Affidavit_of_Wages_Paid_(5).pdf
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- Solicitation number
- ITB-2614
- Issued by
- San Juan County, New Mexico
About this file
This is an Affidavit of Wages Paid form, a compliance document required by the City of Gallup, New Mexico for the New Sunshine Substation Transmission Line Construction project. The form must be completed and submitted to the contracting agency upon project completion and requires certification from the general contractor, subcontractors, and any tiered subcontractors that all workers employed on the public works project were compensated at or above the prevailing wage rates established by the New Mexico Department of Workforce Solutions, Labor Relations Division. The affidavit demands comprehensive contractor information including company name, address, contact details, project title, physical address, State Wage Decision Number, and estimated completion date, with separate signed forms required for each contractor tier involved in the project.
The form carries significant compliance weight, with contractors acknowledging that violations of prevailing wage laws—including incorrect job classification, improper payment of prevailing wages, and overtime violations—result in debarment procedures and mandatory payment of back wages to affected workers under the Public Works Minimum Wage Act (13-4-11 through 13-4-18, NMSA 78) and applicable regulations (11.1.2 NMAC). All fields on the affidavit are mandatory, and the document must be signed and dated by the responsible contractor representative, establishing a binding certification of wage compliance for the transmission line construction project with an estimated cost of $673,000 and prevailing wage rates for McKinley County classifications ranging from $40.94 base/$17.73 fringe for Equipment Operators to $52.98 base/$21.75 fringe for Cable Splicers.
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Text version
AFFIDAVIT OF WAGES PAID
To Be Completed After Construction Is Complete
All FIELDS ARE REQUIRED
FORM MUST BE SENT TO THE CONTRACTING AGENCY
General Contractor Information Company Name:
Address:
City: State: Zip:
Phone: Fax: E-Mail:
Estimated Completion Date: State Wage Decision Number:
Project Title:
Project Physical Address:
Print Name:
General Contractor Signature:
Sub Contractor Information
Date you completed work on this project:
Company Name:
Address:
City: State: Zip:
Phone: Fax: E-Mail:
Sub Contractor Signature:
2nd, 3rd, etc. Tier Sub Contractor Information
Date you completed work on this project:
Company Name:
Address:
City: State: Zip:
Phone: Fax: E-Mail:
Tier Signature:
I hereby certify that the above information is correct and that all workers I employ on this public works project were paid no less than the Prevailing Wage Rate(s) as determined by the Department of Workforce Solutions, Labor Relations Division for this project as identified by the State Wage Decision Number. I understand that contractors who violate Prevailing Wage Laws (i.e., incorrect job classification, improper payment of prevailing wages, and/or overtime, etc.), are subject to debarment procedures and shall be required to pay any back wages due to workers. (Ref. Labor Relations Division Public Works Minimum Wage Act Policy Manual (11.1.2 NMAC) & Public Works Minimum Wage Act (13-4-11 through 13-4-18, NMSA 78)).
Contractor’s Signature Date
(Revised 08/23/13)
INSTRUCTIONS FOR COMPLETING AFFIDAVIT OF WAGES PAID
GENERAL CONTRACTOR
1. Enter general contractor information and provide signature.
2. Enter State Wage Decision Number as listed in bid documents. (Example: BE 13-0123 B)
3. Enter project title - listed in bid documents.
4. Enter project physical address - exact location of project (job site).
5. Enter completion date of project.
6. All Affidavits’ must be sent to the Contracting Agency.
SUB CONTRACTOR
1. Enter general contractor information, but general contractor signature is not needed.
2. Enter sub contractor information as indicated and provide signature.
3. Enter sub contractor completion date.
NOTE: A separate signed form is needed for each contractor.
2ND, 3rd, etc TIER SUB CONTRACTOR
1. Enter sub contractor information, subcontractor signature is not needed.
2. Enter 2nd tier sub contractor information and provide signature.
3. Enter 2nd tier contract completion date.
(Revised 8/23/13)
File details come from the government source that posted it. Updated .