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RESOLUTION ADOPTING A FLEXIBLE BENEFITS PLAN
The undersigned hereby certifies that the following described Resolution was officially and legIly
adopted at the duly authorized official meeting of the body with legal authority (hereafter "Authority")to
pass said Resolution. Said meeting was held on the date set forth below.
WHEREAS, the Authority wishes to adopt a cafeteria plan within the context of Section 125 of the
Internal Revenue Code for the benefit of the employer's eligible employees.
NOW, THEREFORE, BE IT RESOLVED, that the Authority hereby adopts the Flexible Benefits Plan
(consisting of the flexible benefits plan document, the Adoption Agreement, and component benefit
plans and Policies) for the Employer named herein below effective as of the date specified in the
Adoption Agreement.
RESOLVED FURTHER, that any officer of the employer may, without a further resolution, execute the
Adoption Agreement and any related documents or amendments which may be necessary or
appropriate to adopt the plan or maintain its compliance with applicable federal, state and local law.
Name:
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Body With Legal Authority Of Employer To Pass Resolution:
(Examples - Board of Directors, Board of Commissioner, etc.)
Date of Official Meeting of Authority
at which Resolution was Legally Passed:
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*Note: regwremen fir $ valid Board of Directors Resolution vary from state to state. This
docum: el a - - 0 *d form. Each Employer should consult with its own legal counsel to
ensure c• - re able law.
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ign ur of Person with Authority to certify
that esolution was legally passed
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Print Name and Title of Pers6n above_
Date:
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470sgisass046
PROC2978.4