Fillable Complaint Against a Contractor or Tree Trimmer (Licensed (Broward County)

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Complaint Against a Contractor or Tree Trimmer (Licensed (Broward County)

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Environmental Protection and Growth Management Department
BUILDING CODE SERVICES DIVISION | CONTRACTOR LICENSING & ENFORCEMENT
2307 West Broward Boulevard, Suite 300 • Fort Lauderdale, Florida 33312 • 954-765-4400 Option 2 • broward.org/building
Complaint Against a Contractor or Tree Trimmer (Licensed or Unlicensed)
All information provided to the Building Code Services Division is public record and is available for
inspection by the public under the Florida Public Records Law. This includes all the information you have
included in this complaint and supporting documentation.
Complainant Information (Consumer)
Name
Home Phone
Address
City
State
Zip
Mobile Phone
Work Phone
Email
Contractor Information
Name
Company Name
Address
City
State
Zip
Phone
Fax
License # Used
Contact Person
Email
Complaint Initiation
Complaint by Owner
Complaint by General Contractor Against Subcontractor
Complaint by Subcontractor Against General Contractor
Complaint by Material/Equipment Supplier
Other
Project Information
Construction Site Owner Name
Construction Site Owner Phone
Construction Site Owner Address
City
State
Zip
Construction Site Physical Address
City
State
Zip
Describe briefly the work for which you contracted:
Contract Date
Date Work Started
Amount
$
Amount Paid on Contract
$
Why did you choose this contractor?
Regular Customer
Door-to-Door Solicitation
Referral
Advertisement
Other
Please explain:
Is this project a:
Residence
New Construction
Commercial Building
Other
Rev. 11/2017 2
Please explain:
Repair
Remodel
Addition
Other
Please explain:
Was the contract:
Written
Oral
New Home Purchase Agreement
Other
Please explain:
Were there any change orders?
Yes
No
If yes, were they:
Written
Oral
Both
Is your complaint:
Abandonment
Other
Please explain:
Was a building permit obtained?
Yes
No
Unknown
If yes, permit pulled by:
Contractor
You
Salesperson
Unknown
Permit #
Building Department
Was a Notice of Commencement filed?
Yes
No
Unknown
Who presented contract?
Contractor
Salesperson
Other
Name:
Did the contractor have employees?
Yes
No
Unknown
If yes, how many:
Did you fire the contractor or terminate the contract?
Yes
No
Unknown
Was any work performed?
Yes
No
Unknown
Did you receive a “Notice to Owner?”
Yes
No
Unknown
If yes, by whom:
Were any liens filed on this job?
Yes
No
Unknown
What attempts have you made to contact the contractor?
Personal Contact
Phone
Letter
Unable to Locate
Have you obtained an estimate from another contractor to complete or correct the job?
Rev. 11/2017 3
Yes
No
If yes, please provide a copy with your complaint
Contractor Name
Address
Phone
Are you willing to testify under oath at an administrative hearing?
Yes
No
Are you interested in seeking a monetary claim through Broward County’s Central Examining Board Restitution Trust
Fund? Please Note: complaints against a tree trimmer are not eligible for restitution through this fund.
Yes
No
If you receive a recommended order for restitution issued from a hearing officer or if restitution is ordered by a Central Examining
Board, you may pursue reimbursement from Broward County’s Central Examining Board Trust Fund, subject to the requirements of
Chapter 9-141, Broward County Code or Ordinances. To pursue reimbursement, you will need to complete a claim form once an
order has been issued in your favor.
Complaint Information
Please give a complete description of your complaint.
Please provide copies (front and back) of all paperwork related to your complaint, including copies of contracts
and/or estimates, proof of payment
*
and any other pertinent materials – including photographs. Please cross
out all Social Security numbers and bank or credit card account numbers. If copies are not available, please
indicate. Do not send original documents
Rev. 11/2017 4
*Proof of payment includes: (1) if payment was made by cash, a receipt reflecting payment; (2) if payment was
made by check, a photocopy of the front and back of the negotiated check; (3) if payment was made by credit
card, a photocopy of the credit card receipt or statement; (4) if a dispute was filed with your credit card
company, the results of that dispute.
An attempt will be made to assist you and the contractor in negotiating a resolution whenever possible. If this is not
possible, other actions may be taken depending on the result of an investigation.
• If the contractor is licensed, he/she will be informed of this alleged complaint and will be asked to contact us.
• We are unable to direct an unlicensed person to complete or correct any project.
We do not represent private citizens in court – nor can we collect money for you. Please contact an attorney for
advice on filing such action.
Florida Statute §837.06 states: Whoever knowingly makes a false statement in writing with the intent to mislead a
public servant in the performance of his official duty shall be guilty of a misdemeanor of the second degree.
Under penalty of perjury, I declare the facts contained herein are true, correct and complete.
Signature
Date
Notary Public
STATE OF FLORIDA
COUNTY OF _____________________
Sworn to (or affirmed) and subscribed before me this_________ day of____________________________, 20________
by ________________________________________
(name of person acknowledging)
__________________________________________________
(Signature of Notary Public-State of Florida)
__________________________________________________
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known __________ or Produced Identification __________
Type of Identification Produced _______________________________________________________
(NOTARY SEAL)
This complaint form must be notarized in order to be accepted for investigation. Please return this completed form
with all necessary documentation to the Division address on page 1 or FAX to 954-765-4163.
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Complaint Against a Contractor or Tree Trimmer (Licensed (Broward County)

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Completed 8 February 2021

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