Form 112
NYC 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.
_______________________
___________
________________________
_____
Print Company’s name
(Employee’s Signature & Date)
_____ _____________________________
By:____________________
______
(
(
Print Employee’s Name)
Employer Signature & Date)
Title:__________________________
________________________
___________
(
Employer Printed Name)
Sworn to me on this ____day of
Sworn to me on this ____day of
______________, 2010
______________, 2010
________________________
_______________________
Notary Public
Notary Public
Submit Form To: Borough Director, Resident Engineer
Form 112
NYC 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.
_______________________
___________
________________________
_____
Print Company’s name
(Employee’s Signature & Date)
_____ _____________________________
By:____________________
______
(
(
Print Employee’s Name)
Employer Signature & Date)
Title:__________________________
________________________
___________
(
Employer Printed Name)
Sworn to me on this ____day of
Sworn to me on this ____day of
______________, 2010
______________, 2010
________________________
_______________________
Notary Public
Notary Public
Submit Form To: Borough Director, Resident Engineer