Backup Documents 03/27/2012 Item #16E 2ITEM .Nab:-
F I L E *I O .: 12- RMG- 0026+4
ROUTED T
Date: 416/12
16E2-1
f
Purchasing Department
3327 Tamiami Trail East J
Naples, Florida 34112s ^'
Telephone: (239) 252 -2667 A`
FAX: (239) 252 - 6593 r
Email:lynwood @colliergov.net F a'
www.colliergov.net
ttn'
t U
DATE RECEIVED: �'u L
x
DO NOT WRITE ABOVE THIS LINE
Request for Legal Services
4 (a- I-.-;L-
To: Colleen Greene
Assistant County Attorney
From: Lyn M Wood
Procurement Strategist AIA
Re: 12 -6866 — Administrative Services Agreement for Short Term Disability
Contractor: Matrix Absence Management, Inc.
BACKGROUND OF REQUEST:
This Amendment #1 was approved by the BCC on 3/27/12; agenda item 16.E.2.
This item has been previously submitted.
ACTION REQUESTED:
Amendment review and approval.
OTHER COMMENTS:
Please forward to BCC for signature after approval. If there are any questions concerning the document,
please contact me at the telephone number or email address above. Purchasing would appreciate
notification when the documents exit your office.
G/ Acquisitions/ TechFormsandLetters /MemotoRequestLegalServices
Revised: 4 /16//10
16E2 "
MEMORANDUM
Date: April 17, 2012
To: Lyn Wood, Contract Specialist
Purchasing Department
From: Martha Vergara, Deputy Clerk
Minutes and Records Department
Re: Contract #12 -5866 — Administrative Services Agreement
for Short Term Disability
Contractor: Matrix Absence Management, Inc.
Attached is one (1) original of the contract, referenced above (Agenda
' Item,1 2), approved by the Board of County Commissioners on Tuesday,
�(
v March 27, 2012.
One original has been kept by the Minutes and Records Department to
be kept as part of the Boards Official Records.
If you should have any questions please contact me at 252 -7240.
Thank you.
16E2
Amendment to Contract #1
The August 1, 2010 Service Agreement #12 -5866 Administrative Services Agreement for
Short Term Disability by and between Matrix Absence Management, Inc.
( "Administrator ") and Collier County Board of County Commissioners apolitical
subdivision of the State of Florida ( "Client") is this j!ciay of 20 �-
amended to add an Exhibit C to the Agreement:
Exhibit C
Payroll Tax Service
(1) Matrix Payroll Services, Inc. is a wholly owned subsidiary of Matrix
Absence Management, Inc. The Client has provided IRS Form 2678,
Employer Appointment of Agent, authorizing Matrix Payroll Services to
act as agent on Client's behalf.
(II) Once an executed copy of this form is received, Matrix will send it to the
proper IRS office.
(III) Matrix will insure the withholding of Federal Income Taxes, Social
Security Taxes, and Medicare Taxes from Short Term Disability payments
administered by Matrix.
(IV) Matrix will deduct these amounts from Client's Account, including the
employer portion of the Social Security and Medicare taxes, and transmit
the funds to the IRS by Electronic Funds Transfer.
(V) Matrix will be responsible for any late filing penalties to the IRS to the
extent Client has fully funded their liability.
(VI) Matrix will prepare the quarterly Form 941 and annual W2's.
(VII) All reporting is done under the Matrix Payroll Services FEIN.
Page 1 of 2
16E2
All other terms and conditions of the Agreement remain in effect.
ff' BOARD OF COUNTY COMMISSIONERS
ATT COLLIER COUNTY, FLORIDA
Dwi jl 'B. ri
! ck,, rClerkVf Courts
Datq¢ Fred W. Coyle, Chairman
L $` • 4
Mwrt..i�
loft
Matrix Absence Management. Inc.
Contractor
By.
First WitnL4 Signatur
Xr1'5-&C*' Sa.K+;s
Type / print witness name
eoo
Second Witness Typed signature and title
OoerL A4i
Type / print witness name
Approved as to form and
Legal sufficiency:
i
Assistant County Att rney
Caleffiffi -Gwo-
Print Name
Page 2 of 2