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HomeMy WebLinkAboutContract #: 001753 - From: To: - Exception - ExceptionrJ } CAMAL CARPET ar FLOORING `;*r �!-%,Qwjk SPECIALISTS, I INC. i P.O. Box 2633 WOBURN, MA 01888 (781) 935-9430 FAX (781) 935-5737 Date:3 d�rs Att: Henry Sarkis Re: North Andover School Department Administation Bldg. TO: New England Builders & Contractors 464 Merrimack Steet Methuen, MA 01844 We are sending you ® Attached ❑ Under separate cover via following items: ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Samples ❑ Copy of letter ❑ Change Order ® PAYROLL REPORTS the ❑ Specifications Copies No. Description Section Sec. 1 WE: 03/22/15 FINAL THESE ARE TRANSMITTED As Checked Below: ❑ For Approval ❑ Approved As Submitted ❑ Resubmit copies for approval ® For your use ❑ Approved As Noted ❑ Submit copies for distribution ® As Requested ❑ Return for corrections ❑ Return corrected prints ❑ For your review ❑ For Bids Due ❑ Prints Returned After Loan To Us ❑ Color Selections Remarks: Copy To: Signed: NANCY HURLEY WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE March 22 , 2015 1, Mark Marrama President (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Capital Carpet & Flooring Specialists Inc.on theN. Andover School Department Admin Bid (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter)Te hundred and forty nine of the General Laws. 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P ss sr 77, 101 (fin Is mon cn LCU, V 75 Lu 0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of in their weekly payroll records to the awarding authority. For ev employed, a photocopy of the apprentice's idee is ntification card must be attached to the paery week which an yroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion fu the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 3� 2015 (Name of signatory party) do hereby state: ( I iue) That I pay or supervise thepayment of the persons employed by �, +. on the Sri -&O c (Contractor, subcontractor or public body) -ll � 1-7 -w) J Tdt,4� rw ng and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of General Laws. sections twenty-six and twenty-seven of chapter one hundred and forty nine of the Signature Title DMSION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 M 0 1 0 0 PA, Cc> 14 zi '14 : r's two cn 00 LU 4ai Lj) 41o 1 0 0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment Of wages, in the following form: L9y (Namef STATEMENT OF COMPLIANCE S�etic;S --44-1----,20 15. o �. ,u�vry PAY) r— GAf u,2 E-A do hereby state: (Tide) That I pay or supervise the payment of the persons employed by 4� v,� c.mE� J-246L>on the Scy(9c c (Contractor, subcontractor or public body)Mail,-4-0[7 t'41 )'J- TB(�7� o", ng or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % d 6&S DMSION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 f THOMAS E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 TEL (781)233-8810 FAX (781) 231-2151 New England Builders & Contractors 464 Merrimack Street Metheun, MA 01844 LADIES /GENTLEMEN: WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter l:lI' (�)1= -11 11141 �N���lil�l�l����l_ DATE: 3/30/15 JOB NO: 2014-12 ATTENTION: HenrySarkis RE: NORTH ANDOVER SCHOOL Payroll Reports ❑ Attached ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Samples ❑ Change Order ❑ ❑ Specifications COPIES DATE NO. DESCRIPTION 1/1 ORIGINAL/COPY THOMAS E. SNOWDEN, INC. 3/12/15-3/19/15 VIKING INDUSTRIES 3/15/15-3/22/15 J. LEE ASSOCIATES, INC. / GUARDIAN ENERGY 2/21/15-2/28/15 THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS: ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit ❑ Submit ❑ Return the following items: copies for approval copies for distribution corrected prints 20 ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO: FILE SIGN WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE March 19 920 15 NO WORK Clerk Barbara R. Barbolla I, , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature _ Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll .report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE March 12 20 15 NO WORK Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Job N. ANDOVER SCHOOL DEPT. ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MAO 1845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC. P. 0. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 3/22/2015 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COM CE -- ---��LIAN -a-Lq---,--15- I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the payment of the persons employed by VIKING fNDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature � . Tie ,hie x utive ffie h:.. ------------ DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 03/16 03/17 03/18 03/19 03/20 03/21 03/22 Pay This Job Med Name Mar Exemp. ---------------------------------------------------------------------------------------------------------------------------------------- Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay ---------------------------------------------------------------------------------------------------------------------------------------- Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 000 OCG WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COM CE -- ---��LIAN -a-Lq---,--15- I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the payment of the persons employed by VIKING fNDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature � . Tie ,hie x utive ffie h:.. ------------ DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Certified Payroll Registor Job Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. ADMINISTRATION BLDG. P. 0. BOX 32 189 CENTRAL STREET 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 Soc Sec No. ---------------------------- Hours Worked This Job ----------------- Class 03/09 03/10 03/11 03/12 03/13 03/14 03/15 Page:1 Job Number: N ANDOV SC Week Ending: 3/15/2015 -- Deductions -- Fed. Local Gross Pay Fica Other Check # Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Eay Regular 0.000 0.00 Overtime 0.000 0.00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p21B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been ,provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form : STATEMENT OF COMPLIANCE I, Douglas N. Carlson,, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER RHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Si nature e-� Ti9e Chief Ex cutive Officer - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 f0 E W O ZI C 0 �U 2 �U m o 0 m 7 D 0) w 0 c 0 U C13 f0 0 c a> CDU E 8 N c 3 c f6 E T G E U O N 7 m LL O m m c v 3 f6 N L O m cna 0 z Lo O 134l�N��B O Q o A 3 N M W C z � /n �iJ O wm a a OZ 0 N r y Mco a lu o a O m ^' N d e r cw coc (O & L 0 O O co ch a z K o 7 Mw M o c L x - a r T d C C N > �Ws U K ~ W u T�e iE 2 C /� V/ J V m Lo m m a a 03 = c z Liz Z o 3 O D a C a axa 2 a v°Lo d' N r- 1 m � o _ i cO G C L L T V Q cm O A\ •� RS m O C: U _ ,E m 12 0 U Q 4.0 O ++ A0 C z y a ^ ' W a m o 0 U Z e ame m o O N m a o a c o o�`/ L c o (n / m m O U f0 C io F, E U __- o _ Li F] Li T rn m � c Au Au 7t L m wUU m M m E O c� a Z a O m v U w t m m EO L A C � c m U m A 4I oU z 5 7 a \ 5 = z 5` a S. c N a Q a t Ch c _ Om L o m O a E J a W E Z U 6 (7 w f0 E W O ZI C 0 �U 2 �U m o 0 m 7 D 0) w 0 c 0 U C13 f0 0 c a> CDU E 8 N c 3 c f6 E T G E U O N 7 m LL O m m c v 3 f6 N L O m cna WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE I, Kimberly Breault, Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Guardian Energy Mngt Solutions on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter orae -hundred and forty nine of the General Laws. Signature (7Q) Title anager 09/11 L U J O C m E2 7 CL W) O Z O m a d z aoi fM 4N�Ip'- U') O m a1 iasnKo Q aim ¢3" O"o� s; N � C) Z t f W tel/ O W a T m j _�� 5 w CV N V! o a U + m r°- L z ae m O a d Ew a 3 c C) OD 2 Se cIE Q a ��o M o M z Wm a M0 L N Oma.} > O 0) Vl`A�■ m i V m v o J LU c y N m m T N m / 1 m O � � co a` � �3 x c z Or 0 � 0 Z � o 3 oc o Z a` x' a = O. U O. N LO N (n 0 0 � O 2 c cn L L A, V .Q i W G O M� U Q 0 c U m _ C: o Z. E +� 0 O i o C IL ° Z 3 a CD N m s c c o 3 L A, W> c o E m aci O U R N NO El 0 El c WW c N E U N m 0 D m O e m m ZC i < O V c W n 4 O Q y a m a o L- m E v y m C c O 0 U an QJ ._ O fA m Z p 0 h V! N E E m �l z > m CL ¢ (D° L c f m O ° O Z V w 6 O w L U J O C m E2 7 CL W) O Z O m a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE Vhf 1h , 20 I, Kimberly Breault, Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Guardian Energy Mngt Solutions on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one ed and forty nine of the General Laws. Signatur Title Office ager 09/11 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll. report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE March 19 20 15 NO WORK I, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll .report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Barbara R. Barbolla (Name of signatory party) March 12 , 20 15 Clerk (Title) NO WORK do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Certified Payroll Register Page:1 Job Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. O. BOX 32 189 CENTRAL STREET Week Ending: 3/22/2015 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MAO 1845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 03/16 03/17 03/18 03/19 03/20 03/21 03/22 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours pay Regular 0.000 0.00 Overtime 0.000 0.00 0.000 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law 049, p27B, a true a n c accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Departm ent of Labor and W orkforce Developm ent/D ivision of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson,, CEO do hereby state: That I ppayy or supervise the payment of the persons employed by VIKING INDUSTRIES INC. on the N.ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, team sters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Chself x utive fFiibr-- - -- ----- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Certified Payroll Register Job Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. ADMINISTRATION BLDG. P. O. BOX 32 189 CENTRAL STREET 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 Soc Sec No. ---------------------------- Hours Worked This Job ----------------- Class 03/09 03/10 03/11 03/12 03/13 03/14 03/15 P a g e : 1 Job Number: N ANDOV SC Week Ending: 3/15/2015 -- Deductions -- Fed. Local Gross Pay Fica Other Check # Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 .0000 0.00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p27B, a true and accurate record m ust be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orpublic body shall furnish to the Department of Labor and Workforce Developm ent/D ivision of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE _ I, Douglas N. Carlson,, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER RHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices,, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Si nature Title ChieT�Ct-vificer- - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 WI O Z 0 cu �U �U al O U C a5 7 N r 0 r_ 0 U a5 U ca 0 E U C E U a) w c N a7 E _T 0. E U 0 d 7 .m LL O L 7 N 05 c P 3 a5 a5 L O d IL 6 z Y dt� n U N \ Z D W T m ti a 5 C N r N M =3LL W C%4 Y� O 3 N 0 90W M o 3 c 00¢a co co Q 2LL m It M Z M Wa M c (OD L _ LC%J �e�s m 1 c ' tiO F J w N m m m LO Q a o a - o� x O o z o -� z • LO 3 v �N u ¢ m� 6 L n V a N U') r o o cum O •� � � cc c O m C w !� z is �=-/ O +� 0 Q c z y a O U Z3 m ¢ C) 0 N C O O L � _ !E N > N y O U C 3 c R d a o t E0 o aF 1:1 a5 c W C .}J W U N L O Em 7 7 2 iig < m C a 0 E a 4--S O 2 05 CO) ai m V -6Fn Q Fn Z u W y y ` 5 - z >> C CL Q y \T ° C LO L m d o O z V J a W Q1 m 101W E WI O Z 0 cu �U �U al O U C a5 7 N r 0 r_ 0 U a5 U ca 0 E U C E U a) w c N a7 E _T 0. E U 0 d 7 .m LL O L 7 N 05 c P 3 a5 a5 L O d IL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE _ELVI) 9-0 , 20-() - I, Kimberly Breault, Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Guardian Energy Mngt Solutions on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one h`md\d and forty nine of the General Laws. Signature Title Office ager 09/11 N O U N C U c c m O U N C U (D FRI 0 m cna Z LOn y 134Qµ7 O a a� =3 3 N O w r h M =3� 00 W N m o °° a o m m O a e e 3 CV a a ;�W' a 3 �' � ISL OD co C \M QL tai c R .�0. ❑ M Z ' W CD a M o (C) L^, W L aif r O ,CL , Y O W C - J //�� LO m C m mco a n 03 = G O Z p mLO3 O z a IL v a' N L r N N � O _ LL CCD Z i O oF t0 m O m C U _ C: 3 O U < -ar 4cm -6 U m a Q_� Z c +p O Es 0 C z d b 0 o 0 U h Z g C a m : E a a O N ?� F 3 a d' a U2)a c o O L a)W c o cR N m E O U m N 3 c m m El 1:10 El El m c uJ c E. m� LU U l0 O H m Q l0 m 5i Z W 2 a t a c O O m E Cl) L- C c:O 0 U E 2 m 'U 7 Z / E = E m n c ¢ m c O z m a(D m O Z U m J -iW n a C t7 E w N O U N C U c c m O U N C U (D FRI 0 m cna WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE W60 ", , 201—c5 I, Kimberly Breault, Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Guardian Energy Mngt Solutions on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one -hundred and forty nine of the General Laws. r' SignaturLce-M Title ager 09/11 d WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149. §27B. a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of thisa e and p g Includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition. every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF MpPLIANCE 20 z� 1. 7h, <« �y�0Cz/'a- (Xiame of signatory pam l / c1e) do hereby state: T l pay or ,upervise t ie payment of the pe onW11A.0111,12cley, d b t jnl, on the G (Contractor. subcont for or public body) (Budding or -project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forte nine of the General Laws. , Sign _ ! A/ � Titleature / DIVISION OF OCCUPATIONAL SAFETY. 19 STAMFORD STREET. 2nd FLOOR. BOSTON, MA 02114 I 0 D d i T � r. � .N' -a sC-•1' T .. .. 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C ._ O) W d a) Y L U O O _U O O O O O C_ 2 OL.+ O N c6 U "0 C n c C O Co 0) 3 m 0 ) a) U (76 a) C L U c0 O_ C f�4 N C O - U L 'O a) '0 -p '> U C U m H LL O w N w Co N a) a) `� Q O C •c O N J -p a c6 0 E N U '.'� 0 ca L m d E O m a) p C Q N W C U U N C a O U 0 O O U a C C O. O O) C O vL c m o7 E �_� rn E m `� E > E N p ; E a m C a) C o a N T N O" L (n O U a C M C 0) O O Y O L n r U Q T m U v E U a m ca m. a am °c C: co r N cav o m m w 70= no a 0 C_ m� 04� L ° of o rna w �� a Q v o o� >0 2 0 mZ� 3 v vi Ncof4 �UaNi° 41ma.� m 'D L Y60 y C C '0 a) 3 L -0 m Q � m a m U D O V 2 N m 7� >. U a) L O LL L '6 O 7 U y ` C C (n 471 N m N N o @ W w U a) 0 Q 'O C C N O 0 LO") M x L N@ C O E d ,.0. ` W O N m U CL o 0 a) mL � 2 t y 3 m c a) " cm m C: _(D E N N (D -0 L L O y w U 01 m Z "O a) _� 'O I- >. U V1 m C L ._ _ '0 > ._ N (O L 7 N T 41 Cl m LL C m O C 4) -o a N O) U C m a) d -, w T D C C- 3 (n O O- N C m O U N a' O E Co cu�6 f`0 T d T C W ED a) a) N (n -a)O U cc6 O 01 (Nil _O. O- ti N N Na) 4)(D O O N Co U3O CCNU L 0,0 0) M-0 LL U) 70 L.0 N fV C m m m 7 00 �- C N 'C F U V f UO T 3 4) O v U L M C C N d• r a) U N v O U O O.L O�LL N CL(nHata • a) a) 0 a N O. CL 2 ;wUin U m U m<U) 0, Le 0 0 x N E 0 -_]5 ii E a C C u O L = U L ° wxA v O e ca in �• O •L a+ y �xA L O 3 ° o 3 6 A t N 00 F C o 0 0 3= L F x C 3 CC L L O O w i 0 0 o 3F3x O O O G W O O O 0 Q U Y w ¢ H 0 w m c v 3 fm N L O Ell s m IL 6 Z LO U u O LL r3sn�, N f No z m W ++ , o m 2 LL O e CO C / Z � o + W > � a �} ul mO a o znE Y m m w `o c �D CL m co 1- LO coo ¢ a z y� LL ; d' O W d S I,-., IL CV c O a m °1 U T C,xCD F m u J Q W m amf _ � m m Ob a` �3 0 o Z o ,. F ' Z oc a t a o v = a. cD toS m -1-H52 ax 'N^ YJ � y }� 0 0 Cz 4-0 6) � LL — VJ .cn C m � Q � V Mn �L cu U) 0 Q U � g co O 0O w Ix N L 4-0 Cf)E L L o � �. A u � ) E � Q m F a i O Z m J Y _0 i N L ILI U) U C o � U L � L O v 0 N L 3 U w m O E El El 0 Ll El U u, N Z � a� D W L E 0 o O < d Q) m m Y N E Q mC: `c U O E °s >0 > O z m e U) C Q e / 0 E 1 w m Z ami O z^ LL CL Q o w s ¢ m w ( 3 Z o w 0 w m c v 3 fm N L O Ell s m IL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 049, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: March 26, 2015 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature. Title. dministrative Asst. Date: March 26, 2015 I, Leah M. Hatch, Administrative Assistant do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 15`h day of March. 2015 and ending on the 21' day of March, 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by arty person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 f de apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNAff URE Leah M. Hatch, Administrative Assistant 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. MF -e 7 8 a c � c s°w o 0 0 U L � u c � 0 3 4�,O � � O� N all3 00 o a H a o 0 0 3� L H x c 3 •O \ 0 0 0 c O O O L .i L O C 3H3x 00 O 00 a E W o 0 � � U c Uin. t� Y w ¢ H N w H 0 zl 0 r�l m CL d Z m LO L a` \ O O m mC 3o � c �N Ce) +y ; `mFa � lu Y O ig O Z m m m rn 1° c fOj a s E m $ M tico LO `m a a L 5 w o c x a. m N a-) m L m O O Ea y m 3 U VJ T ~ O Q m N m m Ob a L'o3 d z c Z o o=<s= c L o Ur 0 a c aI a N In 0) 1L L n jn 0 V- C) Z V LL .cn m :3 Q � V Mn -L in Q U a) co O t6O 0 W wi L -1-4 -C L O D 1U) -C: Z L OE y Q d m (0 o i O Z w a W O 3 C Q m N V V d ui P a Z a ama U � o m (U L O U % x p _ UH O P - Lj 0 Ll 0 11 1 U V W - V W z E N m o W 4—A 2 : v O L ^' E O m m - c Wm }� ei 3 q C -0 E 0 V '~ (6 4) r. 9 o 2 fA E C E 'mS. S rn o. W m o U)o ci CLICD- w q mE Z w N w H 0 zl 0 r�l m CL Ewu moe DATE 04/02/15 08;40 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 3 FOR PERIOD ENDING 03/28/15 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 03/22 03/23 03/24 03/25 03/26 03/27 03/28 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 73.560 588.48 40.00 2596.56 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079— DT M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 8.00 144.05 148.96 79.77 .00 674.68 1549.10 007221 ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES— 1 TOTAL JOB HOURS— 8.00 TOTAL JOB AMOUNT— 588.48 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: April 2, 2015 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature-62�"_ Zj�� Title: Administrative Asst. Date: April 2, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payrollperiod commencing on 22nd day of March, 2015 and ending on the 28°i day of March, 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNATURE Leah M. Hatch, Administrative Assistant 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. ic y%1% Af7p 6 Z _ _ 'ias' .0 a 3 E Z o a s T d W O y c + 2 LL c U + m N x LO a! a m F d O O d c 0 �;, O. n E W Z O Y N m CL O o C 2 c m p C O O > o _ Z Q Q G x d a `w cU. o d as O a �Z ` ` U K O w z LU c .ami Jo n a o C, m m O O M Z � Z c p O) y LL d t0 w Q L C .0 a am vz¢o= �1:O. a -m CL In co W C li r � m L W ~ U O N Y O J E Y ��y F IW M `o E< = �v N •Z _ O Z o d— u C U) fA Z f (nd o N L) F. 3 0 c o � > L�V C N N N VI y O d ? Q C W n m o = d m L v a) (1) in 0 V t O O a) V Q N 2 H U C Z N lL ¢ c •J a N m�� U�/)� V/ T Q d a aw r E U U U U Z — Z — o 0 O O m E m m O N Z O U U y y U 06 E « .6 m y Z > i a y O a) E d M r U mC amTs mN Lo Z C m y Q O Z CL �a 'E O dI'm C pW Z 0) LU G El w W z 3 O O 0- a� E o � T a a) o c CL y Ud U N O C fa Ln fl_ N U U O d E L � N Co V1 a m E T m a 7 N O c O D a N "O 7 O w C w� @ o o� y T N a C, o U C U ? d a3 N N Eo d U O. L Q O O C is o n mm C y 0 Y -O J U y CY (CDL 2-i OO U O a1 -Ey a7 UO 0,0 C CO OL d -r U C N a) m ��y w ui > v .N �o d �d _ a t _m m c.. O J N_ O O . @ O • m E.2 c m C r U O m Ea J.�c t o E .9 y U r a7 y :01) C U O U U cu(` C m y ._ a) y O TE CL m a n CL cc M.rHtE Li a Z m coi WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE March 30, 2015 I, Ron Tattersall Construction Supervisor (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by New England Builders & Contractors, INC on the North Andover School Administration Building (Contractor, subcontractor or public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Z Title Construction Supervisor 05/14 n N Z 6 T D 3~0': � m 3 0-1 m y w �m 6 T y a a 3'< C N (D (D n O n ? N m m m N O 9- n 0,4 a m N O n 3� N CDA = a 0 0 m 7 N W O .. = N M Wr, -,c a m Q m (O 0' (n m U) S < m = � N m (D c o 7 p 0 CD N oc v O0 a (D 0m m �0 (A n aO 0 .n (p fD _. 7 _ C 0,(D jO j -b o ;w =r a S r N (D O S (D �o _�� m m ' o D (pCD Z o o o �c e. 7 M- 02 3 m v m m a a as O 5. CD o m w' CL o �0­3 R o D O. N (D a pI ,Y 7 a (D .. 3 3 m == PD CL = cn v 7 3 �, m a @ N a N (D Q J 7 O y � f0 (=D O Q� c (D fD m M vFT -a i m p m (D (n d � 7C OZ a a A (D O 7 a o ` O ID p (m/( F 3 _a v m .� _a 3 o m Z 76 N = Q <° a w Nm Q- o n a 4 _ (o < s m CD I H m o 3 m 3 o d 3 m o m m ' a m 3 �$ � W $2 ° A m M N N 0 m m (p -' o (D X rC v� o �c �5 Z 1 v; 6 A 7 C (,p O N ° 3 m m a 3 A S 0 m � a N o CD 0N) Co C, O N mQ.0 nO W n y= 7 � W� C 3 O a- N c0 "' m N d 0 n (D Z d m (p m fto 0 (A 'om m mCD d 0 Z m 3 < o (D y< C o y n N n C(op -1O 2R O @ O N p d jax (D O N 7 N Z n Z nOm \/ i WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE March 30, 2015 I, Ron Tattersall Construction Supervisor (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by New England Builders & Contractors, INC on the North Andover School Administration Building (Contractor, subcontractor or public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Construction Supervisor 05/14 %11* R[7j Z _ a7 ` v /3 SFr. U � � � N O h ♦- .ir ., 350��a d LL x m m m o o rn E � z Q o3 a 0� ~ o a N W L 0 O O O It c fq c LL o m V c 05 z U ,a OD n eo v x U) a a 0 0 d E co p x ao n G W m 06 R IL O $ M o C C m (/� N N m C 'CO LL G O O O Z > O N N O O O O L Q C S d Nd O 0 d iYi N a MZ w:° Lj and 0 0 O I L x 0 J C {V = ? o 0 W do M J c C J � 0 rn m rn J • O) p O m> m Y 0 2 N LO 0o c70 z �Q��0 o_ c cmzc`oo ; . L ai LO LL C 61 o=a N N a M r— U Z-0 d a Q= a Q N O O O O W lL O O O O rn C c Wm L ~ O O O O V O N Y O O Y E 0 W r- da W C Q F- o O o 0 zE c g o 0 o mpn vi NteEo CL Lj Z � (6 g N O W -0 O > cn o 0 0 0 (/� N O C o 0 O C 3 Q 2 N c W a = y� m t N y 0 V L 0 0 0 V QN :� !�-U j aZ cc fn W e a N moi <m LE 0 X X C C E Lu C Z Z p d C O N N ` _ >� � O l4 J0 C) U y U y > 7 c Y N £ m v c6 da U W O U� O io Z O W 4i E O m N w Z> 0 a 7w O N N a U) O w N '� E N _ N N d C 0 U H C� Q Cl) N 000 iav co c r E a Ev` �mc�( # inrn20x H N Q O Z N a ZQ 7L 3p �5 a3dR Y J� X 0 c c a`a c a c % Cl) M W 0 -0 C Ll1 o L Cl) N W 0 A Z E w 'oo U U Z Q H 0 Z 0 U) w i co Q N N 0O Of C ca .. 3 M w N N N T C L fa a> E :a o d w n co -v mLoi 0 � o � O T CL aLL o �^ Z Y 0 "O O - _N E � N N w T uJ a o CL .N O aJ 0 U C m M N m a E MCO U O • m E C f0 � N _ v co E T U D 9 7 C fn N N O •C av a a a'2o ww E) m °c/) T N 0 U0 ca m E U a L C OO c �Q Ta ca O :� m : c O O.0 -0 > V �y -> C Y E O O 0) O N r N N V c O c N L CL ca N C 0 C R O OO Z`- u w to a) =o a '6 N N= Ej m C+ J N _ c O N C 0— 0, E N N cc CD CC . U O R E cu a J m G QE E N U CL _O c N a) C U O f/`1 C C N ` ._ N m w E a u) (L C c _ m m LO H 0 E o T 0 o LL Q Z O 0 F„ 0 4) .a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE March 30, 2015 I, Ron Tattersall Construction Supervisor (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by New England Builders & Contractors, INC on the North Andover School Administration Building (Contractor, subcontractor or public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature _4 Title Construction Supervisor 05/14 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE . 20__ 4 t—AL i�i e ti S'+e K< (Name of signatory party) n GAT VS2 E-A do hereby state: (Title) That I pay or supervise the payment of the persons employed by lN�v✓E;,�GCa3v, �a �, (Contractor,subcontractor or public body)131,11ilitling or ' on the and that all mechanics and apprentices, teamsters, chauffeurs and Iaborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 5 Ye v, v 9 Pf'�'h• � � i � f �' at � w o P IS ry)) fa to d C'.ZZ .� m •:iw,.. arc r C qp kp � XS +75 VNI Y C n m 5 ro- , U 5. I O M � w�7 V a ui ��•' i �i "i' T r O ym �"ai"'pS:i f0 iii o O LU W P x d Ln NV E LU a;E C kv N y M'' f t v (� y o t5 .<;. c f; . •.� a s. !T` kLU :L a CU Is CD , COO a ti lu 0 I 1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §278, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly Payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall fiunish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT NT OF COMPLIANCE ^Z . 20= {Name of signatory party) do hereby state: (Title) That I pay or supervise the payment of the persons employed by (Contractor, subcontractor or public body) On the S (9c r40 n /,.w ,j TA ,97(Building or eco and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed " said project have been paid in accordance with wages determined under the proions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % <E�g�- DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 0 i 4 'O V tl�i •` �F�4 G3Mi U i 3+m ri 0 Q c 7 6 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion statementof its portion of the work a of wages, executed by the contractor, Of or public body who supervises the payment M*" the following form: STATEMENT OF COMPLUNCE 20/1� (Name of signatory party) 1 rz CAP vs2 Ea do hereby state: (Title) That I pay or supervise the payment C --v,, �,��� tha yment of the persons employed by ,-on the (Contractor, subcontractor or public body) and that all mechanics and apprentices, (Bwldrng or project) said project have been paid in accordanouth rs, chawages uffeurs sand laborers employed on sections twenty-six and twenty-seven of c dam' the Provisions of General Laws. �Ptm' one hundred and forty nine of the Signature Title % k(-�q�- 0 E DIVISION OF OCCUPATIONAL SAFM,19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE January 22 , 2015 Clerk I Barbara R. Barbolla , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws.VV '� F Signature` Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 01-29-2015 For the Period Ending: 01-22-15 'Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Mark Rothwell 5 Bow Street Middleton, MA 01949 01-16 01-17 01-18 01-19 01-20 01-21 01-22 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts M - 0 Pipe Fitter Reg 3.00 3.00 64.00 4.15 68.15 204.45 2,264.00 362.88 107.68 204.45 173.19 Totals for N. Andover School Admin BLDG 01-16-15 01-17-15 01-18-15 01-19-15 01-20-15 01-21-15 01-22-15 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions 3.00 .00 .00 .00 .00 .00 .00 3.00 204.45 2,264.00 FWH 362.88 FICA 173.19 SWH 107.68 SDI .00 Other .00 Page 2 Net 1,620.25 Net 1,620.25 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE January 15 , 20 15 Clerk I Barbara R. Barbolla , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S ignatu re `ia, � Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 01-26-2015 Page 3 For the Period Ending: 01-15-15 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 John Mahoney 84 TellIer Way Dracut, MA 01826 01-09 01-10 01-11 01-12 01-13 01-14 01-15 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 2.00 2.00 64.00 11.34 75.34 150.68 2,560.00 436.88 129.86 1,797.42 150.66 195.84 Mark Rothwell 5 Bow Street Middleton, MA 01949 01-09 01-10 01-11 01-12 01-13 01-14 01-15 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 8.00 8.00 64.00 4.15 68.15 545.20 2,523.00 427.63 119.99 1,782.36 545.20 193.02 Totals for N. Andover School Admin BLDG 01-09-15 01-10-15 01-11-15 01-12-15 01-13-15 01-14-15 01-15-15 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions Net .00 .00 .00 .00 8.00 2.00 .00 10.00 695.88 5,083.00 FWH 864.51 3,579.78 FICA 388.86 SWH 249.85 SDI .00 Other .00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE January 08 , 20 15 NO WORK I Barbara R. Barbolla Clerk , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature/ Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE January 01 , 2015 Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature . Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Job:, 14�O1!2 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Robichaud Michael 62 Gulf Road Certified Payroll Report For the Period Ending; 01-01-15 01-29-2015 Derry, NH 03038 12-26 12-27 12-28 1.2-29 12-30 12-31 01-01 Total Pay Fringe Total Gros. Total 015-64-9018 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts M - 0 Pipe Fitter Reg 8.00 8.00 16.00 64.00 4.15 68.15 1,090.40 1,672.00 214.68 79.52 1,090.40 127.90 Mark Rothwell 5 Bow Street Middleton, MA 0;949 12-2.6 12-27 12-29 12-29 12-30 12-31 OI -01 Total Pay Fringe Total Gross Total FWH 029-48-6932 Caucasian Male Fri. Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job SW8 Other M - 0 Pipe Fitter Reg 6.00 6.00 64.00 4.15 66.15 408.90 1,71200 224.88SU 81.YSD42Detlucts 408.90 1.30.96 Totals for N. Andover School Admin BLDG 1.2-26-14 12.-27-14 12-28-14 12-29-14 12-30-14 12-31-14 01-01-15 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours Gross Total .00 .00 .00 14.00 8.00 .00 .00 22.00 'his Job Gross Deductions 1,499.30 3,384.00 FWH 439.76 FICA 258.86 SWH 1.60.94 SDI ,00 Other .00 Page 2 Net 1,249.70 Not 1,274.74 Not 2,524.44 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE January 22 , 2015 Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature g p.. Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report For the Period Ending: 01-22-15 Sob: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 . , Mark Rothwell 5 Bow Street Middleton, MA 01949 01-16 01-17 01-18 01-19 01-20 01-21 01-22 Total Pay Fringe Total Gross 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job M - 0 Pipe Fitter Reg 3.00 3.00 64.00 4.15 68.15 204.45 204.45 Totals for N. Andover School Admin BLDG 01-16-15 01-17-15 01-18-15 01-19-15 01-20-15 01-21-15 01-22-15 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours 3.00 .00 .00 .00 .00 .00 .00 3.00 Gross This Job 204.45 01-29-2015 Total FWH SWH Other Gross FICA SUI/SDI Deducts 2,264.00 362.88 107.68 173.19 Total Gross Deductions 2,264.00 FWH 362.88 FICA 173.19 SWH 107.68 SDI .00 Other .00 Page 2 Net 1,620.25 Net 1,620.25 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE January 15 , 20 15 I Barbara R. Barbolla Clerk , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Stgnatu � � Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 01-26-2015 Page 3 For the Period Ending: 01-15-15 yob: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 John Mahoney 84 TellIer Way Dracut, MA 01826 01-09 01-10 01-11 01-12 01-13 01-14 01-15 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 2.00 2.00 64.00 11.34 75.34 150.68 2,560.00 436.88 129.86 1,797.42 150.68 195.84 Mark Rothwell 5 Bow Street Middleton, MA 01949 01-09 01-10 01-11 01-12 01-13 01-14 01-15 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 8.00 8.00 64.00 4.15 68.15 545.20 2,523.00 427.63 119.99 1,782.36 545.20 193.02 Totals for N. Andover School Admin BLDG 01-09-15 01-10-15 01-11-15 01-12-15 01-13-15 01-14-15 01-15-15 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions Net .00 .00 .00 .00 8.00 2.00 .00 10.00 695.88 5,083.00 FWH 864.51 3,579.78 FICA 388.86 SWH 249.85 SDI .00 Other .00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE January 08 , 20 15 NO WORK Clerk I Barbara R. Barbolla , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature r' Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 I N WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE January 01 2015 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Job: ,14.012 N. Andover School Admin BLIP ' 566 Main Street N. Andover, MA 01845 Robichaud Michael 62 Gulf Road Certified Payroll Report For the Period Ending: 01 -O1 -I.5 01-29-2015 Derry, NH 03038 12-26 12-27 12-28 12-29 12-30 12-31 01-01 Total Pay Fringe Total Gross 015-64-9018 Caucasian Male Fri sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gozoss FItal ICA SUI/SDI Deducts M - 0 Pipe Fitter Reg 8.00 8.00 16.00 64.00 4.15 68.15 1,090.40 1,672.00 214.88 79.52 1,090.40 12.7.90 Mark Rothwell 5 Bow street Middleton, MA 01949 12-26 12.-27 12-28 12.-29 12-30 12-31 01-01 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rete Rate This Job Gross FICA SUI/SDI Deducts M - 0 Pipe Fitter Reg 6.00 6.00 64.00 4.15 68.15 400.90 1,712.00 224.88 81.42 408.90 1.30.96 Totals for N. Andover School Admin BLDG 12-26-14 12-27-14 12-28-1.4 12-29-14 12-30-14 12-31-14 01-01-15 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours Gross Total .00 .00 .00 14.00 8.00 .00 This Job Gross Deductions .00 22.00 1,499.30 3,384.00 :w}i 439.76 FICA 258.86 SWH 160.94 SDi .00 Other .00 Page 2 Net 1,249.70 Net 1,274.74 Net 2,524.44 Job w N. A4',4DOVER SCHOOL DEPT. ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MA 01845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC. P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 1/18/2015 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law, Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of com pletion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardin authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N, ANDOVER RHOOL DEPT. ( Contractor, subcontractor or public body) ( Buildinor project) and that all mechanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws.. �w. n S ig n a to re fiVx�l_� . ��� Title ChielcutiveOffic r &--- - - - - - - - - - -- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 01/12 01/13 01/14 01/15 01/16 01/17 01/18 Pay This Job Med Name Mar Exemp. -----------------------------------------------------------------------------------------========= Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II '"-6224 R: 0.000 8.000 8.000 0.000 0.000 0.000 0.000 16.000 43.310 692.96 325.76 0.00 V4577 INSULATOR -MECHANIC +24.480FR 108.36 149.60 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1747.76 25.35 1035.47 WHITE Male +0.000FR 40hrs 103.22 712.29 Hours Pay Regular 16.000 692.96 Overtime 0.000 0.00 � 9 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law, Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of com pletion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardin authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N, ANDOVER RHOOL DEPT. ( Contractor, subcontractor or public body) ( Buildinor project) and that all mechanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws.. �w. n S ig n a to re fiVx�l_� . ��� Title ChielcutiveOffic r &--- - - - - - - - - - -- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Job N. AVDOVER_! CHOOL DEPT. a ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MAO 1845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC. P. 0. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 1/11/2015 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p21B, a true and accurate record must be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardinauthority. This is required to be done on a weekly basis. Once colleld, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COMf LIANCE -- - -- - 0 t3----,--��--- I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING fNDUSTRIES INC. on the N. ANDOVER HHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature __________ Title Chiel ecutive fficer— — DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 01/05 01/06 01/07 01/08 01/09 01/10 01/11 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II "-6224 R: 0.000 0.000 0.000 0.000 8.000 0.000 0.000 8.000 - --------------------------------------- 43.310 346.48 323.59 0.00 V4564 INSULATOR -MECHANIC +24.480FR 107.82 147.03 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1739.09 25.21 1032.77 WHITE Male +0.000FR 39hrs 102.67 706.32 Hours Pay Regular 8.000 346.48 Overtime 0.000 0.00 8._00 346.48 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p21B, a true and accurate record must be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardinauthority. This is required to be done on a weekly basis. Once colleld, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COMf LIANCE -- - -- - 0 t3----,--��--- I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING fNDUSTRIES INC. on the N. ANDOVER HHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature __________ Title Chiel ecutive fficer— — DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Job N. ANDOVE.& SCHOOL DEPT. PCO ` INI NATION BLDG. 566 MAIN STREET N. ANDOVER, MA 01845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC. P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 1/18/2015 Page: WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of com pletion of the contract. 21 In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after com pletion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the paym ent of the persons em ployed by VIKING INDUSTRIES INC, on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, team sters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. //���, n S ig nature l �cX��_ Title ChieTL cutive facer - - - - - - - - - - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 01/12 01/13 01/14 01/15 01/16 01/17 01/18 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II -"-6224 R: 0.000 8.000 8.000 0.000 0.000 0.000 0.000 16.000 43.310 692.96 325.76 0.00 V4577 INSULATOR -MECHANIC +24.480FR 108.36 149.60 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1747.76 25.35 1035.47 WHITE Male +0.000FR 40hrs 103.22 712.29 Hours Pay Regular 16.000 692.96 Overtime 0.000 0.00 16.000 692.96 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of com pletion of the contract. 21 In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after com pletion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the paym ent of the persons em ployed by VIKING INDUSTRIES INC, on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, team sters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. //���, n S ig nature l �cX��_ Title ChieTL cutive facer - - - - - - - - - - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Job N. ANDOVE. SCHOOL DEPT ADMINIS'RATION BLDG 566 MAIN STREET N. ANDOVER, MA 01845 vviuiivv i ayivii INQvtokai Contractor VIKING INDUSTRIES, INC. P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189CENTRALSTREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 1/11/2015 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMf LIANCE - - - - - - - t1 t3 - - - - I- - I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER S60OL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title ChieT ecutiveOfficer----- - - - - -- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 01/05 01/06 01/07 01/08 01/09 01/10 01/11 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II -'*-*'-6224 R: 0.000 0.000 0.000 0.000 8.000 0.000 0.000 8.000 43.310 346.48 - ----------------- 323.59 0.00 V4564 INSULATOR -MECHANIC +24.480FR 107.82 147.03 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1739.09 25.21 1032.77 WHITE Male +0.000FR 39hrs 102.67 706.32 Hours Pay Regular 8.000 346.48 Overtime 0.000 0.00 SZ -00 346.48 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMf LIANCE - - - - - - - t1 t3 - - - - I- - I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER S60OL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title ChieT ecutiveOfficer----- - - - - -- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 A WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE February 05 , 20 15 Clerk I Barbara R. Barbolla , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and fo nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report A Job: 19-012 N. Andover School Admin BLDG For the Period Ending: 02-05-15 ��,66 Main Street N. Andover, MA 01845 02-13-2015 Page 15 John Mahoney 84 TellIer Way Dracut, MA 01826 01-30 01-31 02-01 02-02 02-03 02-04 02-05 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 64.00 12.24 76.24 609.92 2,432.00 404.88 115.67 1,725.41 609.92 186.04 Totals for N. Andover School Admin BLDG 01-30-15 01-31-15 02-01-15 02-02-15 02-03-15 02-04-15 02-05-15 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours .00 .00 .00 .00 .00 .00 8.00 8.00 Gross Total This Job Gross Deductions Net 609.92 2,432.00 FWH 404.88 1,725.41 FICA 186.04 SWH 115.67 SDI .00 Other .00 w WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE January29 , 2015 NO WORK Barbara R. Barbolla Clerk I, , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one huWandnine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 04 Certified Payroll Register Page: 1 Job Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. 0. BOX 32 189 CENTRAL STREET Week Ending: 2/8/2015 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 02/02 02/03 02/04 02/05 02/06 02/07 02/08 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 0.000 UOD WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p21B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/Division of Occupational Safety within fifteen days after com pletion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPL ANCE -_____a__�/0 I, Douglas N. Carlson,, CEO do hereby state: That I pay or supervise the payment of the persons employed by VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature / _ �-�-u'�- S' ------- Title ChieI E ecutive facer DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Certified Payroll Register Page: 1 Jbb Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. O. BOX 32 189 CENTRAL STREET Week Ending: 2/1/2015 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 01/26 01/27 01/28 01/29 01/30 01/31 02/01 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours pay Regular 0.000 0.00 Overtime 0.000 0.00 0.000 0.00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law 049, p21B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after com pletion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLI NCE --------L--- --/5-- I, Douglas N. Carlson,, CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER S HOOL DEPT, ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. SignatureuJ� tl - ------ Ti a hie ecutive f icer A -1 - DIVISION DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 vviuiicu r ayiun i%oyiawi rays. i Ao Job ` N. ANDOVER SCHOOL DEPT. ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MA 01845 Contractor VIKING INDUSTRIES, INC. P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 1/25/2015 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the paym ent of wages, in the following form: STATEMENT OF COMP IANCE I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the payment of the persons em ployed b VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S i n a to re /cam - N� Tie Chief E'x cutive 6 fficer- - - - - - - - - - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 01/19 01/20 01/21 01/22 01/23 01/24 01/25 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II -"-6224 R: 8.000 0.000 0.000 0.000 0.000 0.000 ----------------------------------------------- 0.000 8.000 43.310 346.48 290.04 0.00 V4590 INSULATOR -MECHANIC +24.480FR 99.50 142.38 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1604.86 23.27 959.34 WHITE Male +0.000FR 39hrs 90.33 645.52 Hours pay Regular 8.000 346.48 Overtime 0.000 0.00 80646 48 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the paym ent of wages, in the following form: STATEMENT OF COMP IANCE I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the payment of the persons em ployed b VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S i n a to re /cam - N� Tie Chief E'x cutive 6 fficer- - - - - - - - - - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE February 05 , 20 15 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and fo nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 02-13-2015 For the Period Ending: 02-05-15 Job: 14-012 N. Andover School Admin BLDG J566 Mein Street N. Andover, NA 01845 John Mahoney 84 Te11Ier Way Dracut, MA 01826 01-30 01-31 02-01. 02-02 02-03 02-04 02-05 Total pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts M - 0 Sheetmetal Reg 8.00 8.00 64.00 12.24 76.24 609.92 2,432.00 404.88 115.67 609.92 166.04 Totals for N. Andover School Admin BLDG 01-30-15 01-31-1.5 02-01-15 02-02-15 02-03-15 02-04-15 02-05-15 Total Gross Total Friday Saturday Sunday Monday Tuesday Wedneady Thursday Hours This Job Gross Deductions .00 .00 .00 .00 .00 .00 8.00 8.00 609.92 2,432.00 FWH 404.68 FICA 186.04 SWH 115.67 SDI .00 Other .00 Page 15 Net 1,725.41 Net 1,725.41 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE January29 , 2015 NO WORK I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the Norm Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one huWandnine of the General Laws. Signature Title Clerk DMSION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Job Contractor Customer N. ANDO1ER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC r ADMINISTRATION BLDG. P. O. BOX 32 189 CENTRAL STREET Week Ending: 2/8/2015 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 02/02 02/03 02/04 02/05 02/06 02/07 02/08 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay --------------------------- Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 UNOU 0.00 WEEKLY PAYROLL RECORDS REPORT N DE OTTOF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPL ANCE ------ �- !o------ I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature r _ _ '_� _ - _ _ _ - Tie C ie� cutive f icer- - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Certified Payroll Register Page:1 Job - Contractor Customer N�ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. 0. BOX 32 189 CENTRAL STREET Week Ending: 2/1/2015 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MAO 1906 N. ANDOVER, MAO 1845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 01/26 01/27 01/28 01/29 01/30 01/31 02/01 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay ---------- Regular 0.000 0.00 Overtime 0.000 0.00 0.666 WO WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law 049, p21B, a true and accurate record m ust be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Department of Labor and W orkforce D evelopm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COMPLIANCE -------JP9-1-V------- 157- 1, Douglas N. Carlson, CEO do hereby state: That 1132 or supervise the payment of the persons employed b VIKING PNDUSTRIES INC. on the N.ANDOVER SHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Si nature Ti a ChieTE Mx &c-ut0fficer-------------- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Hours Pay Regular 8.000 346.48 Overtime 0.000 0.00 8.000 346.48 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMP IANCE p_. - - - - - - - 1 - C9 - I, Douglas N. Carlson, CEO do hereby state: That Ippayy or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Build inor project) and that all mechanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature �c Title ChieT xecutive6fficer--""----""""-- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Certified Payroll Register Page: 1 Job Contractor Customer N. r NDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. 0. BOX 32 189 CENTRAL STREET Week Ending: 1/25/2015 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MAO 1845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 01/19 01/20 01/21 01/22 01/23 01/24 01/25 Pay This Job Med Name ---------------------------------------------------------------------------------------------------------------------------------------- Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay ---------------------------------------------------------------------------------------------------------------------------------------- CORNELIUS A. MC AULIFFE, II -"-6224 R: 8.000 0.000 0.000 0.000 0.000 0.000 0.000 8.000 43.310 346.48 290.04 0.00 V4590 INSULATOR -MECHANIC +24.480FR 99.50 142.38 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1604.86 23.27 959.34 WHITE Male +0.000FR 39hrs 90.33 645.52 Hours Pay Regular 8.000 346.48 Overtime 0.000 0.00 8.000 346.48 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMP IANCE p_. - - - - - - - 1 - C9 - I, Douglas N. Carlson, CEO do hereby state: That Ippayy or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Build inor project) and that all mechanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature �c Title ChieT xecutive6fficer--""----""""-- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 x U N 0 u z En 0 x v rn 44 w z z 9 a .1 ro u a u to w (d01 +' 0 y 0 E u u° ro 0 ro V u 0 w 0 w a o „ v q 1 0 0 0 H Q l y U 0 Sr N of w ro p 0 4j E+ O z ro U N ro Z u 0 O Z y J m :F7: ro x 0 z E O in Q q to 0 V 4J r G7 z 0 7 rE n u 0 ro 0 z o a° N a" aJ <41 w ro u U w a 0 o v 0 •n O •n N .q •n °1 U 1 v w H N N v1 a a f v fa 41 b a H N Cl) N �t M o W 00 Cl ' d w Cl) of x b r 4 q o m 0 C 'i N H H Aj "� ° 0 0 w a v a w m i 0 x F ro y F o a O F m q p o y ro a y o coQ)p E O v N A v a� W Uro L ro 4 Q W d � Y q E N ro o O N N O � W � z D o 't LO CY O C co o Q y O p y O p y O p y O p y O g y O p y O p y U Q iii O p y 0 A -r v ro J r o z 3 x J � O bl � q q o�E- w m x u m 44 3 G)� 3 N + w C O 11 to � W U � a v O E V) N H 'o o � � v 11 y L n wz EQ i, w ?, v � Cl) u 0 0 ao w N Ln 0 ro •H 0 b ° 0 a A A �u a •• uya wwQ mo-� z ai H o— ro N W � v o Of ro E ° 0 .r-1 z m n�rw—" 0 +ro ocr U> "� m i 0 b a ro y cC x o�ox LLI U Q CL J 2 0 LL 0 Z W W Q N 7W, O N M N C) -0 -0 0 N ca NCO > O c EU N crs O J N +� E J N U c:JQ) J c (L6 -�J O- E >ti m C = m N Co L Ln o c E N Q -O j c O »� w N c c O E_ •N L O Z l- p L Cn 0-- E >, a) Q N_j O N> C N U° 00 c= 0)EL N c_°a 0Urn Om U v) cEnFL_�J(n V) Z C N Q N QO E -c p LL (n N E ��H 0 >,o co O o (D co ch E =a a) M-0 -c > 0 Z 0-C O N C N N Q� N � 0 m r O Q >' U) L� N N 0 c m O O 0 Qc N c Qm-0•g --T .c Lp N T -C "a N O M Emmuc 5 Q N C F O� 3 .Q O 7E> j N N _° C N M O N" N N E@ >� O O U m Lp 0 c 3 a 0 a c U cn N Q J ` N" O 0 'O C C) O U) � o- a) > � O p M -0 � N m U "O i U Lo Y O O Lf6 m Y-0 n. 0` Co E o °° c a� 3- C 5 m N N C m N -a J :3 �- N >,N4 -Co -00.0 Q -.n-0 0r - U) F - LL U J J Q Z OO z W Q X X W W 0) c O E N O O O U U) U M - N O- 'D N It N > Q 0 c O N ~ O ° O ` I- d U p N p a O C N O E p LLJ - L c � c >O a o o a (6 = L O a S1L p d O = p p U)U U) C Q= U '- p Q N a -c0 N U c ami U N Q 3 :c < L N — > 0 y Q o 0.. 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CO 0 o c E ro T ro p R) O L U ) -C '6 L L U-0 M OCL QL C O O O) o p- o W -0 - "— -c m `+- E-8 N m 0 a)U a°i 3.c o ro c-> > o J E c o o Q) Q Y cn oca� -���m cts c c o cW• o�> E o 0 -0L y. T L p 0Q.N C (0 O Q C-0 C @ 0) Q) a L Q C C � C >, a � .� (6 r p 0 C L m O to "O p C O ° _0 N � 'J Y a= F- m m U m � .� 0 6 n N N ° ` N 0 L a.- o a F 3 3 0 n.�� ro� 0 N U a) 00 N r - ti 0 LO M M rA 6 Q 00 00 W oob o w .4 h w N w x 44 U N .S U 64 A 71, 8 as a a u 3 L 'y a � � o 3 0 0 3xA � N H ° '.P� o 0 L 3�"3x 3 w L 3 a C o Fix O O O � x m L mrd W 0 � � c� U 64 A 71, W F- 0 ZI r O Fn m a d Z LO J U o � ! 0 13snN (y $ 1_ 2 r m o+ x3LL ,^ LO t S 0 U 00 i ° a o M� O m a 2 d d a 3 E m 8 y co ti tf) 00 m �� r^ Z ��VV��JJ Q L� Fe 2 m ,A�1/ (` a N 1 d X. I 0 c o =3 m Qami m g Cb a m o� Z 0) oc z o = oa o a CD o o N L Cd C) +r O Z = w Q cu Cco V C LL r fA Qca C •i CD Q V 3 ca O m o O W L o E L 65 L r N z t t I- o E _ •Q i Q > Z � u N o 3 a ¢ m e K 'SOLD N r a d Z a y F U c o C > c o Q ca 3 •L U Nor r El El ® - U °^^�,, W� Zcn i W L N W L E � m N 3 U 4l m Q. � L g E (n 3 i a o ° 111 Z m CL o : o U) E V o w a Cml N Z - w W F- 0 ZI r O Fn m a EWU moe PAYROLL AFFIDAVIT REPORT DATE 01/23/15 14:54 FOR PERIOD ENDING 01/17/15 JUPITER ELECTRIC, INC. ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 01/11 01/12 01/13 01/14 01/15 01/16 01/17 PAY INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE PAGE '3 TOTAL JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 8.00 24.00 72.820 1747.68 40.00 2467.68 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03019— DT M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 24.00 136.11 144.71 77.31 .00 612.15 1497.40 007007 JOB TOTALS TOTAL EMPLOYEES— 1 TOTAL JOB HOURS— 24.00 TOTAL JOB AMOUNT— 1,747.68 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 01/23/2015 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title: dministrative Asst. Date: January 23, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payrollperiod commencing on 11 `h day of January, 2015 and ending on the 17th day of January. 2015 all persons employed on said project have been paid the fudl weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by anyperson, other than. permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S. C. 276c), and described below: (2) That any payrolls 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 setforth 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITSARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) I EXPLANATION I NAME AND TITLE SIGNAT / Leah M. Hatch, Administrative Assistant o ✓lam) �(r.L. THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE &TKTEMENTS 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. N A 8 a o� � oa 3�A moo O 0 °°60 o�� i O U = vi C i O O O wxA w x C C ° E N w x 0 3 ° .SE 0 3xA "r N cq H C V o 0 U 0 3= it i N c. 0 O kn kn o C O O O 3 O \ o o � x o O O o i 3 c= o° Hix O Q O T 7t C O O O i O y W o °�' U 0 40.4C U aO eq pl� W Q H i�,Il yam, N N U Q d N O � N 4.0 V CCi vi � CQ 4� U O 3 U o Q z a� b b M 0.1 CQ W b L •� � C O S o a z U N 0 C� tn o w e U o :, z Z o o W y U N .1E N a 3 z z N A 8 a C ta � oa 3�A O O o i O U = vi C i O O O wxA C C ° N w 0 3 ° 0 3xA "r N cq H C V o 0 0 3= i ° H x O O o C O O O 3 O \ o o C ° O O O i 3 c= o° Hix O Q O T 7t C O O O i 3�"3x W 0 U y pl� W Q H N A m 0 w 0 v c O U N C O U a 0 v c m 0 t5 m C U 21N m N N s U J U 0 c m 0 0 CL W F- 0 zI C 0 2 0 m O 8 C m N w 0 c O U m m c U m 0 c m N E 0 U m w c m m E T CL E U O N LL 0 m rn c v 3 m a� L 0 rn d Z Y = U m �N_RE�p LO v o r Xo3� 13gn N a 3 O T m I _ CC m CO z d 3 Y $ v as $Ew R CL p 3 C i e clm D M ti 'n coo c ¢ a cn c o Z 0)E TO Q w o m a _ N c > m o Z m U = A m- Q IDm oba o� o T o Z � c = z V , 3 m C0Q: t 12 S 0 c V m In a V a x a.. 0. N LO ..0 Cd O o O Z .cn C m .n Q c U •L FL cn� Q O (Ci O W L -C L N •^ m Cn •&-a •E Z u L 0 m E Q o O f0 Q a > O z „ =3 W O 3 Q U .m n am W o a N r — a a Z c a F m U � c W CU L N uj L U w W O Y OL w U L � Q y r C O U NON m o=mEl Eli Ll � 0 F U °� w�� Z E (UD) m D W L E O z � o v m N 10 6 E E Q m c a Lll z LE- _o a E t9 Z w m 0 w 0 v c O U N C O U a 0 v c m 0 t5 m C U 21N m N N s U J U 0 c m 0 0 CL W F- 0 zI C 0 2 0 m O 8 C m N w 0 c O U m m c U m 0 c m N E 0 U m w c m m E T CL E U O N LL 0 m rn c v 3 m a� L 0 rn Ewu moe DATE 01/28/15 14:37 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT FOR PERIOD ENDING 01/24/15 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA PAGE 3 EMPLOYEE 01/18 01/19 01/20 01/21 01/22 01/23 01/24 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 16.00 72.820 1165.12 40.00 2245.12 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03019- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 16.00 114.22 134.35 70.26 .00 535.57 1390.72 007031 ------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------- JOB TOTALS TOTAL EMPLOYEES- 1 TOTAL JOB HOURS- 16.00 TOTAL JOB AMOUNT- 1,165.12 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 649, §2713, a true and accurate record must be kept of all, persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 01/30/2015 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title. Administrative Asst. Date: January 30, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payrollperiod commencing on 18&' day of January. 2015 and ending on the 24th day of January. 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. _ (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNATU Leah M. Hatch, Administrative Assistant 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. MW Ul Cd 0 A x C E 0 J ►6 r.� 8 a� a C C as 3' A O o 0 L C C ' w u wxA u C Ix ♦+ Q O �d L 3 Q C co cq O 3 � r Q F C 6� a a o 3= u w 3 H 3 x o 0 0 3 /-r TA 7., L w y L 0�3 3 00 M 00 a 0 R •V C w ¢ H c 0 �U m O c m m w a a U m c E U m O C N E a� E U N c N m E Z CL E U O N LL O w m m Oi c 72 t 0 FN s m a d 2 LO O r 2 w z rn Mm ' + oW C \ fA M + m > o M Y m m Q Y 3 L)3 c w N Y M LO` 000cc ¢ a U c F _ O LL W W m (` A (V c > e o L £v J m � u O W m O a CD '03 z° Z v ° 3 to m cc a cc o'a So N LO � w m +� O O Z = � N Cl) � C1 'L a cca � Q Uco � 3 io O W �0 LL L X_- L F- o g >, • � m v VJ N E Q. .� •Q ? z p � v U m ° v nr ¢ m v r a o a Q H 4 A U C a � O L _ U w m, v m 06o Z E N N U W U y m W i b O � Z � v v m _ C: s m o U Z'CD E E n c (D J U W Q C7 Z c 0 �U m O c m m w a a U m c E U m O C N E a� E U N c N m E Z CL E U O N LL O w m m Oi c 72 t 0 FN s m a Commonwealth of Massachusetts Division of Apprentice Training REG# E-054-476 A JUMER ELECTRIC INC. 14 AYI+TTEROAD rAc�N- +G` SALISBURY, MA 01 9 ELECTRICIAN :xw, Appr. Start Date Pr•0j. Comp. Date 12/26/2013 6/26/2017 ti.p! ct<p+ crrn` crw- crena BRADFORD crop= cr ns crepe Vrp4 8 creph� CONNOR Annual Apprentice W. Cara Fspim 12/23/2014 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: February 5, 2015 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signatur . _�� 'If 122 xzzyc_4_� Title: Administrative Asst. Date: February 5, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That Ipay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on Z5 day of January, 2015 and ending on the 31st day ofJarmarv. 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Actt as amended (58 Stat. 948.63 Stat. 108, 71 Stat. 967; 76 Stat. 357, 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH o Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS I EXCEPTIONS (CRAFT) I EXPLANATION I NAME AND TITLE I SIGNAT Leah M. Hatch, Administrative Assistant ,c t' ' / . 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. cc c b x O F2 ri Y a� A r. i 0 E a C � u sem., W x v a � o 3 0 x H 3030 E x 0 0 0 3 •O \ 0 0 0 � � y Q! L i. 'C L 3 W L bD a� CC U w ¢ H a� A r. i 0 c l0 7 a Ill O Zi M 0 L_ m rn C v 3 m N L 0 Fin Im a d z d ! Ml a` 2 2• m 0 m + + o m M W C c /\ N N o L)j ao tea` Cr) x O a 2 ami m Im d c w T p C 7 ' (.0 co a)QO 'n CSD e to a ¢ a w D z = a m ~a N O o o o m- c �� Q � umi m W m a �3 0 0 m o z a m c m _ m 12 0O Cfl 'n a=.. s2 a c,� a N LO cd O O Z m O N Cl) .0 C 2!1 m Mn Cl) Q V o O 4='a (Q o O W Ln E (n N ' � fa a OED s ao Q J Y o 3 Q � d V N r u o m Q F U C o � > O O m Y v .� L � C O N o®Ll El W zE � m L1.1o Lp O 2 m 2 � m v a B -a 4) z E oc U 0a a72 m D) m VJ C L m Q , m ? A A<` y E° a O o U) v w 4 t� Z E w 0 c l0 7 a Ill O Zi M 0 L_ m rn C v 3 m N L 0 Fin Im a EWU moe PAYROLL AFFIDAVIT REPORT DATE 02/12/15 08:49 FOR PERIOD ENDING 02/07/15 JUPITER ELECTRIC, INC. ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA PAGE 3 J EMPLOYEE 02/01 02/02 02/03 02/04 02/05 02/06 02/07 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 8.00 8.00 8.00 40.00 72.820 2912.80 40.00 2912.80 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03019— DT — — M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 40.00 179.91 165.38 91.42 .00 765.32 1710.77 007078 ---- --------------------------------------------------------------------------------------------- JOB TOTALS TOTAL EMPLOYEES— 1 TOTAL JOB HOURS— 40.00 TOTAL JOB AMOUNT— 2,912.80 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 049, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: February 12, 2015 1, Leah M. Hatch Administrative Assistant (Name of signatory parry) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signa Tit : Administrative Asst. Date: February 12, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That 1 pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on ffday of February, 2015 and ending on the 7th day ofFebruarv. 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Actas amended (58 Stat. 948.63 Stat. 108, 72 Stat 967; 76 Stat. 357, 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS o In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH o Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGN TU Leah M. Hatch, Administrative Assistant 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. ED i z ON M �.. E, E a� a C C as w 3' A o O o v as L U wxA o o O u C C� � L 3 � ° d 2 Okn N O r A H C d 0 o 0 0 3�3� H x O o C v 3 •O \ 0 0 0 y� L 3 E�� o 0 0 'L = O O O h o0 0 3H3x 0 0 0 Q W O O O 4t L I 1 0 Z m = IM BF�p �'e V J U o m � \ C 2 w U o0 3 LL N N o m �a G M ui Y O L E _ I m Y m 3 m w U) LL ♦/1 M a 'nm 000 m o. o O Q c x tu1_ a o m m x O J m 1 ='off a 2 CF) p Y C 2 = 0 � a = d U C N LO Cdm C) +-' O Z `_ = G U Mn cn Q c U •L in a) E Q U > o c6 O W L Cl) m L C/) L ~ • fts � a > O z a m o` 3 Q ama ¢ m x @ a N d a Z $ a vI U C � U L � uj L U H p U o = c i El Ll 1:1 Ll El 1:1 W o z W L E Q O 2 t � •� m v a a 2 n L S R i CL y 5 O u E rn c m O N a „ 1 ® a o _ W Z m Z a C E E m O t°I m N d L U J Un i 0 C :C 7 _ 0_ H WI O z 0 r, s m a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: February 19, 2015 i, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title: ministrative Asst. Date: February 19, 2015 1, Leah M. Hatch, Administrative Assistant: do hereby state: (1) That ]pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payrollperiod commencing on 8th day of February. 2015 and ending on the 14th day ofFebruary. 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S. C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH o Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE GNATURE fq Leah M. Hatch, Administrative Assistant 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. E O 1 Y O 00(1) w 0c\ rwpw m w 0 co L6� MM ZQdC 3 - N� O �C) z J 0 (h O ZCL ou x Ow O o N o Z r W 0 K w O O U O C � 7 O U U= V C NO W Z O O 6> O a c^p U N = Z) O w Q w � O N N c C. 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CL a w w i m O c I w 4 c i I 00!I = a W '� a o I i v m O + cQ C a L T O N I 1 m U L I o M1 i > I w w i 0' O O Ln n p Q =' I iI I n m Z I M '• ~ h co � -- 00 { d 0 0 W I { i1 M M J N � c m 0, I J2 o Z Z O 3� lA c , u O. I C �{ 1 I 1 f f I I I 0 � . N Q 1 f0 O I ` m 2 I 1 E M LL n ra 00 Y '.. Z Q d C C LL I wl w i OI O N a O LO I � I I I ! I ti = I I W > 06 I i L f m I L W O Z 10 ' Z v O I w I z 3 a ! H v O C' N Z I 5 o E c 0 m Z 1 � m in! ' �• E I r—f I ml w 7 L c y m N o a zF w Z z, 4! I O O n p Q =' d 0 0 ~ I ! I r—f I ml w 7 L c y m N o a zF w Z z, 4! WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. The Weekly Payroll Report Form includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the project. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor, within fifteen days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Shannon M. Audet (Name of signatory party) do hereby state: February 12 , 2015 Payroll Admin (Title) That I pay or supervise the payment of the persons employed by Tim's Fabricators, Inc. on the School Department Administration Building Works (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Payroll Admin « OSHA . 0005603'8. 4+ . y. Ft MICHAEL HALLGREN +,amu, aycw,Wed*lG#,ourO AS9"..aa+%eeV' TrdnkV Carse (ri J. Fitzpatrick -2/151`05 ... 1. ,. 001424116 - - �OOi�paNa'alEBg(e�f3t1$(T"1�BBIpiAA�i�Bott � Ad".�' CARR, ,hL4 >Qfe19#r)W'06a�$tlprfel SBtety told H@01[h Cl.,* m �ry08�i ��OSRAA=*W.k=*.W--- nft card admoWerts Atte fe*w'K ha8. 1/ a 10 -honer oa nei h d Health.To* rel Course in Coe arul Health �9I SfbmH 2, tZ 1- 13 mBhaer r>ame – pr" - Wpo (Course end date) imaalio01 OSHA 000842209 aueor ;` OepupNea�t�als!►twilhAOatl�raltian RindWph SPM • Mug omaww W40*0Wtbo, Taw%""" s Nt�. 8, 2005 OSHA _ r;:' u`Daniel Carter ���yy��,' x -�R3rlmentofLappr 'i i",�� (! Sa(ary aiw Health �d+i� n at on } 3 f � Saocessfully oornpleted a Y Tra Hing Coxse in err 00Oau'ational Safety and H ea" (1 fainer� ? (Data f 3 11116 cod 101maiedgm #Wi)M:l1MC 1 I h116, 8. 14flCNX ©Dmoolww sow #Ind liwmlh**Vcwjrsoim i+O11�l1fl�Oil ..rMQ t Russell MacMillan (Peter Vice 66873 9 13 j1'rdrrpr nirtle - pid � tY �,srl¢ t�sj M ca a o � 000 v 00 U L wxA 00 * w tr-- � ro o Q O 0� .� A � N N L O 0 x 3 ° U H C U o 0 0 3= N O o 'n 3 0 3 0 H x tir C7 o C � o a 3 w �! x o C O O O o a L s, � L 3 x Vo rn as o W ^•� it O rn � L ¢ H yam., N N O O C U d d o N O � N �n i. V � vi CQ � O X � O 3 Q o v Q �U�yy z ti U U � •L7 N .b •� y M bo .b d w ti a z o U a' > toO o w U o z N z w O � o W C N u a z z 3 ca a C [ v U L wxA U C � A � N N L O 0 3 ° H C o 0 0 3= in 3 0 3 0 H x O O o C 3 w o C O O O L s, � L 3 x d Er-' W ^•� N L ¢ H 3 d mb O U N C O U 0 c m 0 U cc 0 U CD N m N t U J 0 C ld d WI H O 2 0 r d a O Z � _ yM`BEIp �a O x m o m i 13SDN� N 0 3 F �' A C N d +� o N Cy V N m m o + m m > �a w �� a 2 0 m 3 Im 3 L) a d E c "' p C W IL 3 d °' (M 'n co c a to c O A� y/ LL 2 H x 1 m N e _ > o d U r f? W O m c O c d ~ c J Q � 1 IL 65 �3 0 cV Z , Z u L° 3 u f0 m ` t O 0 c a=` a= 0. v a LO N � W Cd U) O C: Z O cu j .cn C m AQ cn < V •L U) D 3 O cu O w +-r N �C: E N >+ 2 v L m E Q o a2o (0 E a % O Z J -0 1 N m 3O <o u amo a m a v a N tY r+ a a Z .0 i= U, U � o m CU N L W U O v OL U a� r- .aEll Ll Ll — - ::1 U atS wOU � z E � N m m W s✓ E _ O Z " o a a � m 4-0 "' m 'a EV N E CL c `o 3: V T 0) °6 0E _ z2M E a m CL o O o VJ 0 w ; m Z E w 3 d mb O U N C O U 0 c m 0 U cc 0 U CD N m N t U J 0 C ld d WI H O 2 0 r d a EWU moe PAYROLL AFFIDAVIT REPORT PAGE 2 DATE 12/31/14 08:34 FOR PERIOD ENDING 12/27/14 JUPITER ELECTRIC, INC. ALL JOBS ' JOB INFO 14405 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA ' EMPLOYEE 12/21 12/22 12/23 12/24 12/25 12/26 12/27 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00205 BRIAN W. COSGROVE RT 8.00 6.00 8.00 22.00 31.590 694.98 32.00 902.16 108 ELM STREET OT R.RATE PO BOX 171 DT BYFIELD MA 01922- - — S # OF DEP— 1 JOB APPRENTICE HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 22.00 91.66 60.31 33.46 .00 126.12 590.61 006915 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 00985 DANIEL P. RYAN RT 8.00 6.00 8.00 22.00 72.820 1602.04 40.00 2547.04 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT — — M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 22.00 147.66 28.58 88.84 .00 614.53 1667.43 006929 ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES— 2 TOTAL JOB HOURS— 44.00 TOTAL JOB AMOUNT— 2,297.02 Commonwealth of Massachusetts Division of Apprentice Training REG# E-055-469 14JUPITER LAFAYETTE ROAD �o �✓��`�v SALISBURY, MA 01111Q�< cLcC7rtic;lAN Appr. Start Date Proj. Comp. Date 66//23/2014 ^6/23/2018 .Gael .Gape s1rpS Ste t BRIAN step_ �/ steel 'i Sre h P � .Gapv� W. COSGROVE P .StepB s7ep(i :7 Annua/ Apprentice LD. cera Expires �nnots WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c 149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 12/31/2014 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signator . Title: Administrative Asst. Date: December 31, 2014 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 21st day of December, 2014 and ending on the 27th day of December. 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357,- 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH o Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNATURE Leah M. Hatch, Administrative Assistant 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. IF k J cc 0 x ii �v E a C C u L V o o O wxA u C � C .o ° Q O o o � -- 0 3 ° O Y+i H C �+ O \ o 0 0 3 R 3�"3x o O o C co 0 0 3 A C e O O O CC L. L a? 0 O O O Hix ^t L O O 3�"3x O O O O. W O O O tm Q� Y wl H O Z C 0 �U �U m 0 c� C m 7 Mn O C 0 U m m U m 0 c a) E a) E E U a) C 7 atoi m m E T CL U O N 7 LL O 7 rn C U 3 m a) t O En m IL 0 Z v S )M)Alp. i V J u ID O x x�m� a3Si�N� N ¢ a` m MZ C:) m W i ++ >` � JO m S �� -L M C r U) m m �a o `rM ) m O a Z T m m m m m o d W V1 D O C m c� c M LO OD W 4 a T c o '^ V Q W m t Z O o m VJ °•c 0 1°Y O c Fv. m m g V J Q ti � N m IL 65 03 0 d 2 Z ` 3 co toCD Tt2t a 0 a N^ L J y N 0) }, O O C) Z LL -a V V/ =3 � Cl) � V L Mn L u) N Q U m O W 0 L L •� E Z ` iio m Q W (0 O o` > O Z a L m N< CIO O 3 C 'm a m N Z 0 m U o UL L uj m � o Y O _ U .� Q _2 U 9 r. am oEli 1:1 L1 I U m v • z � W w W m Z a a m L E O 2 m /= a � _0 E O E z 1.j. =3 c in O S O V E of m Q O a C N ¢ — n. LLJ z Z d m E U a a W C :5 e 3 Z d 0 w (� wl H O Z C 0 �U �U m 0 c� C m 7 Mn O C 0 U m m U m 0 c a) E a) E E U a) C 7 atoi m m E T CL U O N 7 LL O 7 rn C U 3 m a) t O En m IL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 01/08/2015 I, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title:dministrative Asst. Date: January 8, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That Ipay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 28`h day of December. 2014 and ending on the and day of January. 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no suchh recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNA RE Leah A Hatch, Administrative Assistant 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. g W O Y OO n W O N � w p w m uj 0 ,b ; Zaa� N_M O O LL Jo z O •• z m .0 F H O0 OW C5W z N p a C LU Z J- W ~ 2 O O U O InU 't W w Z L N 0 y _, D7 D O p W cl ca G N � C (n J O Z �0 �=QQF- Q LL W NZp W ' ` 0 N O) E O E 'O CD¢w U) z O a O m UL O U W Q v J Qa Q �O LL ; h` T O 0 y L O�m w M co U y c`0 y m Q C a) o U CL CoC:5 W a) � r O U V) Q C Co Q. 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N 3 c aS J U t � N U N r Ny w Z ZW fa O (n L O- a) N w 0 0 w ,L,,, w0 C)L n o 0 0 L-0 O 'a my c c -0 0 3r N a) F .N T a) a m U r - O U p O N �a a3 C N C — Q Z LL d O V a) C C 0 r- U > cn a y O cu 0 a) O O y .L.. U O �+ -p 7 w p , U N C ~O oU OW X L O O G— 3yc E N .� W m O N co V U oCL cu fn 0 m m 0 0 ca a) w 0c' .O d 0 aim w a1 0L LU c0Ey cc d) C C C T a3 Co .0 C U mU QO O 0 C t. Z 4 j I� L T '7 N O .L. U L 0 E c` LLC w� N� 3 cn o m O E E a)a)Qm m LLLLQ o L) y �w c o 0 o -o m c w I CD Cn a)m U U 0 N O O c N OZL) 2 .. ?) N U) C-4 N 0) a) Li (n 'UO r 3 0 5) L N L O } w U -Up ~ ��•`0 h � cp ~ Q 0(rF- -0.2 L,= (h C C 0 v(D .�.. Y w C ` V �f -a 2 N O U 0 a)w ;g 3�UU cn 0) aaN OJw d cm 5 mQ i a 0 ( �� r7 cr- v ..4In r� .h +3 O a 0 ( �� r7 cr- v WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall fiunish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE _iI Z 2015 r2 CT vy2 E� {Name o signatory party) (Title) do hereby state: That I pay, or supervise the,payment of the persons employed by (Con(ractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title I 141 DIVISION OF OCCUPATIONAL SAFETy,19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 _ 0 z a cr- 90 ;r v: I m 4" G � v 1/ I se FK� }} !— DRi �q R�� a a Y s @ ria O 0 z a cr- 90 ;r v: I m N WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: LLP- y (Name of STATEMENT OF COMPLIANCE S4eX�� party) . 2015 i rz GAT u�2 t.=� do hereby state: k 1 "`el That I pay or supervise thepayment of the persons employed by the 5(-k&0 ( /G� 1 JT DN (Contractor, subcontractor or public body) rz x �p �/ (Building or project) ( J rK and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % dCEAS DMSION OF OCCUPATIONAL SAF,ETy,19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 os. t4 i Mv �•�35i14t7 ,45� . q 0 � ,:'•,� oG Or jz " T � ob 01 eo F`(1 i';e. DS W a y .,ra a..3 T•'"�� a'� rx ,1...: cc cm LL gm 3�' '� .rc "`✓ ' 'r a�� 6 �'�� r�; � s�+�� r '� r �� as 2 � Y J y i 3"�� �. �� vii' X61 � AF Y.s" '�`',�� �" �y" �if�,'c�r•, .a iL' ,gip �� ;�x: � � < ki ,�,`',� V 't�� ® �•. K s \ �^• a � ae wL -� W ti y z 4 43 ! v V cn J n Ojr i t Cl` E O m su v � „ ? J, 0 @� c .`W r= ��, •:gip. YC7 `J m � '` V J , ;-� :� Y -c W >c q fa' WE 51D c E 7 CL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and incls ude all the information required to be kept by law. Every contractor or is required to r sub keep these records and preserve them for a period of three years from the date of completion of the contract In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be atta years. ched to the payroll report. Once collected, the awarding authority is also required to preserve those records for three In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE {Name of signatory party) I Y CAT Udz Ea do hereby state: (Title) That I pay or supervise theayment of the persons employed by J �� (Conor, subon the Sc1-(90 c ACJ tractcontractor or public body) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature —46a -- Title% dCE v'[ 6 DIVISION OF OCCUPATIONAL SAFETy,19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 J z V.. � pv '- X11 11 �O ''��`• G ��. V A -w 4 _ 3 .0i Y, fR L A; U L• (�() Mo �*er 16 «z VIM �"g "'". , x y,s• ,mom, 'u OWN RR zi ca s cr- LL .,,,: Q ,fir`: b4 y' W v b Ml iy 4g SF At J v (v r Ll Zl x J cu U Ak rQkx ` 0 BOW uj WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such awarding authority directly, contractor, subcontractor, or public body shall famish to the within fifteen days after completion of its portion of the work a Of wages, in the following form: statement, executed by the contractor, subcontractor or public body who supervises the payment STATEMENT OF COMPLIANCE 201_4__ (Name of signatory party) do hereby state: (Tilts} That I pay or supervise the payment of the persons employed by J J3v-wfk--,on the 5ck&, c (Contractor, subcontractor or public b . body) .140 f 7 ; � To 47)uil °j✓ , 'ey, 9 or pro and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title DMSION OF OCCUPATIONAL SAFETY, 19 STANIPORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149,§§'2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE I@ L 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordanc/chapZterlo determined under the provisions of sections twenty-six and twenty-seven ofundyed d f rty nine of the General Laws. Signat Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 12-16-2.014 mage 8 i For the Period Ending: 12-04-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Acevedo Geronimo 183 Chester Ave Apt. 1. Chelsea, MA 02150 11-28 11-29 11-30 12-01 12-02 12-03 12-04 Total Pay Fringe Total Gross Total FWH SWH Other 011.-76-9080 Hispanic Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net 5 - 0 Sheetmetal Reg 8.00 8.00 64.00 11.34 75,34 602.72 2,264.00 429.05 105.85 211.68 1,350.02 602.72 167.40 John Mahoney 84 Tell Ler Way Dracut, MA 01826 11-28 11-29 11-30 12-01 1.2-02 12-03 12-04 Total. Pay Fringe Total Gross Total. FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 16.00 64.00 1.1.34 75.34 1,205.44 2,264.00 366.00 117.73 1,607.08, 1,205.44 173.1.9 Totals for N. Andover School Admin BLDG 11-28-1.4 1.1-29-14 1.1-30-14 12-01-14 12-02-14 12-03-14 12-04-1.4 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions Net .00 .00 .00 16.00 8.00 .00 .00 24.00 1,808.16 4,528.00 FWH 795.05 2,957.10 FICA 340.59 SWH 22.3.58 SDI .00 Other 211.68 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided_ A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE a 20 14 I Barbara R. Barbolla Clerk , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dep (Contractor, subcontractor or public body) (Building or protect) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred a d forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 'Thomas E. Snowden, Inc. Certified Payroll Report 12-1.6-2014 Page 7 For the Period Ending: 11-27-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Acevedo Geronimo 183 Chester Ave Apt. 1 Chelsea, MA 02150 11-21 11-22 11-23 11-24 11-25 11-26 11.-2'7 Total Pay Fringe Total. Gross 'Total FWH SwH Other 011-76-9080 Hispanic Male Fri Sat Sun Mon Tue Wed u Hours Rate Rate Rate 'Phis Job Gross FICA SUI/SDI Deducts Net S - 0 Sheetmetal Reg 8.00 8.00 5.00 8.00 29.00 64.00 1.1.34 75.34 2,1.84.46 2,385.85 462.14 112.00 219.00 1,41.5.99 2,184.86 176.72 Louis Bureau 1.346 Sokokis Trail N. Waterboro, ME 04061 11-21 11-22 11-23 11-24 11-25 11-26 11-27 Total Pay Fringe Total Gross Total FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg 5.00 5.00 10.00 64.00 1.1.34 75.34 753.40 2,090.30 21.1.Oi 83.04 370.32 3,219.95 753.40 145.98 Jeffrey Grey 17 Whitney Street Saugus, MA 01906 11-21 11-22 11-23 11-24 11-25 11-26 11.-27 Total Pay Fringe Total. Gross ''Total. FWH SWH Other 030-48-7316 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net S - 0 Pipe Fitter Reg 8.00 8.00 64.00 4.15 68.15 545.20 2,169.80 444.84 109.24 69.11 1,385.91. 545.20 160.70 John Mahoney 84 Te11Ier Way Dracut, MA 01826 11-21 11-22 11-23 11-24 11-25 11-26 11-27 Total Pay Fringe Total. Gross Total. FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 8.00 8.00 32.00 64.00 11.34 75.34 2,410.68 2,264.00 366.00 11.7.73 1,607.0'7 2,410.88 173.20 Totals or N. Andover School Admin BLDG 11-21-14 Net 5,688.92 11-22-14 11-23-14 11-24-14 11-25-14 11-26-14 11-27-14 '.'o tai Gross Total. Friday Saturday Sunday Monday Tuesday Wednesdy Thursday !iours This Job Gross Deductions 21.00 .00 .00 21.00 13.00 24.00 .00 19.00 5,894.34 8,909.95 FWH 1,483.99 FICA 656.60 SWH 422.01. SDI .00 Other 658.43 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE /� of 20 14 Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or protect) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. SiLynatur Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll. Report 12-16-2014 Page 6 For the Period Ending: 11-20-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Acevedo Geronimo 183 Chester Ave Apt. 1 Chelsea, MA 02150 11-1.4 11-15 11-16 11-17 11-18 1.1.-19 1.1-20 'Total Pay Fringe Total Gross Total FWH SWH Other 011-76-9080 Hispanic Male Fri Sat Sun Mon Tue Wed Tau Hours Rate Rate Rate This Job Gross FICA SUT/SDI Deducts Net S - 0 Sheetmetal Reg 8.00 8.00 16.00 64.00 11.34 '15.34 1.,205.44 2,'722.00 553.44 .1.28.95 239.16 1.,598.03 3.,205.44 202.42 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 11-14 11-15 11-16 11-17 11-18 11-19 11-20 Total Pay Fringe Total Gross Total FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate hate Rate This Job Gross FICA SUI/SDI : Deducts Net M - 2 Sheetmetal Reg 7.00 7.00 64.00 11.34 75.34 52.7.38 2,515.63 340.73 11.4.97 200.81 1,682.04 527.38 177.08 Louis Bureau 1.346 Sokokis Trail N. Waterboro, ME 04061 1.1-14 11.-15 I1-16 11-17 1.1-18 1.1-19 1.1-20 Total Pay Fringe 'Total Gross Total FWH SWH Other 01.5-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Bate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg 8.00 8.00 6.00 22.00 64.00 11.34 75.34 1.,657.48 2,451.35 293.15 100.12 402.81 1,481.69 1,657.48 173.58 Jeffrey Grey 17 Whitney Street Saugus, MA 01906 11-14 11-15 11-16 11-17 17.-18 1.1-19 11-20 Total Pay Fringe Total Gross Total. FWH SWH Other 030-48-7316 Caucasian Male Fri Sat Sun Mon Tue Wed Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Ne:. S - 0 Pipe Fitter Reg 2.00 2.00 64.00 4.15 68.15 1.36.30 2,326.72 488.76 11.7.40 69.1'. :,478.'/2 136.30 172.71 John Mahoney 84 Te11Ier Way Dracut, MA 01626 11-14 11-15 11-16 11-17 11-18 11.-19 11.-20 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Bate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 8.00 24.00 64.00 11.34 75.34 1,808.16 2,560.00 440.00 133.12 1,791.04 1,808.16 195.84 Jaun Mercado 33 Washington Street Lawrence, MA 01841-2352 11-14 11-15 11-16 11-17 11-18 11-19 11.-20 'Total Pay Fringe Total Gross Total FWH SWH Other 014-74-0812 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate 'Phis Job Gross FICA SUI: /SDI. Deducts Net M - 3 Pipe Fitter Reg 8.00 8.00 8.00 24.00 63.13 4.37 6'1.50 1.,620.08 2,539.12 257,62 95.19 1.182.63 824.19 3,620.08 178.89 Mark Rothwell 5 Bow Street Middleton, MA 01949 11-14 11-I5 1.1-16 17-17 3.1-18 11-19 13.-20 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932. Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI: Deducts Net M - 0 Pipe Fitter Reg 8.00 3.00 31.00 63.13 4.15 67.28 740.08 2,526.93 431.73 131.40 1.,770.49 740.08 193.31 Totals for N. Andover School Admin BLDG .1.1-14-14 11-15-14 11-16-14 11-17-14 11-18-14 I1-19-14 11-20-14 '!'o tal Gross Total. Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions Net 39.00 .00 .00 37,00 30.00 .00 .00 106.00 7,694.92 17,641.75 FWH 2,805.45 10,626.80 FICA 1,293.83 SWH 821.1.5 SDI .00 Other 2,094.52 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, S2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Ina on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or protect) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S i trnature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 'Phomasi3. Snowden, Inc. Certified Payroll Report i.2-]6-2.014 Page For the Period Banding: 1.1-13-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Acevedo Geronimo 1.83 Chester Ave Apt. 1 Chelsea, MA 02150 11-07 11-08 11-09 11-10 11-11 11-12 I1-1.3 Total Pay Fringe Total Gross Total FWH SWH Other 01.1-76-9080 Hispanic Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI. /SDI Deducts Net S - 0 Sheetmetal Reg 8.00 8.00 64.00 1.1.34 75.34 602.72 2,412.00 469.24 113.32 220.56 1,430.16 602.'72 178.72 Brian Bellville 19 Fairview Circle Groveland, MA 01834 1.1-07 11-08 1.1-09 11-10 11-11 11-12 11-1.3 Total Pay Fringe Total Gross Total FWH SWH Other 01.3-66-5972 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net S - 1 Sheetmetal Reg 8.00 8.00 8.00 8.00 8.00 40.00 64.00 11.34 75.34 3,013.60 2,560.00 530.71. 125.18 152.64 1,561..43 3,01.3.60 190.04 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 11-07 11-08 11-09 1.1-10 11-11 11-12 1.1-13 Total Pay Fringe Total. Gross Total FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed 'Tnu 'Fours Rate Rate Rate This Job Gross FICA SUI. /SDI Deducts Net M - 2 Sheetmetal Reg 8.00 8.00 64.00 1.1.34 75.34 602.72 2,316.00 290.82 104.59 200.81. 1,557.91 602.72 161.81 Louis Bureau 1.346 Sokokis Trail N. Waterboro, ME 04061 11-07 11-08 11-09 i1-10 11-11 11-12 11-13 Total Pay Fringe Total Gross Total. FWH SWH Other 015-52-11.57 Caucasian Male Fri Sat Sun Mon Tue Wed 'Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg 8.00 8.00 64.00 11.34 75.34 602.72 1,952.00 158.57 67.02 540.06 1,064.89 602.72 121.46 John Mahoney 84 Tellier Way Dracut, MA 01826 11-07 11-08 11-09 11-10 11-11 11-12 1.1.-13 'Total Pay Fringe Total Gross Total. FWH SWH Other 01.9-52-'7988 Caucasian Male Fri Sat Sun Mon Tue Wed 'Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M. - 0 Sheetmetal Reg 8.00 8.00 8.00 24.00 64.00 11.34 75.34 1,808.16 2,560.00 440.00 133.12 1,791.04 1,808.16 195.84 Jaun Mercado 33 Washington Street Lawrence, MA 01841-2352 11-07 11-08 11-09 11-10 11-11 11-12 11-1.3 Total Pay Fringe Total Gross Total FWH SWH Other 01.4-74-0812 Caucasian Male Fri Sat Sun Mor: Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI. /SDI'. Deducts Net M - 3 Pipe Fitter Reg 8.00 8.00 8.00 8.00 8.00 40.00 63.13 4.37 67.50 2,700.14 2,525.20 254.84 94.61 12*79.85 818.09 2,700.14 .1.77.81 Mark Rothwell 5 Bow Street Middleton, MA 01949 1.1-07 11-08 11-09 11-10 11-11 11-12 11.-i.3 Total Pay Fringe Total. Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon 'Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 8.00 8.00 8.00 8.00 8.00 40.00 63.13 4.15 67.28 2,691.20 2,525.2.0 446.13 134.39 59.30- 1,806.27 2,691..20 197.71 Totals for N. Andover School Admin BLDG 1.1-07-14 11-08-14 11-09-1.4 11-10-14 11-11-14 11.-12-1.4 11.-1.3-14 'Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday iiours This Job Gross Deductions Net 40.00 .00 .00 48.00 32.00 24.00 24.00 168.00 12021.26 16,850.40 FWH 2,590.31. 1.0,029.85 FICA 1,2.23.39 SWH 772.23 SDI .00 Other 2,234.62 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE // /� , 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one undred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll. Report 12-16-2014 Page 4 For the Period Ending: 11-06-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Mark Rothwell 5 Bow Street Middleton, MA 01949 10-31 11-01 11-02 11-03 11-04 11-05 11.-06 Total Pay Fringe Total. Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri. Sat Sun Mon Tue Wed T:^ .0 Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 6.00 8.00 7.00 8.00 29.00 63.13 4.15 67.28 1,951.1.2 2,460.77 400.37 124.88 59.30 1,692.51 1,951.12 183.71 Totals for N. Andover School Admin BLDG 10-31-14 11-01-14 11-02-14 11-03-14 11-04-14 11-05-14 11-06-14 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday hours This Job Gross Deductions Net 6.00 .00 .00 8.00 .00 7.00 8.00 29.00 1,951.12 2,460.77 FWH 400.37 1.,692.51 FICA 183.71 SWH 124.88 SDI .00 Other 59.30 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter hundred and forty nine of the General Laws. Signa re i� Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FL;OOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 12-16-2.014 Page 3 For the Period Plnding: 10-30-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Acevedo Geronimo 183 Chester Ave Apt. 1 Chelsea, MA 02150 10-24 10-25 10-26 10-27 10-28 10-29 10-30 Total Pay Fringe Total Gross Total FWH SWH Other 011-76-9080 Hispanic Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net S - 0 Sheetmetal Reg 8.00 8.00 8.00 24.00 64.00 11.34 75.34 1,808.1.6 2,560.00 512.19 121.29 219.63 1,51.6.10 1,808.1.6 190.79 Brian Bellville 19 Fairview Circle Groveland, MA 01834 10-24 10-25 10-26 1.0-27 10-28 10-29 10-30 'Total Pay Fringe 'Total. Gross Total FWH SWH Other 013-66-5972 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net S - 1 Sheetmetal Reg 8.00 8.00 64.00 11.34 75.34 602.72 2,478.80 511..40 121..60 140.39 1,520.84 602.72 184.57 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 10-24 10-25 10-26 10-27 10-28 10-29 10-30 Total Pay Fringe Total Gross Total FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 2 Sheetmetal Reg 3.00 3.00 64.00 11.34 75.34 226.02 2,620.75 373.48 121..78 174.93 1,763.46 226.02 187.10 Louis Bureau 1346 Sokokis Trail N. Waterboro, ME 04061 10-24 10-25 10-26 10-27 10-28 10-29 10-30 Total Pay Fringe Total Gross Total. FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg 6.00 3.00 9.00 64.00 11.34 75.34 678.06 2,560.00 363.41. 114.74 230.40 1,655.61. 678.06 195.84 John Mahoney 84 TellIer Way Dracut, MA 01826 10-24 10-25 10-26 10-27 10-28 10-29 10-30 'Total Pay Fringe Total Gross Total. FWH SWH Other 019-52-7988 Caucasian Male Fri sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 8.00 8.00 8.00 40.00 64.00 11.34 75.34 3,013.60 2,560.00 440.00 133.12 1,791.04 3,013.60 195.84 Totals for N. Andover School Admin BLDG 10-24-14 10-25-14 1.0-26-14 10-27-14 10-28-14 10-29-14 10-30-14 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday ::ours 8.00 .00 .00 8.00 22.00 22.00 24.00 84.00 Gross Total This Job Gross Deductions 6,32.8.56 12,779.55 FWH 2,200.48 FICA 954.1.4 SWH 67.2.53 SDI .00 Other 765.35 Net 8,247.05 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE IV 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature 7"��/ Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas Snowden, Inc. Certified Payroll Report 12-16-2014 Page 2 For the Period Ending: 10-23-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 10-17 10-18 10-19 10-20 10-21 10-22 10-23 Total. Pay Fringe Total. Gross Total. FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed Thu hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Ne'.. M - 2 Sheetmetal Reg 2.00 2.00 64.00 11.34 75.34 150.68 1,974.00 211.79 88.1.5 174.93 1.,361..49 150.68 137.64 Louis Bureau 1346 Sokokis Trail N. Waterboro, ME 04061 10-17 10-18 10-19 10-20 10-21 10-22 10-23 Total Pay Fringe Total Gross Total. FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1. Sheetmetal Reg 2.00 2.00 64.00 11.34 75.34 150.68 1,462.00 166.08 69.62 1,114.46 1.50.68 1.11.84 Totals for N. Andover School Admin BLDG 10-17-14 10-18-14 10-19-14 10-20-14 10-21-14 10-22-14 10-23-14 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours .00 .00 .00 .00 .00 .00 4.00 4.00 Gross Total This Job Gross Deductions 301.36 3,436.00 FWH 377,87 FICA 249.48 SWH 157.77 SDI .00 Other 174.93 Net 2,475.95 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or proiect) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S i gnatur <�2 Title Clerk ' DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided_ A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: 1\ � , I— STATEMENT OF COMPLIANCE 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred a d forty nine of the General Laws. Signatur Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General .Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL. SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 12-16-2014 Page 1 • For the Period Ending: 10-02-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 09-26 09-27 09-28 09-29 09-30 10-01 10-02 Total Pay Fringe Total Gross Total. FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 2 Sheetmetal Reg 1.50 1..50 3.00 64.00 17..34 75.34 226.02. 2,560.00 358.29 11.8.62 174.93 1,725.71 226.02 182.45 Totals for N. Andover School Admin BLDG 09-26-14 09-27-14 09-28-14 09-29-14 09-30-14 10-01-14 10-02-14 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours 1.50 .00 .00 .00 1.50 .00 .00 3.00 Gross Total. This Job Gross Deductions Net 226.02 2,560.00 FWH 358.29 1,725.71. FICA 1.82.45 SW7{ 118.62 SDI 00 Other 174.93 K VCII]IICU rdYIUll RtiglJlt!I rage. 'I • �F� Job . N. ANDOVER SCHOOL DEPT. ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MA 01845 Contractor VIKING INDUSTRIES, INC. P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 12/7/2014 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardinauthority. This is required to be done on a weekly basis. Once colleld, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE ----- - - -�-- __✓-- I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the paym ent of the persons em ployed b VIKING rNDUSTRIES INC. on the N. ANDOVER S HOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Sig nature ___________ Title C �eCuOf icer- - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 12/01 12/02 12/03 12/04 12/05 12/06 12/07 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II -"-6224 R: 8.000 8.000 8.000 0.000 0.000 0.000 0.000 24.000 43.310 1069.44 286.30 0.00 V4498 INSULATOR -MECHANIC +24.480FR 98.16 134.82 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1613.18 22.95 996.47 WHITE Male +0.000FR 36hrs 74.48 616.71 Hours Pay Regular 24.000 1,039.44 Overtime 0.000 0.00 Other Types 30.00 24.00 1,069.44 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardinauthority. This is required to be done on a weekly basis. Once colleld, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE ----- - - -�-- __✓-- I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the paym ent of the persons em ployed b VIKING rNDUSTRIES INC. on the N. ANDOVER S HOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Sig nature ___________ Title C �eCuOf icer- - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Certified Payroll Register Page:1 Job Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. O. BOX 32 189 CENTRAL STREET Week Ending: 11/30/2014 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MAO 1845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 11/24 11/25 11/26 11/27 11/28 11/29 11/30 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 0 00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law 049, p276, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orppublic body shall furnish to the Departm ent of Labor and W orkforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment ofwages, in the following form: STATEMENT OF COMPLIANCE 117 I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the paym ent of the persons em ployed b VIKING INDUSTRIES INC. on the N. ANDOVER RHOOL DEPT, ( Contractor, subcon{ractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined uIn er the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Sig nature �- 0 Title ChieT xecutiveOfficer-------------- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 t S Job N. ANDOVER SCHOOL DEPT ADMINISTRATION BLDG 566 MAIN STREET N. ANDOVER, MA 01845 uertitiea Fayroll Kegister Contractor VIKING INDUSTRIES, INC. P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 11/23/2014 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardin authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF CO MjP�I�ANCE � I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER S6OOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all m echanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Siggnature / ��� (�1 Tifle ChalE'xecut-Ive0fficer-------------- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 11/17 11/18 11/19 11/20 11/21 11/22 11/23 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II --*"-6224 R: 0.000 0.000 0.000 8.000 8.000 0.000 0.000 16.000 43.310 692.96 ---------------- 318.78 0.00 V4472 INSULATOR -MECHANIC +24.480FR 106.21 148.40 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1713.12 24.84 1033.66 WHITE Male +0.000FR 40hrs 81.23 679.46 Hours Pay Regular 16.000 692.96 Overtime 0.000 0.00 16.000 691-0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardin authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF CO MjP�I�ANCE � I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER S6OOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all m echanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Siggnature / ��� (�1 Tifle ChalE'xecut-Ive0fficer-------------- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -i h Occupational sally and Health Administration Cornelius McAuliffe Mas successtulty completed a 104xK r Occupational Safety and Health Training Course in Const ucOonoWety & Health (Trainer) JSHA 42=1W (Date) WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 1 L '20 14 Clerk I Barbara R. Barbolla , , (Nance of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or protect) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wage determined under the provisions of sections twenty-six and twenty-seven of/chapter e 1 undyed d rty nine of the General Laws. Signatur Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas '3. Snowden, Inc. Certified Payroll Report 12-16-20:4 rage F For the Period Ending: 12-04-14 ,lob: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Acevedo Geronimo 1.83 Chester Ave Apt. 1 Chelsea, MA 02150 11-28 11-29 11-30 12-01 12-02 12-03 12-04 Total Pay Fringe Total Gross Total FWH SWH Other 011-76-9080 Hispanic Male Fri Sat Sun Mon Tue Wed Thu hours Rate Rate Rate This Job Gross FICA SUI/SD1 Deducts Net 5 - 0 Sheetmetal Reg 8.00 8.00 64.00 11.34 75.34 602.72 2,264.00 429.05 105.85 211.68 1,350.02 602.72 167.40 John Mahoney 84 Tell.Ier Way Dracut, MA 01826 11-28 11-29 11-30 12-01 12-02 12-03 12-04 Total Pay Fringe Total Gross Total. FWH SWH Other 01.9-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net N. - 0 Sheetmetal Reg 8.00 8.00 16.00 64.00 11.34 75.34 1,205.44 2,264.00 366.00 117.73 1,607.08 1,205.44 173.19 Totals for N. Andover School Admin BLDG 11-28-14 11-29-14 1.1-30-14 12-01-14 12-02-14 12-03-14 12-04-14 Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours .00 .00 .00 16.00 8.00 .00 .00 24.00 Gross Total This Job Gross Deductions 1,808.16 4,528.00 FWH 795.05 FICA 340.59 SWH 223.58 SDI .0c Other 211.68 Net 2,957.10 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE O1 , 20 14 Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred a d forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas 71. Snowden, Inc. Total Certified Payroll Report Deductions 5,894.34 8,909.95 FWH 12-16-2014 Page '7 FICA For the Period Ending: 11-27-14 SDI .00 Other Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Acevedo Geronimo 183 Chester Ave Apt. 1 Chelsea, MA 02150 11-21 11-22 11-23 11-24 11-25 11-26 11-2'7 Total Pay Fringe Total Gross Total FWH SWH Other 011-76-9080 Hispanic Male Fri Sat Sur. Mon Tue Wed T:^ .0 Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Ne: S - 0 Sheetmetal Reg 8.00 8.00 5.00 8.00 29.00 64.00 11.34 75.34 2,1.84.86 2,385.85 462.14 112.00 219.00 1,415.99 2,184.86 1.76.72 Louis Bureau 1346 Sokokis Trail N. Waterboro, ME 04061 11-21 11-22 11-23 11-24 11-25 11-26 11-27 Total Pay Fringe Total Gross Total FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M, - 1 Sheetmetal Reg 5.00 5.00 10.00 64.00 11.34 75.34 753.40 2,090.30 211.01 83.04 370.32 :.,279.95 753.40 145.98 Jeffrey Grey 17 Whitney Street Saugus, MA 01906 11-21 11-22 11-23 I1-24 11-25 11-26 11-27 Total Pay Fringe Total Gross Total FWH SWH Other 030-48-7316 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net S - 0 Pipe Fitter Reg 8.00 8.00 64.00 4.15 68.15 545.20 2,169.80 444.84 1.09.24 69.11 1,385.91 545.20 160.70 John Mahoney 84 Tellier Way Dracut, MA 01626 11-21 11-22 11-23 11-24 11-25 11-26 11-27 Total Pay Fringe Total. Gross Tota'. FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 8.00 8.00 32.00 64.00 11.34 75.34 2,410.88 2,264.00 366.00 117.73 1,607.0'1 2,410.88 173.20 Totals for N. Andover School Admin BLDG 11-21-14 11-22-14 11-23-14 11-24-14 11-25-14 11-26-14 11-27-14 'i'otai Friday Saturday Sunday Monday Tuesday Wednesdy Thursday 'Hours 21.00 .00 .00 21.00 13.00 24.00 .00 .1 9.00 Gross Total This Job Gross Deductions 5,894.34 8,909.95 FWH 1,483.99 FICA 656.60 SWH 422.01. SDI .00 Other 658.43 Net 5, 688. 92 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149,§§'27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE ,2014 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or proJect) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Sianatur ----WZ Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 12-16-2014 Page 6 For the Period Landing: 11-20-14 Job: 14-012 N. Andover School Admin BLDG 566 Mair. Street N. Andover, MA 01845 Acevedo Geronimo 183 Chester Ave Apt. 1 Chelsea, MA 02150 11.-14 11-15 11-16 11-17 11-18 11-19 11-20 Total Pay Fringe Total Gross Total FWH SWH Other 011-76-9080 Hispanic Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUT/SDI Deducts Net S - 0 Sheetmetal Reg 8.00 8.00 16.00 64.00 11.34 75.34 1,205.44 2,722.00 553.44 128.95 239.16 1,598.03 1,205.44 202.42 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 11-14 11-15 11-16 11-17 11-18 11-19 11-20 Total Pay Fringe Total Gross Total FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 2 Sheetmetal Reg 7.00 7.00 64.00 11.34 75.34 527.38 2,515.63 340.73 114.97 200.81 1,682.04 527.38 177.08 Louis Bureau 1346 Sokokis Trail. N. Waterboro, ME 04061 11-14 11-15 11-16 11-1.7 11-18 11-19 11-20 Total. Pay Fringe Total Gross Total FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M. - I Sheetmetal Reg 8.00 8.00 6.00 22.00 64.00 11.34 75.34 1,657.48 2,451.35 293.15 100.12 402.81 1.,481.69 1,657.48 173.58 Jeffrey Grey 17 Whitney Street Saugus, MA 01906 11-14 11-15 11-16 11-17 11-18 11-19 11.-20 Total Pay Fringe Total Gross Total FWH SWH Other 030-48-7316 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Ne_ S - 0 Pipe Fitter Reg 2.00 2.00 64.00 4.15 68.15 136.30 2,37.6.72 488.78 11.7.40 69.1: ..,478.!2. 136.30 172.71 John Mahoney 84 Te11Ier Way Dracut, MA 01626 11-14 11-15 11-16 11-17 11-18 11-19 1i-20 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net N. - 0 Sheetmetal Reg 8.00 6.00 8.00 24.00 64.00 11.34 75.34 1,808.16 2,560.00 440.00 133.12 1,791.04 1,808.16 195.84 Jaun Mercado 33 Washington Street Lawrence, MA 01841-2352 11-14 11-15 11-16 11-17 11-18 11-19 11-20 Total Pay Fringe Total Gross Total FWH SWH. Other 014-74-0812 Caucasian Male Fri Sat Sun Mon Tue Wed T -u Hours Rate Rate Rate This Job Gross FICA SCT/SDI Deducts tie_ M - 3 Pipe Fitter Reg 8.00 8.00 8.00 24.00 63.13 4.37 67.50 1,620.08 2,539.12 257.62 95.19 1182.63 82.4.79 1,620.08 178.89 Mark Rothwell 5 Bow Street Middleton, MA 01949 11-14 31-15 11-16 11-17 I1-18 11-19 11-2.0 Total Pay Fringe Total Gross Total FWH SWH Other C29-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 8.00 3.00 11.00 63.13 4.15 6'7.28 740.08 2,526.93 431.73 131.40 1,77;.49 740.08 193.31 Totals for N. Andover School Admin BLDG 11-14-14 11-15-14 11-16-14 I1-11-14 11-18-14 11-19-14 11-20-14 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions Net 39.00 .00 .00 37.00 30.00 .00 .00 106.00 7,694.92 17,641.75 FWH 2,805.45 10,626.B0 FICA 1,293.83 SWH 821.15 SDI .00 Other 2,094.52 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 20 14 Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dep (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Z�az� Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report ',.2-;6-20:4 rage For the Period Ending: 11-13-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Acevedo Geronimo 183 Chester Ave Apt. 1 Chelsea, MA 02150 11-07 11-08 11-09 11-10 11-11 11-12 I.-13 Total Pay Fringe Total Gross Total FWH SWH Other 011-76-9080 Hispanic Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDS Deducts Net 5 - 0 Sheetmetal Reg 8.00 8.00 64.00 11.34 75.34 602.72 2,412.00 469.24 113.32 220.56 1,430.:6 602.72 178.72 Brian Bell.ville 19 Fairview Circle Grove' -and, MA 01834 11-07 11-08 11-09 11-10 11-11 11-12 11-13 Total Pay Fringe Total Gross Total FWH SWH Other 013-66-5972 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net 5 - 1 Sheetmetal Reg 8.00 8.00 8.00 8.00 8.00 40.00 64.00 11.34 75.34 3,013.60 2,560.00 530.71 125.18 152.64 1,561.43 3,013.60 190.04 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 11-07 11-08 11-09 11-10 11-11 11-12 11-13 Total Pay Fringe Total Gross Total FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 2 Sheetmetal Reg 8.00 8.00 64.00 11.34 75.34 602.72 2,316.00 290.82 104.59 200.8:. ',,557,97 602.72 161.81 Louis Bureau 1346 Sokokis Trail N. Waterboro, ME 04061 11-07 11-08 11-09 11-10 11-11 11-12 11-13 Total Pay Fringe Total Gross Total FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg 8.00 8.00 64.00 11.34 75.34 602.72 1,952.00 158.57 67.02 540.06 1,064.89 602.72. 121.46 John Mahoney 84 Tellier Way Dracut, MA 01826 11-07 11-08 11-09 11-10 11-11 11-12 11.-13 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed 'Phu Hours Rate Rate Rate This Job Gross FICA SJ!/SD: Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 8.00 24.00 64.00 11.34 75.34 1,808.16 2,560.00 440.00 133.12 1, 791. 'i4 1,808.16 195.84 Jaun Mercado 33 Washington Street Lawrence, MA 01841-2352 11-07 11-08 11-09 11-10 11-11 11-12 11-13 Total Pay Fringe Total Gross Total FWH SWH Other 014-74-0812 Caucasian Male Fri Sat Sun Mor. Tue Wed`Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 3 Pipe Fitter Reg 8.00 8.00 8.00 8.00 8.00 40.00 63.13 4.37 67.50 2,700.14 2,525.20 254.84 94.6i 3179.85 8i8.09 2,'700.14 177.8' Mark Rothwell 5 Bow Street Middleton, MA 01949 11-07 11-08 11-09 11-10 11-11 11-12 11-13 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 8.00 8.00 8.00 8.00 8.00 40.00 63.13 4.15 67.28 2,691.20 2,525.20 446.13 134.39 59.30- 1,806.27 2,691.20 197.71 ': otals for N. Andover School Admin BLDG 11-07-14 ll -08-14 11-09-14 11-10-14 11-11-14 11-12-14 11-13-14 'Po tai Gross Tota] Friday Saturday Sunday Monday Tuesday Wednesdy Thursday ::ours This Job Gross Deductions Ne_ 40.00 .00 .00 48.00 32.00 24.00 24.00 i68.00 1202:.26 16,850.40 FWH 2,590.31 1.0,029.85 FICA 1,22.3.39 SWH 772.23 SDI .00 Other 2,234.62 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE // /� , 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Deo (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one undred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas 8. Snowden, Inc. 11-01-14 11-02-14 11-03-14 Certified Payroll. Report Friday 12-16-2014 Page 4 This Job Gross For the Period Ending: 11-06-14 .00 .00 B.00 .00 7.00 8.00 29.00 1,951.12 2,460.77 FWH 400.37 Sob: 14-012 N. Andover School Admin BLDG FICA 183.71 566 Main Street 124.88 SDI .00 N. Andover, MA 01845 Other 59.30 Mark Rothwell 5 Bow Street Middleton, MA 01949 10-31 11-01 11-02 11-03 11-04 11-05 11-06 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 6.00 8.00 7.00 8.00 29.00 63.13 4.15 67.28 1,951.12. 2,460.77 400.37 124.88 59.30 1,692.51 1,951.1.2 183.71 Totals for N. Andover School Admin BLDG 10-31-14 Net 1,692.51 11-01-14 11-02-14 11-03-14 11-04-14 11-05-14 11-06-14 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday :fours This Job Gross Deductions 6.00 .00 .00 B.00 .00 7.00 8.00 29.00 1,951.12 2,460.77 FWH 400.37 FICA 183.71 SWH 124.88 SDI .00 Other 59.30 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE , 20 14 Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter hundred and forty nine of the General Laws. Signa re Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report For the Period Ending: 10-30-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 12-16-2C14 Page 3 Acevedo Geronimo 183 Chester Ave Apt. 1 Chelsea, MA 02150 10-24 10-25 10-26 10-27 10-2.8 10-29 10-30 Total Pay Fringe Total Gross Total FWH SWH Other 011-76-9080 Hispanic Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net 5 - 0 Sheetmetal Reg 8.00 6.00 8.00 24.00 64.00 11.34 75.34 1,808.16 2,560.00 512.19 121.29 219.63 1,808.6 i9C.79 Brian Bellville 19 Fairview Circle Groveland, MA 01834 10-24 10-25 10-26 10-27 10-28 10-29 10-30 Total Pay Fringe Total Gross Total FWH SWH Other 013-66-5972 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net S - 1 Sheetmetal Reg 8.00 8.00 64.00 11.34 75.34 602.'12 2,478.80 511.40 121.60 140.39 :.,52.-.84 602.72 184.57 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 10-24 10-25 10-26 10-27 10-28 10-29 10-30 Total Pay Fringe Total Gross Total FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sur. Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net N. - 2 Sheetmetal Reg 3.00 3.00 64.00 11.34 75.34 226.02 2,620.75 373.48 121.78 174.93 1,763.46 226.02 187.10 Louis Bureau 1346 Sokokis Trail N. Waterboro, ME 04061 10-24 10-25 10-26 10-27 10-28 10-29 10-30 Total Pay Fringe Total Gross Total. FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg 6.00 3.00 9.00 64.00 11.34 75.34 678.06 2,560.00 363.41 114.74 230.40 1,655.61 678.06 195.84 - John. Mahoney 64 Tellier Way Dracut, MA 01826 10-24 10-25 10-26 10-27 10-28 10-29 10-30 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 8.00 6.00 8.00 40.00 64.00 11..34 75.34 3,013.60 2,560.00 440.00 133.12 :,79:.04 3,013.6C 195.84 Totals for N. Andover School Admin BLDG 10-24-14 10-25-14 10-26-14 10-27-14 10-28-14 10-29-14 10-30-14 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions Net 8.00 .00 .00 8.00 22.00 22.00 24.00 84.00 6,328.56 12,779.55 FWH 2,200.48 8,247.05 FICA 954.14 SWH 612.53 SDI .00 Other 765.35 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on 'the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE !V b3 , 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title ZClerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 12-16-2014 Page 2 For the Period Ending: 10-23-14 ,Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 10-17 10-18 10-19 10-20 10-21 10-22 10-23 Total. Pay Fringe Tota.'. Gross Total 7411, 5WH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SD.' Deducts No, M - 2 Sheetmetal Reg 2.00 2.00 64.00 11.34 75.34 150.68 1,974.00 211.79 88.15 174.93 1,361.49 150.68 137.64 Louis Bureau 1346 Sokokis Trail N. Waterboro, ME 04061 10-17 10-18 10-19 10-20 10-21 10-22 10-23 Total Pay Fringe Total Gross Total FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg 2.00 2.00 64.00 11.34 75.34 150.68 1,462.00 166.08 69.62 1,:.14.46 150.68 111.84 Totals for N. Andover School Admin BLDG 10-17-14 10-18-14 10-19-14 10-20-14 10-21-14 10-22-14 10-23-14 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours .00 .00 .00 .00 .00 .00 4.00 4.00 Gross Tota'_ This Job Gross Deductions 301.36 3,436.00 FWH 377.87 FICA 249.48 SWH 157.77 SDI .00 Other 174.93 Net 2,475.95 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Si>rnatur Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, 52713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected., the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: h t , I— STATEMENT OF COMPLIANCE 20 14 Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred a d forty nine of the General Laws. Signatur Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE /-a ,2014 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or protect) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 12-16-2014 Page 1 For the Period Ending: 10-02-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 09-26 09-27 09-28 09-29 09-30 10-01 10-02 Total Pay Fringe Total Gross Total FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 2 Sheetmetal Reg 1.50 1.50 3.00 64.00 11.34 75.34 226.02 2,560.00 358.29 118.62 174.93 1,725.71 226.02 182.45 Totals for N. Andover School Admin BLDG 09-26-14 09-27-14 09-28-14 09-29-14 09-30-14 10-01-14 10-02-14 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday :fours This Job Gross Deductions Net 1.50 .00 .00 .00 1.50 .00 .00 3.00 226.02 2,560.00 FWH 358.29 1,725.71 FICA 182.45 SWH 118.62 SDI .00 Other 174.93 4 • Ir UIIIIIUU rdylU11 RUyisLUI rage: I Job N. ANDOVER SCHOOL DEPT. ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MA 01845 Contractor VIKING INDUSTRIES, INC. P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 12/7/2014 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of com pletion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardin authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson,, CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING rNDUSTRIES INC. on the N. ANDOVER S HOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Siy nature h• Title ChielfE cutivIF0fficer------------- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 12/01 12/02 12/03 12/04 12/05 12/06 12/07 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II **-6224 R: 8.000 8.000 8.000 0.000 0.000 0.000 0.000 24.000 43.310 1069.44 ----------------- 286.30 0.00 V4498 INSULATOR -MECHANIC +24.480FR 98.16 134.82 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1613.18 22.95 996.47 WHITE Male +0.000FR 36hrs 74.48 616.71 Hours Pay Regular 24.000 1,039.44 Overtime 0.000 0.00 Other Types 30.00 2-4-.W 1,b�44 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of com pletion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardin authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson,, CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING rNDUSTRIES INC. on the N. ANDOVER S HOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Siy nature h• Title ChielfE cutivIF0fficer------------- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Certified Payroll Register Page:1 Job Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. 0. BOX 32 189 CENTRAL STREET Week Ending: 11/30/2014 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MAO 1906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 11/24 11/25 11/26 11/27 11/28 11/29 11/30 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours pay ----------------------------- Regular 0.000 0.00 Overtime 0.000 0.00 0.000 0.00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p21B, a true and accurate record m ust be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the inform ation required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent, executed by the contractor subcontractor or public body who supervised the payment ofwages, in the following form: STATEMENT OF COMPLIANCE /o /'9 I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the paym ent of the persons em ployed b VIKING rK USTRIES INC. on the N. ANDOVER HHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Tige Cie� E cutiveO ricer- - - - - - - - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Job N. ANDOVER SCHOOL DEPT ADMINISTRATION BLDG 566 MAIN STREET N. ANDOVER, MA 01845 uertiTiea vayroii Kegister Contractor VIKING INDUSTRIES, INC. P. 0. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 11/23/2014 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the DepartmentofLabor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COMP IANCE li ��s J I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N.ANDOVER HHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature _ co Title Chiefee tivre fficeUr------ - - - - -- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 11/17 11/18 11/19 11/20 11/21 11/22 11/23 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II '"-6224 R: 0.000 0.000 0.000 8.000 8.000 0.000 0.000 16.000 ----------------------------------- 43.310 692.96 318.78 0.00 V4472 INSULATOR -MECHANIC +24.480FR 106.21 148.40 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1713.12 24.84 1033.66 WHITE Male +0.000FR 40hrs 81.23 679.46 Hours Pay Regular 16.000 692.96 Overtime 0.000 0.00 16.0009� WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the DepartmentofLabor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COMP IANCE li ��s J I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N.ANDOVER HHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature _ co Title Chiefee tivre fficeUr------ - - - - -- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 y Occupational Sally and Hoeft A&** ration aornelius McAuliffe has succesafuily corrspleted a 10-h" Occupational Safety and Health Training Course in Consttuqbryt' R ety & Health Rra OSHA /,,7 -S -D/ (Date) Dec.22 14 07:00p p.1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1n accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract: In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days affa completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OFCOMPLIANCE I.—IJGC(C,0 � w�1 Q ►� (Name ofstr9ory Paco') Mile) do hereby state: at I pay or 'se a payment of the persons�' 1 eW b �G�C:`� �d< �'r�, ontho 0A y ave_1 (CoaUWar, subcontractor or public bod)'(13u ift or mied) and than all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter and forty nine of the General Laws. Signature u Tide DIVISION OF OCCupAMONAL SAFM,19 STANIFORD STRM, 2nd TWO& BOSTON, MA 02114 Dec -22 14 07:OOp m► I 3 p n Dec.22 14 07:17p 1 Dec -22 14 o7:17p p.2 Qec 22 14 07:17p p.3 3 7 � V O1 a p.3 2 7 s a = C O V L .Ur ° s O O O d wxA U C � \ A O N N o 0 O ray f+l O 3 ° O F C a� 0 0 0 3\ ca L 3 0 o F x O O O C O 3 C O O O RS i. L L 4t O O O � L L 3 s � o W 0 U Cd w ¢ H y�I C O s .0 �U m 0 m Rll 0 w l6 O1 c v 3 m d r 0 rn m a O Z 1 Q � 3 - •. 3 13St�N N M CLi - m 0 N t y O+ _ LL O f N o + m �m �a o M Y m ^N ` m 2 Q m 3 c" 3 0 o ME up. 3 f m m C N � M LO N C O Q LL w 'm .z am a� 1 T x @ O 0 m 0m5� 0 "O 3 WE 2 c V ! o -1 Q m 1 N M ob IL (n o p Z o C f0 75 m� z v 3 g t AL O V O a N LO L 0) 4-0 O E o U) V- C) Z cn -a (UU. .N m cn C= v Ag Q - •� CO 00 o -j L T •� A ''^^ V J ui A Z ;, L m E Q >O a M � v N m C 3 Q n a m m o 'a CN Nra u Z ° .� r'n U C c UA L N L `F � O � Q ca � V � 0 Ll U Z E N W m W E Q q 2 W m C: u E m -a O m E 0_Co L U •� N E O `o $ v m L Q Q Ecm m U) C T m o U WE, 4 t7 z E W C O s .0 �U m 0 m Rll 0 w l6 O1 c v 3 m d r 0 rn m a EWU moe DATE 12/18/14 09:17 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 5 FOR PERIOD ENDING 12/13/14 ALL JOBS JOB INFO 14405 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 12/07 12/08 12/09 12/10 12/11 12/12 12/13 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 8.00 5.00 29.00 72.820 2111.78 40.00 2817.36 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079— DT M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 29.00 171.67 30.65 97.16 .00 724.79 1793.09 006873 -- ------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES— 1 TOTAL JOB HOURS— 29.00 TOTAL JOB AMOUNT— 2,111.78 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 12/18/2014 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title. dministrative Asst. Date: December 18, 2014 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 7th day of December, 2014 and ending on the 13th day ofDecember. 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967, 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE Leah A Hatch, Administrative Assistant SIGNATURE M 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. At 7 � O o Y aha Q z �a C ea y U CC L � m U L wxA o o O U C � W o CQ C rr N o ° 3 ° O v R N vNi 00 ° 3xA M C U R L 7 3�'3x O O O C U 3 C ° O O O 4? 0 O O O Hix �L O O O � � h L x d W A N 0 w ¢ H � O o Y aha Q z C 2 �U Z U m 0 m U C :C MA o a - w O zl rn O z _ v Ib R, zwl -..USG N » cpm t %'ice Q Qo3�j a` D O 2 W C d � d + a m r C e N m U)LU c U m > oa Mu a a a C W z m IL 3 m c M ti 'n c c Q a z 0) tt Q T r w c O o x a a N > i •n m x O o u 0 a w v 01 J V J Q H N m a` A �3 0 o z : C_ _ z c o L a O v a 7 a LO LO a`=v QS ..N^ L / � H (/J ♦� O 0 Z = ,� Q 4-0 'Cl) V ?-, m - D Tcc Cl) Q V •L cn Q Q 3 ^V^'' W o Q O W L--+ L L w U) E • ^ L Z n L ui E 4-0 ^ o c6 O a > O z m J Y -0 o y N m O 3 Q ; a m N o U o U � L Q � 3 � 4` C C. L- 1:1 Ll Ll El �(- z Cl) W U W R 2 -0 v L. E Q o 0 ��I1 W d m N i C E O 0 U N Z i�i. Ul 7 Q E CU 06 vJ n a 3 o cn c°v w d C 2 �U Z U m 0 m U C :C MA o a - w O zl rn EWU moe DATE 12/24/14 08:10 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 5 FOR PERIOD ENDING 12/20/14 ALL JOBS Y JOB INFO 14405 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 12/14 12/15 12/16 12/17 12/18 12/19 12/20 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 8.00 8.00 7.00 39.00 72.820 2839.98 40.00 2912.80 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 39.00 179.91 31.35 100.02 .00 765.32 1836.20 006903 - -------------------------------------------------------------------------------------------------------------- JOB TOTALS TOTAL EMPLOYEES— 1 TOTAL JOB HOURS— 39.00 TOTAL JOB AMOUNT— 2,839.98 Date: December 24, 2014 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payrollperiod commencing on 14th day of December. 2014 and ending on the 20th day of December. 2014 all persons employed on saidproject have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectlyfrom the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNAT Leah M. Hatch, Administrative Assistant 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. 1, WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE (De, 201Lf (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by 2)-x:5 Cm m4rUA 4W On Z&I on the iyor4 & do i -P r Sr,hi,- (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title 05/14 z 0 m 0 l< m m o zCL CD o r' a m s $ ni d 3m `t 3 O a 'm a, Q° c a ti CD CD T m m o 0 3 O cn n�°» z o _ a e o 3 `G CC N n n C W Ci. =r 2 m m (�' 3 n Hm N CL (D (n S � Q OG CDrn Q F1 El El ElO 903 mom w- 0 7 ;r w 0 F m 1U n O w Ocn N 0111 o b C C n:3UJ o' =)O y C C i O c O D o 3 m i d G O m Cl CD W .+ M. v m 0 3(nm CDD 0 m O Q N �- 00 N G x N Q 3 E v CD m 0 x o c co V A 9 m z O � o 2 o o _ � rn rn W o S cn m n O m r R s o N i x B5 c c O CSS O a m M O ti vn m m x a z `. n • ® yr N N NO � 3 cL 3 `� ° 00 O W �o < m m O W pp C31 m d o o m o: 4 cli �? _ T kk$ R§LLi §zs ■0 fm0 aaLL \ { z ) / ca 0c / Ij -0!8 a.;w _— ° (5 L �0cco E E 020 C, k)�§ 8 --e IL L MM ) f\ _ )d\ \ o\ &� — k§ oq - /\ 0 uLL « 0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: 2, STATEMENT OF COMPLIANCE ®el✓ IS, 20_t_� _ (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by r� 2) i -';S m Yr erU �' Ph Wi on the lyorf k� Ai� O P� 'i�t;a HGCf in (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title 05/14 � % \ In 2 Z� / ... ! � 9i )0- / 0015 / ! .... . . . . .. . .. t » Q k £E . f / ■ ? � / � !«! _ occ : . 9 \ < < ;;a- .5 © � 3 _ ± CA .I � F- E g § $ ) k � / / �/ E %LL E -C ƒ k / 1 / .Z • ƒ E 0 } / } k 2 ' ! ') U') � 2 -- - «— ■ Rl I a *` _ ± ) ` _ - / e £ b \ 0 \ \0\ El F El El El F Z> 9 ® (D \ % / ƒ < \ \ C Co P. / f ! 7 ` 0 k a |' m : C.6 2 = 0 § \ u ¢' 3 E , 2 / o i 2 , J £ f1 10 In 2 Z� / M WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: W STATEMENT OF COMPLIANCE (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Lzrnm4ruA on the (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title 05/14 T O k I I M a Z° �= et N cli M U � t9SO O c � m 'm m ° a' GD ut m a m .E c L ¢ a c _oO NLU a d oo Q _ O > O W m r Oqq 7 <� m 7 06 O. c O C', d. 2 z co m l CD N � O Q =p € m L 3 N w m w _ E N v m 3 C ` Q ?� O p N L) N C m € L � _O C U z ` > € E O d inF O O P O c = a o U Cl) .O c Q 3 Q z ; °tS FL v m 2 L m c.i Y Cco C L� 3 O C U 06 `t n rn r X Fl -X_ X 1 El CA CD wOc� > ` m L n• VJ m -0 C Q W m = M W o E m (_ 'i Q a OZ c f0 m rD o C G O z m O E w E. E. c fD T (1)m Z o L m pE U W a. ; L7' W T O k I I M a V 0 v w V N O a` U C Z C O N Cl) f6 p) 2.00 N C m0 O i Q' Q o) — m E O L U o od a) 0 v I 0 R c 0 v WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §275, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at and includes all the information required to be kept bylaw. Everycontractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: N 3 -ke 10 1_INf)L STATEMENT OF COMPLIANCE 0 CC I� , 20 Lt I, 16-1 ✓ n , Ar^ / d fo - (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by or C4-+ Zq on the lyor4AAdotell IOrhot0l fidmIn (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. 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W W Z > O T y O O N .a N C N m J N N U C 7 N O N N a U a O C N Q� o Q m O C O Z N Q N c a ° a o o E UT C Coc `Nw° cm W t DLO w o 4> O'Q0 mm H o= o c 3 mCa� c w QLL U o v m "aQ a c m L° N CO L O E Z N 0 c a f0 'C E .m-. w L +O-. -0 cm (n cn O O m CA >' F- O N� w w m m C a N E° o 0- w U y N N c c m o o ro m o c V v a� c°i a c O T rn 0 O U W m !n W O O C O ' N C C _ >` C C_ L �__ W w „ a� y U `� m N C E~ N d N N C m U ° E m T (� Q T o 0 Zm 3 w. m .L•� m.0 L w 3 N m N o t -o c F - g M `0 0 O. w Ix `O w U)O I- J Z- gUU W 0 z WO j0 >QI-Q O � F- cn QZOQ WQOF_ F -M— O cn z F-- >-WO Z Q2'Ww 0PLU� W ZUWLL 0050 QZ ZM 00-w U)WQ N QHU)LL 45 O `o -JUW M N LLWLLN mJZ � c 3: U) O m y W >— 0 Q F --§UN m L N Mn T C O U U a L L E N C U E o m o n 0 An o m = 0 m N N N s a a UC N C, y w o a o m 0 a 0 c E Q. w N N ° O Cwc L 3 _0 0 tM m m f0 a 3 a o > o o. v O mOL c m o L a o U ca a C O E (D m E v c W 3 y 0om a O fl MCD C m N c w a axi > O T y O N .a N C N m J N N U C 7 N O N N a U a O C N Q� o m O C O 0 O C O N Q N c Om ° a o o E UT C Coc `Nw° cm t DLO w o 4> O'Q0 mm o= o c 3 mCa� c w o v m "aQ a c m L° N CO L O E N 0 c a f0 'C E .m-. w L +O-. -0 cm (n cn O N m CA >' d O N� w w m m C a N E° o w U y N N c c m o o ro m o c V v a� c°i a c O T rn 0 O W m O O C O ' N C C _ >` C C_ L �__ W w „ a� y U `� m N C E~ N d N N C m U ° E m T (� Q T o 0 Zm 3 w. m .L•� m.0 L w 3 N m N o t -o c F - g M `0 0 O. w L aCD E ° N MnZ5 'EC m r� U v E f0 _ C t a n W 'O ° vi 0 Qp ( Jy0 o c c0 m o c o m mZ v 0m mM�N 3 a o m e YC c 0 U-) ) 0 «0c m c0 cO da0 La cm c Cl) o m v Ecmo O °O L c w.m° C 0 cn 3 N N O ww CC) m' O E T E i o a c c E (D m T u U U y C N - U N 7 N CO N 6 a �_ C p p m m- o m 4-) 3 a 0 N C N N C c N - y .L.. 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Oe".h DO MS IM V •t.. L % s .O =1m'�' �""r fir* �'• P 314. Im1 ' � ' a � � V1 � • p 'S ���yyy55Y"`dddkkk { ', • � � ��' :ROY ��OO S C "i NN O a 1 , �€ J 14 • t Jap _El El El P •1 N s lUe a j35 S C C a a ro WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For ev employed, a photocopy of the apprentice's ery week in which an apprentice is identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 20 I4 VAEgo,- y S 4-e irz C- v� Ea {Name of signatory party) (Title) do hereby state: That I pay, or supervise the payment of the persons employed by OAC-b��(A71JOVSv1^t,0E43 Ir aid on the Sc -&C c (Con(ractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature —6 ±1 -- Title % dCE7+S ;,,Z � DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 1-11 n I Rl rl 0 's i?N 3i C Y) cc o cr- Nt (031 RN. J. ti Von W7� ui UL m uj NA LLI ov LLJ 'm RN VVIR �8K zlln. Lu < 4b loo Qt=: Lu Wj 1-11 n I Rl rl 0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years the contract. from the date of completion of In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every employed, a photocopy of the apprentice's identification card must be attached tothe pace yroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall fiunish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE E S 0- (Name of signatory party) 20 )L, l Yz C -A3- vd2 E -a do hereby state: k "ue) That I pay or supervise the payment of the persons employed by -,on the (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature _ 6� Title % dC6hj- ca e47 DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 MW .. 0 O 0 0 a N f/9 74 C 0 U r - w i a E a� a o\w A a o 0 v 3° w L = u a � Aa o A O O O N L C i d O O O L �xA 3 0 i w w 00 00 �o o H x o 0 0 3= L � x 3 L 3 Hix x W �t 0 Ca U U mw ¢ H w i a U J O mm o_ ui O z) O L_ 7 m C 'O mm r 0 m Ima 0 Z tasiia? N a o 3 a` 3 1` i rm 'm N y > LU 0 �s ci �mw m p e c j a 3 2 M in 000 O ge o < a c o O a w c q x a p 0 c J Q m I m N m m 0 c = d z m = R o g m � mL t a o v = a LO w o 4-a � Z o N •@ V C LL Z' CO n cn s= V CD Q U 3 .� > cu 0W 0 '-+ CO C ^L^'' N •� a z i m W 2 � a mu Q Q c nm2� a � 9 N v T -i= a Z o A a OIL' U C o U L � O0 O � 3 L V TQ�m 0 2 Y El 1:1 El F 0 El 0 Z W L- E m z ti _� m N W = u m C m U i U W CL m �s O V f6 a8 z w 5 0 E a E z N� s.�'•� 6 LLl m a a sE CL g m o fA 0 w d 0 Z w U J O mm o_ ui O z) O L_ 7 m C 'O mm r 0 m Ima EWU moe PAYROLL AFFIDAVIT REPORT PAGE 6 DATE 10/02/14 09:29 FOR PERIOD ENDING 09/27/14 JUPITER ELECTRIC, INC. ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 09/21 09/22 09/23 09/24 09/25 09/26 09/27 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 3.00 2.00 5.00 72.820 364.10 40.00 1986.77 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 5.00 87.76 121.69 68.07 .00 453.62 1255.63 006522 - - -- - ------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES- 1 TOTAL JOB HOURS- 5.00 TOTAL JOB AMOUNT- 364.10 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 10/2/2014 i, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title: Administrative Asst. Date: Oct. 2, 2014 I, Leah M. Hatch, Administrative Assistant do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on W day of September, 2014 and ending on the 27th day of September, 2014 all persons employed on saidproject have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357, 40 U.S.C. 276c), and described below: (2) That anypayrolls otherwise under this contract required to be submittedfor 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE -�SIGNATJJLE Leah A Hatch, Administrative Assistant GV 6 --- 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. A r L n :. O N J 8 a a as 3 o A o 0 0 v L p C � � ♦+ su O O O wxA CFS¢, C e A O O O ° C v O O O L �x 3 00 00 N O 3�"3x ti 3 O 0 0 C O CD O Zi fA i. O O O 'L �k O O O 1�CI � � y O 3H3x O O O c W o 0 0 0 U 7i O l0 O C m E 8 E E N c r N N T (0 E >. CL E U M, O w 3 l0 D) c v 3 m m L O O) n Y 2 Y L r a xd oa O .4 a�P s Asn. N ` a S CL (D m 0 C) m �m a �A "�� � �'6l� �'��`•%�,r,. . ` � �� �x.%x '`Xi �'�;� r "y�b�' ��i� � �,�4 ... s? �� �� :c ° � }' r��h�i �X� L4� a1 • �' � r.0 � � �.• � `� `'xka �l^z"'5� �'�'Y' P� `` A "�"�F �` .�'� .`t'a✓ > $ E J{.}.3F•5 r! $' kpA 4, , . � > 9 'Q`� 5,�'"c.�F� �°�'�✓ L2 I.r�� ia� � �,� 1Ynl�k��i�� _r y�s m m 00 �3 x RM� #�^A<: N , 0) y2' •. '� i U) w r— O#` + • ,� O h. '-t• �` 1 - s Q CU 5 CO v liim k... ai Im j. '' Ix �/� U) O F . r^ �� 5- a� N ra r �, Z ' �?P C3 `'T V 15 p a 01 LU Z W m ;• N C0 O E 0 N Z 7i O l0 O C m E 8 E E N c r N N T (0 E >. CL E U M, O w 3 l0 D) c v 3 m m L O O) n WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 049, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 10/9/2014 I, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) o hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature:.%, Title: inistrative Asst. Date: Oct. 9, 2014 I, Leah M. Hatch, Administrative Assistant, do hereby state: (I) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 28th day of September. 2014 and ending on the 4th day ofOctober. 2014 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That. (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNA Leah M. Hatch, Administrative Assistant 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. jig w r b CA O U G7 0 z z U .o P. 8 d a C p w u Q ae C a O O O � wxA p god �xA 0 a �sd xA F d 3F3x o 0 0 3 AM r •�;i � iQn � O C O 3 � at a° 0 0 0 O p 3H3x O O O a W o 0 0 U U m 0 61 a 6 f iy. 36. e� fi'. is 3 ��b`� � xrb o� Je"• _ � � � �.}1 .� (i`,� : Yib frh .�rFy,�'{• �� � 7 �•p �y�y ': �Yyy,^`%V" :::y'.� 4co Lo T N' 00 LL t W N G L y O �• 7 �. §tae, k � �j•: cu LL w t V/ � / � = �2 t uj "a ? a cu 00 W W W y `� >. 0 _0Mai r ter^ y a m m Z W 04 ;tee + } 5,f " N U) > k L� a. .a. R. o (� �am , El El El El U w�U y.... .� a (V 4 N O E5 Q o {-� O cm 0 O m Z a (1) ° 0. M Z W m 0 61 a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 10/16/2014 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) o hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: G� Title: dministrative Asst. Date: October 16, 2014 I, Leah M. Hatch, Administrative Assistant: do hereby state: (1) That 1 pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 51h day of October. 2014 and ending on the 11th day of October. 2014 all persons employed on said project have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357, 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITSARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFM ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) I EXPLANATION NAME AND TITLE I SIGNZO."? Ila `� / Leah M. Hatch, Administrative Assistant n %Yl Q Y ;/ 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. E O r Y w OO O N W W p w c0 m 4J CI a z¢a� NM r O h Q. 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E7 M W cc WO c N E E C R n O a O� p m m tU O S X aN am w N' >,'r - O OW `. > N i N t6 al G O U N A m[C� a O m��O Tm m U N E `cIn C ,rs„ CL d M .a) »°.mO� �E y N ;-i p 20 O N mmQO Eal N U N L N _ Q C 11 y 6. E m C NN mv�w -0 °C� onoc7 .cd>i a.9 L -c m c U G'N N C m aNv a m •jp U U tp f - R CDo m E (D 15 C T3 p J d- O� M w V W A C Q I'm m m t7 a `o n�a�+ m t4 o7 mms c V E m E N m N E O ° p, 'G .��m S q ¢7 >�°`y i-9 o ..',�� O O ���7ct o 0 w cf O a C7 c y, m v O A 4 E Cn U aam O m°'-� Evv� m N N 0 a v Ay m a C >, rn Y7 N y - N �1 C J TED 0 C a m N m,O' .'C... ° OL N C -,C CSt aE O 0 2T O N n F N NU] d J E >"a m m C d N wm ym .2r -RL p4po W0) of — MO NtNMa O U, I.E. p U r rc _ytyW I E-( vdrnmN wQ y d N U NQW z z l� J. uj m m F 0 MSF.' WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years - In addition, each such contractor, subcontractor, or public body shall famish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE -9).24- 20 14, L kEoliey SAex,s i rzCA:fL)32Ea (Name of signatory party) (Title) do hereby state: That I pay or supervise theyayment of the persons employed by ',N C- 6,; 6') 4'_ t� a3 v,"c m � J &vr�,; 4e%> on the S c -6, c 14-o 1-7 i o" i J' T� /}� o�✓ U a (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % CCE ' cw 6v DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 ti... z O IM ('K rri Vmgr �lu F -I F -I F] F-Iis Fq El C) �"'j ?J, �w 3: -M > Lr, �Tl Eo yo, n "g b fiF rt rl 15 00 Nf PwIl r r 17 me lb FT r; —tY 44 -L :? 16 ...... ... ..... I WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project far which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE / 20_ /,f _ i i2 CAT vj2 Ea {Name of signatory party} (Title) do hereby state: That I pay or supervise !he,��ayment of the persons employed by a3v,cmE Yvj-r,onthe Scf-&vt �1�IiwiJ'T�,�J-j�oi✓ (Contractor, subcontractor or public body) (Budding or project) and that all mechanics and apprentices, teamsters, chauffeurs and Iaborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % s 671�s DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 61. i v 0 > Q 0 "O O O O COL O i' Ig. i 0 0 o c 4t O O O ^ Vi 4 0 o O e ei O O O eo CS 0 o O o e 3 0 o 00 a; dx� ao r p pi0 fb o x� O O O p ;nft m on x� 0 m r. a O \ p Q e� o o d f "t 7 w s 2 r�� m o ;eF RR z m L CD 0 m cc 0 CL CD o m CD i a� m c 0 m P © z 6. CD ? , O EIEI EIEI, c +; r► .: :E v 0 b 1 R- 0 O : // \( Y1 "1 L CD x .y e a Z N a` �G 4I;E &.i• CCL f.� I.W ;, J'",�:r 4ryi4 yp�y': 'r"t Nj � $ yNa"S .�c� [ N /�� �i ✓Wk } CD Ch CD TR Rli =rP ." •� r kk X . CD cn �°'' tl���': �"�w ��' rub .i •� a j. �.:. �. :, _ D/� cn 4 h cn cn % .� �t- t_ wal �k. z rax: o � L Oi r 00 O. yL .'. , 0 \V f f b . -Ar y O --4 --4 k SK4 -�,Y f xi`M7 'iii S ff �" k _ 4 fi j,A"•�IF �� �' OD x CA �S sF s35 ".ti"i£$ MSS° T µ�F i 'o F :± Nvser y°+• i 7A Z 9 14 W r�� WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c 149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall fiirnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: Sept. 25, 2014 1, Leah M. Hatch Administrative Assistant (Name of signatory parry) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signatur Z�Z� Title: Administrative Asst. Date: Sept. 25, 2014 1, Leah M. Hatch, Athninistradve Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 14th day of September, 2014 and ending on the 20th day of September. 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS CRAFT EXPLANATION REMARKS AME AND TITLE Leah M. Hatch, Administrative Assistant SIGNA THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CML OR CRIMINAL PROSECUTION. 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A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: August 28, 2014 1, Maureen Marshall Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: //%Miiwu Title: Office Manager Date: August 281, 2014 I, Maureen Marshall, Office Manat+er. do hereby state: (1) That /pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 17th day ofAyg—ust 2014 and ending on the 23rd day ofAygu_st 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by arty person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) I EXPLANATION NAME AND TITLE (SIGNATURE �^ /plot Maureen Marshall- Office Manager / , / 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. 14 oJ IL C E h .•w ik M 0�0 3 8 a C C O A O o O 3` L � O vi ESQ O O O wxA v C g o A o 0 0 O y W C O O O O x A 3 0 3 A cv 00 C 6� o 0 0 3= 3 03 0 F x O o 0 C •O \ O o 0 F L i. *W: O 3F3x O O O a, W o 0 0 4t 0 U MC " 1 k M„_ ��., i• + m �> x ,^ L! r a H r T L 4 � 'I<� '�.' ii '�4fk �}Y� �;•�5y�°i %Yl i �ny�t �. c4r) LO (0 `N✓�k� f !"��. � � -� t! � r * �,'r� :�y" y > it � a �z ��-� „i { �hCF� 4 x.'} t �' � i`� 00 Pl- o 13 Y L luo IV Y ,M N o y ' cu a,LL f s }75 'L i (0 cn \ iO LV V, • ; - r ,� !' t L� h ! d`{ a ',, f. y r. UY mg El El El ElW U w t W CS To 'a a) C o E ca 0 o ' O C° w m a� z a L V w 12 z a. Lul o Z 0 Fql i m a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c 149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: Sept. 4, 2014 I, Leah M. Hatch Administrative Assistant (Name of signatory party) ('Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signator Title: Administrative Asst. Date: Sept. 4, 2014 1, Leah M. Hatch, Administrative Assistant do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payrollperiod commencing on 24th day ofA_ ugus 2014 and ending on the 30th day ofAugust. 2014 allpersons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S C. 276c), and described below: (2) That arty payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage ratesfor 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS I —_ EXCEPTIONS (CRAFT) I EXPLANATION I AME AND TITLE 11IGNATIYE Leah M. Hatch, Administrative Assistant ®2 1,04 06/'-Z 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. O 09 a ,� o� as 3�A o 0 O 8 0 u w N U S o � 0 14 c 0 .� 0 a o 3 H w H w C A �x O O O x U 3 0 w ' ym,A x t- W 00 N V') 00 H U o 0 0 3= a O o 3�"3x o 0 0 aOD oO 3 O p x o w •O \ � o e C O O O 3 o C o Hix 0 0 0 .. 'L k O m O o o0 0 3H3x i.r CD O d G WO U O ai � O o a a a 0 H U Q Q o N O � N � vi CG O 3 c � U U u A z � L b ♦r c � « E eq z o a U � O � � C � � U o z 0 O z w w a 0 o W a z z 3 09 a C as 3�A o 0 0 u aY U S o � 14 o `° 0 0 0 a o $ C A �x O O O 3 0 w ' ym,A x t- W 00 N V') 00 H o 0 0 3= 3�"3x o 0 0 oO 3 O O w •O \ � o e C O O O 3 o C o Hix 0 0 0 'L k O O O o0 0 3H3x 0 0 0 G WO O O a a 0 H 09 U 0 C 7 7 a W H O zI w yO C 7 y d O c O tt E C E C N V c 3 N LD cm E CL E O LD LL 0 t cc m rn c 3 l0 d L O i o °G J" 51 1�SOH0 � O �•`, xo� ¢m %3 N a am) 00 y i S r 4 •pbc 4��� x ��T A3s •M�at s psi i.• M� p1 7d. '£� r�' Y 4'' g ��p, r. G, --�� Y 1 h �r^5}u '� 1T�,'� �`_`�G d ? ,.+� t�'""3,2i�. s�"` a�.{�'K�. C P Iy4"J ON ''tk✓$�Yf 3b k` t M � Ln � '^ .. rs Y x n x#9 kLxAF a rsx d 81 r Q X x'✓hii ,�(y CV Lfr /{.-- r' r § "?:�,g� - r { %�il x'�pfl `� `'�'�2y�3 J3 R �kMlS� �'d' :? o t (�b3•J:^ sr /' ; x Y:' fir. i.4 M CD o CD LO y N aLo Ll li NL •� '}u �+ : 1 5b_ W !`.5ti 10 dflj:y-r-'? Hof y �"-�,'y- f k is 17 ,g co eq Co /,Ri E - :. N � � '^ CD ^' W 3n v .wri ; cu ca N �f 6 C3 c O m U a El 11 Ll El 0 El 0 ,X'd� � O V s� � � woU W = D m m Y N LO o E 2� ZE W Z a m a 1. Z w U 0 C 7 7 a W H O zI w yO C 7 y d O c O tt E C E C N V c 3 N LD cm E CL E O LD LL 0 t cc m rn c 3 l0 d L O i WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: Sept. 11, 2014 i, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) d that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature-, p Title: Administrative Asst. Date: Sept. 11, 2014 1, Leah M. Hatch, Administrative Assistant, do hereby state: (])That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 31st day of August, 2014 and ending on the 6th day ofSeptember. 2014 all persons employed on saidproject have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by arty person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Actas amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967, 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNAT Leah M. Hatch, Administrative Assistant 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. p 00 8 a o � 00 o as 3o A O o 0 L = 4t w v C C%� � w C\ A O O 0 O �xA L 3 x en U _ O� O C 6� U 0 0 0 30 N O o 3F3x a � p 6i Xk rO O O 0 3 M x O •O \ 0 0 0 C Si L •[ 3 0 c Hix o O o c a a O � O v LW v 3H3x U d o W a � 3 U U U Q Q o N O •i.+ Q �M � vi CQ � 3 U o U � �i A� z � L b � � w o Q fi ti z a. `� .0 U cn , N d O bo p cOC a b a w U o z o C C7 U v z o a w -14 z z a" 3 8 a C p o as 3o A O o 0 L = v C C%� � w C\ A O O O �xA L 3 en 00 N _ O� C 6� 0 0 0 30 3F3x p 6i Xk rO O O O 3 •O \ 0 0 0 Si L •[ 3 0 c Hix o O o w O O O 3H3x d W U 0 fN. REr.: x e-®rl.L e � M r.n ftp �—' n �'� �'� 'S xL'�c➢'j d � �j�€ +f 's �3t 1� � � .L (q� }�t2ey J � �k" - r f�ri xf�y,%i� G {C�l Y ,� (• , `' ti - • ^fir z F 3 rs r c �a b C`"�`i ' s 4. CO^ !' �!1 V{'� �6 � x e xk VY €�9p to r > •.. „.. e�K�."i. khn8.,6"�l,t,'ni'ysi' �Tq.' NMn /� >) � r0.Y��4Yfk�..�. ��+�'b �'"'iK¢? }� d'' i"�� � O; 0 C X :':9 { % H �1s_f�'k•� �t .,��!..• 11J: s¢ m Im w - O Y Y' _ x r ,p .:` N�/C� L YJ ;t - Xy ,, fW1^5' cu LL Fall"! :t 4 L • cn cn i �co 2 z .L S Ocu0 b t :Tui t sf ui c) m IN 4A 4 t s O 12 V w G `"ptj Ll 1:1 Ll 1:111 El El U 0 w O t Z L ' d 'C '6 EE V +• m c (J M E' Eo cn ui m r� P: o 0 EWU moe DATE 09/18/14 09:57 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 7 FOR PERIOD ENDING 09/13/14 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 09/07 09/08 09/09 09/10 09/11 09/12 09/13 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY X0985 DANIEL P. RYAN RT 6.00 6.00 72.820 436.92 40.00 2094.04 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079— DT — — M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 6.00 96.57 125.57 71.13 .00 502.11 1298.66 006450 ---------------------------------------------------------------------------------------------------------- JOB TOTALS TOTAL EMPLOYEES- 1 TOTAL JOB HOURS- 6.00 TOTAL JOB AMOUNT- 436.92 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: Sept. 18, 2014 I, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signatur Title: Administrative Asst. Date: Sept. 18, 2014 I, Leah M. Hatch, Administrative Assistant do hereby state: (])That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 7th day of September. 2014 and ending on the 13th day of September. 2014 all persons employed on saidproject have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Actas amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967, 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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) Tlwt any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH o Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS I EXCEPTIONS (CRAFT) I EXPLANATION I NAME AND TITLE SIGNAT �� -�� Leah M. Hatch, Administrative Assistant �=�.A.O.).,� 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. LL! y " m £ �t- 2 g i ; a �•E pr; • 40 a Ct z _/� �Y, /� 3i�' r:� � 3t � mt �. � t1 x . �u� iq° 7 � , �i °' �i{'t� ,, r( t t xs sd � � ' '' �;�' :� �• CV`i In cc Nt O C 95 It xi14 rx � 7w CL O 6 �s; a� a Y ro M ,X�gg ui ca E a. LU m orrj \moi J 1.— J W �?' / L J e Ml M ti Qcq a R r Q EO a i []I[:] El rl 0 J W U C T El C) 12 2 z✓l3 � U a o _ W.rz . z Z ,, A WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years - In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE V2191 20 14- — - ---- I. I, NEoJP-`9 S 4e K,sTYz GAf va (Name of signatory party) (Title) do hereby state: That I pay or supervise the�ayment of the persons employed by [� a3 "c.Q� .r mon the Sc�-c�� c �I n�'� � JT�t/�D oN (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature / Title DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years - In addition, each such contractor, subcontractor, or public body shall fiunish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE —1_ _ 4 20/4 L "E0,Jey �4e-V(-,s T rzCTv42i--A (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by �v 24efk> on the 5cf-& (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % k,E� v� � DMSION OF OCCUPATIONAL SAFETY, 19 STANIFORD S'T'REET., 2nd FLOOR, BOSTON, MA 02114 4 r A WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 9 20 14 I, HE,Np_y S :4f l t= C E -a (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by !� �v✓�(A-r� p3v,[mE If, r-1JJV-Vfk>on the Sly coo (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and Iaborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % �Ci ,q DMSION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall fiunish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 8 , 20(4, (Name of signatory party) (Title} do hereby state: That I pay or supervise the ayment of the persons employed by �� on the SC -coo c (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLL4NCE [ 3i . 20 14 - (Name 4% (Name of signatory party) (Title} A— do hereby state: That I pay or supervise the -payment of the persons employed by �C-0.1CW V3v;cm Cn�,�r ,on the 5��c�oc i�fJl�i��iT�cA-j�o,,. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % A DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 8 7 , 20 /Z1 i 1'L C --AY vdz E� (Name of signatory party) (Title) do hereby state: That I pay or supervise thepayment of the persons employed by W Cv✓��� p3v,[�Ey J ���on the S�' ,, c i�J i �I�I (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % eUCE (,jz CMZ DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 1ZI . 20 /¢ (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by W C-v✓F'�( a'Sv,ca6L3 J ,r-,�Aef -on the 5'ck&o t _ (Contractor, subcontractor or 'public (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and Iaborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % k,E� iqt 6 -SL DMSION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 V`o 0 N) Li 0 !TO c 95 F"n Q3 41 0 j N" 4 4 �g nii & 4111;, .1 L CL L A I 6_1 Lk-: L& LINI, Ld V' E0 llpn F-- Pm �ga tl rw cn 0. El 0 0 El 00 Ila 4b Lu 0 -3 LA WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 1,2 20 l4- Trz GAT uiz 6-A (Name of signatory party) (Title) do hereby state: That I pay or supervise th%?,','vJ-44ef1,>on ayment of the persons employed by W C-v��'GC a3vi the scl- oc ACJ ��W;.iTa��� o,J (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature ;61� Title %C'Jz �. DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFOR.D STREET, 2nd FLOOR, BOSTON, MA 02114 Ilk ,.J WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 6.27.2014 I, ROBERT KAMINSKI PRESIDENT (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Building (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. 4 Signature Title e5 (e'f OL W r- 0 o_ a) O co d Y a) a) ,,j . t O) c a) � a) co =o c � W z Co E OL 0 'O OL L O Y U d Q d Q U z Q O L Z0 0 1111111 U U) Y C Q Q a a)�z O Y p U 0 0C) F—� CN O �zmhcpLo o O) c a) � a) co =o c � W z Co c Z OL 0 'O OL L O Y U d Q d 1111111 1 111m milli m I m 111111111 1' WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: ROBERT KAMINSKI (Name of signatory party) STATEMENT OF COMPLIANCE Date: 7.4.2014 PRESIDENT (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Buildi (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. O Signature Title I- re:5il,i e ,o' •• (3) c E ° c W Wiz° �z .S; E O Y O L 0 Q U zCD CL Q L z O a) O > U ) O Q Q > �Z L. U °o � 3 H -o.c C: U)Q 3 Na �zcoHt�to •• (3) c E ° c W Wiz° �z O Y O L 0 111 1 1 11' 1111 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: ROBERT KAMINSKI (Name of signatory party) STATEMENT OF COMPLIANCE Date: 7.11.2014 PRESIDENT (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Buildi (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Signature Title ' Pr -GS 0 J k m c N a E O E z �Z Q Q U N L -Y L O L U z CL 0- L �> o> O O Q U U) Y O C Q Y a Z 0 U a rno 0 3 ~ C C N O �Zm�titi m c N a E O Lc,,: W z �Z 0> > Q U N L -Y L O L 4 0- U 0- 1 11 11 u 11111111 Q WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the' payment of wages, in the following form: ROBERT KAMINSKI (Name of signatory party) STATEMENT OF COMPLIANCE Date: 7.18.2014 PRESIDENT (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Buildi (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Signatu Title E OL W V- 0 Q N O cu d 21 N N t. E Q V Q z� _ � L ?��� Q >O Q d N > z ,t �— •� O N } Q p 00 � z ED r- co CL O U (B E L 7 O N L O j a)0) a)cu L Lb co cu o� U -EN O O U N _0 C O (B >+ O Q L Y C O O N U a) O L > W W H O Z O) C O E N ca C W .. �Z 0)a)Z c O (D Y O cu L o Ua Q3:a CL O U (B E L 7 O N L O j a)0) a)cu L Lb co cu o� U -EN O O U N _0 C O (B >+ O Q L Y C O O N U a) O L > W W H O Z 111 1 1 1'1 ■ n CL O U (B E L 7 O N L O j a)0) a)cu L Lb co cu o� U -EN O O U N _0 C O (B >+ O Q L Y C O O N U a) O L > W W H O Z V WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: ROBERT KAMINSKI (Name of signatory party) STATEMENT OF COMPLIANCE Date: 7.25.2014 PRESIDENT (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Build (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Signature Title 0 LL V- 0 CL a) O co a Y a) CD U z C7 z a CL V H S FE Q .. O) c � a) LCL,: 3 W �z moz _ Cc U _c p E 'O O Co L U a Q a ■� 1 ■ a� n� 11 1 E 0 N D I Al O�2 YW N 5 O O Co W c0 N 6 ON lne- HWW rn WOQ3: LO l O V Cl) O cM c\ ZQLLC 3 - r r C OLL 0 CO J O I, � O O Z04 X F H 00 U) O O N N W Ow Q o Z N W O w W Cl? C o C> p U 4 Cl) W LO O U C 7 WZ 0) m c6 U C)a my 2 D M 00 O 0 Q W OD O ZZ0 N N C2 c � J Z_ H L6 ? 30 W) L v M: C) 0 U') Q U W O O N p> coF❑ Lo N O O M d1 f� , Z W ? 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O/ O � Ise '`f'-� rte' qui�t. 1.L k � `■ �F (v .q a'`� �F�4 ,A. S3''wrr' `'�� VJ �, �/_1� t i � ix, ��e P.. ���� t, O Y o � • ���€" fix, � t[ . '?--^=?' 4'3^`•x. 4in <"'�' �" W Q r �'�,� awe LD U N O U uq � O k• c 3 �l El El El El El 't p '. 06 EO� r�� W ui Cc Q3 ^ W W ; m Z W V '0I co v 8 m N Vl r U C7 O c E2 7 a 0 zI O A a .WU moe PAYROLL AFFIDAVIT REPORT PAGE 6 )ATE 07/31/14 09:27 FOR PERIOD ENDING 07/26/14 IUPITER ELECTRIC, INC. ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA :MPLOYEE 07/20 07/21 07/22 07/23 07/24 07/25 07/26 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 10248 BRADFORD CONNOR RT 8.00 8.00 44.040 352.32 40.00 1513.92 6 BACK RIVER ROAD OT R.RATE NESBURY MA 01913- DT - - S # OF DEP- 0 JOB kPPRENTICE HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 8.00 231.20 98.44 61.80 .00 237.89 884.59 006164 10985 DANIEL P. RYAN RT 8.00 4.00 4.00 4.00 8.00 28.00 72.130 2019.64 40.00 2750.32 .8 GREEN ACRE DRIVE OT R.RATE ;ALEM NH 03019- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 28.00 159.19 154.81 92.84 .00 740.95 1602.53 006186 JOB TOTALS TOTAL EMPLOYEES- 2 TOTAL JOB HOURS- 36.00 TOTAL JOB AMOUNT- 2,371.96 Comrnonweatth of Massachusetts AL WDivision of Apprentice Training REG# E-064-476._ JUMEAFRIACTRIC INC. 142 TTI ROAD �A��`�Q SALISBURY. MA 01FIV, ELECTRICIAN Appy Start Late Prof. Comp. Late 12/26/2013 6/26/2017 sre�(� .""P © "-"; ❑ `a•�- ® �'rrpy� B"FORD a o CONNOR wep-, he i N • .err 3 prplr Annual Apprentice I.D. r Card Expires 12/23/2oi4 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 649, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: July 31, 2014 Maureen Marshall Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. �.y, . Signature!,��� Title: Office Manager Date: July 31, 2014 1, Maureen Marshalb office Manager, do hereby state: (])That 1 pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 20th day of,/uly 2014 and ending on the 26th day of July. 2014 allpersons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by arty person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFPISARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS AME AND TITLE Maureen Marshall- Office Manager SIGNATURE THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CML OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. C 00 r r 8 � a o C C U 000 I 0 ^O I� oro v y � i U S L A o 0 0 00 wx 0 w x r r C o a .� Q. H a A z O it 0 o 0 3 H w H w i C S A �x O O O L x 3 U w 3A 00 N cc U d i^^t ^: o N 0 3= tn � x at c 0 0 0 �3 •O \ � 0 0 31 i o p o 3 Hix 0 0 0 •L 3k O O o O o P4 a W o� co U U 3 Zo `o U Q Q N N � N O � fin" CQ Q � O 3 � � o U � A z � L b rr r. bb i to o W ti z a ` U � U o go N O � C7 U �o z w w a o o W N z z 3 C 8 � a o C C U 000 I 0 ^O I� v y i U S L A o 0 0 o wx ti C o Q. H a A z O w Qe a o 0 0 i C S A �x O O O L 3 w 3A 00 N cc d o 0 0 3= � x at c 0 0 0 �3 •O \ � 0 0 31 i o p o 3 Hix 0 0 0 •L 3k O O o O 3 W U U C � o U 000 I 0 ^O I� o y o ti o Q. H a A z 0 5 C m IL o � Z vt $ g �z O x �� N o m co C m S r O a " ", a � � et 4i �, �� x' : t i rs ac. �� �'; � 3v `•" fi t, 5 � �� r� A QQc ; �' �S w��3'�`"'�i 3 / � � y •Y 1 ) h�' £� IR# ��V� �,�}'V C .; � L ''f�,� Y' � t" `4#�1 i bpB Y+� A A£�. 5'x iTi 1 � sE'k� •,ypA�vr j'i� W co c � x ar x N v / L cu `f 4 cu ca N Of cu o y N Z a $ e L � L O c 3 0 El 11 y �S = EO W t.: ? D m m L cn LU 0 5 C m IL .WU moe PAYROLL AFFIDAVIT REPORT PAGE 6 )ATE 08/07/14 10:13 FOR PERIOD ENDING 08/02/14 IUPITER ELECTRIC, INC. ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA :MPLOYEE 07/27 07/28 07/29 07/30 07/31 08/01 08/02 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 10248 BRADFORD CONNOR RT 8.00 8.00 16.00 44.040 704.64 32.00 1285.44 16 BACK RIVER ROAD OT R.RATE iMESBURY MA 01913- DT - - S # OF DEP- 0 JOB iPPRENTICE HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 16.00 182.65 83.58 52.47 .00 203.62 763.12 006203 10985 DANIEL P. RYAN RT 8.00 8.00 1.00 8.00 25.00 72.130 1803.25 40.00 2795.28 .8 GREEN ACRE DRIVE OT R.RATE SALEM NH 03019- DT M # OF DEP- 9 JOB OURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 25.00 164.92 157.74 94.82 .00 747.69 1630.11 006224 - ---------------------------------------------------------------------------------------------------- JOB TOTALS TOTAL EMPLOYEES- 2 TOTAL JOB HOURS- 41.00 TOTAL JOB AMOUNT- 2,507.89 WComrnonweatth of Massachusetts Division of Apprentice Training REG# E-054-476 J rTER ELECTRIC L CTE ROAD ������� SALISBURY. MA 01:0 ELECTRICIAN 11^^ — 7 Appr. Start Date ProJ. Comp. Date 12!26/2013 6/26/2017 wpl � .�r.P: ©�� irpr ti,rp- ti7epv n BRADL�'ORD M CONNOR \!c• : ;rep4 C(c'pA .Clap3 ® \0.•pl'Li J1 I Annual Apprentice 17-2. Card E:pine, 1 12/23!2014 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: hereby state: STATEMENT OF COMPLIANCE Date: August 7, 2014 Maureen Marshall Office Ma (Name of signatory party) (Title) That I pay or supervise the payment of the persons employed by iter Electric, Inc. on the N. Andover School Admin. subcontractor or public body) (Building or project) that all mechanics and apprentices, teamsters, chauffeurs and laborers Toyed on said project have been paid in accordance with wages determined -r the provisions of sections twenty-six and twenty-seven of chapter hundred and forty-nine of the General Laws. Signattud: 7 / / Title: Office Date: AugusO, 2014 1, Maureen Marshall. Office Manaeer, do hereby state: (1) That Ipay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 27thday of July 2014 and ending on the 2nd day ofAugust. 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357, 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNATURE % ? L k Maureen Marshall- Office Manager ' 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. A � a � cl t E O ami � v as a 00 O o rn °° as 0 A o O p00 o u ^ M iY N al L y 0 H L O O a O #k 000 w a O\ .N 12 3 H w H w L C i O O O A �x x 3 U 3A te) N 00 U G d o 0 0 3= �o d o 0 0 0 01 11 ai O O O 3 a x •C � O O O L � L °a o o O P rA L at °a o 0 0 o0 0 3H3x 0 0 0 d W O O O 0 U .�, 0 H U � N N U Q Q o N O � N i.r � vi aci O 0 U U " A a � � w w U � O � � b w c z � v o C7 U �o z o o W z z a 3 � a � cl t E O ami � v as a 00 O C � rz aY�i as 0 A o O o u N L y O H L O O a O a 12 r`7 L C i O O O A �x 3 3A te) N 00 G d o 0 0 3= �o 3N3x o 0 0 01 ai O O O 3 •C � O O O L � L °a o o O L at °a o 0 0 o0 0 3H3x 0 0 0 d W O O O 0 U .�, 0 H � a � cl t � O ami � v ani 00 O rn o aY�i N ti O H A z r a ei1 O Z m CN 0) w z m LL N r co � a �.. y yyW+<ry i �Sh°5f h . +..�ffi5 �' '7. � � i F Y �Y rs, r aG � f 4iE f` �l� M� "}'➢.'{i . y,{ �yy 1'(d+�6 ~. CCC M 11t9) dxd k^ t� 3• 'W �t ti 3+�. `�5 �'.edT34 R f �(" .F fi %i 5y 4* 'r'S. 'S. f�" �dJ H; N � � � '� �t '�` rf `�:� ' Y! r�� ,�� ', � rr`i/2�.,." t V J .( C o » D - s� �. . 7'. q• k� F k� ,y. v q 12 �m s ob k =3 � y� C � a3 ' S • � • ��! rte+ �., -0 k, rR •� 6 �"`' /�/��� }� �sded m-� ;`. i iij f#�t�•i Sic". �M. �'` '(^6 �W{ to NVMSiF- J ".t, O ��• Q �,j=:e"• Kf J+id i`'' 'moi `G) �.� cc 0 12 i 4 0 r L € Q m X08 _ El El .. EilEi Ei US EOr W O � Ca m � O (n c E 0 0 `C a� ,ltl, —� I- fi Z a 3 4t Z w U J 0 c c0 0. g rn 'C O m m 3 m 01 L 0 F3, WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: August 14, 2014 Maureen Marshall Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signaturd.' / ( /// f Title: Office Manager Date: August 14, 2014 I, Maureen MarshalG Office Manager, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 3 day ofAyg—us—t 2014 and ending on the 9 day ofAugust. 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by arty person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE Maureen Marshall- Office Mwer SIGNATURE 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. ALF M 8 x 00 L O a d a C C u L L 0 � A L �x 3 o� o x A F C o 0 0 3= 3F3x 3 e O q O O i GS L L' 3E" a°COD O O O •L Xk C O O O L p 0 3F3x O O O d W O O O 0 v L O a m 0 Fl d a ¢� Z �a 2 E 1ashM�y rF a�3� — Ma �3 -- AA�- � ', O ?� M W e= CV) co r � B'F'I Q ° � r 4 �4,$ i ki '4 ^q �V 't `' w e'�1/,� 1' /'1/ A'� �lx''ii`� tNM i l :� �� j�@ i �✓ t Seb �Ah' T IN 4 t1 f N mtTSiit/3 C Q _ In co '. =m =F a �}7�=� r ��•. "gip,: E+Q .-� In R <;•. `� � Yip Aas 4.` { x�`�5 , Lk ;d: ''.1:t '�;., a,a..: f �::- § 'a`< 5 ✓a`- �.�_ ' a"..54' 04 O Wr Ze1.. Q { � /�/�� \/ J 5.4^1 � J co CN U O m — f.. to Ll El ..... ... El D 0 _.. V l '�.: Q � � C O `/ ,�$ ' atS E w E o d w U P AKI o 0 C- O a E. L3S E m 0 Fl d a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c 149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: August 21, 2014 i, Maureen Marshall Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) d that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signatur/// Title: Office Manager Date: August 21, 2014 I, Maureen Marshalb Office Manager. do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 10 day ofAugust. 2014 and ending on the 16 day of August' 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNATURE Maureen Marshall- Office Manager 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. F -I s WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE �-1---� 20� kE�Jgy s4K;S j rzCeU42 Ea (Name of signatory party) (Title) do hereby state: That I pay or supervise hT-J'44e%>onthe yment of the persons em ployed by Sn-&oc I ir�,�,�(Conbn , plic body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and. twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title% �E ' viz � DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 J WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following forth: STATEMENT OF COMPLIANCE --V-1 20__Y- (Name of signatory party) (Title) do hereby state: That I pay or supervise th7.,J-04e-n�>on ayment of the persons employed by v/,(.�E� 3 the _S�� �� c n;�; i7dt��j o,,. (Contractor. subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature �v j Title % k, ,q (w � DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFOR.D STREET, 2nd FLOOR, BOSTON, MA 02114 J Ci O C N Q wl r 0 z o` R d u � ;H .xRErr '•.,� '�. 2 R 4;• BIC Z �`! T�• St�3 E: ` � ^ �: � � �, "' ., �„^•,..�or «a z*, +aaa,. »..., +«77777-7 k f�...., , /� a �7 s"" ,.,. 7 mrd.- £°��.f„i, L Q „� ., k `9� ? ih. 'sw' 6 ......... R'4a- X 5..-4. --.k.. 'L.•i: kf :iT IOU + ps" •v ��4`a' pp � uu» 'ir, rk. ^+ s pkyji T+�O� �l1 � :ys �� � F +�k k " 'jY )f,T' kM� Y ',✓ i ps: ,-: fo +Y f i':. �1^ rte. �;. �;,: N P"n t y 710 w o o i. 0F Ei El o r- El ga 1 .0 lib 2 Z J LU ., 2 J Ci O C N Q wl r 0 z o` R d u WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 7/ 20l4 HEoJP-'-f S A -e -V,-; s T rz C—Af ud2 E-A (Name of signatory party) (Title) do hereby state: That I pay or supervise the,� ayment of the persons employed by W C-v✓��� , a3 v,[m J �l�,) the 5��-(�o c �fil (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature l Title / dZE ' (w E I", DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 4r 8 � O � •x`, 0 n trID osis.: � � �, L• as � � a i;x' �. �� � £� r' �'x� �. .'yr, wf*rf `�--.-•.- a��'•r 'x"*w ar ,cr ,�•' a.,*�ca* „ a m' x " 40 NJ Ix rl Ll i r i �fi r � '- tl: _' �� �� .d go h- &. ,i. ( a' ., ° "�• i tee«. "'r i #• �►1 cn 8 "VVV e i �w s el � ' �p � � 'su V • � j .'01 rte" Y _ .� ...� �'3. / 1 �Y-�� x•x3' b/.n..� fir. ...3 ca�;:!rF. a. ar p R r7 Q ll km F-1 0 0 E 0 0) if ., u p �� J itc-(� u ikD Q a T 0 a C WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE -7 023 .20 1 �- S�1eK,s (Name of signatory party) (Title) do hereby state: That I pay or supervise th7,"J44e"o ayment of the persons employed by onthe Sc--&ot (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % k6fs cg 6va_ DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Mr v J rg I N W ry 8 � a o U i M c A O 00 rn o a�oi as 3 o A o 0 0 w ca b U 93 O o 0 O wxA u A z Q � A O O O 1w.77 .ni 5\ C` O O O L A �x O 3 ° d o xa H ° 0 0 0 3 =° � � h L r+ H x O O O ti t o 0 o 0 3 w d° O O O L rte+ L fz 0 0 0 it O O O .. h L 3N3 c x O o 0 G WO o O 0 U U � aoi 'N. I N W ry � o U i M 61 A O 00 rn o a�oi b w N O A z I'A r, A"' p . ��i NZ, , I- - 6 '[f = )M QEIp4 ti rig "j O ids' x c3 E � u 64 co Al! 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CU r" � � •� � � x x�', �' !iiYs � �,y� S Y3'� '4.14 4 � ca R' b cn p mJoky CN Q H,'' y� <• : �'' r f �- }. i HE W V L.. s C 6 U r < Wx ; ' O 'o O C L I— w Z a w m 0 • IL d WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE July 3.2014 Maureen Marshall I Office (Name of signatory party) (Title) hereby state: That I pay or supervise the payment of the persons employed by N. Andover School Admin. Bldg. Jupiter Electric, Inc. on the North (Contractor, subcontractor or public body) (Building or project) that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on project have been paid in accordance with wages determined under the provisions of ions twenty-six and twenty-seven of chapter one hundred and forty nine of the eral Laws. Signature 7 r drV Title: Office IN it OCA •' o � a 00 RN fl x O a o o� q q v � c o as It 3' A o 0 N 00 0 N ^ y L O v o O o 00 f y > „ w 3 +O• A t`a� At t- cd � O ON O N q O � ai p N 0 0 o 3 H w H w O z � O A x � 3 O U � A x ani b W � U W L w �x d U W ti �N c 3 O � u. ¢� U o U it OCA •' o � a 00 fl x O a o q q v � c as It 3' A o 0 0 o ^ y L O v o O o 1� f y > � � a N 3 +O• A U At d o � N q O � ai p N 0 0 o 0 it C o A O O z � O A x � 3 O U � A z ani b W � � � � W L w �x d U W ti �N c 3 O � u. ¢� U o z � o ;, 3A x z C7 o U o �o w . 00 a z z 3 2 0 a d � a o q q v � c as It 3' A o 0 0 v L O —co e e CQ o O O 0 I= � o q ai p O 0 0 0 o 0 C o A O O z O A x L *a 2 L �x 3 ;, 3A x t "t 00 F C 0 o 0 0 w 3�'3x C 3 •O \ o � o ai 'C L 3 0 0 0 Fix 0 0 0 'L ;O' r � h IR L 3F3x d WO O O 0 as cc U U �' v 0 w ¢ 2 0 � o v � c � o ai O o A z S L a (�k II rn a Fn IL z JM: !�eji► 5 m = to x� t "'* 7 �f� O i, i� Q �5 v :L35f1K ' � \^ v Ls o T m k LO Gi" w o m � O H 00 0 �''tl FaS�"Ik ? 4iyp, V ,rr ,; ?% ° � `nw•' �r yt` .A f ,�.. � �� �.y E � h x �d..rti 9 � � y'`r� � .s'��i7.�� y 7 m r co 04 0 : - V / CD lL s raj�.i+� P t5 1 rrrF iRP9 m, t Q r V'cb k �f✓`..." l� L L f G.� L � � �,_. T 5 i� r F y7..ti 4 Y CU ou 4.4 ci Az co �. Q, ami s -w U N W Ri U 3 , y f�� +r r °a Ll 0 Ll El El 06 E O m "R ^' Y/ ,j .<5 L WEl U a L £ a C ° Q '#� O c EJE z rn a Fn IL W q WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE July 10, 2014 Maureen Marshall Office Ma (Name of signatory party) (Title) hereby state: That I pay or supervise the payment of the persons employed by N. Andover School Admin. Bldg. Jupiter Electric, Inc. on the North (Contractor, subcontractor or public body) (Building or project) that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on project have been paid in accordance with wages determined under the provisions of ions twenty-six and twenty-seven of chapter one hundred and forty nine of the eral Laws. Signature: ' / I Title: Office y 4L 8 ON a 0 00o n o A 2 W) %1. L = C, U y a L o 0 0 wxA ,0 w xt - -r r. ON 0 E it C 0 Y 3 H w H w L x U 3 0 �, 3A .0 00 U 40 Cd o 0 O o In 3�'3x C 3 a x o L 3 o a o 0 0 0 Hix •L F o o 3 3x 0 0 0 a W o 0 rn ce 0 � 60.) U 3 s. U � N N U d d N 0 � N i, � vi LLl � � 3 L� o c4 U ci a� � W �) L y .0., U � O b dr. a w ~ U o z � � o z w w 0 o W a z z 3 8 a o A v L = U y a L o 0 0 wxA u C � o v N �.r L 3 0 �, 3A 00 40 o 0 0 3=° 3�'3x C 3 L 3 o a o 0 0 0 Hix •L F o o 3 3x 0 0 0 a W o 0 0 0 � � U m N vi v r U C) O 3 Lo 3 a Izo r 0 w 3 m D1 C v 3 m L O 2 1N •p£!N k d = A L ,. N r— 03, f MM a, F� m W O b,•• g + rf �. 'P�kJ"'-'A I : sL F3' } by �kM E S Y. l�'� f SU' �i�T _, -Y � �! l� ,5�� ?•'N'H��k� 1'fN � j ,� � R CV) � H 1� �'� � � _i'"' � .r i "G {3't Fy,,.'5s• `#` *ice y �` t' ? �xyi�., r S � Yi .k ��y, �. � •7. Rd1" � f ,� z �+S,P � �� # rr�<- pay z,� ��ta .s / Y`�� �,. � °�' t�s�� . t,3/`,il��Yi\ ^xj r� �� � • � ^, la ; � 3 a��g 3�J':, 3'Ity��` € �� +,1,'`h_.' % '� F ; r+...:�;-> `• J -. 1 ssa .fit ri.'. Ytf'v ys'.'k"f�: 1'Y° W •� o - 6 t,. � � �,' � " m Lp _ � p� t7 � # i;•!�L `' ehjr '� ;C�, f x '4 :: s'as � IY M ,:; Y• ink• y •, It+c ���,a , i �� r x Q', f�!p� �� LL al .. cyc�,l"y, <°S' f _ p 2 y' fi •k'zYsy�p. ,a• R. Y3 r/`• W .'+£ m 9 a� t r•dt, t{.f _5 �'e�(aa}7t? 'ai'i. CU S (uCU''+ ♦fie --?� ry«k c�` v T ON ui M ka. N r 10 a � t t, HE isL > � O U k :4f =c Q qr" O U Mo m. a $ w LI L1 1:1 El r ` E O ami E W a: Z ' W s • Q �w q W m w m N vi v r U C) O 3 Lo 3 a Izo r 0 w 3 m D1 C v 3 m L O f WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE July 17.2014 Maureen Marshall Office Ma (Name of signatory party) (Title) hereby state: That I pay or supervise the payment of the persons employed by N. Andover School Admin. Bldg. Jupiter Electric, Inc. on the North (Contractor, subcontractor or public body) (Building or project) that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on project have been paid in accordance with wages determined under the provisions of ions twenty-six and twenty-seven of chapter one hundred and forty nine of the eral Laws. Signature: Title: Office W t� 'y N � O U o � O o opo o ago ,U. 00 3 v A a � o 00 00r % x U r N o O ate+ L W O O O wxA 3 H w H w 0 o as c '. a x 0 U .00 LO„ A O U O L �yi �+ N W) ow 3 x F Q x+ O 0 0 0 3� c o F x C 3 ++ c 4 °' U � o Fix 3 0 O O o a o � � O � Ca ✓K U N X 0 0 3F3x O O N V N N Fri O O O 0 N O ti � � 0. ea w ¢ H p � vi Lei 4.6 3 U U c A rw z b CG W d w ti a. 8 z o a U Coll 4r �N N 5 C O b4 q c w U o � z � � z 0 o W w z z 3 t� 'y N � O U � a O o o� C O G� as 3 v A O O o u % L C C � o O ate+ L W O O O wxA u 0 o as c '. a o 0 LO„ A O O O L �yi 3 x F 0 0 0 3� F x C 3 •� o Fix 3 0 O O o 'L C O O O X 0 0 3F3x O O O W O O O 0 ti � 0. ea w ¢ H t� 'y N � O U � N O o o� % o H 'O 8 C m CL zfLi FnI m IL 1 X. Z CLi ya # M Lo co CO g'XS�fI�.. Rill wX }i CF) � , r t 00 r{ rte" G 4„N'" LO CN to :E y:t..,'!V of 14 j�3 i.. w p C3 LL nl � � ,rerts�"." � Y� vt #� �£' i �f4�*�,�/ •�" y'�'.� /c Co ca ui Cc) Ate+ ♦� i7' s'r3,fr w i 'id ! L p O Yi ' m . ,a c1 O` �e $$ El El El El Ll El Ll (5ui cx n;F Otj EO m 0 L CD .. ^ CL m m Z a � � o Z W 4i H 'O 8 C m CL zfLi FnI m IL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 649, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Maureen Marshall (Name of signatory party) hereby state: July 24, 2014 Office Ma (Title) That I pay or supervise the payment of the persons employed by N. Andover School Admin. Bldg Jupiter Electric, Inc. on the North (Contractor, subcontractor or public body) (Building or project) that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on project have been paid in accordance with wages determined under the provisions of ions twenty-six and twenty-seven of chapter one hundred and forty nine of the eral Laws. Signature:. , G Title: Offi( WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 6.27.2014 I, ROBERT KAMINSKI PRESIDENT (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Building (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Signature (3_a 1 11 Title e) t�� L 0 LL V- 0 a� O (i5 CL 0 a� J L L y O O O L VL O U O cc R ._ LN 0 L Co O O co U O �i 2a 0) 0 Ao m w E^C OZ L COVJ LL` ,tom+(no OL E 0 E Z E >1cu C: Z O Q 0 E 4D U a cz O U E ++ O o � W V/ L C L L 0 � 0 c 2 O C3 E CZ CZ O o a c .C: N 0 q� 0 3 0 0 � > }- tU o w t -- O Z 4 U Z ` � 0 � L z O 0 U Y L C: <C < aL>Zrt O � C p 0 ON F— O O Q O N C 0 E Z E >1cu C: Z O Q 0 E 4D U a cz O U E ++ O o � W V/ L C L L 0 � 0 c 2 O C3 E CZ CZ O o a c .C: N 0 q� 0 3 0 0 � > }- tU o w t -- O Z WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 7.4.2014 I, ROBERT KAMINSKI PRESIDENT (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Buildin (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. 1 Signature Title��- N. L L O N O L U. L N M CU L LO Lm W U c0 v) m O 0 O O O a C Q CL C c W�n a O U M C C O O � tII (D UC•) N cu O L M O C: o P O U C O O fl- N C O O � i� N W `F- O W F- 0 z C O N W ��Z° �z E C� C L O 0n`. rya .O Q U Z CL 4) v O O Lo<t a� �c _UC rn �o 3 i^-�.� C < 'j C N i Z m 0 (-- V r co a O U M C C O O � tII (D UC•) N cu O L M O C: o P O U C O O fl- N C O O � i� N W `F- O W F- 0 z O) C O N W ��Z° �z — C� C L O 0n`. rya a O U M C C O O � tII (D UC•) N cu O L M O C: o P O U C O O fl- N C O O � i� N W `F- O W F- 0 z .r WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 7.11.2414 I, ROBERT KAMINSKI PRESIDENT (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Building (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Signature Title �r S F4 +- O O O C: I - c � o g) U o U 0 v d p d N m c I�j�IwI�' C fU 0 C co N W cz E a TL ,c o v >, Uti Qin`- .0 Q U Z Q- v � Z 0 0 Q O <C ,G U >Z `p WQ 07 2 Z M - P h- 0? fU 0 C co N W cz �a z a TL ,c o v >, Uti Qin`- WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: ROBERT KAMINSKI (Name of signatory party) STATEMENT OF COMPLIANCE Date: 7.18.2014 PRESIDENT (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Buildin (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Sig Title 4x & U z � z > � U R � � / \ z C: CU Z / k� E 0 m o & 0 >/ tr. WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: ROBERT KAMINSKI (Name of signatory party) STATEMENT OF COMPLIANCE Date: 7.25.2014 PRESIDENT do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Bu (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Signature Title v Q z 0 z 0) E CD c :F; w Z E >1 z m c 0 /� k � � & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 6.13.2014 (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Building (Contractor, Subcontractor or Public body) .(Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Signature` Title E LO LL r O OL O d Y N O .S; E Q U CL z L 0 :Z; U Y C Q O Q ��:z� F -"0.x00 } Q =3 o � z co (o co CL O U. co E -0'i 7 O O � a)(B 0) C L� o� �o o-0 -0O U N N _0 O C: L f6 0 a 0 L Y C N O 3 U N L W O W O z C O E -0 C N W z 0)Z ca C: — 'O Y OL L Q�a tea CL O U. co E -0'i 7 O O � a)(B 0) C L� o� �o o-0 -0O U N N _0 O C: L f6 0 a 0 L Y C N O 3 U N L W O W O z mm 111 1 111 1 ■� p0e 111 CL O U. co E -0'i 7 O O � a)(B 0) C L� o� �o o-0 -0O U N N _0 O C: L f6 0 a 0 L Y C N O 3 U N L W O W O z L. L & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 6.20.2014 �—ti2 is 't'1 K' (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Building (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Signature �- Title E U z z a a U H U i .S E Q U Q - Z z O O O cn - Q O Q a a�3:z� U o 0 0 Oc O 2zco —cfl * CL O U c� E y O O o =3 _0 cu 07u L3 cu a) 0) U (L c � -0 O D U O C c6 0 n 5 >, M Y C N O N U a) L > +- W O W H O Z O) c N E N ca c � W �Z c — OC _ � � Y O L Ud Q -d CL O U c� E y O O o =3 _0 cu 07u L3 cu a) 0) U (L c � -0 O D U O C c6 0 n 5 >, M Y C N O N U a) L > +- W O W H O Z Ram 11� �1 Elm -====moi 1111 CL O U c� E y O O o =3 _0 cu 07u L3 cu a) 0) U (L c � -0 O D U O C c6 0 n 5 >, M Y C N O N U a) L > +- W O W H O Z Le fl 0 x N 0 0 cc C7 z 0 r. :5 Fd ai N R ry E C � ' a c R c m 3 o A o 0 0 R L U L wx° o C aHa0z �x i 3 0 v 0 O y R 3xA V 00 F c e= o o 3\ o 0 0 R i c 3�"3x c ak c o 0 0 3 O \ 0 0 0 R L L 30°ao Hix o O o w �L � H y" L p O Q 3�'3x O O O a 0 � � U ai N ry C � ' O o aHa0z y r O L m 3 m m L CL 6 2 U = m y � U p � 131nN� x N Z W =O c 0 « i m °a Z • O 12 m s .o 3 cW Q p c c m D fir\ CO) fl- (3\ V � Lna3 00 � a. y a O \L/ c x W = a 1m O. 4p >O a ^au$ g 0 Nil® Q m" co o �3 0 o co IL U o' co LO a7LO r - O L = m C-) Z LL Q� m cu �L tip m Q v 3 '' c'aa o � o O W °.' V m U U) s✓ y. (a J Q a i O "pts m Fm 3 Q c se c V a d � ai F a a z» �' U o Q L O L) L) p 2 U ._ L1 C:om�� as El -- ElZ LI El U 0 W�� E N q D W L E m z W u :2v m m CL r : a E a Cz UJ O `t Z a U _ W c v a a c a Z m w y r O L m 3 m m L CL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 649, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE June 19, 2014 I, Maureen Marshall Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by N. Andover School Admin. Jupiter Electric, Inc. on the Bldg. North (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S i g n a t u re M 1 011 4 Title: Office Manager MF v 1 E ►5 It i N z N R R 8 o a C R C A v 3' R L = U L .0 ti .0 N O a h a C z c 'L o as o y a o 0 0 r;•, C o A O O O N �x 3 C 3= o 0 0 .R! L 3 C C O O 3 •O \ � 0 0 C O O O zi L � •74 3 � � 00 o O o •L y' L D O 0 3H3x O O O a W o 0 0 7t 0 � U Gtr Y W Q H R � o coo�o .0 ti .0 N O a h a A z M 0 8 ca 7 N N O L O 7. W z m h o LL 2' r m '4'�/• � _i }�",�Pd � �, k 1� µ� � C &" k � yl� 9' �• t k :. F;i Yf H t ( t'L�' �4 �y�SM+• J�'d,T f b1 'i}Pf i Fi Fn� � l l �M ? _ f {. 'r �a'•. 'f- f m,�� G�-ti ;��` z .�' z'y �D^sJv r'�8 r ,�`r `' ;� a t' .` "y 3' {� M f�d'{�Lo y` - J' °. 1' c- .. � y��� � ��`�"'4'i 4� r `� Y � �,��,+i T r'a 3% l y. -O'M'Y�t PS1T' f 4. �j d tk d,.5 xa.r 13 k'�` p hty.' h+'l9�yr r '� 7 y*: ''"tj'j W,11 .�'•`'��+zv"rr )� .�f �' `,�7`�'S"s )Y} fT'yp "C�2nfj• r VW: rrr�,`G, S•. i A •a I �`4 �' i Ui i _ t,.. 1 _ 04 Lai 2 r b 8' I r'4' ,y$ �' z' d' O q' h M p '7' r � �'�i� Y f. ��'S'�!", k�•a �Af � 1 k� I �;� r - }, q� i� 3` F's'3fn � �� 1 J r, 1� m m m 7 N :nor.. N#-•. #e, 441"L ` O - v r r = { BOJ _0 li � � � tri Yt s.. � � J¢ •. i �r lNi � �� ; � (�{r'�#';.. � ; �U, 9 � �• {,y i{ f '�f f'� f '• i 1'r h�')r'4:' d`.l .. 'wue .1 �_ 4: U_ yf ) ""'"Y' f��� 4t` j 1 '�a i •�i ui �.. Je',�e 4 � � E moi: WI'• a ? zt.,. Cc co ` m ynY� (D E k 5 a; � `` k �s" W f ..t0:. •k%E" lq ���' ,' r5' T ' Al ) $11&,5 4 -�yt✓1l T+' CN 51 vi L � m LOT,2 , `" C (j m Ta o S G tz Ll El Ll; . ' 06 0 w O U . Y11 p : d i }p iiia iPH� rL' V ca O W NL ME M 0 8 ca 7 N N O L O WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE June 26.2014 Maureen Marshall Office Man (Name of signatory party) (Title) hereby state: That I pay or supervise the payment of the persons employed by N. Andover School Admin. Jupiter Electric, Inc. on the Bldg. North (Contractor, subcontractor or public body) (Building or project) d that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on id project have been paid in accordance with wages determined under the provisions of ctions twenty-six and twenty-seven of chapter one hundred and forty nine of the ;neral Laws. Signature. Title: Office Man 1 ; 2 W1 0 Z oilCS I yA 0 21: To. RAW Ims Eli MV7% 777 nr''�F­777 Y:n fit 11 SIM 0,01 o 14: i"IS .......... sit oil tic! ..................... law gg Eli x! I pp� opt lot r 31 A, 4b tit k"S 4 2- I i7 01 i2 1 ; 2 W1 0 Z WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall finish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLiA►NCE 16 20—L�---- i rzCYudzEv, (Name of signatory party) (Title) do hereby state: That I pay or supervise th7,214e,4>onthe ayment of the persons employed by !NC-w�G(fia3v,[a J �_50c��c �frJ1-7;01;17Ayjjo„� (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % DIVISION OF OCCUPATIONAL SAFETY, 19 S'I ANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 C. a 11 a O b d CL y:f s j { 3 ro- � �}' ^,�• ' fir. �, �'�( �: CS U µy F2 a 'RYA //'�� �:y F 113 � ebb '����� � '� �Y�✓n'✓"Y^ Fk �w�w nr"'� Y r ^'°" ,�pC�„•M^"^Y�.4 wo PRIll F yfS• l'.."r I b °", �Y'y y `^w^ y1 }5T �,,'P g t$ r'n in d 3 � /� r fit.°p •"C X" p @ r°k# � � '� &�Y of � �' � B"k°'h {'� •` ✓L.'k r •��' i L a� A` 10 16'14� r MF v s x u If O u�i a El 0 El 0 El El A W U z� c� � I � � V u � u "•m ¢ �cr � \D C. a 11 a O b d CL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 6l_ (20 t¢ L 31Trz GAf ua 6a (Name of signatory party) (Tice) do hereby state: That I pay or supervise th%!--j3vAeu>onthe ayment of the persons employed by !NC-vJ��C a'-Sv,(mE J Sck-6,cc d -K (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % �C6&s (,g ESL DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 1, MW P ca E a 3 o A o 0 0 ° o O O a � C o A O O O L� A O O O i�•i �x 0 3 ° L � r 00 0 3xA H d 0 0\ 0 0 0 3°z0 H x O k G O O O 3 w q O o O r ^ H L 300 0 0 0 Hix 'L � y y' L X 0 0 3H3x O O O a W o 0 0 0 .Fi CC U w ¢ H 2 Q d 3 w O CL 0 U N 7 U LO C C N co E cn w O cr N y O U T c a N C 0 N c U N m L, N C6 rn J 0 0 f0 a wl F ° 2 t� O 7 LO c a L 0 d a : � Z 2 �h ani k A 35µi N 0 .� t o, =3� i CM lz' _ w LO o m O "�.a,•kfi , T b" 2•` m y—` ,�✓,-. C :�+ f'"Y IS IMF �i '. � C.Ti {. � P., 77 R :. � f•1 -.:"� fi� h %✓� � 3: e' i �'* ��.y��li i€r�yi�i'}-. �" � �c 'fit .s��. � +3$� :J +V�w`S' tk •� r �:: �'rsYa" .� F =+,. .t � '� t ,�.; .: t. `4 f • /�� 'k r � r"LW rM 1`"8•x`7 �"'^''� t�� P �,d�3 } ! r � 1 � � 's�'U •'Fz 51 O ' V J b t � � LL ( 9 & : � �' M� �: 1+ r33'C " ply i-�t '4 iii h S � , e 7iF 7. +� � t✓ G � t� �' • V � r � :. G Q: �frA• '.�n� a Y+�. � �} � � ,{>t {�ll' t r A � °�� �� � � G ., �; �` 'C`� r,� t' J � � eJr � m.�.4 r � � � k t� � L & rJ�i,���^9��„� m. '� x,}:,� � t P{�,N'� � 'z�•d »� M1� a § f � �'i � t ,& ly s y � �`y i,.'^!�' k ! � �S�C t _l�i�` � �� 1 � V �, O � F _A *4 �e R� 'Yt �„+� �� x t �S"'•" ,4 6 �7: �.1 ��t'�dS`T �a 3���¢i��,> ''{r'+$ t� Nt M W Cy k � cc cc LO r, Q: ,.4} ✓il: Z Ijf CQC k t'•G' J f'Tr• I 1 iy� h a„ r ` dif ,, }� kR+rY: �' � � �� ' � �`e ' � � "si f �� r .,L"�• raX,' y�'1 � Cx N y"+�r co 'LI 4_4 1.0 \V U O �at r J;, S�'`"FL�iGi, r. 't3c.• l'". ", w G 0 W CD 2k'".m Ocn ca m Q ni N at Z (D 6 o K o L Vl U Oo " > ° Y °El mON El El Un06 O w U L yj AD L c) - a U C ,"' ?�+ O 8 E L O c A a) f` Z Lu 2 Q d 3 w O CL 0 U N 7 U LO C C N co E cn w O cr N y O U T c a N C 0 N c U N m L, N C6 rn J 0 0 f0 a wl F ° 2 t� O 7 LO c a L 0 d a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 649, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Maureen Marshall (Name of signatory party) hereby state: June 5.2014 Office Man (Title) That I pay or supervise the payment of the persons employed by N. Andover School Admin. Bldg. Jupiter Electric, Inc. on the North (Contractor, subcontractor or public body) (Building or project) that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on project have been paid in accordance with wages determined under the provisions of ions twenty-six and twenty-seven of chapter one hundred and forty nine of the eral Laws. Signature: )W41l Title: Office Manan Ldr 53 ii 8 a C C pq 3` A o 0 0 v L wxA C N Axa L 3 o � o 3 L xA 00 C o 0 0 3= L 3�'3x C it SO C O O a3 •O \ 0 0 0 RS i. L Xt 'C O O O � h F O 0 3 3x O O O d FE O O O 0 a 0 CD o3V q t � w o L �pp a CYJ r rsti m'. { rB r x _: rr„ E ;a 4 '+ bF 4 n ci LO co LD ?L #' fir x� R, { iz d• „ �' .� 0 N N dd_ M a' i!7 6 ny 'l _�... Ln ' /� , pyx x 74 Ij : O o r A`■ W {"�� M r•• i t'�ii�'j, 1 ����_ Y'lya'"�` .: ��niyn�' )/�', .T' �� t :� L �.uE�• q r{LL p j Kr y � i�" 8 i. Kr '� ca co U_ .z'�Y F'.< A..m U Rk L 9:s { O P co .-. > 4 ,4 CIO d o. m o '4;.�.• �}' �. , ice. :�• `` N o - El _.. Ll El El El 1 U " U ,._ °� Wow a¢ O o Im o Al a W z z d US m w hn m a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 049, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE June 12, 2014 Maureen Marshall Office Ma (Name of signatory party) (Title) hereby state: That I pay or supervise the payment of the persons employed by N. Andover School Admin. Jupiter Electric, Inc. on the Bldg. North (Contractor, subcontractor or public body) (Building or project) that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on project have been paid in accordance with wages determined under the provisions of ions twenty-six and twenty-seven of chapter one hundred and forty nine of the eral Laws. Signature: Title: Office Ma yr, & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 5.30.2014 (Name of signatory parry) (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Building (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Signature Title /'GSI E LL t / � \ a $ 0 \ \ 0 m 2 ±I d � .z 2 k/cJ $ 3:z @ o G % 3 e=�55 C/) k 7 o \ Z = w r •. / E // E J eta Z CU E CU \ 0(L $¢CL / 0 E E & /0 2/ / E /co T 2 /f § o f / § ) � k \ 0 ƒ \k S R »$ L/ w F- 0 O 2 - : , . . . . i . ® - - e / 0 E E & /0 2/ / E /co T 2 /f § o f / § ) � k \ 0 ƒ \k S R »$ L/ w F- 0 O 2 .0 & STATEMENT OF COMPLIANCE records must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A payroll Form has been printed and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 6.6.2014 (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by MYSTIC PAVING, INC. on the N. Andover School Admin Building (Contractor, Subcontractor or Public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundered and forty nine of the General Laws. Signature Title 1 E i CL 0 U cB E O (nw O O N (D 0) a N ca 0 v 0 c� c � O -0 O U 7 N _ C 0 O cu >, O a U >, � Y C O 0 °' U 3 N N L W W H A rn C N E O "O C y W mZ a (D a Y 0 0 a Q a CL 0 U cB E O (nw O O N (D 0) a N ca 0 v 0 c� c � O -0 O U 7 N _ C 0 O cu >, O a U >, � Y C O 0 °' U 3 N N L W W H A 1 1 1� 1111 CL 0 U cB E O (nw O O N (D 0) a N ca 0 v 0 c� c � O -0 O U 7 N _ C 0 O cu >, O a U >, � Y C O 0 °' U 3 N N L W W H A c m LU W W 3: WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall fiunish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 20j_ i ►2 GAT ug Ea (Name of signatory party) (Title) do hereby state: That I pay or supervise the ayment of the persons employed by -,2�on the S�'�- o c �k7 n�� �idt t-) vv (� (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % K6gs DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Ll a a 74 Fli. ,��i� � �•�'" �' �... ,a..dkYY� �.ss'A *` n,,., &+^ ^C,W�"� S iu4 �. k t� d �._.���.�' �.�� PYe 7 a'a ;%47 A' H. � A.k 1$f�4f. f+3 a � t � {. � d ' i j � � � ld R � k"� ,:m ry� , •� S ; ��C' � � N '�' r� ,l A f! F�� - - F ��L*1d1 p i`� ty3' };1 d f °� •�riM fix'.`p i'# b N J7' Y JW } r N 4Z 15 1707 k t WIN � \ %y' � Y '� � � " � � �§tet✓" { V 33 rim IA � & pq 8 x \ \ 40 air t a't9 �' k U ?lam: c�.•� � �f y El El 0 El 0 LU 'Z ice : � y1; E" � � 2 h a �A w.m 3 o 3 g j I a a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall fiunish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form; STATEMENT OF COMPLIANCE C/ / . 20_Lq- (Name of signatory party} (Title} do hereby state; That I pay or supervise the payment of the persons employed by ���) ,on the Sck6,o ' �fiJ n �; r� y�7 0,✓ (Contractor, subcontractor or public body) (Building or project} and that all mechanics and apprentices, teamsters, chauffeurs and Iaborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % YCCAS cg &d�_ DMSION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 � o OCL o � O o x 00 o a y o a � 00 C as [ A z N 00 � o O to o V o CO L C ca � o O a A O U Q Q o N wxA o O .� V C i, c � � 3 H w H w C o U a U Cie = � 3 A 0 z 0 1-4 5 x o0 7. � O Cy U � LL N O z N O ^ z o o .G a z z 3 U � o OCL o � O o x 00 o a y 41 C as [ A z N � � o O o V o CO L C ca � o O a A O U Q Q o N wxA O V i, c � � W C o U a U Cie = � 3 A 0 z 0 1-4 5 � U o0 7. � O Cy U O � LL N O z o O ^ z o o W a z z 3 � o o ai a y C as [ A z as 3 o A o O o V CO L C ca O y Q( O O O wxA V c 0�° A o 0 0 5 LO L O O O �xA ° 3 ° 0 O v, to 3xA v 00 H C as o 0 0 3= w 3 H 3 x o 0 0 a a3 •O \ o � o O O O �C 30.=0 Hix o O o k C O O O L O 3F3x rY 00 a W 0 w ¢ H � o o ai y a F a A z rn '2 8 O CL �U f0 .6 O l6 3 N N `0 c 0 m E U m 0 c E U E E 8 w c 3 N N m E T n E O 0 0 m 3 LL w 3 m m C 3 m m t 0 O Z Y = m L :M =� -4 U 4 O"" .. N � = W + T O � =ALL r�,^ L / CAm W Ym O O Z 3 3 0 $ W 3 ! �3 : s Ch I� LO ado W z a '� @ V JO. V/� vO O G W m c m N m m M W° G � p ro � O Z m O 3 C f6 o"e 0 t0 G=a c= a a 04 C O L y 0 Z = ¢ V LL V/ cu U cis cu •L U a 5 Q � r o G o W U Q L 0 E 4-f Z L o d y_ cc Q ' 2 m J ; -0 m N o ¢ o m U C a U L i = `� O U Y O Uw • G 0 U � _ m 0 h E]I _ El 0 0 U °6 W°� CD Z o WLI.—W m a ¢ "� L w O m (a Qi o Q O w U EE g •t3 + w m O r n W m a CL o W v Q _ 10 m �i Z o - W U! U 0'm rn '2 8 O CL �U f0 .6 O l6 3 N N `0 c 0 m E U m 0 c E U E E 8 w c 3 N N m E T n E O 0 0 m 3 LL w 3 m m C 3 m m t 0 EWU moe PAYROLL AFFIDAVIT REPORT PAGE 10 DATE 05/29/14 09:22 FOR PERIOD ENDING 05/24/14 JUPITER ELECTRIC, INC. ALL JOBS JOB INFO 14405 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 05/18 05/19 05/20 05/21 05/22 05/23 05/24 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00420 ERIC P. GUILLMETTE RT 4.00 4.00 72.130 288.52 40.00 2346.64 11 FLORAL AVENUE OT R.RATE SALEM NH 03079— DT — — S # OF DEP— 0 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# ------------------------------------------------------------------------------------------------------------------------------------ 4.00 415.15 152.59 103.72 .00 600.48 1074.70 005856 ------------------------------------------------------------------------------------------------------------------------------------ 00567 JOHN D. IANNAllO RT 4.00 4.00 31.310 125.24 40.00 962.96 111 ATLANTIC AVENUE OT R.RATE SALISBURY MA 01952— DT — — S # OF DEP— 0 JOB APPRENTICE HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# ------------------------------------------------------------------------------------------------------------------------------------ 4.00 111.53 61.82 38.81 .00 164.04 586.76 005862 ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES— 2 TOTAL JOB HOURS— 8.00 TOTAL JOB AMOUNT— 413.76 CaTwwnwealth of Mas twusv�fts _ Division of APpreMice Training REG# E--054-559: , t .it.tP'ITER ELECTRIC INC. , _ .tiC'� WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE May 29.2014 Maureen Marshall I Office Ma (Name of signatory party) (Title) hereby state: That I pay or supervise the payment of the persons employed by N. Andover School Admin. Bldg. Jupiter Electric, Inc. on the North (Contractor, subcontractor or public body) (Building or project) that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on project have been paid in accordance with wages determined under the provisions of ions twenty-six and twenty-seven of chapter one hundred and forty nine of the eral Laws. Signature: / 72 Title: Office N lai rr RIF of NEI-, 7 . . . . . . . . . . . . . . . . . . . . . . . yy ------------- chi 1h ,sk. . . . . . . . . . . . . . . . . . . Inn% I �N— PIN 4"�!- W — FPS 01 — ,- 7 f Lid 117 LIZ W',4 ... ....... at r L2, oil HN: il 7 Sol W! F. "n, Ely Eli A NEI El n 0 Ls 161 "Aw. Lu 6 F WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed one public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days atter completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE ,20 14 (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by 0�C-u✓���A a3 v, °�E s Cor.,;argon the Sck&oc (Contractor, subcontractor or public body) (Bwldiag or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. SignatureE�� Title %I�E71s vg 6-zr� DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFOR.D STREET, 2nd FLOOR, BOSTON, MA 02114 -------- T TI- M", IQ 0A -v- rIO ic 5 'w" W-K,111W`�-11�11-t,, 41- b i F�, k� 414 LI tve rr�Av W, 14 R NO wel < < El 0' UA z A Lu is Vr Ilk 2LiJ WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with. Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the dcompletion ate of of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is years. also required to preserve those records for three In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment Of wages, in the following form: STATEMENT OF COMPLIANCE 20 114 rzGAT vd26—A (Name of signatory party) (Title) do hereby state; N C -v,) That I pay, or supervise the payment of the persons employed by fW4'-eA71e0 cmc J' mon the Sclt,o cI i7i-wiJ?Aq-D oN (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. SignatureL'�' .� 74 Title % k6AS vz 621� DIVISION OF OCCUPATIONAL SAFETY, 19 ST ANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 S. I ism TAN FE V' on IN -I r-1 F-1 F r El D IA 55't i2l .......... 7--777 75 91F AIR ri 15 [77 Xr. 7� FBI bid -Ij mom SIT MIT .......... I "too! `q, 77P pulp o F1 Flo, I ti WEEKLY PAYROLL RECORDS REPORT L & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE ,20A 1, HEOIQt?y S�ek;s i ►2�u�Z {Name of signatory party) ('fine} do hereby state: That r supervise the payment of the persons employed by v on the SCS 6,o c I I -7i#-, JTAA-D o/v (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature 42 Title % kEyls (w DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 �y O Tl u a T a� N a W CDN R rs�T S WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Ever► motor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. :lh addition, every contractor and subcontractor is rNuired to submit a copy of their weekly payroll records to the awarding authority This is required to be done on a weekly basis. Once collected, the awarding authority is also squired to presave those records for three y ewo from the date of completion of the project, Each such contmctor or subcontractor shall ffumish to the awarding authority directly within 15 days aftr completion of its portion of tkc warts, a statement, executed by the contractor, subcontractor or by any authofized officer themf who supervised the payiaent of wages, this form. A I 20_±L_ c � rt ,� D� Al, (N me of signatQoy paM--W — (fide) do hereby state; /mat I pay or super se the payment of the� ooIr �ns empi y by On the 11 (Contractor, subnantraittar or public bony) (Sauiding or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and turenty seven: of chapter one hundred and fora, nine of the General Laws. 09/11 }1 Rf�A.i o `v'G9 Y 0 m � m LL F�- N m �.m � N z J fq o a E `y w m + c O Z O d N f6 o a 0 3 c d mi Lu a d rn M `� v OD as„U d a E LL a _ - f6 c 26 m O LL z CO o a m _ o N A c = m x I` y ¢ E W � N o V w 'C► a N ° Z t J J p 1 M A O Z O f 'o o a axv O o -_ O z 0 C.) � 3 2 a } t � ti/ O 3 m U) N a a U a04 J W LL O J W M O = W U Y Z OW o 3:3. O W w CL E WLU mrX = Z ~ ~ N = > m W OO Z z E 20 - W Q zcu �' ` O Y! O m L) Q O O Z W v a m o ¢ � U) Nut U 3:LL V c O i, 2 d Q a O m r 06O W y0 fZ. E m U ZLLI o CD U_ u Y Co � W y E QD 0 m COy f�U E m o �' a C m Z Z m E a v E w in 0 v O E Z C L- •> m lA _ j Q fesf^^ V c o6 y E 2 m y • O � ., Y1 �. C W N ¢ Z W d Z¢ SS Q W o a 3: CL v W w ` a Z o n w 1� :. a) t a� E c• v CDCD O T w m E O T CL E OO mU O s m .- U T N -o o .P T m nm U C 'y0 d .@ m D CL E c -2o m U U � U OC C C m a) o v d E CL 22 n c +r m Q m in o •- m a� CO .0 E a (Do •m n -v v n M m y E O U C c U o m ¢ >, O w (D O U C O C, U _ CL E L a 3_ Q o o m ° N N n c O O to U M .° N O �^ _ O1 a) m a) • V O 0 O �p w.' m a) na 3 c O c a) O U � U c 7 O > �=� -0• m .�m '�m 7 J m C 0 •= Y O N = r- 0 O m `�E o a 3 E 0) m aNi --M o m T E N U m •C CL 00 C7 E E m N y y U (D Q a� m a) ( w o U U L C C C U m o y m ` 7 N T CL a CL n m O U m m LL _m ami m ~L O L E T ¢ LL. -0m Z m 0 o^ LC CL a m U) 0 w Z c a) .- U (a w � c o T T N CL '. a O U a) U C -a y m C O U U U 0 a C C m a) U y E �. 2 L c « m Q a min m o •- m E >. c •� c � a >w o a'c -- a m !� mmo mE J w m OU O U m T m 'N m < CL Z -0 r U C U N m 2 � M n m E L 3 �a 82o amo�>:_ (D0 : Q a N U N .0 'ON a T CM `m ? 0a >- np m U rn— O 3 m C N U L 8 N O f6 m a) n a c a> c U w U o 7 CDem. Z w > 4>) C, .�'.0 m c m c Y O N f0 o c N E O E r a) N (D .- `o m o. 't JU' E E E m r U m ca 0- m m m a) a) j O U O U U L c C U CO �_ N N N y ` E CL CL a n= > c m m w a) m m�I-E Q L0 OL - Z m 0 z mCr� ami c� U s��M3to0. Om hm 01 NJL I c n aCL E W` t6 �• +U W z d rn 1a r U m ¢ G a 3 muj w a M M m ��� C _ LL= O CO o ¢ 'c am =� Nv LL LO z' o N «� m _ N N j d 2 0 a x ~ v ° c Q CL E W N o r w J .. 1 a N L o Z c t ,A o z M u a U y ti .� a Q L 'C) C) O 7 CD O CL a U a LO N O U p WJ Li C% LL M L O 2 Uj U ~ 60 z U J O > W O w Q m U) J o = z M V1 m W a J4 z "2 U) Q O ° O G a > y i U (0 oZ N O a� ago Q O W m ¢ of Q fNnU a U ci a LL 06 C O Q a -U)o dam. 'O (.C)•" 3 W E 0 `m a 1- a N w" U U J Z s N Y f6 U W m v U) J a m C c E�r/� W 0 y R z Q E E g. d C C c p m .�' c 0 ZO Q J 0 m U a p p 4 t�o N C N Q Zd z Q i, W W lu a E W 06 c 'aL o cLo y o E �7 J U W W Q Z w LC CL a m U) 0 w Z c a) .- U (a w � c o T T N CL '. a O U a) U C -a y m C O U U U 0 a C C m a) U y E �. 2 L c « m Q a min m o •- m E >. c •� c � a >w o a'c -- a m !� mmo mE J w m OU O U m T m 'N m < CL Z -0 r U C U N m 2 � M n m E L 3 �a 82o amo�>:_ (D0 : Q a N U N .0 'ON a T CM `m ? 0a >- np m U rn— O 3 m C N U L 8 N O f6 m a) n a c a> c U w U o 7 CDem. Z w > 4>) C, .�'.0 m c m c Y O N f0 o c N E O E r a) N (D .- `o m o. 't JU' E E E m r U m ca 0- m m m a) a) j O U O U U L c C U CO �_ N N N y ` E CL CL a n= > c m m w a) m m�I-E Q L0 OL - Z m 0 WESQ'Ir PAYROLL RECORDS REPORT & STATEMIZEINT OF COIWLIA,.11610E- In accordmce with GdR-MA IaIv C. 149, §27B, a fi-ara and accuiv must be kwt of all mrson employed, on I@ PuTi-lic INOEII-9 Px0jett for which Che enclosed have bwn Provided. A Pa II Fo,-,m begs p�dfltej an ghe Fever of gWs PR& d nP 0 t b Y gt-� B 1 c C, rgm Z. t ag y a- V- UR' e� t e, k - e aa ludes all � tham, ---Ae Jvwa ?"o -w-23 of owary C-u-ninw-tir "and g, yv cap Eecw-as fj Y grIm-d bea dvr,�, or- -.0H, -ntert Orl- ovm7ldihm awy-bp z ty mv ic 'Ise Pom,• x Ihwhi Simb canmwozr az kk:.ai.sh sm,s -avi'v'r. , R , SUL jum).7 ��7 d e:=-nteo by ne, r 'wages, this form. ST ATEPAMENT Cid CGn_vtqp,? ,RA_Kr-pl 20_j 610 hemby atat�n Ons, em. -b 'Urs and henewors agnplraygd on aand@ff Lim- provisions of SMIGRO, WeRq--Siv- and Jhwen,4?-sevea of Chap-Wr ca,-. huadured and fbAy llipa�-- Offlaa Goneml Tu, i1 e 09/11 1� VV#i RF�p� a� t.. c c ._ Z 2 o R T al �fs� N E 'E 0y Z o , a a E m y U U R o N O N O 7 m aLL CL >. r�Q1*• j q N >, Z d o 3 a >- (D q) w o rs LL L C W + p cLE Veit Itt C LL,O+ U a N uJ p p z a°7i 3 rn v° c 3 U)N� a m W a d C) U. co `Y) � ao (Da � C o Z. O '� U S c 0 Z o N < _ N �V N N oAo J O O aCL i N c cmmm b W 9 o U) Z _ r C (� O z3 =_ _ V a L 'O^ O 3 (D N 0 Q e�yy "V d a v a t — J W U- GO M O Uj LIO Ix W = Z U o, F- p W J N W �. U p T y z (5.60 �0 f WAA z .. 2 ;; ca Q p of H N Q V = t6 a` y > Z � N ago Q c W .R�. a X LL Ls a � +� LLI 3E ° m a i= a rn " U U ? o y L f CD U � y m �. 'J y S" E Z Z c CL E v T` X q1 7 gn Q N c .. Q U `tis a 1 IEO 2 y 0 > C in s Q J C7 Z 0 E a a E-16 Z a i Ili e� N W _ a> W — a0)d� - _ a+ j ao LL d n do a� .L 0 W E ; Z aci w N 0 a U N -p N C ao a V C y N R m m E W U U U OC O C C R 4s U y E •- R C U •N C y N OLCL o a c m a a y aim �' E .3 U O N N <>, o vi m EL . a U U M R L E _ -Lr-) $ =mQa O o a R o �. c a .o+ a o w U y cn a m a> m rn� o 3 R C b U L O N O R N a -a m U to6 U >�=� o a• m =' 5. t o m c o YO N — C R N o c vj O p E aj U R `O f6 4 � U R .0 Q r y y U N (,DL N N R M 3 o U U t C C U R i C N N y ` A CLCL LU R� ~- E Q ti .n Z m oci a� t.. c c ._ 2 o R T N E 'E 0y Z o , a a E a y U U R o us U O 7 m aLL CL >. N N >, Z d o 3 a >- (D q) w o rs U N -p N C ao a V C y N R m m E W U U U OC O C C R 4s U y E •- R C U •N C y N OLCL o a c m a a y aim �' E .3 U O N N <>, o vi m EL . a U U M R L E _ -Lr-) $ =mQa O o a R o �. c a .o+ a o w U y cn a m a> m rn� o 3 R C b U L O N O R N a -a m U to6 U >�=� o a• m =' 5. t o m c o YO N — C R N o c vj O p E aj U R `O f6 4 � U R .0 Q r y y U N (,DL N N R M 3 o U U t C C U R i C N N y ` A CLCL LU R� ~- E Q ti .n Z m oci WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLLANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every conbutor or subconuactor is required to beep these records and preserve them for a period of drive year. from the date of completion of the contract. f In addition, evsuy coaatractor and subcontractor is required to submit a copy of their weedy payroll recon to the awarding authority. This is inquired to be done on a weekly basis. Once collected, the awarding authority is also required, to preserve those records for three: year from the date ofcompletion of the project, Bach such coaatmctor or subcontractor shall furnish to the awarding authority, direelly within 15 days aft completion of its portion of the work, a staternaent, executed by he contractor, subcontractor or by any authored officer thereof�jho su wages, this forma. pervised the payment of STATEMENT OF CON[PI L4NCE Z (Name ofsigaatca�atty) (Title) do hereby state: That I pay or supe the payment of the g ons emp est by 1'� �tmon the '� (Contractor, subcontractor or public body} (Sulldittg or project) J and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-sevenof chapter one hundred and forty nine of the General Laws. Signatrar �g Title �o..�___._ 09,/1,1 O m 'O a) o C Z O N `m N a) v_ c CD CL a m cn W Z N Q E 4 U � o o •- w c C o 0 > y Q y 0 a y D .m m # m E -6 VU U) V O U O C C m a) U y E 3 N dC r (0 Q m v, o m C U M .2 : L L a o m CL m� E J U o U) m Q T O N a) Z> a w '� -0 (D U C O N 7 o_ c6 E 3 2 Q o 0 o ami m O mo 0Q.. O "a O y U fA O -a•rn y+ — a5 > m a) •V T tm— 0 3 m c rL)L O N O m am V 0 c ) _ U U CO 3 oma• m = .. m 70, m . o !E Yo N — C M N O y O 0 3 m N � 7 O m o To T E n J.m,C ao E E U (D uJ w oa) m m m U O U C y C m i a) QN a i T Q p_m O� U C13 m a o _ di m ami m� ~r E `o > O O Q LL M Z m u 4) M m a Z WS e� liih U Y j 3sil a F0 x al 3 �C1w0 Q E ° ofIWO a d a C 41 N C + p W to v a +3 �+ d W U C Y C m Q o Z N 33 tm U Y m 'y m p a `p = ami as Wy 0' °- rn ap 06�r- NN If. � 0)L (0 U �y r- @ 0 LL O Z (0 0 (V < _ _ c NJ p 04 00 0 m N NxCO W a u) ° Z L �t .JJ 1 z `o U) c = g o` 1: ¢ e(1 tai O Z QL\i./ C O 0 c�Oo N 4 �ci a IL U a Lf) CN U 60 W J LL M O (/j W = U Y Z of 3: O w e Y.J d W c» o 2 1 = >Z d Z H W NO z e N Q " D O O z v', O _ (d y O • m V a 0 o Z w V a m o Q� U) fAa W to _ r opo m� W w E°-m`r a F- a y W J U Z c A .42 0 U ` U U) y obi L +_ Q a1 m tN6 U ..1��111 Q U) J_ H a G LJo` ei7) m E m o v y c ° 0_ m g 0 .6 0) O E of m _tg� O ,� 7 Z UJ T > C W N N Q rn Z W d y Q L i [ a ? m nN�Xe✓ w i U W w a Z O m 'O a) o C Z O N `m N a) v_ c CD CL a m cn W Z N Q E 4 U � o o •- w c C o 0 > y Q y 0 a y D .m m # m E -6 VU U) V O U O C C m a) U y E 3 N dC r (0 Q m v, o m C U M .2 : L L a o m CL m� E J U o U) m Q T O N a) Z> a w '� -0 (D U C O N 7 o_ c6 E 3 2 Q o 0 o ami m O mo 0Q.. O "a O y U fA O -a•rn y+ — a5 > m a) •V T tm— 0 3 m c rL)L O N O m am V 0 c ) _ U U CO 3 oma• m = .. m 70, m . o !E Yo N — C M N O y O 0 3 m N � 7 O m o To T E n J.m,C ao E E U (D uJ w oa) m m m U O U C y C m i a) QN a i T Q p_m O� U C13 m a o _ di m ami m� ~r E `o > O O Q LL M Z m u 4) M m a VERY PAYROLL RECORDS REPORT STAT-EAfJEN-T 07p COWS LiA�NTC )h 2c---oTdmc@ W.;gl haassfichusep-m- lay -V c- an §27B, a Lw d accum-ro r6 -c MuSt be, ked:ked:of afl parsomws egriployce, op. the pUbil 101 , _t f % u (� ,lie cncjo,5e6 rates have ba --a Folfided. A Payroij Foa . has b@zz�, pyl;uted on the Ea- tw-q p e 'Jude,3 no via 4 �a ba!mro,-, -04V �vw ag di, all J"e,6 c �7.r, U diGS5 zc-rjwf& Ead ,gypa pn c 5 zot-f ,kc,f iS F"�V&Ted X, sAb cam" '�,'�nkdy nt"Vok � t�-- I S� � - gE, V, ,Onz-i� 's 'je, larto 'an A- I= msm-db- af 7- Zvz;ihviiia 5.5 �ft;�F ix p'u,"i-In lof 16a - o Z. t,!• mne wagag, this folm. Zi3 a n. 2 cj-' a T A-TEBM-FINT OF , & --W--e-L- 20--i-q— tv pmyvy) Mrs and labowors e-I-nPIGy6d on Oic"Wined zmnd-T, Cho p.w-visjoFIS of 09/11 all \ \ / Co \ \.� a � � } _ 22{ } f a -.d R.. th 11-0031751611 This card acknor�iedges that the has successfully r aipientcompleted a 1 O -hour Occupational Safety and H"IthTraining Course it Construction Saiety and ljeatth -J. :L-UeM----7 . ....... Maria Alcantara FTratnar 04/28/1 type) -L? (C--ul�e ­en�'date) ` � } � \ �\ \ G e -0 .. � - 66 '� T� ' �� . .vii. .' c v � �' v� - C � L+ y :44 J. u - _ s' � i ■ f «�{}_\ƒ- - qa@.�� / _� — � • \ O 0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is ' required to keep these records and preserve than for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE i 20.1= !� ry party} l it C-�}� vs2 4-AiName of-si ato (Title) do hereby state: OAC-v✓EThat I payor supervise the payment of the persons employed by ;,����v,(mES �� on the 5�� c,o c %7 i �" i J T� F!7� ur✓ , �D'i (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and Iaborers employed on said project have been paid in accordance with wages determined under the provisions of General Laws, sections twenty-six and twenty-seven of chapter one hundred and forty nine of the Signature 729 Title % 1C6AT DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 cs%yv..Rer. titi ':4 \ t.9 \ \ jai S •-. ISJ. ` i tg K.} O 3: tiW - 4 3�,• C .r0 ro :� � �. �7 _i �-a. iia..: �( �;+� t , i' •. ISS -10 f733 �7�. >- © of •' :(T� ?. d" ` }, Nt c UM gg } L�• "_ S 4 � � .� � 5 Ya.r �� = G `o E 3Us ; `vE m i, a a l�1nh 5„43, 9 pC CL T i�Y��k" -•t s � b � U 4r V U �` V a o C a C1 > Q fnEl El P F1 T _ w Ucl _ f •1 J Y r m �' � /�� � 0 a2 §ICE L EL N Z •,c WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE I � � 20 4 t, HES,-\1 S Ae -v(_,S i rz C- L),2{Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by -,��fk>on the Sc, -coo c (Contractor, subcontractor or publu body) � f-7 i #' i J'TA,9-jam o,,, (Bwlding or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % �E7+S 1,a 6v,( - DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOD BOSTON, MA 02114 T 0 O N L o U) m - CL mL•'• Oc O U U L 4) L L L _ r U) ac M n. L ca N p w N_ OZof N O 1 m ° °EN U N N- c ca)c a) L a) L c dr rn a) E a) c O U >.Nw O (n m Q a) °D c c LU = N L .2 O aE CL L aU) m ov U W U m 7 0 Of c _ p Q L p E U r (n U T m N V_ c cL E c LL y W a) Z O E cn..' O N W N p 2 fl c c co a X0 co m (D 0 0 m: m LL W r3(D Z O W 0� I a W = W U Z Z Q W U C c m(a) v m M ° C w •� M � N ' a) c O m a) > co m cc c v) a > a d Y N d o .L-. . x -Co, N Co U N O N(D N « N X > c c (n O- m 7 C° O O N m O m U L 0 •= 00 > 6 6 I N or a) d C c a) a) T 7 .D C r 7 a E � L U T Oro m y m m r U O a (Da)a) a) mCcC. 0 mmc O m«O- N C w C` d d N a) U) E E OE m a) c L T p) 0 0 p C a) C L_ 'O E a) U c" U a) :DN N U m C a) C N ) 3 U N_ .m+ LL ° N N a) m �0 3 N " ac) p Y m C V (o ( N cc N O C E m Q a) d 7 :a C L N O N V N CC r r O L O N C'o 0)- c C LL y N C C CU Q) Or D C Q) T O75 .0 ,N .6 N R E >. C ,= - YO � a) Y U a'L y O O U C.w � m O C � -2 .L-. a) > 7 p U .L U C C 01 C c0 a) 3 m @( aNi v cc a) L v v m o�°.� � C co w cc - c 3 w e a) °� � Q °� c c g yJ.O LL D o E Q) ti p y m j N E O m a) O C Q O C i/) .. O L N U m U a) .N. p v w c,n �xm v v° m U CI- 'E c a F me o 'or ` 'p E O� m E m m( E m a) a)L 0 m m a O. D o 0 -0 C- a ch c 7 N O O N ° O- � a) Q T T a) U G O a m U m y C atf d C C J Ci O N C y' ca 'm0 Q1 m m a C W O p_ Cu�3 O > 0 2 0 w y Z� 3 u �i a`) N 0'm a U (D< Q n m n- CL— cc >- vL_�o ° c c -° a) 3: p m @Q F m am U L T > U cG ° 7 @ 3 (� C U a) = cn O LL L -O O V U` m C C u� fn cn Y m () m a) O 7 W Y U a) C L O -C O m' E N• W O m V - C � U n C :E co m m U) (D y C C N :: Z) m W cO N ca N N NO C C T V U L L ° •+ m 0 a) N _C a) > m macro v c m. Z_ a >- ° O N d'O ° .T+ m .L.. a) L y O .L-. U C L Of m O '§ :� a -O = (° L U W E F r$ LL C m O c Q) N y N O) N C cc N pd W a« M :z m U n y c CLU) r W E d N cA U 'O m 0 0), m y N mO) > a) -O O) 01d ^ LL U 'O L -O 3 0 L N� d L v 0 E 3 3 00 0 °� m ~_ �.° F co Cc t Cu C.L Yw �.0 `_V _ N a)LL N aN nO. fa cu `S 3 YUfn U m U mQ<n c o CL M �N U L OZof C Oc U) ° c � L O a) E a) c O U T m LU CL L > U Cori r @ Z O N ° d c X0 0 U L m a 7 Z Z Q Z En N O 0" � Q) T W W cu y n = J H Z N o N � L � r J Q) O N L v 0 LL W 0 LL fa — U ca W � kt-) U Oca W < ¢O W W xaw LL 0ZL) H O LL LC Z� W Q F U c 0 Z E z O O nJW Q > Q. o < L) U m LL�W LL U)crx w w J H _ QOr W H LL F o _,()o Y Z -i Q a �ZF O LUM Ix Z ' F- vn 0 C c m(a) v m M ° C w •� M � N ' a) c O m a) > co m cc c v) a > a d Y N d o .L-. . x -Co, N Co U N O N(D N « N X > c c (n O- m 7 C° O O N m O m U L 0 •= 00 > 6 6 I N or a) d C c a) a) T 7 .D C r 7 a E � L U T Oro m y m m r U O a (Da)a) a) mCcC. 0 mmc O m«O- N C w C` d d N a) U) E E OE m a) c L T p) 0 0 p C a) C L_ 'O E a) U c" U a) :DN N U m C a) C N ) 3 U N_ .m+ LL ° N N a) m �0 3 N " ac) p Y m C V (o ( N cc N O C E m Q a) d 7 :a C L N O N V N CC r r O L O N C'o 0)- c C LL y N C C CU Q) Or D C Q) T O75 .0 ,N .6 N R E >. C ,= - YO � a) Y U a'L y O O U C.w � m O C � -2 .L-. a) > 7 p U .L U C C 01 C c0 a) 3 m @( aNi v cc a) L v v m o�°.� � C co w cc - c 3 w e a) °� � Q °� c c g yJ.O LL D o E Q) ti p y m j N E O m a) O C Q O C i/) .. O L N U m U a) .N. p v w c,n �xm v v° m U CI- 'E c a F me o 'or ` 'p E O� m E m m( E m a) a)L 0 m m a O. D o 0 -0 C- a ch c 7 N O O N ° O- � a) Q T T a) U G O a m U m y C atf d C C J Ci O N C y' ca 'm0 Q1 m m a C W O p_ Cu�3 O > 0 2 0 w y Z� 3 u �i a`) N 0'm a U (D< Q n m n- CL— cc >- vL_�o ° c c -° a) 3: p m @Q F m am U L T > U cG ° 7 @ 3 (� C U a) = cn O LL L -O O V U` m C C u� fn cn Y m () m a) O 7 W Y U a) C L O -C O m' E N• W O m V - C � U n C :E co m m U) (D y C C N :: Z) m W cO N ca N N NO C C T V U L L ° •+ m 0 a) N _C a) > m macro v c m. Z_ a >- ° O N d'O ° .T+ m .L.. a) L y O .L-. U C L Of m O '§ :� a -O = (° L U W E F r$ LL C m O c Q) N y N O) N C cc N pd W a« M :z m U n y c CLU) r W E d N cA U 'O m 0 0), m y N mO) > a) -O O) 01d ^ LL U 'O L -O 3 0 L N� d L v 0 E 3 3 00 0 °� m ~_ �.° F co Cc t Cu C.L Yw �.0 `_V _ N a)LL N aN nO. fa cu `S 3 YUfn U m U mQ<n c o CL U L O C Oc U) ° c � L a) E a) c O U T m CL L > U Cori r @ Z O N ° d c 0 U L m a 7 En N O O � Q) T cu y n N o N � L � r Q) O N L v fa — U C c m(a) v m M ° C w •� M � N ' a) c O m a) > co m cc c v) a > a d Y N d o .L-. . x -Co, N Co U N O N(D N « N X > c c (n O- m 7 C° O O N m O m U L 0 •= 00 > 6 6 I N or a) d C c a) a) T 7 .D C r 7 a E � L U T Oro m y m m r U O a (Da)a) a) mCcC. 0 mmc O m«O- N C w C` d d N a) U) E E OE m a) c L T p) 0 0 p C a) C L_ 'O E a) U c" U a) :DN N U m C a) C N ) 3 U N_ .m+ LL ° N N a) m �0 3 N " ac) p Y m C V (o ( N cc N O C E m Q a) d 7 :a C L N O N V N CC r r O L O N C'o 0)- c C LL y N C C CU Q) Or D C Q) T O75 .0 ,N .6 N R E >. C ,= - YO � a) Y U a'L y O O U C.w � m O C � -2 .L-. a) > 7 p U .L U C C 01 C c0 a) 3 m @( aNi v cc a) L v v m o�°.� � C co w cc - c 3 w e a) °� � Q °� c c g yJ.O LL D o E Q) ti p y m j N E O m a) O C Q O C i/) .. O L N U m U a) .N. p v w c,n �xm v v° m U CI- 'E c a F me o 'or ` 'p E O� m E m m( E m a) a)L 0 m m a O. D o 0 -0 C- a ch c 7 N O O N ° O- � a) Q T T a) U G O a m U m y C atf d C C J Ci O N C y' ca 'm0 Q1 m m a C W O p_ Cu�3 O > 0 2 0 w y Z� 3 u �i a`) N 0'm a U (D< Q n m n- CL— cc >- vL_�o ° c c -° a) 3: p m @Q F m am U L T > U cG ° 7 @ 3 (� C U a) = cn O LL L -O O V U` m C C u� fn cn Y m () m a) O 7 W Y U a) C L O -C O m' E N• W O m V - C � U n C :E co m m U) (D y C C N :: Z) m W cO N ca N N NO C C T V U L L ° •+ m 0 a) N _C a) > m macro v c m. Z_ a >- ° O N d'O ° .T+ m .L.. a) L y O .L-. U C L Of m O '§ :� a -O = (° L U W E F r$ LL C m O c Q) N y N O) N C cc N pd W a« M :z m U n y c CLU) r W E d N cA U 'O m 0 0), m y N mO) > a) -O O) 01d ^ LL U 'O L -O 3 0 L N� d L v 0 E 3 3 00 0 °� m ~_ �.° F co Cc t Cu C.L Yw �.0 `_V _ N a)LL N aN nO. fa cu `S 3 YUfn U m U mQ<n J 0 O W CL N C w Or Y w W OO q W WU' O L6 m w Q 3 z Q p_� N NM 3 O r Q J O ILA 0U) Z 0) M.!-- F O0 0 W N Ow x a ❑ z H o � O00 W ~O CO p Ow !� C 7 LOU c} W U Z wc O) N0 0) O m O) a mU 2 O Q Q W ❑ N N uiN c (n J 00 2 xx F ❑ Q O � �O~ Cl) S Cl) F0 - (D p N Z WIx M _ .O O tr O O E E a O N Z 'a O O H O m Q U L > LU Z ~¢ CD Q LL CO O Q > U) J O O LU Q K Z H 3 OF N Q a 30: U O c r (O L O O) �j W 00 Q ❑ F- Q Y tr o- o 0 M 3 N � r O O O 2 '1S LIO '10 O w O m O N O N O N O N O N O O c� Q W Z O w O W 3 Y Q a U tO O LL Of R: O NFn J A U E SNOI1dWRX3 O K O ON!0l0HH11M U d0'ON Z K O U U m K m C U) 2 O U N z Z W IY C U' CO U O Z Q LL U W y ZNir ® Z ooh K Q H O 0 > 0 LDW N 00 Z O O = O OU LL Z Z J Z F- Q N G N LL 0 LU LU a 2 zg Of a z a d n° m jp l0 C a C p L w O J d N UU a; d Q N l0 o a 3 d O U J O c d M N U T M E t m Qau ❑ m rn� o d N >. cy a a d d t c 3 � d C C C d C « T c m'- E O jp d N d c y L C c U C E d o -m o d o 0 `c o U ;'a o 0 o d c d N Ol m '> m 3 m d N Q O « 00 a N c d E O V C p 2o a a .. d m U r d rn .03 C- 7. . d d d O V N d Q � d N C N O N O d U a O U C U 7 O C N N N C d O rn c 3 0 N L N d- U LL p N N O N d 0 O N 3 c o c W U d rn €0 co t � ❑ d b C U O T O O V U C U a C d 0 d & O ON d Y O a d y 3 N O N L c a LL y W « d 02 o m U w N d f0 �` T LL - �' c 10 m > O O N U p d O O 3 U 0 �m d � v `o adi E ` o o 0 O O OC U O C N L N O WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at ^.a - and includes all the information required to be kept bylaw. Everycontractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: wI STATEMENT OF COMPLIANCE ,20� (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by - � r�, 41'� Zq on the 1'a(?6'4&doten Or-, (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title C /14 w O 2 c 0 0 ca co 0 0 c 0 ccU m E U 0 c a� aEi U N E E 0 aoi d T N E Q E 0 U 0 m co LL .o rn c td N N t 0 T I I 0 a d Z r co a` O W - t G x3LL LO LO US _ a- 2 r Y 3 r � 0 a c °rn 4 a W _ O' LO o ¢ 3 _ N a 0 V a p f j O W m LC) O Q it mo T m ll1 a 3 Cl? Cl) cc 2 L C = z° LF 3 Z Ll (D CO CL 5 0 S m CY') O O i N O Q c i5 — D S` m L 3 cc N E c 3 c Q cu g > CD N O U ' N t0tq' � U m � N O Z 0) E a rn O o E o z N O C: Q 3 Z ° m c 06 � LO m t/) c O c c O Ur Ej c6 - � 3 c o C O U mom E0 x El Lj - - 0 El � W O U C G .0m > o _0 c '" H a) W L o c6 m IJ (Oj m Z 0 z Z 8 m 0 oC c cu LL z U)C .6 y O E W E c �p o i o m Z o W U W 4 L7 E w O 2 c 0 0 ca co 0 0 c 0 ccU m E U 0 c a� aEi U N E E 0 aoi d T N E Q E 0 U 0 m co LL .o rn c td N N t 0 T I I 0 a V � C c E w UzY a _ a0i d `O 0N O CL a LL a� 0 'o c Q t 0 0 Z v O v y `o U (0 C O U CO alS N 0) � v � O CD Y 9 U Cc m E C t c U 3 3 L CD a� zv� U C C O N Cl) 03 p� O N N f0 O V O E m v Ua L o a c 00 ca 29 ov�o u x �o m � F c 0 0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Forrn is available from the Department of Labor Standards (DLS) at 63, : :;`wo sio y and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: KW2 STATEMENT OF COMPLIANCE OCf 2q , 20j' (Name of signatory party) (Title) t do hereby state: That I pay or supervise the payment of the persons employed by - N rnl :� Imo ^ on the �o��,An(lorQj-, ''CbQolljdTitI (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on Oa said project have been paid in accordance with wages determined under the provisions of w sections twenty-six and twenty-seven of chapter one hundred and forty nine of the OGeneral Laws. Signature Title 05/14 CD s� N d X n N O N F (y d O T C LL 7 0 x N r (D Il co M Uc0 7W N O Cl) O O N (n N O Z I d N N co d O O O ow ci Q � y O O. 0.u. y °o o oaCo N s U .L 6 U C O N� 0 c F -Q mc N � 2 Y 7 N 'O Q O C7 Z o p Y a 1 N N we E M 3 N `o U Z - C Y i W oz rn�o Edo O LL U a co otS O A O C y N N e - v . O O -7 co C7 .0 Q m E T y co 0' ao W 3 L 3 O O Cl) (L)N Z a a O Z N ` O L 0 M V y = N d 'o W E o. T LLI- 04 N O co co N_ N_ O o 0 0 0 0 v (o (O CO v M N CO M to w Lq co o� (n v v O O O O O O N (O N O O O O O O N N N o O N O O co O O o N O O 0 OD Go o O o N O O 0 O[i 0 o Q' 0 x a' 3 0 x (D N co 7 0 x N r (D Il co 0 0 x N co N M co N O Cl) O (O co O N to N (n N O 0 co R O O C O H Q Y y O O pQ Q Q W N s U .L 6 U C O N� 0 (/) 2 Y 7 N 'O Q 2 c o C7 N 2 Z L C N T Nca � y LL co C Y i C a' J ~ O z I 0 U cc N N r 0 0 N c m 0 C 0, U E E 0 v m c a N E Q E O 0 LL 0 w cc cc Im S cc3 0 I a IL Z W) N W N i WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at rr ; r<.w . -- 1, ) . -o -,w and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: we 3 STATEMENT OF COMPLIANCE ()aL9,20/- _ (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by on the 1Vor4A/ do(PrS'ChoUJl9dmin (Contractor, subcontractor or public body (Building or project) `t and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on C said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature i.�' ----- Title A 0 I m IL = r- co CD NNN o U) cD0 N ao NN M_rtEr " a�� $ 3_ a? p rn rn tasnN° 0 = w o` g m 3:O LL Cl) Cl) U') LO Cr) O Cri O M O c cw 0 N a �` 9 ci m' -a> S a O 40 p pp . Lf) Cj pp O CO O 00 Z f) x LOa 04 O u _ m w a 3 � m ¢a z° LO O co Q x `L a `ro a O NO e i oAiU <amg x ` > =35 ii O c m ti m m o 0) p 00 d7 LO Cl) CD Oo r.0CO O OD O o a � L � 0 �} Cl) dp Vp c c i z G o `-' 6 O Z �a a'<- a = �e 88 $ = co N Ch CD N Cv) N C) N Cv) 0 2 U) U) CY) O N p c ' L O Q p 3 m t6 E -0 c N m o 3 L N O Q O O_00 (6 y O CC f0 E d: U)E a) m N c L) F z' L o C C U Q , j c p c a ALO O ; Z .m o o V b 8c o Z, L v W c VI L 3 O%) c C) � O m aw r Fxl F El El El Ch0 �1'� V L W 0 3 Co ' O - O m -_p O m Q O E p, _ Q L P 0 m °° is m -d Em c UN .� tOV ,, O Q L >, U) o E O q c - � c O Z 'c 8p CO U " O U p y c � a) Y 2 Of z � U to a w O c E c W 3 E m O j c 3 G N m 0 L 70 L n m' 3 F—O a) Z m o Y v ) Z W g LL pE C W < 9r m w A 0 I m IL V O MN O v 0 O U f0 R C L S 6 C 3 C 3 O G 0 O Ul M V N f0 0 O d E U t o C W N C N O o v o O � x a 0 0 U R W � N U N T a M co W N m O W M Z m W O O � O O � C F d M N 000 O r- N V V N �0 V U0 N = 0 W N Cl) N aO V M O N M N Cl) O W W W Cl) W Cl) d x cc F c-- 0 W rn W W W n sf n q Vi W f� W n W W x 0 O O O O O O O O O O O W O V M O co V W W N OI O Cl) LL W N N Cl) U0 N d V N N N N W N N N N N r r G j r,: rn r rn co W r� m N rn 1� rn � ) mn n rn � � � 0 o a (o co 0 of co co H U) V N CD LO V LQ C7 d Y d n W O 0 W W dEo rn 0 rn rn rn rn m V Z d d Of A O OO O O O O O O O O O C O O O O O O LL CL �co 0 of co co yM co N CD Vi co C7 co v CD co Ln Cl) co v co c co v r 'Q O O O O O O o CL O W N V N N N N = M co Cl) Cl) M h O O O O O O O O O O O O O O O O L O W v N 04 M M d = c+Ni E O N U) LL N0 W O� O W O O W W O co t M N O F fV N jO N O W O O W 00 OU� co O O O co O O W O O co 0 N o SLQ o 0 0 F— co W O W W co oo N O W O i0 co O O W O W O W C T U d T 0 •- a� � a) m � a; w T >. H 7 7 7 7 7 r U S Cl) co N S W 0) 2 W 2 W Oni 2 M m_ 2 N N Z eo v C6 O c v N co o 10 o r� co co ao V 16 M co L0 in U) N M N V) O O O O O O N co O N O V V W' N V co E E CD �, o m— o —y F— min W y� o cc Z>�'x v>o Q� al -a W k r a3i '> 00 r 3rn N 0 O GI N 0) Z Y Z y c U Oi � cp O C— C_ 0 O C O °' E N L N 3 0 N 0 0 T O C C L j 0 0 LL 0 E° C a ti U' N Z L.. m M N O.Q O m >'?� C W W U O) Z W m f n M LL N 22 a� W>> Y— 3 N M 6 W LL' — J .. v aIt d O a o � C O 00 oo c QJ o M 00 U ti � U L o U y Rf O O O U b ¢ O U i wxA x O v od •.�, C ,UL+ 3 H w H w 0 0 N o x O O O x Axa U L .t' O U .. v aIt d O a C O C 0 y o U ti � U L o U y Rf O O O U b ¢ O U i wxA O v � S C U d a C O C L o U y Rf O O O U i wxA w C o A o 0 0 N o LO O O O x Axa L O 0 3 xA N o H C o 0 0 3= L w 3Hx 3 o 0 0 C U 3 i 30�0 Hix 0 0 0 'L �k O O O � _ h •� L L QS c 0 c 3H3x o Cs, a .. W 0 CO U •� 5 � N GL N w ¢ H r�5 6 Z o 3 a` 3 ~ iasnN N M OC) d c� 'o N c r O« m m a + _ LL ,mw 7 2 m as 0 3 T v M ti Goo c m ¢ 'a 01 c 2 O A Z O Q g m n ca�� ~ O o J Q y m � pmp m O CL � » o a U a L n N ..0 O o � Z m LL 4-0 -cu p U C Q � V •L E > cu O L— 'C U) L � m � E • i..i. ti � fC 4� .E, O i Z ail m \ Q C •m MEW m o N = a ° a U C o � U L L H _ m O F Lil U c7. c 0 U «S E O m ^' Z 06 U N w U m W L m E Q Z a o a m U CU z c in `o 5 E C m Q 'T t Q d W m ° a s s e m 3 o cA U W 4 (0 Z w r�5 EWU moe DATE 10/23/14 09:56 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 4 FOR PERIOD ENDING 10/18/14 _ ALL JOBS JOB INFO 14405 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 10/12 10/13 10/14 10/15 10/16 10/17 10/18 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 1.00 5.00 6.00 72.820 436.92 40.00 2030.48 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079— DT M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 6.00 91.71 123.51 69.44 .00 470.97 1274.85 006629 — — -- ---------------------------------------------------------------------------------------------- JOB TOTALS TOTAL EMPLOYEES— 1 TOTAL JOB HOURS— 6.00 TOTAL JOB AMOUNT— 436.92 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c 149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 10/23/2014 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: '�7i� 9yC=L_ Title: Vdministrative Asst. Date: October 23, 2014 I, Leah M. Hatch, Administrative Assistant, do hereby state: (])That Ipay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 12th day of October. 2014 and ending on the 18th day of October. 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLESIGNAT Leah M. Hatch, Administrative Assistant RE Ckj NAF 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. n 00 N b ami O o R F a Q Z 00 E a q q 00 v q q U cc +-ee o 0 0 u o Q o a 3 � w h w `•=' 0 LC L A O x O L �x U N 3 o � z r- N O x° F ^� q a� N O o o 'n a � '•' to 3F3x a 0 0 q 3 •O \° 0 0 0 q ° O O O 42 N cc 0 0 4' •L � L L 3F3x o, c� a W o 0 0 iii GS a 3 0 eq Ix U U LU A w ¢ U d d o N O tCi vi CC1 O � 3 U O N U cv Q z � •L b �+ Ob N Gq CA W o W ti a U � o q Y o w N U o � 0 c a0i o Z o o W a z z 3 00 N b ami O o R F a Q Z E a q q v q q U cc +-ee o 0 0 u a q o A o 0Ix 0 LC L A O O O L �x 3 o � z r- N O x° F q a� o 0Zi 0 3= '•' 3F3x o 0 0 q 3 •O \° 0 0 0 q ° O O O 0 0 4' •L � L L 3F3x a W o 0 0 0 Ix U U LU w ¢ 00 N b ami O o R F a Q Z C 0 •U Z m 0 ca Mn 0 0 E U m 0 c m m E 0 0 m c m m E A CL E 0 O N LL mm rn c v 3 m t 0 rn s d 2 K i � U L°, Pg c� O LLc9 1�SnN /1 1 V a o 3- a` 0 3 ti /1 O z WW C%4 (� m m a N W Y � � T 8 M i` 'o W a �. a a N � 0 d 0 i 3 ,emm div 1x O o z� OD m _ OO O ° > N m 03 0 Z m m'g^So m u S 3 s co c0 a� 3 o 4-a � O Z o con cu CD � m cn V Q •L CV Q U 3 O Cu O W � •� z u N E Q (0 Q > O z " J a Y ti 8 m w a • a am m m o CV x c h U C o CU L i O _ U2.El L Q L U _ Li El El El Um «S E 0 CU Z E �' Q) W w W m L E O t 00 m m = z p � E � N s3 0 a7 Q O S i m a a W m Z a o W C @ Z I o W 0 d I C 0 •U Z m 0 ca Mn 0 0 E U m 0 c m m E 0 0 m c m m E A CL E 0 O N LL mm rn c v 3 m t 0 rn s WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c 149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 10/29/2014 I, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) o hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Titl Qstrative Asst. Date: October 29, 2014 1, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That Ipay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 19th day of October. 2014 and ending on the 25th day of October. 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE Leah A Hatch, Administrative Assistant IGNATtAt [i 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. % z ' x S ci k yi " n. � � �� �, �°,1�Gs'� y h �� 4$� �✓��,�v�.'� '�""'� '.. Y"ar � al�+� �Y y` ' %+. �^ °xeb ^0.» mde,� �.ai.3 .� i� ,X' �✓.'�' �y,k1*` 'Yu.. PA cS cc LL fs -S " - o3t Lu ggr x' A t I OR O OFrz Os mui gr C, 0 m Lr b'3a U b S rr- C Ova 4 a E �' r. x � �hG 7z• �=� Ell" f (!(^iy PA ��r a El 0 0 F AN P v O<a o , C 1 �� •� sa LS ;Ca V� � � ; 1� '' `` `" 3 3 ✓1J v 11W � ' G LV � r Q � WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 11 % , 20 (Name of signatory Party) r— GAT u� 6-A(Title) do hereby state: That I pay or supervise the payment of the persons employed by the Sck-c,, c 40nt'-w;j r�c,gi70� (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title% �E ' c fz DMSION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 M 0 AEC QY o � S A s C ,:.mss tt ..✓`.Y*e? Y `P .t�y r F } x n Zi LL R ug; to ui LL&�. t� Y � ii zk- %r z tilt ) r p A rw� W pZA Ld iz ;� `fid ai6r '}r�f� p i �fFi � � •> p\. � Q L ^Rr v 1 a`CL na tut ; � Xkl .h r- 4Q 2 `t o `� LD ,1 ✓�J�� 1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE ,20 r4 Aex;S i Y C -A30 vsz E-A (Name of signatory party) (Title) do hereby state: That I pay or supervise the ayment of the persons employed by PV U3v1��E}Zj Jrp �,)3v4ef4>on the 50-(90 c ACJ i7i�" J''T�FJ-jam o v (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % SEs cg DIVISION OF OCCUPATIONAL SAFETY, 19 S1 ANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 LIN w � O C7 N .� n h xa h a o � O � 0 o 0 3\y oA b U Y o � o a L. = a ° 3 ea A U o � N U Q d d' o N C56 N Y° 3 H w H w 0 O o �x x U x 0 � � Q z U 3 b N [ _y w O r� 0 Q z ) (� z o O O .n o bb C = w U � O C7 N .� n o xa a � O � 0 0 3\y oA b U Y o � o a L. = a ° 3 ea A U � N � N U Q d d' o N O N t 0 O o �x x U p 3 0 � � Q z b 3 b N [ _y w O r� 0 Q z ) (� z o O O .n o bb C = w R '. ar. U o z Z o o o w a z z 3 a o 0 0 3\y oA U L. = u c� O �x 3 0 O r� 0 %0 00 o 0 0 3= 3 Q ° �'3x o 0 0 3 rA � L 3 Nix 00 W 0 � d 0 w ¢ OPV 1 d z m = �MFIN., ,W Lg i CO LL J", iasciH� N a 3 r 3 f Om z + O cr m� o m = LL c OrLU y a U + m i m z o d a w Q 00 t� c CID I� to ago $ a Lo c E Z TT V Q 0:12 w N A x a a N o 0 s a ym 07 ~ d, O ° 5 = o J Q m m Ow N m m T m m ` aOb 0 0 O p .i C = Z c m eo ° 8a IL iv a' 'n < LO � O � _O o Z � CIO .N m � Q �_ U � cu fn Q ci d 3 3 {-+ cu W 0 L ~ Is w - N co Ccn d e a T- Y+ a Z o in aao ¢x P a' V o (U L c > O L 3 U .C-) � Q � O moo o El El 0 --- El El otS m z E � N w q W O z � a s m m Z= cc o Co 0 � a o a m a z m ♦`_^^ VJ N Eo o c (Do u w ¢ (3 Z w a t w U m J .D O N Cca N E2 = =O CL rn EWU moe PAYROLL AFFIDAVIT REPORT PAGE 8 DATE 11/06/14 09:11 FOR PERIOD ENDING 11/01/14 ' JUPITER ELECTRIC, INC. ALL JOBS JOB INFO 14405 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 10/26 10/27 10/28 10/29 10/30 10/31 11/01 PAY TOTAL INFORMATION SUN MON TUE WED TNR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 8.00 8.00 8.00 40.00 72.820 2912.80 40.00 2912.80 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# ------------------------------------------------------------------------------------------------------------------------------------ 40.00 179.91 165.37 100.02 .00 765.32 1702.18 006696 ------------------------------------------------------------------------------------------------------------------------------------ 01208 WILBER VILLATORO RT 8.00 8.00 8.00 8.00 8.00 40.00 46.940 1877.60 40.00 1877.60 10 FRANKLIN AVENUE OT R.RATE UNIT #107 DT REVERE MA 02151- - - S # OF DEP- 3 JOB APPRENTICE HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# HISPANIC 40.00 251.51 122.09 76.59 .00 294.84 1132.57 031774 -- -------------------------------------------------------------------------------------------------------- JOB TOTALS TOTAL EMPLOYEES- 2 TOTAL JOB HOURS- 80.00 TOTAL JOB AMOUNT- 4,790.40 fk„_ Corrxnonwealth of Massachusetts ' Division of Apprentice Training REG#.. E-050-413 ._ ... V JUPITER ELECTRIC INC. A 142 B LAFAYETTE ROAD(1�v SAUSBURY, MA 01 - ELECTRICIAN Appr. Start Date Prof. Comp. Date 6/25/2012 6/25/2016 W1LSER vn I ATORo Sr.:�pl n .`'rrp.r �rep� �U{ ❑ \?ep: lH Srep= Stepp .ti'tepA .titep�q Fal Appy IED]entice : Card Ezpires 6/26/2015 Annu WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 11/06/2014 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title: �e�inistrative Asst. Date: November 6, 2014 I, Leah M. Match, Administrative Assistant, do hereby state: (])That Ipay or supervise to payment of the persons employed by Jupiter Electric, inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 26th day of October. 2014 and ending on the 1st day of November, 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967, 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS o In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH o Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNAT Leah M. Hatch, Administrative Assistant 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. r 0 00 0 a o�00 cl _ u o L � o'b ecz x � � � ti cz wxA 3 � Q _ 0 N s. o A o N N ccN O N o+ ti x L O C N [�cl O ?C U O � 3 o U U 0 00 0 a cl _ u o L � a o wxA 3 � Q _ � N s. o A o N N ccN O N o+ ti L O C N [�cl O ?C U O � 3 o U A w c 3 _ xA ti o U N N N _ b i, E-1, 00 b o, ° �s a u L � wxA _ o A O N ccN o+ O L O C O [�cl cl L A �x 0 3 w c 3 _ xA o N N _ i, 3�'3x 6i 3 ♦moi •O \ o� o O O O �I. i. y�+ F 0 (D M cl M FO 3 � W w 'L H O 'Q M M W 0 � � U to 'U h w ¢ H 00 b o, ° Ojl v Z' M o a r tm a d Z � S Yt!�iiEl Ugg s3 � a�3` Asn N a ` M 00 O Z W O m + ++ m 0 3 SLL e `LO L N A a a. + m 0 r a {U Z T m Y C m A 3 y o N a E m c (Yi fl— to 00 m ^ N 0 a) Q U. W c LD VTTJ A C) .2 VJ r o J Q m 1 ® ` N � m m m T N m O CL u3 0 z o m c m o o ILLO o v e a W a = N }0 O E 0 r CD Z LL 2 � V m Q c�c V •L C v cn Q U 3 ca +-+ W r Co o % Z w mCN m n - a Quo a' a Z m h U C o �� U0 L vj a i O � O U N C S . Ll 11 El El' V aES E 0 w c°5L]Ll ^` V! Z m 1(D� W L 0 v m CD z P A c m E o U N EE m `o �. v m O w < Q a zm CL E o o' m e o V E ¢ @c C7 Z w v Z' M o a r tm a EWU moe DATE 11/13/14 08:32 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT FOR PERIOD ENDING 11/08/14 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA PAGE 5 EMPLOYEE 11/02 11/03 11/04 11/05 11/06 11/07 11/08 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 8.00 8.00 32.00 72.820 2330.24 40.00 2817.36 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 32.00 167.74 159.18 95.80 .00 751.00 1643.64 006729 01208 WILBER VILLATORO RT 8.00 8.00 8.00 8.00 32.00 46.940 1502.08 32.00 1502.08 10 FRANKLIN AVENUE OT R.RATE UNIT #107 DT REVERE MA 02151- - S # OF DEP- 3 JOB APPRENTICE HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# HISPANIC 32.00 171.72 97.67 59.99 .00 238.51 934.19 031802 JOB TOTALS TOTAL EMPLOYEES- --------------------------------------------------------------------------------------------------- 2 TOTAL JOB HOURS- 64.00 TOTAL JOB AMOUNT- 3,832.32 Cprnnonwealth of Massachusetts ; ______W r. Division of Apprentice Training ' ce REG#. E-050-413 JUPITER ELECTRIC INC. �� AA 142 B LAFAYETTE ROAD SALISBURY, MA 019 C� � ELECTRICIAN t Appr. Start Date Prot. Comp. Date 6/25/2012 6/25/2016 wn aER VILI ATORO "; H Step I Steps .Step; �/ step Snp9 .Step (il Step: .titepl � StepA � �S� entice I.D.Ca*d EzPj— 6/26/2015 Annual Appy Date: November 13, 2014 I, Leah M. Hatch, Administrative Assistant do hereby state: (1) That Ipay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 2id day of November, 2014 and ending on the 8th day of November. 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: (2) That any payrolls 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 setforth 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE Leah M. Hatch, Administrative Assistant SIGNATURE �V AM 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. 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O. _ .. � iC to N LL U) L 3 L N L N U c E O) O) d 3 3 0o U -0 0 N. ~ m C V) ~ N N U U v O O. N N LL C N a aCL CL N c6 34;Ufn 0 M 0 m Q (n r Rel; ` Q b v � x; �dP 4710 U ? L• p v dm kc AJ a c 'q"f +T.i 4. M a1.'•E �` '".,/ si fi 'R � •i Ufa ro �m <;J� 'ra >�`'� �-y� �'°A°.� �.�a',»-� ,� �x.,..�„Y,.. � �2. Y1�g �v� � �,;w z`:' � ;�.,+� •a! C !f "f3 i cr `�` T .g r sss',,i x. ✓. q� n- a�f '{,_x. S a ' ti r7 m a LULJI It woO _m tA QR 55 LLx. uj Zi V w a E UJ 52 C LLJ N Vis.' r 1`Vo ) `� a C1l V ° �. ° , (n CV IEIL O10 =0F] 1-1 U F1y1- ----------- .2. T -,b ell sag %a a 0 U �3 cn Z WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an report. Once collected, the awarding authoritapprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll years. y is also required to preserve those records for three In addition, each such contractor, subcontractor, or public body shall fiunish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment Of wages, in the following form: STATEMENT OF COMPLIANCE BES,- y S 4e -,k-;,; (Name of signatory party) 20 14' i >? Com' vz E� do hereby state: l' 11e) That I pay or supervise the ayment of the persons employed by �.on the 5c�&� (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature / p Title% dCE- cg� DMSION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 i z° 0 e a 1 fflm� wo a �,y E i:a IM NY ^kz 3I? �. N. � J VI g,y 4 x � i z° 0 e a 1 fflm� wo a �,y i:a s 1- 3I? J VI g,y 4 i z° 0 e a 1 fflm� III C a 1 C WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE C ( L-6 20 14 (Name of signatory party) (Title) do hereby state: That I pay or supervise the,,ppayment of the persons employed by !N vJ�'�eA7��3v,"�h J Cn,r, J >on the S��c�vc (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title DMSION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 J U November 26, 2014 P IHenry Sarkis T New England Builders & Contractors 464 Merrimack Street E Methuen, MA 01844 RRE: Jupiter Electric Payroll Reports Dear Henry, E Please note on the payroll report for the week ending 11/22/2014, an apprentice, Wilbur Villatoro, did not work on 11/18/2014. There was an error on his time card for the previous week, week ending November 15, 2014; his time, 8 hours, on 11/12/2014, was accidently left off his time sheet. L Therefore, he was paid the 8 hours on this week's payroll. He was not paid 8 hours for 11/18/2014. EIf there are any questions at all, please do not hesitate to call. CSincerely, T Leah M .Hatch Administrative Assistant C N C. 142B Lafayette Road A Salisbury, MA 01952 A (978) 499-7776 A FAX: (978) 499-3838 M O as 00 cli 0 h N a a x o 00 y C E 'on i O o m 0 A O en a o co L C C ... co �w aUi to O O O u wxA .� N.0 a y0+ a a � � A U Q Q o N 3 H w H w O O o C9cc A O I\ N M i. x � vi U �L o� U �S W U �3 e 3 Ca z .b � b •� L y U M O as iw 0 a cli 0 N a a x o y C E o i o m 0 A O Oco o co L C C ... co �w aUi to O O O u wxA N a � � A U Q Q o N C O O o C9cc A O I\ N M i. � vi CQ �L o� U �S W U �3 e 3 Ca z .b � b •� L y N 'C L cc c A kn U � H Cy 0 Li. N C as z ami o ou o z o o W 3= H x M O as a y C E o o m 0 A O Oco o co L C C ... co �w aUi to O O O u wxA C O o C9cc A O I\ N M �L •,raj �S W 3 0 cc c A kn H C as o 0 0 3= H x a3 C o O 00 O r y 3. 3Fno �x i L 3 x W N M 0 U � ani CL �„ M O MR 0 m 9L a d a r m �13S[nN N ao3� g m s3 � N o 'm 1� t �a m a d 2 a m ci e w IL $ a m & 0 M ti a`ro < s €a Z O Q LL w C a x 1 o i Nm _`m o Lo - m— A O 0 8 J c Q uhf _�= m w m N 00 F. a C 'off Z M .2 � (0 x E C o w L com to 11-12 o a = S= c° a v a N Lr) t V o)CO 0 0 O C Z l .m � U C LL Fn 3 U) Q U 3 ~ 0 �-+75 0 cn E (A L N ai •� E Z I— p E }/ /moi. 2 Q > 2 H (� Q ¢ m ¢ N r 4 Z c N V C o � U L tU O v C > O U ca L L` m El Ll Ll U °) W N z I � °' m w 4— w O t+ w c = o -C Cc lV zE Q 1 0 E Cl) w� L m a' � a m 'COL U o E b m C mm� 4 3 Z o W to MR 0 m 9L a Ewu moe DATE 11/26/14 08:52 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT FOR PERIOD ENDING 11/22/14 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA PAGE 4 - EMPLOYEE 11/16 11/17 11/18 11/19 11/20 11/21 11/22 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 01023 THOMAS A. SHALLOW RT 8.00 8.00 44.350 354.80 36.00 1459.32 162 WELLS VILLAGE ROAD OT R.RATE SANDOWN NH 03873- DT - - S # OF DEP- 3 JOB APPRENTICE HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 8.00 166.10 95.95 58.82 .00 219.00 919.45 006789 ------------------------------------------------------ 01208 WILBER VILLATORO RT -------------------------------------------------------------------------- 4.00 8*t=lr a �._ 12.00 46.940 563.28 12.00 563.28 10 FRANKLIN AVENUE OT ?� ll`1� lq R.RATE UNIT #107 DT REVERE MA 02151- �k$�� - - S # OF DEP- 3 JOB APPRENTICE HRS FWT FICA/MED SWT 0 -TAX DED NET PAY CHECK# HISPANIC 12.00 22.42 36.64 18.50 .00 97.69 388.03 031860 ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ 00985 DANIEL P. RYAN RT 4.00 8.00 8.00 8.00 28.00 72.820 2038.96 40.00 2817.36 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03019- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# ------------------------------------------------------------------------------------------------------------------------------------ 28.00 167.74 159.17 95.80 .00 751.00 1643.65 006788 ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES- 3 TOTAL JOB HOURS- 48.00 TOTAL JOB AMOUNT- 2,957.04 ,rte, Cornrnonweafth of Massachusetts Division of Apprentice Training i REG# E-050-413 142 LAAr' AYEITE ROAD SALISBURY, YvIA Ol Q� ELECTRICIAN — Appr. Start Date Proj. Comp. Date 6/25/2012 6/25/2016 V;"ER VR LATORO Stc• %tep9 Slept .`'rept cn'p¢ 11 tit PR Step/it Step- Srepo .StcpA P Annual Apprentice I.D. Cs�� 626/2015 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 11/26/2014 I, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature Title:q.�dministrative Asst. Date: November 26, 2014 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payrollperiod commencing on 16'h day of November, 2014 and ending on the 22nd day of November, 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat, 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS AME AND TITLE SIGNATURE Leah A Hatch, Administrative Assistant 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. K O 00 N ° oo E p1 as O o, � M � � oa 3 o A O O ot-0 e zz Q\ 8 O U i a wxA � O O opo O o � E C O a¢i ++ O C O O O i L w A �x 0 z 3 ° U O d Cc 00 cq M 00 ° x F U c ad w o 4n O o �+ L 3E"3x O O o C 6� 3 � x o \ 0 0 0 � � y w O M M �L ca x L g cn 3 U W a p a ca 0 w ¢ U d d o N O � N iSr V Q b�q � vi CQ U p U o 3 z � L 0 N T% L 00 d w ti z c U cl, O � o w U o � z o z w 16 �� 0 o W w z z 3 O 00 N ° E as C O oa 3 o A O O O u O U i a wxA O O O v o � ++ O C O O O i L w A �x 0 3 ° O d Cc 00 cq M 00 ° x F c w o a o 3\ �+ L 3E"3x O O o C 6� 3 •O \ 0 0 0 � � y w O M M �L L 3 W a ca 0 w ¢ O 00 N ° m M .0 0 L_ 7 m CA C 3 m a� t 0 rn m a d Z ro = iM: 8_Eip d ao3� is§ae N a3 V / 2 m a N a z° Q f "i U W T C C c N �//�� (.0 M � 00 r0 Q a- w O ti! N VTJ d � c u o a m V, Fm- J Q m _ 00 IL 03 = r.,.- o z E o _c m z° o 3 .0 g to Qag8$ m d r V 6 LOLO a= a }� 0 a U Z = 2 � -a .Fn c C m cn V T Q E •L v iii > Q U 3 3 � ca O co 0 O _ Mu L •i-+ L L •C: E A Z u L O m E 'Q d (c i O z b a m Q 3lid Q a� m E N s z ' a F I a' U)i () c d L L y m p U 3 • U - Ll 1:1 El El ElZ ca E0 0 m L.LIm L E0 z QD Z9 a s m "O m E 0 U �- Co N E CLc `o v •° i a ¢ O t c z Cf) 0o CL 0 w J a t� Z w m M .0 0 L_ 7 m CA C 3 m a� t 0 rn m a Ewu moe DATE 11/20/14 08:18 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT FOR PERIOD ENDING 11/15/14 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA PAGE 4' EMPLOYEE 11/09 11/10 11/11 11/12 11/13 11/14 11/15 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 8.00 8.00 8.00 40.00 72.820 2912.80 40.00 2912.80 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 40.00 179.91 165.39 100.02 .00 765.32 1702.16 006759 01208 WILBER VILLATORO RT 8.00 8.00 8.00 8.00 32.00 46.940 1502.08 32.00 1502.08 10 FRANKLIN AVENUE OT R.RATE UNIT #107 DT REVERE MA 02151- - - S # OF DEP- 3 JOB APPRENTICE HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# HISPANIC 32.00 171.72 97.67 59.99 .00 238.51 934.19 031841 ----------------------------------------------------------------------------------------------------------------------------- JOB TOTALS TOTAL EMPLOYEES- 2 TOTAL JOB HOURS- 72.00 TOTAL JOB AMOUNT- 4,414.88 Cortwnonweatth of Massachusetts Division of Apprentice Training jUPrM ELECTRIC INC. 142B LAFAYETTE RO 9DO, SALISBURY, MA 019 ELECTRICIAN Appr. Start Date Proj. Comp. Date 6R/25/2012 6/25/2016 W"ER VILLATORO step1 L J .tittP7 .titrpi ®.SreP Srep9 Ste 2 WO Stepli A'tep8 tireplrJ P entice I.D. EXPires (/Z6/20I5 Annual Aper WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 11/20/2014 i, Leah M. Hatch Administrative Assistant (Name of signatory party) ('Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: -/P, Title: Administrative Asst. Date: November 20, 2014 I, Leah M. Hatch, Administrative Assistant do hereby state: (1) That 1 pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 9`h day ofNavember. 2014 and ending on the 15th day ofNovember. 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by anyperson and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. - (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS o In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH o Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNATURE Leah A Hatch, Administrative Assistant 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. O,2Y O M U� O O (n W Luuj (9 co ON n zaa� NM N Z J O O O O z y m •Q U OF LO LO O W Q N M Z H p Q C eD W V OD O p rn L U CV 1] U C V M V• Q7 V W to Z t-. O) O O) N 0. 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A Payroll Form is available from the Department of Labor Standards (DLS) at wv,,r ,� . as . 0 i _ 11­fo',,v and includes all the information required to be kept bylaw. Everycontractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: KW L4 STATEMENT OF COMPLIANCE leov otS,20�_ (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by �+ r ar L� .Aid cr^ eq on the AfWAAl1terftho(i0 (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title 05/14 WI O Z J. O CO CO m 72 3 m L O a z tf) N (fl N to (0 N t- N rn � N N N 4 Cv o n o N .. dco 2 � w o co O lfy l!7 N M p � (N M O CA M O = 3 � O - > {- O O C Y cc if, 3 m as _ U') p w a O op x° r O r- o > Cm o Q m m CQ U') M Cfl Cn C) �' O O O O cc e d 3 _ O�} d' M C.0 pp 00 z° I Z Z v;e a co --- to N -- - CL a Z 'IT � x Cf) i O O7 3 m (6 _ cO E c c Q F q >� fD 7 cm O t6 C U c U _ N O = E 0 C in O Q a _0 m C Q z m t L m LO o a c O U � c O c0 06 �cn-E x x El F]> x Ll El 0 i L a) _0 W —m 0 (Z ji Q e O a Q '� _ O >, -c E E m C Z w O m -0- c m _� .c — — O U c N Z t r g p (O (ca U Y "2 a Y L a � m O 4 c E g. W 3 m W Z c .1 p c .3 r m U s U (D 'O Ep p e C 3- E H e ay Z d o a� Y Z a w v �` LL U W 4 (7 w WI O Z J. O CO CO m 72 3 m L O a 11 Z rn � rn ao g d = w ' m Cl) .. O Y O � <a Ln - Z LO co < £ _ 1 6... 0 p.- ~ O O m d O O 4 a Q �3m c0 z00 2 o C Z = nx_ �°4 CO t� a Z= ` 16 n c Q N O Q -p co t 3 t6 E c6 L c E c N 3 _ _ F o 9 c m a> Z 8 (D . E 0 a i o n 0 a 3 Z = LO m cn � O _ _ O t0 c6 L 3 O O 0 O m X El xn X Ll L E0 W cN GL (a OH -p m = m a E 'z E. Z. Q c i O C m E2 '0m (B d E fLL6 c) a Z `� a' U ) = ' O 3 E z W E m Z m _0 �> ca �p p o E O ~ m O Z o U W 4 is E w 11 N N O N O U l0 W if h r M n N N a, co (D NN O N r Z O O N W ('� O VL G O O n O U N N O n co (O �!1 N m ~ N� r co On n ClR ? LO V) m N Cl) O Cl) O N (h L O O O O O O) O � O O O O O N O (O s� In d m O N V U1 cli W O M n W O x m OO O O O O O O O O O O O O O O ~ N LL (a0 M N a0 m fO') 0) N O Cl) N ` 15 N W (O M R ? n d 0 0 N n N n co N N N f� N O V� rn r- (O 06 OD N O) N O (�O 04 •f N N DD y N m m oav O 0 O v C O � 7 M M � v v ro ro co v N OODD N T w N a0i E rn m rn N_ rn N_ rn C14 m rn N m VZ � _N N_ d d C O O O O O O O O O O O O O O O O LL O (0 d o co co m o is R v 0 (0 co o ui OR IT U) N Il- n v IT v W n M c� Td Fi A") (O O � t0 co (�� co CR O (O m O � co CO M R W coV to 0) Go ? V CL O CO co o C0 O N O O O (O O O O O OD = 7 ? R N d 0 O O 00 O O O O O O Ly O = CO O Ov N OD R O Oa N . 01 E I i w LL M O co O � OD O O OD O OO O co L 0 F- O O OD 00 O W0 Oo O O O c0 O O co O O OD O O co N O O OD CD co O OD 4)00 N o$ o a o F- OD O 00 00 OD 011 2 N 9 9 OD U0 OD O 0 OD o OD O OD o OD C t0 N N W T LF- 0 Ir 0 m m m m m m m m m w cr W w cr Y y 14 O m 3c3x 0 O x O x O x O x O x O x O x cn O comN. W O ` C0 N m co N A Z O (00 O N N (00 N (cam O 7 bf co (n co 9 N v o) 0 ao u) LO M Cl) Co o 0 0 o in o 0 N V O N co IT O O V ? co ECD O> O co NE V) 05 OO�- �3 6O _Q � L3Q> (ON0 m> YD t Q r m m v x U Z o OQ Ov 22 o ` fOZaQW(n Cr Ca O 'O Q O) m m � ON CUN:5L` Jr U Z pN O vi V O N U W C U O (LN 2 C Y r J r O x f� N c) O N>. JJ w r C r (n � WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at a ,1 ,,; and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: 5 STATEMENT OF COMPLIANCE ,/�✓D V25,20 I, /749" b t 5 n d (Name of signatory party) (Title) do hereby state: That I pay or sup=0h the payment of the persons employed by R 3)�5 Min on the J\(or4 Ando (P !' , �Cf odfidmjn (J� (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature` Title MI I La o z (0 O (.0 O `' N 't N C O Cl) O N M p 4 a a� 3" 3 OD O taSnN d = A w o F N r � m = LO LO M O M pLO LO M OLqO Ln M c p T Ln O0 O0 LO 00 Ln O 00 O LO wmZ5 00r ` Ew W '3 W m as = LO Y ¢ w CI `m Oa 00 Q x° O i acmes 'o 4 N p E o L: m m , m F a) W �°+ O O p' Q m m m LO M Lp O O CA Ln M CO � O e— O O o a s 3 = M 00 00 M p M 00 d' i s Z O CpM OCN co co S ci Cl) CF) O m L O Q 2 m - m M_ E c c O o Y L c Q >O 7 N O O * O O M U) E 0) L)o _ a) Ois I E O c p z 0 U CO C Z c m3 o LO o �¢ P v c O _ O (0 c O 01 i> c C O U ^oma 3m =Fxl Ix El X L]E] X E D L W -- O i 0) - m V �1 C E Q Z m a c L O L — N }. i y L E a L w o Q a M o Q °� c p L 3 a> m a� o. c LL z 0 o6 aZ a 5 O <. c E o, W E z C -� L Q _N O L c M L M L (6 L G c 3 m F� �' (DFr Z o Y z LLLJ _� 3$ W MI I La I A /� � / �%!-_ . k• _ ¥ #{m \ Cl) # \ � + ! )ƒ c \ / LO/ u OD Ix .... .. �& £ f 7 ƒ\o f C:) f ) . .a. 7 { a �wo f«! t -0 L< {/` % \ $ ; ) 'f e i 0 2>=Lr fqt .. . . ) 6 M /� 7: ; .m. \ . E 7 7 _0 _ k $ Z5« c 4: .m /��0 mcr- t $ 2 E £-a) = CL . \ \ o .I ° O . < CO q 2 7 $ f 2° ■ �� 2 a *� - ± r / £ 2 < - x x x � x F I F -I m 2 W03 ƒ \ K / } a)< % �2 � I o .. = § t K 2.� 2 U a - �� 7 c ; 0 / ( 2 2# % =z .I 3 « ! \ t 7 a \k 2 L 3 \ ! �k E O c O U otS N d v D y CO m ( O Y �O U m m E rn E c W 3 CC)a) Zv2 U c r m OBD " OMD N N co (? N N O N � 0) r O) m ZO M r OD O) M (O O N V i0 N N N M N C00) r N Cl) ff Oco ) co tO (O y co OD N C11O w O n a) O O Q N O) Lo V (O f.- N O 00 O r. CD C3 M L ( � v O O N ( O Q L? LO 'IO I N � � 0) LO (O d x (O (D O) M � O) O V M m O 'o t0 N v N cO iO U) co b1 O) io n n O Od Cl) Oa) O I� x 0 0 o O o O o o O ti m ~"i 0 0 N 0 0 O 0 0 m 0 M 0 O 0 O) N O V tO m tO o O LL R N N M N -It C2 'o 9 ONE r R N v n d tmj M a) OD N n O t0 O M N N N — N N N N M M N r- N T N h - 0 3 (O O W Oi O 't N M 0 O) N (O )OM (n N � O) (V U N O) m O 0 t0 h O C O M O V O R N VO O 4 N N y n V LO n M ^ N O) U) M ll O) i? OctO m V' Q O M V a tp wv O � N co O d E U2 0 O O M N O M N O M Cl) O M Cl) O M Cl) O M Cl) O M Cl) O M ma) 0 0 0 0 C:, 0 0 0 0 O) O O O O O o O O O C L O O O O O O O O O LL 0 ro v co m p m CL v ad m v v c too 0) t°Do v co ai H� n aa) tLo oc v r°)i LO n 0 N Q >A « )O tO tO LO M (0 O tO tO (O mm M O O) M (O m (0 OO) OR v m v Cl) v mv v v 'a ? O O O O t? O O O O O a p o to 0 o coo 0 to ad o to S v to v v v ` o O O O O O o o O o y 0 CD o O 0 0 0 0 o O O cm O C co 't � N co O O O� co E H 0 oto? Ivo o 0 Od Oa OD o co co O 0 L M O 0 O ( O O F- OD OD OD O M OD o O O 00 O o O y N 0 O O O LL7 O O O O co co M O M OD OD OO p 7 H O Od p OD c0 OD 0 0 00 o O o t0O O o o O C6 OD tp OD O co 00 OD m C T N d too >H F- F- f- N F F- F- F- F- a F- at 0� W O w cr S w Q� 0 - to to m d m to a� d tD � cc w tr w w x tr W Z , >. :1 7 a. It, >. 2. y 7 7 3 3 �5 3 3 3 3 U 2 S S 2 S 2 2 2 0 0) N t0 Q O LO r— O I -N CD 0) co m O N r- N O a' d E c � L N �6 c_ a) Zm o 3 tD -o m 4) Y to U W L U m (Lj 00 "O > 4)r o Z U m O v L ? L LL C, E N U y C I? EL U o LL Y in WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at .v and includes all the information required to be kept bylaw. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: W STATEMENT OF COMPLIANCE Ahov 25 ,20% I, 3� '9" 6-1 n , /VfE i0 " (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by 2)+� falrAmerusk / on the JVQ 4>g do PrL9Ch9ohQ Mtn (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title C 05/14 I a 0 r m rn 3 m 0 t 0 `o CL Z t = rn o Cl) 0 0 Cl) 0o rn o co 0 0 O C'i iM_RfIpG U � � jgN O 43 ft 0 Z w � N � a, Ln Cl) to C'7 O w U m m>w ~ a LO O co to O 00 N1 6 !') OC ' € CL CL m a � 3 � o m CL 2. Lr) O W d G 00 O N Q = L ° a8m$ Qi O c v f C > O m m T l�9 m LO Cl? O CR O r' O 1 `u p < o M OM OD 0 Cc 1 = : 0 3 O Z F211 M d U M 00 00 0 0 2 N a Mcr) S O N m C O 5 Sc m 3 m . O a E C C Y 3 >C > N O V ' CD fd E O cd 'C NN U Z Y ` > E O in � O ° o c Z W U f ;o U') Z =G o m � 0 U m - � L 3 _�x 06 6 (=// C X Fl,�xFo X X � X m (/\ V L W o 8 0 -0 1. m ` O t > Dl m E - C Q o — :3 CO m ¢ m N > L > N 0 e Z Z. O = m O 3 N Y a) —_ N LL V q E _ � = i DI o LS z ,� O m E O C W m A m I.L C 5 to a co 'C a 06 3 0 , 3 z m o 3 W t U_U G ELL E co v E W 3 < t7 E w I a 0 r m rn 3 m 0 t 0 `o CL m N m O Un t - d Oo N OR m Un co m Z ;: -7 m m V) m m N = ;:o Cl) M C F- m 00i L o v m O o 0 Co LO o = M ('N7 (O N 0 i� O O m O V (+) M O N ) F- V m O C9 M r O O m 10 xO O O d F O ' co O to IL N SN LO O O m V O C E W N N N O 7 Y ? y_ co m O v 0) O O m m N d d LL N 0 .� m O h U C f- 0)r W m N Q N L O m m O Z 0) m v ao m C) E v 0 0 a0 0 m 0 m 0 O) U Z �2 c2 m m_ `0 m m V Of o O 0 O o O O O N C O O o O c LL O f0 (N O 00 Um > O m -3 4. N N u') m OD V cD N to o R N (1)) a -_ 00 O` :3 fn m y m E� M� Cl? UM coo 0 rn m'C C M LO R Cl) R LLl ' 0 0 L = O9 O Zvi d Z 04 04 Cl) CIJ Cl) co a0 0 0 0 0 0 y= N V L=M N M co co d N o E a � M w� 7 O - O LL OD O 00 O 0 0 CD F 0 Oo o Oo Y y N 00 o N o O 0 O 0 o OD co � m = c 000 co U)) 0 0 U C OD O OD Oo C Z' 7 Of C V: O CO M N CO m O @ao ar�ow U G) O E CO N Qin y •N 2m' Rm' C Y �• T >. T V% C a N 06 O m v 7 7 J 7 U 2 2 2 2 � O V f0 N co m 1� LO N N N N P4 m- O EY { U Z m o 1 Gi W U U 0 U li { W LL Y LZ WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at and includes all the information required to be kept bylaw. Everycontractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: We L4 STATEMENT OF COMPLIANCE JLye2, 20LY (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Ctrn merUA A'W Ph on thew �,&dotP,rSCho0lA&mJr, (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title 05/14 F wlz T O A O) C m m N L O I 0 CL Z rn � N Y U T E a -3 F dye 131$ it O ¢�3c ❑ 02 O !m N r m • 3 + m N Sa 00 pC' C' CL O Q C $ o Q d WIL c ap N O Q L = m r N O jawx y m m �• m m a � oQ CD V - L o. C Q x' g 3 0 ¢ � d 0 2 O I Q L i cQ � CD C >C L c Q O f0 L ~ CD O t c m Z). L o m C- ui F O,. 'o w E O 'N 3. r^ V/ 0 O' Z C L m y L C O k O U U �• cG - O � C O"' oiS 3 o m a (n .� x El El El El El m m 0:2m EU8 m ¢ L @' -0 Q M1 .P m E E _ ,Z Z " _ O Z m i p f7 c0 N m o U c6 i (3)m iii z w U W C.6 C W m O-. w 0 m. E R C: C W C Z _0 c p m m 3 o � C Z m o F pEp U W e CmJ w wlz T O A O) C m m N L O I 0 CL M t CD V v N v y O N O U d O CL N c t[ i� 'v tM iN ttWO i a (D tW O In Io jW N IM IN ZO ;W ` ,N W I� O air V O O W IW O ILS t0 Ito IO CO I� jN to (W tq IN IW F C N Io o I� I� (� I'M Cl) m O 0 IO jo W loA O to lO �O 10 V W .V IV IW V Cl) Ito tW O iM M j jV NLn O I IN .V V tW co jV IO L- y 'i W M JM ir` N rn Ico o jao �rn m x too o 0 0 0 o o 0 0 0 o 0 0 0 0 0 N mai W I N IM V 10 W Cl) Ip O IN N LL i N Cl) I� Cl) N ` N W !tn jM Itn t.0 I W N U to N h I^ W N IN IN �N n N W t` co V III N Cl) O V m n W v io) N 1W (V c6 In N y N O Cl? IO Cl? II V 0 � n I I O a ~ v m ri r m v v Iv W t0 W N v ccc a O � t rn o M IM (D(v I W O) O to to �r m E W t0 W N co co n (^ N �N U Z � (� N N IN tm C o O O O 10 O O O OO O {O {O O O LL (O I o cc -� a oo v j� Iri jo r c � �ao o Itn m IT w n N W N V r- W ao V to r` co O I^ la) r I IW Arf a cc W ts co iO) t0 M M t0 co W O I i(A IW Iln W W a M M 7 c6 Q6 IT V to Io V V o o O C. Io O O o t CL O x W W oV N OV EW OV N W d! O u)= o o W o W Io 0 0 0 7 N ? 10 0 N 1 OD i H � U) o ;o p !p o 0 LL O co 10 n O IW O IW O O W W L cn O O 10 o O IO to O O O O O O f0 H W 'W O W W W IW II d W N O O q (9 IO 19 a)N o Ln to O IO IW O W W co p P N o t0 upj o IO O O y N W co O W tW 1 co W 0 i to m to m I 17 1 T T 2,0 f go 3 J 7 I2 7 7 2 2 = �o 4 M m O co n O IN ICD r t` � N Cl) N O) N r N (D 04 C? N Ia) 1 �t0 N co v RtW0 o) w o ao Cl) O V to to W to to W I •W A y o o Io Cl) o .tn to :o ,o Cl) N O( , O I N 7 I N ?_ W i I V W N E N Q I _C > (O O 0 O co _i (U O C O N~ Q Q I O N M O y W O V Y U p I W L o 11 I O) Q Z a) y O) YII U> QQ II H iL N W U._ rn O?= 1 U O L I._ Q4'd 3 to c) III O 71 O V Y C I0 ? C N 3 O ILY Q1 C j� (LL p (U m iq U N O N I� N >. Q C :e O LcL< ��°I°—��� O U E WILL ov 31�� mlmz mtm0 �I�Z> N IY J (� �^ W 2 o U �Ia) Ii J ° o� u) , Dai Q WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at and includes all the information required to be kept bylaw. Everycontractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: 5 STATEMENT OF COMPLIANCE aQ V25, 201 �' _ IN (Name of signatory party) (Title) do hereby state: That I pay or supe ise the payment of the persons employed by " )-, 9A4 on the 1V DCfh A/ do tel' S'C%0 & NZ (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Q z T 0 I I CL x d= T O O N O N O M M O M p �M�pG ¢ y 3 _, � � �138fiN�•i Z' w p` o N T r� � 0 3tt7 LL LO Cl) p MLO pLr) M O LOCO O m m> F -O- a T lf) O 00 O 00 T O 00 T U') O Cb W m Ge@ R .. _.. ... C! a m 4 Qi r-it�tl LO ocoQ $ °` r x O O _ =a� r+. r' p ul O Q y m m m m LO M CD O tD O LO M O � p co Q) o o' s cc A 00 d pp V M 0 M 00 d O _ O O p M N M -0 00 I N 0 O S m VJ co m p CN p O -p — ) � i I 2 m i�l s m _ (6 Ec E c N m 3 C QL m O te F Q) N• LL� - C .. COL VJ E L) _ aE o z U Q C: p - — m_ 7 3, Z C o T L O _ cn 0 O 0 c V O2$ 0 m H h - El EE El El El � O L W � CCro CE O o Gd+ .T L) -0 c 7 m a m L U O p u N Q ? Q. a O v b cccuO c Y _N U 4} = Z, `� c m U u a) a> g m 06 ,� r� O E: a W m c c O c t6 fU U c0 U Q Oo N z m o a) Y C � O z 70U W g fY fool F W Q z T 0 I I CL 11 z � (1) O Cf) rn Cl) o C7 CJ r r o u "0 O O 0 w U � CN om =3w O O co O C w 00 O' \ Q m H a CO z. N € a as ir ❑ G z p. t!j pp CIJa O e Q L o : C 'L 0 y {? �, -i° O p Q CD C) co CO 00 CD c' 8 O CD y O N co O N m C LL O Q Sc m F a L � 3 c0 CO E p _ C ctn u a m c N O O O - L N [� � LL ca c r�� C a)r I CO L (V C C � -2 CL O o '0W Q 0 coc °6 a m i Z m O o v U L C m U N 3 O C O U 06 mom. m N C X x x x X L E w (J H a _ •L i O C Z O (� m Q r CO ¢ • a ry 'C: o Z O �. m c w U JE Q) coL10 11 7 N � a D C O 3 Y d Z CD y O ?� N O d IL LL R (TO a D Y O 3 La 7 0 2 U C Z c 0 cn Mrn m 0 m m o o d� E m v�t 0CL fO 5 N d v O R L � C a� d U v � I� m d OR W N U �� O N I OI � r O) M i Z O IOD W iM O N L 'N N N O O r r co M m o O ~ N '� LnId' co - lO N y o 0 0 In o o io o 0 O O O (n V O IN O O 0 co n LLD 0 icon (6 �m m x "D (D W M P� a) O "r OD w m 0 N 7 N aD uD V: ~ Lo T ri 0 O 1l- O Cl) a) lO O r x o O o 0 0 o O o m o O o O o o O o 0 V N N M LL 1 N sr d N IO O V aD tn r o O v '� � l0 O r 7 O N u 4) m w I- O O co g Cl) N N N N N N W clj N ��r V W - o f W R (rn CD (D M (� W (D N W N -N N 0) N 0m o p of co 7 'I (N M o n M OOi y O` M f� N O iD oD r OD O) R r O O i M d V d O (D V O N CD O) d E L 7 o M o M 0 M 0 M 0 M 0 M Cl) M 0 M 0 M U Z d m o 0 0 0 0 o o 0 0 Io. O O O O O O O O .` O O O O O O O O O LL M O CL v oo v c O of (p w m y frn r o � oc OD v Cl) m n O` N __ a d (D (D (D V) M O O co co (D aM O O M M a0 (D Of O) oD '0 3 o O o o (OD o 0 0 0 o CL o o (o 0 o Cl) o co oo o (o = v (D v v c v N O O O oo o O O O O O O O O O O O O O o O O O O N N N W OD O O F O LL O O (OD o O a0 W o0 o OD OD O o o (O L M O D o 0 oo m co o ao W ry N 0 o o O o O 0 0 O wD o O o O o O W OD OD OD O oo aD M j 0 cD O o o ��od 06 oo co 0 on 0 0 0 0 0 o 0 0 0 OO oD oo ao o W Go aD co C m ("o> F F- F F F- F- F- -aF-0: a. 1.- 0: a: o ri: 0 'y T 2. Z. Y O m a o o o o o o o o N (r- (D arD 04 G) CD o � N o V04 o O N Cl o °7aa) m C ' m> dcu L _ co L Y U m O O LL O d (fL O mm y El W U Io 0 ALL Y I� �� ��' iu) v o -- WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at v and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: w STATEMENT OF COMPLIANCE I, A") C11 -05 -en / Awl - (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by 2)4� �1sk on the lVor �A/�(l�ai'P!'C'`-chf3yl/q !?7Nn (Contractor, subcontractor or public body (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title 05/14 Z! c 0 :L) W O U y N w 0 O 0 E ca O C N E U E E O U N caG N a E >. Q E 0 0 m .R O O m m m m t 0 I m CL Z O Cl) ami o rn O 7) O C'i ri c% r- _ O N 0 o N = 3 w LO tC? m p LO (C) Cl) O O ti zi a �' LO O co `' U') O m (a g G of r- m co gffi d Z 000 L-0 s w n ; a n O CV O L g :. > m dLO T RE Cl? (D cq O CD O Q �' co CO O CO e Z »� z a Z see a=a $1 M Cl) co A cc) � C 2 LL O F N O Q . m E (6 L C O C Lcu Q ` � O t0 f 4g E -C Z p CE E I. O WE O Q 2 W N ZLO o �. O >r L U U m-25 - c 3 C O G 0 C) � a� m x x x x E El El m W >L O ° 4? N E 4 t m a� /E ` a'v moi' %O Z 3 m C' = v m Y "� Y 'C z V C d O m E W 3 m m m LL �'} U cu U U a) m E Q a m H :a_' Z W 11 U W. d fmJ. W c 0 :L) W O U y N w 0 O 0 E ca O C N E U E E O U N caG N a E >. Q E 0 0 m .R O O m m m m t 0 I m CL LL R rn � ro m a ao (v of o �N N m m N �m (O N Z O LO o o O Co O o NIC3 O ccljMo Coo 0 Co o o co Loi t o v ro ISO 0 M (1fJ O M N L ci (Mp 0 d Q r O 1 O {(7 O � c7 ch O N G1 x 3 Fm- v CO m O O 7 co 3 Of I s x 0 o a 0 o 0 O 0 F V v o ui � � d T N oo N lL O 0: Q C C ` N U7 O O l a v 9 m V v o O v C E W N N N O 7 Y O n, LO U S S 2 (9 1 O rn o v ud(D _ 0 p 7 Lon N O N y v m m N (T0 0 a a LL N iU 2v m ca .� m O (N � 7 a W r- ai m rn co Lf) Q o L v a m m Q O Z d Y a m 7 Co m d E 0 O O O ri U 2 V �2 (2 M_ o m d Ucm O O O O O O o O (6 C O O O O C LL O N N N o O Co m U aco O to 7 a N m V cn y 0 m v V N m co —_W 7 cn Q m y m E2 nTAc,iLQ om coo m W 7 '0 L 0 0 N O O co O a0 Zero a=m M LIl O O O O O O O O O O O O N 0 04 N M O co £ O a I- LL R O N O m O co A Q O M a H O LO o o O Co O o NIC3 O OO O O 3 Co o Co co 180 = 000voi 0 U C Co O ' co aO c t 3 Of I C V% O � � d T {p O O 0: Q C N O Em a) a) E a) . ca E O L m m Q� m a: 7 I U ,. �. O n, LO U S S 2 S 1 O (O aro m N (No N V N r N co iU 2v m ca Y u 'O y _ U - LU LL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every is employed, a photocopy of the apprentice's identification card must be attached twhich a o the payrollren n ti report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall fwnish to the awarding authority directly, within fifteen days after completioni of its porton of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment Of wages, in the following form: STATEMENT OF COMPLIANCE I Z 1 20-- t, HEaie y S 4e�c;� i rz C- E� (Name of signatory party) (Title) do hereby state: That I pay or supervise the ayment of the persons employed by j wAVALeon the (Contractor, subcontractor or public body)dini: or Ii and that all mechanics and apprentices, teamsters, c auffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. employed, For every week in which an apprentice is a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authorit years. y is also required to preserve those records for three In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE � 20 1 L� S �-e k., � i 12 CAT �,� E� (Name of signatory party) Ti- ( do hereby state: That I pay or supervise thyeayment of the persons employed by O�Cv�E;,,�C�a3v���E� J � on the S��-c�� cj I7i�';JT p� (Contractor, subcontractor or public body) _ JC R7D °N , 'L�'i and that all mechanics and apprentices, teamsters, chauffeurs Burs and laborers employed on said project have been paid in accordance with wages determined under. the provisions ns of General sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature L�— Title % dCE7,�s Cg DMSION OF OCCUPA'T'IONAL SAFM,19 S1 AN'FORD S.I,REEL 2nd FLOOR, BOSTON, MA 02114 I -- s El co O C, N O !P Y0, O O U W rn w�Q3 00 c) 04 Ln.�N N M Z 3 a O Z JO N p .. 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U N c ac T F- LU a Co LUx N N �% M Z5 X ° Y v '2 f0 C 0 30C E y !-' N O d (6 U _ QOr �j TT•• m cc N :E- C N NC7 N N= W LL r LL F o J UQQ O N T C CLCD L T L ° r CD N U 01m« Y 2 LL ZL J 'O CD -0 c$ N C U O N T T-° L L a:,3 r O L L y 7 N L O� O U L W Q JO Q' LL m O d O C ID '0-0N CO N N N O) s S O ° C WZ n f` 7 n �� W m O C T nL C E- `m cu Cn o TDLL N C O N L.. C O 0) �U N E E 0 v O CL 0 T m CLN rL. rn C, .L. G N r m cC N r m E a — � m c N N N w N c � N CO wMco o oc (n o i:- N N L m w T'Cco � @ @ NM N E N c c4 m Q. J U d L U N X > Cm N N L O U °CaiOC 0 L NNN C 0 o N N m a p L N rn C_n 0. N OL�N ro- m I: E U >.y O -03O O m QCmm 0 M�a NN N E .2 EE m C N mN Z N C L n vi cN ° - N M L m m C, O O_,& N° ZO O N Z 'O L (0 N � L � C � 'O .L. N N YO N v av�o L E c8- 4? 03� m —m N m N Q N N L.. C O 0) �U N E E 0 v O CL 0 T m CLN rL. rn C, .L. G N r m cC N r m E m c N N O - N CO wMco N N .L-. C Cn i:- N N L m w T'Cco @ @ NM C d O.L.. J U d L U N X > Cm N N L O U °CaiOC L N E N N C N a) T _U OL�N ro- m I: E U >.y m NN �0 m QCmm 0 M�a NN ONO« .2 EE C N N C L T vi cN ° - N O C L m O O_,& N° ZO Co L 0 y C U N Z 'O L (0 C l6 'O .L. N N YO LL v av�o E c8- 4? 03� Z —m N m N Q N G. d m C L N U N G% g U N N m C N C L 'ON O N �+ � C d N N N C N N C m N L N N U 0 >,- O C D LLJ p L L Y N -0 p n N 7 p U O L YO U 0 'c c N O v Im- •c > O r m Q 3 N N U N U N �_ L U U n.0.fm cr N C - O L U N 'OCL O c V L_JH N N ..O- m N ^ to N --0 C C O m N N "N' N Q C C N E O O N � d c�6 0 E f` N O C 0 U N y U fA O L N V° m O ~ N N 'O N o 0 7 U y r N 3 U N ` N C N E E N N N L nE m N 2 3 �� ,L (D v Q) oM oC Q m v E m r 0m 0 (cn o V .00(Vd Sam c.0 c N 0 otS n ° c c mJU r > N �0v m N aa) y w 3 0= ao d 0 C N .L-. p (n L °' (D> fmA L" 0 01 L°L,,, m m O- Q U 0 O CL o @ Z° - or coo 3 N ° o C N N 3 'I N L NQ 'O @ H �' am^ U 0 m =>+ Y6 U O LL -O O V It C Lp U) C Y N N rM N 0 3 -p W LN. U N c ac (DO o C N N �% M Z5 X ° Y v '2 f0 C 0 30C E y !-' N W m O d (6 U a 0 �j TT•• m cc N :E- C N NC7 N N= W cNEN O N. C N T C CLCD L T L ° r CD N U 01m« Z 'O CD -0 c$ N C U O N T T-° L L a:,3 r O L L y 7 N L O� O U L C C L N E '� ss Q' LL m O d O C ID '0-0N CO N N N O) s S O ° C T N m :: N 0 n f` 7 n �� W m O C T nL C E- `m cu Cn O 0 n d n y m 0 'O N nm y Ix w I E N N m N mN v O v m o c N U m as N y '6 N N= I- 01 O _O LL L (n °' '0 f0 3 c0 L '6 ' L N N N N L (0 c m m m m ap 3 0 m L H° 0 y r N N T r 2d U 0 N U N M C m .... N N v CL.Q U m >iLUCn m U mQtn A L O J 4� O 4.0 C wC C. W E., /t e G1 a `m ui o w � m c y L a U O N N Q � d � 'o35 m y a Oa0 N y UO o m 1- 0E 3 a E t0 J U v dm M N U T C, o m N T cY a m c > v N m n C U O O N N U a U °1m cs L o c E' E`oy E� 0 0 t E O cc o ° m mF d W fn L o N C m3 w m O m o o w U p € c" m O C0 O 2 N a C d E y C L U L U 6d�� O U 0 C y O N O N U O) N N C wag° TL N U 0 N L N 7 C o U LL O C N O 0 O w O � U � _ J C o u p t75 M J d b C U O O U C m m w a o CA C y O Y N C o o c o m d a m LL > O O .> U 0 d O 0 3 v o 0 m m o.� Y m f0 d 3 N a p E � � y O 3 Oa U y m O a CO C y L a U OC a L QO cn LU Lu LU V Cl) (�0 O) m (D 3: 3 Z Q d 0) v C) co M C, C OLL r r O V) Z 06 ZN Q L Cl)CO O � x U O0 O 00 'IT O N LO V OW p p w O O N z L) p Q W LO LO H = Il M l!7 Z O n0 ~O 00 LO co Cl) M 00 O CO U N N LO G W to L ) d) R N O Z O m C LO LO 0) O IY a H WU N 2 M Cl) M 00 00 Lf) O w Q p 00 W N 00 O O C2 C ( JLO O *iO M 1 m � H Q �O~ 0 0)00 N 00 2 (N N N U') C (0 cli Q O O N U Lf) 7 O) LL O O N O) rn Z W co r-:Mco x =O Q \Ce) njO 7 cp ocE E O QW O V N N N Z 'O In O Q 0 H Q O o to Z Q m d O I� co coo O n f� co coo O r - U 'o _ W W c J V) Q w O O O O O O O O pQ a Z cc' O O co N °0 2 - LL iO O co O 00 L p � ♦- 2 r H O U w o- > M Y N c c0 00 O o � 0 � U r D M O 7 fA 2 ai N '1S 210'10 O N O N O y O N O N O w O N O y O z_ p , Z W N O W N LU r Y Q C U M OLL LL J cc a m a U N 5 a 5 a C O SNOIldW3X3 'JN!OIOHHlIM v U) U Q d0'ON z O C w� W D p Z U U C C Z LU U, U O p Z J Q C 5::! N O U W O K O Z O Z goco p LL Q H" O > > 0 0 a O) N L N p vLO w >C pd L LO N 00 O 00 V D Z O O M N(O N OZO O O p LL Z U U LL Z J z H Q N C N LL C C OLUJ O J0 W K Q Of z a `m ui o w � m c y L a U O N N Q � d � 'o35 m y a Oa0 N y UO o m 1- 0E 3 a E t0 J U v dm M N U T C, o m N T cY a m c > v N m n C U O O N N U a U °1m cs L o c E' E`oy E� 0 0 t E O cc o ° m mF d W fn L o N C m3 w m O m o o w U p € c" m O C0 O 2 N a C d E y C L U L U 6d�� O U 0 C y O N O N U O) N N C wag° TL N U 0 N L N 7 C o U LL O C N O 0 O w O � U � _ J C o u p t75 M J d b C U O O U C m m w a o CA C y O Y N C o o c o m d a m LL > O O .> U 0 d O 0 3 v o 0 m m o.� Y m f0 d 3 N a p E � � y O 3 Oa U y m O a CO C y L a U OC a L ii T Em O C') O 0 N L C O O U O N f�0 D cc ° C m d C 0_ a>o w M cn C:a U 0 0 0 c O a p N a c m a' L m m C - 0 N O W Z oN m - m a°m yam ° EN Q U) U N N C () C � L � m o T m ccin C �= m U N 0 am�� .. C > N m O a Z p O a rLO+ m N U) _N N m .6.!= zz Q OV m U c Q3 c Z m o C: 75 •C C a) CC O o ° L CL E" o O. ° N N m o V �O_ 7 m E m m a r d W U m 7 0 O 0 Q Q tO E U 0 U) H U T m f A C E O a) E LL L F - Z _ °L.. 0 2 Z y W d co ac C N p- aL LU a°a(=m y U a U C LL m ° W c 3 N Z LU L w mo a LU x W U co N s - W o ff a 0 m ii Em O C') tf 0 °' C O N c °m ° C U f` w M cn 0 0 0 c O a Co C C O W O � m N � yam Q U) m SL U m o T m ccin � D U N 0 am�� ° Vic m O a Z p L rLO+ m N � m L m zz Q OV m Z 0 c 0 y, d •C C a) CC U L CL m U) O. ° N C (D N �O_ 7 m E m m a r O L U T (D y N O 0 O w J Q U a Y C C N N cm �o N a) E E .L.• O. m F - Z C 0 m Z y a - Z C N p- aL 0 L x L 0 co N C �O 0 U O N L C a U d NCC LL w mo W co N s - r o ff a 0 m N O _N c' —0 ma c` E L c ._ =a> N Uca m � — F: a c Na a W c-0 c > ami a c°m L 75 w\ ° O N C � o y U O,d Z W L H O ul O aw O a m� ;D.0L m 3 m�UaNi Qz U �O w� a� mLc°�� °Lco c ° a� U C v 0 c'c m E Co NJa d d Nv= N m`o E 0- >D OU 0 O- N m -N L O j d E O m L O U tC0 N._ Q O N 2 a) mw Q N _ N C m U U° C o a C C a F WO vL c ` a E °� m �j E m m� E E > �' E N K xaw 3 E a a 0 0 CO -00 N O M C 2 N 0 0� LL LL -C T S yc 0 xf m cc��j m o y m > OZO OU } - Q W CI- 3 0- O. 0 0 L C U) m .L+ p Un L L O_ @ Q EE W U Y w6 `a < L O 0-6 > o Z O ." 0 �. aL c LLOI� N 0 Vj m (a 3L C 0 Q m«o N m n- m O-m� m L T > 6 �0 Co 0 0 v O O c m a a> j �a T U a (D L O LL L a O V .0 U f` '°n='w ~ 7 C p, Y C m 0 0 0 0 N 0>1 �+ CL a@ W 0 0 U a) 0 Q a =ate -a QUZ w X O v Cl.- w0 3 E m °� W m O C m V E 0 VOZ) T LL co w aaw�o (n m m c mem N N cw m 0 0 C w a NIxx _ QOH C T T CLCO C U L m LN 0 -C �0 C 0 m U mC Ur Z LL F LL F o JVO o m a c °'� L = v', o- o-- y E c` C Y ZL LL moo 3 0 a :0 a) a s N 00N L c,) 0 N C T cA a m a)o Q z Q °N' �0 w .0 m O C TO °L E E- m m 2 fn 0 w m or 2af T w E'a) m mNa) W Z HU)0 ii Em O C') tf 0 °' C O c °m ° C U f` w M cn 0 o U) c O a Co C C m C asQ O � m N � yam m SL U m o T m ccin U N 0 am�� ° Vic m O a Z p L rLO+ m N � m L m c 0 y, d •C C a) CC U L CL m U) O. ° N C (D N �O_ 7 m E m m a r O L U T (D y N O 0 O 0 U a Y C C N N cm �o N a) E E .L.• O. m C 0 m Z y a - Z C N p- aL C L 0 co N C �O 0 U O N L C a U d NCC LL a) N> co N s - r o ff a 0 m 0 _N c' —0 ma c` E L c ._ =a> N Uca m � — F: a c Na ii Em O C') c °m ° - w M cn 0 .LO+ N Nm Co C >+� 00 CU 'Ir m C asQ O � C> cc .LO.. yam OL. SL U m o ccin N 0 am�� ° Vic O@N L 00 0 fa 0 y, d •C C a) CC a) i6 T 7 U m a C (D N �O_ 7 m E m m a r O L U T (D y N O N N U a Y C C N N cm �o N fn E .L.• O. ° C 0 N C L °0315 C T mO m� Z C N p- aL C L 0 co N C �O 0 U O N L C a U d NCC LL a) N> co N s - O o ff a 0 m _N c' —0 ma c` E 2 c ._ =a> N Uca Z -Cc -- F: c Na a Ca'�m c-0 c > ami a c°m L 75 ° O N C � o y U O,d O O ul O aw O a m� ;D.0L m 3 m�UaNi v a� mLc°�� °Lco c ° a� U C v 0 c'c m E Co NJa d d Nv= N m`o E 0- V C 0 O- N m -N L O j d E O m L O U tC0 N._ Q O N 2 a) p w _ N C m U U° C o a C C a F m e p vL c ` a E °� m �j E m m� E E > �' E N o 3 E a a 0 0 CO -00 N O M C 2 N 0 0� ° O. � 0 Q n -C T S yc 0 xf m cc��j m o y m > U co N a N �° mac 0 0 0 0 W CI- 3 0- O. 0 0 L C U) m .L+ p Un L L O_ N : 0 0 0 Y w6 `a < L O 0-6 > o Z O ." 0 �. aL C01 C N 0 Vj m (a 3L C 0 Q m«o N m n- m O-m� m L T > 6 �0 Co 0 0 v 0 c m a a> j �a T U a (D L O LL L a O V .0 U f` C C a) U') U) 7 C p, Y C m 0 0 0 0 N 0>1 �+ CL a@ W 0 0 U a) 0 Q a =ate -a C N N (% M X O v Cl.- w0 3 E m °� W m O C m V E 0 U aaw�o (n m m c mem N N cw m 0 0 C m N >+ C T T CLCO C U L m LN 0 -C �0 C 0 m U mC Ur Z L a 0—a o m a c °'� L = v', o- o-- y E c` C LL moo 3 0 a :0 a) a s N 00N L c,) 0 N C T cA a m a)o a 00 H 0 O.m a w .0 m O C TO °L E E- m m 2 fn 0 n m T a y m or 2af T w E'a) m mNa) v moms a�� �on� X❑ 04 a LL (n a m L -O 3 0 L N L (/),o o f m m 3 3cno ~ mz.m H cmi U 2 `p ~ y v m C M C m 0T- 0.0 O. Y w Q-' 0 U m U N nN v 22 N CL CL (D .�... m3wU(n 0lL U m 0 mQcq MW i -_j r7 E as a C y. oa 3�A o 0 0 ca L � L C � L � x A 3 Q O d, 03 M kn 00 H C o 0 0 3= L 21 3 H x c d xt c o 0 0 a3 •O \ 0 0 0 C O O O L 0 �-r 3F3x W 0 � � U U p. a9 w ¢ H M. 0 r, m om. O z �kOt 1 U z 2� CN m + a m o r m 4 x ) ro oa oCV w Y m m z E m 3 3 0 a CLEW M L co y c �L/ '^ O ° w .p A d 0 8 m m g c i3 m �• 1 m m m M W a o O C_ f6 _ z 0) t 3 20 F'L^ �c@ D U Al 3 to In 'm Ix CN LO T-- O O Z o' = N V Q E •� Q m O io O w zi >✓ -C U)+_�+ L r � i, •� m z v L � o E • Q 0 � Q o > O z " t m 3 = e C o U � L c > O U co L U •i••� c o 0 El E O ^' Z N W m W L E Q •z 8 :2o mm m O }� E Z m C: u 9 O -0 � m EU U C _ is N E Q. c o V _ •a w t m { E E Qcn 1 m a a w z" m m CL O 3 • O ) V W a () Z W M. 0 r, m om. EWU Moe PAYROLL AFFIDAVIT REPORT PAGE 3 DATE 12/04/14 08:55 FOR PERIOD ENDING 11/29/14 JUPITER ELECTRIC, INC. ALL JOBS JOB INFO 14405 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 11/23 11/24 11/25 11/26 11/27 11/28 11/29 PAY TOTAL INFORMATION SUN MON TUE WED TNR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 4.00 7.00 6.00 17.00 72.820 1237.94 40.00 2528.92 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079— DT M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 17.00 145.35 35.41 88.04 .00 611.81 1648.31 006817 - ----------------------------------------------------------------------------------------------------------- JOB TOTALS TOTAL EMPLOYEES— 1 TOTAL JOB HOURS— 17.00 TOTAL JOB AMOUNT— 1,237.94 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 12/4/2014 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title: dministrative Asst. Date: December 4, 2014 I, Leah M. Hatch, Administrative Assistant. do hereby state: (])That 1 pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 23rd day of Novembm 2014 and ending on the 29th day of November, 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat 967, 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE T GNATURE Leah M. Hatch, Administrative Assistant 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. r �o a a p v N to N = O O O 0,0 wxA o Cdw y y T 3 h w H w L x U 3 N O H U C, it al O 0 0 OCL o C p vNi p Ri L V � .7 O O O 4t O O ii x p aa3 y' •O \ 0 0 0 O O O L 3�"�x p O O •L 0o O C1" y � in d � � h L 3 x iV. c o, °' U � - O f45 a o 3 0 .G y t1 `,� 0 � w ¢ N O � N it v a � 3 o U U " A z a, Ob N O �" bq o b w � t0l V L � N z � � � ami o z o o w z z w" 3 a ti p v w L = O O O wxA L 3 O H C, O 0 0 0 = C p p Ri L .7 O O O 4t O O O aa3 y' •O \ 0 0 0 O O O L 3�"�x p O O •L � � h L 3 x 8 - O w 0 .G y t1 `,� 0 � w ¢ L U J 0 c m La _ a H 0 Z) rml 0 w m C7 C a� L O r d z � L 'ls'�iN 0 a 3 3 N CO m L + + a z m om 2 g LL YaN Y CN m oa d w CO 2 P x a 3 v a 3 � m CD M 0) `n CL N c O p wa c a 1 d a O o w O C 5 2 c /T J y 1 d � N 9D 0m m 11 TWm o z c _ azo 5. slq 2 u�e oCO o 3 cv t a v d 'n N LO t C) +� O Zcu = � � U c m N Cl) Q U •L E o O +� c0 o O W U) N Z aJ -�•+ d J Yn 'a o u n U m Q O ¢ ¢ m a: a N d y Z c ¢ r d w U C o � U L N L- H O O cts L 3 U 0 O N .� C F--1 Li - - - D El El EO m �U1 W Z E Q) w U W L E Q 4 z_ t p v m Q) 4 m C:t3 e = E o U .-� E 2 Q a fA 7 O .� m E r^ VJ c Q) V 6 w cc c 3' Q) Z a w C) ¢ 13 L U J 0 c m La _ a H 0 Z) rml 0 w m C7 C a� L O r Ewu moe DATE 12/11/14 08:33 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 4 FOR PERIOD ENDING 12/06/14 , ALL JOBS JOB INFO 14405 SCHOOL DEPT ADMINISTRATION ✓ BUILDING, NORTH ANDOVER, MA EMPLOYEE 11/30 12/01 12/02 12/03 12/04 12/05 12/06 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 7.00 1.00 7.00 4.00 27.00 72.820 1966.14 40.00 2894.68 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03019— DT M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 27.00 177.60 31.12 99.22 .00 762.60 1824.14 006845 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES- 1 TOTAL JOB HOURS- 27.00 TOTAL JOB AMOUNT- 1,966.14 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c 149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 12/11/2014 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title. Adminktrative Asst. Date: December 11, 2014 I, Leah M. Hatch. Athninistradve Assistant, do hereby state: (1) That 1 pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payrollperiod commencing on 30th day ofNovember. 2014 and ending on the 6th day of December, 2014 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on beha f of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEF17SARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS I EXCEPTIONS (CRAFT) I EXPLANATION NAME AND TITLE SIGNAT Leah M. Hatch, Administrative Assistant kiliD/I 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. z h is t ft a y� to 13 p 0 `C �C �}�, X� i "� ,. k. � .,+s. 33 ��( 1.� "X"", {_f . ' 3: Prom, , j" a i�, ; r IF V, •� ,4 KI t a a cr, ` V � 3f � � ♦ O %kga91 : NO VON QQ 14 R 5 i Iva SO " { E k'.1 v V Q== Fi aF1 •y .O iii .�5 4 2 41 Luo q J WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall famish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 1 , 20 175 (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by (NC-v�C;.�C a3v,cmE;4� r--J3r4e-%>on the Sck(rc t (Contractor, subcontractor or pubitc body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature — Title %kE-� cw DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 C WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse ofthis page and includes all the information required to be kept by law. Every contractor orcontractor is required to sub keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be atta years. ched to the payroll report. Once collected, the awarding authority is also required to preserve those records for three In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion f u the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 2. 2p_1-_ _ t, f �E,20 ti S 4e K; (Name of signatory ply) 1 yz GAT vg E-A do hereby state: (Title) That I pay or supervise the N Cv✓�,,�«ayment of the persons employed by �� m on the Sck&, (Contractor, subcontractor or public body) I n ?d( Ai-) o,, and that all mechanics and apprentices, t (Building or project) said project have been paid in accordancewithwages dete�ed laborers theprovyed on sections twenty-six and twenty-seven of chapter one hundred and forty provisions of General Laws, rty nine of the Signature46�2- Title % (C6AS (,JZ DMSION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, $OSTON, MA 02114 `vu z ci tam, d 11 'Aft q n` a N Iw! 7 4 8 K y x s �d f.�Q' -pq $a`'� y 'Fl• r f'P� r`.nr a ,� ;_{'�, a .as gr $ , �..^'''i 5+ iPyS ' � ,j4 yyf•. �. ? T';. ,� � '„��`�� . �S?�' ��' y'Yr i�,np,�:� �, � �s y�' ^�q. L. .r ©� Inrn DQ•Z }� C.i :l INS pen': LOP, #n; ING �^ i• y A��. - � U Px �t'akwi� x sem` y"�i `S', �' t oll Or A p. � ia �� y � r � L o- �.. T W '� ��•x�'C, � Noy R„ J woo lie," �z� � �•Y �.e �T�•SO /1 !'�Jp �'� �"r>� 'fix°' :�,�, �� Mal a. 1 1 J Com' d n en i a UA �U l 75 VIOU '= LUQ I N V W O m j IT � o a C WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years - In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE tj Z c�_, 20 1 S 112 GAT uiz E-A (Name of signatory party) (Title) do hereby state: That I pay or supervise thT,53Wfkon yment of the persons employed by [mom the 5 Ck&,c cj 1-7��' i iT�A�� o.J (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature —2� / — Title % klEhs (w �. DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 A r a E x+ O o � o� � �+ o moo as 3�q ,o 0 a o u � o L � = � u � O � 0 � 0 � d GT"xA O 0 i, � U vi e� ^I a N 0 r� o Q O 'r O N x � O •L �' � O U N L C L L �xA U r a E x+ O o � � �+ o as 3�q � 0 o u � o L � = � u � O � 0 � O U � d GT"xA i, � U vi e� ^I a N o U r� r Ca E a as 3�q o 0 0 u L � = � u e o 0 0 GT"xA u a � o Q O 'r O N � O •L �' � O L C L L �xA O 3 ° w' L Od O 0No 0 3xA M N H ° o 0 L 3 0 3 0 F x 0 0 0 C G� O O O 3 � i y L •L O O O L � L 3F3o x 0 0 W N 0 cl W d —Li H Ca rn c 0 �U U t0 yO U t0 0 w 0 0 U t0 (0 .0 m o c m E U C a� E E U to w C N a m E T tz E U Q (U 3 LL .o .c c m rn c 'o 3 N N L O FA d 2 LO .1 Ox � V m � Z w T m y o� 'o m S3LL V m L o m a CY)3 LU m O a Z� o m 3 v c a >.aEiw CL 3 to M ti 'n m as W c c E r IL SQ W d Z Q = o a 1 tL d• ? L O L n 0 m U m m 0 m F O Y O E W x c TT V/ Q m o m m IL 03 0 O Z C C ca S 2 m V! e u moa S t d r- 0 U f1 to a= ax H .�..� p En _ O Zcu x -a U ,C C m Cl) V to Q .L U) Q U 3 ca 0 _ O W J � � L m (0 o � O Z H J a Y "0 o rn m o Qmo Q m fY m Im� o N r :m+ n a Z o a Q H m U o u L5 > O x O c0 L .� i Q U m U (I Z E N W m W L E Q H o Q1 }� a u G COm C 0 t _ (a N E ij. J o U m c0i 0 m N Q i E E ^, H H m Q a W Z W O o L° o U w Q S (; Z w rn c 0 �U U t0 yO U t0 0 w 0 0 U t0 (0 .0 m o c m E U C a� E E U to w C N a m E T tz E U Q (U 3 LL .o .c c m rn c 'o 3 N N L O FA EWU moe PAYROLL AFFIDAVIT REPORT PAGE 1 DATE 01/15/15 09:03 FOR PERIOD ENDING 01/10/15 JUPITER ELECTRIC, INC. ALL JOBS JOB INFO 14405 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 01/04 01/05 01/06 01/07 01/08 01/09 01/10 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00205 BRIAN W. COSGROVE RT 8.00 8.00 8.00 6.00 30.00 31.590 947.70 40.00 1263.60 108 ELM STREET OT R.RATE PO BOX 171 DT BYFIELD MA 01922- - - S # OF DEP- 1 JOB APPRENTICE HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 30.00 159.02 82.17 47.18 .00 201.94 773.29 006969 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 00985 DANIEL P. RYAN RT 8.00 8.00 8.00 6.00 30.00 72.820 2184.60 40.00 2912.80 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 30.00 179.91 165.38 91.42 .00 765.32 1710.77 006982 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES- 2 TOTAL JOB HOURS- 60.00 TOTAL JOB AMOUNT- 3,132.30 Commonwealth of Massachusetts Division of Apprentice Training REGttE-055-469 AOL A �� E R ISA ELECTRIC 142B T' ROAD SALISBURY, MA 0 ELECTRICIAN —, Appr. Start Date I'raj. Comp. Date 6/23/2014 6/23/2018 ste ! P .S1e,pl n .Step? ' JYep .Step9 BRIAN W. COSGROVE Step -,V �/ Sre'P4 �' � .SrePb .S7ep8 .Steplr Annual Apprentice LD. cera Ezpires 7nno15 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: 01/15/2015 i, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature• Title: Administrative Asst. Date: January 15, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on I day of January. 2015 and ending on the 10th day of January. 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of saidN. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGN U Leah M. Hatch, Administrative Assistant 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. THOMAS E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 TEL (781)233-8810 FAX (781) 231-2151 New England Builders & Contractors 464 Merrimack Street Metheun, MA 01844 LADIES /GENTLEMEN: WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter ILI';1lC;iI(0lIIZ,1I�.► fll. DATE: 12/16/14 JOB NO: 2014-12 ATTENTION: HenrySarkis RE: NORTH ANDOVER SCHOOL Payroll Reports ❑ Attached ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Samples ❑ Change Order ❑ ❑ Specifications COPIES DATE NO. DESCRIPTION 1/1 ORIGINAL/COPY THOMAS E. SNOWDEN, INC. 12-11-14-12-25-14 VIKING INDUSTRIES 12-14-14— 14-15 J. LEE ASSOCIATES INC 11-9-14 -- 12-13-14 TRADESMEN INTERNATIONAL, INC 12-21-14 THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS: COPY TO: FILE ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit ❑ Submit _ ❑ Return the following items: copies for approval copies for distribution corrected prints 20 ❑ PRINTS RETURNED AFTER LOAN TO US WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 12/251 20 14 Clerk I Barbara R. Barbolla , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 01-13-2015 Page 3 For the Period Ending: 12-25-14 Job: 19-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Mark Rothwell 5 Bow Street Middleton, MA 01949 12-19 12-20 12-21 12-22 12-23 12-24 12-25 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 6.00 6.00 64.00 4.15 68.15 408.90 1,894.00 273.50 98.49 1,377.11 408.90 144.90 Totals for N. Andover School Admin BLDG 12-19-14 Net 1,377.11 12-20-14 12-21-14 12-22-14 12-23-14 12-24-14 12-25-14 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions 6.00 .00 .00 .00 .00 .00 .00 6.00 408.90 1,894.00 FWH 273.50 FICA 144.90 SWH 98.49 SDI .00 Other .00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 12/18 ) 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one h ed fo nine of the General Laws. Signature.,' Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 01-13-2015 Page 2 For the Period Ending: 12-18-14 Jobc $9-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Louis Bureau 1346 Sokokis Trail N. Waterboro, ME 04061 12-12 12-13 12-14 12-15 12-16 12-17 12-18 Total Pay Fringe Total Gross Total FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg 8.00 8.00 8.00 8.00 8.00 40.00 64.00 11.34 75.34 3,013.60 2,560.00 317.86 105.27 412.59 1,542.37 3,013.60 181.91 Jeffrey Grey 17 Whitney Street Saugus, MA 01906 12-12 12-13 12-14 12-15 12-16 12-17 12-16 Total Pay Fringe Total Gross Total FWH SWH Other 030-48-7316 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net S - 0 Pipe Fitter Reg 5.00 5.00 10.00 64.00 4.15 68.15 681.50 2,311.00 484.38 116.56 69.11 1,469.43 661.50 171.50 John Mahoney 84 TellIer Way Dracut, MA 01826 12-12 12-13 12-14 12-15 12-16 12-17 12-18 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 6.00 8.00 64.00 11.34 75.34 602.72 2,560.00 440.00 133.12 1,949.76 602.72 37.12 Mark Rothwell 5 Bow Street Middleton, MA 01949 12-12 12-13 12-14 12-15 12-16 12-17 12-18 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 4.00 8.00 6.00 8.00 6.00 32.00 64.00 4.15 66.15 2,180.80 2,702.00 475.50 140.50 1,679.30 2,180.60 206.70 Totals for N. Andover School Admin BLDG 12-12-14 12-13-14 12-14-14 12-15-14 12-16-14 12-17-14 12-18-14 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours 25.00 .00 .00 16.00 19.00 16.00 14.00 90.00 Gross Total This Job Gross Deductions Net 6,478.62 10,133.00 FWH 1,717.74 6,640.86 FICA 597.23 SWH 495.47 SDI .00 Other 481.70 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 12/11 20 14 Clerk I Barbara R. Barbolla , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapte l dred;and forty nine of the General Laws. � �J Signature Title / Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 01-13-2015 Page 1 For the Period Ending: 12-11-14 Ooti: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Joseph Bureau 91 Fairmont Ave. Saugus, MA 01906 12-05 12-06 12-07 12-08 12-09 12-10 12-11 Total Pay Fringe Total Gross Total FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 2 Sheetmetal Reg 5.00 8.00 13.00 64.00 11.34 75.34 979.42 2,563.18 352.61 117.44 200.81 1,711.59 979.42 180.73 Louis Bureau 1346 Sokokis Trail N. Waterboro, ME 04061 12-05 12-06 12-07 12-08 12-09 12-10 12-11 Total Pay Fringe Total Gross Total FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg 7.00 8.00 15.00 64.00 11.34 75.34 1,130.10 2,486.00 301.03 101.76 405.92 1,501.04 1,130.10 176.25 John Mahoney 84 TellIer Way Dracut, MA 01826 12-05 12-06 12-07 12-08 12-09 12-10 12-11 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 8.00 24.00 64.00 11.34 75.34 1,808.16 2,560.00 440.00 133.12 1,948.58 1,808.16 38.30 Totals for N. Andover School Admin BLDG 12-05-14 12-06-14 12-07-14 12-08-14 12-09-14 12-10-14 12-11-14 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions Net .00 .00 .00 7.00 21.00 16.00 8.00 52.00 3,917.66 7,609.18 FWH 1,093.64 5,161.21 FICA 395.28 SWH 352.32 SDI .00 Other 606.73 Job Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. ADMINISTRATION BLDG. P. 0. BOX 32 189 CENTRAL STREET 566 MAIN STREET % 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 Soc Sec No. ---------------------------- Hours Worked This Job ----------------- Class 12/29 12/30 12/31 01/01 01/02 01/03 01/04 Job Number: N ANDOV SC Week Ending: 1/4/2015 -- Deductions -- Fed. Local Gross Pay Fica Other Check # Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 000 Orb WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true anc accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardin authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Developm ent/D!vision of Occupational Safety within fifteen days after completion of its portion of the work a statem ent, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE --- -II �-----.--r=5---- I, Douglas N. Carlson, CEO do hereby state: That I payor supervise the paym ent of the persons em ployed by VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT, ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S ig n a to re, C� hIeT E ecutive f ice�- - - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Certified Payroll Registor Page: 1 Job Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. O. BOX 32 189 CENTRAL STREET Week Ending: 12/28/2014 566 MAIN §TREET 32 SPRING AVENUE SAUGUS, MAO 1906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 12/22 12/23 12/24 12/25 12/26 12/27 12/28 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 0.000 0.00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/D ivision of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson,, CEO do hereby state: That I pay or supervise the payment of the persons em ployed b VIKING INDUSTRIES INC. on the N. ANDOVER SHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature btVq4*4-4 - &L&-, Title Chief xecutiv60fficer------------- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Job N. ANDOVER SCHOOL DEPT. ADMINISTRATI6N BLDG 566 MAIN STREET N. ANDOVER, MA 01845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 12/21/2014 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and Includes all the information required to be kept by law, Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority, This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/D ivision of Occupational Safety within fifteen days after completion of its portion of the work a statem ent, executed by the contractor subcontractor or public body who supervised the payment ofwages, in the following form: STATEMENT OF COMPLIANCE ---- --IgIaa - - -- //- I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the paym ent of the persons em ployed by VIKING fNDUSTRIES INC, on the N.ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, team sters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. 1 S i8 n a t u r e Ael '� 0�f I --------- Tie hix cutive f Icer - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 12/15 12/16 12/17 12/18 12/19 12/20 12/21 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II -'"-6224 R: 8.000 8.000 8.000 0.000 0.000 0.000 0.000 24.000 43.310 1039.44 289.55 0.00 V4524 INSULATOR -MECHANIC +24.480FR 98.96 137.54 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1596.18 23.15 979.17 WHITE Male +0.000FR 37hrs 67.81 617.01 Hours Pay Regular 24.000 1,039.44 Overtime 0.000 0.00 24. 0 1,039.44 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and Includes all the information required to be kept by law, Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority, This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/D ivision of Occupational Safety within fifteen days after completion of its portion of the work a statem ent, executed by the contractor subcontractor or public body who supervised the payment ofwages, in the following form: STATEMENT OF COMPLIANCE ---- --IgIaa - - -- //- I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the paym ent of the persons em ployed by VIKING fNDUSTRIES INC, on the N.ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, team sters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. 1 S i8 n a t u r e Ael '� 0�f I --------- Tie hix cutive f Icer - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Jgti N. ANDOVER SCHOOL DEPT. ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MAO 1845 t;ertitiea vayroii Keg ister Contractor VIKING INDUSTRIES, INC P. 0. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 12/14/2014 Nage: t WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of corn pletion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Developm ent/D ivision of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMP IANCE I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the paym ent of the persons em ployed b VIKING INDUSTRIES INC. on the N. ANDOVER S60OL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined undPer the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine ofthe General Laws. Sinature �• Ti e ChiefiE ecutiveOfficer-------------- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 12/08 12/09 12/10 12/11 12/12 12/13 12/14 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II -**-6224 R: 0.000 8.000 8.000 8.000 8.000 0.000 0.000 32.000 43.310 1385.92 ---------------- 332.86 0.00 V4511 INSULATOR -MECHANIC +24.480FR 109.71 150.35 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1769.41 25.66 1066.67 WHITE Male +0.000FR 40hrs 84.16 702.74 Hours Pay Regular 32.000 1,385.92 Overtime 0.000 0.00 32.000,35.92 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of corn pletion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Developm ent/D ivision of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMP IANCE I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the paym ent of the persons em ployed b VIKING INDUSTRIES INC. on the N. ANDOVER S60OL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em loyed on said project have been paid in accordance with wages determined undPer the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine ofthe General Laws. Sinature �• Ti e ChiefiE ecutiveOfficer-------------- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE JL� 1 , 201 1, Karen Siegel ,Accounting Coordinator (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title: Acco nting Coordinato VS - 09/11 m 0 0 a d z \\\\\a 5 a O rn 3 O O LL %�a� tasnµ� (V a o 3_ 0 Ch ° CO= W ;m N y M a o q W m > ��a ILI ae r� a Z IM 3 N ` V e T 0 C co a 3 c m LL O= OD co Lu M a r ° coo L ac N 0 O W = F J m m , �m LOC e Q a= 3 x0 O 0 c = 0 -C ar. cc e g x O d g¢ o m, S o 0 axv ax IL a N LO C) O M 0 _ C s L O n Cc m O � c U m C v O 4-0 F v o E . Ca L ro C O z If a g T ie O Z U t nye v N = a a N ° 0 L' (D a E N ` m O r o m m 4. m woU c Q ul c c O e y N c� m Z z a a v c 0 n 4— O Q t'` a� E O O Ol0 0 0 U V ro z 3 Z H Im U) L a O m E a E m zCL O E � -' CL a a o w O Z 0 uj c� m 0 0 a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 20_&_ I, Karen Siegel ,Accounting Coordinator (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature � 1�a Title: Acc ting Coordinator 09/11 0 d IL d z Oa, x�mO o m o =3= \O N M o ma o " m O s z e 3 N gmW T p C co C O M W` M M ° m coo L a r a N> o E m U z F N m / o a 03 _ o� z u 3 m m Cc .0 mo� < U d N f� �+ in L � O =3 O•� CD L a m m O �c U co ca E o m �_ F C) O OLZ E O Z i6 o z 3 U m a O V u N C o L `o c 'W > m EO / o m CD 3 C v El El 0 El 0 W l02 O E O E W U L) H N P0 0 a � E Z Z i v < (1) 0 0 4 O s U m O 6 .2 C C:L o 2 w c¢ v a p N a Q I O E a E z Y 0O Q N J T 'e 3 L 1 E a.P ami o W Z V W 0 d IL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE ud� '20 I, Karen Siegel ,Accounting Coordinator (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature kn I I/) I NO Q Title: Accu ti g Coordinator 09/11 O m a d z U = VM RE�p n a O /T O N N o m _ �,r� � c m m ra O z y 3 m 3 N u mw T c �D c co (o c v� M o ch U. O W M ° m (o `- N _ L r a N o � yy m m m TNQ7 Lo u e < 06 a 03 _ z o z ° !a ° 3 O d; me t c Z a=o� S= d ti a N U) r O o _ c C Cl) L _ O o �� F 0 (0 m O cu Um iF- a }� O` Ov }r E m z Fo n O/ z ; ) E O N = Y a a u< amo m Ir m o 0 L W `o c E O m Ch c o m T F' El 1:1 E�—j F—I 11 El 11 T w w O c r- U m c O ei E H d � (D �A Z z t v m Li E a O m o m z d m v of h o v N P, Q m c O a umi >O > CL E V m 3 aq� w -E Q N o e w O z c7 O m a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE ,20 fit. I, Katie Oertel ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature S Title: Office anager 09/11 W F O WI 0 m a 0 z OCN \ (N O Z (n tel/ N C:) M W + x°3w M- LU ti ' m �> �a 0 ; Z O T Y p C (N V 0 U C a s c W V O CL i c v m d w c LL 0 iJ (0 � a c � O o co 2 CY)C T 1 ° W a M o a CO L /�� � x ; od N C J N A L(, N O � N ma T 0 m 0. N 5 � _ p O O Z 0 O zLO U3: O m " O. U O. N m r- E2 U) C) x° O m O c U Y (0 ca9 •E c d C o E (U E :�. O+r O r Z L a N i .°. UN O z O V G ate= d a O N d > 0 > c o o L c o m O U m c m � T Q y O = t^ Li El Ll 11 m c W c m E O U LLI �? m O OE m 0 C7 N 7 L Z N a Q N V Z`~ d O E m° 7 c ~ - Oc C U m E U z m 0 �° rn in m .c ` 5 E a` E m z ,1 L O cO ¢ c m N m O, 0 N J � o o w a ¢ ` 1 1 ` d .0. o E w O Z W F O WI 0 m a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 1J-1� 20 11 I, Katie Oertel ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature vuk�� Title: Office Manager 09/11 y�. T rn m Ima o z �' c7 O Z /'1 a d c \ y N O (Y) + o m c m o v m r a` �c r� O a o z o d m Y m N a a ;0w T `O C ? = N 7 CL 3 c d m 005 O �C/O� VJ c LL N c K Ma c M G r w e co in (o AL) x IT N o O E- C d r 0 0 x3� C y Y / m O Q m N Tm[D 0 r 2 O O O Z Y O mJ L ` O m N L O Z a=o'¢ <3: CL U O. N tim N n S L c�� G 'V^, - " s i0 O o� �� m O C C) Y >N C G U Q o iF— O d � z � 2 a C:=3 s a 0 « T i m 0 Z 0 , 1 v t; ` aK= a m v O N m > o > Q H O. y c o � c o o (n > N t0 E O v I Tt \.! o c m T CD cE O U C c m Lu 'E 0 7 L z l o Q C 'p E IEO z N �• O V N � E O E C N > ; = O C:U c U a3 fn CD IO z f0CI U fA L 7 ` 5 m E E Y L A y N N d Q O 4 z O a T oa d o CL L) a w a1 cD E w O Z T rn m Ima WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 20�_ I, Karen Siegel ,Accounting Coordinator (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature &W. (� ��a Title: Acc _ ting Coordinator 09/11 W H ZI m O L 7 ld O) C 3 m N t 0 m CL d z Y = t O/ Cp $ O W I W MCD Y \ Zcl (0V' 0 a a m IT LO r m O s LL OR OR U� v, M 5 N N 0) r W x a Z $ 3 NmW E. C N a 3 c m co c O L c � a q M Z M Wa M0 M CO L ° rn r a r- o c ro m y o (3) Ol W F N u O w Ln D M 00 N LOQ y Oc _ (0 �' M z C Lnz E 3 0 ¢^Oo CO a v z N LO � m C)' O � o x LL "' Q t L O Lr) m • = L co (O (0 c m 0 cU •E c 3 � O N W Q � U m 0 : Z W � p m U Z 30 nmo m LO v O 04 d Y a 0 a ¢ z H ¢ LO c c C L m m (p c o Q% m L L Q E 0 m a� 5 m 3j W w c � N a� r El S LAg 1:1 El 1:1 m W U U c c }� L y m v `m O � 3 Z � D Q (p O l g 0 mom °'ami Nyco mt7)o c �^ E Sof EQx c oto �' °Z , q Z 5 fi t" E N N W- 2 N i5.2 D o V c -co s" N t a O ° >= xrn c S CL Q m O c 'E H m o x w 0 ' W H ZI m O L 7 ld O) C 3 m N t 0 m CL o a 0 O e O O n M co 1 8 co 00 C E Q � a CD g 0 cu to G Q E E e L9 Ll ` .. iiFll� Md Nfce,cl 4.et:.i✓rc�«r Tres card ac!xrxrr.!cdges that the recc;p,ant has ouuocesst6ty competed a 10 -hour QmupaTonyl 5afaty snd Health Trawng Course P General Industry Safety and Health Thomas Watson Andra Mack 5,29/2011 (Tratner rarnn - pri-it or type) (Caursr+ end date) Commonwealth of Massachusetts Division of Apprentice Training REG# E-050-833 J Lee Associates dba J Let El w, a 420 Northboro Road Centr*s1 MARLBOROUGH, r frt?C}�E ELECTRICIAN Appr. Start Date Proj. Comp. Date 7/19/2012 1/19/2016 r.pt �rrp: �",P;�tr{r .rcpt/ THOMAS WATSON . .7cp: ® Gcpt H �r.Po � .xps 8 VrTtr� Annual Apprentice f. D.F Card Espires I 8!15/2015 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 12/25 , 20 14 Clerk I Barbara R. Barbolla , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. ' on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title / Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 01-13-2015 Page 3 For the Period Ending: 12-25-14 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andolier, MA 01845 Mark Rothwell 5 Bow Street Middleton, MA 01949 12-19 12-20 12-21 12-22 12-23 12-24 12-25 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 6.00 6.00 64.00 4.15 68.15 408.90 1,894.00 273.50 98.49 1,377.11 408.90 144.90 Totals for N. Andover School Admin BLDG 12-19-14 12-20-14 12-21-14 12-22-14 12-23-14 12-24-14 12-25-14 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours 6.00 .00 .00 .00 .00 .00 .00 6.00 Gross Total This Job Gross Deductions Net 408.90 1,894.00 FWH 273.50 1,377.11 FICA 144.90 SWH 98.49 SDI .00 Other .00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 12/18 , 20 14 I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hed fo nine of the General Laws. r i Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report Job: 14-012 N. Andover School Admin BLDG For the Period Ending: 12-18-14 566 Main Street N. Ando0er, MA 01845 Louis Bureau 1346 Sokokis Trail 01-13-2015 Page 2 N. Waterboro, ME 04061 12-12 12-13 12-14 12-15 12-16 12-17 12-18 Total Pay Fringe Total Gross Total FWH SWH Other 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg 8.00 8.00 8.00 8.00 8.00 40.00 64.00 11.34 75.34 3,013.60 2,560.00 317.86 105.27 412.59 1,542.37 3,013.60 181.91 Jeffrey Grey 17 Whitney Street Saugus, MA 01906 12-12 12-13 12-14 12-15 12-16 12-17 12-18 Total Pay Fringe Total Gross Total FWH SWH Other 030-48-7316 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net S - 0 Pipe Fitter Reg 5.00 5.00 10.00 64.00 4.15 68.15 681.50 2,311.00 484.38 116.58 69.11 1,469.43 681.50 171.50 John Mahoney 84 TellIer Way Dracut, MA 01826 12-12 12-13 12-14 12-15 12-16 12-17 12-18 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 64.00 11.34 75.34 602.72 2,560.00 440.00 133.12 1,949.76 602.72 37.12 Mark Rothwell 5 Bow Street Middleton, MA 01949 12-12 12-13 12-14 12-15 12-16 12-17 12-18 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 4.00 8.00 6.00 8.00 6.00 32.00 64.00 4.15 68.15 2,180.80 2,702.00 475.50 140.50 1,879.30 2,180.80 206.70 Totals for N. Andover School Admin BLDG 12-12-14 12-13-14 12-14-14 12-15-14 12-16-14 12-17-14 12-18-14 Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours 25.00 .00 .00 16.00 19.00 16.00 14.00 90.00 Gross Total This Job Gross Deductions Net 6,478.62 10,133.00 FWH 1,717.74 6,840.86 FICA 597.23 SWH 495.47 SDI .00 Other 481.70 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 12/11 20 14 Clerk I Barbara R. Barbolla , , (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School Dept. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter dyed and forty nine of the General Laws. Signature f j.� Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowderv, Inc. 12-05 Certified Payroll Report 12-08 12-09 01-13-2015 Page 1 Total For the Period Ending: 12-11-14 Gross Total FWH SWH Job: 14-012 N. Andover School Admin BLDG .00 .00 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue 566 Main Street Thu Hours Rate Rate Rate This Job Gross N. Andover, MA 01845 SUI/SDI Deducts Net M - 1 Sheetmetal Reg SWH 352.32 Joseph Bureau 8.00 15.00 64.00 11.34 75.34 91 Fairmont Ave. 2,486.00 301.03 101.76 405.92 1,501.04 Other 606.73 Saugus, MA 01906 12-05 12-06 12-07 12-08 12-09 12-10 12-11 Total Pay Fringe Total Gross Total FWH SWH Other 030-52-7384 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 2 Sheetmetal Reg 5.00 8.00 13.00 64.00 11.34 75.34 979.42 2,563.18 352.61 117.44 200.81 1,711.59 979.42 180.73 Louis Bureau 1346 Sokokis Trail N. Waterboro, ME 04061 12-05 12-06 12-07 12-08 12-09 12-10 12-11 Total Pay Fringe Total Gross Total FWH SWH Other .00 .00 015-52-1157 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 1 Sheetmetal Reg SWH 352.32 7.00 8.00 15.00 64.00 11.34 75.34 1,130.10 2,486.00 301.03 101.76 405.92 1,501.04 Other 606.73 1,130.10 176.25 John Mahoney 64 TellIer Way Dracut, MA 01826 12-05 12-06 12-07 12-08 12-09 12-10 12-11 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 8.00 8.00 8.00 24.00 64.00 11.34 75.34 1,808.16 2,560.00 440.00 133.12 1,948.58 1,808.16 38.30 Totals for N. Andover School Admin BLDG 12-05-14 Net 5,161.21 12-06-14 12-07-14 12-08-14 12-09-14 12-10-14 12-11-14 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions .00 .00 .00 7.00 21.00 16.00 8.00 52.00 3,917.68 7,609.18 FWH 1,093.64 FICA 395.28 SWH 352.32 SDI .00 Other 606.73 Certified Payroll Register Page:1 Job Contractor Customer N. ANDOVER SCK•OOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. 0. BOX 32 189 CENTRAL STREET Week Ending: 1/4/2015 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 12/29 12/30 12/31 01/01 01/02 01/03 01/04 Pay This Job Med Name Mar ---------------------------------------------------------------------------------------------------------------------------------------- Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay ---------------------------------------------------------------------------------------------------------------------------------------- Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 -0-0 OTO WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardin authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and W orkforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson,, CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING r USTRIES INC. on the N. ANDOVER S600 DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws, S igg n a to re ' Title Chiel Ecutive 0 cer - - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Certified Payroll Register Page:1 Job Contractor Customer N. AN!00VER SCMOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. 0. BOX 32 189 CENTRAL STREET Week Ending: 12/28/2014 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 12/22 12/23 12/24 12/25 12/26 12/27 12/28 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay ----------- Regular 0.000 0.00 Overtime 0.000 0.00 0—.000 0.00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p21B, a true anc accurate record m ust be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law, Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson, CEO do hereby state: That Ippayy or supervise the paym ent of the persons employed b VIKING fNDUSTRIES INC. on the N.ANDOVER S60OL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature _________ Title NT cecutive fficer- - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Job N. ANDOVER SCI�1001_ DEPT ADMINISTRATION BLDG 566 MAIN STREET N. ANDOVER, MA 01845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 12/21/2014 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p218, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE ------ rqfa- _=3 - --- /V - 1, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the paym ent of the persons em ployed b VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Sig nature Tile C ieT ecutive ficer-------- - - - - -- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 12/15 12/16 12/17 12/18 12/19 12/20 12/21 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II '*'-**-6224 R: 8.000 8.000 8.000 0.000 0.000 0.000 0.000 24.000 43.310 1039.44 289.55 0.00 V4524 INSULATOR -MECHANIC +24.480FR 98.96 137.54 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1596.18 23.15 979.17 WHITE Male +0.000FR 37hrs 67.81 617.01 Hours Pay Regular 24.000 1,039.44 Overtime 0.000 0.00 24.000 1,039.44 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p218, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE ------ rqfa- _=3 - --- /V - 1, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the paym ent of the persons em ployed b VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Sig nature Tile C ieT ecutive ficer-------- - - - - -- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Job N. ANDOVER SCHOOL DEPT. Abmir4ISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MA 01845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC. P. 0. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 12/14/2014 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law, Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMP IANCE I, Douglas N, Carlson, CEO do hereby state: That Ippayy or supervise the payment of the persons employed b VIKING fNDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em Toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature _h - - - - - -- Title ChieT ecutive Officer - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 12/08 12/09 12/10 12/11 12/12 12/13 12/14 Pay This Job Med Name Mar Exemp. ---------------------------------------------------------------------------------------------------------------------------------------- Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay ---------------------------------------------------------------------------------------------------------------------------------------- CORNELIUS A. MC AULIFFE, II **-6224 R: 0.000 8.000 8.000 8.000 8.000 0.000 0.000 32.000 43.310 1385.92 332.86 0.00 V4511 INSULATOR -MECHANIC +24.480FR 109.71 150.35 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1769.41 25.66 1066.67 WHITE Male +0.000FR 40hrs 84.16 702.74 Hours Pay Regular 32.000 1,385.92 Overtime 0.000 0.00 03 00 1,385.992 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons em ployed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law, Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 31 In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMP IANCE I, Douglas N, Carlson, CEO do hereby state: That Ippayy or supervise the payment of the persons employed b VIKING fNDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em Toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature _h - - - - - -- Title ChieT ecutive Officer - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE I, Karen Siegel ,Accounting Coordinator (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title: Accd, ting Coordinator 09/11 U) Mn O L 7 f6 O) C V 3 N N t 0 d a O 2 ~ N M Z C0 T Ct O + + >N = > LL N h \' J e 3 3 N 00 d CD co CO o a ML i m � m iLI J m 0 cou p � 33 x LL N zz L(') c o - O a a /W N LO J ,s C c O (n LL N •� L CL O W cu m 0 3 Cc cu U i i n3 W :° O K Z tojj .0 r 0 O 4-dE p (D W 1 .o.. n .. o Z 3 / , v to a� n a p Y o L o o L o w m ', 3 m Q o m El El El i A EO m W0 Vm m y > J L Z L < Qto (� S C 41! kp O � EO O mU EC: m L- o m 0 a a 'a E z O AL Q m J 4 C O fi` m m o > E E Z U) Mn O L 7 f6 O) C V 3 N N t 0 d a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of Wages, this form. STATEMENT OF COMPLIANCE 201 I, Karen Siegel ,Accounting Coordinator (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature A Title: Acco nting Coordinato 09/11 J J J Y L U J 0 O c 7 12 CL Cd HI 0 Z O m aL v�F d Z GBt� lot U �— O o p O x (7 m m Z m O m L O O + 0 m >m x> LL ,/^� LO C W `V w M w o + m S3 �a 0 Y V-- 0 p e m 3 3 N c =mW T a G 3 C c j CD Q aZE O co &L �' n M Z M Wm a co °CDL m � N I` v V T V , J H m m Ni LO e C Q C* d �� O �Z s 0 c LO 3 O �c0. N LO - O � (n o L O � • � z7, � F ',r; Q c m O �. ',. V rF5V /R •� ^ � m 3 N CU `O � m e � Z IL 1' U O U o y N 3 O - C � N cc ,. 3 m LE 2 !t 0Oro E] El 1:1 El El El i' O)m m w i, c r 4, = E `m vO �; m (/7 m di �•':r to O EO m a v m m m '� 'fL m a 1• m eC O n. _ Z y a m ui `; 1 a w Z L U J 0 O c 7 12 CL Cd HI 0 Z O m aL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE A , 20 �q I, Karen Siegel ,Accounting Coordinator (Name of signatory parry) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title: Accbu ting Coordinator 09/11 TF A M a) y a 0 U N O T a T Y a) 3 Z 0 a U a7 U a3 S m ai N O 0 U a U) C: m O U cc C U a) m N ti 2 0 m CDa d Z w S -JM —REIp 134Oµ- ♦ V \ N G m CDZ ill// w -0 0" m + N; w N o °° r o. d CLE � �'w 2 e m rn 3 N ; s 00 Q O ' Z M ui M m CO L x a r .a � N o (3) � U")Co e Q m m Tim a �3 S c Z O O z u o 3 0 te m `e Cc N L N n r 0) J _ CC) G _cn L O O �% • :3 m O c U m o C U (1)Q }1 U m v EF .CL :� o O O. m m E z � am Uo Z ; aw Q m a K u v Q c, N m u a o a t% N 0 ._ 0 L W` O C / O U m N Cm o a m v=ir 0o o o � rn c Q w EO m U m v L O fi m � )m Z L r / a m cn c z p 4_ O s 1 LE m c E o v m N m Z m 'U h m t CL a m mO QUISM JE o_3 V W Q o Z a) y a 0 U N O T a T Y a) 3 Z 0 a U a7 U a3 S m ai N O 0 U a U) C: m O U cc C U a) m N ti 2 0 m CDa WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE ,20 I, Katie Oertel .Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature _ Title: Office anager 09/11 0 C O U 0 c m 0 c 0 coU f0 E U m 0 m E U E O U r c E E CL E O 0 m 3 LL d a 6 z u = �ut4 RE�p i elf Q " is, ,5y O t5 � m N O w r Nm m O ;m + =3LL co 2 o 3 m N c nd a u O CC) C.O M to c, Q �° LL M T, w c. a' M c0 o r N o a a m an d r-: U. LOC o s �--� ZS En O C a <c �, a b z a a a W cV LO f� ° m J o � � ; CL 4� F cl W C CO E c U cu� U LU LU o O O d o -,-j E z iE N O U u a in v 2 N C C ,^ V' O Cl)\ / h N E O `m a d 0 Ll D m U W c E O U _ � ay m O m 0 7 2 y a a ..., U) m 'DR u c d 2 0 O O R O E O m z mQi 5 0 m ^ C ¢ °' O d E a O E z Y L- O 9 CL o 0 E W ¢ O E W O Z C O U 0 c m 0 c 0 coU f0 E U m 0 m E U E O U r c E E CL E O 0 m 3 LL d a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 20 I` I, Katie Oertel Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title: Office Manager 09/11 U 0 T m a T a) O clT 0 0 ro m m C: m a) C U m O m m .m w 0 C: O U cu m E U m 0 c a� E a) U E 0 U L 7 5D T m E T O. U O 2 7 :cl LL =5 0 CL WI H 0 Z FnI `o N a 6 z _ RE�lyG. V�4�U194_ is yN. O A x U a v� O v (o o N c Y ��:o• r� O a m ~a .. - z ,d m Wz r d o. ol c - 00 O 6(C) W c C'7 CO L p VJ J C G d C m m m .52 O11 00 a` �3 1i O O Y Y� z d 3 Q — U :z m @ O a "L a U a W LO it2n J o p () N •� O r 0 W � m W O J ujO LLIO d }' E .O Z in 0 Z p 3 U u N � W � 2 U N C SL C Q C m N E O s m m S -Env El i El W c m y w — 7 L 2 N a Q d = O Em C N c p C:U oC z t0 m .t.�N E d Y s- y y Q d ¢ mO a {� Q _ z m m O 3. CL U m p a- W m 1 c (� o W O Z U 0 T m a T a) O clT 0 0 ro m m C: m a) C U m O m m .m w 0 C: O U cu m E U m 0 c a� E a) U E 0 U L 7 5D T m E T O. U O 2 7 :cl LL =5 0 CL WI H 0 Z FnI `o N a d z L 4�1 (V O 3^-.. x .. rn dj CD (Q Qi 4y.5. ¢;3 23" �t3sn�,a N ; . 0 (h fO n "t Q ° Q ; z d Q �' Q o 3 OR 00 Ln M N N CY) N 1 G 1 00 rp M o.CD i iar x 04 °ti � N Q m m CO aim Q ° x .� 0 (O U.c Q +. o` -� (n dLOu '' v;M s� 0 CL LO rt . m e 'A J p Q In 11 YJ } t L Q OQ c. co (D (D p 0 t6 m Q u. acu �_ V W w V (UCc ♦� ti wO O o Z V)0 N - f—;; z 3 V wCD or to v N d a a a m o LO= c 0 C C U (L, ca Q ° W V V a i a (q E 0 U U Q a) (D o W c c° w W Eo El SoSooa c w U N ai V ca Q D z z o d N a .z Q i m .N om �� y d c „ c o v�o Eax moCO o U >.< d N C •O Y.. V '�, o f , m- m o a d E= c'v— m m \ 4 m�� '�c9 0Uc .y .N Q o. Z oo c Q m c Q C N o � o Q Q _ El U W Q C9 w w m f0 E CL 0 U coO N 7 LL T O 7 co m C 3 m N t 0 d a , 1 � � ! \ � k Lo § k a co \ CD ) § q CD - 4§ m 2 7 a ! 0 \ ) k) & t � o . , w a , afararo-- Ydn�YJNU1raxn r This card acknowledges that the recipient has successfully completed a 10 -hour Occupational Safety and Health Training Course in General Industry Safety and Health Thomas Watson Andrea. Mack 5/29/2011 (Trainer name — piln-tor type) (Course end date) } Commonwealth of Massachusetts a Division of Apprentice Training REG# E-050-833 f c� J Lee Associates dba J Lee Eledy�jt'�vVces 420 Northboro Road Centm,ro MARLBOROUGK v1 ELECTRICIAN �—� Appr. start Date Proj. Comp. Date 7/19/2012 1/19/2016 n F7 n rHOMAS WATSON Annual Apprentice 1.D. 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C O O Z5 m L) 2 2 2 r m IO 00 C0 O M N E () d CN CO � O U A a) 0 m IL U >, cli M � N EL Ci (� a = (1) w � o O U a. +L+ i ami U m = 5 j, U) fC Q) O C _ o Q >+ O OQ. C >, L C r LU t N a) ?+ a _O _O aaE E wum_. �-NM r o U U 4) O Q) N -O O Co C E O 7 N N a) E o 'c a) Q� N 5 � -0 U `- M L O O p U O >, O r coCO N 4- "' C �U O O O 0 O N 0-0 C N co O .- a) — L y O._- U 0 Q) C O -C O o Q) a) Co a) L_ m .r >,. U CO x O a m m o _0 Q) w c m a)a)ma) -C C: E m : C.N. a) .0 a C O N U a) O X CO Q -C O C N C a) m p� N O O m Q) C 4) C c o E N N U O O OU N U m O) L N C "0 C Q 0 N m C O 0 CO N .0 Q) U m p m C O c- C: a O U o p O N Q OU C o 'C E v° `) m _ L 0 0 0 0 0 -O C p V a N a C M" " N N U) N CL c a) > m C � c -m O U L O C m >' m C' u) S] O� Q� O a UO O� m ` a N Lp m O)o a 0 a) .p Q `•- U m "- E-0 N m O ?� C a) a) m c J 7 .- m C c E N .0 p O a) O— O 0 U Cy, N m C C 4] L a) W L Oa) O L U L >, ;- L a) O c- N C +- M mO C a .O a) 0 L CL c -0 -r -o m a) C J m N a) L m m C `o o C � � a o i C N N O� m-oN-" C L Q) 0 w a) L Q):V a) �Ncv�c)a�m�U•TE N0 a) a) s p a) a) N m `. (00 f00a) d C a) 5s am= m0 Q Z 0 F- U) 0 m CJ 2 U T ti �yy� `C✓ * Yii. U �t v iL C4 i m S r "2p tip:. t = x Z U Iii t8' � co O wCD 'o CL W e- 0 LL 7 m a z a T o wCL 00 8 /J z :r/ <U C ti 00 4 . N a 0 A �1co m C 15 a 2 ca ro m 4 ui rri� cad. L Q C N v N O 0 m a a `� Wui m QU m (a E LL a "�' vy � m v E 4 cu as 0 N ,QQ S CL 0 -co > N y ❑ Cli LL E O❑ Oa > w v cr . . - —11 — I.. 11-11-- —.q""'YVu V11 mo PU011k WOrKS project lot wfiwn tile enclosed rates have been provided, A Payroll Forin bats been print(, , I on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve then, ror as period of three years from the date of completion of the contract. In addition, every contractor and subQontm,,�tor is required to submit a copy of their weekly Payroll records to the awardillq, authority, Tds is required to be done on a weekly basis, Once collected, the awarding authority is also roquiiwd to preserve those records for three years ftoin the date of collipleti(yll of the prqiect. Each such contractor or subcontractor shat: furnish to the awarding authority directly within 15 days after completion of itv Portion 01: the work, a statement, executed by the contractor, Subcontractor or by any authorized offll;-.r thereof who supervised the payment of wages, this form. S' I 1 ATEMENT OF C OMPLIANCE 20 q {Nene ol'sigilat ly party) Ti le) do licrebystate; ' [hat I pay orsuPetvise the Payment of tho, persons empjoed by .) itdi-,;V<. , oil th , and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed Oil said prqjecl have been paid in accordance with wi I iges cicterjujiled under the provisions of sections twenty- six and twenty-seven of chapter cize hundred and forty nine of the General Laws, Signature `Title 0911.:1. A I —C" 0) c C CIO Q - co .2 r- C,j (� UL 1:1 El 1:1 G 00 Co co a) LO Lo 0 0) C) < (0 C\i O loz < LO ui t: (0 0 0) c C CIO Q - co .2 r- C,j (� UL 1:1 El 1:1 G 00 0) 0 C\i CL ui 03 x cC L L (D LLJ N < L) CL d) _j 0 E ui ui CO LL C -,J rA ttf x. 0 cz 0) c C CIO Q - co .2 r- C,j (� UL 1:1 El 1:1 G 0) C\i x N It 0 Co 00 00 co IRV- 0) c C CIO Q - co .2 r- C,j (� UL 1:1 El 1:1 G J--... —q—y— ull tljv-, vuvw wows projecT ro.r wmcn me enciosed rates have beets providod. A Payroll Form has been prime on the reverse of this page and includes all the information required to be kept by law. Eve contract. ry contractor or subcontractor is required to keep these records and preserve them for I period od of tbnae years from the date, of completion of the In addition, every contractor and subcontnMtor is required to submit a copy of their weekly Payroll records to the awarding authority, l' its is required to be done, on a weekly basis, Once Collected, the awarding authority is also requii,A to preserve those records for three years from the date of completion of the project. Each such contractor or subcontraetor steal: furnish to the awarding authority directly within 15 days after completion of its portion c;' the work, a statement, executed by the contractor, subcontractor or by ally authorized.ol'fj,,:.-r thereof who supervised the payment of wages, this form. STATEMENT OF C ()M LIANCE , -P 0 - . . . .. . .......5 . ........ (Naine of s pit i7 do hereby state: 1i y Party) That I pay or supervise the payrucilt ofjljfs person ernployedby my, f "'Air (Con M SM)0011tractor or pu ic body) (Building or projject) and that all mechanics and apprentices, teamsters; j, ujfeuls "aid PrOJ n a . s and laborers employed on lecthave been paid in with wit;Res determined under the provisions of sections twenty-six and twonly.seven. oil, chapter one hundred and forty nine of the Gleneral Laws. S Signature—— Title I0 09/ -Li Cc�D (D (D U) d CA w � Op(n ON �� W HWOW m Wc7¢3 N ffl N M z 3 a 0 n Z Q N Z N �0 N HCL U OF L) N x W O 0 W N Z H U cr w rn Z L O = O O m Z V O to LO NO W Z O t 03 O) O w LL H So Z) (D 2 _ W a O 75 c � to T J Z O 30 C3) x `O a U c+j LL N co N 0) Z W V (n m _ x O Z N 00 E E O Q W N (n oa 0 F O a m f� U O V W a V LL 00 ZO a � 2 LL O to co 0n U h O O W W C a a Z 00 co Li 0) O co .r - Q o Lu c 2 0 W > h z � ~ (0 x } O O N r O cu (n co '1S 210'10 O N O 0 O N O N O y O y O y O N C7 Z O W Z 0 WY a 3X U OLL O LL J a v E 0- x K SNOIldVGX3 O ON!0"IOHHIIM U) O d0'ON z O > F_ Wco Z) c c — h D L) z U Z W O p Z Q otf OY N Z N W O LU O ¢ H 0 0 H O .-. O W 04 a 1 GO m 2 00 -E Z O 0 2 Z Z O D Z 0 Z F r o J O U, O W1r Q O Of z z a N y O - �p N c N L a U O N N Q 2 L C O � y UO 0 w N N � m � H p E- ? N O U v ° c d N (h y U ? 'N N O N U n N N O O N N T N N c N L c 3 « m m m aN O ry O O. 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C N m O O L a C Y C E N a L N N !n E E N N C L T �Q Q O C 4) ° ° OY m Z 'pL C L coE_ �0 0° p C 'O U N D N 7 m C N N 2 m LL O _N V) y m N Y 3 U N _ N a) C O ^.. N N C L (n fn L y N C y a N a L w6 C L N L) y "" a U y N E E N -O L ry C •O' � C C d m C m C C ° O>u"-= O N N Cp c6 N N ° N E T N L n aj O O U n O N O > 'O �Lp-. N > 7 p N cu U c c °) •c O m 0) 3 m �U m o a� r v c°) mom � ac o m y (1) C y v° c ' w cn -M v CL °� E ° Li o oado L 5 a)Eom °woo a `gym x o o —L a�._ O m m w U uN?� Y vi c m N�� aCca F ��p mL c �E v m E m SEE 0) (D �_ 3E° OL Q) O -p GL`O co c 7 Ol o O O D n� V a 5 d ° o m c o_a m m m 11- r p m °� D C J U L N '> y - d N p N a) w O= a O a c U) mw ov? L a y o 4) o � mo a L o O a� >0 2 �mZx v rna cNya a c>>.aa m a) — p aL_ Cc 0mo ° c c °° m L ma) c Via_ F m Cam U. cl V L f` C C y LO U) y Y N N m N 0 3 -° N w U N o p 6 C N N M X C y m C p a° W O m V p .m+ Y O E N o DofU C T"cn m ami o t N �� ° �� c >' U 0) .L L L _ N C U >. >. 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U r C co 2 0 a c0 Q � o � c o .N O.Q m� r N am � C w U o� a Y O 3 c a 0)E c a E cm CL � 0 d� N U� L �C U cn cCo a Cc m Li a =0 w c l0 p N a c C E o T M 11 7 'O E Q aooi 0 a O y o T? d Q lL d o 0 a Q- aD E o 0 T a N o c OL N U N U d C w A E R U �p o c m mE 2� M� m E T -0a =3a cn N O 'c a 14 N O' o y U cc N N O N U , as E Z- c j N f6 O at c a3 4):2 Y'2 U 0 3 m L UO m O c a) 8 U c c0 O N o mL [0 c - � N c N @ � O N U O c0 (7 E E y U O N m C U O Co N C ` (D ang �c F0E ZI m 0 s a) cm a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE March 16, 2015 I, Ron Tattersall Field Supervisor (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by New England Builders & Contractors, INC on the North Andover School Administration Building (Contractor, subcontractor or public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Field Supervisor 05/14 M Ar Ll cz O QD a E 0 Cd bA x A 09 R E as a C p o w o O o C � vl N 0 o A .� 44�yy i.r 5a � ^ 3 N00 o xA H o 0 0 3= 3�3pO H x o 0 0 a xt c o 0 0 3 r •O \ 0 0 0 kn �a y O 3N3x O O O d 0 w ¢ H A 09 q d IL d z LO � x N '>W O G w � N U « o U m m;LL F a Y � a Q Y 3 v Ix Ew C MLO` i` coo a c O d � Q LL r o w d z 9 o x a m CN 1 t > o $ P E ° _ �— Ob a 03 ti 3 g � a a v a NLO +L L jp m Z = co � � Q c U �L .D CD ¢ U 3 > F N %, v � E •Q � f0 cs m a` 9 � = 1 m 3 Q a m s N r a Z o Pi of U C u � ci L L W U Y O ca L _ _U L. }, 0 as m � _...... _ 111 Ll 1:1 Vw ad E O � N z E �' Q c ) W L^1 E Q 2 v a 'a W 2 0 C: -0 e m -0 m ECU V Q1 E e o v °s Q zus oECc) E S ° W m E ' c m o Cq U w q d IL EWU moe DATE 02/20/15 09:53 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 3 FOR PERIOD ENDING 02/21/15 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 02/15 02/16 02/17 02/18 02/19 02/20 02/21 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00283 JAMES J. KITTERY RT 8.00 8.00 16.00 31.590 505.44 24.00 777.12 49 BAY STATE ROAD OT R.RATE WAKEFIELD MA 01880- DT - - S # OF DEP- 1 JOB APPRENTICE HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 16.00 72.47 50.53 27.32 .00 128.97 497.83 007115 ------------------------------------------------------------------------------------------------------------------------------------ 00749 STEPHEN G. MUISE RT 8.00 8.00 5.00 21.00 72.820 1529.22 36.00 2419.32 11 ADAMS POND ROAD OT R.RATE DERRY NH 03038- DT - - M # OF DEP- 10 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 21.00 110.94 136.02 71.98 .00 728.30 1372.08 007120 ------------------------------------------------------------------------------------------------------------------------------------ 00985 DANIEL P. RYAN RT 3.00 8.00 8.00 19.00 72.820 1383.S8 40.00 2328.58 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03019- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 19.00 122.43 138.23 72.90 .00 564.29 1430.73 007121 -- - --- -- JOB TOTALS - - --- ---- ------------------------------------------------------------------------------------------------------ TOTAL EMPLOYEES- 3 TOTAL JOB HOURS- 56.00 TOTAL JOB AMOUNT- 3,418.24 Cormrmnwealth of Massachusetts Division of Apprentice Training REG# E-055-149 _ JUPITER ELECTRIC INC. 142 B IAFAYEM ROAD SALISBURY, MA 0IFI ELECTRICIAN s �_ -1 F Appr. Stint Doh Prof. Comp. Dote 5/19/2014 5/19/2018 shpt ® �tapt 8 Ytrp; \trp %I,py JAMFSxnTERY step. Sh'pJ k-6 B p�p3 8 Chpi,4J Annual Apprentice l.D. Card Fx tear5/fN2E15 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: February 26, 2015 I, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: p� TitlekAginistrative Asst. Date: February 26, 2015 I, Leah M. Hatch, Administrative Assistant do hereby state: (]) That Ipay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 15th day of February, 2015 and ending on the 21st day of February, 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNAT Leah A Hatch, Administrative Assistant 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. O 0 bb S x aGi 0 ri a� A w L a 1. R E a C C pq v 3 o A o 0 0 R L v C � C •O W .y � O O ti N ++ O O 3 ° 0 3xA kn N00 H C 6a o o 3 o O O pO 3�3L H x o O o ° 3 •C ° O O O R L L Hix �L it O O O 3 3x d 0 lz U U 'U Y � H a� A w L a H 0 zI C 0 'U �U m w 0 c� C m N 0 c 0 U m m C E 0 m 0 c N U C E E U m X- E E T CL E 8 0 0 LL w m m rn C mm N L 0 Fin m CL d 2 v 1 L J L U 13snN N a�3- �3 \M W CV 2 m m .c m o W 49— c e /\ � V V=1 S. w 0 + 01 a O w 2 O ® y `o m U o ci j E W rn> T a C M tiQa co c LL Lo O 0 1_ 2. Q g W d a a 1 m F u J Q m d !D m m 00 IL 65 03 Z � Z d a V d (.0Lo N LO Cd 0)0 V- 0 }� C: Z E o = w C .� 00 � Q � U 'L (u E +� cu cCj 75 0 W N W -� -C R y L ei Lei o � (d cc Q d > O Z i u Jfn 3 V m n Q m m o tY G NV "CT r 9�` F v a O Z o a w U C o U L L ' p U _ L -- U yam El Ll LIJ 0 Ll 0 - El U E o W 0 Z 1(D Z �_ m v E Q t m m Q ^L' W m z° a u C 'Q C m E O i U ~A' � W E Q c a c L U) uz ¢ Im l�0 f_ = ° Ll1 z m N a E o 2 C c o U W Q Cj Z w H 0 zI C 0 'U �U m w 0 c� C m N 0 c 0 U m m C E 0 m 0 c N U C E E U m X- E E T CL E 8 0 0 LL w m m rn C mm N L 0 Fin m CL Ewu moe DATE 03/05/15 08:39 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 4 FOR PERIOD ENDING 02/28/15 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 02/22 02/23 02/24 02/25 02/26 02/27 02/28 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00749 STEPHEN G. MUISE RT 3.00 3.00 72.820 218.46 38.00 2686.02 11 ADAMS POND ROAD OT R.RATE DERRY NH 03038— DT M # OF DEP— 10 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 3.00 139.60 150.64 81.16 .00 803.91 1510.71 007141 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES— 1 TOTAL JOB HOURS— 3.00 TOTAL JOB AMOUNT— 218.46 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: March 5, 2015 i, Leah M. Hatch Administrative Assistant (Name of signatory party) ('Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature Title. dministrative Asst. Date: March 5, 2015 I, Leah M. Hatch, Administrative Assistant do hereby state: (])That 1 pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 22d day of February. 2015 and ending on the 28`h day ofFebruary, 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by arty person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That arty payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNATV4E CL, Leah A Hatch, Administrative Assistant a 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. Cd xi N 0 iS z z 3 09 E as a a � as 3 o A o o O U L V L c wxA O O O v .Nn •L o V ., y ° R O L 0 3 ° O ti W h kO N n C 3 x A ke) N 00 o0 H C L r+ 3H3x o 0 0 ° cO 3 o 0 •O \ � 0 0 RS i. L r� 3�'cx O O O �k C O O O C 3F3x C LL E � o W 0 Fr" w ¢ H 09 t U J O E m E2 7 a HI O z m O Fy m IL d 2 LO t f a f, O LLG X23§`1lN N a a 3 u` ~ z �m W OI O41 L +C + _ LL NSc C �y` M U) a n o + °1 $ g 0lu nm` x O Z O t - U as N 4 W T O G 7 a 3 f m m 8 M tl- U') coo m a ¢c (0 Qi U. T K 4 Q W C 1 o O m a °8 w m V F T V� 0 Q m 1 m Q N m A m m o CL �3 0 o0 Z @ s �'a m` S_o z O rn v' u 3 o `o c a ci a' N LO O ` o U) 0 Z = 2 cu j _06) V LLi>-%cn . C m :3 Cl) V • ncc �L Q 4-0 3 i� 78 L L ~ Cl) EU) Q: •c •a` 2 — of 4 O i O 2 n v � ) m 3 Q m e CN ° U C o � L O N � O v O � w �� -6-0U � � o- TQ Ll Ll 0 EIJLI 0 m N Z (1) a� W L)l m W O z v L A z a m m m CL _ o U W m w 0 Z E t U J O E m E2 7 a HI O z m O Fy m IL Ewu moe DATE 03/12/15 09:00 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE . 2 FOR PERIOD ENDING 03/07/15 ALL JOBS JOB INFO 14405 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 03/01 03/02 03/03 03/04 03/05 03/06 03/07 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 16.00 73.560 1176.96 40.00 2256.96 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03019- DT M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 16.00 115.73 135.13 70.74 .00 537.34 1398.02 007162 ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES- 1 TOTAL JOB HOURS- 16.00 TOTAL JOB AMOUNT- 1,176.96 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: March 12, 2015 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title: dministrative Asst. Date: March 12, 2015 1, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payrollperiod commencing on 1st day of March. 2015 and ending on the 7" day of March. 2015 allpersons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on beha f of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH o Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS 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. A 0 0 x O C pt ri 22 E a c CC c �y Com% pq o 0 0 3�q u c o u u L CE O O O u wxA C � C C +O+ +u+ c o N p F+ITyI L � 0 3 O �L A In N 000 F W c as e a a o 3\ o 0 0 xt c o 0 0 3 w •O \ 0 0 0 C o O O O 3 0 a Fix o 0 0 w 7t C O O O 3 3x a W L � C ca U 22 \ k � 16 § \ k co\ { E a E E § to E E \ J ■¥ z � M, \ @a» L C) � ) #• ff� M 2 ce)a =k� 0 � 7 . .£ . k a CY) k ` <! . � G LU / ZL§ 2lke 9L) / o .� � � k O IL Cl) .: � ., ■ ; c m `0 . - § } ELI ) 2 3 ? Cd 2 o C) Z M cu � ci � / 0 c o0 75 a . 2 �_ B U `c CL) K 'CL ! 12 co a > ! � R � B / < Z:< 22* J / ) 1 �OC - w k - � C: O @ £ U�o� < {)! --- ' . ----.Ll \ El IE] El 06 Lu E (D § ■ W § :9 k O # k 9 E C % Co B a / Q ¢ £ ■ k { p E E ■ m 7 { / _ @ \ / } k 2 \ k � 16 § \ k co\ { E a E E § to E E \ J ■¥ z � M, Ewu moe DATE 03/19/15 08:44 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 2 FOR PERIOD ENDING 03/14/15 _ ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION _ BUILDING, NORTH ANDOVER, MA EMPLOYEE 03/08 03/09 03/10 03/11 03/12 03/13 03/14 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00248 BRADFORD CONNOR RT 7.00 7.00 44.680 312.76 40.00 1887.68 26 BACK RIVER ROAD OT R.RATE AMESBURY MA 01913— DT — — S # OF DEP— 0 JOB APPRENTICE HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# ------------------------------------------------------------------------------------------------------------------------------------ 7.00 310.63 122.75 77.05 .00 293.95 1083.30 007176 ------------------------------------------------------------------------------------------------------------------------------------ 00985 DANIEL P. RYAN RT 7.00 7.00 73.560 514.92 40.00 2028.48 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079— DT — — M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# ------------------------------------------------------------------------------------------------------------------------------------ 7.00 93.08 124.41 63.45 .00 459.87 1287.67 007183 ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES— 2 TOTAL JOB HOURS— 14.00 TOTAL JOB AMOUNT— 827.68 A" Commonwealth of Massachusetts lly Division of Apprentice Training REG# E-064-476 A JUPITER ELECTRIC INC. 142 B LAFAYETTE ROAD SALISBURY, MA 01 ELECTRICIAN �� Appr. Start Date Yroj. Comp. Date 12!26/2013 6/26/2017 - + BRADFORD r 0 a �c .rw' ❑ ''r nv n CONNOR �rrn_ �r..ps ti'r Th � .r rx O .rel,!„iL'J5 AMM) Apprentice /.D. Card E:pim 12/23/2014 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 649, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: March 19, 2015 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title:dministrative Asst. Date: March 19, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (]).That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 8th day of March. 2015 and ending on the 14"'day of March. 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by arty person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNAT ft el A�\ OL Leah A Hatch, Administrative Assistant Art 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. THOMAS E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 TEL (781)233-8810 FAX (781) 231-2151 New England Builders & Contractors 464 Merrimack Street Metheun, MA 01844 LADIES /GENTLEMEN: WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter Ll:�l��l�l:lZ (1)1= l�l'Z:�•�i��;��111�1��1����1. DATE: 3/16/15 JOB NO: 2014-12 ATTENTION: HenrySarkis RE: NORTH ANDOVER SCHOOL Payroll Reports ❑ Attached ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Samples ❑ Change Order ❑ ❑ Specifications COPIES DATE NO. DESCRIPTION 1/1 ORIGINAL/COPY THOMAS E. SNOWDEN INC. 3/5/15 VIKING INDUSTRIES 3/8/15 J. LEE ASSOCIATES, INC. / GUARDIAN ENERGY 12/20/14-2/14/15 THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS: ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit ❑ Submit ❑ Return the following items: copies for approval copies for distribution corrected prints 20 ❑ PRINTS RETURNED AFTER LOAN TO US t COPY TO: FILE SIGNED: t WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE February 12 , 20 15 NO WORK I, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature0-1 Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Certified Payroll Register Page:1 Job Contractor Customer N. ANDOV R SCA4OL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. O. BOX 32 189 CENTRAL STREET Week Ending: 2/15/2015 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 02/09 02/10 02/11 02/12 02/13 02/14 02/15 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours pay Regular 0.000 0.00 Overtime 0.000 0.00 X06 TTO WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLI NCE I, Douglas N. Carlson, CEO do hereby state: That I pay or supervise the paym ent of the persons em ployed b VIKING INDUSTRIES INC. on the N. ANDOVER S60OL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the G eneral Law s. Signature � �� tl it - ----- Ti a Chiel E ecutyc ive fficer- - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 I" WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE February 12 , 20 15 NO WORK I, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 uertlrlea rayroii rcegister rage. I Job Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. Job Number: N ANDOV SC ADMINISTRATION BLDG. P. O. BOX 32 189 CENTRAL STREET Week Ending: 2/15/2015 5699 MAIN Z*REET 32 SPRING AVENUE SAUGUS, MAO 1906 N. ANDOVER, MA 01845 BARRINGTON, RI 02806 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 02/09 02/10 02/11 02/12 02/13 02/14 02/15 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 0.60-0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of com pletion of the contract. 2] In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor or public body shall furnish to the Department of Labor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLI NCE _ I, Douglas N. Carlson,, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER HHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature � �- Ti a ChieT ecutive f icer DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE February 26 , 20 15 NO WORK I Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. /7 Signature, r � Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE February 19 , 20 15 NO WORK I, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Job , N. ANDOVER SCHOOL DEPT. ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MA 01845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC P. 0. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MAO 1906 Job Number: N ANDOV SC Week Ending: 3/1/2015 Page:1 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 02/23 02/24 02/25 02/26 02/27 02/28 03/01 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay --------------------------------------------------------- Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 0-60 o.OG WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law 049, p21B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law, Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent, executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COMPLIANCE - -------`(- -- -C--- I, Douglas N. Carlson,. CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER HHOOL DEPT. ( Contractor, subcon(ractor or public body) ( Building or project) and that all m echanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature t•� - Title ChIe1 xe utive Officer- - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Job N. ANDOVER SCHOOL DEPT. ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MA 01845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC. P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 2/22/2015 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law 049, p21B, a true and accurate record m ust be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the DepartmentofLabor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson,, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S ig nature k�'"'L)h'J Title Chiefi'Officer--- ill\ - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 02/16 02/17 02/18 02/19 02/20 02/21 02/22 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay --------------------------------- Regular 0.000 0.00 Overtime 0.000 0.00 0.000 0-7UC- WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 11 In accordance with Masssachusetts General Law 049, p21B, a true and accurate record m ust be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the DepartmentofLabor and Workforce Development/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson,, CEO do hereby state: That I pay or supervise the payment of the persons employed b VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S ig nature k�'"'L)h'J Title Chiefi'Officer--- ill\ - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE February 26 , 20 15 NO WORK I� Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature/ Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE February 19 _20 15 NO WORK I, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Certified Payroll Register Job Contractor Customer N-,4NDOVfR SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. ADMINISTRATION BLDG. P. 0. BOX 32 189 CENTRAL STREET 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVER, MAO 1845 BARRINGTON, RI 02806 Soc Sec No. ---------------------------- Hours Worked This Job ----------------- Class 02/23 02/24 02/25 02/26 02/27 02/28 03/01 Page:1 Job Number: N ANDOV SC Week Ending: 3/1/2015 -- Deductions -- Fed. Local Gross Pay Fica Other Check # Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 0.0 0 0.00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works projectforwhich the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the Department of Labor and W orkforce Developm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the paym ent of the persons em ployed b VIKING fNDUSTRIES INC. on the N.ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all m echanics and apprentices, team sters chauffeurs and laborers em toyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title ChieIEecut-Ive fficer------- - - - - -- DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Job N. ANDOVfR SCHOOL DEPT ADMINISTRATION BLDG 566 MAIN STREET N. ANDOVER, MA 01845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC P. O. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 2/22/2015 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law, Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent, executed by the contractor subcontractor or public body who supervised the payment ofwages, in the following form: STATEMENT OF COMPLIANCE ——————c;2———— 1�——— I, Douglas N. Carlson, CEO do hereby state: That I ppaor supervise the paym ent of the persons em ployed b VIKING wNSTRIES INC. on the N.ANDOVER S6OOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature T ige C keftA-ut-i�vi 0'ffice r- - - - -----'.: - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 02/16 02/17 02/18 02/19 02/20 02/21 02/22 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay ------------- Regular 0.000 0.00 Overtime 0.000 0.00 O Un 0.00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law 049, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law, Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statem ent, executed by the contractor subcontractor or public body who supervised the payment ofwages, in the following form: STATEMENT OF COMPLIANCE ——————c;2———— 1�——— I, Douglas N. Carlson, CEO do hereby state: That I ppaor supervise the paym ent of the persons em ployed b VIKING wNSTRIES INC. on the N.ANDOVER S6OOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, teamsters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature T ige C keftA-ut-i�vi 0'ffice r- - - - -----'.: - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE March 5 120 15 NO WORK I, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Job N. ANDOVER SCHOOL DEPT. ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MAO 1845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC. P. 0. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 3/8/2015 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/D!vision of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE ------ �'3�tQ--- 1-5---- I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the payment of the persons employed by VIKING W USTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, team sters chauffeurs and laborers em loved on said project have been paid in accordance with wages determ ined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature P�_U'A.�------- Title Chle cutive f Ice DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 03/02 03/03 03/04 03/05 03/06 03/07 03/08 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay -------------------------- Regular 0.000 0.00 Overtime 0.000 0.00 T600 b 00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orppublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/D!vision of Occupational Safety within fifteen days after completion of its portion of the work a statem ent'executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE ------ �'3�tQ--- 1-5---- I, Douglas N. Carlson, CEO do hereby state: That I ppayy or supervise the payment of the persons employed by VIKING W USTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all mechanics and apprentices, team sters chauffeurs and laborers em loved on said project have been paid in accordance with wages determ ined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature P�_U'A.�------- Title Chle cutive f Ice DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 r m a d z n „rVVVFF 1135(�N7 O x a m i .J _ fl 3 O m)cnmm (0Z � m c m o a co w N m itO a z m 3 tm 3 N CL ;EW a o�c $ `c ro 00 (0 <. c a o M 2 W €o M M Z o coo L^-) _ a r • a r � c W > i m OLO W xc J N m z ��0 3 or - p,xv ax d d N N m ED [� J x° 5O ` Cl) L co c U � m � O U Q 4-0 E CC +� O` m P z a a O Z 3 � ame a m L v Q O N m F= u a o a U) I tll C ° o LA, W C a � c H e O o d m a y aN C Ll 1:1 E] 0 El 1 00 T ElT N W c m .}r L w U U O ui E n ro z ti a _ O m E L E C m O U O U W A' W L 2 U V W hIm tl 7 Q E a E z C Q d m & C E O m d c Z U -i W m Q � R E W r m a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLUNCE 2-2#—, 06- 1, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature ` Title: Office na 09/11 N m q 1p N h• d p @ N N q CLn. «. � S 0 o a .,® .Nca til U y � WW M'.2 � n d J W OSHAr.rrr+e.w This card acknowledges that the recipient has successiWly completed a 10-hour Occupational Safety and Health Training Course in General Industry Safety and Health Thomas Watson Andrea Mack 5/29/2011 (Trainer name — print or type) (Course end date) LL m 0 U m N N w O c 0 U m cc c U m O c E d E E 0 c w a� T m E >, a 0 a� cc LL 0 r 3 m rn 'v 3 m m r 0 m IL d z C) 1� x C%4 c 2 CDA � O+ wc m o 01 c O L U) M c a O+ + 3:0 LL m ��//�� V/ c LU m w o c m m Q z 3 3 N U E �mw e 3 C N j IL i c O coC �/W� W /A G c Op C LL m Q W O (r 0 T a M L = dI C14 C \ O o W = U F � v J y m m 3 N 4] LO Ob a 03 z o z ° 3 O m; me 0 n ZLO N N (n r � CO G ,^ co LL L L� Q O A\ •� j C m O � c U 12Te v C U Q }O + r U d E _ O` O u E m C: z in a Q~° 2 m o Z 3 U `o L amo —1 v V N = a a a O - .7 0 L Q o - m 0 L) m 0 3 m � U) C El ....._, __ I] Li o __ CD ca Q^^ W C i w O U l0 v O E w (7 a z a t < c O m v ti 11 m p e d N E c v o � Y U� z .5� t ¢ E a E z j S C CL uy m T rn C O m m0 (i Z V m 0 U m N N w O c 0 U m cc c U m O c E d E E 0 c w a� T m E >, a 0 a� cc LL 0 r 3 m rn 'v 3 m m r 0 m IL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLUNCE 20 —G— I, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title: Of4an 09/11 qf: C O cc 0 c m U E E U a� w c m f6 E Q E U O N 7 cc LL O L m m c 3 m a� L O •c O P A 'm 0 m CL d z h O co N A T— O 1 a x 4 v 3 ." 0 3 N r 0) 134(1N�,0 z O W a o) N 0) =m 0 3 N ao M �n Ol M L M b U + LL 3> 0 N rn CL d r m m C Z N U �mW o�c m 00 co Qco a� Mfl M z w � a M CO Lw ■I = m a N c T Ln a°. �0) /r/ V ~ O J -0W N V" m m 00LO N N CO m C o cS O z h o � �� � z LO s O N LO I— N r � J 2 C� G N tsr. O .2 0 N — •� o F m m O cU •E c m O V m C Z O v }+ E � m d z C ^' W m m io OU Z O 3 amo a m c In V O N "' u a O a r= b' m c c C $ o o L o cu a fn _U E O o U (D c m m W w c m moo o.N C.4 L L I�0 Ll El � T o,o w E O -i c -t Au V O 5i £ H m 0 m Z a L v a l0 v i o 0 m d E .yob oho o�� mv�o E y 0 ci 2v L o m d U c_ m w W O d Z O c �D D. Q m T s = 2 0 0 m J n W q C E V 6 w O cc 0 c m U E E U a� w c m f6 E Q E U O N 7 cc LL O L m m c 3 m a� L O •c O P A 'm 0 m CL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 2 Z , 20 /C5 I, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Sign r' Title: Offi ager 09/11 0 m IL d z � _ JM-Rfln .Go< U LO O �1340N�r5. O A_ 1 x Qua m� " 0 3 - N \ Z �/�� �/ O a a r c NM \ y • + m 3 LL m m o M W T- oIx C) m a r a o z e m 3 m 3 N r u $E IL c 3 c 00 S coEL <0 � LL `� € o aC — M o ch z W a M [- COo L ` o W d CN V C v O E W U 2> c J N m m m m U') e Q Ob a �3 z ° ZLO O .o gso a v a Z a= c= N LO f� C �+ in o _ CO G Cl) 13 O o �:3 F is m O c U 9 O Q% Q U U m C a Cc E +r C o p Q C z a T in O 0 Z 3 e nmS a m � v p N ro F v a a o a uo) r ._ oS L o b m E O U p m N m N E Q m d fn r _-. _ __.._ Li L-im Elm Ll W W c }I U D "= L OH m Z 1 z Q _ Om M a Li : {— O u m m a E2 u u O 0 m m j ' E E O ?) w c r N w t T a w O a z m m O Em o e am g Z V W ¢ C7 E w 0 m IL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE I, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter -one -hundred and forty nine of the General Laws. 1 SignE Title: 09/11 WI H O Z 0 0 Z U x pM _RfIpG O iasnN� O N //� CDz O W � \ c ° M m + m M: > a a w Y r _ O o a r F- 0 3 A 3 N c da ;E a co O C0 LL € o �y M o z M m Wm a M o m L- N = ca s a} � c ' c _ Ar 1 W V N O IY tl LO ' a =3 d O c z c x z� � 3 2 O = m m = o Z axv ax IL N E2 y 0 O O] o x li C G O 7 O•:3 (���� W }� r m m O C) •E 3 m O U a) Q V ei d Z 0 0 m e Z � a � � 2 U) o Z o U C a6 e v a N ro F > a > U=)a c o 3 0 L O` c o / m O U CD4) m 3 c m .� o d Ta ry O LlO El E � El EF Q ^ = W i W U c @ v' O m a m m J z a 1 a 0(p V z 4— m m N L tl `o C o U 0 � m C 6 Q m L O C eEa O W Q JE WI H O Z 0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE l , 20 IS I, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title: Of 1 e M ager 09/11 m n N O) T N w c m E T CL E U O N LL .o 7 m 'O 3 f6 N r 0 m IL O Z h U-) O O LL�m x mU� (E7rn \ O m Z T \ y °i M m 35> d o `••� c LU O O a F 3 m 3 N aE �mw E �_ a 3 21 m 00 (O Q m < s M LL W� M o a M COo L r a N o' F . A O E5. 23C m J m m m m N Q1 �/� L / Q Q co o O c z ° x zv C Lr) N 3 u O o o? HE a= <_ d U d N LO I- C E 0) V�/ o _ lL cO G C rn o —_ •� L m m O � = v V � E q cc +� om Z W 0 Z 3 I � < N P a € a U)<c ame N C o 0 L C o E `� / m E E O U o � N T Q N o. w C El Ol m W c @m LLI H m v O E m Z z i V ¢ O U O r E L E C ICM a ° O z m v N h a E E z » rn O n m _ CL ¢ m m Q 'E o _ O Z E V -' CL E w 3 a = C7 E w m n N O) T N w c m E T CL E U O N LL .o 7 m 'O 3 f6 N r 0 m IL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE I, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signa� Title:0 a ager 09/11 71 7 0 �U Z 0 f0 0 0 U AhC l6 7 N N 0 c 0 U f0 f0 c .0 m 0 c m a� E coy c N N T f0 E d 0 O N 7 cc LL C O L 7 C13 OI C 3 C13 N S- O d z Gets h � v / O iasnH° O LL m n d' G � o io, c \ r y M a + =3� O w r o m �a z 3 3 N U �mw 3 c u IL o c O 0m (O coLL '� vai �C w O M° G M = w C TCD (o (mo/LD oamH r a M c ' O Q TL w H W u J E c m m aim ry' i Q a �3 x c z Oo z g 0 3 O o c N LO Cd N � W r 0 V/ _ /^� cn i r� � O o N — �:3 c F N m O c c U ca9 3 3 = U 0 V m C d iF-(� Z + p O u � O � m a Z � O U m _ a Z 3 o oao a� 9 N m F u aa a0 2 N o 3n' o L W o H m E O o N C m ami v Q � 2 w aw r Li �Li —_ Ll � `y c m C w N O m v tu (7 m 7 L z a t `o ¢ C QN v c a O m E L E 1 m o rte. C 0 V 0 U as L O Vi Iv 2 NN 0 = E E Z C a <(D ami T 3 .O 1` a o _ (i Z V WQ Q cc t7 E w 71 7 0 �U Z 0 f0 0 0 U AhC l6 7 N N 0 c 0 U f0 f0 c .0 m 0 c m a� E coy c N N T f0 E d 0 O N 7 cc LL C O L 7 C13 OI C 3 C13 N S- O WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 20. I, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signatuafr Title: O 09/11 krY ay O _ a CV N Z U r" a QO g �i I P r' O N M co c c a, Ce) ti ccs LOL I 00 d Q O � L Q z N G it s C Q S P� w, iY Q ' G 0 o o O U 'y C Mp .0 N _ X O moo__ El El .-. 1 El El F Sri z i 2 w ah4K r � %- Q C '4 z 1_ O d c Q Z WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll 1~onn has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these regards and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE ,' 1/ 0 , 2015 1, Karen Siegel ,Accounting Coordinator (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature ,�kA/ l' t_, " . Title: Aceo6nung Coordinator 09/11 i O 2 4M R�r F� K y +arsnNS ., w N N N T— I r CO3 r a m �'IL Z _ M 3 I � O N CY)CID (D'^ M , Q a a LO a N O Qo � d s CN •� 4 C $ �. p m O �. ;w -XI z N HEI Q a x hen 0 El 0 y} r O z 4- Ci a+ C/) 0 w Z WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 1, Karen Siegel ,Accounting Coordinator (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by 9.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature f Title: Acc nting Coordinator 09/11 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 1.49, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE March 5 ) 20 15 NO WORK I, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Certified Payroll Register Job Contractor Customer N. ANDOVER SCHOOL DEPT. VIKING INDUSTRIES, INC. T.E. SNOWDEN, INC. ADMINISTRATION BLDG. P. O. BOX 32 189 CENTRAL STREET 566 MAIN STREET 32 SPRING AVENUE SAUGUS, MA 01906 N. ANDOVEk, MA 01845 BARRINGTON, RI 02806 Soc Sec No. ---------------------------- Hours Worked This Job ----------------- Class 03/02 03/03 03/04 03/05 03/06 03/07 03/08 Page: 1 Job Number: N ANDOV SC Week Ending: 3/8/2015 -- Deductions -- Fed. Local Gross Pay Fica Other Check # Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay Hours Pay Regular 0.000 0.00 Overtime 0.000 0.00 0. OTO bio WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the Information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 2] In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardingauthority. This is required to be done on a weekly basis. Once colleced, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Departm ent of Labor and W orkforce Developm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the paymentofwages, in the following form: STATEMENT OF COMPLIANCE -- - - --alto - -- I,- -- - I, Douglas N. Carlson ,CEO do hereby state: That I pay or supervise the payment of the persons employed by VIKING INDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Building or project) and that all m echanics and apprentices, team sters chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S igg n a to re �'] Title Chie E ecutive 0"fficer DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 Q a w Z, o a m a d Z L PJM Rrjo. C, U LO O all Watt N m m l l 1 O o T m O 03 a i M c W N W � m a O Y O CL 2 e m m 3 m 3 CV Y e =mW d 3 2 m m M W O �/W� W co C LL Q T1 �o M CO W a M coo L CN p O J w LO Y, 1 , co ° Oo z •.mac+ _ z I O 1 s L O a t a �J L ( Sx 4S U a' N LO I� N j U) r _ cO C L- o a) — �� L F 0 m O ca m O m 3 U Q CD F � E — CU �- 0 0 e z L IL i _� 6 0 Z r 1 u in L v O N 2 8 a O a t2 Q(Y m N O - 0 O L (D C � E N c ` / N N E O L) m o C o 3 A r O = w El Ll 0 El T y W c wUU W W O E m o � m z L v m C O O E c Q) e E o p i U y0 E E z ° 00Q am d Oc Eai 4) :i E LC: I mm o ZL ao WLLL—L—LL] w Z, o a m a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 20 I, Kimberly Breault ,Office Manager (Name of signatory parry) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title: Office na 09/11 \ \ . D uw \ f��® m! aR� \CL E c f = c f2FN §q/zaf LU L, - � D � ff a This card ackmMedges that the recipient has successfully completed a 10 -hour Occupational Safety and Health Training Course in General Industry Safety and Health Thomas Watson Andrea Mack 5/29/2011 (Trainer name — print or type) (Course end date) F- U U N 0 d Z � _ �vN •REIo N > O 3S;1N� r O I LL ¢ m 0 3 3 N 2 y (o O W +O a = m o >m Lf) A M + 2 > LL ; W as ,mw z 3 3 N _8 a c 3 � m m = �D 00 (D Q L a IL 0 CO a a�o I (Y)CO z W C M 2 L r a c E-2 CV W J w m T N m ' ^ L / I00 p p / V \ aG �� c O z o' d;<`s m� z Lo u s° 3 O N H � G -" LL CD O �_ •� L �--r F 0co cO m O U cu co _c E a O Z L O D — }+ Cm C a z :3 upi Z 3 a m C l O v o N C O o � C a to ` m m E O U o m m C m m 0 OM El --._-.__.W El 0 � c '�m W�U0 v (0 O E � E a z L a a C O a11 v a C) s m m U) m C v m O C V o U al A iii a ad E E z m Q a m i , ° E. O .o ° o O Z E v �a jE < � t3 E w 0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 20—a- 1, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signatur4ean Title: Of er 09/11 a f c 0 �U �U C13 `o cc C Cn Cnw 0 c 0 U fC U Ca 0 Q) v c m E U 3 N m E >. CL E U O N I LL T O L_ 7 m m c 3 cc d L 0 d z nLO V � OI r m 2 m N r z W tm N M = CM M is + Go LO �} v w r m a ' m o d a Ni (06 O Z $ m m 3 N CL �rW T C C aZL3 c f� OD Cfl AL Ir M M Lj a ML r .a i e > rn ti m m W N tt+ m m 00e N (NO YJ Q a o� O d c U 12 a le 8 .; �t zLO V i -' O w° Z _ a 8 a a N L y j (n r 0 }� _ LL rn o i Cu O CCa U • � m � E c - C O .. (D a E CO o O m Z 0 i z n a) ~ o V_ Z 3 v N Q m a o a nma m Ln N LO a c O L p o (D W E V u) L n Q E Q L) U c ID o 3 W w m � y ma� 0 ¢ m Q w Eow c c N W U L m O m y (� ai 7 Z = a a ¢ a a U E � b O '`o E �� p mm N d E ID / C c3 - Z v � E mm O T oU`c S c w Q t ', m T o c O a z m C��m z v E CD . m o aa)E w w V c 0 �U �U C13 `o cc C Cn Cnw 0 c 0 U fC U Ca 0 Q) v c m E U 3 N m E >. CL E U O N I LL T O L_ 7 m m c 3 cc d L 0 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLUNCE 2Z , 20 l� I, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S ignatur Title: Offi ager 09/11 a a E c 0 �U U m 0 U C m 3 N w 0 C 0 U m c E U F.j O d Z m p IV '31A -RFS V / O y. o x v k Q o N UP 9 a 3 G m O M (v t �' M . + 1: 0 � ° Lu m Q a a.Y c. �Ew 2 e m 3 a 3 N c �m a 3 � c0 CO Q m a OLL M w� M M z ° coo `- a �� r a c ; i o ` d• E 2 c /T1 o TOS m m m m LO V � u m ob o �3 a=a S= z°LO m 3 O Z a o a a N L N j r CDom �\ C C: _I LL 0 m in Q ca ` c U m m c m C Te v O ~ � M � O` O 0 m e z " a O Z 3U o a o N o F = a a n m m o N o s o O L W C o i K (n C ` / y N E O m m C EO d El El -w El 1:111 wW � U f0 m O di m m U W m Z .< o Q Li O m E w o c 0 4± z v `• E m S 3 M h w t o, E O a m Z Uo W Q � W c 0 �U U m 0 U C m 3 N w 0 C 0 U m c E U F.j O WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLLANCE 20 I, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter ndred and forty nine of the General Laws. Sign Title: 09/11 R ■i c 0 �U U 2 0 U coc 0) H 0 0 CO m c E U m 0 c 0 E c E E 0 w c e N a O E _T a E O O m cu LL O L_ 7 m m c 3 m N L O m a d z v x m vM xF�p 46i �F U Lo -O cj �5 �iasnN� 0 K a.o; o m o a 03" N O Z W m c U) M + =3W �> N - � 120 m �a d o r m m a m 3 oS 3 N d ;dW e m �j co Q p aEL O ��� M o eh z We a M 0 m 0 L t c CN 0 W x3= V/ cm ~ O J m �m m06 m LO e a 03 0 c Z LO due 'a y m_ 0 a a d d N LO cd N (n r 7 x CD O ocu C 2 m cu 9 < 0 U V ~ -O m C, o p O -C m 6 C Z t.. m ^` W q r = W Z 0 U U)° nmo air N =_ u a7 o a c o 7 O L c o (Q ` / N N E 0 o m m � 3 c m C au=i'c El 1:1 El 0 F] El El T °i LU c m vw � L O m m Q (7 a O Q O a v u = zdue p 0 r3 m " L- E ui m z O C o V E v � ui N Y p z tl! U a N a N 7 Q E per, E z C n N Q ai LS L T Cl C 0 .., m m O Z V J a W Q @C @ E W c 0 �U U 2 0 U coc 0) H 0 0 CO m c E U m 0 c 0 E c E E 0 w c e N a O E _T a E O O m cu LL O L_ 7 m m c 3 m N L O m a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE '20 /'S I, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. aSignaturTitle: Of 09/11 r CL c `m 3 T a v m `I y o N 'D O U 0 T C13 a o �U O a3 a o UN U a) N a5 � 7 U a) cc c O` 0 21 U M E m L a N o m .o 0 � C m caEi U y (D v E U C a) O w U � c N «+ 2 C N cc Ua3 m E T C p_ 0 E Z U O Q) T c0 7 r- M N LL N 0 L L U :3 J a7 C7 rn � c O N CN a> CL o WI H O Z 0 2 ,G ,y�vM _RP",LO G �r1 f♦ � m M r r w c r o `o � O � m F- (L aE ` w z 3 m a ^ ' c 3 N W AL o 3 � 9 r'n �{ O CD (D ` e U. ¢ a M = CO w` m A\ m K } O £IL ° w x3c m m w LO u as W a � z� 0 O z° IX) z •� ° 3 2 m� a s 0Om; 7 a ? = S o 6 = N LO I� m 10 N r Cl O j 2 li L CY) L — O L m p cu ` c U _ ca c 3 m 3 U QD Q cm T1 V m CU o O z E '� a m zo U i 2 1E O Z ° T� i E v�' O 3 c ra'n <�' m N O - 0 L ( ' W C � c o N C > w W E m O N c o N r m p i.a m O N r El El ___... 0 m m W c iEOU _N DH m O m E W m C9 a m Z 2 L m Em c o o V m 06 m � O » ° m C a / _ a E° Z c CL a � % $ c E m ° o O Z V w < w c `m 3 T a v m `I y o N 'D O U 0 T C13 a o �U O a3 a o UN U a) N a5 � 7 U a) cc c O` 0 21 U M E m L a N o m .o 0 � C m caEi U y (D v E U C a) O w U � c N «+ 2 C N cc Ua3 m E T C p_ 0 E Z U O Q) T c0 7 r- M N LL N 0 L L U :3 J a7 C7 rn � c O N CN a> CL o WI H O Z WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 11112 2o-6- 1, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signa' l Title: 09/11 IL E P_ 14 O m O) 3 m N .r- 2 O m a d z D O LO -. O 1_ O ao3v �3 N Z O w tm O O w` C M ^ A �- r ° U + N m ra LL � O m z° 2 m 3 m _ 3 N CL =mw a m c 3 c m i e 00r CO 2 U)] a CO U. M`z M _ C) w C M D m L s c0 N s W Ar 1 _ _a No O w = J m > mm LOW 1 Cy P Q a w 0 o O Oz ° D U� o < m� S•o m C 3 0 v a Z u. a= N 1� N j W U r G Cl) LL W MM t r W 0 � C U � � 0 � m 3 C v U CD Q it ~ V m C a Z (0 +r o o O m P -� C: Z C .°s� L a ^' W i TZ n Z ; U c C D 'a O N m F u a 9L o a U2) o a� m e o _ 0 O L W` 2 o c / m E O L) W N R m m � o = � El 11 El El El El � `W � w E d wUU m W Om W N U Wo Z i v a C Q a 13 v E0 ° O 8 uN E W o C ci o (D Y ( E m '^ 0 vJ 3 a¢ uN L r = O a z m O E (Un E Z V w Q t7 w P_ 14 O m O) 3 m N .r- 2 O m a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLLANCE I, Kimberly Breault ,Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signatur Title: Of i Man r 09/11 w` n i► O ��i•�tsgnN'+� x �� p N � a N M b N r z �- 0 x co Q O M lua vl co �- 2 0 LOo V c Q'� U. z o o UJ o .. s cc LL l6 cr YCC w 3 E �`o c y S! o W .7 (N MV^' 4V77 GE. _ �C afill m h •� di i "t W qq ' O+4_'-. Z g b � w f'1 V m H WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE n 0 .2015 1, Karen Siegel ,Accounting Coordinator (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. SignatureA ` v Title: Ac rating Coordinator 09/11 � �µ wotpl\ n d Iagna�� t N 9 t _M � 0. i_ W. jig © OD co W M M r _ � p coo N >' LO ~ 0 a - m Z 1 co O U7 .41 d 1 � p a LO Q Q L 0 im i Cc.� L ,i4-0 fax L «. Z F -I F -I ElIF -1 El w 0 7 i ,. CO Y.f Q 4 12 LAat w Z WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 1, Karen Siegel ,Accounting Coordinator (game of signatory party) (7itte) do hereby state: That I pay or supervise the payment of the persons employed by J.Lee Associates on the Central Admin Building (Contractor, subcontractor or ,public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. 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C a) N .N-. Q N c 'C E O Q. Q. N -O E N O C p 0.- N (6 O 7 `) L N V O@ O Z ..L. "O m C U U to C D E v 0 m N c (D n� C N N a) F 3� O (0 L Cl) C N M C N E o n, E N ❑ G >, Y C L CO o(f U O n N C) Z E N •> U L O T.O M a) a'.r d j n W j C CU L n w y N O N m N� W O_ do L d N O C_ O :5 O (n .L.. L y N (n Z DO C N a Q O N U T nL @ 0 aL mo O C @ c v a) 30 U 0�'¢ O" U ¢ L �' > @ O N V' U .~m. 7 O. f` T C 0) N L O T. (n LL 0 7 N N � O _ H >> m c c U� O O N U) (n C Y N N m N N 07 C o 3-0 0 O_ N w Z C U N C .O 0'O a 0 C ` M N NL x ° Y O v 0' 3 .N.. E N w O N OS U nc 00 mw N N c ) N C .c (n N m w O N C 'D N T C U C C L CU � O ¢ 0 W0 .0 O ....N. d N O U O C.L.. _ C `) C L Z � -0 N _ O 3 N O N T Tm L.0 N r NCO L L ._ O 7 N xa- a �' E 'cp s S LL a) a O (6 O C >� 3 D T N O. @ moven LL Q 0 LL O L ��No? a) a) (0 o CL 4) T n fO N T O N w 0> OZ� N N N 'NO U N o m N ... O. n .. X ❑ N N ¢ w H U O (n N f6 U @ C 3 L !6 L d 0) f0 N v C m O) O m z as m 000 c OCH L L 'O p H e N L I- m U L v H O E 3 3(no O� O NL n_ YwR N m N V.N m.N -0 0Jw a m NLL 3L•UCn U m0 CL o <c w LL07 >, cc CL H _ W J F = QOr LL F LL F o JOO Y z L LL J�w ¢ ¢CL wm J Z �0� z r(n0 L C N w 6 m c co 0 O 3 `as T N C U m 2 O m v X 'N Ern CIJM O C n c o m N L yj C V N _O 00 0 O (n C O C> a C o L O :E N E N cZ � (n `o _r_ E T T CC N OT> O 7 C O O r a m L CL N � o >p O f0 j O N LL NE N O N N N 75.00) O L p L C `t f6 `) O w 0a) 2 c N N U L O) (n a C N a) O N C N >, )c c6 ❑ Z C � .- N 'O L O OO y E N O Y N U �O N O N C U N N E N m C y O m Z .L.. 3 " L N 0 (n-20-045 O N o v� 3 cu `° m c$w ZN C0 z ¢ - co _ C L H E m¢ N O 3 �6 C L �' C 'O ' N LL U V! N m w C m N C y� 01 O@ N N L N 0 a) 3 9 N E cu ❑ - ❑ -00 y N ._ L U n N 7 0 U L C N w 6 m c co 0 O 3 `as T N C U m 2 O m v X 'N Ern CIJM O m C N a) _O 00 f6 C N L C> a a) 0- O :E (DJ q� L U _r_ E N Y C N OT> O 7 C O O N m L O n O a) >p O f0 j O N LL NE N O N N N _T 7 U 0-0 L p L C `t f6 `) a) E m w 0a) L U T a) N N U Q C N m' o (n n E E C N .� C L O C N >, )c c6 ❑ Z C � .- N 'O L C @ y E N O Y N U �O N O N C U N LL N C y O .L.. 3 " L N U N YO N C L (n (n-20-045 O N o v� 3 cu E2 c$w �? SL) U z ¢ - co _ C E m¢ N a 3 �6 C L �' C 'O ' 07 VD) �7 m N OC LL U V! N m w C m C y� 01 O@ N N 0 a) 3 9 N E 0 c T C V= ❑ N N N N y N ._ L U n N 7 0 U O L.+ U O U n O C C ,D N O C O C > O N :O N a) 3 m mU aNi v m L m as p O O) nc -.O L'0 N-0 U U C m ".8 H d Nw 0) co N.L. C a) N .N-. Q N c 'C E O N J Q. Q. N -O E N O C p 0.- N (6 O 7 `) L N V O@ O N N N ..L. "O m C U U to C D E v 0 m N c (D n� C N N a) F 3� O (0 L C N M C N E o n, E N ❑ G >, Y C L CO o(f U O n N C) = E N •> U L O T.O M a) a'.r d j n W j C CU L n y N O N m N� W O_ do L d N O C_ O :5 O (n .L.. L y N (n N .O O)L DO C N a Q O N U T nL @ 0 aL mo O C @ c v a) 30 U 0�'¢ O" = m nmv L L �' > @ O N V' U .~m. 7 O. f` T C 0) N L O T. (n LL 0 7 N N 0 L) N m c c U� O O N U) (n C Y N N m N N 07 C o 3-0 0 O_ N w Z C U N C .O 0'O a 0 C ` M N NL x ° Y O v 0' 3 .N.. E N w O N OS U nc C) n n... cu TO N N c ) N C .c (n N m w O N C 'D N T C U C C L CU � O L T .0 O ....N. d N O U O C.L.. _ C `) C L Z � -0 N _ O 3 N O N T Tm L.0 N r NCO L L ._ O 7 N L O U �' E 'cp s S LL a) a O (6 O C >� 3 D T N O. @ moven .0 O L ��No? a) a) (0 o CL 4) T n fO N T O N w E '� N N N 'NO U N o m N ... O. n .. X ❑ N N N N N' n N LL O (n N f6 U @ C 3 L !6 L d 0) f0 N v C m O) O m z as m 000 L L 'O p H e N L I- m U L v H O E 3 3(no C-0 NL n_ YwR N m N V.N m.N v N N o nm m NLL 3L•UCn U m0 CL O v Y O Oto w ON �w0>w> O w0Q> lA� zaa jr N� O JO p. Z m ._ I - O20. W O �_ ❑ w Z H U ❑ w c z LU x O o U O w O V w Z O L f0 N0 O QY LL ~ U _ O D _ O Q w Q ❑ c T 0 J Z XX H�Q 30~ x Q U LL 'D UZW N❑Z (n m �22a E £ Q w O V)O Z Q O m - Q O O UwQ o to a LL Z w 0 Q ; n NU o 'O J h LU w c o Z o o0 a �_ LL M r Q L N ❑ H U Q > w Q O Y K } o_ O O N a0 O (n 2 (n isao'lo o o N o o 0 o m o o n z z Qv LU Z ujM 3 M U O LL ❑ LL Q U SNOIldW3X3 O t� ON!OIOHHIIM U d0'ON x H Z}> O W F U m c D D U U) X C z LU O U O O z Q U LLI Y �� Z ElZ o03 6 7c 0 S2 Q K r > m z O ? OD O O ❑ LL Z U Z J Z H Q N LL O 0 g wLU Z Q Q a° z a N y `o L � Q N N co 2 w L a c p J t0 �n UO m o `o N O U J > 0 M N U T LL ❑ f0 >_ U to N N rnj ° m N � N C Y a > d � L c 3 � N O) t6 N c c fi T oa o U d U N C 75 L a 'a E � o� `c o U o ° m ° c m m ° w�0 rnL 3 N d O O O U O a t0 m E y C L U ° 3 c N d d O U O m O c as m 2 0 cs' m C N O m TL N U N E N c p CO w � 3 c o c m V t0 J U t0 ❑ v � N J 0.. v E O U U o d d n rn N y c - m a a LL o c o m c 0 ° 0 0 4 _a c LL - So O � U p Q a 0 3 Ou p E � m c m > M d 3 ❑ E ° m � d N O 3 Oa O C N � N � o a h` O L CL 0 O ai m y 9D a) 0 .r- 0 0 -O to 0 O N L m U U � " m a c a) o M Ir N C U � U � y d C m a - L m N m p Y y Oz (rO m O N m CL Eu) U) a) m 0 Ua)m T 7"•W C C C N L N C � L m C) w w > N oma cc 2 u y (D E, Q a) 0.5 a) U J--caa))0 C 0 m m a) E v d ymov W. C �C o C: - Q L o E U Y U) U T m N I_ EaLc F- Z Z W -0 (D Z 0 � to 3 O L � a) •Om W o a c co W nv m m a) m N a) p C O z m0 m c a 0 W w 3 L n m LU Of I �- a LU = w U 0 °c CSU w � U O L CL 0 O ai m y 9D a) 0 .r- 0 0 -O to yJ rn M Ir N m >E o w CU m O Oz (rO L O m U) a) T 7"•W @ U a) (D a)A m C) w a) cc (D E, ca C 0 m m c ti U O3 E m Q �C o ami T aci a) O (D a Y F- Z Z a) a) N 7O N >CU 3 O L � a) •Om w m10 -0 N a) p C O Z Q Z 0 C LO L n m C O C U0 U m m O M a.0 y c aS a 0 °c CSU a) L C U W O >0 2 O L mZ� m>0 L U Cy@0 m O N a O C o w w Q 0 naLoCU � y > m maco n C U o H H Z -0- N ID O) 0 0 N p N CL E E•� CD U) 0) a) F ULL a wo CM CM.0 N E 3 3fn0 o..0 _ _T— () a) LL YG � 3 3�Ufn W U z Z w W C7 ww ¢Z U) - w F- > Z) OU mw Q U W =aw OzO LL U ZZEW Q � U c O mU) z E z0 0 v O -jw F- o a�Z U m �-`�w w J a - �afm QOF H H o wF-w (n Z -10 JFM � W Q n JZJ O lil O w m ~ ' Z ' F- U O O L CL 0 O ai m y 9D a) 0 .r- 0 0 -O to m c m y a) N N m c N O C Q) m Ia N L L @ n O .L-. a J v U a) C7 x .a a) L 0 7 U 0 0 N m a) E `) > om ��aci per• 'cC(D 0 C.L. O w 7 m E L U >, m y= m c CO m 0 (D y o Cl a) m a c � a) .0 cA E E CL TCO C a) 0 O- m L o V) Z O 'O L L 3 U N 6 W 0 N N E c ° a) �c O z a Vi c 0m c C d ami m a) p ca >' :C = O O C , O C a C U O C � 'O N r O O1 C U m 0) m 0 0 N m 0 •@ Q. n C O L U U (G aL a1 '� 3 a) v L J I- as a, w w Eomg aa)) c Q %oE L a) V O m O a) .N.. sp 0 -z-cU 01 a) () a) L ~ N () E E > E N 3 E n C o ata) Q T>d U C O co m a V d d m u) -o N a) a) a) ` W O— C o ~ O m m C Vi U) n Q U >, a m .n N m n ID In 3 L 0 m m a F m OL CU y o m am)O 3-p w c m c y 0)c a -0w y Z ca m ' O E y. W O m V 22CN 3-o mE m Cw E a) L a) C N y N O m W 0 0 0 N o C m. m a c a) a) �� Z v a) --O V) m C Y C C L > a) O U (D m 0 O >1 coL ECL Cc 3 W m o c Ta y T c w I CEa)Ncams = m o M- m _n a ._ 3 X❑ m U 3 0 L L N L N V m V M C C m V aN v 0. CL m a co) m 0 m<U) yJ rn O vM,i m >E o w CU m O C C"— 4 8 ! L O m U) a) T 7"•W @ U a) (D a)A m C a) cc (D E, ca C 0 m m c ti U O3 E m Q �C o ami T aci a) O (D a Y d UCL a) a) N 7O N >CU 3 O L � a) •Om w m10 -0 N a) p C O C L c N N m C LO L n m C O C U0 U m m O M a.0 y c aS a 0 °c CSU a) L C m O O >0 2 O L mZ� m>0 L U Cy@0 m O N a O C o N0 So f/! M _c 0 naLoCU � y > m maco n C U o T > Da �r- - T -0- N ID O) 0 0 N p N CL E E•� CD U) 0) a) a) a) ;_, I- CM CM.0 N E 3 3fn0 o..0 _ _T— () a) LL YG � 3 3�Ufn m c m y a) N N m c N O C Q) m Ia N L L @ n O .L-. a J v U a) C7 x .a a) L 0 7 U 0 0 N m a) E `) > om ��aci per• 'cC(D 0 C.L. O w 7 m E L U >, m y= m c CO m 0 (D y o Cl a) m a c � a) .0 cA E E CL TCO C a) 0 O- m L o V) Z O 'O L L 3 U N 6 W 0 N N E c ° a) �c O z a Vi c 0m c C d ami m a) p ca >' :C = O O C , O C a C U O C � 'O N r O O1 C U m 0) m 0 0 N m 0 •@ Q. n C O L U U (G aL a1 '� 3 a) v L J I- as a, w w Eomg aa)) c Q %oE L a) V O m O a) .N.. sp 0 -z-cU 01 a) () a) L ~ N () E E > E N 3 E n C o ata) Q T>d U C O co m a V d d m u) -o N a) a) a) ` W O— C o ~ O m m C Vi U) n Q U >, a m .n N m n ID In 3 L 0 m m a F m OL CU y o m am)O 3-p w c m c y 0)c a -0w y Z ca m ' O E y. W O m V 22CN 3-o mE m Cw E a) L a) C N y N O m W 0 0 0 N o C m. m a c a) a) �� Z v a) --O V) m C Y C C L > a) O U (D m 0 O >1 coL ECL Cc 3 W m o c Ta y T c w I CEa)Ncams = m o M- m _n a ._ 3 X❑ m U 3 0 L L N L N V m V M C C m V aN v 0. CL m a co) m 0 m<U) WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE February 15, 2015 1, Mark Marrama President (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Capital Carpet & Flooring Specialists, Inc.on the N. Andover School Department Admin Bld (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter orae hundred and forty nine of the General Laws. Signatur Title ark arrama, President 05/14 R N C c ti � +� w LO � Q rn U o cnc Y LL 08 0 0 0 � Q O 3 U U U N NN 'N 2 U m Q W — N MI q- m a O � U o L 0 �j uiE Q � CL J i -U m Y Z LU U a 0 - LU 0 U- _ cn W U O ca a = Z a U Z 0 C%4 O Z ►gC O C6 N C c O O) p6 U a) a) L E O Z I L Q U E J W CL N r LO N O fle m L O O O m O � � 0 7 c O'a cu cn a) 0-0 -0 O O U in N U ], Ca C N U (U .� > -C UJ o c ti E a) +� w LO Z m z Q rn a) a) c6 a) Y LL 08 0 0 0 � Q O 3 U U fle m L O O O m O � � 0 7 c O'a cu cn a) 0-0 -0 O O U in N U ], Ca C N U (U .� > -C UJ o O O N M _ m N + O O � to v �~QE W d �O O + fX I� 6s + + + 0 0 m 2 ~ � > m d c CL aE O W ... d C �D 7 oLn Lq c O ' N O O U a m 61), a O OjS y i — p) 00 O Q. N W 2 d d O O I� co N IM 3 cv to 0 O 64 � � V! O ~0 N O N L. W oo w O oo W 3 O U)000/)0clC/)0MU)00c~i)000)0oU)00U)00U)00 O U 'c N +' f0 C V c6 U L O !_ N C LL U F ~ S3400 OINH13 0 E N d Z Q OQ dip map c T Q m C. 06 E 'L U c o - >. c0 W r p C )M U Yw fle m L O O O m O � � 0 7 c O'a cu cn a) 0-0 -0 O O U in N U ], Ca C N U (U .� > -C UJ o i ;:.+:�_i .. :;.::,ark. �,.:!��fafn:n':�;•:x- JOHN MEDAGLIA ran •M�:t�ar, 5ata1��,� Fiei::ti: GREG LAURI•L i MARGrtI 2004 OSHA 001069307 40,,> U S. Oapartment o1 Labor �------ ' 0ccuPa1i0n.91 Safety and Health Adminsirahon Fi KEVIN YOUNG f� n(i e has Sucarns(ullY y ccx t ,[,V a 16-hout Q�;cupationai Safety and Heal!h r Training Course in . _ Construction Safety 8 Health James Wilson MAY 2006 i WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE February 22, 2015 I, Mark Marrama President (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Capital Carpet & Flooring Specialists, Inc.on theN. Andover School Department Admin Bid (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter onl hundred and forty nine of the General Laws. / i Signature Title Mar4 Marrama, President 05/14 c 0 O � U � c E p O U U L N v U L) m m U C Q 2 M fA Q Y c 0 O � U cn O E it O � U O LL cu O O W O N E J n Of O ❑ p CL J } Um Y C: Z W U CuCl p w cma W O p _O = L U 0 ` W c� > 00 Z •- Q U Z 6 E z E z c U Q N U z O U ` O M_ C O cm 06 n L E �J O Z _ CLc in C L J W a- n m 0 0 0 L U N O L a O c Q CV -C N 0 N z o W Q a) rn c R Y C6 O Q � cn it N F- O a NwN LCL J a z ti r O LO r U- r %i R lL Y l0 7 O Q �~Q w d + + 0 0 —0 �2 ~� > m L a c o E w ad d .. = C ND .n 'L = _ O U c a 0 ca d E U w 2 � m m O m m L O �O co N w O F- O x 0000Ooc~i�OOc~iaOoc~i�O0c~i�O0cwoo~wO0woo C O cs `" o p U) W U O S3000 OINH13 LL w W CL E Z d m� m oQ O CL Z E w e `+ WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.inass.gov/dols/1w, and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance fonn. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE March 01 , 2015 I, Mark Marrama President (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Capital Carpet &Flooring Specialists, Inc.on theN. Andover School Department Admin Bid (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter,ne hundred and forty nine of the General Laws. / I I , / Signature Title Mai 05/14 r . 1% O •� L) z O N c U U Y (0 C U CL •� L_ s U m= Q O LU N col Irl it) >, L O a� O } c O U LL cu U o 06 U c m _ L O U) L E w w CM GLCL N O Z ® Z iE LL >, L O O U 4/ O U LL cu U C LM 06 4- O O U) L E w O Z +� E C 0 d J W d ,0 } d Q J }• vm Y C: Z Q ~ w ami Q U F— (L 0LLJ a O O W 2 � 06 U Cl) o U cu U W i OO > c Q w d +>,_dra o=B CL U Q o Z z o a� E N L1J LO Z C EQ Z 0) r cn c6 N C:> >a Y L LL 06 L) 0- Q �: U >, LL Y m 3 O O O Q ~ Q w d +>,_dra o=B + = 0 M -,u 2E'� > C CL w aE 4) o .. = c �D �L C = _ O U L a O o�S d E U W " CD x O m x L O O 2 N cn d UL O 10 3 O x � 0O0O00U)ODcn0Oc~nOOcwocwnOOc~nO0c(n00 C O ca U v� � W U � O S3000 OINH13 ji LL W a NN z O L � d O Q C. 0i5 Z W a IL O U c6 -0 O = -r- O c0 0) O C 7 cu cr n a� L � O U_ c c cn U 'a O :3 U in C O c0 L 0cu CL U >, C N U N > W O W z e WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.inass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE March 08 , 2015 h Mark Marrama President (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Capital Carpet & Flooring Specialists, Inc.on the N. Andover School Department Admin Bid (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapt on hu dred and forty nine of the General Laws. Signatur Title ark,Lrama President 05/14 L- 0 U C O U m a � O O U L � o O (� CL a) E J C: J n O ❑ Q a_ J Y � Z WCL U C� < �a L W _o LL _ 0 N ` W m > U O (- Q Z a. a cu ol Z 6 E Z E >, Z C cu U iZ a) Q O U � L a) E O O z cn N C X U N m E L d CM W G Y J Z 2 F O \ M a m C c Ug) C.6 U) (L) a) E M �, o Z Q E J W 0- T, 0 CV 00 C] M 0 Gh q m A =L- -0 O O -r- (n O ca O C cu cu L m O (0 3 C O O -0 O O U N N LL Y Rf + d �' O Q �~Q W d + + +�2 M— = CL W = E d O Z.c . O ..cn .L O U in c � d O CL O oti m E U W 2 O m L O 3 O cn cn Y L LL O 7 O r,(noocno0wo0w0000c000(noo,(no0woo C O 0 O 0 y W U O S3C100 OINH13 IL W a U) Z d O d � d O Q ZQ. 06 E LU Gh q m A =L- -0 O O -r- (n O ca O C cu cu L m O (0 3 C O O -0 O O U N N WEEKLY PAN. ROLL RECORDS IU -'POR -,r & S'TATE.MEN'f' 01; COMPLIANCE In accordance with IvlassVhuserrs General Law c. 1--49, §27B, a rate and accurate record tutut be lC.,pt of al. persons employed on the p Ib.t,. works project v: wh:ch rhe enclosed rare.; h-ivC been prov*ded. A Payroll Fori 1 l::rs been: printed on the reverse of- this page and includes I; _LII rife in brn at!On rCCGi.ttreG to be kep } lit`:.. cVerV cor!t aCior of �;u.bcontrhCtQi' is required to t Cec{) these records it:id preserve them tor {: Period 0? three years '_rOIr?? tl?C date Of COmpletl0[? of '.ne contract. 9 • ,t ;J!• a rl t r r 1 ,; 1 it - �• ills additlol" eVerl' X01 i f I nd subcO ir' C o. i� eCtl..:-ed !J SUbiil a -vpy Of - kV- - t'a-Vroll records i0- (t1C-i'Oie -.—!l\vti:Ilii .. `.i•ra:, i.. J:e31I C:: .. dL!?tiiication ca!O r?t !b a, he r , �«, sr attic. �d e i1e j. , ru,; u1)0r;. Once collected, he a\,varding aLIN)OF ry is also required to preserve those records for ih!-L:u In addlilon, each such contr_?ctur, si:biomi-ac[or, o, Poli:: J0CIV Sh illl .U;i?ijt? tU file t^:ardino authority directly, within iifteell day's after completion or its portion of the work- a Statement, executed by the contractor, subcontractor or public body �'vho supervises the payment ,)Cwages, in the following form: NO STATEMENT STATEMENT OE COMPLIANCE 1611,1 ,?ol�/ ittT1C J! Si kliB!Ury i�,iitri.,' I 1 ! tttC} Ju hereby state. T at I av supervts the payment of the persons ell Loved by ;P or the ;Co+;!racier, subcor: /actor or public bony) iBmiding or pro i; and that all mechanics and apprentices, tearnsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenry-seven o?`chapter one hundred and iorry nine of the General Laws. l Y+ -ti P: -`1T ItJ' :,L SAFF' . 1' Vic, 1..Ni:'ORD STREET, 2nd H OOJRZ B0St'0N, ;41n 0'-1Iti T >11�s H W t a C U m o N a o m V vo p' & °v t m ! T 44XXtt c� C o m N rn 3, 0 Z cc o ` V y+� � � m Y � •� L f LL o as r ` Q N,LL - _ LLI \ N in V ° d N e � Q c Nt F V QJ o i 5 I h + _ _ 2 L d w 0 0 U P4I lei z r h Nk `1 Q. a E �%!Q43 m � U 1L i T C LL 1- 9 M A r� 4 I o 0 N j - >„ o d e a W 4 0 a o. m a NO y ` CL t N NIS O•: h 117 I -M' I � � `M w w O 3 v � A e O O Q m w U U W�rc-" \ `m©©e I Z 4 u 3 - �� Id �� •� � �Q E U W 6 n M A p 0 OSHA 0010693- US- 0epart-mi Of labor occupanwal Safety avw Admxwat* t's tln S.H '-to' 0"' 6 9 3 0- Vesley Gumienny has S slulty completed a to4*ur 0c0*a,Ona! Salcry -aIVY-rIe t 04 _ W � -� . : Health co,' -se I Safe - ConstructionItf_ I'D (Date) OSHA lu n"0644048 a, 5.31t:t,. jru healln A011 IM-SIU01 Zbigniew Mroczka OSHA u d occupm:or-31 Safety anCl Helilth has su"cesst'jily Mllplale(] 3 101,ouf Ciecupataial Safely an,(I Heatl,' Damian INIroczka TrajraIjg Course it, ,,ea,m Constrfjct.�ofj Safe & Healffi -- Of S"e 1/21/0 Construction Solely & Health (Date) (T.drwf) OSHA A VS. DepanmLm Of LatIT Oczupavoriai Safety a -,C 1-feailn ieszek Pol'a Pizemyslaw Staszek CKc.Dal.ol-a"Sliely and Healit, 7ran.�3 course 1, Construction Safety & Health (0 -Peterff (�Z3 Pale OSHA lu n"0644048 a, 5.31t:t,. jru healln A011 IM-SIU01 Zbigniew Mroczka OSHA u d occupm:or-31 Safety anCl Helilth has su"cesst'jily Mllplale(] 3 101,ouf Ciecupataial Safely an,(I Heatl,' Damian INIroczka TrajraIjg Course it, ,,ea,m Constrfjct.�ofj Safe & Healffi -- Of S"e 1/21/0 Construction Solely & Health (Date) (T.drwf) -J10-693 I.. A VS. DepanmLm Of LatIT h� Safety ah Ac'—rsuam, allq�a: Sa ety ani n ieszek Pol'a J+aS S�cce5s:&), c:.J j *4 Cccupal.""w Safely w..; Hcu�w tion Safety 8 Heal -::jv (0 U S Department of tabor -0ccupatonal Safety and Health Administrahon tiWsIaw Piwowarczyk- hail ~successfuty crimpleted a 14hour occupational Safety and Health, , i . Train(Course in t, `ConptructionSafety. &Health 41•� ail' - 0 e OSHA0183582 82 _l U,S. Department of Labor Occupational Safety and Health Administration J r Mateusz P' i has successfully R'arcw t 1! ccessiul p J � �}� '�• Training Course in om feted ' our Occupational Safety and Health nstruction Safer. & Health 4/27/2008 U.S.561m merit 1 =' Occupational S; has successfully a.$ Training Course i y a 10 -hour occupational Safety and Health OSHA Piotr Piwowarczyk U.S. Department of Labor occupational Safety and Health Admi,Wrat i j Piotr owarczyk } has successfully co a 10 hour occt, Training Course ' pationaI Safety and Health CCOnstruction Safe & Heafth Goo 'Auk Pug pelaS MLj0A W^*oO m0tF01 a petetdu,, ,Q mq..l p3(Z�p >v zTal Matub;rgZ ly uate��7ultupy tARe{{ pus,Qa� �� •r I10rn , 80OPP90 0a iso i (Date) r OSHA. J.S. CenarV neat of tare: Jocuoacional Safety and Heath A -M mirstra;ion Arty Par;.tinowicz has successfully Wrrlp4stetf a 10-rtour Q^:uNa!IcrY3: Safely and- Healer. Train Course in Construction Safety & Heaitn (�rLrw, tDaiel OSHA UU1861030 U.S. Department of tabor i Occupational Safety and Health Administration Janusz Warnajtys has successfully completed a 10-hour Occupational Safety and Health Training Course in j Construction i 41TI M8 Retsno06 0$_: ;r' : (Trainer) `5.`r. c ,Date) OSHA` � G.S: DepaImbnt of-. bor Qccupatidrnal Safety and Healthh Admirnstrahpn ' •-. } i' "'Vi , P&61y_slaw 4 " � Staszek pas sugyessfulty completed a /Ohou Occupationai'Saiety t. ?rafrung Course in and kobhh <` Construction Safety � & Health ' r lQateJ ` , 'IVY a • h< 4, ASd!* WWI, t. CU � �SaY 1. `: �•1m, �5. �y tit. � n 0 m_N n In N `G m pY' , (� 4 O L a w a. o fe m — � 4 d � d � N � o - u N. a - • 2 i y . OSHAj a U.S. Department of labor Occupational Safety and health Administration Dariusz Dziobak has successfully completed a 10 -hour Occupalional Safety and Health Training Course in Construction S&L -Ly & Health PEA'AE Deaent -P ditc�U94 Zk]5 olyintadA P 'I'hisacknowledges that Damian Mroczka to conduct I 0 -and 30- hour Construction outreach training in accordance v%ilh guidelines provided Illy the OSHA Training lllstilille. Directur: Charles -7. Shields ExpireS02/12/13 S.1.1y —d Health Lt j U -J A OSMoeenaauanat This card acknowledges that the recipient has successfully completed a 30 -hour Occupational Safety and Health, T aini'ag Course in onstru/I i/-ct, ion Safety 71PI, name — printortype) OSHA b . , OSHA UU1861UH U.S. Department of tabor occupational Safety and Health Administration I Janusz Warwitys has successfully completed a 10-hour occupational Safety and Health Training Course in ' _ Construction Safety.& Health: > :homas Retano f '; 06 Oft ->, (Date) (Rainer) w OSHA 001069345 u.b. uepartment of Labor Occupational Safety and Health Administration Wesley Gid eii has successfully complel our Occupational Safety and Health Training Course in & Health r (Trainer) _ rGef-yd-- ..... (Date) OSHA 001069351 lep U.S. Department of Labor Occupational Safely and Health Administration Leszek Parafinowicz has successfully completed a 10 -hour Occupational Safety and Health Training Course in Construction Safety & Health rP t 66873 C/28/06 WEEKLY PAYROLL RECORDS 1UPOR'll & STATENMENT OFCOIMPLIANCE tt Mb e Inaccordance w!'d,,.1v1assqFhuseus Gitneral Law c. 149, §27B, d true and accurate record US! Kept of all persons emploved, on -the public work's project for which the enclosed rates peen PrOvIded- A PaivroH Form haS been printed on the reverse. cl!'rbis page and incudes -eqUffed 10 ie frifbrmiarlon req uffed ic be ke��, !,av,_ Ev-ery-conriactor oi- subconMiCLO! is i on- ihr�e years rjuie date tie I? 1hese -,-corLq-s and prtserve chem rbr �-,. oe,7o-d of I Ite ()f'�ornpler;op _,f 'ne contract. Ed* I., in addition, each such corirnaCiur, subcontractor, Of QUbiiC Dody shall Fw-nish ,u uh- authority dhi-euly, within i!_rfteen days after compleri!On portion of the work 0! !is po I M --ater,ien,,-execured.bvthe - contractor, Subcontractor or public body .,rho supervises the payment o-i,vvages, in the Fallo,wing form: Z-1 I STATENMENT OF COMPLIANCE -- 20 Ju herebV Scale: t pa'," 0'_ SU t D. )Vt!L 0\1 pervi�e HY1,1711,111. of the per q- -n -C,/z P.*0 Crt _tp. or. cheS4Av-6e !Cummi:ior, subcontrimor or public boc*�; (Budding or prtfjeci.; ii d, thar all mechanics Lino apprentices, teal-DSLCI-S, chauffeurs and laborers employed on project s id have been paid ir, accordance xvith wages determined under the Provisions of' a] sections rwenty-six and twenry-seven of chapter one hundred and lbruy nine of the General Laws. VIS*CINOF OCCUPATIj.-N.AL SAFETY, ST.ANIFORD STERE—ET, 2nd F; 00R, ,VIA 0' 1 1 r, — 2 .4 add: i 'V-1" 'On r' L: t',?!- Allu"" SUbcontracior reqU,-'-eC!' ,j subn * �1 01 co!)*v, u 114,1n_Voa vr-CCGS e LP6il".- o I - v,vzl� h1ch z: ohow;-up he apprei-J!'Ce iotmI1?ii titiOn card r S nec! 10 :14le p -.I. b- allaci "L LID T% Once collected. the awardin') 8 LI: 1:9 Or. IS also required to ­ those records Cor ihr preser t:,u in addition, each such corirnaCiur, subcontractor, Of QUbiiC Dody shall Fw-nish ,u uh- authority dhi-euly, within i!_rfteen days after compleri!On portion of the work 0! !is po I M --ater,ien,,-execured.bvthe - contractor, Subcontractor or public body .,rho supervises the payment o-i,vvages, in the Fallo,wing form: Z-1 I STATENMENT OF COMPLIANCE -- 20 Ju herebV Scale: t pa'," 0'_ SU t D. )Vt!L 0\1 pervi�e HY1,1711,111. of the per q- -n -C,/z P.*0 Crt _tp. or. cheS4Av-6e !Cummi:ior, subcontrimor or public boc*�; (Budding or prtfjeci.; ii d, thar all mechanics Lino apprentices, teal-DSLCI-S, chauffeurs and laborers employed on project s id have been paid ir, accordance xvith wages determined under the Provisions of' a] sections rwenty-six and twenry-seven of chapter one hundred and lbruy nine of the General Laws. VIS*CINOF OCCUPATIj.-N.AL SAFETY, ST.ANIFORD STERE—ET, 2nd F; 00R, ,VIA 0' 1 1 r, — 2 .4 Q LL I vw ��v i NFA Gq L � 4 ,w` � \ V l I • 0 0 0 re $3 4 1 - � W Y Met'. L _ _. •. w u � o a • � pk • c CL v 3 a a` i+ L v ` _71 S f 2 o v v ' n a n V 4� isNs \ - V - -'r.` ( � •gam, - C E 0 La ♦ 1 1 i o s -o d r 2 e q .y o A` < N;,:E � :ci �` ZV , Z Y � a o V < U ci W: r xc L U t M, I lfg z v w cs Coro Y 3 Q gLIN w b WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to th awarding authority directly, e within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment Of wages, in the following form: STATEMENT OF COMPLIANCE 201 -5_ {Name of signatory party) do hereby state: (Title} That I pay or supervise the ayment of the persons employed by 'r-')3V4efk> on the Scf-& c n �'Ov; .i T ,� (Contractor, subcontractor or public body) - and that all mechanics and a rentices t �uil�tOg or project) said project have been paid in accordance wages determined eurs and laborers th employed on sections twenty-six and twenty-seven of chapter one hundred and forty a provisions of General Laws, rty nine of the Signature Title % DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Oki bR O y f G n^r. VO rk" �� lw 4 •� f� m o a o Y) Sa ✓.rite sir xr Y '� ? 'C �* �1, �✓•'.a � r l3� ¢ s7 A „�� z �-9'�"`v`� � �"�' . "sem 1`f A t,:m �S; rrx '#` P�'�'S' �"" z^ � �,".+..,Ac. � t..r'n,.��K �i ✓i :J� ��yy� a � "`.^° 3 A: t! n x x aaz fit.: x o f cil LL o• sZ &Y 1 : Ny +- V1 V� a_a a:. 2��'c . L� y � r'�; ¢xawql }* LU �• 'mak(• � ' � (a� � — r �' l� /� �a: � 2 `": - "T"-us ry 3�xp� �. .. �..., 1-a•c�.'�T.v v a,�r""; t t uj !'Ppb 'o � el� LU 0MV 16 Lu 1Z.El El F ah. c uj a` z ✓l J 3 6 ° 0 41 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of aff persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall sish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment Of wages, in the following form: STATEMENT OF COMPLIANCE (Name of signatory party) i >2 CT Ud2F-A do hereby state: p itle) That I pay or supervise the�rpayment of the persons employed by �� on the S c,}-&, C-7 i i JT,0 (Contractor, subcontractor or public body) - c and that all mechanics and apprentices, teamsters, c auffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % ,,CES- ;,� 6 DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 4 r H •,' i4 � W" � fY r } I � ' ( 1 V :. i i. m a? V1 0 G i WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall fiunish to the awarding authority directly, within fifteen days after completion of its portion of the worka statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE E.%j 0 - (Name of signatory party) i rz C"L- Ud2 E-A do hereby state: (Title) NCUThat I pay or supervise the payment of the Persons employed by JE,,'e-(A7-Da.SvJ^cv� ` r� on the ,'�; Tdt'D c,,, (Contractor, subcontractor or public body) J�i and that all mechanics and apprentices t (Building or project) said project have been paid in accordancewithwages chauffeurs rmmined laborers them provisions o s sections twenty-six and twenty-seven of chapter one hundred and forty p ns of General Laws. rty nine of the Signature 4-1 Title % ICES viz DMSION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 a: WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor s required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shallfiunish to the awarding authority directly, within fifteen days after completion of its ortion of the work a statement, executed by the contractor, subcontractor or public body whpo supervises the payment Of wages, in the following form: STATEMENT OF COMPLIANCE 3 1 20 / ---Y_ I, HEO'Jr? I S:9fk,-s i i2 C rra (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by ��iAts�jon the SC� (Contractor, subcontractor or public body) (Building ol and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws, Signature ZZGV Title DIVISION OF OCCUPA'T'IONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 n WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE April 2 , 20 15 1, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 04-07-2015 Page 3 For the Period Ending: 04-02-15 JOb: 14-01, N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Mark Rothwell 5 Bow Street Middleton, MA 01949 03-27 03-28 03-29 03-30 03-31 04-01 04-02 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 8.00 8.00 65.00 3.15 68.15 545.20 2,600.00 446.88 133.90 1,820.32 545.20 198.90 Totals for N. Andover School Admin BLDG 03-27-15 03-28-15 03-29-15 03-30-15 03-31-15 04-01-15 04-02-15 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions Net .00 .00 .00 .00 .00 .00 8.00 8.00 545.20 2,600.00 FWH 446.68 1,820.32 FICA 198.90 SWH 133.90 SDI .00 Other .00 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE March 26 920 15 NO WORK I, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. 44E Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Job N. ANDOVER SCHOOL DEPT. ADMINISTRATION BLDG. 566 MAIN STREET N. ANDOVER, MAO 1845 Certified Payroll Register Contractor VIKING INDUSTRIES, INC. P. 0. BOX 32 32 SPRING AVENUE BARRINGTON, RI 02806 Customer T.E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 Job Number: N ANDOV SC Week Ending: 3/29/2015 Page:1 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardin authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Department of Labor and Workforce Developm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson,. CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING fNDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Build in or project) and that all mechanics and apprentices, teamsters chau?feurs and laborers em loyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S igg n a to re Tifle C ieT ecutive fficer- -6s�4 `- - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 -- Deductions -- Fed. Local Soc Sec No. ---------------------------- Hours Worked This Job ----------------------------- Gross Pay Fica Other Check # Class 03/23 03/24 03/25 03/26 03/27 03/28 03/29 Pay This Job Med Name Mar Exemp. Mon Tue Wed Thu Fri Sat Sun Tot Rate All Jobs State Total Net Pay CORNELIUS A. MC AULIFFE, II -"-6224 R: 0.000 8.000 8.000 0.000 0.000 0.000 0.000 16.000 43.310 692.96 334.42 0.00 V4681 INSULATOR -MECHANIC +24.480FR 110.50 150.80 Single 1 0: 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1782.40 25.84 1055.42 WHITE Male +0.000FR 40hrs 105.42 726.98 Hours Pay Regular 16.000 692.96 Overtime 0.000 0.00 16.000 692.99 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE 1] In accordance with Masssachusetts General Law c149, p27B, a true and accurate record must be kept of all persons employed on the public works project for which the encolsed rates have been provided. A Payroll Form has been printed above or on a separate page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. 21 In addition, every contractor and subcontractor is required to subm it a copy of their weekly payroll records to the awardin authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. 3] In addition, each such contractor, subcontractor orpublic body shall furnish to the Department of Labor and Workforce Developm ent/Division of Occupational Safety within fifteen days after completion of its portion of the work a statement, executed by the contractor subcontractor or public body who supervised the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, Douglas N. Carlson,. CEO do hereby state: That I ppayy or supervise the payment of the persons employed b VIKING fNDUSTRIES INC. on the N. ANDOVER SCHOOL DEPT. ( Contractor, subcontractor or public body) ( Build in or project) and that all mechanics and apprentices, teamsters chau?feurs and laborers em loyed on said project have been paid in accordance with wages determined undper the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. S igg n a to re Tifle C ieT ecutive fficer- -6s�4 `- - - - - - DIVISION OF OCCUPATIONAL SAFETY, 100 CAMBRIDGE STREET, 11TH FL BOSTON, MA 02202 2 0 N m CL d Z �.� VO U ^ �183fi� O x N z � CO O a o� '3 O c \ M m M r� o o m H a (V m 0 d e3 N a CL � W T C C N m 00co Qco a M M a c� L wo m m 0 N t o. ro U T y/�, of ~ S{�i. J O W = C L � i P C y m m T N m o o z a ico ! c '- 03 _ +��� Cc Cc � " 3 O t o Z a=a a= a a N LO l r C o' G li .�C O iv "" O ai � � v m 0O U Q V m C o Z u }i m E �1� 0 O Z e 3 o a v N > IL o WO 0 0 N m T rn O My) Li El F! Ll 0 IL __ i El w c m EOE w v `m O q C7 N m Z Z " L W a O O 0 W�� Z O / cu m m o L O E ay'Vo - C U -a _ � _ m 0 m m °' O per, O z d > aa mi -C 0 Z U J W Q C W 2 0 N m CL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE Z , 20—a—_ I, Kimberly Breault, Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Guardian Energy Mngt Solutions on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance wi es determined under the provisions of sections twenty-six and twenty-seven of chapter one h dred and forty nine of the General Laws. Signature Title Manager 09/11 la s c aD 8 a> E E U N a) T E !, CL C3 0 d LL O L 7 fC O) C `o 3 m .0 O VV d z x U u rn 0� O LL nN TI- a C7 ;" o 0 3 co r- N O (0 � a Z O+ _ALL U1 O W Cr) t,40M W > ~a ch a m O �ciGo W �c O M CO Wa M' m coo L (DLO ipp as m �+ ' a I > S Z1 N J )oo m T f0 m O IGGG o O z ° -� Z V L a a a a N 12 <n O � x NLL EM N — o m O .� m O v 'a o 00 _) z gg a=+ .Q o 2 LIL Z U � ° C c S N > — C E 0 m i +� N � w 70m m nN rEl ir D --- W w O U c w O 4E 9' U)m 0 ZW m v ' y 4-- 0 u £ d r. O o V cf! 0 3 ¢ oto N) m U H N r Ts a O E z �mc� c Qp.� la s c aD 8 a> E E U N a) T E !, CL C3 0 d LL O L 7 fC O) C `o 3 m .0 O WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 201 I, Kimberly Breault, Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Guardian Energy Mngt Solutions on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title iceLnager 09/11 . . . . . . . ... , I iTi pa F07 O a Em I I fr MIMI Marl I I � 51 pa F07 O a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years - In addition, each such contractor, subcontractor, or public body shall fiunish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE 20j I, �iE�r?y SAeK;� i rzGAfuj2 (Name of signatory party) (Title) do hereby state: That IIppay, or supervise the payment of the persons employed by W C-v✓�� �, �,J-44e5k>on the ScH&c c (Con(ractor, subcontractor or public body) f7 �" J Tdt #D DV U " (Building or protect) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws, Signature Title %sCE- v� 5 DMSION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 IM7 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE I, 11 S 4e-vc,,S (Name of signatory party) (Title) do hereby state: That%pa r e thpayment of the persons employed by W C-v��� v1 ,on the Sc� &, c (Contractor. subcontractor or publu body) A0 1 I i -"; J TA q -p ti,,, (Building and that all mechanics and apprentices, teamstersor project) , chauf Burs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % 166,q vl � DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 D .14 ZI •`NO U q e` a ♦t�� 3 C v e %�� w �a Vim' 7 Y' r0 4 ^ p 5L4 t V z ZI •`NO U q Y' 4 t J p ^a2 CJd E O'm i •� w � yY v a= W 2 O �J ) �P co zLU 110 D v ZI •`NO U q WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish nish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE -A � 3 , 201_�5- S 4e x;; T yz CArF viz 67-A {Name of signatory party) (Title) do hereby state: Thaty r supervise the payment of the persons employed by ENC-v�6J� ,,, E�,on the Scf-&o (Contractor, subcontractor or public body) — 1-7 i �" ) J T A �J-j"� o v (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % 4-('. a� DIVISION OF OCCUPATIONAL SAFETY, 19 STANIFORD STREET, 2nd FLOOR, BOSTON, MA 02114 c WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall famish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE —ALL0.201 4 NEaJ Ll S 4ftic.;s i rz CAW UP C --A (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by 0�C-v✓���v,"� on the S,111 1111 (Contractor, subcontractor or pubic body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title % K(AS (Itz ESQ DIVISION OF OCCUPATIONAL SAFETY, 19 STANFORD STREET, 2nd FLOOR, BOSTON, MA 02114 R d H D C Q A d `0 � m c N L n U O N N Q � N 0: N y 5 0 ; 0 N U N N`0 C m M N U ci E m mm u.2- a> da> C3 L m m m IT C C L T U y C a c o � d U D_ � � L o..L _ o c c E � a o 0 o v c o U _0 t E `o 0 N C p C N N O av m `c 0 t 0- 0- Is =OUEO y C L U U._ N W .03 c d 0 E ° d y d a O C O ,M;, d m 2 U OI c 3 u F TL N U Q L C c o N Y U U LL O Y N w � U E C 0 v N O cu E yo T`o O U U C U V C N l`0 d 0, d x O y O o'i `o vL N = N 5. 3 MM o w LL = > O O .� U- Z5 Q d 0 m Op mw p N r W p > W> m W C.� Q > Cl) Z Qa� 3 �M O O co p . Z O pp .� 0X < r 0j OW p w Z O Qr K w r Z O O = O U K 4 O W z L a O N N C)—P: my 2 O � O u W CQ L C (n J O 2 � ra� far 2 Q U_ LL N O) UZw N ^ D Z m 0 E E Q = Qw y rn Z O Q o m r o10 Q U O U _ wQ Q (1) Q CL LL O Q > cat h r O _ h W U " W C J N 00 a Z x LL Cl) Q Lu N = W m F O M D: ZY Q Y O O M N V � zip U) N O cc (n co2 N '1S NO ..LO O y O m O m O N O y O y O N O N z Z O W Z O M U W V 3 OLL 3� 0 LL g U SNOUdVOX3 O ON!OIOHHilM U d0'ON r O LU F- 0 UU m z U N r o N 0 O Z J Q US BUOY N ZN d LL 2 00� Q H O O U O 0 a w m 2J r n LL O 7 O O Z z O D LL Z Z F- Q U) < 0Jo wg LU Ix a z a Z d `0 � m c N L n U O N N Q � N 0: N y 5 0 ; 0 N U N N`0 C m M N U ci E m mm u.2- a> da> C3 L m m m IT C C L T U y C a c o � d U D_ � � L o..L _ o c c E � a o 0 o v c o U _0 t E `o 0 N C p C N N O av m `c 0 t 0- 0- Is =OUEO y C L U U._ N W .03 c d 0 E ° d y d a O C O ,M;, d m 2 U OI c 3 u F TL N U Q L C c o N Y U U LL O Y N w � U E C 0 v N O cu E yo T`o O U U C U V C N l`0 d 0, d x O y O o'i `o vL N = N 5. 3 MM o w LL = > O O .� U- Z5 Q d 0 m c 0 c N -o ca N 0 O .r-2 L al N T a) c Q O a) a E rn _ o co 0 O N L my c Co VU M ir N O 'O @ N >. oom r as C y O m C � U U m c> c. L OZ dL O V u)° C C m O-' 0 C L a) — N .2 � Z o D W0 C C U _. O .o a°m E N T 0 Q a) :1 I~ L U N O ca)c C_ U a) a) O E m 0 c� c a) L D1 E C C a) tL°>> ID . C w > N O T Uns Q L- cu ��n U =ca�io a)w CL Z 5 a (D m rZ ZZ _Q E" U ° aLNm Q cn.-a) 0 V O-° c Q. LLJC c. c E r y o OQ L) - Q L p E U (D H U T a) cn Ea,c o ° c LL Z 0--o cn4) O L.. 4) w W H cn L W m 0 ani a w L.o a) N ca d m c � C7 - z of m� m a) LL w 3 aa)) O w af _ O a LU 2 W U LL w E dd CO � U c 0 c N -o ca N 0 O .r-2 L al N T a) c Q O a) a E rn _ o co w my c c a) m M ir N c o >. oom m N U m c> c. OZ � C 0 4X)� O O � O (n C O W0 C C U _. 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C C O• O F a) N O) C D ,� v_L c� v E oa rn U) E U m @ N C O E E Cc° > �' E N Q O O 3 E a L U a M a 'O ~ W 00 = ) )C T a N O O@ C7 w F< z a w 0= a LN O C s a y cu (n O W� >� Q _O L `O OL N V T aL > O ° w -O L S U C N a) y 3 O C a) Q fa N CL— a7 U cc _� O U a1 O � 0 4) `q, 12 C a) OU m w y a) L O T fn LL O, a) L a O 7 .~O. 7 C p, Y C fa 0 a) C Q m WO 0 O C p` a) ° C U N N U) M a`)r X ° OIC a7 O 3 c -O O O W =aw O N ftp U °) E a) ac o Of io c c. U m (U a°i L LU aO�ijm w c vs.5 T .0 rD n U L >` L O Yb Z6 rO N O) rn �? 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N V .N aN aa m .0, _ m §NCL 34-0cn L)) m U mQtn r.0 Q L4 � N a d 00 a o� 00ctlo R �+ O o O 0 e A o 0 ON w v ar, R L v � � � R o� ro w w 0 U y too o Q U d d o N a tn. z O � O N 3 H w H w v b6A N W �r Q cUC o u � O 3 Q o •L z b aL+ x � L Q U U ►�-� � o n. N O q cri ❑ U �" ° 3 ° U o e z 00 00 U r.0 Q L4 � N a d 00 a R �+ O o O 0 e A o 0 0 w v R L v � � � R o� ro e.�. w 0 U y a � o Q U d d o N a � O � N V � ti .0 � v b6A N W �r Q cUC o u � O 3 Q o •L z b aL+ � L Q U W ►�-� � o n. N O q cri ❑ Q w �" ° 3 ° U o e z 00 00 z w w C 3xA k O O W 00 • a � z z GJ 3 09 R a R �+ O o m 0 e A o 0 0 w v R L v � � � R O U 8 L e wxA o 0 0 U a � p v o •L �' U X L ° 3 ° 00 00 d 0 3xA k N 00 H ° 0 0 0 3� R L �+ 3 0 3 c H x o O o ° 3k C O O O 3 •O \ C o o O o O O O O O L O O O Q O 3 3x 00 O 00 W 0 R U � w ¢ H 09 m a N 'O U 0 T m O. T aYi 3 cu O T CL 0 U cc N m 3 c m 3 N O a a `o U N C O U a co a c f0 `o U t`6 c 0 U N Cd rlN T r L U J 0 O c m 0 a WI H O Z 0 rl d a O Z 1/1 3s`nN N ao3` 3 qzt z O m d + �} >p _ > C N U m > a` Ad O a 2 o m Y c 3 0 Ew m p c N a 3 � °° cc co ti` In co < a Ln O moi/ (0 0 d' o LL O w z Q d a o (` m /�� a k ) o p a n m U S 3 c V J C) J uFS � � u m N � d m M o W a a o d p z Y C cu = eo'a o u c 3 a 2 co IL v a' ° _So a � ,N� L , N (/J � }� O o C Zcu = �j �U L m Tca N V }+ Y CIO O 1 fn N W O � Q y � m N o Q r H d � y Q� U o U L 0 E W ' o Y pL U _0 Q Lj LlH o 06 WLD °� Li �{/ • z d L m W Z m vo L E z O o m m = L }� H c -0 E o _ V 47 Co ECL c `o V 6 L E E (n U) I- +w- d )� rn ° — W m CL o C _ L° _;to U) U w Q m Z w m a N 'O U 0 T m O. T aYi 3 cu O T CL 0 U cc N m 3 c m 3 N O a a `o U N C O U a co a c f0 `o U t`6 c 0 U N Cd rlN T r L U J 0 O c m 0 a WI H O Z 0 rl d a Ewu moe DATE 04/09/15 09:13 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 3 FOR PERIOD ENDING 04/04/15 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 03/29 03/30 03/31 04/01 04/02 04/03 04/04 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 73.560 588.48 40.00 2942.40 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 8.00 181.66 167.30 94.33 .00 769.76 1729.35 007242 ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES- 1 TOTAL JOB HOURS- 8.00 TOTAL JOB AMOUNT- 588.48 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c 149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: April 9, 2015 I, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: 'f\A4L1-AJ' Title:inistrative Asst. Date: April 9, 2015 1, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 29 day of March. 2015 and ending on the 4`h day of April2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by arty person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS 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. ii F L �v a C C as 3�A O o 0 u C C 'a L � O O (D 4) wx° u C � U •L y � L 0 0 3 A c N oo F C e 0 O O O � y m L 3F3x o 0 0 c co o O 3 h .�yeya _ ,idy �L L ?? C O O O Hix �L 4t C O O O L H 0 3 N O N c W 0 tm Q � .0 m U •U } a {�-,Y, CCS Y ti w ¢ H U7 `o c 0 c E U m 0 m E U C N E E O U N C N T m E T a E I r 0 O 01 C 72 N r 0 rn H IL O Z Y L U �� y O xc�' 13Sf�N� N a .0 3 _ .. 3 \\ O Z w tm C C U) y O + m m > 0 F a � Y O � d O H m m T p C ii: N O m M ti LO 000 a a O Q) O 1i K w H x a m N m H O $ a c E w o J m Q N m m m o a C a3 0 z o co m m� S= Z o c d 61 .0 1 LLO a N Cd V- O 4-0 C: OO Z O = (n c V LL Cl) •� V cn Q •L O a--+ cu O ED ix L 4.4 _r_ L O A (D E .Q (d O i O 2 N J - a Y 'U g 7 � N 3 V 6 K r Z Q I- Off. N U c O t� U L N 0 O U O C) 2 .L }' U p=er � I El 0El _1 U 0 � E0.0 N z E U N w U H LU m Z -a v � EO N E ca a+ S, QO cma w z m Qi CL o a 3 0 E 0EL) CLd Lu m f7 Z w U7 `o c 0 c E U m 0 m E U C N E E O U N C N T m E T a E I r 0 O 01 C 72 N r 0 rn H IL Ewu moe DATE 04/10/15 08:27 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 4 FOR PERIOD ENDING 04/11/15 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE "04/05 04/06 04/07 04/08 04/09 04/10 04/11 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 8.00 24.00 73.560 1765.44 40.00 2825.04 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 24.00 166.70 159.67 95.21 .00 752.16 1651.30 007264 - - - -------------------------------------------------------------------------------------------------- JOB TOTALS TOTAL EMPLOYEES- 1 TOTAL JOB HOURS- 24.00 TOTAL JOB AMOUNT- 1,765.44 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c 149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: April 16, 2015 I, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title. dministrative Asst. Date: April 16, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That Ipay or supervise topayment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 5" day of Ap—ril 2015 and ending on the L]" day of April. 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by arty person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), anddescribed below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNATU Leah M. Hatch, Administrative Assistant( 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. MW Cd x C E 0 -� 7 Cd C A o o o a;Hacaz 8 a C 0 C u L O O O O v C r� � N w � 0 3 � a L y O v GC 3xA N110 � N00 _ 00 H C o 0 0 3= � ym L w o 0 0 C k O O O 3 •O \ o 0 0 C O O O is w y _ CCI 'L L 3 0 o Hix 0 0 0 'C 4t o O o x Q. W it U � � cG 0 w ¢ Cd C A o o o a;Hacaz Lf. J J a In m N ui 01 a r U J (D 2 0 c m a- Ill H O Z) C 0 �U �U l0 O U C f0 m 0 c 0 U m m c E U m 0 c m U C d E E 0 N c m T m E T CLE O U O N LL L c m 0) C 3 m Fy IL O Z O = 1� HFIp LO U a 0 o y * o m c G c \ N m c Y O w a o z 0 m m 3 Y m m 3 L v Q p j E w C A 0 C = 0 M LO o�D ¢ a CO c O Z Q � R m W m B ? o x a I` IL N ' - 0 iu O m a m m m U /S\ V J� F O u Q 1E 2 c J m O N � m m In m m 0 a` 03 z0 o Z � 0 c_ f0 _ ` 0 c a cfl CD m 12 g o a a=., S o ax 0. o U d tn N� L , i N (%J m O o Z m cu .U) V m � Q � U �L cn `D Q U 3 ca O cc 7E) O W ir L -C L d o �+ LnA •C: N Z v L W,5 E 4-0 LL (� o a % O z n Y _0 O O N MJ � C m Quo N v Z o y U o CUL- 0 U x O ca m �L U om _I 06 N z E Cl)N m o LU L E O z ~ a ///��W��' :t=: C:e70 M m . o mc V Qi E Q c `o -3:v T oa � L o W Qi m O U) E v a w ; c Z w m N ui 01 a r U J (D 2 0 c m a- Ill H O Z) C 0 �U �U l0 O U C f0 m 0 c 0 U m m c E U m 0 c m U C d E E 0 N c m T m E T CLE O U O N LL L c m 0) C 3 m Fy IL Ewu moe DATE 04/23/15 08:30 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 2 FOR PERIOD ENDING 04/18/15 ALL JOBS JOB INFO 14405 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 04/12 04/13 04/14 04/15 04/16 04/17 04/18 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 1.00 3.00 8.00 12.00 73.560 882.72 40.00 2428.32 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079— DT — — M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# ------------------------------------------------------------------------------------------------------------------------------------ 12.00 130.70 143.18 82.85 .00 595.45 1476.14 007283 ------------------------------------------------------------------------------------------------------------------------------------ 01023 THOMAS A. SHALLOW RT 8.00 8.00 44.680 357.44 36.00 1498.10 162 WELLS VILLAGE ROAD OT R.RATE SANDOWN NH 03873— DT — — S # OF DEP— 3 JOB APPRENTICE HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 8.00 170.81 98.05 54.62 .00 230.32 944.30 007284 JOB TOTALS TOTAL EMPLOYEES— — ---------------------------------------------------------------------------------------- 2 TOTAL JOB HOURS— 20.00 TOTAL JOB AMOUNT— 1,240.16 Corrxnonweatth of Massachusetts w Division of Apprentice Training JUPrfME LECTRIR 142 B I.AF SAllSBURY, MA 01 ELECTRICIAN Appr. Start Date Pro} Comp. Date 4/12/2013 4/12/2017 THOMAS a t ere ere ti7ep- V N.p empl B pj ® P' ® B S};AI,LOW, III erc : eAp� enpn ❑ errpR etrph P Annual Apprentice I.D. C-0 Ezptrea 4232016 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: April 23, 2015 1, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature•qV Title. Administrative Asst. Date: April 23, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 12' _day of April2015 and ending on the 18°i day of April' 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Slat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE SIGNAT Leah M. Hatch, Administrative Assistant eL 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. ilk Aero 0 � tz7 O Ai N E z a� ~ � C w C d C U N LO x 'O m F a- 0 2 a d o N i O R 3 C U Cx E CL W c is d O O L m In S 5 d NG/ li O OLL o O c o LL z° p a Q o °7 a 0 o m as > IL RZ O x O Of W d CD S w c (D d O J 0)c r2- 0-;u 4. a o = m m m v J z x°m� O z°M 00 c O y� d (o « L C E V y L_ L00 f� O 0-07(D �2¢ a O2 Q a 0) U ZQ a a a o co w LL �' m L w U � v Y O >O Y € o W W d a EQ v S 7 '' .- Mn Z o c O CO) 3 v 3 u L 0 (0 E Z U i— T fn a O N Lu C30: O W '3D O i O O > > w U) m o y 2 c- Q y c W a m o T� d 9� m L tll V L O _d i VQ Q N N :+ O H U O a Z 3 ca CO W Q K v U) mom V/ TQ m N Q o C Lu 2 Z Z o O O ow m E m O O Z O U H aS E o 06 m A Z `m m o m m o • c o E v Y Em A o= mm mm d O N Z a c C 7 £ C Z Q �j �j O N M in Q Z a m O c c a+ c c Z d A w c p n c w a d d E ) IW L Q H C7 Z w N N p D):5 c n v c O N N N Q o c ao T 1��0 `m v E oU a O y N d Q T y Q- Q LL �. m d O >` Z N N 3 o a n N E r � � T N n w a N o c a .N U U dCu N `a m m U u a o �E ww E T of ca Q O a O. cu (D o 170 0c( Co O n N T N 0.- 0— L) C 1 j m m E L Cl. C _ 0 OL OO C m O m c y a.- 0.2 a TU fA C -"::E W —m d U O) o O 3 m C L r- N m 00 0-0 c N U nm 2- U C N ID CO Z 2w m c" -OO J O N m O ) E2 o m m m M C -r-U O m E m J . C p E co E N U U 42 O m- 2. m �= U j C m ` N CL a�c� m .T C m= ~= O LL. - Z m U d IL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE April 10, 2015 I, Ron Tattersall Construction Supervisor (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by New England Builders & Contractors, INC on the North Andover School Administration Building (Contractor, subcontractor or public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Construction Supervisor 05/14 N N C N Cv a) o .L C O rO roT a_ U Z C m N UCL a m Q V, o � O L. v N am m m .L.. fn a 7 m -O J -0 0. N mE C.L.. E m 't D 0-42 N UO t .0 U N m w CL m CL m m� m a) Li M w � C w L @ O 3 m m a) Q t m c o � E _T N Q� CL Q3 u U a O V o T? W n LL oc T d N 3 O •o Q m � c°� w T ma �D po= U aN d C w L C 7 V V m 0 � O r� dE Mr m E T as 7 � N O c v 1° d a 7 o �- a) m MA a) a C. m 3 O) E a C C O 0 o V1 n'w - � TU C Y '5; m N U L UO 0 m c am 8 i c� c Co r0. N a) m L C c" n O N - a) m O E v � m � o m J 'C C U E9 y U o N m C U O j ` C ` w a) aa8 .T C a) HrE O E o Z m U yy m 2S 4- r�{06 LL m 6 OD -osa 0 � Z Q o a 03 ~ roi 0) N O 7. 5 d W d + >0 2> O C VJ C ++ LL O cp 0 CD 10 00 co co r x LO a m a C W D m c Z p 3 N Y t0 3 �j O a E W m co cp a O 3 C G m (n C co 0 N m O z > > C LL C o c 0 0 0 o 0 0 0 LL v Q ? O = a d o L o d as am mZ c �m �j o 0 O a x c J w @d = o 0 w CLm J 1 N a1 _ CDC) m N fp J O) p o@ Y p co N Z `' Z O m U) Q C O m dOD O ti C E m o N aO a m z Q ,p O `O 0 0¢ a`= O O N O Q 00 a' a= a Q @ CO o o O o w lL O O O O _ C r � m = W ~ O OD O c0 U O N m 0 O 3 m o m o 3 F O OD O w r 'O a S W N /E0 Z OD o U c m OD o In3. C O Z 0 U) a` a) i coQ 3 c x 0 V o W N v m C U O C j d O O O O y 2 a) Q c W a m o n� N 7 3 U QN :O-. O F•U dZ 0 NW co Q�v Q h Off. m N 3:vm Qcn X X Q WOU 2 U U Z Z p (D c O N ` N N = N O U O 7 CO O U y O U 0- y 0> m O a>> N a) c y m E m m c,.> > m m d w o - U O Z O W U ci U ca E $ 06 mCA Z> R a N N� O p N t6 O d J7 E m is `oL C Q ( 7 m N C C QM N p�c7 N pQ ) M J C�2� Z c c m E mm Ev` m o q 3 �'c o @ o fn rn� # U) m O !A Q Z d ca O) m a 3 N N 0 2S O3 a) ca a Y_ J X �M� O C O d 0 N W \3o 'O C R d W m n N L N E E w m w my UZ W QH C7 Z N N C N Cv a) o .L C O rO roT a_ U Z C m N UCL a m Q V, o � O L. v N am m m .L.. fn a 7 m -O J -0 0. N mE C.L.. E m 't D 0-42 N UO t .0 U N m w CL m CL m m� m a) Li M w � C w L @ O 3 m m a) Q t m c o � E _T N Q� CL Q3 u U a O V o T? W n LL oc T d N 3 O •o Q m � c°� w T ma �D po= U aN d C w L C 7 V V m 0 � O r� dE Mr m E T as 7 � N O c v 1° d a 7 o �- a) m MA a) a C. m 3 O) E a C C O 0 o V1 n'w - � TU C Y '5; m N U L UO 0 m c am 8 i c� c Co r0. N a) m L C c" n O N - a) m O E v � m � o m J 'C C U E9 y U o N m C U O j ` C ` w a) aa8 .T C a) HrE O E o Z m U WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.g_ov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: I, STATEMENT OF COMPLIANCE Ron Tattersall (Name of signatory party) do hereby state: April 17, 2015 Construction Supervisor (Title) That I pay or supervise the payment of the persons employed by New England Builders & Contractors, INC on the North Andover School Administration Building (Contractor, subcontractor or public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Construction Supervisor 05/14 pftt'9 ,v,�t'W Y =_ L U 9 m ^ N �� [as[►H a ¢ Z +� _ + r LU Y LO a m f0a) - d C a) �; N c Z p ON Y 00 a) U O CL E a W a O 3 0 = c m O C N� m o N� 46 O O oc LL LL z° G a Q m a) a- 0 o d ° as d �a O^ IL RZ p U m yy CL x F J C w 2> d a3 rn > 2 '� y o T a) CD 0 m m m J O) c0�Y0 00 =� O 0 Z C_ 0 0) O L C 0 CO Q E L C 0 V O 00 C O a o m �^ 0 o? o Q a m 0 Z Q 0. — a= a= a o w ll cm C a N~N m L W Y O J > Y 0 ~ W O AQ d 0 � Z 0 O a v c O 2 cn 30�0 U D. 1 U O 0) IEO Z p U 1— Q 3 U a` L o 3 c o aa)) 0 N w a o 0 m L y Q V c 0 W 0 2 v W N .a—: O S O 3 m ame 2 ._. Q 04 F ci a Z w W Q ,U �/� �// yam aN C w O U CQ c ( N 0 o O O N E a3 m C O C U Z U allU °t3 E a0 atS m Z > R O n O O•L y C O' a) U M E6 Y QV 7 m E ! a C L t a1 E m N ' 0 N O rn Q O Z a m Z Q m 0 'C C C = 6 m C T Z Q: A W O v c W -Oa Q.all w w U Z IO Q 0 Z 0 a m W N v U 0 m U t C C -0 ca 3 3 m ca O T v E N U L O O N T f0 'm LL (D T Y 3 0 a Q - a) � r� a O C OT. N 0 N U O C w R E7 v V 0 A w a O dE ..C, a1 Vl m E T 3 .0 a) 0 a 1O a E N U M rawk Ma 0) O N U 3 m E C C m m aw- a TU C Y') CC (D �U 0 3 a) Uw O C N U C N � O N a• O O L C C I'- O N W O EO_ rn � U 0 a) UE9 U O N a) C U O j f/L) C y JE 3 >, E a..0 8 _ H0 E ZI a) O 0 A CL WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE April 22, 2015. I, Ron Tattersall Construction Supervisor (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by New England Builders & Contractors, INC on the North Andover School Administration Building (Contractor, subcontractor or public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Construction Supervisor 05/14 O O00 E a o � 00 C C a a 00 V o d w 00.4 a e 0 ° 0 C, 0 o N C � O � o N a In V vi 3 H w H w c C ° O U C O U � u � 3 O � Q ° •L � O x w L ate+ .0 G d o bq w zci ti o a i o 0 tn l p M o U w o .ter v, N A U O O00 E a a x C C w v V o d w 00.4 a e 0 ° U ¢ d o N C � O � COD N In V vi CQ N c C ° O U C O U � u � 3 O � Q z •L � O a� 'Cy w L ate+ .0 G d o bq w zci ti o a i o 0 tn l p M o U w o .ter v, N A z od oQU z C7 . U =o o W z o a z 3 E a C C w v Oca C � COD N O •L � O 3 0 tn l N o A H C U o 0 0 3= Un 3�"3x C 3 \ C O O O � � y L 3H x d E" o 0 N on W d E- F 0 Z ro = yM...kFJ'p, LO ^ �1 / O 2 T rn N m r w + + o m c V m o m �a Y O a 2 o ami �' Y m g v° a d E@ C 6m. M ti 000 ` a a O ,^ 0 d O Qw LL m z o o x 0' a N c O i -a m m — R ~ c) A a w =3 J Q vi IL` �3 0 = o o� ? 0 C m w Q v ` c 12 Z m u u a 0 a CD LOa a LO N m m 0 Z cu j -p U .0 C m N U co co U x O Q O w N CQ E N d 0)z • m U L- u }t 42 42 m E o a` > O Z m J Y `o cn O s Q u .m v N a Z 3 i= w U C U L H m O O U L) o 3 U 'i � .( : O U m o E a m L Li El . _ ___ El Ll V aiS m got w v N z E `� `m m W L E Q z t v m Al Y}a/ 3 m y 2� C 0 u— m2 -0 E U ~--� `o m Q z Q E m a � 1 m a W m N � ma o a m o 0Lo— E ; (; Z w F Ewu moe DATE 04/30/15 09:01 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 1 FOR PERIOD ENDING 04/25/15 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 04/19 04/20 04/21 04/22 04/23 04/24 04/25 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 11.00 153.35 153.90 90.63 .00 672.92 1586.00 007303 -- ------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES— 1 TOTAL JOB HOURS— 11.00 TOTAL JOB AMOUNT— 809.16 00985 DANIEL P. RYAN RT 3.00 8.00 11.00 73.560 809.16 40.00 2656.80 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079— DT — — M # OF DEP— 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O—TAX DED NET PAY CHECK# 11.00 153.35 153.90 90.63 .00 672.92 1586.00 007303 -- ------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES— 1 TOTAL JOB HOURS— 11.00 TOTAL JOB AMOUNT— 809.16 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c149, §27B, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: April 30, 2015 I, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: a� Titl Administrative Asst. Date: April 30, 2015 I, Leah M. Hatch. Athninistradve Assistant, do hereby state: (1) That 1 pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 19'h day of April• 2015 and ending on the 25`h day of April' 2015 all persons employed on saidproject have beenpaid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of saidN. Andover School Admin. Bldg. from the full weekly wages earned by arty person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE Leah M. Hatch, Administrative Assistant SIGNA RE 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. THOMAS E. SNOWDEN, INC. 189 CENTRAL STREET SAUGUS, MA 01906 TEL (781)233-8810 FAX (781) 231-2151 New England Builders & Contractors 464 Merrimack Street Methuen, MA 01844 LADIES /GENTLEMEN: WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter Z,�1N��111�1�1�,�1L DATE: 4/29/15 JOB NO: 2014-12 ATTENTION: Henry Sarkis RE: NORTH ANDOVER SCHOOL Payroll Reports ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Attached ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Samples ❑ Change Order ❑ ❑ Specifications COPIES DATE NO. DESCRIPTION 1/1 ORIGINAL/COPY THOMAS E. SNOWDEN, INC. 4/9/15-4/16/15 J. LEE ASSOCIATES, INC. / GUARDIAN ENERGY 3/21/15-3/28/15 THESE ARE TRANSMITTED as checked below: the following items: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 20 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS: COPY TO: FILE SIGNED: J WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE April 16 , 20 15 1, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. 17 Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 04-22-2015 Page 3 For the Period Ending: 04-16-15 Job: 14-012 N. Andover School Admin BLDG ' 566 MainStreet N. Andover, MA 01845 Jeffrey Grey 17 Whitney Street Saugus, MA 01906 04-10 04-11 04-12 04-13 04-14 04-15 04-16 Total Pay Fringe Total Gross Total FWH SWH Other 030-48-7316 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net S - 0 Pipe Fitter Reg 8.00 8.00 65.00 3.15 68.15 545.20 2,600.00 563.02 130.34 69.11 1,643.91 545.20 193.62 John Mahoney 84 TellIer Way Dracut, MA 01826 04-10 04-11 04-12 04-13 04-14 04-15 04-16 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 4.00 4.00 65.00 11.24 76.24 304.96 2,437.50 406.25 125.53 1,719.24 304.96 186.48 Mark Rothwell 5 Bow Street Middleton, MA 01949 04-10 04-11 04-12 04-13 04-14 04-15 04-16 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 8.00 8.00 65.00 3.15 68.15 545.20 2,524.00 427.88 129.99 1,773.04 545.20 193.09 Totals for N. Andover School Admin BLDG 04-10-15 04-11-15 04-12-15 04-13-15 04-14-15 04-15-15 04-16-15 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions Net .00 .00 .00 .00 12.00 .00 8.00 20.00 1,395.36 7,561.50 FWH 1,397.15 5,136.19 FICA 573.19 SWH 385.86 SDI .00 Other 69.11 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE April , 20 15 NO WORK 1, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 d N 'O V N O m Q T N 3 L O T CL U N f0 7 U l6 L C l6 N f6 E m 3 co 0 v d 2 N O U N C U a 7 S c m U N C U N m r N m WI H 0 C 0 'U 'U f0 O f6 7 N O C O U (0 f0 E U m 0 c E E U c co 7 aNi a E T CL E U O N 7 cc LL O L 7 f0 Q1 C P 3 f0 N .0 O a, a O Z T39 A 1_ ao3 q� 03 N M W d Z � CD O w a m a N _ iQ COC q + =ALL 00 > N O 2 m o 3 N c dri O C Co S CD Q S ¢a o O c coo M LL W M M coo L a -a m x F w u O w S 5 c J / 1 O m m d T N m a` ;3 zco° c -Cx Zd LO 0 3 O a IL U L a N LO r- E N r O L O 0 .V m O c U cc .E UZ. _ 0 Cc +r O L- 0 0 Q Z N O y h Z 3 neo N m 7 v o 7 N N m m �\ W 9 R N C Ll El El 1:1 El 1:1 El 0)O. W w L) l0 O E Cj) N 3 Z z v = l0 Z 4_ P cn E L 1 c �� b - c:Vd) /R 0 ca L �� (n n i U .9 w 7 1 ) = O w > eQ c O O. a0i 0 CL ami ° n m g Z U J W I si U' E w d N 'O V N O m Q T N 3 L O T CL U N f0 7 U l6 L C l6 N f6 E m 3 co 0 v d 2 N O U N C U a 7 S c m U N C U N m r N m WI H 0 C 0 'U 'U f0 O f6 7 N O C O U (0 f0 E U m 0 c E E U c co 7 aNi a E T CL E U O N 7 cc LL O L 7 f0 Q1 C P 3 f0 N .0 O a, a WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 20� I, Kimberly Breault, Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Guardian Energy Mngt Solutions on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title anager 09/11 ca 0 m a d z Ln O a rfi'1 �F3Sl�i`" O 1 _ ¢ 0 — o 3 � rn g y 3 N j G Z m � CD tel/ CD=ALL a m c cUA _ r W N Y O a 2 m 3 t 3 N v d CLE00 ga co ccW O z M LL w �o W` M M coo L N ti a r a i > O o r� 9c � F J � m m L ^ J m 75Ob a �3 e z m O U') z u u O U Z o c Q a o ` N LO m U t O � � _ 2 C:lL o ca m O c a cQm .E ti O a v _ � Z. C : 0 0 O - z t IL WL ^^' '° U h 0 Z 3 / 1 v u ame ¢ s Q N m a d a fj H `o_L O V o (n m N m �✓ c m Ll 0 1:1 El 1:1 1:1 W c L E U W U N N O E* C7 Z Z m L w a Q C O v c E 4— O N m o i E °y' m C: v°° `v U L UJ O N q a ?y a 0 E z> i a r O .0 d O Z W m E V ' ¢ 0 W ca 0 m a . 1 F WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 201 I, Kimberly Breault, Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Guardian Energy Mngt Solutions on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one -hundred and forty nine of the General Laws. Signa Title Manager 09/11 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE April 16 , 20 15 1, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 Thomas E. Snowden, Inc. Certified Payroll Report 04-22-2015 Page 3 • For the Period Ending: 04-16-15 Job: 14-012 N. Andover School Admin BLDG 566 Main Street N. Andover, MA 01845 Jeffrey Grey 17 Whitney Street Saugus, MA 01906 04-10 04-11 04-12 04-13 04-14 04-15 04-16 Total Pay Fringe Total Gross Total FWH SWH Other 030-48-7316 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net S - 0 Pipe Fitter Reg 8.00 8.00 65.00 3.15 68.15 545.20 2,600.00 563.02 130.34 69.11 1,643.91 545.20 193.62 John Mahoney 84 TellIer Way Dracut, MA 01826 04-10 04-11 04-12 04-13 04-14 04-15 04-16 Total Pay Fringe Total Gross Total FWH SWH Other 019-52-7988 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Sheetmetal Reg 4.00 4.00 65.00 11.24 76.24 304.96 2,437.50 406.25 125.53 1,719.24 304.96 186.48 Mark Rothwell 5 Bow Street Middleton, MA 01949 04-10 04-11 04-12 04-13 04-14 04-15 04-16 Total Pay Fringe Total Gross Total FWH SWH Other 029-48-8932 Caucasian Male Fri Sat Sun Mon Tue Wed Thu Hours Rate Rate Rate This Job Gross FICA SUI/SDI Deducts Net M - 0 Pipe Fitter Reg 8.00 8.00 65.00 3.15 68.15 545.20 2,524.00 427.88 129.99 1,773.04 545.20 193.09 Totals for N. Andover School Admin BLDG 04-10-15 04-11-15 04-12-15 04-13-15 04-14-15 04-15-15 04-16-15 Total Gross Total Friday Saturday Sunday Monday Tuesday Wednesdy Thursday Hours This Job Gross Deductions Net .00 .00 .00 .00 12.00 .00 8.00 20.00 1,395.36 7,561.50 FWH 1,397.15 5,136.19 FICA 573.19 SWH 385.86 SDI .00 Other 69.11 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. For every week in which an apprentice is employed, a photocopy of the apprentice's identification card must be attached to the payroll report. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the awarding authority directly, within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE April? , 20 15 NO WORK I, Barbara R. Barbolla Clerk (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Thomas E. Snowden, Inc. on the North Andover School (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws, Signature Title Clerk DIVISION OF OCCUPATIONAL SAFETY, 19 STAMFORD STREET, 2nd FLOOR, BOSTON, MA 02114 d cn (L V Z �MJI 1111, R V N N �S L J O �13SM�� N W O 2 a` N r M e =3- > N Nx W j O a m �a Z = md. 3 3 N gE@ N� O 00 (0LL Q < a ��� co z° M o wa M CD L I` LO H 06 W d �i o p z 3 .� Z C Lr) tj O oo=8o ` L O 52- Z nxv Q= IL V a N Cd N � (n r (3)_ ... CC) G N LL O D (� m O � cc U a co G < O a) Q � _ C 0 ` O L E 0PI Q C z V a Z 3 ` a m v a o N m F o s 0 ° O L U a !E � O C m c m T � ry 1:1 El 11 El El 1:1 ww c E O U m 'E O a U) d 0 W • Z Z. z W a m C O U Z T— O 9 /A V/ E L IDc m cu ro p Ztl R 'v 4� M 7 .0 L O Z c CL a y ° O a m -C p Z U W Q w d cn (L WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE I, Kimberly Breault, Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Guardian Energy Mngt Solutions on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature Title anager 09/11 r O 0 Z Y x n , ^ V ,� O a �135:1N7 LL m � N r N rO W � � =3LL m N N M m�m + m N W M T-- O o �a Z m 3 3 N V a mw a 3 g co Cfl Q < a Ln 5o d CD c� 2 LL wla ` M co m � (D a x F CN O . luu - _ x c o J � m m_ Q < m m m m Cb O 0 C O O Z O zis 0 .. o 7 z a v . a N LO Cd N !/1 O � x 2 C m N — o 0 m O c U d M c 3 O V ci o a s a Z 3 U C ame m @ V O N � a 0 a a O L N` V o K Cl) / a m m ^^`` W c m d O m c c c C E O wEl w U b d ca ! O q A v / 3 U . z 2 a W v ¢ c Om1 v 4— O m c m JE m C U m //� O vJ mE a N m a E a O E z > n u O ro d O Z V ami J a W 1 1 A E w r O WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years from the date of completion of the project. Each such contractor or subcontractor shall furnish to the awarding authority directly within 15 days after completion of its portion of the work, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form. STATEMENT OF COMPLIANCE 20!a-- 1, Kimberly Breault, Office Manager (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Guardian Energy Mngt Solutions on the Central Admin Building (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one -hundred and forty nine of the General Laws. Signa Title e Manager 09/11 a) w p Ol C N O w t6 N N 0 a Z a O T �N O. m v N U U U O N O N CL 7 CL Cts a m I'M LL. O 2` Z Y vJ W } N j WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §2713, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE May 06, 2015 I, Ron Tattersall Construction Supervisor (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by New England Builders & Contractors, INC on the North Andover School Administration Building (Contractor, subcontractor or public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature x/12 12, Title Construction Supervisor 05/14 r ti�,9 Afra z 1'%j; U U U N ID O N am a lL 2 IL ~ 0 m c try c + 2 p W .+ O U m LO a °° F a. 0 Z m d o d O 3 C W m �2 IL C) m LL O > LL y 0 U. Z 'a a O a N yO L 0 m N 06 x a Z O ^ CL H c J W 2 LU a c TyN �—I co J > N "a °0 _ o N N m Co J O a> C M 0 Z p i� co Y O) 2 Zac o oa C 0 m N O co C E d 0 0 o? 0'0 a Larn ciZ¢a'`O a= a= a occ w lL C LL 7 LL/ t W V c Y N16 ~ O N YE O ~ WEa v _0 A Z O C U o in Z U F— m ¢ U a` N H Ccn O t O0 ; W N co c y U O c a) O 0 (D m L 2 y v a L C V W 2 v CD 00) N: O j 0 m .-. nye VQ N a Z 0) cc W a a N_ N m�Z U) TQm O=w a O W U U U Z — Z — o o`��- O U y O U w m E m m O N Z O U U ui Y+ U E 06 M Z m a N y p c ` 0 N E L) Y y \= C E E Z C L 0 a m m 2 �O y rn ¢ Z m za m C C N C cy o C T Z d y W p v c W o a W w U Z Q H 0 Z 0 N r L N N N T U O L m N w C aD N N T O n E N U C CL CL M m N 2 3 p v CL .LDE � N N w T N � w a o c CL .0 U c a+ 2 R C U U m 0 � O rC mE �in m E T .0 L] 7 0 N C D M N O' O d co �I O U N7 cm E a C C a > 'r- cn aU -O T— N U o 3 _m N U O C N O C U C f0 > Ln O OL n _ O . _ C N (0 E U N m U O N -I .c •C UEE N U O N �p C U O j �E d � C WlO E zm0 U WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law c. 149, §27B, a true and accurate record must be kept of all persons employed on the public works project for which the enclosed rates have been provided. A Payroll Form is available from the Department of Labor Standards (DLS) at www.mass.gov/dols/pw and includes all the information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. On a weekly basis, every contractor and subcontractor is required to submit a certified copy of their weekly payroll records to the awarding authority; this includes the payroll forms and the Statement of Compliance form. The certified payroll records must be submitted either by regular mail or by e-mail to the awarding authority. Once collected, the awarding authority is required to preserve those records for three years from the date of completion of the project. Each such contractor and subcontractor shall furnish weekly and within 15 days after completion of its portion of the work, to the awarding authority directly by first-class mail or e-mail, a statement, executed by the contractor, subcontractor or by any authorized officer thereof who supervised the payment of wages, this form, accompanied by their payroll: STATEMENT OF COMPLIANCE May 06, 2015 I, Ron Tattersall Construction Supervisor (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by New England Builders & Contractors, INC on the North Andover School Administration Building (Contractor, subcontractor or public body) (Building or Project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined under the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty nine of the General Laws. Signature _,ia '� Z — Title Construction Supervisor 05/14 A NI cz A - r o 00 00 Cd y o C to O U x N o O r— Cd w 44 0 U Q Q o 3 H w H w N r� O N x it N x O � � o � � U NI cz A - y 00 a y C C O U a� o w 44 U Q Q o C � N r� O N it N O � � o � � O 3 A b � v y tn W o � 'b W O Q U on W o? ML O a u > O C b4 U O N � z Z o o W C w z z o 0 3 NI cz A - a C C U L wx° C � r� N O L O F C o 0 0 3= L H x 24 l C 6> 3 3 000, 0 0 0 0 Hix L Xi CC ix„ L C 0 C 3�"3x 'n O kn a W a ca U w Q H NI cz A - m 'O U 0 T mCL CL T N 3 0 a 0 0 U m f` 7 c m m m 7 N 0 v d c d Mn 0 c 0 U c r C m 0 U C U r m m CO N N m It W H O zI C a �U �U m O c� C m 0 N w 0 C 0 U m m E U m 0 c m E U C m E E 0 U N L-. c N T C13 E T CL E U 0 m 7 LL .Q t m 0> c v 3 m m r 0 F; CL 0 Z LO ias`oH N a o3` =3 NZ T m O O LO ,�//�� YJ +wea O o z v d m m a d a 3 m c M co c as Ln c O z 0 �} V r Q LL L m W N o a 0 i a o6 m y m U T V/ r F O . O E w _ J Qc m y N m m oOb t. o z o c m = 512d m3 g c c a t0 d U a LO 'N^ Y J t y O o EO O C: Z cu C 00 M T cn V �L in O Q 4-a U m 0 3 O ♦J (O O W O D u i+ • z u L ui E •Q d (6 � o a � O z "O o W 3 U U C cn > V x L El 0 Ll 0 Ll Ll Lil W ° ° Z E N m W z W z a A m m nET ro Qo -(C z N yyo°c z O OUe@ 1 E w E m oa w Zv w m 'O U 0 T mCL CL T N 3 0 a 0 0 U m f` 7 c m m m 7 N 0 v d c d Mn 0 c 0 U c r C m 0 U C U r m m CO N N m It W H O zI C a �U �U m O c� C m 0 N w 0 C 0 U m m E U m 0 c m E U C m E E 0 U N L-. c N T C13 E T CL E U 0 m 7 LL .Q t m 0> c v 3 m m r 0 F; CL EWU moe DATE 05/07/15 09:31 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE 3 FOR PERIOD ENDING 05/02/15 ALL JOBS JOB INFO 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 04/26 04/27 04/28 04/29 04/30 05/01 05/02 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 3.00 2.00 5.00 73.560 367.80 40.00 2708.00 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# ------------------------------------------------------------------------------------------------------------------------------------ 5.00 151.36 152.68 89.95 .00 737.40 1576.61 007324 ------------------------------------------------------------------------------------------------------------------------------------ JOB TOTALS TOTAL EMPLOYEES- 1 TOTAL JOB HOURS- 5.00 TOTAL JOB AMOUNT- 367.80 WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 649, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: May 7, 2015 i, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signatui Titl. e. Administrative Asst. Date: May 7, 2015 I, Leah M. Hatch, Administrative Assistant, do hereby state: (1) That I pay or supervise to payment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 26h day of April_2015 and ending on the 2nd day of May 2015 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by arty person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS EXCEPTIONS (CRAFT) EXPLANATION REMARKS NAME AND TITLE' IGNATURE Leah A Hatch, Administrative Assistant 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. batt s m tag:) E O v Y O O co w Lu m Lu� . 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N a) Q m _ U C a) tlj C n a7 N m 3=NNaCo•N.). aaE3 y N � N (0pca0) Oa LL (j) V.o N 3 3 7W CLNi U2(n a N T— e' L)@ U M C C@ a)— L a N .V .N v N a) n aNi NLL m CL as (a 3 U (n U a) 0 a) Q U) m C5 x E ►5 ii a I. 0 a C C pa 3�A O o 0 v sem. o 8 L wxA 0 0 0 U N 'i ♦+ y 3 0 i oo t- �n 0 O LA 3xA H C � o 3�"3x O O O 3 •O \ o � o C o O O O i wCC, 3 0 O O O Hix �L k O O O "t' L 0 0 0 x 00 O 00 d E o 0 � Uc� w ¢ H O m a d z U ;.add Y / i"as'nN N 0)z �c m O m = + ++ 0 m 2�LL C E ,` L^ ! ql e `o m + 0 a �/� Li! m O a Z 4 O o c W T C C y m M i` to co m < LL 0 '^ O LL W y i al m C)IL Q y a0 rn T m m a 03 0 Ci C Z O c_ t0 _ z U 0 d O U 7 d W a`= N L LO ED C)co Z 0 4.4 v U .0 m .n T Cl) c U �L mv > a ( � L w 0 a --r L m (� a) >, �C: z v E •Q v- m 0 > 0 z J _0 CL "d o � coV 3 C n a m se K 9d' N � �+ v Z o a i= a w U C o � L O V Y O L _ �L d V o Ll L I I El 1 ad E O mEl -j -I ^,F W z � W U W W 2 3 m v L E O o m a N W ?'d z N c m 0 V Q� E a r m W m Q� CL _ 0 U) v w ¢ m I Z w O m a EWU moe DATE 05/14/15 09:27 JUPITER ELECTRIC, INC. PAYROLL AFFIDAVIT REPORT PAGE .3 FOR PERIOD ENDING 05/09/15 CERTIFIED ONLY JOB INFO -� 14-005 SCHOOL DEPT ADMINISTRATION BUILDING, NORTH ANDOVER, MA EMPLOYEE 05/03 05/04 05/05 05/06 05/07 05/08 05/09 PAY TOTAL INFORMATION SUN MON TUE WED THR FRI SAT HOURS RATE JOB PAY HOURS TOTAL PAY 00985 DANIEL P. RYAN RT 8.00 8.00 73.560 588.48 40.00 2253.84 18 GREEN ACRE DRIVE OT R.RATE SALEM NH 03079- DT - - M # OF DEP- 9 JOB JOURNEYMEN HRS FWT FICA/MED SWT O -TAX DED NET PAY CHECK# 8.00 103.17 129.35 73.40 .00 604.48 1343.44 007351 JOB TOTALS TOTAL EMPLOYEES- 1 TOTAL JOB HOURS- 8.00 TOTAL JOB AMOUNT- 588.48 .. WEEKLY PAYROLL RECORDS REPORT & STATEMENT OF COMPLIANCE In accordance with Massachusetts General Law 649, §2713, a true and accurate record must be kept of all persons employed on the public works construction project for which the enclosed rates have been provided. A Payroll Form has been printed on the reverse of this page and includes all information required to be kept by law. Every contractor or subcontractor is required to keep these records and preserve them for a period of three years from the date of completion of the contract. In addition, every contractor and subcontractor is required to submit a copy of their weekly payroll records to the awarding authority. This is required to be done on a weekly basis. Once collected, the awarding authority is also required to preserve those records for three years. In addition, each such contractor, subcontractor, or public body shall furnish to the Executive Office of Labor within fifteen days after completion of its portion of the work a statement, executed by the contractor, subcontractor or public body who supervises the payment of wages, in the following form: STATEMENT OF COMPLIANCE Date: May 14, 2015 i, Leah M. Hatch Administrative Assistant (Name of signatory party) (Title) do hereby state: That I pay or supervise the payment of the persons employed by Jupiter Electric, Inc. on the N. Andover School Admin. Bldg. (Contractor, subcontractor or public body) (Building or project) and that all mechanics and apprentices, teamsters, chauffeurs and laborers employed on said project have been paid in accordance with wages determined der the provisions of sections twenty-six and twenty-seven of chapter one hundred and forty-nine of the General Laws. Signature: Title: 64inistrative Asst. Date: May 14, 2015 1, Leah M. Hatch, Administrative Assistant, do hereby state: (])That Ipay or supervise topayment of the persons employed by Jupiter Electric, Inc. on the North Andover School Admin. Bldg.; that during the payroll period commencing on 3'd day of Mav' 2015 and ending on the 9"' day of Mav' 2015 all persons employed on saidproject have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said N. Andover School Admin. Bldg. from the full weekly wages earned by arty person and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 2 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act. as amended (58 Stat. 948.63 Stat. 108, 72 Stat. 967, 76 Stat. 357; 40 U.S.C. 276c), and described below: (2) That any payrolls 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 recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments offringed benefits as listed in the contract have been or will be made to appropriate programs for the benefits of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEF17S ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll 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. (c) EXCEPTIONS 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.