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--- | --- |\n| Company's Name: |  |  | Address: |  |  |  |  |  |  |  | Phone No.: |  |  |  | Payroll No.: |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Employer's Signature: |  |  | Title: |  |  |  |  |  |  |  | Contract No: |  | Tax Payer ID No. |  | Work Week Ending: |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Awarding Authority's Name: |  |  | Public Works Project Name: |  |  |  |  |  |  |  | Public Works Project Location: |  |  |  | Min. Wage Rate Sheet No. |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| General / Prime Contractor's Name: |  |  | Subcontractor's Name: |  |  |  |  |  |  |  |  |  | \"Employer\" Hourly Fringe Benefit Contributions |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (B+C+D+E) (A x F) |  |  |  |  |\n| Employee Name & Complete Address | Employee is\u003Cbr>OSHA 10\u003Cbr>Certified (?) | Work Classification: | Appr.\u003Cbr>Rate\u003Cbr>(%) |  |  |  | Worked |  |  | Hours | Project Hours (A) | Hourly Base\u003Cbr>Wage\u003Cbr>(B) | Health &\u003Cbr>Welfare\u003Cbr>Insurance\u003Cbr>(C') | ERISA\u003Cbr>Pension Plan\u003Cbr>(D) | Supp.\u003Cbr>Unemp.\u003Cbr>(E) | Total Hourly\u003Cbr>Prev. Wage\u003Cbr>(F) | Project Gross\u003Cbr>Wages\u003Cbr>(G) |  | Check No.\u003Cbr>(H) |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Total Gross\u003Cbr>Wages |  |  |  |\n|  |  |  |  | Su. | Mo. | Tu. | We. | Th. | Fr. | Sa. | All Other\u003Cbr>Hours |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\nNOTE: Pursuant to MGL Ch. 149 s.27B, every contractor and subcontractor is required to submit a \"true and accurate\" copy of their weekly payroll records directly  to the awarding authority. Failure to comply may result in the commencement of a criminal action or the issuance of a civil citation.","cbCaiemBeIsqpQrh","https://ap.wps.com/l/cbCaiemBeIsqpQrh","pdf",288636,"English","# Employer and project information\n## Employee payroll details\n# Certification notice","[{\"question\":\"Who is required to submit this weekly certified payroll report in Massachusetts?\",\"answer\":\"Every contractor and subcontractor is required to submit a true and accurate weekly payroll record directly to the awarding authority.\"},{\"question\":\"What does the form capture for each employee?\",\"answer\":\"It records employee name and address, OSHA 10 certified status, work classification and approved rate, detailed hours worked, hourly base wage, fringe benefit contributions, and total gross wages plus check number.\"},{\"question\":\"What is the legal consequence of failing to comply with submission requirements?\",\"answer\":\"Failure to comply may result in the commencement of a criminal action or the issuance of a civil citation.\"}]","Massachusetts Weekly Certified Payroll Report Form | PDF",1790074289]