HomeMy WebLinkAbout#5093 Guardian Group Life Insurance RESOLUTION NO. 5093
A RESOLUTION APPROVING A GROUP ENROLLMENT AGREEMENT BETWEEN THE CITY
OF CANTON AND GUARDIAN INSURANCE FOR THE GROUP LIFE INSURANCE PLAN AND
DIRECTING THE MAYOR AND THE CITY CLERK TO EXECUTE AND DELIVER SAID
AGREEMENT ON BEHALF OF THE CITY OF CANTON, ILLINOIS.
WHEREAS,the City of Canton, Illinois has determined that it is necessary and in the best
interest to enter into an agreement with Guardian Insurance to administer the City's Group life insurance
plan as set forth in Exhibit A attached and incorporated hereto.
NOW,THEREFORE, BE IT RESOLVED BY THE MAYOR AND THE CITY COUNCIL OF
THE CITY OF CANTON, FULTON COUNTY, ILLINOIS AS FOLLOWS:
I. That the agreement attached hereto and incorporated herein as Exhibit A is hereby approved by
the Canton City Council.
2. That the Mayor and the City Clerk of Canton, Illinois, are hereby authorized and directed to
execute and deliver said agreement on behalf of the City of Canton.
3. That this Resolution shall be in full force and effective immediately upon its passage by the City
Council of the City of Canton, Fulton County, Illinois,and approval by the Mayor thereof
PASSED by the City Council of the City of Canton, Illinois, at a regular meeting this 18TH day of April,
2017, upon a roll call vote as follows:
AYES: Aldermen Justin Nelson, Gerald Ellis, John Lovell, Angela Hale,Craig West, Tad
Putrich, Ryan Mayhew
NAYS: None
ABSENT: None
AP�P/ROVED:
c Ic
Jeffrey A. , ayor
ATT!
Diana' y ra Clerk
Please print dearly to ensure accurate processing
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APPLICATION FOR A PLAN OF GROUP INSURANCE
REQUESTED COVERAGE
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SIC Code: 11111 Basle Life
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BUSINESS INFORMATION
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7_fraOh-rtes 11892
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Meyer the SUewNy Suwdosto to kM of your lusowiSge for'1W member to NInsured.The bum
"member"mune*Me employees and their depwdena and COBRA paldpwde and their dependent
Provide deteta for lay'Yee mean en a opera*shed De natdIdae to lune allay member.
wit aNa Are any employees current*not actlaBet watt UYae,please mnpW the supplements MWy
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AGREEMENT
Condition Of Agreement Awp W ma of Pen
R Is understood tlml ordy IuImme emulates. and A la further uedarmod that no Insurance MI be slant
*aider*ofsuch ahefl be ebgblw untll the pbn Is aaplad In edtig by Me Iawmna
Cmparryy1W).No conked ofMemene bb as ImpbdIn
any way an ib beep of Me mrQlWon and alMbuon of
Ma apogean
Upon aaepbnce,this appbrann dfl be aliened In and
FidNime employes mum one who regularly wake the as Pen menu Gaup Imursme PNNy.
number of hours In the normal a wash established by
Mb epplloul(ben nal Si Men 30 hours per week)al the Fraud Waste:
appkem'e normal place of business. MY Person who wph Edell to defraud or Moray Mat
he/dm N ferMINI g a fraud aping an In ax.iamb en
space or fan a maim anlsiNng a kW or deceptive
statement may be qday of Maumee fraud.
Inaunna Broker RapmnnmUon:R Is wthsunderstood The undeammd apploant art"that to the Mat of
tied no bra hupowwabdmUot7M Gulden the
air kmxbdpaeM beget,egalthe responses pen am
melaena CompwymAmilalomab or modify any 'coned and complete.The*Ward understands that
request aeppbepm for Immo"ono bind WO slake mann orMerepmnruff rMMUmr mann
Mace companybymaBmg airy oneness m may Way,set In loe r covered.M the pray,ted. mclSon
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SIGNATURES
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Group Plan Number r52 ?0 Lj3 Requested Mae Deb OEO1Q017
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City of Can
Guardian Insurance - effective date 5-1-2017
Basic Life/AD&D
Benefit
Police $20,000
Fire Department $40,000
All other eligible $40,000
Life(per$1,000) $0.26
AD&D(per$1,000) $0.04
Monthly Premium $993.86
PPO Dental Plan
Mo.Prem
Employee Only 20.78
Employee&Spouse 42.19
Employee&Child 55.16
Family 81.84
Voluntary Vision
Mo.Prem
Employee Only 10.94
Employee&Spouse 18.42
Employee&Child 18.79
Family 29.74
Voluntary Life
Age Bracket Rate Per$1.000
< 30 $0.10
30 - 34 $0.12
35 - 39 $0.15
40 - 44 $0.21
45 - 49 $0.34
50 - 54 $0.57
55 - 59 $0.85
60 - 64 $1.30
65 - 69 $2.47
70 + $5.20