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HomeMy WebLinkAbout2004-04-27-9:00AM-Regular2' L ~ BRAZOSCOUNTY BRYAN, TEXAS NOTICE OF MEETING AND AGENDA Y PS BRAZOS COUNTY COMMISSIONERS COURT THE C SESSIO OF TH BRYAN, MISSIONERS COURT OF BRAZOS COUNTY WILL MEET IN REGULAR ON 27 APRIL 2004 AT 9:00 A.M. IN THE COMMISSIONERS COURTROOM BRAZOS COUNTY COURTHOUSE, 300 E. 26TH STREET, SUITE 115, 1. Introcation and Pledge of Allegiance - Commissioner Mallard 2. Ci for citizen's input and/or concerns. take action on agenda items 3 - 31 3. B44get Amendment 03/04-27.1. 4. Pe0onnel Change of Status. 5. Paknent of Claims. 6. Ag4eptance of the April 2004 Report on Delinquent Property Tax Collections for Brazos 7. A roval of Brazos County Resolution 04-005 directing the Brazos County Sheriff to sell sp ific property at a public sale on the first Tuesday in July, 2004 in the manner prescribed by the Texas Rules of Civil Procedure and § 35.05 (c) and (d) of the Tex. Pro). Tax Code. 8 R west by Heart of Texas Goodwill Industries, Inc. for approval of Brazos County Order 04-)01 allowing the issuance of a tax exempt note by Mart Cultural Facilities Cc j oration. Goodwill has requested approval by Brazos County, Texas solely for the pu ose of satisfying the provisions of Section 147(f) of the Internal Revenue Code of 19 as amended, and the requirements of Section 221.030(a) of the Texas Health and Sa tv Code. VOL 55. PAGE= Commissioners Court Agenda 27 April 2004 Page 2 9. A eptance of a Proposal submitted by Patterson Architects for the evaluation of an e sting facility located at 201 Live Oak Street for renovation to the new Justice of the P'ce and Constable's Office for Precinct 3. 10. R~Ouest by Janice McKean for permission to accept a refrigerator that St. Luke's United thodist Church would like to donate to the Brazos Center. 11. Aroval of Tax Resale Deed in the amount of $7,350.00 paid by Mary H. Payton. 12. R uest by Judge Steve Smith for approval of out-of-state travel to attend the annual m ting of the Judicial Division of the American Bar Association on 5-9 August 2004. 13. R west by Donald Lampo, Precinct 2 Constable, for approval to hire a grant writer to a st with a grant that will purchase mobile data computers for the constable vehicles. 14. Approval of the Brazos County Flexible Benefits Plan Adoption Agreement and S nary Plan, effective 1 January 2004. 15. Approval of the Plumhoff & Associates HIPAA Privacy Rules Business Associate 16. Approval of the Blue Cross Blue Shield of Texas (BCBSTX) COBRA Services 17. Approval of Tax Refund Applications for the following: a. Jerry Roe Elledge f. James A. & Jacqueline Pierce b. James W. Kohutek. g. San Investments LLC c. W. A. & Billie R. McNeil h. Travis & Lori Thompson d. Ncrease Communications i. Doris Jean Walker e. Jarrod David & Michele Martha Pharr 18. Approval of the following Blanket Purchase Orders: a. Napa Auto Parts $5,000.00 (R&B) b. Ray Criswell $3,000.00 (Maintenance) c. Team Systems $1,400.00 (Jail) d. Ray Criswell $1,400.00 (Jail) e. Brazos Wholesale $500.00 (Jail) f. Lilly Dairy $3,400.00 (Jail) g. Flower's Bakery $1,600.00 (Jail) h. Ben E. Keith $1,450.00 (Jail) i. Performance $4,000.00 (Jail) j. Sysco Food $7,300.00 (Jail) k. US Foodservice $7,300.00 (Jail) 1. Scarmardo Produce $9,450.00 (Jail). VOL -66-PAGE-6) Commissioners Court Agenda 27 April 2004 Page 3 19 R uest by Purchasing for approval to register as a participant of the US Communities C perative Purchasing Program. 20. R uest by Road & Bridge to renew Bid 42003-030 Poly Jute, for an additional year, with the new bid #2004-025R. 21. R uest by Purchasing for permission to approve Wiginton Hooker Jeffry Architects for t purpose of conducting a study of the space utilization needs for Brazos County. 22. R uest by Road & Bridge for approval of out-of-state travel for Brett Blankner, GIS nager, to travel to San Diego, California to attend the Annual GIS Conference s eduled for 9-13 August 2004. 23. Foal Plat of Indian Lakes Subdivision Phase V, 12.233 acres, J. M. Barrera survey, A- 6 Brazos County, Texas. Site is located In Precinct 1. 24. Fal Plat of Foxworth Subdivision, 41.493 acres, T. Henry survey, A-132 and John P ne survey, A 195, Brazos County, Texas. Site is located in Precinct 1. 25. A eptance of a Warranty Deed from Gerald A. Williams Carter for improvements to a p ion of Rabbit Lane located in Precinct 2. 26. A eptance of a Warranty Deed from Richard Lee Williams, Jr. for improvements to a p ion of Rabbit Lane located in Precinct 2. 27. A eptance of a Warranty Deed from Mary Esther Hudson Burton for improvements to a p ion of Jones Road located in Precinct 4. 28. A eptance of a Temporary Construction Easement from Annie C. Rasco for temporary c struction workspace during the replacement of the bridges on Long Trussell Road to ted in Precinct 2. 29. A eptance of a Temporary Construction Easement from Lavelle C. Cobb for temporary c struction workspace during the replacement of the bridges on Long Trussell Road to ted in Precinct 2. 30. A eptance of a Temporary Construction Easement from Laramie Oil & Gas for to porary construction workspace during the replacement of the bridges on Long T ssell Road located in Precinct 2. 31. A roval of Resolution 04-006 in honor of Former President George W. Bush, Sr. on his 8 t birthday. 32. A nowledgement of Monthly Reports submitted in April 2004. 33. A ouncement of interest items and possible future agenda topics. VOL 5~ PAGE ~5a Commissioners Court Agenda 27 April 2004 Page 4 34. C#I for citizen input and/or concerns. 35. Agency / Board / Committee reports by Court members. 36. Aldiourn. The Brazos rater is wheelchair accessible. Handicap parking spaces are available. Any request for sign interpretive services must be ma two business days before the meeting. To make arrangements, call (979) 361-4102. , VOL ~5-'q PAGE S3 COMMISSIONERS' COURT REGULAR MEETING APRIL 27, 2004 A regular meeting of the Commissioners' Court of B4*zos County, Texas was held in the Brazos County C issioners Courtroom in the Courthouse in Bryan, B zos County, Texas, beginning at 9:00 a.m. on Tuesday, M 4ch 27, 2004 with the following members of the Court p4*sent : Randy Sims, County Judge, Presiding; Eric Caldwell, Commissioner of Precinct 1; Duane Peters, Commissioner of Precinct 2; Kenny Mallard, Commissioner of Precinct 3; Carey Cauley, Jr., Commissioner of Precinct 4; Karen McQueen, County Clerk. II The attached sheet contains the names of the citizens and officials that were in attendance. Commissioner Mallard gave the invocation and led the pA dge of allegiance. There was no citizen input/and or concerns. The Court next considered Budget Amendment #03/04- 2 ~1, that would reallocate funds for Juvenile Services. O I motion by Commissioner Peters, seconded by C rmissioner Cauley, the Court voted unanimously to a rove the budget amendment as submitted, a copy of w ch is attached. 1 55 Page _ 5 Ll Commiss Court meeting April 27, 2004 The Court proceeded to consider the change of status employees as submitted on the attached Personnel A ion Requests. On motion by Commissioner Peters, s onded by Commissioner Cauley, the Court voted u tnimously to approve the changes as submitted. The Court next considered the following Claims as s mitted by the County Treasurer for payment: 1 20062247 through 20062520 motion by Commissioner Cauley, seconded by _ssioner Peters, the Court voted unanimously to adi}rove the Claims as submitted. The Court next heard a presentation of the quarterly d inquent tax report presented by Shelburne Veselka, r resentative of McCreary, Veselka, Bragg & Alen, P.C. A orneys at Law. On motion by the County Judge, s conded by Commissioner Caldwell, the Court voted u 4nimously to approve the report. On motion by Commissioner Peters, seconded by ssioner Caldwell, the Court voted unanimously to a Copt resolution #04-005 directing the Sheriff of Brazos C tnty to conduct a sale on the first Tuesday in July, 2 4 in the manner prescribed by the Texas Rules of Civil P cedure and § 34.05(c) and (d) of the Texas Property 5-6 Page 2 io rs' Court meeting April 27, 2004 T Code. The property, Lots 5 and 6, R. B. Darling S ldivi.sion, City of Bryan, Brazos County, Texas, had p viously been offered for sale pursuant to a judgment o foreclosure for delinquent taxes but no sufficient bid wA$ received. The next matter before the Court was the Adoption of aj Order Allowing the Issuance of a Tax Exempt note by M t Cultural Facilities Corporation for Heart of Texas G dwill Industries, Inc. This is for the purpose of s iisfying the provisions of Section 147(f) of the I# ernal Revenue Code of 1986 as amended, and the irements of Section 221.30(a) of the Texas Health and S ~ety Code. On motion by Commissioner Mallard, seconded i b Commissioner Cauley, the Court voted unanimously to a rove the Adoption of an Order Allowing the Issuance of ai'ax Exempt note by Mart Cultural Facilities Corporation f# Heart of Texas Goodwill Industries, Inc. 11 The Court next considered a proposal submitted by P ~terson Architects for the evaluation of an existing f#ility located at 201 Live Oak Street for renovation to tH(~ new Justice of the Peace and Constable's offices for P# cinct 3. On motion by Commissioner Mallard, seconded bI l Commi ssioner Cauley, the Court voted unanimously to 1 6 5 Page 5(o 3 Commiss a ept the proposal for the feasibility study. P ncipals' hours will be billed at $90 and support p ~sonnel will be billed at $55 per hour. This will be a approximate expenditure of $3,500 to $4,000. The Court next considered a request from the io ears' Court meeting April 27, 2004 D' ector of the Brazos Center for authorization to accept d ated property. St. Paul's Methodist Church would like t donate their refrigerator. On motion by Commissioner P iers, seconded by Commissioner Caldwell, the Court v# ed unanimously to accept the donated property. On motion by Commissioner Peters, seconded by ssioner Cauley, the Court voted unanimously to a horize the County Judge to execute a Tax Resale Deed t the following individual: Mary H. Payton - 5 acres more or less, John H. Jones Survey, Brazos County, Texas. The next matter for consideration by the Court was a r uest submitted by the 361St District Court Judge, Steve S th for approval for out of state travel for himself. e Smith will be traveling to the Annual meeting of the JUdicial Division of the American Bar Association held in A anta, Georgia August 5-9, 2004. On motion by C runissioner Mallard, seconded by Commissioner Peters, the rt voted unanimously to approve the request and payment 1 - 55 Page 5 7 4 Sio rs' Court meeting April 27, 2004 0 out of state travel expense for Judge Steve Smith. The Court next considered a request by Donald Lampo, Pcinct 2 Constable, for approval to hire a grant writer t assist with a grant that will purchase mobile data c puters for the constable vehicles. Estimated grant is $ 0,000.00 to $200,000.00 with the grant writer receiving 1.15% whether the grant is awarded or not. On motion by C issioner Peters, seconded by Commissioner Mallard, the C rt voted unanimously to approve the request. The next matter before the Court was the approval of t Brazos County Flexible Benefits Plan Adoption A eement and Summary Plan, effective January 1, 2004. On m ion by Commissioner Mallard, seconded by Commissioner C ley, the Court voted unanimously to approve the Brazos C my Flexible Benefits Plan Adoption Agreement and S ary Plan effective January 1, 2004. A copy is attached. The Court next considered approval of the Plumhoff & A ociates HIPAA Privacy Rules-Business Associate A eement. On motion by Commissioner Cauley, seconded by C issioner Mallard, the Court voted unanimously to a rove the Agreement. A copy is attached. The next matter before the Court was the approval of 1 '66 Page 6 9. , 5 Commissio rs' Court meeting April 27, 2004 t Blue Cross Blue Shield of Texas (BCBSTX)-COBRA Sq~vices Agreement. Compensation to BCBSTX will be based o two separate components: a charge to the employer per s scriber and a charge (not to exceed two 20 of the a licable premium) made by the employer to a continued p ticipant. On motion by Commissioner Mallard, seconded b Commissioner Caldwell, the Court voted unanimously to a rove the Blue Cross Blue Shield of Texas (BCBSTX)- RA Services Agreement. A copy is attached. The next matter for consideration was approval of t# refund applications from the following individuals /or companies: a. Jerry Roe Elledge, OP $857.25 b. James W. Kohutek, OP $516.70 c. W.A. & Billie R. McNeil, OP $252.00 d. Ncrease Communications, OP $10.34 e. Jarrod David & Michele Martha Pharr, OP $27.00 f. James A & Jacqueline Pierce, OP $70.85 g. San Investments LLC, OP $225.00 h. Travis & Lori Thompson, OP $114.79 i. Doris Jean Walker, OP $370.60 0 motion by Commissioner Peters, seconded by C issioner Caldwell, the Court voted unanimously to a rove the tax refund applications. The Court proceeded to consider the following blanket Purchase Orders: Napa Auto Parts Road and Bridge $5,000 6 1 - 55 Page ' Court meeting April 27, 2004 Ray Criswell Maintenance $3,000 Team Systems Jail $1,400 Ray Criswell Jail $1,500 Brazos Wholesale Jail $ 500 Lilly Dairy Jail $3,400 Flower's Bakery Jail $1,600 Ben E. Keith Jail $1,450 Performance Jail $4,000 Sysco Food Jail $7,300 US Foodservice Jail $7,300 Scarmardo Produce Jail $9,450 O motion by Commissioner Peters, seconded by C issioner Cauley, the Court voted unanimously to a rove the Blanket Purchase Orders as submitted. The next matter before the Court was a request by t e Purchasing Department to register as a participant of t US Communities Cooperative Purchasing Program. This w ld allow the County to use various contracts to ase commodities, technology products, electrical and d a supplies, etc. at no charge for participation. On m ion by Commissioner Cauley, seconded by Commissioner Peers, the Court voted unanimously to approve the rdduest. The Court next considered a request by the Road and B dge Department to renew Bid #2003-030-Poly Jute, for a additional year. Contech Construction, the primary v dor is willing to keep their pricing the same but E#le Industries, the secondary vendor, is requesting a 1 jam. Page 7 Commis sio cars' Court meeting April 27, 2004 6 increase over the current prices. On motion by Commissioner Caldwell, seconded by Commissioner Peters, t Court voted unanimously to approve the request. The n bid number is #2004-025R. The next matter before the Court was the approval of ginton Hooker Jeffry, Architects to provide a study of t space utilization needs for Brazos County and the A eement for Services. The study is not to exceed $137,665.00 with reimbursable expenses to be paid as s nt, but not to exceed $24,690.00. On motion by C issioner Peters, seconded by Commissioner Cauley, the C curt voted unanimously to approve the Agreement. A copy i attached. The next matter for consideration by the Court was a quest submitted by the County Engineer seeking a roval for out of state travel for GIS Manager, Brett Blanker to attend the Annual GIS Conference in San Diego, C ifornia, August 9-13, 2004. On motion by Commissioner C ley, seconded by Commissioner Peters, the Court voted u nimously to grant the request from the County Engineer a approved payment of out of state travel expense for M111 Brett Blanker. The Court next considered approval of the Final Plat 1 Page 8 io rs' Court meeting April 27, 2004 o Indian Lakes Subdivision Phase V, 12.233 Acres in P ~cinct 1. Richard Vance, County Engineer, stated that h+ had reviewed the plat and recommended acceptance. On m ion by Commissioner Caldwell, seconded by Commissioner P ers, the Court voted unanimously to approve the final p t of Indian Lakes Subdivision Phase V, 12.233 Acres as submitted. The Court next considered approval of the Final Plat I~ o Foxworth Subdivision, 41.493 Acres in Precinct 1. Richard Vance, County Engineer, stated that he had r dewed the plat and recommended acceptance. On motion bjj Commissioner Caldwell, seconded by Commissioner C ley, the Court voted unanimously to approve the final p t of Foxworth Subdivision 41.493 Acres as submitted. The Court next considered acceptance of a Warranty D~*d for right-of-way on Rabbit Lane in Precinct 2. On ion by Commissioner Peters, seconded by Commissioner C4*ley, the Court voted unanimously to authorize the C linty Judge to accept on behalf of Brazos County a W ~ranty Deed from Geraldine A. Williams Carter for the e#ansion and improvements to Rabbit Lane. The Court next considered acceptance of a Warranty Dodd for right-of-way on Rabbit Lane in Precinct 2. On 1 5 Page 9 Commissio rs' Court meeting April 27, 2004 m ion by Commissioner Peters, seconded by Commissioner C tley, the Court voted unanimously to authorize the C linty Judge to accept on behalf of Brazos County a I W ~ranty Deed from Richard Lee Williams, Jr. for the e#ansion and improvements to Rabbit Lane. The Court next considered acceptance of a Warranty D ~d for right-of-way on Jones Road in Precinct 4. On m lion by Commissioner Cauley, seconded by Commissioner P iers, the Court voted unanimously to authorize the C my Judge to accept on behalf of Brazos County a W ranty Deed from Mary Esther Hudson Burton. for the expansion and improvements to Jones Road. The Court next considered acceptance of a Temporary struction Easement for temporary construction kspace during the replacement of the bridges on Long T ssell Road in Precinct 2. On motion by Commissioner P ers, seconded by Commissioner Mallard, the Court voted u nimously to authorize the County Judge to accept on b alf of Brazos County a Temporary Construction Easement f m Annie C. Rasco for the expansion and improvements to g Trussell Road. The Court next considered acceptance of a Temporary C#struction Easement for temporary construction 1 ~ Page 10 Commis dot L rs' Court meeting April 27, 2004 w kspace during the replacement of the bridges on Long T ssell Road in Precinct 2. On motion by Commissioner P ers, seconded by Commissioner Cauley, the Court voted u nimously to authorize the County Judge to accept on b alf of Brazos County a Temporary Construction Easement f m Lavelle C. Cobb for the expansion and improvements t Long Trussell Road. The Court next considered acceptance of a Temporary C struction Easement for temporary construction w kspace during the replacement of the bridges on Long T ssell Road in Precinct 2. On motion by Commissioner P ers, seconded by Commissioner Cauley, the Court voted u *nimously to authorize the County Judge to accept on b half of Brazos County a Temporary Construction Easement f Cm Laramie Oil & Gas for the expansion and improvements t Long Trussell Road. On motion by Commissioner Peters, seconded by C issioners Caldwell, Mallard, Cauley and the County J Z e the Court voted unanimously to adopt a resolution h oring former President George Herbert Walker Bush on h' 80th birthday and encouraging all individuals, civic g ups, business, schools, houses of worship and o anizations in Brazos County to participate in the Bush 1 5 Page b4 11 Commissioi~rs' Court meeting April 27, 2004 12 b~thday celebration. The Court acknowledged receipt of the Extension S vice reports for March 2004 and acknowledged receipt o reports from the following County and Precinct Offices s wing revenues collected and remitted to the County T lasurer: Justice of the Peace Precinct 1 Justice of the Peace Precinct 2, Place 1 Justice of the Peace Precinct 2, Place 2 Justice of the Peace Precinct 3 Justice of the Peace Precinct 4 Constable Precinct 1 Constable Precinct 2 Constable Precinct 3 Constable Precinct 4 Road & Bridge District Clerk Sheriff County Clerk A1~opy of the Officials' reports can be viewed in the C~ my Auditor's office. There were no announcements of interest items and pc*sible future agenda topics. There was no citizen input and/or concerns. Under Agency/Board/Committee reports by Court members, t following spoke: Commissioner Mallard Informed everyone that he and the County Judge had gone to an Urban Counties meeting in Austin that addressed the changes the Governor is trying to make in the Legislature. The CUC is trying to make the State .55 Page (95 Commissio Court meeting April 27, 2004 13 Legislators understand the impact on counties and that if they are going to set limits on counties that they set the same limits on themselves. County Judge Stated he has sent out a letter to outside agencies saying based on these legislative changes, their funding will be cut. Richard Vance, County Engineer Announced that they cleared about 10 acres of land at the Expo Center site before the rains this last weekend. There being no further business to come before the Ort, the meeting was adjourned. 1 5.5 Page T ~ foregoing minutes of the Commissioners Court meeting held A it 27, 2004 have been examined and ar approved in open C dirt this the day of , 2004, in Bryan, B ~zos County, Texas. R dy S; Ks C nt Judge e Peters issioner, Precinct 2 C" ey Ca ley, Jr. C .issioner, Preci ~ct Atlfitest : C n McQueen ty Clerk 6 ric Caldwell Commissioner, Precinct 1 Kenny Malle Commission Precinc 3 1 ~S Page U7 C BRAZO MEETIN COUNTY COMMISSIONERS COURT ON 7 2004 AT a e Orga zation/Department 00 J c VOL 5S PAGE GP BRAZO MEETIN COUNTY COMMISSIONERS COURT ON r 2004 AT ,'O0 Name Organization/Department Z/) C~• VOL PAGE (09 BRAZOS COUNTY, TEXAS BUDGET AMENDMENT(S) FOR THE 2003-2004 BUDGET YEAR NO. 03/04-27.1 this the 27`h day of April 2004 at a regular meeting of the Commissioners' Court, the following members *~re present: Randy Sims, County Judge, Presiding Eric Caldwell, Commissioner, Precinct 1 E. Duane Peters, Commissioner, Precinct 2 G. Kenny Mallard, Commissioner, Precinct 3 Carey Cauley, Jr., Commissioner, Precinct 4 Karen McQueen, County Clerk The follo g proceedings were held: T T WHEREAS, on 27 April 2004 the Court heard and approved a budget amendment for the 2003-200 udget year for Brazos County, Texas. EREAS, an expenditure is necessary due to the necessity to meet unusual and unforeseen conditions which could not be reasonably included in the original budget adopted 12 September 2003 the following amendment(s) to the original are hereby authorized, as described on the attached page(s). A PTED AND APPROVED this the 27`h day of April 2004. THE CONWISSIONERS' COURT OF BRAZOS COUNTY, TEXAS. By: I~a nrims, County Judge Original: County Clerk's Office and attached to the original budget Copies: County Auditor County Treasurer Commissioners' Court Minutes VOL65 PAGE '70 BRAZOS COUNTY, TEXAS BUDGET AMENDMENTS No. 03/04-27.1 4/27/2004 FD DI ACCT PROJ DR/CR ACCOUNT NAME Increase Decrease 01 31C( 01 802050 Dr. Computer-Network Cost 220.00 01 31C( 01 715200 Cr. Rental-Vehicles 220.00 Juven Services Divis ion To rea cate funds to allow the computer cables to be run to the detenion intake area in ord ` to hook u the computer on the counter to the network. Z2 VOL.S~ PAGE ~~J PERSONNEL CHANGE OF STATUS F CO T DATE: April 27, 2004 DE RTMENT: Personnel PU POSE: AR~rove Personnel Change of Status DEP ` RTMENT NAME EMPLOYEE NAME ACTION REQUESTED T FFICE BOTELLO, LISA H. NEW HIRE SPACEK, SANDRA VIT SUPPLEMENT DIS CT ATTORNEY PARSONS, JARVIS TRANSFER WITHIN DEPT. RHODEN, SHARLA NEW HIRE DIS LICK CLERK STRAWN, SARAH NEW HIRE JUV NILE SERVICES HERBST, SARA H. NEW HIRE MORGAN, DIEKTRICH L. NEW HIRE ROA 1 ) AND BRIDGE TALLEY, JOHN P. PROMOTION ODSTRCIL, LARRY W. PROMOTION App I ved in Commissioners' Court: April 27, 2004 Cow 11 y Judge's or Commissioner's Signature: (Thi s copy to be attached to minutes) VOL 55 PAGE BRAZOSCOUNTY BRYAN, TEXAS CERTIFICATE FOR ORDER THE STj COUNT hereby "c 1. convene regular r was callE OF TEXAS BRAZOS e undersigned County Clerk of BRAZOS COUNTY, TEXAS (the "County"), tifv as follows: -he Commissioners Court (the "Commissioners Court") of the County n REGULAR MEETING ON THE a7DAY OF APRIL, 2004, at its eting place in the Brazos County Courthouse (the "Meeting"), and the roll of the duly constituted officers and members of the Commissioners Court. All embers of the Commissioners Court were present, except the following: _ NIA , thus constituting a quorum, whereup among other business, the following was transacted at the Meeting, a written: O ER APPROVING THE ISSUANCE OF A NOTE BY THE MART C TURAL FACILITIES CORPORATION FOR HEART OF TEXAS GC I DWILL INDUSTRIES, INC. (the "O was th by the fo AYES 2. the abovE has been the adopt duly cho: and duly ; was duly introduced for the consideration of the Commissioners Court. It duly moved and seconded that the Order be adopted; and, after due such motion, carrying with it the adoption of the Order prevailed and carried wing votes: NOES: ABSTENTIONS: C~ true, full, and correct copy of the Order adopted at the meeting described in ind foregoing paragraph is attached to and follows this Certificate; the Order ,,corded in the Commissioners Court's minutes of the Meeting pertaining to i of the Order; the persons named in the above and foregoing paragraph are i, qualified, and acting officers and members of the Commissioners Court d sufficiently notified officially and personally, in advance, of the time, place, Order No. 04-00 -1- BWOS COUNTY ORDER VOL 5, PAGE S and purp a of the Meeting, and that the Order would be introduced and considered for adoption it the Meeting and each such officers and members consented, in advance, to the holdiiig of the Meeting for such purpose; and the Meeting was open to the public, and publ notice was given, all as required by Chapter 551, Texas Government Code. SIGN~D AND SEALED THIS DAY OF APRIL, 2004. County Clerk, Brazos County, Texas Order No. 04-00 -2- BRAZOS COUNTY ORDER VOL55 PAGE BRAZOS COUNTY BRYAN,TEXAS ORDER NO. 04-001 Omr% ER APPROVING THE ISSUANCE OF A NOTE BY THE MART C TURAL FACILITIES CORPORATION FOR HEART OF TEXAS G DWILL INDUSTRIES, INC. W EREAS, Heart of Texas Goodwill Industries, Inc. ("Goodwill") desires to finance t construction, renovation and rehabilitation of retail stores, receiving centers, training cilities, and administrative facilities located at the following locations througho Central Texas: 26 Texas Avenue Store, Bryan, TX 77802 24 1 E. Hwy. 190, Copperas Cove Store, Copperas Cove, TX 12 East Kathy, Harker Heights, TX 76548 40 E. Stan Schleuter Drive Store, Killeen, TX 76643 41 South 31St Street, Temple, TX 76502 11 "orth 4th, Temple, TX 76502 91 East Waco Drive, Waco, TX 76704 (store building) 10 East Waco Drive, Waco, TX 76704 (sorting center and admin offices) 18 1 Herring Avenue, Waco, TX 76707 24 LaSalle, Waco, TX 76706 15 Hewitt Drive Store, Waco, TX 76643 (the "Project"); and W IUC! REAS, Goodwill desires to finance the Project in part through issuance of a tax exem note to be issued by the Mart Cultural Facilities Corporation (the "Issuer"), in an aggre to principal amount of $3,900,000; and W REAS, Goodwill has requested Brazos County, Texas (the "County") to give its appro I with regard to the issuance of the Note solely for the purpose of satisfying the provi eons of Section 147(f) of the Internal Revenue Code of 1986 as amended (which r uires for tax purposes that the issuance of the Note be approved by jurisdictio in which the Goodwill Project is located) and the requirements of Section 221.030(,- 11 of the Texas Health and Safety Code (which requires the permission of each county w re a cultural facilities corporation is exercising its powers to give its consent to the ex cise of such powers); and Order No. 04-OOP 3- BRAZOS COUNTY ORDER VOL36 PAGE ~EREAS, a duly authorized representative of the Issuer has conducted a public h ring regarding the Note and the Project; and V~MEREAS, the County is willing to consider Goodwill's request in order that the Note ma be issued; and NW, THEREFORE, BE IT ORDERED BY THE COMMISSIONERS COURT OF BRAZO COUNTY, TEXAS: 1. Solely for the purpose of satisfying the provisions of Section 147(f) of the Internal evenue Code of 1986 as amended, and to give the consent required by Section 1.030(a) of the Texas Health and Safety Code, the County hereby approves the issu ice of the Note to finance the Project as defined above. The user of the Project all be Heart of Texas Goodwill Industries, Inc. and the maximum principal amount the Note shall be $3,900,000. 2. This Order is passed based on the express understanding and representation by Goo ill that the Note does not and will not constitute in any way a liability or obligatio of the County in any manner whatsoever, and that the County shall have no liability atsoever for the Goodwill Project. 3. That it is officially found and determined that the meeting at which this Order is passe is open to the public as required by law and that notice of the time, place and subject n1tatter of this meeting has been given in a manner required by law. P ED AND APPROVED this0~m day of April, 2004. 01 County Judge Brazos County, Texas ATTEST Order No. County Clerk " razos County, Texas BRAZOS COUNTY ORDER V 0 L J PAGE P TERSON A HITECTS 701 South Texas Ave Bryan, Texas 77803 979 775 6036 16 AvrH 2004 Randy Sims, County Judge 300 E 21, th Street Bryan, Texas 77803 RE: P posal for Architectural a Engineering Services P 3 - J.P. Complex Dear J*Oge Sims: Patter in * Architects would like to present this proposal for Architectural and Engin ring Services to you for the evaluation of the existing facility (Grapevine Resta t) located at 201 Live Oak Street for renovation to the new justice of the Peace d Constable's Office for Precinct 3 in Brazos County. ARC14ITECTURAL/ENGINEERING SERVICES The Chkner shall provide the. Architect with a basic program of space requirements and pr onceived ideas as to the design intent for the new justice of the Peace and Const le's Office for Precinct 3. The Owner shall provide architect with as, built buil and site information, if available. Patters I n -i~ Architects will, investigate the condition of the existing building and relate ite amenities (utilities, parking, landscaping, etc); develop preliminary design ketches and'provide an estimate of probable construction costs for your review nd use to determine the feasibility of the project. In ad 'on, we will meet with the City of College Station Planning Department to deter 4e their requirements for the "Change of Use" of the existing facility. When propriate, Patterson * Architects will be available to assist the County in preps g the final construction drawings and specifications required for bidding and co truction. ARC ITECTURAL/ENGINEERING FEES The Oner will compensate Patterson * Architects for the designated services listed above follows: Fe 'bility Study - An a unt equal to $90.00 per hour for Principals' time and $55.00 per hour for suppo personnel's' time expended in documentation of existing conditions, design for our children's future AGE VOL P JP C*plex Proposal Page 2 confe nce, preparation of preliminary floor plan, and construction cost estimate, etc. a utlined in the scope of work above. Any requested additional services will be bit d at the above rates. If we etermine that additional consultants are needed to assist in the evaluation, the c ultants fees will be reimbursed at one and one half (1-1/2) times the amo t billed to the Architect for services. A itional Services - Any vice that is not specifically designated in the description of the design or const ction documents package to be provided shall be considered an additional servi and such services shall be compensated at the designated hourly rates. Addi " nal services will be invoiced at our current hourly rates for Principals and Staff or time spent. Additional services may include the following: 1. Detailed preliminary design package prepared specifically for preliminary cost estimating by Contractor/s. 2. Additional presentation drawings, models, etc. shall be considered as additional services and shall be provided only at the request of the Owner. R bursable Expenses - In ad tion to the fees stated above, Patterson * Architects will be reimbursed for the fo owing costs:. t of maps; reports, photographs and surveys, and other documentation of ting information necessary to the conduct of the work and not otherwise !shed by the Owner; long distance telephone calls; postage, handling and ~r similar items; reproduction of drawings, specifications and other unents incurred for the project or requested by the Owner, or special entation materials and models. All of the above will be invoiced at one and fourth (1-1/4) times the amount expended by the Architect's employees and ,ultants in the interest of the project. expenses should not exceed $200.00. CON DITIONS OF THE AGREEMENT Paym t shall be made in monthly installments for services performed. Payments shall due within THIRTY (30) days from billing date and interest shall be charged at a r of .833% per month thereafter. Payment is due for work performed whet r or not the owner elects to proceed to final completion, whether or not the proje is built or terminated in any drawing phase. Shoul collection of this fee or any portion of it require any type of legal costs, the client 11 be responsible for paying these costs in addition to the amount owed the Archi ct. All litigation will be under the jurisdiction of Brazos County, Texas. 3/00 VOL Pace °18 a~5" ® Patterson a Architects JP Cooplex Proposal Page 3 The ner to provide current hazardous material survey for this property and any abate ent, if required, and coordination thereof. All dc ( uments produced by Patterson * Architects under this agreement shall remai ` the property of Patterson * Architects and may not be used by the Owner for an ~ other project without the written consent of Patterson * Architects. Repro ucible copies may be obtained by the Owner for his use. The architect shall not b esponsible for the correctness of drawing prepared by others (as-builts, surve U, engineering, etc.). This reement may be terminated by either party upon 7 days written notice. In the a nt of termination, Patterson * Architects shall be compensated for services perfo ` ed to termination date, including reimbursable expenses then due and all ter 1 expenses. In such an event the Owner shall be provided with a copy of all do nts completed prior to termination of work. This d0cument will serve as a preliminary agreement between us. You may indic your acceptance by signing in the space provided below and returning one (1) si ed copy for our files. The T as Board of Architectural Examiners, P.O. Box 12337, Austin, Texas 78711- 2337 33 Guadalupe, suite 2-350, Austin, Texas 78701-3943, Telephone 512/305- 9000, as jurisdiction over individuals licensed under the Architects' Registration Law, xas civil statutes, Article 249a. Wes erely appreciate the opportunity to submit this proposal and look forward to wo g with you. spegruuy f~ DATE 3/00 VOL,55 PAGE ® Patterson a Architects - T -3:'- L--t A. En B. BRAZOS COUNTY FLEXIBLE BENEFITS PLAN ADOPTION AGREEMENT AND SUMMARY PLAN EFFECTIVE JANUARY 1, 2004 rhis is an amendment and restatement of the Plan originally adopted March 1, 1987) iyer.:Information Name of Employer. Brazos County Address:. 300 East 26th Street Suite: 313, Bryan, TX. 77803. Telephone: (979)-361-4340 Employer Identification Number 74-6000433 Nature of Business: Local County Govt. Name of Plan: The Brazos County Flexible Benefits Plan Plan Number 501 Plan Administrator, if other than Employer: N/A to Date ective Date of Plan: January 1, 2004 its is an amendment to an.existing plan, (1) Effective Date of the Restatement and Amendment: January 1, 2004 (2) Original Effective Date of Plan:. March 1, 1987 C. Plan ear.. T, e first plan year began on March 1, 1987 and ended-December 31, 1987- T, e current plan is from January 1st thru December 31st. D. Eligi i ty: Requirements for Participation. 1 Length of Service: Eligible the 1 st day after ninety days of employment. 2 A I regular employees working 40. + hours per.week. ..Minimum age 21 - (rnay not exceed 21 years of age) _X-No minimum age 1 VOL~3__PAGE ,0b }L E. 1. benefits Year in the cost Contributions Non-Elective Contributions: Employer may at its sole discretion provide a non-elective contribution to provide each Participant under the Plan. This amount will be set by the Employer each Plan niform and non-discriminatory manner. If this non-elective contribution amount exceeds benefits elected by the Participant (a) No excess amounts will be paid to the Participant; or (b) Excess amounts will be paid to the Participant as a taxable cash benefit option. 2. -X-,.- Elective Contributions (Salary reduction): 3. Cash 4. Other E' h Participant may authorize the Employer to reduce his or her compensation by the amount eded for the purchase of benefits elected, less the amount of non-elective contributions. An electi for salary reduction will be made on the benefit election form. T maximum amount available to each Participant for the purchase of elected benefits through lary reduction will be: ( $ per Plan Year, or a prorated amount fora short Plan Year. ( _X Unlimited per Plan Year (Premium Only Accounts) ( X_. $4,000.00 -per Plan Year for the Health Reimbursement FSA; . Xi $5,000.00 per Plan Year for the Dependent Care Assistance Reimbursement FSA. F. Avail 6le Benefits E. I h of the following components should be considered a plan that comprises this Plan. Eligibility uirements may differ from those set forth in Item (D) above, and can be noted by reading t associated- Insurance contracts: _X 1 ospital and-Surgery insurance -The terms, conditions, and limitations-for the Group Hospital Id Surgery Insumante will be asset forth in the insurance policy. (See Sections 4.4of the Plan Doc ent _X 2. isability and/or Accident Income Insurance = The terms, conditions and limitations for the Disa ty and/or Accident Income Insurance will be asset forth in the policy: (See Section 4.7 of the Pl Document) X 3. Dental Insurance - The terms; conditions and limitations for the. Dental Insurance will be as set forti in the Insurance policy. (See Section 4.5 of the Plan Document) X 4. Group Life Insurance - Umited to $50,000 face amount per participant. 2 S Atf' VOL. PAGE _X 5. ion Insurance - The terms, conditions and limitations for the Vision Insurance will be set forth in Insurance policy. (See Section 4.8 of the Plan Document) X_ 6. ncer Insurance - The terms, conditions and limitations for the Cancer Insurance will be set forth the Insurance policy. (See Section 4.9 of the Plan Document) X 7. H Ith Care Reimbursement - (See Section 6.1 of the Plan Document) X 8. D endent Care Reimbursement - (See Sections 7.1 of the Plan Document) G. Change Benefit Elections (See Section 5.4 of the Plan Document) Any rticipant desiring to make a change of election(s) must notify and make such election(s) hin 30 days of an eligible event. For details outlining what events are considered examples of, i change in family status and the procedures to make such election changes, see Section 5.4 the Plan Document. H. Flexible ending Accounts (FSAs) claims procedures - (See specific Plan provisions as referenced cove in F (7) and F (8)). If FSAs for er/both Health or Dependent Care benefits are elected under this Plan, the elected amounts will a deducted from each paycheck and held in a separate account. Upon submission of a complete voucher with attached receipts and documentation validating that the service was provided du g the Plan Year, the Participant will be reimbursed for the amount of the voucher, up to the annua election amount for FSA Benefits (subject to stated maximums above). Payment for qualified me I and dependent care services can also be paid with an approved debit card. Any monies not I imed within 90 days after the end of the Plan Year will be forfeited. If termination of employee's rvices occurs, the employee may, under limited circumstances, elect to continue coverage th is in force at the time of termination. Election to continue must be made in writing to the Plan Ad nistrator within 60 days. If the Plan p vides for the use of an approved debit card, then if claims are paid via the approved debit card a ngement, the claims will be paid electronically at a medical service provider and only for medical penses eligible for reimbursement under the federal code. If expenses are found to be ineligible r reimbursement after being paid by a debit card transaction, the participant will be required to eimburse the Plan (please see the attached "Med-i-Bank, Inc. Policies and Procedures". The Privacy ules of HIPAA require the Plan to do the following (the requirements identified below are outlined nd described in the "Notice of Health Information Privacy Practices" that is attached and ade apart of this Summary Plan Description): • Identi the permitted and required uses and disclosures of Protected Health Information (PHI) • Prohilt the use or disclosure of PHI other than as permitted or required by the Plan or as requi by law; • Requi agents and subcontractors who receive PHI to abide by the same restrictions and condi ens that apply to the Plan and the Employer; • Prohi use of PHI for employment-related actions or in connection with any other benefit J p ' • The mployer must to report to the Plan any improper use or disclosure of PHI; • Give participants access to their PHI and enable them to amend it upon request; • Prov a participants, upon request, an accounting of all disclosures of their PHI; • Mak available to the Department of Health and Human Services all internal practices, books, and records relating to the use and disclosure of plan PHI; • The ployer, once it no longer needs PHI for its intended purpose, to return or destroy all copi of the PHI or, if this is not feasible, to limit farther uses and disclosures; and • Esta ish a "firewall" to ensure separation between health plan operations and the empl ' er's other operations. The Emplo r certifies that the Plan's document provides for these provisions and the Employer a ees to comply with these provisions. STATEMENT OF ERISA RIGHTS You have cetiain rights and protections provided by the Employee Retirement Income Security Act of 1974 (ER A). This law provides for the following: 1. Y can examine all Plan Documents. These include the insurance contracts and copies of all cuments filed by the Plan with the U.S. Department of Labor (DOL). The documents (d with the DOL include such items as annual reports and plan descriptions. The Plan cannot arge you to examine these documents. However, you can only examine them at the office of the an Administrator. 2. Y can obtain copies of all Plan documents and other Plan data. This request must be written and f en to the Plan Administrator. The Administrator may make a reasonable charge for the copies. 3. Y will receive a summary of the Plan's annual financial report, if required of the Plan. The law req i es the Plan Administrator to provide this report to each plan participant. ERISA also imposes duti upon the people who operate the employee benefit plan. These people are fiduciaries, a they must act prudently and with the sole interests of you and other Plan Participants mind. No one, not en your employer, may fire you or discriminate against you in order to prevent you from obtaini a welfare benefit or exercising your rights under ERISA. Under ERIS there are steps you can take to enforce the above-rights. The following are examples. If quested materials are not received within 30 days, you may bring a legal action in state or fede I court. You can also seek help from the courts if a consideration of a claim has been denied or ig red. Further, if Plan fiduciaries misuse Plan assets you can file legal actions. If Plan assets are m used by fiduciaries, you may also seek assistance from the U.S. Department of Labor. 4 VOL~PpGE~U If you take leg I action, the court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. However, if you lose, th court may order you to pay these costs and fees (if it finds, for example, that your claim is frivol s). If you have an questions about this statement or about your rights under ERISA, you should contact the ne rest office of the Pension and Welfare Benefits Administration, U.S. Department of Labor, listed i our telephone directory or the Division of Technical Assistance and Inquiries, Pension and (fare Benefits Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W. Washin n, D.C. 20210. The Plan shall be construed, enforced and administered, and the validity determined in accordance with the Empl ee Retirement Income Security Act of 1974, (ERISA, as amended), the Internal Revenue Cod of 1986 (as amended), and the laws of the State of Texas. Should any provision be determined o be void, invalid or unenforceable by any court of competent jurisdiction, the Plan will continue t perate, and for purposes of the jurisdiction of the court only, will be deemed not to include the provision determined to be void. We ha consulted our attorney with referen to this Plan and Adoption Agreement. This Plan is hereby, dopted thisa?Z_ day of t '2004. Employer: By: -L Title: WITNESS 'COL 5, -6SPAGE BRAZOS COUNTY FLEXIBLE BENEFITS PLAN INTRODUCTION The I recog rewar their shoos and n "Plan' The ii mean the b, excluc sectio This i The d ployer has adopted this Plan with an effective date of January 1, 2004 to ze the contribution made to the Employer by its Employees. Its purpose is to them by providing benefits for those Employees who shall qualify hereunder and pendents and beneficiaries. The concept of this plan is to allow Employees to among different types of benefits based on their own particular goals, desires, ds. The Plan shall be known as the Brazos County Flexible Benefits Plan (the ration of the Employer is that the Plan qualify as a "Cafeteria Plan" within the of Section 125 of the Internal Revenue Code of 1986, as amended, and that :fits which an Employee elects to receive under the Plan be includable or le from the Employee's income under Section 125(a) and other applicable of the Internal Revenue Code of 1986, as amended. an amendment and restatement of the Plan originally adopted March 1, 1987. e of the amendment and restatement of the Plan is effective January 1, 2004. Jr VOL J PAGE_ TABLE OF CONTENTS ARTICLE I DEFINITIONS ARTICLE II PARTICIPATION 2.1 2.2 2.3 2.4 2.5 2.6 2.7 3.1 3.2 3.3 IBILITY ECTIVE DATE OF PARTICIPATION ' LICATION TO PARTICIPATE MINATION OF PARTICIPATION I NGE OF EMPLOYMENT STATUS MINATION OF EMPLOYMENT TH ARTICLE III CONTRIBUTIONS TO THE PLAN 4RY REDIRECTION LICATION OF CONTRIBUTIONS IODIC CONTRIBUTIONS ARTICLE IV BENEFITS 4.1 B EFIT OPTIONS 4.2 H LTH CARE REIMBURSEMENT PLAN BENEFIT 4.3 D ENDENT CARE ASSISTANCE PROGRAM BENEFIT 4.4 H LTH INSURANCE BENEFIT 4.5 D TAL INSURANCE BENEFIT 4.6 G UP-TERM LIFE INSURANCE BENEFIT 4.7 DISABILITY BENEFIT 4.8 VI ON INSURANCE BENEFIT 4.9 H PITAL INDEMNITY POLICY 7 VOL 65 PAGE 4.10 CASH BENEFIT 4.11 NONDISCRIMINATION REQUIREMENTS ARTICLE V PARTICIPANT ELECTIONS 5.1 I TIAL ELECTIONS 5.2 SUBSEQUENT ANNUAL ELECTIONS 5.3 FOLILURE TO ELECT 5.4 ANGE OF ELECTIONS ARTICLE VI HEALTH CARE REIMBURSEMENT PLAN 6.1 TABLISHMENT OF PLAN 6.2 DE'FINITIONS 6.3 F RFEITURES 6.4 L ITATION ON ALLOCATIONS 6.5 NONDISCRIMINATION REQUIREMENTS 6.6 C ORDINATION WITH CAFETERIA PLAN 6.7 HEALTH CARE REIMBURSEMENT PLAN CLAIMS ARTICLE VII DEPENDENT CARE ASSISTANCE PROGRAM 7.1E ABLISHMENT OF PROGRAM 7.2 D FINITIONS 7.3 D PENDENT CARE ASSISTANCE ACCOUNTS 7.4 I CREASES IN DEPENDENT CARE ASSISTANCE ACCOUNTS 7.5 D CREASES IN DEPENDENT CARE ASSISTANCE ACCOUNTS 7.6 A OWABLE DEPENDENT CARE ASSISTANCE REIMBURSEMENT 7.7 ANNUAL STATEMENT OF BENEFITS 7.8 F FEITURES 7.9 LI ITATION ON PAYMENTS VOL ~rJS PAGE g P 7.10 7.11 7.12 DISCRIMINATION REQUIREMENTS RDINATION WITH CAFETERIA PLAN =NDENT CARE ASSISTANCE PROGRAM CLAIMS ARTICLE VIII ERISA PROVISIONS 8.1 C IM FOR BENEFITS 8.2 A LICATION OF BENEFIT PLAN SURPLUS 8.3 N ED FIDUCIARY 8.4 G ERAL FIDUCIARY RESPONSIBILITIES 8.5 N -ASSIGNABILITY OF RIGHTS ARTICLE IX ADMINISTRATION 9.1 P N ADMINISTRATION 9.2 E MINATION OF RECORDS 9.3 P MENT OF EXPENSES 9.4 IN 'DURANCE CONTROL CLAUSE 9.5 INDEMNIFICATION OF ADMINISTRATOR ARTICLE X AMENDMENT OF TERMINATION OF PLAN 10.1 10.2 11.1 11.2 11.3 11.4 ENDMENT RMINATION ARTICLE XI MISCELLANEOUS ►N INTERPRETATION DER AND NUMBER ITTEN DOCUMENT 3LUSIVE BENEFIT 9 VOLJq5 PAGE 11.5 ARTICIPANT'S RIGHTS 11.6 CTION BY THE EMPLOYER 11.7 MPLOYER'S PROTECTIVE CLAUSES 11.8 O GUARANTEE OF TAX CONSEQUENCES 11.9 DEMNIFICATION OF EMPLOYER BY PARTICIPANTS 11.1 UNDING 11.11 OVERNING LAW 11.1 EVERABILITY 11.1 APTIONS 11.1 ONTINUATION OF COVERAGE 11.1 FMLA LEAVE 11.1 USERRA LEAVE 11.17 IPAA PORTABILITY 11.18 IPAA PRIVACY RULES VOLIPAGE ~9 ARTICLE I DEFINITIONS 1.1 " ministrator" means the individual(s) or corporation appointed by the Employer to carry out the administration of the Plan. In the event the Administrator has not been appo ted, or resigns from prior appointment, the Employer shall be deemed to be the Admi strator. 1.2 " iliated Employer" means the Employer and any corporation which is a member of a co oiled group of corporations (as defined in Code Section 414(b)) which includes the ployer; any trade or business (whether or not incorporated) which is under common control (as defined in Code Section 414(c)) with the Employer; any organization (whet r or not incorporated) which is a member of an affiliated service group (as defin in Code Section 414(m)) which includes the Employer; and any other entity requi d to be aggregated with the Employer pursuant to Treasury regulations under Code Section 414(0). 1.3 "neft" means any of the optional benefit choices available to a Participant as outlin in Section 4.1. 1.4 " afeteria Plan Benefit Dollars" means the amount available to Participants, pursu t to Article III, to purchase Benefits. Each dollar contributed to this Plan shall be cony ed into one Cafeteria Plan Benefit Dollar. 1.5 "gpde" means the Internal Revenue code of 1986, as amended or replaced from time t time. 1.6 " mpensation" means the total cash remuneration received by the Participant from the ployer, during a Plan Year prior to any reductions pursuant to a Salary Redir tion Agreement authorized hereunder. Compensation shall include any overtime, com i sions and bonuses. 1.7 " pendent" means any individual who qualifies as a dependent under an Insurance Contr t or under Code Section 152 (as modified by Code Section 105(b)). 1.8 ' ebit Card" means an approved benefit card that pays for eligible medical expe s at the point of sale. 1.9 "Hective Date" means January 1, 2004 for the adoption of the Plan. For this restat Went and amendment of the Plan it means January 1, 2004. 1.10 ' lection Period" means the period immediately preceding the beginning of each Plan ear established by the Administrator for the election of Benefits and Salary Redir tions, such period to be applied on a uniform and nondiscriminatory basis for all Empl ees and Participants. However, an Employee's initial Election Period shall be dete ned pursuant to Section 5.1. 1.11 "Pigible Employee" means any Employee who has satisfied the provisions of Secti 2.1. 1.12 "ployee" means any person who is employed by the Employer, but excludes any perso ho is employed as an independent contractor. However, any Employee who is VOL 55 PAGE a "p -time" Employee shall not be eligible to participate in this Plan. A "part-time" Em yee is one who works, or is expected to work on a regular basis, less than 32 hou a week and is designated as a part-time employee on the Employer's personnel reco ' is. 1.131 1'Employer" means Brazos County and any successor which shall maintain this Plan nd any predecessor which has maintained this Plan. 1.14 'ERISA" means the Employee Retirement Income Security Act of 1974, as ame ed from time to time. 1.15 "Highly Compensated Employee" means, for the purposes of determining disc ination, an Employee described in Code Section 414(q) and the Treasury regu tions thereunder. 1.16 1 lInsurance Contract" means any contract issued by an Insurer underwriting a 1.17 Insurance Premium Payment Plan" means the plan of benefits contained in Sect n 4.1 of this Plan, which provides for the payment of Premium Expenses. 1.18 nsurer" means any insurance company that underwrites a Benefit under this Plan. 1.19 ' ey Employee" means an Employee defined in Code Section 416(1)(1) and the Trea ry regulations thereunder. 1.20 Participant" means any Eligible Employee who elects to become a Participant purs nt to Section 2.3 and has not for any reason become ineligible to participate furth in the Plan. 1.21 rf Ian" means this instrument, including all amendments thereto 1.22 Ian Year" means the period beginning March 1, 1987 and ending December 31, 1987 he first plan year. In subsequent plan years from 1987 through 1993 began Sept ber 1st and ended December 31, 1994. In subsequent years it shall mean Janua,y 1st thru December 31st. In the event a Participant commences participation during a Plan Year, then the initial period shall be that portion of the Plan Year com ncing on such Participant's date of entry and ending on the last day of such Plan Year. 1.23 remium Expenses" or "Premiums" mean the Participant's cost for the insured Bene s described in Section 4.1. 1.24 Premium Reimbursement Account" means the account established for a Parti ' ant pursuant to this Plan to which part of his/her Cafeteria Plan Benefit Dollars may a allocated and from which Premiums of the Participant may be paid or reim rsed. If more than one type of insured Benefit is elected, sub-accounts shall be estab hed for each type of insured Benefit. 1.25 lary Redirection" means the contributions made by the Employer on behalf of nts pursuant to Section 3.1. These contributions shall be converted to Cafeteria 12 VOL 56, . PAGE Plan enefit Dollars and allocated to the funds or accounts established under the Plan purs nt to the Participants elections made under Article V. 1.26 Salary Redirection Agreement" or "Salary Reduction Agreement" means an agre ent between the Participant and the Employer under which the Participant agre to reduce his/her Compensation or to forego all or part of the increases in such Comp nsation and to have such amounts contributed by the Employer to the Plan on the rticipant's behalf. The Salary Redirection Agreement shall apply only to Corn nsation that has not been actually or constructively received by the Participant as of th ate of the agreement (after taking this Plan and Code Section 125 into account) and, bsequently does not become currently available to the Participant. 1.27 pouse" means the legally married husband or wife of a Participant, unless legally divor d by court decree. ARTICLE II PARTICIPATION 2.1 E GIBILITY Any Eligible Employee shall be eligible to participate hereunder as of the 1st of the month following ninety days of active full-time employment (or the Effective Date of the Plan, f later). If a former Participant is rehired during the same period in which termi tion of employment occurs, and such former Participant had revoked existing Benefi: elections and terminated the receipt of Benefits at the time of termination of empl ment, then such rehired former Participant shall be prohibited from making new Benefi~ elections for the remaining portion of the period. 2.2 EFFECTIVE DATE OF PARTICIPATION An E i ible Employee shall become a Participant effective as of the date of the first mont salary redirection, the provisions of which are specifically incorporated herein by refer ce. 2.3 APPLICATION TO PARTICIPATE An E ployee who is eligible to participate in this Plan shall, during the applicable Electi Period, complete an Election of Benefits and Salary Redirection Agreement form, Which the Administrator shall furnish to the Employee. The Participant's election should be for the Plan Year during which he wishes to participate in this Plan. Any such Sala Redirection Agreement shall be effective for the first pay period beginning on or after a Employee's effective date of participation pursuant to Section 2.2. The election and r irection made on such form shall be irrevocable until the end of the applicable Plan ear unless the Participant is entitled to change his/her Benefit elections pursuant to Se ion 5.4 hereof. 2.4 TWMINATION OF PARTICIPATION A P11cipant shall no longer participate in this Plan upon the occurrence of any of the follo q events: (a) Hi~(her termination of employment, subject to the provisions of Section 2.6; 13 VOL~PAGE /a (b) e end of the Plan Year during which he became a limited Participant because of a cha a in employment status pursuant to Section 2.5; (c) Hfi~/her death, subject to the provisions of Section 2.7; or (d) TNe termination of this Plan, subject to the provisions of Section 10.2. 2.5 QHANGE OF EMPLOYMENT STATUS If a rticipant ceases to be an Eligible Employee because of a change in employment stat or classification (other than through termination of employment), the Participant shall ecome a limited Participant in this Plan for the remainder of the Plan Year in whic such change of employment status occurs. As a limited Participant, no further Sala Redirection may be made on behalf of the Participant, and, except as otherwise provi d herein, all further Benefit elections shall cease, subject to the limited Parti pant's right to continue coverage under any Insurance Contracts. However, any balances in the limited Participant's Health Care Reimbursement Fund or Dependent Care ssistance Account may be used during such Plan Year to reimburse the limited Parti pant for any allowable Medical Expenses or Employment-Related Dependent Care xpenses incurred during the Plan Year. Subject to the provisions of Section 2.6, if the Ii ited Participant later becomes an Eligible Employee, then the limited Participant may gain become a full Participant in this Plan, provided he otherwise satisfies the parti ation requirements set forth in this Article II as if he or she were a new Employee and de an election in accordance with Section 5.1. 2.6 TIRRMINATION OF EMPLOYMENT If a rticipant terminates employment with the Employer for any reason other than deat his/her participation in the Plan shall be governed in accordance with the (a) h regard to Benefits, which are insured, the Participant's participation in the Plan shall ease, subject to the Participant's right to continue coverage under any Insurance Cont ct for which premiums have already been paid. (b) ith regard to the Dependent Care Assistance Program, the Participant's parti i ation in the Plan shall cease and no further Salary Redirection contributions shall be de. However, such Participant may submit claims for employment related Dep dent Care Expense reimbursements for the remainder of the Plan Year in which such ermination occurs, based on the level of his/her Dependent Care Assistance Acco t as of his/her date of termination. (c) i h regard to the Health Care Reimbursement Plan, the Participant's participation in the n shall cease and no further Salary Redirection contributions shall be made. How er, such Participant may submit claims for expenses incurred during the portion of the P' n Year preceding his/her date of termination. (d) I the event a Participant terminates his/her participation in the Health Care Reim rsement Plan during the Plan Year, if Salary Redirections are made other than on a o rata basis, upon termination the Participant shall be entitled to a reimbursement for a Salary Redirection previously paid for coverage or benefits relating to the period 4 OL ,PAGE _3 after t~oerdate of the Participant's separation from service regardless of the Participant's claim reimbursements as of such date. (e) T Section shall be applied and administered consistent with such further rights a Parti i' ant and his/her Dependents may acquire pursuant to Code Section 4980B and Secti 11.14 of the Plan. 2.7 DEATH If a rticipant dies, his/her participation in the Plan shall cease. However, such Parti i ant's beneficiaries, or the representative of his/her estate, may submit claims for expe es or benefits for the remainder of the Plan Year or until the Cafeteria Plan Bene i Dollars allocated to each specific benefit are exhausted. A Participant may desig to a specific beneficiary for this purpose. If no such beneficiary is specified, the Admi trator may designate the Participant's Spouse, one of his/her Dependents or a repre ntative of his/her estate. _ ARTICLE 111 CONTRIBUTIONS TO THE PLAN 3.1 S&ARY REDIRECTION Bene under the Plan shall be financed by Salary Redirections sufficient to support Bene that a Participant has elected hereunder and to pay the Participant's Premium Expe es. The salary administration program of the Employer shall be revised to allow each articipant to agree to reduce his/her pay during a Plan Year by an amount dete ned necessary to purchase the elected Benefit. The amount of such Salary Redir tion shall be specified in the Salary Redirection Agreement (or Salary Reduction Agre ent) and shall be applicable for a Plan Year. Notwithstanding the above, for new Partic ants, the Salary Redirection Agreement shall only be applicable from the first day of the ay period following the Employee's entry date up to and including the last day of the PI n Year. These contributions shall be converted to Cafeteria Plan Benefit Dollars and al cated to the funds or accounts established under the Plan pursuant to the Partic ant's elections made under Article V. Any ary Redirection shall be determined prior to the beginning of a Plan Year (subject to initi elections pursuant to Section 5.1) and prior to the end of the Election Period and shall irrevocable for such Plan Year. However, a Participant may revoke a Benefit electi or a Salary Redirection Agreement after the Plan Year has commenced and make new election and/or Salary Redirection Agreement with respect to the remainder of the Ian Year, if both the revocation and the new election are on account of and consi nt with a change in family status and such other permitted events as determined under rticle V of the Plan and consistent with the rules and regulations of the Depa ent of the Treasury. Salary Redirection amounts shall be contributed on a pro rata sis for each pay period during the Plan Year. All individual Salary Redirection Agree ents (or Salary Reduction Agreements) are deemed to be part of this Plan and incur rated by reference hereunder. 3.2 As ICATION OF CONTRIBUTIONS i as reasonably practical after each payroll period, the Employer shall apply the Redirection to provide the Benefits elected by the affected Participants. Any VOLr,)`-) i'AGE ~ contri 'u't made or withheld for the Health Care Reimbursement Fund or Dependent ons Care ssistance Account shall be forwarded to the Administrator to be credited to such fund r account. Amounts designated for the Participant's Premium Expense Reim rsement Account shall likewise be forwarded to the Administrator to be credited to su account for the purpose of paying Premium Expenses. 3.3 PPRIODIC CONTRIBUTIONS standing the requirement provided above and in other Articles of this Plan Notwja That lary Redirections be contributed to the Plan by the Employer on behalf of an Empee on a level and pro rata basis for each payroll period, the Employer and Admtrator may implement a procedure in which Salary Redirections are contributed throu out the Plan Year on a periodic basis that is not pro rata for each payroll period. How r, with regard to the Health Care Reimbursement Plan, the payment schedule for the r ired co ntributions may not be based on the rate or amount of reimbursements Burin he Plan Year. In the event Salary Redirections are not made on a pro rata basis, upon mination of participation, a Participant may be entitled to a refund of such Salary Redir tions pursuant to Section 2.-6. ARTICLE IV BENEFITS 4.1 BENEFIT OPTIONS Each articipant may elect to have the amount of his/her Cafeteria Plan Benefit Dollars appli to any one or more of the following optional Benefits (if selected by the employer as in i ted by the Adoption Agreement and Summary Plan Description of the Plan): (1) H4*Ith Care Reimbursement Plan (2) Dependent Care Assistance Program (3) Insurance Premium Payment Plan (1) Health Insurance Benefit (ii) Dental Insurance Benefit (iii) Group-Term Life Insurance Benefit (iv) Disability and/or Accident Insurance Benefit (v) Vision Insurance Benefit (vi) Cancer Insurance (4) C44h Benefit 4.2 HQE$4LTH CARE REIMBURSEMENT PLAN BENEFIT Each Oarticipant may elect coverage under the Health Care Reimbursement Plan option, in whi case Article VI shall apply. voL~aAce .R5 4.3 DEPENDENT CARE ASSISTANCE PROGRAM BENEFIT Each Participant may elect coverage under the Dependent Care Assistance Program optio ' in which case Article VII shall apply. 4.4 HPALTH INSURANCE BENEFIT (a) ch Participant may elect to be covered under a health and hospitalization Insur, cice Contract for the Participant, his or her Spouse, and his or her Dependents. (b) T Employer may select suitable health and hospitalization Insurance Contracts for use i providing this health insurance benefit, which policies will provide uniform benefits for all [participants electing this Benefit. (c) T1 4 rights and conditions with respect to the benefits payable from such health and hospi lization Insurance Contract shall be determined there from, and such Insurance Contr t shall be incorporated herein by reference. 4.5 DOITAL INSURANCE BENEFIT (a) E h Participant may elect to be covered under the Employer's dental Insurance Contr t. In addition, the Participant may elect either individual or family coverage under such surance Contract. (b) T Employer may select suitable dental Insurance Contracts for use in providing this ntal insurance benefit, which policies will provide uniform benefits for all Partic; ants electing this Benefit. (c) T rights and conditions with respect to the benefits payable from such dental Insur ce Contract shall be determined therefrom, and such dental Insurance Contract shall incorporated herein by reference. 4.6 G UP-TERM LIFE INSURANCE BENEFIT (a) E h Participant may elect to be covered by the Employer's group-term life Insurance Contr t. However, the amount of coverage hereunder on behalf of any Participant may not a ed the lesser of 3 times such Participant's Compensation or $50,000. (b) T Employer may select suitable group-term life Insurance Contracts for use in provi g this group-term life insurance benefit, which policies will provide benefits for all Partic ' ants electing this benefit on a uniform basis. (c) Th rights and conditions with respect to the benefits payable from such group-term life I urance Contract shall be determined therefrom, and such group-term life Insur ce Contract shall be incorporated herein by reference. 4.7 (a) ILITY AND/OR ACCIDENT BENEFIT Participant may elect to be covered by the Employer's Disability and/or Insurance Contracts. VOLE QlkGE_91 (b) T Employer may select suitable Disability and/or Accident Insurance Contracts for use i providing this Disability and/or Accident Benefit. The Disability and/or Accident Insur ce Contracts may provide for long-term or short-term coverage. (c) T rights and conditions with respect to the Benefits payable from such Disability and/ Accident Insurance Contract shall be determined therefrom, and such Disability and/ Accident Insurance Contract shall be incorporated herein by reference. 4.8 VAf>'ION INSURANCE BENEFIT (a) Eh Participant may elect to be covered under the Employer's Vision Insurance Cont ct. In addition, the participant may elect either individual or family coverage. (b) T rights and conditions with respect to the benefits payable from such vision Insur ice Contract shall be determined therefrom, and such Vision Insurance Contract shall incorporated herein by reference. 4.9 CANCER INSURANCE POLICY (a) E h Participant may elect to be covered under the Employer's Cancer Insurance polic In addition, the Participant may elect either individual or family coverage. (b) T rights and conditions with respect to the benefits payable from such Cancer Insur ice policy shall be determined therefrom, and such cancer insurance policy shall be in rporated herein by reference. 4.10 Q4SH BENEFIT If a P icipant fails to make any election of Benefit options or does not elect any Salary Redir ' tions, such Participant shall be deemed to have chosen the Cash Benefit as his/h sole Benefit option. 4.11 NPNDISCRIMINATION REQUIREMENTS (a) It the intent of this Plan to provide benefits to a classification of employees which the S retary of the Treasury finds not to be discriminatory in favor of the group in whose favor discrimination may not occur under Code Section 125. (b) It the intent of this Plan not to provide qualified benefits as defined under Code Secti 125 to Key Employees in amounts that exceed 25% of the aggregate of such Bene provided for all Eligible Employees under the Plan. For purposes of the prece ng sentence, qualified benefits shall not include benefits which (without regard to this p agraph) are includable in gross income. (c) If Administrator deems it necessary to avoid discrimination or possible taxation to Key ployees or a group of employees in whose favor discrimination may not occur in violati of Code Section 125, it may, but shall not be required to, reject any election or redu contributions or non-taxable Benefits in order to assure compliance with this Secti Any act taken by the Administrator under this Section shall be carried out in a unifor and nondiscriminatory manner. If the Administrator decides to reject any election or red a contributions or non-taxable Benefits, it shall be done in the following manner. First, a non-taxable Benefits of the affected Participant (either an employee who is AGL_ -T) highly compensated or a Key Employee, whichever is applicable) who has elected the high t amount of non-taxable benefits will be reduced until the discrimination tests set forth ` this Section are satisfied or until the amount of his/her non-taxable Benefits equa the non-taxable Benefits of the affected Participant who has elected the second high t amount of non-taxable Benefits. This process shall continue until the nond crimination tests set forth in this Section are satisfied. With respect to any affected Parti ant who has had Benefits reduced pursuant to this Section, the reduction shall be mad proportionately among non-insured Benefits, and once all non-insured Benefits are pended, proportionately among insured Benefits. Contributions which are not utiliz to provide Benefits to any Participant by virtue of any administrative act under this ragraph shall be forfeited and deposited into the benefit plan surplus. ARTICLE V PARTICIPANT ELECTIONS 5.1 I"IITIAL ELECTIONS An E ployee who meets the eligibility requirements of Section 2.1 on the first day of, or durin a Plan Year may elect to participate in this Plan for all or the remainder of such Plan ear, provided he elects to do so before his/her effective date of participation purs nt to Section 2.2. However, if such Employee does not complete an Election of Bene i s and Salary Redirection Agreement form and deliver it to the Administrator befor such date, his/her Election Period shall extend 30 calendar days after such date, or for uch further period as the Administrator shall determine and apply on a uniform and n 'ndiscriminatory basis. However, any election during the extended 30-day election perio pursuant to this Section 5.1 shall not be effective until the first pay period follow g the later of such Participant's effective date of participation pursuant to Section 2.2 o the date of the receipt of the election form. by the Administrator, and shall be limite to the Benefit expenses incurred for the balance of the Plan Year for which the electi is made. 5.2 SMSEQUENT ANNUAL ELECTIONS Durin +the Election Period prior to each subsequent Plan Year, each Participant shall be given he opportunity, to elect, on an election of benefits form to be provided by the Admi i trator, which Benefit options he wishes to select and purchase with his/her Cafet is Plan Benefit Dollars. Any such election shall be effective for any Benefit expe s incurred during the Plan Year which follows the end of the Election Period. With and to Subsequent annual elections, the following options shall apply: (a) A rticipant or Employee who failed to initially elect to participate may elect different or ne Benefits under the plan during the Election Period; (b) A articipant may terminate his/her participation in the Plan by notifying the Admi i trator in writing during the Election Period that he does not want to participate in the pl for the next Plan Year; (c) A mployee who elects not to participate for the Plan Year following the Election Period ill have to wait until the next Election Period before again electing to participate in the Ian. 5.3 FAILURE TO ELECT Any rticipant who fails to complete a new benefit election form pursuant to Section 5.2 by the end of the applicable Election Period shall be treated in the following manner: (a) i h regard to Benefits available under the Plan that are non-insured and for which no P mium Expenses apply, such Participant shall be deemed to have elected not to parti : ate in the Plan for the upcoming Plan Year. No further Salary Redirections shall there re be authorized or made for the subsequent Plan Year for such non-insured (b) I h regard to Benefits available under the Plan that are insured and for which Prem m Expenses apply, such Participant shall be deemed to have made the same Bene elections as are then in effect for the current Plan Year. The Participant shall also deemed to have elected Salary Redirection in an amount necessary to purchase such sured Benefit options. 5.4 CHANGE OF ELECTIONS (a) Aft election made under the Plan shall be irrevocable by the Participant during the Plan ar, except as provided in (b) or (c) below. (b) A articipant may revoke an election in writing for the balance of a Plan Year and, if desire , file a new election in writing if both the revocation and the new election are (1) consi nt with the terms of the Dental, Disability and/or Accident, Group Life Insurance, or He 'th Plan in question and (2) made on account of and consistent with a change in famillines status. For this purpose, a change in family status includes the marriage or divot f the Participant, the death of the Participant's spouse or a dependent, the birth or a ion of a child of the Participant, the termination or commencement of empl ent of the Participant's spouse, the switching from part-time to full-time empl ent status (or vice versa) by the Participant or the Participant's spouse, the takinan unpaid leave of absence by the Participant or the Participant's spouse, a signit change in the health coverage of the Participant or the Participant's spouse attrib le to the spouse's employment, and such other events that the Administrator dete will permit a change or revocation of an election (and, if applicable, the filing of a election) during a Plan Year under regulations and rulings of the Internal Reve Service. (c) In jt~e case of coverage under the Dental Plan or a Medical/Health Plan which is provid by an independent third party provider, if 1) the Participants' share of the cost of such coverage significantly increases as i result of a significant cost increase by the independent third-party provider, or ) such coverage ceases or is significantly curtailed, the Administrator may :rmit all Participants electing such coverage for the Plan Year to revoke their ections for the balance of the Plan Year, provided that similar coverage is ected under the Dental Plan or a Medical/Health Plan for the balance of the an Year. /7- 2a a (d) A revocation and new election under this Section 5.4 shall be effective at such time as the Administrator shall prescribe, but not earlier than the first pay period beginning after a revocation and new election. ARTICLE VI HEALTH CARE REIMBURSEMENT PLAN 6.1 E$TABLISHMENT OF PLAN This ealth Care Reimbursement Plan is intended to qualify as a medical reimb ` sement plan under Code Section 105 and shall be interpreted in a manner consi ant with such Code Section and the Treasury regulations thereunder. Participants who ct to participate in this Health Care Reimbursement Plan may submit claims for the re bursement of Medical Expenses. All amounts reimbursed under this Health Care Reim rsement Plan shall be periodically paid from amounts allocated to the Health Care imbursement Fund. Periodic payments reimbursing Participants from the Health Care imbursement Fund shall in no event occur less frequently than monthly. 6.2 D INITIONS For tlio purposes of this Article and the Cafeteria Plan, the terms below have the followi meaning: (a) H Ith Care Reimbursement Fund" means the fund established for Participants pursu t to this Plan to which part of their Cafeteria Plan Benefit Dollars may be allocai"d and from which all allowable Medical Expenses may be reimbursed. (b) "H with Care Reimbursement Plan" means the plan of benefits contained in this Article which provides, for the reimbursement of eligible Medical Expenses incurred by a Partici ` nt or his/her Dependents. (c) "1111-ily Compensated Participant" means, for the purposes of this Article and deter] ing discrimination under Code Section 105(h), a participant who is: 1) one of the 5 highest paid officers; ) a shareholder who owns (or is considered to own applying the rules of Code action 318) more than 10 percent in value of the stock of the Employer; or 3) among the highest paid 25 percent of all Employees (other than exclusions ermitted by Code Section 105(h)(3)(13) for those individuals who are not articipants). (d) "M ical Expenses" means any expense for medical care within the meaning of the term " i I care" or "medical expense" as defined in Code Section 213 or Section 105 and th rulings and Treasury regulations thereunder, and not otherwise used by the Part 'pant as a deduction in determining his/her tax liability under the Code. However, a Part pant may not be reimbursed for the cost of other health coverage such as pre ms paid under plans maintained by the Employer of the Participant's spouse or indi ual policies maintained by the Participant or his/her spouse or Dependent. (e) The definitions of Article I are hereby incorporated by reference to the extent necessary to interpret and apply the provisions of this Health Care Reimbursement Plan. 6.3 RQRFEITURES The ount in the Health Care Reimbursement Fund as of the end of any Plan Year (and fter the processing of all claims for such Plan Year pursuant to Section 6.7 hereof) shall be forfeited and credited to the benefit plan surplus. In such event, the Participant shall ave no further claim to such amount for any reason, subject to Section 8.2. 6.4 L MITATION ON ALLOCATIONS Notw, standing any provision contained in this Health Care Reimbursement Plan to the cont , no more than $2,500.00 may be allocated to the Health Care Reimbursement Fund y a Participant in or on account of any Plan Year. 6.5 NDISCRIMINATION REQUIREMENTS a It the intent of this Health Care Reimbursement Plan not to discriminate in violation of th ode and the Treasury regulations thereunder. (b) II,s a Administrator deems it necessary to avoid discrimination under this Health Care Reim rsement Plan, it may, but shall not be required to, reject any elections or reduce cunt tions or Benefits in order to assure compliance with this Section. Any act taken by t Administrator under this Section shall be carried out in a uniform and nond riminatory manner. If the Administrator decides to reject any elections or reduce conttions or Benefits, it shall be done in the following manner. First, the Benefits desited for the Health Care Reimbursement Fund by the member of the group in whoavor discrimination may not occur pursuant to Code Sections 105 or 125 that elect to contribute the highest amount to the fund for the Plan Year shall be reduced until nondiscrimination tests set forth in this Section or the Code are satisfied, or until the unt designated for the fund equals the amount designated for the fund by the next mber of the group in whose favor discrimination may not occur pursuant to Code Sect105 or 125 who has elected the second highest contribution to the Health Care Reim rsement Fund for the Plan Year. This process shall continue until the nondi rimination tests set forth in this Section or the Code are satisfied. Contributions which are not utilized to provide Benefits to any Participant by virtue of any admi trative act under this paragraph shall be forfeited and credited to the benefit plan surpl i 6.6 CgORDINATION WITH CAFETERIA PLAN All Pa icipants under the Cafeteria Plan are eligible to receive Benefits under this Health Care eimbursement Plan. The enrollment under the Cafeteria Plan shall constitute enroll ent under this Health Care Reimbursement Plan. In addition, other matters 1 ✓ 2 i 104 ing contributions, elections and the like shall be governed by the-general is of the Cafeteria Plan. 6.7 HPALTH CARE REIMBURSEMENT PLAN CLAIMS (a) Al Medical Expenses incurred by a Participant shall be reimbursed during the Plan Year ubject to 2.6, even though the submission of such a claim occurs after his/her partic ation hereunder ceases; but provided that the Medical Expenses were incurred durin he applicable Plan Year. (b) T Administrator shall direct the reimbursement to each eligible Participant for all allow, le Medical Expenses, up to a maximum of the amount designated by the Parti ant for the Health Care Reimbursement Fund for the Plan Year. Reimbursements shall made available to the Participant throughout the Plan Year without regard to the level Cafeteria Plan Benefit Dollars which have been allocated to the fund at any given oint in time. Furthermore, a Participant shall be entitled to reimbursements only for a unts in excess of any payments or other reimbursements under any health care plan vering the Participant and/or-his/her Spouse or Dependents. (c) C ims for the reimbursement of Medical Expenses incurred in any Plan Year shall be pa as soon after a paper claim has been filed as is administratively practicable; provi d however, that if a Participant fails to submit a paper claim within the 90 day perio mmediately following the end of the Plan Year, those Medical Expense claims shall t be considered for reimbursement by the Administrator. Medi expenses can also be paid using an approved debit card associated with this Plan. (d) R i bursement payments under this Plan shall be made directly to the Participant, or if t ,Plan provides for an approved debit card, per the Med-i-Bank. Inc. Policies and Proce res attached hereto and with the submission of the debit card to a medical servi provider. However, at the discretion of the Participant and Administrator, paym is may be made directly to the service provider. A paper application for payment or rei ursement shall be made to the Administrator on an acceptable form within a reaso ble time of incurring the debt or paying for the service. The application shall includ a written statement from an independent third party stating that the Medical Expe has been incurred and the amount of such expense. Furthermore, the Partici nt shall provide a written statement that the Medical Expense has not been reimb 'sed or is not reimbursable under any other health plan coverage and, if reimb 'sed from the Health Care Reimbursement Fund, such amount will not be claimed as a x deduction. The Administrator shall retain a file of all such applications. If medi expenses are paid using an approved debit card, the medical expenses may have It be substantiated per IRS guidelines published in Revenue Ruling 2003-43. ARTICLE VII DEPENDENT CARE ASSISTANCE PROGRAM 7.1 EgTABLISHMENT OF PROGRAM This pendent Care Assistance Program is intended to qualify as a program under Code 16 ection 129 and shall be interpreted in a manner consistent with such Code Section, Participants who elect to participate in this program may submit claims for the reimb ement of Employment-Related Dependent Care Expenses. All amounts 23 reimrsed under this Dependent Care Assistance Program shall be paid from amounts alto ted to the Participant's Dependent Care Assistance Account. 7.2 IPIEFINITIONS For e purposes of this Article and the Cafeteria Plan the terms below shall have the follo ng meaning: (a) ependent Care Assistance Account" means the account established for a Par-ti pant pursuant to this Article to which part of his/her Cafeteria Plan Benefit Dollars may a allocated and from which Employment-Related Dependent Care Expenses of the rticipant may be reimbursed. (b) " pendent Care Assistance Program" means the program of benefits contained in this icle, which provides for the reimbursement of eligible expenses for the care of the Qual lf~ing Dependents of Participants. (c) " rned Income" means earned income as defined under Code Section 32(c)(2), but excl ing such amounts paid or incurred by the Employer for dependent care assistance to th articipant. (d) " mployment-Related Dependent Care Expenses" means the amounts paid for expe es of a Participant for those services which if paid by the Participant would be cons ered employment related expenses under Code Section 21(bx2). Generally, they shall clude expenses for household services or for the care of a Qualifying Dependent, to th extent that such expenses are incurred to enable the Participant to be gainfully empl ed for any period for which there are one or more Qualifying Dependents with resp at to such Participant. The determination of whether an amount qualifies as an Empl ment-Related Dependent Care Expense shall be made subject to the following rules (1) If such amounts are paid for expenses incurred outside the Participant's household, they shall constitute Employment-Related Dependent Care Expenses only if incurred for a Qualifying Dependent as defined in Section 7.2(f)(1) (or deemed to be, as described in Section 7.2(f)(1) pursuant to Section 7.2(f)(3)), or for a Qualifying Dependent as defined in Section 7.2(f)(2) (or deemed to be, as described in Section 7.2(f)(2) pursuant to Section 7.2(f)(3)) who regularly spends at least 8 hours per day in the Participant's household; (2) If the expense is incurred outside the Participant's home at a facility that provides care for a fee, payment, or grant for more than 6 individuals who do not regularly reside at the facility, the facility must comply with all applicable state and local laws and regulations, including licensing requirements, if any; and (3) Employment-Related Dependent Care Expenses of Participant shall not include amounts paid or incurred to a child of such Participant who is under the age of 19 or to an individual who is a dependent of such Participant or such Participant's Spouse. (e) "H hly Compensated Employee" means an Employee who is a highly compensated empl 'ee within the meaning of Code Section 414(q) and the Treasury regulations there der. V"JI 55 ua,t~63 T. (f) "Qualifying Dependent" means, for Dependent Care Assistance Program purposes, (1) a Dependent of a Participant who is under the age of 13, with respect to whom the Participant is entitled to an exemption under Code Section 129(c); (2) a Dependent or the Spouse of a Participant who is physically or mentally incapable of caring for himself or herself; or (3) a child that is deemed to be a Qualifying Dependent described in paragraph (1) or (2) above, whichever is appropriate, pursuant to Code Section 21(e)(5). (g) T definitions of Article I are hereby incorporated by reference to the extent nece ary to interpret and apply the provisions of this Dependent Care Assistance Proa . 7.3 DEPENDENT CARE ASSISTANCE ACCOUNTS The ministrator shall establish a Dependent Care Assistance Account for each Parti ant who elects to apply Cafeteria Plan Benefit Dollars to Dependent Care Assis nce Program benefits. 7.4 IggREASES IN DEPENDENT CARE ASSISTANCE ACCOUNTS A Pa ipant's Dependent Care Assistance Account shall be increased each pay period by th ortion of Cafeteria Plan Benefit Dollars that he/she has elected to apply toward his/h Dependent Care Assistance Account pursuant to elections made under Article V 7.5 DIfjPREASES IN DEPENDENT CARE ASSISTANCE ACCOUNTS A Pa i ipant's Dependent Care Assistance Account shall be reduced by the amount of any E ployment-Related Dependent Care Expense reimbursements paid or incurred on behal ` f a Participant pursuant to Section 7.12 hereof. 7.6 AlIkOWABLE DEPENDENT CARE ASSISTANCE REIMBURSEMENT Subje to limitations contained in Section 7.9 of this Program, and to the extent of the amou contained in the Participant's Dependent Care Assistance Account, a Participant who i urs Employment-Related Dependent Care Expenses shall be entitled to receive from t Employer full reimbursement for the entire amount of such expenses incurred during he Plan Year or portion thereof during which he/she is a Participant. 7.7 Atjt4UAL STATEMENT OF BENEFITS On or efore January 31st of each calendar year, the Employer shall furnish to each Empl a who was a Participant and received benefits under Section 7.6 during the prior tnt endar year, a statement of all such benefits paid to or on behalf of such Partici during the prior calendar year. T, _ 7.8 (FORFEITURES The mount in a Participant's Dependent Care Assistance Account as of the end of any Plan ear (and after the processing of all claims for such Plan Year pursuant to Section 7.12 ereof) shall be forfeited and credited to the benefit plan surplus. In such event, the Parti pant shall have no further claim to such amount for any reason. 7.9 41IMITATION ON PAYMENTS Notmi hstanding any provision contained in this Article to the contrary, amounts paid from Participant's Dependent Care Assistance Account in or on account of any taxable year f the Participant shall not exceed the lesser of the Earned Income limitation desc ed in Code Section 129(b) or $5,000 ($2,500 if a separate tax return is filed by a Parti pant who is married as determined under the rules of paragraphs (3) and (4) of Cod ection 21(e)). 7.10 "ONDISCRIMINATION REQUIREMENTS (a) I is the intent of this Dependent Care Assistance Program that contributions or bene s not discriminate in favor of Highly Compensated Employees or their Dep dents, as prohibited by Code Section 129(d). (b) It the intent of this Dependent Care Assistance Program that not more than 25 perrAs t of the amounts paid by the Employer for dependent care assistance during the Plan ear will be provided for the class of individuals who are shareholders or owners (or t it Spouses or Dependents), each of whom (on any day of the Plan Year) owns more an 5 percent of the stock or of the capital or profits interest in the Employer. (c) If he Administrator deems it necessary to avoid discrimination or possible taxation to Highl Compensated Employees defined under Section 7.2(e) or to principal shar olders or owners as set forth in this Section, it may, but shall not be required to, rejec any election or reduce contributions or non-taxable benefits in order to assure comp nce with this Section. Any act taken by the Administrator under this Section shall be ca 'ed out in a uniform and nondiscriminatory manner. If the Administrator decides to reject ' any elections or reduce contributions or Benefits, it shall be done in the following man r. First, the Benefits designated for the Dependent Care Assistance Account by the H hly Compensated Employee that elected to contribute the highest amount to such acco t for the Plan Year shall be reduced until the nondiscrimination tests set forth in this ction are satisfied, or until the amount designated for the account equals the amou designated for the account of the Highly Compensated Employee who has elect the second highest contribution to the Dependent Care Assistance Account for the P n Year. This process shall continue until the nondiscrimination tests set forth in this tion are satisfied. Contributions which are not utilized to provide Benefits to any Parti ant by vi a of any administrative act under this paragraph shall be forfeited. 7.11 ¢QORDINATION WITH CAFETERIA PLAN All P icipants under the Cafeteria Plan are eligible to receive benefits under this Depe lent Care Assistance Program. The enrollment and termination of participation under he Cafeteria Plan shall constitute enrollment and termination of participation under his Dependent Care Assistance Program. In addition, other matters concerning 26 T_ contritions, elections and the like shall be governed by the general provisions of the Cafet is Plan. 7.12 XPENDENT CARE ASSISTANCE PROGRAM CLAIMS The ministrator shall direct the payment of all such Dependent Care Assistance claim 'to the Participant upon the presentation to the Administrator of documentation of such penses in a form satisfactory to the Administrator. However, at the discretion of the A:ministrator and the Participant, payments may be made directly to the service provi r. If the plan provides for an approved debit card, then Dependent Care Expe es can be paid using the approved debit card per the Med-i-Bank, Inc. Policies and ocedures attached hereto. In its discretion in administering the Plan, the Admi trator may utilize forms and require documentation of costs as may be necei 1. ary to verify the claims submitted. At a minimum, the form shall include a state ant from an independent third party as proof that the expense has been incurred and t amount of such expense. In addition, the Administrator may require that each Parti i ant who desires to receive reimbursement under this Program for Empl ` ment-Related Dependent Care Expenses submit a statement which may contain some r all of the following information: (a) TF* Dependent or Dependents for whom the services were performed; (b) T~ nature of the services performed for the Participant, the cost of which he/she wish reimbursement; (c) Tf o relationship, if any, of the person performing the services to the Participant; (d) If toe services are being performed by a child of the Participant, the age of the child; (e) A statement as to where the services were performed; (f) If y of the services were performed outside the home, a statement as to whether the D `pendent for whom such services were performed spends at least 8 hours a day in the P icipant's household; (g) If toe services were being performed in a day care center, a statement (1) that the day care center complies with all applicable laws and regulations of the state of residence, (2) that the day care center provides care for more than 6 individual (otherthan individuals residing at the center), and (3) of the amount of fee paid to the provider. (h) If Participant is married, a statement containing the following: (1) the Spouse's salary or wages if he or she is employed, or (2) if the Participant's Spouse is not employed, that (i) he or she is incapacitated, or V0Z,,-55.- I D61 (ii) he or she is a full-time student attending an educational institution and the months during the year which he or she attended such institution. 0) If the e Admi Participant fails to submit a claim within the 90 day period immediately following of the Plan Year, those claims shall not be considered for reimbursement by the 0). If ependent Care Expenses are paid using an approved debit card, the Dependent Care xpenses may have to be substantiated per IRS guidelines published in Revenue Rulin_ 2003-43. ARTICLE VIII ERISA PROVISIONS 8.1 C~ AIM FOR BENEFITS (a) A claim for Benefits underwritten by an Insurance Contract shall be made to the Insur If the Insurer denies any claim, the Participant or beneficiary shall follow the Insur s claims review procedure. Any other claim for Benefits shall be made to the Admir ii trator. If the Administrator denies a claim, the Administrator may provide notice to the articipant or beneficiary, in writing, within 90 days after the claim is filed unless speci circumstances require an extension of time for processing the claim. If the Admi i trator does not notify the Participant of the denial of the claim within the 90 day perio specified above, then the claim shall be deemed denied. The notice of a denial of a clai shall be written in a manner calculated to be understood by the claimant and shall it forth: 1) specific references to the pertinent Plan provisions on which the denial is ) a description of any additional material or information necessary for the aimant to perfect the claim and an explanation as to why such information necessary; and 3) an explanation of the Plan's claim procedure. (b) W Min 60 days after receipt of the above material, the claimant shall have a reaso ble opportunity to appeal the claim denial to the Administrator for a full and fair review. ' The claimant or his/her duly authorized representative may: 1) request a review upon written notice to the Administrator; 2) review pertinent documents; and 3) submit issues and comments in writing. (c) A cision on the review by the Administrator will be made not later than 60 days after r eipt of a request for review, unless special circumstances require an extension of tim or processing (such as the need to hold a hearing), in which event a decision V0", 55 ~ !0'1 shoul be rendered as soon as possible, but in no event later than 120 days after such recei The decision of the Administrator shall be written and shall include specific reaso for the decision, written in a manner calculated to be understood by the claim t, with specific references to the pertinent Plan provisions on which the decision is bas . (d) Ai 1 balance remaining in the Participants' Health Care Reimbursement Fund or Depe lent Care Assistance Account as of the end of each Plan Year shall be forfeit and deposited in the benefit plan surplus of the Employer pursuant to Section 6.3 o ection 7.8, whichever is applicable, unless the Participant had made a claim for such Ian Year, in writing, which has been denied or is pending; in which event the amou of the claim shall be held in his/her account until the claim appeal procedures set fo above have been satisfied or the claim is paid. If any such claim is denied on appe I' the amount held beyond the end of the Plan Year shall be forfeited and credited to the enefit plan surplus. 8.2 AI?QLICATION OF BENEFIT PLAN SURPLUS Any f eited amounts credited to the benefit plan surplus by virtue of the failure of a Partic ant to incur a qualified expense or seek reimbursement in a timely manner may, but n d not be, separately accounted for after the close of the Plan Year (or after such furthe time specified herein for the filing of claim) in which such forfeitures arose. In no event hall such amounts be carried over to reimburse a Participant for expenses incurr during a subsequent Plan Year for the same or any other Benefit available under a Plan; nor shall amounts forfeited by a particular Participant be made available to su Participant in any other form or manner, except as permitted by Treasury regul ns. Amounts in the benefit plan surplus shall be returned to the employer as soon administratively feasible. 8.3 NWED FIDUCIARY The A inistrator shall be the named fiduciary pursuant to ERISA Section 402 and shall be re onsible for the management and control of the operation and administration of the PI . 8.4 GI~NERAL FIDUCIARY RESPONSIBILITIES The A inistrator and any other fiduciary under ERISA shall discharge their duties with respe to this Plan solely in the interest of the Participants and their beneficiaries and: (a) fo he exclusive purpose of providing Benefits to Participants and their beneficiaries and M raying reasonable expenses of administering the Plan; (b) wi the care, skill, prudence and diligence under the circumstances then prevailing that a rudent man acting in like capacity and familiar with such matters would use in the condu of an enterprise of a like character and with like aims; and (c) in ccordance with the documents and instruments governing the Plan insofar as such cuments and instruments are consistent with ERISA. 8.5 NQN-ASSIGNABILITY OF RIGHTS ~.0 The ht of any Participant to receive any reimbursement under the Plan shall not be alien le by the Participant by assignment or any other method, and shall not be subject to th 'rights of creditors, and any attempt to cause such right to be so subjected shall not be r ognized, except to such extent as may be required by law. ARTICLE IX ADMINISTRATION 9.1 H4AN ADMINISTRATION The eration of the Plan shall be under the supervision of the Administrator. It shall be a pri ipal duty of the Administrator to see that the Plan is carried out in accordance with its to s, and for the exclusive benefit of Employees entitled to participate in the Plan. The ministrator shall have full discretionary power to administer the Plan in all of its detai subject, however, to the pertinent provisions of the Code. The Administrator's pow shall include, but shall not be limited to the following authority, in addition to all othe owers provided by this Plan: (a) make and enforce such --rules and regulations as the Administrator deems nece ary or proper for the efficient administration of the Plan; (b) T interpret the Plan, the Administrator's interpretations thereof in good faith to be final d conclusive on all persons claiming benefits under the Plan; (c) T decide all questions concerning the Plan and the eligibility of any person to parti i ate in the Plan and to receive benefits provided under the Plan; (d) T reject elections or to limit contributions or Benefits for certain highly compensated parti ants if it deems such to be desirable in order to avoid discrimination under the Plan violation of applicable provisions of the Code; (e) T provide Employees with a reasonable notification of their benefits available under the P n; (f) Tol#pprove reimbursement requests and to authorize the payment of benefits; and (g) T ppoint such agents, counsel, accountants, consultants, and actuaries as may be requi d to assist in administering the Plan. Any procedure, discretionary act, inter tation or construction taken by the Administrator shall be done in a nondi riminatory manner based upon uniform principles consistently applied and shall be sistent with the intent that the Plan shall continue to comply with the terms of Code ection 125 and the Treasury regulations thereunder. 9.2 EXAMINATION OF RECORDS The ministrator shall make available to each Participant, Eligible Employee and any i 0 er Employee of the Employer such records as pertain to their interest under the Plan r examination at reasonable times during normal business hours. 9.3 PWMENT OF EXPENSES Any asonable administrative expenses shall be paid by the Employer unless the Empl er determines that administrative costs shall be borne by the Participants under the P n or by any Trust Fund which may be established hereunder. The Administrator 5. f`G 109 30 T_ may "pose reasonable conditions for payments, provided that such conditions shall not discri inate in favor of Highly Compensated Employees. 9.4 Irj~URANCE CONTROL CLAUSE In the vent of a conflict between the terms of this Plan and the terms of an Insurance Cont ct of a particular Insurer whose product is then being used in conjunction with this Plan, a terms of the Insurance Contract shall control as to those Participants receiving cove 'ge under such Insurance Contract. For this purpose, the Insurance Contract shall contr in defining the persons eligible for insurance, the dates of their eligibility, the condi ns which must be satisfied to become insured, if any, the benefits Participants are a itled to and the circumstances under which insurance terminates. 9.5 II`44)EMNIFICATION OF ADMINISTRATOR The ployer agrees to indemnify and to defend to the fullest extent permitted by law any ployee serving as the Administrator or as a member of a committee designated as A( i inistrator (including any Employee or former Employee who previously served as Admi trator or as a member of such committee) against all liabilities, damages, costs and penses (including attorney's fees and amounts paid in settlement of any claims appr d by the Employer) occasioned by any act or omission to act in connection with the P n, if such act or omission is in good faith. ARTICLE X AMENDMENT OR TERMINATION OF PLAN 10.1 AMENDMENT The ployer, at any time or from time to time, may amend any or all of the provisions of the Ian without the consent of any Employee or Participant. No amendment shall have a effect of modifying any benefit election of any Participant in effect at the time of such mendment, unless such amendment is made to comply with Federal, state or local I s, statutes or regulations. 10.2 RMINATION The ployer is establishing this Plan with the intent that it will be maintained for an indefi a period of time. Notwithstanding the foregoing, the Employer reserves the right to ter nate the Plan, in whole or in part, at any time. In the event the Plan is terminated, no fu er contributions shall be made. Benefits under any Insurance Contract shall be paid i accordance with the terms of the Contract. No f her additions shall be made to the Health Care Reimbursement Fund or Depe ent Care Assistance Account, but all payments from such fund shall continue to be m e according to the elections in effect until the end of the Plan Year in which the Plan t ' ination occurs (and for a reasonable period of time thereafter, if required for the filing claims), or until the balances of all accounts have been reduced to zero, which er occurs first. Any amounts remaining in any such fund or account as of the end of the Ian Year in which Plan termination occurs shall be forfeited and deposited in the benefi: plan surplus after the expiration of the filing period. OL-55 PAGE _//0 31 ARTICLE XI MISCELLANEOUS 11.1PLAN INTERPRETATION All p visions of this Plan shall be interpreted and applied in a uniform, nondiscriminatory man r. This Plan shall be read in its entirety and not severed except as provided in Sect n 11.12. 11.2 KDENDER AND NUMBER Whe ver any words are used herein the masculine, feminine or neuter gender, they shall a construed as though they were also used in another gender in all cases where they ould so apply, and whenever any words are used herein the singular or plural form hey shall be construed as though they were also used in the other form in all case where they would so apply. 11.3 WRITTEN DOCUMENT This Ian, in conjunction with any separate written document which may be required by law, intended to satisfy the written Plan requirement of Code Section 125 and any Reg I' tions thereunder relating to cafeteria plans. 11.4 EXCLUSIVE BENEFIT This plan shall be maintained for the exclusive benefit of the Employees who participate in th Ian. 11.5 PARTICIPANT'S RIGHTS This Ian shall not be deemed to constitute an employment contract between the Empl er and any Participant or to be a consideration or an inducement for the empl ment of any Participant or Employee. Nothing contained in this Plan shall be deem d to give any Participant or Employee the right to be retained in the service of the Empl er or to interfere with the right of the Employer to discharge any Participant or Empl ee at any time regardless of the effect which such discharge shall have upon him as a rticipant of this Plan. 11.6 ACTION BY THE EMPLOYER Whe ver the Employer under the terms of the Plan is permitted or required to do or perfo any act or matter or thing, it shall be done and performed by a person duly auth zed by its legally constituted authority. 11.7 (a) that any, PLOYER'S PROTECTIVE CLAUSES m the failure of either the Participant or the Employer to obtain the insurance plated by this Plan (whether as a result of negligence, gross neglect or se), the Participant's Benefits shall be limited to the insurance premium, if any, nained unpaid for the period in question and the actual insurance proceeds, if :eived by the Employer or the Participant as a result of the Participant's claim. Von_65fAGE~l!~ (b) T Employer's liability to the Participant shall only extend to and shall be limited to any p ment actually received by the Employer from the Insurer. In the event that the full insur ice Benefit contemplated is not promptly received by the Employer within a reas able time after submission of a claim, then the Employer shall notify the Parti i ant of such facts and the Employer shall no longer have any legal oblig on whatsoever (except to execute any document called for by a settlement reac d by the Participant). The Participant shall be free to settle, compromise or refuse to pu ue the claim as the Participant, in his/her sole discretion, shall see fit. (c) T Employer shall not be responsible for the validity of any Insurance Contract issue hereunder or for the failure on the part of the Insurer to make payments provided for u er any Insurance Contract, or for the action of any person which may delay or rend null and void or unenforceable, in whole or in part, an Insurance Contract. With regar to this paragraph, the following shall apply: (1) Once insurance is applied for or obtained, the Employer shall not be liable for any loss which may result from the failure to pay Premiums to the extent Premium noticed are not received by the Employer. (2) To the extent Premium notices are received by the Employer, the Employer's liabilit for the payment of such Premiums shall be limited to the amount of such Prem ms and shall not include liability for any other loss which may result from failure to pays h Premiums. (3) The Employer shall not be liable for the payment of any insurance Premium or an loss which may result from the failure to pay an insurance Premium if the Benefits avail le under this Plan are insufficient to provide for the amount of such Premium cost at th time it is due. In such circumstances the Participant shall be responsible for and see t he payment of such Premiums. The qi~iployer shall undertake to notify a Participant if available Benefits under this Plan are in fficient to provide for an insurance Premium but shall not be liable for any failure to ma such notification. 11.8 1$10 GUARANTEE OF TAX CONSEQUENCES Neith the Administrator nor the Employer makes any commitment or guarantee that any a ounts paid to or for the benefit of a Participant under the Plan will be excludable from a Participant's gross income for federal or state income tax purposes, or that any other deral or state tax treatment will apply to or be available to any Participant. It shall be th bligation of each Participant to determine whether each payment under the Plan is ex dable from the Participant's gross income for federal and state income tax purp s, and to notify the Employer if the Participant has reason to believe that any such ayment is not so excludable. Notwithstanding the foregoing, the rights of Parti ants under this Plan shall be legally enforceable. 11.9 INDEMNIFICATION OF EMPLOYER BY PARTICIPANTS If any articipant receives one or more payments or reimbursements under the Plan that are n for a permitted Benefit, such Participant shall indemnify and reimburse the Empl er for any liability it may incur for failure to withhold federal or state inco tax or Social Security tax from such payments or reimbursements. However, such ndemnification and reimbursement shall not exceed the amount of additional fede I and state income tax (plus any penalties) that the Participant would have owed if the yments or reimbursements had been made to the Participant as regular cash compensation, plus the Participant's share of any Social Security tax that would have been aid on such compensation, less any such additional income and Social Security tax a ually paid by the Participant. 11.10 FUNDING Unle otherwise required by law, contributions to the Plan may, but need not be, placed in tru or dedicated to a specific Benefit, and can be considered general assets of the Empl er. Furthermore, and unless otherwise required by law, nothing herein shall be cons ed to require the Employer or the Administrator to maintain any fund or segregate any ount for the benefit of any Participant, and no Participant or other person shall have any claim against, right to, or security or other interest in, any fund, account or asse f the Employer from which any payment under the Plan may be made. 11.111 GOVERNING LAW This an is governed by the Code and the Treasury regulations issued thereunder (as they 1ght be amended from time to time). In no event shall the Employer guarantee the favole tax treatment sought by this Plan. To the extent not preempted by Federal law, the visions of this Plan shall be construed, enforced and administered according to the I s of the State of Texas. 11.1 EVERABILITY If any provision of the Plan is held invalid or unenforceable, its invali or unenforceability shall not affect any other provisions of the Plan, and the Plan all be construed and enforced as if such provision had not been included herein. 11.1 APTIONS The captions contained herein are inserted only as a matter of cony ience and for reference, and in no way define, limit, enlarge or describe the 5cop r intent of the Plan, nor in any way shall affect the Plan or the construction of any provi i n thereof. 11.1 ONTINUATION OF COVERAGE Notwithstanding anything in the Plan to the contr , in the event any benefit under this Plan subject to the continuation coverage requi ment of CodeSection 4980B becomes unavailable, each Participant will be entitl to continuation coverage as prescribed in Code Section 49808. 11.15 FMLA LEAVE If the Participant makes contributions to this plan, and the Parti ant takes an unpaid FMLA leave, the Participant may revoke an existing election of co rage for the remaining portion of the applicable Coverage Period. Upon return from LA Leave, the Participant may elect to have such coverage reinstated. If the Parti ant elects to continue such coverage during the FMLA leave, the Participant may elect pay the amount required during the FLMA leave either (1) in one lump sum pre-t payment in advance of the commencement of the FMLA leave, or (ii) during the term the FMLA leave on the same schedule as payments would be made if the Partic ant were not on leave. The Participant will make payments from his personal asset through a means other than payroll deduction and an amount equal to such paym is will be credited to his Salary Reduction Election(s) in accordance with the terms f this Plan and all associated provisions of the Plan. ~~o 5 PAL x'13 11.16 abse the I requir to pa com the P from SERRA LEAVE In the event a Participant takes an unpaid USERRA leave of e, each elected health care benefit shall continue for the lesser of the period of e or eighteen months (18), provided that applicable contributions, if any are , for such benefits are timely paid by the Participant. The Participant may elect the contributions on an after-tax basis as due, or on a pre-tax basis prior to ncing the leave. Upon return from an unpaid USERRA leave before the end of n Year in which the leave commenced active participation in the Plan shall be ed and Salary Reduction contributions, if any, and benefits shall resume in nce with the Participant's elections immediately prior to the leave. Upon return unpaid USERRA leave after the end of the Plan Year the Participant shall be as a newly Eligible Employee and Section 2.1 shall apply. If a rticipant does not return to active employment at the conclusion of an unpaid USER FLA leave, the Participant shall no longer be considered an Eligible Employee. 11.17 IPAA PORTABILITY Notwithstanding any other provisions in Article II, any Empl ee who becomes eligible under the Health Insurance Portability and Acco tability Act of 1996 ("HIPAA") for coverage-by an Accident or Health benefit availa a under the Plan shall be allowed to participate in the Plan, so long as such Empl ee complies with the provisions set out in HIPAA. 11.18 IPAA PRIVACY RULES The Privacy Rules of HIPAA require the Plan to do the follow g (the requirements identified below are outlined and described in the "Notice of Health Information Privacy Practices" that is attached and made apart of this Plan Docu nt): Identify the permitted and required uses and disclosures of Protected Health Information (PHI); • I Prohibit the use or disclosure of PHI other than as permitted or required by the Plan or as required by law; • Require agents and subcontractors who receive PHI to abide by the same restrictions and conditions that apply to the Plan and the Employer; • Prohibit use of PHI for employment-related actions or in connection with any other benefit plans; • he Employer must to report to the Plan any improper use or disclosure of PHI; • Give participants access to their PHI and enable them to amend it upon request; • Provide participants, upon request, an accounting of all disclosures of their PHI; • Make available to the Department of Health and Human Services all internal practices, books, and records relating to the use and disclosure of plan PHI; • he Employer, once it no longer needs PHI for its intended purpose, to return or estroy all copies of the PHI or, if this is not feasible, to limit farther uses and isclosures; and Establish a "firewall" to ensure separation between health plan operations and the employer's other operations. NOT Section 11.15 and 11.16 are required by the Family Medical Leave Act of 1993 and t Uniformed Services employment and Reemployment Rights Act of 1994. Both these ws require employers to continue certain health care coverage's for period of unpaid leaves of absence. An employer must allow an employee to make contributions, if an are required, either on a pre-tax basis in one lump sum before the leave com nces or on a month to month after-tax basis. IN WI E! thing ay Brazo Co Signa re: 3 WHEREOF, this Plan document is hereby executed - 1-1) 14 VOL 6PAG v15 Med-i-Bank, Inc. Policies and Procedures ppropriate Use of the Card. :knowledge and agree that upon any inappropriate or fraudulent use of the Card, or termination of )loyment, I will immediately return all Cards issued for use against the Account to Key Bank's agent, the Plan Administrator/Service Provider, or my employer. If I fail to surrender all Cards, I will be ionsible, to the extent permitted by law, for any Card Transactions. urn of the Card. am required to return my Card for any reason before the end of the Plan Year, I shall reimburse my Moyer for any amounts advanced by the employer from the Account for expenses that are not Qualified ,enditures. My employer may also pursue any and all legal means available to it to recover some or all he amounts advanced that I am not entitled to, including but not limited to, deducting such owed iunts from subsequent payroll amounts owed me. isequences in the Event of Non-Qualified Expenditures. the extent that any Card Transactions are not for Qualified Expenditures and I fail to reimburse the punt for such amounts, I authorize my employer to collect from me personally or withhold such funds a my pay or any other amounts due-me including any taxes, fines, surcharges or penalties that may be :ssed for the use of the Card for Non-Qualified Expenditures. I also understand that my Card may be iediately suspended and/or permanently revoked. iness Days For purposes of these disclosures, your business days are Monday through Fridays. idays are not included. ord of Transactions Statements. I will obtain and retain a receipt at the time I engage in a Card isaction to verify Card purchases. I will review Transaction activity statements at least monthly, either -eviewing statements received from my Plan Administrator/Service Provider or by accessing the mbi site, www.theflexcard.corrbWty_ for Unauthorized Transactions. Upon review, I will immediately contact my Plan ainistrator/Service Provider if my Card was used for any transaction without my permission or has been or stolen. If my statement shows Card Transactions that I did not make (even if my Card was not lost), ust and will notify the Plan Administrator/Service Provider at once. If I do not notify the Plan ainistrator/Service Provider within 60 days of the Card Transaction date, I may not recover any money I after the 60 days if Plan Administrator/Service Provider could have stopped someone from taking the iey if I had notified Plan Administrator/Service Provider in time. itact in Event of Unauthorized Transactions. If I believe my Card was lost or stolen, or that someone used my Card without my permission, or there appears to be an error in my statement, I will iediately call my Plan Administrator/Service Provider. I may also report my lost card on your web site at htww.theflexcard.com. P acy & Confidentiality. I eby release you to provide any information necessary for the validation and/or verificadon of any Card T saction, to my Plan Administrator/Service Provider. Otherwise, you will disclose information to third p 'es about the Account only to comply with government agency or court orders; or to verify the existence condition of the Account for a third party, such as a merchant. Ai t horizations. I ee that Card Transactions will be honored only when sufficient funds or coverage are available in the A unt. If you or my employer, at either of your discretion, decides to pay the amount of the Card T ' saction that exceeds funds in the Account, I agree to repay you or my employer in full immediately u notice. I also agree that Card Transactions are subject to prior authorization by you or by a Card sp oring authorization center. V0 t". Med-i-Bank, Inc. Policies and Procedures PLOYEE ENROLLMENT AGREEMENT n this Agreement, the word "I", "me" and "my" means each employee and all of their eligible dependents. You" and "your" means Med-i-Bank, Inc., (dba, mbi) the provider of the services under the Med-i-Bank rogram, which enables me to use a debit-like, stored value card ("Card'I to access coverage under pre-tax avings or Reimbursement "Accounts." "Accounts" are those accounts established, maintained and ontrolled by my employer or its agent, which represents an amount of coverage under my employer's lan(s) ("Plan"). "Card Transaction" means each transaction at a merchant that accepts the Card. ow the Program and the Card Work; Qualified Expenditures. connection with participating in the Program, I request that Key Bank, via its agent, mbi, issue to me one or more Cards. I agree that each Card is the property of Key Bank and will be surrendered to it via its gent, mbi, upon its request. I understand that I can only use the Card for payment of certain eligible xpenses defined in my Plan Document(s) and under federal tax law. Any Card Transaction that is not for a ualified Expenditure is called a "Non-Qualified Expenditure". When I use the Card, I incur an expense hich may qualify for pre-tax reimbursement under the Plan. I understand that my employer will advance ds on my behalf to cover my expenses. You are authorized by me to deduct the amount of each ualified Expenditure from the Account in the same way check transactions are handled. I fin-tber agree at Card Transactions shall be subject to the terms of this Agreement and the rules of the Account and any pplicable federal or state rules or regulations. You are not obligated to me if any merchant refuses to onor my Card or retains my Card if authorization for its use is not given. I understand that if I use my ~ard for a purchase which is returned for a refund, and such purchase was a Qualified Expenditure charged my account, such refund must be made on a credit voucher, which shall be credited to the Account in the ormal course of business. I agree that all Card Transactions may be presented to Plan Fe ministrator/Service Provider through the use of either sales or credit drafts or electronic transmission of transaction information, and that I will, upon request, review transaction statements and sign documents sting to the validity of my Qualified Expenditures. on-Qualified Expenditures understand that if I use the Card for purchases other than Qualified Expenditures, as determined by the lan Administrator/Service Provider, the IRS, or any other party having authority, I have violated this greement and my obligations under my employer's Plan. I understand that, upon notification, I must ediately re-pay the expense to my employer and that my Card may be immediately suspended or yoked for such failure to comply. y Responsibilities accept responsibility for the following: (i) all Card Transactions will be solely for Qualified Expenditures curred (not billed or paid) during the Plan Year in which the Card Transaction was initiated; (ii) the Plan dministrator/Service Provider will determine what Card Transactions are Qualified Expenditures and that u have no responsibility to make any such determination; (iii) all information relating to the Account and y deductions or exclusions from income on my federal or state tax returns and filing are my sole sponsibility; (iv) to the extent that I misrepresent any Card Transaction as a Qualified Expenditure when is a Non-Qualified Expenditure, whether by mistake or otherwise, I indemnify you, and the Plan lministrator/Service Provider, and hold you harmless for whatever penalties and consequences that may r,cur as a result of my actions; (v) if I continually attempt to use the Card for Non-Qualified Expenditures, gardless of whether such transactions are denied, I will be required to return my Card to Key Bank's ent, mbi, the Plan Administrator/Service Provider, or my employer, (vi) Qualified Expenditures for any and Transactions have not been and will not be reimbursed from any source other than the Account, cluding but not limited to any and all insurance payments either from my insurance carriers or my pendents' insurance carriers; (vii) each time I present the Card for payment, I will sign a receipt idencing that the expense has been incurred and reaffirming my representation that it is a Qualified penditure that has not been and will not be reimbursed from any other source. VOL -55.) E ~1 .7 Med-i-Bank, Inc. Policies and Procedures iging or Canceling this Agreement may at any time, and from time to time, upon notification, change or add to any of the terms of this ement. You also may cancel this Agreement and my right to use the Card any time without prior e, but any obligation to pay any items charged against the Account, plus any applicable charges, will nue until paid in full. eipt of Disclosures. signing and using the Card, I hereby acknowledge receipt of this Employee Enrollment Agreement rming me of my rights. Funds. funds do not represent deposits guaranteed, or insured by us, the issuer, or the Federal Deposit Corporation (FDIC), or any other state or federal governmental agency, and are subject to typical 1, non-guaranteed risk. erning Law. Agreement shall be governed by the laws of the Commonwealth of Massachusetts, except to the extent federal law may apply. In the event of any conflict between the provisions of this Agreement and any icable law or regulation, the provisions of the Agreement shall be deemed modified to the extent ssary to comply with such law or regulation. NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES - Purpose of this Notice Your he your pri% medical private This N th information is highly personal, and Brazos County is committed to safeguarding icy. The Plan (Brazos County Flexible Benefits Plan) includes provisions to ensure iformation that identifies you (referred to as "protected health information") is kept as to comply with all legal requirements. tells you about the ways the Plan' may use and disclose your protected health including details about: • )four treatment, • F Oyment of your claims, • 111alth care information used for administrative purposes, and' • I 'I er uses and disclosures of such information allowed by law. It also djocribes your legal right to access and control, the use and disclosure of your protected health in rmation: The Pla ust abide by the terms of this Notice. However, the Plan reserves the right to change i privacy practices for both existing and future health information held by or on behalf of the PI. If a change in privacy practices is made, the terms of this Notice may change and a copy oft revised Notice will be posted by, Brazos County or mailed to you within 60 days of the date the change. The effective date of the posted or mailed Notice will be stated at the top of the do ment Records- covered by this Notice For Plan ministration purposes, the Plan (and various outside service providers hired by the PI ) creates records such as proof of health claims, and this Notice applies to all such records. Records NOT covered by this Notice Other pri% cy notices may apply to your medical records maintained by other entities. For exam le, if you participate in a Plan option that is insured (such as an HMO), the insurer's notices a practices will apply to records created or maintained by that insurer. In addition, other noti s and practices may apply to records created or maintained by your doctor or other health ca provider. How your protected health information may be used or disclosed The Plan possible ,s and discloses your protected health information in different ways. Not every or disclosure is listed here, but all of the ways your information 1 health m be disclosed for Plan administration fit within these categories: • atment • ment • eration of the Plan Treatment Your prot ted health information may be used or disclosed to facilitate medical treatment r services by health care providers, such as doctors, nurses, technicians or hospital p sonnel who are involved in taking care of you. For exam e, to protect you from receiving inappropriate medications, the Plan or a pharmacy benefit manager for the Plan may share information about prior prescriptions if a newly rescribed drug could cause problems for you. The Plan also may share informati about prior treatment with a health care provider who needs this information to treat y or your family members properly: Payment Your protee ted health information may be used or disclosed to: •D ermine your eligibility for Plan benefits, •C rdinate coverage between this Plan and another plan, and •F ilitate payment for services you receive. For exam , your information may be shared with an outside vendor that provides "utilizatio eview" services (oversight of prescribed treatment and changes to determine hether they are appropriate and cost-effective) to the Plan. As another example, ome other insurance carrier or, other third party is responsible for paying medical c is that the plan would otherwise pay, your information may be shared with an outsid mpany hired to help the Plan ensure it is properly reimbursed by the other insurance rrier or third party: Operation of the Plan Your prot ed health information maybe used for various administrative purposes of the Plan. These us and disclosures are necessary to run the Plan. For exam 1"eded , your information might be included as part of an audit designed to ensure that the PI 's outside claims administrator is performing its job as well as it should. Your info tion, combined with that of all other participants, may also be used each year to se ppropriate premiums charged for coverage under the Plan or to help get insurance to financially protect the Plan or Plan sponsor. As you car i see, the Plan relies on outside service providers to handle certain administra a tasks on its behalf. When these tasks involve the use or disclosure of your prote ed health information, the Plan is permitted to share your information with these pro ers (such as companies that process claims for benefits under the Plan). The Plan requires t se providers to keep your protected health information confidential. Fo" 2 4~~ 0 55 The PI also may share your protected health information with the Plan Sponsoror Employer. The sp sor has agreed to prevent unauthorized use or disclosure of the information, and the Brazos ounty employees who handle your protected health information will be governed by the require ents of HIPAA and the terms of this Notice. Additional uses and disclosures allowed law In addi n to the categories of treatment, payment and operation of the Plan listed above, deral law allows "covered entities," including our Plan, to use and disclose your protect health information without obtaining your written authorization in the following circum nces: -if the ue or disclosure is required by federal, state or local law. -For pu~ic health activities, such as preventing or controlling disease and reportin reactions to medications. -To gov ment agencies for victims of abuse, neglect or domestic violence. -For he h oversight activities, such as audits, investigations, inspections and licensur -For jud ial and administrative proceedings, such as lawsuits or other disputes in respons to a court order or subpoena. -For law i nforcement purposes, such as responding to a court order or subpoe , identifying a suspect or a missing person, or providing information about a 'me victim or criminal conduct. -To coroners and medical examiners for identification of deceased persons, to determi a cause of death, or as otherwise authorized by law. -To fune al directors as necessary to cant' out their duties. -To an o an procurement organization or entity for organ, eye or tissue donation -For retrch purposes, or to avert a serious threat to health or safety of a person or the DdIJ lic. *Under s cialized government functions that warrant the use and disclosure of protecte ealth information. These government functions may include military and vete ns' activities, national security and intelligence activities, and protective services for the Presi nt and others. Information may also be disclosed to correctional institutions and otherla% nforcement officials with lawful custody of an inmate or other person. -For co Hance with workers' compensation or similar programs. Other protections you may have under state laws Generall state insurance and other laws do not apply to the operations of employee 3 VOL 4t; : WAGE 4~_) benefit pl s that are "self-insured," such as some of the coverage options available in the Brazos unty Flexible Benefits Plan. Self-insured means the plan sponsor (Brazos County), rather th an insurance company, pays the cost of approved claims. Within the Plan there may or y not be other insurance coverage provided by third party insurance companies. In some ses, though, certain state laws may protect medical records and possibly ~ 11 a you greater rights than those provided under federal law. When the Plan Ad i' istrator becomes aware of any such state laws, you will be notified within a reasonab ` time and told how the state laws affect you. No other uses or disclosures without your authorization Other tha the uses and disclosures described in this Notice, the Plan may not disclose your protected health information or make any other use of it without your written authoriza i n. You may request restrictions You have a right to request restrictions on certain uses and disclosures of your protected ealth information. Specifically, you may request restrictions on the uses and disclosur related to treatment, payment or operation of the Plan (which are otherwise permitted For example, you may not want the Plan to disclose information about your health to ur spouse or children. Please n that the Plan is not required to agree to the requested restriction, and any requeste estriction must be approved in writing by Brazos County to be effective. If the Plan agrees to our request (and Brazos County approves the request in writing), the Plan will not use or dis lose your information in the way you specified unless it is needed to provide emergen treatment. You must ake your requests to restrict the use and disclosure of your protected health informatio by writing to the Plan Administrator for the Plan. The Plan Administrator is shown in a "Introduction" section of each Summary Plan Description (SPD). S s are available at: Brazos County 300 East 26th Street Suite 313 Bryan, TX 77803 Your requ t must state the specific restriction requested and to whom you want the restriction apply. Receiving confidential communications for safety reasons In certain ses, you may ask to have your protected health information sent to you confidenti Ine in a way and/or at a location that you specify. For example, you may request th the Plan contact you regarding a specific aspect of your health only at your work telep number or address: The Plan %~Il attempt to accommodate reasonable requests that clearly state, in writing, 4 that the ual means of disclosing your protected health information could endanger you. Yo ust make your requests for confidential communications by writing to the Plan Ad 'inistrator for the Plan. You gen ally have the right to inspect and copy your protected health, information while it is maintain by the Plan or on behalf of the Plan. This right does not apply to certain narrow types of formation, such as: -hotherapy notes, rmation that may be used in a civil, criminal, or administrative action or ceeding, and rmation that cannot be disclosed by law. Denyin ou Access/Review of a Denial of Access The Pla ay deny your request for access to your protected health information under certain Ii ited circumstances. If your request is denied, you may request a review of the denial b citing to the Plan Administrator for the Plan. The Pla dministrator will respond to your request within 30 days after receipt if the informati is maintained or accessible on site, or within 60 days after receipt if the informati is not maintained or accessible on site. If additional time is needed, you will - be notif in writing to explain the delay and to give you the date when a response to your req st will be sent. In any event, the Plan Administrator will act on your request no later t n 60 days after receipt if the information is available on site, or 90 days after receipt if a information is not available on site. Copying ees You may a charged a reasonable fee to cover costs related to copying your protected health in ation, preparation of an explanation or summary, of the protected health informati , and postage. Amendments to your information If you fee our protected health information is incorrect or incomplete, you may ask the Plan Administ or to amend the information. You have the right to request that your protected ealth information be amended for as long as it is maintained by the Plan or on behalf of the Plan. You must ake your request for an amendment in writing to the Plan Administrator for the Plan. You must also provide a supporting reason for the requested amendment. Your req st for amendment may be denied if it is not in writing or does not include a reason to upport the request. In addition, your request may be denied if: -The Pla or its service providers) did not create the information; -The info ation is not part of the records maintained by or on behalf of the Plan; *The information is not part of the information you would be permitted to inspect and cor)v: r -The inistrator determines that the information is accurate and complete. 5 If your r uest for changes in your protected health information is denied, the Plan Adminis for will notify you in writing with the reason for the denial. The Plan Adminis for will also inform you of your right to submit a written statement disagreeing with the denial. Even if u choose not to submit a statement of disagreement, you may ask the Plan Adminis for to include your request for amendment and the denial any time the informat n you wanted changed is disclosed by, or on behalf of, the Plan. The Plan may pre are, or have prepared on its behalf, a rebuttal to your statement of disagre ent. You will be provided a copy of any such rebuttal. The Pla dministrator (or outside service provider) wills respond to your request within 60 days er it is received. If additional time is needed, the Plan Administrator will notify you in writing t xplain the delay and to give you the date when a response will be sent to you. In any event, th Plan Administrator (or outside service p(ovider) will act on your request within no more thair, 90 days after it is received. - You may request a list of disclosures Effective pril 14, 2004, or later if permitted by federal law, if the Plan or its outside service eiders disclose your protected health information to anyone besides you for reasons at you have not authorized (other than for "payment, treatment and operation of the PI, i " described above), you generally will have a right to receive information about the isclosures. This information is called an "accounting." You mus ake your request for an accounting of disclosures of your protected health informati in writing to the Plan Administrator identified in the "Introduction" section of the Summa Plan Description for the Plan. For each isclosure, you will receive the date of the disclosure, the name of the receiving ntity (and address, if known), a brief description of the protected health informati disclosed, and a brief statement of the purpose of the disclosure (or a copy of the re est for information or your authorization, if any). Your req st for an accounting must specify a time period, which may not be longer than six 14 ars (remember, though, that information is available only for disclosures made on or after April 14, 2004, or later if permitted by federal law). The Plan Administ for will respond to your request within 60 days after its receipt. If additional time is needed, you will be notified in writing to explain the delay and to give you the date by ich a response will be sent. In any event, the Plan Administrator will act on your req st no more than 90 days after it is received. In any gi n onth period, you may receive one accounting of the disclosures of your prot tte-Y'Zea1th information at no charge. For any additional request for an accounti during that period, you may be required to pay a reasonable fee to cover the Plan's co is for preparing the accounting. Exceptions to the list of disclosures There few minor exceptions to the requirement that the Plan provide an account, . By law, the Plan is not required to include in an accounting, any disclosures made fo ational security or intelligence purposes, to correctional institutions or law enforcer I nt officials, or disclosures that are part of a limited data set that contains no more inf mation than: (i) your age or date' of admission, discharge or death and (ii) your city, state, co,11 ty, precinct or zip code. Complaints If you be i' ve the Plan has violated your privacy rights, you may file a complaint with the Plan, Br os County or the U.S. Secretary of Health and Human Services. Complaints to the Plan sho d be filed in writing with the Plan Administrator for the Plan. Complaints to Brazos County uld be filed in writing at: Brazos County 300 East 26th Street Suite 313 Bryan TX, 77803 You will qtt be penalized in any way for filing such a complaint. C 7 VrA Brazos County Flexible Benefits Plan This and Business Associate Agreement %ss Associate Agreement is effective on April 1, 2004 and is entered into by n David K. Young, Consulting and Brazos County Flexible Benefits Plan. Statement of Intent This Ag identifia Brazos busines address covered obligatic 1. Dei Terms L those to Exampl( a. 'nent was developed to provide a framework for the protection of private, individually information in the course of data exchange between David K. Young Consulting and unty Flexible Benefits Plan whereas David K. Young Consulting is known as a >sociate of Brazos County Flexible Benefits Plan. The provisions in this Agreement ncepts and requirements set forth in the Privacy Rule and provisions that allow the tity to be able to rely on the business associate to help the covered entity meet its under the Privacy Rule. A but not otherwise defined, in this Agreement shall have the same meaning as is in the Privacy Rule. of specific definitions: 3usiness Associate. "Business Associate" shall mean David K. Young Consulting. A 3usiness Associate is a person or entity who on behalf of a covered entity, but other han in the capacity of a member of the workforce of such covered entity or arrangement, performs, or assists in the performance of a function or activity involving he use or disclosure of individually identifiable health information or provides, other han in the capacity of a member of the workforce of such covered entity, legal, actuarial, accounting, consulting, data aggregation management, administrative, accreditation, or financial services to or for such covered entity b. overed Entity-. "Covered Entity" shall mean Brazos County Flexible Benefits Plan. c. isclosure means the release, transfer, provision of access to, or divulging in any ther manner of information outside the entity holding the information d. dividual. "Individual" shall have the same meaning as the term "individual" in 45 FR § 164.501: Individual means the person who is the subject of protected health formation and shall include a person who qualifies as a personal representative in ccordance with 45 CFR § 164.502(g). e. rivac Rule. "Privacy Rule" shall mean the Standards for Privacy of Individually entifiable Health Information at 45 CFR Part 160 and Part 164, Subparts A and E. f. rotected Health Information. "Protected Health Information" shall have the same eaning as the term "protected health information" in 45 CFR § 164.501, Protected ealth Information means individually identifiable information, transmitted or aintained in any form or medium. g. a uired B Law. "Required By Law" shall have the same meaning as the term equired by law" in 45 CFR § 164.501. h. [ecreta[y. "Secretary" shall mean the Secretary of the Department of Health and an Services or his designee. i. means, with respect to individually identifiable health information, the sharing, loyment, application, utilization, examination, or analysis of such information in an entity that maintains such information 2. a. B iness Associate agrees to not use or disclose Protected Health Information other th as permitted or required by the Agreement or as Required By Law. b. B iness Associate agrees to use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Agreement. c. BL f iness Associate agrees to mitigate, to the extent practicable, any harmful effect that is own to Business Associate of a use or disclosure of Protected Health Information by BL f. iness Associate in violation of the requirements of this Agreement. d. 131. 1 iness Associate agrees to report to Covered Entity any use or disclosure of the Pr ected Health Information not provided for by this Agreement of which it becomes a jO e. e. B ness Associate agrees to ensure that any agent, including a subcontractor, to whom it vide s Protected Health Information received from, or created or received by B ness Associate on behalf of Covered Entity agrees to the same restrictions and citions that apply through this Agreement to Business Associate with respect to such f. B iness Associate agrees to provide access, at the request of Covered Entity, and in th ime and manner mutually agreed to by the Parties, to Protected Health Information in Designated Record Set, to Covered Entity or, as directed by Covered Entity, to an In idual in order to meet the requirements under 45 CFR § 164.524. g. B ness Associate agrees to make any amendment(s) to Protected Health Information in Designated Record Set that the Covered Entity directs or agrees to pursuant to 45 C § 164.526 at the request of Covered Entity or an Individual, and in the time and m, i ner mutually agreed to by the Parties. h. B ness Associate agrees to make internal practices, books, and records, including po i' ies and procedures and Protected Health Information, relating to the use and di losure of Protected Health Information received from, or created or received by Bu ness Associate on behalf of, Covered Entity available to the Covered Entity, and to th Secretary, in a time and manner mutually agreed to by the Parties or designated by th Secretary, for purposes of the Secretary determining Covered Entity's compliance wit, the Privacy Rule. i. Bu ness Associate agrees to document such disclosures of Protected Health Inf mation and information related to such disclosures as would be required for Cc , red Entity in a time and manner mutually agreed to by the Parties to respond to a re est by an Individual for an accounting of disclosures of Protected Health Information in cordance with 45 CFR § 164.528. j. Bu ness Associate agrees to provide to Covered Entity or an Individual, in time and m ner mutually agreed to by the Parties, information collected in accordance with Se ion 2(i) of this Agreement, to permit Covered Entity to respond to a request by an In i idual for an accounting of disclosures of Protected Health Information in accordance wit 45 CFR § 164.528. 3. Per!hitted Uses and Disclosures by Business AssnriatP :cif ur oses: a. ecific Purposes Ex t as otherwise limited in this Agreement, Business Associate may use or disclose Pro ted Health Information on behalf of, or to provide services to, Covered Entity for the folio ing purposes, if such use or disclosure of Protected Health Information would not viol the Privacy Rule if done by Covered Entity or the minimum necessary policies and pro dures of the Covered Entity. Services may include: • xible Benefits Plan Administration gle Source Billing ■ LBRA 4. Addi nal Use and Disclosure Provisions Except s otherwise limited in this Agreement, Business Associate may use Protected Health Informa n for the proper management and administration of the Business Associate or to carry out the I al responsibilities of the Business Associate. a. cept as otherwise limited in this Agreement, Business Associate may disclose tected Health Information for the proper management and administration of the siness Associate, provided that disclosures are Required By Law, or Business sociate obtains reasonable assurances from the person to whom the information is closed that it will remain confidential and used or further disclosed only as Required Law or for the purpose for which it was disclosed to the person, and the person n if es the Business Associate of any instances of which it is aware in which the c fidentiality of the information has been breached. b. cept as otherwise limited in this Agreement, Business Associate may use Protected alth Information to provide Data Aggregation services to Covered Entity as permitted b 42 CFR § 164.504(e)(2)(i)(B). c. iness Associate may use Protected Health Information to report violations of law to a ropriate Federal and State authorities, consistent with § 164.5020)(1). 5. Obli ions of Covered Entity Provisio for Covered Enti to Inform Business Associate of Privacy Practices and a. C ered Entity shall notify Business Associate of any limitation(s) in its notice of privacy pt i ctices of Covered Entity in accordance with 45 CFR § 164.520, to the extent that s h limitation may affect Business Associate's use or disclosure of Protected Health I rmation. b. C ered Entity shall notify Business Associate of any changes in, or revocation of, p mission by Individual to use or disclose Protected Health Infonmation, to the extent th such changes may affect Business Associate's use or disclosure of Protected H Ith Information. c. C ered Entity-shall notify Business Associate of any restriction to the use or disclosure of. rotected Health Information that Covered Entity has agreed to in accordance with 45 C § 164.522, to the extent that such restriction may affect Business Associate's use or isclosure of Protected Health Information. Covered ntity shall not request Business Associate to use or disclose Protected Health 6. Perm Ititv- Informati in any manner that would not be permissible under the Privacy Rule if done by Covered V ible Requests b Covered Entity 7. a. T m. The Term of this Agreement shall be effective as of April 1, 2004 and shall t inate when all of the Protected Health Information provided by Covered Entity to B iness Associate, or created or received by Business Associate on behalf of Covered E ity, is destroyed or returned to Covered Entity, or, if it is infeasible to return or destroy P tected Health Information, protections are extended to such information, in a ordance with the termination provisions in this Section. b. T mination for Cause. Upon Covered Entity's knowledge of a material breach by Bt j iness Associate, Covered Entity shall either: 1. Provide an opportunity for Business Associate to cure the breach or end the violation and terminate this Agreement if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity; 2. Immediately terminate this Agreement if Business Associate has breached a material term of this Agreement and cure is not possible; or 3. If neither termination nor cure are feasible, Covered Entity shall report the violation to the Secretary. c. E ct of Terminnfinn 1. Except as provided in paragraph (2) of this section, upon termination of this Agreement, for any reason, Business Associate shall return or destroy all Protected Health Information received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the Protected Health Information. 2. In the event that Business Associate determines that returning or destroying the Protected Health Information is infeasible, Business Associate shall provide to Covered Entity notification of the conditions that make return or destruction infeasible. Upon written notification that return or destruction of Protected Health Information is infeasible, Business Associate shall extend the protections of this Agreement to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such Protected Health Information. 8. Miscel; neous a. Re ulato References. A reference in this Agreement to a section in the Privacy Rule me E ns the section as in effect or as amended. b. A ndment. The Parties agree to take such action as is necessary to amend this Ag ement from time to time as is necessary for Covered Entity to comply with the re( t irements of the Privacy Rule and the Health Insurance Portability and Accountability Ac f 1996, Pub. L. No. 104-191. c. Su ival. The respective rights and obligations of Business Associate under Section 7C )(2) and 8E of this Agreement shall survive the termination of this Agreement. d. Int retation. Any ambiguity in this Agreement shall be resolved to permit Covered En i to comply with the Privacy Rule. e. In nifcation. The Covered Entity will indemnify and hold harmless Business As ciate and any of its affiliates, officers, directors, subcontractors, agents, volunteers or ployees from and against any claim, cause of action, liability, damage, cost or ex nse, including attorney's fees and court or proceeding costs, arising out of or in c nection with any violation or failure of Covered Entity to fulfill its obligations under H AA, including any unauthorized Use or Disclosure of Protected Health Information or a failure in security measures affecting Protected Health Information or any other terial breach of the terms of this Agreement by Covered Entity, Employer, or any p son or entity under the Employer or Covered Entity's control. The Employer o gation to indemnify Business Associate will survive the expiration or termination of th Agreement. B iness Associate will indemnify and hold harmless Covered Entity and Employer and a of their affiliates, trustees, officers, directors, employees, volunteers, subcontractors o 'agents from and against any claim, cause of action, liability, damage, cost or e) I ense, including attorney's fees and court or proceeding costs, arising out of or in cc r nection with any violation or failure of Business Associate to fulfill its obligations u er HIPAA, including any unauthorized Use or Disclosure of Protected Health In- i rmation or any failure in security measures affecting Protected Health Information or a other material breach of the terms of this Agreement by Business Associate or any p on or entity under Business-Associate's control. The Business Associate obligation to demnify Covered Entity and Employer will survive the expiration or termination of th ` Agreement. IN ITNESS WHEREOF, the parties hereto have authorized this Agreement to be 1 d K. Young Consulting Name: -6 30 J- _ l~ Health Insurance Portability and Accountability Act (HIPAA) Business Associate Agreement In conforni ty with the regulations at 45 C.F.R. 160.103 and 164.501 (the "Privacy Rules") and for the consideration already existing between the parties, this Agreement is made between Business sociate and Covered Entity so that Business Associate will have the authority to, under the llowing conditions and provisions, create, receive and otherwise have access to certain Pr ected Health Information which Business Associate has created, received or otherwise ve access to in conjunction with the insurance brokerage and/or benefits consulting services to a provided to Covered Entity. 1. De rtions. The following terms, as used in this Agreement, shall have the meaning set forth below: (a) Agreement means this Business Associate Agreement. (b) C.F.R. means the Code of Federal Regulations. (c) Business Associate shall mean Plumhoff & Associates, Inc. (d) Covered Entity shall mean the group health plans of Brazos County for which Business Associate performs services. (e) Designated Record Set has the meaning assigned to such term in 45 C.F.R. §164.501. (f) Individual shall have the same meaning as the term "individual" in 45 C.F.R. § 164.501 and shall include a person who qualifies as a personal representative in accordance with 45 C.F.R. § 164.502 (g). (g) Privacy Rules means the standards for privacy of individually identifiable health information in 45 C.F.R. 160 and 164, Subpart A and E. (h) Protected Health Information, or PHI shall have the same meaning as the term "Protected Health Information" defined at 45 C.F.R. §164.501, and limited to the information created or received by Business Associate from or on behalf of Covered Entity. (i) Secretary shall mean the Secretary of the U.S. Department of Health and Human Services or its designee. 2. Oblkations and Activiti (a) Business Associate agrees to not use or disclose PHI other than as permitted or required by this Agreement or as required by law. (b) Business Associate agrees to use appropriate safeguards to prevent use or disclosure of PHI other than as provided for by this Agreement. (c) Business Associate agrees to report to Covered Entity any use or disclosure of the PHI not provided for by this Agreement of which it becomes aware. (d) Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by Business Associate on behalf of Covered Entity agrees to the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such information. HOU01•760589.1 V S5 f J 5, (e (h; 3. Business Associate agrees to provide access, at the request of and in the time and manner designated by Covered Entity, to PHI in a Designated Record Set, to Covered Entity so that the Covered Entity may meet the requirements under 45 C.F.R. § 164.524. Business Associate agrees to make any reasonable amendment(s) to PHI in a Designated Record Set that the Covered Entity directs or agrees to pursuant to 45 C.F.R. § 164.526 at the request of Covered Entity. Business Associate agrees to make internal practices, books and records, including policies and procedures about PHI, relating either directly or indirectly to the use and disclosure of PHI received from, or created or received by Business Associate on behalf of Covered Entity, available to the Secretary, in a time and manner designated by the Secretary, for purposes of the Secretary determining Covered Entity's compliance with the Privacy Rules. Business Associate agrees to document such disclosures of PHI and information related to such disclosures as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 C.F.R. § 164.528. (a) General Use and Disclosure Except as otherwise limited in the Agreements, Business Associate may use or disclose PHI to perform its obligations as an insurance broker and/or benefits consultant to Covered Entity and/or Covered Entity's plan sponsor, provided that such use or disclosure would not violate the Privacy Rules if done by Covered Entity either jointly or individually. (b) Specific Use and Disclosure Provisions Except as otherwise limited in the Agreements, Business Associate may use and/or disclose PHI for the proper management and administration of Business Associate, provided that disclosures are permitted by the Privacy Rules, or Business Associate obtains reasonable assurances from the person to whom the information is disclosed that the PHI will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached. (i) Except as otherwise limited in the Agreements, Business Associate may use PHI to provide data aggregation services to Covered Entity as permitted by 42 C.F.R. § 164.504(e)(2)(i)(B). (ii) Business Associate may use PHI to report violations of law to appropriate Federal and State authorities, consistent with 42 C.F.R. § 164.5020)(1). 4. Obligations of (a) Provisions for Covered Entity to Inform Business Associate of Privacy Practices (i) Covered Entity shall provide Business Associate with the notice of privacy practices that Covered Entity produces in accordance with 45 C.F.R. § 164.520, as well as any changes to such notice. H0001:760589. -2- o =s , u Jr v -5 a ,s. g I (ii) Covered Entity shall provide Business Associate with any changes in, or revocation of, permission by an Individual to use or disclose PHI, to the extent that such changes affect Business Associate's uses or disclosures of PHI. (b) l 5. (iii) Covered Entity shall notify Business Associate of any amendment or restriction to the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 C.F.R. § 164.522. Permissible Requests by Covered Entity. Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under the Privacy Rules if done by Covered Entity. (a) Term. The provisions of this Agreement shall take effect April 14, 2003, and shall terminate as of the date Business Associate no longer provides insurance brokerage and/or benefits consulting services to Covered Entity and/or Covered Entity's plan sponsor, subject to Section 5(c) herein. (b) Termination for Cause. Without limiting the termination rights of the parties pursuant to the Agreement, and subject to Section 5(c) below, upon Covered Entity's knowledge of a material breach by Business Associate of the provisions of this Agreement, Covered Entity shall provide an opportunity for Business Associate to cure the breach (including amending or terminating sections of the Agreement) or end the violation and terminate the Agreement, if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity. (c) Effect of Termination. Upon termination of this Agreement for any reason, Business Associate shall return or destroy all PHI that Business Associate or its agents or subcontractors still maintain in any form, and shall retain no copies of such PHI. If Business Associate reasonably determines that return or destruction is not feasible, however, Business Associate shall continue to extend the protections of this Agreement to such PHI, and limit further use of such PHI to those purposes that make the return or destruction of such PHI infeasible, pursuant to 45 C.F.R. § 164.504(e)(ii)(2)(I). If Business Associate elects to destroy or return the PHI, Business Associate shall certify in writing to Covered Entity that such PHI has been destroyed or returned. 6 (a) Regulatory References. A reference in this Agreement to a section in the Privacy Rules means the section as in effect or as amended, and for which compliance is required. (b) Amendment. The parties acknowledge that state and federal laws relating to data security and privacy are rapidly evolving and that amendment of this Agreement may be required to provide for procedures to ensure compliance with such developments. The parties specifically agree to take such action as is necessary to implement the standards and requirements of the Privacy Rules and other applicable laws relating to the security and confidentiality of individually identifiable health information. Upon the request of either party, the other party HOU01:760589. -3- 4 (c (d (e) M IN WITN their duly Brazos C on behalf By: Print Nam Print Title: agrees to promptly enter into negotiations concerning the terms of an amendment to this Agreement in order to safeguard PHI consistent with the Privacy Rules and other applicable laws relating to the security and confidentiality of such information. Survival. The respective rights and obligations of Business Associate under Section 5(c) shall survive the termination of this Agreement. Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits Covered Entity to comply with the Privacy Rules. No third party beneficiary. Nothing express or implied in this Agreement is intended to confer, nor shall anything herein confer, upon any person other than the parties and the respective successors or assigns of the parties, any rights, remedies, obligations, or liabilities whatsoever. Governing Law. Except where governed by federal law or regulation, this Agreement shall be governed by and construed in accordance with the laws of the state of Texas. S WHEREOF, the parties have caused this Agreement to be signed and delivered by thorized representatives, as of the Agreement's Effective Date. 1ty the Covered Entity PLUMHOFF & ASSOCIATES, INC. By: 6,~.~ Print Name: 1 ~os Print Title: V. 1- Date: © / - :41~ Date / of H0001:760589. -4- NOTICE OF PRIVACY PRACTICES This notice de that of any p~ alone and not PLEASE NO to the plans address or t PLEASE NOT than the plans to you by that s the medical information practices of the aPlan_Name* (hereinafter referred to (collectively] as the 'Plan and it assists in the administration of Plan claims. Any reference in this Notice to we, us or our refers to the Plan ENT and/or any of its affiliates or subsidiaries. The vast majority of your medical information resides with our business vendors (which provide services d on the cover page). To access the information contained in their files, contact the vendor directly at the e number listed on your Member ID Card. your benefits are being provided from an insurance company, or if you are covered by a group health plan other f above, a notice of privacy practices applicable to that insurer or plan, respectively, should be provided directly PLAN PLEDGE REGARDING MEDICAL INFORMATION We understand at medical information about you and your health is personal, and we intend to protect the confidentiality of that information. Th Ian, similar to your doctor, must create a record of the health care claims you or your doctor submits for payment. These records used to administer the Plan. This notice appl to all of the medical records we maintain. While your personal doctor or health care provider may have different poticles regardi his/her use and disclosure of your medical information, this notice will tell you about the ways in which your Plan intends to use a disclose medical information about you. It also describes our obligations and your rights regarding such use and disclosure. We required by law to ensure that medical information that identifies you is kept private to the extent possible. As a result, we are gi g you this notice of our legal duties and privacy practices with respect to medical information about you, and we expect to follow terms of this notice now and in the future. HOW THE PLAN USES AND DISCLOSES MEDICAL INFORMATION The following ones describe different ways that we use and disclose medical information. While not every use or disclosure in a category will listed, they will describe all of the ways we are permitted to use and disclose information without your authorization. For Treatment) IThe Plan may use or disclose medical information about you to help your doctors provide you with medical treatment. To th end, we may disclose your medical information to all medical providers who are involved in taking care of you. For examp if asked by the pharmacist, we might disclose information about your prior prescriptions if he/she needs it to determine i pending prescription would be harmful to you in light of your other prescriptions. If asked by your doctor, we, or one of Plan service providers, might disclose your medical history in order to help him/her provide the most appropriate eatment for your medical condition, or to help determine whether a proposed treatment is experimental, investigatio 1, or medically necessary. For Payment a Plan may use or disclose information about you to determine your eligibility for benefits, pay the Plan's portion of the medical I determine benefit responsibility under the Plan, or coordinate Plan coverage with benefits you may be receiving from another pla Note, while we may use your personal information to determine your eligibility for Plan benefits, your eligibility for coverage under Plan is not dependent upon your health status. For exampl we may tell your health care provider about your medical history to determine whether and how much the Plan will pay fo our treatment We may also share medical information with a utilization review or pre-certification service provider to p them maximize the benefits available to you. We may share medical information with another party at our discretion t assist with the adjudication or subrogation of health claims, or to another health plan to coordinate benefit payments. ewise, we may share medical information with certain RCLIENTs employees or employees of third parties to process a espond to benefit plan appeals. For Health Care Qperations. The Plan may use and disclose medical information about you for other necessary Plan operations. For exampl we may use our participants' medical information to conduct quality assessment and improvement activities, underwrite a Plan's financial risks and/or other activities relating to Plan coverage. We may also use your medical information t' conduct or arrange for medical review, legal services, audit services, fraud and abuse detection programs, and busine planning and development such as cost management, business management and general Plan administrative activities. SPECIAL SITUATIONS The following si tions describe special circumstances where the Plan may also release your medical information without your authorization. As Required B .w. The Plan must disclose medical information about you when required to do so by federal, state or local law. For examp we may disclose medical information to the federal Department of Health & Human Services, or the Centers for Diseas trol. To Avert a Seri s Threat to Health or Safety. The Plan may use and disclose medical information about you when necessary to prevent a serio threat to your health and safety, or the health and safety of the public or another person. For example, we may disclose medical information about you in a proceeding regarding the licensing, or the revocation of a license, of physician. Also, if you were to contract a serious illness that might pose a threat to public safety, we may disclose yo A information to the proper authorities. Disclosure to her KCUENT* Health Plans. Your Plan is made up of different benefit options depending on the geographic location in whi ou work. Should you transfer to a different location, your information may be disclosed to the responsible party administering th relevant Plan option (including, but not limited to, disclosure to an insurance carrier and/or HMO). This will be done to assist treatment, payment, and health care operations. In addition, minimum necessary access to your medical information may given to CLIENT personnel (such as the Privacy Officer, human resources staff, an accountant, or a computer programmer) for a purpose of ensuring the continued existence and administering the benefits of the Plan. Organ and Ti *e Donation. If you are an organ donor, we may release information to organizations that handle organ procurement or gan, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and tra plantation. Military and Ve ans. If you are a member of the armed forces, we may release medical information about you as required by military comma authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority Workers' Comsation. We may release medical information about you for workers' compensation or similar programs. These programs provid enefits for work-related injuries or illnesses. Public Health lei ks. We may disclose medical information about you for public health activities, including but not limited to the following: II • to report birft and deaths; • to report cabuse or neglect; • to report rions to medications or problems with products; • to notify p e of recalls of products they may be using; • to notify a n who may have been exposed to a disease or may be at risk for contracting or spreading a disease; or, • to notify al, ernment authority if we believe a person has been the victim of abuse, neglect or domestic violence. Health Oversl9 Activities. We may disclose medical information to a federal or state health oversight agency for activities authorized by la hese oversight activities include, for example, audits, investigations, inspections, and licensure. Lawsuits and D utes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or ad nistrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other 1 process by someone else involved in the dispute. Law Enforceme# We may release medical information if asked to do so by a law enforcement official: • in response a court order, subpoena, warrant, summons or similar process; • to identify o to a suspect, fugitive, material witness, or missing person; • about the vi of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement; • about a dea we believe may be the result of criminal conduct; • about crimi conduct at a hospital; and • in emergen circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who mmitted the crime. Coroners, M, This may be r information to National Se intelligence, Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. ary, for example, to identify a deceased person or determine the cause of death. We may also release medical I directors as necessary to carry out their duties. and Intelligence Activities. We may release medical information about you to authorized federal officials for rintelligence, and other national security activities authorized by law. Inmates. If y are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical inform n about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to tde you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of correctional institution. YOUR RIGHTs REGARDING MEDICAL INFORMATION ABOUT YOU You have the f wing rights regarding medical information the Plan maintains about you: Right to Inspeand Copy. You have the right to inspect and copy medical information that may be used to make decisions about your Plan bene To do this, you must submit your request in writing via U.S. Postal Service to the HIPAA Privacy Officer at the address listed the end of this Notice. Your request t include your name, Social Security number, work and home addresses and telephone numbers in order to receive a respo e. You must also identify the name of the health plan to which your inquiry applies and be specific about the time period and subj t for which you are requesting information. If you request copy of the information, we may charge a fee for the costs of compiling, copying, mailing or other supplies associated with our request. We may deny r request to inspect and copy in certain circumstances. If you are denied access to medical information, we will tell you why a may request a review of the deniaL- Right to Amen If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. Yo ave the right to request an amendment for as long as the information is kept by or for the Plan. To request an a ndment, you must provide a reason for your request, and the request must be made in writing and submitted via U.S. Postal Se a to the HIPAA Privacy Officer at the address listed at the end of this Notice. We are not req red to agree to your request. We may deny request for an amendment if it is not in writing or does not include a valid reason to support the request. In addition, we ma eny your request if you ask us to amend information that: • is not part ithe medical information kept by or for the Plan; • was not cr d by us, unless the person or entity that created the information is no longer available to make the amendment; is not part a information which you would be permitted to inspect and copy; or is accurate complete. Right to an Ac nting of Disclosures. You have the right to request an "accounting of disclosures" where such disclosure was made for any pu se other than treatment, payment, or health care operations. To request this 11$t or accounting of disclosures, you must submit your request in writing via U.S. Postal Service to the HIPAA Privacy Officer a address listed of the end of this Notice. Your request m. J.4 state a time period in which the disclosures occurred, but may not be longer than six years from the date of your request and ma of include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, paper or eleetro The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providi a list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs a incurred. Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about for treatment, payment, or health care operations. You also have the right to request a limit on the medical information wed ose about you to someone (other than a medical provider) who is involved either in your care or the payment for your care, like a mily member or friend. For example, you could ask that we riot use or disclose information about a surgery you had. We are not reggod to agree to your request. To request restrii4ons, you must make your request in writing via U.S. Postal Service to the HIPAA Privacy Officer at the address listed at the end this Notice. In your request, must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both, and (3) to whom you nt the limits to apply. Right to Req St Conrrdendal Communications. You have the right to request that the Plan communicate with you about medical matte in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We are not requir o adopt special mailing instructions such as registered or certified mail. To request con ential communications, you must make your request in writing via U.S. Postal Service to the HIPAA Privacy Officer at the address ted at the end of this Notice. While we will ask you the reason for your request, the Plan will only accommodate reasonable requests. Your request must specify how or ere you wish to be contacted. Right to a Co of This Notice. You have the right to a copy of this notice. You may ask us to give you a copy of this notice at any time. Even if y have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice upon your request. To request a cc* of this notice, you must make your request in writing via U.S. Postal Service to the HIPAA Privacy Officer at the address listed 4tfhe end of this Notice. CHANGES TO THIS NOTICE We reserve the ght to change this notice, and to make the revised or changed notice effective for medical information we already have about you s well as any information we receive In the future. You will be provided a new notice within 60 days if there is a material revisio . COMPLAINTS If you believe r privacy rights have been violated, you may file a complaint with the Plan or with the Secretary of the federal Department of alth and Human Services. To file a complaint with the Plan, contact in writing via U.S. Postal Service: HIP I Officer You will not be nalized for filing a complaint. For more information, you may call the Privacy Officer at ( 1 As with all corr ondence with the Privacy Officer called for in this Notice, you must identify both yourself and the Plan in which you participate i vier to receive a response. OTHER USES OF MEDICAL INFORMATION Other uses and closures of medical information not covered by this notice or the laws that apply to us will be made only with your written authori n. If you provide an authorization to use or disclose medical information about you, you may revoke that permission, in ng, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons cov by your written authorization. We are unable to take back any disclosures we have already made with your permission, and are required to retain our records of the care and benefits provided to you. Furthermore, you should be aware that any discos we make pursuant to your authorization strips that information of the protection of the Plan's privacy guidelines. i a J-~ a r.;(J CERTIFICATION TO HEALTH PLAN REAS ((CLIENT)) is the sponsor of an employee welfare benefit plan (hereafter referred to as the employees, retirees and their dependents; and W REAS Plan Sponsor's Plan is a "group health plan" within the meaning of the Health Insurance Poi I bility and Accountability Act of 1996 (HIPAA); and WI- I REAS the Plan provides health coverage to the participants and beneficiaries in the Plan Sponsor's gro K) health plan; and W REAS Plan and Plan Sponsor desire to exchange health information protected under HIPAA ("pr c ected health information or PHI") for purposes related to administration of the group health plan; THE EFORE BE IT RESOLVED, that Plan Sponsor hereby certifies to Plan the following, as required by Set n 45 CFR 164.504(f) of HIPAA: The Ian documents that govern Plan Sponsor's group health plan have been amended to incorporate the foll ng provisions and Plan Sponsor agrees: • not use or further disclose PHI other than as permitted or required by the plan documents or as required by I ; • to a ure that any agents, including a subcontractor to whom the Plan Sponsor provides PHI received from the an, agree to the same restrictions and conditions that apply to Plan Sponsor with respect to such info ation; • not use or disclose PHI for employment-related actions and decisions unless authorized by an individual; • not use or disclose PHI in connection with any other benefit or employee benefit plan of Plan Sponsor unl authorized by an individual; • to r rt to the Plan or the Plan's designee, any PHI use or disclosure, that Plan Sponsor becomes aware of, ich is inconsistent with the uses or disclosures provided for; • to m e PHI available to an individual in accordance with HIPAA's access requirements; • to m e PHI available to an individual for amendment and incorporate any amendments to PHI in acc ance with HIPAA's amendment requirements; • to m e available to an individual the information required to provide an accounting of disclosures; • to m e its internal practices, books and records, relating to the use and disclosure of PHI received from Plan vailable to the Secretary of the U.S. Department of Health and Human Services for the purpose of dete ining the Plan's compliance with HIPAA; • to a re that adequate separation is established between the Plan and the Plan Sponsor as required by HIP (45 CFR 164.504(fx2xiii); and • if fea Irn le, to return or destroy all PHI received from the Plan that Plan Sponsor still maintains in any form and ain no copies of such PHI when no longer needed for the specified disclosure purpose. If return or dest tion is not feasible, Plan Sponsor will limit further uses and disclosures to those purposes that make the r or destruction infeasible. ENT)) Date: OR ((CLIENT)) Privacy Official Date: volt _ 66 13 9 SERVICES AGREEMENT BETWEEN BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATION (hereinafter called BCBSTX) and BRAZOS COUNTY 80950-9901 (hereinafter called the Employer) empii rega Emp WHEREAS, the Employer has established a health benefit program for its i ees and the eligible dependents of its employees; and WHEREAS, Congress has imposed certain statutory requirements ing continuation of health benefits for those persons covered under the er's health benefit program; and WHEREAS, the Employer has requested BCBSTX to furnish certain noni urance services in connection with continuation of coverage under the Empl er's health benefit program; NOW, THEREFORE, in consideration of the mutual promises and ants contained herein, it is hereby agreed as follows: q+f u Article I - Definitions As u A. B. C. D. E. F G. H J. in this Agreement: Calendar Year means the one year period commencing on a January 1 and ending the following December 31. COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended. Collection Services means, except for the initial premium required to establish continued coverage, the process by which a continued Participant is billed for and remits premium for continued coverage. Dependent means any person who is both eligible for coverage and covered as a dependent spouse or child under the Employer's health benefit program on the day before a Qualifying Event. Election period means the period of at least sixty (60) days duration beginning not later than the date on which coverage under the health benefit program terminates by reason of a Qualifying Event and ending not earlier than sixty (60) days after the later of (1) the beginning date or (2) the date a Participant has been notified of the right to elect continued group coverage after the occurrence of a Qualifying Event. Employee means any person who is both eligible for coverage and covered as an employee under the Employer's health benefit program on the day before a Qualifying Event. Notification Services means those actions intended to: (1) notify a Participant of his or her right to elect continued group coverage after the occurrence of a Qualifying Event; (2) attempt to ascertain whether such Participant wishes to elect such continued coverage; and (3) collect the initial premium for such coverage if the Participant has elected to continue the coverage. Participant means an Employee or a Dependent as above defined. Use in this Agreement of the singular shall be deemed to include the plural unless the context clearly indicates the contrary. Qualifying Event means the occurrence of an event which would result in the loss of eligibility of a Participant under the Employer's health benefit program but for the requirements of COBRA. Subscriber means a participant who (1) elected to continue group coverage under COBRA; (2) submitted an application and the entire 2 r. applicable premium; and (3) has a certificate number for continued coverage under COBRA. _ Article II - Services Performed by BCBSTX A. Notification Services - If the Employer requests BCBSTX to furnish Notification Services: 1. Once the Employer has notified BCBSTX in writing of the occurrence of a Qualifying Event and has given BCBSTX the name and current address of a covered Participant, BCBSTX will timely provide the applicable Participant notice of the right to continue group coverage directed to the address provided by the Employer. 2. The notice provided a Participant pursuant to Paragraph 1 of this Section A will also include premium information and an application card, and will state the time limitations for the election to continue coverage. Any Participant electing to continue coverage will be directed to communicate such election in writing to BCBSTX. BCBSTX will bill and collect the applicable initial premium rate from the date of the Qualifying Event to the end of the month in which such election is received. No continued group coverage shall be effective until the entire initial premium rate is received by BCBSTX. When an Employee is eligible under COBRA to continue group coverage and makes an election, the election is deemed to include all Participants except as otherwise stated in such election. When the employee is not eligible under COBRA to continue group coverage and a Dependent spouse is eligible under COBRA to continue group coverage, an election by the Dependent spouse is deemed to include all Participants except as otherwise stated in such election. For purposes of this Section 3, an election includes a declination. B. ollection Services - Once a Participant has elected to continue group overage and the entire initial premium rate has been received by CBSTX. 1. BCBSTX will establish the membership information in the BCBSTX claims system and issue identification cards and a benefit booklet. 65 (no 3 4 2. BCBSTX will provide a monthly statement to the applicable Subscriber. Such statement shall indicate a due date for receipt of the premium rate. Should the premium rate not be received by the due date, any claim(s) incurred after the last date for which the premium rate has been received will be suspended and a delinquent notice will be issued. If all of the premium rate is not received within thirty (30) days of the due date, the continued group coverage will be terminated as of the last day of the month in which the entire, proper premium rate was paid. In the event of such termination, the Subscriber shall be notified by BCBSTX of the termination of continued group coverage. 3. The Subscriber will be notified six (6) months prior to the maximum period of continued group coverage that such coverage will terminate in six months. The notice will contain information concerning any right to an individual-conversion policy. 4. An additional notice will be provided sixty (60) days prior to the maximum period of continued group coverage advising that continued group coverage will terminate in sixty (60) days. The additional notice will contain information concerning any right to an individual conversion contract. Upon receipt of evidence satisfactory to BCBSTX that a continued Participant has become, after the date of election, ineligible for continued group coverage for reasons other than failure to pay the proper premium rate or the expiration of the maximum period of continued group coverage, BCBSTX will notify such ineligible continued Participant that the continued group coverage is being terminated and the date and reason for such termination. 6. BCBSTX shall notify a continued Subscriber of any benefit changes which the Employer may make in regard to its health benefit program and any change in the premium rate. At least semiannually, BCBSTX will provide the Employer a written report giving the status of each continued Subscriber covered on the ending date of such report. Article 111 - Duties of the Employer A. If the employer has requested BCBSTX to furnish Notification Services: vo~ 1'~- 0 A I°~ 1. Within thirty (30) days after the occurrence of a Qualifying Event, the Employer will provide a written notice of such event to BCBSTX. The written notice will be on a form satisfactory to BCBSTX and will describe the nature and date of the Qualifying Event, the name and last known address of each Participant, the certificate number(s) of each Participant, and the type(s) of coverage held by each Participant on the date of the Qualifying Event. Upon request, BCBSTX will provide the Employer with an appropriate notice form. B 2. If the Qualifying Event is either the divorce of the Employee or a Dependent child ceasing to be a Dependent child under the provisions of the Employer's health benefit program, and the Employer had no notice of such Qualifying Event within 30 days of such Qualifying Event, the notice required by Paragraph 1 of this Section A will be provided in writing to BCBSTX no later than fourteen (14) days following the Employer's receipt of notice of the occurrence of such event. 3. Should any Participant communicate or attempt an election or declination of the continued group coverage directly with the Employer or its officers or agents, the Employer shall immediately present any and all information regarding such action to BCBSTX. For purposes of this Paragraph 3, "immediately" means within three (3) work days. If the Employer has requested BCBSTX to furnish only Collection Services: 1. Within ten (10) days of the receipt of a Participant's election to continue. group coverage, the Employer will provide a written notice to BCBSTX of such election. The written notice will be on a form satisfactory to BCBSTX and will describe the nature and date of Qualifying Event, the name and current address of each Participant electing to continue group coverage, the certificate number(s) of each Participant and the type(s) of group coverage each Participant has elected to continue. Upon request, BCBSTX will provide the Employer with an appropriate notice form. 2. The Employer shall remit the entire initial premium rate with the notice required in Paragraph 1 of this Section B. BCBSTX will not provide any Collection Services unless and until the entire initial premium rate has been received by BCBSTX. 3. After the initial premium rate has been received by BCBSTX, should any participant remit any premium rate directly to the Employer or its !L L/s 4 officers or agents, the Employer shall immediately present such payment and any other information regarding the payment to BCBSTX. For purposes of this Paragraph 2, "immediately" means within three (3) work days. C D Effective performance by BCBSTX of its duties and responsibilities pursuant to this Agreement requires that the Employer provide BCBSTX timely and accurate information. BCBSTX shall not be responsible for delay or errors in the performance or nonperformance of this Agreement which are substantially caused by or contributed to in whole or part by the failure of the Employer to furnish accurate and timely information. All time requirements imposed upon the Employer by this Article III are of the essence. In the event of termination of this Agreement, the Employer shall notify Subscribers of such termination and the procedures to be followed to retain the continued coverage. Article IV - Compensation A B. C D The compensation to BCBSTX- by. the Employer for the services requested by the Employer will be based upon two separate components: a charge to the Employer per Subscriber and a charge (not to exceed two (2) percent of the applicable premium) made by the Employer to a continued Participant. The compensation amounts provided in this Article IV shall remain in effect until the December 31 following the effective date of this Agreement. BCBSTX may amend the compensation for each succeeding Calendar Year by providing the Employer written notice of such amendment at least thirty (30) days prior to the commencement of the Calendar Year. The new compensation will apply to any Qualifying Event which occurs in the new Calendar Year. The execution of this Agreement shall be deemed an assignment to BCBSTX of the right of the Employer to charge a Participant an administrative charge or percentage of premium. It is expressly agreed and understood that BCBSTX will charge and collect one hundred two (102) percent of applicable premium to a continued Participant and that the Employer shall not make or request any charge whatsoever from a Participant. Premium shall not be considered part of the Employer's compensation to BCBSTX. In the event a Participant is entitled to an additional eleven (11) months of coverage because of a determination of total disability under E. F G the Social Security Act, BCBSTX shall receive 148% of applicable premium as premium and not as an administrative charge. The compensation for Collection Services is 100.00 per enrolled Subscriber for those Participants who are enrolled on COBRA, January 1 2004, and after. The compensation for Participants who were enrolled on COBRA prior to January 12004, is 75.00 per enrolled Subscriber. The compensation for Notification and Collection Services is 150.00 per enrolled Subscriber for those Participants who are enrolled on COBRA, January 1 2004, and after. The compensation for Participants who were enrolled on COBRA prior to January 1 2004, is 100.00 per enrolled subscriber. BCBSTX will provide a statement to the Employer for Subscribers during the previous billing period. Payment shall be made in full to BCBSTX within thirty (30) days of the billing date. The Employer requests BCBSTX to provide Notification and Collection Services. Signed: By: The Employer requests BCBSTX to provide only Collection Services. Signed: By: 7 Employer Name and Title k"oL 55 Pfi :F .1_ C Article V - Termination A. B This Services Agreement will terminate on the earliest of the following dates: 1. The date on which the compensation owing BCBSTX pursuant to this Agreement becomes overdue. 2. The last day of the month next following the date BCBSTX receives written notice from the Employer that the Agreement is to be terminated. 3. The last date the Employer no longer has any group health insurance contract or Administrative Services Agreement in full force and effect with BCBSTX. 4. The date on which a proceeding is filed by or against the Employer under bankruptcy statutes of the United States, or the Employer is placed under receivership or trusteeship under any state or federal statute. 5. The last day of the month next following the month in which BCBSTX provides written notice to the Employer that the Agreement is to be terminated, provided, however, such termination may not be effective prior to the December 31 following the effective date of this Agreement. In the event of termination of this Agreement, BCBSTX shall have no further duty or responsibility after the date of termination. Any and all compensation due BCBSTX, whether or not previously billed, will be due and payable within thirty (30) days of the date of termination. Article VI - Indemnification In tl part whc Agri judc incu how that frau Emc event BCBSTX or any of its officers, directors or employees are made ~s to any judicial, administrative or other adversarial proceeding arising in or in part out of any service(s) performed or not performed under this ;ment, the Employer shall indemnify and hold them harmless for all cents, settlements, fines and costs (including attorney's fees) which they pay, or become obligated to pay in connection therewith; provided ver, that in the event the court or agency rendering the ruling determines he circumstances underlying the ruling resulted from the gross negligence, or criminal conduct of BCBSTX, its officers, directors or employees, the Ayer shall be released from its obligation of indemnification. s 1 14-7 Article VII - General Provisions A. B C D. E F G. AMENDMENTS: This Agreement may be modified at anytime with the mutual consent of BCBSTX and the Employer. All amendments will be in writing and signed by an authorized representative of each party. Only the President or a Vice President of BCBSTX is authorized to amend this Agreement on behalf of BCBSTX. ENTIRE CONTRACT: This Agreement is the entire contract between the parties. TEXAS LAW GOVERNS: This Agreement has been negotiated and executed in the State of Texas and will be governed by and construed in accordance with the law of the State of Texas. All services performed by BCBSTX shall be deemed to have been performed in Dallas County, Texas. AGENT: In performing its duties and responsibilities pursuant to this Agreement, BCBSTX is acting only as an agent of the Employer and is not a plan administrator or fiduciary. In performing under this Agreement, BCBSTX acts under the supervision and direction of the Employer. In the event of any dispute or disagreement concerning eligibility for continued group coverage, all final responsibility shall be made by the Employer. TAXES: In the event any taxing authority having jurisdiction over either (or both) of the parties determines that the compensation paid to BCBSTX by the Employer results in any tax liability (other than an income tax) to BCBSTX, such tax shall be the responsibility of the Employer, and the amount of such tax shall be paid by the Employer to BCBSTX, upon written request pursuant to Article IV, Section G, of this Agreement. NOTIFICATION: Under no circumstance will BCBSTX be obligated to notify any Participant (regardless of whether or not the Participant has elected to continue group coverage) of the termination of this Agreement. INFORMATION: All written information (including billings and compensation) and notices provided pursuant to this Agreement will be posted by first class mail, postage prepaid to BCBSTX at P. O. Box 665730, Dallas Texas, 75265-5730 and to the Employer at BRAZOS COUNTY Attn: Loraine Nichols 300 E. 26th St. Ste. 107 Bryan, TX 77803 ' 4s i.. 55 1°+Y.i a....._. 4. Article VIII - Effective Date The, ive date of this Agreement is January 1 2004. IN VV:nNESS WHEREOF, BCBSTX and the Employer have caused this Agrent to be executed by their authorized representative. BLUE CROSS AND BLUE SHIELD OF TEXAS, A DIVISION OF HEALTH CARE SERVICE CORPORATION By ate) By: (Sig ture - Employer) 421- & - j"I") le- (Title) ~ a (Dat ) 10 e} ~~g , ;Lk O N Cl) O m CA n O C -Dv 0 n r v D -I m N m O v X m z 0?. D Q m z C CO) -I 70 m y X a m z O O Z -I m z N --I C O Z X O m v O Z CO ° o y X m c ° W y m r n C*) p X X 0 CO) D y r z' m O O -C: 00 M D' 'G O r --i m N r v c z_ 10 4 • v► L Z .--I m w 2 c C 0 0 0 0 r z N o 0 0 N ° O .p D CD Z O C w r N CA al Ch -4 Pu _z ~ 0 0 ~ m (7 c z m En D W m i o w M V N Z b C O W r in O 0 V t 0 N W 0 m 0 0 TEMPORARY CONSTRUCTION EASEMENT Date: March 25, 2004 Mailing Address: P.O. Box 32 North Zulch, Madison County, Texas 77872-0032 Grantee( BRAZOS COUNTY, TEXAS Mailing Address: 300 E. 26`x' Street, Suite 114 Bryan, Brazos County, Texas 77803 Property: that certain lot, tract or parcel of land being a 0.17 acre tract, in the T. BOWMAN S RVEY, Abstract No. 72, Brazos County, Texas and being a part of that certain Called 1 .61 acre tract as described in deed from Annie C. Rasco to Milton L. Risinger and 'e C. Risinger, Co-Trustees of the Rasco Family Trust, of record in Volume 5627, P e 225, Official Records of Brazos County, Texas, said 0.17 of one acre tract being re particularly described by metes and bounds in Exhibit "A" and by plat on Exhibit " attached hereto and made a part hereof for all purposes. Purpose: provide a temporary area to accommodate the operation and storage of construction iipment, materials and excavated earth necessary for the construction of one (1) bridge Long Trussel Road, which lies adjacent to said Easement Property. sum of TEN AND NO/100 DOLLARS ($10.00) and other good and valuable deration, the receipt and sufficiency of which are hereby acknowledged by Grantor. Grant itor, for the Consideration, grants, gives, and conveys to Grantee and Grantee's essors, and assigns an easement over, on, and across the Easement Property for the :ment Purpose, together with all and singular the rights and appurtenances thereto in way belonging (collectively, the 'Basement"), to have and to hold the Easement to 04-1200 TemHrary Construction Easement Page I of 3 55 t ntee and Grantee's successors, and assigns for the Duration of the Easement (defined b ow). Grantor binds Grantor and Grantor's heirs, successors, and assigns to warrant and f ever defend the title to the Easement in Grantee and Grantee's successors, and assigns a inst every person whomsoever lawfully claiming or to claim the Easement or any part t 'reof, to the extent that such claim arises by, through, or under Grantor but not Terms ad Conditions: The following terms and conditions apply to the Easement granted by Agreement: 1 Duration of Easement. The duration of the Easement is that period of time required by Grantee to construct the bridges on Long Trussel Road, but in no event more than fifteen (15) months from the date of this Easement. Grantee shall cause to be recorded in the Official Records of Brazos County, Texas, at the completion of its work, a Release and Termination of this Temporary Construction Easement. Improvement and Maintenance of Easement Property. Construction of fencing or other improvements, if any, necessary for use of the Easement as a temporary construction area and maintenance thereof will be at the sole expense of Grantee. All matters concerning the configuration, construction, maintenance, replacement, and removal of fencing and any other improvements placed thereon, are at Grantee's sole discretion, subject to Grantee's obligation to restore, as near as reasonably possible, the Easement Property to its condition prior its use as a construction easement. 3] Binding Effect. This agreement binds and inures to the benefit of the parties and their respective heirs, successors, and permitted assigns. 4] 1 Choice of Law. This agreement will be construed under the laws of the state of Texas. Venue is in Brazos County, Texas. Waiver of Default. It is not a waiver of or consent to default if the non-defaulting party fails to declare immediately a default or delays in taking any action. Further Assurances. Each signatory party agrees to execute and deliver any additional documents and instruments and to perform any additional acts necessary or appropriate to perform the terms, provisions, and conditions of this agreement and all transactions contemplated by this agreement. 7. Indemnity. Grantee agrees to and does hereby indemnify, defend, and hold harmless the Grantor from any loss, attorney's fees, expenses, or claims arising out of the use of this Easement by the Grantee during the term of this Easement. Integration. This agreement contains the complete agreement of the parties and cannot be varied except by written agreement of the parties. The parties agree that 04-1200 Templo~ary Construction Easement Page 2 of 3 there are no oral agreements, representations, or warranties that are not expressly set forth in this agreement. GRANTOR: ATTEST Karen MWueen, County Clerk STATE TEXAS § CO OF 1 § AGREED TO AND ACCEPTED BY GRANTEE: BRAZOS COUNTY, TEXAS 0'0/ By. o~ Randy 1S4, County Judge instrument was acknowledged before me on this the -X5 day of March, 2004, by LINDA G. MUEGGE k MY CCA USSioN EXPIRES Oat * 21, 2008 fir STATE TEXAS § CO ;OFBRAZOS § C& 4 tj,1.77 6a j, Notary Public, State of Texas (J d s instrument was acknowledged before me on this the day of March, 2004, by Randy S' , County Judge of Brazos County, Texas, on behalf of said County. Notary Public, State of Texas 04-1200 Tem**ary Construction Easement Page 3 of 3 w°t r {-63 EXHIBIT "A " FIELD NOTES BRAZOS COUNTY TEMPORARY R.O.W. EASEMENT 0.17 OF ONE ACRE OUT OF THE MILTON L. RISINGER AND MARIE C. RISINGER, CO-TRUSTEES CALLED 123.61 ACRE TRACT VOLUME 5627, PAGE 225 REFERENCE VOLUME 298, PAGE 5 T. BOWMAN SURVEY, A - 72 BRAZOS COUNTY, TEXAS MARCH 8, 2004 All that ce Abstract described the Rasco Texas, sai yin lot, tract or parcel of land being 0.17 of one acre in the T. BOWMAN SURVEY, 72, Brazos County, Texas, and being a part of that certain Called 123.61 acre tract as i deed from Annie C. Rasco to Milton L. Risinger and Marie C. Risinger, Co-Trustees of "amity Trust of record in Volume 5627, Page 225, Official Records of Brazos county, 0.17 of acre tract being more particularly described by metes and bounds as follows: BEGINNIN(p at a point in the centerline of Long Trussel Road for the most westerly corner, said comer bei the calculated most westerly comer of said Called 123.61 acre tract, said comer being loca d in the northeast line of the Clarence Cobb Called 238.25 acre tract as described in Volume 9 , Page 368 and also being the calculated most southerly comer of the Dale Chaney et al Called .628 acre tract as described in Volume 2299, Page 258; THENCE 143 ° 12 ' 33 " E, along the calculated northwest line of said Called 123.61 acre tract and the ca ulated southeast line of said Called 274.628 acre tract a distance of 44.44 feet to a point on th high bank of said Navasota River "new channel"; THENCE 60 ° 04'30" E, a distance of 105.14 feet to a point for angle point; THENCE 38 ° 16'25" E, a distance of 122.66 feet to a point in the centerline of said Long Trussel R d for the most easterly comer, said point being located in the southwest line of said called 123 1 acre tract and the northeast line of said Called 238.25 acre tract, the calculated most southerly mer of said Called 123.61 acre tract bears S 59 ° 29 ` 57 " E a distance of 404.35 feet; THENCE 1159 ° 29'57 "W, along the southwest line of said Called 123.61 acre tract a distance of 229.25 fee: to the PLACE OF BEGINNING AND CONTAINING AN AREA OF 0.17 OF ONE ACRE OF LAND ORE OR LESS, according to a survey performed during December, 2003, under the supervisio of H. Curtis Strong, Registered Professional Land surveyor No. 4961. North Orientatio s based on rotating the southwest line of said Called 123.61 acre tract to true north by utilizing G Methods. For other information, see accompanying plat. I- A. 14 0IV ~ N C ti y y a 0a N rzn a O z" 2Oz ~ 0,.-4 N 1~1 N a r~ m me r a~ zN p~ 0 AN d.. O 1 T r ~ <m i A T O a c 0 n Dn rr ry m~ ,oom N N Z Awn m C N no ~m Vl N rrl -4 °D 00 N m O*C ~oy~rno z Q0Z~ Z 7v 70 A O o~ m; m 2D~(„^ • , to O 70 C N i' T )li 41 y~y 4 0 O~ Q• e Q~l~. .n 'G OOQ, T vNX O _ .O OOO W Tg0 a (Dj • FZ W ~ + / T iI m ? i Z d b / ..iO c y ~o v ~ O ~ a t ti ~3 'U'30. N O 0 / 0 10 t 3 1 m < V Q 2 d~ y 01 N a o 1.1 q r y n` m f ~ g n ~ aP ~ fi ' ^ -n r- ♦ ~U A W C Z s mNmV~o ~ cNil m ~n a m m N n %tl ) V Z C) m ;1 z v ti f 0 m z 0 IJ O f O O u t .o a oti 0 F y by p! 7 y r a y y4y O°j Ow ~y AO to ~y b4 .~b C.P 4 W X 0 m W w ~v N ^ s m i u N m 4! 0 D n m D r° D mrz p D m N D ~A;Z ~~mQ m(ID 0 D F r Amm mC) = (A > to D O /Om 1 bb q L LO Y .b0` y y4 WG A o` 0 '.P (A C Z z~ n <Z= 0 N O X00 $ aN=N m O 0 m N z F zry mrO I <zz n Cma a N N - D AI 2Nm < O V O A >i ~D°z a s -,Mo m =a, °a oa4 = N n o a N #~R BRAZOS COUNTY COMMISSIONERS' COURT AGENDA REQUEST DAIT SUBMITTED: April 22, 2004 DA-% OF MEETING: April 27, 2004 TED BY: Linda Muegge SUB CT MATTER: Acceptance of a Temporary Construction Easement from Lave C. Cobb for temporary construction workspace during the replacement of the bridg on Long Trussell Road located in Precinct 2. 4 TEMPORARY CONSTRUCTION EASEMENT Date: Gran March 25, 2004 LAVELLE C. COBB Mailing Address: 10027 Nubin Road Bryan, Brazos County, Texas 77808-5801 Grantee BRAZOS COUNTY, TEXAS Granteet4 Mailing Address: 300 E. 26`h Street, Suite 114 Bryan, Brazos County, Texas 77803 Property: Grant that certain lot, tract or parcel of land being 1.78 acres in three (3) separate tracts, in T. BOWMAN SURVEY, Abstract No. 72, Brazos County, Texas and being a part that certain Called 238.25 acre tract as described in Partition Deed from John L. rce, II to Clarence W. Cobb, of record in Volume 924, Page 368, Official Records of izos County, Texas, said 1.78 acre tract being more particularly described by metes l bounds in Exhibit "A" and by plat on Exhibit "B" attached hereto and made a part eof for all purposes. Purpose: provide a temporary area to accommodate the operation and storage of construction ipment, materials and excavated earth necessary for the construction of three (3) ages on Long Trussel Road, which lies adjacent to said Easement Property. sum of TEN AND NO/100 DOLLARS ($10.00) and other good and valuable deration, the receipt and sufficiency of which are hereby acknowledged by Grantor. ement: itor, for the Consideration, grants, gives, and conveys to Grantee and Grantee's essors, and assigns an easement over, on, and across the Easement Property for the ;ment Purpose, together with all and singular the rights and appurtenances thereto in way belonging (collectively, the "Easement"), to have and to hold the Easement to 04-1201 Tenrry Construction Easement Page 1 of 3 03l.. d''ta w., L.A there are no oral agreements, representations, or warranties that are not expressly set forth in this agreement. A Karen Mooueen, County Clerk GRANTOR: r LA ELLE C. COBB AGREED TO AND ACCEPTED BY GRANTEE: BRAZOS COUNTY, TEXAS By: o~ Randy S' , County Judge STATE TEXAS § CO OF BRAZOS § S instrument was acknowledged before me on this the 4S day of March, 2004, by Lavelle Cobb. LINDA a MUEWE W COMMISSION EXPIRES Oaabw 21, 2008 STATE TEXAS § OUNT7 OF BRAZOS § (4N(/C'A - m cx-e ~ eiNotary Public, State of Texas This instrument was acknowledged before me on this the day of March, 2004, by Randy Si s, County Judge of Brazos County, Texas, on behalf of said County. Notary Public, State of Texas 04-1201 Tem~rary Construction Easement Page 3 oj3 ee and Grantee's successors, and assigns for the Duration of the Easement (defined Grantor binds Grantor and Grantor's heirs, successors, and assigns to warrant and ;r defend the title to the Easement in Grantee and Grantee's successors, and assigns ct every person whomsoever lawfully claiming or to claim the Easement or any part ,f, to the extent that such claim arises by, through, or under Grantor but not Terms Vs Con ditions: The following terms and conditions apply to the Easement granted by Agreement: Duration of Easement. The duration of the Easement is that period of time required by Grantee to construct the bridges on Long Trussel Road, but in no event more than fifteen (15) months from the date of this Easement. Grantee shall cause to be recorded in the Official Records of Brazos County, Texas, at the completion of its work, a Release and Termination of this Temporary Construction Easement. Improvement and Maintenance of Easement Property. Construction of fencing or other improvements, if any, necessary for use of the Easement as a temporary construction area and maintenance thereof will be at the sole expense of Grantee. All matters concerning the configuration, construction, maintenance, replacement, and removal of fencing and any other improvements placed thereon, are at Grantee's sole discretion, subject to Grantee's obligation to restore, as near as reasonably possible, the Easement Property to its condition prior its use as a construction easement. Binding Effect. This agreement binds and inures to the benefit of the parties and their respective heirs, successors, and permitted assigns. Choice of Law. This agreement will be construed under the laws of the state of Texas. Venue is in Brazos County, Texas. Waiver of Default. It is not a waiver of or consent to default if the non-defaulting party fails to declare immediately a default or delays in taking any action. Further Assurances. Each signatory party agrees to execute and deliver any additional documents and instruments and to perform any additional acts necessary or appropriate to perform the terms, provisions, and conditions of this agreement and all transactions contemplated by this agreement. Indemnity. Grantee agrees to and does hereby indemnify, defend, and hold harmless the Grantor from any loss, attorney's fees, expenses, or claims arising out of the use of this Easement by the Grantee during the term of this Easement. 81 Integration. This agreement contains the complete agreement of the parties and cannot be varied except by written agreement of the parties. The parties agree that 04-1201 Tem rary Construction Easement Page 2 of3 EXHIBIT "A" FIELD NOTES BRAZOS COUNTY TEMPORARY R.O.W. EASEMENT 0.87 ACRE, 0.29 ACRE & 0.62 ACRE OUT OF THE CLARENCE W. COBB CALLED 238.25 ACRE TRACT VOLUME 924, PAGE 368 T. BOWMAN SURVEY, A - 72 BRAZOS COUNTY, TEXAS MARCH 8, 2004 All that Called 23 Cobb, of i acre tract BRIDGE BEGINNII corner be! the southi 2299, Pac N68°36 THENCE centerline THENCE with the o easterly o S59°29 THENCE point; THENCE point; THENCE CONTAIN BRIDGE BEGINNII comer bei the south% northeast THENCE centerline Long Trus 238.25 ac lot, tract or parcel of land being 1.78 acres in three (3) separate tracts in the T. RVEY, Abstract No. 72, Brazos County, Texas, and being a part of that certain acre tract as described in Partition Deed from John L. Pierce, II to Clarence W. d in Volume 924, Page 368, Official Records of Brazos county, Texas, said 1.78 g more particularly described in three (3) tracts as follows: OF ONE ACRE) at a point in the centerline of Long Trussel Road for the most westerly comer, said t located in the northeast line of said Called 238.25 acre tract and also being located in zt line of the Dale Chaney et al Called 274.628 acre tract as described in Volume 258, the calculated most northerly comer of said Called 238.25 acre tract bears i7 " W a distance of 1539.80 feet; 68 ° 36 ' 57 " E, along the northeast line of said Called 238.25 acre tract with the f said Long Trussel Road a distance of 323.45 feet to a point for angle point; 59 ° 29 ' 57 " E, continuing along the northeast line of said Called 238.25 acre tract terline of said Long Trussel Road a distance of 525.49 feet to a point for the most ner, the calculated most easterly comer of said Called 238.25 acre tract bears 17 " E a distance of 2420.42 feet; 73 ° 20 ' 46 "W, a distance of 292.49 feet to a 1/2" Iron Rod with cap set for angle 60 ° 32 ' 43 "W, a distance of 134.94 feet to a 1/2" Iron Rod with cap set for angle 56 ° 38 ' 52 "W, a distance of 426.47 feet to the PLACE OF BEGINNING AND IG AN AREA OF 0.87 OF ONE ACRE OF LAND MORE OR LESS. OF ONE ACRE) 3 at a point in the centerline of Long Trussel Road for the most westerly comer, said 3 located in the northeast line of said Called 238.25 acre tract and also being located in st line of said Dale Chaney et al Called 274.628 acre tract, an angle point in the ie of said Called 238.25 acre tract bears N 59 ° 29 ' 57 " W a distance of 1313.54 feet; 59 ° 29 ' 57 " E, along the northeast line of said Called 238.25 acre tract with the f said Long Trussel Road a distance of 256.96 feet to a point in the centerline of said ;I Road for the most easterly corner, the calculated most easterly corner of said Called tract bears S 59 ° 29 ' 57 " E a distance of 1375.41 feet; 1 =C2 THENCE point; THENCE point; THENCE CONTAIP BRIDGE BEGINNII corner be the southi northeast THENCE centerline Long Tru: 238.25 ac THENCE point; THENCE point; THENCE CONTAIN 79 ° 41 ' 58 " W, a distance of 113.12 feet to a 1/2" Iron Rod with cap set for angle 57 ° 14 ' 51 " W, a distance of 99.78 feet to a 1/2" Iron Rod with cap set for angle 15 ° 09'20"W, a distance of 100.15 feet to the PLACE OF BEGINNING AND G AN AREA OF 0.29 OF ONE ACRE OF LAND MORE OR LESS. OF ONE ACRE) 3 at a point in the centerline of Long Trussel Road for the most westerly corner, said I located in the northeast line of said Called 238.25 acre tract and also being located in st line of said Dale Chaney et al Called 274.628 acre tract, an angle point in the ie of said Called 238.25 acre tract bears N 59 ° 29 ' 57 " W a distance of 1768.48 feet; 59 ° 29 ' 57 " E, along the northeast line of said Called 238.25 acre tract with the f said Long Trussel Road a distance of 786.71 feet to a point in the centerline of said :I Road for the most easterly-comer, the calculated most easterly comer of said Called tract bears S 59 ° 29 ' 57 " E a distance of 390.72 feet; 68 ° 42 ' 18 " W, a distance of 347.46 feet to a 1/2" Iron Rod with cap set for angle 60 ° 04 ' 30 "W, a distance of 175.00 feet to a 1/2" Iron Rod with cap set for angle 47 ° 27 ' 13 " W, a distance of 274.79 feet to the PLACE OF BEGINNING AND IG AN AREA OF 0.62 OF ONE ACRE OF LAND MORE OR LESS. All tracts taining a total area of 1.78 acres of land more or less, according to a survey performed uring December, 2003, under the supervision of H. Curtis Strong, Registered Professio I Land Surveyor No. 4961. North orientation is based on rotating the northeast line of said Calle 38.25 acre tract to true north by utilizing GPS Methods. For other information see accompan ng plat. VAG Z. N2;A ~ ti 1 ti C 1 ~ m O N <CNO A 2~2 O f D N a r~ - -0 m ,ypp rNAO N m MM 31 Atli c C r, ZN 000 lm 7 03. m ~O ~N< y C 4 A , D 1a O<~ T . i m i m r N O 0 ti N ON 0--l V1-~WpD< 0-0 p NOO n mow m gmoO*c y x Q~oz X~ 0 .0. co i`'< o~ C O <~an N' Z a V V~ m " ca O Co CO O Qo mz •P (7 m o/ 4r py b4 4 y • b4 ` 4y n~ b ~ 0 !A o c •A~ Q ~A pn .~°y j ~e i), •R Y Q O ^Ypwti3' ^ a • Dn rr rD mA om t0 N Z N A A W m W N 0 U - no mm mm N i t o ~ o a~A AF .7 / _;O N m. O> O N m p + 1+ 1- 11 O O < m y m p O m f o U • N ~ N ; a ~ a n ~m r~ D Oor N N 0 ~ W O N A UDD n to m n O N V F u O z z ~ p_ O IF •4" •A• y y4 w4. A C9 by ¢r~ 7 ~ A O y 04+ a~ w+y b4• 2 W~ yA i ~ w m w O tl O f O O 4' t ~O > o' N TW P p \J m T w N a 0 D n m A \ Dam= mri N N D ~ D bA;Z NC~ma ~0, aD rr Amm M C) y O N D A O V C Z zn 3n q G G -I Izz O M M 1 C O N mmo z 2 1.1 mDy =-4D mro C m N H dos Q~"o $C"z ND 9 4m _ I D A Z N0O Q um C y_q- y ~mrAia V1 ~ A H N ; O N O A 202 O f D N p N 1nN~O A + pmm .O CNA a mom = N ~ OOf1 n n 0 m N • < y m D O O<ti O + 2m= m m O A m 0 N m W LA W < mm 11 2Gr_~~ SOW m _AO 0 r) q 5m ^vz O-<N z OZNW'm T ?°O W z m Cto Epp OOn _ C. O Z7om*O -I w T r) moo z F 0n y W~ . O = C% G" w w + z r Awes' 4bn p.l° 3 N `o.4 CO N b4 4 0~ b4 p0 b o / y4 ~ li~74 N60 y~onor }Oy {~'i a A q A ~ v v ~ n O.40 O 00 e ~ G1 Om °1 yo n w £ o 3 F p tn, trw °D Al Y J` Oory ` Oy r ~ py Av tiw a ~ p p 0 Dn rr rD M 4D Om N N 2 A W n Im U ~ O7 D A m m m m ? = C~ ~p w A a < O ~o z F Z C) ~ 1 ` J y" N n N o D } ~ O~y + a o m > i~S L p Y 4 m r Z 12 y~ l a 8 ,~i 1 Y[ 4b a~ c a "S > s i p67 yp ~ o 2 ~y C p y F ~ 0 No~rno BO OD r r . • y~ P D r nm . y~ yDG)O C2 N pv D ~ yL C -4-gzz O I m A y N v^ L / y mzi0 z mOAO T A z=m F x-1y + mr O I «z m _ 0 c N s FO N N N N Q m m O i 0 4 z N s ~A F [ A O r ym-4 D 0 I y O A'! 2 ° A z N Q A ~ N An-A VO't 55 S`AG' l (per BRAZOS COUNTY COMMISSIONERS' COURT AGENDA REQUEST DA DA SUBMITTED: April 22, 2004 OF MEETING: April 27, 2004 TED BY: Linda Muegge #c/ID UB CT MATTER: Acceptance of a Temporary Construction Easement from Oil & Gas for temporary construction workspace during the replacement of the idg on Long Trussell Road located in Precinct 2. 1 TEMPORARY CONSTRUCTION EASEMENT Date: Grantot March 25, 2004 DALE CHANEY and JAKE HOWARD d/b/a Laramie Oil & Gas Mailing Address: P.O. Box 189 Iola, Grimes County, Texas 77861-0189 Grantee# BRAZOS COUNTY, TEXAS Granteei4 Mailing Address: 300 E. 26`h Street, Suite 114 Bryan, Brazos County, Texas 77803 Property: A. I that certain lot, tract or parcel of land being 1.01 acres in three (3) separate tracts, in t T. BOWMAN SURVEY, Abstract No. 72, Brazos County, Texas and being a part o hat certain Called 274.628 acre tract as described in deed from Clarence Willis Cobb et x to Dale Chaney and Jake Howard d/b/a Laramie Oil & Gas, of record in Volume 2'109, Page 258, Official Records of Brazos County, Texas, said 1.01 acre tract being m e particularly described by metes and bounds in Exhibit "A" and by plat on Exhibit " attached hereto and made a part hereof for all purposes. Easemenjtj Purpose: provide a temporary area to accommodate the operation and storage of construction ipment, materials and excavated earth necessary for the construction of three (3) lges on Long Trussel Road, which lies adjacent to said Easement Property. sum of TEN AND NO/100 DOLLARS ($10.00) and other good and valuable deration, the receipt and sufficiency of which are hereby acknowledged by Grantor. Grant of Hasement: itor, for the Consideration, grants, gives, and conveys to Grantee and Grantee's essors, and assigns an easement over, on, and across the Easement Property for the :ment Purpose, together with all and singular the rights and appurtenances thereto in way belonging (collectively, the "Easement"), to have and to hold the Easement to 04-1199 Temp~ry Construction Easement II 'i Page / oj4 VOL ill -e and Grantee's successors, and assigns for the Duration of the Easement (defined Grantor binds Grantor and Grantor's heirs, successors, and assigns to warrant and ;r defend the title to the Easement in Grantee and Grantee's successors, and assigns t every person whomsoever lawfully claiming or to claim the Easement or any part f, to the extent that such claim arises by, through, or under Grantor but not Terms JJd Conditions: The following terms and conditions apply to the Easement granted by t s Agreement: 1 Duration of Easement. The duration of the Easement is that period of time required by Grantee to construct the bridges on Long Trussel Road, but in no event more than fifteen (15) months from the date of this Easement. Grantee shall cause to be recorded in the Official Records of Brazos County, Texas, at the completion of its work, a Release and Termination of this Temporary Construction Easement.- Improvement and Maintenance of Easement Property. Construction of fencing or other improvements, if any, necessary for use of the Easement as a temporary construction area and maintenance thereof will be at the sole expense of Grantee. All matters concerning the configuration, construction, maintenance, replacement, and removal of fencing and any other improvements placed thereon, are at Grantee's sole discretion, subject to Grantee's obligation to restore, as near as reasonably possible, the Easement Property to its condition prior its use as a construction easement. 3] Binding Effect. This agreement binds and inures to the benefit of the parties and their respective heirs, successors, and permitted assigns. 4] Choice of Law. This agreement will be construed under the laws of the state of Texas. Venue is in Brazos County, Texas. 5] Waiver of Default. It is not a waiver of or consent to default if the non-defaulting party fails to declare immediately a default or delays in taking any action. 6. Further Assurances. Each signatory party agrees to execute and deliver any additional documents and instruments and to perform any additional acts necessary or appropriate to perform the terms, provisions, and conditions of this agreement and all transactions contemplated by this agreement. 7. Indemnity. Grantee agrees to and does hereby indemnify, defend, and hold harmless the Grantor from any loss, attorney's fees, expenses, or claims arising out of the use of this Easement by the Grantee during the term of this Easement. 8-I Integration. This agreement contains the complete agreement of the parties and cannot be varied except by written agreement of the parties. The parties agree that 04-1199 Te ry Construction Easement Page 2 of 4 vts there are no oral agreements, representations, or warranties that are not expressly set forth in this agreement. GRANTOR: ATTEST: Dale Chaney, d/b/a amie Oil & Gas AGREED TO AND ACCEPTED BY GRANTEE: BRAZOS COUNTY, TEXAS Karen McQueen, County Clerk Randy S' s, County Judge PTATE OF TEXAS NTY OF BRAZOS This instrument was acknowledged before me on this the 5 4- day of April, by Dale Chaney, d/b/a/ Laramie Oil & Gas. My cohusscM Wms oal W2l, 2= ATE OF TEXAS OF BRAZOS Notary Public, State of Tex This instrument was acknowledged before me on this the day of April, by Randy Sims, County Judge of Brazos County, Texas, on behalf of said County. Notary Public, State of Texas r ~'~1 ' t EXHIBIT "A" FIELD NOTES BRAZOS COUNTY TEMPORARY R.O.W. EASEMENT 0.62 ACRE, 0.28 ACRE & 0.11 ACRE OUT OF THE DALE CHANEY AND JAKE HOWARD CALLED 274.628 ACRE TRACT VOLUME 2299, PAGE 258 T. BOWMAN SURVEY, A - 72 BRAZOS COUNTY, TEXAS MARCH 8, 2004 All that ce BOWMAN Called 27 and Jake of Brazos as follows: BRIDGE 1 BEGINNIN corner beir of the Clari calculated distance of THENCE point; THENCE THENCE Trussel Ro Called 274 bears S 59 THENCE ~ of 404.85 fi THENCEIs southwest BEGINNIN BRIDGE 2 BEGINNIN corner beir of said Cal acre tract I THENCE l' point; THENCE point; fin lot, tract or parcel of land being 1.01 acres in three (3) separate tracts in the T. )URVEY, Abstract No. 72, Brazos County, Texas, and being a part of that certain i28 acre tract as described in deed from Clarence Willis Cobb et ux to Dale Chaney )ward d/b/a Laramie Oil & Gas, of record in Volume 2299, Page 258, Official Records )unty, Texas, said 1.01 acre tract being more particularly described in three (3) tracts 62 OF ONE ACRE) at a point in the centerline of Long Trussel Road for the most westerly corner, said located in the southwest line of said Called 274.628 acre tract and the northeast line ce W. Cobb Called 238.25 acre tract as described in Volume 924, Page 368, a igle point in the south line of said Called 274.628 acre tract bears N 68 ° 36 ' 57 " W a 544.21 feet; '5 ° 41 ' 06 " E, a distance of 462.59 feet to a 1/2" Iron Rod with cap set for angle i1 ° 29 ' 03 " E, a distance of 60.00 feet to a 1/2" Iron Rod with cap set for angle point; 4 ° 26 ' 38 " E, a distance of 277.49 feet to a point in the centerline of said Long I for the most easterly corner, said corner being located in the southwest line of said 28 acre tract, the calculated most southerly corner of said Called 274.628 acre tract 29 ' 57 " E a distance of 1691.44 feet; i9 ° 29 ' 57 " W, along the southwest line of said Called 274.628 acre tract a distance t to a point in the centerline of said Long Trussel Road for angle point; i8 ° 36 ' 57 " W, continuing along the centerline of said Long Trussel Road with the e of said Called 274.628 acre tract a distance of 372.03 feet to the PLACE OF AND CONTAINING AN AREA OF 0.62 OF ONE ACRE OF LAND MORE OR LESS. .28 OF ONE ACRE) at a point in the centerline of Long Trussel Road for the most westerly corner, said located in the southwest line of said Called 274.628 acre tract and the northeast line 1238.25 acre tract, a calculated angle point in the south line of said Called 274.628 )rs N 59 ° 29 ' 57 " W a distance of 1304.10 feet; 0 ° 53 ' 32 " E, a distance of 109.80 feet to a 1/2" Iron Rod with cap set for angle 7 ° 14 ' 53 " E, a distance of 100.21 feet to a 1/2" Iron Rod with cap set for angle 5.5 THENCE 16 ° 16 ' 13 " E, a distance of 96.46 feet to a 1/2" Iron Rod with cap set in the centerline of said Long Trussel Road for the most easterly comer, said comer being located in the southwes ine of said Called 274.628 acre tract, the calculated most southerly corner of said Called 27 628 acre tract bears S 59 ° 29' 57 " E a distance of 537.19 feet; THENCE 59 ° 29'57"W, along the centerline of said Long Trussel with the southwest line of said Call 274.628 acre tract a distance of 255.00 feet to the PLACE OF BEGINNING AND CONTAI I G AN AREA OF 0.28 OF ONE ACRE OF LAND MORE OR LESS. BRIDGE 11(0.11 OF ONE ACRE) BEGINNI at a calculated point at the intersection of the west high bank of the "new channel" of o River with the centerline of said Long Trussel Road for the most southerly corner, the Nava je said corn eing the most southerly corner of said Called 274.628 acre tract; THENCE 59 ° 29'57 " W, with the centerline of said Long Trussel Road with the southwest line of said ca274.628 acre tract a distance of 158.83 feet to a point in the centerline of said Long Trussel R d for the most westerly comer, an angle point in the southwest line of said Called 274.628 tract bears N 59 ° 29 ' 57 -W a distance of 1937.45 feet; THENCE 2 ° 51 '27 " E, a distance of 107.57 feet to a -1/2" Iron Rod with cap set for angle point; THENCE 60 ° 04' 30 " E, a distance of 69.86 feet to a 1/2" Iron Rod with cap set in the west high bank said "new channel" for the most easterly corner, said corner being located in the southeast ' e of said Called 274.628 acre tract; THENCE 143 ° 12 ' 33 " W, along the southeast line of said Called 274.628 acre tract a distance of 44.44 f tit to the PLACE OF BEGINNING AND CONTAINING AN AREA OF 0.11 OF ONE ACRE OF ND MORE OR LESS. All tracts bined being a total of 1.01 acres of land more or less, according to a survey performed uring December, 2003 under the supervision of H. Curtis Strong, Registered Profession I Land Surveyor No. 4961. North Orientation is based on rotating the southwest line of said Calle 74.628 acre tract to true north by utilizing GPS Methods. For other information, see accompan ng plat. /(~.9, o , 65 1 f V1 u W < 2 =f0 Q F O O• < W H V ouW p LLNLL Oo0 N N N N O<0 J a. NWW u OJ0 z;b0 O QH= C Oz)W = OD 0 VI x00: g ~frwo O O I O N zz`-t U Z~J- O> ~r 1 P a~•b ~ v bry ,~v ry p O ~ 'Y ~ ~ b 4~ 'k' Vary P r 4~ A 'y. ` hb. bd'r ry e` lip- .b~~o• ~ ti ryOr :~'3~ bo' 00 } ryFO~c bq • y bw ~ ~ ~V Ny bq ~ p} y~P r t W M 1 W N 3N y S CJ W W U y~ a - Of' oomm vo; f yr~ N O ry y OW~~ O Q ti n f~ f O }ANN lb' O Z J W W O• Q• f 2°J o~v n W 3:N~ ~O. u~14 + ~4 R W p~N<~=O 0o N Y GO=B=YQ~ LLJ >w~~ IV LL. 0 C-4 F- 0(5000 ; j? 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