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(c) The name, title and address of the owner, partners or officers of the undersigned are:

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(d) The names and addresses of all other persons, both natural and corporate, having a substantial interest in the undersigned, and the nature of the interest are (if none, so state):

Name

Address

Nature of Interest

(e) The names, addresses and trade classifications of all other building construction contractors in which the undersigned has a substantial interest are (if none, so state):

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U.S. Criminal Code, Section 1010, Title 18, U.S.C., "Federal Housing Administration transactions", provides in part: "Who ever, for the purpose of.... .influencing in any way the action of such Administration..... makes, passes, utters, or publishes any statement, knowing the same to be false.....shall be fined not more than $5,000 or imprisoned not more than two years, or both."

FHA 2482-A Rev. 11/68

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That he is fully familiar with Section 212 of the National Housing Act as amended and with the determination of prevailing wages made by the Secretary of Labor pursuant to said Section as applicable to the above identified project dated and amendment(s) dated ; that he is aware of certain complaints having been heretofore made alleging nonpayment of prevailing wage rates in accordance with the determination of the Secretary of Labor, and that he has investigated such complaints and has reviewed the wage scale, hours of employment, and skill or skills at which employed of all laborers and mechanics employed in the construction of said project since its inception and as a result thereof has determined the extent to which wages in accordance with the determination of the Secretary of Labor have not been paid, whether through misinformation or misapplication of said determination or otherwise; thereupon, he has paid or caused to be paid to each of said laborers or mechanics (which terms are intended to include any person or persons employed as apprentices, helpers or in any other capacity, whether employed directly by the principal contractor or by any subcontractor) the amount found to be due him for the period of his employment at rates not less than the predetermined rate applicable to the type of work performed and that no deductions or rebates have been made, either directly or indirectly, from the full weekly wages eamed by any person other than permissible deductions as defined in the Regula tions of the Secretary of Labor under the Anti-Kickback Act; further that this certificate is executed by the undersigned for the purpose of inducing the Commissioner to approve for insurance that certain mortgage loan or an advance thereof, made or to be made by the mortgagee in connection with the construction of said project, and with the intent that the Commissioner rely upon this certification to establish compliance with the provisions of Section 212 of the National Housing Act and the Labor Standards Provisions of the construction contract.

The undersigned certifies that he has delivered to all subcontractors a written copy of the applicable determination of prevailing wages and has required each subcontractor as a part of his contract to agree to pay wages at rates not less than those so determined, and has included in all subcontracts Provisions 9, 10, 11, 12 and 13 of FHA Supplementary General Conditions, Revised.

The undersigned further certifies that he has fully performed all the conditions and undertakings of FHA Form 2482 executed by him in connection with this project, required to be performed at this date.

The undersigned understands that if the Federal Housing Commissioner approves the insurance of an advance of mortgage proceeds in reliance upon this certificate the Federal Housing Commissioner makes no determination with respect to the statements contained herein, but accepts this certification at its face value as a true statement of facts and further that he accepts this certification, without reference, to any action which might be indicated based upon previous certifications alleged to be incorrect or any action which might be taken if subsequent investigation indicates this certification is untrue or incorrect.

Subscribed and sworn to before me this

day of

.19

WARNING

Notary Public

U. & Criminal Code, Section 1010, Title 18, U.SC., "Federal Housing Administration transactions", provides in part: "Whoever, for the purpose of... influencing in any way the action of such Administration... makes, passes, utters, or publishes any statement, knowing the same to be false... shall be fined not more than $5,000 or imprisoned not more than two years, or both."

Section 5.6(b) of the Regulations of the Secretary of Labor issued May 9, 1951, pursuant to Reorganization Plan 14 of 1950 provides in part: "Whenever any contractor or subcontractor is found by the Secretary of Labor or the Agency Head to be in aggravated or wilful violation of the prevailing wage... provisions of the applicable statutes listed in Section 5.1... (the statutes listed include the National Housing Act and other Federal statutes requiring compliance with prevailing wage and labor standards issued by the Secretary of Labor)... such contractor or subcontractor or any firm, corporation, partnership, or association in which such contractor or subcontractor has a substantial interest shall be ineligible for a period of three years (from the date of publication by the Comptroller General of the name or names of said contractor or subcontractor...) to receive any contracts subject to any of the statutes listed in Section 5.2" -96422-P Rev. 2/63

FHA-Wash., D. C.

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Listed below are the names of the general contractor and each and every subcontractor (including lower tier contractors) who have started to work on the captioned project and attached are the payrolls due from each of these contractors for pay periods within the calendar week ending

If any payroll is due but not submitted, the contractor's name is listed below and the reason for the delay is given under "comments", including the steps taken to correct any violations.

If a contractor previously engaged in the construction of this project did not work in the above-mentioned week, the contractor's name is listed below and a payroll is enclosed with the notation "no work this pay period".

If any of the enclosed payrolls are final payrolls, they are marked "Final Payroll".

Evidence of registration of each apprentice reported on the enclosed payrolls has either been previously submitted or is enclosed herewith.

Written evidence of the established apprentice wage rates has either been previously submitted or is enclosed herewith.

FHA Form 2482-A has been submitted for each of the contractors listed below.

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U.S. DEPARTMENT OF LABOR WAGE AND HOUR AND PUBLIC CONTRACTS DIVISION

INSTRUCTIONS FOR COMPLETING PAYROLL FORM, WH-347

General: The use of WH 347, payroll form, is not mandatory. This form has been made available for the convenience of contractors and subcontractors required by their Federal or Federally-aided construction-type contracts and subcontracts 10 submit weekly payrolls. Properly filled out, this form will satisfy the requirements of Regulations, Parts 3 and 5 (29 CFR, Sublide A), as to payrolls submitted in connection with contracts subject to the Davis-Bacon and related Acts.

This form meets needs resulting from the amendment of the Davis Bacon Act to include fringe benefits provisions. Under this amended law, the contractor is required to pay not less than fringe benefits as predetermined by the Department of Labor, in addition to payment of not less than the predetermined rates. The contractor's obligation to pay fringe benefits may be met either by payment of the fringes to the various plans, funds, or programs or by making these payments to the employees as cash in lieu of fringes.

This payroll provides for the contractor's showing on the face of the payroll all monies paid to the employees, whether as basic rates or as cash in lieu of fringes and provides for the contractor's representation in the statement of compliance on the rear of the payroll that he is paying to others fringes required by the contract and not paid as cash in lieu of fringes. Detailed instructions concerning the preparation of the payroll follow:

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Column 1 Name. Address, and Social Security number of Employee: The employee's full name must be shown on each weekly payroll submitted. The employee's address must also be shown on the payroll covering the first week in which the employee works on the project The address need not be shown on subsequent weekly payrolls unless his address changes. Although not required by Regulations, Parts 3 and 5, space is available in the name and address section so that Social Security numbers may be listed.

Column 2 Withholding Exemptions: This column is merely inserted for the employer's convenience and is not a requirement of Regulations, Parts 3 and 5.

Column 3 Work Classifications: List classification descriptive of work actually performed by employees. Con-
sult classifications and minimum wage schedule set forth in contract specifications. If additional classifications are
deemed necessary, see Contracting Officer or Agency representative. Employee may be shown as having worked
in more than one classification provided accurate breakdown of hours so worked is maintained and shown on
submitted payroll by use of separate line entries.

Column 4 Hours Worked: On all contracts subject to the Contract Work Hours Standards Act enter as over. time hours all hours worked in excess of 8 hours per day and 40 hours a week.

Column 5 Total: Self-explanatory.

Column 6 Rate of Pay, including Fringe Benefits: In straight time box, list actual hourly rate paid the employee for straight uime worked plus any cash in lieu of fringes paid the employee. When recording the straight time hourly rate, any cash paid in lieu of fringes may be shown separately from the basic rate, thus $3.25/.40. This is of assistance in correctly computing overtime. See "Fringe Benefits" below. In overtime box show overtime hourly rate paid, plus any cash in lieu of fringes paid the employee. See Fringe Benefits" below. Payment of not less than time and one-half the basic or regular rate paid is required for overtime under the Contract Work Hours Standards Act of 1962. In addition to paying not less than the predetermined rate for the classification in which the employee wurks, the contractor shall pay to approved plans, funds, or programs or shall pay as cash in lieu of fringes amounts predetermined as fringe benefits in the wage decision made part of the contract. See "FRINGE BENEFITS* below.

FRINGE BENEFITS Contractors who pay all required fringe benefits: A contractor who pays fringe benefits
to approved plans, funds, or programs in amounts not less than were determined in the applicable wage decision
of the Secretary of Labor shall continue to show on the face of the payroll the basic cash hourly rate and over.
time rale paid to his employees just as he has always done. Such a contractor shall check paragraph 4(a) of the
statement on the reverse of the payroll to indicate that he is also paying to approved plans, funds, or programs
not less than the amount predetermined as fringe benefits for each craft. Any exceptions shall be noted in Section
4(c).

Contractors who pay no fringe benefits: A contractor who pays no fringe benefits shall pay to the employee, and
insert in the straight time hourly rate column of the payroll, an amount not less than the predetermined rate for
each classification plus the amount of fringe benefits determined for each classification in the applicable wage de-
cision. Inasmuch as it is not necessary to pay time and a half on cash paid in lieu of fringes, the overtime rate
shall be not less than the sum of the basic predetermined rate, plus the half time premium on basic or regular rate,
plus the required cash in lieu of fringes at the straight time rate. In addition, the contractor shall check paragraph
4(b) of the statement on the reverse of the payroll to indicate that he is paying fringe benefits in cash directly to
his employees. Any exceptions shall be noted in Section 4(c).

Use of Section 4(c), Exceptions

Any contractor who is making payment to approved plans, funds, or programs in amounts less than the wage determination requires is obliged to pay the deficiency directly to the employees as cash in lieu of fringes. Any exceptions to Section 4(a) or 4(b), whichever the contractor may check, shall be entered in Section 4(c). Enter in the Exception column the craft, and enter in the Explanation column the hourly amount paid the employee as cash in lieu of fringes and the hourly amount paid to plans, funds, or programs as fringes. The contractor shall pay, and shall show that he is paying to each such employee for all hours (unless otherwise provided by applicable determination) worked on Federal or Federally assisted project an amount not less than the predetermined rate plus cash in lieu of fringes as shown in Section 4(c). The rate paid and amount of cash paid in lieu of fringe benefits per hour should be entered in column 6 on the payroll. See paragraph on "Contractors who pay no fringe benefits" for computation of overtime rate.

Column 7- Gross Amount Earned: Enter gross amount earned on this project. If part of the employees' weekly
wage was earned on projects other than the project described on this payroll, enter in column 7 first the amount
earned on the Federal or Federally assisted project and then the gross amount earned during the week on all
projects, thus $63.00/120.00.

Column 8 Deductions: Five columns are provided for showing deductions made. If more than five deductions
should be involved, use first 4 columns; show the balance of deductions under "Other" column; show actual total
under Total Deductions" column; and in the attachment to the payroll describe the deductions contained in the
"Other" column. All deductions must be in accordance with the provisions of the Copeland Act Regulations, 29
CFR, Part 3. If the employee worked on other jobs in addition to this project, show actual deductions from his
weekly gross wage, but indicate that deductions are based on his gross wages.

Column 9-Net Wages Paid for Week: Self-
If-explanatory.

Totals Space has been left at the bottom of the columns so that totals may be shown if the contractor so desires. Statement Required by Regulations. Parts 3 and 5: While this form need not be notarized, the statement on the back of the payroll is subject to the penalties provided by 18 USC 1001, namely, possible imprisonment for 5 years or $10,000.00 fine or both. Accordingly, the party signing this required statement should have knowledge of the facts represented as true.

Space has been provided between items (1) and (2) of the statement for describing any deductions made If all deductions made are adequately described in the Deductions" column above, state "See Deductions column in this payroll." See paragraph entitled "FRINGE BENEFITS" above for instructions concerning filling out paragraph 4 of the statement

Form WH-347 Inst (1/68)

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FORM WH4.347 (1/68) FORMERLY SOL 184 -PURCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS

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