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SWOI (11/07)
EMPLOYER NAME:
ISSUANCE DATE:
FEIN:
..
EMPLOYER ADORES~:
CITY:
WORK~ITE
----.
--
--.
POSTING ADDRESS:
STATE:
.
-.
CITY:
k ....
ZIP:
STATE:
ZIP:
INDUSTRY OF EMPLOYER:
Construction
IJ
Non-construction
Agriculture
STOP-WORK ORDER
Pursuant to Connectic,.t General Statute$ Section 31266 as amended, the above-referenced Employer Is
hereby ORDERED TO CEASE ALL BUSINESS OPERATIONS FOR THIS WORKSITE based on the following
virllation(s);
'
Failure to secure the payment of worker's compensation in violation of sections 31284 subsection (b) by:
Failing to obtain coverage that meets the requirements of section 31-284
Misrepresenting employees as independent contractors- Section 31288
Materially understating or concealing payroll;
Materially m'srepresenting or concealing employees duties so as to avoid proper classification for
calculations.
Materially misrepresenting or concealing lnfonnation pertinent to the computation and application of
an experience rating modification factor.
Failure to produce required payroll and other records within a reasonable time as designated by an
authori2:ed representative of the Labor Commissioner pursuant to section 31-76a of C.G.S.
THIS STOP-WORK ORDER MAY BE AMENDED TO INCLUDE ADDITIONAL VIOLATIONS AND SHALL REMAIN
IN EFFECT UNTIL THE DIVISION ISSUES AN ORDER RELEASING THE STOP-WORK ORDER.
IF THE EMPLOYER CONDUCTS BUSINESS OPERATIONS IN VIOLATION OF THIS STOP-WORK ORDER, A
PENALTY OF $1000.00 PER DAY OF VIOLATION SHALL BE ASSESSED AND EACH DAY OF SUCH
VIOLATION SHAlL CONSTITUTE A SEPARATE OFFENSE.
CERTIFICATEIOF SERVICB
Date:------
Time: _ _ _ __
D
0
By hand delivery:
Date: _ _ _ _ __
Time: _ _ _ __
By certified mail:
Date: _ _ _ _ __
Time: _ _ _ __
SW0-2 (11107)