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DocuSign Envelope ID: EA6C45CD-7691-43D8-B939-A4300A7DD233 <br /> Medical iii Ill iii VIII ii n it <br /> Assistance ii nc l i iirns Adr6iii i ° Mi � Agreement <br /> lt <br /> i <br /> THIS MEDICAL REIMBURSEMENT and DEPENDENT CARE ASSISTANCE CLAIMS ADMINISTRATION <br /> AGREEMENT(the "Agreement") is made and entered into this day of , 20_ by <br /> and between FLORES&ASSOCIATES, LLC ("Flores") and ORANGE COUNTY (the "Company"). <br /> STATEMENT OF PURPOSE <br /> The Company wants to establish a medical reimbursement plan for its employees under <br /> Section 105(b) of the Internal Revenue Code and the Company wants to establish a dependent care <br /> assistance plan for its employees under Section 129 of the Internal Revenue Code. Flores is in the <br /> business of helping establish employee benefit plans and serving as claims administrator for such <br /> plans. Flores has agreed to provide the Company with materials necessary to establish a Medical <br /> Reimbursement and Dependent Care Assistance Plan (the "Plan"). Flores has also agreed to help <br /> the company install the Plan and to serve as claims administrator for the Plan. <br /> NOW, THEREFORE, in consideration of the mutual covenants and agreements contained <br /> herein,the parties to this Agreement agree to the following: <br /> 1. Plan Implementation Services. Flores will provide the Company with the following <br /> forms to implement the Plan: <br /> (a) Plan Documents; <br /> (b) Resolutions for Plan Adoption; <br /> (c) Summary Plan Description; <br /> (d) Notice to Employees Announcing Plan; <br /> (e) Enrollment Forms; <br /> (f) Election/Salary Reduction Agreement; and <br /> (g) Other Administrative Forms. <br /> The Plan Document, Resolutions, and Summary Plan Description are prototype documents <br /> and are intended to be reviewed by and completed/edited with the help of the attorney for the <br /> Company. The Company shall be responsible for enrolling employees on the Participant Enrollment <br /> Forms and having the Election/Salary Reduction Agreements completed. The Company shall furnish <br /> copies of such forms and agreements to Flores. <br /> ORANGE COUNTY 13 Flores <br />