PAYMENT OF PREVAILING WAGE AFFIDAVIT
PAYMENT OF PREVAILING WAGE AFFIDAVIT
State of )
County of )
I, (Affidavit’s Name) declare under penalty of perjury under
the laws of the State of California that:
1. I am the (Officer, Owner, Partner) of
(Company) and I am responsible for the payment of
persons employed by (Company) who performed work on the
(Project).
2. During all payroll periods from (first work date) through
(last work date), all persons employed by
(Company) on the project have at all times been paid the
specific general prevailing rate of per diem wages and any amounts due pursuant to
California Labor Code Section 1813.
Signature
Date
Subscribed and sworn to (or affirmed) before me on this day of , 20
by , proved to me on the basis of satisfactory
evidence to be the person(s) who appeared before me.
(Notary Seal)
Notary Public
Print Name / Commission Expires
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