Statement of Employer Payments - California Department of ...

Statement of Employer PaymentsDate:In Reply, Refer to Case No:Prime:Subcontractor:PROJECT NAME:PROJECT CONTRACT NO.:County/location:HEALTH AND WELFARE NAME OF PLANA ddress, City and Zip ADMINISTRATOR Address, City and Zip CLASSIFICATION(S) USEDCONTRIBUTION PER CLASSIFICATION PER HOURCONTRIBUTIONS:WEEKLY_____MONTHLY____ _QUARTERLY_____ANNUALLY_____PENSIONNAME OF PLANA ddress, City and Zip ADMINISTRATOR Address, City and Zip CLASSIFICATION(S) USEDCONTRIBUTION PER CLASSIFICATION PER HOURCONTRIBUTIONS:WEEKLY_____MONTHLY____ _QUARTERLY_____ANNUALLY_____VACATION/HOL IDAY NAME OF PLANA ddress, City and Zip ADMINISTRATOR Address, City and Zip CLASSIFICATION(S) USEDCONTRIBUTION PER CLASSIFICATION PER HOURCONTRIBUTIONS:WEEKLY_____MONTHLY____ _QUARTERLY_____ANNUALLY_____TRAIN

Statement of Employer Payments Date: In Reply, Refer to Case No: Prime: Subcontractor: PROJECT NAME: PROJECT CONTRACT NO.: County/location: HEALTH AND WELFARE NAME OF PLAN Address, City and Zip . ADMINISTRATOR. Address, City and Zip . CLASSIFICATION(S) USED. CONTRIBUTION PER CLASSIFICATION PER HOUR. …

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