#12-5866 Amendment #1 (Matrix Absence Management, Inc.)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 a political
subdivision of the State of Florida ( "Client ") is this _day 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.
(11) 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.
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All other terms and conditions of the Agreement remain in effect.
BOARD OF COUNTY COMMISSIONERS
ATT COLLIER COUNTY, FLORIDA
_ -•.
Dvrri, E fir, ck, GlsrkVf. Courts
By:
Date;¢ Z Fred W. Coyle, Chairman
.. •3
Matrix Absence Management, Inc.
Contractor
First Witn Signatur
Xrlshnck SoLK4 ;s
Type / print witness name
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Second Witness Typed signature and title
oom- h
Type / print witness name
Approved as to form and
Legal sufficiency:
L"Qln
Assistant County Att rney
Gale #1.
Print Name
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