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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:Full Maintenance Contract, Del Rio, TX
DOL Wage Determination No.:
Workman's Comp Rate - Janitorial:
SUTA Thresholds:
SUTA %:
NOTE: Use as many lines as necessary to describe your coverage.
PostionsPostionsSCA-DOLNumber ofIs the H & W
Last Name, First Name (required)(These are Examples -OccupationRegular Work Hrspaid directly
Tailor this to your contract)CodeScheduled Per WeekDate of Employmentto Employees?
Jones, MikeJanitor11150
Smith, JohnLaborer, Grounds Maintenance11210

File details come from the government source that posted it. Updated .