Employer Legal Name

Nature of Business or SIC Code

Are there any subsidiaries or affiliate companies? Yes No
If yes, please list

Physical Business Address

City State AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NE NH NJ NV NC ND NM NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Select Zip Code

Telephone Number

Fax Number

Email Address

Send Correspondence to:

Requested Proposal Due Date

Anticipated Start Date or Date of First Payroll

GENERAL QUESTIONS:

What services are you interested in?
Administrative Services Only (ASO)
_______ Payroll
_______ HR Administration
_______ Benefits Administration
Professional Employee Organization (PEO)

Are you currently in any form of ASO or PEO Relationship? Yes No

Does your company have any internal HR support currently? Yes No

IF INTERESTED IN PAYROLL SERVICES, PLEASE ANSWER BELOW:

What were your gross wages for the last four quarters?

What were your SUTA taxable wages for the last four quarters?

What is your employee turnover rate for the last four quarters?
(Terminations during quarter divided by employees at end of quarter)

How many of your employees are salaried and how many are hourly?

How many of your employees are exempt and non-exempt?

Are your employees required to receive their pay via direct deposit? Yes No

What type of pay stubs would you like your employees to receive? Paper Pay Stubs Electronic Pay Stubs
If paper, do you require occasional check stuffers? Yes No

Will you be utilizing a time clock system to submit payroll? Yes No
If no, are you interested in a quote including an automated time keeping system? Yes No

What is your pay schedule? Select One Weekly Bi-Weekly Semi-Monthly Monthly Commission Only

Do you have more than one pay cycle? Yes No

Do you have employees in multiple states? Yes No __
If yes, please list states:

IF INTERESTED IN HR SERVICES, PLEASE ANSWER BELOW:

Do you currently have an employee handbook outlining general policies and procedures? Yes No
If so, when was the last time the handbook was updated to reflect current employment and labor regulations?

Do you have an individual employed by your company that is currently responsible for such HR dutites as new hire reporting, EEOC reporting, unemployment administration and termination reporting to the Texas Attorney General?

IF INTERESTED IN PEO OPTION, PLEASE ANSWER ADDITIONAL QUESTIONS BELOW:

What is your current Worker's Comp insurance rate?

What is your current TWC tax rate?

Does your company hold an EPLI (Employer Practices Liability Insurance) policy? Yes No
If yes, please list amount of coverage

IF INTERESTED IN BENEFITS ADMINISTRATION SERVICES, PLEASE ANSWER BELOW:

Please NOTE Benefits Unlimited, Inc. must be deemed "agent of record" and act in a broker capacity in order for CU People to handle benefits administration.

Are you interested in obtaining quotes on benefit options/packages for your company?
Yes No

How do you currently manage COBRA compliance? Select One Internal Support Outsource to TPA None

How do you currently conduct new hire benefits enrollment meetings?

Have you utilized an online system for enrollment and communication with your employees in the past? Yes No

When is your open enrollment period?

What are the current waiting periods for new hires?

If your employees are covered under a short term disability plan, does the carrier report and pay employer taxes? Yes No

Do you currently sponsor a retirement plan such as a 401(k)? Yes No
If so, who is the current administrator?
(Please provide a copy of current documents, summary of investments and estimated annual contributions)

Do you have benefits that are reported on employees' W2s that are not paid through payroll?
Yes No
If so, what?

Comments?