HomeMy WebLinkAbout800891.tiff RESOLUTION
RE: APPROVAL OF AMENDMENT #2 TO POLICY NUMBER 17600 ISSUED TO
WELD COUNTY BY ROCKY MOUNTAIN LIFE INSURANCE COMPANY
WHEREAS, the Board of County Commissioners of Weld County,
Colorado, pursuant to Colorado statute and the Weld County Home
Rule Charter, is vested with the authority of administering the
affairs of Weld County, Colorado, and
WHEREAS, amendment #2 to policy number 17600 issued to
Weld County by Rocky Mountain Life Insurance Company has been
presented to the Board of County Commissioners for approval, and
WHEREAS, the purpose of said amendment is to indicate that
all Weld County Government employees , regardless of their rate
of pay, will be eligible to enroll for the $5 ,000 supplemental
life program, and
WHEREAS, the Board of County Commissioners has studied
said amendment and deems it advisable to approve the same.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Com-
missioners of Weld County, Colorado that amendment #2 to policy
number 17600 issued to Weld County by Rocky Mountain Life
Insurance Company, as more fully set forth above, be, and
hereby is, approved.
The above and foregoing Resolution was, on motion duly made
and seconded, adopted by the following vote on the 29th day of
October, A.D. , 1980 .
BOARD OF COUNTY COMMISSIONERS
ATTEST: s . WELD COUNTY, COLORADO
Weld County Clerk and Recorder
and Clerk to the rd C. W. Kirby, Ohairman
I BY: , / it ecervueti /26-&
Deput oun erk eonard L. Roe, Pro-Tem
P OjLED AS TO F RM:
Norman Carlson
G
County Attorney Lyy
�{i Dun ar
ne K. S irfmark
800891
DATE PRESENTED: OCTOBER 29 , 1980
ROCKY MOUNTAIN LIFE
INSURANCE COMPANY OF COLORADO
AMENDMENT NUMBER 2
Attached to and made part of Renewable Term Life Policy Number 17600 issued by
Rocky Mountain Life Insurance Company of Colorado to Weld County.
Effective October 1 , 1980 this policy is amended as follows:
SCHEDULE OF INSURANCE
Class of Employees Description Amount of Insurance
BASIC COVERAGE ONLY
A Employee with 5 years or more
service $12,000
B Employees with less than 5 years
service $ 7,000
C Retirees per listing dated January 24,
1980 $ 1 ,000
BASIC & SUPPLEMENTAL COVERAGES
D Employees with 5 years or more
service $17,000
E Employees with less than 5 year
service $12,000
Upon attainment of age 65, Life and Accidental Death and Dismemberment benefits
will reduce 35% and will further reduce to $1 ,000 at age 70. Coverage terminates
at retirement for all employees except those included by name of the attached
letter dated Januury 24, 1980 that forms a part hereof. Coverage for those
retirees shall be $1 ,000 life only.
ACCEPTED BY: FOR:
Weld County R ky Mountain Life Insurance Company
Signature Signature
Weld County Commissioner, Chairman President
Title Title
October 27, 1980 October 17, 1980
Date Signed Date Signed
GROUP ABSTRACT Rocky Mountain Life
FORM NO. 99363
Insurance Company of Colorado
G u`ROUP ROYUOL cR(ListSubsidiaries or Affiliates a ates.n Remarks Semol -'--
Weld County
GRiTT>IMsOLICd NUMBER IMSTR IS SEC. EFFECTIVE DATE ANNIVERSARY DATE PREMIUM DUE DATE 9C BS I'.rpT(
'600 * I ** 02-01-80 02-01 ® 1ST ❑ 16TH DI YES ❑ NC
I I
ADDRESS'Sue.e C". Stare Zip Code)
P. 0. Box 758 - Greeley, CO 80631
EXECUTIc'E CORRESPONDENT(Name&Tole) ROUTINE CORRESPONDENT IName&Title) IPH,0NE
Lewis R. Barrett Ann Flot 356-4000
BC BS SAL ES REPRESENTATIVE BC-BS SERVICE REPRESENTATIVE OFFICE PRONE
Paul Bilawsky Terr Code 47 Denver 831-2313
ELIGIBILITY CURRE IC EMPLOYEES
Q' PLAN EFFECTIVE DATE ❑ MONTHS ❑
ELIGIBILITY-NEB EMPLOYEES
❑ NONE V 1ST INS. MONTH AFTER 0 MONTHS EMP. ❑
TERMINATIONS CHANGES F ,
❑ AUTOMATIC ® END OF INS. MONTH 2PREMIUaM DUE'DATE10�& NIVEGe R AYctns Effective on
RY '4
SCHEDULE OF BENEFITS
CLASS DESCRIPTION LIFE SUPL LIFE
BASIC PLAN ONLY AD & D G D
A Employees 5 years or more
service $12,000 $12,000
B Employees less than 5 years
service $ 7,000 $ 7,000
***C Retirees per 1-24-80 list-
ing $ 1 ,000 -0-
BASIC SUPPLEMENTAL PLAN
D Employees 5 years or more $17,000 $17,000
E Employees less than 5 years $12,000 $12,000
FE;-DuCTIDNS
❑ NONE ❑ 50% 65 TERM 70 ❑ 5Ou-0 65 V 35% 65/$1 ,000 age 70/Term Retirement
ADS D
4 24 HR ❑ NON-OCC aSAME REDUCTION AS LIFE ❑ ❑ YES X.
SVPP.F MENTAL LIFE
E OF I 5 YES 5 NO ❑ SAME REDUCTION AS LIFE k( TERMINATES AT Eli 70
DISAB:LTI INCOME
Day Accident Day Sickness ( Day Hospital) Maximum Weeks; Weeks Pregnancy
( • BENEFITS TERMINATE AT AGE 65 • BENEFITS CANNOT EXCEED 66-2'3% OF BASIC WAGE •
EMPLOYEES EXCLUDED
EMPLOYER CONTRIBUTION
NONE ❑ Basic-100%, Supp- 0% EMPLOYEE DEPFNDFr0TS
PREMIUMS REMARKS
CLASS LIFE AD & D DEP. LIFE DIS. INC. TOTALS *SEE ATTACHED
A 4.68 .72 5.40 **SEE ATTACHED
B 2.73 .42 3.15 ***37 Retirees covered by previous
C .39 .00 .39 carrier--no other retirees to
D 6.63 1 .02 7.65 be eligible for this class,
E 4.68 .72 5,40
UNIT
RATE .39 'M .06 /M D U ;$10
NUMBER B - 930 883
EMPYEES S - 558 558
\N-LIME
B-7,492,800 7,445,800
LwpS-2,773,400 2,773,400
moNTHIL1 ,081 .63 1 6.40 2,082.13 456.75
PREMIU"'51 5 NEW ® REVISED EFF. 10-1-80
1 SUPPLEMENTAL LIFE. _% OF TABLE RATES; QUINQUENNIAL DATE ISSUED. 10-17-80
POLICY AMENDMENTS
NO. EFFECTIVE DATE
1 02-01-80 Increase Life Schedule-Class A from $10,000 to $12,000 and
Class B from $5,000 to $7,000. Also includes 37 retirees,
covered by previous carrier, as being eligible for coverage.
2 10-01-80 Change Supplemental Life to $5,000 - not based on an amount of
earnings.
RENEWAL ACTION
POLICY YEAR EFFECTIVE DATE
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