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HomeMy WebLinkAboutResolution - 2007-R0484 - Approve Vendors For Employee Benefit Plan - 10_25_2007Resolution No. 2007-RO484 October 25, 2007 Item No. 5.4 RESOLUTION WHEREAS, the City Council desires to make certain insurance options available to City employees; NOW THEREFORE: IBE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the City Council of the City of Lubbock hereby approves the following vendors and products for the City employee benefit plan. Standard Insurance Company: Group Life Insurance Plan and Accidental Death and Dismemberment Insurance. Davis Vision, Inc. (a wholly owned division of HM Life Insurance Company): Vision Insurance Plan. ING Employee Benefits: Long Term Disability Insurance. ReliaStar Life Insurance Company (dba ING Employee Benefits): Universal Life Insurance, Critical Illness Insurance, and Accident Insurance. THAT the Mayor or City Manager as appropriate under Resolution No. 2005-R0065 may execute any applicable contracts and the City Manager or her designee may execute applications, routine documents or forms necessary to facilitate providing the above named insurance products for employees. Passed by the City Council this 25th day of October , 2007. ATTEST: Rebe ca Garza, City Secretary ;D( A,,S TO CONTENT: 4 sa Hutcheson, Risk Manager AS Ueff Vandiver Attorney of Counsel DDres/Emp1nsVendors07Res October 16, 2007 FORM: 1 / ' DAVID A. MIXLER, MAYOR R_e_s_olution No. 2007—RO RefiaWtaLifeInsurance Company Accident Insurance Group Application For Accident Insurance TINSTRUCTIONS: Complete each section entirely. Print clearly in dark ink, sign and date the form, and return as instructed. Home Office. P 0 Box 20, Minneapolis, MN 55440 Administrative Office: f'.0. Box 122 Minneapolis. MN 55440-0122 1 Legal Name of Group Policyholder City of Lubbock - 2. Address of Group Policyholder. L_ 1625 13th Street, Lubbock. TX 79401 3. Name of Business (dba): _ 4 Proposed Effective Date 12:01 a.m. ! 5. Number of EmployeeslMembers 6. Employee/Member Eligibility: 01 01 _ 2008 Eligible: 1,900 30+ hours per week MM DD YYYY (new applicants and any transfers) 1. Coverage Type: V 24 Hour ❑ Non -Occupational 8. Plan Level: iZ Standard ❑ Choice ❑ Preferred ❑ 9. Adminisirative Information: W( Non-ERiSA Plan D 125 Cafeteria Plan D Policyholder Contribution _ 0 (% or $) lJ ERISA Plan D Pre-tax deduction �f Post -tax deduction 10. Riders Spouse Accident Rider ❑ Off Job Accident Disability Income Rider IV Child(ren's) Accident Rider Maximum Benefit Period: ❑ Wellness Benefit Rider A. ❑ 6 Months ❑ Sickness Hospital Confinement Rider B. ❑ 12 Months Maximum Amount of Monthly Benefit not to exceed" $ j 'Benefit percentages may be limited to 25% of Basic Monthly Salary in California 11. Remarks ReliaStar Life Insurance Company reserves the right to withdraw the plan if participation during the initial enrollment is less than 1251 covered Certificateholders or any other state specific participation requirements. It is understood and agreed that this application shall be made a part of the policy applied for and that no insurance shall be effective until approved by the Company at its home office. FRAUD WARNING STATEMENT Standard: Any person who with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may have violated the state law Arkansas/New Mexico: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison - Colorado: it is unlawful to knowingly provide false, incomplete. or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Florida: Any person who knowingly and with intent to injure, defraud or deceive any insurer, files a statement of claim or an application containing any false, incomplete, or misleading information commits a felony of the third degree. Kansas: Any person who knowingly and with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing false or deceptive statements may be guilty of fraud as determined by a court of law. Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act. which is a crime ACC-RL-GRP-05-MULTI E-Ship: 138194 12/05/05 Louisiana: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and ,may be subject to fines and confinement in prison. Ohio, Any person who knowingly and with intent to defraud, submits an application or files a claim containing any materially false or misleading information, commits a fraudulent act, which is a crime. Oklahoma: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing ary false, incomplete or misleading information is guilty of a felony. Oregon: Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurance company cr application or files a claim containing a false or deceptive statement may be committing a crime. Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information conceming any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Tennessee: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purposes of defrauding the company. Penalties include imprisonment, fines and denial of coverage. Washington DC: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. Signature 8 Title of Grou li nt. i Printed flame: jr 1 ✓ ��""" David A. Miller, Mayor ature of Agent. (ed at (City & State): Lubbock, Texas Printed Name of AgenULicense #: JE"g -Auc.`ati). Date: ram: IMS: October 25, 2007 ACC-RL-G RP-05-MULTI E-Ship: 138194 12105/05 ATTEST: Rebec a Garza, City Secretary APPROVED AS TO CONTENT: Leisa Hutcheson, Director Risk Management APPROVED AS TO FORM: andi r, ttorney of ounse Resolution No. 2007-RO484 ReliaStar Life Insurance Company Horne Office. P.O. Box 20, Minneapolis, MN 55440 Administrative Once. P 0 Box 122, Minneapolis, MN 55440-0122 1. Legal Name of Group Policyholder: City of Lubbock Critical Illness Insurance —� Group Application For Critical Illness Insurance INSTRUCTIONS: Complete each section entirely. Print clearly in dark ink, sign .� and date the form, and return as instructed. 2 Address of Group Policyholder: 162513th Street, Lubbock, TX 79401 3 Name of Business (dba) 4, Proposed Effective Date 12:01 a.m. i 5. Number of Employees/Members 01 _01 2008_ i Eligible: _1900 �MM DD YYYY (new applicants and any transfers) t i 7, Is this replacing a prior plan? ❑ Yes N Is "Yes" please complete questions 8 & 9 10. Administrative Information: 11. x Non-ERISA Plan ❑ ERISA Plan 125 Cafeteria Plan Pre-tax deduction X Post -fax deduction Remarks 0 8. Prior Carrier's Name: Number_ enrolled in pr Plan Election x Critical Illness and Cancer ❑ Critical Illness Only ❑ Cancer Only 5A. Guaranteed Issue Eligibility ❑ NiA i x _20 of eligible EEiMembers) 6. Employee/Member Eligibility. __.-30+_ hours per week 9. Termination date of prior plan: _ I ARM DD YYYY 12. Riders 1 Additional Benefits: _ 18 Chi1d(ren's) Critical Illness Rider Check One: ❑ S2,500 ❑ $5,000 ❑ Wellness Benefit Rider Restoration Benefit Rider Occupational HIV Benefit Rider Other ReliaStar Life Insurance Company reserves the right to withdraw the plan if participation during the initial enrollment is less than [25] covered Certificateholders or any other state specific participation requirements. It is understood and agreed that this application shall be made a part of the policy applied for and that no insurance shall be effective until approved by the Company at its home office. FRAUD WARNING STATEMENT Arkansas, Louisiana, Maine, 'Neer• Nlexico, Ohio, Oklahoma, Tennessee, '%Vashington, Nest Virginia. Any person who. Knowingly with intent to dcfratsd any insurance company or other person files an application for insurance containing any materially false information or conceals. for the purpose of misleading, information concerning any fact material thereto commits at fraudulent insurance act. which is a crime, and may subject such person to criminal and civil penalties. and denial of insurance benefits. Colorado- It is unlawful to knowingly provide false. incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment. fines, denial of insurance, and civil damages. Any insurance company or assent of an insurance company who knowingly provides false, incomplete. or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or a��ard payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. District of Columbia: \VARNING: It is a crime to provide false or misleadinginformation to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. C12-GRP-07-MULTI E-Ship; 142820 C3127i2007 Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance conlaining any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. New Jersey: Any petson who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Pennsvivania: Any person who knowingly and with intent to defraud any' insurance company or other person files an application for insurance or statement of claim containins any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. l Signature & Title oAGrA A�icant I Signature of Age 1 Producer: led at (City & State): Lubbock, Texas : Printed Name: David A. Miller, Mayor Printed Name of Agent 1 Producer and License No. Date: October 114Itc.c.T,A) 25, 2007 i C12-GRP-07-MULTI E-Ship: 142820 03/2712007 ATTEST: - P.V-� , Retie a Garza, City Secretary APPROVED AS TO CONTENT: Leisa Hutcheson, Director Risk Management APPROVED AS TO FORM: 1 L- andiver, Attorney o oun el Resolution No. 2007—R0484 CODfirMation of Volu17tary Coverage Citv of Lubbock, by its duly authorized officer, confirms the following plan of voluntary whole life insurance coverage, voluntary disability insurance and voluntary accident insurance issued by ReliaStar Life Insurance Company will be offered on an exclusive basis to its eligible employees through payroll deduction. Our Guaranteed Issue offer is based oil enrollment access to all employees on a one to one basis and achieving the participation target of at least 1.5%. The following product has been explained to me in detail and the coverage will be offered to all eligible employees: ReliaStar Life Insurance Company Horizon Global Universal Life insurance, Guaranteed Issue ReliaStar Life Insurance Company Premier Critical Illness ReliaStar Life Insurance Company Accident Insurance Payroll Deduction Agreement As a service to our employees, it is agreed that we will honor payroll deduction requests, which are properly signed by our employees, in accordance with your payroll deduction plan for paying insurance and+or annuity premiums. it is understood that ReliaStar Life Insurance Company will forward statements of premium installments to be deducted by us. It is further agreed that this payroll deduction plan may be terminated by either party upon reasonable notice. In the event this agreement is terminated, the payment of premiums will be a matter of accounting between the participating employees and ReliaStar Life Insurance Company. Any employee may voluntarily discontinue the payroll deduction plan upon request that deductions shall no longer be made from his/her pay. We assume no responsibility for the payroll deduction plan as applying to any insured employee subsequent to termination of employment. Premium installments will be deducted from the salaries of participating employees and will be retnitted to you no later than five working days after the final deduction is made. 1625 13th Street Lubbock TX 79401 Street Address City State Zip Code Officer's Signature Agt#t's Signature/Witness H-6261 (12/98) RLNY avor October 25, 2007 Title Date Date ATTEST: Rebecca Garza, City Secretary APPROVED AS TO CONTENT: Leisa Hutcheson, Director Risk Management APPROVED AS TO FORM: on ands `er, oin' ey of Counsel Resolution No. 2007-RO484 -me&andard" Pc6itivety d€fferent. AGREEMENT BY AND BETWEEN THE CITY OF LUBBOCK, TEXAS AND THE STANDARD INSURANCE COMPANY THIS AGREEMENT entered into this 1st day of January, 2008 by and between the CITY OF LUBBOCK, TEXAS, a municipal home rule corporation (herein called "City") and STANDARD INSURANCE COMPANY (herein called "Administrator") to provide services for the purpose of the Group Life Insurance Plan. WHEREAS, the City desires to have services provided for group life and insurance; and WHEREAS, the Administrator has demonstrated that it can provide said services; and WHEREAS, the City and the Administrator desire to enter into an Agreement to provide said services. NOW, THEREFORE, the parties agree as follows: 1. The City agrees to pay monthly premiums to the Administrator according the rate schedule which is attached hereto as Exhibit "A" which is incorporated as if fully set forth herein. Administrator agrees to a three-year rate guarantee. 2. The parties agree to abide by the terms and conditions of the "Group Life Insurance Policy" which is attached hereto as Exhibit `B" which is incorporated as if fully set forth herein. 3. This agreement is for a term of one (1) year from the effective date and may be extended for two (2) additional one (1) year terms at the mutual agreement of both parties. 4. Notices or communications from the Company to the Administrator shall be addressed to the Administrator and shall be deemed to be duly given or served, if the same shall be sent by post office mail, telegraph, telex, FAX, or other similar or analogous means, to the address shown below, unless the Company has been requested to send such communications to another address: The Standard Insurance Company Attn: Jeff Wheeler 2805 Dallas Parkway, Suite 440 Plano, TX 75093 Notices or communications from the Administrator to the Company shall be addressed to the Company and shall be deemed to be duly given or served if the same shall be sent by post office mail, telegraph, telex, FAX, or other similar or analogous means, to the address shown below, unless the Company has been requested to send such communication to another address: The City of Lubbock Attn: Risk Management Benefits Section P.O. Box 2000 Lubbock, TX 79457 Notices and communications described in this paragraph that are sent by post office mail will be deemed duly given or served on the third business day following the date the notice is mailed. 5. This contract shall be construed and enforced according to the laws of the State of Texas. Venue shall be Lubbock County, Texas. b. The City may terminate the services of the Administrator at any time upon giving to the Administrator 90 days written notice of its intention to do so. The Administrator may resign at any time upon 90 days notice in writing to the City. The Administrator upon its resignation shall complete the processing of all services described in this Agreement which have commenced prior to the effective date of the termination of this Agreement. SIGNED THIS DAY, the 25rh of CITY E LU K:F�� David A. Miller, Mayor ATTEST: Rebe ca Garza, City Secretar A ED AS T70NTENT: Leisa utcheson, Director Risk Management APPROVED AS T FORM: axi Don Vandiver, torney of unsel October , 2007. URANCEU COMPANY • � I EXHIBIT "A" January 1, 2008 Monthly Rates Active Employees: Basic Life 0.05/1000 AD&D 0.03/ 1000 Active Voluntary Life (Der $1.000 benefit) 30< 0.09 30 - 34 0.10 35 - 39 0.13 40 - 44 0.20 45 - 49 0.33 50 - 54 0.56 55 - 59 0.91 60 - 64 1.14 65 - 69 1.98 70 - 74 3.21 75 - 79 4.94 80 - 84 8.40 Active Spouse Life Active Child Life Retirees: Retiree Basic & Voluntary Life 0.80/5000 0.50/2500 30< 0.11 30 - 34 0.12 35 - 39 0.17 40 - 44 0.26 45 - 49 0.44 50 - 54 0.78 55 - 59 1.27 60 - 64 1.44 65 - 69 2.38 70 - 74 4.12 75 - 79 6.20 80 - 84 9.75 City Paid Retiree Policies 4.06/1000 Retiree Varying Amount Policies 0.60/ 1000 Retiree Spouse $2,500/Child $1,000 1.25 3 year rate guarantee. $500,000 Max. on Active Voluntary Life. Allow active& retired employee to elect Spouse & Child life coverage without participation in voluntary life. 25 % participation requirement in voluntary life. 50K GI on active employee spouse life. Resolution No. 2007p-R0484 HM LIFE INSURANCE COMPANY APPLICATION FOR GROUP INSURANCE REQUIREMENTS HM Life Insurance Company's (HM) group insurance application policy requires all groups to complete and forward the following documents in order to receive the applicable insurance coverage through HM within their state of domicile. HM APPLICATION FOR INSURANCE FORM (sign and return with original signature of an authorized representative, witness and resident agent, where required). Listing of each employee expected to be disabled or not actively at work on the scheduled effective date as applicable to Life and Accidental Death & Dismemberment (AD&D) insurance, if requested. A copy of the collective bargaining agreement if union members are to be covered by the group insurance requested. * Please Note: Do not attach a check for the premium deposit of an estimated V month's premium. It is not a requirement of either HM or Davis Vision, Inc. Please return the completed application and necessary attachments to: Davis Vision, Inc. Attn: Heather Reynolds 159 Express Street P.O. Box 9104 Plainview, NY 11803-9004 Davis Vision - Conridenual July 2006 P.O. Box 535061 Pittsburg. PA 15222-30" t www,hminswancegtoup.co m LIFE INSUKANCt; COMPANY APPLICATION FOR GROUP INSURANCE This application must be accompanied by the Coverage Transmittal farm, Disclosure Statement and the proposal for coverage requested. A separate Trust Subscription Agreement may be required for some products. Every entry on this form should be completed to avoid delay in processing your request. if an informational block does not apply or information is not available, please indicate'noW in the space provided. if a form is incompiete, it may be returned. Please read the Fraud Notice and when finished, sign and date the form, make a copy for Your records and send the original to HM Life Insurance Company. Pleasit odnt in !slue or black leek. Full Legal Name of Group (to appear on Policy) City of Lubbock Tax ID Number Telephone Number I Fax Number 80ti 775-2317 _ A rasa City State Zip Code P.O. Box 2000 Lubbock--_ Delivery Address (if different than above) ; CityState Zip Code 1325 13th Street Room 104 ILubbock TX 79401 Nature of Business SIC Code ❑ Corporation ❑ Partnership Munir_4nal i ry I a Government ❑ Other: egai Name City I State I Zip Code Name ~Nature of Business City State Name I Nature of Business ❑ We and AD&D ❑ Dependents Life ❑ Additional Life and AD&D ❑ life Only ❑ Dependents Life ❑ Additional Life ❑ Short Term Disability ❑ Long Term Disability Vision ❑ stop Loss ❑ Aggregate ❑ Specific ❑ Other: State vohrntary Products ❑ Life and AD&D ❑ Spouse Life and AD&D ❑ Spouse Life ❑ Child Life i] Life Only ❑ Spouse Life 0 Chili Life ❑ Short Term Disability 1-1-2008 1930 -Will the requested insurance replace existing insurance? © Yes ❑ No Premium Deposit of $ included. Estimated 1' month's premium must be attached to this application, except for Voluntary and Small Business Plan products. The Premium Deposit will be applied to the first premium when due. Make check payable to HM life Insurance Company. Do not make the check payable to the agent or leave the "Payne" blank. if a policy is not issued, the premium deposit will be refunded in full. Definition of Member Wit for Stop Loss): ❑ All active employees working 30 hours or more a week. nother.All active employees working 40 hours or more a we if Defmftion of Member differs by tine of coverage or class, please eaplaln: — i FIC 1658 (4A9) Page t of 2 APPLICATION FOR GROUP INSURANCE Eligibility Waiting Period (n/a for Stop Loss): If eligibility differs by line of coverage, please explain in Remarks section. Fulure Members: Current Members: O No waiting period 0 Same as future Members 0 1" day after days as a Member fl Norte on effective date 0 1" of the month coinciding with or next following days as a Member 0 1' of the month coinciding with or next following becoming a Member [10ther: Cirm yloltinn of nil! fill] 1ia3E p ar4ad Definition of Earnings for benefits: based on earnings' (n)a for Stop Loss) 0 Basic salary, including tax deferred contributions made to a qualified plan sponsored by the Employee and commissions, but excluding bonuses, overtime and other compensation (Commissions based on prior calendar year). © Partners: "Net eamings (loss) from self=empkrymtertt" from the partnership during the prior calendar year, as reported on the partnership federal income tax return. ❑ Other. if De wition of famings differs by lime of coverage or class, please explain: *Prior Calendar year earnings used for Voluntary Products. Active Work Requirement for We and Accidental Death & Dismemberment Irrr:uranee (N/it bin Stop Loss) No employee will become insured unless the employee satisfies an Active Work Requirement on the scheduled Effective Date. Will any employees be Disabled on the last day before the scheduled Effective Date? O Yes' 10 No Off -M0 LW the information on a separate piece of paper and attach to this applications: (1) Provide infonnalmn about each empbyee whoa expected to be disabled on the last day before the scheduled Effective Date: Nerve; Sere; Date of flirtfy Salary; Atuount of Coverage: Diagrrosk Prognosis; Date Lao Wwkedl Expected Date of Return. (2) List all aanployees who wiN not be actively at work on the scheduled Effective Date /other than Disabled eaV*yees tested based on above). Are there any Union Member being covered? ❑ Yes* Q No *If " acapy of the collective bargaining agreement is required with the submission of the application. Remarks: The insurance coverage requested and requested effective date must be approved by HM Life Insurance Company under its current rules and practices, including Active Work, Evidence of Insurability and Pre -Existing Condition provisions. All options and special requests are subject to Underwriting approval. No insurance agent or broker has authority to guarantee acceptability of requested insurance coverage. All materials describing this coverage must be approved in writing by HM Life Insurance Company prior to distribution. Note: Coverage will not be in effect until notified in writing by the Horne (Mice. Do not cancel prior coverage until noted. Premium rates and quotes were based on the data submitted to HM Life Insurance Company. Final premium rates will be determined on the basis of the actual composition of the group of persons who become insured. Any person who knowingly and with intent to defraud or deceive any insurance company submits an insurance application or statement of claim containing any false, incomplete or misleading information may be subject to civil or criminal penalties, depending on state law. I represent that the statements contained in this application are true and complete to the best of my knowledge and belief, and t understand that the form the basis for HM Life Insurance Company's approval of the coverage requested. David A. Miller Signature of Applicant's Authorized Representative /Siguture of VOt A and/or t Signature of Resndent Agent, where required H0658 (4/99) r" Pt proved as to for t� "c f)ty Attorney Representative October 25, 2007 Haor Date Two Lubbock, Texas Lveation 4 tjr, Slats) Agent Lis enw Number fife ed of Aft Page 2 of 2 ATTEST: "-- Rebecka Garza, City Secretary APPROVED AS TO CONTENT: Leisa Hutcheson, Director Risk Management APPROVED AS TO FORM: URATndiver—,A-orney o Counsel Resolution No. 2007-RO484 AGREEMENT BY AND BETWEEN THE CITY OF LUBBOCK, TEXAS AND ING EMPLOYEE BENEFITS THIS AGREEMENT entered into this 1 st day of January, 2008 by and between the CITY OF LUBBOCK, TEXAS, a municipal home rule corporation (herein called "City") and ING EMPLOYEE BENEFITS (herein called "Administrator") to provide services for the purpose of the Advise -To -Pay Plan and the Group Long Term Disability Income Plan. WHEREAS, the City desires to have services provided for an Advise -To -Pay plan and Group Long Term Disability Plan; and WHEREAS, the Administrator has demonstrated that it can provide said services; and WHEREAS, the City and the Administrator desire to enter into an Agreement to provide said services. NOW, THEREFORE, the parties agree as follows: 1. The City agrees to pay monthly premiums to the Administrator according to the following rate schedule 90 Day/67% Benefit Age: Under 25 $.24 25-29 $.26 30-34 $.29 35-39 $.31 40-44 $.41 45-49 $.53 50-54 $.71 55-59 S1.08 60+ $1.33 180 Day/60% Benefit Age: Under 25 $.21 25-29 $.22 30-34 $.24 35-39 $.26 40-44 $.35 45-49 $.45 50-54 $.60 55-59 $.91 60+ $1.13 Advice to Pay: Monthly Retainer $250; Per Claim Review $250 The above rates are guaranteed for two (2) years. 2. The parties agree to abide by the terms and conditions of the Advise -To -Pay Contract and Group Long Term Disability Income Policy which are attached hereto as Exhibit "A" which is incorporated as if fully set forth herein. 3. This agreement is for a term of two (2) years from the effective date and may be extended for an additional one (1) year term at the mutual agreement of both parties. 4. Notices or communications from the Company to the Administrator shall be addressed to the Administrator and shall be deemed to be duly given or served, if the same shall be sent by post office mail, telegraph, telex, FAX, or other similar or analogous means, to the address shown below, unless the Company has been requested to send such communications to another address: ING Employee Attn: Christopher J. Gilbert 15455 Dallas Parkway, Suite 1250 Addison, TX 75001 Notices or communications ffom the Administrator to the Company shall be addressed to the Company and shall be deerned to be duly given or served if the same shall be rent by post office mail, telegraph, telex, FAX, or other similar or analogous means, to the address shown below, unless the Company has been requested to send such communication to another address: The City of Lubbock Attn: Risk Management Benefits Section P.O. Box 2000 Lubbock, TX 79457 Notices and communications described in this paragraph that are sent by post office mail will be deemed duly given or served on the third business day following the date the notice is mailed. 5. This contract shall be construed and enforced according to the laws of the State of Texas. Venue shall be Lubbock County, Texas. 6. The City may terminate the services of the Administrator by terminating the Advise -To -Pay Policy and the Group Long Term Disability Income Policy at any time upon giving to the .Administrator 90-days written notice of its intention to do so. The Administrator may resign by terminating the Advise -To -Pay Policy and the Group Long Term Disability Income Policy at any time upon 90-days notice in writing to the City. The Administrator upon its resignation shall complete the processing of all services described in this Agreement which have commenced prior to the effective date of the termination of this Agreement. SIGNED THIS DAY, the 25th of CITY OF LUBBOCK: T David A. Miller, Mayor ATTEST: 4�,-cc�- Reb cca Garza, City Secretary APPROVED AS TO CONTENT: Lcisa Hutcheson, Director Risk Managenteut APPROVED AS TO FORM: Aclart v kdorney of Counsel October , 2007. ING EMPLOYEE BENEFITS XIAW By: 1Aj Title: