Statement_of_Intent_To_Pay_Prevailing_Wages.pdf
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- Solicitation number
- ITB-2612
- Issued by
- San Juan County, New Mexico
About this file
This is a Statement of Intent to Pay Prevailing Wages form used by the City of Gallup, New Mexico, and the New Mexico Department of Workforce Solutions, Labor Relations Division, to ensure compliance with prevailing wage requirements on public works projects. The form must be completed and submitted to the contracting agency within three days of contract award before construction begins. The document requires general contractors to provide company information, project details including the State Wage Decision Number, project title, physical address, estimated start and completion dates, and total contract amount. Subcontractors and tiered subcontractors must also complete separate forms with their respective contract amounts and start dates. For the G-80 Point of Diversions Well Contract No. 2, the project involves installation of deep well submersible pump assemblies at two locations in McKinley County, with work to be completed within 220 calendar days from Notice to Proceed.
All contractors and subcontractors certify by signature that they will pay workers 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. Violation of prevailing wage laws—including incorrect job classification, improper payment of prevailing wages, or overtime violations—subjects contractors to debarment procedures and mandatory payment of back wages to affected workers, as referenced in the Public Works Minimum Wage Act (13-4-11 through 13-4-18, NMSA 1978) and the Labor Relations Division Public Works Minimum Wage Act Policy Manual (11.1.2 NMAC). The form applies to all tiers of contractors involved in the project, with separate documentation required for each contractor level.
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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 .