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2024-136
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2024-136
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Last modified
11/26/2024 2:04:55 PM
Creation date
7/11/2024 11:58:20 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Addendum
Approved Date
06/18/2024
Control Number
2024-136
Agenda Item Number
12.C.1.
Entity Name
RxBenefits, Inc. (f/k/a Prescription Benefits, Inc.)
Subject
Addendum to Administrative Services Agreement for Group Insurance FY 24/25
Document Relationships
2024-137
(Cover Page)
Path:
\Official Documents\2020's\2024
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Docusign Envelope ID: 4C1 95600-904A-41 DA-A041-3005C422FD42 <br />Certificate Of Completion <br />DocuSign <br />Envelope Id: 7CEFAB0059DE49DA8C5BD8DB41083547 <br />Status: Sent <br />Subject: FOR CLIENT SIGNATURE: Addendum to ASA with Indian River County Board of County Commissioners & RxB <br />Source Envelope: <br />Document Pages: 24 Signatures: 0 <br />Envelope Originator: <br />Certificate Pages: 2 Initials: 0 <br />Alyssa Nelson <br />AutoNav: Enabled <br />3700 Colonnade Parkway <br />Envelopeld Stamping: Enabled <br />Suite 600 <br />Time Zone: (UTC -08:00) Pacific Time (US & Canada) <br />Birmingham, AL 35243 <br />anelson@rxbenefits.com <br />IF Address: 97.85 99.61 <br />Record Tracking <br />Status: Original <br />5/23/2024 7:52:21 AM <br />Signer Events <br />Emily Jackson <br />emily.jackson@lockton.com <br />Security Level: Email, Account Authentiaton <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered via DocuSign <br />Lauren Simmons <br />Isimmons@rxbenefits.com <br />Security Level: Email, Account Authentication <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered via DocuSign <br />In Person Signer Events <br />Editor Delivery Events <br />Agent Delivery Events <br />Intermediary Delivery Events <br />Certified Delivery Events <br />Carbon Copy Events <br />Alyssa Nelson <br />anelson@rxbenefits com <br />Security Level: Email, Account Authentication <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered via DocuSign <br />Donna Buzhardt <br />dbuzhardt@rxbenefits.com <br />Security Level: Email, Account Authentication <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered via DocuSign <br />Holder: Alyssa Nelson <br />anelson@rxbenefits.com <br />Signature <br />Signature <br />Status <br />Status <br />Status <br />Status <br />Status <br />[70!�XED <br />1. COPIED <br />Location: DocuSign <br />Timestamp <br />Sent: 5/23/2024 7:55:13 AM <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Sent: 5/2312024 7:55:11 AM <br />Sent: 5/23/2024 7:55:12 AM <br />Viewed: 5/23/2024 8:55:42 AM <br />
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