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DocuSign Envelope ID:B156146B-0400-4433-84BD-A56E1DCE5DA7 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Flexible Benefits Administrators, Inc.. Party/Vendor Contact Person: Leanne Widenhofer <br /> Contact Phone: 757-340-4567 x 138 Party/Vendor Address: Post Office Box 2070 City Virginia Beach State: VA <br /> Zip: 23450 Department: Amount: $0 Purpose: To authorize Flexible Benefits Administrators to work <br /> directly with Delta Dental Budget Code(s): 10250020/630000 Vendor#61126 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑ No0 Contract Type: (Check one) New l 1 Renewal ❑ Amendment ❑ Effective <br /> Date July 13,2017 Approved by Board Yes Not Agenda Date: <br /> This agreement is approved as to to l44ir •.nd content: <br /> bruA,14. 1%446644o 11/27/2017 <br /> Department Director's Signatur Date: <br /> 11/27/2017 <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 sufficiency � gggystandards,specifications, and requirements: <br /> [(USX 11/27/2017 <br /> Office of the Risk Management Officer Date: <br /> 11/27/2017• ...,.... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> Office of the Chief Financial Officer �o� Date:11/28/2017 <br /> B4E5181ACC1100... <br /> Legal Services <br /> This agreement is approved as t RicIk§igfitddlYil sufficiency: <br /> LOU. A444'1L 1).S(6 <br /> Office of the County Attorney 070AAD525COF4FB... Date: 11/28/2 017 <br /> Clerk to the Board <br /> Received for record retention: <br /> All DocuSign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.gov <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 />