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WD-10 (07/19/2023) D4
OMB No. 1235-0015 Expiration xx/xx/xxxx
Davis-Bacon Wage Survey Form (WD-10)
1. Project Information: Please provide the following information for the project to be included in the
Davis-Bacon Wage Survey. If you are providing information for more than one contractor or
subcontractor on the project, please use a separate form for each. * Indicates required field.
Project Name*
Project Location (address/location)
City*
State*
County or Counties*
Project Description (see examples in instructions)
2. Project Type(s)* (please see instructions for descriptions of each construction type) (check only one;
if the project included multiple types of substantial construction, please report associated wage rates
on separate WD-10 forms. See Instructions - Project Types, Substantial Construction in a Different
Type of Construction).
Residential
Building
Highway
Heavy
Don’t know
Project Begin/Completion Date:
Begin (MM/YYYY)*
/
Completion (MM/YYYY)*
Estimated
Actual
/
Estimated
Prime Contractor on the project
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Actual
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3. Is the project value more than $2,000?*
Yes
No
I don’t know
4. Is the project subject to Federal (Davis-Bacon) prevailing wage requirements?*
Yes
No
I don’t know
5. Contractor or Subcontractor Information: Please provide the following information about the contractor
or subcontractor that employed the workers whose wage data is included below in this Davis-Bacon
Wage Survey response form.
Contractor/Subcontractor Name*
Address
City
State
Zip
–
Contractor/Subcontractor Point of Contact
Name
Email address
Phone
–
–
Type of Work Performed by the Contractor/Subcontractor* (see examples in instructions)
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6. Wage Survey Information: Please provide information about the wages and fringe benefits paid by
the contractor or subcontractor to workers on the project. Please use a separate entry for each separate
classification. For classification and subclassification names and numbers, please refer to the instruction
sheet. When one or more workers work in the same classification but are paid different wage rates,
report each wage rate on a separate entry. Do not average wage rates. Do not report for apprentices.
Please consult the instructions before reporting for forepersons. Please copy this page should you need
additional lines. Additional remarks and comments can be provided below or on a separate page.
A.
Labor
Classification
Number (see
instructions)
Hourly Wage Rate Paid*
$
Sub-Classification
Number(s)
(If applicable,
see instructions)
Labor Classification Name*
Sub-Classification Name(s)
(If applicable, see instructions)
# of workers
Were these workers paid this
performing on this
wage rate under a CBA?
project at this wage rate*
.
Yes
Local Union Name and # (if applicable)
No
Fringe Benefits: If fringe benefits are provided, please report–as a dollar amount per hour, or as a % of the hourly wage rate–the
contractor’s contribution to the fringe benefit plan or contractor’s cost of providing the fringe benefit. The dollar amount per hour can
be calculated by dividing the contractor’s total fringe contributions for the worker by the worker’s total hours worked. Include a brief
description for "Other" in the box provided. If additional room is needed, use the "Additional Fringe Benefits" remarks box on page 8.
Health & Welfare
Pension/Retirement
Apprentice Training
Vacation/Holiday/Sick
Other
Other – specify
$
$
.
$
.
/hour
/hour
% hourly
rate
$
.
/hour
% hourly
rate
C
.
/hour
% hourly
rate
% hourly
rate
$
.
/hour
% hourly
rate
.
Days/Year
.
Days/Year
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B.
Labor
Classification
Number (see
instructions)
Hourly Wage Rate Paid*
$
Sub-Classification
Number(s)
(If applicable,
see instructions)
Labor Classification Name*
Sub-Classification Name(s)
(If applicable, see instructions)
# of workers
Were these workers paid this
performing on this
wage rate under a CBA?
project at this wage rate*
.
Yes
Local Union Name and # (if applicable)
No
Fringe Benefits: If fringe benefits are provided, please report–as a dollar amount per hour, or as a % of the hourly wage rate–the
contractor’s contribution to the fringe benefit plan or contractor’s cost of providing the fringe benefit. The dollar amount per hour can
be calculated by dividing the contractor’s total fringe contributions for the worker by the worker’s total hours worked. Include a brief
description for "Other" in the box provided. If additional room is needed, use the "Additional Fringe Benefits" remarks box on page 8.
Health & Welfare
Pension/Retirement
Apprentice Training
Vacation/Holiday/Sick
Other
Other – specify
$
$
.
$
.
/hour
/hour
% hourly
rate
$
.
/hour
% hourly
rate
C
.
/hour
% hourly
rate
% hourly
rate
$
.
/hour
% hourly
rate
.
Days/Year
.
Days/Year
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C.
Labor
Classification
Number (see
instructions)
Hourly Wage Rate Paid*
$
Sub-Classification
Number(s)
(If applicable,
see instructions)
Labor Classification Name*
Sub-Classification Name(s)
(If applicable, see instructions)
# of workers
Were these workers paid this
performing on this
wage rate under a CBA?
project at this wage rate*
.
Yes
Local Union Name and # (if applicable)
No
Fringe Benefits: If fringe benefits are provided, please report–as a dollar amount per hour, or as a % of the hourly wage rate–the
contractor’s contribution to the fringe benefit plan or contractor’s cost of providing the fringe benefit. The dollar amount per hour can
be calculated by dividing the contractor’s total fringe contributions for the worker by the worker’s total hours worked. Include a brief
description for "Other" in the box provided. If additional room is needed, use the "Additional Fringe Benefits" remarks box on page 8.
Health & Welfare
Pension/Retirement
Apprentice Training
Vacation/Holiday/Sick
Other
Other – specify
$
$
.
$
.
/hour
/hour
% hourly
rate
$
.
/hour
% hourly
rate
C
.
/hour
% hourly
rate
% hourly
rate
$
.
/hour
% hourly
rate
.
Days/Year
.
Days/Year
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D.
Labor
Classification
Number (see
instructions)
Hourly Wage Rate Paid*
$
Sub-Classification
Number(s)
(If applicable,
see instructions)
Labor Classification Name*
Sub-Classification Name(s)
(If applicable, see instructions)
# of workers
Were these workers paid this
performing on this
wage rate under a CBA?
project at this wage rate*
.
Yes
Local Union Name and # (if applicable)
No
Fringe Benefits: If fringe benefits are provided, please report–as a dollar amount per hour, or as a % of the hourly wage rate–the
contractor’s contribution to the fringe benefit plan or contractor’s cost of providing the fringe benefit. The dollar amount per hour can
be calculated by dividing the contractor’s total fringe contributions for the worker by the worker’s total hours worked. Include a brief
description for "Other" in the box provided. If additional room is needed, use the "Additional Fringe Benefits" remarks box on page 8.
Health & Welfare
Pension/Retirement
Apprentice Training
Vacation/Holiday/Sick
Other
Other – specify
$
$
.
$
.
/hour
/hour
% hourly
rate
$
.
/hour
% hourly
rate
C
.
/hour
% hourly
rate
% hourly
rate
$
.
/hour
% hourly
rate
.
Days/Year
.
Days/Year
Form WD-10
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E.
Labor
Classification
Number (see
instructions)
Hourly Wage Rate Paid*
$
Sub-Classification
Number(s)
(If applicable,
see instructions)
Labor Classification Name*
Sub-Classification Name(s)
(If applicable, see instructions)
# of workers
Were these workers paid this
performing on this
wage rate under a CBA?
project at this wage rate*
.
Yes
Local Union Name and # (if applicable)
No
Fringe Benefits: If fringe benefits are provided, please report–as a dollar amount per hour, or as a % of the hourly wage rate–the
contractor’s contribution to the fringe benefit plan or contractor’s cost of providing the fringe benefit. The dollar amount per hour can
be calculated by dividing the contractor’s total fringe contributions for the worker by the worker’s total hours worked. Include a brief
description for "Other" in the box provided. If additional room is needed, use the "Additional Fringe Benefits" remarks box on page 8.
Health & Welfare
Pension/Retirement
Apprentice Training
Vacation/Holiday/Sick
Other
Other – specify
$
$
.
$
.
/hour
/hour
% hourly
rate
$
.
/hour
% hourly
rate
C
.
/hour
% hourly
rate
% hourly
rate
$
.
/hour
% hourly
rate
.
Days/Year
.
Days/Year
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Submitter Name*
Submitter Organization
Submitter Email*
Submitter Phone
–
–
Optional descriptions of any Additional Fringe Benefits:
Optional Additional Wage Survey Form Remarks:
Date (MM/DD/YYYY)*
Submitter Signature*
/
/
The willful falsification of any submitted information may result in civil or criminal prosecution. See 18 U.S.C. 1001.
Note: This information is collected by the U.S. Department of Labor (DOL) as part of a wage survey under the authority of the Davis-Bacon and
Related Acts (DBRA). The information will be used to determine prevailing wage rates that will be the required minimum rates of pay for workers
on construction projects covered by the DBRA. The submission of wage data is strongly encouraged but is voluntary. The use of this specific
form to submit the requested wage data is also optional; respondents may use an alternate form if all the required information is included. There
is no penalty for not submitting the requested wage data, but low participation in a wage survey could result in missing classifications on DBRA
wage determinations or non-publication of a new wage determination for a covered area. The identity of the respondent will be kept confidential
to the maximum extent possible under existing law. OMB No. 1235-0015. Expires XX/XX/XXXX. Agencies may not conduct a collection of
information unless it displays a currently valid OMB control number. DOL estimates that the public reporting burden for this collection of information
will average 20 minutes per response, including 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 the burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden, to the Administrator, Wage and Hour Division, U.S. Department of
Labor, Room S-3502, 200 Constitution Avenue, N.W., Washington, DC 20210 and reference the OMB Control Number.
Form WD-10
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| File Type | application/pdf |
| Author | OneFormUser |
| File Modified | 2023-08-02 |
| File Created | 2023-07-19 |