Fig_B-1_Contractor_Staffing_Declaration.xlsx
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- 47PJ0018R0005
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Contractor Staffing Declaration
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Staffing Contractor Staffing Declaration FIGURE B-1 Contractor Staffing Declaration
Contractor Name: _______________________________________________________________ Current Date: ___________________
| Location: | ||||||
| Contract Number: | ||||||
| Performance Start Date: | ||||||
| Services Provided: | Operations and Maintenance Services | |||||
| DOL Wage Determination Number: | ||||||
| Mechanical Union Name: | ||||||
| Admin Staff Workman's Comp Rate: | ||||||
| Mechanical Workman's Comp Rate: | ||||||
| SUTA Thresholds: | ||||||
| SUTA % Rate: | ||||||
| Self Insured Unemployment Rate: | ||||||
| Postion | SCA-DOL | If Position is Covered by | Number of | Number of | Is H&W paid | Is Pension (if applies) |
| Occupation | Collective Bargaining Agreement | Scheduled | Employees | directly to | paid directly to | |
| Code | Identify CBA Position Title | Hours/Week | with this Schedule | Employee? | Employee? |
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