HomeMy WebLinkAboutMGB CPR - 6-15-20 to 6-19-20Public Works Certified Payroll Reporting Form
Certification under penalty of perjury:
"I, TAMARA JENKINS, the undersigned, am the GENERAL MANAGER (position in business) with the authority to act for and on behalf of MGB CONSTRUCTION (name of business and/or contractor), certify
under penalty of perjury that the records or copies thereof submitted and consisting of certified payroll records for the week ending 2020-06-21 are the originals or true, full, and correct copies of the originals
which depict the payroll record(s) of the actual disbursements by way of cash, check, or whatever form to the individual or individuals named. I certify this on 2020-07-02."
Contractor Name: MGB CONSTRUCTION, INC. Contractor PWCR: 1000005831 License Type: CSLB License Number 797075
Address: 91 COMMERCIAL AVE, RIVERSIDE, CA 92507 FEIN: 330951724 Contractor Email: TAMARAR@MGBCONSTRUCTION.NET
Insurance Number: C65214660
Awarding Body: CITY OF SAN LUIS OBISPO DIR Project ID: 325863
Contract With: CITY SERVICE PAVING County: SAN LUIS OBISPO
Payroll #: 2 - 0 Ctr Payroll #: 2 Week Ending: 06/21/2020
Project Name: ISLAY HILL PARK PLAYGROUND RENOVATION
Address: 1511 TANK FARM, SAN LUIS OBISPO, CA 93401
Statement of Non -Performance? Final payroll for this project?
Public works certified Payroll Reporting Form 07/02/2020 - Page 1