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PROJECT NAME AND NUMBER (IF APPLICABLE):

LOCATION OF PROJECT:

PROJECT DESCRIPTION:

TOTAL COST OF PROJECT:

ESTIMATED DURATION OF THE PROJECT:
Start Date:     End Date:

DATE ADVERTISED TO BID:

CHECK THE TYPE OF SCHEDULE(S) NEEDED:
BUILDING
HEAVY/HIGHWAY
RESIDENTIAL
SPANISH RATES (available in Building Only upon request)

MAIL OR PICK-UP OR E-MAIL (provide email address below)

Please fax or mail it to:

Connecticut Department of Labor
Wage & Workplace Standards Division
Attention: Resa Spaziani or Matthew Ferri
645 South Main Street
Middletown, CT
Telephone Number (860) 754-5181 and (860)754-5186

Click here to downloaded a copy of this form  (PDF, 44KB)

Come visit us on our website at  WWW.CTDOL.STATE.CT.US

As required by law please submit requests for rates at least ten (10) days but not more than twenty (20) days prior to the date of advertisement for bid.

PERSON REQUESTING RATES:

Name:
Street Address:
City:
State:	Zip Code:
Telephone Number:
E-Mail Address: