Statement_of_Intent_To_Pay_Prevailing_Wages.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 a Statement of Intent to Pay Prevailing Wages form required by the State of New Mexico for public works projects. The form applies to the Carbon Coal Road and McKinley County Industrial Park Waterline project in Gallup, New Mexico, which involves installing approximately 2,395 linear feet of 12-inch ductile iron pipe, gate valves, air release valves, fire hydrant assemblies, and associated infrastructure on Carbon Coal Road and Industrial Park Road. The form must be completed and submitted to the contracting agency within three days of contract award. It requires detailed information from the general contractor including company contact details, project title, physical address, total contract amount, estimated start and completion dates, and the applicable State Wage Decision Number for prevailing wage rates as determined by the Department of Workforce Solutions.
The form also accommodates information for subcontractors at multiple tiers, with each tier requiring a separate signed form listing the respective contractor amount and start date. All contractors executing work on the project must certify their compliance with New Mexico's Public Works Minimum Wage Act and agree to pay workers no less than the prevailing wage rates established for the project classification. Contractors who violate prevailing wage requirements face debarment procedures and liability for back wages owed to workers under the authority of 11.1.2 NMAC and sections 13-4-11 through 13-4-18 NMSA 1978. This funding is provided through the U.S. Department of Commerce Economic Development Administration.
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Text version
(Revised 08/22/2013)
STATEMENT OF INTENT TO PAY PREVAILING WAGES
To Be Completed Before Construction Starts
All FIELDS ARE REQUIRED
FORM MUST BE SENT TO THE CONTRACTING AGENCY WITHIN 3 DAY OF THE AWARD
General Contractor Information Company Name:
Address:
City : State: Zip:
Phone: Fax: E-Mail:
Estimated Start Date: State Wage Decision Number:
Project Title:
Project Physical Address:
Total Contract Amount: Estimated Completion Date:
Print Name:
General Contractor Signature:
Sub Contractor Information Sub Contract Amount:
Start date on this project:
Company Name:
Address:
City: State: Zip:
Phone: Fax: E-Mail:
Sub Contractor Signature:
2nd, 3rd, etc. Tier Sub-Contractor Information Contract Amount:
Start date 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 will be 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 1978).
Contractor’s Signature Date
(Revised 08/22/2013)
INSTRUCTIONS FOR COMPLETING STATEMENT OF INTENT TO PAY PREVAILING WAGES
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 estimated start & completion dates of project.
6. Enter general contractor’s contract amount.
7. All Statements 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 contract amount.
NOTE: A separate signed form is needed for each contractor.
2ND TIER SUB CONTRACTOR
1. Enter general contractor information, but general contractor signature is not needed.
2. Enter sub contractor information; subcontractor signature not needed.
3. Enter 2nd tier sub information and provide signature.
4. Enter 2nd tier contractors contract amount.
3RD TIER AND HIGHER CONTRACTOR
1. Attach a copy of this completed form & list the 3rd tier contractor information under the 2nd tier
File details come from the government source that posted it. Updated .