To the best of my information, knowledge, and belief, I hereby certify that the number of hours, basic hourly rate, and
fringe benefit payments listed above are true and correct and that the type of work performed by the number of employees
identified above, relative to the Occupational Title(s) reported, is consistent with 8 CSR 30-3.060.
I am authorized to make this report by the entity for which I am reporting and I make this certification based on my own direct
knowledge of the work performed on the project and of the applicable payroll and benefit records, or based on
information provided directly to me by persons with such knowledge. I recognize that any false statement or
declaration made herein is criminally punishable under Sections 290.340, 570.090, 575.050, and 575.060, RSMo.
Be sure to have the following information before proceeding to the survey.
Surveys cannot be saved in the middle of the process and are not complete until they have been successfully submitted.