Fringe Benefit Statement COMPANY INFORMATION Company Name Date Street Address Suite/Unit City State Zip License Number Issuing Classification Expriation CONTRACT INFORMATION Project Name/Number Contract Number In order that the proper Fringe Benefit rates can be verified for checking payrolls or applied to force account work on the above contract the hourly rates for Fringe Benefits subsistence and/or travel on the allowance payment made for employees on the various classes of work are tabulated below. THIS FORM MUST BE COMPLETED AND SUBMITTED WITH THE FIRST CERTIFIED PAYROLL OR WHEN THERE HAVE BEEN ANY CHANGES. CLASSIFICATION Effective Date FRINGE BENEFIT HOURLY AMOUNT Vacation Health Welfare Pension NAME AND ADDRESS OF PLAN FUND OR PROGRAM Subsistence and/or Travel Pay Apprentice/ Training Other SIGNATURE I hereby certify that fringe benefits are paid to the approved Plans Funds or Programs as listed above.
Award-winning PDF software
How to prepare Fringe Benefit Statement
Online technologies make it easier to organize your file management and increase the efficiency of your workflow. Look through the short information in order to fill out Fringe Benefit Statement, keep away from mistakes and furnish it in a timely manner:
How to fill out a fringe benefit statement California?
-
On the website containing the document, click on Start Now and go towards the editor.
-
Use the clues to complete the appropriate fields.
-
Include your individual information and contact data.
-
Make sure that you enter accurate data and numbers in correct fields.
-
Carefully revise the information in the document so as grammar and spelling.
-
Refer to Help section when you have any questions or address our Support team.
-
Put an digital signature on your Fringe Benefit Statement printable while using the help of Sign Tool.
-
Once blank is completed, click Done.
-
Distribute the prepared via email or fax, print it out or download on your gadget.
PDF editor permits you to make changes on your Fringe Benefit Statement Fill Online from any internet linked gadget, personalize it in line with your requirements, sign it electronically and distribute in several means.
What people say about us
Complex paperwork, simplified
Common Mistakes
Benefit from
People also search for Fringe Benefit Statement
show me forms that can be used for employer fringe benefit payments - FAQ
Popular Fringe Benefit Statement Forms
More info
Show details