Invoice for roof cleanup, Asbestos Removal Corp, Aug 2002

NYC 9/11 Public Portal Document

THE CITY OF NEW YORK OFFICE OF COMPTROLLER BUREAU OF LABOR LAW PAYROLL REPORT (TO BE SUBMITTED WITH REQUISITION FOR PAYMENT) AGENCY: NAME OF DEPARTMENT OF DESIGN AND CONSTRUCTION TRIOCONTRACTOR/SUBCONTRACTpR ASBESTOS REMOVAL CO ADORES 4-20 129TH STREET COLLEGE POINT NY 11356 PHONE No. PAYROLL No. CONTRACT REG No. JOB CODE WEEK ENDING - DATE ( ) - 3 PROJECT NAME AND LOCATION 20766 07/28/02 125 CEDAR/ 120 L Ax I.D. No. U 2) LIST TRADE & 3) 4) DAY AND DATE s) 6) J 'i 11-2869540 BASE ~) SUPPLEMENTAL BENEFITS 11) 121 13) EMPLOYEE'S NAME, CIRCLE WORK T MON TUE WED THU FRI SAT SUN TOTAL RATE 8) 10 ADDRESS, CLA SSIF: TOTAL JOURNEYPERSON M 722 723 724 725 726 727 72 HOURS OF F SOCIAL SECURITY NO. APPRENTICE pOY TOTAL BASE RATE TOTAL GROSS TAX AND OTHER' HELPER E PER PER PAID PAY NET H UR K P AY HOUR PAY HOUR DEOUonoN pAY WOMOCZYL,_._I.REU..U. , JOURNEYMAN R 8.0 8.0 28.15 UE 0 P11 AB-SUPERVIS 0 5.0 5.0 42,22 514.98 80 514.98 458.32

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ITI I I I I I I I I 1 I hereby certify th a info► OF STATEMENT ISA PUNISHABLE on represents FAS wages IFICAa IOslupOp OFFENSE F7062.ELx above P 1 paid ro'ect ring the per' wn. I understand that the Agency relies upon the information aspersons employed by my firm for construction work upon the undersigns being 1omplete and accurate in making payments to the

SIG NAME (Print) TITLE ATE

NYC-WTC 000108063