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4 <br /> STATE RETIREMENT SYSTEMS <br /> ALL SERVICE PROVIDERS MUST COMPLETE THIS PAGE <br /> Service Provider Name: Krazan &Associates, Inc. <br /> Servive Provider Phone Number: (425) 485-5519 <br /> I. Does Service Provider have twenty-five(25) or more employees? YES <br /> IF YES: SKIP REMAINDER OF PAGE <br /> IF NO: ANSWER QUESTIONS 2 AND 3 <br /> 2. If a Service Provider employee will perform Work under this Professional Services Agreement, <br /> did that employee retire under the Public Employers'Retirement System(PERS), School <br /> Employees'Retirement System(SERS),or Teachers'Retirement System(TRS)? <br /> 3. Answer ONLY the question below appropriate for Service Provider's business entity: <br /> Sole Proprietor.Did Service Provider retire under the Public Employers'Retirement System <br /> (PERS), School Employees'Retirement System (SERS),or Teachers'Retirement System <br /> (TRS)? <br /> Partnership. If a partner will perform Work under this Professional Services Agreement, did <br /> that partner retire under the Public Employers'Retirement System (PERS), School Employees' <br /> Retirement System (SERS),or Teachers'Retirement System (TRS)? <br /> Limited Liability Company. If a member will perform Work under this Professional Services <br /> Agreement, did that member retire under the Public Employers' Retirement System (PERS), <br /> School Employees' Retirement System (SERS), or Teachers' Retirement System(TRS)? <br /> Corporation. If a shareholder will perform Work under this Professional Services Agreement, <br /> did that shareholder retire under the Public Employers'Retirement System (PERS), School <br /> Employees'Retirement System(SERS), or Teachers'Retirement System (TRS)? <br /> Page 4 of 4 <br /> Standard Document Approved 11.26.13/office of City Attorney 47 <br />