CONNECTICUT DEPARTMENT OF LABOR WAGE AND WORKPLACE STANDARDS DIVISION
CONTRACTORS WAGE CERTIFICATION FORM
I, Officer, Owner, Authorized Rep. do hereby certify that the
of Company Name
Company Name Street City and all of its subcontractors will pay all workers on the Project Name and Number Street and City the wages as listed in the schedule of prevailing rates required for such project (a copy of which is attached hereto). Signed Subscribed and sworn to before me this day of , .
Notary Public Return to: Connecticut Department of Labor Wage & Workplace Standards Division 200 Folly Brook Blvd. Wethersfield, CT 06109
Rate Schedule Issued (Date):