Affidavit_of_Wages_Paid.pdf
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- Solicitation number
- ITB-2611
- 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. 1 project in McKinley County. The form must be completed and submitted to the contracting agency upon construction completion. The project involves installation of new well houses and yard piping at two locations near Gallup, New Mexico, including earthwork, well buildings, gas chlorination systems, yard piping, station piping, drainage structures, electrical work with SCADA control systems, gravel surfacing, fencing, and erosion control. The general contractor, subcontractors, and tiered subcontractors must each submit signed affidavits certifying that all workers employed on this 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 requires contractors to identify the applicable State Wage Decision Number from the bid documents and acknowledge compliance with New Mexico's Prevailing Wage Laws (13-4-11 through 13-4-18, NMSA 78) and related policies. Contractors violating prevailing wage requirements—including incorrect job classifications, improper wage payments, or overtime violations—are subject to debarment and mandatory payment of back wages to affected workers. Separate signed forms are required for each contractor tier, with completion dates specified for subcontractors and tiered subcontractors. The form was revised on August 23, 2013, and serves as the formal compliance documentation for wage requirements on this federally funded project through the U.S. Department of Commerce Economic Development Administration.
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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 .