HomeMy WebLinkAboutCC RESO 12,024RESOLUTION NO. 12,024
RESOLUTION AUTHORIZING ROBERT S. BOURCIER,
CITY MANAGER, TO ENTER INTO AND SIGN AN
AGREEMENT BETWEEN THE CITY OF NATIONAL CITY
AND THE TRAVELERS INSURANCE COMPANY FOR THE
PURPOSE OF PROVIDING MEDICAL, DENTAL AND
LIFE INSURANCE FOR THE EMPLOYEES OF THE
CITY OF NATIONAL CITY
BE IT RESOLVED by the City Council of the
City of National City, California, that the City
Manager Robert S. Bourcier is hereby authorized and
directed to execute, and the City Clerk is authorized
to attest, that certain memorandum of agreement between
the City of National City and Travelers Insurance
Company for the purpose of providing medical, dental
and life insurance for the employees of the City of
National City.
PASSED AND ADOPTED this 20th day of April,
1976.
ATTEST:
GROUP INSURANCE
PRELIMINARY APPLICATION
T
The Travelers Companies
Application is hereby made to The Travelers Companies, for a Group Insurance Plan providing the form(s) of insurance checked
below and in accordance with specificationsC City of National City, California
Full Legal Name of Applicant
P.O. Address ofApplicont(including Zip Code) 12l.t.3 National Avenue, National City, CA 92050
Insurance to be Provided: (check below)
Employees
and
Dependents
Where state permits
Employees
Only
.ife
'aid -Up Life ❑
Accidental Death, Dismemberment and Loss of Sight
Weekly Income ❑
Long Term Disability Income Benefits ❑
Hospital Expense Benefits
Surgical Procedure Expense Benefits
Benefits for Expense of Physician's Visits Q
Diagnostic Procedures Expense Benefits
Radiation Therapy Expense Benefits ❑
. Supplemental Accident Expense Benefits
Major Medical Expense Benefits X❑
Comprehensive Medical Expense Benefits ❑
' Dental Expense Benefits
Medicare Complement U
LI
PREMIUM PAYMENT: The premium is to be payable Monthly
EFFECTIVE DATE:
It is requested that the insurance be effective from 12:01 A.M., standard time at the Applicant's address, on May 1, 1976
No insurance shall be effective until this application shall have been accepted and the effective date approved
by the Companies and a binder premium shall have been paid, and insurance on a contributory basis shall not be effective until the
date determined when the required per cent. of the eligible Employees shall have agreed to make the required contributions to apply
toward the premium for the insurance.
1 hereby designate as Agent of Record
with P.O. Address (including Zip Code)
This is a preliminary application. Final application for any policy issued is to be si pon eli y he policy.
Dated + 19 76 Signature of Applicant .C(✓J
000000E0
None
in advance.
N/A
Witness:
GC-5225
es7
By
Official Title City Manager
THE TRAVELERS INSURANCE COMPANY, Group Department, Hartford, Connecticut
R ' ived from City of National City, California Amount $ 100.00
a Ivance payment towards the premium for the Group Insurance Plan for which application has been made on this day to The
T elers Companies.
If application shall be accepted by the Companies and the policy or policies issued, and if the advance payment evidenced by
tF Receipt shall be larger than the first premium, the excess will be returned to the applicant or at the election of the applicant
w be applied to the payment of the next premium or premiums falling due. If the application shall not be accepted or if for any
reason the insurance does not become effective, the amount of the advance payment will be returned to the applicant. No agent can
make any insurance effective or make, alter or discharge any insurance policy or extend the time for payment of premiums nor can
the terms of any application, receipt or policy be varied or altered or its conditions waived or nded in any respect except by
the written agreement of the Insurance Company, signed by its President, one of its Vice Pre dnts or Secretaries.
Date
GC-5225A REV. 12-72 PRINTED IN U.S.A.
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Representative