Appendix_A_-_Health_Reimbursement_Arrangement_Plan_Document_(new).pdf

AMENDMENT

TO THE

Administrative Services Agreement for Plan Number 803049

This Amendment to the April 1, 2019 Administrative Services Agreement (“Agreement”) for Plan number 803049 (the “Plan”) is entered by and between County of Orange (“Employer”) and ICMA Retirement Corporation (“ICMA-RC”), effective as of the date of execution by the Employer below (“Execution Date”).

WHEREAS, the Employer sponsors the Plan on behalf of its eligible employees and retirees;

WHEREAS, the Employer entered the Agreement to engage ICMA-RC to provide administrative services and investments for the Plan under the terms specified in the Agreement;

WHEREAS, the parties wish to amend the Agreement to add a new RHS plan number 800161 to the Agreement;

WHEREAS, Article 5 of the Agreement provides that the Agreement may be amended pursuant to a written instrument signed by the parties.

NOW, THEREFORE, the Agreement is hereby amended as follows:

AMENDMENT

The listed plan numbers are: 803049, 800161

In all other material respects, the Agreement is hereby ratified and affirmed.

DocuSign Envelope ID: 856B5154-946A-41FD-8B0F-2EA4FE73B2BE

Amendment 803049, 800161

CONTRACT SIGNATURE PAGE

IN WITNESS WHEREOF, The Parties hereto have executed this Agreement on the dates shown opposite their respective signatures below.

ICMA RETIREMENT CORPORATION:*

Thomas McAndrews Managing Vice President

Signature Date

Erica McFarquhar Assistant Secretary

Signature Date

*If the contracting party is a corporation, two (2) signatures are required: one (1) signature by the Chairman of the Board, the President or any Vice President; and one (I) signature by the Secretary, any Assistant Secretary, the Chief Financial Officer or any Assistant Treasurer. The signature of one person alone is sufficient to bind a corporation, as long as he or she holds corporate offices in each of the two categories described above. For County purposes, proof of such dual office holding will be satisfied by having the individual sign the instrument twice, each time indicating his or her office that qualifies under the above described provision.

In the alternative, a single corporate signature is acceptable when accompanied by a corporate resolution demonstrating the legal authority of the signature to bind the company.

COUNTY of ORANGE A political subdivision of the State of California

Print Name Title

Signature Date

Approved by the Board of Supervisors on: _________________

APPROVED AS TO FORM:

Deputy, Office of County Counsel Orange County, California

Please return an executed copy of the Agreement to a Delivery Address, either:

(a) Via DocuSign

(b) Electronically to PlanAdoptionServices@icmarc.org, or

(c) In paper form to ICMA-RC

ATTN: PLAN ADOPTION SERVICES

777 North Capitol Street NE Suite 600 Washington DC 20002-4240

DocuSign Envelope ID: 856B5154-946A-41FD-8B0F-2EA4FE73B2BE

7/22/2020

7/22/2020

Duane Bankey Senior Program Manager