HomeMy WebLinkAboutContract 47393-R1CITY OF FORT WORTH
CONTRACT RENEWAL NOTICE
CITY SECRETARY
CONTRACT NO..I 3- 91
August 30, 2018
United HealthCare Service, Inc
185 Asylum Street
Hartford, CT 06103 63146
Re: NOTICE OF CONTRACT RENEWAL
Administrative Services for Group Health Plan - Policy Number 905579
Contract No. CSC No. 47393 (the "Contract')
Renewal Term No, 1: January 1, 2019 to December 1, 2019
The above referenced Contract will expire on December 31, 2018. Pursuant to the Contract, contract renewals are at the sole option of
the City. This letter is to inform you that the City is exercising its right to renew CSC No. 47393 for an additional one year period,
which will begin immediately upon the expiration of the current term and will end on December 31, 2019. All other terms and
conditions of CSC No. 47393 remain unchanged. Please return this signed acknowledgement letter, along with a copy of your
current insurance certificate, to the address set forth below, acknowledging receipt of the Notice of Contract Renewal.
Please log onto BuySpeed Online at htt-o://fortworthtexas.eov/Durchasine to insure that your company information is correct and up-
to-date.
If you have any questions concerning this Contract Renewal Notice, please contact me at the telephone number listed below.
Sincerely yours,
Meagan Whitwell
Sr. Benefits Analyst
Human Resources Department
817-392-7787
I hereby acknowledge receipt of the Contract Renewal Notice for CSC No. 47393 for a one year period ending on August 17, 2016.
By �-�`—h i(1 L3l ( /%til [ <i Ctr �nM- Date: q - 'Z4- 2 0 t
Aignat
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CITY OF FORT WORTH:
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S san lapis, Assistant City Manager
Date: 1 ; 12 -a,I
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Kayser, City Secretary
M&C No. not required
RECOMMENDED BY:
Name and Title VFICIAL RECORD
CITY SECRETARY Abhn B. StiongAfsist t City Attorney
FT. WORTH, TX
Texas Department of Insurance
CERTIFICATE NO.11976
THIS IS TO CERTIFY THAT
CERTIFICATE OF AUTHORITY
UNITED HEALTHCARE SERVICES, INC.
MINNETONKA, MINNESOTA
COMPANY NO.31-095260
has complied with the laws of the State of Texas applicable thereto and is hereby authorized to
transact the business of
THIRD PARTY ADMINISTRATOR
within the State of Texas. This Certificate of Authority shall be in full force and effect until it is
revoked, canceled, or suspended according to law.
l
f
A
IN TESTIMONY WHEREOF witness my
hand and seal of office at Austin, Texas, this
19TH day of AUGUST A.D. 1998
ELTON BOMER
COMMISSIONER OF INSURANCE
BY
MATT RAY '
DEPUTY COMMISSIO R
LICENSING GROUP
n<.9R-0972
Subject Considered:
OFFICIAL ORDER
of the
COMMISSIONER OF INSURANCE
of the
STATE OF TEXAS
AUSTIN, TEXAS
DATE: AUG 191998
UNITED HEALTHCARE SERVICES, INC.
MINNETONKA, MINNESOTA
APPLICATION FOR CERTIFICATE OF AUTHORITY
TO OPERATE AS A THIRD PARTY ADMINISTRATOR
Docket No. R-98-0733
General Remarks and official action taken:
On this day, came on for consideration by the Commissioner of Insurance,
pursuant to TEX. INS. CODE ANN. art. 21.07-6 and 28 TEX. ADMIN. CODE H
7.1601-7.16I7, the application of UNITED HEALTHCARE SERVICES, INC.,
MINNETONKA, MINNESOTA, for a Certificate of Authority to operate as a
Third Party Administrator in the State of Texas.
The Commissioner of Insurance is satisfied that there is sufficient basis
to approve the application and that the application is properly supported
by the required documents.
IT IS, THEREFORE, THE ORDER of the Commissioner of Insurance that the
application of UNITED HEALTHCARE SERVICES, INC., MINNETONKA, MINNESOTA,
for a Certificate of Authority to operate as a Third Party Administrator
in the State of Texas, be, and the same is hereby, approved, and that said
company be issued a Certificate of Authority to act as a Third Party
Administrator.
ELTON BOMER
COMMISSIONER OF INSURANCE
BY�Q
MATT RAY
DEPUTY COMMISSI R
LICENSING GROUP
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
B-Q.., V, A---:7 �k(Title
❑ This form is N/A as No City Funds are associated with this Contract
Printed Name Signature
OFFICIAL RECORD
CITY SECRETARY
{, FT. WORTH, TX