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nt Service Agreement FUGA �� R Clie g ( ) i1nnource A Vensure Employer Services Company J. No rights of any third party are created by this Agreement and no person that is not a party to this Agreement may rely on any aspect of this Agreement. K. In the event that any provision contained in this Agreement is held to be unenforceable by a court of competent jurisdiction, the validity or enforceability of the remainder of this Agreement shall in no way be affected or impaired thereby. L. This Agreement shall be valid and enforceable only upon the signature below by an authorized Controlling Person of Matrix. REPRESENTATION REGARDING AMOUNTS OWED: Client represents and warrants that it does not owe (i) any current or prior employee leasing company amounts under a service agreement or (ii) any current or prior insurance company any premium for workers' compensation insurance. If Client is located or has employees in the state of Florida, Florida law provides that Client shall not enter into an employee leasing relationship or be eligible for workers' compensation coverage from an insurer if Client owes amounts to any employee leasing company or premium for workers' compensation insurance to any insurer. Effective as of the effective date indicated and written by an authorized Matrix representative below. Client Business Name: Valrose Investment Group LLC Client Representative Name: Client Representative SignatL Title: Owner nate: INFORMATION BELOW MUST BE COMPLETED BY OR ON BEHALF OF CLIENT:: DBA of Client: (if Client does business under a name other than its legal name (i.e. a trade name), print D/B/A above) Client's FEIN: 87-3780349 Georgia Only: Client's Georgia Department of Labor Account No.:: Physical Address of Client: 4450 E. 11 th Ave Hialeah FL 33013 MATRIXONESOURCE: a d/b/a of: By: Print Name: Title: MOSFORM-FULLPEOENROLLMENTPACK III Mailing Address (if different from Physical Address): Date: @2020 MatrixOneSource