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TION CONTRACTORS STATE LICENSE NUMBER BOARD NUMBER TO: RESIDENT ENGINEER OR DISTRICT LABOR COMPLIANCE OFFICER DATE FEDERAL-AID PROJECT NUMBER BUSINESS ADDRESS Labor Compliance uses the following fringe benefits information (shown or referenced on wage rate determinations) paid to or on behalf of employees in various crafts or classifications to check payroll or apply to force account work on the above contract. COMPLETE AND SUBMIT THIS FORM WITH THE FIRST CERTIFIED PAYROLL OR WHEN THERE HAVE.

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