Statement_of_Intent_To_Pay_Prevailing_Wages.pdf
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- Solicitation number
- ITB-2617
- Issued by
- Mckinley County, New Mexico
About this file
This is a Statement of Intent to Pay Prevailing Wages form issued by the State of New Mexico for the Gallup Municipal Airport's AWOS III PT installation project. The form must be completed and submitted to the contracting agency within three days of contract award. The document requires the general contractor to provide company information, project details including the State Wage Decision Number, estimated start and completion dates, total contract amount, and physical project address. Subcontractors at multiple tiers must also complete separate forms with their respective contract amounts and start dates. All contractors executing work on this public works project must sign and certify compliance with prevailing wage requirements.
The prevailing wage rates applicable to this project are determined by the New Mexico Department of Workforce Solutions, Labor Relations Division, and are identified through the State Wage Decision Number referenced in the bid documents. Contractors are required to pay all workers employed on this public works project no less than the established prevailing wage rates and must comply with overtime requirements. Contractors who violate prevailing wage laws face debarment procedures and are subject to repayment of any back wages owed to workers under the Public Works Minimum Wage Act (13-4-11 through 13-4-18, NMSA 1978). The form serves as a certification mechanism to ensure compliance with state prevailing wage regulations prior to construction commencement.
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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 .