Statement of Compliance Sample - California - Edit, Fill, Sign Online

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)

(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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