#11-5729 Amendment #3 (Allegiance Benefit Plan Management, Inc.) EXHIBIT A-3 Contract Amendment#3 to Contract#11-5729
"Third Party Administrator for Health Benefits"
This amendment, dated Art. ( (2, ,2016 to the referenced agreement shall be by and between the
parties to the original Agreement, Collier County Government (to be referred to as "the Plan Sponsor")
and Allegiance Benefit Plan Management, Inc.,(to be referred to as"the TPA").
Statement of Understanding
RE: Contract# 11-5729"Third Party Administrator for Health Benefits"
In order to continue the services provided for in the original agreement document referenced above, the
TPA agrees to amend the existing Agreement by extending the original renewal term and incorporating an
extension period,as provided below.
Note: Language deleted has been stfuek-threugh. New language has been underlined.
Change No.!: Amend Page 1 of the Agreement as follows:
THIS Administrative Services Agreement (hereinafter "Agreement"), effective for the thirty-six (36)
month period beginning January 1, 2012, and ending December 31, 2014, and may be renewed for two
(23 three(3)additional one(1)year periods as mutually agreed by the parties in writing, is entered into by
COLLIER COUNTY GOVERNMENT, a political subdivision of the State of Florida, Collier County,
Naples, (hereinafter referred to as the "Plan Sponsor"), ALLEGIANCE BENEFIT PLAN
MANAGEMENT, INC., a corporation duly organized and existing under the laws of the State of
Montana(hereinafter referred to as the"TPA").
Change No.2: Amend Article V: Duration of Agreement,Page 10 as follows:
5.1 The Plan Sponsor may, at its discretion, extend the Agreement under all of the terms and conditions
contained in this Agreement for up to one hundred eighty (180) days. The Plan Sponsor shall give TPA
written notice of the Plan Sponsor's intention to extend the Agreement term not less than thirty(30) days
prior to the end of the Agreement term then in effect.
***
All other terms and conditions of the agreement shall remain in force.
(Signature page to follow)
11Paac
Amendment 43 to Contract#11-5-729
"Third Party Administrator for Health Benefits"
IN WITNESS WHEREOF, the parties have each, respectively, by an authorized person or agent, have
executed this Amendment on the date(s)indicated below.
Accepted: i-pr-;( ( a 2016
t.f{ ,rc
THE PLAN SPONSOR:
BOARD OF COUNTY COMMISSIONERS
OF C LIER COUNTY,FLORIDA
Dwi:3 'E:Brock;={Cler lac,.
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By:
`ttest as to Chainitolty Clerk onna Fiala,Chairman
s;ctr 'vP(!tlIV.
TPA's First Witness: THE TPA:
Allegiance Benefit Plan Management, Inc.
A By: -" C - L u �'l--t_/1�)- -
6 4\1011 L 112- By: / ` , % I
Print Name
Print Name and Title
TPA's Second t An .
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Print Qie
Approv Ha 1 P!-- • / -_a tty:
Jeffrey Al la kow, County Attorney
21Pa c
Amendment#3 to Contract#11-5729
"Third Party Administrator for Health Benefits"