EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION Position Applying fon 0 Full-lime O Part-Time O Sasonal SMTWIFSat. Hours Available: and/or its affiliate Ls an Equal Opportunity Employer. We consider applicant for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other legally protected status. NAME Pint Middle Last Sodal Security Number 1 An you at least 18 yen of age O Yes O No Present Street Address • City State Bp Previous Street Address City State Zp Phone Number Alternative Phone Number Are you a US. Gtizen or an you provide venticabon of your legal right to work in the United States O Yes O No Position Desired ci pa Tim, 0 Part Time Date Amiable for Work Have you ever been employed by O Yes C. No Position: • ? _Deter; ' List rums of Mends or relatives now employed b) Met/or its affiliate List offia machines you an operate Rndude WPM and Shorthand) List other equipment you can operate Do you have any special slalh or training related to the position sot;shrt EDUCATION Name of Institution City & State Circle Last Year Completed High School 9 10 11 12 College 1 2 3 4 Graduate School Degree received O Ye 0 No Other r lvaLITARY SERVICE BRANCH Rank Attained Date Entered Date of Cischarse EFTA00316431 EMPLOYMENT: Include all previous jobs starting with the present or most recent. May we contact your present employer? 0 Yes 0 No L Employer Petition Held & Duties AvICIISS Phone 140. Supervisor Datm Employed Fre= To: Rale Pang — Ending Reason foe Leming . - 2. Employer Position Held &Duties Adams PhomNo. Supervisor Data Employed • Pitt To: Pay Rate Stardsc Ending: Reason forEeaving 3. Employer Position Hdd &Duties; Address Phone No. Supervisor Dates Employed Prom: . To: Pay Rate Stanley Endlny Reason for Leaving Have you ever been convicted of a felony or a misdemeanor (other than minor traffic violations)? 0 Yes 0 No If pm, Please explain: PLEASE READ THIS STATEMENT CAREFULLY I agree to comply with all rules of this Company. I understand that any falsification or omission of information provided on this application or while inteniewing will be grounds for dismissal from employment, even if not discovered until after my separation from the Company. I authorize a thorough investigation to be made in conjunction with this application concerning my charade:, genera/ reputa Sonpersonal characteristics and mode of living. whichever maybe applicable. I understand this investigation may include pasonal interviews +rah third parties, such as family members, business asscciates,financial sources,friends,neighbon or others with whom lam acquainted. If len hired, Tape. that my employment and compensation can be terminated with or without G.useand with or without notice at any time, al tie option of theCompary or myself. (understand that no other representative of theCornpany other than thePresidentof N. A. Property, Inc. has the authcci ly to modify this agreement In any way, and that a ny such modification must be in a writing signed by both the Prudent and myself. I have read and affirm the above statement as my own. Signature Chit gr... I /13 EFTA00316432 U.S. Department of JuStIfe Inuarigm Km and Namslization Service OkeNo UlSeijo Employment Eligibility Verification Please read instructions carefully before completing this form. The instructions must be available during completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work eligible individuals. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because of a future expiration date may also constitute Illegal discrimination. Section 1. Employee Information and Verification. To be completed and signed by employee at the time employment begun. Print Name Last First Middle Initial Maiden Name Address IStrece Name end Numbed Apt • Date ol act, fmonrh/day•prarj City State Zip Code Social Security 0 I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest. undo: moony of perjury. O A citizen or national of the 0 A Lawful Permanent Resident 0 An that I am (check one or the 1011Ovong) United States (Allen ff A wok until / I alien authorized to (Alien 0 or Admission ff) Employee's Signature Date (mumble:by/year) Preparer and/or Translator Certification. (Toort completed end signed Section lhaeparedbyaperson *Mee Mon Me empinyet fl attest. under penalty Of perjury. that have assdred on /he complenon of knit ram end that Mine best of my knowledge the esformanon is true end correct. Preparees/Translator's Signature Pint Name AddreSS (Sneer Name and Artmeter. City. State. Zp Cede( Date (rnonthidaylyear) Section 2. Employer Review and Verification. To be completed and signed by employer. examine one document from lilt A OR examine one document from Ust B and one from list C, as aged on the reverse of ma form, and record the title, number and expiration date, art. of the documental List A OR List Et AND List C Document title' *.3 I'l Issuing authority .4 Document • E'i Cagayan Date (I any) —1—l— —1.—1 _ i. . ' ig% i' Document • Expiration Dote re any) —I—I— CERTIFICATION - I attest. under penalty of perjury. that I have examined the document(s) presented by the above-named employee. that the above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on (month/day/year) _1_1_ and that to the best of my knowledge the employee is eligible to work in the United States. (State employment agencies may omit the date the employee began employment.) Signature of Employer or Authorized Representative /— Print Name Title Rosiness or Organization Name Monist (Sure( Name and Number. City. SOM. Zsp SOW Date (month/Joy/Sad Section 3. Updating and Reverificatlon. To be completed and signed by employer A New Name (d oppecable) B. Date ol Attlee (monmicieneer) appfrobV) C. 11 employee's previous grant Cl work authorization has expired. pantie the edormati0n below for the document that establishes Gummi employment eligibility. Document Title Document .arratIon Date tif any}.__ 1 I attest, under penalty or ventaty. that to the best of my knowledge. 014 employee te eigiblv to work in the United States. and if the employee situated docum ent(s). the document()) I have examined appear to be genuine and to retie 10 Ike Int/MMUS Signature of Employer de Authorized Representative Date (Month/day/yead Form 1.9 INt. i1.714111fferit 2 EFTA00316433 LISTS OF ACCEPTABLE DOCUMENTS LIST A Documents that Establish Both Identity and Employment Eligibility 1. U.S. Passport (unexpired or expired) 2. Certificate of U.S. Citizenship (INS Form N560 or N•561) 3. Certificate Of Naturalization (INS Form N•550 or N•570) 4. Unexpired foreign passport, with 1-551 stamp or attached INS Form 1.94 indicating unexpired employment authorization 5. Permanent Resident Card or Alien Registration Receipt Card with photograph INNS Form I-151 or 1-5511 6. Unexpired Temporary Resident Card (INS Form I-6891 7. Unexpired Employment Authorization Card (INS Form I-688A) 8. Unexpired Reentry Permit (INS Form 1-327) 9. Unexpired Refugee Travel Document IIN$ Form 1-5711 OR 10. Unexpired Employment Authorization Document issued by the INS which contains a photograph (INS Form /6888) LIST Documents that Establish Identity AND 1. Driver's license or ID card issued by a state or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color and address 2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color and address 3. School ID card with a photograph 4. Voter's registration card 5. U.S. Military card or draft record 6. Military dependent's ID card 7. U.S. Coast Guard Merchant Mariner Card 8. Native American tribal document 9. Driver's license issued by a Canadian government authority For persons under age 18 who are unable to present a document listed above: 10. School record or report card 11. Clinic, doctor or hospital record 12. Day-care or nursery school record LIST C Documents that Establish Employment Eligibility 1. U.S. social security card issued by the Social Security Administration (other than a card stating it is not valid for employment) 2. Certification of Birth Abroad issued by the Department of State (Form FS.545 or Form DS. 1350) 3. Original or certified copy of a birth certificate issued by a state, county. municipal authority or outlying possession of the United States bearing an official seal 4. Native American tribal document 5. U.S. Citizen ID Card (INS Form 1-1971 6. ID Card for use of Resident Citizen in the United States (INS Farm I-1791 7. Unexpired employment authorization document issued by the INS (other than those fared undo List Al Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-2741 faun 19 (Rev lOPleff line? EFTA00316434 Form W-4 (2017) The exceptions don't apply to supplemental wages Nonwago Incense If you have a largearnount of greater than 31.000.000. nonwage Income, such es interest or 6vIderets, cosider making estimated tax payments uskg Form Bask Instructions. If you anal exempt. complete 040.ES, Estimated Tax kr Individuals OthervAse Purpose. Complete Form W-4 so that your the Personal Allowances Worksheet below. The you may owe see Pal tax. Ilse hanponsion or employer can wthhoki the correct federal income worksheets at page 2 further adjust your annuity Income, see Pub. 505 to find out if you shoed W-4 each year and when your or financial tax from your pay. Consider 4 anew Form vAthholding allowances bawd on itemized deductions. certain credits, actustments to Income, &gust your withholding an Font W-4 orW-CP. 'Mahon changes. or two.earners/nxitiple jobs situations. Two earners or multiple jobs.11 you tan a Exemption from withholding. II you are exempt. Complete all worksheets that apps.. Ho ever, you working spouse or more than me jOb. Nun) the complete only fines 1.2.3,4.3nd 7 and sign the may claim fewer for zero) allowances. For regular total number of allowances you ale era US to claim form to vadat. n. You Son for 2017 expires wages, withholding must be based on allowances on all lobs usng worksheets from on& one Form February 15.2018. See Pub. , Tax Wertholdng you claimed and may not be a Dal amount or vi-4. Your w:thhold.ag usually wis be most accurate and Estimated Tax. Percentage of wages. when el allowances are claimed on tee Form W.s for the highest payng job and :aro alcwances are Note: II another person can dam you as a dependent Head of household. Genomay. you can claim head claimed on the others. See Pub 505 for octets. on Ns Or her lax return, you Can't clam exemption of househed ng status on your tax retum only if from withholding if you, total income exceeds 21,050 You are UnnianiC4 and pay more than 50% of the and include, mire than 5350 ol unearned :mom, (for oasts of keeping up 0 home for yourself and your example, interest and dvidends). dependent(s) or other . qualify:re indrAdvals. See Pub. 601, Exe mason 5. Standard Deduction, and Check your withholding. After your Form W.4 takes &captions. An engto may be able to claim Filing Information, for Information. effect, use Pub. 505 to see how the Whaunt you are exemption from wit mg even if the employee is a dependant, il the employee: Tex credits. You can take Protected tax credits into having withheldcompares to your preeleted total tax account In !goring your 1.10Wable number of Sot 2017. Se* Pub. 5.•speaelly itwur earnings • Is age es welder. exceed 5130.000 (Singe) or withhold atokrxxes. Credits for aid or dependent • Is Win& or care expenses and the Child tax credit may be claimed Future developments. Information about any future 'AIN the Persona: Allowances Worksheet below. developments affecting Form W.4 (such as • WI claim adjustments to income; tax credits: or See Pub. 505 for nformation on converting your other legislation enacted after we release le mll be Posted Iternad asuman'', on Ns or her tax tram. erodes Into withholding allowance& at mvw.ara.gcrelw4. Personal Allowances Worksheet (Keep for your records.) A Enter "1" for yourself if no one else can claim you as a dependent A • You're single and have only one job; or { B Enter "1" if: • You're married, have only one job, and your spouse doesn't work; or • Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less. C Enter "1" for your spouse. But, you may choose to enter --O." if you are married and have either a working spouse or more than one job. (Entering *-0-- may help you avoid having too little tax withheld ) C D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return 0 E Enter "1' if you will file as head of household on your tax return (see conditions under Head of household above) . E F Enter "1" If you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit . . F (Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.) G Child Tax Credit cncluding additional child tax credit). See Pub. 972. Child Tax Credit, for more information. • II your total income will be less than $70,000 ($100,000 if married), enter "2" for each eligible child; then less "1" if you have two to four eligible children or less "2' if you have five or more eligible ctildren. • If your total income wal be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter -1- for each ellgtle chid. G H Add linos A through 0 and enter total here. (Note: This may bo afferent from the number of exemptions you claim on your tax robin.) * H • If you plan to itemize or claim adjustments to Income and want to reduce your withholding, see the Deductions For accuracy. and Adjustments Worksheet on page 2. complete all • If you ere single and have more than one job or are married and you and your spouse both work and the combined worksheets earnings from all lobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 that apply. to avoid having too tittle tax withheld. • II neither of the above situations applies, atop hero and enter the number from line H on line 5 of Form IN-4 below. Nonresident alien, II you are a nonresdent alien, see Nalco 1392. Supplemental Form W -4 instructions tor Nonresident Aliens, before correlating alis Separate hero and give Form W-4 to your employer. Keep the top part for your records. Fenn W-4 ofeeetnstro el the UMW( Internet pane Sete Employee's Withholding Allowance Certificate li. Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject to review by the WS. Your employer may be required to send a copy of this form to the IRS. OMB N0.1645-0074 2017 1 Your first an ad middle Initial last name 2 Vow social security number Home address ( umber and street or rural route) 3 O Slop O Maned O Married, but withhold at riper Stele nate. Note: IlmaMed. NA leg* separated, or spouse is a norresiderl alitncheck to 'Sip' box. City or town, state, and DP code 4 If your last name differs from that shown on your social security card, chock here. You must call 1.900.772.1213 fora replacement card. IP O 5 6 7 Total number of allowances you are claiming (from line H above or from the applicable worksheet on Additional amount, if any, you want withheld from each paycheck I claim exemption from withholding for 2017, and I certify that I meet both of the following conditions • Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, • This year I expect a refund of all federal Income tax withheld because I expect to have no tax liability If you meet both conditions, write "Exempt" here * I page 2) for exemption. and 5 8 $ 7 1 Under penalties of perjury. I declare that I have examined this certificate and, to the best of my knowledge and belief, it Is true, correct, and complete. Employee's signature (This form is not valid unless you sign it.) ► 8 Employees name and address (Employer. Complete lines 8 and 10 only if sending to the IRS.) 9 Offas coda Options) Date ► 10 Employer kleaticalion number (OM For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 102200 Fonts W-4 (2017) EFTA00316435 Form W-4 12017) Deductions and Adjustments Worksheet Note: Use this worksheet only If you plan to itemize deductions or claim certain 1 Enter an estimate of ycer2017 ?remind deduction These incbie (edifying home and local taxes. medal expenses in excess of 10%d your income, and miscellaneous your itemized aducCons if your income is over $313,800 and you're married ling jointly if you're head of householot $261,500 it you're single, not head d hettselice and married ling separately. See Pub. 505 for dela 2 Enter: { $9,350 If head of household S12,700 If married filing jointly or qualifying widower) $6,350 if single or married filing separately 3 Subtract line 2 from One 1. II zero or less, enter "-0-" 4 Enter an estimate of your 2017 adjustments to income and any additional 5 Add lines 3 and 4 and enter the total. (Include any amount for credits Withholding Allowances for 2017 Form W-4 worksheet in Pub. 505.) 6 Enter an estimate of your 2017 nonwage income (such as dividends 7 Subtract line 6 from line 5. If zero or less, enter "-0-' 8 Divide the amount on line 7 by $4,050 and enter the result here. Drop 9 Enter the number from the Personal Allowances Worksheet, line 10 Add lines 8 and 9 and enter the total here. If you plan to use the Two-Eamers/Multiple also enter this total on line 1 below. Otherwise, stop here and enter credits or adjustments mortgage interest, chantable contributions, deducUons. For 2017, you may have or you're a obifying widowlert not a qualifyng Mdow(er) or $156,900 standard deduction (see from the Converting or interest) any fraction H, page 1 Jobs Worksheet, this total on Form W-4, fine to income. state to reduce $287,650 II you're I $ 2 $ 3 $ Pub. 505) 4 $ Credits to 5 S 6 $ 7 $ 8 9 5, page 1 10 Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.) Note: Use this worksheet only if the instructions under line H on page 1 direct you here. 1 Enter the number from line H, page 1 (or from Me 10 above if you used the Deductions and 2 Find the number In Table 1 below that applies to the LOWEST paying job and enter you are married filing jointly and wages from the highest paying job are $65,000 a than sr 3 If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result "-0-") and on Form W-4, fine 5, page 1, Do not use the rest of this worksheet Note: If line 1 is less than line 2, enter *-0-" on Form W-4, line 5, page 1. Complete lines figure the additional withholding amount necessary to avoid a year-end tax bill. 4 Enter the number from line 2 of this worksheet 5 Enter the number from line 1 of this worksheet 6 Subtract line 5 from line 4 7 And the amount in Table 2 below that applies to the HIGHEST paying job and enter 8 Multiply line 7 by line 6 and enter the result here. This Is the additional annual withholding 9 Divide line B by the number of pay periods remaining in 2017. For example. divide by 25 weeks and you complete this form on a date in January when there are 25 pay periods the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld Adjustments Worksheet) it here. However, less, do not enter hero (if zero, 4 through 9 below 4 1 if more 2 enter 3 to 5 it here . needed if you are paid remaining in 2017. from each 6 . . . 7 $ . . 8 $ every two Enter paycheck 9 $ Table 1 Table 2 Married Filing Jointly All Others Married Filing Jointly All Others If wages from LOWEST Ps/0900 be— Enter on Met above a wages from LOWEST paying jab are— Enter on line 2 about a wages from HIGHEST paying job are— Enter on line? above If wages from HIGHEST paying fob are— Enter on Erie? above SO • $7,000 7,001 • 14003 14,001 - 22.030 22.031 - 27,000 27.001 • MOO 35001 - 44,000 44,001 - 55,000 55.801 • 65,000 65,001 - 75000 75001 • 80000 80,001 - 95000 91,001 - 115,000 113,001 • 130.000 130,001 - 140.000 140.001 • 130.000 150,001 and over 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 SO - 38,000 8.031 - 16= 18,001 - 26.000 26,001 - 34,000 34,001 - 44,000 44.001 - 70,000 70,001 - 85,000 85,001 - 110,000 110001 - 125,000 125001 • 140000 140.031 and over 0 1 2 3 4 5 6 7 8 9 ID So - 575000 75,001 • 135,000 135,001 • 205,000 205001 - 360300 360,001 • 405.000 405,001 and over $610 1,010 1.130 1,340 1,420 1.600 SO • 336,000 38,001 - 85,000 85,001 • 185.000 185,001 - 480303 400,001 and over $610 1,010 1.13O 1340 1.600 Primo/Ad and Paperwork ReductionAd Negev. We ask kr en Worm eon on Ws tom 10 Cam 0ul se Interne/ Firrecue laws of the UnitedStates. Internal Revenue Code seders 34028SZ and 6109 and Mrr rely:rations requireyea he provide this Inhormaumg yore enlyieyee uses h to detente sour Waal mcome tax vat/sold:4 Fare to provide wooed/ completed Mtn mil result r your berg unto) as a sin M person who claims no wthhoicing shthswees; preys:rig frauctlera mayfraece may sailed you to penises. Routine uses d this isthrmatial incitte givrg it to the Depalment 01Justke bore and criminal Stylists t0 cities. states. be OeMc10l Columba. and U.S. cannicermearem and possessions lee use is administering their tie Imes and to the Department of Health and Kann Sevicos br use n the Natanal Ornate, of New Hires Wo may also declass this information to other countries under a lax 8,1.SY, to fader& and sate agonies booboo federal nontax amnai laws. or to !criers law mimeo-nen! Lid intelligence agencies to combat terrorism. Page 2 You are not required to provide the inforrnahon requested on • form that is subject to the Paperwork Reduction Act unless the form displays a weld OM control number. Books or records relating toe form or Its instructions must be retained as long as their contents may become material n the administration of any Internal Revenue Law. Generally. lax returns and return inkanation ate confidential, as re:pared by Code section 6103. The average time and expenses required to complete and fit this am wil vary depending on individual circumstance,. For estimeted averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we woad be happy to hoer Iron you. See the instructions for your Income tax return EFTA00316436 CONFIDENTIALITY AGREEMENT In order to induce NES, LW ("NES") to consider the undersigned for employment or engagement as an independent contractor to provide services, including, without limitation, services with respect to NES, Jeffrey Epstein ("Epstein") and any of the Epstein Companies (as hereinafter defined) and real property directly and indirectly owned or occupied by NES, Epstein or any of the Epstein Companies (the "Properties"), and in consideration of any employment or engagement that the undersigned may obtain with NES, Epstein or any of the Epstein Companies, whether with respect to the Properties or otherwise, and any compensation or other remuneration to be hereafter paid to the undersigned in connection therewith, the undersigned, (hereinafter sometimes referred to as the Applicant"), acknowledges that the Applicant has been informed of the Applicant's obligations hereunder and that such obligations are a condition to the consideration by NES, Epstein or any of the Epstein Companies of the Applicant's employment or engagement, and to any employment or engagement that the Applicant may obtain, and the Applicant hereby agrees as follows: Section 1. Term of Employment; Termination. In the event that the Applicant is hereafter employed or engaged as an independent contractor by NES, Epstein or any of the Epstein Companies, the Applicant agrees and understands that nothing in this Agreement shall confer any right on the Applicant with respect to the grant or continuation of the Applicant's employment or engagement as an independent contractor. The Applicant further agrees and understands that, in the event that the Applicant is employed or engaged as an independent contractor, any breach of this Agreement by the Applicant will result, in addition to any and all other remedies which may then be available to NES, Epstein or any of the Epstein Companies, as the case may be, in the Applicant's immediate termination. Section 2. Confidentiality Obligations of the Applicant. 2.1 Definition of Confidential Information. (a) For purposes of this Agreement, the term "Confidential Information" shall mean any "Business Information" (as hereinafter defined) and any "Personal Information" (as hereinafter defined) about any of: (i) the Properties or any other real property owned or occupied directly or indirectly by any of NES, Epstein or any of the Epstein Companies; (ii) NES, (iii) Epstein; (iv) any and all corporations, limited liability companies, trusts, limited partnerships, general partnerships or other entities with which Epstein is affiliated ("Epstein Companies"); (v) any of the members, managers, directors, officers, shareholders, limited partners, general partners, trustees, beneficiaries, employees, contractors or agents of NES, Epstein or any of the Epstein Companies; (vi) any person residing at, visiting or staying for any duration at any of the Properties; and (vii) any personal associate, business associate or client of any of the persons described in the above clauses (ii) through (vi), inclusive; previously or hereafter gathered or learned by the Applicant directly or indirectly during the course of the any interactions between the Applicant, on the one hand, and any of NES, Epstein and/or any of the Epstein Companies, or any representatives of NES, Epstein or any of the Epstein Companies, on the other hand, including, without limitation, during the course of Applicant's application for employment or engagement by NES, Epstein or any of the Epstein Companies and/or in connection with any employment or engagement of the Applicant by NES, Epstein or any of the Epstein Companies. EFTA00316437 (b) For purposes of this Agreement, the term "Business Information" shall mean information of any type which is commonly considered of a confidential nature and includes, but is not limited to, any information (whether in oral, written, photographic, electronic or other recorded form) regarding the existence, identities, contact information, and business records of; the business plans of; mechanized or nonmechanized systems of accounting of; IT related systems or information of; methods of doing business of; vendor information (including, without limitation, existence, identities, contact information, records, fees, and disbursements of, and services and materials provided by, any and all vendors, contractors, consultants, and professional advisors) of; confidential business lists and other proprietary data of; assets of; investment strategies, transactions, records, procedures and history of; financial records of; the skills, business activities, compensation and financial net worth of; and any other information of a similar nature about; any of the persons or entities set forth in Section 2.1(a) (the "Classified Parties"). (c) For purposes of this Agreement, the term "Personal Information" shall mean information of any type which is commonly considered of a personal nature and includes, but is not limited to, information (whether in oral, written, photographic, electronic or other recorded form) regarding the identities of; contact information of; personal characteristics of; physical descriptions of; non-business activities of; IT systems and information of; personal assets of; personal records of; personal plans of; personal lifestyles of; relationships of; friends of; relatives of; individuals who associate with or who are invited to associate with; and any other information of a similar nature about; any of the Classified Parties; and shall also include, without limitation, the appearance and exterior and interior layout of, any and all improvements on, and furniture, furnishings, and other items of personal property contained anywhere in or on, any of the Properties or any other real property directly or indirectly owned or occupied by NES, Epstein or any of the Epstein Companies. 2.2 Confidential Information Shall Not Be Discussed. At all times hereafter, the Applicant will hold in the strictest confidence and will not, directly or indirectly, use, communicate, publicize, lecture upon, publish or in any manner disclose any Confidential Information, unless NES has expressly authorized in writing such use, communication, publicizing, lecturing, publication, or disclosure. The Applicant hereby assigns to NES any and all rights the Applicant may have or acquire in any Confidential Information and acknowledges that all Confidential Information shall be the sole and exclusive property of NES. The Applicant further agrees and acknowledges that under this Agreement, the Applicant is obligated to use the Applicant's best efforts to ensure that no Confidential Information is used, communicated, publicized, lectured upon, published or disclosed by any persons employed or engaged by the Applicant or under the Applicant's supervision or control. To the extent that the Applicant has any doubts, either now or in the future, as to whether information the Applicant possesses is Confidential Information as defined herein, the Applicant will contact NES, for written clarification and approval before divulging or using such information in any manner whatsoever. 2.3 Third Party Information Shall Not Be Disclosed. The Applicant understands that the Applicant may receive Confidential Information from third parties, as well as from NES. The Applicant acknowledges and agrees that Confidential Information which the Applicant receives from third parties is to be treated in the same manner as Confidential Information received from NES and that all of the Applicant's obligations hereunder apply to all Confidential EFTA00316438 Information received, regardless of its source. 2.4 Return of Documents. Upon demand by NES, and upon the expiration or termination of any employment or engagement as an independent contractor of the Applicant by NES, regardless of the reason or basis, if any, for such expiration or termination, the Applicant will deliver to NES any and all documents, written materials, notes, drawings, photographs, specifications and any other materials of any type or nature whatsoever (whether in written, photographic, electronic or other recorded form) which the Applicant has in the Applicant's possession or control, and all drafts, copies and electronic file copies of all or any part thereof, which may constitute, include, reflect or disclose any Confidential Information. Section 3. Review of Agreement. The Applicant acknowledges that the Applicant has read this Agreement, and that the Applicant has had the opportunity to review it and consult about it with the Applicant's own counsel if the Applicant so desires, before signing it. Section 4. Conflicts. 4.1 Avoidance of Conflict of Interest. If the Applicant is or subsequently becomes employed by NES, Epstein or any of the Epstein Companies (rather than being engaged as an independent contractor), the Applicant agrees that during the term of any such employment, so long as the Applicant is employed on a full-time basis, the Applicant will not, without the express written consent of NES, engage in any employment with any third party, or engage in any other business activity that would in any way conflict with the performance of the Applicant's duties of employment. 4.2 No Conflicting Obligations. The Applicant warrants and represents that the Applicant has not heretofore violated any provisions of this Agreement and that the Applicant has not entered into, or made, and agrees that the Applicant will not enter into or make, any written or oral agreement, undertaking, promise, or representation that conflicts with or violates the provisions of this Agreement or otherwise impairs the Applicant's ability to strictly perform the Applicant's obligations under this Agreement or to fully comply with the provisions of this Agreement. The Applicant further warrants and represents that the Applicant is not subject to any subpoena, injunction, decree, writ or order of any court or other authority or to any other duty or responsibility, legal or otherwise, which conflicts with the provisions of this Agreement or otherwise impairs the Applicant's ability to strictly perform the Applicant's obligations under this Agreement or to fully comply with the provisions of this Agreement. The Applicant shall immediately inform NES should the Applicant subsequently become subject to any such subpoena, injunction, decree, writ, order, duty or responsibility. Section 5. Remedies. 5.1 Equitable Relief. The Applicant acknowledges that the Confidential Information constitutes unique and confidential information of NES and the Classified Parties and in the event of a breach or a threatened breach of this Agreement, NES and any affected Classified Parties, will be irreparably harmed and there will be no adequate remedy at law. Therefore, in 3 EFTA00316439 addition to any and all other rights and remedies NES and any such Classified Parties may have, NES and such Classified Parties shall be entitled to injunctive or other equitable relief in the event of a breach or threatened breach hereof and the Applicant hereby waives any right to assert as a defense that there is an adequate remedy at law. 5.2 Liquidated Damages. In addition to any and all other rights, remedies or damages available at law or in equity, the Applicant agrees that if any court of competent jurisdiction finds that the Applicant has breached any of the provisions of this Agreement, the Applicant will pay NES or any affected Classified Party the sum of One Hundred Thousand ($100,000.00) Dollars, as liquidated damages and not as a penalty. The Applicant recognizes and understands that it would be difficult or impossible to calculate the actual amount of damages resulting from such a breach, and acknowledges that the sum of One Hundred Thousand ($100,000.00) Dollars would be reasonable under the circumstances. Section 6. General Provisions. 6.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of New York applicable to contracts executed, delivered and to be fully performed in such jurisdiction, without giving effect to the principles of conflicts of law. 6.2 Severability. If one or more of the provisions of this Agreement are deemed invalid or unenforceable by law, then the remaining provisions hereof will continue in full force and effect, without regard to the invalid or unenforceable provision or provisions hereof, as the provisions of this agreement are intended to be and shall be deemed severable. 6.3 Survival. The provisions of this Agreement shall continue in full force and effect, regardless of whether the Applicant is ultimately employed or engaged by NES, Epstein or any of the Epstein Companies, and if the Applicant is so employed or engaged, the provisions hereof shall survive the expiration or termination of any such employment or engagement of the Applicant, regardless of the reason or basis, if any, for such expiration or termination. 6.4 Binding Effect. This Agreement and all of the provisions hereof shall inure to the benefit of, and be enforceable by, NES, and its successors and assigns, and shall be binding upon the Applicant and the Applicant's heirs, personal representatives, successors and assigns. This Agreement is intended for the benefit of and to be enforceable by NES and by the Classified Parties as third-party beneficiaries of this Agreement. 6.5 Waiver. No waiver of any provision of this Agreement shall be valid unless expressly given in writing, signed by the party against whom such waiver is sought to be enforced, and specifying the specific instance and the specific purpose for which such waiver is given. Each such waiver, if any, shall be effective only for the specific instance and for the specific purpose for which it is given. No waiver by NES or any Classified Party of any breach of this Agreement shall be a waiver of any preceding or succeeding breach. No waiver by NES or any Classified Party of any right under this Agreement shall be construed as a waiver of any other right. Neither NES nor any Classified Party shall be required to give notice to enforce strict adherence to all of the terms and 4 EFTA00316440 provisions of this Agreement. 6.6 Headings. The headings contained herein are for convenience only and shall not control or effect in any way the meaning or interpretation of the provisions hereof. 6.7 Entire Agreement. This Agreement sets forth the entire agreement and understanding between NES and the Applicant relating to the subject matter hereof and supersedes and merges all prior discussions between them relating to the subject matter hereof. No modification of, or amendment to, this Agreement will be effective unless in writing signed by the party to be charged therewith. If the Applicant is hereafter employed or engaged by NES, Epstein or any of the Epstein Companies, any subsequent change or changes in the Applicant's duties, salary or other remuneration will not affect the validity or scope of this Agreement. Signed: Print Name: Date: Address: 5 EFTA00316441 New York Member Enrollment Form - OHI MAILING ADDRESS: P. O. Box 7085. Bridgeport CT 06601 • 1-800-444-6222 • wwwoxfordhealth.com A. Group Information (To be completed by the employe ) Please print neatly using Mack or blue ballpoint pen • ALL DATES MUST St MM/DD/YYYY Group Number Group Name Plan CSP !Billing Group Date of Hire Effective Date Occupation O On Leave of Absence O Retired O Union Employee O Disabled COBRA/Young Adult/SC Gasifying Event Date Event / / Employer Signature Date X / / B. Applicant Details (To be completed by the employee) Employee/Subscriber Spouse Child Child Social Security Number: Last Name: First Name, Middle Initial: Date of Birth: (MWDD/YYYY) / / / / / / / / Gender and Disabity Status: (Check appropriate boxes.) O M O F / 0 Disabled OM OF / O Disabled O M O F / O Disabled OM OF / O Disabled Primary Care Physician (PCP) ID Number: PCP Name: (If an coistais patient of PCP, check "Yes".) O Yes O yes 0 Yes O Yes Check all that apply: O Domestic Penner O Full-time Student O Young Adult O Full4ime Student O Young Adult Prior Carrier Carrier: (List coverage prior to this.) Poky Number: From Date O Same for all Thm date:: I / / / I / / / / I / / I I / / C. Coordination of Benefits Employee/Subscriber Spouse Child Child Check appropriate Medicare Coverage bat and Net effective date: O Part A / / O Part B / / 0 Part D / / O Part A / / O Part El / / O Part D I / O Part A / / O Pan 8 / / O Pan 0 / / O Part A / / O Part 8 / / O Pan D / / Pharmacy Policy Number: O Same for all Carrier: Policy Holder: Effective Data: / / Group Number: Slit Kit 81N: KAI Eat POI: use Pat Policy Number: Medical Carrier: O Same for al Policy Holder: Effective Date: / / / / / / / / I ea aetur• wt ..• Am lkupOW P.M Po* Wri, sun won I pp n .w.talon as. tr• IS sae ow FuNal wse moo M. Jule n lad ntuia• kg Rat 6..4i all w1PU4 • Orbd•• /Ina emigre., man »sawn is *Ansa I gam Midi getdo• on b t. eat yr /4 no mar • Op OdOct I I wen,. Pa • ••• p Ns 110•••••• NM 0••4140/it Inen• a ass/ an Ns O. —nu. nunepallopervenelas 4.6 en. am • weapure. NI • OPP ono al Own% U.0 b yam =man savosow..0.4 Manitoba le teleact021Votateinnlybleatlenneaailarketexameosaartaldilskitid•nrICUtetnadbeholanallat=iltilliettlea WA new] mopes n wan • filnhlir *A ettga mewed Employee's/Young Adult's Address (Apt #) City State Zip Employee's/Young Adult's Signature Date X / / UnitedHealthcar6 Oxford EFTA00316442 NES, LLC January 10, 2018 Presentation - Inforce R BENEFITS Renewal OXFORD HEALTH PLANS 'Open Access' EPO PLAN Freedom Network - Platinum Maximum Benefits Deductible (individual / Family) Coinsurance Out of Pockel Maximum (Individual / Fernity) Including Deductible UCR Office 'Nits • (PCP / Si/eel/ant) Preventive Cate Pay and Lab Semites Erneteetcy Room Visit Hospital Serwats Outpatient Facility Menial Healthcamt • Inpatient Sonsces Mental Healthcare Outpatient Sernces Prescription Drugs (Network Only Irv:heated) Mall Otte Ones Ancillary Benefits (Vision. Centel) Child Otani:trey An Provider websiie IltNetWOrk Unlimited NM 100% 32.500/15.000 NM $20 I $40 Cense 100% X-Ray: S90/ Latr 100: $200 Coon Waived it Admitted/ $400_00Ple.DeLiernissten $300 Coact S400.00MILDOLMIMILMOn $40 Coon $50.dedittiblethraMtS301$601Geneciclush) 2.5x Basic Cat for 90 Oat Suntan Pediatric Dental 4 Vision. Gym Peontsonement $400 (Member) GisiktresiffOung Math lo 26 vesesethp.COID EFTA00316443 aetna• Dental Enrollment/Change Request Aetna Life Insurance Company' Errployer Dap Home= (To EeConcteed or Errclose) "Eripeenm• Futalodeavtadogoneem Pal Snowy rams tatea.Oty are. Trecom.AvreytccoteneeereescrOgresen Typed PttMN-Rrdoyeeacuities Steens A- E Reese Pent Mealy ingmeberts Peter tore insawbere (Mete* beicreccepitierg Infant Yu 1110 SITIO" Mt cowls!) Itts arfcalim inful cr it voll terMmal loy:u mere na dew in recces, kg 1tu algal* respretlett its axutcyardoreekross Enrollment • Credos - Change - ma eine tori 0 kb Spas Died Bs 0 PM 0:921211 at / / Remove or Terminate . mason Me 0 RerroaSporn ci Ft oa04;eteil Ellaireale ChM / / Continuation 01 Coverage. I e it. nay Contact Employer lot emilobleeoll:ffit Compere- 0 0100,00 0 wend Costume% rams): 018 0 ga•Airhableydeterrireeknionte&oe . COBRA. State - not en miens DMO1:O1/3 0 36 0 0ihr 0 Nam EregeoStecter 0 MCCOY! CM Med fttsoftreouterert I I I I 0 Narre Crerca Reason 0 Ore 0 EnglopeWertwat/ Fan Itteirerm SeareyAMIn Wed ire / / 0 CascitallsocaRtn _ Oct e 0 tom/ Coerce / / reClaaltrig Eel / / 0 Oral 0,0222 FitnloreekUfW 9x/al Salyhtne US lira MI ta Mt 'lunar unareeetclen froormtne Anew WM% 382..0 acroltrrtos NM( Walk( I ) Entwe9a Obi 0 Rai 01/ Sat ZPCtile u IFFIVICAJUIS LANITIO • LIE IFIAWA105 IV MOTO )W NO artipcnagngeonoving ammo. MCI SWUM 15 ILOWIN mom novxm =MS PIZ TIA reepatner UMW. LJ LAW; WI5 We I rJJ WU ICIUZA U cumitie //a Ala ticinauz.. Pm /Da Nrre tHrstAddle rilid. Last) Candita ania 9rafirrenal Rua, cto Se( m F lertlxiale FO rree soda gecunty web, CloarlitereStliwlittna Lao blitait net Yew Wen OaOna la Ca." Opacity an lira maw Stow Remy Cate atm etyma oRtaalvidefTed Ohl lenclaasal> manna) insacl atIcamsthwa n2 t• capirpao dzonsalL) taw Sit 0 I3 InA / / vs 0 w• 0 0 NW • 0 Vs NA lea NA No Q Ccdo Ma Unto lefiX10// la glarilyte Reeetnetyomme ern reeds KENt et. Wva Ol• Marnompancalack Ol• Hats la Os- Pal 05. Ott earn laanlltIll Clftcchandlol3 OD / / 0 0 0 0 0 0 0 OD / / 0 0 0 0 0 0 0 OD / / 0 0 0 0 0 0 0 00 / / 0 0 0 0 0 0 0 i nay WU" taraFlalaa p0/031602.02/K fen& micpuTtordirasana gni Or Oda utnerclyas was der t Gant/arta 3 Cooncerearan tomato.. Ke ft ecrwel sideehnteeeieer. I 'Olell/na vta UMW 0105 0 No Specia RaTerkS 2I n*foots DrolOapiirtilYanteltyCova by Malorestoa pokloollia OSA nrret IdkritrOlrollilluaceike. /MS /1/la eta as ed)w Win 00141a001Itubt E Ern:lost &nature ll Evan:My to tat V:11 ewe Intro Aetna Neater. retre's 'iota setterke yokels fa Allan oiled menials ird trtastrd Val rrceacCee tO Matte Cecer cicorletle II Ile Mutt I retressi OO I irtmeien spiel in Cis toms trte ard corpse to te tee ct mitratixigeanitir tektites resdat aaeeb the ardlicredEntentrt alto roans d enD trrertecrge Regest lam I irderscrd rein deem% I lal to ST de tamed* 31 deistatedrarraewaireossta fella rceecn Pere dxs rot wean:aced Ire eine trarsectcn reps* %Win a reetcretle Pre fcliaerg nest rrytedrrytherdat clip* cm/ tie ceded On-eign-2( ieOR G Rao acme - Vim sole/Sol filet bet:deed tty yar etplort Oeck Cne O Irani* MOO O D e r l a F t n 1 H a i t A x d O D a l a i P P o 0 Demi EFP o csaifrostages3sc o rccfrisyrny 0 FO3CF0 0 'CODA Please make a copy for your records. EMS AMON visit us at www.aetnaeOm NY VI flPOO A EFTA00316444 inStrulion50 Employer - Conkte No End a< Got Handal al to tpd !arm Employee • Complete Sections A - E. Section A • Type ol Activity: n Cita Masi a:keg mascr(s)tatainitirgitisEntenatCineRaist Pro/de Mae Ode(a) angled Ewa sue <caged Section B- Employee Information: Orrdeleall liana Maar Witty EnclectOitai Patel becalmed Section C • Plan Options: Sketchy Encptn dread bite enliclAt Section D- Individuals Coveied. Amorgottroa- use w. ail? tointiate Way otamffifrg anwniornidat cdedin tr trt Waal. Pril p.m' Unsnap van tte rere(bd yardeprCertbi tSte Irate FlaccetipCce Sac &Ilan trd &cid Sea* Nate a °WI irctActel Wed RdaicrelipCaii • LteCN.Y: N#t&agvSWlaShatDada'.YAStaeaeiMQlaX.Sccrtsoted Ferrele. r dmofpagat is nOryou sear a tiologai a madly ectuaichila please indicate nacnship to catioyee in Special %Yaks O Late Erten< • I >anfg a g winnyctsenvlopfselgtioenoureipatadera. Icuctadeptcards)vae coact:ha tar enclat ores: Ria insuterce Rwi. deck the 'kW toceratiAdetcgreg acerb elleitecties, rate two pctorunto d Iranixecarrier. data ;ton ditermucearcla Marra tetifiation Nair male wecepriAckd In Rater 1. 01 sacra acerdees) two Oa Drud Cconeca ere< we Carently Come by libliCare, ctak tele tcniestat pridetiegairad enirg tdelnedita ram ardriteinnixrd len= era deli On Cr Ora autos-Oar Mate briiliationNwrbei :he la Waded h Ruhr 2 ir at:lumen is Itrckap:alatlfraniatydgerctri.MedeteirdProilefrol d redone:1 stns kcal, attordrg Mat ©IadEverdei6 a &AA Mack "dt. Pt teir yxr SatryCo.saixdanifetritiot Mee rrey antOslyaapmtepodlamtteawafael haulm EIFfiirreyDerta Olim ID Naar- Locale re ace Carrera the pirreryets tweets:pate crearctayoricrn-DxPer. Met mirepokier drescryarWomeetraccrn". 0 I lcusea curentcelicri. ciatsa Oak tenis" tocuterCtrreri Pat 0 Qykral • Usk° eaKEYncered deasealtr In) Bi<tilEITTiolyccdela eech haat r yin R103? Blinioty WOW' pot to %metric* barn Irthael inreaerroddxt Section E Employee Signature: B Carpels aisetio, Ice al a er ante a waltednat OEcasenataptarddlere Enterrartererge fated Incatat bet/comet fii chard relacnitereateadeicultrea tie Petra Wager. Peas ebbe< asenteatale la di Anse vertairmeMs to utarstardwu we/ataxia feceidalWerecanensel ire Iwo ardtions of Enrollment Appicant AdicrateOrats wad AgreaTents Qiwijfd wed ad We dicendwts feted on We rase se. I ape tocr tan re Ictaieg ectq Mecgetla ty enaing in an Moo al co m193 s littivalen a strnstered bird Peru I-00mm= (to w& (Sorel 13 ancinr) 20lalltrimitdeimslannyavrtrgstr en/Cate= awed la COM/Gen I *Wee lorrama 0 re:weary masts as rezireAccaeax0 trantertlat bre evt thsEnerertCran;e Bloat rrey te Ira-witted DMIntia agErt Marankor cr Sagan. 1 afroize an/pep:in cihir rattarepciessioa. topical snails( nteittcareagrazion MoAclot) to Ova Astrecr Nssport irfamgoiorosnrg the rredcal taw aces a !meta puttedto anme Ilstelcn tlis BrarertOwc,Reqxst km% axing tee incltirg wend tea satarceause PIWACIS threw antite Aare to use eel tante ird lodsctee itch trari:ft df Ades akin paps Oa ireuerA Bird terbalhaWin meta'*, onalatsanipaTmicut aftotesratnjuisckton %ten rexeray icr mime cr trelmrt Pairrel a seal ket teepalitaidnnealth pen cr tocona relate armies I la dazed the terns d tisataaticnianyausearlanataactItepsrdertsat I to <tared tear masa Iota° terms I venal tat ths avian is woad trdW ale latiOrd that tyro arathwataf van We rrarirg d Wetted taith Marne Ratty kobstalatty Act Ths atrnaireCmwll remin told fa We temd encampat so krg delta as anal bitchy I tragetrd ee I <rattled Ionics% a ccp,id thsaitalan tccn rapist ird Wel a chcaqty sasaedasteegad. 4.01113 pan &areas w/ tharrire iterittsard mscorebbiesd malteds) at yid gam it inert ley° arta bith ay Oats amen= swayer ater detcapicnct re liana 5.01 utastand and Ka thlt WM to feateld Mae RObTeDitnca di re IttiPernpAdel (rthana all p260011rg pry care Oasts) achales We Mace-den cmnan an:1 Serer& alas ra entewees d Pea Pare Pt< lave Celivay td.G isasaidaryd PCs it lie a nti*yd wyperesirectoAdarcemi 9.enyteed era poam nztvok cmpstans Wei iodate Watt to dirge Wed te Peed accactrtevatiacatie stated Mweprisentaion Any pricn vito Icargya-ti vitt at too:baud ay instate carprycr da perwin lies an apatite la lane stalerrel d damccrtartrg writ ten:Ilya° iturrellat a ccrceelstr tha prizes d rrideadrg aerate catemrg aryl= meta thereto ccrrrnIs a tattier* ireuance act eicti Be crime adalai se lolled badtil ;locally <a to exceed lie Wawa Cat ad lie staled endued tie climb cach tilatcn woos) v1 an-6797144 EFTA00316445 Dental Benefits IN-NETWORK SE I OUT-OF-NETWORK Prev. Svcs. Basic Svcs. Major Ortho. Svcs. / off' Co pay. Indvi.11ed. / Max. Ortho. Svcs. / Idyl. Ded. / Max. Svcs. Max. Ben. Max. Ben. CURRENT PRODUCT(S) Option 9; Passive PPO 2000 PROPOSED RENEWING PRODUCT(S) Option 9; Passive PPO 2000 100% 80% 50% Dependent Children Only Only None $50 / $2,000 Dependent Children 350 / $2.000 ALTERNATE PRODUCT(S) Option 10; DMO Copay 41 Per Schedule Per Schedulefer Schedule None I I J $5 Noce/None N/A N/A / N/A Option 2; DMO 100% 80% I 50% None I None None None $5 None None / None N/A N/A / WA Option 7; Consumer Directed DentalFund 100% - None - Option 3; Freedom-of-Choice: PPO Max 100% 90% 80% I 60960 5696- None None $5 None None / None 350 / 31,500 L N/A N/A / N/A Option 4; PPO Max 1500 100% None $50/ $1.500 Option 5; Active PPO 100% 80% i 50% 60% 50% None None None I None $5 None $50 / $1,500 None $50/ $1,000 Option 8: Freedom of Choice; PPO 1500 100% 90% 80% None / None N/A N/A / N/A Option 6: Passive PPO 1500 100% $50/$1,500 None 350/$1,500 Option 9: Passive PPO 2000 100% 80% I 50% None None $50 / $2,000 None $50 / 32.000 100% I 80% 50% iDependent Children Only None I $50 / $2,000 Dependent Children Only_ 350 / $2.00001H Proposal Type: Renewal Group name: NES. DX PSUID: 81115562 Quote ID: 13752926 Effective Date: 02/01/18 to 02/01/19 Proposal Generated On: 11/29/2017 00:12 aetna® Pave 8 EFTA00316446