Attachment_6_SF_1444.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, 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 No.: 9000-0089 Expires: 04/30/2005

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 No.: 9000-0089 Expires: 04/30/2005 8.2.1.4029.1.523496.503679