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Payroll No
STATEMENT OF NON - PERFORMANCE
Date: JUNE 29, 2020
Name of Prime/Subcontractor: CUSWAN CONTRACTING CORPORATION
I do hereby certify under penalty of perjury that no persons were employed on the
construction of the project SLO DISINFECTION
during the payroll period commencing on the 21st DAY OF JUNE, 2020 and ending the 21th DAY OF JUNE, 2020.
TA1v4v1Y L. BASTIAN
(name) (title)
(signature)