Resolutions - Jersey City

FORMAA-201
STATE OF.NEW JERSEY Assignment
DIVISION OF CONTRG COMPLIANCE
EQUAL EMPLOYME;NT OPPORTUNIT IN PUBLIC CONTRAGs Code
Revised i 0/03 INITIAL PROJEIT WORKFORCE REPORT CONSTRUalON
. Offcial Use Only
For instructions on completing the form, go to: http://ww.state.nj.us/treasury/contract_compliance/pdf/aa201 ins.pdf
1. FlO NUMBER
CONTRACTOR 10 NUMBER. 5. NAME AND ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT
22-:iG?;o q5f 12.
Name: c.i+y of c.k~('$e.y c) 7
3. NP;E AND~DRESS OF PRIME CONTRACTOR Address: 6"76' fr 44 t)
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(Name)
fJD 1ôw OC\th t0
(Street Address) . 6. NAME AND ADDRESS OF PROJECT ( 7. PROJEcrNUMBER
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CONTRCT NUMBER DA~rFAWARD DOLLAR AMOUNT OF AWARD
;ZOOl" -oiee . ~ 110111 .. "1 no
Name: La. fCMt,ft-e poD.
Address:Jo
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(0tY) (State) lZipCode) 8. IS THIS PROJECT COVERED BY kPROJ
4. IS THIS COMPANY MINORITYOWNED ( ) OR WOMAN OWNED () COUNTY LABOR AGREEMENT (PLA)? YES tI
9. TRADE OR CRAFT PROJECTD TOTAL EMPLOYE . PROJECT MINORIT EMPLOYEES PROJECT PROJECTD
ivll\L~ -~lvil\Lr MALt It-tMALt. . PHASE-IN COMPlEON
. J . AP J AP J AP J AP DATE DATE
1. ASBESTO$ WORKER
L. BRICKLAYER OR MASON .
3. CARPENTER ,.
4. ELEGRICIAN
5. GLAZIER
6. HVAC MECHANIC
7. IRONWORKER
8. .OPERATING ENGINEER
9. PAINTER
10. PLUMBER
11. ROOFER '.
12. SHEET METAL WORKER
13. SPRINKLER FITTER
.14. STEAMFITTER .
15. SURVEYOR
16. TILER
.17. TRUCK DRIVER
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18. LABORER 5" 3 (PliD/ll C7/ iJ11 Ll
19. OTHER . i
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20. OTHER
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I hereby certify that the foregoing statements made by me are true. I .m .w.", ",ot · '"0"'~ 10:"""9 lttements are willfully
false, I am subject to punishment
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(Title) .
(Sign.ature)
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(Area Code) rrelepho~e Number) JEx.)
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