Laserfiche WebLink
2 <br /> STATE RETIREMENT SYSTEMS <br /> ALL SERVICE PROVIDERS MUST COMPLETE THIS PAGE <br /> Service Provider Name: Geo/Test Services,Inc. <br /> Servive Provider Phone Number: 360-733-7318 <br /> 1. Does Service Provider have twenty-five(25)or more employees? <br /> 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,did that employee <br /> retire under the Public Employers'Retirement System(PERS),School Employees'Retirement System(SERS),or <br /> Teachers'Retirement System(TRS),or Law Enforcement Officers and Fire Fighters plan(LEOFF)? <br /> NO <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(PERS),School <br /> Employees'Retirement System(SERS),or Teachers'Retirement System(TRS),or Law Enforcement Officers and <br /> Fire Fighters plan(LEOFF)? <br /> Partnership.If a partner will perform.Work under this Professional Services Agreement,did that partnerretire <br /> under the Public Employers'Retirement System(PERS),School Employees'Retirement System(SERS),or <br /> Teachers'Retirement System(TRS),or Law Enforcement Officers and Fire Fighters plan(LEOFF)? <br /> Limited Liability Company.If a member will perform Work under this Professional Services Agreement,did that <br /> member retire under the Public Employers'Retirement System(PERS),School Employees'Retirement System <br /> (SERS),or Teachers'Retirement System(TRS),or Law Enforcement Officers and Fire Fighters plan(LEOFF)? <br /> Corporation.If a shareholder will perform Work under this Professional Services Agreement,did that shareholder <br /> retire under the Public Employers'Retirement System(PERS),School Employees'Retirement System(SERS),or <br /> Teachers'Retirement System(TRS),or Law Enforcement Officers and Fire Fighters plan(LEOFF)? <br /> NO <br /> Page 4 of 4 <br /> Standard Document Approved 4.22.14/Office of City Attorney <br /> 7 <br />