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Fringe Benefit Statement - CA Construction

Fringe Benefit Statement COMPANY INFORMATION. Company Name Date Street Address Suite/Unit #. City State Zip License Number Issuing Classification Expriation State(s). CONTRACT INFORMATION. Project Name/Number Contract Number In order that the proper Fringe Benefit rates can be verified for checking payrolls or applied to force account work on the above contract, the hourly rates for Fringe benefits , subsistence and/or travel on the allowance payment made for employees on the various classes of work are tabulated below. THIS FORM MUST BE COMPLETED AND SUBMITTED WITH THE FIRST.

CERTIFIED PAYROLL, OR WHEN THERE HAVE BEEN ANY CHANGES. $_____ Title: Fringe Benefit Statement.sdr Author: Jacob Created Date: 7/2/2008 10:28:11 AM ...

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