08-13-07-Resolution-Establishing a 457 Deferred Compensation Plan-09/04/2007RESOLUTION NO, 08-13-07
A RESOLUTION ON A 43 /DEFERRED COMPENSATION PLAN FOR
THE CITY OF SANGER
WHEREAS, the City of Sanger has employees rendering valuable services; and
WHEREAS, the establishment of a deferred compensation plan for such employees serves the interests of
the City of Sanger by enabling it to provide reasonable retirement security for its employees, by providing
increased flexibility in its personnel management system, and by assisting in the attraction and retention of
competent personnel; and
WHEREAS, the City of Sanger has determined that the establishment of a deferred compensation plan to
be administered by the ICMA Retirement Corporation serves the above objectives; and
WHEREAS, the City of Sanger desires that its deferred compensation plan be administered by the ICMA
Retirement Corporation, and that some or all of the funds held under such plan be invested in the Vantage
Trust Company, a trust established by public employers for the collective investment of funds held under
their retirement and deferred compensation plans;
NOW, THEREFORE, BE IT RESOLVED that the City of Sanger hereby adopts the deferred plan (the
"Plan") in the form of the ICMA Retirement Corporation Deferred Compensation Plan and Trust, referred
to as Appendix A.
BE IT FURTHER RESOLVED that the City of Sanger hereby executes the Declaration of Trust of the
Vantage Trust Company, attached hereto as Appendix B, intending this execution to be operative with
respect to any retirement or deferred compensation plan subsequently established by the City of Sanger, if
the assets of the plan are to be invested in the Vantage Trust Company,
BE IT FURTHER RESOLVED that the assets of the Plan shall be held in trust, with the Employer serving
as trustee, for the exclusive benefit of the Plan participants and their beneficiaries , and the assets. shall not
be diverted to any other purpose.
BE IT FURTHER RESOLVED that the City of Sanger hereby agrees to serve as trustee under the Plan.
BE IT FURTHER RESOLVED that Steven Glickman, Human Resource &Accounting Technician, shall
be the coordinator for this program; shall receive necessary reports, notices, etc. from the ICMA Retirement
Corporation or the Vantage Trust Company; shall cast, on behalf of the City of Sanger, any required votes
under the Vantage Trust Company; Administrative duties to carry out the plan may be assigned to the
appropriate departments, and is authorized to execute all necessary agreements with ICMA Retirement
Corporation incidental to the administration of the Plan.
P SSED, ADOPTED AND APPROVED by the City Council of the City of Sanger this `7 day of
2007.
Higgs,
0
Rosalie Chavez,
ADMINISTRATIVE SERVICES AGREEMENT
Between
ICMA Retirement Corporation
City of Sanger
Type: 457
Account #: 306280
Plan number 306280
ADMINISTRATIVE SERVICES AGREEMENT
This Administrative Services Agreement ("Agreement"), made as of the day
of , 2007 (herein referred to as the "Inception Date"), between the International
City/County Management Association Retirement Corporation ("ICMA-RC" ), a
nonprofit corporation organized and existing under the laws of the State of Delaware, and
the City of Sanger ("Employer"), a City organized and existing under the laws of the
State of Texas with an office at201 Bolliver, Sanger, Texas 76266.
RECITALS
Employer acts as a public plan sponsor for a retirement plan ("Plan") with
responsibility to obtain investment alternatives and services for employees participating
in that Plan;
VantageTrust (the "Trust") is a common law trust governed by an elected Board
of Trustees for the commingled investment of retirement funds held by various state and
local governmental units for their employees,
ICMA-RC acts as investment adviser to the Trust; ICMA-RC has designed, and
the Trust offers, a series of separate funds (the "Funds") for the investment of plan assets
as referenced in the Trust's principal disclosure document, "Making Sound Investment
Decisions: A Retirement Investment Guide." ("Retirement Investment Guide").
The Funds are available only to public employers and only through the Trust and
In addition to serving as investment adviser to the Trust, ICMA-RC provides a
complete offering of services to public employers for the operation of employee
retirement plans including, but not limited to, communications concerning investment
alternatives, account maintenance, account record -keeping, investment and tax reporting,
transaction processing, benefit disbursement, and asset management.
AGREEMENTS
1. Appointment of ICMA-RC
Employer hereby appoints ICMA-RC as Administrator of the Plan to perform all
nondiscretionary functions necessary for the administration of the Plan with respect to
assets in the Plan deposited with the Trust. The functions to be performed by ICMA-RC
shall be those set forth in Exhibit A to this Agreement.
Plan number 306280
2. Adoption of Trust
Employer has adopted the Declaration of Trust of v antage I rust and agrees to the
commingled investment of assets of the Plan within the Trust. Employer agrees that
operation of the Plan and the investment, management, and distribution of amounts
deposited in the Trust shall be subject to the Declaration of Trust, as it may be amended
from time to time and shall also be subject to terms and conditions set forth in disclosure
documents (such as the Retirement Investment Guide or Employer Bulletins) as those
terms and conditions may be adjusted from time to time. It is understood that the term
"Employer Trust" as it is used in the Declaration of Trust shall mean this Administrative
Services Agreement,
3. Emplo. env to Furnish Information
Employer agrees to furnish to ICMA-RC on a timely basis such information as is
necessary for ICMA-RC to carry out its responsibilities as Administrator of the Plan,
including information needed to allocate individual participant accounts to Funds in the
Trust, and information as to the employment status of participants, and participant ages,
addresses, and other identifying information (including tax identification numbers).
ICMA-RC shall be entitled to rely upon the accuracy of any information that is furnished
to it by a responsible official of the Employer or any information relating to an individual
participant or beneficiary that is furnished by such participant or beneficiary, and ICMA-
RC shall not be responsible for any error arising from its reliance on such information.
ICMA-RC will provide account information in reports, statements or accountings.
4. Certain Representations and Warranties
ICMA-RC represents and warrants to Employer that:
(a) ICMA-RC is anon -profit corporation with full power and authority to
enter into this Agreement and to perform its obligations under this
Agreement. The ability of ICMA-RC to serve as investment adviser to the
Trust is dependent upon the continued willingness of the Trust for ICMA-
RC to serve in that capacity.
(b) ICMA-RC is an investment adviser registered as such with the U.S.
Securities and Exchange Commission under the Investment Advisers Act
of 1940, as amended. ICMA-RC Services, LLC (a wholly owned
subsidiary of ICMA-RC) is registered as a broker -dealer with the U.S.
Securities and Exchange Commission ("SEC") and is a member in good
standing with the National Association of Securities Dealers ("NASD")
and the Securities Investor Protection Corporation ("SIPC").
(c) ICMA-RC shall maintain and administer the Plan in compliance with the
requirements for eligible deferred compensation plans under Section 457
of the Internal Revenue Code and other applicable federal law; provided,
K3
Plan number 306280
however, that ICMA-RC shall not be responsible for the eligible status of
the Plan in the event that the Employer directs ICMA-RC to administer the
Plan or disburse assets in a manner inconsistent with the requirements of
Section 457 or otherwise causes the Plan not to be carried out in
accordance with its terms. Further, in the event that the Employer uses its
own customized plan document, ICMA-RC shall not be responsible for
the eligible status of the Plan to the extent affected by terms in the
Employer's plan document that differ from those in ICMA-RC's standard
plan document. ICMA-RC shall not perform any service that ICMA-RC,
in its sole judgment, considers might cause ICMA-RC to be treated as a
"fiduciary" of the Plan under applicable law.
Employer represents and warrants to ICMA-RC that:
(d) Employer is organized in the form and manner recited in the opening
paragraph of this Agreement with full power and authority to enter into
and perform its obligations under this Agreement and to act for the Plan
and participants in the manner contemplated in this Agreement. Execution,
delivery, and performance of this Agreement will not conflict with any
law, rule, regulation or contract by which the Employer is bound or to
which it is a parry.
(e) Employer understands and agrees that ICMA-RC's sole function under
this Agreement is to act as recordkeeper and to provide administrative,
investment or other services at the direction of Plan participants, the
Employer, its agents or designees in accordance with the terms of this
Agreement. Under the terms of this Agreement, ICMA-RC does not
render investment advice to the Plan, is not the Plan Administrator or Plan
Sponsor as those terms are defined under applicable federal, state, or local
law, and does not provide legal, tax or accounting advice with respect to
the creation, adoption or operation of the Plan and the Trust.
(f) Employer acknowledges that certain such services to be performed by
ICMA-RC under this Agreement may be performed by an affiliate or
agent of ICMA-RC pursuant to one or more other contractual
arrangements or relationships, and that ICMA-RC reserves the right to
change vendors with which it has contracted to provide services in
connection with this Agreement without prior notice to Employer.
5. Participation in Certain Proceedings
The Employer hereby authorizes ICMA-RC to act as agent, to appear on its behalf, and to
join the Employer as a necessary party in all legal proceedings involving the garnishment
A benefits or the transfer of benefits pursuant to the divorce or separation of participants
in the Employer Plan. Unless Employer notifies ICMA-RC otherwise, Employer consents
to the disbursement by ICMA-RC of benefits that have been garnished or transferred to a
r�
Plan number 306280
former spouse, current spouse, or child pursuant to a domestic relations order or child
support order.
6. Compensation and Payment
(a) Plan Administration Fee. The amount to be paid for plan administration
services under this Agreement shall be 0.55% per annum of the amount of
Plan assets invested in the Trust. Such fee shall be computed based on
average daily net Plan assets in the Trust.
(b) Account Maintenance Fee. The annual Account Maintenance Fee for Plan
participants will be waived for Employers who use EZLink for
contribution processing and submit deposits by wire transfer or ACH. In
the event that Employer does not use EZLink for contribution processing
and ACH/wire transfer, the annual Account Maintenance Fee shall be
$36.00 per Plan participant. If applicable, this fee is payable on the first
day of the calendar quarter following establishment and is prorated by
reference to the number of calendar quarters remaining on the day of
payment. The Account Maintenance fee is debited from each Plan
participant's account.
(c) Mutual Fund Services Fee. There is an annual charge of 0.15%assessed
against average daily net Plan assets invested in the Trust's non-
proprietary funds of VantageTrust.
(d) Compensation for Management Services to the Trust; Compensation for
Advisory and other Services to the Vantagepoint Funds. Employer
acknowledges that in addition to amounts payable under this Agreement,
ICMA-RC receives fees from the Trust for investment management
services furnished to the Trust. Employer further acknowledges that
certain wholly owned subsidiaries of ICMA-RC receive compensation for
advisory and other services furnished to the Vantagepoint Funds, which
serve as the underlying portfolios of a number of Funds offered through
the Trust. The fees referred to in this subsection are disclosed in the
Retirement Investment Guide. These fees are not assessed against assets
invested in the Trust's Mutual Fund Series.
(e) Redemption Fees. Redemption fees imposed by outside mutual funds in
which Plan assets are invested are collected and paid to the mutual fund by
ICMA-RC. ICMA-RC remits 100% of redemption fees back to the
specific mutual fund to which redemption fees apply. These redemption
fees and the individual mutual fund's policy with respect to redemption
fees are specified in the prospectus for the individual mutual fund and
referenced in the Retirement Investment Guide.
E
Plan number 306280
(f) Payment Procedures. All payments to ICMA-RC pursuant to this Section
6 shall be paid out of the Plan assets held by the Trust and shall be paid by
the Trust, to the extent not paid by the Employer. The amount of Plan
assets held in the Trust shall be adjusted by the Trust as required to reflect
such payments. In the event that the Employer agrees to pay amounts
owed pursuant to this section 6 directly, any amounts unpaid and
outstanding after 30 days of invoice to the Employer shall be withdrawn
from Plan assets held by the Trust.
The compensation and payment
Employer's use of ICMA-RC's
submitting contribution funds by
term of this Agreement.
7. Custody
set forth in this section 6 is contingent upon the
EZLink system for contribution processing and
ACH or wire transfer on a consistent basis over the
Employer understands that amounts invested in the Trust are to be remitted directly to the
Trust in accordance with instructions provided to Employer by ICMA-RC and are not to
be remitted to ICMA-RC. In the event that any check or wire transfer is incorrectly
labeled or transferred to ICMA-RC, ICMA-RC may return it to Employer with proper
instructions.
8. Indemnification
ICMA-RC shall not be responsible for any acts or omissions of any person with respect
to the Plan or related Trust, other than ICMA-RC in connection with the administration
or operation of the Plan. Employer shall indemnify ICMA-RC against, and hold ICMA-
RC harmless from, any and all loss, damage, penalty, liability, cost, and expense,
including without limitation, reasonable attorney's fees, that may be incurred by, imposed
upon, or asserted against ICMA-RC by reason of any claim, regulatory proceeding, or
litigation arising from any act done or omitted to be done by any individual or person
with respect to the Plan or related Trust, excepting only any and all loss, damage, penalty,
liability, cost or expense resulting from ICMA-RC's negligence, bad faith, or willful
misconduct.
This Agreement may be terminated without penalty by either party on sixty days advance
notice in writing to the other.
10. Amendments and Adjustments
(a) This Agreement may not be amended except by written instrument signed by the
parties.
0
Plan number 306280
(b) No failure to exercise and no delay in exercising any right, remedy, power or
privilege hereunder shall operate as a waiver of such right, remedy, power or
privilege.
(c) The parties agree that enhancements may be made to administrative and
operations services under this Agreement. The Employer will be notified of
enhancements through the Employer Bulletin, quarterly statements or special
mailings. Likewise, if there are any reductions in fees, these will be announced
through the Employer Bulletin, quarterly statement or special mailing.
11. Notices
All notices required to be delivered under Section 10 of this Agreement shall be delivered
personally or by registered or certified mail, postage prepaid, return receipt requested, to
(i) Legal Department, ICMA Retirement Corporation, 777 North Capitol Street, N.E.,
Suite 600, Washington, D.C., 200024240; (ii) Employer at the office set forth in the first
paragraph hereof, or to any other address designated by the party to receive the same by
written notice similarly given.
12. Complete Agreement
This Agreement shall constitute the complete and full understanding and sole agreement
between ICMA-RC and Employer relating to the object of this Agreement and correctly
sets forth the complete rights, duties and obligations of each party to the other as of its
date. This Agreement supersedes all written and oral agreements, communications or
negotiations among the parties. Any prior agreements, promises, negotiations or
representations, verbal or otherwise, not expressly set forth in this Agreement are of no
force and effect.
13. Titles
The headings of Sections of this Agreement and the headings for each of the attached
schedules are for convenience only and do not define or limit the contents thereof.
14. Incorporation of Schedules
All Schedules (and any subsequent amendments thereto), attached hereto, and referenced
herein, are hereby incorporated within this Agreement as if set forth fully herein.
16. Governing Law
This Agreement shall be governed by and construed in accordance with the laws of the
State of Texas, applicable to contracts made in that jurisdiction without reference to its
conflicts of laws provisions.
0
Plan number 306280
In Witness Whereof, the parties hereto certify that they have read and understand this
Agreement and all Schedules attached hereto and have caused this Agreement to be
executed by their duly authorized officers as of the Inception Date first above written.
CITY OF SANGER
By Date 16 h)
Signature
$'titre. a �lc' At) 0F1 &
Name and Title (Please Print)
INTERNATIONAL CITY/COUNTY MANAGEMENT
ASSOCIATION RETIREMENT CORPORATION
Angela C. Montez
Assistant Corporate Secretary
Please return fully executed contract to:
New Business Unit
ICMA-RC
777 North Capitol Street NE
Suite 600
Washington DC 200024240
Plan number 306280
Exhibit A
Administrative Services
The administrative services to be performed by ICMA-RC under this Agreement shall be
as follows:
(a) Participant enrollment services, including providing a welcome package and
enrollment kit containing instructions and notices necessary to implement
the Plan's administration.
(b) Establishment of participant accounts for each employee participating in the
Plan for whom ICMA-RC receives appropriate enrollment forms and
records. ICMA-RC is not responsible for determining if such Plan
participants are eligible under the terms of the Plan.
(c) Allocation in accordance with participant directions received in good
order of individual participant accounts to investment funds offered under
the Trust.
(d) Maintenance of individual accounts for participants reflecting amounts
deferred, income, gain or loss credited, and amounts distributed as
benefits.
(e) Maintenance of records for all participants for whom participant accounts
have been established in paper or electronic format. These files shall include
enrollment instructions, beneficiary designation instructions (to the extent
provided to ICMA-RC) and all other written correspondence and documents
concerning each participant's account, and if applicable, records of any
transaction conducted through the Voice Response Unit ("VRU"), the
Internet or other electronic means.
(f) Provision of periodic reports to the Employer and participants of the status
of Plan investments and individual accounts.
(g) Communication to participants of information regarding their rights and
elections under the Plan.
(h) Making available Investor Services Representatives through atoll -free
telephone number from 8:30 a.m. to 9:00 p.m. Eastern Time, Monday
through Friday (excluding holidays and days on which the securities
markets or ICMA-RC are closed for business (including emergency
closings), to assist participants.
(i) Making available atoll -free number and access to VantageLine, ICMA-
RC's interactive VRU, and ICMA-RC's web site, to allow participants to
access certain account information and initiate plan transactions at any
time.
(j) Distribution of benefits as agent for the Employer in accordance with
terms of the Plan.
0
Plan number 306280
(k) Upon approval by the Employer that a domestic relations order is an
acceptable qualified domestic relations order under the terms of the Plan,
ICMA-RC will establish a separate account record for the alternate payee
and provide for the investment and distribution of assets held thereunder.
(1) Loans may be made available on the terms specified in the Loan Guidelines,
if loans are adopted by the Employer.
(m) Online Advice may be made available through a third party vendor on the
terms specified on ICMA-RC's website.
in
401/457ONLINE OPTIONS FORM
This form allows you to establish the following features for your plan(s):
I�IYI ^� (1) View
and update
,/�'�` (2) View and update beneficiary information online
(3) Display beneficiary information on participant account statements
3ttik/ingRetirement Security (4) Online withdrawal requests
Please fax the completed form to the attention of the New Business Unit at 202-962-4601.
Plan Number: -� A,/ b � � ❑ Make these changes to all of our 401/457 plans
Plan Name: C, J of s� L9p t'
1. Online deferral changes will be made avail/ab�le to the plan:
❑ YES 0 NO
This plan allows (select all that apply):
Pre-tax deferrals:
After-tax deferrals:
Minimum
Minimum $
Minimum
Minimum $
❑ Pre -Tax Deferrals ❑After -Tax Deferrals
Maximum % (Please enter whole percentages only)
Maximum $ (Please enter whole dollars only)
Maximum % (Please enter whole percentages only)
Maximum $ (Please enter whole dollars only)
2. Beneficiary infor tion should be displayed online so that it can be viewed and updated:
YES ❑ NO
3. Beneficiary information should be displayed on participant statements:
LA YES ❑ NO
4. Online withdrawals will be made available the Plan:
❑ YES NO
Employer Authorization:
Plan Coo
Print Name
ICMA-RC Use Only:
Form Rec'd by:
Date:
icmA �C
Building Retirement Security
457 DEFERRED COMPENSATION PLAN DATA FORM
• Instructions to Employer: Provide necessary information to establish your plan properly. Please
contact your New Business Unit Analyst at 1-800-32&7272, if you have any questions.
ICMA-RC Use Only
1. Employer Number: 30
General 2. (902)Employer's Full Name:___
Information 3. (924) Street Address: ( 13 ul, v6; r`
(925)
4. (9m City: VN
(9t9) State: (920) Zip Code: 6L _ 6
5. (633) Primary Contact Name: t 4eJj fu'Fe K
6. (634) Primary Contact Title: k�� T1_1c;tkrct cVJ1 /16 COJAr` i Wit. 43L i'40yA
7. (631) Primary Contact Telephone#: ( ) €-ts ��'7473
8. (632)Fax M ) 4 '?�!t1 c)
9. (882) Employer's Federal Tax Identification Number:
Plan 10. (sit) Contribution Information (See "Important Contribution Information" later in this book)
Implemen- a. Frequency: (check one): 0) Bi-weekly* ❑ (4) Monthly ❑ (8) Semi -quarterly
tation ❑ (1) Weekly ❑ (5) Semi-monthly ❑ (9) Bi-annually
Information
❑ (2) Semi -weekly ❑ (6) Bi-quarterly ❑ (10) Annually
❑ (3) Bi-monthly ❑ (7) Quarterly ❑ (11)Serni-annually
b. Deposit Medium: (624) ❑ Wire WACH
11. First Contribution Date Following Implementation: IQ 5/ 4) (mmddyyyy).
12. Number of Eligible Employees: 4o)— Expected Number of Participants:__
Default Fund ( 13. Default Fund for Investment Allocations:
Instructions -Use the Vantagepoint Funds Brochure or sheet to complete this section.
Default investment allocation. List the fund code(s) and percentage for investment allocation if a par-
ticipantelected allocation is not available. (Note: If no fund code is listed, the default will be Fund 71
PLUS Fund.)
Page 1 of 3
457 DEFERRED COMPENSATION PLAN DATA FORM
ICMA-RC Use Only: Employer Number: 30
Brrilding Retirunent Secrrriry
Primary PLAN CONTACTS
Contact 14. PT00
Information . .
(200) Primary Contact Name/Title: �7 aYt : { x. g C,� • � �( t
(422) Email Address:
Disbursement/ 15. PT01 Contact Signature: A6'
Loan Contact ( f
Information (200) Contact Name/Title: O/ U1LOVU,
Please (420) Telephone: ( v(j ► C. Fax:( ,O )
alternate 16. PT08 Contact Signature: ; f
addresses (200) Contact Name/Title: 54 ' V?^ G fr�C k n,,ses.1 �' /� �AcGtl �ec L%
in Comments
Section on (420) Telephone: l_ N� 1 % c4 3 0 Fax:( (l v ) 14 5" 3 4-1 �� 0
Page 3
17. PT09 Contact Signature:
(200) Contact Name�tle:
(420) Telephone: ( ) Fax:( 1
Contribution/ 18. PT02 (200) Contact NamelTitle: �� d �'n �-r�i� �. ..;�,� �c� a� �-�=ws�rer�c�' �r�G•�cr.r��
Mink _
Contact (420) Telephone: (1'° 9 � ) � `J ` 7 } Fax:( ) �n� f
Information
Does the EZLink Contact initiate ACH/wire for payroll? UYes ❑ No
If No, please provide ACH/wire contact information:
Name/Title: Telephone: ( )
EZLink is ICMA-RC's standard contribution detail summary format. Please complete and return the
EZLink Access Form. You must also complete a successful EZLink test before your first contribution can be
submitted.
Quarterly 19. PT04 (200) Contact Name�tle: 4��
Statement
Contact (420) Telephone: (ClHt3 1 145±j, 706,30 Fax:( qqQ ) W `& 44160
Information
►f this section is not completed, the Primary Contact will receive mailings.
Plan 20,PT05(200) Contact Name: `lt1ev� C�7itC ow
Coordinator
Contact Contact Title: UeK&� s< - -AfAe 1e6t1fA;C(61%
Information Note: Changing this title requires an amendment to your resolution.
(420) Telephone: (qJ0 ) 4-15 - �)410 Fax: ( _) Ll PC)
Name/Title:
Billing 21. PT05 (200) Contact
`�'R�..r"1 �d t" �g'Y�
(Fees)
Information (420) Telephone: ( ) w -fin 3() Fax:(7'TU ) S it zra
Comments:
(Alternate
Addresses
for #15-21)
Page 2 of 3
ICMAX(
Building Retirement Security
457 DEFERRED COMPENSATION PLAN DATA FORM
ICMA-RC Use Onl)r Employer Number: 30
Plan Asset 24. Will there be a transfer of assets to ICMA-RC from your current administrator?
Transfer
Information ❑ Yes �No
How many participants will be eligible to transfer assets to ICMA-RC?
What is the estimated cash value of the assets to be transferred to ICMA-RC? $ IVA
Your New Business Unit Analyst will contact you to discuss the process regarding the transfer of assets. ICMA-
RC will work with the prior administrator and your local Retirement Plans Specialist to coordinate the transfer of
assets in a timely manner.
Co -Provider 25. Does your plan have a co -provider relationship*?
Information
❑ Yes M No
If yes, please provide the co -provider information:
Name of Co-ProviderlsL'
Co -Provider 1:
Address:
Street
City
Phone Number
Co -Provider 2:
Address:
Street
City
Phone Number
State
State
*This information is required for the accurate record keeping of plan assets.
Internal Use Only
641
912
Zip Code
Zip Code
Page 3 of 3
1 CMAf&
Building Retirement Security
Plan Name* (®' +4 T �c.,�
Number*
Other Plan Number(s) (If Applicable)
(*This information must be completed to avoid processing delays.)
Plan
Coordinator
Information
2
Adoption
of Online
Withdrawal
Approval
3
Password
Holder
Information
Youmustprovide
the 'Password
Holderinforma-
tion " to establish
User ID's and
passwords
for additional
members of
yourstaff
Plan Coordinator Name: tiT
Phone Number: H46N LA S
Email Address: (
Mailing Address: lIN/ pY
City:
Title:
t�f N h
State: Zip: , �i6
❑ We hereby adopt Online Withdrawals and authorize ICMA-RC to permit disbursements from
participant accounts upon receipt of termination dates. Additionally, we understand Online
Withdrawals are only available for 401 and 457 plans, termination dates should be submit-
ted in a timely manner, and employer approval is not required for individual disbursement
requests. (Note: Please contact an EZLink Specialist at 1-800-326-7272, for information on
submitting termination dates.)
Select One: LJ Add New User ID
Name: �i4C'4e
Title: �3, <<LA
Phone #:i_
❑ Reassign User ID ❑ Update User ID ❑ Remove User ID
Access:
Inquiry— Balances &Reports N
Enrollments/Rehires ��Y _N
Participant Changes Y _N
name, address, etc.)
(
Current User ID: e�
mail Address:
Contributions &Loan Repays � _N
Participant Data Transfer: _Y _N
.....................................................................................................................................................................
Select Outs:, Ill Add New User ID ❑ Reassign User ID ❑ Update User ID ❑ Remove User ID
Name: ' o o L �vE`
P
hone
Access:
Inquiry —Balances &Reports � _N
Enrollments/Rehires �Y _N
Participant Changes Y _N
name, address, etc.)
(
Current User ID:
Email Address:
Contributions &Loan Repays � _N
Participant Data Transfer:
n�
...........................................................................................................................................................................
Select One: ❑ Add New User ID El Reassign User ID ❑ Update User ID ❑ Remove User ID
tie:
Name:
Ti
Phone #:
Access:
Inquiry —Balances &Reports _Y _N
Enrollments/Rehires _Y _N
(name, address, etc.)
Participant Changes _Y _N
Current User ID:
Email Address:
Contributions &Loan Repays _Y _N
Participant
Data Transfer: _Y _N
Please fax your completed EZLink Access Form to the "EZLink Administrator" at 1-202-962-4601.
FRM000-019-200508
ICM/M%400
Building Retirement Security
3
Password
Holder
Information
Select One. ❑
Name:
Title.
Phone M
Add New User ID ❑ Reassign User ID ❑ Update User ID
Access:
(continued) Inquiry - Balances & Reports _Y _N
Enrollments/Rehires _Y _N
Participant Changes _Y _N
(name, address, etc.)
urrent
CUser ID:
Email Address:
❑ Remove User ID
Contributions &Loan Repays _Y _N
Participant Data Transfer: _Y _N
.......................................................................................................................................................................... .
Select One, ❑ Add New User ID ❑ Reassign User ID ❑ Update User ID ❑ Remove User ID
tie:
Name:
Ti
Phone #:
Access:
Inquiry -Balances &Reports _Y _N
Enrollments/Rehires
Participant Changes _Y _N
(name, address, etc.)
Current User ID:
Email Address:
Contributions &Loan Repays _Y _N
Participant Data Transfer: _Y _N
ICMA-RC considers participant information to be highly confidential, and we go to great lengths to avoid breach-
4 ing that confidentiality. For this reason, ICMA-RC cannot be responsible for (il negligent or intentional misuse of
Plan the password by the municipality's officers, employees, agents or contractors, (ii) a breach of confidentiality that
Coordinator may occur as a result of such negligent or intentional misuse of the password, or (iii) a breach of confidentiality
Approval that may occur as a proximate result of the municipality's access to the participant database. If the municipality
uses EZLink online transaction processing, please remember to review all financial information you have entered
(Plan coordinator for your participants, as ICMA-RC is not responsible for incorrect data transmitted by the municipality. ICMA-RC
UserlDandpass- recommends that you encourage all participants to review statements and confirmations for accuracy.
wordautomatiCally ICMA-RC's Web site is normally available 24 hours a day, seven days a week. However, service availability is not
generated.) guaranteed. Neither ICMA-RC or its affiliates, the VantageTrust Company, nor The Vantagepoint Funds will be re-
sponsible for any loss (or forgone gain) you may incur as a result of service being unavailable.
Please signify your agreement to these terms by signing in the space indicated below. You may fax this signed
form to the EZLink Administrator at 1-202-9624601. We will provide you with User ID(s) and Password(s)
to begin using EZLink. Should you have questions regarding EZLink, please contact an EZLink Specialist at 1-8M
326-7272.
Agreed: Date: Plan Coordinator
Print Your Name *1i
He4<�f\ C'1 � n
Please fax your completed EZLink Access Form to the "EZLink Administrator" at 1-202-962-4601.
FRM000-019-200508