EFTA01223242

Please fill out the documents listed below: ❑ Cover Sheet ❑ Confidentiality Agreement ❑ General Statement of Employment Policy O Direct Deposit ❑ Employment Application ❑ Form 1-9 O Notification/Release of Information Form ❑ W-4 O Liability Release Form ❑ Emergency Contact Form EFTA01223242 CONFIDENTIALITY AGREEMENT In order to induce LSJE, LLC, a Virgin Isla "Company"), to consider me for employment nds limited liability company (the with the Company or to consider engaging an independent contractor of the Company, and me as in consideration of any future employment or engagement that I may obtain with the Compan y and any compensation or other remune be hereafter paid to me in connection therewith, ration to I, (her eina fter sometimes referred to as the Applicant"), acknowledg e that I have been informed of my obli hereunder and that such obligations are a con gations dition to the Company's consideration employment or engagement by the Compan of my y, and any subsequent employment or engage may obtain, and I hereby agree as follows: ment I Section 1. Term of Employment; Termination. In the eve employed by the Company, notwithstanding nt that I am hereafter anything to the contrary provided in the Islands employment law, I agree and understand Virgin that nothing in this Agreement shall con right with respect to the grant or continuatio fer any n of my employment by the Company. I furt agree and understand that, in the event that her I am hereafter employed or engaged by the any breach of this Agreement by me may resu Company, lt, in addition to any and all other remedie may then be available to the Company, in my imm s which ediate termination. Section 2. Confidentiality Obligations of the Applicant 2.1 Definition of Confidential Information. Agreement, the term "Confidential Information (a) For purposes of this " shall mean any "Company Information hereinafter defined) and any "Personal Info " (as rmation" (as hereinafter defined) abo Jeffrey Epstein, (ii) Little St. James Island and ut any one of (i) Gre Company, any corporation, limited liability com at St. James Island (the "Property"). (iii) the pany, partnership or any other entity controlled by Jeffrey Epstein ("Affiliate"), or owned or any of the members, managers, partners, officers, shareholders, or agents thereof, directors, (iv) any other employee of the Com Affiliate or any other person or entity emp pany or any loyed or engaged to provide services respect to the Property, (v) any person visiting on or with the Property or any of the Company's (vi) any personal associate, business associat offices, and e or client of any of the persons describe above clauses (i) through (v), inclusive, d in the gathered or learned by the Applica indirectly during the course of the Applica nt directly or nt's application for employment or engage Company and/or in connection with any emp ment by the loyment or engagement of the App Company. licant by the (b) For purposes of this Agreement, the term mean information about the Company of "Company Information" shall any type which is commonly con confidential nature and includes, but is not sidered of a limited to, information (whether in oral, photographic or recorded form) regarding written, the pers services; business plans; mechanized or non ons or entities for who the Company provides mechanized systems of accounting procedures in conducting activities; drawings, ; method plans, permits or filings with respect s or Property; vendor lists; assets; financia to the l records; the identities, skills, busines compensation and financial net worth and s activities, any other information of a similar nature the persons or entities described in clauses about any of (i) through (vi), inclusive, of Section 2.1(a) of this EFTA01223243 Agreement (the "Classified Par ties"). (c) For purposes of this Agree information of any type which is ment, the term "Personal commonly considered of a person Information" shall mean not limited to, information (w al nature and includes, but hether in oral, written, photograp is the identities; the nonbusiness hic or recorded form) regard activities; personal assets; person ing relationships, friends and relativ al plans; the personal lifesty es of, the individuals who associ le, associate with, and any other inform ate with or who are invited ation of a similar nature about any to of the Classified Parties. 2.2 Confidential Information Shall hereafter, I will hold in the stricte Not Be Discussed. At all times st confidence and will not use, pub or in any manner disclose any Co licize, lecture upon, publish nfidential Information, unless authorized in writing such disclo the Company has expressly sure, use or publication. I hereby rights 1 may have or acquir assign to the Company any e in any Confidential Informatio Confidential Information shall n and acknowledge that all be the sole and exclusive proper agree and acknowledge that und ty of the Company. I fur er this Agreement, I am obligated ther ensure that no Confidential Inform to use my best efforts ation is disclosed. To the extent tha to now or in the future, as to wh t I have any doubts, either ether information I possess is Co herein, I will contact the Comp nfidential Information as any for clarification before divulg defined ing or using such informatio n. 2.3 Third Party Information Shall No may receive Confidential Inform t Be Disclosed. I unders ation from third parties, as well tand that I acknowledge and agree that Co as from the Company. I nfidential Information which I rec treated in the same manner as Co eive from third parties is to nfidential Information received be of my obligations hereunder from the Company and tha apply to all Confidential Informatio t all source. n received, regardless of its 2.4 Return of Documents. Upon the Company any and all demand by the Company, I documents, written materials, will deliver to specifications and any other ma notes, drawings, photog terials of any type or nature wh raphs, possession or control, and all atsoever which I have in copies thereof, which may my Confidential Information. constitute, include or disclo se Section 3. Review of Agreement. I acknow and that I have had the opport ledge that I have read thi unity to consult and review it wit s Agreement, before signing it. h my own counsel if I so desire, Section 4. Conflicts. 4.1 Avoidance of Conflict of Intere employment or engagement of me st. I agree that during by the Company, so long as I the term of any full-time basis, I will not, withou am employed or engaged t the Company's express written on a employment or other business act con sen t, eng age in any ivity other than the performance of my duties for the Company . 4.2 No Conflicting Obligations. entered into, and agree that I warrant and represent I will not enter into, any agreem that I have not ent (either written or ora l) that EFTA01223244 conflicts with the provisions of this Agr eement or otherwise impairs my ability to obligations hereunder. I further warrant perform my and represent that I am not subject to decree, writ or order of any court or to any injunction, any other duty or responsibility, legal or conflicts with the provisions of this Agreem othe rwise, which ent or otherwise impairs my ability to obligations hereunder. I shall immediately perform my inform the Company should I subsequentl subject to any such injunction, decree, writ y become , order, duty or responsibility. Section 5. Remedies. 5.1 Equitable Relief. I acknowledge that the Confidentia constitutes unique and confidential information l Information of the Company and the other Classified and in the event of a breach or a threaten Parties ed breach of this Agreement, the Company Classified Parties will be irreparably harm and the other ed and there will be no adequate rem Therefore, in addition to any and all othe edy at law. r rights and remedies the Company and Classified Parties may have, the Compan the other y and the other Classified Parties shall injunctive or other equitable relief in the be entitled to event of a breach or threatened breach here hereby waive any right to assert as a defense of and I that there is an adequate remedy at law. 5.2 Liquidated Damages. In addition to any or damages available at law or in equity, and all other rights, remedies I agree that if any arbitrator(s) or a cou jurisdiction finds that I have breached any rt of competent of the provisions of this Agreement, I Company the sum of One Hundred Thousan will pay the d ($100,000.00) Dollars, as liquidated not as a penalty. I recognize and understand that dam ages and it would be difficult or impossible to the actual amount of damages resulting from calculate such a breach, and acknowledge that the One Hundred Thousand ($100,000.00) Dollars sum of would be reasonable under the circums tances. 5.3 Enforcement by Other Classified Parties. and agree that each of the Classified Part I understand, acknowledge ies other than the Company is an inte beneficiary of Section 2 and Section 5.1 of nded third party this Agreement and that each of them right to enforce my obligations hereunder shall have the in an action brought in his, her or its own name. Section 6. General Provision. 6.1 Governing Law. This Agreement shall be in accordance with the laws of the Uni governed by and construed ted States Virgin Islands applicable to con delivered and to be fully performed in such tracts executed, jurisdiction, without giving effect to conflicts of law. the principles of 6.2 Severability. If one or more of the provisions of deemed invalid or unenforceable by law this Agreement are , then the remaining provisions hereof full force and effect, without regard to will continue in the invalid or unenforceable provisio hereof, as the provisions of this agreement n or are intended to be and shall be deemed seve provisions rable. 6.3 Survival. The provisions of this Agreement and effect, regardless of whether the App shall continue in full force licant is ultimately employed or engaged by the 3 EFTA01223245 Company, and if the Applicant is employed or engaged by the shall survive the termination of Company, the provisions hereof any such employment or engage Company. ment of the Applicant by the 6.4 Binding Effect. This Ag binding upon, and inure to the reement and all of the benefit of, the parties hereto and provisions hereof shall be assigns. heirs and personal repres their respective successors, entatives. 6.5 Waiver. No waiver by the Co shall be a waiver of any preced mpany of any breach of ing or succeeding breach. No this Agreement right under this Agreement shall be waiver by the Company of any construed as a waiver of any oth not be required to give notice to er right. The Company sha enforce strict adherence to all of the ll Agreement. terms and provisions of thi s 6.6 Headings. The headings contain shall not control or effect in any ed herein are for convenien way the meaning or interpretation of ce only and the provisions hereof. 6.7 Entire Agreement. This Ag understanding between the Comp reement sets forth the entire any and the Applicant relating to agreement and supersedes and merges all prior the subject matter hereof and discussions, understandings and oral, between them relating to agreements, whether writte the subject matter hereof. No modif n or this Agreement, nor any waive ication of, or amendme r of any rights under this Agree nt to, writing signed by the party to ment, will be effective unl be charged therewith. If the Applic ess in engaged by the Company, any ant is hereafter employed terms of employment or statem or by the Applicant, and any subseq ents of employment policy uent change or changes in the Ap sig ned remuneration will not affect the plicant's duties, salary or validity or scope of this Agree other ment. Signed: Print Name: Date: Address: 4 EFTA01223246 LSJE, LLC GENERAL STATEMENT OF EMPLOYMENT POLICY 1. Please read the following General Statement of Employme nt Policy of LSJE, LLC (the "Company") very carefully. If you have any quest ions about any part of this General Statement of Employment Policy, or how it affects you and your position, please ask a member of management of Little St. Jame s Island / Great St. James Island (the "Island"). No question is unimportant or insign ificant. When used in this General Statement, the `Owner" refers to the principal who resides on the Island. 2. Proof of CitizenshipTheaal Status and Authority to Work . A. The Company employs only United States citizens and those non-U.S. citizens authorized to work in the United States in compliance with the Immigration Reform and Control Act of 1986. Each employee, as a condition of employment, must complete the Employment Eligibility Verification Form I-9 and present documentation establishing identity and employment eligibility. The documentation required to be presented is described on the Form 1-9 and the instructions to that Form . Former employees who are rehired must also complete the Form if they have not completed a Form I-9 with the Company within the past three years or if their previous Form 1-9 is no longer retained or valid. Each employee must present unexpired employment authorizatio n on or before the expiration date of documentation used for Form I-9 verifi cation. B. Anyone unable to show employment verification will not be able to work on the Island until they obtain the necessary documents. 3. Work Guidelines A. At any given time, times and the length of your workday may vary, depending on the arrival and departure schedules of the Owner and guests on the Island, physical conditions on the Island, special needs of the Island, the Company, the Owner or the Owner's guests, or any number of other circumstances. Because such arrival and departure schedules, physi cal conditions, special needs and other circumstances are not always predictable, you should be prepared to work an extended work day or up to 10-12 or more consecutive work days on little or no notice. The Company and the Island's managers will endeavor to provide you with advance notice, if possible under the circumstances, with respect to any variance in the work day or work week, but notice may not always be possible and you are expec ted to remain flexible and work as necessary as a requirement of your emplo yment. 1 EFTA01223247 B. You will be provided transportation by boat to the Island. You supervisor and the Island's management will advise you in adv ance of the times that the boat will leave American Yacht Harbor to transpor t you to the Island. Please be on board by those times. If you miss the boat you will be marked absent from work with a reduction to your salary. C. You must carry your Social Security Car 9x your Green Card with you at all timesdwhi and either your United States Passport le you travel to and from the Island. The boat captain or a member of his staff may require you to show these documents before you will be allowed to board the boat. If you do not have the documents you will not be permitted to boa rd, and the boat will leave without you. If that happens you will be marked abse nt from work with a reduction to your salary. D. Your compensation is based on an annual salary paid over 26 bi-weekly installments. As a salaried employee, you are being hired to complete a job for which you are responsible. You will not be compensated at an hourly rate based on the number of hours worked. 4. Your work schedule will be prepared on a wee kly basis by the Island's managers and your supervisor, but may be subject to change s on little or no notice, depending on the arrival and departure schedules of the Ow ner and guests on the Island, physical conditions on the Island, special needs of the Island, the Company, the Owner or the Owner's guests, or any number of other circ umstances. 5. M A. Vacation Days - Each employee may take off paid vacation days as follows: • After you have completed one full year of wor k on the Island, you may take off 5 paid vacation days per year, beginning after the completion of your first full year of work. • After you have completed two full years of work on the Island, the number of paid vacation days per year that you may take off will increase to 10 paid vacation days per year, beginning after completion of your second full year of work. This number of paid vacation days per year will remain in effect until after you have completed the fifth full year of work. • After you complete five full years of work on the Island, the number of paid vacation days per year that you may take off will increase to 15 paid vacation days per year, beginning after completion of you r fifth full year of work. • After you complete ten full years of wor k on the Island, the number of paid vacation days per year that you may take off will increase to 20 paid vacation days per year, beginning after completion of your tenth full year of work. After you complete, ten full years of work on the Island, this number of paid vacation days per year will remain in effect for as long as you continue to work for the Company. 2 EFTA01223248 You must make a written request to the Island's managers at least one month in advance for any permitted vacation days. The Company prefers that permitted vacation days be taken not more than 5 consecutive days at a time. However, if management, in its discretion, deems that there is a good reason to make an exception, management may authorize you to take permitted vacation days for up to the maximum of 10 consecutive permitted vacation days. If you wish to request more than 5 consecutive permitted vacation days at one time, please include the reason in your written request. Vacation days will not be carried over from year to year and no payment will be given in lieu of vacation days. You must use your permitted vacation days in the year that they apply or they will be lost. Based on the rules described above, requests for permitted vacation days will be honored as long as the Island's managers and your supervisor determine in their discretion that the requested vacation days do not interfere with the Island's staffing requirements for the period of time requested off. B. Sick Time — Up to a maximum of 5 days per year that you do not work because of sickness will be paid. Any additional sick days taken will be taken with a reduction to your salary. Sick days will not be carried over from year to year and no payment will be given in lieu of sick days. If you are sick and unable Lpayork on a given work day, you must notify the Island's managers by 7:00.0. of that workday. If you do not do so, you will not be paid for that sick day even if you have not used all of your allotted sick days for that year. If possible, please notify the Island's managers the evening before. You must deliver a doctor's note to your supervisor or the Island's managers in the event that your illness requires you to take more than 3 days off work. If you fail to provide your supervisor or the Island's managers with a doctor's note to explain your absence for more than 3 days work, you will not be paid for those sick days, even if you have not used all of your allotted sick days for that year. Failure to provide your supervisor or the Island's managers with the required Doctor's note more than one time will give the Island's managers grounds to terminate your employment, although the Island's Managers may, in their discretion, impose other disciplinary sanctions as discussed in paragraphs 9 and 14 of this General Statement, including written and verbal warnings, if they decide it is appropriate under the circumstances. 3 EFTA01223249 C. Holidays — The Island's managers will provide you with a list of holidays during each calendar year for which each emp loyee will receive full payment, even if employee does not work that day. Dep the ending on the arrival and departure schedules of the Owner and guests on the Island, physical conditions on the Island, special needs of the Island, the Company, the Owner or the Owner's guests, or any number of other circums tances, you may be required to work on one or more of these holidays as a requ irement of your employment with little or no notice. If you are required to work on a Holiday, an alternate day off may subsequently be given by the Island's man agers at their sole discretion. D. Unscheduled Personal Time Off— Staffing at the Island is scheduled so that each department operates efficiently. The unsc heduled absence of even one employee in a department could interfere with the dep artment's work schedule and should be avoided. The Company understands that unexpected personal issues, apart from illness, do occur, and will permit emp loyees to take up to a maximum of 3 personal days off. However, as you will not be working for the day that you take off as a personal day, it is the general policy of the Company that you will not be entitled to receive any compen sation for any permitted personal days off. However, the Island's managers, in their discretion, may permit you to use a permitted paid vacation day for a personal day taken off. It is the general policy that no additional pers onal days will be permitted, except in the discretion of the Island's man agers for extreme or extraordinary cases. You must make a verbal request to the Island's managers 24 hours in advance of any personal days off you may seek to take. In extraordinary cases, such as unexpected emergency situations, notification must be given to the Island's managers prior to 7:00 am. If you fail to report for wo thout giving the appropriate notice or calling Island's managers by 7:00 the that will be considered a violation of your employment duties for which the appropriate disciplinary measures will be determined by the Island's managers in their disc retion. They may impose any disciplinary sanctions for your violation as they determine appropriate, including those discussed in paragraphs 9 and 14 of this General Statement of Employment Policy (for example, written and verbal warning s, and/or termination of employment, if they decide it is appropriate under the circumstances). If you fail to report for work without any noti ce for two consecutive days, you will be considered to have abandoned your emp loyment. Based on the rules described above, requests for unscheduled personal days will be honored as long as the Island's managers dete rmine in their discretion that your request does not interfere with the Island's requ irements for the period of time requested off. 4 EFTA01223250 E. Absenteeism - If you fail to report for wor k for even one day without the required notice under the circumstances (for exampl e, required notice when you are sick or required notice when you have an emergen cy requirement for unscheduled personal time off), that will be considered a breach of your employment duties for which the appropriate disciplinary measure s will be determined by the Island's managers in their discretion. If you fail to report for work without the required notice for two consecutive days, you will be con sidered to have abandoned your employment. 6. Please do not bring your personal problem s to work with you. You will not be perm to do your personal laundry on the Island. itted 7. You are expected to avoid use of any tele phone on the Island for personal calls, exc cases of emergency. ept in Use by any worker on the Island of personal cell phones and audio devices with head during work hours is prohibited. sets 8. For safety and other security reasons, the boat captain and the Island's managers mus have the right to search any bags or packag t es carried onto the boat, or onto or off of Island. For that reason you should be awa the re that any bags you bring to or from the Isla could possibly be subject to search by the boat nd captain or his staff or the Island's managers from time to time. Any illegal items found during such search will be confiscated. To minimize any intrusion on your privacy that may result from these possible searches, we ask that you please avoid carrying multiple, oddsized or ove rsized packages or bags on board the boa and avoid bringing unnecessary personal item t s to work with you. YOU ARE STRICTLY PROHIBITED FROM REMOV ING ANY ITEMS FROM THE ISLAND THAT DO NOT BELONG TO YOU (INCLU DING, BUT NOT LIMITED TO, ANY ITEMS OF TRASH ON THE ISLAND OR ANY ITEMS BELIEVED BY YOU TO BE DISCARDED BY THE ISLAND'S OWNER S OR MANAGEMENT). 9. It is the Company's goal to create a pleasant, con genial, safe and productive work environment on the Island which is free of any persons or conduct which may jeopardize that environment or harm any of the employe es, workers, guests, or managers on the Island or the Owner. In order to create such an environment, the Company has adopted a Zero Tolerance policy regarding the following acti vities: A. Being under the influence, possessing or using drugs (including abusing prescription drugs) or alcohol while on the Isla nd and/or during work, and drug or alcohol related criminal offenses while away from work. B. Possessing or using any weapons, including gun s and knives, on the Island or during work, and weapons related criminal offenses while away from the Island. 5 EFTA01223251 C. Theft. D. Dishonesty. E. Fighting. F. Insubordination. G. Disrespectful, violent, aggressive, abusive or otherwise inappropriate behavior towards another employee, staff member, manager or owner. H. Any conduct constituting discrimination based on race, color, national origin, alienage, citizenship status, creed, religion, religious affiliation, age, sex, martial status, disability, or otherwise as may be prohibited by federal or Virgin Islands law. I. My form of sexual harassment towards an employee, supervisor, any of the Island's managers, Owner or guest of the Owner. J. My criminal conduct while away from wor k. If the Island's managers have reason to beli eve that you have committed any of the abo activities, you may be subject to disciplinary ve action as described below and in paragrap 14 of this General Statement of Employment h Policy, including immediate removal from the Island, suspension or even permanent term ination of employment. You may be reported to and held for the prop er investigation by the Company's representativ authorities. You also may be subject to es. In addition, you and your personal effects and storage areas on the island may pos sibly be searched, and any materials violating this Zero Tolerance policy or U.S. Virg in Islands or federal law might also be confiscated. The Company and the Island's managers rese rve the right to treat each case of employee misconduct on an individual basi s and to take or not to take whatever actions the Company deems appropriate to make the Island a better place to work for everyone. 10 Confidentiality - As a condition to your emp loyment, you are required to maintain in the strictest confidence any and all information rega rding the Company, the Island, employees, workers, managers, the Owner and the Owner's guests. You are also required, as a condition of your employment, to sign a separate Confidentiality Agreement. Gossiping about the Company, the Island, emp loyees, workers, the Island's managers, the Owner or the Owner's guests is strictly forbidde n. If anyone (even a family member, a friend or any other person) asks you any que stions regarding the Company, the Island, employees, workers, the Island's managers, the Owner or the Owner's guests, tell that 6 EFTA01223252 person the following: "I am unable to answer your questions. If you wish, you may put your questions in writing and send them to "LSJE, LLC." Violation of this confidentiality policy or any violation of your separate Confidentiality Agreement will be immediate grounds for termination of your employment, no exceptions. 11. Uniforms — The Island's managers will inform you verbally of dress/uniform requirements applicable to your position. The Company may also adopt a formal policy regarding uniforms. A copy of this policy will be provided to you separately at such time as it is adopted. 12. Tools —All tools, equipment and vehicles required for you to perform the duties of your employment will be provided to you. You will sign for and be responsible for the return of all tools, equipment and vehicles issued to you each day. You will be responsible for any abuse or any unlawful use by you of the tools, equipment and/or vehicles issued to you. Abuse or unlawful use by you of any of the tools, equipment or vehicles issued to you could result in Company disciplinary action against you as discu ssed in paragraphs 9 and 14 of this General Statement of Employment Policy. You may also be held responsible for the costs of repairing any of the tools, equipment or vehicles abused by you. The Company may adopt a separate written policy regarding tools, equipment and vehicles provided to you and the other employees while on the Island. A copy of that policy will be provided to you separately at such time as it is adopted. 13. Telephones. Radios and Beepers — In the event the Company issues to you any telephones, radios or beepers to perform the duties of employment, use of such telephones, radios and beepers for anything other than work-relate d purposes is not allowed. You will be responsible for any increased costs to the Company resulting from your non-work related use, including long distance fees. You will be responsible for the cost to replace any telephone, radio or beeper lost by you and for the cost to replace any telephone, radio or beeper damaged or destroyed as a result of abuse by you. Violations of this policy will subject you to disciplinary action as described in paragraphs 9 and 14 of this General Statement of Employment Policy. The Company may adopt a separate written policy regarding teleph ones, radios and 7 EFTA01223253 beepers it may issue to you and other employees when required to perform the duties of employment. A copy of that policy will be provided to you separately at such time as it is adopted. 14. Termination and Discipline - Under the terms of your contract, you are an at-will employee and may be terminated with or without cause. Without in any way limiting this, in the event that you: A. Violate any part of this General Statement of Employment Policy or any other Policy Statement of the Company; B. Take or fail to take any action, and such action or inaction would be grounds for your termination under the laws of the United States Virgin Islands; or C. Take or fail to take any action, and such action or inaction is otherwise contrary to the best interests of the Company, the Island, the Owner or the Owner's guests. Then the Company, may, in its sole discretion, suspend or permanently terminate your employment or subject you to other disciplinary action, including issuing a verbal warning, issuing a written warning, or suspending your employment for a period of time. A disciplinary file will be maintained for each employee. It will be no defense in response to any disciplinary action by the Company, that the Company responded differently in a previous situation, whether regarding the same or different persons and whether regarding the same or similar employee misconduct. Each disciplinary decision will be made on a case-by-case basis. Depending on the circumstances, the Company may, in its discretion, determine that even a single policy violation or other form of misconduct, whether by itself without any prior occurrences of such violation or misconduct or in combination with current or past violations or misconduct of a similar or different nature, will justify disciplinary sanctions as great as suspension or even permanent termination. Please read this General Statement of Employment Policy and all other Policy Statements given to you with great care to avoid any unintended violations. 15. The Company reserves the right to issue additional or supplemental Policy Statements and to change, modify or amend all or any part of this General Statement of Employment Policy, and each of its other Policy Statements, at any time and as many times as the Company deems appropriate. Once you are given notice, you will be required to comply with each and every such addition, supplement, change, modification or amendment as if it were specifically set forth in this General Statement of Employment Policy or any other Policy Statements on the date that you signed this General Statement of Employment Policy or such other 8 EFTA01223254 Policy Statements. 16. If you fully comply with this Gener al Statement of Employment Po other agreements with the Comp licy and all of your any, the Company is confident tha pleasant work experience. t you will have a Thank you in advance for your dil igent service. Please acknowledge that you hav e read and understand and agree Statement of Employment Policy to comply with this General by signing your name in the spa ce provided below. Dated: ACKNOWLEDGED AND AG REED: (Please sign your name) (Please print your full) 9 EFTA01223255 Policy Statements. 16. If you fully comply with this Gener al Statement of Employment Policy other agreements with the Comp and all of your any, the Company is confident tha pleasant work experience. t you will have a Thank you in advance for your dil igent service. Please acknowledge that you hav e read and understand and agree Statement of Employment Policy to comply with this General by signing your name in the space provided below. Dated: ACKNOWLEDGED AND AG REED: (Please sign your name) (Please print your full) 9 EFTA01223256 LSJE, LLC 6100 Red Hook Quarters, Suite 8-3 _, St. Thomas, VI 00802-1348 Phone: 340-775-2525 E-mail: Direct Deposit Payment Applicatio n Employee Name: I authorize LSJE. LLC to make ACH credits and debits to the above reference account: Name(s) on bank account: Bank name: Bank routing number. Bank account number: Account type: 0 Checking O Savings Employee Signature: Date: EFTA01223257 LSJE, LLC 6100 Red Hook Quarters, Suite B-3, St. Tho mas, VI 00802-1348 Phone: 340-775-2525 E-mail: Employment Application Position for which Applying: Today's Date: Date Available to Begin: Last Name: First Name: Nickname: J Date of Birth: [ Social Security Number: Drivers License Number: 1 Mailing Address: Physical Address: Cell Phone: Phone (other): E-mail: • L In case of emergency, please contact: { Relationship: Contact Phone: EFTA01223258 Ust most recent and/or relevant employment Employer: City, State: Position Held: Dates Employed: Responsibilities: Reason for Leaving: May we contact this employer? Employer Phone: Provide two personal references: Reference Name: Relationship: Reference Phone: Please list any qualifications/ certifications held for this position: Proof of eligibility for employment Is required. Please attach a.) a Photocorw of your US. Passport or Passport Card, OR b.) a photo ID AND-5uPPOrtin,g documentation.establishin g V.S. Emoloyment Authorization. Employee Signature: Date: Received by: Date: For internal use only. Date: I Rate: Department: Forms Completed L Position: W4 Ell 19 IDs D LSJE, LLC Policy Items Issued: Processed By: Date: I Signature: EFTA01223259 Employment Eligibility Verifica tion USCIS Department of Homeland Secu rity Form I-9 U.S. Citizenship and Immigration Serv OMB No. 1613-0047 ices Expires 08/31/2019 lo START HERE: Read Instructio ns carefully before completing this form during completion of this form. Employer . The instructions must be available, eithe s are liable for errors in the completion r In paper or electronically, of this form ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work document(s) an employee may pres -authorized individuals. Employers CAN ent to establish employment authoriza NOT specify which an individual because the documentation tion and identity. The refusal to hire or presented has a future expiration date may continue to employ also constitute illegal discrimination. Section 1. Employee Informa tion and Attestation (Employee than the first day of employm s must complete and Sign SeCtiOn ent but not before accepting a lob offer.) I ofForm 1-9 no later Last Name (Family Name) Frst Name (Given Name) Middle Initial Other Last Names Used (Many) Address (Street Number end Name) Apt Number City or Town State ZIP Code Date of Birth (mnildci/WYY) U.S. Social Security Number Employee's E-mail Address Employee's Telephone Number I am aware that federal law prov ides for imprisonment and/or fines for false connection with the completion statements or use of false docu of this form. ments in I attest, under penalty of perjury, that I am (check one of the follo wing boxes): O 1. A citizen of the United State s O 2. A noncitlzon national of the United Stales (See ins lUCt0n5) O 3. A lawful permanent resident (Alien Registration Number/USCIS Numb er): O S. An alien authorized to work until (expiration date, If applicable. mrniddryyyy): Some aliens may write WA- in the expiration date field. (See insfructronS) Aliens aulhortred to work must provide only one of the iollOwing document numb An Alien Registration Number/USCIS ers to Complete Form 1-9: OR Colo- Section T Number OR Form 494 Admission Number Do Nu Mo. in one space OR Foreign Passport Number. 1. Alien Registration Number/USCIS Numb er. OR 2. Form 1-94 Admission Number: OR 3. Foreign Passport Number. Country of Issuance: Signature of Employee Todays Date (mre/dclftyy) Preparer and/or Translator Certification (check one): O I did riot use a preparer or trans lator. O A prepareds) and/or transtator(s) (Fields below must be completed assisted the employee In COM:feting Secti and signed when preparers and/or on 1. translators assist an employee in attest, under penalty of perjury, completing Section 1.) that I have assisted in the completi knowied the information is true on of Section 1 of this form and and correct. that to the best of my Signature of Preparer or Translator Today's Dale (mm/dcloyyyy) Last Name (Penury Name) First Name (Given Name) Address (Street Number and Name) City or Town go Employer Completes Next Page SI Form 1.9 11/I4/2016 N Page I of 3 EFTA01223260 Employment Eligibility Verification USCIS Department of Homeland Security Form 1-9 U.S. Citizenship and Immigration Services OMB No 1615-0047 Expires 08/31/2019 Section 2. Employer or Authorized (Employers or their authorized represema Represe ntative Review and Verification the must complete end sign Section 2 'Whin must physically examine one docu 3 business days of the employee's first ment fromList A OR a combination of one docu day of employment. You of Acceptable Documents., ment from Litt B and one document from List C as listed on the 'Lists Employee Info from Section 1 Last Name (Family Name) First Name (Given Name) Cilizenshiprimmigration Status List A OR Identity and Employment Authoriza List B AND tion Identity List C Document Title Document Title Employment Authorization Document Title Issuing Authority Issiing Authority Issuing Authority Document Number Document Number Document Number Expiration Dale Of any)(mmIddryyyy) Expiration Date eny)(mm/ddhyyy) Expiration Date (If any)(mmIddiyyy y) Document Title Issuing Authority Additional Information OR Code • Sado* 2 4 3 Do No Olio rn TNr 3p4oe Document Number Expiration Date (if any)(mmiddryyyy) Document Title Issuing Authority Document Number Expiration Date (ifany)(mmitddyyyy) Certification: I attest, under penalty of per ury that (1) I have examined (2) the above-Ilsted document(s) the document(s) presented by the appear to be genuine and to relat above named employee, employee is authorized to work In the e to the employee named, and (3) to United States. the best of my knowledge the The employee's first day of employm ent (mm/dd/yyyy): (See Instructions for exem Signature of Employer or Authorized ptions) Representative I Todays Dale(mmIddNyyy) Last Nemec(Ernployer or Atthortzed Rqreserta tim First Nana of EnVbyer or Authorized I rate o Employer or Authorized Represen Representative Employers Busin tative ess or Organization Name Employers Business or Organization Address (Street Number and Name) City or 1 Town State ZIP Code Section 3. Reveriflcation and Rehires (To be completed and signed by emp A. New Name (11applicable) loyer or authorized representative .) Last Name (FamilyName) I First Name (Given Name) 8. Date of Rehire (if appli cable) I Middle Initial Date (min/CICIMyy) i C. If the employees previous grant of employment authorizabon has expired. continuing ernoicoment authorization in provide the information or the docu the &Pace Provided below. ment or receipt that establishes Document Tide Document Number nuaradon Oaten/ any) ffilln/dr/43YY) I attest, under penalty of perjury, that to the best of my knowledge, the employee presented doCument this employee Is authorized to (s), the document(s) I have exam work in the United States, ined appear to be genuine and to and if Signature of Employer or Authorized relate to the individual. Representative Today's Date (mS) Name of Emptoyer or Authorizeci RepresentaliVe Form 1-9 11/14/2016 N Page 2 of 3 EFTA01223261 LISTS OF ACCEPTABLE DOCUMENT S All documents must be UNEXPIRED Employees may present one selection from List A or a combination of one selection from List B and one selection from List C. LIST A LIST B LIST C Documents that Establish Documents that Establish Both Identity and Documents that Establish Identity Employment Authorization Employment Authorization OR AND 1. U.S. Passport or U.S. Passport Card 1. Driver's license or ID card issue d by a 1. A Social Security Account Num 2. Permanent Resident Card or Alien State or outlying possession of the ber card, unless the card includes one of Registration Receipt Card (Form 1-551 United States provided it contains a ) the Sowing restrictions: photograph or information such as 3. Foreign passport that contains a name, date of birth. gender. height, eye (1) NOT VALID FOR EMPLOYMEN T temporary 1-551 stamp or temporary color, and address (2) VALID FOR WORK ONLY WITH 1-551 printed notation on a machine- INS AUTHORIZATION readable immigrant visa 2. ID card issued by federal, state or local government agencies or entities. (3) VALID FOR WORK ONLY IMTEI 4. Employment Authorization Documen provided it contains a photograph or DHS AUTHORIZATION t information such as name, date of birth that contains a photograph (Form , 2. Certification of Birth Abroad 1-766) gender, height, eye color, and address issued by the Department of State (Form FS -545) 5. For a nonimmigrant alien authorized 3. School ID card with a phot ograph to work for a specific employer 3. Certification of Report of Birth 4. Voters registration card issued by the Department of State because of his or her status: 5. U.S. Military card or draft record (Form DS-1350) a. Foreign passport, and b. Form 1-94 or Form l-94A that has 6. Military dependent's ID card ..1 4. Original or certified copy of birth the following: certificate issued by a State. 7. U.S. Coast Guard Merchant Mariner county, municipal authority, or (1) The same name as the pass Card territory of the United States port and bearing an official seal (2) An endorsement of the alien's 8. Native American tribal document nonimmigrant status as long as 5. Native American tribal docu 9. Driver's license issued by a Canadian ment that period of endorsement has government authority 6. U.S. Citizen ID Card (Form 1-197 not yet expired and the ) proposed employment is not in For persons under age 18 who are 7. Identification Card for Use of conflict with any restrictions or Resident Citizen in the Unite limitations identified on the form. unable to present a document d States (Form 1-179) listed above: 6. Passport from the Federated States of 8. Employment authorization Micronesia (FSM) or the Republic of 10. School record or report card document issued by the the Marshall Islands (RMI) with Form 11. Clinic, doctor. or hospital record Department of Homeland Secu 1.94 or Form l-94A indicating rity nonimmigrant admission under the 12. Day-care or nursery school Compact of Free Association Between record the United States and the FSM or RMI Examples of many of these docume nts appear in Part 8 of the Handbo ok for Employers (M-274). Refer to the instructions for more info rmation about acceptable rec eipts. Form I.9 11/14/2016 N Page 3 of 3 EFTA01223262 LSJ, LLC 6100 Red Hook Quarters Suite B3 St Thomas USVI 00802 Notification/Release of Information Form The Purpose of this form is to notify you that consumer report will be conducting on you in the course of consideration for employment with Last Name: First Name: Middle Name: Social Security: ' Driver's License tt: State Issued: (please attach a copy) Passport #: (please attach a copy) Date of Birth: Place of Birth: Current Address: City: State: Zip: In connection with this request I authorize all corporations, former employers, credit agencies, educational institutions, law informant agencies, city, state county, federal courts and military services to release information about all my background including, but not limited to information about all employment, education, consumer, credit history, driving record, criminal record and general public history to the person or company with which this form has been filed or their agent. This releases the aforesaid parties from any liability and responsibility for collection of the above information. Applicants Signature Date EFTA01223263 Form W-4 (2019) using this calculator if you have a more complicated tax situation, such as if you Specific Instructions Future developments. For the latest have a working spouse, more than one job, Personal Allowances Worksheet information about any future developments or a large amount of nonwago income not Complete this worksheet on page 3 first to related to Form W-4, such as legislation subject to withholding outside of your job. determine the number of withholding enacted after it was published, go to After your Form W-4 takes effect, you can allowances to claim. www.irS.gov/FormW4. also use this calculator to see how the amount of tax you're having withheld Line C. Head ofhouseholdplease note: Purpose. Complete Form W-4 so that your Generally, you may claim head of household compares to yew projected total tax for employer can withhold the correct federal filing status on your tax return only if you're 2019. If you use the calculator, you don't income tax from your pay. Consider unmarried and pay more than 50% of the need to complete any of the worksheets for completing a new Form W-4 each year and costs of keeping up a home for yourself and Form W-4. when your personal or financial situation a qualifying Individual. See Pub. 501 for changes. Note that if you have too much tax more information about filing status. withheld, you will receive a refund when you Exemption from withholding. You may Line E. Child tax credit. When you file your file your tax return. If you have too little tax claim exemption from withholding for 2019 tax return, you may be eligible to claim a withheld, you will owe tax when you file your if both of the following apply. child tax credit for each of your eligible tax return, and you might owe a penalty. • For 2018 you had a right to a refund of all children. To qualify, the child must be under federal income tax withheld because you Filers with multiple jobs or working ago 17 as of December 31, must be your Spouses. If you have more than one job at had no tax liability, and dependent who lives with you for more than a time, or if you're married filing jointly and • For 2019 you expect a refund of all half the year, and must have a valid social your spouse Is also working, read all of the federal income tax withheld because you security number. To learn more about this instructions including the instructions for expect to have no tax liability. credit, see Pub. 972, Child Tax Credit. To the Two-Eamers/Multiple Jobs Worksheet reduce the tax withheld from your pay by If you're exempt, complete only lines 1, 2, before beginning. taking this credit into account. follow the 3. 4. and 7 and sign the form to validate it. Nonwage income. If you have a large instructions on line E of the worksheet. On Vow exemption for 2019 expires February amount of nonwage income not subject to the worksheet you will be asked about your 17, 2020. See Pub. 505, Tax Withholding withholding, such as interest or dividends, total income. For this purpose, total income and Estimated Tax, to learn more about consider making estimated tax payments includes all of your wages and other whether you qualify for exemption from using Form 1040-ES, Estimated Tax for income, including income earned by a withholding. Individuals. Otherwise, you might owe spouse If you are filing a joint return. additional tax. Or, you can use the General Instructions Line F. Credit for other dependents. Deductions. Adjustments, and Additional When you file your tax return, you may be It you aren't exempt, follow the rest of Income Worksheet on page 3 or the eligible to claim a credit for other these Instructions to determine the number calculator at wynvirtgov/W4App to make dependents for whom a child tax credit of withholding allowances you should claim sure you have enough tax withheld from your paycheck. It you have pension or Can't be claimed, such as a qualifying child for withholding for 2019 and any additional who doesn't meet the age or social amount of tax to have withheld. For regular amuity income, See Pub. 505 or use the security number requirement for the child wages, withholding must be based on calculator at wwwirs.gov/W4App to find tax credit, or a qualifying relative. To learn allowances you claimed and may not be a out if you should adjust your withholding more about this credit, see Pub. 972. To flat amount or percentage of wages. on Form W-4 or W-4P. reduce the tax withheld from your pay by You can also use the calculator at Nonresident alien, a you're a nonresident taking this credit into account, follow the www.irs.gov/W4App to determine your alien, see Notice 1392. Supplemental Form instructions on line F of the worksheet. On tax withholding more accurately. Consider W-4 Instructions for Nonresident Aliens, the worksheet, you will be asked about before completing this form. your total income. For this purpose, total Separate here and give Form W-4 to your employer. Keep the worksheet(S) for your records. Form W-4 Employee's Withholding Allowance Certificate OMB No. 15454:074 Deparbnent ci the TreauxY rir Whether you're entitled to claim a certain number of allowances or exemption from wierhokilng is Interml Revenue Sono, subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS. 1 Your first name and mica initial Last name 2019 2 Your social security number Home address (number and street or rural route) 3 El Seigle 0 Married 0 Married, but withhold at higher Single rate. Note: It mauled wing separ-1..ely. meek 'Married. but withhold at higher Singe rate' City or town, state, and 21, code 4 If your last name differs from that shown on your social security card, check here. You must call 800.772-1213 for a replacement card. la 0 5 Total number of allowances you're claiming (from the applicable worksheet on the following pages) . . . 5 8 Additional amount, If any, you want withheld from each paycheck 6 $ 7 I claim exemption from withholding for 2019. and I certify that I meet both of the following conditions for exemption. • Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and • This year I expect a reliaid of all federal Income tax withheld because I expect to have no tax liability, If you meet both conditions, write "Exempt" here /e• 7 I Under penalties of perjury. I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true. correct, and complete. Employee's signature (This form is not valid unless you sign it.) to Date s• 8 Employer's name and address (Employer: Complete boxes 8 and 104 sending to IRS and complete 9 First detect boxes 8. 9, and 10 if sending to State Directory of New Nrsa.) 10 Employer identification employment number (Ens!) For Privacy Act and Paperwork Reduction Act Notice, see page 4. Cat. No. 10220O Fern, W-4 (2019) EFTA01223264 Form W-4 (2019) income includes all of you r Page 2 other income, including incowages and don't complete this worksh eet, you might a spouse it you are fikng a join me earned by have too little tax withheld. and 10 to comply with the new t return. owe tax when you file your tax If so, you will reporting requirement for a newhire Line O. Other credits. You ly hired reduce the tax withheld from may be able to might be subject to a penalty return and employee. A newly hired emp loyee is an . employee who hasn't previous paycheck If you expect to your Figure the total number of allowances ly been claim other tax employed by the employer, credits, such as tax credits you're entitled to claim and or who was any previously employed by the for (see Pub. 970). If you do so, education amount of tax to withhold on additional emp worksheets from only one Forall jobs using has been separated from suc loyer but will be larger, but the amo your paycheck h prior unt m W-4. Claim employment for at least 60 that you receive when you of any refund all allowances on the W-4 that you or your consecutive file days. Employers should con return will be smaller. Follow your tax spouse file for the highest pay tact the your family and claim zero allo ing job in appropriate State Directory of the Instructions for Worksheet New Hires to 1-6 in Pub. 505 wan find out how to submit a cop if you want to reduce your Forms W-4 filed for all other jobs ces on y of the with . For completed Form W-4. For Info take these credits into accoun holding to example, if you earn 560,000 per links to each designated Sta rmation and t. Enter "-0-- your spouse earns $20,000, you year and on lines E and F if you use Worksheet 1-6. should New Hires (Including for U.S te Directory of complete the worksheets to . territories), go dete to www.acf.hhs.govIcssle Deductions, Adjustme nts, and what to enter on lines 5 and 6 rmine mployers. Additional Income Wo W-4, and your spouse should of your Form If an employer is sending a cop y of Form rksheet ("-0-") on lines 5 and 6 of his enter zero W-4 to a designated State Dire Complete this worksheet to determine if W-4. See Pub. 505 for deta or tier Form New Hires to comply with the ctory of you're able to reduce the tax new ils. reporting requirement for a new hire your paycheck to account withheld from Mother option is to use the calculator at employee, complete boxes 8, ly hired for your Itemized wiinvirs.gov/W4App to make 9, and 10 as deductions and other adjustm follows. income, such as IRA contribu ents to withholding more accurate. your do so, your refund at the tions. If you Box 8. Enter the employer's nam Tip: If you have a working spo end will be smaller, but your pay of the year Incomes are similar, you can use and your address. If the employer is sen e and check will be che ding a copy of this form to a State Director larger. You're not required "Married, but withhold at high ck the worksheet or reduce your with to complete this rate" box Instead of using thiser Single Hires, enter the address wherey of New holding if child you don't wish to do So. you choose this option. then worksheet. If support agencies should send inco me You can also use this should fill out the Personal each spouse withholding orders. worksheet to figure Allowances Box 9. If the employer is sen out how much to increase the Worksheet and check the "Ma from your paycheck if you tax withheld withhold at higher Single rate rried, but this form to a State Director ding a copy of y of hav amount of nonwage income e a large W4, but only one spouse " box on Form enter the employee's first date New Hires, withholding, such as Interestnot subject to allowances for credits or NIshould claim any employment, which is the date of out services for or dividends. Deductions, Adjustments, and the payment were first perform ed Another option is to take thes e items Into Income Worksheet. Additional employee. If the employer reh by the account and make your ired the withholding more employee after the employe accurate by using the calculat e had been or at Instructions for Employe separated from the employer's vninv.irs.gov/W4App. If you use r at least 60 days, enter the rehi service for calculator, you don't need to the Employees, do not complet re date. com of the worksheets for Form W-4 plete any 10. Your employer will com box 8, 9, or e Box 10. Enter the employe r's employer . plete these identification number (EN). boxes if necessary. Two-Earners/Multiple Job s New hire reporting. Employ Worksheet required by law to report newers are Complete this worksheet if employees to you a designated State Director than one Job at a time or are have more Employers may use Form W-4 y of New Hires. mar jointly and have a working spo ried filing , boxes 8, 9, use. If you EFTA01223265 Form W-4 (2019) Personal Allowances Page 3 A Enter "1" for yOUrsell Worksheet (Keep for you r records.) 8 Enter 9" if you wil file as mar ried filing jointly A C Enter "1" if you will file as head of household B • You're single, or married 0 filing separately, and have only C Enter "1" if: { • You're mar one job; or ried filing jointly, have only one job, and your spouse doe • Your wages from a second sn't work: or job or your spouse's wages (or D E Child tax credit. See Pub the total of both) are $1,500 or . 972, Child Tax Credit, for less. 1 • If your total income will mo re info rmation. be less than $71,201 ($103,35 • It yOur total income will 1 if married filing jointly), be from $71,201 to $17 enter "4" for each eligible chil eligible child. 9,050 ($103,351 to $345,85 d. 0 if married filing jointly), ente r "r for each • If your total Income will be from $179.051 to $200,000 ($34 each eligible child. 5,851 to $400,000 if mar ried filing jointly), enter "1" for • If your total income will be higher than $200,00 F Credit for other dependent 0 ($400,000 If married filing s. See Pub. 972, Child Tax jointly), enter --O-" • If your total Income will be Credit, for more intonation E less than 571,201 ($103,35 . • If your total income will 1 it married filing jointly), enter be from $71,201 to $179,05 "1" for each eligible depend two dependents (for exa 0 ($103,351 to $345,850 ent. mple. "-0-'2 for one depend if married filing jointly), ente four dependents). ent, ^1^ if you have two or r "1" for every three dependents. and "2" if you have • If your total income will be higher than $179,050 ($345,85 0 Other credits. ft you have 0 if married filing jointly), other credits, see Worksheet enter "-0-" here. If you use Worksheet 1-6 of Pub. 505 and enter the F 1-6. enter "-0-" on lines E amount from that worksheet H Add fines A through G and and F enter the total here 0 Ir. H • If you plan to Itemize or clai have a large amount of nonwag m adjustments to income For accuracy. and want to reduce your with see the Deductions, Adjustm e income not subject to withholding and want to incr holding, or if you complete all ents, and Additional Income ease your withhold:1g, • If you have more than Wo rksh eet below. worksheets work, and the combined one job at a time or are mar that apply. earnings from all jobs exceedried filing Jointly and you and your spouse both Two-Eamers/Multiple Jobs Wo $53,000 ($24,450 if married filing rksheet on page 4 to avo id having too fitue tax withheldjointly), see the • If neither of . W-4 above. the above situations applies. stop here and enter the number from line ki on line 5 of Form Deductions, Adjustme Note: Use this worksheet only nts, and Additional Inc ome Worksheet if you plan to itemize ded income not subject to withhold uctions , claim certain adjustments ing. to income, or have a large amount of normage 1 Enter an estimate of your 2019 itemized deducti charitable contributions, ons. These include qualifyi state and local taxes (up to ng home mortgage interest your income. See Pub. 505 for $10,000), and medical expenses , details in excess of 10% of { $24,400 if you're married filin 2 g jointly or qualifying wldow( 1 $ Enter: $18,350 if you're head of er) household $12.200 if you're single or mar 3 ried filing separately 2 $ Subtract line 2 from line 1. If zero or less enter "-0- 4 Enter an estimate of your " 2019 adjustments to inco 3 additional standard deducti me, qualified business income on for age or blindness (see deduction, and any 5 Pub. 505 for Information abo Add lines 3 and 4 and ente ut these items) . . r the total 4 6 Enter an estimate of your 201 9 nonwage income not sub 5 7 Subtract line 6 from line 5. ject to withholding (such If zero, enter "-0-". If less than as dividends or interest) 8 zero, enter the amount in 8 Divide the amount on parentheses line 7 by $4,200 and enter the . . 7 Drop any fraction result here. If a negative amo unt. enter In parentheses. 9 Enter the number from the 8 Personal Allowances Worksh 10 Add tines 8 and 9 and ente eet, line H, above r the total here. If zero or less 9 Multiple Jobs Worksheet , enter "-0-". if you plan to , also enter this total on line use the Two-Earners/ arid enter this total on Form 1 of that worksheet on pag W-4, line 5. page 1 e 4. Otherwise, stop here 10 EFTA01223266 Form W-4 paw) Note: Use this worksheet only if the Two-Earners/Multiple Jobs Wo Pa t 4 instructions under line H from rksheet the Personal Allowances Wo I Enter the number from the rksheet direct you here. Personal Allowances Wo Deductions, Adjustments rksheet, line H. page 3 , and Additional Income Wo (or, if you used the worksheet) rksheet on page 3. the num ber from line 10 of that 2 Find the number in Table 1 below that applies to the LOW 1 married fling jointly and wages EST paying job and enter it from the highest paying job are here. However, if you're you and your spouse are 575.000 or less and the com $107,000 or less, don't ente bined wages for 3 r more than "3* If line 1 is more than or equ al to line 2, subtract line 2 2 and on Form W-4, line 5, pag from line 1. Enter the result e 1. Do not use the rest here (if zero. enter "-0-") Note: If line I Is less than line 2, of this worksheet figure the additional with enter It-0-" on Form W-4, lin e 5. page 1. Complete lines 4 3 holding amount necessary to through 9 below to 4 avoid a year-end tax bit Enter the number from line 2 of this worksheet 15 Enter the number from 4 line 1 of this worksheet 8 Subtract line 5 from line 4 5 7 Find the amount in Table 2 below that applies to the 6 8 Multiply One 7 by line 6 and HIGHEST paying job and ente enter the result here. This is r it here the additional annual withhold 7 $ 9 Divide line 8 by the number of ing needed . . . pay periods remaining in 201 8 $ 2 weeks and you complete this 9. For example, divide by 18 form on a date in late Apr if you're paid every 2019. Enter the result here il when there are 18 pay per and on Form W-4, line 6, pag iods remaining in from each paycheck e 1. This is the additional amo unt to be withheld Table 1 9 S Married Filing Jointly Ta Al Others ble 2 If wages from LOWEST Enter on Monied Sing Jointly IS wages from LOWEST Ente All Others Pareelobare- line 2 above 00$1.7 lab r on If wages from HIGHEST Ws— Jim 2 tove paying job aro— Enter on H wages born HIGHEST Ente $O • $5,000 o line 7 above paying lob am— r on 5,001 • 9.500 SO - 57600 0 Ste 7 above 9,501 - 19.500 1 7001 - 13,000 30 - 524, 900 5420 2 13,001 - 27,500 1 24,901 • 84,450 SO - $7,200 $420 19.501 - 35.000 3 2 $4,4 500 7.201 - 36.975 35.001 - 40.000 27.601 • 32.000 51 - 173, 900 910 500 4 3 173,901 - 326,950 36.9 76 - 81,700 910 40,001 - 48,000 32.001 • 40,000 4 1,000 81.7 01 - 158,225 5 40,001 • 60.000 328951 - 413,700 1,330 1.000 46,001 - 55.000 6 5 413,701 - 617,850 158,226 - 201,600 65,001 - 60600 60,001 - 75.000 6 1,450 201. 601 1.330 7 75.001 - 85.000 617,851 and over - 507.800 1.450 80.001 - 70.000 7 1.540 507,801 and over 70.001 - 75,000 e 86.001 • 98000 8 1,540 75,001 - 85.000 9 95,001 - 100,000 9 88001 - 98000 10 t0000f - 110,000 11 110,001 - 115,000 10 95,001 - 125.900 12 11 125,001 - 155.000 115,001 - 125,000 12 155,001 - 165,000 13 125,001 • 135,000 14 13 165,001 - 175.000 135, 001 • 145.000 14 175001 - 180,000 16 145,001 • 180.000 16 160, 001 15 110.001 - 195,000 • 180.000 16 195601 - 205.000 17 180. 001 and over 16 17 205.001 earl over 19 Privacy Act and Paperwork Reduction cities states, the District of Act Notice. We ask for the Columbia, and info this form to carry out the Internarmation on U.S. commonwealths and pos to a form or its instructions must be l laws of the United States. Inte Revenue use in administering their tax sessions for retained as long as their con tents may Code sections 3402(4(2) and rna l Revenue the Department of Health andlaws; and to become material in the adm their regulations require you 8109 and Services for use in the Nationa Human any Internal Revenue law. inistration of Gen to information; your employer useprovide this New Hires. We may also disc l Directory of returns and return information erally, tax determine your federal inco s it to information to other countries lose this confidential, as required by are me tax under a tax Code section withholding. Failure to provide treaty. to federal and state 6103. a properly agencies to completed form will result in enforce federal nontax crim The average lime and expens your being inal laws, Or to es treated as a single person who federal law enforcement and inte to complete and file this form will required withholding allowances; pro claims no agencies to combat terrorism. lligence depending on individual circ vary viding fraudulent information may You aren't required to provide For estimated averages, seeumstances. subject you to the penalties. Routine uses of this information requested on a form the instructions for your income tax include giving it to the Departminformation subject to the Paperwork Red that's If you have suggestions for return. ent Justice for civil and criminal litig of unless the form displays a vali uction Act form simpler, we would be hap making this ation; to control number. Books or rec d OMB from you. See the instructions py to hear ords relating for your income tax return. EFTA01223267 ACKNOWLEDGEMENT, ASSUMP TION OF RISK, WAIVER, RELE ASE AND INDEMNITY THIS ACKNOWLEDGEMENT, AND INDEMNITY dated ASSUMPTION OF RISK, WAIVE R, RELEASE, 201_. By: (Print Name and Address) (the undersigned, together wit h all of the past, present and managers, employees, sub future dir contractors, representatives and ectors, officers, undersigned, are hereinafter ref agents of the erred to, collectively, as "1" , of the Indemnified Persons (as "me" or "my") in favor defined below). WHEREAS, I desire to be independent contractor of one engaged as a vendor, supplie or more of Nautilus, Inc., LSJE, r and/or an Jeffrey Epstein, and/or other LLC, Great St. Jim, LLC, corporations, limited liability affiliated with any of the foreg companies or entities oing (hereinafter referred to as provide services and/or pro "you" or "your"), to vide and/or install products equipment for, on or with res , materials, machinery, pect to either or both of the known as Little St. James Isla properties located at and nd and Great St. James Island (th more particularly described on e "Properties"), all as Exhibit A hereto (the "Work"); and WHEREAS, my actions in conne from the Properties and my ph ction with such engagement, my travel to and ysical presence on the Propertie engage in Inherently Dangerou s may cause me to s Activities (as defined below Inherently Dangerous Conditio ) and expose me to ns (as defined below); and WHEREAS, as a material induceme you to consider me for such eng nt and an express condition pre agement, and to so engage me, cedent for of any such engagement that I ma and in consideration y obtain from you, I have agreed of, to waive, and to Release, ind to assume the risk emnify and hold harmless the (as defined below) from and agains Indemnified Persons t, any and all past, present an any way arising out of, related d future claims in to or connected with, any and all future damage and/or destruction past, present and to personal property, any and This document is confidential and all past, present is intended only for the use of LLC Unauthorized use, disclosu the authorized recipient. It is the re or copying of this document property of LSJE. unlawful. C 2017 LSJE. LLC Al or any part thereof Is strictly proh • rights reserved. ibited and may be 1 EFTA01223268 and future personal injuries, and/or my death in connection with such engagemen my past, present and future travels to and t, from the Properties, my past, present and future physical presence on the Properties, my past, present and future exposure any and all Inherently Dangerous Con to ditions, my past, present and futu participation in any and all Inherently re Dangerous Activities or any other pas present and future acts or omissions on t, or with respect to the Properties; NOW, THEREFORE, in consideration of the foregoing premises, and for other good and valuable consideration, the rece ipt and sufficiency of which are hereby acknowledged by me, I, intending to be legally bound, hereby agree as follows: 1. ACKNOWLEDGEMENT. I understand Properties, including, but not limited and acknowledge that the to, the pathways, roadways, docks, riprap, buildings, structures, improvements, landscape, topography, hardscape, ponds, shores, surrounding waters, and other falls, features thereof, both natural and man may contain defects, both hidden made, and obvious, and "attractive nuisanc vegetation, animals and other conditio es," ns ("Property Conditions"), and that there are used on the Properties tools, equipment, machinery, chemicals, and other materia as a material part of the conduct of nor ls mal operations on the Properties ("Prope Equipment and Material?), and that rty such Property Conditions and Proper Equipment and Materials may be dangero ty us to my person and property ("Inherentl Dangerous Conditions"). I further underst y and and acknowledge that in connection with my present and future engagement, my past, present and future travel to and from the Properties, and my past, pres ent and future physical presence on the Properties, I may have been and may be required to engage in activities that exposed or will expose me to such Proper ty Conditions, and required or may require my use of such Property Equipment and Materials, and that such activities may be dangerous to my person or property ("In herently Dangerous Activities"). I furt acknowledge, agree and represent tha her t I fully understand the nature of the Inherently Dangerous Conditions pre viously, presently or hereafter on Properties and the nature of any Inhe the rently Dangerous Activities that I have undertaken or may undertake, and that I am in good heath and in proper physica condition to bear the risk of exposure to l such Inherently Dangerous Conditions and to engage in any such Inherently Dangero us Activities. I further agree that it is and shall be my sole responsibility to, and I shall, obtain and maintain my own liab insurance policies for the work, naming ility you as an additional insured, in suc amounts as we shall mutually agree, and h I have obtained and shall obtain and maintain workman's compensation insuranc e for my employees, in such amounts and with such coverages as are require d by law, to insure against past, present future damage and destruction to pers and onal property, and past, present and future personal injury or death to my subcon tractors and direct and indirect employe who have provided or may hereafter provide es the Work 2. ASSUMPTION OF THE RISK. I fully und present and future engagement by you erstand that (a) my to provide the Work, my past, presen t This document s confidenbal and is inten ded only for the use of the authorized recip LLC Unauthorized use, disclosure or copying ient. It is the property of LSJE. of this document or any part thereof is strictly prohi unlawful. C 2017 LSJE. LLC - All rights reser bited and may oe ved. 2 EFTA01223269 and future travel to and from the Properties, my past, present and futu physical presence on the Properties re , my past, present and future exposu any Inherently Dangerous Con re to ditions and my past, present and engagement in any Inherently Dan futu re gerous Activities INVOLVES RISKS DANGERS of serious bodily injury, AND including permanent disability, par and death ("Dangers"); (b) these Dan aly sis gers may have been or may be caused my own actions or Inactions, the by actions or inactions of others, the conditi existing at the time that the Danger ons s occur, or the negligence of one or Indemnified Persons; and (c) there more are or may be other risks, damages losses either not known to me or not and readily foreseeable at this time; and FULLY ACCEPT AND ASSUME I ALL SUCH DANGERS AND RISKS AND RESPONSIBILITY FOR ALL LOSSES, COS ALL TS, AND DAMAGES that may have and may hereafter be incurred by been me as a result of or in connection wit Properties, my present or future engage h the ment by you to provide the Work, past, present and future travel to my and from the Properties, my past, pre and future physical presence on the sent Properties, my past, present and futu exposure to any Inherently Danger re ous Conditions and my past, presen future engagement in any Inherently t and Dangerous Activities. I fully underst and agree that I HAVE BEEN, AM AND and SHALL BE FULLY RESPONSIBLE FOR OWN SAFETY WHILE ON THE PRO MY PERTIES. I expressly agree to ass risk and liability that I have suffered ume the or may suffer, directly or indirectly, injury, including, but not limited to, total loss or destruction, to my proper or personal injury, including, but not ty limited to serious bodily harm or dea whether due to some Inherently Dan th, gerous Condition, Inherently Dan Activity or otherwise, whether kno gerous wn or unknown to you, or any own shareholder, member, director, offi er, cer, manager, supervisor, employ representative, attorney, contractor ee, or agent of you (you, together with such owners, shareholders, mem all bers, directors, officers, supervisors, employees, representative man agers, s, attorneys, contractors and agents you, collectively, the "Indemnified of Persons"), whether disclosed or disclosed to me, and whether or not not caused by any act of negligence Indemnified Person, as long as suc of any h acts do not constitute willful and misconduct. wanton 3. CAREFUL INSPECTION. I agree, repr carefully consider and inspect each Inhe esent and warrant that I will rently Dangerous Condition to which I exposed and each Inherently Dangerous am Activity in which I take pan, and that observe any condition which I consider , if I to be unacceptably hazardous or dangero I will notify you in writing regardin us, g the same and will not take part unacceptably hazardous or dangero in such us activity until the condition has corrected. been 4. WAIVER AND RELEASE OF CLAIMS. acquit and forever discharge each and I hereby waive, and release, all of the Indemnified Persons from liability for, any and all past, presen all t and future claims, demands, loss es, or This document is confidential and is inten ded only for the use of the authorized recip LLC Unauthorized use. disclosure or copy ient. It is the property of LSJE. ing of this document or any part thereof strip unlawful. C 2017 LSJE. LLC • AN rights Is y prohibited and may be resented. 3 EFTA01223270 damages previously, now or hereafter arising out of, relating to, or connec with, the Properties, my presen ted t and future engagement by you to pro Work, my past, present or future vide the travel to and from the Properties present or future physical presence , my past, on the Properties, my past, presen future exposure to any Inherently t or Dangerous Conditions and my past, or future engagement in any Inh pre sen t erently Dangerous Activities, incl not limited to, any and all clai uding, but ms, demands, losses, or damages present and future loss or destruc for past, tion, to my property or for any past, and future serious bodily harm or present death, and including, but not limited to, and all claims, demands, losses or dam any ages arising out of the past, presen future negligence of any of the t and Indemnified Persons (hereinafter refe as "Released Claims"). rred to 5. COVENANT NOT TO SUE. I hereby or initiate, prosecute, participate expressly covenant not to sue in or otherwise pursue any claim action against any of the Indemnifie or cause of d Persons arising out of or relating to Released Claim, whether past, pre any sent or future. 6. INDEMNIFICATION. To the fullest ext I defend, indemnify and hold harmle ent permitted by law, I shall ss each and all of the Indemnified Per from any and all claims, actions sons and/or damages in any way arising relating to, or connected with any out of, and all matters, whether past, presen future, within the scope of any Release t or d Claims, whether such claims, actions and/or damages are asserted by me or any third parties, including, withou limitation, for past, present and t future bodily injury and property dam well as for attorneys fees and cos age, as ts of you. This indemnity shall con waiver of any immunity conferred stitute a by any applicable workers compen laws. sation 7. ADDENDA. I shall cause each and eve the undersigned and each and every one ry one of the subcontractors of of the direct or indirect employees of undersigned who may provide the Wo the rk to agree in writing to be subject to, bound by, the provisions of this inst and rument for the benefit of the Indemni Persons, as if such subcontractor or emp fied loyee was an original signatory hereto, signing an Addendum in the form of Exh by ibit B attached hereto. 8. THIRD-PARTY BENEFICIARIES. expressly agree that the provisions of I hereby acknowledge and this ACKNOWLEDGEMENT, ASSUMP RISK, WAIVER, RELEASE, AND INDEMN TION OF ITY shall be fully enforceable against any of the Indemnified Persons, each of me by whom is hereby expressly deemed to be intended third-party beneficiary hereof. an 9. GOVERNING LAW. This ACKNOWLED RISK WAIVER, RELEASE, AND INDEMNITY GEMENT, ASSUMPTION OF shall be governed by, and construed in accordance with, the laws of the United Stat es Virgin Islands, applicable to contracts This document is confidential and is inten ded only for the use of the authorized recipient. LLC Unauthorized use. disclosure or copying of this document or any It is the property of LSJE . unlawful. m 2017 LSJE. LLC -Al rIghLs reser part thereof Is strictly prohibited and may ved. be 4 EFTA01223271 executed and to be performed entirely therein without applic ation of any principles of conflicts of laws. [SIGNATURE ON THE NEXT PAGE] IN WITNESS WHEREOF, the undersigned has caused this Agreement to be executed as of the day and year first above written. Name: Name and Title, if any, of Authorized Signatory: Signature: This document Is COnfideolial and is intended only for the use of the authorized recipient. It is the property of LSJE LLC Unauthorized use. disclosure or copying of this documem or any part thereof Is strictly prohibited and may be unlawful. Ci 2017 LSJE. LLC - All rights reserved. 5 EFTA01223272 EXHBIT A DETAILED DESCRIPTION OF SCOPE OF WORK [ATTACHED] This oocument is confidentia l and is intended only for the LW Unauthorized use. disc use of the authorized recip losure or copying of this docu ient. It is the property of LSJ urlavela 402017 LSJE. LW ment or any pad thereof is stric E. - All rights reserved. tly prohibited and may De 6 EFTA01223273 EXHIBIT B INDEMNITY AND HOLD HA RMLESS AGREEMENT [ATTACHED] This document is confidentia l and is intended only for the LW Unauthorized use. disc use of the authorized recipient. losure It is unlawful. 2017 LSJE. LLC • All or copying of this document cr any part thereof Is strictly the properly of LSJE. rights reserved. prohibited and may be 7 EFTA01223274 made by the un dersigned in fa without limitatio vor of the Inde n, the assumptio mnifi indemnification n of the risk of, an ed Persons, including, of the Indemnifi d present and futu ed Persons with re the waiver, release and re claims by the sp ect to, any and al damage or destru undersigned for l past, ction to the unde past, present an future personal in rsig d futu juries to the unde ned's property or for past, presen re specifically prov rsigned or the un t and ided in the Ackno dersigned's deat wledgement. h, all as IN WITNESS W executed as of the da HEREOF, the Undersigned has caus y and year written ed this Addendum below. to be THE UNDERSIGNED : Name: Name and Title of Authorized Signatory, if any: Signature: Address: Date: I hereby confirm that attached to Acknowledgemen this Addendum is t, and that I have ca a complete copy refully read that do o cument in its entiret f the y. Signature: This document is confidential end is LLC Unauthorized intended only for the us use unlawful. re 2017 LS e, disclosure or copying of this docume of the authorized recipient It is the pro JE, LLC • AU rights nt or any pan thereo pe reserved. f is strictly prohibite rty of LSJE. d end may be 9 EFTA01223275 ADDENDUM Reference is hereby RISK, WAIVER, RELE made to the ACKNOW ASE, AND INDEMNI LEDGEMENT, ASSUMPT TY dated ION OF (the "Original Party 201_ by Persons as defined ther "), in favor of the ein, a copy of which Indemnified reference herein (th is attached hereto and e "Acknowledgemen incorporated by otherwise defined he t"). All capitalized te rein shall have the m rm s used but not Acknowledgement. eanings given to thos e terms in the Pursuant to Section 7 cause each and ever of Acknowledgement, y one of the Original the Original Party is re indirect employees w Party's subcontractor quired to ho provide the Work s and direct or bound by, the provisi to agree in writing to ons of the Acknowledg be subject to, and Persons, as If such emen subcontractor or em t for the benefit of the Indemnified Acknowledgement, ployee had original by signing an Add ly signed the Acknowledgement. endum in the form of Exhibit B to the This Addendum is inte 7 of the Acknowledg nded to serve as the A ement and is in th ddendum referred to e form attached as in Section Acknowledgement. Exhibit B to the As material inducemen "your" have the sam t for you (for purpos e meanings given to es of clarity, the term such terms in the Ack s "you and allow the undersigned nowledgement) to access to the Propertie the undersigned or s and for the Original engage the unders Party to employ consideration of su igned to provide th ch access and empl e Work, and in hereby agrees as follo oyment or engagemen ws for the benefit of t, the undersigned Persons: the Original Party an d the indemnified 1. The undersigned ha Acknowledgement and s carefully reviewed fully understands the this Addendum and contents of both docu the ments. 2. By signing this Adden the undersigned orig dum, the undersigne inally signed the Ack d agrees to be treated governed and bound nowledgement, and, as if by the provisions of as a result, to be undersigned had orig inally signed the Ackno the Acknowledgement, as if the that, as a result of th wledgement. The un e undersigned's signi dersigned agrees "me" or "my" are us ng this Addendum, when ed in the Acknowle the terms "I', references to the unde dgement they shall be rsigned. un derstood as 3. Without limiting the expressly agrees th generality of the forego at all acknowledgem ing, the undersigned releases, indemnitie ents, assumptions of s, representations, risk, waivers, provisions contained warranties, agreem in the Acknowledgem en ts and other This document is confide en t sh al l be de em ed to have been ntial and is intended on LLC Unauthorized use. ly for the use of the autho unlawful. O 2017 LSJE disclosure or copying of *is document c; an rized recipienL It is the , LW - All rights reserv y part thereof is ebictty pro property of LSJE. ed. hibited and may be 8 EFTA01223276 LSJE, LLC 6100 Red Hook Quarters. Suite 13-3, St. Thomas, VI 00802-1348 Phone: 340-775-2525 E-mail: Emergency Contact Form Today's Date: Start Date: Employee Name: Date of Birth: Physical Address: Mailing Address: Cell Phone: Phone (other): E-mail: Marital Status: Title/Position: Driver's License No: Allergies or Health Concerns: Blood type: ❑ A- ❑ A+ ❑ AB- ❑ AB- ❑ Ef- ❑ B+ ❑ 0- ❑ 0+ ❑ Unknown Current Medications: Doctor's Name: Doctor's Phone: Doctor's Name: Doctor's Phone: In case of emergency, please contact: Name: Relationship: Phone: Name: Relationship: Phone: This information is for your safety and the safety ofothers. EFTA01223277