Department of Labor and Industries

Department of Labor and Industries
Prevailing Wage
(360) 902-5335
www.lni.wa.gov/TradesLicensing/PrevWage
·  This form must be typed or printed in ink.
·  Fill in all blanks or the form will be returned for correction (see instructions). / Intent to Pay Prevailing Wages Addendum A
Additional List of Crafts
Public Works Contract
No Additional Filing Fee Required
Intent ID # (Assigned by L&I)______
(Please staple this addendum to the corresponding Intent to Pay Prevailing Wages form.)
Project Name / Contract Number
Company Name / Title / Signature
UBI Number / Contractor Registration Number / Awarding Agency

List all Crafts/Trades/Occupations your firm will use for this project.

Crafts/Trades/Occupations and Apprentices – For Apprentices enter the name, registration number, trade, wage and fringe rate for each apprentice). / Estimated Number of Workers / Rate of Hourly Pay / Rate of Hourly Usual (“Fringe”) Benefits
For L&I Use Only
APPROVED: Department of Labor and Industries
By ______
Industrial Statistician

F700-160-000 Addendum A to Statement of Intent to Pay Prevailing Wages 06-2010 DO NOT SEPARATE FORMS PRIOR TO APPROVAL BY L&I