Get Mn Dot Statement Of Compliance Form

The Mn Dot Statement of Compliance Form is essential for contractors who have worked under federally or state-funded contracts. This guide offers a step-by-step approach to completing the form online, ensuring accuracy and compliance with necessary regulations.

Follow the steps to complete the Mn Dot Statement Of Compliance Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by indicating the total number of workers performing work on the project. This section is crucial for assessing compliance and resource allocation.
3. Check the appropriate box regarding fringe benefits. If '4(a)' is checked, provide the names of workers not receiving fringe benefits in the designated area. This may include nonunion or seasonal workers.
4. If '4(b)' or '4(c)' is checked, confirm that these workers receive a total contract rate. This amount is considered taxable income and must reflect as cash on their paychecks.
5. Indicate if all workers receive the same fringe benefit rate by listing the title of the plan. If rates differ, document each worker’s name along with their respective amounts.
6. Alternatively, if additional space is needed, you may attach a separate sheet detailing each worker’s benefits and note this on the form by writing ‘See Attached Sheet.’
7. Specify the dollar amount contributed per hour as a fringe benefit. Ensure this information is accurate, as omissions will lead to rejection of the form.
8. Fill out the complete name and address of the fringe benefit plan in the corresponding fields.
9. Provide the benefit account number along with the contact person's name and their telephone number.
10. Finally, print clearly the name and title of the representative signing the payroll. Remember, the form must be signed to be accepted.

Complete your forms online today to ensure compliance and timely submission.