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2015 Prevailing Wage Survey
Contractor Information

1 NAME OF BUSINESS OR ORGANIZATION:
WV CONTRACTORS LICENSE NUMBER:
2. STREET ADDRESS: 3. CITY: 4. STATE: 5. POSTAL CODE:
6. TELEPHONE NUMBER: 7. FAX NUMBER: 8. OWNER OR REPRESENTATIVE:
9. PLEASE ENTER YOUR EMAIL ADDRESS (OPTIONAL)
10. CLASSIFICATION 11. NUMBER OF INDIVIDUALS IN THIS CLASSIFICATION 12. BASE HOURLY RATE 13. FRINGE BENEFITS (IF APPLICABLE)*

HEALTH & WELFARE/
INSURANCE

PENSION ANNUITY HOLIDAY PAY VACATION APPR. TRAINING

14. APPRENTICESHIP SCHEDULE (IF APPLICABLE)
IF YOU PARTICIPATE IN AN APPRENTICESHIP PROGRAM, FAX A COPY OF YOUR UNITED STATES DEPARTMENT OF LABOR, BUREAU OF APPRENTICESHIP AND TRAINING, APPRENTICESHIP AGREEMENT TO OUR MAIN OFFICE AT 304-558-3797.

14a. APPRENTICE CLASSIFICATION 14b. NUMBER OF INDIVIDUALS IN THIS CLASSIFICATION 14c. PLEASE LIST PERCENTAGES OF THE APPLICABLE JOURNYMAN'S RATE FOR EACH INTERVAL OF TRAINING 14d. PLEASE LIST APPLICABLE FRINGE RATE FOR THE APPRENTICE CLASSIFICATOIN (PERCENT BASED UPON THE TRAINING INTERVAL)

15. GIVE DESCRIPTION OF WORK PERFORMED FOR EACH CLASSIFICATION LISTED ABOVE

16. *LIST ANY ADDITIONAL FRINGE BENEFITS NOT CATEGORIZED ABOVE*

17. NAME OF BUSINESS OR ORGANIZATION:
18. IS YOUR BUSINESS SIGNATORY TO A COLLECTIVE BARGAINING AGREEMENT?
19. IF SO, WHAT TRADES?
20. IS YOUR BUSINESS OR ORGANIZATION A TRADE UNION?
21. WHAT CRAFT DOES IT REPRESENT?
22. HOW MANY ACTIVE MEMBERS:

23. LIST COUNTIES WHERE WORK WAS PERFORMED OR COVERED BY CONTRACT

Barbour Cabell Gilmer Hardy Lewis Mason Monongalia Pendleton Raleigh Taylor Webster
Berkeley Calhoun Grant Harrison Lincoln McDowell Monroe Pleasants Randolph Tucker Wetzel
Boone Clay Greenbrier Jackson Logan Mercer Morgan Pocahontas Ritchie Tyler Wirt
Braxton Doddridge Hampshire Jefferson Marion Mineral Nicholas Preston Roane Upshur Wood
Brooke Fayette Hancock Kanawha Marshall Mingo Ohio Putnam Summers Wayne Wyoming
24. BY MY SIGNATURE, I HEREBY CERTIFY THE ATTACHED INFORMATION TO BE TRUE AND ACCURATE.
25. PRINT NAME:
IF THE INFORMATION YOU SUBMIT IN THIS SURVEY IS USED AS PART OF THE MAJORITY FOR DETERMINING THE PREVAILING WAGE, YOU MAY BE ASKED TO SUPPLY ADDITIONAL SUPPORTING INFORMATION.

27. ADDITIONAL ROOM FOR INFORMATION IF NEEDED
This area to be used to list any additional pertinent information.