Loading...
09/20/2010 4 PENSION TRUSTEES AGENDA Location: Council Chambers-City Hall Date: 9/20/2010- 9:00 AM 1. Call to Order 2. Approval of Minutes 2.1 Approve the minutes of the August 16, 2010 Pension Trustees Meeting as submitted in written summation by the City Clerk. Attachments 3. Pension Trustee Items 3.1 Approve a contract with Riverbridge Partners as a small cap growth manager for the Employees' Pension Plan and authorize the appropriate officials to execute the same. Attachments 3.2 Approve the termination of Lee Munder as the Pension Plan's small cap growth manager and authorize the appropriate officials to execute the same. Attachments 3.3 Accept new hires into Pension Plan as listed. Attachments 3.4 Mark Carlson, Gregory Wolfe, Elaine Muldowney, Joseph Arrien, Muhammad Abdur-Rahim and Cynthia Goudeau be granted regular pensions under Sections 2.397 and 2.398 of the employee pension plan, as recommended by the Pension Advisory Committee. Attachments 3.5 Katrina Breedlove, Jim Sokal, Ami Beery and David Marshall be allowed to vest their pensions as provided by Section 2.397 of the Employees' Pension Plan, as recommended by the Pension Advisory Committee. Attachments 4. Other Business 5. Adjourn Meeting Date: 9/20/2010 Pension Trustees Agenda Council Chambers City Hall SUBJECT / RECOMMENDATION: Approve the minutes of the August 16, 2010 Pension Trustees Meeting as submitted in written summation by the City Clerk. SUMMARY: Review Approval: 1) Clerk Cover Memo Item # 1 Attachment number 1 Page 1 of 10 TRUSTEES OF THE EMPLOYEES' PENSION FUND MEETING MINUTES CITY OF CLEARWATER August 16, 2010 Present: Trustee/Chair Frank Hibbard, Trustee George N, Cretekos, Trustee John Doran, Trustee Paul Gibson, and Trustee Bill Jonson. Also William B. Horne II - City Manager, Jill S. Silverboard - Assistant City present: Manager, Rod Irwin - Assistant City Manager, Pamela K. Akin - City Attorney, Cynthia E. Goudeau - City Clerk, and Rosemarie Call - Management Analyst. Unapproved 1. Call to Order - Trustee Frank Hibbard The meeting was called to order at 9:26 a.m. at City Hall. 2. Approval of Minutes 3. Pension Trustee Items 3.1 Approve the sub-advisory relationship tw n Wentworth, aus r and Violich, Inc. and irava a Investments and authorize aoorooriat officials to execute same. In April 2008, the Employees' Pension Plan hired and started funding Wentworth, Hauser and Violich, Inc. (WHV) as a large cap international equity (EAFE) manager. WHV has reorganized and created a sub-advisory company, Hirayama Investments, to manage the large cap international equity fund in which the City participates. The investment team the plan hired in 2008 has remained the same. The structure of the organization is the only change being made. The Pension Investment Committee supports the change and the pension plan's attorney has reviewed and approved the sub-advisory agreement. Pension Trustees 2010-8-16 Item #11 Attachment number 1 Page 2 of 10 In response to questions, Cash and Investments Manager Steve Moskun said professional fund managers have specialized expertise and have representation around the world. The industry has standardized fees and staff negotiates fees to standard norm or below. The city currently pays $2 million in fees for a $600 million portfolio, approximately .003%. Trustee Bill Jonson moved to approve the sub-advisory relationship between Wentworth, Hauser and Violich, Inc. and Hirayama Investments and authorize appropriate officials to execute same. The motion was duly seconded and carried unanimously. 3.2 Approv hiring MEPT as a core real estate manager for the Employees Pension Ian authorize a contract with New Tower Trust as the trustee and authorize the aproriat officials to execute same. Earlier this year, the Trustees authorized staff to conduct a search for a core real estate manager. Cap Trust the plan's consultant assisted with the search. Cap Trust generated a list of seventy-five potential real estate managers. The list was pared down to eliminate managers with excessive debt, oversized redemption queues, significant style deviation, lack of staff and depth, limited investment capacity, and problematic geographic distribution. Funds that did not meet the definition of an open-ended core domestic fund were also eliminated. These criteria reduced the list of potential managers to twelve. The remaining twelve managers answered a thirty-page questionnaire with one hundred and eighty questions. Based on the fund manager's answers to those questions the list was reduced to the following six managers that was presented to the Pension Investment Committee. American Core Reality Fund Cornerstone Property Fund MEPT TIAA-CREF- Core Properties Fund ING Lion Properties Fund UBS Turnbull Property Fund The Pension Investment Committee reduced the list to the top four listed potential managers and received presentations from the four firms. All of the candidates that presented to the Pension Investment Committee were high quality firms. MEPT is being recommended over the other firms for a variety Pension Trustees 2010-8-16 Item #21 Attachment number 1 Page 3 of 10 of reasons, which include its track record, length of time in business, quality and size of its portfolio, organizational structure and for its ability to weather market downturns and other unforeseen events. MEPT is highly regarded in the industry and has the recommendation of both of the plans consultants and a unanimous recommendation of the Pension Investment Committee. MEPT was founded April 1, 1982 and is organized as a bank collective trust, which is maintained by New Tower Trust Company. The Fund is managed by three entities: Kennedy Associates Real Estate Counsel, LP, of Seattle, Washington, serves as the real estate investment advisor, Landon Butler & Company, LPO, provides investor relations and marketing services to MEPT, and New Tower Trust Company serves as the trustee and fiduciary of the Fund. Our contract is with New Tower since they are the fiduciary for the fund. The Pension Plan attorney has approved this contract. Funding for MEPT will come from a reduction in the allocation to out REIT manager. The dollar amount of the plan's exposure to real estate will remain the same. The addition to MEPT increases the diversification of this asset class specifically and of the plan in general. Northern Trust, the plan's custodian will assist with the transition. In response to questions, Cash and Investments Manager Steve Moskun said the real estate manager purchases or buys properties and the city owns a percentage of the whole fund. The fund is well diversified but mainly residential. Trustee John Doran moved to approve hiring MEPT as a core real estate manager for the Employees Pension Plan, authorize a contract with New Tower Trust as the trustee and authorize the appropriate officials to execute same. The motion was duly seconded and carried unanimously. 3.3 Accept new hires into Pension Ian. Pension Elig. Name. Job Classification. & Department/Division Hire Date Date Cliff Norris, Recreation Supervisor I/Parks & Recreation 4/3/80 6/10/10 * originally hired on 4/3/80 and denied pension; reexamined and pension eligible as of 6/10/10 Pension Trustees 2010-8-16 Item #31 Attachment number 1 Page 4 of 10 Trustee George N, Cretekos moved to approve the employees listed into the City of Clearwater's Employees' Pension Plan as approved by the Pension Advisory Committee. The motion was duly seconded and carried unanimously. 3.4 Approve plod r u sts for regular pensio s. Jeanette Paterkiewicz, Staff Assistant, Public Utilities Department, was employed by the City on August 7, 1989, and her pension service credit is effective on that date. Her pension will be effective August 1, 2010. Based on an average salary of approximately $36,007 per year over the past five years, the formula for computing regular pensions, and Ms. Paterkiewicz' selection of the Joint & Survivor Annuity, this pension will approximate $20,775 annually. Diana Henderson, Police Service Technician, Police Department, was employed by the City on December 4, 1989, and her pension service credit is effective on that date. Her pension will be effective August 1, 2010. Based on an average salary of approximately $44,128 per year over the past five years, the formula for computing regular pensions, and Ms. Henderson's selection of the Joint & Survivor Annuity, this pension will approximate $25,170 annually. Charles Maybin, Parks Service Technician III, Parks & Recreation Department, was employed by the City on January 15, 1990, and his pension service credit is effective on that date. His pension will be effective August 1, 2010. Based on an average salary of approximately $43,471 per year over the past five years, the formula for computing regular pensions, and Mr. Maybin's selection of the 75% Joint & Survivor Annuity, this pension will approximate $24,643 annually. Sandra Herman, Planner III, Planning & Development Department, was employed by the City on January 27, 1986, and her pension service credit is effective on that date. Her pension will be effective August 1, 2010. Based on an average salary of approximately $70,352 per year over the past five years, the formula for computing regular pensions, and Ms. Herman's selection of the Life Annuity, this pension will approximate $52,195 annually. Beverly Verner, Staff Assistant, Parks & Recreation Department, was employed by the City on November 4, 1985, and her pension service credit is effective on that date. Her pension will be effective July 1, 2010. Based on an average salary of approximately $35,120 per year over the past five years, the formula for computing regular pensions, and Ms. Verner's selection of Pension Trustees 2010-8-16 Item #41 Attachment number 1 Page 5 of 10 the Joint & Survivor Annuity, this pension will approximate $23,742 annually. Julia Jablonski, Solid Waste Program Coordinator, Solid Waste/General Services Department, was employed by the City on December 28, 1987, and her pension service credit is effective on February 22, 1988. Her pension will be effective August 1, 2010. Based on an average salary of approximately $52,463 per year over the past five years, the formula for computing regular pensions, and Ms. Jablonski's selection of the Joint & Survivor Annuity, this pension will approximate $32,377 annually. Carl Swigart, Solid Waste Supervisor I, Solid Waste/General Services Department, was employed by the City on February 12, 1981, and his pension service credit is effective on that date. His pension will be effective December 1, 2010. Based on an average salary of approximately $54,412 per year over the past five years, the formula for computing regular pensions, and Mr. Swigart's selection of the 100% Joint & Survivor Annuity, this pension will approximate $43,533 annually. Alison Johnson, Storeskeeper, Public Utilities Department, was employed by the City on February 2, 1987, and her pension service credit is effective on that date. Her pension will be effective August 1, 2010. Based on an average salary of approximately $41,621 per year over the past five years, the formula for computing regular pensions, and Ms. Johnson's selection of the Life Annuity, this pension will approximate $28,390 annually. Sandra Howard, Customer Service Accounting Representative, Customer Service Department , was employed by the City on March 26, 1984, and her pension service credit is effective on that date. Her pension will be effective August 1, 2010. Based on an average salary of approximately $38,400 per year over the past five years, the formula for computing regular pensions, and Ms. Howard's selection of the Joint & Survivor Annuity, this pension will approximate $27,820 annually. Kate MacDonald, Police Information Technician II, Police Department, was employed by the City on November 10, 1986, and her pension service credit is effective on that date. Her pension will be effective September 1, 2010. Based on an average salary of approximately $40,254 per year over the past five years, the formula for computing regular pensions, and Ms. MacDonald's selection of the Joint & Survivor Annuity, this pension will approximate $26,300 Pension Trustees 2010-8-16 Item #51 Attachment number 1 Page 6 of 10 annually. William Fairchild, Public Utilities Technician II, Public Utilities Department, was employed by the City on May 23, 1988, and his pension service credit is effective on that date. His pension will be effective September 1, 2010. Based on an average salary of approximately $47,694 per year over the past five years, the formula for computing regular pensions, and Mr. Fairchild's selection of the Joint and Survivor Annuity, this pension will approximate $29,197 annually. William Kunzman, Parking Enforcement Specialist, Engineering Department, was employed by the City on March 23, 1987, and his pension service credit is effective on March 31, 1987. His pension will be effective August 1, 2010. Based on an average salary of approximately $40,514 per year over the past five years, the formula for computing regular pensions, and Mr. Kunzman's selection of the Life Annuity, this pension will approximate $31,779 annually. Steven Grasso, Tradesworker, Marine & Aviation Department, was employed by the City on October 7, 1982, and his pension service credit is effective on January 5, 1985. His pension will be effective September 1, 2010. Based on an average salary of approximately $47,289 per year over the past five years, the formula for computing regular pensions, and Mr. Grasso's selection of the Joint and Survivor Annuity, this pension will approximate $33,349 annually. Rick Mishler, Utilities Mechanic, Public Utilities Department, was employed by the City on June 17, 1985, and his pension service credit is effective on that date. His pension will be effective September 1, 2010. Based on an average salary of approximately $55,615 per year over the past five years, the formula for computing regular pensions, and Mr. Mishler's selection of the 75% Joint & Survivor Annuity, this pension will approximate $38,642 annually. Patricia Warren, Administrative Support Manager, Information Technology Department, was employed by the City on July 17, 1978, and her pension service credit is effective on that date. Her pension will be effective September 1, 2010. Based on an average salary of approximately $55,199 per year over the past five years, the formula for computing regular pensions, and Ms. Warren's selection of the Joint & Survivor Annuity, this pension will approximate $48,743 annually. Douglas King, Drafting & Mapping Technician, Engineering Department, was employed by the City on June 12, 1978, and his pension service credit is effective on that date. His pension will be effective August 1, 2010. Pension Trustees 2010-8-16 Item #61 Attachment number 1 Page 7 of 10 Based on an average salary of approximately $43,945 per year over the past five years, the formula for computing regular pensions, and Mr. King's selection of the Life Annuity, this pension will approximate $42,601 annually. Richard Hamilton, Professional Land Surveyor, Engineering Department, was employed by the City on January 6, 1975, and his pension service credit is effective on July 7, 1975. His pension will be effective August 1, 2010. Based on an average salary of approximately $59,599 per year over the past five years, the formula for computing regular pensions, and Mr. Hamilton's selection of the 100% Joint & Survivor Annuity, this pension will approximate $55,704 annually. John Richter III, Construction Inspector II, Engineering Department, was employed by the City on June 30, 1980, and his pension service credit is effective on that date. His pension will be effective August 1, 2010. Based on an average salary of approximately $44,049 per year over the past five years, the formula for computing regular pensions, and Mr. Richter's selection of the 100% Joint & Survivor Annuity, this pension will approximate $35,635 annually. Jerry Williams, Solid Waste Equipment Operator, Solid Waste/General Services Department, was employed by the City on August 20, 1980, and his pension service credit is effective on that date. His pension will be effective September 1, 2010. Based on an average salary of approximately $35.687 per year over the past five years, the formula for computing regular pensions, and Mr. Williams' selection of the Joint & Survivor Annuity, this pension will approximate $29,442 annually. Russell Dunning, Public Services Technician III, Public Services Department, was employed by the City on May 21, 1990, and his pension service credit is effective on January 31, 1998. His pension will be effective September 1, 2010. Based on an average salary of approximately $45,942 per year over the past five years, the formula for computing regular pensions, and Mr. Dunning's selection of the 10-Year Certain and Life Annuity, this pension will approximate $15,054 annually. Barbara Schill, Senior Accountant, Finance Department, was employed by the City on June 19, 2000, and her pension service credit is effective on that date. Her pension will be effective September 1, 2010. Based on an average salary of approximately $45,736 per year over the past five Pension Trustees 2010-8-16 Item #71 Attachment number 1 Page 8 of 10 years, the formula for computing regular pensions, and Ms. Schill's selection of the Joint & Survivor Annuity, this pension will approximate $12,815 annually. Gary Johnson, Police Officer, Police Department, was employed by the City on September 24, 1990, and his pension service credit is effective on that date. His pension will be effective October 1, 2010. Based on an average salary of approximately $61,596 per year over the past five years, the formula for computing regular pensions, and Mr. Johnson's selection of the 10-year Certain & Life Annuity, this pension will approximate $33,878 annually. Larry Harbert, Police Officer, Police Department, was employed by the City on September 24, 1990, and his pension service credit is effective on that date. His pension will be effective October 1, 2010. Based on an average salary of approximately $68,614 per year over the past five years, the formula for computing regular pensions, and Mr. Harbert's selection of the Joint & Survivor Annuity, this pension will approximate $37,738 annually. Robert Fava, Police Officer, Police Department, was employed by the City on March 29, 1989, and his pension service credit is effective on that date. His pension will be effective August 1, 2010. Based on an average salary of approximately $74,450 per year over the past five years, the formula for computing regular pensions, and Mr. Fava's selection of the Joint & Survivor Annuity, this pension will approximate $43,347 annually. James Thomas, Fire Lieutenant, Fire Department, was employed by the City on January 4, 1988, and his pension service credit is effective on that date. His pension will be effective September 1, 2010. Based on an average salary of approximately $76,072 per year over the past five years, the formula for computing regular pensions, and Mr. Thomas' selection of the 10-year Certain & Life Annuity, this pension will approximate $50,341 annually. Mark Beaudette, Police Officer, Police Department, was employed by the City on May 17, 1989, and his pension service credit is effective on that date. His pension will be effective August 1, 2010. Based on an average salary of approximately $70,139 per year over the past five years, the formula for computing regular pensions, and Mr. Beaudette's selection of the 100% Joint & Survivor Annuity, this pension will approximate $40,286 annually. Pension Trustees 2010-8-16 Item #81 Attachment number 1 Page 9 of 10 Robert Wierzba, Police Sergeant, Police Department, was employed by the City on March 23, 1987, and his pension service credit is effective on that date. His pension will be effective September 1, 2010. Based on an average salary of approximately $96,958 per year over the past five years, the formula for computing regular pensions, and Mr. Wierzba's selection of the 100% Joint and Survivor Annuity, this pension will approximate $61,931 annually. Norman Jernigan, Fire Medic Lieutenant, Fire Department, was employed by the City on January 6, 1986, and his pension service credit is effective on that date. His pension will be effective September 1, 2010. Based on an average salary of approximately $80,936 per year over the past five years, the formula for computing regular pensions, and Mr. Jernigan's selection of the 10-Year Certain and Life Annuity, this pension will approximate $54,871 annually. Lawrence Borland, Police Sergeant, Police Department, was employed by the City on October 18, 1982, and his pension service credit is effective on that date. His pension will be effective September 1, 2010. Based on an average salary of approximately $82,750 per year over the past five years, the formula for computing regular pensions, and Mr. Borland's selection of the 100% Joint and Survivor Annuity, this pension will approximate $61,043 annually. James Houck, Police Officer, Police Department, was employed by the City on April 3, 1989, and his pension service credit is effective on that date. His pension will be effective September 1, 2010. Based on an average salary of approximately $66,831 per year over the past five years, the formula for computing regular pensions, and Mr. Houck's selection of the 100% Joint & Survivor Annuity, this pension will approximate $38,744 annually. Section 2.393 provides for normal retirement eligibility when a participant has completed thirty years of credited service, has reached age 55 and completed twenty years of credited service, or has reached age 65 and completed ten years of credited service. Section 2.393 also provides for normal retirement eligibility when a participant has completed twenty years of credited service or has reached age 55 and completed ten years of credited service in a type of employment described as "hazardous duty" and further defines service as a Police Officer, Fire Lieutenant, Police Sergeant, and Fire Medic Lieutenant as meeting the hazardous duty criteria. Ms. Paterkiewiz, Ms. Henderson, Mr. Maybin, Ms. Herman, Ms. Verner, Ms. Jablonski, Mr. Swigart, Ms. Johnson, Ms. Howard, Ms. MacDonald, Pension Trustees 2010-8-16 Item #91 Attachment number 1 Page 10 of 10 Mr. Maran, Mr. Fairchild, Mr. Kunzman, Mr. Grasso, Ms. Clement, Ms. Meri, and Mr. Mishler qualify under the age 55 and 25 years of service criteria. Ms. Warren, Mr. King, Mr. Hamilton, Mr. Richter, and Mr. Williams qualify under the 30 years of service criteria. Mr. Dunning and Ms. Schill qualify under the age 65 and 10 years of service criteria. Mr. Johnson, Mr. Harbert, Mr. Fava, Mr. Wilt, Mr. Thomas, Mr. Beaudette, Mr. Wierzba, Mr. Jernigan, Mr. Borland, and Mr. Houck qualify under the hazardous duty criteria. Trustee Paul Gibson moved to grant Jeanette Paterkiewicz, Public Utilities Department; Diana Henderson, Police Department ; Charles Maybin, Parks & Recreation Department; Sandra Herman, Planning and Development Department; Beverly Verner, Parks and Recreation Department; Julia Jablonski, Solid Waste/General Services Department; Carl Swigart, Solid Waste/General Services Department; Alison Johnson, Public Utilities Department; Sandra Howard, Customer Service Department; Kate MacDonald, Police Department; William Fairchild, Public Utilities Department; William Kunzman, Engineering Department; Steven Grasso, Marine and Aviation Department; Rick Mishler, Public Utilities Department; Patricia Warren, Information Technology Department; Douglas King, Engineering Department; Richard Hamilton, Engineering Department; John Richter III, Engineering Department; Jerry Williams, Solid Waste/General Services Department; Russell Dunning, Public Services Department; Barbara Schill, Finance Department; Gary Johnson, Police Department; Larry Harbert, Police Department; Robert Fava, Police Department; James Thomas, Fire Department; Mark Beaudette, Police Department; Robert Wierzba, Police Department; Norman Jernigan, Fire Department; Lawrence Borland, Police Department and James Houck, Police Department regular pensions under Section 2.393 of the Employees' Pension Plan as approved by the Pension Advisory Committee. The motion was duly seconded and carried unanimously. ® f- - Business - None. Adjourn The meeting was adjourned at 9:37 a.m. Chair Employee's Pension Plan Trustees Attest City Clerk Pension Trustees 2010-8-16 Item 401 Meeting Date: 9/20/2010 Pension Trustees Agenda Council Chambers City Hall SUBJECT / RECOMMENDATION: Approve a contract with Riverbridge Partners as a small cap growth manager for the Employees' Pension Plan and authorize the appropriate officials to execute the same. SUMMARY: Staff received notice in mid July that the Pension Plan's current small cap growth manager, Lee Munder, was terminating the product in which a portion of the Pension Plan assets were invested. Staff directed Cap Trust, the Pension Plan's consultant, to start a small cap growth manager search. Cap Trust had recently completed a small cap growth manager search for another client and was able to present a list of well-qualified candidates in a short amount of time. Those firms were: Eagle Asset Management, Riverbridge Partners, Cortina Asset Management and Lee Munder. The product Lee Munder offered in the search is different than the pension plan's current investment product. Staff worked with Cap Trust and decided to interview the following firms:Eagle Asset Management, Riverbridge Partners and Lee Munder Based on the interviews and other due diligence, the Pension Investment Committee recommends the hiring of Riverbridge Partners as the Pension Plan's small cap growth manager. The fee Riverbridge charges is 0.90% (90 basis points) which represents a special fee Cap Trust negotiated with Riverbridge, as opposed to their standard fee of 1% (100 basis points). This fee is lower than the average fee comparable managers charge. Staff will work with Northern Trust, the Pension Plan's custodian, to facilitate the transfer of assets from Lee Munder to Riverbridge. It should be noted that during July, staff began the process of rebalancing the portfolio in accordance with the approved assets allocation study results. As part of that rebalancing, more than half of the assets under Lee Munder's management were moved to ING, our large cap growth manager. This limited our exposure to the Lee Munder product during the time when they are moving toward closing the product. Type: Current Year Budget?: Operating Expenditure None Budget Adjustment: None Budget Adjustment Comments: Current Year Cost: Not to Exceed: For Fiscal Year: Annual Operating Cost: Total Cost: to Review 1) Financial Services 2) Office of Management and Budget 3) Legal 4) Clerk 5) Assistant City Manager 6) Clerk 7) City Approval: Manager 8) Clerk Cover Memo Item # 2 Attachment number 1 Page 1 of 9 INVESTMENT ADVISORY AGREEMENT This Investment Advisory Agreement is between RIVERBRIDGE PARTNERS, LLC., a Minnesota limited liability company ("Adviser"), and _City of Clearwater, Florida-("Client") This Agreement details the terms and conditions under which the Client is employing the Adviser as an investment adviser to manage certain of its assets. These assets are further identified in the attached Exhibit A (the "Account"). Through the execution of this Agreement, the Adviser and the Client agree to the following: 1. Employment of Adviser. Discretionary Authority; Duties; Investment Objectives and Restrictions. The Client employs the Adviser as an investment adviser to manage the Account. The Adviser agrees to supervise and direct the investment of the Account in accordance with the written investment objectives and restrictions of the Client. These objectives and restrictions are identified in Exhibit B. Adviser will give the Client the benefit of continuing study of economic conditions, security markets and other investment issues. On the basis of these studies, and consistent with the Client's investment objectives and restrictions, the Adviser may invest the assets in the Account in securities of any kind, including, but not limited to, common and preferred stocks, warrants, options, rights, financial futures instruments, corporate, municipal or government bonds, notes or bills, mortgage-backed securities, mutual funds and unit investment trusts ("securities"). All or a portion of the Account may be held in cash or cash equivalents. The Adviser shall have full discretionary authority as agent and attorney-in-fact with respect to the Account, at any time, (a) to buy,. sell, exchange, convert or otherwise trade the securities and other investments in the Account, (b) to place orders for the execution of these securities transactions as specified in Section 2 below, and (c) to act on behalf of the Client in all other matters necessary or incidental to the handling of the Account. The Adviser does not guarantee the investment performance of any of the investments in the Account. Adviser acknowledges that it is fully familiar with the laws of the State of Florida governing public employee retirement systems (Chapter 112, Part VII), and is fully Item # 2 Attachment number 1 Page 2 of 9 familiar with the provisions of the Charter and Code of the City of Clearwater relating specifically to the management of this Pension Plan. Adviser agrees to observe the laws of the State of Florida and the Charter and Code of the City of Clearwater and the investment policy and guidelines as set forth by Client in Exhibit B hereto. In the event that Adviser should purchase any security in violation of the applicable investment policy and guidelines, and as a result of any sale thereof realizes a loss as measured by the initial purchase price of the security, Adviser shall make Client whole for any such losses. 2. Custodial Responsibilities and Brokerage. a) Custodial Responsibilities. The Adviser will not act as custodian for the Account. The brokerage firm or custodian bank as stated below, which has been selected by the Client, shall assume custodial responsibilities. The Client shall cause the Account's broker or custodian bank (or trustee bank acting as custodian, as the case may be) to take all steps necessary to settle purchases, sales and trades made by the Adviser, including delivery of certificates, payment of funds and all such other acts as may be necessary to fulfill its custodial responsibilities. The Adviser shall give notice and directions (and copies thereof) with respect to transactions regarding the Account in a manner mutually agreed upon between the Account's broker or custodian bank, the Client and the Adviser. Custodian Northern Trust b) Brokerage. The Adviser shall enter orders for the Account with the broker(s) and brokerage firm(s) the Adviser selects unless Client specifies that brokerage should be directed to Client's broker acting as custodian. If the Client has chosen such broker, the brokerage commissions the Client shall pay shall be negotiated between the Client and the broker. As a result, the Adviser will not negotiate brokerage commissions or discounts on commissions on the Client's behalf. The Client -2- Item # 2 Attachment number 1 Page 3 of 9 understands that the brokerage commissions paid by the Client may be in excess of commissions that could be obtained from another brokerage firm because of portfolio services in addition to pure execution provided by the broker. If the Adviser selects the broker(s), the Adviser may consider the brokerage and research services (as these terms are used in Section 28(e) of the Securities Exchange Act of 1934) provided to the Client and/or other clients of the Adviser, and the Adviser may pay such broker(s) an amount which is in excess of the commission another broker would have charged, if the Adviser determines in good faith that such commission was reasonable in relation to the value of the brokerage and research services provided by such broker viewed in terms of that particular transaction or in terms of all of the accounts of the Adviser. The client who "restricts" brokerage may be subject to disadvantages regarding allocation and aggregation of orders. Unrestricted accounts will be aggregated together by the Adviser for order placement and may receive more favorable execution. The Adviser shall not be liable to the Client for any act, conduct or omission of any broker. Please check here if Client selects a broker Selected Broker 3. Broker Confirmation. The Client authorizes the Adviser, in its discretion, to request the issuance of average price confirmations by participating brokers. 4. Adviser Reports. On a quarterly and annual basis, the Adviser will provide the Client with a written portfolio appraisal of the Client's Account. This appraisal will include the Account's assets, current market value and performance data for the period. 5. Compensation. The Adviser agrees to accept as full payment for its services an annual fee of .9% of assets under management. This annual fee shall be determined on a quarterly basis and shall be based on the fair market value of all assets of the Account (including cash and cash equivalents) as of the end of each calendar quarter of each year during which this Agreement is in effect. Securities listed on a national exchange or on NASDAQ will be valued at the price as established by nationally recognized pricing services. Other securities and all other assets will be valued at fair -3- Item # 2 Attachment number 1 Page 4 of 9 value as determined in good faith by the Adviser. The Adviser will send to the Client a quarterly statement showing the amount of the management fee due, the Account value on which the fee is based and how the fee was calculated. Unless directed otherwise by the Client, the fees shall be paid from the Account. If this Agreement is not in effect for a full calendar quarter, the fee for a partial calendar quarter shall be based on the fair market value of all assets of the Account on the last day that this Agreement is in effect and shall be equal to the amount determined by multiplying the full quarterly fee by the fraction of which the numerator is the number of days in that quarter during which this Agreement is in effect and the denominator is of the total number of days in the calendar quarter. 6. Investment Advisers Act. The Adviser is duly registered with the Securities and Exchange Commission as an investment adviser pursuant to the Investment Advisers Act of 1940, as amended (the "Investment Advisers Act") 7. The Client's Responsibility. The Client will furnish the Adviser with complete and accurate information concerning the Client's financial and economic situation, the Client's investment objectives, and any restrictions the Client wishes to impose. The Client represents that all financial and other data that it furnishes to the Adviser relating to the Client's assets, liabilities, present and future income and obligations are true and correct and may be relied upon by Adviser for the purposes of providing the services described in this Agreement. The Adviser and its directors, officers, employees and agents shall be entitled to rely, and shall be protected from liability in relying, upon any information furnished to it (or any of them as individuals) which is believed in good faith to be accurate and reliable. Client agrees to inform Adviser of any material change in Client's circumstances, which might affect the manner in which Client's assets should be invested. 8. Representations by Client. The Client acknowledges that Client received the written disclosure statement (Part 2 of Form ADV) required by Rule 204-3 of the Investment Advisers Act at least 48 hours prior to the execution of this Agreement or, in the alternative, that Client received a written disclosure not less than five days prior to the delivery of any assets to the Adviser or the communication to it of any instructions regarding investment of the Account, and the Adviser has not, during this five-day interval, effected any disposition of the Account, and has allowed the Client full freedom to withdraw all or any part of the Account without incurring any penalty or liability -4- Item # 2 Attachment number 1 Page 5 of 9 whatever. The Client represents that all corporate or other action required for the Client to enter into this agreement has been taken 9. Limitations on Liability. Adviser agrees to reimburse Client for, and to hold Client and each entity having an interest in the Portfolio Assets harmless from, all liabilities, claims, losses, costs, and expenses arising from, or in connection with, Adviser's performance of its duties under this Agreement (including reasonable attorneys' fees and expenses) which are judicially determined to result from the Adviser's willful misconduct, lack of good faith, or negligence, or, from the actions or inactions of, or by, Adviser in violation of its duties hereunder or for which it would otherwise be legally liable under applicable law. The agreement and obligation of Adviser under this provision shall survive the termination of this Agreement. 10. Other Clients. Client understands that the Adviser and certain of its directors, officers, employees and agents render investment management, advisory and other services to others who may or may not have investment policies, objectives and investments similar to those of the Client, and that the Adviser and its directors, officers, employees and agents may, from time to time, give advice and take actions on behalf of such other clients which may differ from the advice given or actions taken with respect to the Account. If the purchase or sale of securities for the Client and one or more other clients is considered at or about the same time, transactions in such securities will be allocated among the several clients in a manner determined by the Adviser. Client recognizes that transactions in a specific security may not be accomplished for all clients at the same time or at the same price. 11. Termination; Amendment. This Agreement shall continue in full effect until terminated by either party, at any time, by giving written notice to the other party at least thirty days prior to the date on which such termination is to take effect. This Agreement may be amended at any time in writing by the mutual consent of the parties. 12. Notices. Any notice, advice or report to be given under this Agreement will be delivered in person, by U.S. Mail or overnight courier. It may also be transmitted by e- mail or by facsimile transmission (with a hard copy sent by U.S. Mail). It shall be deemed duly given (a) if to the Adviser, when received at Riverbridge Partners, LLC, -5- Item # 2 Attachment number 1 Page 6 of 9 Midwest Plaza West, 801 Nicollet Mall, Suite 600, Minneapolis, MN 55402 and (b) if to the Client at the address set forth below: City of Clearwater PO Box 4748 Clearwater, F133758-4748 Attention: Finance Director 13. Governing Law and Severability. This Agreement shall be construed and enforced in accordance with the laws of the United States of America and, to the extent not inconsistent therewith, the laws of the State of Florida. Adviser consents to the exclusive jurisdiction of Florida courts with respect to all legal proceedings instituted by Adviser or Client hereunder. Venue shall be exclusively in Pinellas County, Florida. If any provisions of this Agreement shall be held invalid by a statute, rule, regulation, decision of a tribunal or otherwise, the remainder of this Agreement shall not be affected, and, to such extent, the provisions of this Agreement shall be severable. 14. Assignment. This Agreement may not be assigned by the Adviser without the consent of the Client. For purposes of determining client consent in the event of an assignment, Adviser will send the Client written notice of the assignment. If Client does not object in writing within sixty (60) days of sending of such notice, the Client will be deemed to have consented to the assignment. The Agreement and all subsequent amendments shall inure to the benefit of the successor and assignees of the parties hereto. 15. Counterparts. This Agreement may be executed in several counterparts, each of which shall be deemed an original, but all of which, together, shall constitute one and the same instrument. 16. Confidentiality. Except as otherwise agreed in writing or as required by law, the Adviser will keep confidential all information concerning the Client's identity, financial affairs or investments. 17. Fiduciary Status. Adviser represents that it is an "investment manager" as such term is defined in the Employee Retirement Income Security Act of 1974 ("ERISA") with respect to the Portfolio Assets and, by reason thereof, a fiduciary as such term is defined in ERISA with respect thereto, notwithstanding the fact that the terms and provisions of -6- Item # 2 Attachment number 1 Page 7 of 9 ERISA may not be applicable to this Agreement. Adviser agrees to discharge its duties, as investment manager and fiduciary, with respect to the Portfolio Assets solely in the interest of Client and the beneficiaries thereunder and with the judgment, care, skill, prudence, and diligence under the circumstances then prevailing that a prudent man acting in the like capacity and familiar with such matters would use in the conduct of an enterprise of a like character and with like aims. Adviser further agrees that it will continue at all times during the term of this Agreement to be an investment manager and a fiduciary as above described, and that it will comply with all laws, rules, and regulations of any governmental authority or agency having applicability to the transactions contemplated by this Agreement, and that it will perform in accordance with the standards of care set forth in this section and this Agreement. 18. Proxy Voting. The Adviser votes Client proxies unless otherwise directed by Client 19. Proxy Votinq for ERISA Accounts. If the Account is for a pension or other employee benefit plan governed by ERISA and Client directs Adviser not to vote proxies for securities held in the Account, the right to vote such proxies has been expressly reserved for (please choose one of the following): The plan's trustees: The plan's fiduciary: 20. Class Action Lawsuits. The Adviser will not respond to any class action related notifications or inquiries on the Client's behalf. At the request of Client, the Adviser will provide copies of confirmations, custodial statements or other information to Client to assist Client in responding to such notifications or inquiries. Client shall be solely responsible for responding to any class action related notifications or inquiries. 21. Investigations and Complaints. To the extent permitted by applicable law, Adviser shall promptly disclose to Client in writing any extraordinary investigation, examination, complaint, disciplinary action or other proceeding reasonably related to or materially affecting Adviser's ability to perform its duties under this Agreement or involving any investment professional employed by Adviser who has performed any service with respect to Client's account in the twenty-four (24) preceding months, which is -7- Item # 2 Attachment number 1 Page 8 of 9 commenced by any of the following: (A) the Securities and Exchange Commission of the United States (ASEC@), (B) the New York Stock Exchange, (C) the American Stock Exchange, (D) the National Association of Securities Dealers, (E) any Attorney General or any regulatory agency of any state of the United States, (F) any U.S. Government department or agency, or (G) any governmental agency regulating securities of any country in which Adviser is doing business. Except as otherwise required by law, Client shall maintain the confidentiality of all such information (including refraining from trading in any security based on such information) until the investigating entity makes the information public. 22. Insurance. Adviser represents and warrants that it presently has in effect insurance coverage which complies with the bonding requirements of Section 412 of ERISA, and Adviser covenants that it shall keep such insurance coverage as required by said section (as the same may from time to time be supplemented or amended) in effect during the term of this Agreement, notwithstanding the fact that the terms and provisions of ERISA may not be applicable to this Agreement. Upon request of Client, Adviser shall provide to the Client evidence that the premium therefor has been paid. Adviser's insurance shall be primary and Client's insurance, if any, and responsibility shall be secondary. Adviser presently has in effect, and will maintain during the term of this Agreement, fiduciary liability insurance (Errors & Omissions) in an amount at least equal to the greater of $2,000,000 or the maximum currently provided by Adviser to any other client, which provides coverage with respect to any loss resulting from a breach of its fiduciary duties and including coverage in the event of recourse against it by, or on behalf of, its clients. Adviser, at the time of execution of this agreement and annually thereafter and, in addition thereto, upon written request of Client, shall deliver to Client certificates of insurance evidencing the foregoing coverages. Adviser shall notify Client in writing of any reduction, cancellation or substantial change of policy or policies as soon as possible, but no later than at least fifteen (15) days prior to the effective date of said action. Adviser shall name Client as a certificate holder on the aforesaid professional liability insurance policy and furnish Client evidence of such designation of Client as a certificate holder. Adviser's insurance shall be primary and Client's insurance, if any, and responsibility shall be secondary. -8- Item # Z Attachment number 1 Page 9 of 9 The Client and the Adviser have executed this Agreement on this day of September, 2010. All signatures represent review of this document and acceptance of its contents. RIVERBRIDGE PARTNERS, LLC By ?s n Riverbridge Partners, LLC Principal THE CLIENT BOARD OF TRUSTEES OF THE EMPLOYEES' PENSION PLAN OF THE CITY OF CLEARWATER, FLORIDA By: Frank V. Hibbard Chairperson kttest: Cynthia E. Goudeau City Clerk -9- Item # 2 Meeting Date: 9/20/2010 Pension Trustees Agenda Council Chambers City Hall SUBJECT / RECOMMENDATION: Approve the termination of Lee Munder as the Pension Plan's small cap growth manager and authorize the appropriate officials to execute the same. SUMMARY: Staff received notice in mid July that the pension plan's current small cap growth manager, Lee Munder, was terminating the product in which a portion of the Pension Plan assets were invested. Staff and Cap Trust, the Pension Plan's consultant, felt it is was more appropriate for another manager to manage this asset class. Staff and Cap Trust are recommending the hiring of Riverbridge to manage these assets under another agenda item It should be noted that during July, staff began the process of rebalancing the portfolio in accordance with the approved assets allocation study results. As part of that rebalancing, more than half of the assets under Lee Munder's management were moved to ING, the pension plan's large cap growth manager. This limited the plan's exposure to the Lee Munder product during the time it was being closed. If the trustees approve these actions, the assets will be removed from Lee Munder to Riverbridge Partners. Northern Trust, the pension plan's custodian, will help facilitate the transfer. Review Approval: 1) Office of Management and Budget 2) Legal 3) Clerk 4) Assistant City Manager 5) Clerk 6) City Manager 7) Clerk Cover Memo Item # 3 Meeting Date: 9/20/2010 Pension Trustees Agenda Council Chambers City Hall SUBJECT / RECOMMENDATION: Accept new hires into Pension Plan as listed. SUMMARY: Pension Name, Job. Class, & Dept./Div. Hire Date Elig Date Gervis Ochoa, Administrative Analyst/Public Utilities 6/21/10 6/21/10 Jeremy Kotter, Solid Waste Wkr./Sol. Waste-Gen. Ser. 2/15/10 7/17/10* Robert Bostick, Solid Waste Wkr./Sol. Waste-Gen. Ser. 3/4/10 7/17/10 ** Michael Finocchio, WWTP Oper. Trainee/Public Utilities 5/24/10 7/17/10 *** Sean Witherspoon, Electronics Technician/Engineering 7/19/10 7/19/10 *originally hired as temporary on 2/15/10; status changed to permanent and pension eligible as of 7/17/10 **originally hired as temporary on 3/4/10; status changed to permanent and pension eligible as of 7/17/10 ***originally hired as temporary on 5/24/10; status changed to permanent and pension eligible as of 7/17/10 Review Approval: 1) Human Resources Cover Memo Item # 4 Meeting Date: 9/20/2010 Pension Trustees Agenda Council Chambers City Hall SUBJECT / RECOMMENDATION: Mark Carlson, Gregory Wolfe, Elaine Muldowney, Joseph Arrien, Muhammad Abdur-Rahim and Cynthia Goudeau be granted regular pensions under Sections 2.397 and 2.398 of the employee pension plan, as recommended by the Pension Advisory Committee. SUMMARY: Mark Carlson, Construction Inspector II, Engineering Department, was employed by the City on January 26, 1981, and his pension service credit is effective on that date. His pension will be effective November 1, 2010. Based on an average salary of approximately $50,018 per year over the past five years, the formula for computing regular pensions, and Mr. Carlson's selection of the 100% Joint & Survivor Annuity, this pension will approximate $40,115 annually. Gregory Wolfe, Gas Technician III, Gas Department, was employed by the City on November 19, 1990, and his pension service credit is effective on that date. His pension will be effective December 1, 2010. Based on an average salary of approximately $47,159 per year over the past five years, the formula for computing regular pensions, and Mr. Wolfe's selection of the 75% Joint & Survivor Annuity, this pension will approximate $26,025 annually. Elaine Muldowney, Customer Service Representative, Gas Department, was employed by the City on September 28, 1987, and her pension service credit is effective on that date. Her pension will be effective September 1, 2010. Based on an average salary of approximately $35,980 per year over the past five years, the formula for computing regular pensions, and Ms. Muldowney's selection of the 10-Year Certain & Life Annuity, this pension will approximate $24,779 annually. Joseph Arrien, Fleet Manager, Solid Waste/General Services Department, was employed by the City on October 4, 1982, and his pension service credit is effective on that date. His pension will be effective August 1, 2010. Based on an average salary of approximately $66,645 per year over the past five years, the formula for computing regular pensions, and Mr. Arrien's selection of the Life Annuity, this pension will approximate $58,547 annually. Muhammad Abdur-Rahim, Stormwater Maintenance Manager, Public Services Department, was employed by the City on March 20, 1974, and his pension service credit is effective on October 3, 1983. His pension will be effective November 1, 2010. Based on an average salary of approximately $70,564 per year over the past five years, the formula for computing regular pensions, and Mr. Abdur-Rahim's selection of the Joint & Survivor Annuity, this pension will approximate $52,475 annually. Cynthia Goudeau, City Clerk, Official Records & Legislative Services Department, was employed by the City on November 27, 1978, and her pension service credit is effective on October 1, 1979. Her pension will be effective October 1, 2010. Based on an average salary of approximately $96,259 per year over the past five years, the formula for computing regular pensions, and Ms. Goudeau's selection of the 50% Joint & Survivor Annuity, this pension will approximate $84,583 annually. Section 2.397 provides for normal retirement eligibility when a participant has completed thirty years of credited service, has reached age 55 and completed twenty years of credited service, or has reached age 65 and completed ten years of credited service. Mr. Carlson, Mr. Wolfe, Ms. Muldowney, Mr. Arrien and Mr. Abdur-Rahim qualify under the 20 years of service and at least age 55 criteria and Ms. Goudeau qualifies under this criteria and the 30 years of service criteria. Cover Memo Review Approval: 1) Human Resources Item # 5 Page 1 of 29 Ci T Y v^F CLE'Mr, VVA T ER EMPL O PEES' SEPARA T/ON PA Y PREFERENCES PREFERENCE #1 Employees can receive a lump sum payment for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), 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 month. PREFERENCE #2 Employee can extend termination date by part or all of the time due for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), and 1 /2 of accrued sick leave. Employee may choose to run out this time in any manner. Balance will be paid in a lump sum on employee's final paycheck. Termination date will be the final day of extended time. Pension benefits will begin the following month. C1 V-k /S an employee of the City of Clearwater, pension benefits under the City's Employees' Pension Plan. hereby apply for I hereby certify that I fully understand the preferences offered to me. I choose to retire using separation pay preference # i and wish my benefits to be calculated under this preference. Please use my leave in the following manner: Run Out vacation sick floaters bonus hours Lump Sum 42, '? vacation s ?? SIsick floaters W` bonus hours I understand that my preference cannot be changed once this form is signed and that my decision is irrevocable. EMPLOYEE'S SIGNATURE SOCIAL SECURITY #: ITNESSES: ADDRESS: PHONE Revised 1/02 Form #9900-0008 1 kTE: 7?0??? File Name: Employee Separation Pay Pref Item # 5 Page 2 of 29 CITY OF CLEARWATER PENSION ENTITLEMENT OPTION REQUEST FORM I, 1' ? 10 r k /y, cc:t,- 6 o v) do hereby apply for retirement under the City of Clearwater General Employees' Pension Plan. Job Classification: ?' r " ,,lio, ? C'?-7??? Sex:k, M F Department: /)Q 1 Division: Benefits Date:? Date of Hire: Date of Birth: J S A. Resignation Date: , 1l / U Spouse's Name: 60 A . Ca 0 1. Sex: M(D Spouse's Date of Birth: _ i1 1 S S'7 The type of pension for which I am applying is (check only one): X 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 (b) (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) (1)] Option 3 - 10 Year Certain R 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. If payments to the beneficiary commence and he/she dies before the total of 120 payments has been made, the remainder of the payments is paid to the beneficiary's estate. If the first beneficiary predeceases the participant, he/she may designate a new beneficiary. If no beneficiary is alive at the time of the participant's death, the participant's estate will be paid the balance of the 120 payments. [Section 2.398 (b) (2) (a) (2)] Option 4 - 50% Joint P. 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 his/her 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) (3)] 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 his/her 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) (3)] Item # 5 Page 3 of 29 Option 6 - i 1%, joint &- -n savor 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 his/her 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) (3)J 1 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 my first pension check is received, my decision on this option is irrevocable. 1 Option #: Description: Joint and Survivor Annuity 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: Option Description: 6-V 1-1-1110 v,:? cr??J?'v??,? s7yJ(,, ?, My desi at d benggficiy is: Name: 0/ `u r60,?, Date of Birth: Sex M F Social Security Number: Phone Number: Address: Employee's Signature: X 041A Ck,- - Date: 7 k)_ G / U STATE OF FLORIDA The foregoing in trument was acknowledged before me this COUNTY OF PINELLAS `7A by 04 who is personally known to me or who has provided as ide t ficati and who /di n ?ta e oat Notary Public (S/ignature). ba )fQ A i - /7Jy'C%r Name of Notary Printed My Commission expires: NOTARY PUBLIC-STATE OF FLORIDA Deborah L. Ford Commission #DD763426 Rev. 4/08 Expires: MAY 15, 2012 Form #9900-0009 BONDED THRU ATLANMC BOISDING coFl Name: Pension Entitlement Option Form Item # 5 Page 4 of 29 11 Estimated Pension Worksheet II Mark Carlson GROSS CALENDAR PENSION YEAR EARNINGS LAST DATE PAID: 10/28/2010 2004 $46,514.18 BENEFITS DATE 1/26/1981 2006 $49,751.42 CREDITED SERVICE 29.7556 2007 $50,427.53 2008 $50,971.10 2009 $52,427.79 $250,092.02 (5 Year Total) 5/ $50,018.40 (Yearly Avg) 12/ $4,168.20 (Monthly Avg) x 0.0275 (Benefit Rate) x 29.7556 (Yrs of Service) $3,410.75 (Est Mtly Pension) Prepared by: Deborah Ford Date: 7/26/10 Item # 5 Page 5 of 29 City of Clearwater Employees' Pension Plan Actuarial Equivalence Factors ESTIMATE 26-Jul-10 sm clract01 Version: Employee Name: Mark Carlson 1-4-96 Employee Date of Birth: 10 28 1955 Marital Status: m Spouse Date of Birth: 11 15 1957 Beneficiary Date of Birth: 11 15 1957 Benefit Commencement Date : 11 1 2010 Estimated Monthly Normal Reti rement Benefit: $3,410.75 Actuarial Equivalent Adjustment Factors: Option 1 Normal Form 1.00000 Option 2 Life Annuity 1.08833 Option 3 10 Year Certain 1.07264 Option 4 50% J&S 1.03139 Option 5 75% J&S 1.00510 Option 6 100% J&S 0.98011 ESTIMATE Estimated Monthly Benefit $3,410.75 $3,712.03 $3,658.50 $3,517.82 $3,428.14 $3,342.92 Item # 5 Page 6 of 29 CITY OF ^,LEAREI?ATER EMPL O YEES' SEPARA T/ON PA Y PREFERENCES PREFERENCE #1 Employees can receive a lump sum payment for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), 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 month. PREFERENCE #2 Employee can extend termination date by part or all of the time due for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), and 1 /2 of accrued sick leave. Employee may choose to run out this time in any manner. Balance will be paid in a lump sum on employee's final paycheck. Termination date will be the final day of extended time. Pension benefits will begin the following month. I- 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 preferences offered to me. I choose to retire using separation pay preference # and wish my benefits to be calculated under this preference. Please use my leave in the following manner: Run Out vacation k,9-3- sick floaters bonus hours Lump Sum vacation sick floaters bonus hours I understand that my preference cannot be changed once this form is signed and that my decision is irrevocable. EMPLOYEE'S SIGNATURE: l AYI?3?Z SOCIAL SECURITY #: , - WITNESSES: ADDRESS: / Cy cr rL ??e V11 0 Al, PHONE: 7?7/S?? °Z/ay DATE: /ol Co o Revised 1/02 Form #9900-0008 File Name: Employee Separation Pay Pref Item # 5 Page 7 of 29 CITY OF CLEARWATER PENSION ENTITLEMENT OPTION REQUEST FORM I, of Clearwater Job Classification: Department: Benefits Date: _ Date of Birth: ral Employees' Pension Plan. G? s J cc- A 90 Spouse's Name: Spouse's Date of Birth: V'&- do hereby apply for retirement under the City 'clgn Sex: F Division: Date of Hire: / / `? (3 Resignation Date: i t b q / 0 1.110' 1 fE Sex: M 0 The type of pension for which 1 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. tion 1 - Joint and Survivor Annuit?r 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 (b) (1)] Option 2 - Life Annuity t 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) (1)] - (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. If payments to the beneficiary commence and he/she dies before the total of 120 payments has been made, the remainder of the payments is paid to the beneficiary's estate. If the first beneficiary predeceases the participant, he/she may designate a new beneficiary. If no beneficiary is alive at the time of the participant's death, the participant's estate will be paid the balance of the 120 payments. [Section 2.398 (b) (2) (a) (2)] 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 his/her 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) (3)] 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 his/her 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) (3)] Item # 5 Page 8 of 29 Option 6 - 100% Joint R Survivor Ann, joty _ (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 his/her 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) (3)] 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 my first pension check is received, my decision on this option is irrevocable. Option #: 1 Employee's Signature: Description: _ Joint and Survivor Annuity Dependent children under the age of 18 and residing in my household are: Child's Name Sex Date: Date of Birth If taking Option 2 sign below: Option #: 2 Description: Life Annuity Employee's Signature: Date: Option #: . 5, = Description: -7S ?-' J0rn'f -* S y:? Q , ?/0 - As-l *r y , `I My des' ate beneficiy ry is: Name: a?lo Ac di e, Date of Birth: > Z Sex M(9 Social Security Number: Phone Number: 712 7 / SS-y-'? Address: -S o'l ler mU f • ?GrGc? ?Cd 37?0 'OF Employee's Signature: -7 /J_ G Ifs STATE OF FLORIDA The foreg ing instrument was acknowledged before me this COUNTY OF PINELLAS -) UU, 0 by t'gOfu /Wod' /f1C• who is personally known to me or who has provided as iderytificatiQn and who did/did rest take an oath. V Notary Public Rev. 4/08 Form #9900-0009 UJ?X7 / Gi-/1 A-- VV ? e Name of Notary Printed 1?My Commission expires: ??ARYPUB?gbor h LOF YLU . Ford :Commission #DD763426 Expires: MAY 15, 2012 i0NDE1) TI?RU AT" N- nc BONDING CO., INC. File Name: Pension Entitlement Option Form Item # 5 Page 9 of 29 L- Estimated Pension Worksheet 1 Gregory Wolfe LAST DATE PAID: BENEFITS DATE CREDITED SERVICE Signature: Date: GROSS CALENDAR PENSION YEAR EARNINGS 11/19/2010 2006 $44,177.25 11/19/1990 2007 $46,320.48 20.0000 2008 $47,917.18 2009 $48,286.93 2010 $49,093.20 estimated $235,795.04 (5 Year Total) 5/ $47,159.01 (Yearly Avg) 12/ $3,929.92 (Monthly Avg) x 0.0275 (Benefit Rate) x 20.0000 (Yrs of Service) $2,161.46 (Est Mtly Pension) Item # 5 Page 10 of 29 City of Clearwater Employees' Pension Plan Actuarial Equivalence Factors ESTIMATE 26-Jul-10 sm clract01 Version: Employee Name: Gregory Wolfe 1-4-96 Employee Date of Birth: 2 24 1955 Marital Status: m Spouse Date of Birth: 11 28 1947 Beneficiary Date of Birth: 11 28 1947 Benefit Commencement Date : 12 1 2010 Estimated Monthly Normal Reti rement Benefit: $2,161.46 Actuarial Equivalent Adjustment Factors: Option 1 J&S Annuity 1.00000 Option 2 Life Annuity 1.05683 Option 3 10 Year Certain 1.03995 Option 4 50% J&S 1.02058 Option 5 75% J&S 1.00337 Option 6 100% J&S 0.98673 ESTIMATE Estimated Monthly Benefit $2,161.46 $2,284.30 $2,247.80 $2,205.95 $2,168.75 $2,132.79 Item # 5 Page 11 of 29 CITY OF CLEARWA TER EMPL O PEES' SEPARA TION PA Y PREFERENCES PREFERENCE #1 Employees can receive a lump sum payment for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), 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 month. PREFERENCE #2 Employee can extend termination date by part or all of the time due for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), and 1 /2 of accrued sick leave. Employee may choose to run out this time in any manner. Balance will be paid in a lump sum on employee's final paycheck. Termination date will be the final day of extended time. Pension benefits will begin the following month. e_ vlii - mit UW 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 preferences offered to me. I choose to retire using separation pay preference # and wish my benefits to be calculated under this preference. Please use my leave in the following manner: Run Out vacation sick floaters bonus hours Lump Sum 9 3 ° vacation sick floaters ?d S bonus hours I understand that my preference cannot be changed once this form is signed and th my decision is irrevocable. 1' ,!! a , EMPLOYEE'S SIGNATURE: WITNESSES: Revised 1/02 Form #9900-0008 SOCIAL SECURITY #: ADDRESS: 3 a r? As? W, oe w Pb#- +- 14 cji eq F_L 3 y (.s-S PHONE: :7 `:D jq 3 7 - 9 1 11 DATE: a /i o File Name: Employee Separation Pay Pref Item # 5 Page 12 of 29 CITY OF CLEARWATER PENSION ENTITLEMENT OPTION REQUEST FORM 1, r I ca V\ n e-- I I\ u I Ct o cap In c of Clearwater General Employees' Pension P Job Classification.u S A-6 ?n c.?r _??e it ? ?"c C_ 7k- do hereby apply for retirement under the City ?C S V14-(.' "IQ Sex: M 6 Department: Division: Benefits Date: Date of Hire: Date of Birth: ka y G Resignation Date: d? O Spouse's Name: !? Nl n ?'1 V ' yI?CJW ?1 Sex: UM F Spouse's Date of Birth: $-? Y 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 (b) (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) (1)] - (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. If payments to the beneficiary commence and he/she dies before the total of 120 payments has been made, the remainder of the payments is paid to the beneficiary's estate. If the first beneficiary predeceases the participant, he/she may designate a new beneficiary. If no beneficiary is alive at the time of the participant's death, the participant's estate will be paid the balance of the 120 payments. [Section 2.398 (b) (2) (a) (2)] 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 his/her 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) (3)] 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 his/her 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) (3)] Item # 5 Page 13 of 29 Option 6 - 10 G/„ join' Fs 1I,rvivor 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 his/her 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) (3)] 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 my first pension check is received, my decision on this option is irrevocable. Option #: I Description: Joint and Survivor Ann ,qty 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: Option #: Description: 1 b - YtC4 - My designated b.,epefiV i?: 41 j Name: P?w?P u??jc°Vate of Birth: / Social Security Number: Address: >q 3y? 91 U u,i1- ASA Se<9 F Q Phone Number: 7?7 / / 3 7-???5_ Ne d - , Ole , , FL ?'y6ss nature: STATE OF FLORIDA COUNTY OF PINELLAS Rev. 4/08 Form #9900-0009 The fore oing instrument was a5knMledged before me this ?a by KenJn nu1C?w personally known to me or who has provided o is as ident' 'catio and who id/d t2,Qt PU th. Notary Public 0(s* re) C? 'OL. /"? ?GY Name of Notary Printed My Commission expires: NOTARY A Deborah L y,=Commission #DD7634<:& Expires: NIAY 35, 2022 BOND%D THRU ATL&%-nC BONDING Co., IN -;. File Name: Pension Entitlement Option Form Item # 5 Page 14 of 29 11 Estimated Pension Worksheet Elaine Muldowney GROSS CALENDAR PENSION YEAR EARNINGS LAST DATE PAID: 8/27/2010 2004 $35,178.95 BENEFITS DATE 9/28/1987 2006 $35,455.37 CREDITED SERVICE 22.9139 2007 $35,831.85 2008 $36,208.10 2009 $37,223.91 $179,898.18 (5 Year Total) 5/ $35,979.64 (Yearly Avg) 12/ $2,998.30 (Monthly Avg) x 0.0275 (Benefit Rate) x 22.9139 (Yrs of Service) $1,889.32 (Est Mtly Pension) Prepared by: Deborah Ford Date: 7/12/2010 Item # 5 Page 15 of 29 City of Clearwater Employees' Pension Plan Actuarial Equivalence Factors ESTIMATE 22-Jul-10 sm clract01 Version: Employee Name: Elaine Muldowney 1-4-96 Employee Date of Birth: 8 24 1946 Marital Status: m Spouse Date of Birth: 5 22 1948 Beneficiary Date of Birth: 5 22 1948 Benefit Commencement Date : 9 1 2010 Estimated Monthly Normal Reti rement Benefit: $1,890.24 Actuarial Equivalent Adjustment Factors: Option 1 J&S Annuity 1.00000 Option 2 Life Annuity 1.13897 Option 3 10 Year Certain 1.09240 Option 4 50% J&S 1.04795 Option 5 75% J&S 1.00768 Option 6 100% J&S 0.97040 ESTIMATE Estimated Monthly Benefit $1,890.24 $2,152.93 $2,064.89 $1,980.88 $1,904.77 $1,834.29 Item # 5 Page 16 of 29 CiT Y OF CLEARVVIMTER EMPL O PEES' SEPARA T/ON PA Y PREFERENCES PREFERENCE #1 Employees can receive a lump sum payment for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), 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 month. PREFERENCE #2 Employee can extend termination date by part or all of the time due for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), and 1 /2 of accrued sick leave. Employee may choose to run out this time in any manner. Balance will be paid in a lump sum on employee's final paycheck. Termination date will be the final day of extended time. Pension benefits will begin the following month. Arrt*01 I, , an employee ol the City of Clearwater, hereby apply for ' pension benefits under the City's Employees' Pension Plan. I hereby certify that I fully understand the preferences offered to me. I choose to retire using separation pay preference # and wish my benefits to be calculated under this preference. Please use my leave in the following manner: Run Out vacation sick floaters bonus hours Lump Sum D vacation sick 1-5 floaters bonus hours ????'?[ -7 r p Cir.S'? ?'??. ) 1.? tt( ftl S ? 7_ S hrt I understand that my preference cannot be changed once this form is signed and that my decision is irrevocable. EMPLOYEE'S SIGNATURE: SOCIAL SECURITY #: - WITNESSE : ADDRESS: 2307 N? LiKrnFl,y PHONE: 77-7-797- 9325 DATE: Revised 1/02 Form #9900-0008 File Name: Employee Separation Pay Pref Item # 5 Page 17 of 29 CITY OF CLEARWATER PENSION ENTITLEMENT OPTION REQUEST FORM 1, -J'Waz vn -r r r I t-r r do hereby apply for retirement under the City of Clearwater General Employees' Pension Plan. Job Classification: FL4_-X17- tr A&;Aj c-7Z_ Sex F Department: ?. ?` g L S ?lr l Division: ?t?tT ? ?? W1 Benefits Date: o_ ?_ g' Date of Hire: 70" Y-k2 Date of Birth: I I ` ZZ-" '-t Resignation Date: `1 -1 - lot c, Spouse's Name: /77pley V A&tzi c-A-? Spouse's Date of Birth: Sex: M f 5' The type of pension for which I am applying is (check only one): t/ 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 (b) (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) (1)] 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. If payments to the beneficiary commence and he/she dies before the total of 120 payments has been made, the remainder of the payments is paid to the beneficiary's estate. If the first beneficiary predeceases the participant, he/she may designate a new beneficiary. If no beneficiary is alive at the time of the participant's death, the participant's estate will be paid the balance of the 120 payments. [Section 2.398 (b) (2) (a) (2)] 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 his/her 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) (3)] 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 his/her 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) (3)] Item # 5 Page 18 of 29 Option 6 - lini f inini R cvIvO (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 his/her 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) (3)J 1 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 my first pension check is received, my decision on this option is irrevocable. Option #: Employee's Signature: Date: Dependent children under the age of 18 and residing in my household are: Child's Name Sex Date of Birth It taking Option 2 sign below: Option #: 2 D Employee's Signature: It taKing option :3, 4, 5 or 6 fill in bWeficiary information and sign below: Date: la Option #: Description: My designated beneficiary is: Name: Date of Birth: Sex M F Social Security Number: Phone Number: Address: Employee's Signature: Date: STATE OF FLORIDA The forego'ng instrument was ack owledged before me this COUNTY OF PINELLAS ? ?? Lt /? U by S 4 ?V K who is personally known to me or who has provided as idZ=/di not e oath Notary Public (Signature) Name of Notary Printed My Commission expires: - Rev. 4/08 Form #9900-0009 Description: Joint and irvivor Annuity File Name: Pension Entitlement Option Form Item # 5 Page 19 of 29 11 Estimated Pension Worksheet 11 Joseph Arrien LAST DATE PAID: BENEFITS DATE CREDITED SERVICE Prepared by: Deborah Ford Date: May 24, 2010 CALENDAR YEAR 6/30/2010 2005 10/4/1982 2006 27.7389 2007 2008 2009 5/ 12/ x x GROSS PENSION EARNINGS $62,058.89 $64,529.92 $67,111.20 $69,762.16 $69,762.16 $333,224.33 (5 Year Total) $66,644.87 (Yearly Avg) $5,553.74 (Monthly Avg) 0.0275 (Benefit Rate) 27.7389 (Yrs of Service) $4,236.50 (Est Mtly Pension) Item # 5 Page 20 of 29 City of Clearwater Employees' Pension Plan Actuarial Equivalence Factors ESTIMATE 29-Jun-10 sm clract01 Version: Employee Name: Joseph Arrien 1-4-96 Employee Date of Birth: 11 22 1948 Marital Status: m Spouse Date of Birth: 3 31 1954 Beneficiary Date of Birth: 3 3 1954 Benefit Commencement Date : 7 1 2010 Estimated Monthly Normal Reti rement Benefit: $4,236.50 Actuarial Equivalent Adjustment Factors: Option 1 Normal Form 1.00000 Option 2 Life Annuity 1.15163 Option 3 10 Year Certain 1.11492 Option 4 50% J&S 1.05194 Option 5 75% J&S 1.00830 Option 6 100% J&S 0.96813 ESTIMATE Estimated Monthly Benefit $4,236.50 $4,878.89 $4,723.35 $4,456.54 $4,271.65 $4,101.49 Item # 5 Page 21 of 29 CITY OF CLEARWA TER PREFERENCE #1 Employees can receive a lump sum payment for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), 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 month. PREFERENCE #2 Employee can extend termination date by part or all of the time due for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), and 1 /2 of accrued sick leave. Employee may choose to run out this time in any manner. Balance will be paid in a lump sum on employee's final paycheck. Termination date will be the final day of extended time. Pension benefits will begin the following month. oftlill n '' )) --- - I, V kavn ma AYJOIV/1 RA 11M, '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 preferences offered to me. I choose to retire using separation pay preference # I and wish my benefits to be calculated under this preference. Please use my EMPL OYEES' SEPARA TION PA Y PREFERENCES leave in the following manner: Run Out vacation sick floaters bonus hours floaters ( ta- 5 bonus hours Lump Sum gc)'O31 vacation ?a`' _79 sick I understand that my preference cannot be changed once this form is signed and that my decision is irrevocable. .,, EMPLOYEE'S SIGNATURE: SOCIAL SECURITY #: WITNESSES: ADDRESS: Ave (11 ea r?a4 tl FL Ss PHONE: 'y Y 3"b '?Yd DATE- 9 43 U Revised 1/02 Form #9900-0008 File Name: Employee Separation Pay Pref Item # 5 Page 22 of 29 CITY OF CLEARWATER PENSION ENTITLEMENT OPTION REQUEST FORM of Clearwater General Employees' Pension Plan. Job Classifica Department: _ Benefits Date: Date of Birth: _ S4VrMWCt4/_ 0 0 do hereby apply for retirement under the City n Q /)c e- 0) Arl Q. Sex: NQ F Division: Date of Hire: a? 74 n Resignation Date: C1 as /d Spouse's Name:{r ?Y? ?'? ?? ?'- ??h'1 ? Sex: Me Spouse's Date of Birth: it ffl?- 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 (b) (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) (1)] - (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. If payments to the beneficiary commence and he/she dies before the total of 120 payments has been made, the remainder of the payments is paid to the beneficiary's estate. If the first beneficiary predeceases the participant, he/she may designate a new beneficiary. If no beneficiary is alive at the time of the participant's death, the participant's estate will be paid the balance of the 120 payments. [Section 2.398 (b) (2) (a) (2)] 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 his/her 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) (3)] 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 his/her 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) (3)] Item # 5 Page 23 of 29 Option 6 - 100%h 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 his/her 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) (3)] 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 my first pension check is received, my decision on this option is irrevocable. Option #: 1 Employee's Signature: f Dependent children under fhe age of 18 and residing in my household are: Child's Name Sex ly Date: -7120110 Date of Birth If taking Option 2 sign below: Option #: Description: Life Annuity Employee's Signature: Date: If takina Option 3.4. 5, or 6 fill in beneficiary information and sian below: Option #: Description: My designated beneficiary is: Name: Date of Birth: Sex M F Social Security Number: Phone Number: Address: Employee's Signature: Date: STATE OF FLORIDA COUNTY OF PINELLAS The for7.30 oing jnstrument was acknowledged before me this/ / 7 J0 by MuAOPhrn4cn W-AA,rnwho is personally known to me or who has provided as iden ' ' atio and who di did of k a oath. Notary Public (Signature) / fd L- Name of Notary Printed My Commission expires: NOTARY PUBLIC-STATE OF FLOT\Lo-, Deborah L. Fo"4 Commission # DD763426 Expires: MAY 15, 2012 U BONDED MRV ATI ANClC ]501,DINO GO:, ING File Name: Pension Entitlement Option Form Item # 5 Page 24 of 29 Estimated Pension Worksheet Muhammad Abdur-Rahim LAST DATE PAID: 10/22/2010 BENEFITS DATE 10/8/1983 CREDITED SERVICE 27.0417 Signature: P Date: '7130110 GROSS CALENDAR PENSION YEAR EARNINGS 2005 $65,699.26 2006 $68,327.22 2007 $71,060.34 2008 $73,867.30 2009 $73,867.30 $352,821.42 (5 Year Total) 5/ $70,564.28 (Yearly Avg) 12/ $5,880.36 (Monthly Avg) x 0.0275 (Benefit Rate) x 27.0417 (Yrs of Service) $4,372.91 (Est Wily Pension) Item # 5 Page 25 ot 29 CITY OF CLEARWA TER EMPL O YEES' SEPARA TION PA Y PREFERENCES PREFERENCE #1 Employees can receive a lump sum payment for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), 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 month. PREFERENCE #2 Employee can extend termination date by part or all of the time due for vacation, floating holiday pay, sick leave incentive, bonus days (if applicable), and 1 /2 of accrued sick leave. Employee may choose to run out this time in any manner. Balance will be paid in a lump sum on employee's final paycheck. Termination date will be the final day of extended time. Pension benefits will begin the following month. an employee of pension benefits under the City's Employees' Pension Plan. the City of Clearwater, hereby apply for I hereby certify that I fully understand the preferences offered to me. I choose to retire using separation pay preference # and wish my benefits to be calculated under this preference. Please use my leave in the following manner: Run Out vacation sick floaters ? ? ? - bonus hours Lump.Sum 5? 5' -73 vacation l f 9sick floaters 11 dSbonus hours I understand that my preference cannot be changed once this form is signed and that my decision is irrevocable. EMPLOYEE'S SIGNATURE: K 1 Tt ?Ck-?- SOCIAL SECURITY #: WITNESSES: ADDRESS: t cq?.??u? e? , f-C, 37 PHONE: Ja-7I 7J-S° 5U( -7 DATE: ? I V 11 Q Revised 1/02 Form #9900-0008 File Name: Employee Separation Pay Pref Item # 5 Page 26 of 29 CITY OF CLEARWATER PENSION ENTITLEMENT OPTION REQUEST FORM of Clearw Job Classification: 1 Department:( '4 Benefits Date: C 9 Date of Birth: i 0 30 Spouse's Name: Spouse's Date of Birth: -L / do hereby apply for retirement under the City r. Division: _ Date of Hire: Resignation Date: Sex: Q F The type of pension for which I am applying is (check only one): X 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 (b) (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) (1)] - (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. If payments to the beneficiary commence and he/she dies before the total of 120 payments has been made, the remainder of the payments is paid to the beneficiary's estate. If the first beneficiary predeceases the participant, he/she may designate a new beneficiary. If no beneficiary is alive at the time of the participant's death, the participant's estate will be paid the balance of the 120 payments. [Section 2.398 (b) (2) (a) (2)] 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 his/her 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) (3)] 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 his/her 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) (3)] Item # 5 er General Employees' Pension Plan. Page 27 of 29 Option s - 100% .ioint & survivor Annuitw - (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 his/her 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) (3)] 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 my first pension check is received, my decision on this option is irrevocable. Option #: 1 Employee's Signature: Description: Joint and Survivor Annuity Dependent children under the age of 18 and residing in my household are: Child's Name Sex Date: Date of Birth If taking Option 2 sign below: Option #: -.,?- Description: Life Annuity Employee's Signature: Date: Option #: y Description: ?«`?? :i ?a??- 5U?'??v'G+? r?r?v; 1L?? My desig ed beneficiary is: Name: J ivnrs ?•???rc, v Date of Birth: f / /11 9t Sex (0 F Social Security Number: Phone Number: '7 -7 Address: r,? '7 c. 10 cL -?4cl , j ? ? ? ?,z? ? ?? . 2- 3 3 7 (: l nature: )L- Date: -7// STATE OF FLORIDA The foregoin instrument was cknowledgedbefore QQme this COUNTY OF PINELLAS -? I ? `'j 11 0 by _U4 a"&,_ Qt) "J'ra tJ who is personally known to me or who has provided Rev. 4/08 Form #9900-0009 as idZ=o i' t take an oath. {,.??9 Notary Public /gnatre) 1 V ?? 1?I IC-SIMEU,F Name of Notary Printed PUbLLMI My Commission expires: Deborah L. Ford Commission Expires: IvIAY 15, 2012 BONDED THRU ATLA.ti EIC BONDL\G CO., UNC. File Name: Pension Entitlement Option Form Item # 5 Page 28 of 29 11 Estimated Pension Worksheet 11 Cyndie Goudeau LAST DATE PAID: BENEFITS DATE CREDITED SERVICE 9/24/2010 10/1/1979 30.9806 Signature: Date: 7 / / 0 GROSS CALENDAR PENSION YEAR EARNINGS 2005 $89,622.60 2006 $93,207.40 2007 $96,935.80 2008 $100,764.82 2009 $100,764.82 $481,295.44 (5 Year Total) 5/ $96,259.09 (Yearly Avg) 12/ $8,021.59 (Monthly Avg) x 0.0275 (Benefit Rate) x 30.9806 (Yrs of Service) $6,834.12 (Est Mtly Pension) Item # 5 Page 29 of 29 City of Clearwater Employees' Pension Plan Actuarial Equivalence Factors ESTIMATE 15-Jul-10 sm clract01 Version: Employee Name: Cyndie Goudeau 1-4-96 Employee Date of Birth: 10 30 1952 Marital Status: m Spouse Date of Birth: 11 4 1951 Beneficiary Date of Birth: 11 4 1951 Benefit Commencement Date : 10 1 2010 Estimated Monthly Normal Retirement Benefit: $6,834.12 Actuarial Equivalent Adjustment Factors: Option 1 J&S Annuity 1.00000 Option 2 Life Annuity 1.08830 Option 3 10 Year Certain 1.06670 Option 4 50% J&S 1.03138 Option 5 75% J&S 1.00510 Option 6 100% J&S 0.98012 ESTIMATE Estimated Monthly Benefit $6,834.12 $7,437.59 $7,289.95 $7,048.59 $6,868.95 $6,698.25 Item # 5 Meeting Date: 9/20/2010 Pension Trustees Agenda Council Chambers City Hall SUBJECT / RECOMMENDATION: Katrina Breedlove, Jim Sokol, Ami Beery and David Marshall be allowed to vest their pensions as provided by Section 2.397 of the Employees' Pension Plan, as recommended by the Pension Advisory Committee. SUMMARY: Katrina Breedlove, Senior Systems Programmer, Information Technology Department, was employed by the City on June 12, 2000, and began participating in the Pension Plan on that date. Ms. Breedlove terminated from City employment on July 2, 2010. Jim Sokol, Electronics Technician, Engineering Department, was employed by the City on January 8, 1996, and began participating in the Pension Plan on that date. Mr. Sokol terminated from City employment on July 2, 2010. Ami Beery, Customer Service Coordinator, Customer Service Department, was employed by the City on January 19, 1999, and began participating in the Pension Plan on that date. Ms. Beery terminated from City employment on August 6, 2010. David Marshall, Police Officer, Police Department, was employed by the City on June 9, 1997, and began participating in the Pension Plan on that date. Mr. Marshall terminated from City employment on July 15, 2010. The Employees' Pension Plan provides that should an employee cease to be an employee of the City of Clearwater or change status from full-time to part-time after completing ten or more years of creditable service (pension participation), such employee shall acquire a vested interest in the retirement benefits. Vested pension payments commence on the first of the month following the month in which the employee normally would have been eligible for retirement. Section 2.397 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. Breedlove would have completed 20 years of service and reached age 55 on October 2, 2026. Her pension will be effective November 1, 2026. Mr. Sokol would have completed 10 years of service and reached age 65 on June 16, 2013. His pension will be effective July 1, 2013. Ms. Beery would have completed twenty years of service and reached age 55 on August 14, 2025. Her pension will be effective September 1, 2025. Section 2.393 also (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 Police Officer as meeting the hazardous duty criteria. Mr. Marshall would have completed 20 years of service on June 9, 2017. His pension will be effective July 1, 2017. Review 1) Financial Services 2) Office of Management and Budget 3) Clerk 4) Assistant City Manager 5) Clerk 6) City Approval: Manager 7) Clerk Cover Memo Item # 6 Page 1 of 4 (RECEIVED APPLICATION FOR VESTED RIGHTS PENSION Jul 12 2016 H. R, DEPT Katrina D. Breedlove being a person leaving employment with the City of Clearwater, Florida, and having completed ten (10) or more years of credited service, such service having occurred during the period from (date of entry into Pension Plan) 6/12/2000 to (date of resignation or change of status) 7/2/2010 hereby makes application to receive the vested rights pension provided for by the City Code of Ordinances. As such former employee, I understand the pension requested will be computed pursuant to the provisions of the City Code of Ordinance in effect on the date of resignation. I hereby further certify that my date of birth is 10/2/1971 The date I will begin to receive my pension will be 11/1/2026 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, I have not ,been convicted of a felony during my period of employment, and I have not receiv9d any other type of pension from the City. Sidfiature Social Security Number Information Technology/Software Applications 3791 Sweepstakes CT #2003 Department/Division Street Address Senior Systems Programmer Palm Harbor, FL 34684 Job Classification City, State, Zip Code STATE OF FLORIDA The foregoing instrument was acknowledged before COUNTY OF PINELLAS me this J0 day of U y , 20 "`pPr PAUL S i E G E R Commission # DD 749184 `: My Commission Expires p January 15, 2012 who is personally know to me or who has provided L 1 L ! kt r L'(1-c' 0- ? as identification and who did/ take an oath. Notary Public Name of Notary Printed My commission expires: Rev. 4/09 Vested PAM AA Page 2 of 4 APPLICATION FOR VESTED RIGHTS PENSION xim S-ok©' 4.?ir?ly .? r. r. re. ?.r. I.. r.. ........ ,.........1... .....,__L ...:LL iL_ City of Clearwater, Florida, and having completed ten (10) or more years of credited service, such ser ice having occurred during the period from (date of entry into Pension Plan) 1 to (date of resignation or change of status) _ Wb ho hereby makes application to receive the vested rights pension provided for by the City Code of Ordinances. As such former employee, I understand the pension requested will be computed pursuant to the provisions of the City Code of Ordinance in effect on the date of resignation. I hereby further certify that my date of birth is La Z q , The date I will begin to receive my pension will be ?"?I ??af3 Further, I additionally certify that I have made no application contributions that I paid into the Pension Fund during the pi above, I have not been convicted of a felony during my perk received any other type of pension from the City. A t 6 - Signature xx L-'w ftVIAs rOAL U12M - bepartme Division Job Classification seeking to obtain a return of the riod of my employment set forth d of employment, and I have not Social Security Number Street Address arg6 . .33-7 3 ity, State, Zip Code STATE OF FLORIDA The foregoing instrument was acknowledged before COUNTY OF PINELLAS me this ` day of em u„ ,? , 20 / 0 by cx ?y Q ?? • Z a46- ,-(' who is personally know to me or vio has provided j c identification issssssssasssssssssssssssssarssasssessrsssssss= and who did/did not take an oath. LEAH R. CULP _ ,a"":"•., Comm#DD0735416 -, i?KA 12/5/2011 Notary Public Expires ?'M' Florida Notary Aesn., Inc m > //7 . .. •ss.erssssrsa Name of Notary Printed My commission expires: 2 -S- - 2 0 Item # 6 Rev. 4/09 Vested Pension Form Page 3 of 4 AECEIVED APPLICATION FOR VESTED RIGHTS PENSION . R DEPT AR 2 7 1010 '?'/?'? / 3 c e ? being a person leaving employment with the City of Clearwater, Florida, d having completed ten (10) or more years of credited service, ?uch service having occurred during the period from (date of entry into Pension Plan) ?fi?tnvary I9, 199 to (date of resignation or change of status) _364 (v hereby makes application to receive the vested rights pension provided for by the City Code of Ordinances. As such former employee, I understand the pension requested will be computed pursuant to the provisions of the City Code of Ordinance in effect on the date of resignation. I hereby further certify that my date of birth is AUWC-- I?Z 10 lq70 19 The date I will begin to receive my pension will be e.r f a 0 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, I have not been convicted of a felony during my period of employment, and I have not rec any other type of pension from the City. Xe' e '7®"-L..-Oan' 60?A? -_ _ Signature ?j Social Security Number ? n e7c ?.'" y S' 7-0 k'» e ? S e e- y i ;C If o? 7 0 7 ?G l7 p7er J? Department/Division Street Address ``G?S?V?)1(°? ?.?t?r'?L ??Ui??CtTZ/V /It? FZ7?+ Job Classification City, ate, Zip Code STATE OF FLORIDA The foregoing instrument was acknowledged before COUNTY OF PINELLAS me this Z `? day of . ?._ , 20/0 by who is personally know to me r who has provided as identification and who di did not ake an oath. Notary Public < < 2 • ffa Name of Notary Printed My commission expires: ?•••••••••••• •U •a c"'°'°"" comm# DD0745115 Expires 1213012011 Florida Notary Assn., Inc ni .e®s eneRUSnsa caeuuu....••.•••auu.u•ne Item # 6 Rev. 4109 Vested Pension Form Page 4 of 4 APPLICATION FOR VESTED RIGHTS PENSION _D 1M A t2S ? hq-) A being a person leaving employment with the City of Clearwater, Florida, and having completed ten (10) or more years of credited service, such service having occurred during the period from (date of e ,,t into Pension Plan) -L?01q'7 to (date of resignation or change of status) p hereby makes application to receive the vested rights pension provid d for by the City Code of Ordinances. As such former employee, I understand the pension requested will be computed pursuant to the provisions of the City Code of Ordinance in effect on the date of resignation. I hereby further certify that my date of birth is The date I will begin to receive my pension will be ???., 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, I 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 Social Security Number ?l +c-r-l l 13a Department/Division Street Address ""?Ic'?- 0??' C??Q- Job Classification City, State, Zip Code STATE OF FLORIDA The foregoing instrument was acknowledged before COUNTY OF PINELLAS me this day of 20 is personally know to me r who has provided as identification Public rinted My commission expires: LAURA A. SPELMIW r MY COMMISSION # DD 927639 EXPIRES: September 24, 2013 P?QrFOV "e Bonded Thor Budget Notary Services Rev. 4/09 Item # 6 Vested Pension Form and who did/did not take an oath.