2023/11/29 Council Agenda Packet

© Peak One Administration 2016 14 BENEFIT PLAN SERVICES APPENDIX The Client has established the following employee benefit plans for which it is engaging PSP to assist it with performing certain ministerial administrative services: A Code Section 125 Plan to allow eligible employees who make a proper election to pay for their share of certain benefit plan coverage with pre-tax salary reductions (“Cafeteria Plan”). A Flexible Spending Account to allow participants to be reimbursed for eligible medical expenses (“FSA”). A Code Section 105 health expense reimbursement plans (“HRA”) to allow participants to be reimbursed for eligible medical expenses. A Code Section 129 dependent care assistance plan to allow participants to be reimbursed for eligible dependent care assistance expenses (“DCAP”.) A Premium Only Section 125 Plan (“POP”). A Health Savings Account (“HSA”). A Parking/Mass Transit Fee Plan (“Transportation Plan”). A Section 115 Plan (“Section 115 Plan”) (Collectively the selected plans are referred to in this Appendix as “Benefit Plans”) PSP will perform services only with respect to the employee benefit plans for which PSP has provided the sample plan documentation or, if PSP’s sample plan documentation is not utilized, then only such plans identified by Client and agreed to by PSP pursuant to separate written notice. This Service Appendix is incorporated into, and made a part of, the Administrative Services Agreement (the “Agreement”). The effective date of this Service Appendix is the effective date of the Agreement or if later, the date that both parties have signed this Service Appendix as set forth below. The responsibilities of the parties set forth in this Service Appendix are in addition to any responsibilities set forth in the Agreement. If there is a conflict between this Service Appendix and the Agreement, the Agreement controls. In consideration for the mutual promises set forth below, the Client and PSP agree as follows: A. Responsibilities of PSP The services PSP will perform pursuant to this Appendix are limited to the following: 1. Benefit Plan Documents and Forms. PSP will provide sample plan documentation for the Benefit Plans for review by Client and its selected legal counsel. Such documentation will include, but not necessarily be limited to, plan document, summary plan description (“SPD”), board resolutions, adoption agreement, plan information summary, resource manual, employee communications package, payroll stuffers, announcement letter, and enrollment forms. PSP will customize such documentation only to the extent necessary to incorporate the Client’s responses to certain plan design questions submitted by PSP. Client understands and acknowledges that it is responsible to ensure that all documents and forms for the Benefit Plans, including any template or sample documents and forms provided to Client by PSP in accordance with this Agreement, comply with the applicable laws and regulations. Although PSP has taken steps to provide sample documents and forms that are of the highest quality and intended to comply with the applicable laws, PSP cannot be aware of all of the facts and circumstances that