25A - AGMT FOR FLEX SPENDING - Laserfiche WebLink

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DocuSign Envelope ID: CFCE3443-EF374FD4-8DCD-D85D559F77AE notice to the Participant. If no response is received within 14 days, a second request for substantiation will be sent. If no response is received within 7 days of this second request, the Card may be deactivated and the expense will be deemed ineligible. Once a transaction is deemed ineligible, resolution is required and can be made through one of the following methods: a. Submission of adequate receipts as substantiation to the Contract Administrative Firm within the corresponding plan year. Upon receipt, the transaction will be approved therefore reactivating the Card (if applicable); b. Refunding the applicable reimbursement account on an after- tax basis equal to the amount of the transaction. This refund must be made in accordance with the Client's internal policies. The Contract Administrative Firm will reverse the ineligible transaction and release the associated funds for future use upon written notification from the Client. c. A written report outlining unresolved and therefore ineligible transactions will be provided to the Client on a monthly basis. At the end of the plan year, all remaining ineligible transactions must be added to the Participant's W-2 as taxable income. 17. The Client agrees that, at any time during the Term of the Agreement as defined herein, if it should file in the United States for debt relief or reorganization of any type, all services from the date of the filing forward may terminate immediately. The Client further agrees that it is its responsibility to ensure that written notification of filing for debt relief or reorganization of any type is provided to the Contract Administrative Firm in a reasonable timeframe. 18. The Client agrees that in the event of an acquisition or merger that it is its responsibility to ensure that written notification is provided to the Contract Administrative Firm in a reasonable timeframe. The Client further agrees to provide all information as requested and in a timely mannerto assist the Contract Administrative Firm in identifying aspects of current administration that may be impacted or require alteration as a result of an acquisition or merger, including but not limited to an amended Agreement, amended specimen reimbursement account documentation, and system adjustments. Client solely is responsible for determining whether or not, as a result of an acquisition, merger, or other business transaction it is a component member of a controlled group, common control group, or affiliated service group, under Code 4 414(b), (c), or (m) and for the consequences, under ERISA and the Code, /GOE City of Santa Ana Spending Account Administrative services Agreement Client Initials: PEPM17 Page 10 25A-12