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Administrative Services Agreement - Schedule of Fees Indian River County BCC Effective Date — October 1 , 2010 FSA Administration The one- time implementation fee is waived . The monthly administration fee is $ 3 . 09 per participant (in either or both accounts) per month . Participants may elect to receive a debit card as an alternate means of accessing money in the FSA account(s) . There is a debit card administration fee of $ 1 . 50 per Flexible Spending Account participant per month, which will be deducted from the participant ' s account in one lump sum on the date participation begins for the plan year . This fee is not refundable for early termination from the plan . Each FSA employee participant will receive one debit card. The Flexible Spending Account participant may order additional cards or replace lost cards for a fee of $ 5 . 00 per card . This fee is charged to the participant ' s FSA . The use of the debit card does not eliminate the requirement that expenses be substantiated as eligible under IRS guidelines . The employer will be responsible for a minimum deposit of funds to activate the debit cards and prompt replenishment of disbursed funds . The employer is responsible for the operation of the Flexible Spending Account plan and will assist JAG Enterprises , LLCBenefitsWorkshop in recovering any overpayments which may result from the improper use of the debit cards . JAG_ Enterprises , LLCBenefitsWorkshop will not be liable for intentional or unintentional overpayments or any fraudulent use of the cards . Plan Documents and Nondiscrimination Testine There is a $ 100 . 00 annual fee for plan documents for the Section 125 plan and underlying benefits such as the FSAs , and access to our online Section 125 nondiscrimination testing services . cknowledged By. (P Spon r) (Title) (Date) APPROVED AS TO FORM AMD LEGAL SUFFICIENCY BY r— ; ALAN S. POLACKWH Page 7 COUNTY ATTORNEY g