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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/10/2017 <br />Name Tierra Davis Department Admin & Finance <br />BPW Date 02/28/2017 Phone Extension 5510 <br />Required Prior to Submittal to Board id <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the Appropriate Item Type — Required for All Submissions <br />® Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />® Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I-1 Other: <br />Company or Vendor Name NORTH AMERICAN ADMINISTRATORS, L.P. <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Flexible Benefit Plan <br />Project Number <br />Funding Source Claims Administration <br />Account No. 711-0401-671-34-18 <br />Amount $3.55 per eligible employee per month and a $300 initial document <br />fee. <br />Terms of Contract Fee is to be paid monthly. <br />Purpose/Description NAA will provide services in respect to the Flexible Benefit Plans. <br />NAA will process claims for medical reimbursement and dependent <br />care. <br />® Required Contractor's Certification Form Attached (Non - <br />Amount of <br />Required For Chanqe Orders Only I <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy Original <br />® ❑ John M <br />Dispersal After Approval <br />, Christine Villaire, Jennifer Hockenhull, Tierra Davis <br />