09/18/20121. Call to Order
2. Approval of Minutes
PENSION TRUSTEES AGENDA
Location: Council Chambers - City Hall
Date: 9/18/2012- 9:00 AM
2.1 Approve the minutes of the August 13, 2012 Pension Trustees meeting as submitted in written summation
by the City Clerk.
� Attachments
3. Pension Trustee Items
3.1 Approve the request of the new hires for acceptance into the pension plan as listed.
6� Attachments
3.2 Approve the request of employees George Miller of the Solid Waste Department and Peter Rullo of the
Public Utilities Department for a regular pension as provided by Sections 2.397 and 2.398 of the
Employees' Pension Plan.
� Attachments
4. Other Business
5. Adjourn
Pension Trustees Agenda
Council Chambers - City Hall
Meeting Date:9/18/2012
SUBJECT / RECOMMENDATION:
Approve the minutes of the August 13, 2012 Pension Trustees meeting as submitted in written summation by the City Clerk.
SUMMARY:
Review Approval:
Cover Memo
��11�:�)
Attachment number 1 \nPage 1
TRUSTEES OF THE EMPLOYEES' PENSION FUND MEETING MINUTES
CITY OF CLEARWATER
�� � �
Present: Chair/Trustee George N. Cretekos, Trustee Paul Gibson,
Doreen Hock-DiPolito, Trustee Bill Jonson, and Trustee �
Polglaze.
Also Present: William B. Horne II - City Manager, Jill S. Siluerbc�ard -
Manager, Rod Irwin - Assistant City Manager; Pamela
Attorney, Rosemarie Call - City Clerk, and Nicole 5pr�
Records and Legislative Services Coordinator.
To provide continuity for research, items are in agenda
necessarily discussed in that order.
Unapproved
�
The meeting was called to ord
2.
2.
I of Minute�
tl�� minutes
� in �+ritten s
Trustee Doreen H
Pension Trustees
motion was duly s
Pension Trustee
isted.
�
16, 2012 P�ri�i�.n T
rv the Citv Gl�r�.
a
not
eetina as
lito movec! tQ,approve the minutes of the July 16, 2012
as submit�ed in written summation by the City Clerk. The
and carried unanimously.
Name, Job. Cla�s, &"Dept./Div. Hire Date
I���ir� Salz�r;� Planner 111/Planning and Dev� 06/04/12
Andr�w Mc�c�rmick, Public Utilities Tech./PU Dept. 06/18/12
Chad Paukert, Parks Service Tech I/Parks and Rec Dept. 06/18/12
Darla Ismail, Police Comm Oper Trainee/Police Dept. 06/18/12
Christopher Dahmer, Police Comm Oper Trainee/PD 06/18/1
Roger Beatty, Engineer Specialist/Engineering Dept. 06/18/12
Gina Trieste, HR Analyst/Human Resources Dept. 06/18/1
Pension
Elig. Date
06/04/12
06/18/12
06/18/12
06/18/12
2 06/18/12
06/18/12
2 06/18/12
Pension Trustees 2012-08-13 1
Item # 1
Attachment number 1 \nPage 2
Trustee Jay Polglaze moved to approve the request of the new hires for acceptance into
the pension plan as listed. The motion was duly seconded and carried unanimously.
3.2
Services Department; Lawrence G. Gallop of the Enqineerinq DeK
Gordon Jerrell of the Gas Department and Russell Carter of �h� P
the Emplovees' Pension Plan.
.^:I
Steve Bochno, Administrative Analyst, General Services, was employed by the
City on January 28, 1991, and his pension service credit i� eff�;ctive on that da1
His pension will be effective July 1, 2012.Based on an au�rage sa�ary of
approximately $49,377.05 per year over the past five years, the fiQrrnula for
computing regular pensions, and Mr. Bochno's sele�tic�n of the 100%� Jaint and
Survivor Annuity, this pension will approximate $28,22�:�2 annually:
Lawrence G. Gallop, Survey Assistant; ll, E`ngineering [��p�
by the City on April 23, 1984, and his pension servic�: credi'
date. His pension will be eff�ct��e August 1, 2012.�ased or
approximately $39,109.50 per year over the past five years
computing regular pensions, and Mr. Gallop's s�lection of t�
Anr�ui#y, �his pension�will approximate $30,3��.40 annually'�;
on Septemkier 1
His pension will
approximately �
computing regu
Annuity, this pe
ent, was ernployec
effective on �ha#
a�erage salary of
� fiormula for
laint �nd Survivor
rvice Qi�patcher, Gas Departrn�:nt, was employed by the City
� 980, a��l his.„pension service ceedit�is effective July 13, 1992�
��:ffective August 1, 2012.Based on an average salary of
,972.61 per year over the past five years, the formula for
pensions, and Mr. Jerrell's selection of the Joint and Survivor
on will approximate:$20,884.92 annually.
Russell Carter, Athletic Field Coordinator, Parks and Recreation Department, was
employed by the City Qn December 21, 1987, and his pension service credit is
effective on that da#�. His pension will be effective October 1, 2012.Based on an
average salary;of approximately $59,818.14 per year over the past five years, the
Forrn,ula fQr cc�mputing regular pensions, and Mr. Carter's selection of the 100%
Joint and; �urvivor Annuity, this pension will approximate $39,866.88 annually.
Sectian 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
Pension Trustees 2012-08-13 2
Item # 1
Attachment number 1 \nPage 3
of credited service. Mr. Bochno Mr. Gallop, Mr. Jerrell, and Mr. Carter qualify
under the age 55 and 20 years of service criteria.
Trustee Paul Gibson moved to approve the request of employees Steve Bocho of the
Solid Waste/General Services Department; Lawrence G. Gallop of the Engineering
Department; Gordon Jerrell of the Gas Department and Russell Carter of the Parks and
Recreation Department for a regular pension as provided by Sections 2.397 c�f the
Employees' Pension Plan. The motion was duly seconded and carried un�inimously: ,
3.3 Approve the request of emplovee Douqlas Pulver
Douglas Pulver, Fleet Mechanic, General Services Department
by the City on May 27, 1986, and began participating in the Pei
that date. Mr. Pulver terminated from City ernplQyment on June
The Employees' Pension Plan provides`�kh�t'should an
employee of the City of Clearwater or change status fr�
after completing ten or more years Qf creditable s�ruicf
such employee shall acquire a:uested interest in'#kte re
pension payments comrn�nce on the first of the month
which the emplovee nQrm�llv would have k�een eliaible
�p) pr�
5 and
30 years oi
credited se
Mr. Pulver woul�
55 on July 16, 2
emp�oy
Plan on
�12.
loyee ceas�: to be an
�II-time to pa;��t�me
nsion participation),
ient benefits. Vested
wina the month in
des'for normal retirement eligibifity when a participant has
�rnple#ed twenty year� c�f cre�lited service, has completed
rvice,�or has reached age G5 and completed ten years of
completec! at least 20 years of service and will reach age
is pension will be effective August 1, 2013.
Trustee Doreen Hock-DiPcalifio'moved to approve the request of employee Douglas
Pulver, General Service� #c� �r�:st his pension as provided by Section 2.397 of the
Empl�yees' Pension Plan:: The motion was duly seconded and carried unanimously.
3.4 �=r�ve �.c���ient with Gabriel Roeder Smith and Companv. current plan
a�tia�r� fic�r �c�mpletion of a comprehensive experience studv related to actuarial
authc�,rize the aaaroariate officials to execute same.
Pension Trustees 2012-08-13 3
Item # 1
Attachment number 1 \nPage 4
Experience studies for review of actuarial assumptions and methods should be
perFormed regularly to assure that actuarial assumptions and methods reflect the
evolving Plan experience. Changes in assumptions and actuarial methods can
increase or decrease the overall liability of the plan. The goal is to have the most
realistic assumptions and methods that will more accurately predict future benefit
payouts. Per Government Finance Officers Association (GFOA) best practices
guidance, comprehensive experience studies should be completed at least every
five years.
The last experience study for the Employees' Pension R1an was dated 5�pfi�:mber
1, 2006. Staff recommends that an experience study be �ampleted �r-ior to the
January 1, 2013, plan actuarial valuation.
Trustee Jay Polglaze moved to approve agreement with Gabriel Roed�r Smith and
Company, current plan actuary, for completion of a comprehensive e�cp�rience study``
related to actuarial assumptions and methods, for a not-to-exceed amc�unt of $25,000,
and authorize the appropriate officials to execute same: The motion was :�uly seconded
and carried unanimously.
3.5
in the Citv of Clearwater Em
the plan.
Section 2.393 of the
cc�n;tract aositions (�
�
nsion Ordinance excludes emplf
6) from partici�aation in the Cifiy's
�
s`hired into
ployee
In 2005, the Ci�y k�egan erriplQying individuals fror� oufs'ide the organization to
serve as Assistant Fire and RQ1i�e,Chiefs. Because these individuals were hired
into contract posi#�Qns (SAMP 4�nd 5), they were treated the same as other
similarly situated employees and°w�re enrolled in the City's 401A program instead
of the pension plan:lAW our Pensian ordinance. The Pension Plan Attorney has
rendered an opinion regarding this practice that State Statutes requires
participation by all firef�ghters and police officers in pension plans governed by
Chapters 175 and 1$5_ Since Section 2.393 of the current Pension Ordinance
conflicts with Chapters'175 and 185 in this instance, the Plan Attorney has opined
that Florida statutory provisions prevail. The only exception is for Fire and Police
�h�efs wh� hau�: the option to not participate. It is also their opinion that all
Assistant;Fire and Police Chiefs be enrolled in the City Pension Plan on a
prospectiue basis and that they be permitted to purchase credited service
retroactive to their dates of hire if they so choose. The City can require that the
Assistant Chiefs pay the actuarial cost for prior service credit or the equivalent of
what would have been their annual employee contribution. They can also be
Pension Trustees 2012-08-13 4
Item # 1
Attachment number 1 \nPage 5
permitted to roll over the balance in their purchase money plan account to pay for
prior service credit.
The Pension rewrite that will be considered at referendum in November will
include a change requiring these employees to participate in the Pension plan
when hired.
The current Pension ordinance authorizes the Trustees to "determine from time to
time which persons are full-time employees for purposes Qf th;e plan."
Trustee Paul Gibson moved to determine that hazardous duty con#ract �mpioyee;
eligible for participation in the City of Clearwater Employee Pensic�n Plan and dire
be enrolled in the plan. The motion was duly seconded and carried unanimously.
�' � .
Pension Trustees 2012-08-13
5
Item # 1
Pension Trustees Agenda
Council Chambers - City Hall
SUBJECT / RECOMMENDATION:
Approve the request of the new hires for acceptance into the pension plan as listed.
SUMMARY:
Name, Job. Class, & Dept./Div.
Ellen Walton, Library Assistant, Library
Benjamin Carter, Park Ser Tech I, Parks and Rec
Amy Anton, Legal Staff Assistant, Legal Dept
Rachel Robledo, Librarian II, Library
Carl Allison, WWTP Operator, Public Utilities
Paul Mac, Electronic Technician, Public Utilities
Katherine Femandez, Police Info Tech, Police Depart
Malik Salam, Public Utilities Technician, Public Utilities
Hire Date
02/ 14/2012
07/02/2012
07/02/2012
07/02/2012
07/ 14/2012
07/ 16/2012
07/ 16/2012
07/ 16/2012
Eli�. Date
06/3 0/2012 *
07/02/2012
07/02/2012
07/02/2012
07/ 14/2012
07/ 16/2012
07/ 16/2012
07/ 16/2012
Meeting Date:9/18/2012
*Originally hired as part-time on 02/14/2012; transferred to full-time and pension eligible as of 06/30/2012.
Review Approval:
Cover Memo
��11�:��
Pension Trustees Agenda
Council Chambers - City Hall
Meeting Date:9/18/2012
SUBJECT / RECOMMENDATION:
Approve the request of employees George Miller of the Solid Waste Department and Peter Rullo of the Public Utilities Department for
a regular pension as provided by Sections 2397 and 2398 of the Employees' Pension Plan.
SUMMARY:
George Miller, Solid Waste Equipment Operator, Solid Waste 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 August 1, 2012.
Based on an average salary of approximately $47,076.73 per year over the past five years, the formula for computing regular pensions,
and Mr. Miller's selection of the 100% Joint and Survivor Annuity, this pension will approximate $40,185.84 annually.
Peter Rullo, Industrial Pretreatment Technician, Public Utilities Department, was employed by the City on July 24, 1989, and his
pension service credit is effective on that date. His pension will be effective September 1, 2012.
Based on an average salary of approximately $51,692.14 per year over the past five years, the formula for computing regular pension
and Mr. Rullo's selection of the Joint and Survivor Annuity, this pension will approximate $32,813.73 annually.
Section 2397 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. Miller
quali�es under the thirty years of service criteria and Mr. Rullo quali�es under the age 55 and 20 years of service criteria.
Review Approval:
Cover Memo
��11�:��
Attachment number 1 \nPage 1
CtTY OF CLEARWATER
EMPLOYEES' SEPARATtON PAY 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 {ast day of work will be the termination date and pension benefits will
begin the fol�owing 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, �Q,-�-�T ��� �(� , 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:
-�_•.
Lump Sum
v�e�#tan
) 7U .1717�'acation
.�- #�ea�e�5 t��s
,�""76 .�`] sick _ � (O 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: �'
SOCIAL SECURITY #:
WITNESSES: ADDRESS: 7� ��- 'S H�2 `�ly�-!�� S�✓c� �
� �/e� ��T ���,�y Fi 3��s �
,
PHONE: 70� ��`f�- O�Sd `{ DATE: �7 �o� �! d G� �
Revised 1l02
Form #9900-0�08
File Name: Employee Separation Pay Pref
��11�:��
CITY OF CLEARWATER
PENSION ENTITLEMENT OPTION REQUEST FORM
I, T� �- «..��
of Clearwater General Employees' Pension Plan.
Job Classification:
Department: PU,.�
Benefits Date: ��
Date of Birth: �.
Spouse's Name: �t
Spouse's Date of Birth:
19S
Attachment number 1 \nPage �
do hereby apply for retirement under the City
Division:
Dat�. of Hire: _�
Resignation Date:
The type of pension for which I am applying is (check only one):
'✓r Regular Pension based on years of service
Job-connected Disability Pension
Non-job-connected Disability Pension
�(�, Sex: �M F
� `�-r��`�;o�- ��r&
u ta8�
s�' �-�I 2o i z.
Sex: M �
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 ret:irement benefit. The
other optional forms (#2 -#6) shall be computed to be the Actua�ial Equivalent of the normal benefit.
Option 1- Joint and Survivor Annuity
The normal form of retirement benefit shall be an annuit�/ 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
beneflciary, 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)j The ParticipanYs 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 diE;s 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 a{ive 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/_=;he 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 8� 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)]
I[�'ii�:�c3
Attachment number 1 \nPage �
Option 6 100% Joint & Survivor Annuitv -(rnust 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 aiternative 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.
a i tion 1 si n below:
�p�tion #: 1 Des � tion: Joint and Survivor Annuity
Employee's Signature: .
Date: � l°� 7�a O f o2.
Dependent children under the age of 18 and residing in my household are: Date of Birth
Child's Name Sex
if taking nntion � sign bQl9w=
Option #: 2
Employee's Signature:
Description: Life Annuity _
If taking Option 3, 4, 5, or 6 fill in beneficiary information and
Option #: Description: _
My designated beneficiary is:
Name:
Social Security Number:
Address:
Employee's Signature:
Date of Birth:
Date:
�n below:
Sex M F
Phone Number:
Date:
STATE OF FLORIDA The foregoing instrument was acknowledged before me this
COUNTY OF PINELLAS � j-h �,�l by _�p����� f �r who is
personally known to me or who has provided _��
MICHELLE KUTCH
t NOTARY PUBLtC
STATE OF FLORIDA
, Comrr►* EE201501
Expkes 5/23f2076
Rev. 4/08
Form #9900-0009
as identification and who dicj/did not take an oath.
My Commission expires:
Notary Public
Name of Notary Printed
File Name: Pension Entitlement Option Form
��11�:��
Peter Rullo
LAST DATE PAID:
BENEFITS DATE
CREDITED SERVICE
Estimated Pension Worksheet
8/2412012
7/24/1989
23.0833
Prepared by: Michelle Kutch
Date: 7/20/12
Attachment number 1 \nPage �
GROSS
CALENDAR PENSION
YEAR EARNINGS
2007 $49,452.55
2008 $52,057.22
2009 $52,693.52
2010 $51,757.59
2011 $52,499.80
$258,460.68 (5 Year Total)
5/ $51,692.14 (Yearly Avg)
12/ $4,307.68 (Monthly Avg)
x 0.0275 (Benefit Rate)
x 23.0833 (Yrs of Service)
$2,734.48 (Est Mtly Pension)
I[�'ii�:�c3
City of Clearwater Employees' Pension Plan
Actuarial Equivalence Factors
ESTIMATE
20-Ju1-12
sm
clract01
Version:
Employee Name: Peter Rullo 1-4-96
Employee Date of Birth: 1 10 1956
Marital Status: m
Spouse Date of Birth: 2 13 1959
Beneficiary Date of Birth: 2 13 1959
Benefit Commencement Date : 9 1 2012
Estimated Monthly Normal Retirement Benefit: $2,734.48
Actuarial Equivalent Adjustment Factors:
O�tior. 1 J�S A.nnuit� 1.00000
Option 2 Life Annuity 1.10214
Option 3
Option 4
Option 5
Option 6
10 Year Certain
50% J&S
75% J&S
100% J&S
ESTIMATE
1.08254
1.03600
1.00583
0.97736
Attachment number 1 \nPage �
Estimated
Monthly
Benefit
$2,?34.48
$3,013.77
$2,960.18
$2,832.93
$2,750.41
$2,672.56
I[�'ii�:�c3
Attachment number 1 \nPage �
CITY OF CLEARWATER
EMPLOYEES' SEPARATION PAY PREFERENCES
PREFERENCE #1 Employees can receive a lump sum payment for vacation, floating holiday pay, sick
leave incentive, bonus days (if applicable), and 112 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 eamings in the calculation of the
pension. The last day of work w�ll 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, =��9�i�� ��ll.��' , 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
Lump Sum
var�tion sick� _ floaters bonus hours
��� .�� � �',
��f � acation '�y�.��.?.� _ �y floaters ��d _ bonus hours
I understand that my preference cannot be changed once this form is signed and that my decision is
irrevocable. ' '�`'
^ ;/!; .� ; '
EMPLOYEE'S SIGNATURE: � ° ' � `��'�
WITNESSES:
r � ��
Revised 1/02
Form #990b-0008
SOCIAL SECURITY #:
ADDRESS:
�
�
,
��' 1 � b Y jr�� �--.� � ,�� ,l 3 3 �s �
PHONE: ��_ DATE: ��,� �i `. 2G' � �
File.Name: Employee Separation Pay Pref
��11�:��
Attachment number 1 \nPage �
CtTY OF CLEARWATER
PENSION ENTITLEMENT OPTION REQUEST FORM
� ;���Q� �� 1 i� _ do hereby appiy for retirement under the City
of Clearwater General Employees' Pension Plan.
. _ � � �_ Sex: M� F
Job Classification: °
Department: -Z � Division:
Benefits Date:
���Z. Date of Hire: _ S ��
Da te o f Bi rt h: t� �Z Resignation Date: `�"1 1
Spouse's Name: ✓a- ' � ���
Spouse's Date of Birth: _� j� ��f 5
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
Sex: M �
The City of Clearwater Employees' Pension Pian provides muftiple 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 tne 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
originai 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 shali be deemed to be the k�eneficiary 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 beneficiar�'s estate. If the first benefic:iary predeceases the
participant, he/she may designate a new beneficiary. If r�o beneficiary is alive at the time of the participant's
death, the participanYs estate will be paid the balance of the 120 payments. [Section 2.398 (b) (2) (a) (2)J
Option 4- 50% Joint S� Survivor Annuitv -(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, t�enefits cease. [Section 2.398 (b) (2) (a) (3)j
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 hislher death, benefits cease. [Section 2.398 (b) (2) (a) (3)]
I[�'ii�:�c3
Attachment number 1 \nPage �
Option 6 100% Joint & Survivor Annuitv -(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 P{an 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.
If takin O tion 1 si n below: -
Option #: 1 Description: Joint and Survivor Annuity
Employee's Signature: Date: _
Dependent children under the age of 18 and residing in my household are: Date of Birth
Child's Name Sex
If taki!?� Qn�jOn � SIO�l bElO�;
Option #: 2
Employee's Signature:
If takin
Option #:
Description: Life Annuity _
II in beneficiary information and sign belo�rv:
. �--
Description: / ii�.� �L�
My designated beneficia is,1:_ .�-. D
Name: I�i�1i' d I�i� n�l]�-� Date of Birth: I 0 j� �_ Sex M F
Social Security Number: _
Address: �7b� ��
� �.37�
Employee's Signature:
Date:
Phone Number:
� 37-���3-yyi
Date: � � �P � � �
STATE OF FLORIDA The foregoing instrument wa:> acknowledged before me this
COUNTY OF PINELLAS a�q2 l ��/` by _ ��r�� i//�-/� who is
personall known to me or who has provided ��L �/� G f�l �o "' ��`�'� ��
MICHELIE KUTCH
� NOTARY PUBLIC
STATE OF FIORIDA
� Comm# EE201501
Expires 5/2312�16
Rev. 4l08
Form #9900-0009
fication and who did/did not take an oath.
My Commission expires:
Notary Public
Name of Notary Printed
File Name: Pension Entitlement Option Form
��11�:��
George Miller
LAST DATE PAID:
BENEFITS DATE
CREDITED SERVICE
Estimated Pension Worksheet
7/27/2012
8/20/1980
31.9361
Prepared by: Gina Trieste
Date: 7/26/12
Attachment number 1 \nPage �
GROSS
CALENDAR PENSION
YEAR EARNINGS
2006 $45,631.79
2008 $47,815.43
2009 $47,460.60
2010 $46,630.97
2011 $47,844.88
$235,383.67 (5 Year Total)
5/ $47,076.73 (Yearly Avg)
12/ $3,923.06 (Monthiy Avg)
x 0.0275 (Benefit Rate)
x 31.9361 (Yrs of Service)
$3,445.40 (Est Mtly Pension)
I[�'ii�:�c3
City of Clearwater Employees' Pension Plan
Actuarial Equivalence Factors
ESTIMATE
26-Ju1-12
sm
clract01
Version:
Employee Name: George Miller 1-4-96
Employee Date of Birth: 2 17 1952
Marital Status: m
Spouse Date of Birth: 10 14 1957
Beneficiary Date of Birth: 10 14 1957
Benefit Commencement Date : 8 1 2012
Estimated Monthly Normal Retirement Benefit: $3,445.40 Estimated
. Monthly
Actuarial Equivalent Adjustment Factors: Benefit
Attachment number 1 \nPage 1I
Option 1
Option 2
Option 3
Option 4
Option 5
Option 6
J&S Annuity
Life Annuity
10 Year Certain
50% J&S
75% J&S
100% J&S
ESTIMATE
1.00000 $3,445.40
1.13040 $3,894.66
1.10212 $3,797.26
1.04521 $3,601.18
1.00726 $3,470.42
0.97197 $3,348.82
I[�'ii�:�c3