Circle Group Claim Form [english]


CLAIM YOUR MONEY BY COMPLETING THE FORM BELOW.

Estimated number of weeks you worked at the SkyHouse Denver under Circle Group: (If you dispute this estimate, you may challenge it through clear documentary evidence by 11/22/2017. Please contact Optime Administration to raise your dispute. Optime will resolve the matter in its sole and binding discretion)

INFORMATION ABOUT YOU

 

Name:  

Date of Birth:  

Address:  

City: State: Country:  Zip Code:  

Telephone number:  

Do you have an email address? If so, what is it?  

 

I understand that by signing this claim form I’m making a claim to recover from a class action settlement of claims brought under Colorado law. I also understand that by signing this Claim Form, I am agreeing to OPT-IN to a Fair Labor Standards Act (“FLSA”) claim, 29 U.S.C. § 216(b), and thus release my claims under the FLSA against Circle Group for work performed on the SkyHouse Denver project. If I do not sign this form, I will not recover from the class settlement, but I will not necessarily release my claims against Circle Group under the FLSA.

Instead of completing this form, I also understand that I can choose to not to be a member of the FLSA or Colorado state law class by completing and returning the Opt-Out form. If the red form is completed by me and submitted, I understand I will not receive any payment from the settlement fund and that I am not guaranteed any payment whatsoever from Circle Group if I bring my own claim. I also understand that I have the option to object to the settlement by following the instructions for objection in the Notice that came with this form.

By signing above, I am providing my consent to join the Fair Labor Standards Act and Colorado state law claims against Circle Group in this matter. I understand that completing, signing, and submitting this form will prevent me from bringing another claim for unpaid wages or overtime premiums under the Fair Labor Standards Act or pursuant to Colorado law for work I provided on the SkyHouse Denver site under the Circle Group.

 

HOW DO I SUBMIT THIS FORM AND HOW CAN I GET MORE INFORMATION?

 

 

All forms in response to this notice (opt-in/claims forms and opt-out forms) should be digitally submitted via an electronic signature or by telephone, fax, or email. If you have problems with digital submission or any other questions about this case, please contact Optime using the contact information below. All objections should be mailed or emailed to the settlement administrator at its address below. Please contact the settlement administrator if you have questions.

Circle Group Settlement Administrator

c/o Optime Administration, LLC

P.O. Box 3206 Brockton,

MA 02304

Phone: 844-625-7313

Fax: 781-287-0381

Email: circlegroupsettlement@optimeadmin.com

PLEASE DO NOT CALL THE COURT OR THE CLERK OF THE COURT.

Sign here to claim this money:

Signature Date:

Leave this empty:

Circle Group Settlement https://circlegroupsettlement.com
Signature Certificate
Document name: Circle Group Claim Form [english]
Unique Document ID: fe4cb7cf69673cdcc1165a22f72fcc5cab5f7ea7
Timestamp Audit
September 18, 2017 10:34 am ESTCircle Group Claim Form [english] Uploaded by Scott Simpson - ssimpson@optimeadmin.com IP 71.192.72.70