Fringe benefit statement form 2026

1. Click ‘Get Form’ to open the fringe benefit statement in the editor.
2. Begin by entering your company information. Fill in the Company Name, Date, Street Address, Suite/Unit #, City, State, Zip, License Number, Issuing State(s), and Classification.
3. Next, move to the Contract Information section. Input the Project Name/Number and Contract Number to ensure proper identification of your contract.
4. In the Fringe Benefit section, list the hourly rates for various benefits such as Vacation, Health & Welfare, and Pension. Ensure you include the effective date for each classification.
5. Complete any additional fields for Subsistence and/or Travel Pay and other classifications as necessary. Make sure all amounts are accurately filled in.
6. Finally, certify your information by providing your Print Name, Title/Position, Authorized Signature, and Date at the bottom of the form.

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