Fillable OPERATING ENGINEERS TRUST FUNDS

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OPERATING ENGINEERS TRUST FUNDS

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12/18/2018
Inactive Status Request
We do not presently employ Operating Engineers and do hereby request “Inactive status” and ask to be relieved
of the requirement to remit Employers Monthly Reports to Trustees for the below noted Employer ID(s).
We do hereby agree and stipulate that should Operating Engineers be employed by us in the future, we will
advise your office in writing immediately and request that you furnish the necessary Employer Monthly Reports
to Trustees and pay the necessary contributions when they are due, all in accordance with the terms and
provisions as stated in our Collective Bargaining Agreement with the International Union of Operating Engineers
Local No. 12.
Employer Information
Employer ID(s)
Job Name (If Applicable)
Reason for Request Effective Work Period
______/_______/__________
Employer Name
Street Address
Suite/Unit#
City
State
ZIP Code
Phone Number
( )
Fax Number
( )
Signature (required)
X
Date
______/_______/__________
r
Fund Office Use Only
Processed By
Process Date
______/_______/__________
Effective Work Period
______/_______/__________
Copy to Field Rep.
Return to: Operating Engineers Trust Funds, PO Box 7064, Pasadena, CA 91109
OPERATING ENGINEERS TRUST FUNDS
I.U.O.E. LOCAL 12 HEALTH & WELFARE / PENSION / VACATION / TRAINING
100 CORSON STREET, SUITE 100 · PASADENA, CALIFORNIA 91103 · (866) 400-5200
P.O. BOX 7063, PASADENA, CALIFORNIA 91109
TTY: (626) 356-3582 WEBSITE: www.oefi .org
rev 6_2017
rev 3_2019
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Completed 29 November 2021

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