Affidavit_of_Wages_Paid.pdf
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- Solicitation number
- ITB-2612
- Issued by
- San Juan County, New Mexico
About this file
This is an Affidavit of Wages Paid form required by the State of New Mexico for the G-80 Point of Diversions #8 & #13 Well Contract No. 2 - Well Equipping project located in McKinley County near Gallup, New Mexico. The form must be completed and submitted to the contracting agency upon construction completion. The project involves the installation of deep well submersible pump assemblies, including 4" O.D. J-55 steel column piping, check valves, electric cable, stainless steel air lines, centralizers, and associated appurtenances within existing 13 3/8" O.D. well casings. Work at POD #8 extends 1,650 feet below surface level, while POD #13 extends 2,465 feet below surface level. The scope also includes construction of new wellheads with well disinfection at POD #13 only, system startup, and coordination with other contractors at each site.
The Affidavit of Wages Paid requires comprehensive documentation from general contractors, subcontractors, and all subsequent tier subcontractors, with separate signed forms required for each contractor level. All workers employed on this public works project must be paid no less than the prevailing wage rates established by the Department of Workforce Solutions, Labor Relations Division, as identified by the State Wage Decision Number included in the bid documents. Contractors who violate prevailing wage laws, including incorrect job classification, improper payment of prevailing wages, and overtime violations, are subject to debarment procedures and must remunerate any back wages owed to workers. This requirement is established under the Public Works Minimum Wage Act (NMSA 78, sections 13-4-11 through 13-4-18) and the Labor Relations Division Public Works Minimum Wage Act Policy Manual (11.1.2 NMAC).
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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 .