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Employment at Will Form


Employment at Will Form document sample

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									                                               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 ($)
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

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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