Get Cem 2503

CEM2503 This statement of compliance meets needs of the state and federal payroll requirements to pay fringe benefits in addition to payment of the minimum rates. The contractor shall report in the statement of compliance that he or she is paying to others fringes required by the contract and not paid directly to the employees in lieu of fringes. STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION STATEMENT OF COMPLIANCE CEM-2503 REV 8/1996 CONTRACTOR/SUBCONTRACTOR CONTRACT NUMBER FIRST DAY AND DATE OF PAY PERIOD LAST DAY AND DATE OF PAY PERIOD I do hereby certify under penalty of perjury 1 That I pay or supervise payment to employees of the above-referenced contractor on the above-referenced contract. All persons employed on said project for the above-referenced time period have been paid their full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf of said contractor 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. 2 That any payrolls otherwise under this control 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 that the applicable wages rates Specified in the applicable wage determination incorporated into the contract a b Determined by the Director of Industrial Relations for the county or counties in which the work is performed that the classification set forth therein for each laborer or mechanic conform with the work he or she performed* 3 That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency. 4 That fringe benefits as listed in the contract Have been or will be paid to the approved plan s fund s or program s for the benefit of listed employee s except as noted below. Have been paid directly to the listed employee s except as noted below. c See exceptions noted below. EXCEPTION CRAFT EXPLANATION REMARKS NAME PLEASE PRINT. TITLE SIGNATURE DATE On federally-funded projects permissible deductions are defined in title 29 Code of Federal Regulations part 3 issued by the Secretary of Labor under the Copeland Act 40 U* S* C. 276c. Also the willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution See section 1001 of title 18 and section 3729 of title 31 of the United States Code. ADA Notice For individuals with sensory disabilities this document is available in alternate formats. For information call 916 654-6410 or TDD 916 654-3880 or write Records and Forms Management 1120 N Street MS-89 Sacramento CA 95814. The contractor s obligation to pay fringe benefits may be met by payment of the fringes to the various preapproved plans funds or programs or by making these payments directly to the employees as part of their weekly wage payments.