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ACTION AGENDA
Board of Trustees of the Employees' Pension Fund
March 4, 1996'
1. Call to order .. 1. 9:00 a.m. ,
' 2,- Approval of Minutes 2. Approved as submitted.
j
. of 2112196
3. Request for acceptance 3. Approved,
r into membership:,
a) Michele Berman
b) Brian Blanco
c) Keisha Bradley
dl Albert Craig
e) Shawn Meeks
` f) Michael Ogliaruso
g) Sherilla Pittman
h).'James Sokol
1) William Whitstine,
• m) Michael Whittaker
4. Regular Pension to be granted; 4. Approved.
Charlie Brinson
5. ' . Regular Pension to be granted: 5. Approved,
Malcolm G. Blankenship
6. Regular Pension to be granted: 6, Approved.
Clarence L. Fails
7. Regular Pension to' be granted: .7. Approved,
Richard P. Evans
8. ' Regular Pension to be granted: 8. Approved.
William D. Cantlin
9: Other Business: 9. H. M. Laursen, Human Resources
Director, reported an opinion from r
Assistant City Attorney Leslie Dougafl-
Sides indicates regular pensions need to
come to the Trustees for approval.
10. Adjournment: 10..9:04 a.m.
" TRUSTEES OF THE EMPLOYEES' PENSION FUND Item # 3.
Meeting Date: VA19 S1 g
Agenda Cover Memorandum
R
Subject:
Membership in Employees' Pension Plan ,
Recommendation/Motion:
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.
?Arvnrvv Iw ?r?.
NAme and Job Class
Michele Berman, Public Infor. Spec.
Brian Blanco, Police Recruit
Keisha Bradley, Police Com. Operator
Albert Craig, Maintenance Worker I
Shawn Meeks, Police Recruit
Michael Ogliaruso, Police Recruit
Sherilla Pittman, Staff Assistant I
James Sokol, Electronics Technician
William Whitstine, Police Recruit
Michael Whittaker, Electronics Tech.
Reviewed by:
Legal NA
Budget NA
Purchasing NA
Risk Mgmt. N?
CIS _NA
Originating Dept:
Flumen Resources
User Dept.:
ACM L., - Advertised:
Other .ANA-- Date:
Submitted
(}ft Paper:
? Not required
y: p parties
? Notified
E ? Not required
Seniority Pension
?gpt./Div. Date Cffeclive Dfite
Gas 2/6/96 216196
Police 216/95 1/8/96
Police 1/22196 1/22/96
Parks & Rec. 1122196 1122196
Police 1/8/96 118/96
Police 118/96 118/96
Gen. Ser./Fleet Maint. 118196 118196
Engineering 1/8/96 118196
Police 1/8/96
118196
Engineering 118/96 118196
oats:
Total
Current FY
Funding Source:
? Capt. Imp.
? Operating
? Other
Appropriation Code:
Commission Action:
? Approved
? Approved w/conditions
? Denied
? Continued to:
Attachments:
Lelter(s)
? None
h.3,? .{. ;51, i'.4'?'k.l . •. . ... ... ??;?Ti+.'h'.- ..". i ! ! ',?.r.• >. t. ' ' .. r ? A'i. , f ,=^-I
CITY OF, CLEARWATER
` EMPLOYEES' PENSION PLAN
PENSION ADVISORY COMMITTEE
i
TO: Pension. Trustees
FROM: Pension Advisory Committee
SUBJECT;' Recommendation for-Acceptance into nsion Plan
DATE: February 8, 1996
` 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".
These employees are eligible for pension 'membership as noted in .the Pension Eligibility Date
column below,, and it is the recommendation of the Pension Advisory Committee that they be
accepted into membership. "
Pension Elig.
a,b._ Clnsj._& DepylHare Datc D-M
02/06/96 02/06/96
Michele Berman
Public Information Specialist, Gas Dept. ,
Brian Blanco 02106195 01/08/96
Police Recruit, Police Dept.
Employee hired from part-time
to full-time permanent status.
Hire date reflects date hired part-time,
Keisha Bradley 01/22/96 01/22/96
Police Communication Operator, Police Dept.
Albert Craig 01/22/96 01/22/96
Maintenance Worker I, Parks & Rec. Dept.
Shawn Meeks 01108/96 01/08/96
Police Recruit, Police Dept.
I
Michael Ogliaruso 01 /08196 01/09/96
Police Recruit, Police Dept.
Sherilla Pittman 01/08/96 01/08/96
Staff Assistant 1, General Services Dept./Fleet
James Sokol 01/08/96 01/08/96
Electronics Technician, Engineering Dept./Traffic
William Whitstine 01/08196 01/08/96
Police Recruit, Police Dept.
Michael Whittaker 01/08/96 01/08/96
Electronics Technician, Engineering Dept./Traffic
m
cam..
a?
osts: S4ZQ.24Q
Total
Item #
Meeting Date: 31419 B
Subject:
Pension to be Granted.
Recommendation/Motion:
Charlie Brinson, Public Works Department, be granted a regular pension under Section(s) 2.393
and 2.397 of the Employees' Pension Plan as approved by the Pension Advisory Committee.
? and that the a ropdate officials be authorized to execute same.
BACKGROUND:
Charlie Brinson, Public Works Supervisor I, Public Works Department, was employed
by the City on July 21, 1959, and began participating as a full-time employee in the Pension Plan
on that date. His retirement will be effective on February .23, 1996.
Mr. Brinson's pension was approved by the Pension Advisory Committee (PAC) on
February 8, 1996. Section 2.393 (p) defines normal retirement date as when a participant reaches
age 55 and has completed twenty years of credited service or when the participant has completed
thirty years of credited service regardless of age. Mr. Brinson is eligible under either criteria.
Based on an average salary of approximately $35,946 per year over the past five years, the formula
for computing; regular pensions, and Mr. Brinson's selection of the 50% Joint & Survivor Annuity,
this pension will approximate $37,885 annually. Charts from Finance which take into
consideration mortality rates and age reflect the "present value cost of financing" this pension
will be approximately '$478,340. The estimated pension cost (cash payout over the life of t h e
pensioner and his spouse) is 1,174,445.
Reviewed by:
Legal __ _NA _,
Budget _ NA_ ,
Purchasing NA__,
Risk Mgmt. NA
CIS _ - __._NA_
ACM
Other --NA
Subm?tted
f
t ?by'
City M?
ger
ana
TRUSTEES OF THE EMPLOYEES' PENSION FUND
Agenda Cover Memorandum
Originating Dept:
Human Resources
User Dept.:
Advertised:
Date:
Paper:
? Not required
Affected parties
? Notified
? Not required
Current FY
Funding Source:
? Capt. Imp.
? Operating
? Other Pension
Appropriation Code:
64 5-OZ4 10- 51410 0-5 85-
Commission Action:
? Approved
? Approved w/conditions
? Denied
? Continued to:
Attachments:
Letter(s)
? None
C I T Y 0-F C L E A, R ,W A.T E R
POST OFFICE BOX 4748
CLEARWATER, FLORIDA 34816-4748
Human Resmwces Department
(819) 462-N70
7D' Honorable Mayor and Members of the City Commission as Trustees of the
Employees' Pi nsion Plan.
FROM: Pension Advisory Committee
COPIES: Debbie Bailey, Payroll Services Manager
Employee's File
SUBJECT: Regular Pension-Charlie Brinson
3 '
DATE: February 8, 1996
The Pension Advisory Committee received an application for regular pension from Charlie
Brinson on February 8, 1996.
Mr. Brinson was employed by the City on July 21,-1959, and has been a participant in the
Pension Plan since that date. The amount of Mr. Brinson'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 February 8, 1996, the Pension Advisory
Committee approved/recommended a regular pension based on years of service for Charlie
Brinson in accordance with Sections 2.393 and 2.397 of the Pension Ordinance. This pension
will be effective on February 23, 1996, at the end of the day.
I hereby certify that the Pension Advisory Committee has approved the granting of a
regular ret irement pension for Charlie Brinson and (lie above dates are correct.
Mayor Rita Garvey
Actin; Chairman, Pension Advisory Committee
-Equal Employment and Affirmative Action Employer-
PENSION REQUEST FORM
1, eh.a rl„i a A i asnn do hereby apply to retirement from the
City of Clearwater General Employees' Pension Plan
My job classification is public Works Supervisor I and I work in the
Public Works Deportment, _Sanitary Sewers Division.
My benefits date is 07/21/59 My date of hire is 07/21/59
My date of birth is _, a s / 011 a _,, My resignation date is a 3
My spouse"s name is Rose Brinson and birthday is 07/17/52
Dependent children under the age of 18 and residing in my household are:
Child's Name Sex Date of Birth
N/A
The type of pension for which I am applying is (check only one):
xx Regular Pension based on years of service
Job-connected Disability Pension
Non job-connected Disability Pension
The City of Clearwater Employees' Pension Plan provides multiple options to Plan Participants as to
the manner of the pension benefit payment. Option I below represents the standard or normal form of
retirement benefit. The oilier optional forms (#2 - 96) shall be computed to be the Actuarial
Equivalent of the normal benefit.
Option, 1- Joint and Survivor Annul
The normal form of retirement benefit shall be an annuity paid monthly for the life of the
Participant, with a 100% survivor annuity paid monthly for a period of five years following the
death of the Participant to the beneficiary, provided that following such five year period the
survivor annuity shall be reduced to M0°/a of the original survivor annuity amount. [See section
2.397 (a) (3) (A)] The Participant's surviving spouse receives the designated amount for the
rest of his/her life or until he/she remarries. If no surviving spouse, dependent children under
the age of 18, shall be deemed to ba the beneficiary and 'reccive the designated amount until the
age of 18. [Section 2.397 (a) (3) and Section 2.398 (e) (3)]
O tioa 2 - Life Annuity
The Participant receives his/her pension as long as he/she lives. Upon the death of the
Participant, benefits cease. [Section 2.398 (b) (2) (A) (i)]
Option 3 - 10 Year Certain & Life Annuity - (must designate a beneficiary)
The Participant receives his/her pension as long as he/she lives, If the Participant dies before
120 monthly payments have been made, the remaining payments up to the 120 payments are
made to his/her beneficiary, or the his estate if his/her beneficiary is not alive, [Section 2.398
(b) (2) (A) (ii)]
F•
4292m - M NO A-19ni Asavift - (®mst designate a benefidlary)
7U P"cipant mccives Iusl w pension as fang as bdshe livenAt'the Participant dies first, the
beneficiary receives WA of the pension for the mi of their life. If the ben4ciary dies rust,
the Participant continues to roceive I00A of his/her pension and upon his/her death, benefits
cease. [Section 2.398 (b) (2) (A) (ih)]
tioa S - 75% Joint & Survivo Annuity - (must designate a beneficiary)
The Participant receives his/her pension as long as be/sbe lives. If the Participant dies first„ the
beneficiary receives 75% of the pension for the rest of their life. If the beneficiary dies fast,
the Participant continues to receive 1004/• of his/her pension and upon his/her death, benefits
cease. [Section 2.398 (b) (2) (A) (iii))
Lion b -100% J int Survivor Anna' - (most designate s bemeficlary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first, the
beneficiary receives I0(r% of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to receive 100% of his/her pension and upon his/her death, benefits
cease. [Section 2.398 (b) (2) (A) (iii)]
I have considered the normal form of benefit payment under such Plan (which is designated on this
Form as Option 1) and the various alternative optional benefit payment methods (Options 2 through 6)
under such Plan and have elected to receive my retirement benefits as indicated below. (Note: Option
selection to be indicated both by Number and Description.) I understand that once this Form is signed,
my decision is irrevocable.
Option #: - ---_ Description: %o ?o w31 rt--Su?,v? bR Ny via iT y
My designated beneficiary is:os
Bate of Birth: -2? ?i - Soria] spcurity Number. _ %A ty - RO- a $Ra
Employee's Signature- _
Employee's SSN:
Date:
STATE OF FLORIDA The fo aing instrumext t t ac? wledged before me this
COUNTY OF PINELLA?S L - by 6 p rlr e 1 r; ,San who is
rsonally known to me or who has provided
s en i ication and who did/di not take are oath.
MM E. MATMM
W car+ssaa+ 0 tis96 WPM
.? z,- Notary Public
;?; = octrb?r 6.1998 (S )
?'r?.??dj pO?pEDT11RU11D1'FiRilEiliRilCE.tIG
Y Name of Notary Printed
my Commission expims: l Z)261 6
¦"
CITY. OF CLEARWATER
GENERAL EMPLO'YEES' PENSION PLAN OP'T'IONS
OPTION #l Employees can receive a lump sum payment for vacation and holiday pay
and 1/2 of accrued sick leave at the time of separation from the City.
There will be no 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 the following day.
OPTION #2 Employee can extend termination date by the time due for vacation,
holiday pay, and 1/2 of accrued sick leave. Termination date will be the
final day of extended time. Pension benefits will -begin the -following
day. ,
Only available to employees hired prior to 1011190 or Fire bargaining
employees hired prior to 10/1188.
OPTION #3 Police bargaining empl^yees can split their accumulated sick time at
one-quarter pay and one-quarter early retirement time., That portion
received as one-quarter pay wily have no deduction for pension nor will
it count as earnings in the calculation of the pension. The portion
applied toward early retirement time will be subject to the pension
deduction and will count as earnings for pension calc ulations.
Termination date will be the final day of extended time; pension benefits
will begin the following day.
Only available to Police employees hired prior to 1011/'90 covered by the
FOP 10 or the Sergeants and Lieutenants labor contracts.
, .
•****************************************************************************
an employee of the City of Clearwater, hereby apply for
pension benefits under the City's Employees' Pension Plan.
I hereby certify that I fully understand the two options offered to me. I choose to retire using
Option # 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:
SOCIAL SECURITY #: _
?, A5t?, (?4?ou v E
WITNESSES: ADDRESS: \IG%
C?_c-ARwmc-_kz FL 3yc?ltd
7?A R
CCU `l C.. ' , DATE:. t I R G .. „
Revised 1/96
16.
•TRUSTEES OF THE EMPLOYEES' PENSION FUND Item #
agenda Cover Memorandum Meeting Date: 3/4/96
Subject:
Pension to be Granted.
Recommendation/Motion:
Malcolm G. Blankenship, Public Works Department, be granted it regular pension under Section(s)
2.393 and 2.397 of the Employees' Pension Plan as approved by the Pension Advisory Committee.
? and that the a pro riate officials be authorized to execute same,
BACKGROUND.
Malcolm G. Blankenship, Public Works Supervisor 1111, Public
Works Department, was employed by the City. on April 30, 1958, and began participating as a
full-time employee in the Pension Plan on that date. His retirement will be effective on March 29,
1996. '
Mr. Blankenship's pension was approved by the Pension Advisory Committee (PAC) on
February 8, 1996. Section 2.393 (p) defines normal retirement date as when a participant reaches
age 55 and has completed twenty years of credited service or when the participant has completed
thirty years of credited service regardless of age. Mr. Blankenship is eligible: under either
criteria.
Based on an average salary of approximately $40,996 per year over the past five years, the formula
for computing regular pensions, and Mr. Blankenship's selection of the 100% Joint & Survivor
Annuity, this pension will approximate $39,643 annually. Charts from Finance which take into
consideration mortality rates and age reflect the "present value cost of financing" this, pension
will be approximately $503,762. The estimated pension cost (cash payout over the life of the
pensioner and his spouse) is $1,149,653.
Reviewed by:
Legal NA - ??
Budget NA
Purchasing NA
Risk Mgmt. NA
CIS .. r ..NA_-
ACM
Olher __NA_
r'rA
Subm tied by:
City anagor
Originating Dept:
Human Resource:
Costs: $5Q3.762
Total
Commission Action:
User Dept.:
Advertised:
Date:
Paper,
? Not required
Affected parties
? Notified
? Not required
Current FY
Funding Source:
? Capt. Imp.
? Operating
? Other Pension
Appropriation Code:
M
? Approved
? Approved w/conditions
? Denied
? Continued to:
Attachments:
Letter(s)
? None
Human Resources Department
(813) 462.6870
C 1,T "Y Q F 'C ILE A R,''W A T E R
POST OFFICE 60x 4749
CLEARWATER, FLORIDA 34618-4748,
'It? 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-Malcolm E., Blankenship
DATE: February 8, 1996
The Pension Advisory Committee received an application
E. Blankenship on ' February 8, 1996.
Mr. Blankenship was employed by the City on April 30,
the Pension Plan since that date, The amount of D
computed by the Finance Department at such time as his
can be calculated.
for regular pension from Malcolm
1958, and has been a participant i n
Ar. Blankenship's pension will be
last five years of service and salary
By motion made and duly carried at its meeting of February 8, 1996, the Pension Advisory
Committee approvedtrecommendcd a regular pension based on years of service for Malcolm
E. Blankenship in accordance with Sections 2.393 and 2.397 of the Pension Ordinance. This
pension will be effective on March 29, 1996, at 3:30 P.M.
I hereby certify that the Pension Advisory Committee has approved the granting of a
regular retirement pension for Malcolm E. Blankenship and the above dates are correct.
Mayor Rita Garvey
Acting Chairman, Pension Advisory Committee
'Equal Employment and Affirmntive Action Employer'
?J
PENSION REQUESC FORM
1, Malaclm E, do hereby apply to retirement from the
City of Clearwater General Employees' Pension Plan
My job classification is public Works Su a rv i sar ii and I. work in the
Public Works Department, 'mater 9 Uort servicDivision.
My benefits date is _ P 4 L3 015 8 w My date of hire is 0 4 / o L 5 L
My date of birth is 12/ 2 2 / 3 3 My resignation date is _ a 3/ 9 %/ n S
Myspouse'snameis Alice L. Bianke-nsiip _ -and birthday is 10/07/40
Dependent children under the, age of 18 and residing in my household are:
Child's Name Sex Date of Birth
N/A
The type of pension for which I am applying is (check only one):
xx Regular Pension based on years of service
Job-connected Disability Pension
Non-job-connected Disability Pension
The City of Clearwater Employees' Pension Plan provides multiple options to Plan Participants as to
the manner of the pension benefit payment. Option t below represents the standard or normal form of
retirement benefit. The other optional forms (#2 - #6) shall be computed to be the Actuarial
Equivalent of the normal benefit.
Option 1 - Joint and Survivor Annuity
The normal form of retirement benefit shall be an annuity paid monthly for the life of the
Participant, with a 100% survivor annuity paid monthly for a period of five years following the
death of the Participant to the beneficiary, provided that following such five year period the
survivor annuity shall be reduced to 5001* of the original survivor annuity amount. [See section
2.397 (a) (3) (A)] The Participant's surviving spouse receives the designated amount for the
rest of his/her life or until he/she remarries. If no surviving spouse, dependent children under
the age of 18, shall be deemed to be the beneficiary and receive the designated amount until the
age of 18. [Section 2.397 (a) (3) and Section 2.398 (e) (3)1
Option 2 - Life Annuity
The Participant receives his/her pension as long as he/she lives. Upon the death of the
Participant, benefits cease. [Section 2.398 (b) (2) (A) (i)j
Oration 3- 10 Ye2r Certain & !Life Annuity - (must designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies before
120 monthly payments have been made, the remaining payments up to the 120 payments are
made to his/her beneficiary, or the his estate if his/her beneficiary is not alive. [Section 2.398
(b) (2) (A) (ii)]
90-2* 4 S4' hiMt & Sarviwnr Alaaaiti? - (mast designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first, the
beneficiary receives 50% of the pension for the nest of their life. If the beneficiary dies first,
the Participant continues to receive 100'/o of his/her pension acid upon his/her death, benefits
cease. (Section 2.398 (b) (2) (A) (iii)]
Qbtiorr_5 - 75% Joint dr Survivor Annuity - (must designate ar beneri ckry)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first, the
beneficiary receives 75% of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to receive 100% of his/her pension and upon his/her death, benefits
cease. (Section 2.398 (b) (2) (A) (iii)]
Option_ b_-100% Joint dr Survivor Annuity - (must designate a beneficiary)
Tice Participant receives his/her pension as long as he/she lives. If the Participant dies first, the
beneficiary receives 100% of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to receive 100% of his/her pension and upon his/her death, benefits
cease. [Section 2.398 (b) (2) (A) (iii)]
I have considered the normal form of benefit payment under such Plan (which is designated on this
Form as Option 1) and the various alternative optional benefit payment methods (Options 2 through 6)
under such Plan and have elected to receive my retirement benefits as indicated below. (Note: Option
selection to be indicated both by Number and Description.) I understand that once this Form is signed,
my decision is irrevocable.
option #: 6• Description: 100% Joint &_ Survivor Annuity
My designated beneficiary is: Alice L. Blankenship
Date of Birth: 10/07/40 Social Security Number. 265-60-1973 Employee's Signature:
Employee's SSN: 264-41-541? Date: ?-
STATE OF FLORIDA The foregoing instrument, was acknowledged before me this
COUNTY OF P24ELLAS 31 in% -by aI eol,r,-+ f.41onkenst who is
personally known to me or who has rovid Fj_ 0 r I of 's L i c, Y'n s
as identification and who did/did not take an oath.
Notary Public
?rbat ?` ?' Sj u Name of Notary Printed
My Commission expireS:
DEBORAH K 5MU17
NMARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC2W29
MY COMMISSION FXP. MAY 22.1 7
OPTION 1:- Employees can receive a lump sum payment for vacation and
holiday pay and 1/2. of accrued sick leava 'at . the time of
. separation from the City. There will be 'no 6% deduction for
' pension from this lump. sum payment nor will this amount c o u n t
as earnings in the calculation of the pension. The last day of
' work will be the termination date and pension benefits will begin
the following day.
OPTION #2: Employee can extend termination ., date by the time due for
- vacation, holiday pay, and 1/2 of accrued sick leave. Termination
date will be the final day of extended time. Pension benefits will
begin the following day,
(Only available' to employees hired prior to 14/1/90.)
.. M * ¦ • * ! ! f q1 t * i/ r * ! • ! ! • # M ! • w ¦ • r ¦ • # ¦ R • ie r • ! r R R ! ¦ ! ¦ • R R # ¦ • # ¦ ¦ • # M * r ¦ ! ¦ w * • R v 1t
Malcolm E. Blankenship an 'employee of the City. of Clearwater, hereby apply for
pension' benefits under the City's Employees' Pension Plan.
I hereby zertify :hat I fully understand the two options offered to me.. I choose to retire using
Option 4 and wish my benefits to be "calculated under this option.
I .-inderstand that once this form is signed, my decision is irrevocable.
WMWESSES:
-C
..., _ ,.
EIMPLOYEE S SIGNATURE:
SOCIAL S ECt?UTY 4. 2G4-44-5413
ADDRESS: 2175 Egret Drive
Clearwater FL 34624
DATE:
U ..
to TRUSTEES OF THE EMPLOYEES' PENSION FUND
Agenda Graver Memorandum
Item #
Meeting Date: 3/4/96
Subject:
Pension to be Granted.
Recommendation/Motion:
Clarence L. Fails, Solid Waste Department, be granted a regular pension under Section(s) 2.393 and
2.397 of the Employees' Pension Plan as approved by the Pension Advisory Committee.
? and that the appropriate officials be authorized to execute same.
BACKGROUND:
Clarence L. Fails, Solid Waste Ecluipment Operator, Solid
Waste Department, was employed by the City on August 18, 1965, and began participating as a
full-time employee in the Pension Plan on August 18, 1965. His retirement was effective on
January 30, 1996.
Mr. Fails' pension was approved by the Pension Advisory Committee (PAC) on February 8, 1996.
Section 2.393 (p) defines normal retirement date as when it participant reaches age 55 and has
completed twenty years of credited service or when the participant has completed thirty years of
credited service regardless of age. Mr. Fails is eligible under the thirty years of service criteria.
Based on an average salary of approximately $31,890 per year over the past five years, the formula
for computing regular pensions, and Mr. Fails' selection of the 100° Joint & Survivor Annuity,
this pension will approximate $26,266 annually. Charts from Finance which take into
consideration mortality rates and age reflect the "present value cost of financing" this pension
will be approximately $356,595. The estimated pension cost (cash payout over the life of t h e
pensioner and his spouse) is $971,854.
Reviewed by:
Legal _ NA
Budget NA
Purchasing NA
Risk Mgmt. NA
Cis _NA
ACM . A/, 12>
Other NA
Submltte by:
City an g r
Originating Dept:
Human Resource:
User Dept.:
Advertised:
Date:
Paper:
? Not required
Affected parties
? Notified
? Not required
Costs: $356_._595
Total
Current FY
Funding Source:
? Capt. Imp.
? Operating
? Other Pension
Appropriation Code:
046.OZ410-514104-585-
M
Commission Action:
? Approved
? Approved w/conditions
? Denied
? Continued to:
Attachments:
Letter(s)
? None
Human Resocxces Department
(S13)462.6870
i, .
C I. T.Y .0 F
C E E A R W A T E 'R
POST OFFICE 80X 4748
CLEARWATER. FLORIDA'34618-4748
TO. 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-Clarence L. Fails
DATE. February 8, 1996
The Pension Advisory Committee received an application for regular pension from Clarence
L. Fails on February 8, 1996.
Mr. Fails was employed by the City on August 18, 1965, and. has been a participant in tile
Pension Plan since that date. The amount of Mr. Fails'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 February 8, 1996, the Pension Advisory
Committee approved/recommended a regular pension based on years of service for Clarence
L. Fails in accordance with Sections 2.393 and 2.397 of the Pension Ordinance. This pension
will be effective on January 30, 1996, at the end of the day.
I hereby certify that the Pension Advisory Committee has approved the granting of a
regular retirement pension for Clarence L. Fails and [lie above dates are correct.
Mayor Rita Garvey
Acting Chairman, Pens n Advisory Committee
"Equal Employment and Affirmative Action Employer"
i
PENSION (REQUEST FORM
I, 'Clarence L. Fails do hcmby apply to retirement from the
City of Clearwater General Employees' Pension Plan.
My job classification is Solid Wa,, a EQuipmeal o22,r,At9K and i work in the
Solid Waste Department, Recycling-CollectionDivision.
My benefits date is o8/18/65 My date of hire is 08/1§/65
My date of birth is 11/25145 My resignation date is / ?C _("
My spouse's name is '1n n i e Fails and birthday is 0 3 0 8 /4 9
Dependent children under the age of 18 and residing in my household are:
Child's Name Sex Date of Birth
s F 08131/85___
The type of pension for which I aim applying is (check only one):
xx Regular Pension based on years of service
.Fob-connected Disability Pension
Non-job-connected Disability Pension
The City of Clearvrater Employees' Pension Plan provides multiple options to Plan Participants as to
the manner of the pension benefit payment. Option I below represents the standard or normal form of
retirement benefit. The other optional forms (#2 - 06) shall be computed to be the Actuarial
Equivalent of the normal benefit.
Option-1 - Joint and Survivor Annnity
The normal form of retirement benefit shall be an annuity paid monthly for the life of the
Participant, with a 100% survivor annuity paid monthly for a period of five years following the
death of the Participant to the beneficiary, provided that following such five year period the
survivor annuity shall be reduced to 501/o of the original survivor annuity amount. [See section
2.397 (a) (3) (A)] The Participant's surviving spouse receives the designated amount for the
nest of his/her life or until he/she remarries. If no surviving spouse, dependent children under
the age of 18, shall be deemed to be the beneficiary and receive the designated amount until the
age of 18. [Section 2.397 (a) (3) and Section 2.398 (e) (3)]
Option 2 - Life Annui
The Participant receives his/her pension as long as he/she lives. Upon the death of the
Participant, benefits cease. [Section 2.398 (b) (2) (A) (i))
Option 3 -10 Year Certain & Life Annuity - (must designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies before
120 monthly payments have been made, the remaining payments up to the 120 payments arc
made to his/her beneficiary, or the his estate if his/her beneficiary is not alive. [Section 2.398
(b) (2) (A) (ii)]
!(?ntioa 4 - 5VIe .faint & Survivor Anon ,? - (most designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first,.the
beneficiary receives 50% of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to receive 10VIo of his/her pension and upon his/her death, benefits
cease. [Section 2,398 (b) (2) (A) (iii)]
Option S - 75% Joint & Survivor Annul - (mint designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first, the
beneficiary receives 75% of the pension for the rest of their life. If the beneficiary dies first,
the, Participant continues to receive IWI* of his/her pension and upon his/her death, benefits
cease. (Section 2.398 (b) (2) (A) (iii)]
Option 6 - 100% Joint & Survivor Annuity - (must designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first, the
beneficiary receives 100% of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to receive 100% of his/her pension and upon his/her death, benefits
cease. [Section 2.398 (b) (2) (A) (iii)]
I have considered the normal form of benefit payment under such Plan (which is designated on this
Form as Option 1) and the various alternative optional benefit payment methods (Options 2 through 6)
under such Plan and have elected to receive my retirement benefits as indicated below. (Note: Option
selection to be indicated both by Mumber and Description.) I understand that once this Form is signed,
my decision is irrevocable.
Option #: to Description: ,_ _ ., °7G S n, N -*-__S u K\)% V o R...._ N Nu ? ?_
My designated beneficiary is: ? 0 0 + F. 7-P OLs
Date of Birth: S - 4 y Social Security Number. ?-59 - L-G - 9LM) 0
Employee's Signature: C,
.?
Employee's SSN: Date:
STATE OF FLORIDA
COUNTY OF PINELLAS
??, The foregoing instrument was acknowledged before me this
,,A..CY AN'A' DLLEON
::'`7iz+?'i I'??F:1.::,
/--)u o by ClarencE F'a, I who is _
r-yL0 ` 11 a
personally known to me or who has provided E 1? r L?' c-
as identification and who did/did not take an oath. y S " yes
?sJ?4
A."p tI
1 Notary Public
Wc,DLI t l P o rr1 Name of Notary Printed
My Commission expires: 1R)e r',
.e
CI'T'Y OF CLEARWATER
GENERAL EMPLOYEES' PENSION PLAN OPTIONS
OPTION #I Employees can receive a lump sum payment for vacation and holiday pay
and ; 1/2 of accrued sick leave at the time of separation from the City.
There will be no'-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 the following day.
OPTION #2. Employee can extend termination date by the time due for vacation,
holiday pay, and 1/2 of accrued sick leave. Termination date will be the
final day of extended time. Pension benefits will begin the following
day.
Only available to employees hired prior to 10/1/90 or Fire bargaining.
employees hired prior to 10/1/88.
OPTION #1 Police bargaining employees can split their accumulated sick time at
one-quarter pay and one-quarter early retirement time. That portion
received as one-quarter pay will' have no deduction for pension nor will
it count as earnings in the calculation of the pension. The portion
applied toward early retirement , time will be subject to the 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.
Only available to Police- employees hired prior to 10/1/90 covered by the
FOP 10 or the Sergeants and Lieutenants labor contracts.
I. ?L ?t C to LE FAQ LS ,-,?, an employee of the City of Clearwater, hereby apply for
pension benefits under the City's Employees' Pension Plan.
I hereby certify that I fully understand the two options offered to me. I choose to retire. using
Option # and wish my benefits to be calculated under this option.
I understand that once this formes signed, my decision is irrevocable.
EMPLOYEE'S SIGNATURE
64, Cz &= _z
SOCIAL SECURITY #: -14 .\
WI'T'NESSES: ADDRESS: V!. Q a1= Ias T ST i;E ra- i
4?m Li\ 9-c,c) , L 3\11LI g
DATE:..
Revised 1/96
Im ..
TRUSTEES OF THE EMPLOYEES' PENSION FUND
Agenda Cover Memorandum
Item # _r7
Meeting Date: 514/95
Subject:
Pension to be Granted.
Recommendation/Motion:
Richard P. Evans, Fire Department, be granted a regular pension under Section(s) 2.393 and 2.397
of the Employees' Pension Plan as approved by the Pension Advisory Committee.
? and that the appropriate officials be authorized to execute same.
rf ui ?i ¦m ? ?r?"u .resin ir?nrn?rurrir??miinrrrn?i.?imnr ?
BACKGROUND:
Richard P. Evans, Fire District Chief, Fire Department, was employed by the City
on August 27, 1973, and his pension service credit is effective on that date. His retirement will be
effective can February 29, 1996.
Mr. Evans' pension was approved by the Pension Advisory Committee (PAC) on February 8, 1996.
Section 2.393 (p) provides for normal retirement eligibility when a participant has completed
twenty years of credited service in a type of employment described as "hazardous duty" and
further specifically defines service as a firefighter as meeting the hazardous duty criteria.
Based on an average salary 'of approximately $51,430 per year over the past five years, the formula
for computing regular pensions, and Mr Evans selection of the 100% Joint & Survivor Annuity,
this pension will approximate $34,571 annually. Charts from Finance which take into
consideration mortality rates and age reflect that the "present value cost of financing" this
pension will be approximately $406,708. The estimated pension cost (cash payout over the . life of
the pensioner and his spouse) is $1,039,400
Reviewed by: Originating Dept: Costs: ?0§.708 Commission Action:
Human Resources, Total
Legal. _N6. ? Approved
Budget C] Approved wlconditions
Purchasing 6 User Dept.: Current FY ? Denied
Risk Mgmt. NA ? Continued to:
cis Funding Source:
ACM -' Advertised: ? Capt. imp,
Other . N6 _ Date: ? Operating
t?P Paper: ? Other Pension _ Attachments:
? Not required
Submitt b Affected parties Appropriation Code: Letter(s)
? Notified
? Not required §46-07d 10-514100-585m ? None
City a ager 9514
¦il
•Hurnon Resources Dopartrnent
. . (813)462.6870
C.1 T Y O F. C :L',E A R -W A T E R
POST OFFICE SOX 4748
CLEARWATER, FLORIDA 34 61 8-474 8 ,
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----Richard P. Evans
DATE: February 8. 1996
The . Pension Advisory Committee received an application for regular pension from Richard
P. Evans. on February 8, 1996.
Mr. Evans was employed by the City on August 27, 1973, and has been a participant in the
Pension Plan since that date. The amount of Mr. Evans'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 February 8, 1996, the Pension Advisory
Committee approved/recommended a regular pension based on years of service for Richard
P. Evans in accordance with Sections 2.393 and 2.397 of the. Pension Ordinance. This pension
will be effective on February 29, 1996, at 0800 hours.
1 hereby certify that the Pension Advisory Committee has approved the granting of a
regular retirement' pension for Richard P. Evans and the' above dates are correct.
Mayor Rita Garvey
Acting Chairman, Pen, ion Advisory Committee
"Equal Employment and Affirmative Action Employer"
i
PENSION REQUEST FORM
I, Ei ;hard , P. E v i ng do hereby apply to retirement from the
City of Clearwater General Employees' Pension Plan
My job classification is Fire District Chief and I work in the
Fire" Demtnt. F i r e S u r e s s i o n Division.
My benefits date is 0 4/ 2 7/ 7 3 My date of hire is 0 8L2 7 7 3
My date of birth is .. 12/17/45 My resignation date is .2 ?y6
My spouse's name is ??r ,?i.?a.oy¢i?S and birthday is 06/24/4x)
Dependent children under the age of 18 and residing in my household are:
Child's Name Sex
VA
Date of Birth
llm#4
The type of pension for which I am applying is (check only one):
X X Regular Pension based on years of service
Jab-connected Disability Pension
Non-job-connected Disability Pension
The City of Clearwater Employees' Pension Plan provides multiple options to Plan Participauts as to
the manner of the pension benefit payment. Option I below represents the standard or normal form of
retirement benefit. The outer optional forms (#2 - #b) shall be computed to be the Actuarial
Equivalent of the normal benefit.
Option_ I Joint and Survivor Annuity
The normal form of retirement benefit shrill be an annuity paid monthly for the life of the
Participant, with a 100% survivor annuity paid monthly for a period of five years following the
death of the Participant to the beneficiary, provided that following such five year period the
survivor annuity shall be reduced to SO% of the original survivor annuity amount. JSee section
2.397 (a) (3) (A)] The Participant's surviving spouse receives the designated amount for the
rest of his,qter life or until he/she remarries. If no surviving spouse, dependent children under
the age of 18, shall be deemed to be the beneficiary and receive the designated amount until the
age of 18. [Section 2.397 (a) (3) and Section 2.398 (e) (3)]
a tion 2 - Life Annul
The, Participant receives his/her pension as long as he/she lives. Upon the death of the
Participant, benefits cease. (Section 2.398 (b) (2) (A) (i)]
Option 3 - 10 Year Certain & Life Annuity - (must designate a beneficiary)
The Participant receives his/her pension as long as he/she lives, if the Participant dies before
120 monthly payments have been made, the remaining payments up to the 120 payments arc
trade to his/her beneficiary, or the his estate if his/her beneficiary is not alive. [Section 2.398
(b) (2) (A) (ii)]
Qg&on 4 M "!jj fi SaC&or Assalft - (must designate a benefidary)
IU Participant receives hisfies pension as long as he/she lives. If the. Participant dies fiat, the
beneficiary receives 500A of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to receive 104'/a of his/her pension and upon his/her death, benefits
cease. [Section 2.398 (b) (2) (A) (iii)]
Option 5 - 75% Joint & Survivor Annuity - (must designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first, the
beneficiary n=ivrs 75% of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to receive 100% of his/her pension and upon his/her death, benefits
cease. (Section 2.39$ (b) (2) (A) (iii)]
Option _6 -100% joint _&_Survivor Annuity - (mast designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first, the
beneficiary receives 100% of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to receive 100% of his/her pension and upon his/her death, benefits
cease. [Section 2.398 (b) (2) (A) (iii)]
I have considered the normal foam of benefit payment wider such Plan (which is designated on this
Form as Option 1) and the various alternative optional benefit payment methods (Options 2 through 6)
under such Plan and have elects d to receive my retirement benefits as indicated below. (Note: Option
selection to be indicated both by Number and Description.) I understand that once this Form is signed,
my decision is irrevocable.
Option 4: t;
My designated beneficla lls
Date of Birth: / ?.1 4r-
Employee's Signature:
Employee's SSN: -_3
Description: , 140°Ia -r,,;,V r 414 Salr Vie re. 4W?V,0 i rY
11 c ,? G ??p cd
Social Security Number: e
-Ii? 4c--V cz
.2// Date. /-,,2 3
STATE OF FLORIDA
COUNTY OF PINELLAS
In
'? ? l61f COhltfiSSO? ? t;C+lt1
? .?= p??td.tWa
Ding instrument was aclatowly?ged before me this
{4 / by ?C, c'?arc? l • r? ns who is
knnow'n to me or who has provided
cation an who did/ id not take an oath.
Notary Public
is???1
111?, /7V SName of Notary Printed
?~? My Commission expires: ! tp Y
CITY OF CLEA.RWATER
GENERAL EMPLOYEES' PENSION PLAN OPTIONS
OPTION #1 Employees can 'receive a lump sum payment for vacation and holiday. pay
and 1/2 of accrued sick leave at the time of separation from' the City.
There will be no 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 the 'following day.
OPTION #2 Employee can extend termination date by the time due for vacation,
holiday pay, and 1/2 of accrued sick leave. Termination date will be the
final day of extended time. Pension benefits will begin the following
day.
Only available to employees hired prior to 1011140 or Fire bargaining
employees hired prior to 10/1188.
OPTION #3 Police bargaining employees can split their accumulated sick time at
one-quarter pay and one-quarter Carly retirement time. That portion
received as one-quarter pay will' have no deduction for pension nor will
it count as earnings in the calculation of the pension. The portion
applied toward early retirement time will be subject to the pension
deduction and will count as earnings for pension calc ulations.
Termination date will be the final day of extended time; pension benefits
will begin the following day.
Only available to Egli= employees hired prior to 1011190 covered by the
FOP- 10 or the Sergeants and Lieutenants labor contracts.
i+k##1k####i###########+t4?#####i+k#+I?+k##+k##Ur#?Mii?######+M##iFiakii*iFi?lr##*ii?k#iiriiii#ii
I, Richard P. Evans an employee of the City of Clearwater, hereby apply for
pension benefits under the City's Employees' Pension Plan.
I hereby certify that I fully understand the two options offered to me. I choose to retire using
Option # and wish my benefits to be calculated under this option.
I understand that once this form is signed, my decision is irrevocable.
WT1`NESSES:
Revised 1/46
EMPLOYEE'S SIGNATURE:
- -- -
SOCIAL SECURITY #i• 377-44-2211
ADDRESS: 4773 - 57 Terrace Ncrbh
St. Petersburg, FL 33714
- 4;V
AS
DATE: / r-.7 3
L".
M
• TRUSTEES OF THE EMPLOYEES' PENSION FUND
Agenda Cover Memorandum
Item 0
Meeting Date: 3 / Q 19 6
Subject:
Pension to be Granted.
Recommendation/Motion:
William D. Cantlin, Finance Department, be granted a regular pension under Section(s) 2.393 and
2.397 of the Employees' Pension Plan as approved by the Pension Advisory Committee.
? and that the appropriate officials be authorized to execute same.
BACKGROUND:
William D. Cantlin, Administrative Support Manager II, Finance
Department, was employed by the City on March 8, 1976, and began participating as a full-time
employee in . the Pension Plan on September 11, 1976. At the time of Mr. Cantlin's employment,
pension deductions for employees were not immediately commenced. Subsequently, w h e n
employees were provided an opportunity to make up pension contributions, he did not elect to do
so. He began contributing to the plan on September I1, 1976. His retirement will be effective on
November 13, 1996.
Mr. Cantlin's pension was approved by the Pension Advisory Committee (PAC) on February 8, 1996.
Section 2.393 (p) defines normal retirement date as when a participant reaches age 55 and h a s
completed twenty years of credited service or when the participant has completed thirty years of
credited service regardless of age. Mr. Cantlin is eligible under the age 55 and twenty years of
service criteria.
Based on an average salary of approximately $50,155 per year over the past five years, the formula
for computing regular pensions, and Mr. Cantlin's selection of the 100% Joint & Survivor Annuity,
this pension will approximate $27,009 annually. Charts from Finance which ta ke into
consideration mortality rates and age reflect the "present value cost of financing" this pension
will be approximately $355,265. The estimated pension cost (cash payout over the life of t h e
pensioner and his spouse) is $1,062,363.
Reviewed by:
Legal
Budget N ,
Purchasing NA _?-
Risk Mgmt. NA
CIS NE,
ACM
Other NA____
Subm ited b
City Wage
Originating Dept:
Human Resource:
User Dept.:
Advertised:
Date:
Paper:
? Not required
Affected parties
? Notified
? Not required
Costs: 55.265
Total
Current FY
Funding Source:
? Capt. Imp.
? Operating
? Other ansJon
Appropriation Code
696-07410-514100-585-
M
Commission Action:
? Approved
? Approved w/conditions
? Denied
? Continued to:
Attachments:
Letter(s)
? None
Human Rosources Department
(813) 462.6870
C I T Y OF C L E A R W A T E R
POST OFFICE BOX 4748
CLEARWATER, FLORIDA 34618-4748
r
TO.. 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-William 'D. Cantlin
DATE: February 8, 1996
The Pension Advisory Committee received an application for regular pension from William
D. Cantlin on February 8, 1996,
Mr. Cantlin was employed by the City on March 8, 1976, and has been a participant in the
Pension Plan since September 11, 1976. The amount of Mr. Cantlin'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 February 8, 1996, the Pension Advisory
Committee approved/recommended a regular pension based on years of service for William
D. Cantlin in accordance with Sections 2.393 and 2.397 of the Pension Ordinance. This
pension will be effective on November 13, 1996, at the end of the day.
I hereby certify that the Pension Advisory Committee has approved the granting of a
regular retirement pension for William D. Cantlin and the above dates are correct.
Mayor Rita Garvey
Acting Chairman, Pen 'on Advisory Committee
"Equal Employment and Affirmativo Action Employer"
PENSION REQUEST FORM
I, w i i l j„a m D. Gant 1 i n do hereby apply to retirement from the
City of Clearwater General Employes' Pension Plan.
My job classification is Administrative Su ort Manager II and I work in the
Finance Department, Administration Divisior.
My benefits date is 09/11/76 My date of hire is 03/08/76
My date ofbirth is_ 04ZOI/4I My resignation date is 11/13/96
My Spouse'S name is Linda L. Cantl in and birthday is 06/01/52
Dependent children under the age of 18 and residing in my household are:
Child's Name Sex Date of Birth
N/A
The type of pension for which 1 am applying is (chock only one):
xx Regular Pension based on years of service
Job-connected Disability Pension
Non-job-connected Disability Pension
The City of Clearwater Employees' Pension Plan provides multiple options to Plan Participants as to
the manner of the pension benefit payment. Option 1 below represents the standard or normal form of
retirement benefit. The other optional forms (42 - 46) shall be computed to be the Actuarial
Equivalent of the normal benefit.
Qption I - Joint and Survivor Annuity
The normal form of retirement benefit shall be an annuity paid monthly for the life of the
Participant, with a 100% survivor annuity paid monthly for a period of five years following the
death of the Participant to the beneficiary, provided that following such five year period the
survivor annuity shall be reduced to 50% of the original survivor annuity amount. [See section
2.397 (a) (3) (A)] The Participant's surviving spouse receives the designated amount for the
rest of hislhcr life or until he/she remarries. If no surviving spouse, dependent children under
the age of 18, shall be deemed to be the beneficiary and receive the designated amount until the
age of 18. [Section 2.397 (a) (3) and Section 2.398 (e) (3)]
Option 2 - Life Annuity
The Participant receives his/her pension as long as he/she lives. Upon the death of the
Participant, benefits cease. [Section 2.398 (b) (2) (A) (i)]
Option 3 - 10 Year Certain & Life Annul ft - (must designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies before
120 monthly payments have been made, the remaining payments up to the 120 payments are
made to his/her beneficiary, or the his estate if his/her beneficiary is not alive. [Section 2.398
(b) (2) (A) (ii)]
,t. -
fatiou 4 - SQ°d. LoIn j fE' ¦EXhor Asnalft - (mat designate a beach bay)
The Participant receives histim pension as long as he/she lives. If the Participant dies fuss, the
beneficiary receives WA of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to receive 10044 of his4wr pension and upon his/her' dearth, benefits
cease. (Section 2.398 (b) (2) (A) (iii)]
Potion-5 - 75% Joint & Survivor Annai -(must designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first, the
beneficiary rives 75% of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to roceive 100'/a of hi&Ur pension and upon hislher death, benefits
cem. (Section 2.398 (b) (2) (A) (iii)]
O Lion 6. 100% Joint & Survivor Annni -(most designate a beneficiary)
The Participant receives his/ber pension as long as he/she lives. If the Participant dies first, the
beneficiary receives 1001/6 of the pension for the rest of their life. If the beneficiary dies first,
the Participant continues to receive 1000% of hislher pension and upon hi&Ur death, benefits
cease. (Section 2.398 (b) (2) (A) (iii)]
I have considered the normal form of benefit payment under such Plan (which is designated on this
Form as Option 1) and the various alternative optional benefit payment methods (Options 2 through 6)
under such Plan and have elected to receive my retirement benefits as indicated below. (Note: Option
selection to be indicated both by Number and Description.) I understand that once this Form is signed,
my decision is irrevocable.
Option it: Description: , /oo % '-7D-.,!v-rf L&AfL Ko,= A,y/yu,rf -
My designated beneficiary is: Li,,14A t• 0AMa1_^_Z
Date of Birth. sZ Social Security Number: 3? if -!TS ° /fzy
Employee's Signature: ?c, •??-=- L=
-?•-9L
Employee's SSN: Z?7-C.? •3?z Date:
STATE OF FLORIDA The fo of instrument wales C, w tS? before me this
COUNTY OF PII4ELLAS byV\ is
Personally known me or who has provided
I enti tePlt'on and who did/did not take an oath.
C
Notary Public
(s.
P1 Name of Notary Printed
My Commission expires:
-FI A SEA
L'Y1ti'TFILk M ANDERSON
NCrrARY puBUC STATE DF MORIDA
Cgbl?ltSSTQ;3 N:o. CC..W649
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i
CITY OF CLEARWATER
GENERAL EMPLOYEES' PENSION PLAN
OPTIONS • GENERAL EMPLOYEES
OPTION #1: 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 6% deduction for
pension from thin lurnp 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
the following day,
OPTION #2 Entployee. can extend termination date by the time, due for
vacation, holiday pay, and 112 of accrued sick leave, termination
date will be the final day of extended time. Pension benefits will
begin the following day.
(Only available to employees hired prior to 1011190.)
¦ iE L • i i ! i i f # y ¦ # # ¦ # i M * # ¦ • • # # ¦ # i # i • ¦ • # ? • w R ¦ i ¦ iii • • • t ¦ i ¦ ¦ s # i i i i i • i # i • # #
1, William D. Cantlin an employee of the City of Clearwater, hereby apply for
pension, benefits under the City's Employees' Pension Plan.
I hereby certify ,hat I fully understand the two options offered to me. I choose to retire using
Option 4 and wish my benefits to be calculated under this option.
I understand that ante this form is signed, my decision is irrevocable.
EMPLOYEE'S SIGNATURE: 1 '
SOCIAL. SECURITY;: 267-64-3125
%WUNESSES: :ADDRESS: 705 Karlyn Drive
Clearwater FL 34G15
DATE: zr;11., . /Z, 1996