IMPORTANT: This report is mandatory under P.L. 86-257, as
amended. Failure to comply may result in criminal prosecution,
fines, or civil penalties as provided by 29 U.S.C. 439 or 440.
Required of persons, including Labor Relations Consultants and
Other Individuals and Organizations, under Section 203(b) of
the
Labor-Management Reporting and Disclosure Act of 1959, as
amended (LMRDA).
Office of Labor-Management Standards
U.S. Department of Labor
For Official Use Only
E
OLMS
Read the instructions carefully before completing this report.
1.a. File Number: C-71413
Amended:
X
2.
Name and mailing address (including Zip Code):
Name:luis amaya
Title:n/a
Organization:Luis Amaya
P.O. Box., Bldg., Room No., if any:
Street:2109 old landing way
City:WoodbridgeState:VA
ZIP code:22191
3.
Other address where records necessary to
verify this report are kept:
Name:
Title:
Organization:
P.O. Box., Bldg., Room No., if any:
Street:
City:State:
ZIP code:
4.
Date fiscal year ends:Jan /1
5.
Type of person
a.
X
Individual b.
Partnership
c.
Corporation C d.
Other
Specify:
Nature of Agreement or Arrangement
6.
Full name and address of employer with whom made (include ZIP Code):
Name:Kristin Ashurst
Organization:Peet's Coffee, Inc.
Trade Name, if any:
P.O. Box., Bldg., Room No., if any:
Street:1400 Park Avenue
City:EmeryvilleState:CA
ZIP code:94608
7.
Date entered into07/22/2024
8.
Name of person(s) through whom made:
Name:Alex Casillas
Signature and Verification
Each
of the undersigned declares, under penalty
of
perjury
and
other
applicable penalties of law, that all of the
information
submitted in this report (including the information
contained in
any accompanying documents) has been examined by
the
signatory
and
is, to the best of the undersigned's
knowledge
and
belief,
true, correct, and complete. (See Section
VIII on
penalties in the
instructions.)
13.
SIGNED:
luis amaya
Title:
PRESIDENT
Date:
Sep 19, 2024
Telephone Number:
571-438-5791
14.
SIGNED:
Title:
TREASURER
Date:
Telephone Number:
Form LM-20 (2003)
9.
Check the appropriate box(es) to indicate
whether an object
of the activities undertaken is directly
or
indirectly:
a.
To persuade employees to exercise or not to
exercise, or persuade employees as to the manner of
exercising, the right to organize and bargain collectively
through representatives of their own choosing.
b.
X
To supply an employer with information
concerning the activities of employees or a labor
organization in connection with a labor dispute involving
such employer, except information for use solely in
conjunction with an administrative or arbitral proceeding
or
a criminal or civil judicial proceeding.
10.
Terms and conditions.
(Explain in detail;
see
instructions.
Written agreements must
be attached.):
XWritten Agreement/Arrangement
Verbal agreement with Peets coffee to work from July 26 to August 6 in California. Billing rate of 100 dollars the hour. The purpose of the agreement was to work at 4th street coffee shop and talk to employees. Hear the employees reasons why they filed a petition to unionize. I was tasked with working during business hours at a capacity of consultant and not to perform any work on the restaurant other than talking to employees and clearing up any questions about company policies.
Specific Activities to be performed
Activity1
11. For each activity, separately list in detail the information required.
(See instructions.)
a. Nature of activity:I was tasked to work at 4th street coffee shop, I was responsible for answering any questions employees may have about company policies or general questions about Unions. My agreement was to be at the store during business hours and not to perform any task other than talking to employees, The conversations were voluntary, no meetings were hosted. I was also asked to ensure accurate information was provided using talking points provided by the company and labor material straight from the NLRB web
11.b.Period during which activities
performed:
July 26 to August 6
11.c. Extent of performance:
Completed
11.d.
Name and address of person(s) through
whom
activities were performed or will be performed:
Name:luis amaya Organization:Luis Amaya
P.O. Box, Bldg., Room No., If any:Street:2109 old landing wayCity:WoodbridgeState:VAZip:22191
11.d.
Name and address of person(s) through
whom
activities were performed or will be performed:
Name:Alex Casillas Organization:Action Resources
P.O. Box, Bldg., Room No., If any:Street:100 n Green valley parkwayCity:HendersonState:NVZip:89074
12.a. Identify subject groups of employees:
Employees at 4th street Peet's coffee location
1776 4th street , Berkeley, CA 94170
12.b. Identify subject labor organizations:
INDUSTRIAL WORKERS OF THE WORLD( BRANCH MID-VALLEY IWW) - 546476