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 City of Gallup, New Mexico for the Carbon Coal Road, McKinley County Industrial Park Waterline Project, a publicly funded infrastructure improvement initiative. The form must be completed and submitted to the contracting agency within three days of contract award, prior to construction commencement. The document requires submission of general contractor information including company details, contact information, project title, physical address, state wage decision number, total contract amount, and estimated start and completion dates. Subcontractors at multiple tiers (second, third, and higher) must each submit separate signed forms with their respective contract amounts and project start dates. The form serves as a certification mechanism for all contractors and subcontractors involved in the project to acknowledge their obligation to pay workers no less than the prevailing wage rates established by the New Mexico Department of Workforce Solutions, Labor Relations Division, as identified by the applicable State Wage Decision Number.
The prevailing wage certification requirement applies to all contractors and subcontractors performing work on this public works project exceeding the $60,000 threshold. Contractors who fail to comply with prevailing wage laws—including improper job classification, inadequate wage payment, or overtime violations—are subject to debarment procedures and are required to remit any back wages owed to workers. This document is governed by the Public Works Minimum Wage Act (13-4-11 through 13-4-18, NMSA 1978) and the Labor Relations Division's Public Works Minimum Wage Act Policy Manual. The form's instruction section clarifies submission requirements for general contractors, subcontractors, and multiple tiers of subcontractors, with each tier requiring separate documentation and appropriate signatures based on their contractual tier 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 .