Dd Form 879 – Fill Out and Use This PDF

STATEMENT OF COMPLIANCE	Form Approved
	OMB No. 1215-0149
	Expires June 30, 2000

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PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. RETURN THE COMPLETED FORM TO THE CONTRACTING OFFICER.

I,

,

do hereby state

(Name of signatory party)

(Title)

(1) That I pay or supervise the payment of the persons employed by

(Contractor or subcontractor)

on the

; that during the payroll period commencing on the

day of

(Building or work)

,

, and ending the

day of

,

, 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		from the full weekly wages earned by any person
	(Contractor or subcontractor)

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 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended

(48 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 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 and 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 fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below.

(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

	EXCEPTION (Craft)			EXPLANATION
5.	REMARKS
6.	NAME (Last, First, Middle Initial)	7. TITLE		8. 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 3729 of Title 31 of the United States Code.

DD FORM 879, APR 1998	PREVIOUS EDITION MAY BE USED.	ADOBE PROFESSIONAL 8.0

INSTRUCTIONS FOR PREPARATION OF DD FORM 879,

STATEMENT OF COMPLIANCE

DD FORM 879 (BACK), APR 1998