CEM2501: Fringe Benefits Statement - CEM2501-1 2026

1. Click ‘Get Form’ to open the CEM2501: Fringe Benefits Statement in the editor.
2. Begin by filling in the 'Contractor or Subcontractor' section. Clearly print your name and provide the contract number, ensuring accuracy for compliance.
3. Next, enter your Department of Industrial Registration Contractors State License Number and Board Number. This information is crucial for verification purposes.
4. In the 'Fringe Benefit Hourly Amount' section, list each classification along with its corresponding fringe benefit amounts such as Vacation, Health and Welfare, Pension, and any other applicable benefits.
5. For each benefit listed, include the name and address of the plan, fund, or program associated with it. Make sure to note the effective date for clarity.
6. Finally, certify your entries by printing your name and title, signing the document, and providing your business telephone number before submitting it with your first certified payroll.

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