"Prevailing Wage Complaint Form" - Metropolitan Sewer District of Greater Cincinnati, Ohio

"Prevailing Wage Complaint Form" - Metropolitan Sewer District of Greater Cincinnati, Ohio Download Pdf
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Prevailing Wage Complaint Form is a legal document that was released by the Ohio Department of Commerce - a government authority operating within Ohio. The form may be used strictly within Metropolitan Sewer District of Greater Cincinnati.

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METROPOLITAN SEWER DISTRICT OF GREATER CINCINNATI
EQUAL EMPLOYMENT OPPORTUNITY AND
CONTRACT COMPLIANCE PROGRAM
PREVAILING WAGE COMPLAINT
A prevailing wage complaint may be filed with the MSDGC Prevailing Wage Coordinator or the Bureau of Wage and Hour for
investigation. Information regarding filing with the Wage and Hour Bureau can be found at
www.com.state.oh.us
Before filing a prevailing wage complaint, please read carefully!
You may file a complaint with the Metropolitan Sewer District of Greater Cincinnati (MSDGC) if:
A. You were or are employed on the project.
B. You meet one of the following:
Any person who submits a bid for the purpose of securing the award of a contract for construction of the public
1.
improvement.
2. Any person acting as a subcontractor of a person mentioned in (B.1.) above.
3. Any bona fide organization of labor which has as members or is authorized to represent employees of a person mentioned in
(B.1. or B.2.) and which exists, in whole or in part, for the purpose of negotiating with employers concerning the wages,
hours, or terms and conditions of employment of employees.
4. Any association having as members any of the persons mentioned in (B.1. or B.2.) of this section.
Do Not Fill Out This Form If:
A. The project has been completed for two (2) years.
B. You acted as an "independent contractor" and not as an "employee" of the business, or you were self-employed.
C. Your claim is against a contractor who you intend to sue in a private action.
D. You already have a judgment involving the same wage claim.
E.
The contractor has filed for bankruptcy. (If so, you will need to contact the Bankruptcy Court for further instructions.)
Filing More Than One Complaint:
A.
You must use a separate complaint form for filing against each contractor and/or project.
B.
Each claimant intending to file against a contractor and/or project must use a separate complaint form.
Completing The Prevailing Wage Complaint Form:
A.
Read all questions on the wage claim form carefully before answering. Please fill out your claim completely, legibly, and
accurately. You must sign and date.
B.
Provide the contractor's name, name of business, correct address, county, and telephone number. You as the claimant are
responsible for providing this information.
C.
To help prove your claim, please provide copies of any documentation you have available. For example, pay stubs or a personal
record of hours worked on the project. DO NOT SEND ORIGINALS.
D.
Be certain that your name, address, social security number, and telephone number are correct. If you do not have a telephone
number, please provide a phone number where you can be reached. If your address or telephone number changes, it is your
responsibility to notify us immediately or your claim could be closed.
The Prevailing Wage Complaint Form (PDF) can be downloaded at www.msdgc.org.
Return Form to:
Michelle Schaber
Senior Administrative Specialist
City Purchasing Division
805 Central Avenue, Suite 234, Cincinnati, Ohio 45202
Questions? Call the Prevailing Wage Coordinator at 513-352-3278.
MSDGC - Prevailing Wage Complaint – Page 1
METROPOLITAN SEWER DISTRICT OF GREATER CINCINNATI
EQUAL EMPLOYMENT OPPORTUNITY AND
CONTRACT COMPLIANCE PROGRAM
PREVAILING WAGE COMPLAINT
A prevailing wage complaint may be filed with the MSDGC Prevailing Wage Coordinator or the Bureau of Wage and Hour for
investigation. Information regarding filing with the Wage and Hour Bureau can be found at
www.com.state.oh.us
Before filing a prevailing wage complaint, please read carefully!
You may file a complaint with the Metropolitan Sewer District of Greater Cincinnati (MSDGC) if:
A. You were or are employed on the project.
B. You meet one of the following:
Any person who submits a bid for the purpose of securing the award of a contract for construction of the public
1.
improvement.
2. Any person acting as a subcontractor of a person mentioned in (B.1.) above.
3. Any bona fide organization of labor which has as members or is authorized to represent employees of a person mentioned in
(B.1. or B.2.) and which exists, in whole or in part, for the purpose of negotiating with employers concerning the wages,
hours, or terms and conditions of employment of employees.
4. Any association having as members any of the persons mentioned in (B.1. or B.2.) of this section.
Do Not Fill Out This Form If:
A. The project has been completed for two (2) years.
B. You acted as an "independent contractor" and not as an "employee" of the business, or you were self-employed.
C. Your claim is against a contractor who you intend to sue in a private action.
D. You already have a judgment involving the same wage claim.
E.
The contractor has filed for bankruptcy. (If so, you will need to contact the Bankruptcy Court for further instructions.)
Filing More Than One Complaint:
A.
You must use a separate complaint form for filing against each contractor and/or project.
B.
Each claimant intending to file against a contractor and/or project must use a separate complaint form.
Completing The Prevailing Wage Complaint Form:
A.
Read all questions on the wage claim form carefully before answering. Please fill out your claim completely, legibly, and
accurately. You must sign and date.
B.
Provide the contractor's name, name of business, correct address, county, and telephone number. You as the claimant are
responsible for providing this information.
C.
To help prove your claim, please provide copies of any documentation you have available. For example, pay stubs or a personal
record of hours worked on the project. DO NOT SEND ORIGINALS.
D.
Be certain that your name, address, social security number, and telephone number are correct. If you do not have a telephone
number, please provide a phone number where you can be reached. If your address or telephone number changes, it is your
responsibility to notify us immediately or your claim could be closed.
The Prevailing Wage Complaint Form (PDF) can be downloaded at www.msdgc.org.
Return Form to:
Michelle Schaber
Senior Administrative Specialist
City Purchasing Division
805 Central Avenue, Suite 234, Cincinnati, Ohio 45202
Questions? Call the Prevailing Wage Coordinator at 513-352-3278.
MSDGC - Prevailing Wage Complaint – Page 1
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
to
Total Hours on Project: Regular
Overtime
MSDGC - Prevailing Wage Complaint – Page 2
YES
NO
Were you paid time and
½ for hours worked over 40 per week?
Did employer provide written notice of job classification?
Did employer provide written notice of Prevailing Wage Rate?
Did employer provide written notice of name of Prevailing Wage Coordinator?
What Fringe Benefits were paid by the company?
None
Health Insurance $
Life Insurance $
Paid Vacation $
Paid Holidays $
Paid Sick Leave $
Pension $
Bonus
Other
Training _
Hours worked recorded by:
time card/sheet
called into office
recorded by foreman
other
SIGNATURE AND NOTARY
I hereby certify that this is a true statement to the best of my knowledge and belief.
____________________________________________________________
________________________________
Signature
Date
Sworn to and before me and subscribed by the said: _____________________________________________________
In my presence this ________ day of ______________________________________________, 200 _________________
__________________________________________________________ Notary Public
SEAL
MSDGC - Prevailing Wage Complaint – Page 3
Prevailing Wage Form Ohio Department of Commerce Ohio Legal Forms United States Legal Forms

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