AMWINS Client Work Order

AccountID

This Broker Work Order for CLIENT (the “Work Order”) is made and entered into effective (the “Work Order Effective Date”), by and between BenefitsApp Inc. (“BenefitsApp”) and AMWINS Broker (“BROKER”) pursuant to the Master RESELLER Agreement of dated May 1, 2023, (the “Master Agreement” on file with AMWINS).

Today's Date

Broker Contact

First NameLast Name

Broker Name and Location

Broker Email

Broker Phone Number

Please enter a valid phone number.

Employer Group or Client Name

The company that will use BenefitsApp for their employees

Client Point of Contact:

First NameLast Name

Client Email

Email to send a work order agreement and NDA.

Phone Number

Please enter a valid phone number.

The term of this Work Order shall be twelve (12) months from the Launch Date (the “Initial Term”), and shall thereafter automatically renew for successive one (1) year terms (each, a “Renewal Term”) unless either party gives written notice to the other party at least ninety (90) calendar days prior to the expiration of the then-current term of its intent not to renew the Work Order.

You will receive email confirmation of this Work Order. On review of the work order, BenefitsApp will send you a work order for your signature approval.

Target Launch Date :

The launch date is the target date for release to employees.

Estimated Number of Users: (records per census file)

A census may include employee, employee + spouse and/or children over 18. Each user is a member for PMPM.

Annual License to Client:*

This is the annual production fee for converting benefits information into BenefitsApp and providing the platform.

PMPM to Client:*

Per Member Per Month rate quoted to Client and will be their annual, quarterly or monthly invoice for total number of users (e.g. total number of unique member IDs able to register and use BenefitsApp on their mobile phones)

PMPM Instructions*

Annually based on actual number of census member IDs (employees) on the launch date.Monthly (Invoiced by 3rd day of each month)

BenefitsApp Licensee: (receives invoices)*

BrokerClient

Accounts Payable Email:

If known, AP Email address for responsible party to receive a BenefitsApp invoice.

Invoice or Other Instructions:

Please provide instructions for billing and any other comments related to the client's BenefitsApp. These comments are between Broker and BenefitsApp and not shared with the client contact.

Additional Production and Messaging Fees:

One Class included. Additional Classes are $500 per class per year.
Creative Production Management by BenefitsApp: $75/hour (push message development, marketing literature or other) for pre-approved creative production management.
SMS Fees: 10 messages per member per month included, $0.01 per message after 10 messages.
Push/In-App Fees: 10 messages per member per month included, $0.01 per message after 10 messages.

If available, please upload the most recent Benefits Guide and additional files for the BenefitsApp.

DO NOT UPLOAD CENSUS DATA HERE.

Please verify that you are human*

By submitting this signed Broker Client Work Order, the BenefitsApp team will review the BenefitsApp specification, and if everything is in order, BenefitsApp will send a Client Agreement with NDA for digital signature to your Client Contact's email.

Upon signature, BenefitsApp will send an Annual Invoice (Annual License + Annual PEPM if that option is checked) to the Accounts Payable Email address. Upon payment, the BenefitsApp team will engage the Client Contact for development and distribution of BenefitsApp to their employee members.

AMWINS Client Work Order

BenefitsApp Order Form: