Contracting Agency Original Request for Prevailing Wage Rate Form

Contracting Agency Original Request for Prevailing Wage Rate Form
A member of the State of Connecticut Wage and Workplace team will be processing your rate request after successful submission of this form. We will contact you after the rate request has been processed. Please be patient since we are currently handling a large number of rate requests. Thank you very much.
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:*

MonthDayYear
Date
Estimated Duration of the Project - End Date:*

MonthDayYear
Date
Date Advertised to Bid:*

MonthDayYear
Date
Check The Type of Schedule(s) Needed:*

BuildingHeavy/HighwayResidential
Come visit us on 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.

Holly.Carter@ct.gov 860.263.6549 or Mary.Toner@ct.gov 860.263.6606
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Should be Empty: