City of New York |
Form 112 |
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Parks & Recreation |
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N.Y.C Department of Parks & Recreation
Labor Law Compliance
EMPLOYEE PREVAILING WAGE REQUIREMENT
1). I, _________________________, social security number _____________ residing at
_______________________________________have received and read the Prevailing Wage Schedule
NYS Labor Law, Section 220 presented to me by my employer ____________________.
2). I am currently performing work on a NYC Department of Parks & Recreation construction project known as ___________________________________________________, Contract No:_____________,
Registration No: ___________________ in the borough of _______________.
3). I am aware that my trade classification, __________________________, entitles me to the prevailing
Wage of $____ per hour and the supplemental benefit of $____ per hour.
4). I am also aware that if for any reason my employer fails to pay me the applicable wage rate and/or Supplemental benefit rate for my trade, it is my right to file a complaint with the NYC Department of Parks & Recreation; and file a complaint with the New York City-Office of the Comptroller against my employer.
__________________________________ |
_____________________________ |
(Employee’s Signature & Date) |
Print Company’s name |
__________________________________ |
By:__________________________ |
(Print Employee’s Name) |
(Employer Signature & Date) |
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Title:__________________________ |
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___________________________________ |
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(Employer Printed Name) |
Sworn to me on this ____day of |
Sworn to me on this ____day of |
______________, 2010 |
______________, 2010 |
________________________ |
_______________________ |
Notary Public |
Notary Public |
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Submit Form To: Borough Director, Resident Engineer |
Revised 03/2010 |