01/11/2011
4 PENSION TRUSTEES AGENDA
Location: Council Chambers - City Hall
Date: 1/11/2011- 9:00 AM
1. Call to Order
2. Approval of Minutes
2.1 Approve the minutes of the December 13, 2010 Pension Trustees meeting as submitted in written
summation by the City Clerk.
Attachments
3. Pension Trustee Items
3.1 Approve new hires for acceptance into Pension Plan as listed and recommended by the Pension Advisory
Committee.
Attachments
3.2 Approve the requests of employees Jo Ellyn King, Parks and Recreation Department, and Ronald Nessler,
Public Utilities Department, for regular pensions as provided by Sections 2.397 and 2.398 of the
Employees' Pension Plan and recommended by the Pension Advisory Committee.
Attachments
3.3 Approve the request of employee Mladen Zdjelar to vest his pension as provided by Section 2.397 of the
Employees' Pension Plan and recommended by the Pension Advisory Committee.
Attachments
4. Other Business
5. Adjourn
Meeting Date: 1/11/2011
Pension Trustees Agenda
Council Chambers - City Hall
SUBJECT / RECOMMENDATION:
Approve the minutes of the December 13, 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 3
TRUSTEES OF THE EMPLOYEES' PENSION FUND MEETING
MINUTES
CITY OF CLEARWATER
December 13, 2010
Present: Chair/Trustee 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,
Rosemarie Call - City Clerk, and Karen Vaughan - Administrative Analyst.
Unapproved
To provide continuity for research, items are in agenda order although not
necessarily discussed in that order.
1. Call to Order - it Frank Hibbard
The meeting was called to order at 8:47 a.m. at City Hall.
2. Approval of Minutes
2.1 Approv the minutes of the November 1, 1 Pension Trustees meeting as
submitted in written summation the City Clerk.
Trustee John Doran moved to approve the minutes of the November 1, 2010 Pension
Trustees meeting as submitted in written summation by the City Clerk. The motion was
duly seconded and carried unanimously.
3. Pension Trustee Items
3.1 Approve n w hires for ccetanc into Pension Ian as listed and recommended
by the Pension Advisorv Committee.
sionName, Job. Class, & Dept./Div.
Deborah Del Sole, Field Service Rep. I/Customer
Service
Hire Pension Elig.
Date Date
10/4/10 10/4/10
Kevin Nurnberger, Planner II/Planning and 10/18/10 10/18/10
Development
Manuel Diaz, Police Aide/Police 12/22/07 10/11/10"
Sean Kelly, Systems Programmer/Information Tech. 10/11/10 10/11/10
Pension Trustee 2010-12-13 Item #11
Attachment number 1
Page 2 of 3
Cheri Drigan, Customer Service Representative/Gas 10/11/10 10/11/10
Ekaterini Gerakios, Economic Dev. Coordinator/Econ. 10/4/10 10/4/10
Dev.
'illiam Olive, Police Communications 9/27/10 9/27/10
perator/Police
*Originally hired as part-time on 12/22/07; transferred to full-time and pension
eligible as of 10/11/10
Trustee George N. Cretekos moved to approve new hires for acceptance into Pension
Plan as listed and recommended by the Pension Advisory Committee. The motion was
duly seconded and carried unanimously.
3.2 Approve the r gu sts of ploy s borate Richter of Police, ark ohe n of
arks and cr ation, Jos ph Young of Police, and Ronald ulr of Police for
regular p nsions as provided y Sections 2.397 and 2.398 of the Employees
Pension Ian as recommended by the Pension Advisorv Committee.
Deborah Richter, Administrative Support Manager, Police Department, was
employed by the City on July 27, 1981, and her pension service credit is effective
on that date. Her pension will be effective August 1, 2011.
Based on an average salary of approximately $60,963 per year over the past five
years, the formula for computing regular pensions, and Ms. Richter's selection of
the 100% Joint and Survivor Annuity, this pension will approximate $49,995
annually.
Mark Goheen, Administrative Analyst, Parks and Recreation Department, was
employed by the City on September 6, 1979, and his pension service credit is
effective on February 8, 1981. His pension will be effective March 1, 2011.
Based on an average salary of approximately $54,260 per year over the past five
years, the formula for computing regular pensions and Mr. Goheen's selection of
the Joint and Survivor Annuity, this pension will approximate $44,835 annually.
Joseph Young, Police Lieutenant, Police Department, was employed by the City
on May 20, 1988, 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 $107,153 per year over the past five
years, the formula for computing regular pensions and Mr. Young's selection of
the Life Annuity, this pension will approximate $72,577 annually.
Ronald Sudler, Police Lieutenant, Police Department, was employed by the City
Pension Trustee 2010-12-13 Item #21
Attachment number 1
Page 3 of 3
on April 12, 1982, 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 $95,696 per year over the past five
years, the formula for computing regular pensions, and Mr. Sudler's selection of
the 100% Joint and Survivor Annuity, this pension will approximate $74,019
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. Section 2.397 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 Lieutenant as
meeting the hazardous duty criteria. Ms. Richter and Mr. Goheen qualify under
the 30 years of service criteria. Mr. Young and Mr. Sudler qualify under the
hazardous duty criteria.
Trustee Paul Gibson moved to approve the requests of employees Deborah Richter of
Police, Mark Goheen of Parks and Recreation, Joseph Young of Police, and Ronald
Sudler of Police for regular pensions as provided by Sections 2.397 and 2.398 of the
Employees Pension Plan as recommended by the Pension Advisory Committee. The
motion was duly seconded and carried unanimously.
4. Business Other 5.
The meeting was adjourned at 8:48 a.m.
Chair
Employee's Pension Plan Trustees
Attest
City Clerk
Pension Trustee 2010-12-13 Item #31
Meeting Date: 1/11/2011
Pension Trustees Agenda
Council Chambers - City Hall
SUBJECT / RECOMMENDATION:
Approve new hires for acceptance into Pension Plan as listed and recommended by the Pension Advisory Committee.
SUMMARY:
Name, Job. Class, & Dept./Div.
Pension
Hire Date Elig Date
Steven King, Administrative Analyst/Parks & Rec. 11/15/10 11/15/10
Raymond Croze, Police Officer/Police 10/25/10 10/25/10
Jason Slaughter, SW Equip. Oper./Solid Waste/Gen'1 Ser. 11/8/10 11/8/10
Horace Purifoy, Public Utilities Technician I/Public Utilities 11/9/10 11/9/10
Ashley Bailey, SW Worker/Solid Waste/General Services 11/8/10 11/8/10
Kyle Clark, Public Utilities Technician I/Public Utilities 11/8/10 11/8/10
Ermesto Rodriguez, SW Equip. Oper./Solid Waste/Gen' Ser. 11/8/10 11/8/10
Chaddrick Cann, SW Equip. Oper./Solid Waste/Gen'1 Ser. 11/8/10 11/8/10
Martin Lindemann, SWWorker/Solid Waste/Gen'1 Services 11/8/10 11/8/10
Robert McAnally, Fleet Mechanic/Solid Waste/General Ser. 11/8/10 11/8/10
Leonardo Aragones, Fleet Mechanic/Solid Waste/Gen'1 Ser. 11/8/10 11/8/10
Kevin Wylie, Public Utilities Technician I/Public Utilities 11/8/10 11/8/10
Eric Pickford, Public Utilities Technician I/Public Utilities 11/8/10 11/8/10
Brandi Montgomery, SW Equip. Oper./SW/Gen'1 Ser. 10/25/10 10/25/10
Joseph Czop, Police Officer/Police 10/25/10 10/25/10
Maria Pita, Police Officer/Police 10/25/10 10/25/10
Ronald Hayes, Gas Technician UGas 10/25/10 10/25/10
Todd LaBrecque, Warehouse Clerk/Solid Waste/Gen'1 Ser. 10/25/10 10/25/10
Mike Mailles, Gas Technician UGas 10/25/10 10/25/10
Ralph Shaw, Recreation Programmer/Parks & Recreation 4/3/10 10/24/10 **
Alan Tyler, Gas Technician I/Gas 10/25/10 10/25/10
Paul Thompson, Field Service Representative/Cust. Service 11/22/10 11/22/10
Celia Wilcox, Field Service Representative/Cust. Service 11/22/10 11/22/10
Brian Palmer, Public Utilities Technician I/Public Utilities 10/26/10 10/26/10
*Originally hired as temporary on 8/10/10; transferred to full-time and pension eligible as of 11/8/10
**Originally hired as part-time on 4/3/10; promoted and pension eligible as of 10/25/10
Review Approval: 1) Assistant City Manager 2) City Manager 3) Clerk
Cover Memo
Item # 2
Meeting Date: 1/11/2011
Pension Trustees Agenda
Council Chambers - City Hall
SUBJECT / RECOMMENDATION:
Approve the requests of employees Jo Ellyn King, Parks and Recreation Department, and Ronald Nessler, Public Utilities Department,
for regular pensions as provided by Sections 2.397 and 2.398 of the Employees' Pension Plan and recommended by the Pension
Advisory Committee.
SUMMARY:
Jo Ellyn King, Parks Service Supervisor I, Parks and Recreation Department, was employed by the City on November 10, 1980, and her
pension service credit is effective on that date. Her pension will be effective January 1, 2011.
Based on an average salary of approximately $50,483 per year over the past five years, the formula for computing regular pensions, and
Ms. King's selection of the Life Annuity, this pension will approximate $44,490 annually.
Ronald Nessler, Wastewater Treatment Plant Operator A, Public Utilities Department, was employed by the City on July 10, 1980, and
his pension service credit is effective on that date. His pension will be effective January 1, 2011.
Based on an average salary of approximately $68,862 per year over the past five years, the formula for computing regular pensions, and
Mr. Nessler's selection of the Joint and Survivor Annuity, this pension will approximate $57,710 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. Ms. King and
Mr. Nessler qualify under the 30 years of service criteria.
Review Approval: 1) Clerk
Cover Memo
Item # 3
MLLGG III IIHIRTRT[I DU I I
Page 1 of 9
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.
cJ Cs /'
I, r1 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 O YEES' SEPARA TION PA Y PREFERENCES
CITY OF CLEARWATER
leave in the following manner:
Run Out
vacation
sick floaters bonus hours
5ca' Sb sick floaters / 0' C` bonus hours
Lump Sum -TT ? 6?1 vacation
I understand that my preference cannot be changed once this form is signed and that my decision is
irrevocable.
EMPLOYEE'S SIGNATURE: `
SOCIAL SECURITY #:
TNESSES: ADDRESS: c:;Z
/v? ?L -70
l/
PHONE: DATE: &I
Revised 1/02
Form #9900-0008 File Name: Employee Separation Pay Pref
Item # 3
ruiaciuneni iiuinuei i
Page 2 of 9
CITY OF CLEARWATER
PENSION ENTITLEMENT OPTION REQUEST FORM
I, .i co C_I(4h /r, I/-) ?j
of Clearwater General Employees' Pension Plan.
Job Classifica ?`k ecuI'C
Department: a ec rr
Benefits Date: //11 O
Date of Birth: ` lo /9 Spouse's Name: J C? U
Spouse's Date of Birth: /o
do hereby apply for retirement under the City
S SJ J2 1 J j G d -+L Sex: M GF
I
Division:
Date of Hire: I / U 8 Ci ,
Resignation Date: l.;L 3
Sex: @ F
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 # 3
Page 3 of 9
Option 6 -100% Joint & Survivor Annuity - (must designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first, the beneficiary
receives 100% of the pension for the rest of 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 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:
If taking Option 3. 4. 5. or 6 fill in beneficiarv information and sign 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 The fore oing nstrument was acknowledged befor me this
COUNTY OF PINELLAS 177 ?? ?,? by O ?( cs ?) ? ? S
who is
personally known to me or who has provided
as ident?filcatiop and who rfid/did raot,talsk an oath.
1._? !/ I , If V-"V-- Notary Public
JCII
.Y .nature
0 Y[ ? / U
?° Name of Notary Printed
NOTARY PUBLIC-STATE OF FLORIDA
My Comm ission,sxpves: Deborah L. Ford
Cornmission #DD763426
Expires: MAY 15, 2012
BONDED THRD ATLANITC BONDDJG co,, LYC.
Rev. 4/08
Form #9900-0009
File Name: Pension Entitlement Option Form
Item # 3
ruiaciuneni I1UH1Uei i
Page 4 of 9
II Estimated Pension Worksheet II
Joellyn King
LAST DATE PAID:
BENEFITS DATE
CREDITED SERVICE
Prepared by:
Date:
GROSS
CALENDAR PENSION
YEAR EARNINGS
12/31/2010 2006 $46,861.43
11/10/1980 2007 $50,144.08
30.1417 2008 $51,004.53
2009 $52,201.34
2010 $52,201.34 estimated
$252,412.72 (5 Year Total)
5/ $50,482.54 (Yearly Avg)
12/ $4,206.88 (Monthly Avg)
x 0.0275 (Benefit Rate)
x 30.1417 (Yrs of Service)
$3,487.07 (Est Mtly Pension)
Deborah Ford
11/22/2010
Item # 3
Page 5 of 9
City of Clearwater Employees' Pension Plan
Actuarial Equivalence Factors
22-Nov-10
sm
ESTIMATE c1ract01
Version:
Employee Name: Joellyn King 1-4-96
Employee Date of Birth: 10 9 1957
Marital Status: m
Spouse Date of Birth: 10 4 1954
Beneficiary Date of Birth: 10 4 1954
Benefit Commencement Date : 1 1 2011
Estimated Monthly Normal Retirement Benefit: $3,487.07 Estimated
Monthly
Actuarial Equivalent Adjustment Factors: Benefit
Option 1 Normal Form 1.00000 $3,487.07
Option 2 Life Annuity 1.06322 $3,707.54
Option 3 10 Year Certain 1.05066 $3,663.72
Option 4 50% J&S 1.02281 $3,566.60
Option 5 75% J&S 1.00373 $3,500.08
Option 6 100% J&S 0.98535 $3,435.99
ESTIMATE
Item # 3
ruiaciuneni iiuinuei i
Page 6 of 9
CITY OF CLEARWATER
EMPL OYEES' 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.
Q
dIn, an employee of the City of Clearwater, hereby apply for
I,
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
leave in the following manner:
Run Out vacation sick floaters bonus hours
Lump Sum i 13, !A. vacation sick floaters --XO' 0 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 #:
WIAINESSES: ADDRESS: S hcJ eo,
Ck -7 (o
PHONE: J A-7 S 3?'? 3 4 DATE: I I I
Revised 1102
Form #9900-0008 File Name: Employee Separation Pay Pref
Item # 3
ruiaciuneni iiuinuei i
Page 7 of 9
CITY OF CLEARWATER
PENSION ENTITLEMENT OPTION REQUEST FORM
1, KOVnu\ c? y (Jess\ P-Vr
of Clearwater General Employees' Pension Plan.
do hereby apply for retirement under the City
Job Classificat?' n: LIAOTP Coe - fd f
Department: 1?b1?ci? ??-ic? Division: _
Benefits Date: Date of Hire:
Date of Birth: S Resignation Date:
Spouse's Name:
Spouse's Date of Birth:
Sex: M F
t-t? U>rLS
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)]
Qption 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 d - 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)]
IU A-
Item # 3
Page 8 of 9
Option 6 - 100% Joint & Survivor Annuity - (must designate a beneficiary)
The Participant receives his/her pension as long as he/she lives. If the Participant dies first, the beneficiary
receives 100% of the pension for the rest of 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.)
understand that once my first pension check is received, my decision on this option is irrevocable.
If taking Option I sign below:
Option #: I Description.- Joint and Survivor Annuity
Employee's Signature: Date: H
Dependent children under the age of 18 and residing in my household are..
Child's Name Sex Date of Birth
If taking Option 2 sign below:
Option #: 2 Description: Life Annuity
Employee's Signature: Date:
If taking Option 3 4 5 or 6 fill in beneficia information and sign below:
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 for goin instrument was acknowledged before me this
COUNTY OF PINELLAS i I lr33l I o _ by__ tOk GZ1 d T 005de-?' who is
personally known to me or who has provided
as ide I i atiom and who did/did obtttaA an oath.
Notary Public
D, U
V foil L- iV? V-4 Name of Notary Printed
My Commission expires:
NOTARY PUBLIC-STATE OF FLORIDA
Deborah L. Ford
Commission #DD763426
Rev. 4/08%,,, ,•,•` Expires: MAY 15, 2012
BONDED THRU ATLANTIC BONDING CO., INC.
Form #9900-0009 File Name: Pension Entitlement Option Form
Item # 3
Page 9 of 9
II Estimated Pension Worksheet II
Ronald Nessler
LAST DATE PAID:
BENEFITS DATE
CREDITED SERVICE
12/31/2010
7/10/1980
30.4750
Prepared by: Deborah Ford
Date: 11/23/10
GROSS
CALENDAR PENSION
YEAR EARNINGS
2006 $60,617.71
2007 $75,675.26
2008 $70,031.44
2009 $71,897.28
2010 $66,086.20 estimated (pension gross ytd of $59
$344,307.89 (5 Year Total)
5/ $68,861.58 (Yearly Avg)
12/ $5,738.47 (Monthly Avg)
x 0.0275 (Benefit Rate)
x 30.4750 (Yrs of Service)
$4,809.20 (Est Mtly Pension)
Item # 3
Meeting Date: 1/11/2011
Pension Trustees Agenda
Council Chambers - City Hall
SUBJECT / RECOMMENDATION:
Approve the request of employee Mladen Zdjelar to vest his pension as provided by Section 2.397 of the Employees' Pension Plan and
recommended by the Pension Advisory Committee.
SUMMARY:
Mladen Zdjelar, Network Analyst, Information Technology Department,was employed by the City on June 12, 1995 and began
participating in the Pension Plan on that date. Mr. Zdjelar terminated from City employment on December 3, 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. Mr. Zdjelar
would have completed 20 years of service and reached age 55 on June 12, 2015. His pension will be effective July 1, 2015.
Review Approval: 1) Clerk
Cover Memo
Item # 4
Page 1 of 1
APPLICATION FOR VESTED RIGHTS PENSION
f ` t l a d e `l ??j?e ?cr Y being a person leaving employment with the
City of Clearwater, Florida, and having completed ten (10) or more years of credited service,
Bch service having occurred during the period from (date f entry i fnfto Pension Plan)
':'jvvle 1. , 19' q S to (date of resignation or change of status) - I e tern h er 3t .?-0 / y
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 ? h 00Y The date I will begin to receive my pension will be Jy I S=j 1 C'g d
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
received any other type of pension`From the City.
'xu
Signature
Department/Division
f-
Job Classification
my period of employment, and I have not
Social Security Number
Y7r?(P 4 vqus ve
St eet Address
F-L 3(/6
City, State, Zip Code
STATE OF FLORIDA The foregoing instrument was acknowledged before
VyeyAep , 20/0
COUNTY OF PINELLAS me this /C day of JV
by /y I' 1 Icc de r1
who is personally know to me or who has provided
as identification
and who did/did not take an oath.
_4??Notary Public
( d l L - '-'Cl Name of Notary Printed
My commission expires:
NOTARY PUBLIC-STATE OF FLOar'.
Deborah L. Forc
j Commission #DD763426
Expires: MAY 15, 2012
BONDED THRH AT"NnC BON'DING CO., NC.
Rev. 4/09 Vested P@F O Arai