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-71524
Amended:
X
2.
Name and mailing address (including Zip Code):
Name:Larry Wold
Title:N/A
Organization:Larry Wold
EIN:
P.O. Box., Bldg., Room No., if any:
Street:po box 7321
City:covingtonState:WA
ZIP code:98042
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:Dec /24
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:T Blagmon
Organization:Amazon DII4
EIN:
Trade Name, if any:
P.O. Box., Bldg., Room No., if any:
Street:9751 Massachusetts st
City:Crown PointState:IN
ZIP code:46307
7.
Date entered into11/18/2024
8.
Name of person(s) through whom made:
(a) Employer Representative (to be completed by the Primary Consultant):
Name and Title:
OR
(b) Primary Consultant (to be completed by the Sub-consultant):
Name and Title:Larry Wold, N/A
Organization:N/A
File Number:71524
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:
Larry Wold
Title:
PRESIDENT
Date:
Jan 20, 2025
Telephone Number:
253-719-4685
14.
SIGNED:
Title:
TREASURER
Date:
Telephone Number:
Form LM-20 (2025)
9.
Check the appropriate box(es) to indicate
whether an object
of the activities undertaken is directly
or
indirectly:
a.
X
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.
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.):
Written Agreement/Arrangement
Verbal Arrangement to amazon at their facility in Indiana billed $250 per hr.
Plus actual and reasonable expenses.
Specific Activities to be performed
Activity1
11. For each activity, separately list in detail the information required.
(See instructions.)
a. Nature of activity:To educate employees and to answer questions on rights afforded by the National Labor Relations Act (NLRA)
11.b.Period during which activities
performed:
11/18/2024 -12/20/2024
11.c. Extent of performance:
Completed
11.d.
Name and address of person(s) through
whom
activities were performed or will be performed:
Name:Larry K Wold Organization:Larry Wold Title:N/AFile Number:71524
P.O. Box, Bldg., Room No., If any:Street:po box 7321City:covingtonState:WAZip:98042