Step 1 of 3 - Personal Information 33% IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION Eagle, et al. v. Vee Pak, Inc., et al., Case No. 12-cv-09672 IMPORTANT NOTICE You are receiving this Claim and Release Form because you may be eligible to receive money due to Settlement of a class action case involving the alleged denial of job assignments to African American workers. If you are African American and sought work assignments through Staffing Network during the period of January 1, 2011 up through and including December 31, 2015 or through ASI during the period of January 1, 2011 up through and including January 16, 2018, or through MVP during the period of January 1, 2011 up through and including October 21, 2013, but on one or more occasion were not assigned to work at Vee Pak, you may be eligible to participate in a class action Settlement if you complete the Claim and Release Form below. Questions? Please call 1-888-212-3832 INSTRUCTIONS: You must complete, sign and submit this Claim and Release Form in order to be eligible for a monetary recovery. Your Claim and Release Form must be submitted on or before Friday, March 22, 2024. If you move, it is your responsibility to update your contact information with the Claims Administrator at the address listed above. Submitting this Claim and Release Form does not ensure that you will share in the Settlement proceeds. You will share in the proceeds only if (1) the Court approves the Settlement and (2) you meet requirements for recovery set forth in the three Settlement Agreements, which are summarized in the accompanying Notice. You must respond to the below questions under penalty of perjury. YOU MUST COMPLETE THIS CLAIM AND RELEASE FORM IN ORDER TO BE ELIGIBLE FOR MONETARY RECOVERY. INCOMPLETE OR UNTIMELY CLAIM AND RELEASE FORMS WILL BE REJECTED. YOU MUST SIGN AND SUBMIT THE CLAIM AND RELEASE FORM NO LATER THAN FRIDAY, MARCH 22, 2024: Vee Pak Class Claims Administrator c/o Atticus Administration PO Box 64053 St. Paul, MN 55164 Fax: 1-888-326-6411 Email: [email protected] CLAIM AND RELEASE FORM If your address is different from those shown below, update it now. ClaimFormNoHiddenHiddenLastName* Social Security Number or Tax Identification* Name* First Last Address Change (if any):* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Email* Daytime Telephone Number*Evening Telephone Number* Eagle v Vee Pak Payment OptionPlease select the Payment Option by which you would like to receive your payment and complete the steps as prompted. Chosen Payment Method* HiddenPayment Token* PART I: QUESTIONNAIRE Be advised - this agreement is only for African Americans who allege they were denied an assignment from Staffing Network, ASI or MVP's offices that made assignments to Vee Pak. In order to recover a Settlement Payment, you must respond to the following questions under oath. Do not complete this Claim and Release Form if you are not African American. Tenga en cuenta - este acuerdo es solo para los Afroamericanos que alegan que se les negó una asignación de las oficinas de Staffing Network, ASI o MVP que hizo asignaciones a Vee Pak. Para recuperar un pago de liquidación, debe responder a la siguiente pregunta a continuación bajo juramento. No complete este formulario de reclamo si no es Afroamericano. Are you African American?* Yes No Did you seek work from a staffing agency known as Staffing Network (at its Cicero Office, Chicago South Office or Burbank Office) from January 1, 2011 through December 31, 2015, or from a staffing agency known as ASI (at its Cicero Office) from January 1, 2011 through January 16, 2018, or from a staffing agency known as MVP (at its Cicero Office) from January 1, 2011 through October 21, 2013?* Yes No [Answer “yes” if you sought work from at least one of these staffing agency offices.] PART II: WAIVER AND RELEASE WAIVER AND RELEASE* I, the undersigned, hereby irrevocably and unconditionally waive, release, and forever discharge Vee Pak, Inc., Vee Pak, LLC d/b/a Voyant Beauty and Staffing Network Holdings, LLC and each of their current, former, and future affiliates, including, without limitation, parents, subsidiaries, and related entities, predecessors, successors, divisions, joint ventures and assigns, and each of these entities’ past or present owners, shareholders, advisors, directors, officers, employees, partners, members, employee benefit plans (and their agents, administrators, fiduciaries, insurers and reinsurers), principals, insurers, co-insurers, re-insurers, managers, , attorneys, and personal or legal representatives, in their individual and representative capacities (collectively referred to as the “Releasees”) from any and all race discrimination claims against the Releasees and that arise out of the same transactions or occurrences alleged in Plaintiffs’ Sixth Amended Complaint (“Released Claims) in the matter entitled Eagle, et al. v. Vee Pak, Inc., et al., (Case No. 12-cv-09672 (N.D. Ill. 2012)). I acknowledge and agree that the scope of release for the Releasees shall be the same as permitted under the doctrine of res judicata had a judgment been entered in Vee Pak, Inc., Vee Pak, LLC d/b/a Voyant Beauty and Staffing Network Holdings, LLC’s favor. I also acknowledge and agree that explicitly not released and excluded from this settlement are any claims related to any conduct or omissions occurring after January 1, 2019 and that this Waiver and Release explicitly does not waive any rights that cannot be waived by law, including my right to file a charge of discrimination with an administrative agency, such as the United States Equal Employment Opportunity Commission (“EEOC”) and my right to participate in any agency investigation or proceeding. I understand, however, that I am waiving any right to recover a monetary award from any of the Releasees in connection with such a charge or investigation related to the Released Claims for a charge filed by me or by any other individual, by the EEOC, or by any other city, local, state, or federal agency. ACCORDINGLY, I declare under penalty of perjury that the answers to the questions in this Claim and Release Form are true and correct. Claimant ID* *Located on your mailed Notice*Unique ID