HomeMy WebLinkAboutFringe Benefit Statement - Spec 91436STATE OF CALIFORNIA. DEPARTI\,4ENT OF TMNSPORTATION
FRINGE BENEFIT STATEMENT
cEM-2501 (REV 8/1994
CONTRACTOFySUBCONTRACTOR (Please Pdnl)
D-KAL ENGINEERING INC
TO: RESIDENT ENGINEER DISTRICT LABOR COMPLIANCE OFFICER
MARK WILLIAMS
FEDERAL AID PROJECT NUMBER OATE
9/20120018
BUSINESS ADDRESS
CITY OF SAN LUIS OBISPO
919 PAIM ST
SAN LUIS OBISPO CA 9340I
CLASSIFICATION FRINGE BENEFIT HOURLY AMOUNT NAME AND AOORESS OF PLAN, FUND, OR PROGRAM
Effective Date
1^ /Z0t 5
Subsistence andTor Travel Pay:
$
Health &
- 5.00 orevailins wases
Apprentice/ $
Training
Other $
Pphcvc
2440 Preofessional Drive STE 100
Roseville, CA 95661
CLASSIFICATION FRINGE BENEFIT HOURLY AMOUNT NAME AND ADDRESS OF PLAN. FUND. OR PROGRAM
Enect|ve uale
Subsistence and/or T|avel Payi
$
Vacalion $
Health & q
Pension $
Apprentice/ $
Training
Other $
CLASSIFICATION FRINGE BENEFIT HOURLY AMOUNT NAME AND ADDRESS OF PLAN. FUND. OR PROGMM
Effective Date
Subsistence and/or Travel Pay:
$
Vacation $
Health & $
Pension $
Apprentice/ $
Training
Other $
I cerlify under penalty of peiury that fringe benefits arc paid ao ahe approved Plans, Funds, or Programs.aa listed.above.
BUSINESS TELEPHONE NUMBER 5{
wilh sensory disabililjes, this dodrment is available in altemate formats. For information c€ll (S16) 65,4-6410 or TDD (916)cEM2501
or write Records and Forms Management, 1120 N Slreet, I\,4S89, sacramento, cA 95814.