STATE ASSESSMENT CERTIFICATION The undersigned authorized representative of the corporation contracting herein certifies that the following indicated statement is true and correct and that the undersigned understands making a false statement is a material breach of contract and is grounds for contract cancellation. The corporation certifies that: _______ It is current in Unemployment Insurance taxes, Payday and Child Labor law monetary obligations, and fees and assessments payable to the State of . _______ It has no outstanding Unemployment Insurance overpayment balance payable to the of . Signature Date Typed Name and Title Offeror’s Organization
STATE ASSESSMENT CERTIFICATION The undersigned authorized representative of the corporation contracting herein certifies that the following indicated statement is true and correct and that the undersigned understands making a false statement is a material breach of contract and is grounds for contract cancellation. The corporation certifies that: _______ It is current in Unemployment Insurance taxes, Payday and Child Labor law monetary obligations, and fees and assessments payable to the State of . _______ It has no outstanding Unemployment Insurance overpayment balance payable to the of . Signature Date Typed Name and Title Offeror’s Organization
PBWDB-TRS-Mentor-Assessor-Forms-10-2018.docx