MONTHLY EMPLOYMENT REPORT AMERICAN RECOVERY AND REINVESTMENT ACT 1. First day of reporting period (mm/dd/yy) 2. Report Month (mm/yy) 3. Contracting Agency 4. Federal Proj. Number State 0154089 5. Project ID 6. State Project Number 7. Project Description ARRA 15-4(89)240 4320 DEARBORN REST AREA 8. Contractor Name and Billing Address 9. DUNS Number DICK ANDERSON CONSTRUCTION INC - HELENA, 3424 HWY 12 E, HELENA, MT, 59601 089514434 10. Add an "X" if changes have been made to the address or DUNS Number 11a. Prepared by CEO or Payroll Official: (Name and Title) 11b. Date 12. Employment Data - Direct, On Project Jobs TOTAL EMPLOYEES TOTAL HOURS TOTAL PAYROLL ($) Contractor Subcontractor Name(s) Monthly Prime and Subcontractor Employment Report American Recovery and Reinvestment Act Submission of Form ARRA_1589 is required monthly on all projects that receive funds from the American Recovery and Reinvestment Act of 2009 (ARRA). The prime contractor must complete a report for each month from the Notice to Proceed until completion of the contract. Form ARRA_1589 contains information about the Contractor's workforce and information about the workforce for each Subcontractor active that month. This information includes data from each payroll that ends in the reporting month. Do not split payrolls between months. Submit the form electronically (by email) to the EPM by the 7th of the month for the previous month's report. Completion Instructions: BOX 1 Enter the date of the beginning of the first payroll period (for the Contractor) that ends in the reporting month. BOX 2 Enter the report month. BOX 3 This will be entered by MDT. BOX 4 This will be entered by MDT. BOX 5 This will be entered by MDT. BOX 6 This will be entered by MDT. BOX 7 This will be entered by MDT. BOX 8 This will be entered by MDT. Verify correctness. BOX 9 The unique nine-digit number issued by Dun & Bradstreet. This will be entered by MDT. Verify correctness. BOX 10 Enter an "X" in the box if the address or the DUNS Number has been corrected. BOX 11a Enter the name and title of the person responsible for preparation of the form. By completing the form, the person certifies that they are knowledgeable of the hours worked and employment status for all the employees. Contractors and Subcontractors are responsible to maintain data to support the employment form and make it available to the state should they request supporting material. BOX 11b Enter the date the form is completed. BOX 12 List the total number of employees, hours worked and payroll for the Contractor and each Subcontractor. Include every employee who works on the jobsite, including any supervisors, engineering personnel, inspectors, sampling and testing technicians and lab technicians.
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