RES 1167 02/10/1998 -1W
ORDINAL SENT WITH CONTRACT
TO AFLAC
RESOLUTION 1167
RESOLUTION ADOPTING A FLEXIBLE BENEFITS PLAN
The undersigned hereby certifies that the following described Resolution was officially and legally
adopted at the duly authorized official meeting of the body with legal authority (hereafter "Authority") to
pass said Resolution. Said meeting was held on the date set forth below.
WHEREAS, the Authority wishes to adopt a cafeteria plan within the context of Section 125 of the
Internal Revenue Code for the benefit of the employer's eligible employees.
NOW, THEREFORE, BE IT RESOLVED, that the Authority hereby adopts the Flexible Benefits Plan
(consisting of the flexible benefits plan document, the Adoption Agreement, and component benefit
plans and Policies) for the Employer named herein below effective as of the date specified in the
Adoption Agreement.
RESOLVED FURTHER, that any officer of the employer may, without a further resolution, execute the
Adoption Agreement and any related documents or amendments which may be necessary or
appropriate to adopt the plan or maintain its compliance with applicable federal, state and local law.
Name:
Body With Legal Authority Of Employer To Pass Resolution:
(Examples - Board of Directors, Board of Commissioner, etc.)
Date of Official Meeting of Authority
at which Resolution was Legally Passed:
Signature of Person with Authority to certify
that Resolution was legally passed
Sam Bauder, Mayor
Corporate Secretary Print Name and Title of Person above
[OFFICIAL SEAL] Date: 2-10-98
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"Note: Legal requirements for a valid Board of Directors Resolution vary from state to state. This
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N document is merely a suggested form. Each Employer should consult with its own legal counsel to
ensure compliance with applicable law.
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RESOLUTION ADOPTING A FLEXIBLE BENEFITS PLAN '11�'7
The undersigned hereby certifies that the following described Resolution was officially and legally
adopted at the duly authorized official meeting of the body with legal authority (hereafter "Authority") to
pass said Resolution. Said meeting was held on the date set forth below.
WHEREAS, the Authority wishes to adopt a cafeteria plan within the context of Section 125 of the
Internal Revenue Code for the benefit of the employer's eligible employees.
NOW, THEREFORE, BE IT RESOLVED, that the Authority hereby adopts the Flexible Benefits Plan
(consisting of the flexible benefits plan document, the Adoption Agreement, and component benefit
plans and Policies) for the Employer named herein below effective as of the date specified in the
Adoption Agreement.
RESOLVED FURTHER, that any officer of the employer may, without a further resolution, execute the
Adoption Agreement and any related documents or amendments which may be necessary or
appropriate to adopt the plan or maintain its compliance with applicable federal, state and local law.
Name:
Body With Legal Authority Of Employer To Pass Resolution: Ci go Lo C�;� y Nc c L
(Examples - Board of Directors, Board of Commissioner, etc.)
Date of Official Meeting of Authority
at which Resolution was Legally Passed:
Signature of Person with Authority to certify
that Resolution was legally passed
Corporate Secretary M��•P—
Print Name and Title o Person above
[OFFICIAL SEAL] Date: �7 ! p C'
"Note: Legal requirements for a valid Board of Directors Resolution vary from state to state. This
N document is merely a suggested form. Each Employer should consult with its own legal counsel to
ensure compliance with applicable law.
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