HomeMy WebLinkAbout760622.tiff RESOLUTION
RE : AMENDMENT TO AGREEMENT BETWEEN WELD COUNTY AND PACIFIC
MUTUAL LIFE INSURANCE COMPANY.
WHEREAS, heretofore, Weld County, by Resolution, did
enter into a contract with Pacific Mutual Life Insurance
Company for group insurance covering Weld County employees
under various group insurance policies, including group
policy No. GP-3651, and amendments thereto, and
WHEREAS, now Pacific Mutual Life Insurance Company has
submitted an additional amendment to the aforementioned group
policy No. GP-3651, entitled, "Amendment No. 3" , and
WHEREAS, the Board of County Commissioners of Weld
County, Colorado, believe it to be in the best interest of
the County to accept the aforementioned Amendment No. 3 to
the aforementioned group policy as proposed, covering its
said group policy as hereinabove mentioned and on the basis
recited herein.
NOW, THEREFORE, BE IT RESOLVED by the Board of County
Commissioners, Weld County, Colorado, that the hereinabove
mentioned Amendment No. 3 submitted by Pacific Mutual Life
Insurance Company amending group policy No. GP-3651, a copy
of which is attached hereto and made a part hereof by reference,
be, and hereby is, approved.
BE IT FURTHER RESOLVED that the Board be and hereby is
authorized to execute Amendment No. 3 to the aforementioned
group policy, to-wit: GP-3651 as submitted, and to make the
same effective forthwith.
The above and foregoing Resolution was, on motion duly
made and seconded, adopted by the following vote on the 6th
day of October, A.D. , 1976.
BOARD OF COUNTY COMMISSIONERS
WEL ,COUNTY, COLORADO
ATTEST: CLug C nw .. 27i z
aetWeld County erk and Recorder
an Clerk to the rd
eputy Cou
RO D AS TO • —
County Attorney
/ aaft
2.1) ?m ." w- 760622
AMENDMENT NO, 3 POLICYHOLDER'S COPY
Attached to and part of t;roup Rrlicy No. GP-3651 by and between Pacific Mutual Life Insurance Company, and the
Policyholder.
THE BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, COLORADO.
The Policyholder and Pacific Mutual hereby agree that, effective May 1, 1976, the policy is amended as follows:
A. The pages listed under Column I are deleted from the policy and the attached pages listed under Column II, each marked
by "Amendment No. 3 effective May 1, 1976 ", are inserted into the policy.
COLUMN I - PAGES DELETED COLUMN II - PAGES INSERTED
2, as amended 2
6 6
B. Weld County General Hospital is deleted from the list of employers eligible to cover employees under the policy.
IN WITNESS WHEREOF, the panics hereto have, by their duly authorized representatives set their hands on the date set forth
beneath their respective signatures.
POLICYHOLDER PACIFIC MUTUAL LIFE INSURANCE COMPANY fl&stfeSignature of Officer President
TITLE 0-1-k/1 I I yla •
_��d�' +✓ /.
I3DGl`fct of CoU ( Ot-7Vimakid(OxfutA f1 Secretary
DATE Celle AA_e 61197h ATTEST 44.--<:111-;144".,17-, 144-€2',
Registrar
/'�
DATE r L27 ! / / 76
GR-4828-3651-A3
•
ARTIC . - ELIGIBILITY AND EFFECTIVE DATE OF _ FRANCE
SECTION 1. ELIGIBILITY: All employees of the Employer are eligible for insurance under this policy except part-time
employees(but not excepting full-time employees temporarily working on a part-time basis). Persons not eligible for in-
surance hereunder shall nor, for the purposes of this policy, be deemed to be employees. Retired employees who retired
prior to January 1, 1973, are eligible under this policy and cessation of active work shall not terminate insurance for such
employees.
Each employee shall be eligible for insurance under this policy immediately upon completion of one calendar month of
full-time employment with the Employer.
SECTION 2. EFFECTIVE DATE OF AN EMPLOYEE'S TERM INSURANCE COVERAGE: The employees covered for Term
Insurance shall be such of the eligible employees as make written request for insurance under this policy to the Employer
and agree to make the required contributions to the Employer; provided that:
(a) if such request is made by an employee on or before his date of eligibility, the employee shall become cov-
ered for Term Insurance on such date of eligibility;
(b) if such request is made by an employee within thirty-one days after his date of eligiblity, the employee shall
become covered for Term Insurance on the date of such request;
(c) if such request is made by an employee more than thirty-one days after his date of eligibility, or is made af-
ter previous termination of Term Insurance coverage because of failure to make the required contribution,
the Insurance Company reserves the right to require of the employee, without expense to the Insurance Com-
pany, evidence of insurability satisfactory to the Insurance Company before he may become covered for Term
Insurance. If such evidence is required and submitted, the employee shall become covered for Term Insurance
on the date the Insurance Company determines the evidence to be satisfactory.
In any instance in which an employee is both disabled and not working on the date he would otherwise become covered
for Term Insurance, the effective date of the employee's Term Insurance coverage shall be deferred until his return to
active work.
SECTION 3, EFFECTIVE DATES OF PAID-UP INSURANCE: Paid-Up Insurance for an employee may be purchased only
while Term Insurance coverage is in force for the employee and shall become effective as and when purchased.
ARTICLE II - AMOUNT OF INSURANCE AND EMPLOYEE CONTRIBUTIONS
SECTION 1. TOTAL AMOUNT PAYABLE AT DEATH: The total amount payable at the death of an insured employee
shall be equal to the sum of the amounts of Paid-Up Insurance which have been purchased for him under Section 5 of
this Article and which are in force at his death, plus the amount, if any, of Term Insurance for which the employee is
then covered.
SECTION 2. AMOUNT OF TERM INSURANCE: The amount of Term Insurance for each employee covered for Term In-
surance shall at any time be equal to the excess, if any, of the employee's Total Insurance, as determined from Section
3 of this Article, over the sum of the amounts of Paid-Up Insurance which have been purchased for the employee and
which are in force.
GR-202-3651 AMENDMENT NO. 3 EFFECTIVE MAY 1, 1976
-2-
SECTION 2. PREMIUMS FOR TERM INSURANCE COVERAGE: The premium rates for Term Insurance Coverage shall be
those in Table III.
At the beginning of each six-month period of each policy year during the continuance of this policy commencing on July
1, 1955, each individual Employer shall pay to the Insurance Company the premium which the Insurance Company esti-
mates will be required for Term Insurance coverage during the six month period then beginning.
At the end of each policy year the average amount of Term Insurance coverage in force during such year for employees
at each age shall be determined and the correct premium for such year shall be computed from such averages. The
difference between the estimated prmium paid and the correct premium for such year shall be computed from such
averages. The difference between the estimated premium paid and the correct premium for such policy year shall be
payable to the Employer by the Insurance Company or to the Insurance Company by the Employer, as the case may be,
upon notice of its amount from the Insurance Company to the Employer.
SECTION 3. PAYMENT OF PREMIUMS AND GRACE PERIOD: This policy is issued in consideration of the payment by
the Employer to the Insurance Company at its Home Office of the premiums provided for in this Article V.
Thirty-one days of grace without interest charge will be allowed for the payment of every premium after the first.
ARTICLE VI - DISCONTINUANCE OF POLICY
SECTION 1. CAUSE AND EFFECTIVE DATE OF DISCONTINUANCE: If any premium is not paid before the expiration
of the grace period allowed for its payment, this policy shall automatically discontinued with respect to all employees
at the expiration of the grace period, except that if the Employer shall have given the Insurance Company written no-
tice in advance of an earlier date of discontinuance during such grace period, this policy shall discontinue with respect
to all employees as of such earlier date. The Employer shall be liable to the Insurance Company for the premium for
Term Insurance coverage for the time such coverage was in force during the grace period.
If any premium is not paid before the end of the grace period allowed for its payment, the Employer may tender such
premium to the Insurance Company at its Home Office together with interest thereon at the rate of 5% per annum from
its due date to the date of ternder, provided it is tendered not later than thirty-one days after the end of the grace period
allowed for its payment. With respect to each such tender, the Insurance Company shall have the absolute right, in its
own discretion, either to accept or refuse to accept such tender. If such tender is accepted, no discontinuance of this
policy shall be caused by the non-payment of the premium within the grace period.
The Insurance Company reserves the right to discontinue this policy at the end of any policy month when(a) there are
fewer than fifty employees contributing under this policy, or(b) less than seventy-five per cent of the total number of
employees who are then actively working for the Employer and eligible for insurance under this policy are contributing
under this policy; provided that the Insurance Company shall give the Employer at least
intent to discontinue.
SECTION 2. EFFECT OF DISCONTINUANCE: Upon discontinuance of this policy with respect to any employee, any Term In-
surance coverage of such employee shall automatically expire on the date of discontinuance, and no further Paid-Up Insurance
shall be purchased for him under this policy. If the amount of his Paid-Up Insurance in force at date of discontinuance is less
than $100, such Paid-Up Insurance shall be cancelled automatically at date of discontinuance, and the Insurance Company shall
(Continued)
GR-202-3651 AMENDMENT NO. 3 EFFECTIVE MAY 1, 1976
-6-
Hello