JOINT STIPULATION OF CLASS ACTION SETTLEMENT AND RELEASE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 AKIN GUMP STRAUSS HAUER & FELD LLP GREGORY W. KNOPP (SBN 237615) VICTOR A. SALCEDO (SBN 317910) [email protected][email protected]1999 Avenue of the Stars, Suite 600 Los Angeles, CA 90067-6022 Telephone: 310.229.1000 Facsimile: 310.229.1001 Attorneys for Defendants, WSP USA INC. AND HOWROYD-WRIGHT EMPLOYMENT AGENCY, INC., DBA APPLEONE EMPLOYMENT SERVICES SHIMODA LAW CORP. Galen T. Shimoda (SBN 226752) Erika R. C. Sembrano (SBN 306635) 9401 E. Stockton Blvd., Suite 200 Elk Grove, CA 95624 CASTLE LAW: CALIFORNIA EMPLOYMENT COUNSEL Timothy B. Del Castillo (SBN 277296) 3200 Douglas Blvd., Ste. 300 Roseville, CA 95661 Attorneys for Plaintiff, AARON CARR SUPERIOR COURT OF THE STATE OF CALIFORNIA FOR THE COUNTY OF SACRAMENTO AARON CARR, an individual and on behalf of all others similarly situated, Plaintiff, v. HOWROYD-WRIGHT EMPLOYMENT AGENCY, INC., dba APPLE ONE, a California Corporation; WSP USA INC., a New York Corporation; and DOES 1 to 100, Inclusive, Defendants. Case No. 34-2018-00228290 JOINT STIPULATION OF CLASS ACTION SETTLEMENT AND RELEASE Date Action Filed: March 2, 2018 DocuSign Envelope ID: A31EBAFF-6F99-49A1-8A7F-C4BB477D0EFB
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JOINT STIPULATION OF CLASS ACTION SETTLEMENT AND RELEASE
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AKIN GUMP STRAUSS HAUER & FELD LLP GREGORY W. KNOPP (SBN 237615) VICTOR A. SALCEDO (SBN 317910) [email protected][email protected] 1999 Avenue of the Stars, Suite 600 Los Angeles, CA 90067-6022 Telephone: 310.229.1000 Facsimile: 310.229.1001
Attorneys for Defendants, WSP USA INC. AND HOWROYD-WRIGHT EMPLOYMENT AGENCY, INC., DBA APPLEONE EMPLOYMENT SERVICES
SHIMODA LAW CORP. Galen T. Shimoda (SBN 226752) Erika R. C. Sembrano (SBN 306635) 9401 E. Stockton Blvd., Suite 200 Elk Grove, CA 95624 CASTLE LAW: CALIFORNIA EMPLOYMENT COUNSEL Timothy B. Del Castillo (SBN 277296) 3200 Douglas Blvd., Ste. 300 Roseville, CA 95661
Attorneys for Plaintiff, AARON CARR
SUPERIOR COURT OF THE STATE OF CALIFORNIA
FOR THE COUNTY OF SACRAMENTO
AARON CARR, an individual and on behalf of all others similarly situated,
Plaintiff,
v.
HOWROYD-WRIGHT EMPLOYMENT AGENCY, INC., dba APPLE ONE, a California Corporation; WSP USA INC., a New York Corporation; and DOES 1 to 100, Inclusive,
Defendants.
Case No. 34-2018-00228290
JOINT STIPULATION OF CLASS ACTION SETTLEMENT AND RELEASE
Page 1 of 5 NOTICE OF PROPOSED CLASS ACTION SETTLEMENT AND HEARING DATE FOR FINAL COURT APPROVAL OF SETTLEMENT
SUPERIOR COURT OF THE STATE OF CALIFORNIA
FOR THE COUNTY OF SACRAMENTO
AARON CARR, an individual and on behalf of all others similarly situated, Plaintiff, v. HOWROYD-WRIGHT EMPLOYMENT AGENCY, INC., dba APPLEONE EMPLOYMENT SERVICES, a California Corporation; WSP USA INC., a New York Corporation; and DOES 1 to 100, Inclusive,
Defendants.
Case No. 34-2018-00228290 CLASS ACTION NOTICE OF PROPOSED CLASS ACTION SETTLEMENT AND HEARING DATE FOR FINAL COURT APPROVAL OF SETTLEMENT
ATTENTION: Any and all non-H[HPSW�RU�KRXUO\�SDLG�HPSOR\HHV��ZKHWKHU�GLUHFWO\�HPSOR\HG�E\�:63�86$��,QF���³:63´��
or provided by Howroyd-Wright Employment Agency, dba AppleOne Employment Services �³$SSOH2QH´�� RU� DQRWKHU� VWDIILQJ�agency, who performed work for WSP in California on tKH�&DOLIRUQLD�+LJK�6SHHG�5DLO��³&$+65´��SURMHFW�IURP�0DUFK����������WR ___(Order Granting PAM Date)_____.
PLEASE READ THIS NOTICE CAREFULLY. THIS IS A NOTICE OF SETTLEMENT OF A CLASS ACTION LAWSUIT FOR ALLEGED LABOR CODE VIOLATIONS. YOU ARE ENTITLED TO RECEIVE A PAYMENT UNDER THE TERMS OF THIS CLASS ACTION SETTLEMENT. THIS NOTICE CONTAINS IMPORTANT INFORMATION ABOUT YOUR RIGHT TO PARTICIPATE OR TO OPT OUT OF THE SETTLEMENT ACCORDING TO THE PROCEDURES DESCRIBED BELOW.
Pursuant to the Order Granting Preliminary Approval of Class Action Settlement of the Sacramento County Superior Court
entered _______________________, 2019, YOU ARE HEREBY NOTIFIED AS FOLLOWS:
I. BACKGROUND OF THE CASE
On about March 2, 2018, Plaintiff Aaron Carr filed a Complaint against AppleOne and WSP (collectively, ³'HIHQGDQWV´��in the Sacramento &RXQW\�6XSHULRU�&RXUW��³&RXUW´��on behalf of himself and all other similarly situated employees who worked for Defendants as non-exempt or hourly employees. On about May 25, 2018, Plaintiff filed a First Amended Complaint against Defendants alleging further specific FODVVHV�RI�SHUVRQV�DIIHFWHG�E\�'HIHQGDQWV¶�DOOHJHG�YLRODWLRQV�RI�WKH�ODZ. The Class Period is between March 2, 2014, and ________________ �WKH�³&ODVV�3HULRG´�� Plaintiff and Defendants may be collectively referred to as WKH�³3DUWLHV�´�
In the Action, Plaintiff specifically contended that Defendants violated California law by failing to pay overtime, failing to pay minimum wages, failing to provide meal and rest periods, failing to reimburse expenses, failing to provide accurate wage statements, failing to pay final wages, violating Labor Code section 558, failing to keep accurate time records, failing to provide written notice pursuant to Labor Code section 2810.5, and violating the PULYDWH�$WWRUQH\V�*HQHUDO�$FW� �³3$*$´�� (Labor Code § 2699, et seq.). Plaintiff contended that, based on the forgoing, Plaintiff and Class Members are entitled to damages and penalties. There have been on-going investigations, including the exchange of extensive documentation and information. Furthermore, the Parties have participated in extensive private settlement negotiations, including a mediation facilitated by a neutral third party. Based upon the negotiations, and all known facts and circumstances, including the various risks and uncertainties related to legal actions, the Parties reached a class-wide Settlement. By settling this action, the Parties will avoid the risks and costs associated with a lengthy litigation process. Defendants deny all allegations and claims. Defendants deny any liability or wrongdoing of any kind and believe their wage and hour practices were legally compliant in all respects. The Court has made no determination about the merits of 3ODLQWLII¶V�FODLPV�RU�WKH�GHIHQVHV�DVVerted by the Defendants.
The Parties have entered into a Joint Stipulation of Class Action Settlement and Release between Plaintiff and Defendants
�³6HWWOHPHQW´�RU�³$JUHHPHQW´�, which has been preliminarily approved by the Court. The Settlement applies to all non-exempt or hourly paid employees, whether directly employed by WSP or provided by AppleOne or another staffing agency, who performed work for WSP in California on the CAHSR project from March 2, 2014, to ______________ �³6HWWOHPHQW�&ODVV´�. The Settlement
Page 2 of 5 NOTICE OF PROPOSED CLASS ACTION SETTLEMENT AND HEARING DATE FOR FINAL COURT APPROVAL OF SETTLEMENT
Class will not include persons who submit valid Requests for Exclusion (as explained below).
You have received this notice because 'HIHQGDQWV¶ records indicate you fall within the Settlement Class. If you are part of the Settlement Class, yRX�KDYH�WKH�RSSRUWXQLW\�WR�SDUWLFLSDWH�LQ�WKH�6HWWOHPHQW��RU�WR�H[FOXGH�\RXUVHOI��³RSW�RXW´��IURP�WKH�6HWWOHPHQW���This notice is to advise you of how you can either participate in the Settlement or be excluded from the Settlement.
II. SUMMARY OF THE PROPOSED SETTLEMENT
A. The Amount of the Settlement Under the terms of the Settlement, Defendants agree to pay a maximum gross total of $1,195,000.00 �³0D[LPXP�6HWWOHPHQW�
$PRXQW´����Deducted from this Maximum Settlement Amount will be sums approved by the Court for a Service Payment to the Class Representative in an amount not to exceed $20,000.00; the fees and expenses of the Claims Administrator estimated not to exceed $10,000.00; $25,000.00 payable to the California Labor and Workforce Development Agency �³/:'$´��IRU�DOOHJHG�PAGA penalties, twenty-five (25%) of which will be re-distributed back to the Settlement Class; DWWRUQH\V¶�IHHV�QRW�WR�H[FHHG�WKLUW\-five percent (35%) of the Maximum Settlement Amount, which equals $418,250�����DWWRUQH\V¶ costs not to exceed $12,500.00, which will result in a ³Net Settlement Amount´ for distribution to all Class Members. As explained further EHORZ�� WKH� DPRXQW� RI� HDFK� &ODVV� 0HPEHU¶V�Settlement Award will depend on the number of weeks worked by participating Class Members as non-exempt employees during the Class Period. Defendants will also pay employer-side payroll taxes, but this will be in addition to the Maximum Settlement Amount, not out of the Maximum Settlement Amount.
The enclosed Estimated Distribution Form lists the number of weeks you worked during the Class Period as a non-exempt
employee and your estimated share of the Net Settlement Amount �³6HWWOHPHQW�$ZDUGV´�. The actual amount received may be more or less than the amount stated on the Estimated Distribution Form depending on the actual number of weeks determined to be worked by Class Members, the resolution of any disputes regarding workweeks, and the distributions finally approved and allocated by the Court.
B. Settlement Formula and Settlement Awards
Defendants will pay Settlement Awards through the Claims Administrator, as described below, to each Class Member who does not opt out of, or exclude themselves, from the Settlement. All Settlement Awards will be subject to appropriate taxation. The Parties have agreed, based on the allegations in the Action that all Settlement Awards payable to eligible Class Members will be allocated from the Net Settlement Amount and paid as forty percent (40%) alleged interest for which IRS Forms 1099-MISC will issue and sixty percent (60%) alleged unpaid wages for which IRS Forms W2 will issue. Aside from the employer-side payroll taxes that Defendants will pay, Participating Class Members will be responsible for the payment of any and all taxes on the amounts the Participating Class Members receive. Thus, in the event claims arise related to taxes for or from these Settlement Awards besides any claim related to employer-side payroll taxes, each Participating Class Member will defend, indemnify, and hold Defendants free and harmless from these claims.
Settlement Awards to Class Members will be based on the number of weeks worked by individual Class Members as non-exempt employees during the Class Period. The number of workweeks will be determined by reference to 'HIHQGDQWV¶ records. The Claims Administrator, based on 'HIHQGDQWV¶ records, will calculate the number of workweeks for each Class Member during the Class Period. Each Class Member¶s Settlement Award shall be determined by taking the weeks worked as a non-exempt employee during the Class Period and dividing that by the total number of weeks worked as non-exempt employees for all Class Members and multiplying that fraction by the Net Settlement Amount. Payment to Class Members of their Settlement Award will not require the submission of any claim form. Receipt of the Settlement Awards will not entitle any Class Member to additional compensation or benefits under any company compensation or benefit plan or agreement in place during the period covered by the Settlement.
C. Calculations to Be Based on Defendants’ Records
For each Class Member, the amount payable will be calculated by the Claims Administrator from 'HIHQGDQWV¶ records. 'HIHQGDQWV¶ records will be presumed correct, unless evidence to the contrary is provided to the Claims Administrator. 'HIHQGDQWV¶ records and any additional evidence will be reviewed by the Claims Administrator in the event of a dispute about the number of workweeks worked by an individual Class Member. If a Class Member disputes the accuracy of 'HIHQGDQWV¶ records, all supporting documents evidencing additional workweeks must be submitted by the Class Member with the Estimated Distribution Form. The dispute will be resolved by the Claims Administrator as described in Section E below.
Page 3 of 5 NOTICE OF PROPOSED CLASS ACTION SETTLEMENT AND HEARING DATE FOR FINAL COURT APPROVAL OF SETTLEMENT
³'HIHQGDQWV´ DQG� WKH� ³5HOHDVHG� 3DUWLHV´� LQ� WKH� $FWLRQ� LQFOXGH� Defendants and all of their present and former parents, subsidiaries, affiliates, and joint ventures, and all of their shareholders, members, managers, officers, officials, directors, employees, agents, servants, registered representatives, attorneys, insurers, successors, and assigns, and any other persons acting by, through, under, or in concert with any of them.
The Settlement contains a release which releases Defendants and the Released Parties from any and all claims (i) asserted in
the Action, including in the First Amended Class Action Complaint filed on May 25, 2018, or (ii) arising from, or derivative of, the claims or fDFWXDO�DOOHJDWLRQV�DVVHUWHG�LQ�WKH�$FWLRQ��LQFOXGLQJ�WKRVH�FRQFHUQLQJ�'HIHQGDQWV¶�SUDFWLFHV�UHJDUGLQJ�PHDO�DQG�UHVW�EUHDNV�and break premiums, payment of wages for time worked, business expenses, maintenance of payroll records, payment of final wages, and ZDJH� VWDWHPHQWV� �³5HOHDVHG� &ODLPV´��� � 7KH� 5HOHDVHG� &ODLPV� LQFOXGH�� EXW� DUH� QRW� OLPLWHG� WR�� DQ\� FODLPV�� ULJKWV�� GHPDQGV��liabilities, and causes of action of any kind or nature in law or in equity, under any theory, whether contract, common law, constitutional, statutory or otherwise, of any jurisdiction, foreign or domestic, whether known or unknown, anticipated or XQDQWLFLSDWHG��LQFOXGLQJ�IRU�GDPDJHV��UHVWLWXWLRQ��SHQDOWLHV��LQWHUHVW��FRVWV��DWWRUQH\V¶�IHHV��H[SHQVHV��HTXLWDEOH�UHOLHI��Lnjunctive relief, and any other relief. As to the Released Claims only, Class Members who do not submit a valid and timely Request for Exclusion will be deemed expressly to have waived the provisions, rights, and benefits of California Civil code section 1542, which provides:
A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR.
Plaintiff and Class Members may discover facts in addition to or different from those which they now know or believe to be true with respect to some or all of the Released Claims (including unknown claims as defined above), but Plaintiff and each Class Member will be deemed as of the Effective Date to have fully and finally released, discharged, and settled all Released Claims (including unknown claims as defined above), suspected or unsuspected, contingent or non-contingent, whether or not concealed or hidden, which have existed, now exist, or come into existence in the future as defined above.
E. Resolution of Workweek Disputes
If a Class Member disputes the accuracy of 'HIHQGDQWV¶ records as to the number of workweeks worked, any documentation supporting such dispute must be submitted to the Claims Administrator with the Estimated Distribution Form. All workweek disputes will be resolved and decided by the Claims Administrator, and the Claims AdministrDWRU¶V�GHFLVLRQ�RQ�DOO�GLVSXWHV�ZLOO�EH�ILQDO�DQG�binding.
F. Service Payment for the Class Representative
Subject to approval by the Court, Plaintiff Aaron Carr will receive a Service Payment of up to $20,000.00. This payment will be made for his service as Class Representative, including active participation in prosecution of the Action, as well as willingness to DFFHSW�WKH�ULVN�RI�LQFXUULQJ�&ODVV�&RXQVHO¶V�FRVWV�RU�SD\LQJ�'HIHQGDQWV¶ DWWRUQH\V¶�IHHV�DQG�FRVWV�for an unsuccessful outcome in the Action.
G. Attorneys’ Fees and Costs
Defendants agree tR�SD\�&ODVV�&RXQVHO¶V�DWWRUQH\V¶� IHHV�and costs to be set by the Court out of the Maximum Settlement Amount, up to a maximum of thirty-five percent (35%), which equals $418,250.00, and attorneys¶ costs not to exceed $12,500.00. &ODVV�&RXQVHO¶V�DWWRUQH\V¶�Iees and costs will be paid and deducted from the Maximum Settlement Amount.
H. Reasonableness of Settlement
All attorneys for the Parties to the Action believe the amounts payable to Class Members and amounts IRU�DWWRUQH\V¶�IHHV�DQG�costs requested are fair and reasonable. The Class Representative and Class Counsel support this Settlement. Among the reasons for support are the defenses to liability potentially available to Defendants, the inherent risk of trial on the merits, the risk of denial of class certification, and the delays associated with litigation.
III. WHAT ARE YOUR RIGHTS AS A CLASS MEMBER
A. Participating in the Settlement
If you wish to participate in the settlement, you do not need to take any further actions. Payment will be automatically made
Page 4 of 5 NOTICE OF PROPOSED CLASS ACTION SETTLEMENT AND HEARING DATE FOR FINAL COURT APPROVAL OF SETTLEMENT
to you consistent with the terms of the Agreement and Court Order. If you wish to dispute the workweek calculation, you may follow the procedures outlined Section II.E. California law protects Class Members from retaliation based on their decision to participate in the Settlement.
B. Excluding Yourself from the Settlement
If you do not wish to participate in the Settlement, you may be excluded (i.e.�� ³RSW� RXW´�� E\� VXEPLWWLQJ� D� WLPHO\�ZULWWHQ�request to the Claims Administrator stating you have received notice of the Settlement, decided not to participate in the Settlement, DQG�GHVLUH�WR�EH�H[FOXGHG�IURP�WKH�6HWWOHPHQW��RU�ZRUGV�WR�WKDW�HIIHFW��³5HTXHVW�IRU�([FOXVLRQ´����<RXU�5HTXHVW�IRU�([FOXVLRQ must also state your full name, address, date of birth, and the last four digits of your Social Security Number. The Request for Exclusion must be signed, dated and mailed by First Class U.S. Mail or the equivalent, to:
[admin info]
The Request for Exclusion must be postmarked no later than _______________, 2019. If you submit a Request for
Exclusion which is not postmarked by _________________, 2019, your Request for Exclusion will be rejected and you will be bound by the Release and all other Settlement terms. If the Request for Exclusion is sent from within the United States it must be sent through the United States Postal Service by First Class Mail, or the equivalent. Do not use a postage meter as that may not result in a postmark appearing on the envelope containing your Request for Exclusion.
Any person who submits a complete and timely Request for Exclusion shall, upon receipt by the Claims Administrator, no
longer be a Class Member, shall be barred from participating in any portion of the Settlement, shall receive no benefits from the Settlement, and shall not be deemed to have relinquished the Released Claims against the Released Parties.
C. Objection to Settlement
If you do not exclude yourself from the Settlement, you can object to the terms of the Settlement before Final Approval. However, if the Court rejects your objection, you will still be bound by the terms of the Settlement. You can ask the Court to deny approval by filing an objection. You cannot ask the Court to order a larger settlement; the Court can only approve or deny the settlement. Any objection should state each specific reason for your objection and any legal support for each objection. Your objection must also state your name, address, and date of birth. If the Court denies approval, no settlement payments will be sent out and the lawsuit will continue. If that is what you want to happen, you must object.
You may object to the proposed settlement in writing. You may also appear at the Final Approval Hearing, either in person
or through your own attorney. If you appear through your own attorney, you are responsible for paying that attorney. All written objections and supporting papers must (a) clearly identify the case name and number (Carr v. Howroyd-Wright Employment Agency, dba Apple One, et al., Sacramento County Superior Court, Case No. 34-2018-228290), (b) be submitted to the Court by filing them with the Civil Clerk of the Court, (c) a copy of the objection filed with Court must also be served on the Claims Administrator (address above), Class Counsel (address below), and 'HIHQGDQWV¶ Counsel (address below), and (d) be filed or postmarked on or before _________________.
IV. EFFECT OF THE SETTLEMENT: RELEASED RIGHTS AND CLAIMS
Upon Final Approval being granted by the Court, each and every Class Member who does not opt out of the Settlement will release Defendants and the Released Parties from the Released Claims as described above. In other words, if you were employed as a Class Member by Defendants in California during the Class Period, and you do not exclude yourself from the Settlement Class, you will be deemed to have entered into this release and to have released the above-described Released Claims. In addition, you will be barred from ever suing Defendants and the Released Parties with respect to the Released Claims covered by this Settlement. If the Settlement is not approved by the Court or does not become final for some other reason, the litigation will continue.
V. FINAL SETTLEMENT APPROVAL HEARING
The Court will hold a hearing in Department __ of the Sacramento County Superior Court, 720 Ninth Street, Sacramento California 95814 on ________________, 2019, at _________ a.m./p.m. to determine whether the Settlement should be finally approved as fair, reasonable, and adequate. The Court also will be asked to approve Class &RXQVHO¶V�UHTXHVW�IRU�DWWRUQH\V¶�IHHV�DQG�costs and the Service Payment to be paid to the Class Representative. The hearing may be continued without further notice to Class Members. It is not necessary for you to appear at this hearing, unless you wish to object to the Settlement.
Page 5 of 5 NOTICE OF PROPOSED CLASS ACTION SETTLEMENT AND HEARING DATE FOR FINAL COURT APPROVAL OF SETTLEMENT
VI. ADDITIONAL INFORMATION
Above is a summary of the basic terms of the Settlement. For the precise terms and conditions of the Settlement, you should FRQVXOW� WKH� GHWDLOHG� ³Joint Stipulation of Class Action Settlement and Release´� that is on file with the Clerk of the Court. The pleadings and other records in this Action, including the Settlement, may be examined at any time during regular business hours at the Office of the Clerk of the Sacramento County Superior Court, at 720 Ninth Street, Sacramento California 95814.
If you want additional information about this lawsuit and its proceedings, you can contact Class Counsel DQG�RU�'HIHQGDQWV¶
Counsel:
Galen T. Shimoda, Esq. SHIMODA LAW CORP. Co- Class Counsel for Plaintiff 9401 East Stockton Boulevard, Suite 200 Elk Grove, CA 95624 Telephone: (916) 525-0716 Timothy B. Del Castillo CASTLE LAW: CALIFORNIA EMPLOYMENT COUNSEL Co- Class Counsel for Plaintiff 3200 Douglas Blvd., Ste. 300 Roseville, CA 95661 Telephone: (916) 245-0122
Gregory W. Knopp AKIN GUMP STRAUSS HAUER & FELD LLP Counsel for Defendants 1999 Avenue of the Stars, Suite 600 Los Angeles, CA 90067 Telephone: (310) 229-1000
3/($6(� '2� 127� 7(/(3+21(� 7+(� &2857� 25� 7+(� &2857� &/(5.¶6� 2)),&(� 72� ,148IRE ABOUT THIS
CLASS MEMBER SETTLEMENT ESTIMATED DISTRIBUTION FORM
AARON CARR, an individual, Plaintiff v. HOWROYD-WRIGHT EMPLOYMENT AGENCY, INC., DBA APPLEONE EMPLOYMENT SERVICES, a California Corporation; WSP USA INC., a New York
Corporation, and DOES 1 to 100, inclusive, Defendants.
SACRAMENTO COUNTY SUPERIOR COURT, Case No. 34-2018-00228290
1. Instructions. If you want to receive a share of the class action settlement in the above entitled case, review the information below to confirm that your contact and personnel information is correct. If this information is accurate, do not return this form. You will automatically receive your settlement share unless you opt out of the proposed settlement. If the information below is not correct, please provide the correct information where indicated under penalty of perjury, date and sign this document, and mail it, post marked no later than ____________, to the following address:
[TITLE] c/o ___________
[ADDRESS] Phone number: ______________
Do not mail or deliver this notice to the Court, the settling parties, or their counsel. Only submit the corrected information to the claims administrator at the address above. You are responsible for maintaining a copy of this completed form containing the corrected information. You will not receive any acknowledgment of receipt from the claims administrator. To prove that you mailed this form with the corrected information, you must send it to the claims administrator via certified mail. You are allowed to send it by regular mail, but, if it is lost or misplaced, you will have no ability to prove that you sent it on time unless you send it via certified mail. If you submitted a request to opt out of the class, do not submit this form to the claims administrator as you may not participate in this settlement after opting-out. If you have questions about this form, you may contact the claims administrator at the above address and telephone number. 2. Personal Information and Workweeks. According to Defendants’ records, the following information is applicable to you and your potential share of the settlement:
If the information above is not correct, please provide the correct information, below:
After consultation with Plaintiff’s counsel and Defendants’ counsel regarding documentary evidence for your weeks worked, the claims administrator will make a final determination concerning the disputed information by ____________, 2019. Any completed forms that are not submitted by ______________, 2019, will be dismissed as untimely regardless of whether the assigned number of workweeks is disputed. // // //
Name:
[last, first, middle initial]
Mailing Address:
[street, city, state, zip]
Number of Weeks Worked as a Non-Exempt
Employee Between March 2, 2014, to preliminary approval date:
[workweeks]
Estimated Pre-Tax Settlement Share (subject to change
pending resolution of any disputed workweek claims and approval by Court of settlement):
$[monetary amount]; $[penalty amount]
Corrected Name:
Corrected Mailing Address:
(include telephone number, starting with the area code)
Corrected Number of Workweeks and Basis for Dispute (include any supporting documentation) (DO
NOT include any workweeks performed outside the March 2, 2014, to preliminary approval date time