• 11 4 0 LSJE, LLC 6100 Red !look Quarters Suite B-3 St. Thomas, VI 00802 Tel: Emergency Contact Form Date: 03/19/18 Employee Name: Leiria fliornit t Address: Phone Coll- Title / Position: H emergency Information: Allergies or Health Concerns: Blood Type: Current Medication: Doc

• 11 4 0 LSJE, LLC 6100 Red !look Quarters Suite B-3 St. Thomas, VI 00802 Tel: Emergency Contact Form Date: 03/19/18 Employee Name: Leiria fliornit t Address: Phone Coll- Title / Position: H emergency Information: Allergies or Health Concerns: Blood Type: Current Medication: Doc

• 11 4 0 LSJE, LLC 6100 Red !look Quarters Suite B-3 St. Thomas, VI 00802 Tel: Emergency Contact Form Date: 03/19/18 Employee Name: Leiria fliornit t Address: Phone Coll- Title / Position: H emergency Information: Allergies or Health Concerns: Blood Type: Current Medication: Doc