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04-22-1980 Supporting DocumentsCITY OF CL,RMMONT MINUTES REGULAR MEETING A regular meeting of the City Council of the City of Clermont was held in the Council Chambers on Tuesday, April 22, 1980. The meeting was called to order by Mayor Claude E. Smoak, Jr. at 7:30 P.M. with the following Councilmen in attendance: Lester Cole, Dennis Thomas, Carlisle Byrd and James Meginloy. Other City Officials present were City Manager Forbes, City Attorney Baird and Deputy Clerk Pat Meyer. The Invocation was offered by Councilman Byrd, followed by repeating of the pledge of allegiance by all present. The Mayor asked if there were any additions or corrections to the Minutes of the meeting held April 8, 1980. tie noted that under Council Reports where he reported he would be in Tallahassee this month, it states he would be on the Agenda of the Natural Resources Committee. He asked that the minutes reflect he is not as yet scheduled but hopes to appear before that Committee. CITY MANAGER'S REPORT City Manager Forbes reported that Mr. Jay Knierim has been hired as our Summer Recreation Supervisor. He also reported the Kiwanis Club is holding a Fish -a -than this Saturday and - — requested the Council review the Pension Plan Report. He will be attending the State City Managers Conference Thursday and Friday at Daytona Beach. MAYOR'S REPORT Mayor Smoak discussed holding a Town Hall Meeting either the last of May or first of June to report on the Recreation Committee's recommendations, the Landscape Committee's work, the Clean Community's report, Effluent Disposal and the proposed Utility Rate increases. After discussion it was unanimously agreed to hold the meeting June 10, 1980. COUNCIL REPORTS Councilman Byrd reported he would be attending the Board of Directors Meeting of the East Central Florida's Regional Planning Council on Wednesday, April 30 and on the 7th of May he would be attending the Annual Meeting of the entire membership of the ECFRPC. He requested all interested Council Members and guests attend this meeting. Mr. Byrd also discussed thehandling 'ofsolid wastes by the City with emphasis directed to recycling these wastes whenever possible. A motion was made by Councilman Byrd, seconded by Councilman Meginley and unanimously carried that the City Manager begin a City -Wide program for recycling aluminum and establish a collection station with the target date to begin June 1, 1980. Councilman Meginley asked questions regarding the Effluent Disposal Meeting held in Tavares. Councilman Thomas asked for clarification of the action by the County Pollution Board. h k CITY OP CUMIONT MINUTES REGULAR MEETING cont'd. The Mayor explained the original motion to allow the City to pursue the request failed for lack of a majority vote, the Board then granted the City an additional six months variance under which the City is operating now in order for the Board to more fully explore the idea of wet lands disposal. The Mayor then stated publicly for the record, expressing the appreciation of the City to Or. Tom Odom and Dr. Ronnie Best who appeared voluntarily in support of the proposal of the City of Clermont; not from the stand- point that they had any interest in it, nor were they in- volved in the investigative work. Theydid it simply be- cause they think it is the appropriate thing for the City to do. He discussed Dr. Odom's synopsis if you put treated effluent on a sand hill, be sure it runs into a marsh before it gets into a lake. AUCTION OF SURPLUS PROPERTY City Manager Forbes discussed the intergovernmental auction being held in Leesburg on May 3, 1980. He recommended the City auction a 1972 Dodge Pickup and a 1977 Ford car, since replacement vehicles were purchased this year for both ve- hicles. There were no objections from the Council for placing the car and truck in the Leesburg Auction. EARLY RETIRMENT The City Manager discussed a letter regarding the early re- tirement of Griffin Keys who has served the City for 22 years. He asked the Council to grant Mr. Keys early retirement at age 62 as required by the City Code of Ordinances regarding 80-71 pensions. A MOTION WAS MADE BY COUNCILMAN COLS, SECONDED BY COUNICLMAN T OMAS AND UNANIMOUSLY ADOPTED 0 GRAN MR. KEYS EARLY RETIREMENT. The Mayor suggested Mr. Forbes invite Mr. Keys to appear before the Council and an appropriate remembrance be presented at that time in appreciation of his service to his community. WORKMEN'S COMPENSATION CO-INSURANCE COVERAGE The City Manager explained that effective August 1, 1980 the Workmen's Compensation Law requires Insurance Companies to offer all employers co-insurance coverage. Co-insurance cover- age means the city would participate in the payment of 20% of every claim, up to either a $2,500 or 5,000 limit per claim. City Manager Forbes recommended the co-insurance coverage be refused since the city was averaging higher savings under its present Plan. He also explained the City would be rebidding its insurance in the near future. A MOTION WAS MADE BY 80-72 COUNCILMAN BYRD, SECONDED BY COUNCILMAN MEGIILE AND UNANIMOUSL The meeting adourned at 8:10 P.M. C Mayor Clerk -2- Memo to; Clermont City Council. From: City Manager subject: Weekly Memo Data: April 18, 1980 PUBLIC WORKS. '19:1s week the fence was constructed at J. C. Bench and nt the Orange 11111 Park. Work ❑lso began on the Tennis Courts at the Middle School. We Lire presently working on the layout for the sidewalk to be constructed on Bloxam Avenue from Lake Shore Drive to Highway 50. Work is scheduled to begin on this project within the next two weekq. After two weeks of trial, we have placed the garbage collection process back on the normal two truck, six man system. We did learn from this trial that the one truck system can work for a limited period of time. However, the much longer hours required on this system created problems with the collection process. UTILITIES. The Utility Department has been flushing water -- mains and repincing meters. ... _. Last Saturday, Preston Davis gave an excellent demonstration of the Treat- ment Plant process. Nine persons attended this meeting and all. seemed to enjoy the explanation of how a Treatment Plant works. I believe they left this meeting with a better understanding of the Ci.ty's options and problems regarding Waste Treatment. KIWANIS CLUB. The Kiwanis Club will be holding a Fish-A-Thon for children on Saturday, April 26, 1980 from 8:30 a.m. until Noon at the City Fishing Pier on Lake Minneola. ZONING. Enclosed is the letter on the Notice of Zoning Change being sent to property owners effected by the Transition Zone changes. POLICE. Fifteen Traffic Citations were issued in various parts of the City last week. We have received some complaints of speeding on Lake Shore Drive and have been carefully watching this area. CLEAN COMMUNITY COPMISSION. Bob Smythe, Bob Wertz, and Ray Jack- son are doing an excellent job working with the Clean Community Commission. They are presently investigating the City's trash and garbage collection system, and holding meetings with area businessmen to explain the Clean Community System. They intend to have enough progress made to report to the City at a Town Hall Meeting that could be held in June. Respectfully, /mil � �Z e)'.�; a George D.�orbes City Manager CDF:pm _ Enclosure i 4a ►. P.O. nOx 219 • WnmoNT, FLORIDA 32711 • PHONE 004/394A001 1 April 8, 1980 r RE: NOTICE 01.1 ZONING CHANGE, Dear Clermont 1'roper.ty Owner: The City Council of the City of Clermont i❑ conducting a Public Nearing to rezone land within the aren shown on the attached map. Thin property is presently zoned under u temporary 'Transition Zone classif- ication that was established in 1969. The purpose of these Transition Zones was to allow existing uses within these zones to remain and expand for a period of fifteen years (Itil 1984), after which time all uses were to con- form with the requirements of the R-3 multiple Family Zone. This means that ae the Zoning Ordinance is presently written, in June of 1984 I all of the uses in the Transition Zones must conform to the uses permitted in the Multiple Family Zone. It does not allow for the Industries and Businesses 1 presently located within these Zones. The proposed Zoning Revisions remove the Transition 'Lone classification from the Zoning Ordinance, and rezones these '1 properties in a manner that would reflect their best use in our community. The attached map shows the proposed zoning changes. The City Council of the City of Clermont would be interested in any comments that you might have on this matter. A Public Hearing on these 'Zoning Amendments has been set for Tuesday, may 27, 1980 at 7:30 p.m. in the City Council Chambers, which is located at 882 DeSoto Street in Clermont (Public Safety Building). I Thank you for your consideration. Respectfully, George D Forbes City manager GDF:pm Enclosure LECAI, NII'IICE AMRNMMENV; '1'O ZONINC ORDINANCE The City Cminrll of Lhc CITY of Clcrmuml A II be CotidiirlIng n i'ub1lu Ilc,iring on Proposed Admendnarnta to the CILy Zoning Ordlmm�•e on 'I'ucndily, Miry 21, 1980 at 7:30 p.m, In III,- CILy Ceunrl 1. L'hnmbi.rro, 11112 DOSnta Stt•vet, Clermont, Florida (1111bllr Salety Ilullding). The purpose of the I'ropoecd Chnnl;oa +Ira lu Conatdert I. Ortlitimte No. 208-C amending Appendix A, Zoning Ordinance of the Clty of Clermont. 2. Ordinance No. 206-C emending Lha official. Zoning Map of Clormimt, Florida rezoning real proporty from Tranuttlon Zono cl-;siflcation to Industrial, Mul.tipic Family, Light, and Con - oral Comumel'clal Dlstrtct CLisall'tl;atians PIDILISN IN THE, SOUTH LAKE PRESS Aprti 24, L980 and May 1.5, 1980. Memo to: City Council. From: City Manager Subject: Pena Lan Plan Actuarial Valuation Uatc: April 10, 1980 'Ilia CiCy's Actuaries, the Firm of Kruse, O'Connor and Ling, Inc. has completed the Actuarial Valuation of the City'a Pension Plans an of October 1, 1979. The Actuaries Report demonstrates that all of our Pension Plans are fiscally sound, and a brief evaluation of the Report on the Plan is an follows: GENERAL F.NPLOYEL•'S PENSION FUND. Two of the most important criteria of ❑ sound Pension Plan is that the required Clty contributions re- main level, and that the total assets of the trust are enough to fund all the accrued and vested benefits of the plan. Attachment 1 shows that as of October 1, 1979, the total assets of the General Employee's Pension Plan is $151,495, which is more than the present value of benefits earned by employees vested in the plan, or $133,135. The required City contribution of 8.1% of payroll to fund this plan has been and is level by dollar amount, although the percent must beincreasedto 8.7% in next year's budget. This increased percentage reflects an adjustment necessary to pay the unfunded accrued liability that resulted when the plan was started in 1960. When a Pension Plan is as for a given group, the members of the group on the date of establishment are granted credit for all past service for benefit purposes. Therefore on the effective date of the plan, a liability immediately arises for service performed to such date. This liability is called the unfunded accrued liability, which is funded over a 40 year period of time or until the year 2,000. 'file General Employee's Retirement Plan is funded solely by the City, with no employee contributions. The normal retirement date for General Employees is age 65, with early retirement allowed with City Council permission at age 60. POLICE PENSION PLAN. Attachment 2 demonstrates that the Police Pension Plan is also sound. Ilia present value of benefits accrued and vested by employees as of October 1, 1979 was $49,513, while the total assets of the trust are $75,769. The Police Pension Plan is funded in part by the City and by insurance premium tax refunds. There is no difference in the benefits received by Policemen and Firemen except for retirement dates. State law mandates that Police and Fire Pension Plans allow normal retirement at age 60, with early retirement at age 55. The percent of payroll needed to fund the Police Pension Plan beginning 1980 Is 12% which is slightly less than the 12.3% required for the past two years. Again, tl:e fairly stable amount of annual contributions required is a sign of a sound Pension Plan. Pago 2 Msmo to; City Council Subject: Pension Plan Actuarin] Vn.luntlnn Da to: April 18, 1980 POLICE PENSION PLAN (conClnucd however, in the Pont few yearn there wan no required City contribution to the Police Trust since Insurance tax refunds funded the entire plan. In 1980, the City will be required to contribute 5.3% of our Annual payroll to this plan and the remain- ing 6.7% will be funded by the expected State contributions. This is the result of an unexpected decrease in State Premium tax refunds over the last two years. The present level of local contributions of 5.32 of payroll will be required until the amounts received from the State again exceed the level of 12% of payroll. VOLUNTEER FIREMEN. Lost year the City began the Volunteer Firemen Pension Plan. This Plnn in fully funded by the State and no further contributions are necessary at this time. Attachment 3 shows that the present value of benefits accrued and vested by employees to date is $5,308, while the total assets of the trust are $30,688. CONCLUSION. The City's Pension Plans are fiscally sound. Monies in all trusts presently exceeds the amount of benefits vested by City employees. It is disturbing that the State contributions to the Pension Plans dropped for two years 1n a raw. We will further investigate the situation. Respectfully, George D. Forbes City Manager CDF:pm Enclosures ATTACHMENT 1 I a GENERAL EMPLOYEES SUMMARY OF VALUATION RESULTS As of October 1 1977 1979 Number Includud In Valuation Active Employees 40 34 Retirees and Beneficiaries 5 5 Vested Terminations 0 0 Annual Valuation Payroll $308.369 $290,480 Present Value of Benefits Total 325,086 370,533 Accrued to Date and Vested 101,640 133,135 Assets 1o5,495 151,495 Unfunded Accrued Liability (UAL) 103,472 111,126 Amount Required to Amortize the UAL - over a 40 Year Period beginning In _ 1960. 8,410 9,446 v of Covered Annual Payroll 2.7% 3.32 Normal (Current Service) Cost 16,730 15,827 % of Covered Annual Payroll 5.4% 5.4% Total Contribution 25,140 25,273 2 of Covered Annual Payroll 8.1% 8.7% AY[I',1'6, NYi61',%'UliemllJ.\U, I.PC ! ATTACHMENT 2 5 POLICE SUMMARY OF VALUATION RESULTS As of October 1 1977 19779 Number Included In Valuation Active Employees 6 Retirees and Beneficiaries 0 0 Vested Terminations 0 0 Annual Valuation Payroll $ 61,631 $ 99,1111 Present Value of Benefits Total 141,888 205,217 Accrued to Date and Vested 36,062 49,513 Assets 53,921 75,769 Unfunded Accrued Liability (UAL) 37,909 38,134 Amount Required to Amortize the UAL over a 40 year Period beginning - - In 1960. 3,085 3,241 % of Covered Annual Payroll 5.0% 3.3% Normal (Current Service) Cost 4,520 8,697 % of Covered Annual Payroll 7.3% 8.7% Total Contribution 7,604 11,939 % of Covered Annual Payroll 12.3% 12.0% Expected State Contribution * 8,306 6,627 % of Covered Annual Payroll 13.5% 6.7% Required City Contribution 0 5,312 % of Covered Annual Payroll -- 5.3% *Assumed same as amount received In previous year. l.l.P! 1, L1'C . AWACHMENT 3 6 VOLUNTEER FIREMEN SUMMARY OF VALUATION RESULTS As of October I 1979 Number Included In Valuation Active Employees 15 Retirees and Beneficiaries 0 Vested Terminations 0 Present value of Benefits Total $ 18,375 Accrued to Bate and Vested 5,308 Assets 30,688 Unfunded Accrued Liability (UAL) 0 Amount Required to Amortize the UAL over a 40 year Period beginning In 1960 0 2 of Covered Annual Payroll -- Normal (Current Service) Cost 0* % of Covered Annual Payroll -- Total Contribution 0 % of Covered Annual Payroll __ Expected State Contribution ,tn 2,665 % of Covered Annual Payroll -- Required City Contribution 0 % of Covered Annual Payroll - Plan Is.fully funded t Assumed same as amount for previous year. 6 K1!.17(, U'("/ %,\ nK onJ /.l,%,;. /AC 'DILLS PAID AS OF MARCH 31, 1980 Allied Chlorins Chlorine $ 1,46.00 Armstrong Paints Paint Suppliers 54.50 935.00 B 6 II Bales Inventory 35,00 r , Bill u Auto Laren Truck Seat 4.77 Bob Wads Ford, Inc. Auto Repairs 87.75 Cal 11agntrom Company copier supplies P 4.75 Carroll Gas Fuel 1.00 Chain of Lakoa Clermont Buildar.o Supply Auto Parts BuLlding Supplian 251.10 128.57 Clermont Auto Parts Auto Parts 92'�r�r Curlwoad Safety, Inc. Cloven Typewriter Top 10.00 Clermont Cabinet Shop Clement's fast Control Service Charge 13.00 108.00 Clermont Travel Air fare /Mayor 52.25 Michael J. Colitz and Assoc. Pump Parts 155.71 Curtin Matheson Scientific, Inc. Lab Supplies 307.83 Davis Water and Waste Ind. Chemicals 481.18 Dowling Fire Equipment Inv. Supplies 2,§78.02 R. C. Dunn Oil Gas Electric Motor Repair Corp. Parts Strip Charts 53.1.19 Envirotech Electro Protective Corp. March Services 161.10 33.60 Electra - Mash Corp. Relays for Scorboard 708.06 Florida Telephone Utilities 9,891.83 Florida Power Utilities Plumbing Repairs 429,68 Floyd's Plumbing Gene Forhand Plumbing Repairs Repairs 10.00 9,000.00 Greenlee, Paul, Furnas and Kerr as 78-79 Audit Hardware Supplies 31.99 Howard's Hardware Heintzelman's Truck, Inc. Transmission Repair 2,104.58 172.48 Harmon Glass of Florida Wired Glass Inventory Supplies 178.55 Hughes Supply Hunt's Garden Supplies Garden Supplies 39.33 20.40 Hubbard Construction Co. mens Vest OffFlaice Supplies 878.19 _ Hilltop Stationery Electrical parts 32.00 Hanks Electric Maintenance Agreement . 871 0 2870 IBM Jerry's Lock and Key Lock Guard 31..90 John's Radiator Repair Radiator 37.14 Karla Photo Shop Film Supplies 189.80 Kirkland Cabinet Shop Kiplinger, Washington Editors Tile Magazine Subsci g p' 32.00 502.43 Kennedy and Company A/C Maintenance 355.00 Lake Communications Services Solid State Comm. 158.29Landfill Lake Apopka Natural Gas Utilities 539.25 Lake County Board of Comm. Charges Class if Ads 40.54 Leesburg Commercial Tire Repair 150.00 Leesburg Tire and Battery 13.81 Harry P. Lee, Inc. Saw Cemetery Monuments 513.00 Mathews Motorola, Inc. Maint. Agreement 105.50 5,411.00 Olivbaum Insurance Co. Workmens Comp. Adj. 33.60 Orlando Labortories Lab Supplies 25.57 Packaged Merchandise Ring Kit Gov't En•?elcprs 15.95 Press Time Soap Dispensers 18.46 Pro Chem Camera Supplies 10.49 Publix Tennis Net 94.44 Radnor Corp. Uniforms 51.50 Sears Shelfer Ford Tractor Repairs 148.88 69.45 South Lake Press Classified Ads Professional Eng. Services 2,762.89 Springstead and Assoc. 11.14 Seidle's Chevrolet Door Handle 2,046.20 Sta Con Wesco Starter 302.43 Standard Auto Parts parts Resurfacing Tennis Courts 2,624.00 Joe W. Teel, Inc. Checks 375.24 Valbro Business Forma Irrigation Supplies 39.69 The Water Role Williams Steele Ind. Acetylene Gas 23.85 10.40 Zee Medical Service Medical Supplies $46,695.34 61e1110 to: C.LormonL City Council. Fron;: City Motingar Sub;JeeL: Auction of Surplus ProparLy Data; April 18, 1980 The City of Lce;tburg is conducting an lnLergovernnwntal Auction to be held on May 3, 1980. 1 would recommend that Lila City's 1972 Dodge Pickup and 1977 Ford as described on the attached memo be declared surplus property in order to sell these vehicles nt the auction. Replacement vehicles were purchased this year for both of these auto- mobiles. Respectfully,. i George D. Forbes City Manager GDF:pm Enclosure :ram CITY OF CLERIWOii T 1. 0, Ito% "lio • cl nimow, rt 01110A :0111 • 11110Nf W11114 4nol April 7, 1990 John Spcncu i'nl'chnoing Agent City a LceaburC Lcenburg, Vlorida 72748 Ucar Mr. Spence: The Clty of Clermont would 1_11u: to Lncludc tho following In the Lntergovernnmlttal Auctlon to he hold, May 1, "110, 1. olur 1972 Dodge pickup, 1i Ton Vohlcic IdontHIt-ulon ll 1114AIi2n5't5'4'il Mlnlnnull hid2. Rttl)0. One 1977 ('nrd 4-door Sed;ltt _ .. Vahlcle Idontirtcatlon ll 7112'711162'121 Mlnluwnl hid $1,250. If you u11otil.1 uecd any further informal: foil, please call.. Sincr.rely, IJ;ty11�✓ tinondcro Rlnance DIrcctor IJS : pm hlomo to: (aty Council From: City Planagor. Subject•: Enr.l.y Ietirement KequellL Date: April 18, 1980 Attached is a letter requesting early retirement from Griffin Keys, n City Public Works employee. Plr. Keys requests that the City +:llaw hi.m to retire at age 62. The City's Pension Plan provides for a normal. retirement at age 65. however, Section 16-5 of the Municipal. Code of Ordinances allows early retirement at age 60 upon approval by the City Council. Mr. Keys has been employed by Lhe City for. 22 years ❑nd has been a valuable and loyal employee. Last year he was seriously ill with diabetes and had to have part of his foot amputated. Due to this disability he now wishes to retire, and 1 recommend that his request be granted. Respectfully, / George D. Forbes City Manager GDP:pm Enclosure George Forbes City Manager #1 Westgate Plaza Clermont, Florida 32711 Dear Mr. Forbes: This is my formal request for retirement. I would like my retirement to become effective April30, 1980. I was 52 years old September 15, 1979 and have worked with the City since October 20, 1958. Sincerely, Griffen Keys Memo to: City Council. From: City Manager Subject: Workmens Compensation Insurance Date: Apr1.l.18, .I980 linelosed is a letter from the 01tvenbaum insurance Agency regarding tlae City's Workmenn Compensation Plan. Effective August 1, 1979, the new Workmenn Compensation Law requires Insurance Companies to offer all employers co-insurance coverage. Co-insurance coverage means that an employer will participate in the pay- ment of every claim. It would require the City to pay 20% of: every claim, up to either a $2,500 or $5,000 limit per claim. All claims above this limit would be payed by the insurance agency. Enclosed is a memo from the Finance Director regarding the co-insurance coverage. While this coverage would have saved the City an average of $457 a year over the past three years, the type of plan in which the City is currently enrolled has paid a dividend averaging $1,002 a year over the past. ten, years. I would recommend that the City reject the co-insurance coverage. Respectfully, George D. Forbes City Manager GDF:pm Enclosure c r 3� s t r f� r r s+ } a, a r a.� AW CITY OF CLERMONT P.O. BOX 219 CLERMONT, FLOMDA 32711 • PHONE D04/394.4081 Memo to: City Manager From: Finance Director Subject: Co -Insurance Option Date: April 17, 1980 I have received an option for agreement to or rejection of a Co -Insurance Plan. After investigating the alternatives, I have concluded the City could have saved an average of $457 a year over the past three years with this type plan. How- ever, the participation type plan in which the City is cur- rently enrolled has paid an average dividend of $1002 a year over the past ten years. In light of these facts, I would strongly recommend the City reject the Co -Insurance Option. - Respectfully, Way e aunders Finance Director WS:pm r �'7 .w (�/eue��lGCIIIIIJ %rJaur[uJee� nC, 4iWW11 loll/111 �.s......._.._...,-,...,......�....,.»....._.......... ,....__........... .,.. .__.......... .........�..._..... _.,...�..._..� 11 0 00R ,.'1U 77U MONI'fiOSL S1 "I nuvunnoY: ul npu ❑nNIN Y:"" C:I.LHM014'1, FLORIDA 32711 An11111i 1111N 1r' III; IIIN Y'lI N" PIICING 394,3923 IMPORTANT INFORMATION CONCERNING WORKEKS' COMPCNSATION REQUIREMENT Dear Customer: Effective August I, 1979, thu new Workers' Cempensation Law of the State of Florida requires that coinsurance coverage be offered the employer. If the employer desires full coverage, he14UST specifically reject the coinsurance coverage. Coinsurance coverage means that the employer will participate in the payment of EVERY claim, during the policy period, on a percentage basis, up to a specified amount. If the employer elects the coinsurance coverage, his annual premiums will be reduced by a set percentage, dppending on. which coinsurance program he elects. The law permits the employer to pay 20% of EVERY CLAIM, both medical and Indemnity benefits, up to either $2,500.00 oror $5,000.00- — per claim. If the employer elects the $2,500.00 program, his maximum participation per claim would be $500.00 (20% of $2,500.00), and his annual premium would be reduced 5%. If the employer elects the $5000.00 program, his maximum participation per claim would be $1,000.00 (20% of $5,000.00), and his annual premium would be reduced 6.1% On the reverse of this letter is an example of haw each plan will effect you on a per claim basis. Please note that your savings will be small unless you have a very large annual workers' compensation premium. A 3% savings on a $1,500.00 annual premium would be only $75.00 and you would have to pay up to $500.00,per claim for each employee injured during the policy year. tl>ti>4t1 i�ir,'Iin4ic,4 ATTACHED IS YOUR ELECTION/REJECTION FORM THAT MUST BE SIGNED AT ONCE AND RETURNED TO OUR OFFICE WITHIN 10 DAYS. Please do not fail.to make your selection as this is a requirement of the Department of Workers' Compensation. Thank you. Very truly yours, GTenn A. 01ivenbaum 1 COINSURANCI! COVIMME PROGRAM - rl,OlMJA P.PfECI'IVII 8-1-79 ALTERNATIVE Ill - INSUREDS PARTICIPATION III' TO $500.00 PER CLAIM (M% of $2500,00), VREMIUM REDUCED 5.Ak -.___.-.--_-- LossE:; TOTAL LOSS COST (PER CLAIM EMPLOYERS PORTION (PER CLAIM) INSIIRANC1: COMPANY PORTION WHR CLAIMS`. $ 0.00 $ 0.00 $ 0100 $ 100.00 $ 20.00 $ 80.00 $ 150.00 $ 30.00 $ 120.00 $ 200.00 $ 40.00 '6 160.00 $ 300.00 $ 60.00 1: 240.00 $ 500.00 $ 100.00 $ 400.00 $ 1,000.00 $ 200.00 $ 800,00 $ 1,500.00 $ 300.00 $ 1,200.00 $ 2,000.00 $ 400.00 $ 1,600.00 $ 2,500.00 $ 500.00 $ 2,000.00 $ 3,000.00 $ 500.00 $ 2,500.00 $ 5,000.00 $ 500.00 $ 4,500.00 $10,000.00 $ 500.00 $ 9,500.00 lr', $15,000.00 $ 500.00 $14,500.00 ". $20,000.00 $ 500.00 :F19,500.00 ALTERNATIVE 02 - INSUREDS PARTICIPATION UP TO $1000.00 PER CLAIM (20% of $5000.00). PREMIUM REDUCED 6.1% LOSSES TOTAL LOSS COST (PER CLAIM) EMPLOYERS PORTION (PER CLAIM) INSURANCE COMPANY POKHON (PER CLAIM) $ 100.00 $ 20.00 $ 80.00 $ 200.00 $ 40.00 $ 160.00 $ 300.00 $ 60.00 $ 240.00 $ 500.00 $ 100.00 $ 400.00 $ 1,000.00 $ 200.00 $ 800.00 $ 2,000.00 $ 400.00 $ 1,600.00 P $ 3,000.00 $ 600.00 $ 2,400.00 $ 5,000.00 $ 1,000.00 $ 4,000.00 $ 7,000.00 $ 1,000.00 $ 6,000.00 $10,000.00 $ 1,000.00 $ 9,000.00 $15,000.00 $ I,000.00 $14,000.00 $20,000.00 $ 1,()00.00 $19,000.00 Pi' The FIorlda Workers' Compensation Law provides fnl c0IIIs" fail I tl M Ills opholI of IIin Inbured Ili insured may elect to pay 20% of heneflL, due under the Llw up to $2,500 oI $5,000 pet 0.1.111 and, in such case, the carrier is responsible for the femaming henehls Hill, Pulsuanl In the plovi"lons of the Florida Workers' Compensation Law, anyrelectlon Ill c011"arllllt.0, ioo1 t he made In WI Itlnq. I lnl N Io confirm that the coinsurance option has hewn road" avadahl" dolt ynul ele, hrin. The undersigned hereby aglow In arr",I'l I nuruianl"uI to rya I t um,w,uol e,r, unh: etml Accept Relent mavintunt c-nitn.tm" $5,000 ma,tunum colnsufance��� _ April 23 1980 Employer Name Date SuJ na ule and Title Ccorge D. Forbes, City Manager Agent Name. Dale Slgnalum I I 1 I y CITY OF CLCRMONT P.O. BOX 210 • CLERMONT, FLORIDA 32711 • PHONE 9D4/394•4001 April 23, 1980 olivenbaum Insurance Post Office Box 218 Clermont, Florida 32711 Dear Axel: Enclosed is the City of Clermonts rejection of Co-insurance coverage._ Please sign this document and forward it to, the appropriate �? agencies. �E 13iank you for your continued cooperation, and if you have it any questions, please feel free to contact me. Respectfully, llff �i . v George D. Forbes City Manager CDF:pm �> Enclosure I:' The Flotilla Workers' Compensation Lew prnvnlm Im rnur,u,attrn ar Ihr nl taus of Ih-: ar,00td the el5ungl nrry elect to pay 20% of heartily, doe undue Iha Lew ul, Io J.",Y)o n V000 pm ,lams dad. M such ca%r„ ille earner i5 tespnnsihle for the irniaaanq henohl5'bay Ihnsu.u,l to Ihu ptnvr,u ns of Ihrt Ilunda Workut5' Compumal Ion Law, anyirryct. Hon al r aM•au anrr nin,I W. in.rdv ar vn,lmq. Ihr•, r, w conholl Ihel lira colmolam'r} olrlron h.,% la•nn nwdr ,w.rd,ildON., hno Cha undr15vrptrd hrrehy l(j ryes In ,n , epI , uur,w nni e ur In n „ t r n rrdu aro as M li alyd j j accept Rem 1 1;I1. � ,I Q,?,y(1t1 nia. nnum �.nut5wam n 1 1-1 yV 'a J,OQ(( Ir 41�III II IIa CIlalSlllda�'e ,, VV _..' Gnployet Namr Dalo Ccorge t1 i Ponceu, City Manager l • n!Irnl M,unu Dale Supratwr. r'I r ��, �., o•,n wo