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norton <br />LifeLock Benefit Solutions <br />Broker Information (if applicable) <br />Broker <br />Agency Name Lockton Companies - Southeast <br />Contact Name Danielle Riess <br />Email Danielle. Riess@lockton.com <br />Phone 954.883.2047 <br />Writing Number C1A779 <br />Employer Signature <br />A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />UNITED STATES <br />Group Application <br />General Agent/Secondary Agent <br />Agency Name <br />Contact Name <br />Email <br />Phone <br />Writing Number <br />By signing below, Employer agrees to the terms and conditions of this Group Application and the Employer Benefits Program <br />Terms attached hereto, which are incorporated herein and exclusively govern this Group Application. <br />Terms&Conditions . 'GOh1�1�SSj`' <br />.,���y ..• o s.. APPROVED AS TO FORM <br />AND GA SUFFICIENCY <br />Indian River County <br />'Employer Name 13Y <br />Jose h E. Fleser''``� <br />'Authorized Signer (Print Name) ;t CHRI OP ERA. HICKS <br />'Authorized Signer (5gnature) : cSQSSISTA T C NTY ATTORNEY <br />'Date of Signature eptember 2 � 202- y';.,+';, ..\o •' <br />Attest: Ryan L. Butler, Clerk of <br />'Authorized Representive Phone Circuit Court and Comptroller <br />'Authorized Representative Email <br />* Required <br />By: 51� <br />�Clek <br />This Group Application is with: Gen Digital Inc. of 60 E. Rio Salado Pkwy, Ste 1000, Tempe AZ 85281 (formerly known as <br />NortonLifeLock Inc.) NortonLifeLock merged with Avast in September 2022. The merged entity is known as Gen Digital. <br />Norton and LifeLock products/services are now added to the Gen brand portfolio. <br />Questions? Contact us at: <br />M 844-698-8640 <br />® EB_Sales@GenDigital.com <br />norton ON Avast ./ LifeLock- 0 Avi ra- <br />rtonGen, <br />REPUTATION .CCleaner <br />AVG. •/ by normo DER' <br />No one can prevent all cyberc rime or prevent all identity theft. <br />Copyright® 2023 Gen Digital Inc. All rights reserved. Norton LifeLock Benefit Solutions is part of Gen-- a global company with a family of consumer brands including <br />Norton, Avast, LifeLock, Avira, AVG, Reputation Defender and CCleaner. <br />