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U.S. Department LaborEmployment and Training Administration

0MB Control No. 1205-0134 Expiration Date: March 31, 2019 • Agricultural and Food Processing Clearance Order ETA Form 790

Orden de Empleo para Obreros/Trabajadores Agricolas y Procesamlento de Allmentos

(Print or type in each field block - To Include additional Information, go to block II 28 - Please follow Step-By-Step Instructions) (Favor de usar letra de molde en la solicitud - Para incluir informaci6n adicional vea el punto # 28 - Favor de seguir las instrucciones paso-a-paso)

1. Employer's and/or Agent's Name and Address (Number, Slreet. City, Staleand Zip Code / Nombre y Direcci6n del Empleador/Patr6n y/o Agente (Numero, Calle. Ciudad, Estado y C6digo Poslal ):

George's Mnrke1 and Nursery, LLC 240 Wade Road Ex1. Lalltam, NY 121 JO

C/O Leonard J. D'Arrlgo, Esq.Whlleman Oslermnn & Hanna, LLI' One Commerce Plain Albany, NY 12260

a) Federal Employer Identification Number (FEIN) / Numero federal deldentificaci6n del Empleador:

03-0395753

b) T elephone Number I Numero de T elerono:

518-365-4113

c) Fax Number/ Numero de Fax: 518-785-1001

d) E-mail Address/ Direccion de Correo Eleclr6nico: georgcsmnrket@gmail.com

2. Address and Directions to Work Site / Domicillo y Direcciones al lugar de trabajo:

240 Wade Road Ext. Latham NY 12110 680 Albany-Shaker Road, Latham NY 12110 Both in Albany County, NY

All worksites owned and operated by George's Market & Nursery, LLC

3. Address and Directions to Housing / Domicilio y Direcciones al lugar de vivienda:

39 Johnson Road, Latham NY 12110 Take 787 N to U.S Route 9N to NY-7W to Johnson Road

a) Description of Housing/ Descripci6n de la vivienda:

Wood frame, 4 bedroom Colonial house. 2 1/2 Baths

Capacity: 4 workers

Nos. 4 through 8 for STATE USE ONLY Numeros 4 a 8 para USO ESTATAL

4. SOC (O.NET/OES) OccupationalCode I C6digo Industrial:

4s�oqao� a. SOC (ONET/OES) Occupational

Tille/ Titulo Ocupacional f<'.t Y fYl WW tl-tl ¢ LAb

Cr'\)

5.Job Order No. / Num. de Orden de Empleo:

6. Address of Order Holding Orlice (include Telephone number) / Direcci6n de la Oficina donde se radico la oferla (incluya el numero de telefono ):

Z ,1,.. tf(p &; -- q7 51 a. Name of Local Orfice Representative (include direct dial telephone

number)/ Nombre del Represenlante de la Oficina Local (lncluya el numero de telefono de su linea directa).

7. Clearance Order Issue Date/ Fecha de Emisi6n de la Orden de Empleo:

� ( 1 / "-0 / g8. Job Order Expiration Date/ Fecha de Vencimiento o Expiraci6n de la Orden

de Empleo: 8 / ;}, 5 / :)-0 / S

9. Anticipated Period of Employment / Periodo anticipado o previslo de Empleo:

From / Desde: 05/5/20 I 8 To I Hasta: 12/15/2018

10. Number of Workers Requested / Numero de Trabajadores Solicilados:

4

11. Anticipated Hours of Work per Week I Horas Anticipadas/Previstas de Trabajo por Semana. Total: 40

Sunday I Domingo___ Thursday /Jueves_7 __ Monday I Lunes _, __ Friday I Viernes_' __Tuesday / Martes _, __ Saturday/ Sabado _, __ Wednesday I Miercoles_' __

12. Anticipated range of hours for different seasonal activities:/ Rango previslo de horas par alas diferentes acUvidades de la lemporada:

9:00a.m -5:00p.m

13. Collect Calls Accepted from:/ Aceplan Uamadas por Cobrar de:

Employer I Empleador. Yes/ SI O No I&)

�By2=====-=-i

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14. Describe how the employer intends to provide either 3 meals a day to each worker or furnish free and convenient cooking and kitchen facilities for workers to prepare meals/ Describa c6mo cl cmpleador tiene la intenci6n de ofrccer, ya sea 3 comidas al dia a cada trabajador, o proporcionar gratuitamenle instalaciones para cocinar.

Housing is provided at no cost to workers who are not reasonably able to return the same day to their place of residence. Housing is not provided to non-workers. Free and convenient kitchen facilities provided at no charge. Workers will buy and prepare their own food. Each week the workers will be provided free transport to and from town to shop for groceries.

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15. Referral Instructions and Hiring Information / lnstrucciones sobre c6mo Referir Candidatos/Solicitantes • (Explain how applicants are to be hired or referred. and the Employer's/Agent's available hour to interview workers/ Explique c6mo los candidatos seran contratados o referidos. y las horas disponibles del empleador/agenle para entrevislar a los lrabajadores). See instructions for more details/ Vea las inslrucciones para mas detalles.

All applicants that meet the minimum job requirements will be interviewed. All interviews will take place at: 240 Wade Road Ext. Latham NY 12110 between 9:00 am to 5:00 pm either in person or over the phone. Hiring authority is at the discretion of the employer.

Contact employer directly, George Vogt, (518) 365-4113 or nearest One Stop Office.

16. Job description and requirements / Descripci6n y requisites del trabajo:

All workers must have at least 3 months verifiable of experience operating SS+HP Farm Equipment. Workerwill perform various tasks involved in planting, cultivating and harvesting vegetable crops including corn,tomatoes, cucumber, green/yellow squash and pumpkins according to supervisor's instructions. Workers willtill soil, plant stock, and perform pruning activities using a variety of non-mechanical tools. SEE ADDENDUM

1. Is previous work experience preferred?/ Se prefiere previa experiencia? Yes/ Si�No D If yes, number of months preferred:/ Si es asi, numero de meses de experiencia: _, __

2. Check all requirements that apply:

D Certification/License Requirements / Certificaci6n/Licencia Requisites D Criminal Background Check/ Verificaci6n de antecedentes penales D Driver Requirements / Requisites del conductor IR:l Drug Screen / Detecci6n de Drogas D Employer Will Train/ Empleador entrenara o adiestrara D Extensive Pushing and Pulling/ Empujar y Jalar Extensamente D Extensive Sitling / Estar sentado largos ralos D Exlensive Walking I Caminar por largos ratos � Exposure to Extreme Temp./ Expuesto a T emperaluras Extremas � Frequent Stooping/ lnclinandose o agachandose con frecuencia � lirting requirement/ Levantar o Cargar �-lbs./libras D OT/Holiday is not mandatory/ Horas Extras (sobre tiempo) / Dias Feriados no ORepetitive Movements I Movimientos repelitivos obligatorio

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17. Waae Rates, Soecial Pav Information and Deductions / Tarifa de Paao, lnformaci6n Sobre Paaos Especiales Y Deducciones (Rebajas)Crop Activities Hourly Wage Piece Rate / Special Pay Deductions' Yes/Si No Pay Period/

Unit(s) (bonus. etc.) Periodo de Pago

Cullivos Salario par Hora Pagos Especiales

Pago par Pieza I (Bono, etc.) Oeducciones

I I

Unidad(es)

Corn S 12.83 $NIA Social Security I 0 0 Weekly / Semana

Seouro Social

s 12.83 SN/A Federal Tax/ [&]

Tomatoes lmpuestos 0 0

Federales

s s Stale Tax 0 0

Bi-weekly/ Cucumbers 12.83 NIA /lmpuestos Quincenal

Estatales D

Squash/Beans $ 12.83 $NIA Meals / Comidas D 0

$ $NIA

Other (specify)/ D 0

\tonthly/Mensual Pumpkins 12.83 Otro (especifica)

D

Other/Otro

D

18. More Details About the Pay I Mas Detalles Sabre el Pago:

H-2A workers are exempt from U.S. Social Security and Medicare withholding, however, all required taxes andwithholdings will be made for U.S. workers. Raises and/or bonuses may be offered to any worker in the specifiedoccupation, at the company's sole discretion, based on individual factors including work performance, skill ortenure.

19. Transportation Arrangements/ Arregtos de Transportaci6n

Employer agrees to reimburse inbound transportation and subsistence expenses to each worker, and any perso�, government agency or private organization which, on behalf of the worker has paid or advanced such transportation and subsistence expenses, from the residence, place of last employment or place of recruitment to the job site after the worker has completed 50% of the stipulated period of employment, from initial date of need or from the day after actual arrival of worker if later than the stated date to report. Employer will also provide return transportation to work-site and subsistence expenses to workers.

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20. Is it the prevailing practice to use Farm Labor Contraclors (FLC) to recruit. supervise. transport, house. andior pay workers for this (these) crop activity(ies)? I lEs la practlca habitual usar Contratistas de Trabajo Agricola para roclutar, supervisar, transportar, dar vivienda, ylo pagarle a los trabajadorespara este(os) tipo(s) de cosecha(s)? Yes I Si D No 0

If you have checked yes, what is the FLC wage for each activity?/ Si contesto ·s;: cual es el salario que le paga al Contratista de Trabajo Agricola por cada actividad?

NIA

21. Are workers covered for Unemployment Insurance?/ lSe le proporcionan Seguro de Desempleo a los trabajadores? Yes/Si@ No D

22. Are workers covered by workers' compensalion? I lSe le provee seguro de compensaci6nlindemnizaci6n al lrabajador: Yes/Si[[] No D

23. Are tools. supplies. and equipmenl provided at no charge lo lhe workers?/ lse les proveen herramientas y equipos sin cos to al gun o a los trabajadores?

Yes/Si!Il No D

24. List any arrangements which have been made wilh establishment owners or agents for the payment or a commission or other benefits for sales made loworkers. (If there are no such arrangemenls, enter "None•.)/ Enumere todos los acuerdos o convenios hechos con los propietarios del establecimiento o sus agentes para el pago de una comisi6n u otros beneficios por ventas hechas a los trabajadores. (Si no hay ningun acuerdo o convenio, I ndique 'Ninguno'.)

NONE

25. List any strike. work stoppage, slowdown. or interruption of operation by lhe employees at the place where the workers y,ilf be employed. (If there are no such incidenls, enter "None'.) / Enumere tOda huelga, paro o interrupci6n de operaciones de lrabajo por parte de los empleados en el lugar de empleo. (Si no hay incidentes de este tipo, lndique 'Ninguno".)

NONE

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26. Is tin Job order to be pl3C*I In ameclao "''DI 1 � A?lf,cabl ix Temp,nry Em;foymert Cel6calico for� WOl',a;rs7 I LEsla aden di! � ha silo puesta en coneld6n con tria iNl8 solai.d de c:811ikacl6n dt emi:1110 IIJ� para llsbejadores H-2A?

Yos/Sl0No0

Upon issunoce of Job Order, the employer wiU submit Form ETA-9142 to U.S. Department of Labor,

27. Employo(s Certifica!lon: This job order dosctlbes lhe actual terms and condlUons of tho employment being offered by m9 and cmtalns all lhc metorlol ter� and conditions of the job./ Certlflcaci6n det Empleador. Esta ocden de trabajo describe tos Mrminos y condlcione, del empleo quo so lo ofro ce, y contlene lodos los t�rmloos y condlclonos matelieles ofreddos.

GEO ROE VOGT, OWNER Employer's Printed Namo & Title/ Nombre y TlhJlo 011 Letro do Molde/fmprenta def Emploador

READ CAREFULLY. ln view o/ lhe statulorlly utabldlod basic funcOon of the Employment Service as a no-lee labor exchar19e, lhat Is, as a forum l0t bringing togelher employers and job scekors, nelthor lho Employmont ond Training Administration (ETA) nor the State agoncl os an> guo1ontors ot tho accuracy or trulhfulness of lnlormaUon contained on jo b orders submitted by empioyers. Nor does any job order ac cepted or reCl\llted upon by tho American Job Cenler consUtufo a contractual Job otter lo which the American Job Center. ETA or a Stale aoericy l, In Any w•y • p•rty.

LEA CON CUIOADO, En 'IISla de la lund6n baslca det 5eMclo de Em;:leo e.stablec:ida poi ley, cano UNI �d de inlercambio l.tioral sin oomisiones, u dlldr, como un foro para re\J\lt o los emplcadore, y los $0licltanles de emptoo, nl ETA nl las agencta, dol estado pueden garanmr la exacUtud o veracldad de la lnlomlaolm coot en Ida on las 6rdenes do ttobajo somollda, por los ompfoadoros. Nl nnguna orden dtl lfabajo aceplado o conl/atado en el Centro do Cerreras (AmerlC811 Job Cenfe,) co11stituyon una olerta de trabafo conllacwatos o las quo el Amert�n Job Center, ETA o un o,ganlsmo estatal es de nlngtr1a manera une de las partes.

PUBLIC BURDEN STATEMENT The pubfic repo1U11g bufl!en for rospoodlng to ETA Form 790, v.tilch is required lo obtain or retain benefits (44 USC 3501), ts estimated to be approximately 60 minutes per re$ponse, lnclud1rQ irno fof re'llewlng Instructions, $01tchlng existing data sources, gathering and re"llewlllg the coflecOon. The public nood not respond to� co11ection of intormalion unless ii d1spays a C!/ffanll)t v:ild 0MB Cooool NIITlbcr. TWs 1$ public ilfamaton and lhero Is oo mqiectaUai ol conf'Jdenlaldy. Send conmonts regcWM911iS bvrden eefrrata 01 eny oChet es� ol this ooiloclX>II. lndulin9 suggestons ror re<Wng ttis burden, lo Ole U.S. Oopenment or Law, Ernplo-,mml ano Tfillni'G AdmiuSlllltlon, OFIOll cl Workforoe lnvcstrncnl, Room C-4510, 200 Comt� AvinJfl, /1,N, Wastingtoo, DC 20210.

OECLARACION DE CAROA P\lBUCA La cs,ga de nlormad6npdbb pua re�era 13 FCll1!13 ETA 790,que seraqulerepara cbtllnero relellCrbeneficio, (4' USC 3501),se estira en apr0)1kn:ltfalr.en:e60 mhltos Pl>r re�a. lrdJylwldo el t'en,po para urm•las lnsw::ctmes. MC8f luentes de dalos ex!stentes. � y tMSar ta ccleocl6n. 8 pub(co no 6e.'II par qui raspondef a esta raco� da '.r1orm!ldon a meoo, que muestre 111 ri:mero de cmrd OMB-a:rdo. Esta lntonnac& OG �li!i,::e y no hay nilguN e,peclativa d9 confldonclaOdad. Envto sus comen'.al!os acen;a do C$la c:1rga o cualquter ovo aspecto de esta GOlecc:ioo, 111cfu)'endo suge1encias para r«b;fr osta ca/!111, el U.S. Department of Lebol, Emplo-fmentord Trtnlng AdnmlrtaCon. Ol/'ce ol Worldorne lnve3lmen� Room c-4510, 200 CnVl/Oon Avonuo. tffl, WislinglM, OC 20210 .

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28. Use this section lo provide additional supporting information (including section Box number). Include attachments, ii necessary./ Utilice esla secci6n para proporcionar inlormaci6n adicional de apoyo; inciuya el numero de la secci6n e incluya archivos adjuntos, si es necesario.

Perform a variety of tasks, which will include any combination of the following, but not limited to: Plant, Stake,

cultivate and harvest crops listed in this order. Workers will plant seed in trays kept in environmentally

controlled structure. Transplant seedlings to prepared beds according to instruction, worker will assist in

preparing fields for planting. Sow seed, or place plants into prepared field. Thin and weed plants, using hand tools, such as hoes and shovels or power drawn implements. Irrigate field to provide moisture for crop growth. Drive and operate farm machines to grow and harvest crops. Must be able to work in cold, wet, hot and humid weather, and able to work on feet in bent, squat, kneel, stooped, or standing positions for longer periods of time. Must be able to lift up to 50lbs. Work tools, supplies, and equipment provided by employer. Housing provided for workers who cannot reasonably return home same day. Random drug testing may be required at employer expense after hire. The employer assures that workers hired under this order who will be handling pesticides will be provided appropriate training, if applicable.

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20 CFR 653,501

Assurances

INTRASTATE AND INTERSTATE CLEARANCE ORDER

The employer agrees to provide to workers referred through the clearance system the number of hours of work per week cited in Item 11 of the clearance order for the week beginning with the anticipated date of need, unless the emplo•ter has amended the date of need et least 10 working days prior to the original date of need by so notifying the Order-Holding Office (OHO). If the employer falls to notify the OHO at least 10 working days prior to the original date of need, the employer shall pay ellglbl� workers referred through the Intrastate/interstate clearance system the specified hourly rate or pay, or In the absence of a specified hourly rate or pay, the higher of the Federal or St<ite minimum wage rate for the first week starting with the original anticipated

· date of need. The employer may require workers to perform altematlve work If the guarantee IsInvoked and If such alternative work Is stated on the job order.

The employer agrees that no extension of employment beyond the per1od of employment shownon the job order will relieve the employer from paying the w.iges already earned, or specified In the job order as a term of employment, providing transportation or paying transportationexpenses to the worker's home.

The employer assures that all working conditions comply with applicable Federal and Stateminimum wage, child labor, social security, health and safety, farm labor contractor registrationand other employment-related laws.

The employer agrees to expeditiously notify the OHO or State agency by telephone lmmedlately upon learning that a crop Is maturing earlier or later, or that weather conditions, over recruitment, or other factors have changed the terms and conditions of employment.

The employer, if acting as a farm labor contractor, has a valid farm labor contractor registrationcertificate.

The employer assures the avallablllty of no cost or publlc housing which meets applicable Federaland State standards and which Is sufficient to house the specified number of workers requestedthrough the clearance system.

The employer also assures that outreach workers shall have reasonable access to the workers Inthe conduct of outreach activities pursuant to 20 CFR 653.107.

Employer's Name ClORG&VOC'T

J:mployer.s ?lgnature·

Besides the material terms and conditions of the employment, lhe employer must agree to these assurances If tho job order Is to be placed as part of the Agricultural Recruitment System. This as,urance statement must be signed by the employer, and It must accompany the ETA Form 790.

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NEW YORK STATE DEPARTMENT OF LABOR Form ET A 790 Attachment

Terms and Conditions/Clarifications and Assurances/ Additional Information

A: CLARIFICATION OF ITEMS ON FORM ETA-790

Item 3: Housing

a. Housing and utilities are provided at no cost to H-2A workers and those workers in correspondingemployment who are unable to return to their place of residence the same day.

b. Housing beds, bedding, and mattresses will be furnished at no cost to the workers.c. Housing will be clean and meet the applicable Federal and State housing standards.d. Workers will be responsible for maintaining housing and surrounding areas in a neat, clean manner.

Item 14: Board Arrangements Employer willO will not[8] provide three meals per day and will deduct $0 per day. Employer will[8] will notO furnish free dishes, cooking utensils and convenient kitchen and cooking facilities. Employer will(gj will notO provide transportation to assure workers access to stores where they can purchase groceries and/or other incidentals, and/or medical necessities.

Item 16: Job Specifications

a. Workers must be able to demonstrate that they are physically able to perform the work as described.b. The employer will provide O days of training and/or allow O days of work for worker to reach production

standards if applicable.Employer may terminate worker with timely notification to the NPC and OHS, if the worker:

1) Refuses, without cause, to perform work for which the worker was recruited and hired;2) Commits serious acts of misconduct;3) Abandons Job ("Job Abandonment") - is absent for five consecutive previously scheduled days

without prior notification to employer.

Employer may terminate the worker (foreign and/or domestic) with notification to the employment service if employer discovers a criminal conviction record or status as a registered sex offender that employer reasonably believers, consistent with current law, will impair the safety and living conditions of other workers).

Item 17: Wage Rates, Special Pay Information and Deductions

The employer will offer, advertise in its recruitment, and pay a wage that is the highest of the AEWR, the prevailing hourly wage or piece rate, the agreed upon collective bargaining wage, or the Federal or State minimum wage, except where a special procedure is approved for an occupation or specific class of agricultural employment. Employer assures that if a change in the AEWR requires an increase such increase will be paid as of the effective date of the increase. Also if the AEWR is decreased this will become the wage effective on the date of the decrease. a. If piece rate earnings for total hours of work at a piece rate during a pay period do not result in

average hourly earnings equal to the guaranteed minimum hourly rate, the worker will receive make­up pay to the guaranteed minimum wage rate.

b. In New York State, the only deductions that can be taken from worker pay are:1. Those required by law, such as Social Security, income tax, and garnishment of wages; and2. Those that benefit workers and are authorized in writing, such as life insurance, or a savings

account.

Any other deductions are illegal.

c. The employer guarantees to offer employment for a minimum of¾ ("three-fourths guarantee") of thehours in the workdays during the period of the contract, and all extensions thereof. This guaranteebegins with the first workday after the worker's arrival at the place of employment and ends on thedate specified on the job order or extensions thereof. In fire, weather, or Act of God terminations (asdetermined by the Certifying Officer) the ¾ guarantee period ends on the date of termination. Theemployer must make efforts to transfer the worker to other comparable employment acceptable to theworker, consistent with existing immigration law, as applicable. If such a transfer is not affected, theemployer must (1) return the worker, at the employer's expense, to the place from which the worker(disregarding intervening employment) came to work for the employer, or transport the worker to theworker's next certified H-2A employer, whichever the worker prefers; (2) reimburse the worker the fullamount of any deductions made from the worker's pay by the employer for transportation andsubsistence expenses to the place of employment; and (3) pay the worker for any costs incurred bythe worker for transportation and daily subsistence to that employer's place of employment. Dailysubsistence must be computed as set forth in paragraph (h) of 655.122. The amount of thetransportation payment must not be less (and is not required to be more) than the most economicaland reasonable common carrier transportation charges for the distances involved provide theguarantees in Item 19 (a) below.

d. Workers will not be required to work more than the number of hours specified in the job order for aworkday or on their Sabbath or federal holidays to meet this guarantee. The worker's average hourlyearnings will be used under this guarantee where wages are paid on a piece rate basis. Workers whoare terminated for cause or who voluntarily abandon their job are not entitled to this guarantee ifemployer provides timely notification to the NPC and OHS.

e. On or before each payday the employer will provide to each worker in one or more written statementsthe following information: (1) the worker's total earnings for the pay period; (2) the worker's hourly rateand/or piece rate of pay; (3) the hours of employment offered to the worker (showing offers inaccordance with the ¾ guarantee as determined in paragraph (i) of the regulations at 20 CFR sec.655.122(k), separate from any hours offered over and above the guarantee); (4) the hours actuallyworked by the worker; (5) an itemization of all deductions made from the worker's wages; (6) if piecerates are used, the units produced daily; (7) beginning and ending dates of the pay period; and (8) theemployer's name, address, and FEIN.

f. Workers with school age children who have migrated with such children and who depart in time toreturn home for the beginning of the school year shall be paid, in addition to the basic wages, anybonus or other incentive payments or other expenses to which they would be entitled had they stayedthe entire job order period.

g. The employer will provide workers referred through the interstate clearance system 40 hours of workfor the week beginning with the anticipated date of need, unless employer has amended the date ofneed by notifying the SWA no later than 1 O business days before the date of need. If the employerfails to notify the NYS Department of Labor, then the employer shall pay an eligible worker referredthrough the clearance system $513.20 (number of hours of work x AEWR/prevailing wage/minimumwage) for the first week starting with the originally anticipated date of need. If worker referred fails tonotify the NYS Department of Labor of continued interest in the job at least 5 days before date ofneed, worker will be disqualified from this assurance. Employer willD will not� require worker toperform alternative work if the guarantee cited in this section is invoked.Alternative work: NIA

h. Employer will maintain adequate payroll records. Workers will be paid weekly on Friday for workthrough the previous Friday.

Item 19: Transportation

!t 12 o1 Employer agrees to reimburse inbound transportation and subsistence expenses (� per day minimum to a maximum of $51.00 per day) to each worker, or any person, government agency, or private organization which, on behalf of the worker, has paid or advanced such transportation and subsistence expenses, from the place from which the worker has come to work for the employer, whether in the U.S. or abroad to the place of employment, after the worker has completed 50% of the stipulated period of

2

employment, from initial date of need or from the day after actual arrival of worker if later than the stated date to report.

a. Employer will provide or pay the cost of return transportation and subsistence to each worker whocompletes the employment period, or who is terminated for medical reasons, or as the result of fire,weather, or an Act of God (as determined by the Certifying Officer), from place of employment to placeof recruitment, except if the worker prefers not to return to his place of recruitment and has subsequentemployment with an employer - see Item 17 ( c) above. Employer will not be responsible for providingreturn cost of transportation and subsistence from place of employment to place of recruitment if theworker voluntarily abandons the job or is terminated for cause and employer provides timely notificationto the NPC and OHS.

b. The amount of the transportation payment will be equal to the most economical and reasonable similarcommon carrier transportation charges for the distance involved. All transportation provided by theemployer will be by common carrier or other transportation facilities which conform to the applicable

regulations of the Interstate Commerce Commission or the United States Department of Labor. Theamount of daily subsistence will be in accordance with current rates published in the Federal Register(for workers with and without receipts).

c. If requested by the worker, employer will assist in making transportation arrangements.d. Employer will provide transportation, at no cost to the worker, from the employer provided housing to

the actual work site and return at the end of the day.

Item 22: Workers' Compensation

The employer assures that Policy #3101W6134 issued by Farm Family Casualty Insurance Co. provides the required insurance for injuries arising out of and in the course of employment.

Employer's proof of insurance coverage will be provided to the Chicago Processing Center before certification is granted.

Item 23: Tools and Equipment

The employer will furnish without cost all tools, supplies, or equipment required in the performance of work.

B: OTHER CLARIFICATIONS AND ASSURANCES

1. The employer agrees to abide by the regulations at 20 CFR 653.501 and 20 CFR 655.135.2. The employer will expeditiously notify the State agency by telephone immediately upon learning that a crop

is maturing earlier or later, or that weather conditions, over-recruitment, or other factors have changed theterms and conditions of employment.

3. Outreach workers shall have reasonable access to the worker in the conduct of outreach activities pursuantto 20 CFR 653.501 (xvi).

4. Where appropriate, the employer is certified in the use and application of pesticides per FederalEnvironmental Protection Agency and State Department of Environmental Conservation requirements. Theemployer assures that workers hired under this order who will be handling pesticides will be providedappropriate training.

5. The employer will provide to an H-2A worker no later than the time at which the worker applies for the visa,or to a worker in corresponding employment no later than on the day work commences, a copy of the workcontract between the employer and the workers in a language understood by the worker.

6. The employer assures that if acting as a farm labor contractor (FLC) or farm labor contractor employee(FLCE) on the order, he/she has a valid federal FLC certificate or FLCE identification card.

7. The applicant assures that he/she complies with NYS registration requirements. Farm labor contractorsanticipating employment contracting with growers or processors in New York State, growers or processorsin New York State who use the services of a farm labor contractor, and growers or processors in New YorkState who, without using the services of a farm labor contractor, are responsible for bringing into the statefive or more out-of-state migrant farm or food processing workers, not including H-2A workers, arerequired to register with the New York State Department of Labor and pay a registration fee in addition to

3

any other fees that may be applicable. This statement applies only to H-2A employers who also employ five or more out-of-state migrant workers.

03/2017

4

I • I<,' ...

Notice of Entry of Appearance OHS Form G-28

0MB No. 1615-0105 Expires 03/31/20 I 8

as Attorney or Accredited Representative

Department of Homeland Security

Part 1. Information About Attorney or

Accredited Representative

1. USCIS ELIS Account Number (i/ any)Iii>-

Name and Address of Attorney or Accredited

Representative

2.a. Family Name{last Name)

2.b. Given Name (First Name)

2.c. Middle Name3.a. Street Number

and Name 3.b. Apt. D Ste.

I DARRIGO jLeonard !Johnlone Commerce Plaza

� Fir. D !1900

3.c. City or Town ... I A_l_b_a_n_y _____________, 3.d. State EJ 3.e. ZIP Code�' 1_2_2_6_0 _____ _.3.f.

3.g.

3.h.

4.

5.

6.

7.

Province

Postal Code Country !united StatesDaytime Telephone Number 15184877600

Fax Number 15184877777

E-Mail Address (if any)limmigration@woh.com Mobile Telephone Number (if any)

Fonn G-28 05/05/16 Y

Part 2. Notice of Appearance as Attorney or

Accredited Representative

This appearance relates to immigration matters before (Select only one box):

1.a. � USCISl.b. List the form numbers

IETA790, ETA9142 & I-129

2.a. 0 ICE2.b. List the specific matter in which appearance is entered

3.a. D CSP3.b. List the specific matter in which appearance is entered

I enter my appearance as attorney or accredited representative at the request of: 4. Select only one box:

D Applicant (gJ Petitioner D Requester D Respondent (ICE, CBP)

Information About Applicant, Petitioner,

Requestor, or Respondent

5.a. Family Name lvooT(last Name) �· =========================� 5.b. Gi�en Name I George (Ftrst Name) �· =========================�

5.c. Middle Name6. Name of Company or Organization (if applicable)

!Georges Market and Nursery LLC

Page I of4

Part 2. Notice of Appearance as Attorney or

Accredited Representative (continued)

Information About App/lca11t, Petitioner, Requestor, or Respondent (coutinued)

7. USCIS ELIS Account Number (if any)

�

8. Alien Registration Number (A-Number) or Receipt Number

9. Daytime Telephone Number15183654113

I 0. Mobile Telephone Number (if any)

11. E-Mail Address (if any)

lg eorg esmarket@gmail.com

Mailing Address of Applicant, Petitioner, Requestor, or Respondent

NOTE: Provide the mailing address of the applicant, petitioner, requester, or respondent. Do not provide the business mailing address of the attorney or accredited representative unless it serves as the safe mailing address on the application, petition, or reques1 being filed with this Form G-28. 12.a. �����,:;1ber 1240 Wade Road Ext.

12.b. Apt. 0 Ste. 0 Fir. D ._I ______ ___.

12.c. City or Town I Latham�-----�-- -_-_-_-_-_-_-_-_-_-_-_:-_-_-_--'-12.d. State EJ 12.e. ZIP Code ._

I 1_2_1_1_0 _____ _,12.f. Province

12.g. Postal Code12.h. Country

!united States

Fonn G-28 05/05/16 y

Part 3. Eligibility Information for Attorney or

Accredited Representative

Select all applicable i1ems. I.a. [gJ I am an attorney eligible to practice law in, and a

member in good standing of, the bar of the highest courts of the following states, possessions, territories, commonwealths, or the District of Columbia. (If youneed additional space, use Part 6.)

Licensing Authority INew York

l.b. Bar Number (if applicable)

14372553 I.e. Name of Law Firm

lwhiteman Osterman & Hanna LLP J.d. I (choose one) [8] am not O am

subject to any order of any court or administrative agency disbarring, suspending, enjoining, restraining, or otherwise restricting me in the practice of law. If you are subject to any orders, explain in the space below. (If you needadditional space, use Part 6.)

2.a. 0 I am an accredited representative of the followingqualified nonprofit religious, charitable, social service, or similar organization established in the United States, so recognized by the Department of Justice, Board oflmmigration Appeals, in accordance with 8 CFR 292.2. Provide the name of the organiza1ion and the expiration date of accreditation.

2.b. Name of Recognized Organization

2.c. Date accreditation expires(mmlddlyyyy) � ._

I

______ _.

I I I I

I 'I I I

Page 2 of 4

Part 3. Eligibility lnformntion fol' Attorney or Accredited Representative (continued)

3. 0 I am associated wi1h

Ibo attorney or accredited n:prcsenta1ivc of record who previously tiled Fom1 0-28 in this ousc. and my appearance as an attorney or u,crcdited representative is ot bl! or her request. NOTE: If you select this itcni, also complclc Item Numbers 1.a. - 1.b. or Item Numbers 2.11 •• 2.c. in P:art 3. (wldd1ever is appmpriole}.

4.o. 0 I am II luw student or law gruduatc working under thedirect supervision of tho nttomcy or accrcdircd ,epr,:sc:nllltive of rt cord on this form in accordance wi1h the requirements in 8 Cl'R 292. l(a)(2Xiv).

4.t,. Nnme of Law Student or Law Onidunlc

Part 4. Applicant, Petitioner, Rcqucstor, or Respondent Consent to Representution, ContJlct Information, nod Signature

Cu11sc/rf to ReprescJttation n11d Release of l1,furma1io11

J. I have rcqucslcd the rcprcscn101ion of and consented 10 hcing rcpniscnlcd by the auomcy or occreditcdrcprcscnrauve named ia Part 1. of this form. Accordingto lhc Privacy Act of 1974 o.nd OHS policy. I also consentto the disclu.wre to tho named attorney or accn:tlitcd rep1c:.enw1ivc of any record pertBining to me 1lun appears in any system ofrceords orUSCIS, ICE or CBP.

When you (tbt: applicant, petitioner, rcquCS1or, or n:spondcnt) are represc111cd, OHS will send notices to botli you ond your attorney or accn:dit�'<I representu1ivc cilhcr through mail or electronic delivery.DIIS will ulso send tho Fonn 1-94, Arrival Dcportut'<:Record, tu you unless you select Item Numhcr 2.11. inPurt 4. All secure identity document., and TravelDocuments will be sent to you (tho npplicanl, petitioner,rcquestor, or respondent) ot your U.S. mailing nddrcssunless yuu a.� us to send your secure identity docnmculsto your :ittomey of record or accredited l'Cfll'CSCDliltive.

l'onn <1-211 05/0.s/16 Y

If you do nut wanl to receive orisinal notict:.i or �ccurc identity doetimcnts dir�lly, but would rather have such notices ond documents senl to your nttomcy of record or accredited rcprc.�enL'llivc, please select all opplicahlc boxc:s below:

2.a {81 I request OHS send llllY nolicc (including Fonn 1-94) on nn npplication, petiliun, or request to the U.S. business address uf my attorney of record or oceteditcd repn:sc11tetive as listed in this fonn. I undcr.wmd thnt I may chani;e this election at any future date through written notice to D11S.

2.b. O I request that OHS �nd any stcu:n:: identity document,such as o Pcnn111ent Rc,ident Card, Employm�nl Anthorizalioo Document, or Trnvcl Docunienl, that 1 am npprovcd to receive and aulhurizcd to possess, to ihe U.S. business address of my 11llurney of record or eceredltcd n:prcscntanvc as liJtcd in lhi.s fonn or to a dc.1igrn11cd military or diplomulic addrc� for pickup in a foreign countiy (if pcnuitll!d). 1 consent to h.wing my se<:uni identity c!ocumcnl sent to my attorney of reccrd or acx-n:ditcd rcpreseutati\-e's U.S. husinC$$ aJdn:ss and undcrs1and that l may requesl, ot ony future dffte and lhrough writtcn notice to DHS, lb:lt OHS send ®Ysecuro identity documcnl lo me dinxtly.

3•,

�

AppU�,1, P<titio

tt

•"

-.1:;zaa� J.b. OatcofSignoturo (111f!,lddlJ'YYJ�.,,,. liJ3...J.iiif'j2Pf ?I

Pnrt S. SigoRture of Attorney or Accredited

Representative

l h:ive re:id nncl undcrsland the regulations :md conditions contnined in 8 CFR 103.2 and 292 guvc:ming appearances and representation before the ncpartment of Homeland Security. I declare under i,eMlty of perjury undc,r tho luwu of the Urutcd States th:lt the information I have provided on this form is true nndcom:ct.

I.

2.

3. Dote of8isnan1re (,nmltld/yyy;�.,,,.

11 Page 3 of4

!Part 6. Additional InformationUse the space provided below 10 provide additional infonnation pertaining lo Pnrt 3., Item Numbers I.a. - l.d. or 10 provide your U.S. business address for purposes ofrecciving secure

identity documents for your cl ie111 (if your client has consented 10 your receipt of such documents under Part 4.)

Form G-28 05/05/16 Y Page 4 of4