Central States, Southeast and Southwest Areas Pension Fund et al v. Industrial Transmission Equipment, Inc.

Filing 11

MOTION by Plaintiffs Central States, Southeast and Southwest Areas Pension Fund, Howard McDougall for judgment and prove up of damages (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4 Exhibit D)(Bacon, Laura)

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EXHIBIT A IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION C E N T R A L STATES, SOUTHEAST AND SOUTHWEST AREAS PENSION FUND, and HOWARD McDOUGALL, trustee, Plaintiffs, ) ) ) ) ) ) Case No. 09 C 5934 Judge Blanche M. Manning Magistrate Judge Mason v. INDUSTRIAL TRANSMISSION EQUIPMENT, INC., an Indiana corporation, Defendant. ) ) ) ) ) ) AFFIDAVIT OF JUAN J. BEATON State of Illinois County of Cook ) ) SS ) I, Juan J. Beaton, having been duly sworn on oath, depose and state as follows: 1. I am the Division Manager - Collections at the Central States, Southeast and Southwest Areas Pension Fund ("Pension Fund"). I have personal knowledge of the facts set forth below and would be competent to testify as to these facts if called as a witness in this matter. 2. am responsible for managing the collection of past due employer contributions owed to the Pension Fund, including past due employer contributions owed by Defendant Industrial Transmission Equipment, Inc., an Indiana corporation ("IT Equipment"). F319293 I 09111000' 11125/09 -1 3. In the regular course of business, the Pension Fund keeps and maintains files relating to the contributions owed by Defendant to the Pension Fund. The file is under my dominion and control. 4. On the date this action was filed and to the present date, Plaintiff Howard McDougall was and is one ofthe trustees and a fiduciary ofthe Pension Fund. The Trustees are the plan sponsors of the Fund within the meaning of Section 4001 (a)(1 0) of ERISA, 29 U.S.C. § 1301 (a)(1 0). 5. The Pension Fund is a multiemployer plan which is administered at its principal place of business at 9377 West Higgins Road, Rosemont, Illinois 60018-4938. 6. The Pension Fund receives employer contributions from employers pursuant to collective bargaining agreements by and between employers and various local unions affiliated with the International Brotherhood ofTeamsters ("IBT"). All principal and income from such contributions and investments thereof is held and used for the exclusive purpose of providing benefits to participants and beneifibaries of the Pension Fund and paying the administrative expenses of the Fund. 7. The Pension Fund's records indicate that Defendant was bound by a collective bargaining agreement entered into with Local Union No. 364 of the IBT ("Local 364") under which Defendant was required to pay employer contributions to the Pension Fund on behalf of certain of its employees. 8. Defendant also entered into a Participation Agreement with Local Union No. 364 of the IBT that requires Defendant to pay contributions to the Pension Fund. 9. Defendant is bound by the Pension Fund's Trust Agreement. F:3192931 09111000 111125109 -2 10. The Pension Fund relies upon employers to self-report the work history of eligible employees. The Pension Fund relies upon these reports submitted by employers to prepare a monthly contributions bill that is sent to the employers. 11. IT Equipment self-reported the work history of its employees to the Pension Fund for the period May 2009 through October 2009. 12. Since Plaintiffs filed their complaint in this case, IT Equipment has paid the contributions and interest owed for the period May 2009 through July 2009. 13. However, IT Equipment has not paid all employer contributions owed by to the Pension Fund for the period of August 2009 through October 2009 based upon the employee work history reported by the Defendant in the principal amount of $10,171.79. A true and genuine copy of the Pension Fund's Breakdown of Contributions Outstanding for Defendant is attached hereto as Exhibit 1 and is incorporated herein by reference. 14. The Pension Fund is entitled to thefoliowing relief when prevailing in an action under Section 515 of ERISA, 29 U.S.C. § 1145: (i) (ii) (iii) the unpaid contributions; interest on the unpaid contributions; an amount equal to the greater of the interest or liquidated damages as provided under the Plan in ,an amount not in excess of twenty percent (20%) of the unpaid contributions; and reasonable attorney's fees and costs. (iv) 15. Pursuant to the terms of the Pension Fund's Trust Agreement, the Pension Fund is entitled to pre-judgment interest on the entire outstanding balance at an annualized interest rate equal to two percent (2%) plus the prime interest rate established by JPMorgan Chase Bank, NA for the fifteenth (15th) day of the month for which interest is charged and shall be compounded annually. F:3192931 09111000 111/25109 -3 16. Through November 30, 2009, Defendant owes interest on the unpaid employer contributions in the total amount of $58.66 to the Pension Fund. 17. Pursuant to the terms of the Pension Fund's Trust Agreement, the Pension Fund is entitled to the greater of doubled interest or liquidated damages in the amount of twenty percent (20%) of unpaid employer contributions. 18. Defendant owes liquidated damages in the greater amount of twenty percent (20%) of the unpaid employer contributions in the total amount of $2,034.36 to the Pension Fund. 19. As a result of Defendant's failure to pay all of the contributions owed by Defendant to the Pension Fund, Defendant is indebted in the total amount of $12,264.81 to the Pension Fund, exclusive of attorney's fees and costs. 20. Under the Pension Fund's Plan, interest on a judgment entered against an employer is computed and charged at an annualized interest rate equal to two percent (2%) plus the prime interest rate established by JPMorgan Chase Bank, NA for the fifteenth day of the months for which the interest is charged. FURTHER AFFIANT SAYETH NOT. Subscribed and sworn to before me, a Notary ublic, this O?S-,...-<. da 0 0 ~ CK~ Juan J. Beaton -4 Official Seal Kart Schofield Notary PublIC Slate 011111n0l9 My Comolission Expires 1010912011 F : 3 1 9 2 9 3 I 09111000 111125109 EXHIBIT 1 CENTRAL STATES, SOUTHEAST AND SOUTHWEST AREAS PENSION FUND SUMMARY OF COt>TRIBUTIONS OUTSTANDING AS OF NOVEMBER 24, 2009 INDUSTRIAL TRANSMISSION ACCOl.;NT NO. 3996600·0108 TRANS. NO 2004206 INT. THRU 11130/09 36.56 PAYMENTS APPLiED 1,394.61 1,000.00 DATE POSTED 1112/2009 1II612009 BALANCE DUJ.l DESCRIPTION AMOUNT 4,488.00 08/2009 Billing 2,129.95 3,606.00 4,494.50 2023350 2042289 0912009 Billing 10/2009 Billing 3,590.40 4,488.00 15.60 6.50 TOTALS $1256640 $2.394 61 FOOTNOTES: 'Interest thru 11130109 computed on individual items from date due . .. A judgment entered against an employer shall include the total balance due as stated above plus an additional amount equal to the greater of: (A) Doubling of interest (B) Liquidated damages, based on the unpaid contributions in the amount of 20% $2.Q34.36 MEMBER CONTRIBUTION REPORT MEMBER INFORMATION mployer ; INOUSTRIAL TRANS EaUlPMENT IN Report Date 1112412009 Page 1 of4 Period Start: 081{)1/2Q09 ~ Period Stop: Hlll1l1U09: Sorted by ~ Torminal_ Member Name JAN APPLEWHITE, RfCHARD FEB MAR GJlm APR MAY Year: 2009 JUN .rul ETLe AUG No 3996600 · 0108 LOti lOU '"ill OUll 0111(1 rHr.!S "'" $0,00 $0,00 "'" '''"' oua ,,.,, 03"2 OZi1S {]311S "'" "'" tM!12 OlItHl '''''' ,"" O~lO 051:J1 '""0 01/05 mns _coo SEP OOJ64A OCT NOV DEC Empfoyetr Type' RegullJr oam 10111 HV18 lOU 11101 11120 """ PEN Year: ;;>oog O&IP2 IOU 0$114 0$f11 06/11 0711 ;: 01119 oam "'" "" & i l ! U LOU CW2J) lOU $1),00 10ftJ4 tOO l.OIJ LCI<) Iwa l111S 11122 10.00 12106 1<11;1 06116 L.otI 08113 LOU Imo H&W PEN Year: 2009 "''''SO.OO H&W "'.'" "'.00 $000 "'''' "'''' ,,,, "''' ltl!2S lO\.r to,1X) $C'" $0.00 '"'' "'''' "'" 07112 $0'" rom "00 "'.00 ETLC No, 3996600 ~ sooo $1)00 \Cwo tOXIC "'" 0100 ~ '"'' 11i01 BEATTY, TERRY 11/26 "'" OU11 0111& Glm ow, "'" "'" itnu 1000 SODO 00364A EmplOyee Type: ReguitJr 03/01 """ OllIS 031,2 "'" 0<1111 04119 H&W PEN $000 10/)0 "'''' "'00 SSN, 03106 03.<15 $0.00 """ "'" ",n, ",n "'"$<tOO W.OO O5IJI OMI1 "'" cm~ ~2 "'OT ACT """ """ ".00 $0,00 08100 ...:.;r ACT Dan:] ACT oer.;c "'0" 09J0G. 0""13 "'CT Oll!'O ACT om! ACT "C" lll1'O4 ACT lCili ACT 10119 ACT 'M" 1111$ 11122 SO,I)O $(l,l)() ll1ZG 1:1"106 '.11:\ 07/19 ,0.00 $0,00 oams 121<Q ".00 Year; 2009 \21211 H&W SMIQ ".00 "", "'00 $408.00 $0,00 $J2$,lC , 00364A 1Mi5I'CT $0.00 _.00 PEN Week,,; 14 tU42.A{1 ETLe No . .)996600 w "" Employee Type' Regular CHIZUM, MA TTHEW 021t>1 Year; 2009 0100 "'" ovn ojlte O\fZ5. ""'" """ ,"" $OJlO $C,OO '''"' """ "'" 04112 0~11S1 "'". ,W; "'NO OS", MOS 01105 O1M O1f2d Leu 0$'";10 LOll OMIS LOU 0&113 LOO <KIn1 leu H&W PEN sooo Year; 2009 lZIU so.oo H&W ,w.oo "'00 "'.00 SSN' 03101 """ ,." "'" """ PEN OW2 Loo 08.KJ9 LOO MIlS LOO ICi04 LOU 11101 11<\)6. ",,, 12/13 lV'::9 JUt11 tOO 11ltS l1!?Z 10,00 OWl' $0,00 Dl'f1iO' $0.00 09f20 LOU 10fU;! \.OU "",,00 tOil:1 LOU '"1<1 w,ot) Mf.oo $C.oo "'.00 o:mo 04/O~ "'.00 "'."" "'.00 Year. 2009 {l5;Jl w.oo SO.OO so.oo "'.00 ",00 "'.00 06/.JO AC" woo "" "'.00 CSJ2r Acr 1101:"11 CORNETT, GARTH C2Xll ETLC No, 3996600 - DtOB · DOJ64A O(I!?!} fimpJayee TyPD . Regultif la/04 ACT 10t11 ACT ClI04 01!t1 0:008 OV1S IYlI!m O3I1S 04112 0412& {l5iQ:l 05110 01126 ACT oSlIn ACT 08J00 ACT oom 00114 0110$ om? 01,111 0Si06 /leT 0"/13 ACT ,,.,, Hll$ 11122 $000 $0.00. 1,1:19 "'" lV1C Clile 01/25 em2 $000 $(lOO $000 $0(1) 0V12 SO.OO W.oo 04/19 SO.OC ${l.OO 05111 MI2-4 00121 $0 00 $0,00 calls AC! OS/2) ACl: $0 00 $.IQlHlC 09/20 .. C! $0,00 llV16 ..CT 101Z5 ACT $0,00 $40000 un, SC OL} Haw PEN $0 00 $0,00 $0,00 $0.00 $326Ao. soot) Employee Type: Ragul8f Year; 2QO!1 DOODY, ARTHUR 12rl6 H&W so.oo SSN. PEN W_k.s~ 14 $1142.40 ETLC No, 3996600 - 0 1 0 8 · OOJ64A 02NI D2115 "'" mIn (HI'~ ''''' so 00 SO,OO """ OJ'" 03115 ron. ""' ""' j)<If12 Year: ;:009 """ """ 05!17 {l5i31 $!IH ,,", $0,00 $~1.00 00"' wro, om~ 07116 ,,00 illl/02 lotJ 06f.:!O LeU 09121 LOU }0104 LOll 1'11)1 111X1 09106 LOU 09/13 LeU 05110 01125 """ $0.00 $0,00 00'" 50,CO 00/21 0111$ -'''' OceIlt\U::t: 10i11 lOU "'" I Ill!> "'" 12113 12120 09120 ~cv 10110 lOLl ll1n 05124 H&W PEN "'.00 SI),OO 1<1"" $0,00 """ $0,00 "" 50,00 to/25 ~OU "'.00 $000 Y~r~ .2009' H&W SO.OO "'" """ SO !)() PEN ta.M """ "''''' '0.00 $0,00 $0.00 !W.OO M~MBER CONTRIBUTION REPORT Report Dale 11/24/2009 Page 2 M E M B E R !NFORMATfON m p l o y e r : INDUS TRIAL TRANS EQUfPMENT IN Period Start: 08101/2009 ~ Period Stop: 10/31(2009 Sorted by : Tel'tl'linal. Me>mber Name' or 4 JAN DUCKETT, RICHARD 1 ZI11:I1 Ovct 0$'0a FEB Oli1)l MAR ApR 00129 1)400 MAY JUN JUL AUG ETLC SEP 00364.4 0iji30 LOU OCT NOV OEC SSN: OMltl O3tl~ Yesr: ZOOS Q5f.ll No. 3996600 · 0108 0IW6 lOU 011/1:) tOO 001'10 lOU Empfc'f&<'J Typo: Regulal 00/'21 lCt.i O6Ile 071\)5 0111 ~ 01119 O?121; WU tli!l1 \1121< OIK14 mill 011111 01125 UUlS ~ill 02115 0212l 05.1:1:.1 !Wtn j)5,/11 Q5a4 06J(l1 00114 0IY21 06102100 CMi9 lOU ON,6 lOU OBrj!3 tOO lMJ4 lOt.! 10111 1-00 10t1S ;.au 10l2:li LOU "'''' 11/22 "'oo IV13 ,V21) 111j$ ClI22 ()ollIe f~W~-=~------~~---------=~------~~~-------=~--------~~------~~------~~~------~~--------~=-------~~~------~~----PEN SOJXl woo HAW $0.0& 1000 SOOQ £(l,OD $000 $0,00 $0,(10 litOO $000 $0,00 SO 00 Year: 2009 PEN SSN: Year. 2009 $O.C() FOOTE, RICHARD " H&W 1212$ ill/11 .. eTLC No. 3996600 0108 08131) t.Cl ~ 00364.4 00121 ACT Employee TYpe. Regular 11101 11/29 10>U4 M:t 1M1 ACT 02101 01118 "." "'" e>m ""' ".00 Haw "'" """ <no> O~115 01125 "'''' ".", ".00 "'., 03129 ",n, OM' 00", 08114 ''''' llSll1 0512~ "'" "'.00 "'00 PEN "''' "'''' $1141.40 01126 ACT Il6IIl2 ACT "'''' so.oo so,oo Week.:s; 14 I1tWJ 07119 OlllOl;l ,o.CT -"" 09113 ACT ,""" 111\$ "'" 1211:) WII1G ACT 00123 ,0>,(;1 0&rnI ACT $0)')(1 10i16 ACT 1&25 ACT '"'' $1;1,00 $OJ~J 12120 ",00 PEN Year; 2009 12t2S "'" to.OO O:M)l '"'' "'.00 SSN; '"'' "'.00 ."" ".00 woo $4[')~.oo il20AO · "'.00 $<I(J(!))O "'" Employee Typo. Regu!al 1112'1 FOSTER, FRANK, J Yesl: 2009 ETLe No. 3996600 0108· 00364,4 08i3G IilCT 0\:1100 ACT 09113 ACT "'" 01/11 "0""'"" 02115 011111 G1/25 ",m SODO $0-00 """ $o.,{)O ClI15 "'" ~ll:Z ""'" "'00 03110 "'''' "'" 05.117 0'''' "'.00 $0.00 (Afl'll """ """ ""'" 000. ",00 """ "'., orne ACT W/?7 ACT 101G<1 ACT lOi11 ACT 11101 osm;a i<CT Oe..tr9 i'J:;r 011116 I\CT Oer.!:J Act OJ'!12 01119 "'" 11115 1112'2 "'''' lVlJ ilQJ2:O Ae' 10/16 "CT H&W $0.00 "'"so,oo "'.00 PEN Year: 200S 1112e 0111)4 OJ/P 011111 01115 H&W "'''' ",,, "'" SSN 00115 "'" "00 PEN Wtte.lr.s: 14 $1142.4<1 ,0<" $0,00 $401300 "''' , w Hlil5 Acr ~'20 "'''' $i),aLl '"'' 40 iJ.4o!!LQO '''0 j1/01 "'" "'" 11129 "'"' Employee Type. Reguld! HOPPE. WiLLIAM. T Year 2009 \;V15 02122 """ """ "'oo $(),OO <n'" D<l1I2 0411~ rem "'" "'00 ro.oo "'.. ,,., H&W P"N """ $0 00 "'.." $0,00 "'" "n' "'" "., "'" W" ,..." "". 07105 07l1~ EnG No. 3996600 0111.& too O&'O~ 0109 · 00364A 0911.1 V)U O!!/!XIlOu tOO ti9100 LOU 09113 tOO 10104 l.O'J 11)1\1 LOU 01lIIl$ LOU 1111!J 11m "'" ,,"" 'm~ 00119 \;\'1116 ;.ou 0&23 \..O\.i $0,00 $0,00 011120 LOU l()flll U:W 10125 tOil.! $(UIO 1140 "00 $i).00 PEN Yoar: 2009 10-00 SO.DO "''' $000 Yoa:r: 2009 H&W So,&<I "<>0 '"'' "'" OIJIJ() M:T "'.00 "'''' "'.00 \1101 WOO $000 HORVATH JR. WILLiAM 12126 SSN 02101 02108 "'" 01/11 01,,9 01125 """ 0'122 woo $0,00 50.00 """ """ OllIS "'" ,fl}.oo "'" w'" ,OJ" 0"," "'''' "". ''''' 05117 ",., 0&'14 ERe No 3996600 · Oi08 · 00364A Employes Typo. RegUlar 09!21 ;l,CT 10111 ACT 10119 ~<:T 1(1125 -"-CT 11$'10 00.' $0,00 ",00 """ (l71O!> orl!;! O1tlf> ;l,CT jt129 0IW2 ACT OSJOO 1';(;1 08iJe ~c; """ "" J ) W U M:l 0.", 000. 0711& H&W PEN "'.00 H&W 50.00 "'" "'''"'oo "'.00 QSIlJ ACT -'" ""'" '" $408,00 "roo 11/15 1Hl:! $0,00 SO,OO ''''' "m "'" "00 $000 W'" $114ZAD $0'" $4118.00 "'.00 $32e40 .,," Year: 2009 PEN Waekt;: 14 '''" MEMBER CONTRIBUTION REPORT MEMBER INFORMATION mplo~er Report Date, 11/2412009 Page 3 o( 4 : INOUSTRIAL TRANS EQUIPMEIliT IN Period Start: 0810112009 ~ Period Stop: 1()131i200lJ SQrted by : T(lnninal- M e m b e r Name JAN FEB MAR APR rom MAY JUN 0$131 JUL AUG HRYCK1EWfCZ, TOM SSN,' 03K11 'fear: 2009 ETLe No. 3996600 una "'" 01111 01118 """ 00"' (12(15 01125 "'" $(lOO $tLOO $000 """ """ ,." "'."' "'' SSN: 0JI(J1 ""'" "'", "'"' ,,00 $MO H&W PEN """ "'" ''''. O~IHl ..,,,. ."" ",m """ _coo w SEP OCT NOV 11101 .,c Employoo Typo Regular 11/21'1 0108 · OOJ64A 09f,!7 tOO 10Kl4 tOO 07126 la;) 01105 07/11 07l1S """ coo 0&00 leu O!!r.:: "'"'s "" LOO """ ,00 OO!):! LOU 0912:0 LCJ\J HIM 1111$ 05117 1Ml tOO 1MB La; 10n5 LOU on! $(l.CO $0,00 "'" """ 12113 ".00 sooo 10.00 Year: 2009 12128 S1">o H&W $C,CO ""' 1);l.7e "'00 ",00 ool2e $0,00 $QJIO $0.00 10,00 ,"00 50,00 $0.00 "'.00 PEN $0.00 KOVACS, TERRY, A OVOl Yaar: 2009 ()3129 ETLe No. 3996600 - 0 1 0 8 · 00364A 051:.\1 07>74 ACT Emp/.:)y&a Typo RlJguJar OB127 AC'I oet.ro: l)$IIJG ACT 11'01 11/08 11t15 11129 01/1)4 0111 f 01l1a DInS H&W PFN 02J08 02115 0:v:;!2 (iJ,()6 03115 0'$122 f"A'05 04112 (\4J1G OMl3 G(iflO 05111 05114 OfiJQT 00114 OOIZt 011\)$ 07f12 OUI" 08."'ll! ACT 06I0l0 IICT OOl16 ACT 06121 ACT $ltOO $40600 $ ACT 09113 ACT oe!2Q ACT l0AJ4 I<Ci 11li!1 Acr t0J16 ACT 1M~ ACT $(l,oo ~oo 1:.wO 121130 11,n """ $000 10.00 teoo ;Roo $0,00 SO.OO $(l,OO $000 $OJ~) 11000 $fLOO $0,00 $325,40 W.OO YHr: 2009 mw 02101 OZJ('lIl $C.OC PEN WHks: 14 $1142.40 MF.CHUNG, ROBERT, E lZ/U1 01/04 SSN.' 00/01 Y(I.;:tr: 2009 ETLe No. 3996500 051'1!1 w Ot08 · OO,:l84A 0M7 "" 11/01 EmplOY/H) Type; Regu!at 11129 ~2/Oe "no 01111 02m,i 01118 011<5 02122 "'"" "'" ""', "'.00 "'00 """ "'''' 0.;" 1(1,00 H&W PEN $0,00 $0,00 "'00 woo H&W $0,00 02101 02~~ "'.00 Year: 20'09 """ "'''' "". ".'" "OJ 05lH $0.00 110m 0611. "'" $0_00 07r.lS ACT O/W;] 07/05 01'!1< ACT """ ".00 PEN WhitS: 14 $114'2,4(J CUle ".00 .,00 -"" """ "" OIlija AC, """ "" ''''' "'" 1)9113 ACT 1t1104 AC" lQ.th ACT 11/06 Ht1~ 09120 >oCT \O/la ACT 10125 ACT 11.'22 ",00 ,,,., "'.00 1211:1 $40!U:rO '''''' "'.00 S326,<l0 "00 M0800 woo ;0,01) MORGAN, STEVE, A nne "'" 01111 01/18 01i'l.'} 02Ni 02!n $MO $0'" WOO "'" $0.00 co,,, ."., "S", SSN Veer. 2009 ETLC No, 3996600 · 010S · 00354A Empioyoe Type Regular 09121 A(..'T """ ""'" """ ",n, woo ro.oo ..". 0'"' 05110 ",,, $0,00 10.00 05111 "," "6m ""''' "'''' "'''' "'.00 PEN Weeks; 14 06128 07/o~ 1)712B ACT CMI2 ACT """ MO' 11/Oi 11/19 &7112 ()111s ""'"' "''' 0Ili16 ACT -"''' OW!::! ,ocr 1)\}j{(1 ACT 11101).4 4(;T 11/06 ,0/11 ACT 10/18 ACf 11/15 HiCl! 1210 1212)) 11122 $0.00 oono "'" "'.00 10r.:S ACT H&W PEN "'oo H&W "'OO 10'" w'" woo $~uaoo "'.00 S32{14() $000 M08,00 $0" .,,'" Emp!oyi;Ul Type, Regular 11129 1ZiCO 1.2!I~ woo Yaar: 2009 'c~ (lllT! $114l.4(J PHILLIPS, MICHAEL, P SSN OWl "'" 5000 10.00 01/113 01125 "'" 0'''' ..,'" "'.00 """ "'"' 0311:5 """ "''''' ",00 ".," 0"''' """ ".", "00 so", """ tWill "'" 0'''' YfJ$r: 2009 00;01 ETLC No 3995600· 0108 · 00354A "'" "'". '"'' so.oo $0,00 OS,,!! 07/05 07/12 001119 07128 ACT OEI.'OI ACT OOiC9 ACT cano ACT 09121 ACT 11/01 11/08 11/15 OBtIS ACT D!!I2J ACT H&W PEN w'" $0.00 $1f4l.~ ",00 ~4tsoo , ""'" "" """ "'" 00113 ACT II)/Dot ACT 101'11 O\(;r 10ml ACT 10/25 I\CT 1.1122 lVZU $0_00 .,00 132641) Ye.tr: 20/19 H&W "'"$0',00 w'" PEN Weeks: 14 ..'" · s~oe_oo .,,'" ."" '$0.00 so'" MEMBER CONTRIBUTION REPORT MEMBER INFORMATION mployer : tN.oUSTRIAI.. TRANS EQUIPMENT IN Repoft Date: 1112412009 Pago4of4 JAN RONf;iY. TIM, J MAR SSN: APR MAY JUN JUL AUG (lm~ SEP OCT OW27 ACT 101(]4 ACT 1(1(11 ACT NOV Emplo~ DEC Type: Regular uno avo; """ 01<11 01l1!! j)lll~ """ ,un 02Jj~ "'" "'" "'" so,oo "'" (I,.j/12 0<t11l1 "'.. "' $0.00 .. Yesr, 2009 Ene No. 3996600 · 0108 · 00364A "'"., M H&W PEN "''''' Year: 2009 "''' $0,00 ,"00 "''' "'"' """ """ "'" "". Mm "'" Ol1ll 01119 """ ACT OB130 ACT 09/06 ACT Ollt02 ACT OIil(iS ACT 00113 ACT 09t20 ACT ,,'" 11101 06116 so."" SSN: .0"" H&W ""OIl 00<)' "''"' "'."" ,,00 PEN "'.00 .,," !O,OQ ACT 08123 ACT 10116 ACT 0000 $409.00 $0.00 $JUi~O ,em ACT £<'" ~4oeOO ,,'" 11/\$ "'" "'" ,,,'" 12113 ro."" $oJJC "'.00 "'.00 Empfoyee Type: Regular ~MIJ:14 $1142.40 ETLC No. 3996500 - 0 1 0 8 - 00364A SNEAD, JEREMIAH, 0 "'I' """ Gtl11 02!Ol mit8 H.W "'" W"" PEN .,," PEN "'" "'., 0:/'1$ $(tOO ""'" WI> Olf22 "'" """ 04112 '''h' WOO .,.". "" """ "'2< 05110 Year: 2009 "'" "m """ "'" "'.00 "'.00 PEN Weeks: 14 "'hZ "h' """ oms ,.." ACT o1!O~ 06/02 ACT 013116 ACT "" 5 """''''' 09Ji)6 ACf 09127 AC'l' tl)J()4 AC"f 11!Ol llf(l5 , Hill lllZ9 00113 ACT 10/11 ACT oono ACT 1M8 ACT 10125 ACT ,,,,, 11115 Oat23 ACT '''''' .,OO roO< ",OO $0,00 200. "'-00 H&W SO,OO $0,«1 "''' sO,OO $000 "oo "'.00 "'''' ".00 S1142,40 ro.oo S4()8,OO 10.00 IIJ.OO ,,00 ".00 S32E 40 S4oe.OO Rep04 f9t~{.: H&W "'''' $(l.OO so,oo "'.00 "'.00 ".., "'.00 "'.00 $0,00 "'.00 !QOO ".00 $44$8,00 $0"" $:I590,M) "'.00 J44e8,OO "'.00 $Om rom "'oo

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