California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 8 - Office of the Director › Subchapter 4 - Labor Compliance Programs › Article 5 - Enforcement › Appendix D - Request for Approval of Forfeiture - Suggested Format

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
AWARDING BODY / THIRD PARTY
						LCP:
Name and Contact Information:
Date of
								Request:
Name and Contact Information for Awarding Body if
								different from LCP:
LCP Approval Status (specify if either interim or
								temporary or if LCP has extended authority):
2.
PROJECT
						INFORMATION:
Project Name:
Contract Number:
Project Location:
Bid Advertisement Dates:
Estimated Date
								Project is to be completed:
Acceptance Date of Project by the Awarding
								Body:
Notice of Completion/Date Recorded with County Recorder:
Other Relevant Deadline (specify):
Amount
								being held in Retention:
3.
CONTRACTOR
						INFORMATION:
Name and address of Affected
								Contractor:
Name and address of Affected Subcontractor:
General Description of Scope of Work of
								the Entire Project:
General Description of Scope of Work
								covered in the proposed Forfeiture (describe and attach relevant portions of
								contract or subcontract):
4.
LABOR COMPLIANCE PROGRAM
						INVESTIGATION AND FINDINGS:
Total Amount of Request for
								Notice of Withholding of Contract Payments:
Wages Due:
Training Funds
								Due:
Total Penalties Due:
Potential Liquidated Damages [Wages +
								Training Funds]:
LC 1775 Penalties Due:
LC 1813 Penalties
								Due:
LC 1776 Penalties Due:
Other:
[Provide narrative summaries covering the
						following]:
A. Statement of Issues.
B. Investigative Report (detailed narrative
						including but not limited to how the investigation was conducted including
						worker declarations, reviewing certified payroll records, verification of
						employer payment contributions, etc.).
C. Audit Report (detailed explanation of how
						audit was completed addressing each of the issues above).
D. Affected contractor and subcontractor
						information (how affected contractor and subcontractor were informed of
						potential violations; summary of their response with respect to violations and
						penalty issues; and any other information considered in determining recommended
						penalties).
E. Recommended penalties under Labor Code Section
						1775(a)
						and basis for recommendation, including how factors in subsection (a)(2) of
						Section 1775 were applied to arrive at the
						recommended amount(s).
ATTACHMENTS
1. Audit Summary (Appendix B)
2. 1st Bid Advertisement
						Publication
3. Notice of Completion
4. Scope of Work
5. Complaint form(s) and Declarations, if any
___________________________
Send the Request and all Attachments to:
DIVISION OF LABOR STANDARDS ENFORCEMENT
BUREAU OF FIELD ENFORCEMENT
ATTN.: REGIONAL MANAGER
300 OCEANGATE BLVD., NO. 850
LONG BEACH, CA 90802
COPIES OF THIS REQUEST, INCLUDING ALL ATTACHMENTS,
						SHALL BE SERVED ON THE AFFECTED CONTRACTOR AND AFFECTED SUBCONTRACTOR AT THE
						SAME TIME THAT IT IS SENT TO THE DIVISION OF LABOR STANDARDS
						ENFORCEMENT.