Standard Form 1093 - Schedule Of Withholdings Under The Davis-Bakon Act And/or The Contract Work Hours And Safety Standards Act - 1971

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TO THE CLAIMS DIVISION
U.S. GENERAL ACCOUNTING OFFICE
WASHINGTON, D.C. 20548
Contractor or subcontractor charged
with violations
Prime contractor
Contract No.
,
(Date)
Report concerning irregularities transmitted to--
,
(Date)
Deducted from amounts otherwise due the contractor, for deposit to the account "05X6022," covering wages due the
employees whose names, social secuirty numbers, and current addresses are listed on the attached schedule, are
withholdings pursuant to the following laws:
$
Davis-Bacon Act
$
Contract Work Hours and Safety Standards Act
$
Total
Forwarded herewith is check No.
, dated
for $
(Disbursing officer or other administrative official)
Standard Form 1093
October 1971
4 GAO 46

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