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DocuSign Envelope ID: EA6C45CD-7691-43D8-B939-A4300A7DD233 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Flores&Associates,LLC Party/Vendor Contact Person: Mario Flores Contact Phone: 800-532- <br /> 3327 Party/Vendor Address: 1218 S. Church Street City Charlotte State: NC Zip: 28203 Department: <br /> Amount: $0.00 Purpose: Medical Reimbursement and Dependent Care Assistance Claim Administration Agreement <br /> Budget Code(s): Vendor # (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® <br /> Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 7/1/2015 Approved by Board <br /> Yes❑No® Agenda Date: <br /> D c Si ned b <br /> This agreement is approved as to tec 1�a ark' copter}t:� <br /> �'j 7/15/2015 <br /> Department Director's Signature PC98D269F0148F... Date: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficient 4ISIff" �""�yWaLidards,specifications,and requirements: <br /> Qllsa bvvte& 7/22/2015 <br /> Office of the Risk Management Officer 7FDCF9176800498... Date: <br /> Financial Services <br /> This instrument has been pre-audited i r Off�t�iup$, iced by the Local Government Budget and Fiscal Control Act: <br /> q� �M 7/22/2015 <br /> Office of the Chief Financial Officer 232DFFC2CFA8476 Date: <br /> Legal Services <br /> This agreement is approved as t le Da fc' dAd sufficiency: <br /> l \ 7/28/2015 <br /> Office of the County Attorney 4035C68304CA4A9.. Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloydLyoran ecoun nc.g <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 10/14 4 <br />