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HomeMy WebLinkAboutRESO 6057• ·ORIGINAL RESOLUTION 6057 RESOLUTION Of THE COUNCIL OF THE CITY lF PALO ALTO ESTABLISHING AH INTERNATIONAL CITY MANAGEMENT ASSOCIATION OEFERREV COMPENSATION PLAN WHEREAS. the City has employed Wiiliam Zaner as 1ts City Manager; and WHEREAS. the City Manager is and will be rendering valuable services to the City; and WHEREAS, the City has considered the establishment of a Deferred Compensation P 1 an for the City Manager made available to the City and to the City Manager by the International City Management Association Reti~ement Corporation; and WHEREAS, the City receive~ benefits under said plans by being <E 1 e to assure reasonable retirement security to the City Manager. NOW, THEREFORE, the Council of the City of Palo Alto does RF.SOLVE as follows: SECTION 1. That the City establish said Oeferre<i Compensation Pian for the C~"''Y Manager and hereby authorizes 1ts Mayor to execute the Deferred Compensation Plan with the International City Management Association Ret1 rement Corporation, attached hereto as Appendix A. SECTION 2. That the Mayor may, on behalf of the City, execute a11 J ni nder Agreements with the City Manager, which are necessary for the City Manager to participate in the Plan, an example of which appears as Appendix B. INTRODUCED Afll PASSED: July 26, 1982 AYES: Bechtel, Cobb, Eyerly, Fletcher, Klein, Levy, Witherspoon NOES: None ABSTENTIONS: None ABSENT: Fazzino, Renzel ATTEST: ) ~ ~~~l~ c~,,· APPROVED: APPROVED AS TO FORM: APPROVEll: .. , • • INTU.Nl'.TIONAL aTY MANAG£MENT ASSOCIATION R£TlR£MEHT CX>UORATION D£FE&JlED OOMPENSATJON PLAN APPENDIX A I 11 _.., _...., ..... D9BUB COlilrBMTlt* PLAN.,.. lie 111.-.ct Ol'I .. dlll leor'I WNdl N ~ i. m19eCS a to tie IUCIMd llJ I'!~ ..... IWa ....... Oii...,... '11 -Gli>Si-.., ill'I .. _......., blblil ~ ... Df.FEARED COl........,.110H"'-M .. notbe.._,....._._ ... _....,.~-... ,.., ~ . ': 1 ........... COI0018llOl•untilaNotic:eol ~Ace: BJ •ic» ,_ ~ ........ l:'P I. --------------------------- ,. .. ~ ..... ,....._~t/l.CM!lrol.at ---·------------ ........ ...,..,...., ____ _ ................... $ ., --- ._ ...... .,,.. ._•••1•t•N•11u#I'•-------·-------------------- T.-....... f/llillllft'll-liJlllllflllll'9•IL---------...., fll • ............... 11'1 r • -~ 918 ..... ~ .. ..,..., rllliDmtiolL 911#1 ..... ioll ....... 9llct ...., ...,, .. frOfft .. dllllt of "°' tllng lfw::I llPOrl .,....,.... ol llUCCll:GOl IU1Umll to lediarte.3.. lliltllCNillef 11'1111 iirlt occu. a.c.art U . ......,.,. Cit T,,__ 1'ht ~ rt.ay 191NM Iha TNOle • _.. tllM b, ~to the T,..._ 1 Miilen notice OI i1a ......a ... lrl ~--11 of.~ pur-..it to s.ction 9.3. tu:fl ,...,.,.. ..... nol .. -.ct prior to lia1Y .,, --tram IUd\ ~ ~ .. fN9fiM .... IO el\ .... tll'9dMI dllt•. llcloll 1.3. AppoilMWlt ol SllCClllO" l.,,... n. ~oil. NDWto .. TNllMttllll .. ehcfypcri .. ~10U.Truatee al(a9 • ~ lr'I Mtling eir;tlQUtld b!f ttte ~ IPC)Ui!'lting IUd\ ..,._.., WllllOMf•llJ IUCf'! IUCC llll:lf from~ bthe 41Ctssid om·11lar• ol • P'edK••or. llnd (bl., acosut111Ce In writing. exercut.IC! bt wc:tl WI: c I lOt. M GI a. pt'OllilllallS s tcrth '*9ln ... raapect to !hi T~ 11'11 ...... IO .... •cc I UOt ..... 1'18 --force M!S dk:t -If 9!dl ~Md bM9'I orfginllltt nmMd • Tnistel ~- I a •ICCll90" Ill not_... Mltlirl ~ i9Clt _.after the ff\191 .. --notiCI ol ft9 ~· ~ ~ Sedicn8.1., 1he TNllM n-.y .,ey to *\' crwrt of ~-juriedic:tion IOI 11p110111em1nt o1 • ~. Sedksl 14. T...-atFundl lo Se!ICCeMO". Upon .. ~or rtlflllMIGlbtTrullt99~ ~ Gla1UCC918Dr ......... final ecco.d ol .. T..-. hM bMr\ ~ Nltllld. .. TrwlM 1111111 ..... Md dlli'llW"" of O. ll\tlt Funds~ to 1UCt1 •ICCIMO' . M'ntU VI. DunllllM ..s Rau a c ¥•• ol 'n..at A8ltl 11111nt. 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"' "'" ................ .,, .. --.. ......, ... ,;MftOriled ........ .., ..... ...., ........... ! .. tar ....... Cl1 Council. .... --. We A;IW•lll • _,,,._ ... .., ... ouculan o1-. _.. ........... • ~ 11. tMSTIJil ""'8T AGAUMENT MIA&MllN't ,,_ t1r end~ the &be!WMO ~ 9'td IN ~1111 ~ ...,._,.... ~ ~ Corpar.tion .,__...,.., .,. ""Tf\191M" or "Alttrement CcrporeJiorn. • noro-otit OOf1ilCll'lllon arglfllled encl •111Pn9 under lht ...... ol the Stal• ot Oct a .. kw ... ~ c!A ir"'11111in1 encl OIMI.,. ....,.hlnn; the bldilMl~~Eft~inCOlileCllOhwlltio..red~tion .......... ~ MEAEAI. ,.,. ~ ---lo ... into ~ '#!!ti ltl ltl:;dog.-..._.•~,.•IV• todlter ~of soeerfled I*~ ol 01 ~ from t"9ir total COl'l*iMttOn a -cWfeo'Te<I ~-ii dClfnld .., Mid ..,...,_ ... until ttw occunence 01 09'tlin.....,_ WtEAEAS.. ifl ord1r ltlM "*9 wlfl be ~ .. _.._ ..,....... to CfilldW9l h tareQOlllQ cot*w:tuel ~16. ~ Employ9r dMlrM lo ........ ~ lftlGIRs __.IO the~ of~ ~ WHEREAS. -...,,. ... aida. together Witt!" and .. ~fl "*"'°· ... to be-~ wlttlll'I.,. dommniOn. control. #Id~~ ol trw ~. and llA:llK• to me Emol0yer'1 lii»Olul• right of"""'° ...... the ('It'~ heWinO ;-.) ...... wtwi&DWef ...-.n. NOW. nEAEFORe. ""-....,.... wi111uM" tNI c• !he~­ .. pey ~ to !he TNll\M to b9 plac9d in Dltterred Comoensation Acccu'ltll ,.,,,.,. ~~I IN Truaw.~ !hat rt will i:.old UICi ...... and ~ =--Midi wt'ldl it !MY~ .... Wider. '" trust fOf the .-Md ~and loCIOfl-. *"'-~ COl'dtlonl tweinatter 1tmed . ..., (Cl .. .,., .. hel'oto lqH. ~ MTICLE L o.Nllll DlllM al tt>e ,..._ ~ 1.' General [Uy of tfllt ~. The~sn.tlmeke ~ l*1Dclc: ............. ~ .. .rnaunlll fli 119 ~HC1 ....... ~ wNc:tl .. ~ in~ IMlh .. terms and COldtiOl•olo.r.n-1 ColllperlHllon ~ ~qwltti lldl ~ ...... Cir wlh Wrt IUbMQUelUI modlfic.Jtlon ~. ~ 1.2. O..• Dublts ot tM TNlllM The Trustee Jft&M Mid au Ml&tarercei¥edbr it.....-. wtlidl. ..... with ttle income ttlefefrOfl'I . .... CClftllltiUltt 119 Tns Funai. ti oe.-edlftll ... the Trull Funcia. cOl1ect .. n:ome ..... MCI .,... 1111,,..,.. ... tr6etrom. • • weinarter llllfOllidlCl. lN Ti:uatN etllll ataio i'*9 d TIUI! Fundl wlllct> are lr!lnsfen'ed to It • ~ TN9tM br ... Emplc,.r trom .... hfl9 Oetened oompei...sien _,.lljllll'ft9I ... wiOl itl ~ -"!Ct! tneel IN ~ ..._,......_..Coebreoo~~GIMl'"ltl91CMA-AC o.f«red ec-... 1111 o • Ptln. 9'ldl Trust Funm .,,.. be subllC1 to a11 d. ttwt terme MIS~ of h& AQ!'Wlt ""'1CU I.,_.,. Mil ~ of .. TIWCM ilrl ~ ••n I d1a•91fan. .,.~of N ,,..,...._ 11.cton 2.1. ..... ........ ~ n Ducllll al IN Tnaui. The TNlllM .... hllwe 9'e DQUl9r in d9 ~IO "'"I~~~ ~ .,_, 11C01R9 ol lfte T"* fund9 end k-c> lhlt Trust F&niS ......._ .-out di911tdlol1 ..-..n ~ end income ,,, Md'' 9llCUflillS •in altlllF orociertv.,... or l*1Cift91. ~ l'tuated. n IN! T1'U1111Mt ellGlll dMfn &JCM ..... ~ 1:1ut not lift'llted to. Stocki . __...er .,.....,,.,, l:IOftda. ,...,.....,. ~Hid ..,.ance pc!4le>n. ....,....., a-. ewllllCN of ii di ..... OI ownersftc>, :Mid In ClllRll!OI w.t ""'*"of~~ or'""'""*" !M14ullonS. Mtl'i i.ct1 ......,.... -*'9 11 Truaeae o1 tlUdl conwnon tntat tur.a. or ...... .._....,.,,. twPeS of ... ·~ lrldudlng llQ!Jtfy. tiqct. lncame. in:! .... 11tcti Mfll ,.._....-. d ~MCI ioc.1 ~ _... lliwS. ealliblllhecl with 1'JCI\ ~ hNncllll OI ~ ......... For ltlliM ~ ~ TRiit f1"de may b9 COH-"'9<1 .... °'*1 GlflDWted by !119 T~ undmr IWiclrm of 119'_...,.. ~ oe-~. 1" w.-.ig ilUCfl ft: .. ,.. ... .,_ T~ INll ltOt be ~ .. ""' .. to" ................ ~"19-inweelltiCPMdlUCI. W6. In 11t._ll pawers lirldn .....,II ~wstedinfle T""'9e • ---·· ••es ................ .. --..... ,_._ ........ _ ... __._.. _. ........ .._.,,,, ...... , ............... . • .._ • .__... .. es• s • .... .._ ............. ,._.. • .,a& MO_. .. .._.__ ... . ... -.. ··=·-.... -... _. ....... 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',, ................................ -...... .,., .. _....,. .. ...._.._.....,.. .. -..-.•ea••-• .. ._ ........ ~QlllGS a •• , ......... ......_ ...,.._.. •c It ---#5 Zfl .... l9¢ ... .. ....,,....,.,.urcu .. ~•_......_... .,..._.._.,......,. .. _...,.....,. .................. a..>. . ........... -.......... ._ ...... ., ....... . .......... -..... --....................... . ................. 1 ·-·-· ...... ...... .._.......,. .... ··--·-· ...... ....-.... .. .._.,, .. ,, ............. •'CuOJ-............... _.1111• • .....,~w---• ... ......... --··--· • ..... It J ·---------· I 1.-~ . ............ -..... ... ___ ....._.::.-.. .. ........................... ., ........ TI ....,.,.f:'J ..... .__. ••fl1"9QO • .._..._ 1'119 _.... ............. ._..__ .. _, ...... ............. ,ct-.............. ..... t .... I ........ .,. Ii ¢!Q ......... . ----·· ..... _... ......... ; •t 5 .... .. ........ -....................... , ..... ..... ..,,._ • ._I OI••• • ._. .... _,.....__ ___ ....._Cc cs....,..,. ...... ., ......... ..._ .... -..~._,,..,,...,. .... .,... oar .. ..................... ·-·-----..... ................................ .. .., ............ .,. ... u ms •••11 s• •'llll •09e ••••• .. .....,• .. •• 1 .-. ......... s rs ar •••• ti 11 •oze~•...._..,.,._._., N1W1 1 M ............ I r•-ullO••W ---............ _ .... .,....._ .. . ............... ...................... t; ....................... ...... · · ·-- • .... ,...., -· ..................... (# •• -......................... u I 111 1..-•9"•& IZCIJ •U ..... .,.. .. tilll ¥ CJ ........ ••• JI It••• ...... I S'JP -.... -....................... . " •• • t ............................... ., • ......................... ,. Cl~fl _________ _.. ............ . ----...... I ........ ,,..__._. ___ ....._ __ I I ................. • ------'*-9llllSlll't ' ts fll I S P' _.,.,. at tf N ... ............................ ~-..... -... • ....... c. ............ .. r ......... -_. .... OCI rl•Otft;•--..... ...,,. ..................... . The w.m.tlol• City~ ~ ._...9"1111'11 t.orp-~ tlon. ........... Aemlmeftt Cofllolation (JI ICMA-AC .... ~ llllllw#e CorJ)ora11CWt It l\al bMt\ claNiftad •I fax"9QlllClt orgllf'liUlion ..... ttllt P'CMliOlll of Section 501 (C)(3) of ... '"'9mlll ~Code. Aa tt'!llCl.,tht~o4llllteandmunicip91~ .,~ lie !Mil-" Coriicn'«ion ii orgMized tor ... ~cf ntce'Wto.,., m.flng dlf9rre<i ~IHtion tunds ol 11m n local government• n:l ltleir ~ and cor.1rOllecl publiC ..... Clfglnizationa whicl\ .. tax-exempt under s.ctian 501 of the lnt9"'l8I AIMtlue Code, ~ ~tou·~·; to9Ct•W...Stdl0119'ftllorttle cclltlctiol1 .,., rainvMtment ol ... income therefrom; and to Id -.,.. tor lliD1 ~Md" !tleirexolicil direction tortfleli9111butionolthe 1utldlend ....u. cf lheir accwn111 kl their pctielpltinQ ~ CineludinQ indepalldellt connctorsl In acc:ot'dell ~ Wilt; QCl@ionl prOWid9d in ~ Wllrl'llltic:lMI City Mwolmenl ~ Aatnmenl Cotpoiation Oetorted ~Pieri. herlllnafter '9fenild to .. tfle ~ ~ oM the "ICW'"°AC P11n." The ICMlrFIC Plan la Ml ~ below In two PWts: L The eet.fred Compensation~ AQtMment Ind l The MMt•Trwt ~ "*"'· Aa .. tout below, ... EmolOyer oldgpt8 ... Plan• lta ~· with !tit' Pll't~IQ ~.,., ICMA-RC. and tfle Emoloyw ..... ~ in IN Plan thrOl.~ fie •ecution of 1 Joinder /19""*'4, whictl b>/ its '9fm8 lnCC. P<'l'rM aft d lhe P'OWiliOnl of tfle Plan. A cop,r of the Plan lh.il be IUOPUd to actl ~ fol' hla ~ and "'1lilr- ~ priof to hla eQCUtion cf tM Joinder AQrNment. The~. lhrOugtl INir ~ in the Plan, ...,,... thtir ... to ... lhe blDMfit ol lhe continued lc>plty, MMce Ind~ of.,.. ~ and to Wilt '*" in pl"OViding fgf '"' c:clfltillQelw:i99 of old llge declef"td9ncy. dllatlill!y, and death. This Plilr'I may be mmendlld f\"am time to time tor~ of ..umg its ~rfllllCll to IN requirwnenta ol ~~lair Cit Nie 01 '9gllle- ticrl ~ theretO, and to preMtVe tlle ...._lft!Pl ltatua of._ Awl and tt'8 Aa\Wement ~No arnacidrMnl nw:y elltW direcity or illdnctty operate to derM q ~~of Ila benefici.J intllnlst in ttle TIWI •it ii lien condtutied. The Aetlril!NI It CofPordon wil~ ltle~ig ~of 81"1 •••--toW. PWI no ...., ttw'I 9ix1Y Clays priOr IO ila ~ dll!ll. IVr/ IMi'I -Onent will become~ ...... ~ gf ttwt period of*'-· eac.pC .. to ltlOM ~ U nW)' tile ., objec;tiOIL No 8"1911dmeft! propoM(:I by ~~Iha!! lie d9cWe un19M 1r1JMC1tobythe1CMA Retirement ~~tho lign8tuf9,,, ... omc.-. PART I. DEFSIAEDCOJFENSATICIN EMP\.OYMEMT AGfEBaNT Umila 1., For ... pur1XJM of 1l'lii ~ .. talDwing clef•litior• apo4y: & ~* compenption" • .,. tOUI of~ lc1blls-id by .. ~far lh9~oftt.~.19(11tdaMof lt'9 ....... MMd tor its CC!fl!POI ........ tor .............. pey," ... lddltiDf'l 10 .... pay."-~·~. etc., b '1M8ned ~~. _. ~ Ol l*C*l'8;9 of .. tobll~ol-~whlcfl--~Clll'l'9nt~ ........... ~to-~. ft, ..... darCIOeill W diO a Def9n'eel ~ Accounl wi191 ltle Aiatil91M!\t Cof'potl&lOn""""' .,. ..,,.. °'"-Plan. Def9ffed ~ 'M¥ include~ ll'om0t ~ olbOtti '*-._.... ..i ~~I ~· OI • Ny inClud9 ....... fftllrl CZ" Ol«*'tttll of Ol'ilY one of ttw ~- c ~ ~-i9 ~ pcit11Qnoftfte Empioy•'• 1IMI ~-ion !llltllCh • not defined~ -detlrJtd ~'°" 11 dtfirwd ,..._ n d ....... pm\!' ... alatK .-,y of ttle ~. 2 • .. .... . .. t .2 Cclmpenutaon nwy be cllltened lar .,,., cabnda' ~ only If • .JoWld9r ~MfMM fol' llUCh deferral n. llMf'l n•ed into blllote l'le bagilwq al IUCh monltt The detefftWla!lOl'I of N lf'llbtll mnount or P9fcent-oe llftd al .,,., futon cftlfioe in amoin 0t l*C*llfliOll al o.tenld ~"""I be l'llltde before the tieplwilig of the calender moNh for wtiid\ ttle C'.QmP90'!Nh0'1 IS ~ Suen tuue cn.n;n ll'lllY bll nmdc more trequentty m.n once I* ~ ~ ~ ill the ~ direchOrl al the ~- 1.3 The""°""""~ total compenUtion may be 9diulted ;,om time to tinl9 without altering the fen\ll of lhia Plan Howelter. the par· centaee or llTIOUnt al Clahlfflld C0"1PllllW!!Ol1 IN)' be adjusted on1y in ecc:oidln:e wnn U Mlove. Alff IUCh arJll,.<atment ot ltle per. Cllnl9lill or ~ of daferrlld c:o.npenaahon sneit be com- ~to the~·~. the Rehrement C#por1tion. n i11e ~ in ttie aclrAted ~eritagn or amQUflta, rt ctlln9ed froon IN Pfiaf cuc•bn; per~ or amounts. lhal1 thereafter be made by lhe ~ inlo Its Aetw,.menl Corpota- tion M:ourit t.4 Co!!lperution dafen'ed ~ the Plan' for My Employ .. -. ~yes be9i" ling after Dltcember 31. 1978. tna11 not exCMd .,. -.... o! (11 '7,500, or C2l 33-1/3 ~of~ CSlffe<ence ~ WI ~·s total ccmpvnutioll 9ltd Ml ctaten'ed compeftMtiCn. ue9pt a ;ircMcMd .,, 1.5 belotw' 1.5 For one or more of that ~·11at ttne ta.able yelfS ending b9fara ._ attaina norTMl relirement age unc:ler the Plan, ttltt e.i1tnQ ... forth in ~ , ' abQvit shall be lhe lnHI' Oii - & 115.000. Of b the IUn'I al - Ct I !fie PW\~ ntabli9hecl tor put1)0M5 of P.,agraptt 1 .4 tor .. luable ~ (determined without 19Qllt0 to thla Ps~.- C2l IO muctl gf the Plan CfMlitlg Mtllblilhed toi PU'POSH of ParllQl1ICll'l 1 4 fol' ~ \191111'1 betofe ~ tP<lble year •has not thefMotoa• been uM<I unctef Paragraph i .4 or .,. PeragrlC)h. Tiw arnDl.lllt of compensation defemtd under ttn Paragraph shall not exceed In~·· to'*c:ampensati<Jn TheWOldl .• l'IOITNI •w~ aoe.· • UMd 1n tf'llg ~IPf'I. sP\a:• ma1111 tne "Clasignated age," .. deflne<I ~ ~ 6 beloW 2-Det9"ed ~il:ln ~CO'Jllt Under tnisPl.i. ~ea compen- Mtiorl INll be ~ and paid mo ltla Trust eataoltshed ano ,,....,,_, Wilt! the lr .... mational City ~ ANoci&tion RI· ~ Corporation • Trustee Tl'le Rlltrement Cotl>otSTtO" IS a nonprofit corixntion fomlild tor tN ~he ~ of inYQttng and ~ admil._,1110ttlit funds of sMf Trust The T:u.t may be rlt\'Oked It lf'l)I time ~ tt'le ~. sld ~ r~ ot said Trust All of ihe IDMtS 1181'1'of -.a return to and,...,., to rhe Employer The E~ INt llfMIC) 8CCU"ll-le books Ind NCCWOI wi1t'1r..-ef10 lf'!t' ~·1 toial ~ OI 00.-eamed lftConMI ~ Mii r~ to ~II &Mic' • laid Truat 3-~ of Funoa ~ tN Ernc>lo,w nor "'>' beMflC*'Y ....,, 11'1111 "-any '"""'"' ~ "' lfte funcll paid ttl10 the Oiltarred Compenutmn Accownt • ., f'O ~or ngfq~ wtlll Ill.ct\ II--. or in 1'1111 ~~to Mldtiundl. ~. o; ngl'ltS . wt'llC:tl dtllll Id ell times relNlft a _.. ~ tne ~. 11Jb1K1 IO rta llblollM ~. COl'ltrc:l4. and rogtlC of ~ U"1tl such ll'M u 1tle .,,_ Of MMla of lw A::counl .. ~ to N iElllPIO'Yff 1n lllCCO'daa Wlilh IN~ of 11115 Pliln. The~ of th4I ...,._. IO ~ ~ ~ 11 colllrKtual only. tnl ElflPIO¥M ~,... prlMnff or llP9Clal intero'lt or clelm. tiv war of trust. ~.or OU.wi• . ., Ind to Iha I08Ck tunct5aindMNt•Pleldin1t1e Dr' "rad Ccr·ciwuiion ~ Ttie ~ 01111i911ion of the ~ '° -the klfldl arl(I ...... in Is Dllilmld ~ion ACCOldlil to .. ~ or 1'111 tMlnllflcaery an "9 IPPhelble ~IOll -------- :hedc One . '°'I' AGREEll£NT B ~~.~ o AmetldmeT'C~Agt'Mment To MA Retirement Corporation defetred ~of Beneficiary ON, com sation plan. ·o: APPENDIX B ..,......,..°'~ ' :.; Mr 0 ... 0Mrs OMlll firsi Moodie l• : r:rom: Full Harne ~MOUNT OF DEFERRED COMPENSATION ALLOCATION TO INVESTMENT FUNDS i-IOTICE Efttc:tNe anuary 1. 1979. fed.ral law ptONblts arpt person ffom I fequesl mat !he totai amount$ ol defei-recs ~tlOl'I be ~ 1o !he IJelefr~ mor• than 2!'!oa of IOtai ~lion OI $7.SOO. wl'ldlev.-•S a\'a•laOle •r'IVHlment 1unm 111 ~~rig percertlages (5" ICMA·RC An· ~ Total componsaton IS yout satary. ~any amounts oetened nua1 Report lor discussion ot lurldsl ·nectlVe on the pa~ shown below. 1 dPsire ro tie p.id, in 1"19 lotm °' 1Jef9"'9d ~. as follows· • ,;I"'~ ,.,...,,. .,, ........ :~ ........ OIO-.,-. IE...,...,1 '""""°""I l\1•.f' ..... , .. *" .. , . 0.0....i.--~. ~l T-II.JM C)o;;-Jfllll ... _ ..... "" -----"--"" -IOll\I Ho,,...,~ ... 1111: .. •'I Pre ..... Mtd'Oll .. .. .. . ... • .• -.1 . ··-' ;•1111,, ·1•Dollel~ $ s ,.,... OIY Dll"Odl s ' ........... . ' 'l'fdaY on wtuc:n plari rs ro tiegiri . " Mo Oay Yr . .ty current salart is S per pay pel'lO(l I vnce:stand ltldt ~e srare or It" J! ·.1w ••hit•·" 1•1t> "dlure ot rl'le "•P.SI· ~r:: ot ~ri,,.s .. l\:Mds ~al •I will De nt"t:es~rt 10 ·~,,·•..-! 1ne •n".:>~l,.,!?'1t <:h0oce am paid ev~ 12 ~s. montn. • S days etc l _ TO lllose .JY.llllallle UNW IN?·- ::SSENTIAL EMPLOYEE INFORMATION I I ~ ;-':-1-! I l [ ~ ;ex . . M =F Date of Birth S«-•ai Security Numtle! I -'4o. Day Vr ·~1'itle Deoa.1mer1t )! I ~ ! I ·~Address ' No. Street City State Z•o 'ESIGNA TION OF BENEFICIARY (See lnst:vctiOnS) 4ote. ~ amei Idol ;g yow ~ do l'IOf c:omplele lhts section unless you Wl3'1 to cttange oenet1C1anes !T' o ~ Sn.II the ptoc:etds be payable II" tase of y04J1 deailfl? Give Pil$t Nll'Tltt. middle 1n~at Otnd 1.-.s1 name Mar, fl.. Re1arionsl'11p to you. ~Ith inot Mts. Jol'tn Smith) For )IOU!' chfldren. you may 'limply use ane tlffll "My Ct111dfen llt'd leave tl'\e Oa1e ot Date ol 8'r'th 1 e . w1te. son aau9l' .. _'f". 9•t'ltl atld Rel~ ~ Ciani! Th<S :erm ~.ill ~ equal 1reatment among ... our Cl"•id"M-pr'1Senl and Mo c_·, .-ea< 1 If .,~ne stale """'eltler uture-bom O! any and all m.mages ancl any d'lllOten legally acJOplell at an>< trrne ~r•end ;;reortOt e:c t -' ···-·-·~)(a.al): I I I I .. ieflc~I (a.. I). II...,: I ' ~-------! ' trhl right IO thange ~is rnerwid ID me. I ~TE: H r'O Primary Benefic..-y (C&ass Ii tS IMng al trrne of yov dNtft, !tie prcl(:99d$ are payable to the Contingent Benericlafy(iesl fOasls Ill If a Class ll1Cu:!ell tnOl'9 IMn one per,on, thl proceeds ate ~ ~.uy 8ITIOf'lg the liW'lg ~ ot !he Oau. - FOR SUPPLEMENTAL PROVISIONS - Th9 uncMr1ignN ~ --q ~ lo!' ~ sn m. ICMA Rebr~ Cotpor-...i dMn'llCI ~ pllln as eslabllVeO by my 9mployer I underStand m, ~rs~ iu my~·· ...,......, 9N'9"' c.tow. and Wiii be pernecs br in._.. dol::urnent. !t5 ~. ~ tn.s ~ :=i-lhtglll'llflll PIMSiof'f~onttlll ,...,_side. l~rUOparaw1Pf14onltte~Sldllofthts99'8eft..,.. MO~~ ltwt \ M10Ut1C I ,..,. Mid ~ IO dNI' dOeS nnt ~ 25'1!ii of my IOllll ~or $7.500. whdiower it'°"'· -. . , .. Signatunt Employer ~al and Agreement : . ! ' '--a.. ~<i~~· 0.. -i ,You~ liQn'/Olf ~Joindlw~tor~~-#you ' itllD ect .. '/OJI~··~ offlolli.,,.. Mdlet ~.,.. -I ~ . IO 19" ~ ............ P-1"1 ,...,,. and Tltl9 of Ofhcqil ,.,.,..,,