| CASE NUMBER | I-200-24071-788327 |
| CASE STATUS | Certified |
| RECEIVED DATE | 3/11/2024 |
| DECISION DATE | 3/18/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Senior Software Engineer |
| SOC CODE | 15-1252.00 |
| SOC TITLE | Software Developers |
| FULL TIME POSITION | Y |
| BEGIN DATE | 7/24/2024 |
| END DATE | 7/23/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | WORKERS' COMPENSATION INSURANCE RATING BUREAU OF CALIFORNIA |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 1901 Harrison St. |
| EMPLOYER ADDRESS2 | 17th Floor |
| EMPLOYER CITY | OAKLAND |
| EMPLOYER STATE | CA |
| EMPLOYER POSTAL CODE | 94612 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 14157787023 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 524298 |
| EMPLOYER POC LAST NAME | Forsberg |
| EMPLOYER POC FIRST NAME | Monica |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Sr. HR Business Partner |
| EMPLOYER POC ADDRESS1 | 1901 Harrison St, |
| EMPLOYER POC ADDRESS2 | 17th floor |
| EMPLOYER POC CITY | Oakland |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 94612 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 14157787023 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | MForsberg@wcirb.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | BAHNAN |
| AGENT ATTORNEY FIRST NAME | NADINE |
| AGENT ATTORNEY MIDDLE NAME | KHAMIS |
| AGENT ATTORNEY ADDRESS1 | 555 MONTGOMERY STREET |
| AGENT ATTORNEY ADDRESS2 | 4TH FLOOR |
| AGENT ATTORNEY CITY | SAN FRANCISCO |
| AGENT ATTORNEY STATE | CA |
| AGENT ATTORNEY POSTAL CODE | 94111 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 14159861446 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | NBAHNAN@FRAGOMEN.COM |
| LAWFIRM NAME BUSINESS NAME | FRAGOMEN, DEL REY, BERNSEN & LOEWY, LLP |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | SUPREME COURT |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 1901 Harrison Street |
| WORKSITE ADDRESS2 | 19th Floor |
| WORKSITE CITY | Oakland |
| WORKSITE COUNTY | ALAMEDA |
| WORKSITE STATE | CA |
| WORKSITE POSTAL CODE | 94612 |
| WAGE RATE OF PAY FROM | 177616.4 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $147,368.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2023 - 6/30/2024 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 2 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | BAHNAN C#8036315 |
| PREPARER FIRST NAME | NADINE |
| PREPARER MIDDLE INITIAL | K |
| PREPARER BUSINESS NAME | FRAGOMEN, DEL REY, BERNSEN & LOEWY, LLP |
| PREPARER EMAIL | NBAHNAN@FRAGOMEN.COM |
| BEGIN DATE CONVERTED | 2025-12-07 |
