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 4/17193
LANTNAVFACENGCOM A&E GUIDE
(1)
Contract N62470-
Atlantic Division
Naval Facilities Engineering Command
AFFIDAVIT
TO ACCOMPANY INVOICE NO.
(2)
STATE OF
)
(3)
COUNTY OF
)
I
(4)
, being
(Name and Title)
duly sworn to depose and say that
(5)
(Prime Contractor)
and his Subcontractors who have performed at the site any
part of the work under Contract N62470- (6)
for the period
ending
(7)
and covered by this invoice, have complied with the
Labor Standards provisions of the contract.
(8)
Sworn to before me this
day of
(9)
,19
.
(10)
(Notary Public)
(SEAL)
(To be accomplished by person authorized to sign invoice)
LANTDIV NORVA 4-4235/4 (Rev. 5/81)
1-17
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