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
Statement of Intent to Pay Prevailing Wages Summary
This is a State of New Mexico prevailing wage compliance form required for public works projects at Gallup Municipal Airport under NMDOT Project No. GUP-24-03. The document must be completed by the general contractor and all subcontractors before construction commences and submitted to the contracting agency within three days of award. The form captures essential project information including the contractor company details, project title, physical address, total contract amount, estimated start and completion dates, and the applicable State Wage Decision Number. All contractors must certify that workers employed on the project will receive no less than the prevailing wage rates established by the New Mexico Department of Workforce Solutions, Labor Relations Division. A separate signed form is required for each tier of contractors, including the general contractor, first-tier subcontractors, second-tier subcontractors, and any higher-tier subcontractors.
The form serves as a binding certification of compliance with New Mexico prevailing wage laws (13-4-11 through 13-4-18, NMSA 1978) and the Public Works Minimum Wage Act Policy Manual. Contractors who violate prevailing wage requirements face debarment procedures and mandatory back wage payments to affected workers. The document requires signatures from the general contractor and all applicable subcontractors, with attestation that the provided information is accurate and complete. No specific wage rates are included in the form itself; instead, contractors must reference the State Wage Decision Number identified in the related bid documents for the AWOS-III P/T installation project to determine applicable prevailing wage rates for each job classification.
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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 .