Form WD-10 Davis--Bacon Wage Survey Report of Construction Contract

Form WD-10
Davis-Bacon Wage Survey
Report of Construction
Contractor’s Wage Rates

U.S. Department of Labor
Employment Standards Administration
Wage and Hour Division

OMB No. 1215-0046 Approval Expires 01/31/2011

1. Please indicate the full name, address and phone number of the General/Prime Contractor or Subcontractor reporting wage data
for the project indicated on this form.
NAME OF CONTRACTOR/SUBCONTRACTOR

INSTRUCTIONS - Please enter the information in the white boxes
and fill in the circles as appropriate. You can either hand print the
information in blue or black ink, or use a typewriter or printer.
Detailed instructions for completing this form (or obtaining
additional copies), as well as definitions for many of the terms used
on this form are found on a separate instruction page.

them to: U.S. Department of Labor, Wage and Hour Division,
Administrator, Room S-3502, 200 Constitution Avenue NW,
Washington, DC 20210.
NOTE: This form is used by the U.S. Department of Labor to
determine the locally prevailing wage rates under the DavisBacon and related Acts. The submission of wage data is
encouraged but is voluntary. This is an optional form provided to
ensure consistency in submission of wage data. Respondents
may use an alternate form if all the information requested is
included. The identity of the Respondent will be kept confidential
to the maximum extent possible under existing law. Persons are
not required to respond to this collection of information unless it
displays a currently valid OMB control number.

We estimate that it will take an average of 20 minutes to complete
this collection of information, including the time for reviewing
instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the
collection of information. If you have any comments regarding the
burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, send

4. Indicate if project is subject to a Federal (Davis-Bacon) or state wage determination.

ADDRESS

FEDERAL
STATE

CITY
EXTENSION

PHONE

STATE

NEITHER

ZIP

FAX

2. Submitter information

5. Please select one choice at right.

I AM THE

A. Please provide a list, on the enclosed
form, of any subcontractors you used on
this project, including addresses and
phone numbers.

B. For the project being reported on this
form state the date the work

LAST NAME AND FIRST NAME

THE LIST IS BEING RETURNED
WITH THIS FORM

TITLE

THE LIST WAS
PROVIDED EARLIER

ORGANIZATION

THERE ARE NO
SUBCONTRACTORS

GENERAL/PRIME CONTRACTOR

BEGAN
M M

D D

Y Y Y Y

ENDED
M M

EXTENSION

C. If you are a Subcontractor for the
project being reported indicate the date
your work
BEGAN
M M

D D

Y Y Y Y

D D

Y Y Y Y

ESTIMATED

ACTUAL

ENDED
D D

Y Y Y Y

ESTIMATED

ACTUAL

PROJECT VALUE
$

PHONE

SUBCONTRACTOR

M M

SUBCONTRACT VALUE
$

FAX

EMAIL ADDRESS

6. Please fill in the circle indicating the type of construction for the project being reported and all relevant descriptors. If the project
has more than one type of construction please mark the additional type.
APARTMENT BUILDING *

MOTEL/HOTEL

RESIDENTIAL *

3. Please supply the complete name of the project, project description (area within a building, highway section, specific room
number, etc.), address, and name of General/Prime Contractor if different from Item 1.

BICYCLE PATH

NURSING/ASSISTED LIVING
FACILITY *

ROAD/STREET/HIGHWAY/DRIVE

FULL NAME OF PROJECT

BRIDGE OVER NAVIGABLE
WATER

OFFICE/COMMERCIAL
BUILDING

SCHOOL

BRIDGE (ANY OTHER TYPE)

PAVING

SITE PREPARATION

DORMITORY

PARKING LOT

TREATMENT PLANT

HOSPITAL

PLAYGROUND

WATER/SEWER

PROJECT DESCRIPTION
ADDRESS
CITY

OTHER
STATE

COUNTY
*

NAME OF GENERAL / PRIME CONTRACTOR

If you selected APARTMENT, NURSING FACILITY, or RESIDENTIAL:
NUMBER OF STORIES

KITCHEN IN EACH UNIT?
(If yes, fill in circle.)

BATH IN EACH UNIT?
(If yes, fill in circle.)

Form WD-10
Davis-Bacon Wage Survey
Page 2 (see reverse for instructions)
OMB No. 1215-0046 Approval Expires 01/31/2011

7. Classifications and Fringe Benefit Information. In the questions
below, CBA stands for Collective Bargaining Agreement. In the
five benefit-related columns, please describe the benefits (if any)
for each classification, and also tell us how they are paid. If the
benefit is paid out periodically, tell us how much you pay and how
frequently you pay it, using a single letter abbreviation. Use ‘H’
for hourly, ‘D’ for daily, ‘W’ for weekly, ‘M’ for monthly, and ‘Y’ for

CLASSIFICATION

PEAK WEEK ENDING DATE

TYPE OF WORK PERFORMED

# OF EMPLOYEES

M M

D D

HOURLY RATE

Y Y Y Y

PEAK WEEK ENDING DATE
M M

TYPE OF WORK PERFORMED

D D

M M
TYPE OF WORK PERFORMED

D D

M M
TYPE OF WORK PERFORMED

D D

PEAK WEEK ENDING DATE

TYPE OF WORK PERFORMED

# OF EMPLOYEES

M M

D D

PEAK WEEK ENDING DATE

TYPE OF WORK PERFORMED

D D

% OF HOURLY RATE

$ per EMP. per

$ per EMP. per

$ per EMP. per

% OF HOURLY RATE

% OF HOURLY RATE

% OF HOURLY RATE

$ per EMP. per

$ per EMP. per

$ per EMP. per

% OF HOURLY RATE

% OF HOURLY RATE

% OF HOURLY RATE

$ per EMP. per

$ per EMP. per

$ per EMP. per

% OF HOURLY RATE

% OF HOURLY RATE

% OF HOURLY RATE

$ per EMP. per

$ per EMP. per

$ per EMP. per

% OF HOURLY RATE

% OF HOURLY RATE

% OF HOURLY RATE

Y

$ per EMP. per

$ per EMP. per

$ per EMP. per

% OF HOURLY RATE

# OF EMPLOYEES
Y

% OF HOURLY RATE

% OF HOURLY RATE

# DAYS PER YEAR

# DAYS PER YEAR

$ per EMP. per

$ per EMP. per

% OF HOURLY RATE

% OF HOURLY RATE

# DAYS PER YEAR

# DAYS PER YEAR

$ per EMP. per

$ per EMP. per

% OF HOURLY RATE

% OF HOURLY RATE

# DAYS PER YEAR

# DAYS PER YEAR

$ per EMP. per

$ per EMP. per

% OF HOURLY RATE

% OF HOURLY RATE

# DAYS PER YEAR

# DAYS PER YEAR

$ per EMP. per

$ per EMP. per

% OF HOURLY RATE

% OF HOURLY RATE

# DAYS PER YEAR

# DAYS PER YEAR

$ per EMP. per

$ per EMP. per

% OF HOURLY RATE

% OF HOURLY RATE

# DAYS PER YEAR

# DAYS PER YEAR

N

$

PAID UNDER A
CBA?

% OF HOURLY RATE

% OF HOURLY RATE

N
DESCRIPTION OF ANY ADDITIONAL FRINGE (SEE LAST COLUMN OF ITEM 7)

8. COMMENTS OR REMARKS

YOUR SIGNATURE

% OF HOURLY RATE

$ per EMP. per

N

HOURLY RATE

Y Y Y Y

% OF HOURLY RATE

$

PAID UNDER A
CBA?

M M

Y

HOURLY RATE

Y Y Y Y

$ per EMP. per

Note: The willful falsification of any submitted
information may result in civil or criminal
prosecution. See 18 U.S.C.1001.
DATE M M

D D

ADDITIONAL FRINGE

$ per EMP. per

N

# OF EMPLOYEES

CLASSIFICATION

$ per EMP. per

$

PAID UNDER A
CBA?

CLASSIFICATION

Y

HOURLY RATE

Y Y Y Y

$ per EMP. per

$

# OF EMPLOYEES

PEAK WEEK ENDING DATE

APPRENTICE TRAINING VACATION & HOLIDAY

N

HOURLY RATE

Y Y Y Y

PAID UNDER A
CBA?
CLASSIFICATION

Y

ONLY SUPPLIED MATERIALS

N

# OF EMPLOYEES

PEAK WEEK ENDING DATE

PENSION (401K, ETC)

$

PAID UNDER A
CBA?
CLASSIFICATION

Y

HOURLY RATE

Y Y Y Y

HEALTH & WELFARE

If you only supplied building materials, and no employees worked
on the project, then fill in the circle below. You may skip the rest
of this question, and sign and date the form.

$

PAID UNDER A
CBA?
CLASSIFICATION

yearly. If the benefit is paid as a percentage of the hourly rate,
check the appropriate box, then tell us the percentage using the
boxes below the checkbox. Regarding the Vacation & Holiday and
additional benefit columns, if appropriate, tell us how many days
are paid annually.

Y Y Y Y