| CASE NUMBER | I-200-24319-475355 |
| CASE STATUS | Certified |
| RECEIVED DATE | 11/14/2024 |
| DECISION DATE | 11/21/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | DENTIST |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | Y |
| BEGIN DATE | 2/23/2025 |
| END DATE | 2/22/2028 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | JACQUELINE KOTULA DDS, INC |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 4050 REDWOOD HIGHWAY, STE. A |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | SAN RAFAEL |
| EMPLOYER STATE | CA |
| EMPLOYER POSTAL CODE | 94903 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 14154997700 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | KOTULA |
| EMPLOYER POC FIRST NAME | JACQUELINE |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | OWNER |
| EMPLOYER POC ADDRESS1 | 4050 REDWOOD HIGHWAY, STE. A |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | SAN RAFAEL |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 94903 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 14154997700 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | DRKOTULA@MARINDENTALCARE.COM |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | GOLD |
| AGENT ATTORNEY FIRST NAME | DANA |
| AGENT ATTORNEY MIDDLE NAME | ANN |
| AGENT ATTORNEY ADDRESS1 | 1630 N. MAIN STREET |
| AGENT ATTORNEY ADDRESS2 | SUITE 44 |
| AGENT ATTORNEY CITY | WALNUT CREEK |
| AGENT ATTORNEY STATE | CA |
| AGENT ATTORNEY POSTAL CODE | 94596 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 19252320442 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | DANA@GOLDLAWOFFICES.COM |
| LAWFIRM NAME BUSINESS NAME | GOLD LAW OFFICES |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | SUPREME COURT |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 4050 Redwood Highway, Ste A |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | San Rafael |
| WORKSITE COUNTY | MARIN |
| WORKSITE STATE | CA |
| WORKSITE POSTAL CODE | 94903 |
| WAGE RATE OF PAY FROM | $106.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $94.92 |
| PW UNIT OF PAY | Hour |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | CARONE |
| PREPARER FIRST NAME | Sandra |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Gold Law Offices |
| PREPARER EMAIL | sandra@goldlawoffices.com |
| BEGIN DATE CONVERTED | 2025-02-23 |
