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Fillable Printable Statement of Compliance Sample - California

Fillable Printable Statement of Compliance Sample - California

Statement of Compliance Sample - California

Statement of Compliance Sample - California

Also, 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 231 of Title 31 of the United States Code).
(Contractor or subcontractor)
(Contractor or subcontractor)
(Project)
STATE OF CALIFORNIA
STATEMENT OF COMPLIANCE
Date:
do hereby state:
(Name of signatory party) (Title)
(1) That I pay or supervise the payment of the persons reported on the Certified Payroll Report by
on the , that during the payroll period
commencing on the day of and ending the day
of 20 , all persons working on said project have been paid the full weekly
sums earned, that no rebates have been or will be made either directly or indirectly to, or on
behalf of, said from the full weekly sums earned by any person
and that no deductions have been made either directly or indirectly from the full sums earned by any person,
other than permissible deductions, as described below:
(2) That any payrolls or listings or 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 he 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.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
(b) WHERE FRINGE BENEFITS ARE PAID IN CASH
(c) EXCEPTIONS
EXCEPTION (CRAFT) EXPLANATION
Remarks:
NAME AND TITLE
SIGNATURE
In addition to the basic hourly wage rates paid to each laborer or mechanic listed in
the above referenced payroll or listings 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.
Each Laborer or mechanic listed in the above referenced payroll or listings has been
paid as indicated on the payroll or listings 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:
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