IBEW LOCAL UNION 292
Prevailing Wage Form
PROJECT TYPE
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Bid
Project Number
________________________
COMMERCIAL over $2,500
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Negotiated
Project Value______________________
HIGHWAY/HEAVY over $25,000
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Maintenance
Sub-Contract Value ________________
PROJECT NAME ____________________________________________________________________
PROJECT ADDRESS OR LOCATION ___________________________________________________
PROJECT COUNTY, CITY ____________________________________________________________
CONTRACTOR NAME _______________________________________________________________
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CONTRACTOR IS:
GENERAL/PRIME
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SUB-CONTRACTOR, if Sub-Contractor, who is the
GENERAL/PRIME on this project ______________________________
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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 _________________________________________________________________