Orange County NC Website
9 <br />EXHIBIT A <br />BENEFITS WAIVER FOR ASSIGNED EMPLOYEES <br /> <br /> <br />AGREEMENT AND WAIVER <br /> <br />In consideration of my assignment to Client by NCAPHA, I agree that I am solely an employee <br />of NCAPHA for benefits plan purposes and that I am eligible only for such benefits as NCAPHA <br />may offer to me as its employee. I further understand and agree that I am not eligible for or <br />entitled to participate in or make any claim upon any benefit plan, policy, or practice offered by <br />Client, its parents, affiliates, subsidiaries, or successors to any of their direct employees, <br />regardless of the length of my assignment to Client by NCAPHA and regardless of whether I am <br />held to be a common-law employee of Client for any purpose; and therefore, with full knowledge <br />and understanding, I hereby expressly waive any claim or right that I may have, nor or in the <br />future, to such benefits and agree not to make any claim for such benefits. <br /> <br /> <br /> <br /> <br />EMPLOYEE <br /> <br /> <br />WITNESS <br /> <br /> <br />Signature <br /> <br />Signature <br /> <br />Printed Name <br /> <br />Printed Name <br /> <br />Date <br /> <br />Date <br /> <br /> <br /> <br />DocuSign Envelope ID: 78CB7A35-BD54-48BB-BDBB-5B6DA920511B