Staff Report - Budgetary Adjustments, Plans and Specifications Approval, and Contract Award for the 34th Street Rehabilitation Project — Sacramento City Council, August 9, 2022 (part 2 of 2)

OTHER
NAME OF PLAN Address, City, State, Zip
ADMINISTRATOR Address, City, State, Zip

CLASSIFICAITON(S) USED/EFFECTIVE DATE CONTRIBUTION PER CLASSIFICATION/PERHOUR CONTRIBUTIONS: WEEKLY  MONTHLY  QUARTERLY  ANNUALLY  OTHER
NAME OF PLAN Address, City, State, Zip
ADMINISTRATOR Address, City, State, Zip

CLASSIFICAITON(S) USED/EFFECTIVE DATE CONTRIBUTION PER CLASSIFICATION/PERHOUR CONTRIBUTIONS: WEEKLY  MONTHLY  QUARTERLY  ANNUALLY 

Page 2 of 2 ends

How to Fill out the DAS 140 Correctly:

Process:

If the total dollar value of a project exceeds $30,000, apprentice must be requested. The DAS-140 form is to be forwarded directly to an apprenticeship committee of the contractor’s choice, and a copy with verification of proof of submission uploaded into SDCRAA Labor Compliance Departments electronic system; LCP Tracker.

Submit the contract award information in writing to each of the apprenticeship program sponsors in the locality of your public works project within 10 days of the prime execution of the contract or subcontract, but in no event later than the first day in which the contractor has workers employed on the project.

The DAS140 is simply a “notification of award” and is not automatically a request for dispatch of a registered apprentice.

State regulations state a contractor on a public works project must employ one (1) hour of apprentice work for every five (5) hours performed by a journeyman. Please follow up with the selected apprenticeship committee to confirm ‘Apprentice’ to ‘Journeyman’ ratio, as ratios do vary from trade to trade.

All contractors must request ‘dispatch of an apprentice’ from an apprenticeship program (for each apprentice- able craft or trade) by giving the program notice of a minimum of 72 hours (business days only) before the date on which apprentices are required. Contractors who are not already participating in an approved program and who did not receive a sufficient number of apprentices from their initial request, must dispatch apprentices from all other apprenticeship committees within the locality, if more than one exists in the area of the public works project.

What are the differences between box 1, 2, and 3 at the bottom of the DAS 140? • Box 1 is for contractors who are already approved to train by an apprenticeship program (signatory/member).
• Box 2 indicates that a contractor is willing to comply with a program's Standards for the current project only.

This generally means that the fringe benefits and the training funds will be paid to that Committee’s Trust Fund. It also allows a contractor to take advantage of a more generous maximum ratio than the CAC Standards, but does not affect the minimum ratio of 1 apprentice hour for every 5 journeyman hours. • Box 3 means that a contractor will be governed by the regulations of the California Apprenticeship Council.

Generally this means that the minimum and maximum ratio for apprentices is the same – 1 apprentice hour for every 5 journeyman hours per each craft, totaled at the end of the project. It also means the Training Fund Contribution is usually paid to the California Apprenticeship Council.

SELECTING BOXES:

1. Contractor has a signed “Agreement to Train Apprentice” with an affiliated (state certified) apprenticeship committee, the contractor has apprentices on staff and has the ability to train apprentices.
a. Must provide a copy of the DAS7 agreement for verification OR a letter from the JATC or UNION stating that the contractor is approved to train apprentices.

2. Contractor is not currently affiliated with a state approved program, is selecting a committee, and requesting apprentice; will be abiding by committee’s standards.

3. Contractor will contact a committee and request an apprentice, but is not obligating to maintain affiliation w/any-one committee; additionally contractor will not commit to selected program committee standards but will follow state standards (most commonly used for out-of-state contractors). a. Per the DAS, this is not the preferred selection; however the State is not requiring a contractor to join a program, just ensuring that apprentices are utilized on Public Work Projects.

PUBLIC WORKS CONTRACT AWARD INFORMATION
Contract award information must be sent to your Apprenticeship Committee if you are approved to train. If you are not approved to train, you must send the information (which may be this form) to ALL applicable Apprenticeship Committees in your craft or trade in the area of the site of the public work. Go to: http://www.dir.ca.gov/das/PublicWorksForms.htm for information about programs in your area and trade. You may also consult your local Division of Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under California, State of, Industrial Relations, Division of Apprenticeship Standards.

Do not send this form to the Division of Apprenticeship Standards.

NAME OF YOUR COMPANY CONTRACTOR'S STATE LICENSE NO
MAILING ADDRESS- NUMBER & STREET, CITY, ZIP CODE AREA CODE & TELEPHONE NO.

NAME & ADDRESS OF PUBLIC WORKS PROJECT DATE YOUR CONTRACT EXECUTED

DATE OF EXPECTED OR ACTUAL START OF PROJECT

NAME & ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT ESTIMATED NUMBER OF JOURNEYMEN HOURS

OCCUPATION OF APPRENTICE
THIS FORM IS BEING SENT TO: (NAME & ADDRESS OF APPRENTICESHIP PROGRAM(S)) ESTIMATED NUMBER OF APPRENTICE HOURS

APPROXIMATE DATES TO BE EMPLOYED
This is not a request for dispatch of apprentices.

Contractors must make a separate request for actual dispatch, in accordance with Section 230.1(a) California Code of Regulations Check One Of The Boxes Below

1. We are already approved to train apprentices by the
Apprenticeship Committee. We will employ and train under their Standards. Enter name of the Committee

2. We will comply with the standards of
Apprenticeship Committee for the duration of this job only. Enter name of the Committee

3. We will employ and train apprentices in accordance with the California Apprenticeship Council regulations, including § 230.1 (c) which requires that apprentices employed on public projects can only be assigned to perform work of the craft or trade to which the apprentice is registered and that the apprentices must at all times work with or under the direct supervision of j o ur ne y m a n /men.

Signature
Typed Name
Title
Date
DAS 140 (REV. 1/04)
State of California - Department of Industrial Relations DIVISION

OFAPPRENTICESHIPSTANDARDS
AGREEMENT TO TRAIN APPRENTICE District No.

DAS File No.

NAME OF EMPLOYER

MAILING ADDRESS (STREET AND NUMBER) CITY STATE ZIP CODE TELEPHONE NUMBER

ADDRESS OF TRAINING LOCATION (IF DIFFERENT)
OCCUPATION(S) O*Net Code

NAME OF APPRENTICESHIP COMMITTEE AND STANDARDS
AREA COVERED BY APPRENTICESHIP STANDARDS or NAME AND ADDRESS OF PROJECT THE OFFICIAL, whose signature follows, agrees on behalf of the above named employer to train apprentices in the designated occupation in accordance with the apprenticeship standards and apprentice agreement and to comply with the provisions thereof. [SIGNED] By
Printed name
Title Date
THE APPRENTICESHIP COMMITTEE accepts and approves the employer as qualified to train apprentices under its standards in the designated occupation.
[SIGNED] By
Printed name
Effective until:

Revoked
End of Project (Enter project
Title Date name and address in Area Covered above)
Date
Accepted: Date
DIVISION OF APPRENTICESHIP STANDARDS Other
Specify

EFFECTIVE DATE
REMARKS:
[SIGNED] By Date
Apprenticeship Consultant

STATE OF CALIFORNIA

DEPARTMENT OF INDUSTRIAL RELATIONS

DIVISION OF APPRENTICESHIP STANDARDS
DAS 7 (REV 11/09)
MUST be signed by both Committee and DAS prior to submission A B C D E Official Use
D. O. FILE NUMBER Gender Ethnic Dependents Education Yrs Employ STATUS State of California -- Department of Industrial Relations --DIVISION OF APPRENTICESHIP STANDARDS

APPRENTICE AGREEMENT

APPRENTICE LAST NAME, FIRST NAME MIDDLE SOCIAL SECURITY NUMBER APPRENTICE ADDRESS (NUMBER AND STREET / CITY, STATE & ZIP) BIRTHDATE(mm/dd/yyyy) F - VETERAN Yes: No:

COUNTY OF RESIDENCE
OCCUPATION O*Net code

TERM OF APPRENTICESHIP
HoursWithin Years

STRAIGHT TIME
Hours per day: 8 Hours per week: 40
This agreement is between the above named apprentice employed by the below named employer, and

PROGRAM SPONSOR
AGREEMENT: The undersigned parties mutually agree that they will use their best endeavors to secure employment and training for the apprentice. The apprentice agrees to perform satisfactorily all work and learning assignments. The provisions of the Apprenticeship Standards for the above occupation adopted by the program sponsor and approved by the Chief of the Division of Apprenticeship Standards are hereby made a part of this agreement. An official copy of the standards is on file in the headquarters of the Division of Apprenticeship Standards. This apprentice agreement will continue in effect until the training is completed or otherwise terminated in accordance with the standards.

The apprentice commences participation under these standards on the date of execution of this agreement by the Apprentice. The signatory apprentice is credited with having months toward completion of the term of apprenticeship. The apprentice is expected to complete training on or about , 20 , upon satisfactory completion of the total remaining hours of on-the-job training and hours and/or units of related and supplemental instruction.

APPRENTICE: I, the undersigned apprentice, understand and agree that there is a valid and reasonable necessity that those academic records accumulated throughout related and supplemental instruction during my period of apprenticeship be made available to the apprenticeship committee. Further, I agree to release to the apprenticeship committee any other academic records which I feel may enhance my status as an apprentice.

I, the undersigned apprentice, hereby request that the Administrator of Apprenticeship terminate any other apprenticeship agreements in which I am currently registered.

Executed this day of , 20 by DAY MONTH YEAR SIGNATURE OF APPRENTICE

AGREED TO BY THE EMPLOYER
SIGNATURE OF PARENT OR GUARDIAN (IF APPRENTICE IS 16 OR 17)

SIGNATURE OF EMPLOYER OR ITS REPRESENTATIVE TITLE

AGREED TO AND APPROVED BY, FOR THE COMMITTEE

NAME OF EMPLOYER

ADDRESS

SIGNATURE -- SECRETARY / CHAIR / COORDINATOR DATE

ACCEPTED BY DAS
for unilateral programs only]
This agreement is approved by

SIGNATURE -- APPRENTICESHIP CONSULTANT DATE
for the Administrator of Apprenticeship
DAS 1 (REV. 4/12) APPRENTICE AGREEMENT
TO THE APPRENTICE: California Civil Code Sec. 1798.17 requires State agencies which collect personal information to indicate the authority under which the data are requested. If personal information not specifically authorized by law is requested, individuals must be informed that supplying the information is voluntary. It also provides that state agencies may change or modify records at the request of the individual.

Questions C and E below are voluntary. All others are authorized by law, as indicated by the reference in each section. If the authorized questions are not answered, the apprentice agreement cannot be accepted.

The Division hopes, through collection of this data, to improve the apprenticeship program both for those presently enrolled and for future apprentices. Thank you.

CALIFORNIAAPPRENTICEQUESTIONNAIRE
(USE INK OR BALLPOINT PEN)
A. Gender
 Male  Female
(Cal. Code of Regulations, Title 8, Ch. 2, Sec. 215
C. Number of Dependents (Do not count yourself)
0  None 4  Four
1  One 5  Five
2  Two 6  Six of More
3  Three
(Voluntary)
B. Ethnic or Race Derivation (Check onlyone)
1  WHITE (Not of Hispanic Origin) -- A person having origins in any of the original peoples of Europe, North Africa or the Middle East.
2  BLACK (Not of Hispanic Origin) -- A person having origins in any of the Black racial groups of Africa.

ASIAN OR PACIFIC ISLANDER -- A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent or the Pacific Islands. The area includes, for example, China, Japan, Korea and Samoa.

A  Asian Asian Indian
B  Asian Bangladeshi
C  Asian Chinese
D  Asian Cambodian
6  Asian Filipino
E  Asian Hmong
I  Asian Indonesian
J  Asian Japanese
K  Asian Korean
L  Asian Laotian
M  Asian Malaysian
P  Asian Pakistani
R  Asian Sri Lankan
T  Asian Taiwanese
U  Asian Thai
V  Asian Vietnamese
F  Native Hawaiian Fijian
G  Native Hawaiian Guamanian
H  Native Hawaiian Hawaiian
S  Native Hawaiian Samoan
W  Native Hawaiian Tongan
4  AMERICAN INDIAN OR ALASKAN NATIVE -- A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition.
 HISPANIC -- A person of Mexican, Puerto Rican, Cuban, South 7 Central American or other Spanish culture or origin, regardless of race.
(Cal. Labor Code, Ch. 4, div. 3, Sec. 151)
D. Highest Year of Education Completed
1  8th Grade or less 6  1 Year of College
2  9th Grade 7  2 Years of College
3  10th Grade 8  3 Years of College
4  11th Grade 9  4 or more Years of
College
5  12th Grade (or GED
Certificate)
(Cal. Labor Code, Ch. 4, div. 3, Sec. 3076.3)
E. Number of Years You Have Been Employed Full Time to Date (Except for Military Service)
0  None
1  Less Than 1 Year
2  1 But Less Than 2 Years
3  2 But Less Than 3 Years
4  3 But Less Than 4 Years
5  4 But Less Than 5 Years
6  5 Years or More
(Voluntary)
F. Have You Served on Active Duty (other than reserve status) in the U. S. Armed Forces?
 Yes  No
If yes, Please Enter:

Month and Year Entered
Month and Year Separated
Total Months served on Active Duty
Apprentice's Signature
REQUEST FOR DISPATCH OF AN APPRENTICE – DAS 142 FORM

DO NOT SEND THIS FORM TO DAS
You may use this form to request dispatch of an apprentice from the Apprenticeship Committee in the craft or trade in the area of the public work. Go to: http://www.dir.ca.gov/databases/das/pwaddrstart.asp for information about programs in your area and trade. You may also consult your local Division Apprenticeship Standards (DAS) office whose telephone number may be found in your local directory under California, State of, Industrial Relations,Division of Apprenticeship Standards. Except for projects with less than 40 hours of journeyman work, you must request and employ apprenticesin no less than 8 hour increments.

Date: Contractor Requesting Dispatch:

Name:

Address:

License No.

Tel. No. Fax No.

To Applicable Apprenticeship Committee:

Name:

Address:

Tel. No. Fax No.

Project Information:

Contract No. _
Name of the Project:

Address:

Dispatch Request Information:

Number of Apprentice(s) Needed: Craft or Trade:

Date Apprentice(s) to Report: (72 hrs. notice required) Time to Report:

Name of Person to Report to:

Address to Report to:

You may use this form to make your written request for the dispatch of an apprentice. Requests for dispatch must be in writing and submitted at least 72 hours in advance (excluding weekends and holidays) via first class mail, fax or email. Proof of submission may be required. Please take note of California Code of Regulations, Title 8, § 230.1 (a) for all applicable requirements regarding apprenticeship requests and/or visit http://www.dir.ca.gov/DAS/DASApprenticesOnPublicWorksSummaryOfRequirements.htm DAS 142 (Revised 04/14)
Documents Required During the Life of the Construction Project

1. CAC-2- Training Fund Contribution Form:
a) All Contractors must submit a CAC-2 Form monthly for the prior month’s hours. b) This form is now available to be filled out on the DIR website. The previous CAC- 2 form is to be disregarded. CAC-2 forms must be done electronically.

The link is as follow: https://www.dir.ca.gov/das/tf/cac2.asp. You must enter all requested information in order to ensure successful submission and processing of your payment. You will need to have a working printer currently connected to your computer in order to print the complete paper form in the end of this session that you will upload in to LCPtracker.net and send with your payment when mailed. The address is as follows:

State of California
Department of Industrial Relations
California Apprenticeship Council
P.O.Box 511283
Los Angeles, CA 90051-7838
c) If applicable and fringes are paid directly to an approved JATC or Union Shop please state so and fill out on the Training Fund Contribution Union Contractor form that is provided and available to be downloaded on LCPtracker. Filled out forms are uploaded into LCPtracker.net under the eDocuments tab.

2. Training Fund Contribution Letter Form:
a) All Contractors must submit a Training Fund Contribution Letter monthly for the prior month’shours.
b) If applicable and fringes are paid directly to an approved Union Shop please submit the Union Status Letter stating that the Contractor is up to date with all fringe and training fund contributions for the requested month. The letter should specify the month, project name, and project number. c) If you can’t provide a letter and the DAS has not been updated with your contribution at Contractor may provide a copy of a cancelled check submitted to the proper JATC or the DAS with the amount that matches that on the CAC-2.

You may check the status of your contributions submitted to DAS online at:
http://www.dir.ca.gov/CAC/trainingfund/Tfsearch.html. Thismay also be submitted in lieu of the Training Fund Contribution Letter.

3. Certified Payroll Reports CPR’s and/orNon-Performance Reports:
a) To be submitted by all Contractors working on the project to the City of Sacramento and the Department of Industrial Relations Electronic Certified Payroll Records site.
b) The reports submittedto the City of Sacramento are submitted through the contracted electronic reporting program, LCPtracker.net, which can be found online at www.lcptracker.net. If you don’t already have a user name and password for this website please contact your labor compliance officer with the City of Sacramento to be set up.
c) The Electronic Certified Payroll Records for Contractors can be found at the following link: https://apps.dir.ca.gov/ecpr/DAS/AltLogin d) Submit CPR/NPR weekly; starting (10) calendar days after the close of your pay period. This is when you begin onsite/offsite “craft” labor. This may mean you have weeks in between work on a particular job. NPR’s will need to be submitted for that timeframe.

4. Apprenticeship Certification and/or Apprentice Agreement:
a) The first time an apprentice is listed on a certified payroll report an “Apprenticeship Certification” or Apprentice Agreement(DAS-1 form) must be submittedfor each apprentice utilized.
b) Please upload the Apprenticeship Certification or DAS-1 form in the eDocuments section of LCPtracker.net, add the apprentice ID andpertinent information under the employee information and notify the labor compliance officer in your department that approval is need prior to certification of payroll.

5. Miscellaneous Documents:
a) Authorization for Deductions:
i. Voluntary deductions require an Authorization for Deductions form; garnishments require a copy of notice (redact personal information). A form has been provided on LCPtracker to address other deductions that are recorded on the Certified Payroll Reports submitted.
b) Receiptfor Payment of Back Wages:
i. For use when wage errors require supplemental wage payment (s).

FORMS REQUIRED DURING

THE LIFE OF THE

CONSTRUCTION PROJECT
DIR - Compliance Monitoring Unit
https://apps.dir.ca.gov/ecpr/DAS/AltLogin[4/7/2015 3:37:26 PM] Home About DIR Contact DIR Site Map Conditions of Use Disability accommodation Disclaimer Archives Privacy Policy Help Public Records Act Frequently Asked Questions Copyright © 2013 State of California
Electronic Certified Payroll Records - Contractors
Welcome to the new online CMU Payroll Records Application.

First time users will need to setup their account using the "First Time User button".

You will need your Contractor ID (CSLB# or Professional #) to create an account.

The PWC 100 is an online notification system that requires public agencies to submit detailed public works project information (Awards) to the Department of Industrial Relations (DIR). Once the Award is in the system, Contractors will need to report their Certified Payroll Records.

Contractors will be able to upload Certified Payroll Records (CPRs) and Statements of Employer Payments (PW 26) through the eCPR application using PDF format. Prime contractors will be able to add their subcontractors to an Award so that subcontractors can upload their CPRs using the eCPR application. In order to upload CPRs and other payroll documents, contractors must be associated with one or more Awards.

If you have any questions, please contact CMU at [email protected] Sign In
Email Address:

Password:

Remember me on
this computer
To create an account
please select the
First Time User
button above.

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DASCACTrainingFundContributions
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This Site California
Home Labor Law Cal/OSHA - Safety & Health Workers' Comp Self Insurance Apprenticeship Director's Office Boards CAC - Training Fund Contributions
You must enter all requested information in order to ensure successful submission and processing of your payment.

Training Fund Contributions are due on the 15th of each month.

All fields with * are required.

You must use the BUTTON on the bottom of the page to submit for an invoice coupon.

TO NAVIGATEBETWEEN FIELDS, DO NOT HIT RETURN OR ENTER KEY AFTER EACH ENTRY. USE THE TAB KEY INSTEAD.

You need to have a working printer currently connected to your computer in order to print the complete paper form in the end of this session so that you can mail it with your payment.

Training Fund Contributions Form CAC2
Date:

CLEAR FORM
Contractor/Sub Contractor
making contributions
Contractor Period covered
by contribution
Jobsite Location
(including County)
(from – to)
* Name: * License Number: * Period Start: If applicable, give name of school, hospital, building, etc. * Address:
* City:
* State:
* ZIP:
* Contract/Project Number * Period End:
(MM/DD/YYYY)
Comments:
* Name of the submitting party: * Submitter's Title: * Submitter's Email: *Submitter's Phone:
e.g., (999) 999 -9999
Instructions: You may want to use the keyboard TAB key to navigate the fields and the Up /\ | Down \/ ARROW keys to select a list item. * County of Work * Classification * Hours (max: 9,999.99) * Rate (max: $9.99) Amount *1) Select a county Select an occupation $ $ 0.00
2) Select a county Select an occupation $ $ 0.00
3) Select a county Select an occupation $ $ 0.00
4) Select a county Select an occupation $ $ 0.00
DASCACTrainingFundContributions
5) Select a county Select an occupation $ $ 0.00
6) Select a county Select an occupation $ $ 0.00
7) Select a county Select an occupation $ $ 0.00
8) Select a county Select an occupation $ $ 0.00
9) Select a county Select an occupation $ $ 0.00
10) Select a county Select an occupation $ $ 0.00
11) Select a county Select an occupation $ $ 0.00
12) Select a county Select an occupation $ $ 0.00
13) Select a county Select an occupation $ $ 0.00
14) Select a county Select an occupation $ $ 0.00
15) Select a county Select an occupation $ $ 0.00
16) Select a county Select an occupation $ $ 0.00
17) Select a county Select an occupation $ $ 0.00
18) Select a county Select an occupation $ $ 0.00
19) Select a county Select an occupation $ $ 0.00
20) Select a county Select an occupation $ $ 0.00
TOTAL AMOUNT: $ 0.00
When done with some or all the entries above please carefully review and then enter the code you see below:

Copyright © 2014 State of California
The electronic submission of the CAC-2 Form is to be used in place of the previous CAC-2 Form that was submitted on LCPtracker. This form can be retrieved at: https://www.dir.ca.gov/das/tf/cac2.asp. You need to have a working printer currently connected to your computer in order to print the complete paper form in the end of this session so that you can mail it with your payment. Payments are to be mailed to State of California, Department of Industrial Relations, California Apprenticeship Council, and P.O. Box 511283, Los Angeles, CA 90051-7838 Please use a separate form for each jobsite, listing the occupations for the jobsite and dollar amount paid for
each classification. Once checks have been sent to
the appropriate JATC please upload this form to
LCPtracker under the e-Documents tab. A letter from
the specific JATC or Union specifying that the required Training fund contributions and Fringe Benefits were
paid will be accepted as proof of payment.

TRAINING FUND CONTRIBUTIONS

VERFICATION FORM UNION CONTRACTORS
**Training Fund Contributions are due on the 15th of each month** PLEASE TYPE OR PRINT IN BLACK OR BLUE INK. ALL FIELDS MUST BE FILLED IN TO ENSURE COMPLETION OF LABOR COMPLIANCE REQUIREMENTS.

NAME AND ADDRESS OF CONTRACTOR/SUB CONTRACTOR MAKING CONTRIBUTION CONTRACTOR'S LICENSE NUMBER

CONTRACT OR PROJECT NUMBER

JOBSITE LOCATION (INCLUDE COUNTY) IF APPLICABLE - GIVE NAME OF SCHOOL, HOSPITAL, BUILDING, etc. NAME AND ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT

PERIOD COVERED BY CONTRIBUTION (FROM - TO)
CLASSIFICATIONS OF WORKERS (CARPENTER, PLUMBER, ELECTRICIAN, ETC). COUNTY WORK PERFORMED IN ALL HOURS CONTRIBUTION AMOUNT

RATE PER HOUR
TOTAL

IF APPRENTICES WERE EMPLOYED, PLEASE LIST THE APPRENTICESHIP PROGRAM AND NUMBER OF APPRENTICE HOURS WORKED

TYPE OR PRINT YOUR NAME AND TITLE DATE

EMAIL AREA CODE & TELEPHONE NUMBER
CAC 2 Union Contractors (rev.10/14) TRAINING FUND CONTRIBUTIONS Project Name:

Project Number:

Employee Name:

AUTHORIZATION FOR PAYROLL DEDUCTION
1) Reason for Deduction: