Standard Wage Rate Determination for Certain Service Workers
"
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" indicates a required field.
State Agent:
*
Contract Name and Number (if applicable):
Location of Work Being Performed:
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Contract Description:
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Total Cost of Contract:
*
Estimated Duration of The Project - Start Date:
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Month
-
Day
Year
Date Picker Icon
Estimated Duration of The Project - End Date:
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Month
-
Day
Year
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Date Advertised to Bid:
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Month
-
Day
Year
Date Picker Icon
Name:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
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Area Code
Phone Number
Email:
*
example@example.com
Please verify that you are human
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For verification purposes, please trace the image presented:
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Submit
Should be Empty: