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G 4. CONTRACTOR a. Name and Address b. Ending 5. POINT OF HIRE (location when hired) Location at time of hire 6. THE WORK RATE IS BASED ON ALL OPERATING SUPPLIES BEING FURNISHED BY CONTRACTOR b. EIN/SSN: c. Telephone Number (day) d. Telephone Number (night) GOVERNMENT 7. OPERATOR FURNISHED BY CONTRACTOR GOVERNMENT 8. TYPE OF CONTRACTOR ("X" appropriate boxes) SMALL BUSINESS LARGE BUSINESS SMALL DISADVANTAGED OWNED 9. ITEM DESCRIPTION (include make, model, year, serial number and acc.

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