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SCORE-Bench

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877-370-3377
Golkow Technologies, A Veritext Division
www.veritext.com
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--------------------------------------------------- Unstructured Plain Text Format 1.0.4
Jens Walter
Apimeister Consulting GmbH
Freidrichstr. 123
10117, Berlin
Room No. 17003
Conf No. 895557014
Arrival 11/28/21
Departure 12/02/21
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DATE DESCRIPTION Room Charges Payments
11/28/21 Deposit Applied 209.75
11/28/21 Deposit Applied 1,222.32
11/28/21 Room Rate 185.00
11/28/21 Room Tax 24.75
11/28/21 Resort Fee 39.00
11/28/21 Resort Fee Tax 5.22
11/28/21 Guest Overnight Parking Fee 15.00
11/29/21 Room Rate 225.00
11/29/21 Room Tax 30.11
11/29/21 Resort Fee 39.00
11/29/21 Resort Fee Tax 5.22
11/29/21 Guest Overnight Parking Fee 15.00
11/30/21 Room Rate 138.75
11/30/21 Room Tax 18.56
11/30/21 Resort Fee 39.00
11/30/21 Resort Fee Tax 5.22
11/30/21 Guest Overnight Parking Fee 15.00
12/01/21 Room Rate 329.00
12/01/21 Room Tax 44.02
12/01/21 Resort Fee 39.00
12/01/21 Resort Fee Tax 5.22
12/01/21 Guest Overnight Parking Fee 15.00
12/02/21 Mastercard -200.00
XXXXXXXXXXXX5052 XX/XX
MASTERCARD XXXXXXXXXXXX5052
TOTAL USD 200.00
AID:
TVR: TSI:
IAD: ARC:
--------------------------------------------------- Unstructured Table End
--------------------------------------------------- Unstructured Plain Text Format 1.0.4
Jens Walter
Apimeister Consulting GmbH
Freidrichstr. 123
10117, Berlin
Room No. 17003
Conf No. 895557014
Arrival 11/28/21
Departure 12/02/21
--------------------------------------------------- Unstructured Table Begin
DATE DESCRIPTION Room Charges Payments
ENTRY CODE: ICC
Total 1,232.07 1,232.07
Balance 0.00
--------------------------------------------------- Unstructured Table End
Credit card refunds are processed immediately upon your departure from the hotel, but may not be reflected on your banking statement for up to 10 business days. Any complimentary offerings received will not show on your printed folio, these items are removed completely from your bill.
If you were a guest at an MGM Resorts property within the last 14 days and have subsequently tested positive for the coronavirus (COVID-19), we ask that you contact us at covid19@mgmresorts.com so that we can provide your information to the local health department to support their contact tracing efforts.
--------------------------------------------------- Unstructured Plain Text Format 1.0.4
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Part B (continued) – ELECTION OF PORTABLE COVERAGE FORM
To be Completed by the Recordkeeper (Shaded areas to be completed by the Recordkeeper). To be Completed by the Employee (For each Type of Coverage, please indicate whether you want to continue, discontinue, increase, or decrease the amount of insurance in the shaded column. Select just one option for each Type of Coverage).
Continue coverage Discontinue coverage Increase coverage Decrease coverage
Type of Coverage Amount of Insurance Terminated or Reduced Insert the actual $$ amount of coverage (i.e. $50,000) I want to continue the same amount of insurance in the shaded column. I want to discontinue the insurance in the shaded column. I want to increase my insurance in the shaded column by the following amount.¹ (Ex. $25,000 means you want to increase your insurance amount in column 1 by $25,000). I want to decrease my insurance in the shaded column by the following amount. (Ex. $30,000 means you want to decrease your insurance amount in column 1 by $30,000).
Employee 2,3