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STATE RETIREMENT SYSTEMS FORM <br />ATTACHMENT TO PROFESSIONAL SERVICES AGREEMENT <br />ALL SERVICE PROVIDERS MUST COMPLETE AND SIGN THIS FORM <br />:: <br />:': <br />e to ees • Y <br />es': o.:law* <br />. <br />s or ther <br />e m <br />Seri �ive'f2) Y •_ <br />::#s3Qes.:Sr�licePrgyicezZvtt iY <br />'2.s. ii s ._ .. ,. .AND sic :; Lo. ;: ; ::; •: <br />:YES:KP:fJESTION..�.PQ. ,.. <br />AI�r'W ..:i: <br />_ _ _ • _ __ _ ;S` e Se •vie <br />o ss• •_ .. a A =:: <br />erii loiree ;zl "rip aiic citicler-this t'r . ::..:.. <br />2. `3aervice,Provai P �4' a .. <br />etn p to y eetret*re.underflie.l?}i ilic En p1oyer?.I-Ret ofl ezt Systtaii;,(PJE •S);tl o.Q.1 : =' . <br />` SI RS "Teache s.'• etireme .i.:$Y t . M).?;a r Lapr,:. ;�• ,' : <br />air layes:•etireziieut.Syefiez�x { - ), .. <br />:e <br />a:. <br />• Enfareemettt.0�€[cers and 7iir', e :�'3ghters �lar�: �E i ) . _ . <br />.wer thp:ippropiaiti : ttes ipabeiow-fat Service 1/4igi tier's.basi es .nrganix ©u:.;; : ::`:'.• • -''-: <br />....:-...-.•_ - <br />.sss - - <br />cier be�ublieE.oyers'.R.tireirientSystem_ ;; <br />;Soto Prolirleior` D.id;aervice iAvi$err t .. ?., <br />• Em 'la ees°• Rehr iueiit S :s. eri ($E$S) Teachers' ;•eti ez ent Sysi'ei•?t. (Ci3S),` . `: <br />lay Enforberaenf 3.#t.aers andIi'e iglatefs play L;EQFF)2 t:'•' .';es, `:It:P:1:V:: ' ._ <br />:':. <br />cos A emStf "ihd :` '; <br />a ariner.wall• erfaxr� Vor c.,tux.;ex this Professiaual .Seruz .. ,. <br />- _,4, :�---- - .:�:n_: c iDQI7Qi' C'nk'nn1 l3mt�Yriv�Pe'.?t•': <br />:,•.. •: <br />.that pitorrexre.iirid- <br />=Jtelxrearian 1 'stem.�Sl�a �,)'1`0.aclteis' .et i�eni i�t sjs%mi`(Tlp <br />'RS}o avr:F a._ Lt.• C} cars;; , <br />s ` laic LEf)F <br />'; <br />e Fr fifer • Q • :azidFu .( �i• <br />.• _ <br />imtfeciI:Iabali ompanv' rf a:me�nlierwill ,erforin. <br />ork iiiicler tfii Professional <br />• Agreement, dad thaember:rete-?mod rthePub�zcElnplflyers?•RefitremefiSyst�in•{PE1tS},:::,;.;;: <br />S 1tgn1Bm la ees9 �:t•etirpMs montSstpy�y SERS,Teachers°.tRetjrenieiit, ystem,(t. br.Laev:',:;:< <br />EniorcenAent flffapexs and ire.kl titers. lair LSOPPfi.: <br />a: <br />• <br />ptid { <br />' •t_ . r : .Yi ,fin...... 'TTY_�.T •.......7 Ai.:.,•fi,...fnnttnn'KtAPiTS9VS.greeiile>a'G ' <br />EiLU Scha 1 . •s.'.': <br />or. kw • . • .. . <br />1F.•HEIS'S�E'.{ A1tiVERTOANYARF:QCiJESTIlY.Z'QIi.3,AbSADD110 <br />CQUES'IT01�T1! A ,+..(AVtI aU 'ROM H• ORL,EOEW•1VITJST fl pion <br />Char eharshblder re e urider,#-w 1blicTn iSayers'•:R, irement,Sysfez , <br />.;'. ' Et>}playee�' Rot ex r it Syste SE1t8), .Teaclaers':•Rei rexxaent Syate» <br />'-Eiwforeznef Queers 4•ndEi ighfers.til i.(L• <br />`. <br />• <br />ED. <br />1TR:... <br />S ervae° Provider r ..Na• 61 fir .tiN. ... ... . <br />• <br />ISi 'natur <br />Printed Name: <br />q, u ifle:s. <br />(Retirement Farm Approved by City Attorney's Office June 15, 2014) <br />U :Yeso <br />OUTC4N,. ;:; . . <br />.• .• <br />. <br />4 itt 117191 1 • <br />