LICENSE TERMS AND CONDITIONS
1. LICENSE TERMS AND CONDITIONS
Licensor hereby grants to Licensee a temporary, revocable license (the "License") and nonexclusive right to use and occupy the Premises commencing on License Commencement Date and continuing until the License Termination Date, defined below, subject to the terms and conditions contained herein.
2. PERMITTED USES
This License shall be limited to Licensee's use and occupancy of the Club as an entertainer/dancer and Licensee shall be entitled to perform entertainment services at the Club. Licensee shall not use or occupy the Club or act or fail to act in any way which would constitute an event of default by Licensee under this Agreement.
The Licensee agrees to:
- a. Perform clothed, topless, and (where permitted);
- b. Promote her services at the Club but in connection with such promotion may not use the name, logo, trademarks, service marks without prior written authorization of the Licensor;
- c. Not violate any federal, state and local laws or governmental regulations;
- d. Be responsible at her sole cost and expense for all necessary licenses, permit, certificates, etc. to conduct her business;
- e. Maintain accurate records of all income generated under this Agreement or otherwise arising out of Licensee's use and occupancy of the Premises for a period of at least five (5) years following the date this license terminates and be solely responsible for all taxes, fees, etc. incurred by her in the operation of her business; and
3. DURATION OF LICENSE; TERMINATION OF LICENSE
This Agreement shall be for the period commencing on the License Commencement Date and shall terminate on the day preceding the first anniversary of the License Commencement Date. The License shall be automatically extended for successive periods equal to the current term. Notwithstanding the foregoing, at any time after the first year of the License term, this License may be terminated (a) within thirty (30) days after the receipt of written termination notice from the Licensor to Licensee, (b) the last day of the month that is ninety (90) days after the receipt of a written termination notice from Licensee to Licensor, or (c) such sooner date in accordance with paragraph 11 hereof, any of such dates which shall be the "License Termination Date." Upon the License Termination Date, Licensee shall have no further right to use and occupy the Premises.
4. BASE LICENSE FEE
In consideration of Licensor's granting to Licensee the right to use and occupy the Premises up through and including the License Termination Date, Licensee hereby agrees to pay to Licensor a daily license fee as set forth on Exhibit A attached hereto and made a part hereof (the "Base License Fee"). The Base License Fee shall be due and payable each day that Licensee performs at the Club. The Base License Fee is subject to change upon notice by the Licensor.
5. COMPENSATION
Licensee shall be entitled to retain all fees received by customers of the Club for performances of Licensee's services (such fees hereafter referred to "Performance Fees"). The Licensee specifically acknowledges that the Performance Fees attributable to personal dances (i.e. "lap dances") or performances in private or semi-private rooms are a non-discretionary mandatory service charge to the customers and are not tips or gratuities to the Licensee.
6. HOURS
Licensor is to provide to Licensee the non-exclusive right, in common with other entertainers, to perform at the Club, during the Club's normal business hours. Licensee shall have the right to perform at the Club at all times only subject to availability. Licensor may request that Licensee inform the Club at least one (1) week in advance of Licensee's intent to appear at the Club to allow Licensor to plan accordingly.
7. SERVICES
In exchange for the Base License Fee and in addition to use of the Club premises, Licensor shall provide the following services at the Club, at Licensor's expense:
- a. Music (including ASCAP/BMI/SESAC fees);
- b. Dressing Room Facilities;
- c. Lockers;
- d. Wait Staff;
- e. Beverage Service;
- f. Advertisement of the Club (any advertisement specific to the Licensee shall be at Licensee's sole cost and expense and Licensor shall have no obligation to advertise for the Licensee); and
- g. Licensee agrees that the License Fee does not include fees for the following services: hair and make-up artists and any other ancillary services which shall be contracted for and paid directly by Licensee, at Licensee's sole cost and expense.
8. RELATIONSHIP
Licensor and Licensee each acknowledge and agree that the relationship of the parties hereto is that of licensor and licensee and is not an employee/employer relationship. Nothing in this Agreement shall be construed so as to create an employee/employer relationship between the parties hereto. Licensee shall be solely responsible for obtaining and maintaining, at Licensee's sole cost and expense, all necessary business licenses and permits and insurance including but not limited to, health, disability and workers compensation and for paying all federal, state and local taxes and contributions imposed upon any income earned by Licenses at the Club.
The Club and Licensee acknowledge and represent that if the relationship between them was that of employer and employee, the Club would be required to collect, and would retain, all Performance Fees paid by customers to Licensee. Licensee acknowledges and agrees that if the relationship were one of employer/employee, all Performance Fees would be the property of the Club. THE PARTIES ACKNOWLEDGE AND REPRESENT THAT LICENSEE'S RIGHT TO OBTAIN AND KEEP PERFORMANCE FEES PURSUANT TO THIS LICENSE IS SPECIFICALLY CONTINGENT UPON THE BUSINESS RELATIONSHIP OF THE PARTIES BEING THAT OF LICENSOR AND LICENSEE.
In order to comply with applicable tax laws and to assure that the Club is not unjustly harmed and that Licensee is not unjustly enriched, the Club and Licensee agree that if there is any ruling or decision of an arbitrator, court or other tribunal with jurisdiction over the matter that the relationship is one of employer/employee, Licensee shall surrender, reimburse and pay to the Club, all Performance Fees, in excess of any minimum wage obligations found to be due and owing, that were received by Licensee at any time she performed on the Premises - all of which would otherwise have been collected and kept by the Club had they not been retained by Licensee under the terms of this License - and shall immediately provide a full accounting to the Club of all tip income which she received during that time;
Any Performance Fees that Licensee fails to repay to the Club are deemed service charges to the customer and as such the Club shall be entitled to offset any wage obligations.
9. RELEASE FROM LIABILITY
Licensee agrees that Licensor shall not be responsible or liable for any damage or injury to any property or to any person or persons at any time on or about the Premises arising from any cause whatsoever even where such damage or injury is caused by the negligent acts or omissions of Licensor, except Licensor's willful misconduct. Licensee shall not hold Licensor in any way responsible or liable therefore and will indemnify and hold Licensor harmless from and against any and all claims, liabilities, penalties, damages, judgments and expenses (including, without limitation, reasonable attorneys' fees and disbursements) arising from injury to person or property of any nature arising out of Licensee's use or occupancy of the Premises and also for any other matter arising out of Licensee's use or occupancy of the Premises including damage or injury caused by Licensee.
10. NO ASSIGNMENT
No assignment of this License shall be made by Licensee.
11. DEFAULT
In the event Licensee shall be in default of any obligation to pay money under this License or in the event Licensee shall be in default of any non-monetary provision of this License (including but not limited to violation of any Federal, state or local laws or regulations or any rules established by the Club to prevent violation of such laws or regulations), this License shall immediately terminate, and Licensor shall have the right to the extent permitted by law, to (i) immediately withdraw the permission hereby granted to Licensee to use the Premises; and (ii) remove all persons and property therefrom, without being deemed to have committed any manner of trespass. Such remedies shall be in addition to any other rights or remedies Licensor may have hereunder or at law or equity.
In the event of any breach by Licensee of the requirements of Section 2.f, the parties agree that Licensee shall be prohibited from arguing she was performing at Licensor's facility at any time not reflected in Licensor's records.
12. CONFIDENTIALITY
Licensor and Licensee acknowledge that each may come into contact with information in all forms regarding the other's business, clients and clients' businesses. All such information shall be deemed confidential information and shall not be used or communicated by the other at any time for any reason whatsoever. Licensor further acknowledges that Licensee has a privacy and security interest in keeping Licensee's personal information confidential and private. Such information shall include but not be Licensee's legal name, address, telephone number, email address, and other contact information. All such information shall be deemed confidential information and shall not be disclosed to any third parties by Licensor, both during and after this License, without the express written consent of Licensor, unless otherwise required by law.
Acknowledgement of this Section 12:
Licensor:
Signature:
Date:
13. NOTICES
Any notices required or permitted to be given to either party under this License shall be given to the respective parties at the address written on the first page of this Agreement by hand, by reputable overnight courier (for next business day delivery) or by certified mail, return receipt requested. Such notices shall be deemed given upon: a) delivery, in the case of hand delivery; b) one business day after mailing, in the case of overnight courier, and c) three business days after mailing, in the case of mailing.
14. LEGAL ACTION
THIS AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF COLORADO WITHOUT GIVING EFFECT TO THE CONFLICTS OF LAWS PRINCIPLES THEREOF.
15. ARBITRATION
The parties agree that, except as otherwise provided herein, pursuant to the Federal Arbitration Act (the "FAA"), any and all disputes between Licensee and Licensor 1, including, but not limited to, disputes in connection with the performance of services by Licensee at the Club or in connection with any future relationship of any kind between Licensee and the Club, will be subject to binding arbitration governed and settled by a neutral arbitrator agreed upon by the parties. In the event that the parties confer but are unable to agree upon the selection of an arbitrator, the claiming party shall file the claim with Resolute Systems, LLC, under Resolute Systems' Commercial Arbitration Rules. In the event of a conflict between the provisions of this agreement and Resolute Systems' Commercial Arbitration Rules, the provisions of this agreement shall control. The arbitrator will have no authority to make any ruling, finding or award that does not conform to the terms and conditions of this Agreement. The arbitration provision contained herein shall be self-executing and shall remain in full force after expiration or termination of this Agreement. The place of arbitration shall be Denver, Colorado. The arbitrator shall give effect insofar as possible to the desire of the parties hereto that the dispute or controversy be resolved in accordance with good commercial practice and the provisions of this Agreement.
THE PARTIES WAIVE ANY RIGHT TO LITIGATE SUCH CONTROVERSIES, DISPUTES, OR CLAIMS IN A COURT OF LAW, AND WAIVE THE RIGHT TO TRIAL BY JURY. ALL PARTIES SHALL HAVE THE RIGHT TO BE REPRESENTED BY LEGAL COUNSEL AT ARBITRATION. THE ARBITRATOR SHALL PERMIT REASONABLE DISCOVERY AND THE PARTIES AGREE THAT SUCH REASONABLE DISCOVERY SHALL BE GOVERNED BY THE LIMITATIONS OF THE LEVEL 1 RULES FOUND IN THE COLORADO RULES OF CIVIL PROCEDURE, AS THEY EXIST ON JULY 1, 2021, UNLESS AND UNTIL THE ARBITRATOR SHALL MODIFY THOSE LIMITATIONS UPON A FINDING OF GOOD CAUSE TO DO SO. THE PARTIES SHALL HAVE THE RIGHT TO SUBPOENA WITNESSES IN ORDER TO COMPEL THEIR ATTENDANCE AT HEARING AND TO CROSS-EXAMINE WITNESSES, AND THE ARBITRATOR'S DECISION SHALL BE IN WRITING, SHALL BE ISSUED AND MAILED TO THE PARTIES WITHIN THIRTY DAYS OF THE FINAL HEARING, AND SHALL CONTAIN FINDINGS OF FACT AND CONCLUSIONS OF LAW.
AT LEAST FOURTEEN (14) DAYS BEFORE THE DATE SET FOR ARBITRATION, A PARTY DEFENDING AGAINST A CLAIM MAY SERVE ON AN OPPOSING PARTY AN OFFER ON SPECIFIED TERMS, WITH THE COSTS (INCLUDING ATTORNEYS' FEES) THEN ACCRUED. IF, WITHIN FOURTEEN (14) DAYS AFTER BEING SERVED, THE OPPOSING PARTY SERVES WRITTEN NOTICE ACCEPTING THE OFFER, EITHER PARTY MAY THEN SEND A COPY OF THE OFFER TO THE ARBITRATOR AND NOTICE OF ACCEPTANCE, PLUS PROOF OF SERVICE. THE ARBITRATOR MUST THEN ENTER AN AWARD IN THE SPECIFIED AMOUNT, AND THE ARBITRATION SHALL BE DEEMED CONCLUDED.
AN UNACCEPTED OFFER IS CONSIDERED WITHDRAWN ON THE FIFTEENTH (15th) DAY AFTER SERVICE. EVIDENCE OF AN UNACCEPTED OFFER IS NOT ADMISSIBLE EXCEPT IN A PROCEEDING TO DETERMINE COSTS.
IF THE MONETARY AWARD THAT THE OFFER RECIPIENT FINALLY OBTAINS IS NOT GREATER THAN ANY UNACCEPTED OFFER, (1) THE OFFER RECIPIENT SHALL NOT BE ENTITLED TO THE RECOVERY OF THE OFFER RECIPIENT'S COSTS, INCLUDING BUT NOT LIMITED TO ATTORNEYS' FEES, INCURRED AFTER THE OFFER WAS MADE AND, (2) TO THE EXTENT PERMITTED BY APPLICABLE LAW, THE OFFER RECIPIENT MUST PAY THE COSTS, INCLUDING, BUT NOT LIMITED TO ATTORNEYS' FEES, OF THE OFFERING PARTY INCURRED AFTER THE OFFER WAS MADE
THE ARBITRATOR SHALL HAVE EXCLUSIVE AUTHORITY TO RESOLVE ANY AND ALL DISPUTES OVER THE INTERPRETATION, APPLICABILITY OF THIS AGREEMENT TO ANY DISPUTE, OR SCOPE OF THIS AGREEMENT, INCLUDING BUT NOT LIMITED TO DISPUTES OVER THE VALIDITY, ENFORCEABILITY AND/OR ALLEGED UNCONSCIONABILITY OF ANY PART OF THIS LICENSE, INCLUDING THE TERMS OF THIS SECTION 15, AND TO THE EXTENT ANY PROVISION(S) OF THIS AGREEMENT ARE FOUND BY THE ARBITRATOR TO BE INVALID, UNENFORCEABLE AND/OR UNCONSCIONABLE AS APPLIED TO A PARTICULAR CASE OR CONTROVERSY, THE ARBITRATOR SHALL HAVE AUTHORITY TO MODIFY SUCH PROVISIONS TO ALLEVIATE ANY INVALIDITY, UNENFORCEABILITY AND/OR UNCONSCIONABILITY. ANY AWARD BY THE ARBITRATOR MAY BE ENTERED AS A JUDGMENT IN ANY COURT HAVING JURISDICTION. THE PARTIES CONSENT TO THE JURISDICTION OF THE STATE AND FEDERAL COURTS WITH JURISDICTION OVER DENVER-DADE COUNTY, COLORADO ONLY IN CONNECTION WITH ANY APPLICATION BY ANY PARTY FOR EQUITABLE OR INJUNCTIVE RELIEF.
NOTWITHSTANDING THE FOREGOING, CLAIMS FOR SEXUAL HARASSMENT OR SEXUAL ASSAULT ARE NOT SUBJECT TO ARBITRATION UNDER THIS SECTION 15 AND MAY BE BROUGHT IN COURT (OR OTHER APPLICABLE FORUM) ON AN INDIVIDUAL BASIS, OR A CLASS OR COLLECTIVE BASIS TO EXTENT AUTHORIZED UNDER APPLICABLE LAW. FOR PURPOSE OF CLARITY, THIS EXCEPTION TO MANDATORY ARBITRATION APPLIES ONLY TO SEXUAL HARASSMENT OR SEXUAL ASSAULT CLAIMS AND ALL OTHER CLAIMS ARE SUBJECT TO ARBITRATION AND MAY NOT BE "PAIRED" WITH SEXUAL HARASSMENT OR SEXUAL ASSAULT CLAIMS IN COURT, EXCEPT AS OTHERWISE AGREED BY THE PARTIES.
THE ARBITRATOR SHALL HAVE NO AUTHORITY TO AWARD PUNITIVE, CONSEQUENTIAL, SPECIAL OR INDIRECT DAMAGES. THE ARBITRATOR SHALL NOT HAVE THE POWER TO ALTER OR MODIFY ANY EXPRESS PROVISION OF THIS AGREEMENT, OR TO RENDER AN AWARD WHICH, BY ITS TERMS, HAS THE RESULT OF EFFECTING SUCH ALTERATION OR MODIFICATION.
TO THE EXTENT ALLOWABLE BY APPLICABLE LAW, THE PARTIES TO ARBITRATION SHALL EQUALLY SHARE THE COSTS AND EXPENSES CHARGED BY THE ARBITRATOR OR ANY ARBITRATION FORUM DURING THE PENDENCY OF THE ARBITRATION PRIOR TO A DETERMINATION OF WHICH IS THE PREVAILING PARTY. THE PARTIES AGREE THAT ANY JUDGMENT, ORDER, OR RULING ARISING OUT OF A DISPUTE BETWEEN THE PARTIES SHALL, TO THE EXTENT PERMITTED BY APPLICABLE LAW, AWARD COSTS INCURRED FOR THE PROCEEDINGS AND REASONABLE ATTORNEYS' FEES TO THE PREVAILING PARTY.
TO THE EXTENT PERMITTED BY APPLICABLE LAW, ANY CLAIM MUST BE INITIATED WITHIN ONE (1) YEAR FROM THE DATE THE CLAIM AROSE OR SHALL FOREVER BE WAIVED AND ALL OTHER PROCEEDINGS BARRED. IF A PERIOD OF LIMITATIONS INCLUDES A SUBSTANTIVE LAW COMPONENT, SUCH AS AN EXTENSION OF TIME BASED ON A FINDING OF WILLFULNESS, THE PARTIES AGREE THAT THIS LAW SHALL BE GIVEN EFFECT BUT IT SHALL ALTER OR EXTEND THE ONE YEAR PERIOD DESCRIBED ABOVE ONLY. A party who did not institute arbitration proceedings 2 may assert counter claims.
The parties understand and acknowledge that, pursuant to Section 16 of this Agreement, by signing this agreement the parties specifically waive any right to participate in any class action or collective action as against the other party in any forum.
Licensee acknowledges that she has read and understands Section 15, as well as all the other Sections of this Agreement, and has been given the opportunity to ask questions and consult with an attorney.
16. CLASS WAIVER
All claims or disputes between the parties will be adjudicated individually; the Parties understand and agree, except as otherwise provided for in this agreement or where applicable law does not allow a waiver of joint, collective, or class actions, that they will not consolidate their claims with the claims of any other individual; will not seek class or collective action treatment for any claim that they may have; and will not participate in any class or collective action regardless of the forum in which they pursue their rights. If at any time Licensee is made a member of a class in any proceeding, Licensee will "opt out" at the first opportunity, and should any third party pursue any claims on Licensee's behalf, the Licensee must waive Licensee's rights to any such monetary recovery.
THE PARTIES UNDERSTAND AND ACKNOWLEDGE THAT BY SIGNING THIS AGREEMENT THEY SPECIFICALLY WAIVE ANY RIGHT TO PARTICIPATE IN ANY CLASS ACTION OR COLLECTIVE ACTION AS AGAINST THE OTHER PARTY REGARDLESS OF THE FORUM IN WHICH THE PARTY PURSUES THEIR RIGHTS AND IF AT ANY TIME LICENSEE IS DEEMED A MEMBER OF ANY CLASS CREATED BY ANY COURT, ARBITRATOR OR ANY OTHER TRIBUNAL, SHE WILL "OPT OUT" OF SUCH CLASS AT THE FIRST OPPORTUNITY, AND SHOULD ANY THIRD PARTY PURSUE ANY CLAIMS ON HER BEHALF LICENSEE SHALL WAIVE HER RIGHTS TO ANY SUCH MONETARY RECOVERY.
Licensee acknowledges that she has read and understands Section 16, as well as all the other Sections of this Agreement, and has been given the opportunity to ask questions and consult with an attorney.
17. MISCELLANEOUS
This Agreement constitutes the entire understanding of the parties. No representations or warranties have been made by either party to the other, or by anyone else, except as expressly set forth in this Agreement. No prior oral or written statements, representations, promises and inducements have been made by either of the parties relating to the subject matter hereof which are not embodied in this Agreement. If any provision of this Agreement or the application thereof to any person or circumstance shall, for any reason and to the extent, be invalid or unenforceable, the remainder of this Agreement and the application of such provision to the other person or circumstance shall not be affected thereby, but rather shall be enforced to the greatest extent permitted by law. Licensor's failure to insist on compliance or enforcement of any provision of this Agreement shall not affect the validity or enforceability of this Agreement or operate or be construed as a waiver of any future enforcement of that provision or any other provision of this Agreement. This Agreement represents the entire agreement of the parties with respect to the subject matter thereof, and may not be modified or amended except in accordance by a writing signed by each of the parties hereto. Sections 8 through 16 shall survive the termination of this Agreement.
18. NO DURESS.
Licensee acknowledges that she has entered into this Agreement freely, voluntarily and without duress and that this Agreement was neither presented to her nor executed under compromising circumstances.
1 The parties agree that Licensor's parents, subsidiaries, affiliates, and insurers__ and all officers, directors, employees, and agents of Licensor or the foregoing entities and individuals__("Third Party Beneficiaries") shall be express third party beneficiaries under this agreement and they shall have the right, but not the obligation, to arbitration under the terms of this agreement of any and all disputes between Licensee and any Third Party Beneficiaries.
2 Instituting arbitration proceedings does not include actions taken to compel arbitration under this agreement where the originally filing party files a dispute in any form or forum other than as required under this agreement.
____ Licensee's Initials
MODEL RELEASE
For Consideration herein acknowledged as received, and by signing this release I hereby Players Club. ("Club") Club and Assigns, my permission to use the Content in any media for any purposes (except pornographic or defamatory) which may include, among others, advertising, promotion and marketing. I agree that the Content may be combined with other images, text, graphics, film, audio, audio-visual works, and may be cropped, altered or modified. I agree that I have no rights to the Content, and all rights to the Content belong to the Club and Assigns. I acknowledge and agree that I have no further right to additional consideration or accounting, and that I will make no further claim for any reason to Club or Assigns. I acknowledge and agree that this release is binding upon my heirs and assigns. I agree that this release is irrevocable, worldwide and perpetual, and will be governed by the law of the State of Colorado.
It is agreed that my personal information will not be made publicly available but may only be used directly in relation to the licensing of the Content where necessary (e.g. to defend claims or protect rights) and may be retained as long as necessary to fulfill this purpose. I am at least 18 years of age and have the full legal capacity to execute this release. I have read this document and fully understand its contents. It is agreed that any disputes related to this document will be resolved through binding arbitration with each party splitting the costs equally or as allowed under applicable law.
Definitions: "ASSIGNS" means a person or any company to whom Club has assigned or licensed rights under this release as well as the licensees of any such person or company. "CONSIDERATION" means $1 or something else of value received in exchange for the rights granted in his release. "CONTENT" means all photographs, film, audio, or other recording, still or moving, taken of me as part of the Shoot. "MEDIA" means all media including digital, electronic, print (including but not limited to calendars), television, film, radio and other media now known or to be invented. "MODEL" means me and includes my appearance, likeness and voice. "CLUB" means Club or any other person or entity photographing or recording me. "SHOOT" means the photographic, film or recording session described in this form.
Attach Visual reference of Model
(i.e. driver's license, photograph, photocopy etc..)
Entertainer Biometric Information Privacy Policy
Company Name: Players Club. (the "Company")
The entertainer named below has been advised and understands that the Company, its vendors may collect, retain, and use biometric data for the purpose of verifying entertainer identity and recording time entries if the Company is using biometric timeclocks or timeclock attachments.
Biometric timeclocks are computer-based systems that scan an entertainer's hand, finger, retina or other physical characteristic and extract unique data points to create a unique mathematical representation. This representation is used to verify the entertainer's identity, for example, when the entertainer records their hours worked. The Company's biometric timeclocks do not collect or store images of entertainer's handprints, fingerprints, retinas or other physical characteristics.
The entertainer understands that the Company will retain biometric data only until, and shall request that its vendors permanently destroy such data when:
- The initial purpose for collecting or obtaining such biometric data has been satisfied such as the termination of the entertainer's contract with the Company, or the entertainer moves to a role within the Company for which the biometric data is not used; or
- Within three (3) years of the entertainer's last interaction with the Company.
The undersigned entertainer voluntarily consents to the collection, storage, and use of biometric data through a biometric timeclock as described above. The undersigned entertainer also voluntarily consents to the Company providing such biometric data to its vendors for the purposes identified above.
Entertainer Name (print):
Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-9O
MB No. 1615-0047
Expires 10/31/2022
► START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following boxes):
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")
List A
Identity and Employment Authorization
List B
Identity and Employment Authorization
List C
Identity and Employment Authorization
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions)
Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)
Title of Employer or Authorized Representative
Manager
Last Name of Employer or Authorized Representative
Arellano
First Name of Employer or Authorized Representative
Manuel
Employer's Business or Organization Name
Players Club
Employer's Business or Organization Address (Street Number and Name)
6710 N Federal Blvd
City or Town
Denver
State
CO
ZIP Code
80221
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
A. New Name (if applicable)
C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.
I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED
Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.
Examples of many of these documents appear in the Handbook for Employers (M-274).
Refer to the instructions for more information about acceptable receipts.
Form I-9 10/21/2019
View Colorado New Hire Reporting Form
