AGREEMENT between BROWARD COUNTY and Cummings ...

Exhibit 2
Page 362 of 379
PREVAILING WAGE RATES – STATEMENT OF COMPLIANCE
Project Title: Terminal 4 Gate Replacement
RLI No. R0787918R1
The undersigned CONSULTANT/CONTRACTOR hereby swears under penalty of
perjury that, during the period covered by the application for payment to which this
statement is attached, all personnel, mechanics, laborers, and apprentices, employed of
working on the site of the Project, have been paid at wage rates, and that the wage
rates of payments, contributions, or costs for fringe benefits have not been less than
those required by the Davis-Bacon Act or Broward County Ordinance No. 83-72, as
applicable, and the applicable conditions of the Contract.
Dated _____________, 20___
_________________________________
(CONSUTLATN/CONTRACTOR/FIRM)
By _______________________________
(Signature)
STATE OF ______________
COUNTY OF ____________
By ________________________________
(Name and Title)
The foregoing instrument was acknowledged before me this ________ day of
__________________, 20__, by _____________________________ who is personally
known to me or who has produced _____________________ as identification and who
did/did not take an oath.
WITNESS my hand and official seal, this ______ day of ___________, 20__.
(NOTARY SEAL)
(Serial number, if any)
My commission expires:
_________________________________
(Signature of person taking acknowledgment)
_________________________________
(Name of officer taking acknowledgment)
(typed, printed or stamped)
__________________________________
(Title or rank)