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Page 1 of 2 <br />PLANSOURCE ORDER FORM #Q-90836 <br />Offer valid until: February 28, 2026 <br />BILLING INFORMATION <br />Customer Name:THE CITY OF EVERETT <br />Customer Contact Name and <br />Email: <br />Chelsi Bardwell <br />cbardwell@everettwa.gov <br />Customer Address:2930 Wetmore Avenue <br />Everett, Washington 98201 <br />Billing Contact Name and Email, <br />if different from above: <br />Ana Mechler <br />amechler@everettwa.gov <br />Billing Address, <br />if different from above: <br />Payment Terms:Net 30 <br />Recurring Services <br />Target Go-Live** Date:June 1, 2026 Services Term Length:36 Months <br />Start Services Term Date:June 1, 2026 End Services Term Date:5/31/2029 <br />*PlanSource utilizes ACH for payment processing. <br />**Intended launch of the Services to Customer's participants. <br />RECURRING SERVICES <br />Recurring Services Basis Billing <br />Frequency <br />Quantity Min. <br />Quantity <br />Price per Basis <br />Benefits Platform Subscription Fees Benefits Eligible Employees Monthly 1,200 1,200 USD 3.25 <br />Benefits Platform Monthly Subscription <br />Fees for Benefits-Ineligible Employees <br />Ineligible employees Monthly 1 0 USD 0.25 <br />ACA Measurement & Reporting Per Employee Monthly 1,200 1,200 USD 0.50 <br />OTHER SERVICES <br />Other Services Basis Billing Frequency Quantity Price per Basis <br />Implementation Flat Fee One-Time 1 USD 15,000.00 <br />ACA Fulfillment Per mailed form 1 USD 2.50 <br />Other Charges: Customer agrees to pay PlanSource fees for its use of the Services above based upon the outlined price per Unit, subject to t he <br />Minimum Quantity above. For any Services performed that are not outlined in this Order Form, additional fees will apply.