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I ' . � ` •' ' ,1 ' ' . . r � � �1 .. 1 ` � � . � . . . ' . r . �': • ' ' , • • ' ' . • ' � • �. ' ' .. �� , ' , .� � . � I .. . � . i e •' ' ' 1 ' � '. ' . , ' , � � ' , . , AG��X�A, � ,. , , � , . �� . . � . � � `. 'Board of Trt�stees of the Emplayges' �enslnn��und , � � � • � .� ,. . � . , � � .January 4; 1993 ' .. ,. , � . , ..,. . , � ; . . � � 9:OOA.M. � ".. , . , . .... , � �� , . � � � , . � � . . 3 . 'Call to arc�er � ' ' � � � 1. 9:25 a.m. � ' . . , , . , . , . � , �. , � . '�'`' . � 2. ° Ap�roval of ��Minutes . . 2. � ApAroved as submitted. � � � ,� �' � � ... . ; � of12/1�/92' ' � . ' � ' � � ',�: � ' ' , .� 3: Req�ast for acceptanc� ' 3. Accepted. � , ; . � ' into membership:. . . , . . , . . , , � ,, . , . . . , � . t . . . . . . ., . � ' . ay Joyce Kirc�toffer . , . � � . . .. � . �� . ' b) Rabe�rt Caidwell � : .. . , .. .. . . . , � .. , .; , � , . �. c! �Balinda L. Westar � , � . � ' , . . : . , � ,. , ; � dj James Atherholt , ,. . � . . . , , . �; . .' e? Timathy R. Becherer ' . . � , : ; - � , ` ' 4, �'ensian(s) to be grarited: � � � 4. � Approved. � � , � Regular . . ' . � � . � . � � Cecil M. Henderson,. Jr. ; , � . �. - � � . � � , 5. Pension(s) tn be granted: ' 5. . Approved. �, . � . � • Joh-Connected Disability � � . ' , . , ' . . � �� , ' � ' J4i�n A, Nichofson . ` . . • ' 6. �ther Business: � ' �. � ❑iSCU558d, ' � � '.'� .. � a1 Request by PAC to discuss � ° , , .Carpentieri� Pension ' � . ' � I 7. Adjaurnment: . , � 7. 10:02 a.m, . 1 � . . , '� • � . ,. ' � ' � •.� . . ' �e: • `.�'� . 4, - � . . . � ' , . �•`. , . ' , - . ' ' - . ' , t., . ,,• }; ?fy.;' i• , , . ,:i •:� . . � > .�, . . , . . .� . ' . , ' � , . ' ' ,, r'� . �. . , ' ' ' t �`�'"''b3l�- • q �1y ' �1 ', d , � ' � � . ;1 �, � ' , . : � � . , . ! � � • .. . ' , . � '' .� . �e(5j[ �.f ` .� ' `; . �� • I . Y' e . '� 1 ' �' ' ' , II ' . . ; . ' . , F. 1� �� i�. �� ' . , . ' , F . . • � � , • '3`�'' . , ' ' . . `. i . r . .� ,. , � ' � �i � . � ' ' . .. ' . . . �e: �j-' �r� . �. . . � . 'e ' , � , . • . . • . . 't, �I.�t � ` .• . . �r�,: � ' .. ' . ' ' ` � . ' . � , ' . . , . ' . � � .. �} . F: ''i . �}' . V . � .j. . .'. . 1 r. . � . • � • . ' � ' � . ..` ' , � ' ' , • , .4, , F .,�. '!�. ' r,' .° �' , . ' . .y , . ' ,i ' . . , ' � �' . . . . � . .. , .,, t,. . f ` �.�. . !j • ' . ' � .. . ' . �i. ' . . , ' . t. .. � , ,'' r•' �4�� ° .f:,:; � . ,i�. � ` � S . . ' . � � . . . � ' �3. , , ' ' , ' , _ . . . t� 'e `( . .' ,9 .`' : �.`. . \' ,t ;1.. .li�r�.. ' � . • ' � .1� , ! I ' . , I, , $ . 'f=: � � }. i. . ' - . � r � . .. , ' . � � . ,�:..t.`..1�` � . , °i� �V.,. � i . .. ° .,. ' , .. , . ; ' ' � , � _ •ii�. `� ��i . ' �. , , � ,f� . , ,. i'.. S_ . .! . . . � . . , . . � . . . . , '�I.,y' , ;', , ,� . ;;.� .. 'r.,�,`;, , ' ' , ' , • ' �. � .. ` �.' . ' ' ' , ' . , . . , . � �t,p4�.o,`� er� � :t',3LVGS�7:1L+ .s.�I'i"t'' +a°s, ..��,. �e . � '°r ' ' ' ' .'e.r�� ::i;� -e� � s�r�,' :'.{�'' ra ,.�F, ' .S •��Is?. eF.�`�1 i.a'C�s3�i_d �1�%�.,��� .yii:A.5'i•r :rM,. , ., o . . ' '':' " ' �!�' , .� ;r��..:.�:,t:' � . . . � . �, r�:.. �i�.t+,� ,,;�n.,.'JC- .... - . ��4t,° �. ,:I .. .. , . , g. .F� � �. , • � , ` ' , , ' ' • , t ' ' `„ , . ; 1 , , . , , �,'� ' ' ' . , . ' , , . ' ' . , , • '. . ., , �� � � , AGENDA � � , . . . . . , � - � . ' Baard af Trustees af the Emplayeos' F�ensior� Fund ' � � � • ' . ' ' , Jan�tary 4, 1993 , � . . - , 9:Q0 A.M. � � � ' � . � � , ��. , .:� ; `, , . • .' " � ' • , � � . � � . , .. � ; .. : � . , i+'. . _ . '.. � 1. ' � Call to urder � . , . . . � : . . , ' � . . ' 2., , Approva) of Minutes , • � , . � o# 121i 41J2 . � ' , . � � i� � ' .�� , , �, . � . � • , ', . ,"; .. : „ 3., _ . Requsst for acceptance � � � � . � , �, , � • , . . .. into�membership:. . � ., ' � . . � � . . . . ' �. � �a1 Jayce Kirchoffer , � , � . ' . � . � . b1 Robert Caldweli � , . . , . � . . � . , ' c1 Beiinda L. Wester � � � , � • � . . � ' ' . . . df Ja�nes At�erholt � � � , I�. � . e} Timothy R. Becherer � ' , � . � . � � :., . . , . � . , � , � =� � 4. F'ensionis} to��e granted: � . � . � � , . R�gular . • � � � � ' ' � � Cecil M. Henderson, Jr. � � � �, � � � . , . ,. � „ 5. ` Pension(s? to b� granted: � � � ` ' � Ja�-Cnnnected Disa�ility � , I . � .. John A. Nicholsan � � ' � � � � '� I� . . , I 6. Other Business: � �. . � ' �? R�quest by �'AC tq discuss � � � �'� Carpentieri Pension • � , ' � � . '7. Adjournment: � , .� � . • � ' , ', �� . . . � � � i ,;� . , . . . ' . ,, , , . . . 3's . . , i I 1 • ' � . 5 � i " ,., , . '. .. 1, , , ' ' `. ' . . . .� . . / . � � • 5�1. ��� • ' . �. ,� ,,,, �� CL�ARWAT�R CITY COrlliMiSSION . � ,� in � agend� C+3ver 161lamorandum c�em N. 7�it'E�.�`'�4 Tf'LiSlCC3 of thc Employccs' Fensi�n �und Meeting Date: 1�/g� SubJact: - � ' � � . N�cmbcrship in Employccs' Pension Plan � ' �ecommendaSi�nlMotion: . Em�r�oycc{s} listed bclow be accepted inta thc Emplayces' Pcnsian Plan as rccommended by the Pcnsion Advisory Comn�itt.ce. ' . , [� and that the approprkate otlicials ba authnrized lo executo same. BACKGROU[�D: � :� � .. _ Seniority D��t./Div. Datc Joyce Kirchoffcr, Staff Assistant I Pub. Wks./Envir. 11 /2/92 Ro�ert �aldwell, Library Asst. i Libraries 9/8/92 Bclinda L. Westcr, M�int.. Worker I ' Parks & Rcc. 12/14/92 JAn�es AEhcrholt� I�ccrcali�n LeAder Pttrks & Rcc. 12/14/92 Timothy R. Becherer, Sanitation Worksr Pub. Wks./Solid Waste 6I15/92 Revfewed by: Legak �%k . . Budget N� Purchasing �¢ R3sk Mgmt, � �" QfS �. �' _.. ACM Other_. N� � . Submltted by: City Manager �� D�tc Pension �ff��tivc 12/2$/92 13/16/92 12/14/92 12/14/92 12/16/42 Orlginating Dept.: �`� `� Costa; N�. Commissian Aation: Human Rcsources Total j� Approved �7 Approved wlcondlUans Uaer Dept.: ❑ Qenied Curre�t FY ❑ Continued ta; Acivertlsed: Oate: Paper: � Nol required Aftected p�rties ❑ Notffied IJ� Not roquired Funding Source: ❑ Capt. Imp. ❑ Operating ❑ Othar Appropriatian Cade; Attachments: ❑ None Lcttcr(s) ' � • • ' . ' • , . : •. : . , . . . � , . � �. „' , ' . ' • - � , � � ' ' � ' � . , , . � � . , , . . , l.''/� , 'l . ' . ' � ' " • , . . • � . . , . ,. � � l! . . � . ' . . � � � . � � � � . ! . . ' , . ' . . . .� � . � . . ' . .' . ' . . • 1 . . . . � . • . . . i� . � ' • � .. 1 . . ' i � � . � ..r ' I . ' ' . • , ' ' , ' i.� ..i .'. , • , . . . i , • ' . . � � 1 . • , . ' . , I t`� � .!, �'''i�. .. ' . ' . 1` ' .' .I`'! i�. , � � , , . ' ' ' ' ; • . . ' 1� t ' . .. . ' .i > • • �.` ' ' I � . � ; • � . . 1 , , 't •' . �j'� . � .. , E ' . :-` i1''SE .f,. _ � . r ' . �.� .. . , . ' � . ' ' . .. . ' � �. .• , . . ''' . .'.tg.� �",• .. . . ' . . . , . � . . �,e�l;.;Y'i;`y`�'�•' ^''� ;i`�',f. ;Sf ��: � s' �t�w�;},e��':, n�r . � ' . , � ;ye'�, . :� ii'.7: :'i� 4 5� �,,. },.�,� 1 - � , . , . , a}'h:'}:.?'.': �},'. ' �?s':E'�It�s.`.S'�,�"�r.,�:.�i?�'�i'il'`:°`�.'(.���t.:n '�.i�ykJ=�, s. �a• t.�'i`1 � .F .. ' . r . <. .. .,�� ..... . . x,... . .�''� .�s: .>. . ,�i"�::�'1:•:^ . �.,,, .,.,-�u..... . � . . . .. ti. . , . .... . . .� ' � . , „ r . .�. .�.� 't• . . � � . � , � .� � . ~ . , ' , • . , ' , • ' . , ' ' ' ' 'i� � . ' ' • ' . , . , . , . , � � . � � CITY OF CLEARWAI'ER � � � � � ' ' , EMPLOYEES' PENSION pLAN • � -� . PENSIQN' ADVi50RY CUMMiTTEE , ;-. � �� i� .. �� `. � '. . u•� 'I� . . Pcn�ion Trustecs � • . , • G��ti . . , , . • HROM: Pensian Advfsory Committee � iw� � � � � SUBJF,G'I': Recommendation far Acccptance into Fension Plan . •.' � DA'iE:. Deccmbcr 15, 1992 ' � • , . . , '; As . Trustces flf the City af CleArwAter Empioyces' I'ensinn Fund, you arc hcreUy. nnti�ed that the cmplayecs listcd . below have hcen duly exttminec! by u lncal pt�ysiciun und enah hns been designated ns n"firat class risk". � These employe�s ttre eligiblc for pension memhcrship ms noked in thc Pension Eligibility D�te column belaw� and it is the recommendntion of the Pension Advisnry Cnrtmmiitce thut ti�ey be � acceptcd inlo membcrship. � .�f4tne. Job. CIa55� & Dcnt./Div. Birth Dgte Joyce , Kirchoffer, Staff � Assistant I, 1/5/�49 Pabiic WorlcslEnviron�mental *Emplayee hired from permaneni part-time to full-time perm�nent status. Hire dnte � reflects date iiired �s permanent part-timc. Robert Cttldwell� Librnry ASSist�nt [, 5115J68 Library *�mploycc hired from permanent part-timc ta ful!-time pennunent status. Hire datc reflects date hired as permanent pnrt-timc. ' Bcii�da L. Wcstcrt Maintenance S/25/65 War�cer I, Parks & Recreation , James Atherholt, Recreatron Leuder, 11/6/b8 P�rks &, Recrentioa Department Timothy R. Becl�erer, Snnitutian 10/1S/59 Worker, Pubiic WarkslUtilitieSlSolid Wuste *E�npinyce hired fro� temparary ta full-time permanent status. Hirc dste reflects date hired as permanent part-timc. � , �tr ' . . - ,. .�. .. ; 1 • - , Hirc Dfltt� 11/2/92 9/8/92 12/ 1 A/92 12/ 14/92 6/15/92 Pensian Llig. . � �12/28/92* ' • 11/1b/92* � 12/l4/92 12/14/92 � 12/16/92* r . . , ` i ' j , � - � ' . . . . � ' . . , S�. _ _ _ _ _ - - 4y . ' . , . .. . � • , . , .r�� ' .� ' , M � . . �,�4��'ti ' . �,�`.,,, s � � �LEARWAT�R CITY COMMlSS�ON � `� ^-� � Age�da Cover Memorandum u�m n .� �:-,_ � 7������� Trt�stees of the Employces' Acnsion Fund Mee�ing t]ate; St��ject: � . � Pcnsion(s) Tn Bc Grantcd � � � pecommendationlMotion: � • EmQloyec(s} li�ted below be grantec# a regt�Iar pcnsion und�r Section{s) 26.34 and/ar 26.37 of the Emp�oyccs' Pe�sian P1an as rccammcnded by the Pensian Advisary Cammittcc. � and that the appropriale afflclals bQ authorizod ta execute same. BACKGRQUND: � ►:� Cecil M. Henderson, Jr., Assistant Director oP Public WorkslEngineerin�, P�blfc Warks D�partment, was ccnployed by the City on August 17, I97p, � and bcgan patticipating in the Pension Plan an that datc, His retirement will he cf%ctive on ]anuary �4, 1993, at thc cnd af the day. ' . R�viev�ed by: Origir�atFng De�t.: E.egai._, u�- Human Res� Budget nJ M P�rchasing �h' „ Uasr Qept.: Rlsk Mgmt.. +`�A'' ois �� ACM �'�- Advertlsed: Other ��- Date: Submltted by: �'aper': (� Hot required Aflecled parties �'.1 Natitied Clty Manager �- �ot requlred ��: ., . Costs: . NR� Comm3ssian ActiAn: Tota1 [] Approved ❑ Appravod wlcanditions Current FY � D�nied � Cantinued to; Funding 5aurc�: ❑ Capt. Imp. U Operaling ❑ Other Appropriation Cada; Attachments: �� None Lettcr(s) Rcqucst Farm ��� � � .�� . - ,� � . ��. - , .�� . � �: . ;.� ;. , � � � , � � � , � . ' . . ( . 1 • . I . . . . � . . 1. . ' , , � ' • . 1 � , � ' � � . • � � . . � ' ' . ' 3� ' . � i , . . ; . . � ' ' . ' . • . . . I . . � � •.l ; . ' . . . . ' . • . � � 1 . . , ' i � � . , . . ' � , � � � r . ' , . ' • � t ' • � i . � t ' ' . < 1 " • . ' � ' � . .;1 � �. . � � c , , ' ' . ' , � .. i • . . ' , ' ; � . . . ' � . . , � ' . . . , . • ��S r.�,� a . � .. . . . � Ifk�...�� a�.�..�i.. i1.i• � . .... , . � .... .. � . .,. � ' . .)`� . . . . � .+' ' � . ' . . ' . � . i , • � � � . ' � ,r} ,� ' r'a c'!e.�i.�r.x<.c�r�7:i�.._._ E -, � :. ; ;.;.-:::.. . ....._ ..; . .........._ , . E . ' � ' AY1tii�.�y��. pe►aonne! pepartmen! 462�fi874 � , . . � . � 1 . ' C I T Y U F C L E A R W A T E I� . POST OFFICE,9Q% 4748 . . � . C[.EARWAT�R, �[.DFi1bA 3n6i8-n7n8 T� Honarablc . Mayor and Members of the City Comrnissinn as Trustces of 'the . Employees' Pcasian Pl�n , FROM: � Pension Advisory -Commiitec , ' � COPiES: Cecil � He�dcrson, Ir.; Dan . Deignun, Assistant Director of Administrutive Service/ Finance � Directoc; Employe�'s �File � � SUBJEGT: Reguler Pension—Cecil M.. Henderson, Jr. - ' DATE: December 16, 1992 � Thc Pcnsion Advisc�ry CommitteG receivcd an applictttian for rcgular pcnsion from Cecil M, Hendersan, Jr., an December , 1992. Mr. Henderson was employed by thc City an . Au�ust 17, 1974, and ha� bccn a�articiQant in the Pension Pian since August 17, Z970. Thc amauni of Mr. Hcnderson's pcnsion will be computed by the Financc Dcpartment at such tirne as his fast �ve years of scrvicc and 58�3C}� ca� be . aalcufated. By motion rnade And duly c�rricd at its meeting of December 16, 1992, the Pension Advisnry Committee appravcd/recammendcd a regular pcnsion based on ycars of service for Ceci1 Henderson, Jr., in Accorda�ce witl� Sectian 26.34 of the City Codc. This p�nsion wil! be effectivc on January �4, I993, at the cnd of the day. I hereby certify that thc Pcr�sion Advisary Cammittee l�as a�pr�vcd thc granting of a regular retiremeni pcnsion for Cecil M. Hendcrson, Tr., and thc al�ove d�tcs are carrcct. , • -�T- M . /�'�i�v'r. �� Chs� rnan, Pension Advisory Comm�ttce .� ('fr.y''".�.:, ' r ,� `�`���f:�tF . "�qual �mp�oyment and Aflirmative Actian �mployor" --- � .. -- - �.�, � �' � ,,. � � � ' , •• , , . , , - � , . • ., �.t . , . . �� , � , . t. .. � , . � . • � . , , �'. . . : " . , . , e . . f � � ' � ' , , . ��ti . , ,.... � i�•�r� . ., , . ... . ' ' .' . , . , . .. . . . ' . , . . . , • , . . , . , , + , . . . , J �.. � . ' � PENSI4N REQUEST F4RM ;� ' Cec�.a. M. Henderson, .Tr. do hereby apply for ratircment � fxam the City of CIearwater Gencra� , Emp�oyc�s' Pcusiaa Pl�. � M benef�� dats is Augu�t 17 � 1970 y tEntr7 date into pcasion , plan) " My �lat� af hire is Augc�st �7, 197D � � . My birthd�y is August � 3I, 1937 ,. . My job �lassifi�atipn i� A$st, Di.r. o� Pub. Wks. /Engineering �d I work • irx t�e �'���i� w°'��s Department. Division. January 4, 1993 M y resignatian date is ' Tbe iype of peztsion Cor which I am app[ying is (check only oncy: , X Regular Ptnsian based on years of scrvice. ' � ,�ob-con�ected Disa�ititr peasiaa . Noa-sob-conncct�d Diszh'sl':tr Aeasioa My spvuse's aar�e ia; Linda S: � Dcpc�dent ct�i�dre� under tht age of 1R and residiag in miy haLLsehald �re: . (Prittt Chi2d's Fuli Name) � � (Child's I7ate cf Air�h) r � I bereby ctrufy a!1 af thc above t� bc true and correct: � . .,Q.G(� / � , � D��cem�er� 1, 1992 � ' Gc.Kit � i�� � � f Date� . (Notary Public) � �}TXRy pt1BLIC STA'i� OF FL�gg� 1i CO�+�SISSIQlf �XP SEPT,24, . B�O�D THRtI 6£I€R1U. IttS. lilifl. , , , �-- �. , '� , , ,� , �• . � � _ 0 ,� . � � � . , .. � _' , .. . , i �� , 3 . ., . . . �. . �,: , . � , . . , . .. , / ' .. ' � � . . . . 1 ' . `I . . , � . • ' " �. . . . . . . . . � . � , �' �.r .�.�I " . ``t" lf1. '�o . .. • • � ' .. � � ! • . • � . . A � �, . � .. . ' ._ , u , � . . , I , �� � - CITX E}F CLEAR�VATER � � � ' GEMERA�L EMPLOI'E�S' P�I'�5IQN PLAN . � QP'TiONS .- GEN'�RA�, EMP�.OY�ES ' � ' � dPTION #].: Employces ca� rccci�c a lump sum gaymcnt f4r ' � � vacation and haliday pay and 112 at� accrucd sick lcavc , � at tlie timc of se�aration from the City. Thcre wii� bc no , , 8�'n dcdc�ccian %r �c�siorz frocu this lump sum payme�t ,� . aor wi[1 t�is amount counc as eamings ia thc • '. ' ca.fculatian� of thc pcnsian. The last day af work wii� bc ' the termination datc and �pcnsion bcncfits wilt bcgi�t . � ' the following day. � OP7I�N #'Z: � � Employec can cxtend cermiaatian date by lhc timc duc (Oaly availabta to for vac�tio�, holiday p�y, and I/z of accrocd sick leave. em�iayess hRred Tcrmiria�ion datc will bc the fnal day of extendcd time, prior to I0/1l9Q) Pensiort benefics wi2� bc�in the fo2lowir�� day. 1rrr�N�kf1��Mi�i�f�*�fi*�Yi�Y�i��t*�rYMiG ' Y� Cecil M. Hsndersan, .7r. , 3t� cr�ploycc of �he City of i ' � � � Cl�arwater. hereby apply far pensivn beneiits under thc General �mployces' Per�sion Plan. � . i hercby certify that I futly �ndcrstaad thc two o�tians offered to ma. t choose io retirc using Qption # Z ar�d wish my . bcac�ts ta be calcula�ed u�dec fhis option. r I undcrsta�d that once this forr�z is sig�acd, my �ccisi �s inevo ab�e , � � � EMPLOYEE'S SIGNAT[JAE:_ � �SOCIAL SECUItITY #: ��5—�0-1613 ADDRESS: _' 1�i66 North Hibiscus Str�et . �� 5� Cl.earwater, FL 34615 . � - � DATE: _ December 1 � 199z � • ' , �. R �« . . . . ..�w� r � �. ' � . ' . . ; �� t A . , . . , , ' F , . , . . . ' , • .� . ' ' f' . ' ' ' • � � ' . , . i � . . . , i � . , ' .. � , . ' � . � 1�.. " ' . +. � ' • � ' ' ' , � ' . { ; •' . . . '" . . ' 1 ' . ' ., , ' . ' , 1 • . � • � . . ' ' . . , F• , � � ' . ' � ` 3 ° t�ti a • ..i , . _ ' ' . . . . " . � , • . '�'.. . . . . .P.'.l:�t�.e .c. . �'.�f�..til'Yre,.. ...... . . . . . ' . ... .�,. .. . . ' .. . . . . ., . . , ... � ' � . . . .5i� . i� ' . � :� , ny�l S r . � ' '. '£''il!/1.� I/.i7�is�if:� �TjY�+� ! . ' . A• . .. .� , •�1 f� • . . . ' , �j�, w'�r 1�i."�, . i, . , , � , . • � , , . .. .. � . "1' ''. � :;°��:.i��� Y�lf�� . � ' . .. . . ' . . , . . , . . ... "�". . • . . ..- . . �A.}'.i1{'.f:4fv�+��.� ' �, . � r . , .T.�r...r��R�, �y. . , +� , . . . •; ,. ._,:,� . . ��� . a' �. �'zr'f�i� *. i . '}" ' ' ' r . �� � `, . . . � ' � S ' � . .�.t 'r �.4� ' ' , . '! ' 'A . c ` � I �.. �' .'.S!.����i'j 1� �A. :'}:� � -:' ,,.. <� ,�., .z.. . _ <'' :t° , . . , . , , , , , , . •• � .. '`.,:r�'+�7�t#��" �',�: : � �. .. . . ^:.��::.�:��` � ; , . , . ; .. . . �, � . . . �'����TY �[]F. .� CLEAR'VIIATE�i. . .:.zr;ri ��, +:��,�:����� i , : . ,. . , ', � � . • � � ... , . ��.� • :�-rw.�ir.�r.4"'f�- , �.. Inte�departmental Corcespondence 5hset �'� '""�`�"'�'�� � _ -�r'� �1��� � ' .. �`i�" ;34' . ., � . , :f�:: � . ' . °. ' . ..Y::d�'�� L�!� . . . . ;f`' � .. .. . . . - . , ' .. . . , .i , . . . � ,' i . . � � '�.�; : .:s",,,7 �r�.;'s'�i' I.. . ' . � • . ., . .. . . . . � . `,1 ��`.f��:e , i� '-'�•��{..4 << , .� . ,..'� M'schaci Wright. City Manager' ; . • : �. . �- �. . . .. _ . . -- '«•�7���7��,�� . i�� .,.. . . �. - .. . • • , ' .. ,. . � . .':tz��':,r • � • FROM: H: Michacl Lanrsea. Sccretary� to the Pension Advisnry Cammitte� . . ����. ��� . � � � , . , , . . , t. .. ... . ,'.;=, :-_ :�;�; , • ` . , .: .. .. . . . . w.�.�:: . . . *. . . . � .CUPIF.S: Kathy Ri�a. Dcpnty City Managcr Pension Advisory Commiuec �. �.. � � . , ,�_ , • � •� . � � , �,. , - ' � � ,. , SUB�CT: Discussion Bcfvrc Trnscccs ,Regazding Arthur C�rpondori Decision � � . . . ; , � � . . . . � _. ' . � DATE: De�embor lb, 1992 . -� � . � . • ' 1 � • . • . . ` ° �, � ;, ., At its regular � meeting today, thc Pansioa Advisory Committc� capresscd its dcsirc .to , �'� appcar before thc Tcustees � as a committee to dESCUSS the m�tter af �� Art��r Car�c�iieri's rcquest to � chan$c his rcgular pensian to a job-connccted disability pensiou. � , :' Pleasc have this placed an the agcnda as a disc�ssion item for the Trustees' meeting to b� � on M��a,siay. uary 4. I993. � � . � . � � . r HML/dlf i ..��.'C,i '' .. � . � . . .F� .t. .. " ' . ' • , '. � ' . , , � 1 . /` .�ll {� * � r� s . � •� . ; n� �� . � �°�C.��9 rg � C! �•y C r ���. . L��k � . . �a►� �a�w.. � F�.OF�IQA Q�PAR7M�N7 OF 1.A8E?F� AND EMPLOYMENT SECURlTY .IA �c�j� ; i�.f�1�;,����:- DIV1510N Q� WONK�FiS' GOMPENSATiON � ;.� :.AOO•3tz•t74: w contact s�.� �,�,...� �.� � i 1 y�cx Weal otface �ar assf�ta�ce r,,,, �t :,,.„rt�� :� N01'ICE +DF INJURY �. � vr•: r;. ,'•v . Fleport ail de�lhs wkthin 2d hour� (904) 488•3044. , r, � _.; �:�,���.'�, LL 3�::� � 3 APR 2 3 4�91 �t. � FOR CAFIRI�R'S �AT� Sl'l1MP REC'D BY CAF�q1ER SENT TO �II(ISION �:� •r R�C�4WED ,,�� , /ti`, , � �� �4 , .'.. `�� APR 2 7 199, � • � .,•' '. Ni'�1� �i,s �ittis _ ,' NC. ' ��A#�l.OYEA INFO�ih1AT10N FlRM'S I�AAdE pNU AQOFE55 ._._.,� _.. --_ -f�OENAL f.D. fVUMB�R ---- •[�i$ AND 7Fki� FlFiS'F REPOA7FD 4ity o� Cleartva�er, Dept;. �.22q 5- � P. O. Bi7X �%�� W.C. COVERAGE 6Y AOLfCYl1.TEMBEA NU/YtB�fi C1 earwater, F�. 3��18 w �N�ur�+�c� co. 's�t�•WSUREp NAME. ADQF�55, iFE.EPHQNE OF t�pHON� INSURIWC� CO. QR S�RV1C� CQi�IPANY WILL YOU CONiR�tJE TO PAY - �••c�•__8,�3;'�' !4_b2- ,1ai�ns �astern Compeny, �Kc. 5AlApY� [�tr�s nt� P�..ac� oF �cC�O�rtr i5�reef G�ry. Co�mry, Staley post OFfice BOx 33 � 8 IAST pAY PAIU TFiR0UG1�1 1%00 i� .�� � G�fET` i�� . 5ara�cta, Fi. 3423Q : r C�earwat�r, FL {pinelias) I-eoo-749-3�4 RATEO�PAY ❑HR �wx N.4ME. .�naA�S5 ANn 7EL�PHONE S-),.Z.�Z�ER ❑ OVlY = J�10 pF PFiY51ClAN OR H05P17A1. t�lumt�r t�urs a��d�v blWile Qlq THE EMP{.OYEE }(lJOWINGI'/ qEFUS� T� US� A SAFET'f ?�1�rto n P l a n t Flos p i ta 1 N�� �+ � �- ApPtTANCE PFiWtb�p F3Y 1'CA,I. TTi� �MF�LGY�H7 G YES (� N� per wnek }�•�1 323 Jeffords Street +����d� �ATE EMPLt7YFD LASi OJ1T� E1�+IPLOYE� WORKEO per week OI � l.5 r 73 04 ! 2D! 92 C3earwat�r, FL �ror-oAO�r��rNru�r AFTURN@0 1U WOFiK � Y�S [�(NO �U7HORlZEa BY EMP�4YEH YE5 ❑ NO YE5 IVO ❑ IF vES. G1VE DATE t IOCATIpN AOpRESS ` 'NAS 1N.flJI�Y FATAL7 � YC5 �'J(NQ iF v�"o. (ilVC OA� E CF DE.��H 1 l ILOC�TION I , IF APF'L:C�BLE) AGAE�'Nl7H O��CRIP�IDN OF iCG1DE1�FT7 HAT�RE OF BUSINESS = YE5 C] NO tF Np ATTACH EXPLANAT117N Any �ersen who, �[npwmgly an� wrth mtffrti t0 �rtj[lrc1, dafrac�d w Cecaive arry ��rrpb}�ar ar smployea, fnsutnnts [ompsny ot snll•i4sured Droqratri. Nea try elmer,,onf d c'a�m cont�minq any �El�a ar rrnslabai�q intormalbn h qu�Ny of a Ielony of !he thkd degrre. i hav�n prav,ded 1ho en►dayee the�r copy a� thla notlCe: [: in Pc�sa� �(B lls+►-- tdnt Av_� i l ah3 a�nr S.�Lld.�llrP -�'�J/ � � � T�..G� !� --- �MFCtfYEc SiQN4TUfiE rf n�a ks �qn� LLliE E1dPlD''�EA SKS1tATURE OAi� CAFiF�IEFi ItVFOFiMATlC7� ci` .. Carrier Audii i� � ���� Lacalia� +� Service Co. � D 4� Carner F'i1e +1 "� ��� L;. !. Cantrvverting Case-{}VJGt2, NOT1C� OF D�NIAI� ATTACHEO e� r �2. losi 13me Casn-Da!e ot Firs! Raymenl � �°L�'?�WW !p 3$`��Comp Rale ��� First day ai disahi4ty �� Z4 �� z' -Date al Frsl Contecl wil� Claimani.�� ���C.. In Ferson ❑ Telephone Mail -Nn�ice �i1ed que to Multiple Periads ol Disabi�tty, pales Covered by �irst Payment z'S �� S � �� , �D. �.1 T.P.D. Dale Form Rec'd. l � Q Cataslraphic C� F'.7,D. Gi Geath � 3. Medical4nlv whic h trecame a Lost 1'3rn� Gns4. (Cnmp�ete aN i�formation in ilem 2 aCove} ��M.aRKS: .� � - --- -- ----- A0,IUSTEp 5lGNATURE � rn r...... �rv� i�� ai� GAAHi�R NAM�. AppHF55 � 7ELEPHONE; � v2R�avJ� nn��:'�� � i� �: . :. . _.. :��� �:;�., ���:. IJ, � .'. t�•!'.: :c�� i � �arasoSa, �� 3�";;� _ ° Cs��� �57-aoat . ..,.�.�,..� i nr+r�.i � 1 Q ��'i�y� ' ��f.{ •�, ' , � , � • 1' � • . ` .� ' . � ' . . . ' � . [ . � ' "• . � � � . ' . . � i � ' � ' . . . ' '� , •.� , • . ' � . ; ' . . . .. , ' . � � ' • , ' . � . r. ; ' . � ' � . , . . ' �, . . . , , .. t , . . . , ' r , . .. . • . . . ' , � �. +� . . L , . • � ' • 1, � ' ' • � , . . ' ^ . � , � . 1 ' �� . ' 1 .. . . ' . �� • . , . . ' . ' , . ' . , 1.. . ' I' , �' , - � f � . . , i . :j�. .. ' ' t`i, ' , ' .. 7, , ' ` .'. 1 � . ' � � ' ' � . 1 �, , . 1 ,4 ' 7`' '4, :., .. • .. . ��F�•� '.I(' '�l., . " ' , : �I .. �I � � ; . • � ' � •� � •' � .. , . ' ' � , . , ; ' ,. '. ' r' .. • ..' . , � r . . � rt,'. . . - . ,.�;. . ' ,', . . � � � � .. . , ' . ' .. , ' � , . ' , . `. ' F-' . li i " 1� i. .'�` �. .�f�1 ' • ' . . . �` . I re . � • , � ' I • . ' r , ' � . . 1 � ' . , . . ' . ' �F r ,: . ' . . � , ' . . . ��* r .... ..'.Y•a��s�': . j`r:�:r�lf{:!'1'k`f�"=��''ii�hswr�..w._.... . .. � � .. .. . � � � . . t'' �.' r . � . � � , . . . , � ; . . . . . ... '�I i "d'. • . .« . . , ....... ... � ... .. , . . � ' � i � � � � Ct�arwater Cardiovascular Consu�tants � • ' . � ' 1100 Clearwat¢r-Lnrgo Road � � ' . ' � � , . l..nrga Florida 3�36�nW-+413i . � , • �� ,. • . ����� ����`F . . ' Dont�ld R. �ubnnl�s, M.f). �' � Michaal D., Wii�amscn, M.D. ` � . �� Paul L. PhiUips. M.D �' ; . . . ,.`; ' . � ' , Jose L. Gallastegul, M.D. • - • Dougl�'J. Spriggs, M.D. ' ' � . Vanessa d. LucarellA, M.D. . .� � . � December 14 , ' 199 2 , , � � . . . . .'�T� WHOM IT MAY CQNCERN: ' . , , . . Re: Mr. Jahn A. Nicho].son � � �• SS#: ., 2b7-84--5b87 , �, �This� letter.�is to verify that Mr. John Nicholson susta3.ned a myacardi.al infarction in April ot 3.992. He has had xeft ventriau],ar dysfunct;ian �nd evidence oE an abnormal stress Thallium 'study two months after his inf�rction, I�consider him � to be tota�.�.y and ; permanently disable. Mr. � Nicho].son is compl.ete3.y unemp�oyab].e and most �defini.te�y would not be able to perform the rigorous and str�ssfu�. functions demanded being empioyed as a�ire�ighter. � Please�:Eind recnrds enclosed, . . If x may.prov3.de any �urther information nr assistance, p�ease do not hesi�ate ta contact me. SincerPly, , � . Paul, L. Phillips, M.D. � � PLP/ldr Enc�osures . ' � a ..«. . .� � ,� . , . , . ---__-�_____�..._..._.._..,..�,.. : . , , . . � . . . , . . , ; . . . ; . , , � . . � . . . . , : , ' , • � . . � ' . �. ` ' . ' � . �._ : , . � � � . .' ' . � � � . . . � . ; . ..• . , , . , .. , . ; �,- . , � •. ' . , � ' � ' ' r' � , ' ' � � . . r • i ' ' . . � 't i ' . . . • . � � . � . , r . ' • ' � ' • . . "I ,' 11 . - , � ' • � , ' � ' � , ' .� ! . 1 � , • ' . . . ' . ' ' Is {� . , , . �. ' � .1 . ` . � , ' . . . ' . • T.� � . � . • •• . . . I � . . . . 11i1` . .�,. i. .,.......r�.l'. r . . � . ' ..�-.i.., .. . . .�.. ...� .. . s . . '' •` . � i ...•. . ,. , .,, . • . • ' i�racl��iltn�i . . , , ` , � ,' � .. ,I ^ i::ta�cliulu�y , , . � .� :. . Crnl�r . , . , . , . , ; . . , � . •• , i • :'tY:1 Ilti�il Av►�iun� I.,i!�I . , . . ' i Ilisi+ittuliat. I 1��ui,� :I�t?r111 , � ' } t��l�•plum�,� 111:!!l•11f ::'t! � • , � - . I . . . E , � . i . , • ` ,Novemyez �0� 1�97 ' ' � ' , � ' ' � � � �Ta Wh�m �t Mzy Concern: � . . .' � , . � , � , . " �Re: Mr. John Nichalson � � , . � ' . . ' , � + . ' �. h1r. N�c:lio3.soi� has 1u�en evalua�ecl in aur ot�ic� i'oz � � ' 11i�� atherosc�,exotic heart cli�seas�, ise yu�t�rec} an . � acutc inLerior wal� myac�zdia]. inCa�rc�ion an Apr�]. ' � . ?.0, .3��2. �v��.ua�aon s.incc thaL- 1:.ime i�as ,r�vealed . . � L•1YC 2�res�f�ce o� scar ti.�sue oL tl�e inic�rior wali ' �i�c3 al�o �ame rev�rsik�l,e i.�cl�emia ov�r..ttle inCerior ' ' ' wa13. oX �11e �vet7�11,c1e. 3'his sGar tissue anQ �iyocarciiai. dantiay� is �aermariet��:. �:,��.�„�ti .��„�� �.r�� � n� � �•�itli Ctia aluove cc,i:orary ai�cry c�ise�sc 1te is �.. ..r� ri.�..�.. �ti� i n� . ► r,.,,�..,.� 1�,. ., �a�, ��,� , � n� ,• u��3V�.e t;a rc:i:urn �0 11i� u�ual, l.iiie a,C work as a .•u..�„� ,'.""�." ►„' � �• ` tire[igiiCer. (se is perma�icsi��y �tist�ulec� �roi�s hi� • � �. �. i � . �. ,.., �.t i � � � ca��iac �oncla.ti.vn to rel:urn t�r� fir�fiy}�tiny as a �.�.„��,� ..� ,,.�..�.,,; ,, ,,, �,,,,,,,,, ,,,,,, I�roLc��ion. . i� . , , . ,. � .����.. � ..�� n i ,�. �' .",•.'���..��'�"�,"� xL• 4:a may� �nswer ariy yues��ons, �c1Q naL l3esi.�ate L•o �:al l us . � �ince� el.y, � • � �,.r.».. .... .,.�„ . . � , /-_�.�.... . . � . k�;..., � _ . . . . nik�erto �. rio,��alvo, r�.D., r•.n.c.c..� 11L'M/th ' � . � cc.: Mr. John Ki.cholson , . . � . � . . , �. ' � � �n r ' . ' ' ' 1 . . . i , . , . , ' • i � . • ' . . , ' , ' ' ' � e . . . , ' r � .. ' , . ' ., . � .r � . i . . . � . s ', ' , . . ' � . . ' � � ' , . , � . . . ' � � . � ° �� � ' � . . . , . . '!.•:�tn... .., r'4�. � . ' .'�" {qla.ta�r�.:h3. � . . . ' . ' . . • — , .. .. . . . . � . � . . ( . , ' .. . . , . � CITY 4F C�EARWATER � � � � � � � . � � GEN�RAL EMPLOYEES' PENSI4N PLA,N. ' � � � � OPT�ONS - FIREFIGHTERS . � .' � OPTiON #1: , E�ploy�cs can rcceive a lump snm payment far � . ' vacatioa and holiday pay �nd I/2 of accnied sicl� Ieavc . � at t�e tim�e of sepazatian fmm thc City. Thcre wiil ��c ao . �� . ' S%n dcductian� for peusion froin this t�mp sum paymcnt . ,' . nor will this amount count as earnings in thc � � ca�cuiation of thc pensinu. Thc last day of work wi1[ be � , the termiriatian datc and pcnsio� beucfits will begin ' . . ' � . . ' � ` the follawing day. . OPTI�N #2: Emplflyee can extcnd termi�atian date by the timc ditc • {���p av�ilab�� to for vacauan, ho�ic�ay pay, and Z/Z of . accrved sicl: leavc. � employees , hirec� Termination datc will be the fnal day of cxtendcd timc. . prior to IO11188y �ension bencf'sts will �cgia thc fot�owir�g d�:y. ****�******�*******:�**** � ' i, ,Tohn A. Nicholson ��a �mp�ay�� �F thc City nE Clcarwatcr, hereby apply far pcnsion bcnefits undcr thc Gcaeral �cnpioyecs' Pcnsion Plan. �� I hcreby ccrtify that I fully un�derstand the �wo 4ptions offercd to me. I ct�oose to retire usin� Optian # 2 aad wisb niy bene�ts ta be calculatcd under ' � this optian. I ttnd�rstan� titat once this form is signcd, my decision is irrevoCable�. EMPL�YEE'S SIGNATURE:_ l -/ � � SOCIAL SECURITY #•_._ _2b��84-5b87 � DD�ESS•,;.. �1�� �°"n�ry G1ub Way, �1201 r _ I � SarasoCa, FL 34243 • "� DATE: _ �°vember 30, 1992 � �.; . , . . �� . i � � ' � .� � . , ' . . . • ' . . „ � . i ' . ' . . . . r ' . � . . . . , , ' ' .' � , . .. ` , . . ' . � .. � . � ' , x:h�,� � ' ' I ' . . , ' ' • . . � r . .. ..��� ... . . «. - , . . . �., .. . ' � . . .. . . ' , , '�' � o'. ,, ' .. � . �p , � . PENSION REQUEST FQRM ; , • � I, John A. N�.chalson d4 hcrcby ap�ly for recrrcmcnt � irom tttc � Ci[y nf Clc�rwatcr Genera! Emplayccs' Per�sion P1an, ' � � ,My benefits dttte is ' 1��$��� (Entry� date into pension ptanl My date o� hire is _ 1I15/73^ , �.w,�. , , My birthday i� iU/Ifl147 � . Firefighter My �ab classi�c�tion is and I work ,' ' , .��� �'ire Department, � D i v is i o n. M y• resign�tiqn d�te is �° �� d�termined • . The type of pettsion i'a� which I am apply�ag is (c�ecfs only anC): � � Regnl�r Pensias� based oa years of service - x 3ob-coanectcd Disab�lity Pen�ioa � . ' Nna-jab-ean�ecsed Disa6ility Peasion ' . My spo�s�'s ua�e is: E].�.en �. � Dependent children under the age of 18 and residing i�� my �iousc�old are: • Mary Katixerine � Nov�;mber 25, 1492 (Print Ci�ild's Fuil Name) (Child's Date of �Binh� ' I herrby certify �11 of the a�uve to b� we and correcc: � � � ���� � �d � � ovember? 3Q � 1992 r Jl �� �� �� (Date) (J�,/t ���N���ar�• �ublic} : � rioram vu�x-ic s�A�� � �LOat�� . . . �!at �a �s�� �i�a� ii 's a��o � " � F � ' ,� , ; � ' . : , . . . ; . '. � . �, •. . '', , , , ' . ' • ' . , - , ' ..' , ,' . ' ..,: . ' . . ,. . , f�. . ., , . "� � � ' : � ' T''i.. .. �. � . 1' . . � , .y��:, . ' �n..l� . ."YP�1 — �_!.>. . . . . ', ), J. . ' ' . , . ... : . 1 • ' i. •-��G� riirf"i fl'�!'�''i.,,....... � . . i , • I ---.=; ..... � 54t �)�;'�i Punsonnel Dopanment ' 4fi2�970 C I T Y . ' • f ' , ' t 1 . . • , i O F C Y� L A R W.A �` �� NQST OFFIC� g4X 4740 CLEAfiWA7ER, FLf)RIpA 3481a•aTae 'I� I-Ianorublc Mayor and Membc�rs of the City Commission as Trustccs af thc � Employecs' Pensinn Plan • FRQM: P�nsion Advisory Coms�iitce � ` G'4PIES: John A. Nicholson; Ri�k Management; Dan Deignar�, Assistant Dircctor af � � Admin'sstrativc Services/Fin�ncc �irecior; Employee's Filc. SUBJECT: Pension for Joh�; A. Nicholson--,�nb-Connected Disability Pcnsio�i � ' DATE: Deccmbcr l6, 1992 � The Pcnsion Advisory Committce (PAC) receivcd an �pplicativn i'or disability pcnsio� from Jahn A. Nicholsan on Novcrnber 3U, 1992. Mr. Nicholsan has bc�n dctcrrnincd by the Pension Ativisory Carrimittce to mcct t�c requirements af E�e Pensian Flan for a job-cannecic� dis�hility pension. He was cmplaycd by tt�e City an January 15, 1973, Qnd bcgan p�rt.icipating in tlic Pcnsion PIAn nn 3anuary � 1S, 1973, Further, hc has submitted medi��l documentation, copies of which are attached, r�lative ta ris disability which htts t�ecn rcvi�wcd and approv�d by thc PAC. By mation made � and. ciuly carried at its mecting af Dccecnber lb, 199Z, thc Pcnsion Advisory Commettec approved/rcc�mrttendcd tlle granting of a,�ob-connec�cd disnbisily pension to Mr. NichoIsan it� accordance with provisions of Section 26.35 of the Cily Codc. This pcnsion is i� be effective on u date to be dctcrmined. The �mount of Mr. Nicholson's pcnsion will bc calculated by thc �'inancc Department According to chc formula in tf�c Pension Plan for job-connnccted disAbility pension at such time as his l�st iive ycars of service and salary cun t�c computcci. I hcrcby certify tha� t�c Pcnsion Advisory Committec has approvec�, thc granting of a job-car�nect�ct diss�bility pension #'or John A. Nichnlsan and the abnve datcs are corrcct. . � ,+ / ��Ch ir rian, Pcns�on" Advisory Cbmmittcc r ' ' . J /►'1• l��frN2 �',�'y4�� � , .,s�f���:/ "�quaf �mploymenl and Aflirmative Action Employer" �-� 3 � . ,�������" R �L�ARVYATEA Cl7Y C0�11M1SS10N . �, �r �, � � Agonda CovPr Nl�mor�ndum ue�, � � 4�g3 y�'�liEA��'Q� � Trustccs of � thc Employccs' Pcnsion Fund �eeting Date: Subject: , � Pcns�on(s) Ta Bc Grantcd � . � RecommendatianlMotfon; 7ohn A. Nichalson, Firef'tghtcr, Firc DcpmrtmGnt, be grttntcc# u job-conn�ctcd disability pensian under Scction(s) 26.35 vf thc Employccs` Pcnsion Plan as recommcnde� 6y t�e Pcnsion Advisory Cnmmiltcc. �: ar�d th�! ths apprapriate olticfals be authorizet! ta execute s�me. BACKGRDUND: � John A. Nicholst�n, Firefighter, Fire Depariment, was cmploycd 6y the City as a Firefighter on January 15, I973, and beg�n participating in t�e Employecs' Pe�sion Plan o�n ��tnuary 15, 1973. He suffcrcd A heart attac3� on April 20, 19�2, whilc on duty. I3e is rcqucsling a job-cannected disabiiity pension bASed nn h�s hcart prabtesn wt�ich res�Ited from the att�ek t�c suffcred while on� duty. � Mr. N�chalson has submitt�d letters from Dr. Albcrtn E. Ma�talvo, dated Novcmbcr 10, 1992, and Dr. Pani L. Phiflips, dated DCCesn�icr 14, 1992, in suppan of his rcguest t'ar a job-conncctcd disahility pension, Th� �etier frflm Ur. Phiilips slates that Mr. Nicholson "suslaincd a myucardiAl infarction...] consider him to bc tatally t�rtd �erntunently disat�Ie..,compietcly uncmployablc and most dcfinilely woUld noi bc ab�c ta perform the rigoro�s and siressf�l functions dernandcd bci�g cntplayed as a fireCghter...." Dr. IMontalvo's lett�r states thnt "He suffercd an acute infcrior w�l] mys�cardia� infarckic�n...With thc abovc corortary aRery c�iscasc, k�e is unable to reit�rn to ttis �sual line of work as a fire��htcr, '1-ie is pernianeatly disabled...." Undcr tt�e Florida "presumption" law, any heart or lung problems suffered by a�'ire�ghter is presumed ta bc jnb-rclated. Mr. Nic6olson's disability pcnsion was appraved by tt�e Pension advisory Co�rimittse �t its meeti�g of December 16, 1992. Based an an average salary of approximatcly $35,129 ovcr t,he past fivc ycars and the scventy-Eive p�rccnt {75%) mit�imum disability Ucne�'it, Mr. Nictyolson's pcnsion will a�proximata $26.347 annually. Charts from Finance which take into consideratidn mortaliiy rates and age reflect the "prescnt vajue �cost of �nancing" ihis pension will be approximatcly $294,713. Mr. Nicholsar� h�s ane ch'sfd u�ader thc age of 18; and, thcrcforc, tt�e dcpendent child supplcmcnt io thc pcnsio� will be grovided i'or i�yis child. Re�i�weci by: �.e�a� _�l !.� .- Budget � �I�- Purchasing �- Risk Mgmt. �� pES ACM ..� Other � �- 5ubmitte�d by: Clty Mpnager _, . Originai[ng []ept.:j� I Casts: Humun Resoarccs User Dept.: �ld�eni�ed: Qato: Paper: [� Nnt required Alfecled parties ❑ f�ofified � iVat required 7otal Cc�rrertt FY �uitding 5ource: �� Cppt. 1mp. L1 Opernting �� Qther Appropriation Coda: Cnmmisslon Actiarr: [wl Approved {� Approved wlconditio�s C� Denied C� Conll�usd tn: _ Attachments: � None Lcttcr(s) Rc4ucst Form