STATE OF CALIFORNIA Wage Claim Summary Report

Department of Industrial Relations Case Number: WC-CM-958836

Labor Commissioner's Office Date filed: 6/1/2023
Phone: 833-526-4636

Claimant Information

Are you submitting a wage claim for yourself or on behalf of the claimant? Yourself
Name: KAYLEE LYNN STEIN
Birth Date: 04/21/1983
Cell Phone: +1-510-260-3984
Text messages may incur additional charges. Do you want to opt-out of text messages from the Labor Commissioner’s Office?: I do
not want to receive text messages.
Home Phone: +1-510-260-3984
Email: klsteinzel@gmail.com
Address: 65-5E STEINEL Way 4th TENDERLOIN CA 94109
Do you need an interpreter? No

Industry Information

What is the primary industry the employer engages in? Hospital Employment
Provide a list of the job duties you performed: Physision

Claim Filed Against (Employer Information)

Employer/Business Type: General Partnership

Business Name: Hotel Le Steinzel
Address: 655 Ellis st Tenderloin CA 94109
Business Phone: +1-510-260-3984
Email: klsteinzel@gmail.com
Website: covahotel.com
Total number of employees who worked for your employer at the time of your employment: 500
If you have documents with any information on it about the person or business you worked for, you can upload them here:
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ADMINISTRATIVE_SUBPOENA_TO_APPEAR_AND_TESTIFY_DEPOSITION_04_2020_EMAIL_PROCESSING (1).PDF
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ADMINISTRATIVE_SUBPOENA_TO_APPEAR_AND_TESTIFY_DEPOSITION_04_2020_EMAIL_PROCESSING (1).PDF
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Is there a union contract covering your employment? No
Are other employees also filing wage claims against this employer? No
Have you filed a Retaliation Complaint against your employer with the Labor Commissioner? No
Is this claim related to COVID-19? No
Name of person in charge of your work
Name: KAYLEE STEIN
Describe how this person may be responsible: Owner and CEO

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Wage Claim Summary Report (continued) Case Number: WC-CM-958836 Date filed : 6/1/2023

Who paid you? No one yet

Who set your work schedule? Myself
How did your employer keep track of the hours you worked? Electronic
Were you ever told to sign the time card even when the hours on the time card were not accurate? No
If someone else recorded your work hours for you, enter their full name here: Front desk and room 414
Is this employer still in business? No
Has your employer recently closed their business, are they selling major assets such as the business or their property, or have they
recently filed or threatened to file for bankruptcy? Yes
Upload documents about your employer's finances or assets, such as bank statements or pay stubs with bank information:
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List any banks you believe this employer uses/has used (e.g., Bank of America, Wells Fargo, Citibank, JP Morgan Chase). You can
find these in the company or personal pay checks received.: Found
Did your employer's business change its name during your employment? Yes
Employer/Business Type: General Partnership
Business Name: STEINEL UNIVERSITY MEDICAL CENTER
Address: 65-5E Steinel Way Tenderloin CA 94109
Phone: +1-5102603984
Email: klsteinzel@gmail.com
Website: covahotel.com
Total number of employees who worked for your employer at the time of your employment: 500
Enter the dates you worked for your employer under this business name
Start Date: 01/25/2022
End Date: 01/25/2023
Did your employer change the name of the business after your employment?: Yes
Employer Information (Successor): Employer/Business Type: Individual/Sole Proprietor
Name: KAYLEE STEIN
Address: 655 Ellis St no 417 San Francisco CA 94109
Business Phone: +1-510-260-3984
Email: klsteinzel@gmail.com
Total number of employees who worked for your employer at the time of your employment: 1

Other Work Location

Is the address where you worked different from the business address provided? Yes
Add the address where you reported for work
Address: 0325 CSM 701 LARKIN HOUSE Tenderloin CA 94109
Approximate Location: 710 Ellis
Phone: +1-510-260-3984

Label Information

Employment Status and Final Wages

Date of Hire: 06/16/2009

Name of person who hired you: Ines Rodriguez
How were your wages paid? Other
Explanation: Not paid yet
Were your wages always paid on the payday established by your employer? No
Did you receive itemized wage statements (pay stubs) when you received cash or check payments? No
Are you still working for the identified employer? Yes

Payment of Wages

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Wage Claim Summary Report (continued) Case Number: WC-CM-958836 Date filed : 6/1/2023

Wage type: Salary rate for each pay period

Were you paid or promised a FIXED amount of wages per pay period, no matter how many hours you worked? Example: $400 per
week, regardless of how many hours you worked?
I was paid: $632000 Per Annual
Start Date: 03/19/2018
End Date: 06/03/2019
I was promised: $1896000 Per Annual
Wage type: Commission rate
Did you receive a written commission agreement? No

Workweek and Workday

Does your employer follow the standard workweek of Sunday to Saturday? No

Select the employer-defined workweek: Monday to Sunday
Do you know if your employer follows the standard workday of midnight to midnight? Yes

Hours You Typically Worked

Select one of the following: My work hours and days of work were usually the same each week that I worked
Day: Monday
Shift Start Time: 09:00 AM
Time First Meal Began: 12:00:00.000
Shift End Time: 5:00 PM
Length of Meal Period: 30
Total Work Hours: 7hr 30min
Day: Tuesday
Shift Start Time: 09:00 AM
Time First Meal Began: 12:00:00.000
Shift End Time: 5:00 PM
Length of Meal Period: 30
Total Work Hours: 7hr 30min
Day: Wednesday
Shift Start Time: 09:00 AM
Time First Meal Began: 12:00:00.000
Shift End Time: 5:00 PM
Length of Meal Period: 30
Total Work Hours: 7hr 30min
Day: Thursday
Shift Start Time: 09:00 AM
Time First Meal Began: 12:00:00.000
Shift End Time: 5:00 PM
Length of Meal Period: 30
Total Work Hours: 7hr 30min
Day: Friday
Shift Start Time: 09:00 AM
Time First Meal Began: 12:00:00.000
Shift End Time: 5:00 PM
Length of Meal Period: 30
Shift ends following day true
Total Work Hours: 7hr 30min
Day: Saturday
Shift ends following day true

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Wage Claim Summary Report (continued) Case Number: WC-CM-958836 Date filed : 6/1/2023

Total Work Hours: 0

Day: Sunday
Shift ends following day true
Total Work Hours: 0
Were there any exceptions to your typical schedule -- days when you did not work? Example: laid off, vacation, sick leave, business
closed by the employer Yes
How many total days of work did you miss during your claim period?: 45
Reason(s) for missed work?: Week of birth date April 21
Select any holidays you did not work:
Other holidays you did not work
Other holidays you did not work: Birthday

Wage Claims

Late Payroll
You indicated earlier that you may not have been paid on time. This claim has been added. To add claims for multiple late paydays,
enter the start date for the first payroll period and the end date of the last payroll period.
Start date of this claim (MM/DD/YYYY): 01/03/2019
End date of this claim (MM/DD/YYYY): 06/01/2023

[]  I worked but was not paid – either partially or at all

Commission Agreement
Start date of this claim (MM/DD/YYYY): 06/01/2023
End date of this claim (MM/DD/YYYY): 06/01/2023
Total amount of commissions earned for this period: $ 632000
Total amount of commissions paid for this claim period: $ 0
Salary rate
Start date of this claim (MM/DD/YYYY): 06/01/2023
End date of this claim (MM/DD/YYYY): 06/01/2023
What was the pay period frequency? Daily, weekly, biweekly, monthly etc.: Annual
How much did you earn per pay period? $ 0
How many pay periods did you work during the claim period? 0
What is the total amount you were paid during this claim period? $ 0

[]  I was not paid all the overtime or double time wages I earned

If there are any other claims you would like to make that are not listed here, please explain in the space provided. You have a 500
character limit Never was paid due to employees stealing mail

Certification and Authorization

File Name
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Certification Statement By submitting this form, I hereby certify that the information I have provided is true to the best of my knowledge and/or
recollection, and I further acknowledge that this information is being collected by the State and may be shared with another state agency or
private party in accordance with California Civil Code section 1798.24 and the Information Practices Act of 1977 generally. For more information
regarding the Department of Industrial Relation's Privacy Policy, please go to www.dir.ca.gov/od_pub/privacy.html.
Authorization Date: 06/01T17:23:54.596Z/2023
Authorized by: Dr Kaylee Lynn Stein

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