1996-074 ICMA Retirement Corporation Agreement•
'
RESOLUTION NO. 74-96
A RESOLUTION OF THE VILLAGE COUNCIL OF THE VILLAGE
OF NORTH PALM BEACH, FLORIDA, AUTHORIZING THE MAYOR
AND VILLAGE CLERK TO ENTER INTO AN ADOPTION
AGREEMENT WITH ICMA RETIREMENT CORPORATION ATTACHED
AS EXHIBIT "A" FOR THE PURPOSE OF ESTABLISHING A
MONEY PURCHASE RETIREMENT PLAN FOR CERTAIN
EMPLOYEES OF THE VILLAGE; AUTHORIZING THS MAYOR AND
VILLAGE CLERK TO ACCEPT AND TO ENTER INTtS~ AN
ADMINISTRATIVE SERVICES AGREEMENT WITH THE
INTERNATIONAL CITY MANAGEMENT ASSOCIATION
RETIREMENT CORPORATION ATTACHED AS EXHIBIT "B" AND
TO ACCEPT THE PRICING, OFFER AND ACCEPTANCE
DOCUMENT ATTACHED AS EXHIBIT "C"; AND PROVIDING FOR
AN EFFECTIVE DATE.
WHEREAS, the Village of North Palm Beach has employees who
have rendered valuable services; and
WHEREAS, the Village Council of:the Village of North Palm
Beach is,desirous of establishing a.money purchase retirement plan
benefitting certain employees by. providing funds for retirement and
funds for their beneficiaries in the event of death;
~:: WHEREAS, the Village of North Palm Beach is desirous that its
money purchase retirement plan be administered by 'the ICMA
Retirement Corporation, and that the funds held under such plan be
invested in the ICMA Retirement Trust, a trust established by
public employers for the collective investment of funds held under
their retirement and deferred compensation plans.
BE IT RESOLVED BY THE VILLAGB COUNCIL OF NORTH PALM BEACH,
FLORIDA:
• Section i. The Village Council of the Village of North Palm
Beach, Florida, does hereby approve the adoption agreement with
ICMA Retirement Corporation attached as Exhibit "A" which is for
the purpose of establishing a money purchase retirement plan for
certain employees of the Village.
Section 2. The Mayor and Village Clerk are hereby authorized
and directed to execute the said adoption agreement with ICMA
Retirement Corporation set forth in Exhibit "A" for and on behalf
of the Village of North Palm Beach.
Section 3. The Mayor and Village Clerk are hereby authorized
and directed to execute the Administrative Services Agreement with
the International City Management Association Retirement
Corporation attached as Exhibit "B" and to accept and execute the
pricing, offer and acceptance document attached a.s Exhibit "C" for
and on behalf of the Village of North Palm Beach. .
Section 4. This Resolution shall take effect immediately upon
its adoption.
.PASSED AND ADOPTED THIS 12th DAY OF DECEMBER 199
;1
'(Village Seal)
A'T'TEST
MAYOR
•
EXHIBIT "A"
PROTOTYPE MONEY PORCH $ PLANN & TRUST
• ADOPTION AGREEMENT
#001
Account Number 9501
The Employer hereby establishes a Money Purchase Plan and Trust to be known as V i 11 age o f NPB
Executive Money Purchase (the "Plan") in the form of the ICMA Retir
Corporation Prototype Money Purchase Plan and Trust. ~ _
This Plan is an amendment and restatement of an existing defined contribution money purchase plan,
^ Yes
~ No
If yes, please specify the name of the defined contribution money purchase plan which this plan
hereby amends and restates:
1• Employer: Village of North Palm Beach, Florida
IL Prototype Sponsor.
Name: ICMA Retirement Co
rporation
Address: '777 N. Capitgl Street, N.E.
Washington, D:C. 20002-4240
TelephoneNumbet-. (202)962-4600
l! 1. The Effective Date of the Plan shall be the first day cf the Plan Year during which the
Employer adopts the Plan, unless an alternate Effective Date is hereby specified:
January 01 1997
1~'• Plan Year will mean:
^ The twelve (12) consecutive month peciod which coincides with the limita-
' •tion year. (See Section G.OS(i) of the Plan.)
• ~ The twelve (l2) consecutive month period commencing on 1-1- 97 and
each anniversary thereof.
Mi'd' /adoption ng~eement 12/23/94
nD1-9q
V .Normal Retirement Age shall be age B D (nor co exceed age 65).
Vl. ELIGIBILITY REQUIREMENTS:
The following group or groups of Employees are eligible to participate in the. Plan:
All Employees
All Full-Time Employees
Salaried Employees
Non-union Employees
Management Employees
Public Safety Employees -
General Employees
Other (specify below)
The group specified must correspond to a group of the same designation that is defined
in the statures, ordinances, rules,.regulations, personal manuals or other material in
effect in the state or (ocalCty of the Employer.
2. The Employer hereby waives or reduces the requirement of a twelve (12) month
Period of Service for participation. The required Period of Service shall be N/A
(write N/A if an Employee is eligible to participate upon employment).
If this waiver or reduction is elected, it shall apply to all Employees within the
Covered Employment Classification.
3• A minimum age requirement is hereby specified for eligibility to participate. The
minimum age requirement is . N A (not to exceed ago 21. Write N/A if do
minimum age is declared.)
CONTRIBUTION PROV[S[ONS
I. The Employer shall contribute as follows (choose one, if applicable):
~ Fixed Employer Contributions With Or Without Mandatory Participant
Contributions.
The Employer shall contribute on behalf of each Participant 11.O9y of
Earnings or $~. for the Plan Year (subject to the limitations of Article Vl
of the Plan). Each Participant is required to contribute -0- 96 of Earnings
or $~o -- for the Plan Year as a condition of participation in the Plan. (Write
• "0" if no contribution is required.) [f Participant Contributions are requited
under this option, a Participant shall not have the right to discontinue or
• vary the rate of such contributions after becoming a Plan Participant.
MPP Adoption Agreement
The Employer hereby elects to "pick up" tl,e Mandatory/Required Participant
• Contribution.
$f1 Yes ^ No
[Note to Employer: Neithec an opinion letter issued by the Intemal
Revenue Service with respect to the Prototype Plan, nor a determination
letter issued to an adopting Employer is a ruling by the Internal Revenue
Service that Participant contributions that are picked up by the Employer are
not includable in the Participant's gross income for federal income tax pur-
poses. The Employer may seek such a ruling.
Picked up contributions are excludable from the Participant's gross
income under section 414(h)(2) of the Internal Revenue Code of 1986 only
if they meet the requirements of Rev. Rul. 81-35, 1981-I C.B. 255. Those
requirements are (1) that the Employer must specify that the contributions,
although designated as employee contributions, are being paid by the Em-
ployer in lieu of contributions by the employee; and (2) the employee must
not have the option of receiving the contributed amounts directly instead of
having them paid by the Employer to the plan.)
^ Fixed Employer Match of Participant Contributions.
The Employer shall contribute on behalf o ash Participant _% oEEam-
ings for she Plan Year (subject to'the' li nations of Articles V and~V[ of the
Plan) for each Plan Year that such rticipant has conaihuted _% of
Eamings or $_ Under this ' tion, there is a single, fixed rate of Em-
ployercontributions, but a P ticipantmay decline to make the required
Participant contributio n any Plan Year, in which case nu Employer contri-
bution will be made the Participant's behalf in that PL•ut fear.. ~/~,~.
^ Variable Employer Match Of Participant Contributions. !/
telrmined as follows (object to the limitat o e of Article. \''~u~.l V[ of the Plan):
% of the Patticipanc cunt utions made Icy the Participant for
the Plan Year (not including Partici nt contribution< exccc.ling __% of
Earnings or $ ).
_ PLUS % of the retributions made by tltc P:uticiPanr for the
['fare Ycar in excess of rhos included in the above Inrai;ral•h (but rent includ-
ing Participant contribu ores exceeding in the aggregate "~,', of Eamings
• or $ ).
Employe retributions on behalf of a Participan; (ur :~ Plan Ycar
shall not; xt • d $ or _% of Earnings, a•hichc,•r/r i/s ^ murc or
MPP Adoption Agreement 12/23/94
nn, ...
•2• Each Participant may make voluntary (unmatched), after-tax contribution, subject to
the (imitations of Section 4.05 and Articles V and V[ of the Plan.
^ Yes ® No
3. Employer contributions and Participant contributions shall be contributed to the
Trust in accordance with the following payment schedule:
VIII. EARNINGS
Earnings, as defined under Section 2.09 of the Plan, shall include:
(a) Overtime
^ Yes ® No
(b) Bonuses
^ Yes l~ No
LIMITATION ON ALLOCATIONS
if the Employer (i) maintains or ever maintained another qualified plan in which any Par-
ticipant in this Plan is (or was) a participant or could possibly become a participant, and/or
(ii) maintains a welfare benefit fund (as defined in section 419(e) o the Code) oran indi- '
vidual medical accouttt (as defined in section 415(!)(2) of the e, under which atriounts
are treated as Annual Additions with respect to any Participa to this Plan) the Employer
hereby agrees to limit contributions to all such plans as prow' ed herein, ifnecessary in order •
to avoid excess contributions (as described in Sections 6. and 6.04 of the Plan).
i • If the Participant is covered under another alified •defined contribution plan
maintained by the Employer, other than. egional Prototype Plan, the provisions
of Section 6.02(a) through (f) of the P n will apply as if the other plan were a
Master Prototype Plan, unless anot method has been indicated below.
^ Other Method. (Provi the method under which the plans will limit
total Annual Additi to the Maximum Permissible Amount, and will
properly reduce a excess amounts, in a manner that precludes Employer
discretion.)
•
MPP Adoption Agreement 12/23/9
Z• If the Participant is or has ever been a participant in a defined benefit plan main- ;
• rained by the Employer, and if the limitation in Section 6.04 of ze Plan would be
exceeded, then the Participant's Projected Annual Benefit u er the defined be~tefit
plan shall be reduced in accordance with the terms thereo o the extent necessary to
satisfy such limitation. If such plan does not provide for uch reduction, or if the
limitation is still exceeded after the reduction, annu additions shall be reduced to
the extent necessary in the manner described in S bons 6.01 through 6.03. The
methods of avoiding the limitation described i is paragraph will not apply if the
mployer indicates another method below.
~~J
^ Ocher Method. (Note to Emplo r: Provide below language whi~ will satisfy
the 1.0 limitation of section 5(e) of the Code. Such language must
preclude Employer discreti .See section 1.415-1 of the Regulations for
guidance.)-
3• The limitation year is the following nsecutive month period:
X. VESTING PROVISIONS ~~
The Employer hereby specifies the following vesting schedule; subject to (1) the minimum
vesting requirements as noted and (2) the concurrence of the Plan•AdministraCOC.
Years °f Specified
Service Percent Minimum
Completed Vesting
Vestiu Requirements**
Zero 100
One ~' No minimum
Two % No minimum
Three ~' No minimum
flour ~' Noc less than 2096
Five ~' Not less than 40%
~' Not less than 60%
Six %
Seven, or more Not less than l30%
--~-~' Must equal 100%
(•*Three minimum vesting requirements conform to the Code's three to seven year vesting
schedule. [f the employee becomes 100% vested by the completion of five years of service,
there is no minimum for years three and four.)
(-pans arc permitted under the Plan, as provided in Article XIV:
Q Yes ^ No
MPP Adoption Al;reement 12/23/94
oar-qa
KI1. The Employer hereby attests that it is a unit of state or local government or an agency or
.nstrumencalicy of one or more units of state or local government.
<lll. The Prototype Sponsor hereby agrees to inform the Employer of any amendments to the
Plan made pursuant to Section 15.05 of the Plan or of the discontinuance or abandonment
of the Plan.
C[V. The Employer hereby appoints the Prototype Sponsor as the Plan Admittistrator pursuant to
the terms and conditions of the ICMA RETIREMENT CORPORATION PROTOTYPE
MONEY PURCHASE PLAN 6t TRUST.
The Employer hereby agrees to the provisions of the Plan and Trust.
:V. The Employer hereby acknowledges it understands that failure to properly fill out this
Adoption Agreement may result in disqualification of the Plan.
VI. An adopting Employer may not rely on a notification letter issued by the National or
District Office of the Intemal Revenue Service as evidence that the Plan is qualified
under section 401 of the Intemal Revenue Code. In order to obtain reliance with
respect to plan qualification, the Employer must apply to the appropriate key district
office for a determination letter.
This Adoption Agreement may be used only in conjunction with basic Plan document
number 001.
Witness WhergAf, the Employer hereby causes this Agreement to be executed on
~ (°~TN day of ~,y6,G.- , 19 9b.
~iPLOYER Accepted: ICMA RETIREMENT CORPORATION
~ ~ D Bye
:le: V-A. Marks, M.D.,(1 ayor~ Ttcle:CorporateSecatary
t Attest: _
C~-u-.~
'~~
•
MPP Adoption Agreement 7 2/23/94
•
Type: 401
fCMA '
RETIREMENT
CORPORATION
may;
Account Number: 9501
I:XIIIBIT °B"
ADMINISTRATIVE SERVICES AGREEMENT
•
Plan N 9501 icnan .'
RET[REMENT
CORPORATION;
• ADMINISTRATIVE SERVICES AGREEMENT
This Agreement, made as of the day of
199 , (herein referred to as the "Inception Date"), between The International
City Management Association Retirement Corporation ("RC"), a nonprofit corporation
organized and existing under the laws of the State of Delaware; and Village of North
Palm Beach ("Employer") a Village organized and existing under the laws of the State
of Florida with an office at 501 U.S. Highway 1, North Palm Beach, Florida 33408.
Recitals ~'
Employer acts as a public plan sponsor for a retirement plan ("Plan") with
responsibility to obtain investment alternatives and services for employees
participating in that Plan;
The ICMA Retirement Trust (the "Trust"1 is a common law trust governed
by an elected Board of Trustees for the commingled investment of retirement funds
held by state and local governmental units for their employees;
RC acts as investment adviser to the Trust; RC has designed, and the
Trust offers, a series of separate funds (the "Funds") for the investment of plan
assets as referenced in the Trust's principal disclosure documents, "Making Sound
Investment Decisions: A Retirement Investment Guide" and "A Retirement Investment
Guide for the Mutual Fund Series." The Funds are available only to •public employers
and only through the Trust and RC.
In addition to serving as investment adviser to the Trust, RC provides a
complete offering of services to .public employers for the operation .of~ernployee
retirement plans including, but not limited to, communications concerning investment
alternatives, account maintenance, account record-keeping,' investment and tax'
reporting, form processing, benefit disbursement and asset management.
•
-2- '
Plan N 9501 icMn .'
RGTIREMBNT
• -~ CORPORATION
• Agreements
1 • ApnninimPnt of R(`
Employer hereby designates RC as Administrator of the Plan to perform
all nori-discretionary functions necessary for the administration of the Plan with
respect to assets in the Plan deposited with the Trust. The functions to be performed
by RC include:
(a) allocation in accordance with participant direction of individual
accounts to investment Funds offered by the Trust;
(b) maintenance of individual accounts for participants reflecting
amounts deferred, income, gain, or loss credited, and amounts disbursed as benefits;
(c) provision of periodic reports to the Employer and participants of the
status of Plan investments and individua(accounts;
(d) communication to participants of information regarding their rights
and elections under the Plan; and
(e) disbursement of benefits as agent for the Employer in accordance
with terms of the Plan.
2• Adnntinn of Trust
Employer has adopted the Declaration of Trust of the ICMA Retirement
Trust and agrees to the commingled investment of assets of the Pian within the Trust.
Employer agrees that operation of the Plan and investment, management anii
disbursement of amounts deposited in tFie Trust shall be subject to the Declaration
of Trust, as it may be amended from time to time and shall also be subject to terms
and conditions set forth in disclosure documents (such as the Retiremt:rit'Investment
Guide or Employer Bulletins) as those terms and conditions may be adjusted from time
to time. It is understood that the term "Employer- Trust" as It is used in the
Declaration of Trust shall mean this Administrative Services Agreement.
3• EmnIAVPr nut~+ rn F~~roish~rlfarmation
Employer agrees to furnish to RC on a timely basis such information as
is necessary for RC to carry out its responsibilities as Administrator of the Plan,
including information needed to allocate individual participant accounts to Funds 1n
e Trust; and information as to the employment status of participants; and
ticipant ages, addresses and other identifying information (including tax
-3-
Plan ~ 9501 ~cnan
RETf R EM ENT
CORPORATION
~entification numbers). RC shall be entitled to rely upon the accuracy of any
nformation that is furnished to it by a responsible official of the Employer or any
information relating to an individual participant or beneficiary that is furnished by such
participant or beneficiary, and RC shall not be responsible for any error arising from
its reliance on such information. RC will provide account information in reports,
statements or accountings. All account discrepancies must be reported to RC within
120 days of the close of the quarter in which the discrepancy occurs. After that
time the report, statement, or accounting shall be deemed to have been accepted by
the Employer and the participants
4• amain RP.nfPSAntAtlnnc U! rr ntiPe ~ ' r`n * .. .
RC represents and warrants to Employer that:
. (a) RC is anon-profit corporation with full power and authority to enter
into this Agreement and to perform its obligations under this Agreement: The ability
of RC to serve as investment adviser to the Trust is dependent upon the continued
willingness of the Trust for RC to serve in that capacity.
(b) RC is an investment adviser registered as such with the Securities
and Exchange Commission under the Investment Advisers Act of 1940, as amended.
ICMA-RC Services, Ino, (a wholly owned subsidiary of RC) is registered as a ~broker-
.dealer with the Securities and Exchange Commission (SEC) and is a member in good
standing of the National Association of Securities Dealers, inc:
RC covenants with employer that:
(c) RC shall maintain and administer the Plan in compliance with the
requirements for plans which satisfy the qualification requirements of Section 401 of
the Internal Revenue Code; provided; however, RC shall not be responsible for fhe
qualified status of the Plan in the event that the Employer directs RC to administer the
Plan or disburse assets in a manner inconsistent with the requirements of Section 401
or otherwise causes the Plan not to be carried out in accordance with its terms;
provided, further, that if the plan document used by the:Employer contains terms that
differ from the terms of RC's standardized plan document, RC shall not be responsifle
for the qualified status of the Plan to the extent affected by the differing terms in the
Employer's plan document.
Employer represents and warrants to RC that:
(d) Employer is organized in the form and manner recited in the opening
graph of this Agreement with full power and authority to enter into and perform
bligations under this Agreement and to act for the Plan and participants in the
-4-
Plan # 9501 Icmrn
RETIREMENT
CORPORATION
~anner contemplated in this Agreement. Execution, delive
Agreement will not conflict with any law, rule, regulation oacontract by which thie
Employer is bound or to which it is a party.
5• P_articloatlnn in r`Prtain PrnrpPdinnc
The Employer hereby authorizes RC to act as agent, to appear on its
behalf, and to join the Employer as a necessary party in all legal proceedings involving
the garnishment of benefits or the transfer of benefits pursuant to the divorce or
separation of participants in the Employer Plan. The Employer consents to the
disbursement by RC of benefits that have been garnished or transferred to a former
spouse, spouse or child pursuant to a domestic relations order.
6. Cmm~Pncatinn ^nrt p-#~.>.,~*_
(a) Plan Administration Fee. The amount to be paid for plan
administration services under this Agreement shall be 0.90% per annum of the
amount of Plan assets invested in the Trust. Such fee shall be computed based oh
average daily net Plan assets in the Trust.
(b) Account Maintenance Fee. There shall be an annual account
maintenance fee of 525.00. The account maintenance fee is payable in full on
January 1 of each year on each account in existence on that date. For accounts
established after January 1, the fee is payable on the first day of the calendar quarter
following establishment and is prorated by reference to the number of calendar
quarters remaining on the day of payment.
(c) Annual Plan Fee. There shall be an annual Employer fee of $500.00.
The annual Plan Fee will be billed evenly on a quarterly basis and is' payable within
30 days of receipt of billing. Plans which are initially established midyear will be
billed on a pro-rata basis.
(d) Mutual Fund Services Fee. There Is an annual charge of 0.10% of
assets under management that are held in the Trust's Mutual Fund Series.
(e) Compensation for Advisory Services to the Trust. Employer
acknowledges that in addition to amounts payable under this Agreement, RC receives
fees from the Trust for investment advisory services furnished to the Trust, except
that this fee is not assessed in the Mutual Fund Series.
(f) Payment Procedures. (i) All payments to RC pursuant to Section
1, (b) and (d) shall be paid out of the Plan Assets held by the Trust and shall be
-5-
Pian J/ 9501 (cnTn
RET(REME~T
CORPORAT(ON~
aid by the Trust. The amount'of Plan Assets held in the Trust shall be adjusted by
~he Trust as required to reflect such payments. (ii) All payments to RC pursuant to
Section 6(c) shall be paid directly by Emptoyer, and shall not be deducted from Plan
Assets held by the Trust.
7. f:"a___~ t~
Emptoyer understands that amounts invested in the Trust are to be
remitted directly to the Trust in accordance with instructions provided to Employer
by RC and are not to be remitted to RC. In the event that any check or wire transfer
is incorrectly labeled or transferred to RC, RC is authorized, acting on behalf of the
transferor, to transfer such check or wire transfer to the Trust.
$• QP.CnnnClhlll
RC shall not be responsible for any acts or .omissions of any person other
than RC in connection with the administration or operation of the Plan.
9. Tarm
This Agreement may be terminated without penalty by either party on
sixty days advance notice in writing to the other.
~0• Ampnrimrnts ^nd Arliuct - t
(a) This Agreement may not be amended except by written instrument
signed by the parties.
(b) The parties agree that compensation for services under this
Agreement and administrative and operational arrangements may be adjusted as
follows:
RC may propose an adjustment by written notice to the Employer given
at least 60 days before the effective date of the adjustment and the notice may
appear in disclosure documents such as Employer Bulletins and the Retirement
Investment Guide. Such adjustment shall become effective unless, within the 60 day
period before the effective date the Employer notifies RC in writing that it does not
accept such adjustment, in which event the parties will negotiate with respect to the
adjustment. ..
(c) No failure to exercise and no delay in exercising any right, remedy,
wer or privilege hereunder shall operate as a waiver of such right, remedy, power
~rivilege.
~ -6-
~_
•11. fJntirac
Plan N 9501 ~cntn
RET[RElv1ENT
CORPORAT[ON
All notices required to be delivered under Section 10 of this Agreement
shall be delivered personally or by registered or certified mail, postage prepaid, return
receipt requested, to (i) Legal Department, ICMA Retirement Corporation, 777 North
Capitol Street, N.E., Suite 600, Washington, D.C, 20002-4240; (ii) Employer at the
office set forth in the first paragraph hereof, or to any other address designated by
the party to receive the same by written notice similarly given.
12. ~mm~lPtP AnrP m r
This Agreement shall constitute the sole agreement between RC and
Employer relating to the object of this Agreement and correctly sets forth the
complete rights, duties and obligations of each party to the other as of its date. Any
prior agreements, promises, negotiations or representations, verbal or otherwise, not
expressly'set forth in this Agreement are of no force and effect.
13. f;nvar_~ ni ~ I a~
This agreement shall be governed by and construed in accordance with
the laws of the State of Florida applicable to contracts made in that jurisdiction
without reference to its conflicts of laws provisions.
In Witness Whereof, the parties hereto have executed this Agreement
as of the Inception Date first above written.
VILLAGE OF NORTH PALM BEACH
Signature/Date ~
V.A. Marks, M.D. (Mayor)
Name and Title (Please Print)
INTERNATIONAL CITY MANAGEMENT
ASSOCIATION RETIREMENT
•• CORPORATION
by:
• Stephen Wm. Nordholt/Date
Corporate Secretary
7-
EC-15-9~. THU 11:34 PM
P . C+2
401 EMPLOYEE ENROLLMENT FORM a
" Vr< thla term w cocoa in the RC Pcr(u<.nmee Plan. Plua<prine Irp'blt In >nls. .. .. • w
• R<ad tnatcu<tio,u on the back b<focc eon.plerlop aN. fnau t4tt
• Make ehaMes to edstina employ«rccordr on lOl Emplorce Lhctse<Porm avaWNe from RCxyeur xmployxr• wtnacwu.~•
faaaOMifOH
', Emplpycr Plan Number Employer Plan Name Stale
ParUNpaM 1 0 O K _ P t. N F /J' C/ R C ..
Information dal Security N~unt~bcr ~ON/Zle ~~~
Persmal ? 7 - L-CJJ - / '/ 3
®ex Hom~ e Numb ~ Date ~f OIrO Marital Status
M Area Code Monl Oay ear Marcied Sin le
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2
9eneficiary
Designation
If monied,
Special rules
apply. See
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reverse side.
3
Amoun[ of
4
Allocalian of
Cont•ibutions
5
Rehiredi Work Phone Number
s6 -~- 3 9
Check tax If yes Area e
Name Relationship to yrou Social Setvrily Number °!. of benefit
Primary Beneficiaries: (if available)
SNA2LyN /KELLY fX•NffF .r~~•S8'SPPI /G0
Contingent Beneficiaries, if any:
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!or Employer Usr. the employer stall con(r(6ure~% or S .The employee sW/! eortuibute ~ A - 7G or S «6
Allocate in percmtaea among fund choices. Alloatlon percentages tntut ttxa1100 percent. If the alloutlon total tlpea not add up co 100
percent thrn the reroatnder wQl be alkxatcd to the PLUS Food. If eto aelcction U eivm, your cgneribution will be allocated M the default
fund aeleoted by your cmpk>ya. Uu wllb(e perccnagea tee., SD pactnt, oa 73 1/3 percent). DO afoc ttx llxed dollar amotfnu-
Fill in the boxer ac eight
wtth coder of the fund(s)
y04 want tO lnveK lm A
1(st of funds And coda arc
nn ehe bark of the form.
SEE BACK OF FORM
OR INVESTMENT
OPTIONS SHEET
FOR FUND CODES
Gb0¢
3S EMPLOYER at:couNr
GOdY eteerx
~o EMPLOYEE accouNi
Cods Perowtl a PNClN
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TOTgC.100X TOTAL.l00X
Stste taw, locol law, a your ettspkal~t may plact raaittlem on investment (n that funds.
1 have mJ Part/
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PaniNpanl Signature
d rtaJ theaxrcnr IQdA RetlrarwnrTrtael
I unlcrNUU1 d.rt th<Rat4emem Cwxronhv
Employer flag Number
IMPORTANT ^ PLEASE RETURN 7FII5 COPY TO RC
br modtl laves Ikt 1 atan..ledxr that
rduKSC uanJrr. thar In:ludt pctfunal
ckvw< to trmr(er (unJs hr ulcpMaw,
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IUv1A Rcliremcm Corporation . P. O. (bx 96220 • Washington, l7C 20090if220 • Toll Free I-B00-66Y-i100
raver AOCCf.tee.J
• yrrrm
THE VILLAGE OF
North Palm Beach
501 U.S. HIGHWAY 1 ~ NORTH PALM BEACH, FLORIDA 33400 ~ 407-84&3474
Department of Flnanc
December 20, 1996
Ms. Veta Dunston " "
Employee's Services
ICMA Retirement Corporation
7,77 North Capitol Street NE
Washington, DC 20002-4240
e
Dear Ms. Dunston:
Per instructions from Jonathan Epstein, enclosed are the following documents to establish
401 (a) plan for ow Village Manager effective 1-1-97:
1. Pricing Offer and Acceptance
2. Trust Adoption Resolution
3. Adoption Agrcerrient
4. Administrative Services Agreement
5. 401 Employee Enrollment Form from Dennis Kelly, Village Manger.
Please sign and return a copy of the Administrative Services Agreement and Trust
Adoption Agreement for ow records. Thanks.
Sincerely, /~
Shaukat Khan
Director of Finance
Attachments
ce: Jonathan Epstein
• 3475 Pinewalk Drive North #106
Margate, FL 33063
EXHIBIT ^C"
Village d: North Palm Beach
Money Purchase (Executive)
"ICMq Retirement ~[ 14, 1996
rporation
The ICMA Retirement Corporation proposes the following fees and terms:
Fees
• Plan Administration Fee; Investment returns are repotted net of the annual plan adminishatioa fro of 0.75% of
assets under management.
Mutual Fund Services Fce: Investment returns of the Mutual Fund Series are reported net of the annual mutual fund
services foe of 0.25% of assets under managemwt.
Model Portfolio Fund Fee: Investment mfirms of Model Portfolio Funds are reported net of the annual model portfolio
fund fce of 0.10% of assns under management.
Participant Fee: 525 per participant will be deducted from individual account balances each January.
Employer Annual Fce: 5500 annual employer fee will be billed quarterly on a pro-rated basis,
nvestmeat management fee and fund expenses ere detailed is the enclosed disclostme documents,
7~faktogSound lovutmrnt DeMslonr; A Retlremrnt lrrvertment Guide" end "ARetlrrmrnt lrrvumrnt Gu(de jor theA~futual FWrd Setfp",
Cerms
Ezpiration: This offer of pricing expires January 12, 1997.
ly dgaing this page, I at5rm that I understand, and am authorized to accept on behalf of the ~wveemployer, the IQv1A Retirement
btporation's offer. I understand that rho ICMA Retirement Corporation will 3ssve as AdminisuativE SetvIas
filch will describe their duties and those of the employer. The terms of this offer will be effective once tits ASAmgafd~.
ignalure of pees//on signing on behalf of employer ~7
tinted name of ~ ~~~~~ ~J• r/
person signing on behalf of employer
V.A. Marks, M. D.
itie of person signing on behalf of employer
Mayor
lllage of North Palm Beach
Il U.S. ILghway I
orth Palen Beach, Fi. 33408
07) 848-3474
•
Date
,~ ~~