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 City of Gallup, New Mexico for the G-80 Point of Diversions #8 & #13 Well Contract No. 2 - Well Equipping project. The form must be completed and submitted to the contracting agency after construction is complete and serves as certification that all workers employed on the public works project were paid no less than the prevailing wage rates determined by the New Mexico Department of Workforce Solutions, Labor Relations Division. The affidavit requires completion by the general contractor, all subcontractors, and any second, third, or subsequent tier subcontractors, with each contractor providing their company information, project details, work completion date, and authorized signature. Separate signed forms are required for each contractor involved in the project.
Contractors who violate Prevailing Wage Laws—including incorrect job classification, improper payment of prevailing wages, and overtime violations—are subject to debarment procedures and required to pay any back wages due to workers under the Public Works Minimum Wage Act (13-4-11 through 13-4-18, NMSA 78) and the Labor Relations Division Public Works Minimum Wage Act Policy Manual (11.1.2 NMAC). The form was last revised on August 23, 2013, and requires the State Wage Decision Number as listed in the project's bid documents to be entered for reference and compliance verification purposes.
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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 .