HomeMy WebLinkAboutAgr 2018-01-01 (WageWorks FSA) WageftrksW
Funding Profile
Effective Date: 1/1/2018
Client.
Town of Tiburon
1505 Tiburon Blvd.
Tiburon,CA 94920
FSA/HRA Funding
• Funding Payment Method: ACH Debit
FSA Funding
• Required Funding: Client shall initially provide and,thereafter,maintain Funding in an amount equal to 4% of
estimated benefit claims for the applicable Plan year. If WageWorks commences the provision of Services after
the start of a Plan year,this amount shall,instead,be equal to 4% of estimated benefit claims for the remainder
of that Plan year. The initial funding amount due must be received prior to the first day of the Plan year.
• Reconciliation: At the completion of each Plan year,the remaining Funding shall be reconciled and returned to
Client(less any amounts owed to WageWorks)as soon as administratively practicable,but in no event later
than ninety(90)days after the completion of any Run-out Period and any ancillary manual claims settlement.
• Reporting: A comprehensive suite of funding reports is available for download via WageWorks'website.
• Payment Term: Net I day(s)from the date of invoice.
Additional Terms
• Service Charge on Overdue Amounts: 2%Per Month
• If notified by WageWorks of insufficient Funding,Client shall provide additional Funding to WageWorks
within one(1)business day via electronic funds transfer.
• Any Service Delivery Standards shall be waived during the period of time that payment of Funding is delayed.
Client ACH Debit Authorization(Primary):
Bank Name Bank of Marin
Bank Address 1 Blackfield Drive,Tiburon,CA 94920
ABA Routing No.(9 digits) 121141877
Direct Deposit Account No. 06313787
Finance Contact Email merleekatzman@bankofmarin
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Signature• fiORR/1e Oeelff an
Suzanne Creekmore(Nov 7,2017�
Email: screekmore@townoftiburon.org
Title: Management Analyst
Company: TownofTiburon
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Order Form
Client:
Town of Tiburon
1505 Tiburon Blvd.
Tiburon,CA 94920
Effective Date*: 1/l/2018 Payment Method: ACH Debit
End Date: 12/31/2020 Payment Terms: Net 30 days
Service Charge on Overdue Amounts: 2% Per Month
Products:
FSA Admin Fee $3.90 PPPM Per Participant Per Month
FSA Monthly Minimum $50.00
FSA Implementation Fee $1,000.00
FSA HSA Plan Additional Service $0.00 FSA/HSA Plan Document and Summary Plan Description.
Document and Fee Priced per plan.
Summary Plan
Description
Non-discrimination Additional Service $0.00 Each non-discrimination testing session which includes:
Testing Session- Fee Section 125 Key Employee Concentration Test,Section
Standard Package 129 More Than 5%Owners Test(Dependent Care FSA)
and Section 129 55%Average Benefits Test(Dependent
Care FSA test). Up to three tests per year.
Terms and Conditions:
• This Order Form is subject to WageWorks'General Terms and Conditions of Service that may be viewed at
httos://www.waeeworks.com/emhovers/terins-and-conditions.aspx,and all terms defined therein shall have the
same meaning in this Order Form unless otherwise specified herein.
• *This Order Form shall be effective as of 1/1/2018(unless this Order Form is incomplete or does not match our
records). Billing shall commence upon start of Service(s).
Client ACH Debit Authorization
Bank Name: Bank of Marin
Bank Address: I Blackfield Drive,Tiburon,CA 94920
ABA Routing No.(9 digits): 121141877
Direct Deposit Account No: 06313787
Finance Contact Email: merleekatzman@bankofmarin.com
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Signature: A�����9g�6
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Email: hbigall@townoftiburon.org
Title: Director of Administrative Services
Company: TownofTiburon