Request for Wage Determination and Response to Request Revised 2016

U.S. DEPARTMENT OF LABOR EMPLOYMENT STANDARDS ADMINISTRATION REQUEST FOR DETERMINATION AND RESPONSE TO REQUEST (Davis-Bacon Act as Amended and Related Statutes)

Submit Request To: Department of Housing and Community Development Community Development Block Grant (CDBG) Program 2020 West El Camino Avenue, Suite 650 Sacramento, CA 95833 Attn: Marc Firestone (Labor Standards Specialist)

Or VIA e-mail: [email protected]

Jurisdiction Name:

Response to Request Standard Agreement number Type of Work: Residential Building OR Highway Heavy PI Waiver

Requesting Officer: 10 Day Update Request? Phone: Yes No

Date of this Request: Est. Advertising Date: Est. Bid Opening Date:

Prior Decision Number (if any) Est. Contract Value Est. Award Date: $

Project Name: If Housing Address/Project Location: # of Units: City: # of Stories: County: # of Dwellings: State: California Description of Work:

Address to which wage determination should be e-mailed:

 HCD USE ◀◀◀ Use area determination for: Approved: Date: Name: Marc Firestone

(916) 263-1583 Position: HCD Representative II Title: Labor Standards Specialist

Request for Wage Determination and Response to Request revised 2016