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 CONTRACTOR/SUBCONTRACTOR DEPARTMENT OF DESIGN AND CONSTRUCTION TRIO ASBESTOS REMOVAL CO ADD 14-20 5129TH STREET PHONE No. PAYROLL No. COLLEGE POINT NY 11356 CONTRACT PEG No. ( ) - 3 JOB CODE WEEK ENDING - DATE PROJECT NAME AND LOCATION

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TO DEDUCTIO 20766 07/28/02 125 CEDAR/ 120 L PII

AND 1) LIST TRADE & 3) 4) DAY AND DATE 5) 6) 7) SUPPLEMENTAL BENEFITS 11) 12) T .. EMPLOYEE'S NAME, CIRCLE WORK T MON TUE WED THU FRI SAT SUN j3! TOTAL RATE 81 10) ADDRESS, CLASSIF: I JOURNEYPERSON HOURS PAY OF SOCIAL SECURITY No. M 722 723 724 725 726 727 72 TOTAL RATE l II TOTAL GROSS APPRENTICE BASE OTHERi HELPER E PER PAS, PER ion PAID PAY NET pAY E P AY HOUR HOUR eck) WOMOCZYL I,R------ Z JOURNEYMAN R 8.0 8.0 28. 15 U E O

PII AB-SUPERVIS O T 5 .0 5.0 42.22 514.98 80 514 .98 458.32

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I hereby certify th above P 1 ro'ect rin9 the per' a info► O T

FALSIFICATION OF STATEMENT IS A PUNISHABLE OFFENSE 'on represents wages and supplemental benefits paid to all persons employed by my firm for wn. I understand that the Agency relies upon construction work upon the the information as being complete and accurate in making payments to the F7062.E SIG NAME (Print) TITLE ATE

NYC-WTC 000108063