Metropolitan Sewer District Equal Employment Opportunity And Contract Compliance Program Prevailing Wage Complaint Form (Page 2 of 3) in pdf

Metropolitan Sewer District Equal Employment Opportunity And Contract Compliance Program Prevailing Wage Complaint Form Page 2

METROPOLITAN SEWER DISTRICT

EQUAL EMPLOYMENT OPPORTUNITY AND

CONTRACT COMPLIANCE PROGRAM

PREVAILING WAGE COMPLAINT FORM

PROJECT INFORMATION

Project Name:

Project Address:

City:

County:

Zip:

Over 2

Project completed (

CONTRACTOR INFORMATION

List name of contractor complaint is against in Name (1)

Name (1):

Address:

City:

Zip:

County:

Telephone No.

General

Prime

Subcontractor If Subcontractor, list name and address of General/Prime in Name (2)

Name (2):

Address:

City:

Zip:

County:

Telephone No.

COMPLAINANT INFORMATION

Name:

Address:

City:

Zip:

County:

Telephone No.

Other number you can be reached:

Complainant Status:

Employee

Former Employee

Interested Party*

*To allege Interested Party status, you MUST attach sufficient evidence that you have either bid on the public

improvement or are a subcontractor of a bidder, labor organization representing current employees of a bidder, or

association which presently has any of the above named persons as members. R.C. Sec. 4115.03(F)

REASON FOR FILING COMPLAINT

Prevailing Wage Not Paid

Wages Not Paid

Fringe Benefits Not Paid

Overtime

Misclassification

Please enclose sufficient evidence to justify your complaint.

Work Classification:

(Apprentices show level/year)

Hourly Rate Paid:

Dates worked: From

Total Hours on Project: Regular

Overtime

MSDGC - Prevailing Wage Complaint – Page 2

Metropolitan Sewer District Equal Employment Opportunity And Contract Compliance Program Prevailing Wage Complaint Form Page 2

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