Complaint Form Under Title 5, Section 55 Required Information

Contact person for Private Enterprise

1. Name

2. Address

3. Telephone Number

4. E Mail Address

Private Enterprise(s) impacted (one entity, group, statewide impact)

5. Business/Group Name

6. Address

7. Telephone Number

Government Agency causing impact

8. Agency name

9. Address (if known)

10. Location of activity (if different)

11. Contact Person (if known)

12. Type of Impact (loss of work, market fluctuation, etc.)

13. Duration of impact (start date if known, end date if known)

14. Support - facts/proof

15. Requested Resolution

Please submit this form to:
David F. Emery, Chair
Advisory Committee on Fair Competition with Private Enterprise
78 State House Station
Augusta, ME 04333-0078