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'0 <br />Client File Requirements Checklist for PEO/CBP MATRD <br />4;neSOurce <br />A Vensure Employer Services Company <br />Information and Checklist <br />Client Name:Valrose Investment Group LLC Date: 03/02/2022 <br />Consultant/Broker: Thomas Deming <br />EOriginal signed and dated Client Service Agreement with all necessary exhibits <br />El Signed Exhibit "A" <br />F] 3 -Years loss runs or signed "Loss History Affidavit Form" if no losses. Plus Request (PEO) <br />F-1PEO-CBP closed deals require Certificate of Work Comp. Insurance naming "MatrixOneSource" as the cert <br />holder. Loss runs are not required for GBP deals. <br />Completed "Client Set -Up Sheet" <br />Signed "Issuing a Certificate of Insurance" form <br />ZCompleted Employee Enrollment Applications for All Current Employees <br />`If applicable- EE Child Support Deduction Agreement <br />PEO-CBP closed deals require work comp. disclosure signed by each employee <br />ESigned "Retention of 1-9 Forms" <br />F Enrollment Forms Orientation: BC (initials): <br />FReporting Accident Procedure Form: BC (Initials): <br />Client (Initials): JG <br />Client (Initials): JG <br />Certificate of Insurance for General Liability (Work Comp if CBP) & (and Auto, if applicable) listing the certificate <br />E! holder as: "MatrixOneSource" <br />G.L. Certificate must be received by Matrix within 72 business hours. <br />Client Profile Submission (Page 2) signed by the owner / principal <br />- -- ------------- - - ---- <br />Website Forms BC (initials): Client (Initials): <br />Workers' Comp. request form enclosed (if applicable) <br />DOL Overtime Form <br />N Deductible Program <br />Collateral Required <br />Notes/Remarks: <br />Valrose Enterprises Inc., DBA Awnings By Valrose reassigning employees and payroll to Valrose Investment group LLC <br />Please Use EXISTING DIRECT DEPOSITS ON FILE <br />Business Consultant Signature: <br />Date: 03/02/2022 <br />MOSFORM-FULLPEOENROLLMENTPACK 1 @2020 MatrixOneSource <br />