Class Action Settlement Claim Form printable pdf download

Class Action Settlement Claim Form

JONES ET. AL V. 3 WEISS GUYS ET. AL

SAN DIEGO COUNTY SUPERIOR COURT CASE NO. 37-2008-00095231-CU-OE-CTL

CLASS ACTION SETTLEMENT CLAIM FORM

This class action settlement Claim Form is to be used to make a claim in the class action of Jones

et. al v. 3 Weiss Guys et. al, San Diego Superior Court Case No. 37-2008-00095231-CU-OE-

CTL. This class action includes only those person who were employed by 3 Weiss Guys, Inc.

dba Bourbon Street and/or Michael Weiss dba Lei Lounge (hereinafter referred to as

“Defendants,” “Bourbon Street” or “Weiss”) as non-exempt service employees between

November 3, 2004 and December 31, 2008.

If you believe that you fall within this class as defined, and wish to make a claim, you must

complete this Claim Form and return it to the Claims Administrator at the address set forth

below. Submission of a Claim Form will waive any and all claims against Bourbon Street

and Weiss to seek unpaid meal and rest break wages and/or compensation for work

performed between November 3, 2004 and December 31, 2008.

Jones v. 3 Weiss Guys, Inc., et. al.

c/o Simpluris, Inc.

PO Box 26170

Santa Ana, CA 92799

Toll Free 888-369-3780

ONLY THOSE CLAIM FORMS RECEIVED BY THE CLAIMS ADMINISTRATOR

AND POSTMARKED BY JUNE 25, 2010 WILL BE VALID. IN ADDITION, CLAIM

FORMS MUST BE COMPLETELY FILLED OUT TO BE VALID.

ONLY VALID

CLAIM FORMS WILL BE PROCESSED.

You will not receive any acknowledgment of receipt from the Claims Administrator. To prove

that you mailed your Claim Form, you must send the claim to the Claims Administrator by

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 in on time unless you send via certified mail.

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Class Action Settlement Claim Form