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<br />...,. July lor IIIe _.... projC. ~ __ aI
<br />onilollI1. ::,=~~"::;b;C:-"",=
<br />~............. II ID bo .......... Fam =,.,. II.......
<br />Job~" bolrIgNqUhdby........-...__
<br />benoqWreClb ClIIid _ '-' ~__
<br />ilL IIONllEGREGATED FAClLmEI
<br />~ b.. ........ __....- _ 10"
<br />__"I~.OOOOl_.)
<br />
<br />at [~~=",..:.:=.:r.:=""":=:,:
<br />01,......._. ..~. "1lilIlW, F:=_
<br />lion _. ............. ........ eowIor. or vendor. ..
<br />~""_"IIm_IlllI_Ot~Ior'"
<br />....,.."....", ngNgIIed.... at.",.. b........_
<br />tIlel thit 11m _1lllI....... b ~ 10 pedomo \helr........
<br />at en, Ioc:eIIon, ....... -. -- ~ .......
<br />IftIinlelned. The 11m _ .... ....... ciI iii ....-..uan II .
<br />oiolIIIon cI ... EEO ~ of.. __ The IIml ......
<br />__"'no""""_bo___IO~_
<br />on ..1lUo of _ or-..
<br />b. "" wed -............... ........ "IesJ'egeted .......
<br />m_.",.....-.a _ __ _erid-..,
<br />....--....-*'8-.---- -
<br />_ __ 01 IIl-*G --. pMdng Iota. ...-. IounIolna.
<br />='" ~~~ ~"""==""-:"'by '=
<br />
<br />~ 00:...., '" led. ~ 011 1M _ cI .... color.
<br />reIgIon, .._ ~ .ge or --,. ...... a11lell1l. IlaI
<br />cullom. or __. The...... --. _ bo lor lhe diMIlIed
<br />__.. _lor --..,0MIIde III.lI.lIIAIllod pnIng).
<br />
<br />Co TIle__....._or..._
<br />
<br />===.,":"..c::.:==:..=
<br />euDIIIr __ of 110.000 or __ end ... II .. ..... eud>
<br />c:wIIliCelfOns '" b __
<br />IV. PAYMENT", PIl2IlE1BlIIIIIm___
<br />IADollceblt ID .. F-.....Id ....1IrucIIon __ ~
<br />S2,001'."" ID.. _...-. ......Iorpqecle_ on
<br />~_"__lI'nnlmnorcalledon.__
<br />euqIl.)
<br />1.0...:
<br />.. 101 mec:IWlIca _lIboIWISeqlIo\Iod II' ~ upon"
<br />... of.. _... bo paid ........_~.... _ oIIen...
<br />_ . _ end ..... ........ _ 01 rIboIe on .",
<br />-- I... - ...,.cII -- . .. pemoIIIod ~
<br />~(211CFR3I_by"~a1Le__"
<br />CcjpeIend Aa(40 U.s.c. 2'IlIc...... _ of.-gnend _
<br />~ ~ (II' ..." equMIonIs "--"I chie .. lime of
<br />~_:-~":--be==':'-:rlhe~-:
<br />LeIlorCheteInelW...IleOIo:.........,_ 1Iell8dled_
<br />end........, "-of, '-"lIeaol.", __ ~
<br />_ may be eIoDodloedil '*-'.. _orb-..
<br />___ __end.....,..,..., TheWllge_.,iIl_
<br />~ng""~===m-=~
<br />OtForm~411!l]_Ile~" "'_by"_
<br />_ Ie IUIIcor-. .. IhII ... of .. _ '" . ..- end
<br />---ot:=:- --... ....._bylhe....... For"
<br />:.=::.::'~-"==~~
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<br />o..tHleconAclI~U.s.~)..._a1-.or_
<br />____IDIIUlh_or_nice...,biOCIlO
<br />Ille ........... '" SecIlon IV. --" :!Ib,....... -La.III!
<br />_ of"~ ~conIrtIlu*Ina....Ot_.........
<br />lor I1IOnlthen . ~ pedod (buI not ... often ... ~~
<br />.............. -. or Pftlll'WN. - ...... .........._ ~
<br />
<br />~-s.:."'.:::..~n;::a~ ..
<br />
<br />._ ....IInd/mge _on lIle_deIenrIIaelion
<br />/or ... dhal'ICIIUon 01 _ ......., perIarmod. Wllhou1 ~ ID
<br />1ldI. ""'PI" powIdod III ~ 411nd 5 01.... _ III.
<br />
<br />, ,
<br />
<br />F.... FHWA.-U73 (Rev. 3-84]
<br />
<br />b. ........... 01_ perIllrnlg _ III _...._
<br />=: :'&.bo,::,,~ ':'-;"',"::,~':.-:
<br />~~IeClOI\tI~MlIcdI" .......eech
<br />c:IeioIb1ioft ro ""*" _ II pedoriaed.
<br />Co 101 ndraIlInd ............ "'.. llrooIe-lIecon Aallnd
<br />nIolod _ oonlliIlod '" 211 CFR 1.3. _ 5........ ~
<br />by"-'" .... COIll/eCl
<br />2.~~
<br />
<br />-:. ~~..:...~~:t.~"=
<br />='~~'T~~_bo~ln-
<br />
<br />b. The'""*-<ting.................. en oddIlIonel~
<br />:::'==...,Iririge-ClIlIJ-IIle-.g-
<br />
<br />(1) "_ID"'~ ~E~cIeulIca-
<br />tion ~ II not pedoriaed by . .. !he _
<br />--.;
<br />(2) ... eddBbneI cteuIIkaIIon II""'''''' _ by 1M
<br />-Ind.-y.
<br />(31 .. pIqllleod ..................", - ldelmge
<br />-._._.--.10.....__
<br />In" _ -.....on; end
<br />
<br />"'-In':l.==:"~==. -..-..
<br />
<br />c. .lhe_or~..--...
<br />__ _ _ II ~ ID be.....,..,. III... eddIloneI
<br />=:u:. ~1IoI! ~.: == :e.~-:o-=
<br />='::nIor..:1:=t~J.:.= ~
<br />__cllIleWegeencfHour/liwlllon, ~lItendeIde
<br />-..on. ~.c. 211Z1o. The weoe _ lieu
<br />~or.. _==:.--...:~=
<br />......endllO:=....-..;ng_OI.. notIIylhe_
<br />Olg oIIicer_.. 3CkIeJ period Ihel-... _ 11_.
<br />d. 1n"_"_OI~"eIlllnlClfI.
<br />ale, .. _ 01 mec:IWlIca 10 ... ........ In IIle eddiIoioII
<br />~Ot_....._.end"~_do
<br />notegreeon"pIqllleod~__ "'11rdl*IG'"
<br />- ~ lor tinge -. _ ........], ..
<br />--.v..............IheQuelllllne. ~ ..._of..
<br />___......IIndIhe._.._._oI..anr-.oIIoer.
<br />10 ... Wage .... Hour M......... lor _ _
<br />=='1o:::=:':..~1',:::=':'lI-=:
<br />=-=.:.:~ olIceI _ .. 3Oo4ey pMod ...
<br />
<br />~=::~~==...~
<br />_ID .. __ ~1";"'1n III. _ CIIeIIIIcelIlOI
<br />'''''" the.... day on _ _ II ~ In ...............
<br />3. "-'" 01 Fr............
<br />.. __....__....~In..oonIrecl
<br />lor. .... cI _01_ ft:UIee.fringe"""_
<br />llnot~ ....houIly..... "_01'---'
<br />..~ _.....~.. _....Iod"'lhlI_
<br />dIlemIW'eUon or IhIII pay _ _ lillo Imge _ or en
<br />houtlJcae~_
<br />b. ....._OI_._lIAJIOllllele.donnol
<br />..... IleJIl** 10 . ...... 01 _ IlinI -. -.. Ny
<br />.......... ... pel! 01 .. _.. 01 .", _ or _ lhit
<br />amount 01.", COIlS --'>Iy ~ III ~ bonelillo
<br />~~41=:=n.::z:m-..=.:-'..=-.~
<br />"epplicebIe___oI"'~AcI__""" TIle
<br />~ 01 Lebor IIW)' ..... Ole _ 10 .. uldo In .
<br />_..........._ /or"'-o.vol~uncllt"plen
<br />01 pro;tem.
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<br />.... .
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<br />82
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