Tovar v. Drew’s LLC.

Proof of Claim Form (can be completed and submitted on-line)

 

GENERAL INSTRUCTIONS

This Claim Form relates to Gherson Tovar v. Drew’s LLC, No. 16-L-313, in the CircuitCourt of St. Clair County, Illinois.

To be eligible to share in the Settlement Fund for the Settlement Class in the above-named class action, you must have (1) directly purchased Drew’s All-Natural Salad Dressings and Quick Marinades for personal use (not for resale); (2) made such purchaseduring the time period of June 15, 2011 through February 15, 2017; and (3) made suchpurchase in the U.S.

If you fit this description, you are a member of the Settlement Class and are entitled tosubmit a claim to share in the Settlement Fund. Excluded from the Settlement Class are(a) all Persons who purchased or acquired the Product for resale (i.e., retailers,distributors, etc.);

(b) Drew’s and its employees, principals, affiliated entities, legal representatives,successors and assigns; (c) any Person who files a valid, timely Request for Exclusion; (d)federal, state, and local governments (including all agencies and subdivisions thereof, butexcluding employees thereof) and (e) the judges to whom this Action is assigned and anymembers of their immediate families.

Settlement Class Members who seek payment from the Settlement mustcomplete and return this Claim Form. Completed Claim Forms must be mailed to Drew’s Class Action Settlement, PO Box 12723, Birmingham, AL 35202 and postmarked no later than July 15, 2017 at 11:59 pm, eastern time.  

If you do not have valid Proof of Purchasemay recover up to a maximum of $1.50 per Household by completing Sections 1 and 3 below.  If you have a Proof of Purchase, you may recover $.50/Product for each Product purchased, up to a maximum of 20 Products/$10.00 per Household by completing Sections 2 and 3 below and providingyour Proof of Purchase. Proof of Purchase means a receipt, UPC code, picture ofopened Product showing UPC code, or other documentation from a third-partycommercial source reasonably establishing the fact and date of purchase of the Product during the Class Period in the United States. You can elect to file a Claim under either Tier 1 or 2. You may not file a claim for more than one Tier, and only one claim may be submitted per Household.  If you file a Claim under either Tier, you will also receive a coupon for $3 off a future Drew’s purchase as described in the Notice.   

Before you complete and submit this Claim Formyou should read and be familiar withthe Notice of Proposed Class Action Settlement (“the Notice”).  By submitting thisClaim Form, you acknowledge that you have read and understand the Notice, and youagree to the Releases included as a material term of the Settlement Agreement.  Allcapitalized terms used herein but defined herein shall have the meaning ascribed to suchterms in the Settlement Agreement.

If you fail to submit a timely Claim Form, your claim may be rejected and you may beprecluded from any recovery from the Settlement Fund. If you are a member of theSettlement Class and you do not timely and validly seek exclusion from the Settlement Class, you will be bound by any judgment entered by the Court approving the Settlementregardless of whether you submit a Claim Form.

Claimant Information

Claimant First Name  

Claimant Last Name    

Street Address              

Street Address 2          

City                    

State            

Zip                       

Daytime Telephone   

Evening Telephone   

E-mail Address          

Section 1 (Tier 1)

If you do not have valid Proof of Purchase, you may recover up to a maximum of $.50 per product, up to 3 products, for a total of $1.50 per Household.  In order to recover these amounts, you must fill out this Section 1 and Section 3 below.

 Purchase Information

1. Please identify the store(s) at which you purchased the Products:

 

Target    Whole Foods     Aldi     Sam's Club     Straub's     Safeway     Kroger     Albertson's     Tom Thumb     Publix

 

Other :  

2. Please identify the Products purchased during the Class Period:

 

3. How many Products were purchased during the Class Period?

4. Did you buy a 12 oz. bottle, a 16 oz. bottle, or a 24 oz. bottle(s)? 

Section 2 (Tier 2)

If you have valid Proof of Purchase, you may recover $.50 per each unit for which you have proof of purchase, up to 20 units per Household, by providing proofs of purchase as well as completing Section 3 below. Please attach your proofs of purchase. [Tier 2 claims (signed Section 3 along with proofs of purchase) may be US mail or to Claim@NoticeClass.com.] 

Section 3 (Certification)

Certification under Penalty of Perjury 

By signing below, you are submitting to the jurisdiction of the Circuit Court of St. Clair County, Illinois.

I hereby certify under penalty of perjury that:

  1. I have read the Notice and agree to its terms;
  2. The information provided in this Claim Form is accurate and complete to the best of my knowledge, information and belief;
  3. The selection of the appropriate Tier and information for the benefit in the Tier is true and accurate;
  4. The additional information provided to the Settlement Administrator to support my claim is an original or a complete and true copy of the original document;
  5. I am a member of the Settlement Class and did not request to be excluded from the Settlement Class;
  6. I have not previously entered into a settlement for any of the claims set forth in this Claim Form;
  7. I am neither (a) Person who purchased or acquired the Product for resale; (b) Defendant and its employees, principals, affiliated entities, legal representatives, successors and assigns; (c) a government entity; or (d) A judge to whom this Action is assigned or any member of the judge’s immediate family;
  8. I have not submitted any other claim for the same purchases and have not authorized any other person or entity to do so, and know of no other person or entityhaving done so on my behalf; and
  9. No other person in my Household has submitted a Claim under this Settlement.
Signature 
Dated