Attachment 20 - SF 1444 - Request for Authorization of Additional Classification and Rate.pdf
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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, Employment Standards Administration
WAGE AND HOUR DIVISION
U.S. DEPARTMENT OF LABOR
WASHINGTON, D.C. 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) (SCA 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 (SCA 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 (SCA) OR FAR 22.406-3 (DBA)) 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 copies 1, 2, and 3 to Department of Labor)
SIGNATURE OF CONTRACTING OFFICER OR
REPRESENTATIVE
STANDARD FORM 1444 (REV. 12-2001)
Prescribed by GSA-FAR (48 CFR) 53.222(f)
TITLE AND COMMERCIAL TELEPHONE NO. DATE SUBMITTED
CHECK APPROPRIATE BOX
SERVICE CONTRACT
CONSTRUCTION CONTRACT
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS USABLE
Public reporting burden for this collection of information is estimated to average 15 minutes 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 aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat (MVP), Office of Acquisition Policy, GSA, Washington, DC 20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0089), Washington, DC 20503.
OMB Number: 9000-0089 Expiration Date: 7/31/2014
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, Employment Standards Administration
WAGE AND HOUR DIVISION
U.S. DEPARTMENT OF LABOR
WASHINGTON, D.C. 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) (SCA 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 (SCA 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 (SCA) OR FAR 22.406-3 (DBA)) 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 copies 1, 2, and 3 to Department of Labor)
SIGNATURE OF CONTRACTING OFFICER OR REPRESENTATIVE
STANDARD FORM 1444 (REV. 12-2001)
Prescribed by GSA-FAR (48 CFR) 53.222(f)
TITLE AND COMMERCIAL TELEPHONE NO.
DATE SUBMITTED
CHECK APPROPRIATE BOX
SERVICE CONTRACT
CONSTRUCTION CONTRACT
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS USABLE
Public reporting burden for this collection of information is estimated to average 15 minutes 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 aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat (MVP), Office of Acquisition Policy, GSA, Washington, DC 20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0089), Washington, DC 20503.
OMB Number: 9000-0089 Expiration Date: 7/31/2014 8.2.1.4029.1.523496.503679
| CHECK APPROPRIATE BOX. SERVICE CONTRACT: 0 |
| CHECK APPROPRIATE BOX. CONSTRUCTION CONTRACT: 0 |
| 2. FROM: (REPORTING OFFICE): |
| 3. CONTRACTOR: |
| 4. DATE OF REQUEST. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 9. DATE OPTION EXERCISED (If APPLICABLE) (SCA ONLY) Enter 2 digit month, 2 digit day and 4 digit year.: |
| 8. DATE CONTRACT WORK STARTED. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 7. DATE OF AWARD. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 6. DATE BID OPENED (SEALED BIDDING) Enter 2 digit month, 2 digit day and 4 digit year.: |
| 5. CONTRACT NUMBER: |
| 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: |
| 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. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY) 1 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY) 9 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY) 10 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY) 8 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY) 7 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY) 6 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY) 5 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY) 4 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY) 3 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY) 2 of 10.: |
| 13b. WAGE RATE(S): |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 14. TITLE OF SUBCONTRACTOR REPRESENTATIVE (IF ANY): |
| SIGNATURE OF CONTRACTING OFFICER OR REPRESENTATIVE: |
| 14. SIGNATURE OF SUBCONTRACTOR REPRESENTATIVE (IF ANY): |
| TITLE: |
| 14. SIGNATURE OF PRIME CONTRACTOR REPRESENTATIVE (IF ANY): |
| SIGNATURE OF CONTRACTING OFFICER OR REPRESENTATIVE: |
| CHECK APPROPRIATE BOX-REFERENCING BLOCK 13. AGREE: 0 |
| CHECK APPROPRIATE BOX-REFERENCING BLOCK 13. DISAGREE: 0 |
| THE INTERESTED PARTIES AGREE AND THE CONTRACTING OFFICER RECOMMENDS APPROVAL BY THE WAGE AND HOUR DIVISION. AVAILABLE INFORMATION AND RECOMMENDATIONS ARE ATTACHED.: 0 |
| 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.: 0 |
| TITLE : |
| COMMERCIAL TELEPHONE NUMBER: |
| DATE SUBMITTED. Enter 2 digit month, 2 digit day and 4 digit year.: |
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