PEO QUOTE | Millennium Medical Solutions Inc.

Company Name *

First Name *

Last Name *

Address *

Single Line Text

City *

State

Zip Code *

Phone # *

Email *

FT Employees #? *

PT Employees #? *

PEO/HRO

Are you Currently with a PEO? *

Yes

No

GENERAL HEALTH QUESTIONNAIRE

Is anyone currently pregnant? *

Yes

No

ACKNOWLEDGEMENT

MMS pecializes in connecting its clients with vendors who provide a wide variety of services such as, but not limited to, professional employment organizations (PEO), human resources organizations (HRO), administrative service organizations (ASO), payroll and insurance solutions, and more; and the Prospect/Client specifically authorizes MMS to act as an intermediary to obtain proposals from vendors who are able to provide the services sought by the ProspectClient;

Terms & Conditions

1. Services – MMS agrees to obtain proposals from third-party vendors who can perform the services sought by the Prospect/Client. The Prospect/Client reserves the option to enter into a contract with a vendor introduced by MMS. The Prospect/Client is under no obligation to enter into a contract with a vendor introduced by MMS.

2. Relationship of the Parties – The Parties understand and agree that MMS serves as an independent contractor. MMS is not an agent or employee of any third-party vendor that it solicits proposals from on behalf of the Prospect/Client. MMS is not acting in any fiduciary capacity to the Prospect/Client. MMS is not an advocate for the interests of the Prospect/Client or any third-party vendor.

3. Due Diligence – MMS routinely performs standard financial and legal background checks on the vendors that it solicits proposals from. MMS however, does not vouch, recommend, or endorse these vendors. The Prospect/Client is ultimately responsible for performing its own due diligence with regard to a vendor prior to entering into a contract with said vendor.

4. Indemnification – The Prospect/Client hereby waives, forever releases, discharges, acquits, and covenants to hold harmless and give up any monetary claims and rights against MMS, its officers, agents, employees, successors and assigns, for any claim it may have premised upon an action, omission, breach, or tort committed by a third-party vendor. To the fullest extent permitted by law, the Prospect/Client agrees to defend (including attorney’s fees), pay on behalf of, indemnify, and hold harmless the MMS, its officers, agents, employees, successors and assigns, against any and all claims, demands, suits or loss, including all costs connected therewith, and for any damages which may be asserted, claimed or recovered against or from the Broker, its officers, agents, employees, successors and assigns, which arise from any action, omission, breach, or tort committed

5. Payment – The Prospect/Client will at no time owe any compensation to the Broker for the services performed under this Agreement and Release. If the Client enters into a contract with a third-party vendor introduced by MMS, MMS will receive compensation solely from the third-party vendor.

6. Choice of Law – This Agreement and Release shall be governed by the laws of New York and adjudicated in New York courts.

I understand and agree to the terms set forth. If this is made by a corporation, its proper corporate officers sign and its corporate seal is affixed. This Agreement and Release may be executed in identical counterparts, each of which shall constitute an original and all of which shall constitute one and the same Agreement and Release.

By signing below you acknowledge that you agree to terms set forth above.

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