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Consumers Business License/Permit Holders & Applicants Other Government Agencies        
Affidavit Of Compliance

I, ______________________________________________________________________________
(Name of person signing affidavit)(Title)

do hereby certify that the wages paid to all employees of
(Company Name)

for all hours worked on the
(Project name and location)

project, during the period from ___________________ to ___________________ are in
(Project Dates)

compliance with prevailing wage requirements of Chapter 4115 of the Ohio Revised Code.

I further certify that no rebates or deductions have been or will be made, directly or indirectly,

from any wages paid in connection with this project, other than those provided by law.

(Signature of Officer or Agent)

Sworn to and subscribed in my presence this ___________________ day of ___________________,

20 _______.
(Notary Public)

The above affidavit must be executed and sworn to by the officer or agent of the contractor or subcontractor who supervises the payment of employees. This affidavit must be submitted to the owner (public authority) before the surety is released or final payment due under the terms of the contract is made.


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