Affidavit_of_Wages_Paid.pdf
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- Attached to
- Carbon Coal Road, McKinley County Industrial Park Waterline - US Department of Commerce (EDA) 08-79-05634
- Solicitation number
- ITB-2609
- Issued by
- Quay County, New Mexico
About this file
This is an Affidavit of Wages Paid form required by the City of Gallup, New Mexico for the Carbon Coal Road, McKinley County Industrial Park Waterline Project, a public works initiative funded by the US Department of Commerce Economic Development Administration. The form must be completed after construction is finished and submitted to the contracting agency. It requires general contractor information including company details, phone, fax, and email; the State Wage Decision Number; project title and physical address; and estimated completion date. Subcontractors and tiered subcontractors must also complete separate sections with their respective information and completion dates. All fields are mandatory, and a separate signed form is required for each contractor involved in the project.
The affidavit serves as a certification mechanism for prevailing wage compliance under New Mexico's Public Works Minimum Wage Act (13-4-11 through 13-4-18, NMSA 78). By signing the form, all contractors and subcontractors certify that all workers employed on the public works project were 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. Contractors who violate prevailing wage laws through incorrect job classification, improper wage payment, or overtime violations are subject to debarment procedures and must pay back wages to affected workers. This certification requirement ensures compliance with the Public Works Minimum Wage Act Policy Manual (11.1.2 NMAC) and protects worker compensation standards on publicly funded construction projects.
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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 .