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Contracting Agency Original Request For Prevailing Wage Rate Form

The Prevailing Wage Rate form is also available here to download and print. (PDF, 116KB)

(Use the Tab key to move forward a field and Shift-Tab to move back a field)
CONTRACTING AGENCY/POLITICAL SUBDIVISION
OR THEIR AGENT REQUESTING RATES:

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: Holly Carter
200 Folly Brook Blvd
Wethersfield, CT 06109
Fax Number (860) 263-6541
Telephone Number (860) 263-6549

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:




200 Folly Brook Boulevard, Wethersfield, CT 06109 / Phone: 860-263-6000

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