Prevailing Wage Survey Form
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3Prevailing Wage Survey Form
KYLC ES-46
For instructions refer to:
07/08
Survey of wage rates: Upon submitting evidence, the contractor will include all projects both public works construction and private construction. Acceptable evidence
will include all public works (prevailing wage jobs) and private commercial projects with total project cost in excess of $250,000.00 that were under construction or
completed from the last hearing date indicated on the Legal Notice through the date of the current hearing. Please copy and provide this form to all subcontractors also
performing work. Evidence must be submitted within the guidelines as stipulated on the Legal Notice.
Company/Contractor Name
Address
Phone
Company/Contractor Representative
Check one:
Prime-General or
Subcontractor:
Location of Project
Type of Project
Estimated Project Value/
Full Name of Project
Description of Project
(Street, City, & County)
Bldg/Hvy/Hwy
Total Project Cost
Select
Select County
Each category of this form must be completed in order to be accepted as
See asterisk page 2
*FRINGE BENEFITS PAID
evidence.
Peak Week
Peak #
$ Base Hourly
$ Insurance
$ Pension
$Apprenticeship
Classification
$ Other Explain
Ending Date
Employed
Rate
Health/Life/Dental
Retirement
Training
Plumber / Pipefitter
P.I.C.K.
Industry
Fund
Drug
Policy
Advertising
PAC
Contractor/Employer
Labor Union Representative _____________________________________________________________________________________
Check appropriate box above
Signature of Representative submitting evidence
Page 1 of 3 KY Prevailing Wage Survey Form KYLC 1047 US HWY 127 S. STE 4 Frankfort, KY 40601
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