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�J <br />E <br />FLEXIBLE SPENDING ACCOUNT <br />ADMINISTRATIVE SERVICES AGREEMENT <br />To: DCA, Inc. <br />400 DCA Center <br />13100 Wayzata Boulevard <br />Minnetonka, MN 55343-5636 <br />We, the Employer or Plan Sponsor named below, acknowledge having <br />reviewed thiOe greementermst Iincludreondhe schedule o_ Services and <br />Fees and agr_to <br />It is understood that DCA, Inc. ("DCA") will be previdina the <br />Base Services as outlined in the Schedule, and will be charging <br />the fees indicated for those services. it is further understood <br />that if services other than Base Services are required orriate <br />requested by us, they will be provide6 by DCA for the appro p <br />fees indicated. <br />He agree to pay these fees as billed to us by DCA, within 30 days <br />of the oilling date. <br />Citv of Moundsview <br />yer or P an Sponsor Print�j�nt or T_vpe <br />Donald Paule <br />O u cer's Name an Tit a Print or Type <br />2401 <br />ress <br />612-784-3055 <br />Te ep one tram er <br />$ie <br />gnaatur <br />Accepted by DCA, Inc. <br />Signature <br />554, <br />Date <br />Date <br />