20221107120454568STATEMENT Ulm NON-PERFORMANCE
Payroll Number: 10
Contractor: White Rock Construction Inc.
Date: 11/6/2022
I do hereby state that no persons were employed on the construction of
(H2 - Keller -Heavenly Phase 2
during the payroll period commencing on the day of 10/22/2022
ending on the day of 10/28/2022
(Signature of th�cGthorized Person)
Katie McCrosky, Secretary
(Name)
This statement is not required to be submitted until after the submission of the
initial payroll period.