PROJECT WAGE RATE AND SECTION 3 CLASSIFICATION FORM
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PROJECT WAGE RATE AND SECTION 3 CLASSIFICATION FORM Project Name: Wage Decision & Modification Number: Contractor: Project Number: Project County: Person Completing Form: Title: Employee Name Wage Classification (must be listed in wage decision or approved additional classification) Hourly Rate Fringe Benefits Total Wage Initial Hire Date Section 3 Worker (Check) Targeted Section 3 Worker (Check) Health Insurance Vacation Pay Sick Leave Pay Retirement Benefits Other - List: ________ TOTAL FRINGE _____________________________________ ____________________ * If multiple pages are needed to list all (Certifying Signature) (Date) workers, sign and date last page. 2021 CDBG Manual Chapter I: Labor Compliance I-1
Transcript of PROJECT WAGE RATE AND SECTION 3 CLASSIFICATION FORM
PROJECT WAGE RATE AND SECTION 3 CLASSIFICATION FORM
Project Name: Wage Decision & Modification Number: Contractor:
Project Number: Project County: Person Completing Form:
Title:
Employee Name
Wage Classification
(must be listed in wage
decision or approved
additional
classification)
Hourly
Rate
Fringe Benefits Total
Wage
Initial
Hire Date
Section
3
Worker
(Check)
Targeted
Section 3
Worker
(Check)
Health
Insu
rance
Vacatio
n
Pay
Sick
Leav
e
Pay
Retirem
ent
Ben
efits
Oth
er - List:
__
__
__
__
TO
TA
L
FR
ING
E
_____________________________________ ____________________ * If multiple pages are needed to list all
(Certifying Signature) (Date) workers, sign and date last page.
2021 CDBG Manual Chapter I: Labor Compliance
I-1