HomeMy WebLinkAboutResolution - 2009-R0516 - Amendment To Standard Insurance Company: Group Life Insurance Plan, Etc. - 11/19/2009Resolution No. 2009-80516
November 19, 2009
Item No. 5.9
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock, an Amendment to the
Standard Insurance Company: Group Life Insurance Flan and Accidental Death and
Dismemberment Insurance, as executed on October 25, 2007, and all related documents.
Said Amendment is attached hereto and incorporated in this Resolution as if fully set
forth herein and shall be included in the minutes of the Council.
Passed by the City Council this
19th day of November '2009.
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TOM MARTIN, MAYOR
TTEST:
OVER AS TO CONTENT:
Hutcheson, Director of Risk Management
Resolution No_ 2009-RO516
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Request for Group Insurance Amendment
Standard Insurance Company
900 SW Fifth Avenue
Portland, OR 97204-1282
Employee Benefits Consultant: Brock Glessner
Employee Benefits Service Representative: Derek Jones
Employee Benefits Sales and Service Office: Dallas
Employer Name: City of Lubbock
Group Number: 643367 A
As an authorized representative of the Employer, I request that Standard Insurance
Company ("The Standard") amend the above Employer's coverage under the Group
Policy to make the following change(s):
643367-A Class 1 - Add Line of Duty benefit to Basic AD&D with no increase in rate.
(this does not include retiree classes).
I request that the amendment become effective on 1/ 1/20 10. 1 understand that the
amendment will not become effective unless approved and issued by The Standard.
I request that the amendment be approved by The Standard subject to The Standard's
usual underwriting requirements, including, if applicable, Evidence of Insurability or a
Pre-existing Condition provision.
I understand that the amendment, if approved by The Standard, will be issued in the
policy language customarily used by The Standard.
I understand that any increase in Insurance for a Member who is not Actively At Work
all day on the Member's last regular work day before the scheduled effective date of the
amendment will be deferred until the first day after the Member completes one full day
of Active Work.
Standard Online Amendment Request 11 / 11/2009 12:54 PM
I request that the amendment, if approved and issued by The Standard, become
effective by its terms without any further acceptance by the Employer, and that a copy
of this Request for Group Insurance Amendment form be attached to and made a part
of the amendment.
Signed this 19thday of November , 2009.
CITY OF LUBBOCK
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TOM MARTIN, Mayor
ATTEST:
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REBECC15ARVA, Crt Se r�ta
Approved as to Content:
LEISA HUTCHESON irector Risk Management
, ssist nt City Attorney
Standard Online Amendment Request 11 / 11/ 2009 12:54 PM