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 Well Contract No. 2 - Well Equipping project involving deep well submersible pump assembly installations at Point of Diversions (PODs) #8 and #13 in McKinley County. The form must be completed after construction is finished and submitted to the contracting agency. It requires documentation from the general contractor, all subcontractors, and any additional tier subcontractors, including company information, project details, completion dates, and signatures. Each contractor tier requires a separate signed form, and all parties must certify that workers were paid no less than the prevailing wage rates as determined by the Department of Workforce Solutions Labor Relations Division using the applicable State Wage Decision Number provided in the bid documents.
The affidavit serves as a compliance document ensuring adherence to New Mexico's Prevailing Wage Laws (13-4-11 through 13-4-18, NMSA 78) and the Public Works Minimum Wage Act Policy Manual. Contractors who violate prevailing wage requirements through incorrect job classification, improper wage or overtime payment, or other violations are subject to debarment procedures and mandatory repayment of any back wages owed to workers. The form requires completion of all fields and collection of signatures from appropriate contractor representatives at each tier, with instructions specifying that general contractor signatures are needed only on the general contractor section, while subcontractor and tier subcontractor sections require signatures from those respective entities.
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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 .