Affidavit_of_Wages_Paid.pdf
PDF 111 KB Posted
- Attached to
- Whole Block Reconstruction - Ciniza Drive, Gallup NM State and local contract opportunity
- Solicitation number
- ITB-2701
- Issued by
- Quay County, New Mexico
About this file
The Affidavit of Wages Paid is a compliance document required by the State of New Mexico for the Whole Block Reconstruction project on Ciniza Drive in Gallup, New Mexico. This form must be completed and submitted to the contracting agency upon completion of all construction work. The affidavit requires detailed information from general contractors, subcontractors, and any additional tier subcontractors involved in the project, including company contact information, project details, and the state wage decision number assigned to the project. Each contractor tier must submit a separate signed affidavit documenting their work completion date and certifying compliance with prevailing wage requirements.
The affidavit serves as a certification mechanism ensuring 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 applicable State Wage Decision Number. Contractors executing this document acknowledge understanding that violations of prevailing wage laws—including incorrect job classification, improper wage payment, and overtime violations—subject them to debarment procedures and liability for back wages owed to workers under the Public Works Minimum Wage Act (13-4-11 through 13-4-18, NMSA 78). The form requires signatures from all general contractors and respective subcontractors, with instructions specifying that general contractor signatures are not required on subcontractor affidavits and that tier subcontractor signatures are not required on second or higher tier affidavits.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Whole_Block_Reconstruction_-_Ciniza_Drive,_Gallup_NM_(Addendum_#1_Revision).pdf | ||
| Whole_Block_Reconstruction_-_Ciniza_Drive,_Gallup_NM.pdf | ||
| Plans:_Whole_Block,_Ciniza_Drive_ITB-2701-stamped.pdf | ||
| Engineer_Estimate_Whole_Block_Ciniza.pdf | ||
| Wage_Rates_MC-26-2209-A.pdf | ||
| Gallup_Sample_Contract.pdf | ||
| EPA_Form_3510-9.pdf | ||
| NMDOT_A-066TrafficControlRoadwayWorkPermit.pdf | ||
| EPA_Form_3510-13.pdf | ||
| Gallup_Municipal_ROW-Public_Easement_Work_Permit.pdf | ||
| NMDOT_Indemnification_and_Hold_Harmless_Agreement.pdf | ||
| Statement_of_Intent_To_Pay_Prevailing_Wages.pdf |
Show all 12
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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 .