HomeMy WebLinkAboutHR18-161 - Amendment - CIGNA - Group Long Term Disability Policy #LK-965532 - 01/01/2021ApprovalOriginator:Department:
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Director or Designee Mayor
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Type:Review/Signatures/RoutingDate Received by City Attorney:
Comments:
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Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category:
Vendor Number:Sub-Category:
Project Name:
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Start Date:
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Termination Date:
Local Business? Yes No*
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If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace.
Notice required prior to disclosure?
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Contract Number:
Agreement Routing Form
For Approvals, Signatures and Records Management
This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms.
(Print on pink or cherry colored paper)
Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20
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rev. 200821
FOR CITY OF KENT OFFICIAL USE ONLY
(Optional)
* Memo to Mayor must be attached
OK to sign 3/19/2021.
LIFE INSURANCE COMPANY OF NORTH AMERICA
(herein called the Company)
Amendment to be attached to and made a part of the Group Policy
A Contract between the Company and
City of Kent
(herein called the Policyholder)
Policy No.: LK - 965532
The Company and the Policyholder hereby agree that the Policy is amended as follows:
Effective January 1, 2021, the following rates will remain in force for Classes 1 and 2 for coverage under the Policy:
$.29 per $100 of Covered Payroll
Covered Payroll for an Employee will mean his or her Covered Earnings for the insurance month prior to the date the
determination is made. However, an Employee's Covered Payroll will not include any part of his or her monthly Covered
Earnings which exceed $10,499.
No change in rates will be made until 24 months after the effective date of this Amendment. However, the Company
reserves the right to change the rates at any time during a period for which the rates are guaranteed if the conditions
described in the Changes in Premium Rates provision under the Administrative Provisions section of the Policy apply.
Except for the above, this Amendment does not change the Policy in any way.
FOR THE COMPANY
William J. Smith, President
Date: September 21, 2020
Amendment No. 02
TL-004780
Accepted by:
CITY OF KENT
By:__________________________
Dana Ralph, Mayor Date
03/22/2021