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If the payment is different for Participants once they terminate employment, complete again: <br /> El N/A <br /> ❑ Fixed fees shall be charged to the Plan and paid from the general assets of the <br /> Adopting Employer; asset-based fees shall be charged to the Participant and paid <br /> from the Participant's HC Account. <br /> ❑ All fees shall be charged to the Plan and paid from the general assets of the <br /> Adopting Employer. <br /> ❑ All fees shall be charged to the Participant and paid from the Participant's HC <br /> Account. <br /> • Other(Describe): As outlined on the fee schedule for the plan. <br /> 10.7 Governing law—State of Washington <br /> 10.16 Statute of Limitations: <br /> ® As provided in the Basic Plan Document <br /> El Other(Describe): <br /> ACKNOWLEDGEMENTS <br /> 1. Pursuant to Section 2.9(b) of the Basic Plan Document, any collectively bargained Employees <br /> participating in this Plan participate because the collective bargaining agreement provides for <br /> coverage under this Plan. <br /> 2. This Plan has been duly adopted or authorized to be adopted by the Adopting Employer. <br /> 3. This Plan is a"covered entity"for purposes of the Privacy Rules under the Health Insurance <br /> Portability and Accountability Act(HIPAA). <br /> ADOPTING EMPLOYER: City of Everett <br /> Grant agreement between Benefit Plans Administrative Services, LLC("BPAS")and Hand Benefits& <br /> Trust (HB&T)and the City of Everett. <br /> CITY OF EVERETT: <br /> Date: 3 J q/g4 9-0 <br /> Mayor <br /> ATTEST: <br /> 3l q 2-1 a <br /> Date: / <br /> City Clerk <br /> APPROVED AS TO FORM: <br /> Office of the City Attorney <br /> APPROVED AS TO FORM <br /> David C.Hall,City Attorney <br /> Date: <br /> City Attorney <br /> ©Copyright 2017 Hitesman&Wold, P.A. Page 6 <br /> PRA Basic Plan Document Adoption Agreement(Single Employer Non-ERISA) <br />