Okaloosa County BOCC — August 18, 2015 — Group Flexible Benefits Plan — reading text

GROUP FLEXIBLE BENEFITS PLAN This is an Agreement between Board of County Commissioners of Okaloosa County, Florida (hereinafter referred to as the “PLAN SPONSOR” ) and Lockard & Williams Insurance Services, P.A. The Pian Service Provider (hereinafter referred to as “L&W") for Group Flexible Benefits Plan Administration HRA Administration WHEREAS, the PLAN SPONSOR has established a Group Flexible Benefits Plan and a HRA (called the pian in this Agreement) for certain of its employees; and WHEREAS, the PLAN SPONSOR has requested L&W to act as its agent with regard to the payment of certain benefits of the plan and to furnish services with respect to the plan. NOW, THEREFORE, in consideration of the mutual promises and covenants contained in this Agreement, the PLAN SPONSOR and L&W agree to the provisions as set forth in this Agreement. bl SECTION 1. PLAN - As used in this Agreement, plan means the Group Flexible Benefits Plan set forth in the plan document, together with any and all amendments and supplements thereto. SECTION 2. EFFECTIVE DATE This Agreement is effective October 1, 2015 through September 30, 2016; with an option for additional years if agreed upon and executed by both parties in writing. SECTION 3. PLAN BENEFITS SUBJECT TO THIS AGREEMENT The plan benefits subject to this Agreement are employee benefits. SECTION 4. L&W RESPONSIBILITIES (a) L&W wiil process initial election forms and revocation forms to initiate the process. (b) L&W will provide to PLAN SPONSOR reimbursement claim forms with instructions on how to complete and file. (€) L&W will issue reimbursement checks to the participants of the plan as eligible claims are received and processed. A check register for all checks that are printed will be provided to the PLAN SPONSOR. (d) L&W will provide a reimbursement file to the PLAN SPONSOR which identifies all data pertaining to each check that is issued on each specified check cycle. This information will include employee name, social security number, check number, check amount and benefit account drawn from. This file will be delivered to the PLAN SPONSOR in a time frame agreed upon by both parties. (e) L&W will administer discrimination testing and provide interpretation based on information provided by the PLAN SPONSOR. (f) L&W will provide contribution reports on an ongoing basis as the plan year progresses. Page 1 of 5 (@ (h) ) @ (1) (m) (n) (a) (b) (c) (a) (b) (a) (b) L&W will provide forms to the PLAN SPONSOR in communicating participant terminations and family status changes to L&W. L&W will prepare Form 5500 annually if needed and requested by PLAN SPONSOR. L&W will supply election forms at the end of each plan year for use in making elections for the following plan year as requested. L&W will make any amendments necessary to the plan document and summary plan description. L&W will provide each participant with a statement of account at a minimum of two times per plan year. We will also attach a memo with the final statement of each plan year for those employees that have a balance remaining in the flexible spending account. L&W will provide an annual forfeiture report to the PLAN SPONSOR. L&W will provide and initiate any amendments to the plan document ar summary plan description that may become necessary during the plan year. This will be done at no charge to the PLAN SPONSOR. L&W will maintain an amount and type of liability insurance coverage acceptable to the PLAN SPONSOR. SECTION 5. PLAN SPONSOR RESPONSIBILITIES The PLAN SPONSOR will report participant terminations and changes of family status to L&W. The PLAN SPONSOR will reconcile payroll amounts redirected to the plan based on contribution worksheets provided by L&W. If reimbursement checks are provided to the PLAN SPONSOR those checks will be signed by an authorized representative of the PLAN SPONSOR and then distributed to those employees receiving a reimbursement. SECTION 6. L&W LIABILITY L&W will use care and due diligence in performance of its duties under this Agreement. In the event an incorrect payment is made by L&W pursuant to this Agreement which is a result of the failure of L&W to exercise reasonable care in making the payment, L&W will be liable for this mistake. However, if the incorrect payment is the result of incorrect information provided by the PLAN SPONSOR to L&W, L&W will not be liable for the incorrect payment. L&W and the PLAN SPONSOR will make a diligent effort to recover any incorrect excess payment made. SECTION 7. PLAN SPONSOR LIABILITY The PLAN SPONSOR retains the ultimate responsibility for claims made pursuant to the plan. The PLAN SPONSOR is responsible for all expenses incidental to the plan. SECTION 8. REIMBURSEMENT OF L&W By the 5" of each month L&W will submit a statement showing the amount of fees for the previous month. The PLAN SPONSOR will pay L&V the amount within ten (10) days of receipt of the statement. (1) Pian Education/Enroliment/Start up fees will be billed at no cost for the initial plan year and each year thereafter. 2) There will be a fee of $1.00 per month payable to VISA for those employees that elect to utilize the Debit Card with their Flexible Spending Account and or the HRA Account. This fee can be paid by the participant or by the PLAN SPONSOR. Page 2 of 5 (3) Our Monthly fee for administration of the Okaloosa Board of County Commissioners Flexible Benefits Plan will be at a fee of $4.00 per participant per month. The Monthly fee for administration of the Okaloosa Board of County Commissioners HRA will be at a fee of $3.00 per participant per month. (4) There are no other fees associated with the administration of the plan other than those listed above and these fees are guaranteed not to increase for a minimum of five (5) years. 5) Once an employee becomes a participant in the Plan that employee will be billed for until the Plan year ends regardless of employee leaving employment with Okaloosa County. As new employees become participants in the Plan during the Plan year those employees will be billed for from the time they become participants until the end of the plan year. SECTION 9. CONTRACT SEVERABILITY If any provision of this Agreement is held invalid by a court of law, the invalidity will not affect any other provision of this Agreement. The provisions of this Agreement are severable. It is provided, however, that the basic purposes of this Agreement must be achieved through the remaining valid provisions. SECTION 10. CAPTIONS AND HEADINGS The captions and headings throughout this Agreement are for convenience and reference only. The words of the captions and headings will in no way be held or deemed to define, describe, explain, modify or limit the meaning of any provision, or the scope or the intent of this Agreement. SECTION 11. CONTRACT COMPLIANCE - NONWAIVER Failure by the PLAN SPONSOR, L&W or both to insist upon compliance with any term or provision of this Agreement at any time or under any set of circumstances will not operate to waive or modify that provision or render it unenforceable at any other time whether the circumstances are or are not the same. SECTION 12. ASSIGNMENT Any assignment of this Agreement or of any rights contained in this Agreement without prior written consent of the other party, will be void and of no force or effect. A request for assignment of this Agreement will not be unreasonably withheld. SECTION 13. AMENDMENT This Agreement may be amended either by the PLAN SPONSOR or by L&W at any time provided the amendment is agreed to by both parties and mutually executed in writing. A written amendment will state the effective date of the amendment and will be given no less than thirty (30) days prior to the effective date of the amendment. SECTION 14. TERMINATION (a) This Agreement may be terminated either by the PLAN SPONSOR or by L&W at any time with or without cause, provided the terminating party gives the other party prior written notice. The written notice will state the effective date of the termination. The written notice will be given no less than one hundred (100) days prior to the date of the termination by L&W and no less than thirty (30) days prior to the date of the termination by the PLAN SPONSOR. If due to a rate increase the notice of termination would be a minimum of 100 days. (b) This Agreement will terminate automatically and immediately as of the date: Page 3 of 5 (c) (d) (e) ® (1) The PLAN SPONSOR fails to pay any charges within thirty (30) days after charges are due and payable as provided in this Agreement or (2) Either party fails to perform its obligations in accordance with this Agreement. Termination will not relieve the PLAN SPONSOR of its obligation to reimburse L&W for payment of plan benefits or (3) The PLAN SPONSOR amends the plan regarding plan benefits subject to this Agreement without prior written acknowledgment of L&W or (4) The plan or the plan benefits subject to this Agreement are terminated or (5) Either party becomes insolvent or bankrupt or subject to liquidation or receivership. If the plan or the plan benefits subject to this Agreement are terminated, the PLAN SPONSOR and L&W may mutually agree that the provisions of this Agreement will continue in effect solely for the purpose of payment of any claims for which proofs of loss have been received by L&W before the date of termination. If this Agreement is terminated while the plan continues in effect, the PLAN SPONSOR and L&W may mutually agree that the provisions of this Agreement will continue in effect solely for the purpose of payment of any claims for which proofs of loss have been received by L&W before the date of termination. If provisions of this Agreement are continued in effect in accordance with subsection (c) or (d) of this section, the PLAN SPONSOR and L&W will mutually determine an appropriate charge to be paid téy the PLAN SPONSOR to L&W during the period the provisions of this Agreement are continued. Termination of this Agreement will not terminate the rights or obligations of either party arising out of the period during which this Agreement was in effect. Section 15. PUBLIC RECORDS L&W shall allow public access to all documents, records and other materials, in accordance with the provisions of Chapter 119, Florida Statutes, prepared or received by L&W in conjunction with this Agreement. Section 16. AUDIT The PLAN SPONSOR shall have the right from time to time, with notice to L&W, at its sole expense to audit the compliance by L&W with the terms, conditions, obligations, limitations, restrictions, and requirements of this Agreement and such right shall extend for a period of three (3) years after termination of this Agreement. Section 17. GOVERNING LAW & VENUE This Agreement shall be interpreted in accordance with the laws of the State of Florida without regard to its principles of conflicts of laws. Venue for any legal proceedings arising out of this Agreement shall be in Okaloosa County, Florida. Page 4 of 5 IN WITNESS WHEREOF, the PLAN SPONSOR and L&W have caused this Agreement to be executed in their names by their undersigned officers, the same being duly authorized to do so. Lockard & Williams Insurance Services, P.A. Title: ficflefl?) Hoanrage/ Date: f '/0 '010/5 Okaloosa Board of County Commissioners By: Nathan D. Boyles, Chairman Date: Page 5 of 5