202109101741541389/10/2021
Contractor:
Creekside Electrical Contractors, Inc.
For week beginning on: Q/2/2O2i
For week ending on: 0/8/2021
Payroll Number: 5
09-21 Keller Water Storage Improvements Project
09'21 Keller Water Storage Improvements Project
|, Jennifer Andrews the undersigned, amthe President with the authority huact for and mnbehalf ofCreukoideElectrical
Contractors, Inc.
certify under penalty of perjury that no work was performed for the week for week ending on: 9/8/2021.
| herein certify under penalty ofperjury that all ofthe above is true and correct as submitted.
�e /uv�lo,
,
Jennife(A dr�ews, Preolent
9/10/21, 10:34 AM eCPR Form Application
Your payroll submission request has been processed.
Please review the results of your submission. Should you have any questions please contact the eCPR unit at
publicworks@dir.ca.gov.
Statement of non-performance created...
Contractor Name: CREEKSIDE ELECTRICAL CONTRACTORS, INC.
Contractor Address: 3059 AIRPORT RD. CARSON CITY NV 89706
Awarding Body: SOUTH TAHOE PUBLIC UTILITY DISTRICT
Project ID: 371032
Contract With: WHITE ROCK CONSTRUCTION, INC.
Week Ending Date: 2021-09-08
Payroll Number: 5
Amendment Number: 0
0 employee payroll record(s) processed
Your Transaction ID is: 12041636
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