Att_20_SF1444-13a.pdf

REQUEST FOR AUTHORIZATION OF

ADDITIONAL CLASSIFICATION AND RATE

INSTRUCTIONS: THE CONTRACTOR SHALL COMPLETE ITEMS 3 THROUGH 16, KEEP A PENDING COPY, AND SUBMIT THE REQUEST, IN

QUADRUPLICATE, TO THE CONTRACTING OFFICER.

1. TO:

ADMINISTRATOR,

WAGE AND HOUR DIVISION

U.S. DEPARTMENT OF LABOR

WASHINGTON, DC 20210

2. FROM: (REPORTING OFFICE)

3. CONTRACTOR 4. DATE OF REQUEST

5. CONTRACT NUMBER 6. DATE BID OPENED (SEALED

BIDDING)

7. DATE OF AWARD 8. DATE CONTRACT WORK

STARTED

9. DATE OPTION EXERCISED (If

APPLICABLE) (SERVICE

CONTRACT ONLY)

10. SUBCONTRACTOR (IF ANY)

11. PROJECT AND DESCRIPTION OF WORK (ATTACH ADDITIONAL SHEET IF NEEDED)

12. LOCATION (CITY, COUNTY AND STATE)

13. IN ORDER TO COMPLETE THE WORK PROVIDED FOR UNDER THE ABOVE CONTRACT, IT IS NECESSARY TO ESTABLISH THE FOLLOWING RATE(S) FOR THE INDICATED CLASSIFICATION(S) NOT INCLUDED IN THE DEPARTMENT OF LABOR DETERMINATION

NUMBER: DATED:

a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES;

AND RATIONALE FOR PROPOSED CLASSIFICATIONS (Service contracts only) b. WAGE RATE(S)

c. FRINGE BENEFITS

PAYMENTS

(Use reverse or attach additional sheets, if necessary)

14. SIGNATURE AND TITLE OF SUBCONTRACTOR REPRESENTATIVE

(IF ANY)

15. SIGNATURE AND TITLE OF PRIME CONTRACTOR REPRESENTATIVE

16. SIGNATURE OF EMPLOYEE OR REPRESENTATIVE TITLE CHECK APPROPRIATE BOX-REFERENCING BLOCK 13.

AGREE DISAGREE

TO BE COMPLETED BY CONTRACTING OFFICER (CHECK AS APPROPRIATE - SEE FAR 22.1019 (SERVICE CONTRACT LABOR

STANDARDS) OR FAR 22.406-3 (CONSTRUCTION WAGE RATE REQUIREMENTS))

THE INTERESTED PARTIES AGREE AND THE CONTRACTING OFFICER RECOMMENDS APPROVAL BY THE WAGE AND HOUR DIVISION. AVAILABLE

INFORMATION AND RECOMMENDATIONS ARE ATTACHED.

THE INTERESTED PARTIES CANNOT AGREE ON THE PROPOSED CLASSIFICATION AND WAGE RATE. A DETERMINATION OF THE QUESTION BY THE WAGE AND HOUR DIVISION IS THEREFORE REQUESTED. AVAILABLE INFORMATION AND RECOMMENDATIONS ARE ATTACHED.

(Send 3 copies to the Department of Labor)

SIGNATURE OF CONTRACTING OFFICER OR

REPRESENTATIVE

STANDARD FORM 1444 (REV. 4/2013)

Prescribed by GSA-FAR (48 CFR) 53.222(f)

TITLE AND COMMERCIAL TELEPHONE NUMBER DATE SUBMITTED

CHECK APPROPRIATE BOX

SERVICE CONTRACT

CONSTRUCTION CONTRACT

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS USABLE

PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to U.S. General Services Administration, Regulatory Secretariat (MVCB)/IC 9000-0089, Office of Governmentwide Acquisition Policy, 1800 F Street, NW, Washington, DC 20405.

OMB Number: 9000-0089 Expiration Date: 9/30/2017

REQUEST FOR AUTHORIZATION OF

ADDITIONAL CLASSIFICATION AND RATE

INSTRUCTIONS: THE CONTRACTOR SHALL COMPLETE ITEMS 3 THROUGH 16, KEEP A PENDING COPY, AND SUBMIT THE REQUEST, IN

QUADRUPLICATE, TO THE CONTRACTING OFFICER.

1. TO:

ADMINISTRATOR,

WAGE AND HOUR DIVISION

U.S. DEPARTMENT OF LABOR

WASHINGTON, DC 20210

2. FROM: (REPORTING OFFICE)

3. CONTRACTOR

4. DATE OF REQUEST

5. CONTRACT NUMBER

6. DATE BID OPENED (SEALED

BIDDING)

7. DATE OF AWARD

8. DATE CONTRACT WORK

STARTED

9. DATE OPTION EXERCISED (If

APPLICABLE) (SERVICE CONTRACT ONLY)

10. SUBCONTRACTOR (IF ANY)

11. PROJECT AND DESCRIPTION OF WORK (ATTACH ADDITIONAL SHEET IF NEEDED)

12. LOCATION (CITY, COUNTY AND STATE)

13. IN ORDER TO COMPLETE THE WORK PROVIDED FOR UNDER THE ABOVE CONTRACT, IT IS NECESSARY TO ESTABLISH THE FOLLOWING RATE(S) FOR THE INDICATED CLASSIFICATION(S) NOT INCLUDED IN THE DEPARTMENT OF LABOR DETERMINATION

NUMBER:

DATED:

a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES;

AND RATIONALE FOR PROPOSED CLASSIFICATIONS (Service contracts only)

b. WAGE RATE(S)

c. FRINGE BENEFITS

PAYMENTS

(Use reverse or attach additional sheets, if necessary)

14. SIGNATURE AND TITLE OF SUBCONTRACTOR REPRESENTATIVE

(IF ANY)

15. SIGNATURE AND TITLE OF PRIME CONTRACTOR REPRESENTATIVE

16. SIGNATURE OF EMPLOYEE OR REPRESENTATIVE

TITLE

CHECK APPROPRIATE BOX-REFERENCING BLOCK 13.

AGREE

DISAGREE

TO BE COMPLETED BY CONTRACTING OFFICER (CHECK AS APPROPRIATE - SEE FAR 22.1019 (SERVICE CONTRACT LABOR STANDARDS) OR FAR 22.406-3 (CONSTRUCTION WAGE RATE REQUIREMENTS)) THE INTERESTED PARTIES AGREE AND THE CONTRACTING OFFICER RECOMMENDS APPROVAL BY THE WAGE AND HOUR DIVISION. AVAILABLE

INFORMATION AND RECOMMENDATIONS ARE ATTACHED.

THE INTERESTED PARTIES CANNOT AGREE ON THE PROPOSED CLASSIFICATION AND WAGE RATE. A DETERMINATION OF THE QUESTION BY THE WAGE AND HOUR DIVISION IS THEREFORE REQUESTED. AVAILABLE INFORMATION AND RECOMMENDATIONS ARE ATTACHED.

(Send 3 copies to the Department of Labor)

SIGNATURE OF CONTRACTING OFFICER OR REPRESENTATIVE

STANDARD FORM 1444 (REV. 4/2013)

Prescribed by GSA-FAR (48 CFR) 53.222(f)

TITLE AND COMMERCIAL TELEPHONE NUMBER

DATE SUBMITTED

CHECK APPROPRIATE BOX

SERVICE CONTRACT

CONSTRUCTION CONTRACT

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS USABLE

PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to U.S. General Services Administration, Regulatory Secretariat (MVCB)/IC 9000-0089, Office of Governmentwide Acquisition Policy, 1800 F Street, NW, Washington, DC 20405.

OMB Number: 9000-0089 Expiration Date: 9/30/2017 8.2.1.4029.1.523496.503679