Cem 2505 Form PDF Details

In order to be admitted to Cem 2505, you will need to fill out the Cem 2505 form. This form can be found on our website, and is required for all students who wish to take this course. The form asks for basic information such as your name and contact information, as well as your academic history and current GPA. Please make sure that all of the information listed is accurate, as it will be used to determine your eligibility for the course. If you have any questions about the form or about Cem 2505, please don't hesitate to contact us. We look forward to hearing from you!

QuestionAnswer
Form NameCem 2505 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesowner operator listing cem 2505, cem 2505 pdf, california dot owner operator, owner operator listing pdf

Form Preview Example

STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION

 

 

 

 

 

 

 

 

 

 

ADA NOTICE

 

 

 

 

 

 

 

For individuals with sensory disabilities, this document is available in alternate

 

OWNER-OPERATOR LISTING

 

 

 

 

 

 

 

 

 

formats. For information call (916) 654-6410

or TDD (916) 654-3880 or write

 

CEM-2505 (REV 05/2001)

 

 

 

 

 

 

Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF CONTRACTOR EMPLOYING OWNER OPERATOR(S)

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYROLL NO.

FOR WEEK ENDING

 

PROJECT AND LOCATION

 

 

 

 

 

 

 

 

CONTRACT NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME, ADDRESS, SOCIAL SECURITY

 

 

DESCRIPTION

TRUCK CAL T NO.

 

 

 

 

DAY AND DATE

TOTAL

 

HOURLY

GROSS

 

 

WORK

 

ST

 

 

 

 

 

 

 

 

 

CHECK

 

 

 

 

 

 

 

 

 

NO. AND CONTRACTORS LICENSE NO.

 

OF

AND/OR EQUIP.

 

 

 

 

 

 

 

 

WEEKLY

 

RATE OF

PAYMENT

CLASSIFICATION

 

OR

 

 

 

 

 

 

 

 

 

NO.

 

 

 

 

 

 

 

 

 

OF OWNER-OPERATOR (IF ANY)

 

EQUIPMENT

LICENSE NO.

 

 

 

 

 

 

 

 

HOURS

 

PAY

EARNED

 

 

OT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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NOTE: CERTIFICATION WILL BE ACCEPTED ONLY FROM THE CONTRACTOR EMPLOYING THE OWNER

OPERATOR: IT WILL NOT BE ACCEPTED FROM THE OWNER OPERATOR HIM / HERSELF.

STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION

OWNER-OPERATOR LISTING STATEMENT OF COMPLIANCE

CEM-2505 (REV 05/2001)

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

do hereby state:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Name of signatory party)

 

 

 

 

(Title)

 

 

 

 

 

(1) That I pay or supervise the payment of the persons reported on this form as Owner-operators by

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Contractor or subcontractor)

on the

 

, that during the payroll period commencing on the

day of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Building or work)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and ending the

day of

,

 

, all persons working on said project have been paid the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

full weekly sums earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said

from the full weekly sums earned by any person and that no deductions have

(Contractor or subcontractor)

have been made either directly or indirectly from the full sums earned by any person, other than permissible deductions, as

described here:

(2)That any payrolls or listings or otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed.

(3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency.

(4)That:

(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS

In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll or listings payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below.

(b) WHERE FRINGE BENEFITS ARE PAID IN CASH

Each Laborer or mechanic listed in the above referenced payroll or listings has been paid as indicated on the payroll or listings an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below:

(c) EXCEPTIONS

EXCEPTION (CRAFT)

EXPLANATION

 

 

 

 

 

 

 

 

 

 

 

 

Remarks:

NAME AND TITLE

SIGNATURE

On federally-funded projects, permissible deductions are defined in regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c).

Also, the willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution (see Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code).

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form cem 2505 conclusion process clarified (part 1)

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