Ibew Local Union 292 Prevailing Wage Form

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IBEW LOCAL UNION 292
Prevailing Wage Form
PROJECT TYPE
□
□
Bid
Project Number
________________________
COMMERCIAL over $2,500
□
□
Negotiated
Project Value______________________
HIGHWAY/HEAVY over $25,000
□
Maintenance
Sub-Contract Value ________________
PROJECT NAME ____________________________________________________________________
PROJECT ADDRESS OR LOCATION ___________________________________________________
PROJECT COUNTY, CITY ____________________________________________________________
CONTRACTOR NAME _______________________________________________________________
□
CONTRACTOR IS:
GENERAL/PRIME
□
SUB-CONTRACTOR, if Sub-Contractor, who is the
GENERAL/PRIME on this project ______________________________
□
□
□
This is the 1st Visit
2nd Visit
3rd Visit
Visit Date _______________________________
Project Start Date _________________________
Project Finish Date _________________________
BRIEF DESCRIPTION OF WORK PERFORMED:
EMPLOYEE FULL NAME
LABOR CODE /AGREEMENT UNDER
__________________________________________ ______________________________________________________
__________________________________________ ______________________________________________________
__________________________________________ ______________________________________________________
__________________________________________ ______________________________________________________
__________________________________________ ______________________________________________________
__________________________________________ ______________________________________________________
__________________________________________ ______________________________________________________
__________________________________________ ______________________________________________________
__________________________________________ ______________________________________________________
NAME OF STEWARD__________________________________________________________
SIGNATURE _________________________________________________________________

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