Request for Additional Wage Classification & Rate
The Davis-Bacon Act requires a valid Wage Decision be included in the bid package and construction contract
specification before bids are open and be in effect on the date of the construction contact award. Obtain the most
current Davis-Bacon wage decisions at
Date: ______________________________
Subrecipient: ____________________________________ Ordinance No. _________ IDIS No.______
Project Description: ___________________________________________________________________
Construction Location (including county): _________________________________________________
Contract Execution Date: ____________________ Construction Start Date: _____________________
Applicable Wage Decision Number: _________________ Publication Date: _____________________
Prime Construction Contractor: __________________________________________________________
Address: ___________________________ City: _____________ State: _____ Zip Code: _________
Phone Number: ____________________________ Email: ____________________________________
Additional Classification
Hourly Rate
Fringe Benefits
Describe duties to be performed in this classification:
I agree the above classification is commensurate with the hourly rate and fringe benefits:
Contractor’s Signature ______________________________ Date: ________________________
Company Name: __________________________________ Phone Number: ________________
I agree the above classification, hourly rate and fringe benefits:
Worker’s Signature: _______________________________ Date: ________________________
(Worker should not sign if the above classification & wage is not agreed upon.)
Subrecipient’s Labor Standards Officer: ___________________________________________________
Phone Number: __________________________ Date: ____________________________________
Community Development Department Recommendations: Approve Disapprove
Signature ________________________________ Date: _______________________________