25M - AGMT - 3RD AMNDMNT GREAT-WEST FINANCIAL

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b. SSN: e. Address: d. Date of Birth: The Alternate Payee is the Participant's former spouse. The Alternate Payee shall have the duty to notify the Plan Administrator and/or Recordkeeper of any changes in nailing address subsequent to the entry of this Order. 4. Plan Name. The name of the Plan to which this Order applies is the City of Santa Ana 457 Deferred Compensation. Plan. (hereafter referred to as "Plan"). Any changes in the Plan Administrator, Plan Sponsor, or name of the Plan shall not.affect Alternate Payee's rights as stipulated under this Order. 5. Effect of this Order as a Qualified Domestic Relations Order: This Order creates and recognizes the existence of an Alternate Payee's right to receive a portion of the Participant's benefits payable under an employer-sponsored defined contribution plan that is qualified under Section 457 of the Internal Revenue Code (the "Code"). It is intended to constitute a Qualified Domestic Relations Order ("QDRO") under Section 414(p) of the Code. 6. Pursuant to State Domestic Relations Law: This Order is entered pursuant to the authority granted in the applicable domestic relations laws of .. 7. Provisions of Marital Property Rights:, -This Order relates to the provision of marital property rights as a result of the Order of Divorce between the Participant and the Alternate Payee. 8. Amount of Alternate Payee's Benefit: ThistOrder assigns to the Alternate Payee an amount equal to [choose either option 8Al or 8A2 below]: 8AI S of the Participant's Total Account Balance under the Plan as of the date this Order is processed. OR 8A2 $ (dollars and cents) or _% (percent)] of the Participant's Total Account Balance accumulated under the Plan as of I (or the closest valuation date thereto). The Alternate Payee's benefit herein awarded shall be credited With any investment income (or losses) attributable thereon from the aforesaid valuation date (or the closest valuation date thereto), until the date of transfer of the Alternate Payee's share to the Alternate Payee. (Note to drafting attorney: The Plan's current recordkeeper is not able to determine the value of the Participant's account balance and any investment earnings and/or losses prior to The parties will need to arrive at a dollar figure or percentage of benefits payable to the Alternate Payee as of a date that is no earlier than The Plan's current recordkeeper can determine the account value and calculate any earnings and/or losses from through the date assets are transferred or distributed to the Alternate Payee. Keep in mind that if you must adjust the valuation date forward and a percentage is awarded to the Alternate Payee in this section, you should consider whether to adjust the Alternate Payee's awarded percentage to account for any additional contributions (and any gains/losses accruing thereon) made by or for the Participant to the account after the originally intended valuation date.) Such Total Account Balance shall be determined after the account is reduced by the outstanding balance of the Participant's account reduction loan(s), if any, as of the valuation date specified above, such that the Account Balance shall not include the outstanding balance of any account reduction loan(s) as of the valuation date. The obligation to repay any Participant Plan loan(s) from and after the date of this Order remains solely with the Participant. Such Total Account Balance shall include all amounts maintained under all of the various accounts and/or sub -accounts established on behalf of the Participant, including rollover and transfer contributions. The Alternate Payee's portion of the benefits described above shall be allocated on a pro rata basis first from all of the core accounts and/or core investment options maintained under the Plan on behalf of the Participant other than life insurance or Self -Directed Brokerage ("SDB"), if any. The Plan shall redeem amounts from a life insurance contract, if any. issued for the Participant under the Plan only to the extent necessary to obtain the amount that this order awards to the Alternate Payee. If there are any SDB investments, and if the balance in the core investments is insufficient to satisfy the judgment, Participant must initiate a transfer of the amount needed to satisfy the judgment From the SDB into the core investments. If participant fails to initiate such a transfer, or if the transfer is City of Santa Ana Service Agreement Amend No 3 25M-9