"Prompt Payment Complaint Form - Construction" - Oklahoma

Prompt Payment Complaint Form - Construction is a legal document that was released by the Oklahoma Department of Transportation - a government authority operating within Oklahoma.

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Download "Prompt Payment Complaint Form - Construction" - Oklahoma

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PROMPT PAYMENT COMPLAINT
Civil Rights Division
Construction
200 N.E. 21st Street, Room 1-C1
Oklahoma City, OK 73105
Phone: (405) 521-3186
Fax: (405) 522-2136
Prior to filling out this form, ensure that you have completed the following.
1. Did you verify the work in question has been approved by the department?
YES
NO
2. Did you verify the Prime was paid by ODOT? (click here or click on "Prime
Contractor Payment" under "Doing Business" at www.ok.gov/odot)
YES
NO
3. Did you contact the Prime to try and resolve the issue? If no, you will need to contact
YES
NO
the Prime before filing your complaint. If yes, what was the outcome?
4. Has the project been completed?
YES
NO
Date:
Project:
Residency:
Contract ID:
Prime Contractor:
Name of Complainant:
Name of Company:
Address:
City/State:
Zip Code
Phone:
Email:
List pay items for which payment has not been made:
Pay Items
Quantity
Amount $
Estimate #
Total Amount:
PROMPT PAYMENT COMPLAINT
Civil Rights Division
Construction
200 N.E. 21st Street, Room 1-C1
Oklahoma City, OK 73105
Phone: (405) 521-3186
Fax: (405) 522-2136
Prior to filling out this form, ensure that you have completed the following.
1. Did you verify the work in question has been approved by the department?
YES
NO
2. Did you verify the Prime was paid by ODOT? (click here or click on "Prime
Contractor Payment" under "Doing Business" at www.ok.gov/odot)
YES
NO
3. Did you contact the Prime to try and resolve the issue? If no, you will need to contact
YES
NO
the Prime before filing your complaint. If yes, what was the outcome?
4. Has the project been completed?
YES
NO
Date:
Project:
Residency:
Contract ID:
Prime Contractor:
Name of Complainant:
Name of Company:
Address:
City/State:
Zip Code
Phone:
Email:
List pay items for which payment has not been made:
Pay Items
Quantity
Amount $
Estimate #
Total Amount:
Explain action or conditions giving rise to this complaint, including contacts made with prime contractor
and/or ODOT personnel.
Attach copies of documents to support complaint: subcontract, invoices, notes, time & diaries, payrolls,
correspondence, etc.
Complaints should be emailed to
ODOT-promptpayment@odot.org
and/or submitted by mail to:
Civil Rights Division
200 N.E. 21st Street, Room 1-C1
Oklahoma City, OK 73105
Phone: (405) 521-3186
Fax: (405) 522-2136
Signature
Date
Print Form
The Oklahoma Department of Transportation (ODOT) ensures that no person or groups of persons shall, on the grounds of race, color, sex,
religion, national origin, age, disability, retaliation or genetic information, be excluded from participation in, be denied the benefits of, or
be otherwise subjected to discrimination under any and all programs, services, or activities administered by ODOT, its recipients, sub-
recipients, and contractors. To request an accommodation please contact the ADA Coordinator at 405-521-4140 or the Oklahoma Relay
Service at 1-800-722-0353. If you have any ADA or Title VI questions email: ODOT-ada-titlevi@odot.org.
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