2012-09-26 CC Packet - Laserfiche WebLink

Home Browse Search

:) Plan Start Date: * Re• ires Certificate of Coverage, which can be obtain from each carrier, must be received within two weeks of application submittal. ERISAEd: • Admin. Only - Special Instructions (11) PAYPATH (A) Fast Track Applicati • Plan Information Number of Employees: Frequency of Payroll (Wee ly, Bi- Weekly, Monthly, etc.): Fast Track Application Proces equires a follow up "telephone application" appointment with a TASC representative who will obtain more detailed Payroll inf. mation from you and complete the application process. A representative will be contacting you shortly to setup an appointment ti ' e for this "telephone application" Preferred method of contact to schedu • "telephone application" appointment (phone or email): Best Time(s) to Contact: Owner /Principal's Guarantee Because I am an owner and /or principal of the employer iden.'fied in this Group Services Plan Application ( "Administrator ") and will benefit from TASC agreeing to provide the PayPath services .. Administrator, I agree to guarantee payment of all obligations of Administrator under the Group Services Application and Servi • - Level Agreement (together, the "Agreement "). This is an unconditional and continuing guarantee of payment of Administrator obligations. I agree that my guarantee shall not be released, in whole or in part, or discharged by: (i) the renewal, extension, mo.'fication or alteration of the Agreement; (ii) any waiver, release or termination of any right or remedy of Administrator under t - Agreement or the failure of Administrator to assert or claim any right, benefit, defense or remedy it may have under the Agre: ent; (iii) the invalidity or unenforceability of any of the payment obligations of Administrator; or (iv) the insolvency, bankruptcy, liq. idation or dissolution of Administrator. I expressly waive: (i) demand of performance or payment, presentment, protes notice of dishonor, or nonpayment of any of Administrator's obligations; (ii) notice of acceptance of this guarantee and notice of a • liability to which it may apply; (iii.) all other notices and demands of any kind; and (iv) any defenses of Administrator pertaining • its obligations except for the defense of discharge by payment. TASC shall not be required to pursue any remedies against Ad istrator as a condition to enforcement of my guarantee. Signature Date Printed Name TC -3923- 080111 Employer Initial I A.T 22