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XII1BIT" 17 <br />CF', FIFCaCA V)N OF d_TlN).)ERSTAN DMG <br />ANT 0;/,�,UTHORIZATION <br />"'roiec?: Name: <br />.j , Nuniber: _ <br />this is to acrtify tha'the principals and the autl���rizud payroll officer, below, have read and understand the labor <br /><andav& clauses pertaining to the subject, projer t. <br />the following person(s) is designated as the payroll officer for the undersigned and is authorized to sign the <br />-�tatenlent of Compliance, which will accor_nxiny our weekly certified payroll reports for this project: <br />_..fldrpra..._..fo z��S�ne,crn�vl�i'�- <br />------ <br />Payroll Officer's Name <br />� � <br />Payroll Officers �j's rgnature <br />nlv►/iy�, SU�nhedv✓ <br />Coni for/Subcontractor <br />by <br />Signa�urc <br />_ Le' ro <br />Printed Nacre <br />Ticks <br />Date <br />91dDB2 <br />_.-_.._. - - ---- ----....... ------ .. ---- -- <br />4. c ;Ktor/Subcontractor License No. <br />g5'Os33p,9; <br />DUNS Numbor <br />�DCS3\FFZOPSVCS\HUDFORMS\MBU5BC4AMB-S.d.r3Spxc DOC <br />