EFTA01223506.pdf

LSJE, LLC 6100 rs, Suite B-3, St. Thomas, VI 008 Phone: 02-1348 E-mail: thesaintjames.group@ gmail.com Subcontractor Employment Fo rm Today's Date: o021/1/02-O/q Start Date: Position/Title: Hourly Pay Rate: Last Name: itives First Name: 1y4 vid Nickname: Date of Birth: /02/051/ 417c2 Social Security Num Driver's License Number: Mailing Address: Physical Address: ■ Cell Phone Phone (other): E-mail: Marital Status: Plarried In case of emergency, please contact Contact; ve_s Relationship: \190 ktSe Contact Phone Supervisor Notes: Proof of eligibility for employm ent is required. Please atta b.) tam _ID...allawdottingslg ch a.) a ohotocopv of your U.S. Pas gstmentmlgagfls sport or Passport Card OR t Authorization Employee Signature: Date: Supervisor Signature: Date: EFTA01223506  Faro W-9 (Rev. November 2017) Request for Taxpayer Identification Number and Give Form to the Deparbnere of the Treasury intend Revenue Seneca Certification requester. Do not YJ e, IP Go to wiwaragov1ForrnW tfley(as 9 for Instructions and the late send to the IRS. your interne tait robin) Nam st information. e is required on this We; do not leave this tine blank. M;chae4 ANC) 2 Business narnefffingerded entity nam e. 2deferent from above to 3 foIlo Cheek appropriate box ving seven boxes. ier federal tax classification of the person whose name is entered on lie 1. Check oNy one of the 4 Exemptions (cedes apply only to ❑ IndviduaVsole crem certain entities, net inr3M<Sua ts; see ator or 0 c Corporation Mstiuctloin on pap 3): single-member LLC Corporation O Pannonia) O Inastrestra ID United liability company. Ente r the lax Classineallon (C.L-C Exempt Parr, corio any) Note. Check the appropriate corporation. $4 corporation, PL box in the li -PartneredO LLC if the Lib le ciasefied as ne abov e for the a ldwate-rnernbet LW that ettax classification of the single-member owner. Do not Check another LI.0 that is not disregard disregarded ken the own Exemption from FATCA repo is 63/nettled from the Owner ShO ed from the own er for U.S. federal tax purposes er unless the owner of the Ilea rting ttld cheek the appropria omensee. a single-member LLC te box for the I that coda at any) as Owner. meows se ao:o.o er~ooeieser rrelASJ Requesters name and address (option$ l i ala Taxpayer Identification Number (TIN) Enter your TIN in the appropr backup withholding. For Indi iate box. The TIN provided must match the name give viduals, this is generally you n on Snot to avoid resident alien, sole prop r social security number rietor, a disregarded enti (SSM. However, for a entities, it is your employer iden ty, see the instructions for Part I, late tification number (EIN). If you r. For other TIN, later. do not have a number, see How to get a Note: If the account is In mor e than one name, see the akimbo. To Give the Reques Instructions for line 1. Alto see ter for guidelines on whose Whet Name and Employer Identification num number to enter. ber Part II Certification Under penalties of perjury, I certify that 1. The number shown on this form Is my correct taxpaye 2.1am not subject to backup r identification number (or I withholding because: (a) I am am waiting fora number to be Service (MS) that I an sub exempt from backup with issued to me); and ject to backup withholding as nolding, or (b) I have not bee no longer subject to backup a result of a failure to repo n notified by the Internal Rev withholding; and rt all interest or dividends. enue or (c) the IRS has notified me 3.1am a U.S. citizen or othe that I am r V.S. person (defined belo 4. The FATCA code(s) ente w); and red on this form (d any) Indi cating that I am exempt from Certification instructions. FATCA reporting is correct. You must cross cut item 2 abo you have felled to report all ve if you have been notified Interest and dividends on you by the IRS that you are curr acquisition or abandonment of r tax return. For real estate ently subject to backup with transactions holding because other than interest and dMd secured property. cancellation of debt, contributions to an indiv , item 2 does not apply. For mortgage Interest pad, ends, not requied to sign the cert idual retirement arrangem ification, but you must provide ent (RA). and Sign your correct TIN. See the instr generally. payments Signature of uctions for Part II. later. Here US plirso Dose & ell/ General Instructions • Form 1099-08( (dividen q/c> 1 O/ Section references are to ds, including those from stoc the Internal Revenue Code funds) ks or mutual noted. uniess otherwise • Form 1099-MISC (various Future developments. For the types of income. prizes, awa latest information about dev proceeds) rds, or gross related to Form W-9 and elopments its Instructions, such as • Form 1099-8 (stock or after they were pubished, go legislation enacted mutual fund sales and cert to www.iis.gov/FormW9. transactions by brokers) ain other Purpose of Form • Form 1099-S (proceeds from real estate transactions • Form 1099-K (merchant ) An individual or entity (Form card and third party network W-9 requester) who is required transactions) information return with the to • Form 1098 (home mortgag IRS must obtain your correct taxp file an 1098-T (tuition) e interest), 1098-E (studen t loan interest), identification nuMbe, (TIN) whic ayer h may be your social security ISSN), individual taxpayer iden number • Form 1099-C (can tifica tion num ber (ITIN), adoption celed debt) taxpayer identification num • Form 1099-A (acquisition ber (ATM), or employer iden or abandonment of secu (EIN), to report on an informa tification number red property) tion return the amount maid to Use Form W-9 only if you are a amount reportable on an info you, or other U.S. person (including a resi rmation return. Examples of alien), to provide your corr dent returns include, but are not limit information ect TIN. ed to. the following. • Form 1099-INT (Interest IIyou do not return Farr, earned or paid) W-9 to the requester with be subject to backup withhold a nAl, you might ing. See What is backup with later holding, Cat, Na. 10231X Form W-9 (Rev. 11-2017) EFTA01223507  LSJE, LLC 6100 Red Hook Quarters, Suite B-3 , St. Thomas, VI 00802-1348 Phone. E-mail: thesaintjames.group@gmail. com Emergency Contact Form Today's Date: az/J.7104)g Start Date: Employee Name: Date Physical Addr Malting Addre Cell Phone: Phone (other): E-mail: Marital Status: niarricd Title/Position: Driver's License N Allergies or Health Concerns: N/A Blood type: El A- O A+ O AB- O AB+ O 8- O 9+ O 0- O0+ Unknown Current Medications: Doctor's Name: Mei M6Veatz Doctor's Phone: Doctor's Name: Doctor's Phone: in case of emergency, please contact: Name: er viell; 4Vei,c Relationship: hon Name: Rolation3hIp. Phone: 1 This information is for your safety an d the safety of others. EFTA01223508  ACKNOWLEDGEMENT, ASSUMPTION OF RISK, WAIVER, RELEASE AND INDEMNITY THIS ACKNOWLEDGMEN AND INDEMNITY dated T, ASSUMPTION OF RI Oct SK, WAIVER, RELEASE, 2011. By: 1 0110S ame an Address) (the undersigned, togeth er with all of the past, pres managers, employees, ent and future directors, of subcontractors, represen ficers, undersigned, are hereinaf tatives and agents of ter referred to, collectively, the of the Indemnified Perso as "I" , "me" or "my") in fav ns (as defined below). or WHEREAS, I desire to independent contractor of be engaged as a vendor one or more of Nautilus, Inc , supplier and/or an Jeffrey Epstein, and/or ot ., LSJE, LLC, Great St Jim, LL her corporations, limited C, affiliated with any of the liability companies or en foregoing (hereinafter refe tities provide services and/or rred to as "you" or 'your provide and/or install "), to equipment for, on or with pr od ucts, materials, machinery respect to either or both of , known as Little St. James the properties located at an Island and Great St. Jame d more particularly described s Island (the "Properties"), on Exhibit A hereto (the "W all as ork"); and WHEREAS, my actions in co from the Properties and my nnection with such engagem physical presence on the Pr ent, my travel to and engage in Inherently Dang op erties may cause me to erous Activities (as defined Inherently Dangerous Cond below) and expose me to itions (as defined below); an d WHEREAS, as a material in you to consider me for such ducement and an express co engagement, and to so enga ndition precedent for of any such engagement that ge me, and in consideration I may obtain from you, I have of, to waive, and to Release agreed to assume the risk , indemnify and hold harmles (as defined below) from an s the Indemnified Persons d against, any and all past, pres any way arising out of, relat ent and future claims in ed future damage and/or destr to or connected with, any and all past, present and uction to personal property This document is confide , any and all past, present ntial and isIn:ended only for the LW Unauthorized use. dis closure or copying of this doc use of the authorized recipient. It is the property of LS unlawful. O 2017 LSJE, ument or any part thereof JE. LLC - All rights reserved. is strictly prohibited and ma y be 1 EFTA01223509  and future personal injuries, and/or my death in connection my past, present and future tra with such engagement, vels to and from the Propertie future physical presence on s, my past, present and the Properties, my past, present any and all Inherently Da and future exposure to ngerous Conditions, my pa participation in any and all st, present and future Inherently Dangerous Activi present and future acts or om ties or any other past, issions on or with respect to the Properties; NOW, THEREFORE, in conside good and valuable considerat ration of the foregoing premis ion, the receipt and sufficiency es, and for other acknowledged by me, 1, inten of which are hereby ding to be legally bound, hereb y agree as follows: 1. ACKNOWLEDGEMENT. 1 Properties, including, but no understand and acknowledge t limited to, the pathways, that the buildings, structures, impro roadways, docks, riprap, vements, landscape, topograp shores, surrounding waters, hy, hardscape, ponds, falls, and other features thereof, bo may contain defects, both th natural and man made, hidden and obvious, and vegetation, animals and other "attractive nuisances," conditions ("Property Conditio used on the Properties tools, ns"), and that there are equipment, machinery, chemic as a material part of the condu als , and other materials ct of normal operations on the Equipment and Materials"), Properties ("Property and that such Property Co Equipment and Materials ma nditions and Property y be dangerous to my person an Dangerous Conditions"). I fur d property ("Inherently ther understand and acknowle with my present and future dge that in connection engagement, my past, present from the Properties, and my and future travel to and past, present and future ph Properties, I may have been ysical presence on the and may be required to eng exposed or will expose me to suc age in activities that h Property Conditions, and req my use of such Property Equip uired or may require ment and Materials, and that suc dangerous to my person or pro h activities may be perty ("Inherently Dangerous acknowledge, agree and rep Activities"). I further resent that I fully understan Inherently Dangerous Conditio d the nature of the ns previously, presently or Properties and the nature of hereafter on the any Inherently Dangerous Ac undertaken or may undertake tivities that I have , and that 1 am in good heath condition to bear the risk of exp an d in proper physical osure to such Inherently Dang to engage in any such Inherentl erous Conditions and y Dangerous Activities. I furthe shall be my sole responsibility to, r agree that it is and and I shall, obtain and maintain insurance policies for the wo my own liability rk, naming you as an addition amounts as we shall mutually al insured, in such agree, and I have obtained an maintain workman's compensa d shall obtain and tion insurance for my employee and with such coverages as are s, in such amounts required by law, to insure again future damage and destruction st past, present and to personal property, and past, personal injury or death to my present and future subcontractors and direct and who have provided or may herea indirect employees fter provide the Work 2. ASSUMPTION OF TH present and future engagement E RISK. I fully understand that (a) my by you to provide the Work, my This document is confidentia past, present l and is intended only for the use LLC Unauthorized use. disclosu d the authorized recipient It is the ursawtul. 2017 LSJE, LW Allre or copying of this document or any pan thereof is strictly proh property of LSJE. - rights reserved. ibited and may be 2 EFTA01223510  and future travel to and from the Proper physical presence on ties, my past, presen the Properties, my pa t and future any Inherently Da st, present and future ngerous Conditions exposure to engagement in any and my past, pres Inherently Dangerous ent and future DANGERS of serious Activities INVOLVES bodily injury, includi RISKS AND and death ("Danger ng permanent disa s"); (b) these Danger bility, paralysis my own actions or s may have been or inactions, the actions may be caused by existing at the time or inactions of others that the Dangers occu , the conditions Indemnified Person r, or the negligence s; and (c) there are of one or more losses either not kn or may be other risks own to me or not re , damages and FULLY ACCEPT AND adily foreseeable at th ASSUME ALL SUCH is time; and I RESPONSIBILITY FOR DANGERS AND RISKS ALL LOSSES, COSTS, AND ALL and may hereafter be AND DAMAGES that incurred by me as a re may have been Properties, my presen sult of or in connectio t or future engagem n with the past, present and fu en t by you to provide th ture travel to and fro e Work, my and future physical m the Properties, m presence on the Prop y past, present exposure to any Inhe erties, my past, pres rently Dangerous Co ent and future future engagement in nditions and my past, any Inherently Dange present and and agree that I HAVE rous Activities. I fully BEEN, AM AND SHALL understand OWN SAFETY WHILE BE FULLY RESPONSIBL ON THE PROPERTIES. E FOR MY risk and liability th I expressly agree to at I have suffered or assume the injury, including, bu may suffer, directly t not limited to, tota or indirectly, or personal injury, in l loss or destruction, cluding, but not limite to my property whether due to some d to serious bodily ha Inherently Dangerous rm or death, Activity or otherwise Condition, Inherently , whether known or Dangerous shareholder, membe unknown to you, or r, director, officer, an y owner, representative, attorn manager, supervisor, ey, contractor or agen employee, such owners, shar t of you (you, together eholders, members, with all supervisors, employee di rectors, officers, s, representatives, at managers, you, collectively, th torneys, contractors an e "Indemnified Perso d agents of disclosed to me, and ns"), whether disclo whether or not caus sed or not Indemnified Person, as ed by any act of negl long as such acts do ig ence of any misconduct. not constitute willful an d wanton 3. CAREFUL INSPECTION carefully consider and in . I agree, represent an spect each Inherently Da d warrant that I will exposed and each Inhe ngerous Condition to wh rently Dangerous Activ ich I am observe any condition ity in which I take part, which I consider to be un and that, if I I will notify you in wr acceptably hazardous or iting regarding the sam dangerous, unacceptably hazardou e and will not take s or dangerous activ pa rt in such corrected. ity until the condition has been 4. WAIVER AND RELEASE OF acquit and forever discha CLAIMS. I rge each and all of the In hereby waive, and release, liability for, any and al demnified Persons from l past, present and fu all ture claims, demands, This document Is Con fide ntial and lo ss es , or Unauthorized use, disclosur iS intended only for the use of the authorized rec unlawful. C2017 LSJE. e or copying of this docum ipient. It is the property of U.0 • All rights reserved. ent or any part thereat is stri LSJE. ctly prohibited and may be 3 EFTA01223511  damages previously, now or hereafter arising out of, with, the Properties, my pre relating to, or connected sent and future engageme Work, my past, present or nt by you to provide the future travel to and from present or future physical the Properties, my past, presence on the Properties future exposure to any Inh , my past, present or erently Dangerous Cond or future engagement itions and my past, presen in any Inherently Da t not limited to, any and ngerous Activities, including, bu all claims, demands, losses t present and future loss or , or damages for past, destruction, to my property and future serious bodily or for any past, present harm or death, and includ and all claims, demands, los ing , but not limited to, any ses or damages arising ou future negligence of any of t of the past, present and the Indemnified Persons as "Released Claims"). (hereinafter referred to 5. COVENANT NOT TO SUE. or initiate, prosecute, I hereby expressly covena participate in or otherwise nt not to sue action against any of the pursue any claim or cause of Indemnified Persons arisin Released Claim, whether pa g out of or relating to any st, present or future. 6. INDEMNIFICATION. To the I defend, indemnify and ho fullest extent permitted by ld harmless each and all of law, I shall from any and all claims, the Indemnified Persons actions and/or damages in relating to, or connected any way arising out of, with any and all matters, future, within the scope of whether past, present or any Released Claims, wheth and/or damages are assert er such claims, actions ed by me or any third pa limitation, for past, presen rties, including, without t and future bodily injury an well as for attorneys fees an d property damage, as d costs of you. This Indem waiver of any immunity co nity shall constitute a nferred by any applicable wo laws. rkers compensation 7. ADDENDA. I shall cause each the undersigned and each an and every one of the subco d every one of the direct or ind ntractors of undersigned who may provid ire ct employees of the e the Work to agree in writin bound by, the provisions g to be subject to, and of this instrument for the ben Persons, as if such subcontract efit of the Indemnified or or employee was an origin signing an Addendum in the for al signatory hereto, by m of Exhibit B attached hereto. 8. THIRD-PARTY BENEFICIAR expressly agree that the provis IES. I hereby acknowledge and ions of this ACKNOWLEDG RISK WAIVER, RELEASE, AND EMENT, ASSUMPTION OF INDEMNITY shall be fully enf any of the Indemnified Perso orceable against me by ns, each of whom is hereby exp intended third-party beneficia ressly deemed to be an ry hereof. 9. GOVERNING LAW. This ACKN RISK WAIVER, RELEASE, AND IND OWLEDGEMENT, ASSUMPTIO EMNITY shall be governed by, N OF accordance with, the laws of the and construed in United States Virgin Islands, applic able to contracts TMs document is confidential and is intended only for LLC Unauthorized use, disclosu the use of the authorized recipien re t. It Is the prop unlawful O2017 LSJE, LW - All or copying of this document or any part thereof is strictly prohibite erty of LSJE, rights reserved.* d and may be 4 EFTA01223512  executed and to be perform ed entirely therein without ap of conflicts of laws. plication of any principles [SIGNATURE ON THE NE XT PAGE) IN WITNESS WHEREOF, th executed as of the day and ye e undersigned has caused th ar first above written. is Agreement to be Name: It AJtieS Name and Title, if any, of Au thorized Signatory: This document Is confide ntial and is intended only for the LLC Unauthorized use, disclo use of the authorized recipient. tt is uniaeAul. O 2017 LSJE, LLC sure or copying of this document or any part thereof is strictly the property of LSJE. - Ail rights reserved. prohibited and may be S EFTA01223513  CONFIDENTIALITY A GREEMENT In order to induce LSJE. LLC, a Virgin "Company"), to conside Islands limited liability r me for employment company (the an independent contr with the Company or actor of the Company, to consider engaging engagement that I ma and in consideration me as y obtain with the Company of any future employm be hereafter paid to me in an*any_comit ensation or en t or connection therew other remuneration to referred to as the Ap ith , I, pitVILI VteS plicant"), acknowledge (hereinafter sometimes hereunder and that such that I have been inform ed of my obligations employment or engageme obligations are a condition to the Company's nt by the Company, an consideration of my may obtain, and I he d any subsequent emplo reby agree as follows: yment or engagement I Section 1. Term of Employment; employed by the Comp Termination. In the ev any, notwithstanding ent that I am hereafter Islands employment law anything to the contrary , I agree and underst provided in the Virgin right with respect to the and that nothing in this grant or continuation of Agreement shall confer an agree and understand tha my employment by the y t, in the event that I am any breach of this hereafter emplo