The Commissioner of Labor and Industry reserves the right to request payroll records and other data that the Commissioner deems sufficient to confirm these affirmations at any time. Name of Authorized Representative: _______________________________________ _____________________________________________________________________ Signature of Authorized Representative Date _____________________________________________________________________ Title _____________________________________________________________________ Witness Name (Typed or Printed) ______________________________________________________________________ Witness Signature Date (submit with Bid/Proposal)
The Commissioner of Labor and Industry reserves the right to request payroll records and other data that the Commissioner deems sufficient to confirm these affirmations at any time. Name of Authorized Representative: _______________________________________ _____________________________________________________________________ Signature of Authorized Representative Date _____________________________________________________________________ Title _____________________________________________________________________ Witness Name (Typed or Printed) ______________________________________________________________________ Witness Signature Date (submit with Bid/Proposal)
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