OEBO - Ordinance Violation Complaint Form

Ordinance Violation Complaint Form

The purpose of this form is to provide a vendor, certified or not, with a means to file a complaint about an alleged EBO Program Ordinance violation. Complete this form in its entirety, date, and sign before submitting. Please direct all questions to (561) 616-6840

Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Complainant Information

Complainant First Name *This question is required.

Complainant Last Name *This question is required.

Address *This question is required.

City *This question is required.

State *This question is required.

Zip *This question is required.

Company Name (Complainant) *This question is required.

Daytime Telephone *This question is required.

Fax

Email *This question is required. This question requires a valid email address.

Company Name and Employee (subject to complaint, i.e. Respondent) *This question is required.

Select the appropriate ordinance reference(s) that identifies the violation (write in) *This question is required.

Describe in detail the alleged action taken against your company that you believe is a violation of Palm Beach County EBO Ordinance 2-80.28 and why? *This question is required.

Specify the role of the Respondent *This question is required.

Please enter an 'other' value for this selection. * This question is required.

Approximate date of the alleged violation(s) *This question is required.

Signature of Complainant *This question is required.

Clear

Signature of

E-mail Disclaimer:

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

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