2016-665-E HR - Selerix Systems, Inc. for ACA filing terms and conditions

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DocuSign Envelope ID:9786A36A-88C6-45C6-8299-B927DCBC8AFC f. The fee for Electronic Submission of IRS Forms described shall be charged to the SUBSCRIBER for each Employer Identification Number file to be submitted. The one-time fee varies by employer size: Employers with fewer than 500 employees $500 Employers with 500 or more employees $750 2. Employee 1095-C Form Distribution SELERIX will cause the SUBSCRIBER's IRS Form 1095-C to be printed, inserted and mailed to employees on the SUBSCRIBER's behalf after SUBSCRIBER has reviewed and affirmatively approved SUBSCRIBER'S 1095-C forms. a. 1095-C forms will be printed, inserted and delivered to the US Postal Service("USPS) within 6 business days after receipt of the SUBSCRIBER's approval of the file. b. Selerix will require any third party printing vendors to have executed a Business Associates Agreement before any confidential data is transferred to such third parties. c. Selerix will provide SUBSCRIBER notice of the quantity and date of delivery of materials delivered to the USPS. d. The fee for Employee 1095-C Distribution described above shall be charged to the SUBSCRIBER based on the number of packages delivered to the USPS. The per package fee for the initial distribution is $1.50; if a package needs to be sent a second time, for any reason, the per package fee is$1.00. 3. SUBSCRIBER SERVICE ELECTIONS If"Electronic Submission of IRS Forms" is marked"accepted" immediately below, then Selerix will provide the services and SUBSCRIBER will have the obligations described in Section 1 above. If "Employee 1095-C Form Distribution" is marked "accepted" below, then Selerix will provide the services and SUBSCRIBER will have the obligations described in Section 2 above. Electronic Submission of IRS Forms(per Sec. 9 above)ACCEPTED x DECLINED Employee 1095-C Form Distribution (per Sec. 2 above)ACCEPTED_x_DECLINED C. SELERIX's provision of services to SUBSCRIBER does not include any consulting, legal, tax, or accounting professional services. D. SELERIX's obligations hereunder shall continue until the first to occur of the following, at which point SELERIX will no longer be required to provide to SUBSCRIBER or file on SUBSCRIBER's behalf any IRS Forms: (a) the SUBSCRIBER's IRS Forms have been accepted by the IRS; (b) May 31, 2017; or (c) SUBSCRIBER is no longer an authorized user of the Licensed Product. E. In addition to the limitation of liability agreed upon in the Subscription Agreement, under no circumstances will SELERIX or its related persons be liable to SUBSCRIBER or SUBSCRIBER's clients or customers for any consequential, indirect, special, punitive, or incidental damages or lost profits, whether foreseeable or unforeseeable,whether or not arising out of breach or failure of express or implied warranty, breach of contract, misrepresentation, negligence, strict liability in tort or otherwise, based on SUBSCRIBER's claims, including, but not limited to claims for use of the completed or filed IRS Forms or any services provided hereunder. F. IN ADDITION TO THE INDEMNIFICATION SET FORTH IN THE SUBSCRIPTION AGREEMENT, SUBSCRIBER SHALL INDEMNIFY AND HOLD HARMLESS TO THE EXTENT PROVIDED BY NORTH CAROLINA LAW SELERIX, ITS AFFILIATES, SUBSIDIARIES, SUCCESSORS, ASSIGNS, AGENTS, OFFICERS, DIRECTORS, REPRESENTATIVES, AND EMPLOYEES, FROM AND AGAINST ANY LIABILITY, CLAIMS,ACTIONS,DAMAGES OR LOSSES,FOR INJURY, INCLUDING DEATH, TO ANY PERSON OR DAMAGE TO ANY PROPERTY OR PROPERTY RIGHT ARISING OUT OF OR IN CONNECTION WITH SELERIX'S PROVISION OR FILING OF THE IRS FORMS OR ANY USE OF THE SAME BY SUBSCRIBER (COLLECTIVELY, A "LOSS"), EVEN IF THE LOSS RESULTED FROM SELERIX'S OWN NEGLIGENCE, BUT NOT IF THE LOSS RESULTED FROM THE GROSS ACA FILING TERMS AND CONDITIONS AMENDMENT PAGE 2