HABD.ORG



THE HOUSING AUTHORITY BIRMINGHAM DISTRICTPROCUREMENT OFFICE1826 3rd AVENUE SOUTHBIRMINGHAM, ALABAMA 35255TELEPHONE: 205-521-0611 FAX 205-521-7704In accordance with HUD prevailing wage rate requirements. Contracts for routine maintenance service or construction work must comply with prevailing wage and other labor standards provisions. Contracted maintenance service or construction work requested by the Housing Authority will contains the wage rates for the classification that will be employed. Therefore, all contractors must complete the following Hourly Wage Form before maintenance service or work is performed. Does your company comply with all Federal Labor Standards applicable to the above-named job? __ Yes __ No Does your company comply with all Contract Work Hours and Safety Standards Act applicable to the above-named job? __ Yes __ No PRINT NAME: ___________________________________________________ SIGNATURE: ____________________________________________________ _________________________ Agrees to maintain payroll records to demonstrate compliance with applicable Federal Standards provisions and to preserve such records for at least three years following completion of the above-named contract work. DATE: COMPANY NAME: ADDRESS: CITY: Birmingham STATE: ZIP: TELEPHONE # FAX # (205) 223-8705E-MAIL ADDRESS CONTACT PERSON: PO # PROJECT # WORK TO BE DONE: LIST OF INDIVIDUALS TO PREFORM WORK CLASSIFICATION HOURLY RATE FRINGE BENEFITS HOURLY WAGE FORM ................
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