HomeMy WebLinkAboutHR18-161 - Amendment - CIGNA - Group Accident Policy #OK 969625 - 01/01/2021ApprovalOriginator:Department:
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Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category:
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If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace.
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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, TW.
Life Insurance Company of North America
1601 Chestnut Street
Philadelphia, Pennsylvania 19192-2235
AMENDMENT
Policyholder: City of Kent Policy No.: OK - 969625
This Amendment is attached to and made part of the Policy specified above. It is subject to all of the policy provisions tha t
do not conflict with its provisions.
Policyholder and We hereby agree that the Policy is amended as follows:
Effective January 1, 2021, the following rates will remain in force for Class 1 for coverage under the Policy:
Premium Rate: Basic Insurance
Employee Rate: $0.02 per $1,000
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.
Life Insurance Company of North America
William J. Smith, President
Date: September 21, 2020
Amendment No. 02
GA-00-4000.00
Accepted by:
CITY OF KENT
By:__________________________
Dana Ralph, Mayor Date
03/22/2021