HomeMy WebLinkAboutstatement of compliance•
00923 STATE OF COMPLIANCE
(DAVIS BACON ACT) (If applicable)
No.
Contract No.
ProjectTitle
The undersigned CONTRACTOR hereby swears under penalty of perjury that, during
the period covered by the application for payment to which this statement is attached,
all mechanics, laborers, and apprentices,
and employethat the wage rates the
of site
paymen# S
Project, have been paid at wage rates,
contributions, or costs for fringe benefits have not been less than those required by the
Davis Bacon Act and the applicable conditions of the Contract.
Dated , 20
STATE OF
COUNTY OF
) SS
By:
By:
Contractor
(Signature)
(Print Name and Title)
The foregoing instrument was acknowledged before me this wday a is
f
, 20_,.., by
personally known to me or who has produced as
identification and who did/did not take an oath. , 20
WITNESS my hand and official seal, this day of
(NOTARY SEAL)
My commission expires:
(Signature of person taking acknowledgment)
(Name of officer taking acknowledgment)
(typed, printed or stamped)
(Title or rank)
(Serial number, if any)
City of Miami
154 Bid No. 04-05-011