05/24/2022 6/7/2022 Renewal No:. P106DOLT22 GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS THE OFFICE OF MANAGEMENT AND BUDGET No. 5041 Narre Gade Emancipation Gardens Station, 2nd Floor Charlotte Amalie, U.S. Virgin Islands 00802 Telephone: (340) 774-0750 GOVERNMENT OF THE VIRGIN ISLANDS NOTIFICATION OF GRANT AWARD 1 The Government of the Territory of the United States Virgin Islands, through the Office of the Governor, 21-22 Kongens Gade, St. Thomas, VI 00802 does hereby provide a sub-recipient award as per the following: FEDERAL AWARD IDENTIFICATION NO: SLFRP3818 SUB-RECIPIENT/Unique Entity ID: Virgin Island Department of Labor/ Unique Entity ID: DJBBVD7ETN63 NAME OF FEDERAL AGENCY: U.S. Department of Treasury AUTHORITY: Public Law: American Rescue Plan Act of 2021 (ARPA) REGULATIONS: 2CFR as applicable AWARD PERIOD OF PERFORMANCE: October 1, 2021, through September 30, 2022 AWARD AMOUNT: $100,000.00 PROJECT DESCRIPTION: To provide funding to hire thirteen (13) UI Temporary Customer Service Representatives to assist with the increase of unemployment claims due to the pandemic. TERMS AND CONDITIONS: The above award is subject to the terms and conditions set forth in the authority above and is managed by the Office of Management and Budget. In addition, the sub-grantee is required to submit monthly progress and financial reports. The first one is due April 10, 2022, and the tenth of every month following the end of the month. Reports should be submitted to the Office of Management and Budget via email to arpa@omb.vi.gov. NAME AND SIGNATURE OF AUTHORIZING OFFICIAL: ________________________________ ___________________________ Jenifer O’Neal, Director Date Office of Management and Budget October 1, 2021 2 GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS THE OFFICE OF MANAGEMENT AND BUDGET AMENDED GRANT AGREEMENT THIS GRANT AGREEMENT (this “Agreement”) dated __October 1st _, 2021 in between the Virgin Islands Office of Management and Budget (“Grantee”), and the Virgin Islands Department of Labor (“Sub-Grantee”). WHEREAS, the COVID-19 pandemic has had a detrimental impact across the globe; the United States Congress responded by creating the American Rescue Plan Act of 2021 (ARPA); and WHEREAS, the United States Virgin Islands have been awarded for the purpose of addressing acute pandemic needs and to bolster response to the COVID-19 emergency and its economic impacts as authorized by the Department of the Treasury; and WHEREAS, the Grantee will provide funding to Virgin Islands Department of Labor to provide funding for thirteen (13) UI Temporary Customer Service Representatives to assist with the increase of unemployment claims due to the pandemic. NOW THEREFORE, the parties agree as follows: 1. SCOPE The Grantee will provide an award in the amount of One Hundred Thousand Dollars ($100,000.00) for use by the Sub-Grantee to provide funding for thirteen (13) UI Temporary Customer Service Representatives to assist with the increase of unemployment claims due to the pandemic. All purchases must be consistent with Title 31 V.I.C. § 239(a) (1-4) to provide transparency and compliance for federal funds. All expenses must be supported by documentation. All expenditures shall be in accordance with federal guidelines. The Subgrantee will perform activities under this grant in compliance with the terms, conditions, and budget included in its grant proposal documents including, but not limited to its ARPA Funds Request Form and its Justification for ARPA Funding. 2. PROJECT DATE/EFFECTIVE DATE The Sub-Grantee agrees to utilize the funds for the purposes outlined within this grant agreement. The project effective date is October 1, 2021, to September 30, 2022. 3. REPORTING The Sub-Grantee shall provide a monthly accounting for the funds expended from this award. This includes, but is not limited to, receipts, invoices, and contracts executed to secure services related to these expenditures. The monthly progress and financial report shall be submitted by 3 the 10th day of the following month, beginning April 10, 2022. If this day falls on a non- business day, the report shall be submitted by next immediate business day. 4. DISBURSEMENT OF FUNDS The Grantee will provide payment through the GVI’s MUNIS ERP system. 5. RECORDS Sub-Grantee, when applicable, will present documented precise records of the manner in which these funds were expended for eligible expenses. The Subrecipient shall maintain all records required by the Federal regulations specified in 24 CFR 570.506, that are pertinent to the activities to be funded under this Agreement. 6. COMPLIANCE WITH LAWS/REGULATIONS The Subgrantee agrees to comply with all applicable Federal and Territorial laws and regulations, including but not limited to 2 CFR 200 and the American Rescue Plan Act and its supporting Treasury regulations and policies. The Subgrantee understands that material noncompliance with laws and regulations could result in suspension or termination of the grant and suspension or debarment of the subgrantee, as well as other remedies. 7. ELIGIBILITY The subgrantee certifies that the activities carried out under this Agreement will meet the American Rescue Plan section 3.1 Public Sector Workforce: Payroll and Benefits for Public Health, Public Safety, or Human Services Workers. 8. AUDITS AND INSPECTIONS All Subgrantee records with respect to any matters covered by this Agreement shall be made available to the Grantee, Grantor Agency, and the Comptroller General of the United States or any of their authorized representatives, at any time during normal business hours, as often as deemed necessary, to audit, examine, and make excerpts or transcripts of all relevant data. 9. RIGHT TO REVIEW AND EVALUATE The Grantee retains the right to review and conduct an evaluation of the disbursement of funds by the Sub-Grantee, which may include requests for documents or visitation from Grantee personnel. All pertinent documents shall be made available upon request within a reasonable time. Sub-Grantee will receive notice of the Grantee’s review findings, and at the discretion of the Grantee, be given the opportunity to correct any non-compliance issues. 10. CONFLICT OF INTEREST The Subgrantee shall maintain a written code or standards of conduct that shall govern the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Federal funds. 11. RETENTION 4 The Subrecipient shall retain all financial records, supporting documents, statistical records, and all other records pertinent to the Agreement for a period of seven (7) years. 12. RETURN OF FUNDS Any funds not expended on or before October 1, 2022, must be returned to the Grantee within thirty (30) days of expiration. 13. RELATIONSHIP OF PARTIES Sub-Grantee and Grantee agree that this Grant does not create a principal-agent relationship of any type between the parties and that Sub-Grantee will not, by act of omission or commission, foster any belief on the part of third parties that such relationship exists. 14. INDEMNIFICATION To the extent permitted by law, the Sub-Grantee agrees to indemnify, defend and hold harmless the Grantee from and against any and all loss, damage, liability, claims, demands, detriments, cost, charges, and expense and causes of action of whatsoever character which Grantee may incur, sustain or be subjected to, arising out of or in any way connected to the services to be performed by the Sub-Grantee under this award and arising from any cause, except the sole negligence of Government. 15. AUTHORITY The individual executing this Agreement on behalf of Sub-Grantee warrants that he/she has full power and authority to execute this Agreement on behalf of such organization. 16. NONDISCRIMINATION No person shall be excluded from participating in, be denied the proceeds of or be subject to discrimination in the performance of this award on account of race, creed, color, sex, religion, disability, or national origin. 17. NO GUARANTEE OF FUTURE FUNDING Provision of this Grant does not imply any future funding commitment by the Grantee. 18. ENTIRE AGREEMENT This Grant Award Agreement and all attachments constitute the entire Agreement between the parties regarding this award and supersedes all previous related understandings or written or oral agreements between the parties. 19. WAIVER AND AMENDMENT No waiver, modification or amendment of any term condition or provision of this Agreement shall be valid or of any force or effect unless made in writing, signed by the parties hereto or their duly authorized representatives, and specifying with particularity the nature and extent of such waiver, modification, or amendment. Any such waiver, modification or amendment 5 in any instance or instances shall in no event be construed to be a general waiver, modification, or amendment of any of the terms, conditions, or provisions of this Agreement, but the same shall be strictly limited and restricted to the extent and occasion specified in such signed writing or writings. 20. GOVERNING LAW This Agreement shall be governed by the laws of the United States Virgin Islands and jurisdiction shall remain in the United States Virgin Islands. 21. NOTICE Any notice required to be given by the terms of this Agreement shall be deemed to have been given when the same is sent by certified mail, postage prepaid or personally delivered, addressed to the parties as follows: GOVERNMENT Jenifer C. O’Neal, Director Office of Management and Budget 5041 Norre Gade, 2nd Floor St. Thomas U.S. Virgin Islands 00802 SUB-GRANTEE Gary Molloy, Commissioner Department of Labor 2353 Kronprindsens Gade, St. Thomas, VI 00802 22. DEBARMENT CERTIFICATION By execution of this Agreement, the Sub-Grantee certifies that it is eligible to receive awards using federally appropriated funds and has not been suspended or debarred from entering into agreements with any federal agency. Sub-Grantee shall include this provision in each of its subcontracts hereunder and shall furnish its subcontractors with the current “LIST OF PARTIES EXCLUDED FROM FEDERAL PROCUREMENT OR NON- PROCUREMENT.” In the event Sub-Grantee or any subcontractor misrepresents its eligibility to receive contract awards using federal funds, the Sub-Grantee or subcontractor agrees that it shall not be entitled to payment for any work performed under this Grant Agreement or any subcontract and that the Sub-Grantee or subcontractor shall promptly reimburse the Government of the Virgin Islands for any progress payments heretofore made. 23. FALSE CLAIMS Sub-Grantee warrants that it shall not, with respect to this Agreement, make or present any claim upon or against the Government of the Virgin Islands, or any officer department, board, commission, or other agency thereof, knowing such claims to be false, fictitious, or 6 fraudulent. Sub-Grantee acknowledges that making such a false, fictitious, or fraudulent claim is an offence under Virgin Islands law. 24. NOTICE OF FEDERAL FUNDING Sub-Grantee acknowledges that this grant award is funded, in whole or in part, by federal funds. Sub-Grantee warrants that it shall not, with respect to this Grant Agreement, make or present any claim knowing such claim to be false, fictitious, or fraudulent. Sub-Grantee acknowledges that making such a false, fictitious, or fraudulent claim is a federal offence. IN WITNESS WHEREOF, the parties have hereunto set their hands on the day and year first above written. WITNESSES: GRANTEE 1. ___________________ __________________________ __________ Jenifer C. O’Neal, Director Date Office of Management and Budget 2. ___________________ SUB-GRANTEE 1. ___________________ ____________________________ __________ Gary Molloy, Commissioner Date 2. ___________________ VI Department of Labor 10/01/2021 10/1/2021 December 8, 2021 Gary Molloy Commissioner Department of Labor 4K A Sion Farm, Suite 1 Christiansted, St. Croix VI 00820-4245 Dear Commissioner Molloy: Transmitted via email herewith for filing and distribution is executed contract for Professional Services P019DOLT22, between the Government of the Virgin Islands (Department of Labor) and Select Temp Staffing and Business Center, LLC. Please disseminate to all parties involved. You can obtain a certified copy of this Contract by written request. Respectfully, Lisa M. Alejandro Assistant Commissioner LMA/df Encls: OPCMR CONTRACT FOR PROFESSIONAL SERVICES TillS AGREEMENT is made this ____— day of , 20, in the Territory ofthe Virgin Islands, by and between the Government of the Virgin Islands, Department ofProperty and Procurement, on behalf of the Department of Labor (hereinafter referred to as “Government” or “VIDOL”) and Select Temp Staffing & Business Center, LLC.. (hereinafter referred to as “Contractor”). WITNESSETH: WHEREAS, the Government is in need of the services of a Contractor to provide temporary employees to assist in the Unemployment Insurance Division. which duties and responsibilities are more particularly described in Addendum I (Scope of Services) attached hereto; and WHEREAS, the Government solicited the services under 31 V.I.C 239(a)(8); and WHEREAS, the Contractor represents that it is willing and capable of providing such services; and NOW, ThEREFORE, in consideration of the mutual covenants herein contained, and intending to be legally bound by this written instrument, the parties hereto do covenant and agree as follows: 1. SERVICES The Contractor will provide the services described in Addendum I (Scope of Services) attached hereto and made a part of this contract. 2. TERM AND EFFECTIVE DATE This Contract shall be effective upon the date of execution of this Contract by the Commissioner of the Department of Property and Procurement and shall terminate six(6) months thereafter. The Government in its sole discretion, shall have the option to renew this Contract for a period of one additional six month (6) term subject to the same terms noted herein, by providing the Contractor with sixty (60) days written notice ofthe Government’s election to renew. 3. COMPENSATION The Government, in consideration of the satisfactory performance of the services described in Addendum I (Scope of Services), agrees to pay Contractor a sum not to exceed o undred Ninety-Six Thousand One Hundred Fifteen Dollars and Twenty Cents ($2 6,1 5.20) in Contract No. _______________ Contractor Initials ____________ 7th December 21 P019DOLT22 OPCMR accordance with the provisions set forth m Addendum U (Compensation) attached hereto and made a part ofthis contract. 4. TRAVEL EXPENSES Inclusive of the compensation for services as specified in Paragraph 3 (Compensation) above, the Government agrees to pay documented transportation, subsistence, lodging and other travel expenses, while in travel status, for trips which have been authorized in writing, in advance, by the Government. These costs shall be advanced or reimbursed on the same basis as is applicable to non-contract employees of the Government, or as agreed to by an addendum to this Contract, however, said costs and expenses shall not exceed NA 5. RECORDS The Contractor when applicable, will present documented precise records of time and/or money expended under this Contract. 6. PROFESSIONAL STANDARDS The Contractor agrees to maintain the professional standards applicable to its profession and to consultants doing business in the United States Virgin Islands. 7. DOCUMENTS, PRIIWTOUTS, ETC. All documents, books, records, instructional materials, programs, printouts and memoranda of every description derived therefrom and pertaining to this Contract shall become the property of the Government and shall be turned over to it at the termination of this Contract. The above described materials shall not be used by Contractor or by any other person or entity except upon the written permission of the Government. 8. LIABILITY OF OTHERS Nothing in this Contract shall be construed to impose any liability upon the Government to persons, firms, associations, or corporations engaged by Contractor as servants, agents, or independent contractors, or in any other capacity whatsoever, or make Government liable to any such persons, firms, associations, or corporations for the acts, omissions, liabilities, obligations and taxes of Contractor of whatsoever nature, including but not limited to unemployment insurance, gross receipt, excise, and social security taxes for Contractor, its servants, agents or independent contractors. 9. ASSIGNMENT The Contractor shall not subcontract or assign any part ofthe services under this on act without the prior written consent ofthe Government. Contract No. _________ Contractor initi I ____________ P019DOLT22 OPCMR 10. INDEMNIFICATION Contractor agrees to indemnify, defend and hold harmless Government from and against any and all loss, damage, liability, claims, demands, detriments, costs, charges and expenses (including attorney’s fees) and causes of action of whatsoever character which Government may incur, sustain or be subjected to, arising out of or in any way connected to the services to be performed by Contractor under this Contract and arising from any cause, except the sole negligence of Government. 11. INDEPENDENT CONTRACTOR The Contractor shall perform this Contract as an independent contractor and nothing herein contained shall be construed to be inconsistent with this relationship or status. 12. GOVERNING LAW This Contract shall be governed by the laws of the United States Virgin Islands and jurisdiction shall remain in the United States Virgin Islands. 13. WAWERS AND AMENDMENTS No waiver, modification or amendment of any term, condition, or provision of this Contract shall be valid or of any force or effect unless made in writing, signed by the parties hereto or their duly authorized representatives, and specifying with particularity the nature and extent of such waiver, modification or amendment. Any such waiver, modification or amendment in any instance or instances shall in no event be construed to be a general waiver, modification or amendment of any of the terms, conditions or provisions of this Contract, but the same shall be strictly limited and restricted to the extent and occasion specified in such signed writing or writings. 14. ENTIRE AGREEMENT This agreement constitutes the entire agreement of the parties relating to the subject matter addressed in this Agreement. This agreement supersedes all prior communications, contracts, or agreements between the parties with respect to the subject matter addressed in this agreement, whether written or oral. 15. RIGHT TO WITIIHOLI) Ifwork under this Contract is not performed in accordance with the terms hereof, Government will have the right to withhold out of any payment due to Contractor, such sums as Government may deem ample to protect it against loss or to assure payment of claims arising th om, and, at its option, Government may apply such sums in such manner as Government ay eem proper to secure itself or to satisfy such claims. Government will immediately noti the Contractor in writing in the event that it elects to exercise its right to withhold. Contract No. _____________ Contractor I lal P019DOLT22 OPCMR No such withholding or application shall be made by Government if and while Contractor gives satisfactory assurance to Government that such claims will be paid by Contractor or its insurance carrier, if applicable in the event that such contest is not successful. 16. CONDITION PRECEDENT This Contract shall be subject to the availability and appropriation of funds and to the approval of the Commissioner of the Department ofProperty and Procurement. 17. TERMINATION Either party will have the right to terminate this Contract with or without cause on thirty (30) days written notice to the other party specifying the date of termination. 18. PARTIAL TERMINATION The performance of work under this Contract may be terminated by the Government, in part, whenever the Government shall deem such termination advisable by providing thirty (30) days written notice to the Contractor. This partial termination shall be effected by delivering to the Contractor a Notice of Partial Termination specifying the extent to which the term and/or duties under this Contract are terminated and the date upon which such termination becomes effective. The Contractor shall be entitled to receive payment for services provided to the date oftermination, including payment for the period of the thirty (30) day notice. 19. NON-DISCRIMINATION No person shall be excluded from participating in, be denied the proceeds of or be subject to discrimination in the performance of this Contract on account of race, creed, color, sex, religion, disability or national origin. 20. CONFLICT OF INTEREST (a) Contractor covenants that it has no interest and will not acquire any interest direct or indirect, which would conflict in any manner or degree with the performance of services required to be performed under this Contract. (b) Contractor further covenants that it is: (1) not a territorial officer or employee (i.e., the Governor, Lieutenant Governor, member ofthe Legislature, or any other elected territorial official; or an officer or employee ofthe legislative, executive or judicial branch of Government or any agency, board, commission or independent ins en lily of the Government, whether compensated on a salary, fee or :); or (2) a territorial officer or employee and, as such, has: Contract No. P019DOLT22 OPCMR (i) familiarized itselfwith the provisions ofTitle 3, Chapter 37 ofthe Virgin Islands Code, pertaining to conflicts of interest, including the penalties provision set forth in section 1108 thereof, (ii) not made, negotiated or influenced this Contract, in its official capacity; and (iii) no financial interest in the Contract as that term is defined in section 1101(1) of said Code chapter. 21. NOTICE Any notice required to be given by the Terms of this Contract shall be deemed to have been given when the same is sent by certified mail, postage prepaid or personally delivered, addressed to the parties as follows: GOVERNMENT Anthony D. Thomas Commissioner Department ofProperty and Procurement 8201 Sub Base, Suite 4 St. Thomas Virgin Islands 00802 Gary Molloy, Commissioner Department ofLabor 4401 Sion Farm-Christiansted St. Croix, ‘/1 00820 CONTRACTOR Juliette Bynum Select Temp Staffing & Business Center, LLC. 3009 Orange Grove Shopping Center Christiansted, VI 00820 22. LICENSURE The Contractor covenants that it has: (a) obtained all of the applicable licenses or permits, permanent, as required by Title 27 of the Virgin Islands Code; and (b) familiarized itselfwith the applicable provisions ofTitle 27 ofthe pertaining to professions and occupations. or otherwise Contract No. Contractor P019DOLT22 OPCMR 23. OTHER PROVISIONS Addenda I and U attached hereto are a part of this Contract and are incorporated herein by reference. 24. DEBARMENT CERTIFICATION By execution of this contract, the contractor certifies that it is eligible to receive contract awards using federally appropriated funds and that it has not been suspended or debarred from entering into contracts with any federal agency. The Contractor shall include this provision in each of its subcontracts hereunder and shall furnish its subcontractors with the current “LIST OF PARTIES EXCLUDED FROM FEDERAL PROCUREMENT OR NON PROCUREMENT”. In the event the Contractor or any subcontractor misrepresents its eligibility to receive contract awards using federal funds, the Contractor or subcontractor agrees that it shall not be entitled to payment for any work performed under this contract or any subcontract and that the Contractor or subcontractor shall promptly reimburse the Government of the Virgin Islands for any progress payments heretofore made. 25. FALSE CLAIMS Contractor warrants that it shall not, with respect to this Contract, make or present any claim upon or against the Government of the Virgin Islands, or any officer department, board, commission, or other agency thereof, knowing such claims to be false, fictitious or fraudulent. Contractor acknowledges that making such a false, fictitious or fraudulent claim is an offence under Virgin Islands law. 26. INSURANCE Contractor shall maintain the following insurance coverages during the term of this Contract (a) COMMERCIAL GENERAL LIABILITY: Commercial general liability insurance, in a form acceptable to the Government, on a “per occurrence” basis with a minimum limit of not less than one million dollars ($1,000,000.00) for any one person per occurrence for death or personal injury and one million dollars ($1,000,000.00) for any one occurrence for property damage. Insurance policy(ies) shall name the Government ofthe Virgin Islands as the certificate holder. (b) WORKERS’ COMPENSATION: Contractor shall supply current coverage under the Government Insurance Fund or other form of coverage. 28. FACSIMILE, ELECTRONIC & DIGITAL SIGNATURES A facsimile, electronic or digital signature on this Contract shall be deemed an upon the Parties hereto. Contract No. Contractor Initials P019DOLT22 OPCMR IN WITNESS WHEREOF, the parties have hereunto set their hands on the day and year first above written. GOVERNMENT 01? THE VIRGIN ISLANDS G’Ctioner Department of Labor Anthony D. Thomas, Commissioner Department ofProperty and Procurement Juli tt Ty I3n, Manager Se1Staffing & Business Center, LLC Date 11/17/2021 (Corporate seal, if Contractor is a corporation) APPROVED AS TO LEGAL SUFFIC C DEPTMENT OF JUSTICE BY: 12/7/2021 A s an Arney neral PURCHASE ORDER NO. WITNESSES: 11/17/2021 Date Contract No. Contractor Initials _____________ 12/7/2021 P019DOLT22 OPCMR Addendum I Scope of Services The Contractor will provide temporary staffing to VIDOL to assist with the processing of claims for the Unemployment Insurance Division in the District of St. Thomas. Contractor will provide ten (10) temporary employees — nine (9) Claim Processors and one (1) Financial Analyst. This will consist of seven (7) employees in St. Thomas District (6 Claim Processors and 1 Financial Analyst) and three (3) Claim Processors in the St. Croix District. These temporary employees are expected to work a forty-hour work week, Monday through Friday from 8:00 AM to 5:00 PM excluding holidays. The ten temporary employees are expected to begin training within ten (10) days of Contract execution. Temporary staff shall have at least one year of administrative experience, Temporary staff will be trained and are expected to perform their respective duties according to the job description for each position on file in the Division of Human Resources. Select Temp is responsible for the interviewing and hiring of the positions based on the job description for each position. The positions will be supervised by the Assistant Director in St. Thomas. The supervisor will ensure that the temporary staff arc meeting expectations ofthe job description. The Contractor assumes the responsibility for paying all local and federal taxes, Worker’s Compensation, and Unemployment Insurance for all temporary staff. Should a temporary staffmember leave VIDOL for any reason, Contractor will replace within 10 business days. Contract No. Contractor’s P019DOLT22 Addendum II Compensation In consideration of the satisfactory performance of the Contractor in accordance with Addendum I Scope of Services, the Government agrees to pay contractor a sum not to exceed Two Hundred Ninety-Six Thousand One Hundred Fifteen Dollars and Twenty Cents ($296,115.20) for the services. Payments shall be made according to the following schedule: Each Temporary Employee - $27.90 Per Hour worked Temp to Hire One time Payment (if required) - $582.40 per Employee Hired The Contractor shall invoice the Government monthly by the 15th of the following month. Each invoice shall list temporary employee name, hours worked, and total amount for that employee. The bottom line of the invoice shall list the total amount owed to Contractor for the month and shall be submitted with a copy of each temporary employee’s timesheet. The Government shall use its best efforts to, within 30 days of receiving an invoice, to pay the invoice or give a written explanation for non-payment for any contested portion of the invoice. Failure of the Government, despite its best efforts, to respond to an invoice within thirty (30) days of receipt of the invoice shall not be interpreted as an indication that Government no longer desires the Contractor’s services. Contract No — 1 Contractor’s P019DOLT22 VI-OMB NO. 210-2021-02 American Rescue Plan Act Funds Request Form Agency: Project Name: Date Submitted: August 31, 2021 Contact Person: Gary Molloy Contact Email: gary.molloy@dol.vi.gov Contact Number: 3407731994 A. Please provide a brief description of your request. The Virgin Islands Department of Labor is still struggling to process the benefits for a significani B. Which category(s) of COVID response/support does this project address? Select all that apply. 1: Public Health Li COVID-19 Vaccination A Li COVID-19 Testing A Li COVID-19 Contact Tracing Li Prevention in Congregate Settings (Nursing Homes, Prisons/Jails, Dense Work Sites, Schools, etc.)* Li Personal Protective Equipment Li Medical Expenses (including Alternative Care Facilities) Li Capital Investments/Physical Plant Changes to Public Facilities that respond to the Covid-19 health emergency Li Other COVID- 19 Public Health Expenses (including Communications, Enforcement, IsolationlQuarantine) I Payroll Costs for Public Health, Safety, and Other Public Sector Staff Responding to COVID-l9 Li Mental Health Services* Li Substance Use Services* Li Other Public Health Services VI-OMB NO. 210-2021-02 Agency: Project Name: 2: Negative Economic Impacts LI Household Assistance: Food Programs* A LI Household Assistance: Rent, Mortgage, and Utility Aid* A LI Household Assistance: Cash Transfers* A LI Household Assistance: Internet Access Programs* A LI Household Assistance: Eviction Prevention* A LI Unemployment Benefits or Cash Assistance to Unemployed Workers* LI Job Training Assistance (e.g., Sectoral job-training, Subsidized Employment, Employment Supports or Incentives)* A LI Contributions to UI Trust Funds LI Small Business Economic Assistance (General)* A LI Aid to Nonprofit Organizations* LI Aid to Tourism, Travel, or Hospitality LI Aid to Other Impacted Industries LI Other Economic Support* A LI Rehiring Public Sector Staff 3: Services to Disproportionately Impacted Communities LI Education Assistance: Early Learning* A LI Education Assistance: Aid to High-Poverty Districts A LI Education Assistance: Academic Scrvices* A LI Education Assistance: Social, Emotional, and Mental Health Serviccs* A LI Education Assistance: Other* A LI Healthy Childhood Environments: Child Care* A LI Healthy Childhood Environments: Home Visiting* A LI Healthy Childhood Environments: Services to Foster Youth or Families Involved in Child Welfare System*A LI Healthy Childhood Environments: Other* A LI Housing Support: Affordable Housing* A LI Housing Support: Services for Unhoused Persons* A LI Housing Support: Other Housing Assistance* A LI Social Determinants of Health: Other* A LI Social Determinants of Health: Community Health Workers or Benefits Navigators* A LI Social Determinants of Health: Lead Remediation A LI Social Determinants of Health: Community Violence Interventions* A 4: Premium Pay LI Public Sector Employees I Private Sector: Grants to Other Employers VI-OMB NO. 210-2021-02 Agency: Project Name: 5: Infrastructure LI Clean Water: Centralized Wastewater Treatment LI Clean Water: Centralized Wastewater Collection and Conveyance LI Clean Water: Decentralized Wastewater LI Clean Water: Combined Sewer Overflows LI Clean Water: Other Sewer Infrastructure LI Clean Water: Stormwater LI Clean Water: Energy Conservation LI Clean Water: Water Conservation LI Clean Water: Nonpoint Source LI Drinking water: Treatment LI Drinking water: Transmission & Distribution LI Drinking water: Transmission & Distribution: Lead Remediation LI Drinking water: Source LI Drinking water: Storage LI Drinking water: Other water infrastructure LI Broadband: “Last Mile” projects LI Broadband: Other projects 6: Revenue Replacement LI Provision of Government Services 7: Administrative • Administrative Expenses LI Evaluation and Data Analysis LI Transfers to Other Units of Government LI Transfers to Non-entitlement Units (States and territories only) 5Denotes areas where recipients must identify the amount of the total funds that are allocated to evidence-based interventions (see Use of Evidence section above for details) Denotes areas where recipients must report on whether projects are primarily serving disadvantaged communities (see Project Demographic Distribution Section above for details) C. When are these funds being requested for? Immediately - September 1, 2021 VI-OMB NO. 210-2021-02 Agency: Project Name: Please provide line-item descriptions and costs for your associated request. . . Total Initial Total Ongoing Item Description of 1eed and/or Use Costs Costs 9 - Customer Service 9 positions - 3 for STX and 6 for STT $241,056 0 Reps to process the backlog of benefit 1 -Financial Analyst Work involves supervising and $41 664 0 directing_accountants_in_effective 9-Temp to Hire Onetimeof 14% of annual pay -$18x $5,241.60 0 40x52_xO.14 1 - Temp to Hire One time of 14% of annual pay - $28x $8,153.60 0 40x52 xO.14 = Provide spreadsheet if additional lines are needed. If ongoing costs are required, how does your entity intend to fund these costs moving forward? No ongoing cost after the 6 month period as project will be complete. Please attach furtherjustification that adequately describes 1,0w this request iizeets the eligibility requirements ofthe American Rescue Plan Act. aIIysgnedbyGaoy Agency Head Approval: Gary Molloy Dale 2021.0831 002417 .0400 Total Requested: $ 296,115.20 Date: 08/31/2021 Agency: Department of Labor Project Name: Total Approved: $ 296,115.20 0MB Director Approval: Sember 3, 2021 Date: 0MB Comments Governor Total Approved: $ Approval: (if different front 0MB Approved) Date: 11-15-21 Office of the Governor Comments THE GOVERNMENT OF THE VIRGIN ISLANDS DEPARTMENT OF LICENSING AND CONSUMER AFFAIRS BUSINESS LICENSE KNOW ALL BY THIS PRESENT —“.a— i1RGINiS’. it. in accordance with the applicable provisions of Title 3 Chapter 16 and Title 27 V.lC. relating to the licensing of messes and occupations, and compliance having been made with the orovisions of 10 V.I.C. Sec. 41 relating to Civil Rights Act of the Virgin Islands, the following license is hereby Licensee: Trade Name: Mailing Address P0 BOX 2433 KINGS HILL ST. CROIX VI Business ‘ I F As provided by law, the authorized licensinithori sMl1! have the power to revoke or suspend any License issued hereunder, upon finding, after notice and adequate i ng, that such revocation or suspension is in the public interest; provided, that any persons aggrieved by any such decision of this office shall be entitled to a review of the same by the Territorial Court upon appeal made within (30) days from the date of the decision; provided, ftirther, that all decisions of this office hereunder shall be final except upon specific findings by the Court that the same was arrived at by fraud or illegal means. 2021 If a renewal is desired, the holder is responsible for making application for same without any notice from this office. It is the responsibility of the Licensee to notify the Department in writing within (30) days, when a license is to be cancelled or placed in inactive status. Failure to do so will result in the assessment of penalties as authorized by law. St. Croix,V.I. Commissioner, Department of Licensing and Consumer Affairs SELECT TEM STAFFING & BUSINESS CENTER, SELECT AFFING & BUSINESS CENTER, - Physical Address BAY 12 ORANGE CHRISTIANSTED ST. CROIX VI 00820 r License No: F’ Types of License(s) ,Temporary Help Contracting Agency -I fr\q;;v Valid from Printed on Issued at 11/08/2021 until 11I30/2022 11108/2021 Fee 130.00 THIS LICENSE MUST BE PROMINENTLY DISPLAYED AT PLACE OF BUSINESS Business Entity No. 575856 Government of The United States Virgin Islands -0- Office of the Lieutenant Governor Division of Corporations & Trademarks CERTIFICATE OF GOOD STANDING To Whom These Presents Shall Come: I, the undersigned Lieutenant Governor the United States Virgin Islands, do hereby certify that SELECT TEMP STAFFING & BUSINESS CENTER, LLC has filed in the Office of the Lieutenant Governor the requisite annual reports and statements as required by the Virgin Islands Code, and the Rules and Regulations of this Office. In addition, the aforementioned entity has paid all applicable taxes and fees to date, and has a legal existence not having been cancelled or dissolved as far as the records of my office show. Wherefore, the aforementioned entity is duly formed under the laws of the Virgin Islands of the United States, is duly authorized to transact business, and, is hereby declared to be in good standing as witnessed by my seal below. This certificate is valid through June 30th, 2022. Entity Type: Domestic Limited Liability Company Entity Status: In Good Standing Registration Date: 06/13/2008 Jurisdiction: United States Virgin Islands, United States Witness my hand and the seal of the Government of the United States Virgin Islands, on this 13th day of September, 2021. //3 / /t Tregenza A. Roach Lieutenant Governor United States Virgin Islands d’s Certificate This Insurance Is effected with certain Underwnters at Lloyds, London (not incorporated). This Certificate is issued in accordance with the limited authorization granted to the Agent or Coverholder by certain Underwnters at Lloyds, (such Underwriters being hereinafter called 9inderwriters) whose names and the proportions underwritten by them wilt be supplied on application to the office of said Agent or Coverholder and in consideration of the premium specified herein, the said Underwriters are hereby bound, severally and not jointLy (in accordance with the Several Liability Provision contained in this Certificate), their Executors and Administrators, to insure subject to the terms and conditions contained in or endorsed on this Certificate. The Insured is requested to read this Certificate, and if It is not correct, return it immediately to the Agent or Coverholder for appropriate alteration. In the event of a claim under this Certificate, please notify the following Agent or Coverholder: Island Insurance Agency 2019 Mt Welcome Christianted, St. Croix, VI 00820 VCI LMA3097 10 June 2010 This Declaration Page is attached to and forms part of Certificate provisions (Form VC-1 LMA3097). Previous No. Contract/Authority Ref. No. Certificate No. GL-7010-028 81 216PRWP214300 GL-7622O28 Name and address of the Insured: Select Temp Staffing & Business Center, LLC 3009 Estate Orange Grove Suite 12 Christiansted, Vi 00820 Effective from 10/25/2021 to 10/25/2022 Both days at 12:01 a.m. standard time. iisrance is effective with certain UNDERWRITERS AT LLOYDS, LONDON. Percentage: 100 % Amount Coverage Rate Premium COMMERCIAL GENERAL LIABIUTY POLICY AS PER A1TAGIW DECLARATIONS $3,000.00 TRIA REJECTED Special Conditions: SUBJECT TO FORMS AND ENDORSEMENTS AS PER AUACHED ENDORSEMENT NA” in the event of a claim, please notify thefollowing: Island Insurance Agency P. 0. Box 222880 Christiansted, VI 00822 L\i Agent/Coverholder Date: October 19, 2021 sac COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS Policy No. GL-7622-028 LIMITS OF INSURANCE General Aggregate Limit (Other than Products-Completed Operations) $1,000,000 Products — Completed Operations $i,oao,ooo Personal and Advertising Injury Limit $1,000,000 Each Occurrence Limit $1,000,000 Fire Damage Limit $ 50,000 ANY ONE FIRE Medical Expense Limit $ 5,000 ANY ONE PERSON DESCRIPTION OF I3USINESS AND LOCATION OF PREMISES Form of Business: Limited Liability Corporation Business Description: Temporary Staffing Agency Location of All Premises You Own, Rent or Occupy: Plot #2 Orange Grove Company Qtr., Suite #12 Christiansted VI 00820 PREMIUM ___ — ______ _____ ______________ Classification Code No. Premium Basis Rate Advance Premium Sales or Service Organizations 47367 (p) ON FILE ON FILE $3000.00 Janitorial Services 96816 (p) ON FILE ON FILE Total Advance Premium $3,000.00 From: Hubert Frederick To: Kevin Dennin Cc: Juliette Bynum Subject; [EXTERNAL MAILJSelect Temp Staffing - Proof of Coverage Date: Tuesday, November 16, 2021 1:27:57 PM Attachments: Select Temp - Insurance Policy Declaration Pae.df Hi Kevin, As per your request and the approval of the Insured, I have attached a copy of the Insurance Declaration Page for our mutual client. Additionally, I have included the Underwriter’s response to Adding the VI Govt to this policy: “Based on the information provided and the absence of professional liability coverage we will not be able to assist with this request. We are unable to add the Government of the Virgin Islands Department of Labor as an additional insured to this policy.” Regards, Hubert L. Frederick, M.S., CFSA, CFE Owner/Broker-Agent ISLAND INSURANCE AGENCY Quick Online Quote: islandinsurancevi.com 2019 Mt. Welcome Christiansted, VI 00820 (340) 773-6006 ph/fax Better Service, Better Coverage, Better Value with our great new lineup of discounts! - We appreciate your referrals!!! Auto* (see below) - Home - Business - Liability - Life - Health Active and/or Available Carriers: MAPFRE. (Red Hook Agencies, NEMWIL), United Healthcare, CIGNA, AFLAC and AMERICO. *Mapfi.e has discontinued offering Auto Coverage in the USVI effective 11/1/2018. **** This transmission and any attached information represent privileged and confidential information intended solely for the named recipient(s). If you received this transmission in error, please notify the sender immediately, destroy any hardcopy, and delete any material from your system. If you are not the intended recipient, any disclosure, copying, distribution, or use of the contents of this transmission and attachments for any reason is strictly prohibited. Security Warning: Please note that this e-mail has been created with the knowledge that internet e-mail is a means of communication which is not 100% secure. You are advised to take into account this lack of security when e-mailing. Caution: This e-mail has originated outside of GVI network. Do not click on links or open any attachment (s) that might look suspicious unless you have knowledge of who the sender is. — ..rZEZE_ — GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS Office ofthe Custodian, government Insurance ¶Funcl p1wqzpqToq’ FiArcE Certificate ofgovernment Insurance Coverage I certfy that the employer SELECT TEMP STAFFINL .7-[asfiledwith the Custodian ofthe government Insurance Fund the cEmployer’s R.,eport to the Commissioner ofFinance antipaid the requiredpremium in accordance with the provision of’Tit(e 24 Chapter 11, Section 273, ofthe ‘Virgin Islands Code, antiaccorthngly is entitlecito the iights J4nti6enefits ofthe insurance coverage establislied6y law. ‘The risk.,ofthis employer is covered cBypolicy74lll ortheperiodfrom JANUARY 01, 2021 TO DECEMBER 31, 2021. NAME & ADDRESS OF EMPLOYER: SRECT TEMP STAFFING P.O. BOX 2433 KINGSHIL, VI OL181 __________________ i_-_ -_--__—.---..- .__ZEZZ ::;_. -.:z..:.:.zz_ .. -: It..—-—•-—-— -----..••-•-.•—--— ---.—-•-.—--. -•-• cDate: MARCH 30, 21121 II Il ector Government Insurance Fund CONSENT OF MEMBERS OF SELECT TEMP STAFFING & BUSINESS CENTER, LLC The undersigned, being all of the Members of that certain limited liability company more commonly known, and identified, as Select Temp Staffing & Business Center, LLC, a duly organized and existing limited liability company under the laws of the Territory of the United States Virgin Islands (the “Company”), consent to the following actions being taken without a meeting, all of which actions are required or permitted to be taken at a meeting of Members. VOTED: That the Company, through its Manager, to wit, Juliette C. Bynum, is hereby authorized to do and perform all acts and things and to execute and deliver all instruments and documents of whatsoever kind and nature necessary or incidental to or required to consummate the transaction contemplated by that certain United States Small Business Administration Loan in the original principal amount of $80,000.00 by Independence Bank to the Company (the “Loan”), and it was further; VOTED: That the Members of the Company, to wit, Juliette C. Bynum and Joseph M. Benjamin, be and hereby are authorized, acting together and separately, without any approval of, or notification to, any other person or entity, to examine, execute, seal and deliver any and all documents, instruments or agreements in furtherance of the foregoing vote and to do any and all other things as may be necessary or desirable in their discretion, to carry out the foregoing authority, the execution and delivery of all such documents, instruments and agreements containing and upon such terms and conditions as said Members deem proper, to be conclusive evidence of their authority hereunder, and it was further; VOTED: That all acts and things heretofore done and all documents and instruments heretofore executed on behalf of the Company in the transaction of its business with regard to the above-referenced Loan are hereby ratified, approved and confirmed. IN WITNESS WHEREOF, the undersigned, being all of the Members of that more commonly known, and identified, as Select Temp Staffing & Lter, LLC have executed this Consent on this 9th day of November, 2015. ZJ14 Joseph M. Be jamin, Member a a t — - —. / Member Witness:4) Cr€ 4L-tt.Z Print Wame: 7it) . &Pd4€2A Witness: PrinJame cThA2t,/,ôdgfd3 I ARTICLES OF ORGANIZATION OF Select Temp Staffing & Business Center LLC I, the undersigned natural person of legal age acting as the organizer of a limited liability company (LLC) in accordance with the Uniform Limited Liability Company Act, Title 13, Chapter 15 of the Virgin Islands Code, do hereby adopt the following Articles of Organization for such limited liability company: ARTICLE I The name ofthe limited liability company is: Select Temps & Business Center LLC ARTICLE II The physical address of the designated office of the limited liability company is No. 1OA Golden Rock Shopping Center located on St. Croix, Virgin Islands, with a mailing address of Box 2433 King Hill St. Croix, VI 00851 ARTICLE III The resident agent for service of process shall be Juliette Bynum of 73 Mount Pellier, Frederiksted, St. Croix, VI 00840, with a mailing address of Box 2433 Kings Hill St. Croix, Virgin Islands 00851 ARTICLE IV The name and physical address of the organizer of the limited liability company are Juliette Bynum and Joseph Benjamin of 73 Mount Pellier Frederiksted, St. Croix, VI 00840. ARTICLE V The minimum amount of capital with which the company shall commence business is $1,000.00 dollars. ARTICLE Vi Territory of the U S Virgin Islands Creation - LLC 4 Page(s) The duration of the limited liability company is for.a specified term and it shall terminate on December 31, 2050. ARTICLE VII The limited liability company shall be manager-managed and the managers shall be Juliette Bynum of 73 Mount Pellier Fredericksted St. Croix 00840. Mailing address 2433 Kings Hill St. Croix, VI 00851 and Joseph Benjamin of 73 Mount Pellier Fredericksted St. Croix 00840. Mailing address 2433 Kings Hill St. Croix, VI 00851. ARTICLE VIII MANAGEMENT Each member shall have an equal voice in the management of Select Temp Staffing and Business Center, LLC. No member shall take the following actions on behalf of Select Temp Staffing, LLC. without the written consent of the remaining member: a. Borrow or lend money; b. Make, deliver, or accept commercial paper c. Execute any mortgage, security agreement, bond or lease; or d. Buy or execute a purchase agreement, or sell or execute a sales agemnt - for any property other than that bought or sold in the regujar crsef Select Temp Staffing and Business Center LLC’s business. in .r__ r A..+ 1 Vi r... cc t-I1L1cIe BANK ACCOUNT All funds of Select Temp Staffing and Business Center, LLC in account(s) with Banco Popular located in St. Croix, or such bank(s) as the members may agree upon from time to time. All withdrawals from these accounts shall be made by check signed by both members. ARTICLE X DISSOLUTION A. When dissolution May Occur. Select Temp Staffing and Business Center, LLC shall be dissolved and liquidated upon the happening of any of the following: 1. By the written consent of the members; Q 2. The occurrence of any other event causing the dissolution of Select Temp Staffing and Business Center, LLC under the Uniform Limited Liability Company Act of the Virgin Islands. ARTICLE XI The limited liability company shall be liable for the debts and obligations pursuant to Title 13, Chapter 15, and Section 1303(c) of the Virgin Islands Code. IN WITNESS WHEREOF, the unde igedperson(s) ha hereunto set her hand as organizer of the limited liability company t s D day of 0 iM’\L , ______ Juliette Bynum 2-?J)44 ri’1 (Th — 111 () ACKNOWLEDGMENT TERRITORY OF THE VIRGIN ISLANDS ) DISTRICT OF ST. THOMAS/ST. JOHN ) ss: On this ‘ e , ______ before me, the organizer personally appeared Juliette Bynum/Joseph Benjamin, known to me and satisfactorily proven to be the person(s) whose name is subscribed to within the instrument and acknowledged that she executed the same for the purpose therein contained. My commission expires on _____________ GLADYS SANCHEZ NOTARY PUBLIC - ST CROIX US.V.I. COMMISSION NO. NP-111-04 MY COMMISSION EXP’RES 10111/2008 Consent of Agent for Service ofProcess —0- ____________Juliette Bynum_____ (Type or print agent’s name) ________Select Temp Staffing and Business Center, LLC (Name of Limited Liability Company) Subscribed and sworn to before me this _____ day of__________ ______ en 4)Lt,1WJh(/. C’!ity UT 3 ayo 13 ._ cn c- •••- — ><- (-‘3 ; C’,, (Notary Public) JEAN B. GOODRiCH NOTARY PUBUC -St CROIX, US.V.I. COMMISSION NO. NP203.07 MY COMMISSION E)CPIRES 1Of11O1I This writing witnesseth that the undersigned having been designated by the ________ as agent of the said company upon whom service of process may be made in all suits arising against the said company in the Courts of the Virgin Islands, do hereby consent to act as such agent, and that service of process may be made upon me in accordance with Title 13 of the Virgin Islands Code. IN WITNESS WHEREOF, I have hereunto set my signature this 1 (Signature of the Agent) Dayti e Contact No. 340 626-0825 .&SAMGOV® SELECT TEMP STAFFING & BUSINESS CENTER, LLC ALERT! This entity is only available FOR OFFICIAL USE ONLY. DUNS Unique Entity ID SAM Unique Entity ID CAGE I NCAGE 071597203 MBL3V56L7IJ7 7SMN8 Purpose of Registration Registration Status Expiration Date All Awards Active Nov 3, 2022 Physical Address Mailing Address 3009 Orange Grove Shopping Center STE 12 P0 Box 2433 Christiansted, Virgin Islands 00820 Kingshill, Virgin Islands 00851 -2433 United States United States Inforinatlár Doing Business as Division Name Division Number B&B Maintenance (blank) (blank) Congressional District State / Country of Incorporation URL Virgin Islands 98 Virgin Islands I United States (blank) MPIN *****5765 Registration Dates Activation Date Submission Date Initial Registration Date Nov 15, 2021 Nov 3, 2021 Jan 25, 2017 Entity Dates Entity Start Date Fiscal Year End Close Date Jul 1, 2008 Dec 31 Immediate Owner CAGE Legal Business Name (blank) (blank) Highest Level Owner CAGE Legal Business Name (blank) (blank) Executive Compensation In your business or organization’s preceding completed fiscal year, did your business or organization (the legal entity to which this specific SAM record, represented by a DUNS number, belongs) receive both of the following: 1. 80 percent or more of your annual gross revenues in U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or cooperative agreements and 2. $25,000,000 or more in annual gross revenues from U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or cooperative agreements? No Does the public have access to information about the compensation of the senior executives in your business or organization (the legal entity to which this specific SAM record, represented by a DUNS number, belongs) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 780(d)) or section 6104 of the Internal Revenue Code of 1986? Not Selected Proceedings Questions Is your business or organization, as represented by the DUNS Number on this entity registration, responding to a Federal procurement opportunity that contains the provision at FAR 52.209-7, subject to the clause in FAR 52.209-9 in a current Federal contract, or applying for a Federal grant opportunity which contains the award term and condition described in 2 C.F.R. 200 Appendix XII? No Does your business or organization, as represented by the DUNS number on this specific SAM record, have current active Federal contracts and/or grants with total value (including any exercised/unexercised options) greater than $10,000,000? Not Selected Within the last five years, had the business or orpanization (represented by the DUNS number on this specific SAM record) and/or any of its principals, in finding of fault with either a monetary fine or penalty greater than $5,000 or reimbursement, restitution, or damages greater than $100,000, or other acknowledgment of fault? Not Selected SAM search Authorization I authorize my entity’s non-sensitive information to be displayed in SAM public search results: Yes ntityITypes Business Types Entity Structure Entity Type Organization Factors Partnership or Limited Liability Partnership Business or Organization Limited Liability Company Profit Structure For Profit Organization Soclo-Economic Types Minority Owned Business Economically Disadvantaged Women Owned Small Business Woman Owned Small Business Woman Owned Business Black American Owned Check the registrants Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA-certified HlJBZone small business concern. Additional small business information may be found in the SBA’s Dynamic Small Business Search if the entity completed the SBA supplemental pages during registration. • -- Financial Informatior Accepts Credit Card Payments Debt Subject To Offset Department Code No No (blank) EFT Indicator CAGE Code 0000 7SMN8 Electronic Funds Transfer Account Type Routing Number Lock Box Number Checking *****6690 (blank) Financial Institution Account Number UNITED FIDELITY BANK, FSB *****1 256 Automated Clearing House Phone (U.S.) Email Phone (non-U.S.) 3407187114 (blank) (blank) Fax (blank) Remittance Address Select Temp Staffing P0 Box 2433 Kingshill, Virgin Islands 00851 United States er Information 4— EIN Type of Tax Taxpayer Name *****281 3 Applicable Federal Tax Select Temp Staffing Tax Year (Most Recent Tax Year) Name/Title of Individual Executing Consent TIN Consent Date 2015 Director Nov 3,2021 Address Signature P0 Box 2433 Juliette Bynum Accounts Receivable POC Juliette C Bynum, Director jbynum@selecttempstaffing.com 3407187114 Electronic Business g P0 Box 2433 Juliette Bynum, Director Kingshill, Virgin Islands 00851 jbynum@selecttempstaffing.com United States 3407187114 Government Business ?* P0 Box 2433 Juliette C Bynum, Director Kingshill, Virgin Islands 00851 jbynum@selecttempstaffing.com United States 3407187114 rity Information 4 Company Security Level Highest Level Employee Security Level (blank) (blank) rvlc ons NAICS Codes Primary NAICS Codes NAICS Title Yes 561320 Temporary Help Services 561990 All Other Support Services Size Metrics IGT Size Metrics Annual Revenue (from all lGTs) (blank) Worldwide Annual Receipts (in accordance with 13 CFR 121) Number of Employees (in accordance with 13 CFR 121) $1,200,000.00 49 Location Annual Receipts (in accordance with 13 CFR 121) Number of Employees (in accordance with 13 CFR 121) (blank) (blank) Industry-Specific Barrels Capacity Megawatt Hours Total Assets (blank) (blank) (blank) Data Interchange (EDI) Information This entity did not enter the EDI information Disaster Response Yes, this entity appears in the disaster response registry. States Counties Metropolitan Statistical Areas Virgin Islands Vi: Saint Thomas, Saint John, Saint Croix Exp.ense Reimbursement Form Emptoyee Name: Michael. R. Francisco Expense Period ID: — _________ From: To: Manager Name: Pamela R. Tepper Department: Solicitor GeneraL Business Purpose: VI Bar Association Annual Meeting and CLE Training Itemized Expenses DATE DESCRIPTION CATEGORY COST 10/1/21 Payment to VI Bar Association for registration Training Fees $240.00 SUBTOTAL $ 240.00 Note: Mileage reimbursement for personal car = $O.XX/mi[e Less Cash Advance TOTAL REIMBURSEMENT $ 240.00 Don’t forget to attach receipts! Employee Signature Date Approval Signature Date Reimbursement Form Template by Vertex42.com