EXHIBIT “1”

Case 1:20-cv-22603-JG Document 159-1 Entered on FLSD Docket 05/02/2023 Page 1 of 4
U.S. Department of Labor 

Wage and Hour l)ivision 

Receipt for Payment of Back Wages, Lic1uidated Damages, 

Employment Benefits, or Othe1· Compensation 

I, Diaz, Leonel ·--~---, have received payment of wages, liquidated damages, employment 

(typed or printed name of employee) 

benefits, or other compensation due to me from -------~--=G=R-=I:.:L::;L:::._c~~TERPRISES, LLC 

(name and location of the establishment) 

____________ 1_0_7_75--.:NW=._4:.;1-:,cst: Street Miami FL 33178 ·------------

for .the period beginning with the workweek ending 03/11/2017 ·-----through the 

workweek ending ___ 03/09/2019 The amount of the payment I received is shown below. 

This payment of wages and .other compensation was calculated or approved by the U.S .. Department of Labor Wage and Hour 

Division (WHD) and is based on the findings of a WIID investigation. This payment is required by the Act(s) indicated below in 

the marked box(es): 

[21 Fair Labor Standards Act ( FLSA) 

.Gross Amount BackWugcs . $133. 36 Gross l\mourit Liquidated Damages $0, 00 

Legal Deductions from Back ~""1:Ji:.f":'t; ______ Other Amount Paid --·-·----------·- __ --· .--··-

Net.Amount Received $'_f4J. !:,.s"" (please specify type) 

NOTICE TO EMPLOYEE: Your acceptance of this payment of wages and/or other compensation due under the Fair Labor 

Standards Act (FLSA) or Family Medical Leave Act (FMLA), based on the findings of the WIID means that you have given up 

the right you have to bring suit on your own behalf for the payment of such unpaid minimum wages or unpaid overtime 

compensation for the period of time indicated above and an equal amount in liquidated damages, plus attorney's fees and court 

costs under Section 16(b) of the FLSA or Section 107 of the FMLA. Generally, a suit for unpaid wages or other compensation, 

including liquidated damages, must be filed within two years ofa violation of the. FLSA or FMLA. Do not sign this receipt unless 

you have actually received this payment in the amount indicated above. 

RETALIATION AND KICKBACKS PROHIBITED: Your employer is prohibited from retaliating against you for accepting 

payment ofwages you are owed or from requiring you to return or decline payment of the wages owed to you. Your employer is 

also prohibited from retaliating against any person who files a complaint with the. Wage and Hour Division (WI-ID) or cooperates 

with a WHD investigation. Your employer is also prohibited from interfering with, restraining, or denying the exercise of Family 

Medical Leave Act (FMLA) rights. You should contact the WHD immediately if your employer takes any of these actions or fails 

to comply with the Jaw in the future. Your identity will be kepi confidential to the maximum extent possible under existing law. 

You may contact the WI-ID by callino/6,.,..Yj 2 or 305-598-6607. 

Signature of employee . ~/,F,,r;/, - . ;1:-------- Date O S/06 /zo'(.J_ 

Address ·--'~.:.8..0 · ::)_..4. Pr , ____ _ 

I .tmderstand thnt my signntur.e-ofl this rccei11t and waiver attests.to the fad that I have actually received the p11y111cntin the.amount 

indicated above of.the wages; li11uidatcd dnmnges, or other compensation due to me, and thnt I lYnivc my right to bring suit as 

described above, and .covering the 11eriod set forth above. 

EJ\11'1.0\'ER'S CERTIFICATION TO WAGE Al'/D IIO!)R DIVISION OF Tim ni-;PARTMENT OF LABOR: 

I hereby certify that I have on this (Date) 5 / (:.,./_f_':f_ . __ paid the above-n~med 

employee in full covering lc.ist or denied wages, liquidated ~~magcs, or other compensation as stated above. I further certify that I 

have not and \Viii not retaliate against the above-named employee for accepting this payment and I have not and will ·not ask the 

• I ~ I employee to return all pa of 1is pa:ym t to me. ~ f 

Signature ----~~~~~:..._4:~~:::::::_ __ Title. ____ f_e_~_-~_c>---=f',-\..'---'-------------

(c111ploycr or authorized representative) 

PENALTIES INCLUJ)ING l•INESOR IMPIUSONJ\IENT ARE PRESCRIBED FORA FALSE 

STATEMENT OR J\IISIU:PRESENTA'l'ION UNDER U.S. CODE, TITLE 18, SEC. 1001 I .. 

Dme:04/1812019 11:23:31 AM Case ID: li72675 

,.,111.411111 I._ lJWt.C..V 

Fom1 Wl-1-58 (Rev. April 2017) 

Page I 

Case 1:20-cv-22603-JG Document 159-1 Entered on FLSD Docket 05/02/2023 Page 2 of 4
nesa 

0.00 0.00 

SSN: ltXll-XX-8073 

_____ 29 ... .4 ...... 0_ FED SOCSEO 

29.40 FED 

MEDCARE 

hed< I Check No: 90009 $27. 15 

0.00 

0.00 

SSN: XXX•lut-8318 

___ 

1 ... 33.., ...,3.6.. FED SOCSEC 

133.36 FED 

MEDCARE 

heck/ Check No: 90010 $123.15 

ardo D 

0. 00 

0.00 

SSN: XXlMU<~071i 

__ .....,:4,..4.1_6;.. FED SOCSEC 

44.16 FED 

MEDOARE 

ec.k I Check No: 90011 $40,78 

0.00 0.00 

SSN: XXX~Xl(-7432 

307.84 FED SOCSEC 307.84 FED 

MEDCARE 

eck/ Check No: 90012 $284.29 

e M 

O. 00 

0.00 

S8N: )O(X-lllt-3370 

435.88 FED FIT' 

435:88 FEO SOCSEC 

FED 

MEOCARE 

.Ctiecl<No: ~013 $389.72 

!Nldy 

0,00 

0..00 

Y. I 

0.00 

rprises LLC 

19 - Payroll 1 · 

""-.&......_ .. nA/'40/"")_n_,fO 

S95J.64 FED FIT 

$950.64 FEP SOCSEC 

FED 

MEOCARE 

$9e0.e4 FED FIT 

Payroll Details 

1.82 

0.43 

2.25 

8.27 

1.94 

10.21 

2.74 

0.64 

3.38 

19.09 

4.46 

23.55 

12.82 

27.02 

6.32 

46.16 

$12.82 

$58.94 

$13.79 

~5.55 

$12.82 

1 of 2 

Run Number: 0163 

27.15 FED SOCSEC-ER 

FED MEDCARE-ER 

123.15 FED SOCSEC-ER 

FED MEDCARE,ER 

40.78 FE_D SOCSEC-ER 

FED MEDCARE·ER 

284.29 FED SOCSEC-ER 

FED MEDCARE·ER 

FEDFUTA 

FLSUI-ER 

389.72 FED SOCSEC-ER 

FED MEDCARE-ER 

$865.09 FEO SOCSEC,ER 

FED MEOCME-ER 

FEDFI.Jf(l. 

FlSUl,ER 

$865,09 .. FEO SOCSEC.i;R 

1.82 

o.43 

2.25 

8:Zl 

1.9:, 

10.20 

2.74 

0.64_ 

3.38 

19;09 

4.46. 

1.85 

0.31 

25.71 

27.02 

6.32 

33.34 

$56.94 $13.-78 

,ue 

$0.31 

$74,88 

$61li4 

Oat& Print~: 05/16/201917:57 

22303671 - RA/46A 

20-cv-22603-JG Document 159-1 Entered on FLSD Docket 05/02/2023 Page 3 of 4
Earnings 

Regular 

Tipped hours 

Cash tips 

Cash Tips owed 

Paytolhe 

order of: 

This amount: 

CHASE 

Company Code Loe/Dept Number Page 

RA/ 46A22303671 01/ 90010 1 of 1 

Grill Enterprises LLC 

1450 Brickell Ave Suite 2080 

Miami, FL 33131 

Taxable Marital Status: Single 

Exemptions/Allowances: Tax Override: 

Federal: O Federal: 

State: O State: 

Local: O Local: 

Social Security Number: XXX-XX-XXXX 

rate hours/units 

Gross Pay 

Statutory Deductions 

Federal Income 

Social Security 

Medicare 

Net Pay 

Grill Enterprises LLC 

1450 Brickell Ave Suite 2080 

Miami, FL 33131 

Leonel Diaz 

0.00 

Leonel Diaz 

380 NW 85th Place 

Miami, FL 33126 

this period 

133.36 

0.00 

0.00 

0.00 

$133.36 

this period 

0.00 

-8.27 

-1.94 

$123.15 

year to date 

133.36 

2549.34 

435.29 

9018.23 

$12,136.22 

year to date 

1341.29 

752 .45 

175.98 

Earnings Statement 

Period Starting: 04/18/2019 

04/18/2019 

04/18/2019 

Period Ending: 

Pay Date: 

Leonel Diaz 

380 NW 85th Place 

Miami, FL 33126 

Your federal taxable wages this period are $133.36 

63-8413/2670 

Payroll Check Number: 90010 

Pay Date: 04/18/2019 

$123.15 

Case 1:20-cv-22603-JG Document 159-1 Entered on FLSD Docket 05/02/2023 Page 4 of 4