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Wendy Kallergis-Licensewar r IIIMIMIMIMIHIMOI COUNTY: MIAMI -DADE Industry Verification Form, BLS 3023 -NVS Form Approved, O.M.B. No. 1220 -0032 In cooperation with the U.S. Department of Labor The questions on this form concern the work focation(s) using Unemployment Insurance account number: 0003961550 IN FLORIDA This report is mandatory under Florida Statutes, Chapter 443, and is aut __ �iy law, 29 U.S.C. 2. Your cooperation is needed to make the results of this survey complete, accurate, and time y. Purpose, use and help information are located on the back of this form. We appreciate your response within 14 days. Thank you. FLORIDA DEPARTMENT OF ECONOMIC OPPORTUNITY BLS Na /A 1 9 BUSINESS MAILING ADDRESS Please Print corrections to the right of the is mailing address. NVSA -FL- 013668 ** * *** *"*."5 -DIGIT 33139 L GREATER MIAMI HOTEL & MOTEL ASSOCIA 1674 MERIDIAN AVE STE 420 MIAMI BEACH, FL 33139 -2807 II'I,I111111(II'IIIIIIIIIIIII' III, It tll'I.IIII,IIIiIIIIIIf11IIIIII1 Your web ID and Password * * * * * * * * * * * * * * * * * * * * ** * * ID: 120003961550 * Password: Fa762244 * -k * * * * * * * * * * ** * * * * * * * * ** REPORTING INSTRUCTIONS If you DO NOT have any changes to Items 1, 2, 3 and 4, If you have changes to Items 1, 2, 3 or 4, then you may respond toll free: 1- 888 -256 -0864. Visit our website to file your report. https: / /idcfars.bls.QOVIARSJ If you do not wish to use the phone or internet to fife your report, please use the included postage paid envelope. 12 xi t . %� PHYSICAL LOCATION ADDRESS Please print corrections to the right of this address. Do not include P.D. Box or Out-of-state addresses. Check the box, if applicable. 16,114 Mer t d t a.n kve . , ste. Liao t MIAMI BEACH, FL 33139 ❑ More than one physical location. Please attach a sheet listing each site and include: (1) business name (2) physical location address (3) number of employees (4) county and (5) main business activity. Please do not count client sites or off -site projects lasting fess than a year. 13'YES ...lf the information directly above is correct. ❑ NO...Please provide corrections to the right. I ,.. =_ "a.Business associations promoting the business interests of their members may conduct research on new products and services, develop market stati certification standards, lobby public officials, or publish newsletters periodicals, etc. for distribution to their members. Examples include, * Chambers of commerce * Manufacturers' associations * Trade ass * Farm bureaus * Real estate boards Businesses owned by their members but organized to perform a specific b such as common marketing of crops, joint advertising or buying cooperat Drimary activity. DOES NOT INCLUDE promoting the professional interests of their members whole; trade unions; or lobbyists. MAIN BUSINESS ACTIVITY The association stics, sponsor quality and , books, but are not limited to: ociations usiness function, ivies according to their and the profession as a 813910 While your business may not be engaged in all of the economic activities listed above, does the description above accurately include your main business activity during the past 12 months? If the business has been closed, sold, or moved out of state, please answer in terms of its former activity. rnuptequel ` /� 10fl9,'o L10 YES...Go to item 5 n NO...Piease list the main activities and their percentage of sales /revenues here 1,;(0. CONTACT INFORMATION Name (Please Print): YOUR STATE FIPS AND UI ACCOUNT NUMBER: FLORIDA DEPARTMENT OF ECONOMIC OPPORTUNITY For questions:. LABOR MARKET STATISTICS CENTER concerning this 107 E. MADISON ST form, contact MSC G -020 TALLAHASSEE, FL 32399 -4111 PHONE: (800) 672 -4664 FAX: (850) 245-7202 96 Website: SA OW. G�15T'►A.0 ©mone:3D5- 53c-3533 State Code: 12 UI Account Number: 0003961550 OFFICE USE FY11 10/15/11 CMI EMPL NAICS CTY TV;N4 OWN MEEI AT 01 3 813910 086 - 5 1 U L' 013668