Fillable Printable Form 700-129-000
Fillable Printable Form 700-129-000
Form 700-129-000
F700-129-000 pw complaint-interested parties 11-2006
Department of Labor and Industries
Prevailing Wage Program
PO Box 44540
Olympia Washington 98504-4540
Phone (360) 902-5335 / Fax (360) 902-5300
INTERESTED PARTY
CHECKLIST
ALLEGED VIOLATOR NAME/PROJECT:
For the Filing of
Prevailing Wage Complaints
Note: This Interested Party checklist is to be utilized by “Interested Parties” only. The checklist should be
considered a guide with departmental requirements and recommendations provided in order to assist in the filing
of prevailing wage complaints.
Fully complete the F700-129-000 Prevailing Wage Complaint form for Interested Parties.
o A separate complaint form must be submitted for each project in which you have substantiated a violation.
Ensure that the project involved is subject to provisions of Washington State Public Work Act (RCW 39.12).
o Complaints may be filed when there is a violation of state law. The department cannot take action on
disputes related to employment agreements that are in excess of what the law provides (i.e., collective
bargaining agreements), as L&I has no enforcement authority for such agreements unless there is a
violation of state statutes.
o Complaints may not be filed for work performed outside the state of Washington.
Determine if Statements of Intent or Affidavits of Wages Paid have been filed. If filed, provide copies with
your complaint form.
o If you cannot locate form(s) on file, contact alleged violator/prime contractor/awarding agency for
information as to filing status and, if filed, obtain copies.
Provide the following information:
o Bid due date/contract award date;
o Wage rates for classifications of work performed.
Status of the project.
o Generally, you must file a complaint within 30 days of the project’s acceptance date by the awarding
agency in order for the department to investigate.
o Provide all requested dates such as work start dates, expected completion date or completion date, and
acceptance date or projected acceptance date. Additionally, if accepted, state the manner of acceptance.
Describe the nature of the alleged violation.
o Provide a statement explaining the alleged violation(s).
o Cover the classification(s) and regulation(s) involved.
o Provide the required prevailing hourly wage rate(s).
Provide a statement of action(s) taken by the Interested Party.
o Give an overview of your investigation (i.e., visited job site, interviewed worker(s), contacted awarding
agency/prime contractor, etc.), and include all action(s) taken by you to achieve compliance.
o Provide copies of any correspondence regarding the alleged violation(s).
Provide a statement outlining the evidence/documentation/information you gathered to substantiate the
alleged violation(s) and provide copies of each when filing the complaint. Depending upon the alleged
violation(s), this documentation may include:
o Statements/interviews with workers.
o If wage-related, provide evidence to support claimed wages due and attach copies of available records.
Payroll records and statement of earnings records for workers;
Wage Transcription/Computation Sheets;
Hours of work logs maintained by workers/employer/project manager;
List names, addresses, phone numbers of any workers, individuals, agencies or interested parties who
can verify information concerning the alleged violation(s) or that have access to documentation to
support your allegation(s).
F700-129-000 pw complaint-interested parties 11-2006
INTERESTED PARTY CHECKLIST For the Filing of Prevailing Wage Complaints (Continued)
Suggested investigative procedures:
Contact the prime contractor to advise them of the specifics of the complaint. Ask them for assistance in
achieving compliance with the alleged violator.
Obtain the following information and copies of documentation, if available:
o A contact person calls/correspondence should be addressed to;
o The current status of the project and when completion and/or acceptance are anticipated;
o Verify bid due date/contract award date;
o A copy of the contract with the subcontractor and/or awarding agency;
o Awarding agency information such as name, address and contact person;
o If certified payrolls records and 4/10 work agreements are on file;
o If the project manager/inspector kept a daily/weekly log of manpower reports on the alleged violator.
Contact the awarding agency to advise them of the specifics of the complaint. Ask them for assistance in
achieving compliance with the alleged violator.
Obtain the following information and copies of documentation, if available:
o The division that is responsible for the project;
o A contact person/project manager calls/correspondence should be addressed to;
o The current status of the project and when completion and/or acceptance are anticipated;
o Verify bid due date/contract award date;
o A copy of the contract with the subcontractor and/or prime contractor;
o Prime contractor information (if firm being investigated is not the prime contractor);
o If certified payrolls records and 4/10 work agreements are on file;
o If the project manager/inspector kept a daily/weekly log of manpower reports on the alleged violator;
o Where liens are filed, lien information, lien custodians and if any other liens have been filed.
F700-129-000 pw complaint-interested parties 11-2006
Department of Labor and Industries
Prevailing Wage Program
PO Box 44540
Olympia Washington 98504-4540
Phone (360) 902-5335 / Fax (360) 902-5300
www.lni.wa.gov/WorkplaceRights
PREVAILING WAGE
COMPLAINT FORM
for Interested Parties
Combined Prevailing Wage “Interested Party Complaint Form” and “Project Collection Information Sheet”
Note: This complaint form is to be utilized by “Interested Parties” only. Employees/workers who need to file a prevailing wage
complaint must utilize a Worker Rights Complaint form (form number F700-027-000).
The Prevailing Wage Complaint Form for Interested Parties must be completed in full in order to be investigated. It is your
responsibility to substantiate the validity of the complaint. At the time of filing, you must supply documents or records that support
the complaint, e.g., copies of pay statements, time records, calendars or any record kept of days and hours worked and the activities
performed, or, explain why the records and documents cannot be supplied. (See the bottom of page two for a list of acceptable
documents.) Failure to follow the procedures outlined or to respond to requests from the department will cause the complaint to be
closed. A separate complaint form must be submitted for each project in which you have substantiated violations.
INTERESTED PARTY INFORMATION
Organization Name:
Name of Complainant: ⏐Title, if applicable:
Mailing Address: ⏐City/State/Zip:
Phone: ⏐Fax, if available: ⏐e-mail, if available:
ALLEGED VIOLATOR INFORMATION / PER PROJECT
Business Name:
Mailing Address: ⏐City/State/Zip:
Location Address, if known: ⏐City/State/Zip, if known:
Phone: ⏐Fax, if known: ⏐e-mail, if known:
UBI Number, if registered ⏐Ownership: Sole Proprietor Corporation Partnership
Contractor Registration Number, if registered: ⏐Expiration Date of Registration, if registered:
Contractor Bond Number, if bonded: ⏐Total Amt. of Claims Against Contractor Bond, if known: $
Surety Name, if insured: ⏐Address, if insured: ⏐City/State/Zip, if insured:
Is this firm still in business? Yes No Don’t know ⏐Has firm filed for bankruptcy? Yes No Don’t know
Date WORK STARTED by alleged violator: ⏐LAST DATE WORKED by alleged violator:
Has a STATEMENT OF INTENT been filed? ⏐Has an AFFIDAVIT OF WAGES PAID been filed?
Yes No If YES, please attach a copy. ⏐ Yes No If YES, please attach a copy.
Do you have a copy of the alleged violator’s contract for the project? ⏐Are CERTIFIED PAYROLL records for the project on file?
Yes No If YES, are copies attached? Yes No ⏐ Yes No If YES, are copies attached? Yes No
Does the firm have signed 4/10 work agreements on file for this project? Yes No Don’t know If YES & available, please attach copies.
If known, how often does the firm pay workers? Monthly Twice Monthly Every other week Weekly Daily
If known, place a checkmark in the box(es) below for any benefits provided by the alleged violator.
Medical Dental Vacation Pension Holidays Other (describe)
PUBLIC WORKS PROJECT INFORMATION
Project Name:
Physical Address of Project:
Contract Number, if numbered: (If possible, please provide a copy of contract.)⏐Contract Amount, if known: $
Bid Due Date: ⏐Award Date:
Date Work Started: ⏐Expected Completion Date (if not completed):
Completion Date: ⏐Date Project Accepted:
If NOT Accepted, Anticipated Date: ⏐Manner of Acceptance (i.e., letter, minutes, etc.):
Description of Project:
(Continued on reverse)
F700-129-000 pw complaint-interested parties 11-2006
PREVAILING WAGE
COMPLAINT FORM
PUBLIC WORKS PROJECT INFORMATION (continued) for Interested Parties
NAME OF AWARDING AGENCY: Is there RETAINAGE on this project? Yes No Don’t know
Amount of RETAINAGE, if known: $
Contact Name, if known: Has a NOTICE OF CLAIM (lien) been filed with the Awarding
Title, if known: Agency? Yes No Don’t know If YES & available,
Mailing Address: attach a copy and note the name of the filer and the date filed below:
City/State/Zip: Name: Date:
Phone: ⏐Fax, if available:
Was all work performed in Washington?
Yes No Don’t know
NAME OF PRIME CONTRACTOR: (If not alleged violator.) PROJECT PERFORMANCE BOND, if required for project:
Bond Amount:
Contact Name, if known: Bond Number:
Title, if known: Surety Name:
Mailing Address: Address:
City/State/Zip: City/State/Zip:
Location Address:
Phone: ⏐Fax, if available:
City/State/Zip: Has the Prime filed a STATEMENT OF INTENT?
Phone: ⏐Fax, if available:
Yes No If YES, please attach a copy.
Contractor Registration Number, if registered: If job site visited, were all INTENT forms posted? Yes No
Expiration Date of Registration, if registered: Has the Prime filed an AFFIDAVIT OF WAGES PAID?
UBI Number, if registered: Yes No If YES, please attach a copy.
DETAILS OF COMPLAINT
Nature of violation(s): • Statement explaining the violation(s); • Cover classification(s)/regs. involved; • Provide PW hourly wage rate(s)
Statement of actions taken by complainant: • Overview of investigation (i.e., visited job site, interviewed workers, contacted AA/Prime)
Statement outlining evidence/documentation/information gathered to substantiate the alleged violation: • Attach evidence/documentation
If complaint is WAGE-RELATED, have you performed an audit to ascertain the amount of wages you believe are due?
Yes No If YES, please attach a copy of your audit and documentation, then provide the following information:
• GROSS AMOUNT OWED: $_______________________ • NUMBER OF WORKERS:___________________
Below is a list of records which will aid in our investigation. Checkmark the records that are available to you, then provide copies when
filing the complaint. Additionally, it would be beneficial for you to provide a list of the names, addresses and phone numbers of any
workers, individuals, agencies or interested parties who can verify information concerning the alleged violation(s) or that have access to
documentation to support your allegation(s).
Wage Transcription/Computation Sheets Written wage agreement Shift schedules
Payroll check stubs Employer-maintained time records Worker-maintained time records
Attendance rosters Employee handbook Worker interviews/statements
Copies of bad checks Copies of any correspondence Other (describe)
DATE AND SIGNATURE
Date Signed: Signature:
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