1978-31 Award Bid to Washington National Insurance Co.
RESOLUTION N0. 31-78
A RESOLUTION OF THE VILLAGE COUNCIL OF NORTI[ PALM B};AC}f,
FLORIDA, ACCF,PTING THE BID OF WASHINGTON NATIONAL INSURANCE COMPANY
FOR h1EDICAL ANll LIFF. INSURANCE.
BE IT RF,SOLVED BY THE VILLAGE COUNCIL OF NORTH PALM B};ACH,
FLORIDA:
Section 1. The bid of Washington National Insurance
Company, copy of which is attached to this Resolution, is hereby
accepted by the Village of North Palm Beach in accordance with its
terms. 7'he appropriate Village officials are hereby directed to
advise said bidder of this acceptance. The monies are to be expended
from various departmental fringe benefit accounts.
Section 2, This Resolution shall take effect immediately
upon passage.
PASSF,U AND ADOPTED THIS 10TH DAY OF AUGUST, 1978.
/s/ Al Moore
MAYOR
ATTEST:
/s/ llolores R. Walker
Village Clerk
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Gentlemen: .-/~-~tM~ ..,
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The undersigned, as bidder,"does declare that no other person other than the
~ bidder herein named has any interest in this proposal or in the contract to be taken,
~ and that it is made without any connection with. any other person or persons making
proposal for the same article, and is in all respects fair and without collusion or
fraud.
The undersigned further declares that he has carefully examined the specifica-
tions and is thoroughly familiar with its provisions and with the quality, type and
grade of material called for.
The undersigned further declares that he proposes to furnish the articles called
for within specified time set in this .proposal for the follot•~ing price, and guarantees
that parts and service for the articles listed below are available within the State
of Florida; to wit:
DATE: June 12, 1978
`PROPOSED BENEFITS
ITEM 1. Life Insurance and Accidental Death
Proposed Life Benefit:
Proposed Acc. Death Benefiit:.
ITEM 2 Major Medical (Comprehensive)
Lifetime Maximum
Automatic Annual Restoration:
` $ lOD% of annual earnings to a
nax mum o 5,000. (rounded
$ to next lower $1,000)
$ 250,000.00
$ 2,000.00
Calendar Yeah Deductible: $ 100.00 /Individua
Deductible Accumulation Period: calendar rear
Nervous and Mental:' $ same'as In-Patient
preeen~t p -an
Dependent Coverage to Age: 19 Un-married Children
$ sar.:e as Family
presen .p an
~ same as Out-Patient
presen pan
23 Students
Co-Insurance•
( Daily Room & Roard Rate: $ 65.00
Hospital Services & Supplies: $ 3,000 in full, 80% of next $3,000, balance 100%
In-Patient •
Surgical Fees: Attach Separate Schedule
~- Physicians Visits Per Day:, $ ao%
_7-
~( Laboratory Fbes: $ BO%
{ X-Ray: $ 80%
Out-Pat- (( Radiation Therapy: $ 80%
ient
,Physical Therapy: $ 80/
ITEhI 2a MAJOR t4EDICAL (80/20)
Lifetime Maximum: $
Automatic Annual Restoration: $
• Calendar Year Deductible: $ /Individual $ /Family
Deductible Accumulation Period:
Nervous and Mental: $ in-Patient $ Out-Patient
Dependent Coverage to Age: Un-Married Children Students
Co-lnsurance•
(Daily Room & Board .Rate: $
(Hospital Services & Supplies: $
In-Patient
Surgical Fees: Attach Separate Schedule
Physicians Visits Per Day $
(Laboratory Fees:- $
X-Ray: $
Out-Patient
Radiation Therapy: $
'-Physical Therapy: $
ALTERNATE 1.
Maternity Benefits: Attach a description of proposed plan or describe below.
ALTERNATE 2.
Dental Benefits: Attach a description of proposed plan or describe below.
$100 calendar year deductible
80% co-insurance
$500 yearly maximum
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PROPDSAL 'CO TFIE VILLAGE OF NORTH PALh1 BEAC}i, FLORIDA (Con'td.)
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RATE PROPOSAL
ITEt4 1. Life Insurance and Accidental Death
Rate Per $1 ,000. Coverage $. .. 6__ ~__r- /Month
ITEht 2. Major Medical (Comprehensive)
Employee Rate $ z~z /Month •
Dependent Rate $ .3~ Month
ITEM 2a h1AJOR tdEOICAL (80/20)
• Employee Rate $ ________.___ Month •
Dependent Rate $ ~~/Month'
ALTERNATE 1. MATERNITY BENEFITS ~
Rate $ ./D ~~ /Month + •~R defer./Pe-- loo ~~.neF'~lL
ALTERNATE 2 DENTAL BENEFITS _ -~'
Empl oyes Rate $ _~ ~ 9 /Month '
Dependent Rate $ 6.G3 /Month
RATE GUARANTEE:. otv F Years
PRESENT PLAN WITH $1,000,000 maximum Employee Rate $ Z 3. 7 ~ /Month
Dependent Rate $ 3 ~ ~ Month
PRESENT PLAN WITH NO CO-INSURANCE LIMIT AND
NO 100% HOSPITAL COVERAGE Employee Rate $ a /. /Month
Dependent Rate $ 3/. j,Z /Month
PRESENT PLAN WITEi SEMI-PRIVATE HOSPITAL Employee Rate $ 2 Z /Month
P.00`I RATE P,ECOGNIZED
Dependent Rate $ 3~f, s'~ /D[onth
I"L"tEDIATE ELIGIBILITY FOR EXECUTIVES No charge
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kEt1ARKS/EXCEPTIONS: was ng on a ona ag ees
indicating paid premiums and paid & incurred losses separately for life and accidental
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/ death benefits and mayor medical. ~ i
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Officers of Corporation or tderrbers of Partnership: I
NAME TITLE ADDRESS
E. E. CP.AGG, CLU, FLMI PRESIDENT Evanston, Illinois 60201
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FIRM: WASHINGTON NATIONAL INSURANCE COMPANY
O Corporation- O Partners ip. ~ Indiv
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SIGNED DY: ~~~ /~. ~-
TITLE- Group Manager, Miami Group Office
WITNESSES:
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ADD?ESS: -
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