HomeMy WebLinkAboutR 2017-640-E HR - Flexible Benefits Administrators, Inc. (FBA) to authorize FBA to work directly with Delta Dental DocuSign Envelope ID:B156146B-0400-4433-84BD-A56E1DCE5DA7
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Flexible Benefits Administrators, Inc.. Party/Vendor Contact Person: Leanne Widenhofer
Contact Phone: 757-340-4567 x 138 Party/Vendor Address: Post Office Box 2070 City Virginia Beach State: VA
Zip: 23450 Department: Amount: $0 Purpose: To authorize Flexible Benefits Administrators to work
directly with Delta Dental Budget Code(s): 10250020/630000 Vendor#61126 (N/A if new vendor) Vendor is a
BOCC consultant? Yes ❑ No0 Contract Type: (Check one) New l 1 Renewal ❑ Amendment ❑ Effective
Date July 13,2017 Approved by Board Yes Not Agenda Date:
This agreement is approved as to to l44ir •.nd content:
bruA,14. 1%446644o 11/27/2017
Department Director's Signatur Date:
11/27/2017
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficiency � gggystandards,specifications, and requirements:
[(USX 11/27/2017
Office of the Risk Management Officer Date:
11/27/2017• ...,....
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
Office of the Chief Financial Officer �o� Date:11/28/2017
B4E5181ACC1100...
Legal Services
This agreement is approved as t RicIk§igfitddlYil sufficiency:
LOU. A444'1L 1).S(6
Office of the County Attorney 070AAD525COF4FB... Date: 11/28/2 017
Clerk to the Board
Received for record retention:
All DocuSign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.gov
The following signature block is for hard copies only and is not required for DocuSign contracts:
Office of the Clerk to the Board Date: