Licensed Contractor Complaint Form - Nevada State Contractors Board Page 3
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412. BRIEFLY STATE YOUR COMPLAINT: (If additional space is required, please use additional sheets)
13. What is the type of project?
Residence
Commercial Building
Other (Describe)
14. Is this project a/an:
Addition
Repair
Replacement
New Construction
New Purchase
15. What type of contract was involved?
Oral
Written
New Home Purchase Agreement
Other
16. Were there any change orders?
Yes
No
If Yes, were they:
Written
Oral
Both
17. Is your complaint:
Abandonment
Workmanship
Money Owing
Other
18. Building permit obtained by:
Contractor
You
Salesperson
Do not know
Name of building department:
19. Who presented contract? (Name):
Salesperson
Contractor
Do not know
20. Did the contractor have employees?
Yes
No
Do Not Know
If yes, how many?
21. Were employees, subcontractors, or material suppliers paid?
Yes
No
Do not know
If yes, by whom?
22. What attempts have you made to contact the contractor(s)?
Unable to locate
Personal contact
Telephone
Letter
(copies attached)
No Attempt Made
23. Were any liens filed on this job?
Yes
No
Do not know
If yes, by whom?
24. Have you filed in court to recover damages on this complaint?
Yes
No
If Yes, please attach applicable documentation with this form.
25. Have you filed a claim against the Contractor’s bond?
Yes
No
If Yes, please attach applicable documentation with this form.
26. Have you filed a claim against the Board Recovery Fund?
Yes
No
27. Have you obtained an estimate from another contractor to complete or correct job?
Yes
No
If Yes, provide name, address, phone number of the contractor, and if possible, a copy of the estimate.
28. The Nevada Administrative Code (NAC) 624.7251, permits an enhancement in the assessment of fines, if a fine is assessed, and
the violation is perpetrated against a Senior Citizen, age 60 or older.
Does your case qualify for the enhanced penalty provisions of the Nevada Administrative Code?
Yes
No
PLEASE SEND COPIES OF ALL PAPERS RELATED TO YOUR COMPLAINT
Please attach copies of both sides of contracts, cancelled checks, and other pertinent materials.
Include invoice and payment balance sheet (See attached Consumer Complaint Form Checklist).
DO NOT SEND ORIGINALS. If copies are not available, please explain.
A.
If this contractor is licensed, he/she will be informed of this alleged complaint and will be asked to contact you.
B.
The Nevada State Contractors’ Board cannot direct a non-licensed contractor to complete or correct a project.
C.
The Nevada State Contractors’ Board cannot represent private citizens in court or collect money for you. Please contact an
attorney or the small claims counselor at your local municipal court for advice on filing such an action.
The information contained in this form is true, correct, and complete to the best of my knowledge. I will assist in the investigation
or in the prosecution of the contractor or other parties, and will if necessary, attend hearings and testify to facts. I understand
that the Nevada State Contractors’ Board is unable to represent private citizens in court or to collect money or to levy fines.
26. SIGN HERE:
27. DATE:
Revised 3/2012
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