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O <br />--I <br />D <br />r <br />N <br />23. In the following chart please list the companies that will be used for the construction or rehabilitation associated with the <br />project. Indicate the name and address of each company; list the dollar amount of the work to be provided by each company; <br />indicate whether ar not 100°l° of the workers are employees of that company or independent contractors; indicate ~vliether or not <br />the company pays workers wages that meet the wage rates for each classification of laborers and mechanics published by the U.S. <br />Department of Labor; indicate whether or not the company contributes to a health plan for its employees; indicate whether or not <br />the company contributes to a pension plan for its employees; and indicate whether or not the compan~+ maintains an affirmative <br />action plan or other similar plan to achieve racial diversity. Additional information maybe requested for verification of this <br />information. (If additional space is needed, please photocopy this page). <br />Construction Company Cost a1' Aft Workers Pay 'Contribute Contribute Maintain <br />Name and Address ~ Work Employees or Wage to a to a Affirmative <br />ar independent Rate Health • Pension Action <br />contractors /n) Plan ~/n Plan (/n Plan (vln <br /> <br /> <br /> <br /> <br /> <br /> ~, <br />w~ <br /> E'. <br /> <br /> i •~ i <br />I <br /> •~;: a 7 <br /> <br /> <br />(Rev 8?l 1?03) <br />9 <br />_~ <br />ti <br />c <br />r <br />i <br />A <br />N <br />m <br />m <br />m <br />m <br />n <br />0 <br />3 <br />m <br />n <br />0 <br />z <br />d <br />m <br />c <br />~i ~ <br /> <br />i .:~ A <br />f <br />~ <br />~~ <br /> W <br /> <br />v ~ <br /> m <br /> N <br /> f-+ <br /> <br />N <br />N <br />