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AGREEMENT FOR SERWCES ORIGINAL SELF FUNDED DENTAL PLAN ADMINISTRATION THIS AGREE,NT is made this first day of~ between /91 ' referred to as the "Employer", and The Lipman Company, Inc. (dba The Contract Administrator), hereinafter referred to as the "Contract Administrator. " WHEREAS, the Employer has established a Self-Funded Dental Benefit Plan under Section 105 of the IRC for the benefit of its employees and dependents (hereinafter referred to as the "Plan") to be funded out of the general assets of the employer; WHEREAS, the Plan is intended to be an employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974 (ERISA); WHEREAS, the Employer has retained the Contract Administrator to provide services for the Plan in accordance with the following terms and conditions: NOW, THEREFORE, IN CONSIDERATION OF THE MUTUAL PROMISES AND AGREEMENTS HEREIN CONTAINED, THE RECEIPT AND SUFFICIENCY OF WHICH IS HEREBY ACKNOWLEDGED, THE PARTIES HEREBY AGREE AS FOLLOWS: The Employer: 1. Agrees to provide the Contract Administrator on a reasonable and timely basis a copy of the Plan benefits and all changes affecting the Plan's administration services. 2. Agrees to provide the Contract Administrator with a monthly list of eligible participants. 3. Acknowledges they are the plan sponsor, plan administrator and plan fiduciary under the Employee Retirement Income Security Act of 1974 (ERISA). 4. Agrees to the fee schedule presented in Exhibit A. S. Agrees to make all payments necessary to maintain the Plan. 6. Agrees they shall be solely responsible for all state and federal disclosure and reporting requests. 7. Agrees to maintain the Plan in full compliance with all existing laws. 8. Agrees to assist the Contract Administrator in the collection of contributions owed, claims overpayments and third-party liens involving Plan participants. 1 -,., ., T