WEEKLY PAYROLL Bureau of Public Work
THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date (b) WHERE FRINGE BENEFITS ARE PAID IN CASH I (Name of signatory party) (Title) - Each laborer, worker, or mechanic listed in the above-referenced payroll has been paid, as indicated on the payroll, an amount not less than …
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