Sun Life Assurance Company of Canada 12/10/2024

Sun Life Assurance Company of Canada is a member of the Sun Life group of companies. © 2024 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. The Sun Life name and logo are registered trademarks of Sun Life Assurance Company of Canada. GGFM-ER-8514 Maxwell Health Employer Information Form 02/24 Authorization and signature, continued 7.Employer web portal authorization: The employer authorizes the administrators named in the “Benefits administrators and plan administration” section above to have access to the employer web portal and requests that a user name and password be assigned to allow for such access. Sun Life’s interactive web services requires an electronic identification. The use of the electronic identification by Employer’s representatives is the legal equivalent of Employer’s written signed instructions to Sun Life. Sun Life will rely on instructions from persons using the electronic identifications assigned by Employer. Actions taken by persons using an electronic identification assigned by Employer will be deemed to be authorized by Employer. For this reason, Employer must safeguard the electronic identifications and inform Sun Life promptly to terminate an identification if Employer believes the security of an identification has been compromised or person previously issued an identification is no longer authorized. 8.I acknowledge receipt of Sun Life's Privacy Policy, as well as the HIPAA Notice of Privacy Practices applicable to the SLF Dental product, made available to me electronically on Sun Life Connect. I certify that the above statements and all information provided in this document are true and complete. Name of employer Date Signature of authorized employer representative X Title Docusign Envelope ID: BA987120-63B9-40BD-A4CA-C6E248AD9B65 City of Everett Mayor 12/10/2024