Form LAW1003 "Affidavit of Compliance Prevailing Wages" - Ohio

What Is Form LAW1003?

This is a legal form that was released by the Ohio Department of Commerce - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2019;
  • The latest edition provided by the Ohio Department of Commerce;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form LAW1003 by clicking the link below or browse more documents and templates provided by the Ohio Department of Commerce.

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Download Form LAW1003 "Affidavit of Compliance Prevailing Wages" - Ohio

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Affidavit of Compliance
Prevailing Wages
I,
(Name of person signing affidavit) (Title)
do hereby certify that the wages paid to all employees of
(Company Name)
for all hours worked on the
(Project name and location)
project, during the period from
to
are in
(Project Dates)
compliance with prevailing wage requirements of Chapter 4115 of the Ohio Revised Code. I further
certify that no rebates or deductions have been or will be made, directly or indirectly, from any wages
paid in connection with this project, other than those provided by law.
(Signature of Officer or Agent)
Sworn to and subscribed in my presence this _______ day of
__________, 20__________.
(Notary Public)
The above affidavit must be executed and sworn to by the officer or agent of the contractor or
subcontractor who supervises the payment of employees. This affidavit must be submitted to
the owner (public authority) before the surety is released or final payment due under the terms
of the contract is made.
Bureau of Wage and Hour Administration
614-644-2239
Fax 614-728-8639
6606 Tussing Road
TTY/TDD 800-750-0750
Reynoldsburg, OH 43068-9009
com.ohio.gov
LAW1003
An Equal Opportunity Employer and Service Provider
3/2019
Affidavit of Compliance
Prevailing Wages
I,
(Name of person signing affidavit) (Title)
do hereby certify that the wages paid to all employees of
(Company Name)
for all hours worked on the
(Project name and location)
project, during the period from
to
are in
(Project Dates)
compliance with prevailing wage requirements of Chapter 4115 of the Ohio Revised Code. I further
certify that no rebates or deductions have been or will be made, directly or indirectly, from any wages
paid in connection with this project, other than those provided by law.
(Signature of Officer or Agent)
Sworn to and subscribed in my presence this _______ day of
__________, 20__________.
(Notary Public)
The above affidavit must be executed and sworn to by the officer or agent of the contractor or
subcontractor who supervises the payment of employees. This affidavit must be submitted to
the owner (public authority) before the surety is released or final payment due under the terms
of the contract is made.
Bureau of Wage and Hour Administration
614-644-2239
Fax 614-728-8639
6606 Tussing Road
TTY/TDD 800-750-0750
Reynoldsburg, OH 43068-9009
com.ohio.gov
LAW1003
An Equal Opportunity Employer and Service Provider
3/2019