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FLEXIBLE BENEFITS ADMINISTRATION SERVICES AGREEMENT This Agreement made effective as of January 1, 2017 (the "Effective Date"), by and between SAMPLE COMPANY, 123 Main Street, Buffalo, NY 14202 (the "Employer"), and P&A ADMINISTRATIVE SERVICES, INC., 17 Court Street, Suite 500, Buffalo, NY 14202-3294 ("P&A"). WITNESSETH: WHEREAS, the Employer maintains a cafeteria plan as defined in Section 125 of the Internal Revenue Code for its eligible employees (the "Plan"); and WHEREAS, the Employer desires to retain P&A to provide administrative services with respect to the Plan, and P&A desires to provide such services upon certain terms and conditions; NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein and for other good and valuable consideration, receipt of which is hereby acknowledged, the parties hereto, with the intention of being legally bound hereby, covenant and agree as follows: 1. Services. P&A shall provide the following services with respect to the Plan: a. prepare such Plan documents as shall be necessary to properly restate the Plan as of the Effective Date, including a Plan document, a summary of the Plan for distribution to employees eligible to participate in the Plan ("Participants"), and an enrollment form. At the time provided to the Employer, such documents shall conform in all respects with applicable laws and regulations; b. with the assistance of the Employer, enroll Participants in the Plan; C. provide to each Participant who elects benefits under the Plan's Medical Expense Reimbursement Account benefit option or Dependent Care Assistance Account benefit option an electronic payment card that may be used to pay expenses that are eligible for reimbursement under that benefit option, and such additional cards for use by family members of the Participant as he or she reasonably shall request; d. substantiate the eligibility of expenses paid by use of an electronic payment card to the extent required by applicable law; e. provide Participants who have elected flexible spending account benefits under the Plan with a form to use in submitting flexible spending account claims; f. receive, review and, when authorized by the Plan and by applicable law, approve flexible spending account claims; g. from time to time, notify the Employer of the aggregate amount of funds needed from the Employer to pay pending approved claims and receive said funds as transmitted by the PM