10-15-2001Agenda/Pension
10/15/O1
ACTION AGENDA
Board of Trustees of the Employees' Pension Fund
October 15, 2001 - 9:00 a.m.
1. Call to Order - 9:05 a.m.
2. Approval of Minutes: 09/04/01 - Approved
3. Request for acceptance into membership: Scott O'Hare, Patrick Pothier, Darrell Goodin, Richard
Kephart, Brian Matheriy, Modesto Gonzalez, Seth Eigenmann, Debra Davis, Douglas Alvarez,
David Kessinger, John Schroeder and Frederick Hemerick. - Approved
4. Regular Pension(s) to be granted: Linda Lange, Deloris Butler-Moody, Janis Przywara and
James Maglio. - Approved
5. Other Business - Award contract to Christiansen & Dehner, P.A. for legal services
6. Adjourn - 9:06 a.m.
Meeting Date: 0- 15" 01 Approved by Trustees:
CITY OF CLEARWATER
EMPLOYEES' PENSION PLAN/
PENSION ADVISORY COMMITTEE
TO: Pension Trustees
FROM: Pension Advisory Committee
SUBJECT: Recommendation for Acceptance into Pension Plan
DATE: September 13, 2001
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". The employment of these individuals brings the number of FTE's as of this
date to 1706.11 of 1801.3 budgeted positions (including the City Commission).
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.
Name. Job. Class, & Dept./Div. Hire Date Date
Scott O'Hare, Police Recruit/Police 7/16/01 7/16/01
Patrick Pothier, Tree Trimmer/Public Services 7/30/01 7/30/01
Darrell Goodin, Tree Trimmer/Public Services 7/30/01 7130/01
Richard Kephart, Senior Planner/Planning & Development Services 7/31/01 7/31 /01
Brian Matherly, Parks Service Technician I/Parks & Recreation 7/30/01 7/30/01
Modesto Gonzalez, Field Service Representative/Customer Service 7/30/01 7/30/01
Seth Eigenmann, Courier/Information Technology 12/2/00 6/4/01
Debra Davis, Senior Payroll Technician/Finance 8/13/01 8/13/01
Douglas Alvarez, Public Utilities Technician I/Public Utilities 8/13/01 8/13/01
David Kessinger, Fire Assistant Chief-Production/Fire 7/30101 7/30/01
John Schroeder, Police Communications Operator Trainee/Police 8/13/01 8/13/01
Frederick Hemerick, Field Service Representative/Customer Service 8/27/01 8/27/01
originally employed as part-time; transferred to full-time and pension eligible as of 6/4/01
. t4-toc
Pension Advisory Com Chair
9Q?ATEtt?`?Q.
Trustees of the
Employees' Pension Plan
Agenda Cover Memorandum
Final Agenda Item it
Meeting Date: 10/15/01
SUBJECT/RECOMMENDATION:
Linda Lange, Library Division Manager, Library Department; Deloris Butler-Moody, Custodial Worker, Parks &
Recreation Department; Janis Przywara, Administrative Support Manager, Legal Department; and James Maglio,
Assistant Solid Waste Director, Solid Waste Department, be granted regular pensions 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.
SUMMARY:
Linda Lange, Library Division Manager, Library Department, was employed by the City on
March 29, 1971, and her pension service credit is effective on September 29, 1971. Her pension will be effective
November 1, 2001.
Based on an average salary of approximately $59,332 per year over the past five years, the formula for computing
regular pensions, and Ms. Lange's selection of the Life Annuity, this pension will approximate $52,896 annually.
Deloris Butler-Moody, Custodial Worker, Parks & Recreation Department, was employed by the City on
June 25, 1979, and her pension service credit is effective on that date. Her pension will be effective
November 1, 2001.
Based on an average salary of approximately $25,069 per year over the past five years, the formula for computing
regular pensions, and Ms. Butler-Moody's selection of the joint & Survivor Annuity, this pension will approximate
$15,379 annually.
Janis Przywara, Administrative Support Manager, Legal Department, was employed by the City on
May 4, 1981, and her pension service credit is effective on that date. Her pension will be effective
December 1, 2001.
Based on an average salary of approximately $39,748 per year over the past five years, the formula for computing
regular pensions, and Ms. Przywara's selection of the joint & Survivor Annuity, this pension will approximate
$22,490 annually.
James Maglio, Assistant Solid Waste Director, Solid Waste Department, was employed by the City on
October 5, 1981, and his pension service credit is effective on that date. His pension will be effective
November 1, 2001.
Based on an average salary of approximately $55,213 per year over the past five years, the formula for computing
regular pensions, and Mr. Maglio's selection of the 50% Joint & Survivor Annuity, this pension will approximate
$31,586 annually.
Reviewed by: Originating Dept: Costs
Legal NA Info Tech NA Debbie Ford/Human Resources . Total
Budget NA Public Works NA User Dept. Funding Source:
Purchasing NA DCNA/ACM captial h"pVoveme"t Current Fiscal Year
Risk Mgmt NA Other NA Attachments operating
other
Appropriation Code:
Submitted by: O None
City Manager
Printed nn rervrted naner Rrv_ 719R
Regular Pensions
Page 2
October 15, 2001
These pensions were approved by the Pension Advisory Committee on September 13, 2001. Section
2.393 (p) provides for normal retirement eligibility when a participant has reached age 55 and completed
twenty years of credited service, has completed 30 years of credited service, or has reached age 65 and
completed ten years of credited service. Ms. Lange qualifies under the 30 years of service criteria and
Ms. Butler-Moody, Ms. Przywara, and Mr. Maglio qualify under the age 55 and 20 years of service criteria.
?SEAIM• r?
Trustees of the
Final Agenda Item #
9Q?y?TEmployees' Pension Plan Meeting Dr,te: 10/15/01
Agenda Cover Memorandum
SUBJECT/RECOMMENDATION:
Award a contract to Christiansen & Definer, P.A., Sarasota, Florida, in the estimated amount of $30,000 for legal
services for the Board of Trustees of the Employees' Pension Plan during the contract period October 1, 2001, to
September 30, 2002.
and that the appropriate officials be authorized to execute same.
SUMMARY:
In 1999 the Board of Trustees of the City of Clearwater's Employees' Pension Plan entered into an
agreement with the law firm of Christiansen & Deliner, P.A., to provide services to the Board of Trustees
and Pension Advisory Committee. The Pension Advisory Committee and Pension Trustees have been
satisfied with the services provided by the firm.
A proposal has been submitted to renew the contract effective October 1, 2001, at the current rate of
$210.00 per hour for attorney services and $105.00 per hour for travel. This contract period will run from
October 1, 2001, through September 30, 2002.
The renewal of this contract was approved by the Pension Advisory Committee on September 13, 2001. It
now comes before the Board of Trustees for its consideration.
Reviewed by: Originating Dept:
Legal Info Tech NA Debbie Ford/Human Resources
Budget t J Public Works NA User Dept.
Purchasing DCM/ACM
Risk Mgmt NA Other NOY Attachments
Submitted by: p None
City Manager
Printpd nn recvrled naner
Costs
Total
Funding Source:
Captial I mproN ement
Operating
Other
Current Fiscal Year
Appropriation Code:
646-07410-530100-585-000
Rev. 2/98
LEGAL SERVICES AGREEMENT
THIS AGREEMENT is made on the day of , 2001, by and between the
BOARD OF TRUSTEES OF THE EMPLOYEES' PENSION PLAN of the CITY OF
CLEARWATER, FLORIDA, P.O. Box 4748, Clearwater, Florida 33758-4748 (the "Board") and the
law firm of CHRISTIANSEN & DEHNER, P.A., 63 Sarasota Center Boulevard, Suite 107,
Sarasota, Florida 34239 ("Counsel").
WITNESSETH:
WHEREAS, the Board wishes to retain Counsel to provide Pension Attorney Services to
the Board.
NOW, THEREFORE, in consideration of the promises and mutual covenants herein
contained, the parties hereto do hereby agree as follows:
SECTION 1. AUTHORIZATION TO PROCEED AS COUNSEL. Counsel is hereby
authorized to provide pension attorney services as described in and for the professional fees
described in this Agreement.
SECTION 2. SCOPE OF SERVICES. Counsel hereby agrees to provide pension
attorney services to the Board, which shall include legal advice, document and ordinance
preparation, and other services as directed by the Board.
SECTION 3. TERM. This Agreement will be effective from October 1, 2001, through
September 30, 2002.
SECTION 4. PROFESSIONAL FEES FOR SERVICES. The Board and Counsel agree to
a rate of $210.00 per hour for attorney services and $105.00 per hour for travel time, plus
reimbursement for reasonable compensable expenses subject to Board approval.
SECTION 5. COMPENSABLE EXPENSES. Reimbursement of expenses shall be
made by the Board to the firm for reasonable out-of-pocket expenses as determined by
the Board without markup, including but not limited to long distance calls and facsimiles,
copying or reproducing documents, postage, court costs, parking costs and travel
incurred by Counsel in performance of the duties hereunder. Travel and per diem costs
as well as auto travel expenses shall not exceed that which is available to City of
Clearwater employees.
SECTION 6. INDEMNIFICATION AND INSURANCE. Counsel agrees to protect, defend,
indemnify and hold the Board and its officers, employees and agents free and harmless from and
against any and all losses, penalties, damages, settlements, costs, charges, professional fees or
other expenses or liabilities of every kind and character arising out of or due to any negligent act
or omission of Counsel, its employees, agents and subcontractors in connection with or arising
directly or indirectly out of this Agreement and/or the performance hereof. Without limiting its
liability under this Agreement, Counsel shall procure and maintain during the life of this Agreement
professional liability insurance in an amount of $2,000,000. This provision shall survive the
termination of this Agreement.
SECTION 7. CONFLICT OF INTEREST. It is understood by the Board and Counsel that
Counsel is not aware of any clients of the firm that currently present any conflict between the
interests of the Board and other clients of Counsel. If any potential conflict of interest arises
during the time Counsel is representing the Board, Counsel will promptly inform the Board. The
Board is under no obligation to agree to permit the conflict representation.
SECTION 8. CONSTRUCTION AND AMENDMENTS. This Agreement shall be
governed by and construed in accordance with the laws of the State of Florida. This Agreement
may be amended only by a writing duly entered into by the Board and Counsel.
SECTION 9. CANCELLATION OF AGREEMENT. The Board may cancel or terminate
this Agreement upon ten days advance written notice to Counsel. In the event of cancellation,
Counsel shall immediately cease work hereunder and shall be reimbursed for eligible and
documented reimbursable expenses incurred prior to the date of cancellation. Further, it is
understood and agreed between the Board and Counsel that H. Lee Dehner and Scott R.
Christiansen will be the lead attorneys assigned by the firm to provide the services contained
herein. The Board in its absolute discretion may immediately terminate this Agreement upon
written notice to the firm if the services of this attorney are unavailable to the Board.
IN WITNESS WHEREOF, the Board and Counsel have executed this Agreement as of the
date first written above.
BOARD OF TRUSTEES OF THE
EMPLOYEES' PENSION PLAN OF THE
CITY OF CLEARWATER, FLORIDA
By:
Brian J. Aungst
Chairperson
Approved as to form: Attest:
Pamela K. Akin Cynthia E. Goudeau
City Attorney City Clerk
CHRISTIANSEN & DEHNER, P.A.
Attest:
By:
Its
2
CITY OF CLEARWATEi!
EMPLOYEES' SEPARATION PAY ACES
PREFERENCE 01 Employees can receive a hemp sun payment for vacation, floating holiday pay.
. t sick leave incentive, bonus days Of applicable!e and 112 of accrued *k leave
at the time of separation front the Gty. Then wM be no deduction for
pension from this hump sum payment nor wM this amount count as earnfts in
the calculation of the pension.. The ian day of work wM be the termination
date and pension benefit wM begin the following month.
PREFERENCE i2 Employee can extend termination date by part or d of the fte due for
vacation. floating holiday pay,, sick leave incentive, bonus days Of appl!"ble).
and 112 of 'accrued sick leave. Employee may choose to run out Na tone In
any manner. Balance wit be paid. h a hunp sum on em oyeel Snal
C:rJ*ck. Termination date wM be the final day of extended tirne. Peaslon
neffts will begin the foffovAM month.
Only wadable to employees hired prior to 1011180 or fire baroakft
employees hired prior to 10/11M
PREFERENCE 03 Police bwg,aifq employees can split their accumulated sick time at one-
quarter pay and one-quarter early retirement time. That portion recelved as
ane-quarter pay wM have no deduction for pension nor wM It cost as
earnings in the calculation of the pendon. The reduction an applied toward early
retirement time wig be subjeat to the pension and wr7 count as
sa? s for pension calculations. Twn*wtlon date w7 be the final day of
warded time: pendorf benefits wM begin the fc#owbV month..
Only available to Police employees hired prior to 1011/80 covered by the FOP
10 or the Sergeants and Ueutenents labor contracts.
L _ cd w n M j, `c e l 1 . an employee of the City of Clearwater. hereby apply for
pension benefits under the City's Employees' Penslon Fhm
1 hereby certify that 1 tuft understand the preferences offered to me. i choose to retire uskWseparation
pay preference • and wish my benefits to be calculated under as preference. Please use my
leave In the (allowing manner:
Run out 7, vacation y 3. GSsidc Aoebm - boms Flours
Lump SUM __. vocadon sick fioebA h-R a • o borws doss
1 understand that my preference cannot be changed once this torn Is stoned and that my decision is
irrevocable.
EMPLOYEE'S SIGNATURE
t evft r M
ft" 09906000:
ADDRESS:
PHONE 7,Z '7 zs a 7 - o i L
DATA
me "Wwe 00188 fton" M he
CITY OF CLEARWATER
PENSION ENTITLEMENT OPTION REQUEST FORM
1, C;'dr l? i ll 0"I "c e l l
of Clearwater General Employees' Pension Plan.
Job Classification:
Department: -5- 4t
Benefits Date: 1a
Date of Birth: 6
Spouse's Name:
Spouse's Date of Birth: 7 I k
k,/GS?C. C? C,I
do hereby apply for retirement under the City
9 01 c fl-f oe/- Sex: j(g) F
ion:
Date of Hire: 6/1-2/7-5
Resignation Date: /o (,/0/.
n M1,
Sex: M 4:-- )
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
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 (#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 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 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 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 estate if his/her beneficiary is not alive. [Section 2.398 (b) (2) (A) (ii)]
Option 4 - 50% 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 50% 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 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
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 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
Number and Description.)
I understand that once this option is approved by the Pension Trustees, my decision is irrevocable.
if taxing Upti
Option #: 1
Employee's Signature:
below:
Date:
Dependent children under the age of 18 and residing in my household are:
Child's Name Sex Date of Birth
If taking Option 2 sign below:
Option #: 2 Description: Life Annuity
Employee's Signature: Date:
If taking Option 3 4, 5 or 6 fill in beneficiary information and sign Below:
Option #: (o Description: U 0 6 -11,0, ' yr ??V?r i'Ihv?
My design ed beneficiary is:
Name: /vet v)n Mi -re f' f Date of Birth: 2bq/5R-SexM0
Social Security Number: 5.1 - 3,?- Phone Number: 7 7 IS vZ 7 -
Address: 11:5 30
6 P IC
Employee's Signature:
Description: Joint and Survivor Annuity
Date: 9 'oL 5"-0 /
STATE OF FLORIDA The foregoing instrument was apa owlledged before me this
COUNTY OF PINELLAS C? _ol 5_?j / by C e /! who is
personally known to me or who has provided.
as identification and who did/did n t t ke an oath.
kc,&,?c Cllr Notary Public
gna ve
- 440fe `? L - Name of Notary Printed
My Commission expires:
EBORAHLFORD 1.
uauc smm OF FLORIDA
L'
New 2/96 ?tlSSloN NO. CC9Ca077a
Form #9900-0009 ?diSSIONtC"?t?E ion Entitlement Option Form
I
Estimated Pension Worksheet
Calvin Mizell
263-72-9532
GROSS
CALENDAR PENSION
YEAR EARNINGS
LAST DATE PAID: 10/26/01 1996 $33,303.29
BENEFITS DATE 12/18/75 1997 $34,438.24
CREDITED SERVICE 25.8583 1998 $36,612.82
1999 $37,832.29
2000 $40,312.46
$182,499.10 (5 Year Total)
5/ $36,499.82 (Yearly Avg)
12/ $3,041.65 (Monthly Avg)
x 0.0275 (Benefit Rate)
x 25.8583 (Yrs of Service)
$2,162.93 (Est Mtly Pension)
Signature:
Date: 9 -07 S- O l
City of Clearwater Employees' Pension Plan
Actuarial Equivalence Factors
25-Sep-01
sm
ESTIMATE clract01
Version:
Employee Name: Calvin Mizell 1-4-96
Employee Date of Birth: 6 28 1946
Marital Status: M
Spouse Date of Birth: 7 19 1952
Beneficiary Date of Birth: 7 19 1952
Benefit Commencement Date : 11 1 2001
Estimated Monthly Normal Retirement Benefit: $2,162.93
Actuarial Equivalent Adjustment Factors:
Option 1
Option 2
Option 3
Option 4
Option 5
Option 6
Normal Form 1.00000
Life Annuity 1.10384
10 Year Certain 1.08792
50% J&S 1.03657
75% J&S 1.00591
100% J&S 0.97702
Estimated
Monthly
Benefit
.$2,162.93
$2,387.53
$2,353.11
$2,242.02
$2,175.72
$2,113.23
ESTIMATE
CITY OF CATER
EMPLOYEES! SEPARATION PAY PREFERENCM
PREFERENCE 01 Employees can receive a hump sure payment for vacation, floating holiday pay,
sick leans incentives borws days Of applicable!. and 112 of accrued skit leave
at the time of separation from the City. There wM be no deduction for
pension from this lump sum payment nor will thls amount count as earnings in
the calculation of the pension.. The lad day of work wil be the termination
date end pension benefit will begin the folowhV month.
PREFERENCE 02 Employee can extend termination date by part or d of the time dus for
vacation, floating holiday pays sick leans incentive, bonus days of applicable).
and 1/2 of-'accrued sick leave. Employee may choose to run out this time in
any manner. Balance wil be paid. in a kunp sum on employee's final
paycheck. Temninstion date wa be the final day of extended time. Pension
benefits will begin the following month.
Only avalabtf to employees hired prior to 1011M or Me bargaining
employees hired prior to 1011181.
PREFERENCE 03 Police bargaining employees can split their accumulated sick time at me-
quarter pay and one-quarter retirement time.. That pardon . received . as
one-"rtw y wM have no deduction for pension nor wU it count as
earrings In the calculation the pension. The mion applied to and early
retirement time wit be subject to the pension deduction and count as
aarnbV3 for pension calculations. Tumbution date wit be the find day of
extended time: pension benefit wit begin the following rnandL.
Only available to police employees hired prior to 1011190 covered by the FOP
10 or the Sergeants and Usutenants labor contracts.
;4+ an employ" of the City of Clearwater. hereby. apply for
pension bens under the City's Employees' Pension Rare.
1 hereby certify that t fully understand the preferences offered to me. I choose to retire using-separation
pay preference_ and wish my benefits to be aatcutated under this preference. Soria use my
ieaw In the foffmft marrw:
Run 0!ut vacation _ attic tlosters bonus Hors
oft, L lick fTaWS 90, bonus Ham
Ltrnp SWI1 a N 0d vBCatIOA ?
1 446:stand that my preference carrot be changed once this foam b eipned and that my decision a
irrevocable.
y nrNESSE&O
r:..r..r 7AV
t:e.A. nsoaooa
EMPLOYEE'S SIGNATURE
Soc la sECURmr #: o? -7 y- IS d
ADDRESS: P54-o l (2,'rc k W.
aIPr^ . 1:-L,
M40M '-7a 71573 G X19 0 / DA-M `1/02 7/0/,
we xs? aM.r.ldpwe" OV hd
CITY OF CLEARWATER
PENSION ENTITLEMENT OPTION REQUEST FORM
do hereby apply for retirement under the City
of Clearwater General Erripllo?y?ees' Pension Plan.
Job Classification: (,/PGC1 x111 C)'TC C A v/ /'C / 4 vl
Department: / e Division: rq ?'
Benefits Date: co a- -7 Date of Hire: &- -7
Date of Birth: /,:3L /10 Resignation Date:
Spouse's Name: q, y4S
Spouse's Date of Birth:
Sex:
i V (I vC-
Of
Sex: M G
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
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 (#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 shalt 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 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 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 estate if his/her beneficiary is not alive. [Section 2.398 (b) (2) (A) (ii)]
Option 4 - 50% 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 50% 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 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
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 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
Number and Description.)
I understand that once this option is approved by the Pension Trustees, my decision is irrevocable.
If taking Option 1
Option #: 1
Employee's Signature:
below:
Date:
Dependent children under the age of 18 and residing in my household are:
Child's Name Sex Date of Birth
If taking Option 2 sign below:
Option #: 2 Description: Life Annuity
Employee's Signature: Date:
If taking Option 3, 4, 5, or 6 fill in beneficia information and sign below:
Description: Q-0 o a, ,, a,- V/ LAY k- ilrl v
Option #:
My desi nated b nefciary I
Name: M4 /",, #S Date of Birth: 3 Sex M
/
Social Security Number: c? 7V- Va - ? I V 7 Phone Number: _ 7 0- 7 /5- 34 -- 99,6
Address:
Employee's Signature:
/Tale W
Date: y' /P- 7
STATE OF FLORIDA The foregoing instrument was acknowledged before me this
COUNTY OF PINELLAS 9- p] -7 `01 by (GrLt Ft-,, r7-S, who is
personally known to me or who has provided ;P--L bVI,urk '.S 1 ;Lc'v) L
as identification and who did/did not take an oath.
Notary Public
?? e) C? ,?e.,C?IJ?b gr Name of Notary Printed
My Commission expires:
OFF ICIAL•NUrARYSEAL
DEBORAH L IUD
NOTARY PUBLIC STATE OF FLORIDA
New 2/96 COMMWON W.OCWM '
Form #9900-0009 MYCOMMWION EXP. MAY t jile Name: Pension Entitlement Option Form
Description: Joint and Survivor Annuity
I
Estimated Pension Worksheet
Gary Fritts
267-74-1508
GROSS
CALENDAR PENSION
YEAR EARNINGS
LAST DATE PAID: 12/11/01 1996 $35,685.37
BENEFITS DATE 6/18/77 1997 $36,163.34
CREDITED SERVICE 24.4833 1998 $38,314.39
1999 $41,797.07
2000 $40,458.62
$192,418.79 (5 Year Total)
5/ $38,483.76 (Yearly Avg)
12/ $3,206.98 (Monthly Avg)
x 0.0275 (Benefit Rate)
x 24.4833 (Yrs of Service)
$2,159.23 (Est Mtly Pension)
Signature:
Date: 9 -7 0 /
City of Clearwater Employees' Pension Plan
Actuarial Equivalence Factors
27-Sep-01
sm
ESTIMATE c1ract01
Version:
Employee Name: Gary Fritts 1-4-96
Employee Date of Birth: 12 10 1946
Marital Status: m
Spouse Date of Birth: 3 18 1946
Beneficiary Date of Birth: 3 18 1946
Benefit Commencement Date : 1 1 2002
Estimated Monthly Normal Reti rement Benefit: $2,159.23
Actuarial Equivalent Adjustment Factors:
Option 1 Normal Form 1.00000
Option 2 Life Annuity 1.07671
Option 3 10 Year Certain 1.06119
Option 4 50% J&S 1.02745
Option 5 75% J&S 1.00447
Option 6 100% J&S 0.98250
Estimated
Monthly
Benefit
$2,159.23
$2,324.87
$2,291.35
$2,218.50
$2,168.89
$2,121.44
ESTIMATE
CITY OF CLEARWATER
EMPLOYEEV SEPARATION PAY PREFEMCES
PREFERENCE 01 Employees can receive a limp sure payment for vacadol% ffoadrq holiday pay,
sick leave Gxendve, bonus days 0 eppUsblels and 112 of accrued sick leave
at the time of separation from the 00. Then wM be no deduction for
pension from this lump sum payment nor will this amount count as earnings In
the calculation of the pensio(L. The ian day of work wM be the termlMdon
date and pension benefits will begin the following month.
PREFERENCE 02 Employee can extend termination date by pert or ali of the tune due for
vacation, floating holiday pay, sick leave incentive, bonus days Of applicable).
and 112 of'accrued sick leave. Emplom may choose to no out this time in
any manner. Balance wig be . In • hump sum on employee's final
ppTermination date wM the f nal day of extended time. .Pension
efits wil begin the following month.
Only available to employyeeesss hired prior to 1011180 or Fire bargab tnp
employees hired prior to 1011M.
PREFERENCE 03 Police bargaining employees can split ft k accumulated okk time at one-
quarter pay and one-quarter early retirement dme.. That portion received . as
one-quarter pay wM have no deduction for pension nor wM it count as
on applied toward early
earnings In the calculation of the pension. Theredo
redre aq time wit be subject to the pension c
tion and wig count as
"rrfts for pension caicvladom Termtnedon date wM be the final day of
extended time: pension benefits will begin the followinv month..
Only available to Poffm employees hired prior to 1011180 covered by die FOP
10 or the Sergeants and Lieutenants tabor contracts.
II. 7 n CIJh ?' Cv P",b an employee of the qty of Clearwater, hereby- apply for
pension benefits under the City's Employees' Pension Fft"
1 hereby certify that 1 fully understand the preferences offered to me. 1 choose td retire uslng"separation
pay preference • = and wish my benefits to be calculated under dots preference. Please use my
leave h the fa v*" monad.
Run Out o`? 9 vacation 019 0.1 yc J/_ D O listens ____,_ bonws Hoes
twnp Suns vacation yam= yak ___. fi $me /20, c bonus Hours
1 understand that my preference cannot be changed once this forms Is signed and that my decision h
irrevocable.
vrrnMssES:
no%&" 17M
ft" 0090*000e
EMPLOYEE'S SIGNATUM
SOC AL•SMRiTY !t i s 3 P -913 5
ADDRESSC '7 S c u /h % v t°.. ?? y
Q e a rwq ??? , F=C. 3 3 7 S" G
MONIh
iN Room aIbl" $WOW" till he
CITY OF CLEARWATER
PENSION ENTITLEMENT OPTION REQUEST FORM
I, 1 d h n Wh i-f Cd..n b do hereby apply for retirement under the City
of Clearwater General Employees' Pension Plan.
Job Classification: ?v / GC WG2 S T-? W14 V /? C? Sex:, OM F
Department: e. Division:
Benefits Date: f 3 d- Date of Hire: i / 3 7 ?
Date of Birth:
E S St Resignation Date: / 75 V6 --5-
Spouse's Name: Sex: M F
Spouse's Date of Birth:
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
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 (#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 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 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 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 estate if his/her beneficiary is not alive. [Section 2.398 (b) (2) (A) (ii)]
Option A - 50% 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 50% 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/tier 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
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 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
Number and Description.)
I understand that once this option is approved by the Pension Trustees, my decision is irrevocable.
If taking option 1 sign below:
Option #: 1
Employee's Signature:
Date:
Dependent children under the age of 18 and residing in my household are:
Child's Name Sex Date of Birth
If taking Option 2 sign below:
Option #: 2 Description: Life Annuity
Employee's Signature: Date: /o b?__ O .
If takin
Option M
or s fin in beneficiary information and sign below:
Description:
Sex M F
My designated beneficiary is:
Name: Date of Birth:
Social Security Number:
Address:
Employee's Signature:
Phone Number:
Date:
STATE OF FLORIDA The foregoing instrument was acknowledged before me this
COUNTY OF PINELLAS by C7-d/j n (L) /I ?Ccl n) who is
personally known to me or who has provided
as identification and who did/did n .Qt take an oath.
xuuv,4? W_ Notary Public
jb?qnalure)
O la ,) - /'-U?? Name of Notary Printed
My Commission expires:
WI •NOTARYSLAL
TARY5f11L DEBORAH L FORD
D NOTARY PUBLIC STATROF FLORIDA
ENOTA.:.,?. -R FLORIDA C NW SSION NO. CC9t30773
New 2/96 OMY C0?1Mt56tOV E?(P. MAY is
Form #9900-0009 C?w__ I
s le Name: ension ntit ement Option Form
Description: Joint and Survivor Annuity
Estimated Pension Worksheet
John Whitcomb
012-38-9139
LAST DATE PAID: 1/13/02
BENEFITS DATE 1/13172
CREDITED SERVICE 30.0028
0101,
Signature: . 4 a'-Ik4?
Date: 611OLS-I&
GROSS
CALENDAR PENSION
YEAR EARNINGS
1996 $27,412.69
1997 $28,042.38
1998 $31,378.59
1999 $32,342.65
2000 $29,477.52
$148,653.83 (5 Year Total)
51 $29,730.77 (Yearly Avg)
12/ $2,477.56 (Monthly Avg)
x 0.0275 (Benefit Rate)
x 30.0028 (Yrs of Service)
$2,044.18 (Est Mtly Pension)
11
City of Clearwater Employees' Pension Plan
Actuarial Equivalence Factors
25-Sep-01
sm
ESTIMATE clract01
Version:
Employee Name: John Whitcomb 1-4-96
Employee Date of Birth: 4 15 1951
Marital Status: S
Spouse Date of Birth:
Beneficiary Date of Birth: 10 31 1952
Benefit Commencement Date : 2 1 2002
Estimated Monthly Normal Reti rement Benefit: $2,044.18
Option 1
Option 2
Option 3
Option 4
Option 5
Option 6
Actuarial Equivalent Adjustment Factors:
Normal Form 1.00000
Life Annuity
10 Year Certain
50% J&S
75% J&S
100% J&S
1.00000
0.99027
0.95678
0.93653
0.91713
Estimated
Monthly
Benefit
$2,044.18
$2,044.18
$2,024.29
$1,955.82
$1,914.45
$1,874.78
ESTIMATE
APPLICATION FOR VESTED RIGHTS PENSION
0 5(f being a person leaving
employment v;jTJ the City of Clearwater, Florida, and having completed ten (10) or
more years of credited service, suo srvice having occurred during the period from
(date of entry Into Pension Plan) K- bCt' X211 /'/7V to (date of resignation)
,,ep7i e,- /. o? u 61 i hereby makes application to receive the vested rights
pension provided for by Section 2.397 of the City Code or Ordinances. As such former
employee I understand that the' pension requested will be computed pursuant to the
provisions of Section 2.398 of the City Code of Ordinances.
hereby further certify that my date of birth Is J U'-) C / % V ?J
54
The date 1 will begin to receive my reduced pension will be .1u ?u ?. ? c) (7
Further, I additionally certify that I have made no application seeking to obtain a return
of the contributions that I paid Into the Pension Fund during the period of my
employment set forth above; 1 have not been convicted of a felony during my period of
employment and I have not received any other type of pension from the City.
. Signature
??0'7? S ? G??ctr ?/CGrv?c:?c?t'?` ? >'•7G d
ess
Departrwt/Divislon
l?i?-Yo 20Y
Social Security Number
STATE OF FLORIDA The foregoing Instrument Was acknQwlsdged before no
COUNTY OF PINELLAS this " 0 / by .V c ; T !? K« ?'tn?,la /,/. who
Is personally known to me or who has produced
•
Identification and who did/dId not take an oath.
&ee 4-CA4?-' YPublic
(Signature)
L . ?-- ?r Commission No.
d,'e (Name of Notary Printed)
OFACIAL•NOTAR Y SEAL
DEBORAH L FORD
NOTARY PUBLIC STATE OF FLOR IDA
COMMLSSiON NO. CC430773
My COMM' MS.0N r:h. NMY 1520m