47PH0223R0003 FIGURE B-1 Contractor Staffing Declaration.xlsx
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Staffing
FIGURE B-1
Contractor Staffing Declaration FIGURE B - 1 Contractor Staffing Declaration
Contractor Name: _______________________________________ Current Date: _____________________
| Location: | |
| Contract Number: | |
| Performance Start Date: | |
| Services Provided: | Operations and Maintenance Contract, El Paso, TX and Southeastern NM Region |
| DOL Wage Determination No.: | |
| Workman's Comp Rate - Janitorial: | |
| SUTA Thresholds: | |
| SUTA %: |
| NOTE: Use as many lines as necessary to describe your coverage. | |||||
| Postions | Postions | SCA-DOL | Number of | Is the H & W | |
| Last Name, First Name (required) | (These are Examples - | Occupation | Regular Work Hrs | paid directly | |
| Tailor this to your contract) | Code | Scheduled Per Week | Date of Employment | to Employees? | |
| Jones, Mike | HVAC Mechanic | 23410 | |||
| Smith, John | General Maintenance Worker | 23370 |
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