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IASURANOC NOT REQUIRED <br />ORK AWAY PROCEED <br />& • CLERK OF GO NCIL. <br />DATE:' 3C7 <br />0, HPOI <br />ICAARC <br />BUILDING PUBLIC SECTOR <br />RETIREMENT SECURITY <br />Vantage(are Retirement Health Savings (RHS) <br />PLAN AMENDMENT PACKET <br />To amend your existing RHS flan, please complete the entire Adoption Agreement, including items <br />that are not being amended. When you send your amendment to ICMA-RC, please summarize the <br />changes in your cover letter. <br />Please note that ICMA-RC does not require the use of a resolution to amend the plan. Should you <br />require legislative action, you may use the Suggested Resolution for Amendment on the following <br />page. If you do not require legislative action, you may complete the Suggested Affirmative Statement <br />for Amendment which follows. <br />Once the amendment is completed, retain a copy for your records and send the original with the <br />cover letter and either the resolution or the affirmative statement to 1CMA--RC as follows: <br />Via Mail <br />ICMA-RC <br />Arm — New Business Services <br />Suite 600 <br />777 North Capitol Street, NE <br />Washington, DC 20002-4240 <br />Via Facsimile <br />202-9624601 <br />Atm — New Business Services <br />You will receive notification that your amendment has been received and accepted. <br />A030�6' 2-091CxW 1,2 <br />r <br />