07-18-1994r= r t •'t} '?1 I t 1 I• f ? . I r t! I ? ? .. 1 '
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.. ACTION AGENDA'
Y Board of Trustees of the Employees' Pension Fund
Monday, July 18, 1994
:t.;. 9:00 A.M.'
Call to order 1. 12:16 p.m.. '
2. Approval of Minutes 2. Approved as submitted.'
of 6114194
., 3. Request for acceptance '3. Approved, .
into membership:
a) William Keeley :. '
b) .Carl Conyers
c) Anjanetta Newton ,
d) Todd S. Johnson
e) Roberto F. Beruvides
f} Sharon Goff
g) Ralph Hodge
h) Donald Hlinka
i) James Hornaday
j) Anthony Pittaluga ' '
' k) Scott Shore'
' 1) Anna Rowell
m) Nathan Ballouz
n) Carmine Tripi
4. Regular Pension to be granted: 4. Granted. ;
Ronald Luchan
5. Non-Job-Connected Disability 5. Granted.
Pension to be granted:
. James Mosley
' 6. Other Business: 6. None.
7. Adjournment: 7. 12:17 p.m..
..
Seniority Pension
12ept./12L Date Effecttu _ Date
Central Permitting 5/31194 5131194
Police 5131194 5/31/94
Police 7113192 5/3 1 /94
Police 5/31 /94 5131194
Police 5131 /94 513 1194
Human Relations 3125191 5/20/94
Library 413189 5/16/94
Gas 6/ 13/94 6/ 13194
Gas 6/ 1 3/94 6/ 13/94
Police 5/3 1 /94 5/31 /94
Fire 5/ 16194 5116194
Fire 5116194 5116/94
Fire 5/16/94 5116/94
Pub. Wks./Solid Waste 6113/94 6113/94
TRUSTEES OF THE EMPLOYEES' PENSION FUND item #
Agenda Coyer Memorandum Meeting Date: 71.1?
'
:s
Subject:
Membership in Employees' Pension Plan
Recommendation/Motion:
i. Employee(s) listed below be accepted into the Employees' Pension Plan as recommended by the
Pension Advisory Committee.
? and that the appropriate officials be authorized to execute same.
BACKGROUND:
Name a
William Keeley, Bidg. Inspector I
Carl Conyers, Police Recruit II
Anjanetta Newton, Police Recruit I
Todd S. Johnson, Police Recruit 11
Roberto F. Beruvides, Police Recruit 11
Sharon Goff, Staff Assistant I
Ralph Hodge, Library Assistant I
Donald Hlinka, Gas Technician I
James Hornaday, Gas Technician I
Anthony Pittaluga, Police Recruit IT
Scott Shore, Firefighter
Anna Rowell, Firefighter
Nathan Ballouz, Firefighter
Carmine Tripi, Solid Waste Equip. Oper.
Reviewed by:
Legal NA_
Budget NA_
Purchasing
Risk Mgmt. -NA-
Cis __ NA-
L
ACM
Other NA
Submitted by:
Citv Manaec
Originating Dept: Costs: Commission Action:
Human Resources Total
? Approved
? Approved w/conditions
User Dept.: Current FY ? Denied
? Continued to:
Advertised:
Dine:
Paper:
Not required
Affected parties
Notified
Not required
Funding Source:
? Capt. insp.
? Operating
? Other _
Appropriation Code:
Attachments:
Letter(s)
? None
L,,
CITY, OF CLEARWATER
EMPLOYEES' PENSION PLAN
's PENSION ADVISORY COMMITTEE
TO. Pension Trustees
FROM: Pension Advisory Committee
SUBJECT: Recommendation for Acceptance into Pension Plan
"' . DATE: June 15, 1994
As Trustees of the City of Clearwater Employees' Pension Fund, you are hereby notified that the
employee(s) listed. below have been duly examined by a local physician and each has been .
designated as a "first class risk".
'T'hese employees are eligible for pension membership as noted in the Pension Eligibility Date
column below, and it is the recommendation of the Pensi on Advisory' Committee that they be
accepted into membership.
Pension 13lig.
Nam 'v, Birth Date Hire Date ?Lx
William Keeley, Building Inspector I,
Central Permitting 1012157 5131194 5131194
Carl Conyers, Police Recruit Il,
Police Department 116165 5131194 5131194
Annjanetta Newton, Police Recruit I,
Police Department 5128165 7113192 5/31/94*
*Employee 'hired from permanent
part-tithe to full-time per111411nent status.
Hire date reflects date hired as permanent
part-time.
Todd S. Johnson, Police Recruit 11,
Police Department 3125/71 5131 /94 513 1194
Roberto F. Beruvides, Police Recruit 11
Police Department 7/11164 5/3 1 /94 513 1194
Sharon Goff, Staff Assistant I,
Human Relations- Department 8130147 3/25191 5120194*
*Employee was originally denied pension
participation, Re-examined and approved
for pension on 5/20194.
Ralph Hodge, Jr.,Library Assistant I, 10/29/71 4/3189 5116/94*
Library
*Employee hired from permanent
,
part-time to full-time permanent status.
Hire date reflects date hired as permanent
part-time.
Donald Hlinka, Gas Technician 1, 10/20/54 6/ 1 3194 6/ 1 3/94
Gas System
James Hornaday, Gus Technician I, 1013 1 /52 6113194 6113194
Gus System
tJi CF .1:•_'•?n 14 6. ?. "t. ?l if? is -?? r ??
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Page 2 I
is r•' . Recommendation for Acceptance into Pension Plan
t ' June 15, 1994
Pension' 'Elig,
Name, Job, Class._?_DentJ? 'Birth Date Hire Date 1711i?
' Anthony Pittaiuga,Police. Recruit 11, 1/17168 5131194 .5131194,
. Police 'Department
i
• . Scott Shore; Firefighter,
9114162 '
511'6/94
5116/94
Fire Department ;
An nu Rowell, Firefigher, 2/ l 2169 5116194 '5116.194
` Fire Department
Nathan , Ballouz, Firefighter, 10/17/60 5116/94 511619 :
Fire Department
Carmine Tripi, Solid Waste Equipt. Op., 5122155 '6113194 , 6113/94
j
PW/Utilities/Solid -Waste
;•.
s
TRUSTEES OF THE EMPLOYEES' PENSION FUND Item #
Agenda Cover Memorandum Meeting Dale: 711 8194
E
Subject:
Pension to be Granted.
Recommendation/Motion:
Ronald Luchan, Police Officer, Police Department, be granted a regular pension under Scction(s)
2.396 of the Employees' Pension Plan as recommended by the Pension Advisory Committee.
and that the a pra rlate officials be authorized to execute same.
BACKGROUND.
Ronald Luchan, Police Officer, Police Department; was employed by the City on
October 15, 1973, and began participating in the Pension Plan on that date. His retirement will be
effective on December 20, 1994, at the beginning of the day.
Mr. Luchan's pension was approved by the Pension Advisory Committee at its meeting of June .15,
1994. Based on an average salary of approximately $39,130 over the past five years and t h e
formula for computing regular pensions, Mr. Luchan's pension will approximate $20,739
annually. Charts from Finance which take into consideration mortality rates and age reflect the
"present value cost of financing" this pension will be approximately $212,731.
Reviewed by:
Legal NA
Budget
Purchasing _ NA
Risk Mgmt. ?lYt9
Cis
ACM
Other NA
Submitted by:
Cltv Manaqer
Originating Dept:
Human Resources
User Dept.:
Advertised:
Date:
Paper:
0 Not required
Affected parties
? Notified
® Not required
Costs: $212-7_3 _ Commission Action:
Total
? Approved
? Approved wlconditions
Current FY ? Denied
? Continued to:
Funding Source:
? Capt. imp.
? Operating
? Other Pomion - Attachments:
Appropriation Code: Letter(s)
9446-07410-MMM-585 ? None
Human RaWUfCes Department
8131462-6870
C I T Y O F
C L,E A•R WA T E R
POST OFFICE B'OX 4748
CLEARWATER, FLORIDA 34618.4748
Honorable Mayor and Members of the City Commission as Trustees of the
Employees' Pension Plan
FROM: Pension Advisory Committee
COPIES: Debbie Bailey, Payroll Services Manager
Employee's File
SUBJECT: Regular Pension---Ronald Luchan
DATE: June 15, 1994
The Pension Advisory Committee received an application for regular pension from
Ronald Luchan on May 19, 1994.
Mr. Luchan was employed by the City on October 15, 1973, and has been a participant in the
Pension Plan since that date. The amount of Mr. Luchan's pension will be computed by the
Finance Department at such time as his 'last five years of service and salary can be
calculated.
By motion made and duly carried at its meeting of June 15, 1994, the Pension Advisory
Committee approved/recommended a regular pension based on years of service for
Ronald Luchan in accordance with Section 2.396 of the City Code. This pension will be
effective on December 20, 1994, at the beginning of the day.
I hereby certify that the Pension Advisory Committee has approved the granting of it
regular retirement pension for Ronald Luchan and the above dates are correct.
(K t4c,
Chairm Pension Advisory Committee
L
''Equal Employment and Allirmative Action Employer''
V
PENSION REQUEST FORM
I? Ronald Luchan do hereby apply for retirement from the City of Clearwater
General Employees' Pension Plan.
My benefits date is bet 15, 1973 (Entry date Into pension plan)"
M y , date of hire is October 15, 1973
My birthday is May 27, 1945.
My job classification is Police Officer and I work in the
.police Department, Division.
My resignation date is December 19, 1994
The type of pension for which I am applying is (check only one):
x Regular Pension based on years of service
rob-connected Disability Pension
Non-job-connected Disability Pension
My spouse's name is: Mary
Dependent children sunder the age of IS and residing in my household are:
(Print Child's Full Name)
(Chili's Date of Birth)
I hereby certify all of the above to be true and c ect:
(Signature)
t,jay 19- a
(Date)
STATE OF FLORIDA The eg }}tt ?'ns umel t w s a snow •dged before me this
COUNTY OF PINELL?,S "1b who is erso !y
kno n t me or who has produced
s identification nd who did/did not take an wmh.
\ Notary Public
(Signature) NOTARY PUQLIC. STATE OF FLORIDA.
My COMMIS ON EXPIRES: SEPT. 24. 19!
ComA union-44OV wY Punuc u1492191%WALT11
An&?:a?lame of Notary Printed)
l
:f• l
f
1 '
[ ? 1
CITY OF CLEARWATER
GENERAL EtiIPLOYEES' PENSXON PLAN
OPTIONS - POLICE OFFICERS
OPTION #I: Employees can receive a lump sum payment for vacation and
holiday pay and 112 of accrued sick leave at the time- of
separation from the City. There will be no M 'deduction, for
pension from this lump sutra payment nor" will 'this amount
count as earnings in the calculation, of the pension. The last
day of work 'will be the termination date and pension benefits
will be& the following day.,
OPTION nl: Employee can extend terminatioa date by the time due for
(Only available to vacation. holiday pay, and 112 of accrued sick leave.
employees hired Termination date will be the final day of extended time.
prior to 1011190) Pension benefits will begin the following day.
OPTION 93: Employees ? can split their accumulated' sick time at
(Ouly available to one-quarter pay and one-quarter early retirement time. That
employees• hired portion received as one-quarter pay will not have 3%
prior to 1011190) deducted for pension nor will it count as earnings in the
calculation of the pension. The, partion applied toward early
retirement time will be subject to the 356 pension deduction
and will count as earnings for pension calculations.
Termination date will be the final day of extended time:
pension benefits will begin the following day.
* *?sr? Wtie >K ,?x>K >MwM M?>M?ie aw MMf. 14
I, Ronald I,uchan as employee of the wCity of
Clearwater, hereby apply for pension benefits under the General Employees'
Pension Plan.
i hereby certify that I fully understand the three options offered to me. I
choose to retire using Option 9? 2 and wish my benefits to be
calculated under this option.
I understand that once this form is signed, my deci ' irrevocable.
EZWLOYEE's SIGNATURE:
SOCIAL SECURITY 494-48-6062
E ADDRESS: 2873 Paddock Drive
' Palm Harbor, FL 34684
DATE: - May 19, 1994
TRUSTEES OF THE EMPLOYEES' PENSION FUND
liltAgenda Cover Memorandum
Item It
Q
Meeting Date: y / 18 19
Subject:
Pension(s) To Be Granted
Recommendation/Motion:
James Mosley, Gas Pipeline Welder I, Gas Department, be granted a non-job-connected disability
pension - under Section(s) 2.396 and/or 2.399 of the Employees' Pension Plan as recommended by
the Pension Advisory Committee.
? and that the appropriate officials be authorized to execute same.
BACKGROUND:
James Mosley, Gas Pipeline Welder I, Gas Department, was employed by the City on
June 15, 1966, and began participating in the Employees' Pension Plan on December 15, 1966.
On May 19, 1994, James Mosley submitted a request to the Pension Advisory Committee (PAC) for a
non-job-connected disability pension. Mr. Mosley suffers from diabetes and has had an
amputation of, his leg which is the basis for this request for pension, Letters from
Dr. Ca.rlina Jimenea, dated May 26, 1994; Dr. F. R. May, dated May 23, 1994; and Dr. Allan H. Haydon,
dated May 18, 1994, were submitted in support of this request.
The letter from Dr. Jimenea states, "Mr. Mosley underwent above knee amputation of the left. lower
extremity on 4/22/94 for severe vascular. disease due to insulin dependent. diabetes mellitus,
complicated by non-healing ulcers of the left foot. 'T'his patient is permanently and totally
disabled and will not be able to return to work as a welder." The letter from Dr. May states, "I am
acquainted with this gentleman's medical status and specifically aware of the fact that he has
undergone amputation of the left leg. This renders him disabled regarding his current job
capability, and therefore I am supportive of his application for disability pension retirement."
The letter from Dr. Haydon states, "Mr. Mosley underwent an above knee amputation for life
threatening infection of the left lower extremity... The patient certainly does suffer from disability
secondary to this illness and subsequent amputation. This is obviously a permanent disability. 1
feel that this does disable Mr. Mosley from his job performance with regard to his classification, as
a gas pipeline welder I."
Reviewed by:
Legal NA
Budget NA
Purchasing N6
Risk Mgmt. N6
CIS
ACM
Other NA
Submitted by:
Originating Dept:
Human Resources
User Dept.:
Advertised:
Date:
Paper:
0 Not required
Affected parties
? Notified
® Not required
Costs: ?S189,209
1 Total
Current FY
Funding Source:
? Capt. Imp.
Operating
Other pgt]sjgl
Appropriation Code
646.07410.530100-595
Commission Action:
? Approved
? Approved w/conditions
? Denied
? Continued to:
Attachments:
Letter(s)
? None
Cit
r, 'r I??}'?;tiSt??:4`'a•d;`','tg'r"yf'.€a`?;?{??%it?'%'9q): i?. ?'?' :?fi.i. -r.: '4 "r^ ,i` sl' fir .1i,1?? <,'?f' •'ft '.I 'r,
Agenda' Item-James' Mosley
Page 2
' .,July .18, 199
Based on an average salary of approximately, $30,287 over the past five years and the formula f o r
computing.non-job-connected. disability pensions, this • pension will' approximate $21,201 annually. ,
Charts from Finance which take. into consideration mortality rates and age reflect the "present
value cost of financing". this 'pension will be approximately $189,289.
Note: When Mr. Mosley was originally employed, pension deductions were not taken for the first
six ` months and employees contributed to Social Security. When employees were given an option to
buy back their first six mopths of service, 'Mr. Mosley chose not. to exercise such option..
:W?`S?.t ;,, •$: ?f???. .r''.' '1,+• !. .??:i ?Yf'Se•?i ?: ?`.i?:i, : ' e ,.I ' ,
ti4? C I T Y 4 F C LEA R W A T E R
POST OFFICE BOX 4740
D
CLEARWATEA. FLORIDA 34818-47411
Q_ IEW,
Human Resources deparlmenl
81314624870
W.
'IUt Honorable Mayor and Members of the City Commission as Trustees of the
Employees' Pension Plan
FROM: , Pension Advisory Committee
COPIES: Debbie Bailey, Payroll Services Manager
Employee's File
SUBJECT: Pension for James Mosley-Non-,job-connected Disability Pension
DATE: June 24, 1994
The Pension Advisory Committee (PAC) received an application for disability pension from
James Mosley an May 19; 1994.
Mr. Mosley has been determined by the Pension Advisory Committee to meet t h e
requirements of the Pension Plan for a non-job-connected disability pension. He was
employed by the City on 'June 15, 1966, and began participating in the pension plan on
December 15, 1966. Further, he has submitted medical documentation, copies of which are
attached, relative to his disability which has been reviewed and approved by the PAC.
By motion made and duly carried at its meeting of June 24, 1994, the Pension Advisory
Committee approved/recommended the granting of a non-job-connected disability pension
to Mr. Mosley in accordance with provisions of Section 2.396 of the City Code, This pension
will be affective on June 1, 1994, at the beginning of the day.
The amount of Mr. Mosley's pension will be calculated by the Finance Department according
to the formula in the Pension Plan for non-job-connnected disability pension at such time
as his last five years of service and salary can be computed.
I hereby certify that the Pension Advisory Committee has approved the granting of a non -
job-connected disability pension for James Mosley and that the above dates are correct.
Ch. 'r an, Pension Advisory Committee
''Equal Employment and Affirmative Action Employer"
F •?
PENSION REQUEST FORM
I, ,James Mosley do hereby apply' for retirement from the City of Clearwater
• General Employees' Pension. Plan.
' My benefits{ date is December 15, 1966 (Entry, date into pension plan)
M y date of hire is June 15, 1966
My birthday is _ January 22, 1936
My job classification is Gas Pipeline Welder I_ - and .I work in , the
Gas Department, Division.
M y resignation date is to be determined
The type of pension 'for which I am 'applying is (check only one):
Regular Pension, based on years of service
Job-connected Disability Pension
Non-job-connected Disability ' Pension „
ML y spouse's name is:
Dep endent children under the age 'of IS and residing in my household are:
(Print Child's Full Name) (Child's Date of Bit•th)
I hereby cerrify all of the above to be true and correct:
(Sigpa6re)
(Date)
STATE OF FLORIDA The foregoing instrument was acknowledged before me this
COUNTY OF PINELLAS who is ersonali
own to me r who has produced
as ide ficatian and who did/did not take an oath.
O FiC1AL NOTARY SEAL - Notary Public.
SANDRA DEE HARRIGER (Signature)
[NOTARY PUBLIC 5TA?E OF FLORIDA Commission Nn. y & 4
COMMISSION I1 O, CC239831
MY MISSION FXF. NOV. 1,1996
(Name of Notary Printed)
?e
5
i
t .r
CITY OF CLEARWATER
GENERAL EMPLOYEES' PENSION PLAN
OP'T'IONS - GENERAL EMPLOYEES
OPTION #1: Employees can receive a lump sum a went fo
¦ , c
i
I
r
!a Y
vacation and holiday pay and IJ2 of accrued sick leave
at the time of separation from the' City. There will be no
87o deduction- for pension. from this lump sum payment
nor will this . amount count as earnings in . the
calculation of the pension. The last day of ' work will be
the termination date and pension benefits will begin
th'e following day.
OPTION #2: Employee can extend termination date by the time due
(Only available to for vacation, holiday pay, and 1/2 of accrued sick leave.
employees hired Termination date will be the final day- of extended time.
prior to 1011!90) Pension benefits will begin the following day. .
I, James Mosley an employee of the City of
Clearwater, hereby apply for pension benefits' under the General Employees'
Pension Plan.
I hereby certify that I fully understand the two options offered to me. I choose
to retire using Option n ' and wish my benefits to be calculated under
this option.
I understand that once this form Is signed, my decision is irrevocable.
EMPLOYEE'S SIGNATURE} . 911 0
SOCLAL SECURITY k 260-r,?-441 7_
ADDRESS: _ 700 N. Jefferson Avenue
Clearwater, FL 34615-4315
DATE: _ SIl Y?Y y -
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. ",? .h,. t .? %T `. .: ., ? %r"r'ef 'X,¢ .. .. e i i.' 'r• • ?""' .. ..
F .. .?
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CIGNA Employee Benefits Companies
1419 South Belcher Road
Clearwater, Ft 34624
813) 535.0741
F
ox;(813)531-8171
i
l CIGNA Healthplan of Florida, Inc.
Clearwater Health Care Center
26 May 1994
Re: James Mosley
iD#: 26052441701
To Whom It May Concern:
Mr. Mosley underwent above knee amputation of' the 'lef't lower
extremity on 4/22/94 for 'severe 'vascular disease due to insulin
dependent diabetes mellitus, complicated by non-healing ulcers of
the left foot.
This pati..ent is now permanently and totally disabled and will not.
be able to return to work as a welder.
Should you have any questions regarding the above, please feel free
to contact me.
Sincerely,
Carlina Jim ea. M.D.
{3
11 " .
i
RErr ;?V
Clearwater Gas Systern
cc: medical record
Comoctfcuf Geneid Life Inu rome Company -Lila Inuxonce Cornpony of North America • CIGNA Heolfhp;on Comparwos -CIGNA Dentc%Hodth Compork it
t
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?
Florida Suirgieal Associates ? • '? , ?' ? ? ,
William S. Maistrellis, M.D.
P.R. May, M.D.
Peter W. Blumencranz, M.D.
Allan H. Hnydon, Ph.D.; M.D.
May 23 , 1994
Clearwater Gas System
'Administrative Offices and'Operations Center.
400 North Myrtle Avenue
Clearwater, FL 34615
Re: 'James Mosley
.Dear Sirs:
1 am, acquainted with this gentleman's .medical status and
sped fical.ly aware' of the 'fact that he' has undergone
amputation of the left leg. This renders him disabled
regarding his'current job capability,and therefore .1 ' am
supportive of his application for disability pension
retirement.
It would seem most difficult to find a job at ..this paint in
time which is suitable far his disability. This. would
require reassesment, retraining and job availability.
In light of these complexities, I Chink that unfortunately
his limb loss is probabl'y going to make it difficult if not
impossible for him to find suitable employment.
If I can provide further information, please feel. free. to
call upon me in verbal or written form. .
General, Vascular, oitcoiogic & Laparoscopic Surgery
Diplomates American Board or Surgery • Fellows American College of Surgeons
1305-A S. Fort Harrison Avenue • Clearwater, Florida 34616 • Telephone: (813) 461.3204
3890 Tampa Road, Suite 404 • Palm Harbor, Florida 34684 a 'T'elephone: (813) 785.0040 '
Please Reply to Clearwater Office
Sincerely, /
. 11 I
F. R Ll?y
FRL? / Idsd ,
Florida Surgical Associates.
William S. Maistrollis, M.D,
F.R. May, M.D.
Poter W. Blumoncranz, M.D.
Allan H. Hnydon, Ph.D., M.D.
May 18, 1994
:Tames Lewin, SR
Assistant Director-
CGS-Marketing and.Pll.nning
Clearwater Gas System:
400 N.' Myrtle .Ave.
Clearwater, FL 34615
Re: Jamds•Mosely
.Dear Mr. Lewin:
I am writing with regard to the above patient in response to
your recent letter.
Mr. Mosely underwent an above knee, amputation for life
threatening infection of the left lower extremity. This was
on 5/3/94. He was last seen by me in the office on 5/18/94.
At that time,'his amputation site was healing nicely.
We are going to begin the process of rehabilitation with
hope in the future of the patient being able to ambulate
with a prosthesis.
The patient certainly does suf=fer from disability secondary
'to this illness and subsequent amputation. This is obviuasly
a permanent disability. I feel that this does disable Mr.
Mosely from his job performance wish regard to aiS
classification; as a gas pipe welder I.
If I can be of any further assistance, please do not
hesitate to call.
Sincerely,
Allan N. ayd an, M.
AHH/ldsd
General, Vascular, Oncologic & Laparoscnpic Surgery
Diplomates American Board of Surgery • Fellows American College of Surgeons
1305-A S. Fart Harrison Avenue • Clearwater, Florida 34516 • Telophono: (813) 461.3204
3890 Tampa Road, Suite 404 • Palm Harbor, Florida 34684 • Telephone: (813) 785-0040
Please Reply to Clearwater Office
'W"