Certificate of Contractor (or Subcontractor) to the Comptroller or

Financial Officer of the City of New York

Under the provision of Section220-a of the Labor Law of the State of New York, and the terms and conditions of Contract
NC-41G with the Department of Environmental Protection of The City of New York, and Schiavone/WDF A Joint
Venture as contractor, the undersigned CONTRACTOR (or SUBCONTRACTOR) 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 (or SUBCONTRACTOR) to laborers for daily or weekly wages on account of labor
performed upon the work under the aforementioned Contract, and for material and/or supplies delivered for use on the work
and for which payment is due, to wit:
AMOUNTS DUE FOR:
NAMES LABOR MATERIALS & SUPPLIES
NONE

(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

NONE

(Note: If no subcontractors are employed, state above “None.”)

Classico Building Maintenance, Inc.

Contractor (or Subcontractor)

By:
President
STATE OF New York ,
--ss:
COUNTY OF Bronx

____________________being duly sworn, deposes and says that he is the CONTRACTOR (or
SUBCONTRACTOR) named in and who executed the foregoing statement; 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 NC-41G with the Department of Environmental Protection of the City of New York.

X
President

Sworn to before me this day of , 2010

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