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DocuSign Envelope ID:97D49820-FEB8-4DCA-BA8C-7909CD9FA2F9 <br /> IRS(January—December of reporting year).SUBSCRIBER acknowledges the <br /> delivery of services is for the reporting calendar year. <br /> (2) Payment Terms.SUBSCRIBER agrees to pay the fees set forth above.Invoices Will <br /> be sent on a quarterly basis lin advance for all components provided by SELERIX. <br /> Payments are due upon receipt of the invoice and delinquent on the 30th day after <br /> the date of the invoice. <br /> (3) Any amount not paid before becoming delinquent shall thereafter bear interest unlit <br /> paid at a rate equal to The lesser of one and one half percent(1 V%)per month or the <br /> maximum rate allowed by applicable law. <br /> 3) Optional 1095-C Form Fulfillment. <br /> SUBSCRIBER may request 1 095-C Form Distribution services,in writing.If such r-iwuest is <br /> made SUBSCRIBER and accepted by SELERIX in its sole discretion,then: <br /> a. SELERIX.will have the following responsibilities: <br /> II I) SELERIX will cause the SUBSCRIBERS IRS Form 1095-C to be printed,inserted <br /> and mailed to employees on the SUBSCRIBERS behalf atter SUBSCRIBER has <br /> reviewed and affirmatively approved SUBSCRIBERS 1095-C forms. 1095-C forms <br /> will be printed„inserted and delivered to the USPS within 14 business days after <br /> receipt of the SUBSCRIBER's approval of the file.SELERIX will provide <br /> SUBSCRIBER notice of the quantity and date the 1095-C materials that were <br /> delivered to the USPS. <br /> (2) SELERIX requires third party printing vendors to have executed a Business <br /> Associates Agreement before any confidential data is transferred to such vendors. <br /> SUBSCRIBER will have The following responsibilities: <br /> (I) SUBSCRIBER is responsible to review the Employee's 1095-C forms and provide <br /> written approval to SELERIX. <br /> b. 1095-C.Form Distribution Services Fee Structure <br /> The fee is based on the number of packets delivered to the USPS.The per package fee <br /> for the initial distributions is$1.50;if a package needs to be sent a second time for any <br /> reason,the per package fee is$1.00. <br />