Free Contracting Agency Certification Form - Connecticut

~NOTICE~
TO ALL CONTRACTING AGENCIES

Please be advised that Connecticut General Statutes Section 31-53, requires the contracting agency to certify to the Department of Labor, the total dollar amount of work to be done in connection with such public works project, regardless of whether such project consists of one or more contracts. Please find the attached "Contracting Agency Certification Form" to be completed and returned to the Department of Labor, Wage and Workplace Standards Division, Public Contract Compliance Unit.

O Inquiries can be directed to (860)263-6543.

CONNECTICUT DEPARTMENT OF LABOR WAGE AND WORKPLACE STANDARDS DIVISION CONTRACT COMPLIANCE UNIT
CONTRACTING AGENCY CERTIFICATION FORM

I, authorized representative for contracting agency

, acting in my official capacity as title , located at address

,

,

do hereby certify that the total dollar amount of work to be done in connection with , located at project name and number shall be $ address ,

, which includes all work, regardless of whether such project

consists of one or more contracts. CONTRACTOR INFORMATION Name: Address: Authorized Representative: Approximate Starting Date: Approximate Completion Date:

Signature

Date

Return To:

Connecticut Department of Labor Wage & Workplace Standards Division Contract Compliance Unit 200 Folly Brook Blvd. Wethersfield, CT 06109

Date Issued: ___________________________