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CLIENT AFFIDAVIT OF ZERO WAGES FORM

Inactive Zero Wages Pay Period

I the undersigned owner of Client Company below hereby certifies that the Client Company is reporting ZERO WAGES for the Pay Period noted below, referred to commonly as an Inactivity Week of which I will pay a fee of $150 as per the Professional Employer Service Agreement.

Client Company affirms to Cornerstone Employer Solutions that it has NOT performed any of the following, directly or indirectly, during the Pay Period noted below:

1. Employed and/or paid in any manner any persons acting as an employee and has ZERO payroll to report.
2. Performed any work warranting payment or any compensation to any persons or employees.

3. Performed any work for Cornerstone Employer Solutions certificate holders, or implied workers compensation coverage under the Cornerstone Employer Solutions Professional Employer Service Agreement.

Further, I and Client Company hereby agree to release and hold harmless Cornerstone Employer Solutions and its respective affiliated companies, officers, directors, agents, employees, and insurance carriers from, and to indemnity each of them against any and all liabilities, obligations, contractual or otherwise, claims and causes of action for renumeration, injury, death, disease, or employer liability arising from or in connection or arising during the Pay Period noted below.

This hold harmless and indemnification includes, but is not limited to any and all (i) workers compensation coverages or liabilities, (ii) employment related requirements or liabilities, (iii) employment related taxes or required filings, and/or (iv) obligations under the Professional Employer Service Agreement.

Under penalty of perjury, I certify that the information presented in this affidavit is true and accurate. I the undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of the Professional Employer Service Agreement and any remedies at law or equity