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8 <br />STATE RETIREMENT SYSTEMS FORAM <br />ATTACHMENT TO PROFESSIONAL SERVICES AGREEMENT <br />ALL SERVICE PROVIDERS MUST COMPLETE AND SIGN THIS FORAM <br />1. Does Service Provider have tweritwfve (25) or more employees? Q Yes ❑ No <br />IF YES: SKIP QUESTION 2, SKIP QUESTION 3, AND SIGN BELOW. <br />IF NO: ANSWER QUESTIONS 2 AND 3. <br />2. If a Service Provider employee will perform Work under this Professional Services Agreement, <br />did that emDloyee retire under the Public Employers' Retirement System (PERS); School <br />Employees' Retirement System (SERS), Teachers' Retirement System (TRS), or Law <br />Enforcement Officers and Fire Fighters plan (LEOFF)? ❑ Yes ❑ No <br />3. Answer the appropriate question below for Service Provider's business organization: <br />Sole Proprietor.. Did Service Provider retire under the Public Employers' Retirement. System <br />(PERS), School Employees' Retirement System (SERS), Teachers' Retirement System (TRS), <br />Law Enforcement Officers and Fire Fighters plan (LEOFF)? ❑ Yes ❑ No <br />Partnership. If a partner will perform Work under this Professional Services Agreement, did <br />that partner retire under the Public Employers' Retirement System (PERS), School Employees' <br />Retirement System (SERB), Teachers' Retirement System (TRS) or Law Enforcement Officers <br />and Fire Fighters plan (LEOFF)? ❑ Yes ❑ No <br />Limited Liability Company. If a member will. perform Work under this Professional Services <br />Agreement, did that member retire under the Public Employers' Retirement System (PERS), <br />School Employees' Retirement System (SERS), Teachers' Retirement System (TRS) or Law <br />Enforcement Officers and Fire Fighters plan (LEOFF)? ❑ -Yes ❑ No <br />Corporation. If a shareholder will perforin Work under this Professional Services Agreement, <br />did that shareholder retire under the Public Employers' Retirement System (PERS), School <br />Employees' Retirement System (SERS), Teachers' Retirement System (TRS), or Law <br />Enforcement Officers and Fire Fighters plan (LEOFF)? ❑ Yes ❑ No . <br />IF THERE IS A "YES" "ISWER. TO ANY PART OF QUESTIONS 2 OR 3, AN ADDITIONAL <br />QUESTIONNAIRE (AVAILABLE FRONI HR OR LEGAL) MUST BE FILLED OUT AND <br />SUBMITTED WITH THE CONTRACT. <br />Service Provider Name: <br />Aspect Consulting, LLC <br />Sr. Associate <br />v Erik An erseri. ' e <br />tu_a. - PrintedNarne Title: %-I LC <br />(REti,C:P Ci:I FC- THI AD TO k cd by City ALLOT ey'S 0M1ce TtuIne 13, 211_ 4) <br />71 <br />