HomeMy WebLinkAboutContract 46072-R1 Life Insurance Renewal Offer
City of Fort Worth
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CONTRACT N0.
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Estimated Annual Cost
Life Insurance Coverages
Coverage Current Renewal Volume Renewal Annual
Rate/$1000 Rate/$1000 Cost
Basic Life Insurance $0.097 $0.075 410,847,450 $ 369,763
Basic AD&D Insurance $0.025 $0.025 410,847,450 $ 123,254
Supplemental Life Insurance-Employee and Spouse Rates
Age-banded rates include AD&D
Age Current Renewal
Rate/$1000 Rate/$1000
<25 $0.082 $0.082
25-29 $0.092 $0.092
30-34 $0.112 $0.112
35-39 $0.122 $0.122
40-44 $0.172 $0.172
45-49 $0.242 $0.242
50-54 $0.402 $0.402
55-59 $0.632 $0.632
60-64 $0.942 $0.942
65-69 $1792 $1792
70-74 $2.882 $2.882
75+ 1 $2.882 $2.882
Supplemental Dependent Life Insurance
Coverage Current Renewal
Rate/$1000 Ratel$1000
Option 1 $0.152 $0.152
Renewal Expiration Date: 12/31/2018
Commissions: Net ��.,-.
Rate Guarantee: 1 years OFFICIAL RECORD
CITY':SECRETARY
FT. WORTH TX
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In order for us to process this renewal in a timely manner, please sign below and return the completed form via fax,
email or mail to your Account Manager.
This form only acknowledges acceptance of the renewal rates. Amendments may need to be signed by the
policyholder for any changes to the current contract and will be sent after acceptance of the renewal.
Autmorize �, rr�.;�°�� Date
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City of Fort Worth Attested by
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01/01/2018 Mary J Kay
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Life Insurance is underwritten by ReliaStar Life Insurance Company. Policy for 4vary by state).
M&C: NA
1295: N
1".PPROVED AS TO FORM AND LEGALITY:
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH, TX
INVESTMENTS NSURANCE PtAlAlkCiAV*
Contract Compliance Manager:
By signing I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ensuring all performance and reporting requirements.
Name of Employee/Signature
Title
This form is N/A as No City Funds are associated with this Contract
Printed Name Signature