"Illinois Prevailing Wage Complaint Form" - Illinois

Illinois Prevailing Wage Complaint Form is a legal document that was released by the Illinois Department of Labor - a government authority operating within Illinois.

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Illinois Department Of Labor
ILLINOIS PREVAILING WAGE
160 North Lasalle Street, Ste 1300
Chicago, Illinois 60601
COMPLAINT FORM
DOL.PWD@illinois.gov
http://labor.illinois.gov/
Section A: Complainant Information
Name
Title
Organization
Address
Address2
City
State
ZIP Code
Daytime Phone
Fax Number
Email
Section B: Contractor/Project Information
Name of Company
Owner
General Contractor
Sub-Contractor
Address
Address2
City
State
ZIP Code
Daytime Phone
Fax Number
Email
Project/Contract Number
County
Location of Project
City
State
ZIP Code
Describe Work Performed
If No, Date Project Completed
Is Work Currently Being Performed?
Yes
No
Section C: Public Body Information
Public Body
Administrator
Address
Address2
City
State
ZIP Code
Daytime Phone
Fax Number
Email
Section D: Description of Violation
PLEASE EXPLAIN WHY YOU BELIEVE THERE WAS A VIOLATION
Did You Observe The Worksite?
Yes
No
If Yes, Give Dates
Number Of Workers
Classifications
SUPPORTING DOCUMENTATION (PLEASE SUBMIT WITH COMPLAINT FORM - COMPLAINTS FILED WITHOUT SUFFICIENT DOCUMENTATION MAY BE DISMISSED)
Employee Interviews
Check Stubs
Pictures/Video
Notes/Observations
Bidding Reports
Public Body Docs
Corporate Search
Affidavits
Project Mgr Reports
Meeting Minutes
News Articles
Payroll/Time Logs
Other (describe)
Section E: Signature
Date
Signature
Print
Illinois Department Of Labor
ILLINOIS PREVAILING WAGE
160 North Lasalle Street, Ste 1300
Chicago, Illinois 60601
COMPLAINT FORM
DOL.PWD@illinois.gov
http://labor.illinois.gov/
Section A: Complainant Information
Name
Title
Organization
Address
Address2
City
State
ZIP Code
Daytime Phone
Fax Number
Email
Section B: Contractor/Project Information
Name of Company
Owner
General Contractor
Sub-Contractor
Address
Address2
City
State
ZIP Code
Daytime Phone
Fax Number
Email
Project/Contract Number
County
Location of Project
City
State
ZIP Code
Describe Work Performed
If No, Date Project Completed
Is Work Currently Being Performed?
Yes
No
Section C: Public Body Information
Public Body
Administrator
Address
Address2
City
State
ZIP Code
Daytime Phone
Fax Number
Email
Section D: Description of Violation
PLEASE EXPLAIN WHY YOU BELIEVE THERE WAS A VIOLATION
Did You Observe The Worksite?
Yes
No
If Yes, Give Dates
Number Of Workers
Classifications
SUPPORTING DOCUMENTATION (PLEASE SUBMIT WITH COMPLAINT FORM - COMPLAINTS FILED WITHOUT SUFFICIENT DOCUMENTATION MAY BE DISMISSED)
Employee Interviews
Check Stubs
Pictures/Video
Notes/Observations
Bidding Reports
Public Body Docs
Corporate Search
Affidavits
Project Mgr Reports
Meeting Minutes
News Articles
Payroll/Time Logs
Other (describe)
Section E: Signature
Date
Signature
Print