________________________________________________ and

Signature (original signature required)

In lieu of submitting Form 07-6058, a contractor may submit his/her payroll

(2) That _______________________________________________________

form. However, the payroll form shall contain the same information required on

(Contractor/Subcontractor)

Name & Title (Print or Type)

this form.

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

employment preference for Alaska residents as outlined in AS 36.95.010; and

Sec. 36.05.040. Requires that all contractors or subcontractors who perform

work on a public construction contract for the state or for a political subdivision

(3) Than any payrolls otherwise under this contract required to be submitted

The willful falsification of any of the above statements or information

of the state shall, BEFORE THE FRIDAY OF EACH WEEK, file with the

for the above period are correct and complete; that the wage rates for laborers,

may subject the contractor or subcontractor to civil or criminal

Department of Labor a sworn affidavit for the previous week, setting out in

mechanics or field surveyors contained herein are not less than the current

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

detail the number of workers employed, wages paid, job classification of each

applicable wage rates established by the Alaska Department of Labor; that the

States Code. Also see AS 36.05.060.

employee, hours worked each day and week, and other information which the

classification set forth therein for each laborer, mechanic or field surveyor

Department of Labor requires.

conforms with the work performed; and

CONTRACTORS WHO DISREGARD THEIR OBLIGATIONS TO THEIR

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

EMPLOYEES,

INCLUDING

PAYMENT

THE

APPROPRIATE

bona fide apprenticeship program registered with the State apprenticeship

PREVAILING RATES OF PAY, UNCONDITIONAL PAYMENT, AND

agency recognized by the Bureau of Apprenticeship and Training, United

PAYMENT NOT LESS THAN ONCE A WEEK BE DEBARRED FROM

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

PUBLIC CONSTRUC-TION.

registered with the Bureau of Apprenticeship and Training, United States

Department of Labor; or

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

Weekly Certified Payroll Form, pg 2:

Revised 4/2004

or exceeds the prevailing wage for each hour I have worked. My last progress

Date: _______________________________

payment was received on _________________ for $___________________.

(date)

Certified Payroll - Alaska Department Of Labor & Workforce - 2004 Page 2

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