PSPRS 457 Plan Adoption Agreement

Participating Employer Name: ____________________________________________________________ 
Legal Plan Name: ______________________________________________________________________
The effective date of the Plan for the Participating Employer is: __________________________________
IN WITNESS WHEREOF, the parties hereto have executed this Joinder Agreement effective as of the 
effective date above. Upon execution of this Joinder Agreement, eligible employees of the Participating 
Employer are permitted to begin Contributions into the Plan as of the effective date.
Participating Employer Name:   
________________________________________
Authorized Signatory Name:  
 
________________________________________
Authorized Signatory Signature: 
________________________________________
Title: 
 
 
 
 
________________________________________
Date:   
 
 
 
________________________________________
Acceptance by the Plan Administrator on the Adoption Agreement
Signature: ____________________________
Name: _______________________________
Title: ________________________________
Date: ________________________________
1
 
The undersigned, by executing this Adoption Agreement, elects to become a Participating Employer in the  
Plan identified above, as if the Participating Employer were a signatory to that Plan Document. The           
Participating Employer accepts and agrees to be bound by all of the elections granted under the provisions 
of the Plan as made by the Plan Sponsor. 
Plan Administrator or Designee: ___________________________ 
PSPRS 457(b) PLAN ADOPTION AGREEMENT 
City of El Mirage
City of El Mirage PSPRS 457 Plan
08/22/2023
City of El Mirage
Mayor
Alexis Hermosillo