Rev. 02/24/97
Certificate of Contractor to the Comptroller or
Financial Officer of The City of New York
Under the provisions of Section 220a and/or Section 237 of the Labor Law of the State of New York,
and the terms and conditions of Contract
................................................................................................... with The Board of Education of The
City of New York, the undersigned CONTRACTOR hereby certifies to the Comptroller and the
Director of Finance of The City of New York that the following is a true and correct statement of the
amounts now due from the said CONTRACTOR to laborers for daily or weekly wages on account of
labor performed upon the work under the aforementioned contract, and the material and/or supplies
delivered for use on the work, and for which payment is due, to wit:
AMOUNTS DUE FOR:
NAMES L
ABOR MATERIAL & SUPPLIES
(Note: If no money is due to any laborers, state above "None due to laborers." If no money is due to
other persons for material and/or supplies delivered for use on the work, state above "None due to
materialmen and supplymen.")
That the following is a true and correct list of all subcontractors who have employed laborers and/or
used materials and/or supplies for work performed under said contract:
NAMES OF SUBCONTRACTORS WORK SUBCONTRACTED
(I) or (We) have complied with all provisions of Section 220
and/or Section 230 (as each applies) of the New
York State Labor Law.
(Note: If no subcontractors are employed, state above "None.")
..............................................................................
Contractor
By..........................................................................
President
STATE OF NEW YORK,
COUNTY OF.............................
}
ss.:
..............................................................................................................., being duly sworn, deposes and
says that he is the ...................................................... of the ...................................................., the
CONTRACTOR named in and who executed the foregoing; that he has read the foregoing statement
subscribed by him and knows the contents thereof, and that the same is true of his own knowledge and
is executed under the provisions of Section 220-a of the Labor Law of the State of New York,
and the terms and conditions of Contract ..........................................................................................
with The Board of Education of The City of New York.
..............................................................................
Sworn to before me this ............................................. President
day of ....................................., 20..............................
....................................................................................
Notary Public, County of ..................................................
Note: A County Clerk's notarial certificate must accompany this
document if it is executed outside the State of New York
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