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Home My WebLink AboutDocumentation_Pension General_Tab 08_02/02/2009 ~. PILLAGE GF 'I'EQUESTA CI~EC'I~ UES`I` ~lendor # Date: f ~ y (~ ~ 1VIai1 Return to Dept. ~Iendor Name: ~~1~~~ ' ~ ~rr.N~-~.~ 1~~I ~,t~~•~~`- ~ti -~i~. Address: Z L 4 y~~i~-~c-h-.~.. ~~~--' Reason for Request: (Please attach appropriate documentation) `~? ~-- / C~a~/~~8 ~' ' t'` '~ L U1 ~ G'-~--t,~ i~t1-z^-zt -- ~ -~ ° ~ v ..~z~r~-~ ~, f ~ l-ti~-~ e- Charge to Account No. CaG ~• ~o4.~3 ~• ~L~ 'Amount: ~ 1 ~ l ~ ~/ Total ~ 1 (e ~ - ~ l I R d B ~ ~ ~~`'~ equeste y: J Approved By: (Department Head) Special Instructions: .- ~ ,d ~~ ~~ REQUESTS RECEIVED IN FINANCE BY TUESDAY AT 5:00 PM WILL BY AVAILABLE. FOR DISTRIBUTION BY THE FOLLOWING MONDAY AT NOON. PLEASE PLAN YOUR REQUESTS ACCORDINGLY! WP80VvtyFiles~Check Request .~- BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 October 24, 2008 Invoice No. 8-81 TO: General Employees Pension Board INVOICE Office work for week ended October 17, 2008 .....................1.00 hrs Office work for week ended October 24, 2008 ......................3.75 hrs 4.75 hours @ $33.98 Total Due .................................................................... $161.41 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 ~~~~AGE ~~ ~~UEa~~~ ~.EC UE~~ \Iendor # Date: - G ~ Mail Return to Dept. ,. r_. Address: ~ ~ G%' ~`'~ ~,z-~~z-.~1._~'.~.. ~`, ~...~~ ., _ ,~ ~~J~' ~ ~L ~~~ ---~ ~~C~ Reason for Request: (Please attach appropriate documentation) ~t -¢t.~f_z- ~-~--~' t~ 1~.-~: ~~~-~~J:.-p~ ~i:`~ ~'Z-~~_... ~``?~ ~t `~-~~C~~ ' .~.'s 2 ~.c?.~-. C~'C.t- allf> ~ %'Lst~ ~ &,{ ;I Charge t0 ACCOtInt No. Cr G ~• G}Li~~ :~',~ /• t.~ /~ AmOUnt: ~ ~/~ ~ ~ <~ ~ - Total ~ ~C~..3~, ~ Z~ Requested By: ~ -~-`~`~ APPmved By: C~t~ ~~•&.~- ~•f (Department Head) Special Instructions: ~~+~ -rc, a ..~ te r ,. REQUESTS RECEIVED IN FINANCE BY TUESDAY AT 5:00 PM WILL BY AVAILABLE. FOR DISTRIBUTION BY THE FOLLOWING MONDAY AT NOON. PLEASE PLAN YOUR REQUESTS ACCORDINGLY! WP80VvIyFiles\Check Request t BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 November 7, 2008 TO: General Employees Pension Board INVOICE Invoice No. 8-88 Office work for week ended October 24, 2008 (not previously billed) ...........................................................1.50 hrs Office work for week ended October 31, 2008 .....................3.75 hrs Office work for week ended November 7, 2008 ....................3.75 hrs 9 hours @ $33.98 Total Due ...... . . . ........................................................... $305.82 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 ., ~~L~A~AE ~~` ~~UES~A C~EC~ ' tl.J EtJ~T ~Iendor # Date: ' ' _,._ ~ 6v ~ ~ IVlail Return to Dept. ~lendor Name: `' ~-~-~ -~ -~~ , ~ AJ [~lj`'yI~Li7.P it ~' ~ , yu J - ~ ~a -~ Address: ~ ~ C. 12~~~`~-~-~~-t. ~r` Reason for Request: (.Please attach appropriate documentation) 0 Charge to Account No, ~ C` ~- ~ ~ L%~ :~;.~/, ? ~:! Amount: ~ ;~ S ~. ~; Total ~ ~~~, ~ , ~; Requested By: ~c"Z---t-c.,~l~ Appmved By: w (its' +~''' f (Department Head) Special Instructions: REQUESTS RECEIVED IN FINANCE BY TUESDAY AT 5:00 PM WILL BY AVAILABLE. FOR DISTRIBUTION BY THE FOLLOWING MONDAY AT NOON. PLEASE PLAN YOUR REQUESTS ACCORDINGLY! WP80VvIyFileslCheck Request BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 November 21, 2008 TO: General Employees Pension Board Invoice No. 8-91 INVOICE Office work for week ended November 14, 2008 ... .............3.75 hrs Office work for week ended November 21, 2008 ..................3.75 hrs 7-1/2 hours @ $33.98 Total Due .................................................................... $254.85 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 ~~~ ~~ ~, ~~LLAGE ®~' ~'E®UESTA CxEC~ QUEST Vendor # Date: ~,~, ~-- ~ ~ IVlail Return to Dept. Vendor 1Vame: ~ .~,r,~c;t',~~j ~--D-re~l~u.~~.~-~..; ~~-u~ Address: ~ !~ ~~ 1~-F~-t~~~--~., .Z }-- ~~ CY ~~, .~ ~ y- l d Reason for Request: (Please attach appropriate documentation) G' y - ,, (N„ ~~,`~ G'~,~,~., , D~,_~~ (~~--~:C.12,--C/11'vt.J ~,t--~. Charge to Account 1Vo. ~ f~ ~ . ~ OD, ~3 %. ~~0 rf 'Amount: ~ ~'~• L~ S~ Total ~~ SZf' • g S Requested By: A roved B ~- PP Y epartment Head) Special Instructions: REQUESTS RECEIVED IN FINANCE BY TUESDAY AT 5:00 PM WILL BY AVAILABLE. FOR DISTRIBUTION BY THE FOLLOWING MONDAY AT NOON. PLEASE PLAN YOUR REQUESTS ACCORDINGLY! WP80\MyFilu\Check Rtquest BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 December 5, 2008 Invoice No. 8-97 TO: General Employees Pension Board INVOICE Office work for week ended November 26, 2008 ... .............3.75 hrs Office work for week ended December 5, 2008 ....................3.75 hrs 7-1/2 hours @ $33.98 Total Due .................................................................... $254.85 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 VILLAGE OF TEOUESTA CIIECI~ REQUEST Vendor # C Date: ~ j ~~,~'/o g I IVlail ~ Return to Dept. Vendor Name: ~-vc., ~~ Address: o~ a I~--ti ~i`c~ Reason for Request: (Please attach appropriate documentation), l~.,.~ ~ ~ Charge to Account No, ~ d ~-: 00 ~/F S 3 / . ~d Lf Amount: ~ . -' ~`~ ~/ =~- Total ~ :~ ~ ~ Requested By: ,f, ~ _ ` ~_ ~~c~ %-~~ Approved By: f (Department Head) ~~~ r , ,- . -, , ~_~ . .; ;, -- '~ L. f ~_f"_.. ~t '.. .~ ' ~` `_' ~ ' ~~ "`"` N FINANCE BY TUESDAY AT 5:00 PM WILL BY ," r UTION BY THE FOLLOWING MONDAY AT NOON. ~``: r,`,-` ~ ~ ~; ~' ~`.'~ ; ' OUR REQUESTS ACCORDINGLY! BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 November 26, 2008 TO: Village of Tequesta General Employees' Pension Board INVOICE Invoice No. 8-95 Attend General Employees' Pension Board Regular Quarterly meeting held November 3, 2008, and prepare minutes for the meeting (3-1/4 hrs for meeting; 7 hours preparation of minutes) 10-1/4 hours @ $33.98 ..............................................................................................................$348.29 Total Due ......................................................................................................................................$348.29 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 BUSINESS SERVICES CONNECTION, INC. 260 RIVERSIDE DRIVE, PALM BEACH GARDENS, FL 33410 561-694-7963 Fax 561-694-1591 November 26, 2008 TO: Village of Tequesta General Employees' Pension Board Invoice No. 8-95 INVOICE Attend General Employees' Pension Board Regular Quarterly meeting held November 3, 2008, and prepare minutes for the meeting. (3-1/4 hrs for meeting; 7 hrs preparation of minutes) 10-1 /4 hours @ $33.98 ..........................................................................~~ ~4g.z~j Total Due ....................................................................... .29 .'~ `1 ~~'~i`~ Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 Vendor # Date: ~ Q ~ Iviail - Return to Dept.::. Vendor Name°. Address; Crr-,1,~•i .er* Z'c,8~"n1 ~~itic., '2 (p (,? ~l^ ~L~ 33~/d Reason :for. Request: (Please attach appropriate documentation) ~~ ~ ZD d ~U Charge to Account No. Co 0 2.0 6 ~ . ~~ , ~ a y 'Amount: ~ a...~~ ~ 8 Total ~ 5 ~ . ~ 5 Requested By: Appmvcd By: ~ ~'` ~ ~ i ~.L,,J ~~,-~. (Depot Hid} Special Instructions R~Q~~S~'S RECD ~N Ffl~Al~iC~ B~~ T~5#~AY A'~' ~:~ F~'~~I. ~t3~ AVA~i,,~~,~ D-i~~'#~~`4~i ~Y` '1~~ ~L4~G `~#Di'~'A~Y`~`~' ~V(3i~lV. F~.~l~~ "`SAN YQU~ ~~~'~ ACC~~.'Y! WP80tA~4yFiies~Cgeck iteque~t BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 December 19, 2008 TO: General Employees Pension Board Invoice No. 8-104 INVOICE Office work for week ended December 12, 2008 ... .............3.75 hrs Office work for week ended December 19, 2008 .................3.75 hrs 7-1/2 hours @ $33.98 Total Due .................................................................... $254.85 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 _ k i ~ ` 'L T ,. _* {`' _ .. f ~ ~~~V~ ~~• ~ ~ _ '1 4 ` `k F SY 4 ` 1. s~ t~ ik ' sx ' d r' 1y,; 1~ f.~ #;. t *~~ 1T CIS %.vh . ~ t h ?erh tea. ~ ~p :~' .,~ Ft.~ t `# + ~ f J ~ 4 :S ~ ..~k.F a ~ ti:~ 'f r . ^ ~ ` `2 ~ ~ { - + :~ . t~~~ ~ _ r. ~ " A ~ ~ ate T ~~*~,*ra-~,~!~ ,3~ ~~~.'~ i u skis t.: ~. - ti b r ~~ J~'~~ ir, ~ ~ ~ ~ "i lY f-..1.y n~~~ ~~' t , ~ 1~ k ~~ ~~ ~ ~ k . A .,f,,, :k Fwd ~ ~ 'h n ai ~ r~?5~ w.~- r ~~-"L b3". r , ~ ' ~ 'r ,~v ,.t H i~ lX~,~r' ti ~ .~ E .~ _ 1 ,:! ,... ... 7 °'S(. ... .. .S ire:. .~0., .~ ~~~. f 5' 4 ' } F ' t . ~ I t f Y tYrv ~ L ~ t4 rb^{7c ~. i . ,? L Z 'V2 19: P '~ 1, .'4 k. ~ ~t ~' ~ ~ _ - ~~ ~ e~~ r ~ ~.~1w~1-..~ Y r +et , , l „ ' C ~ 1~' i ~ ~ h ~ X .. . , 3 . ,f ~ , , ' ~ ~~ t a i ~F . ~ i :~~ ~.-r 3?. ~ .~ ` 7 ,~ ! ~'aqs hew ~~~~ ~; , J Y_ n r ;ry 'i ~ ~ . kl ~t'A L '?{ :~ .`s~~ cSi t ~ ~; 4; :.g ti ri 1~ w YHV' ~, 1 ~ .. . ~ ~ BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 January 2, 2009 Invoice No. 9-2 TO: General Employees Pension Board INVOICE Office work for week ended December 26, 2008 ... .............3.75 hrs Office work for week ended January 2, 2009 .......................3.75 hrs 7-1/2 hours @ $33.98 Total Due .................................................................... $254.85 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 ~, ~~~~AQ,s~ ®~ ~~®U~eS~~ ~,E~• ~UE~~ Vendor # Date: // ~~ ~ G' ~~ Mail Return to Dept. Vendor Name: ~~r~~1 /Y ~~ . X' -~~ _, n y~- ,~, ~~ Address: ~G'-~9 ~~%~~r~E~,~c~~~> ~~.e.~-~~~~~ ,~-f,~~ ~-~ ~.~u~ ~C ~ ~~ /lam' 1'_-y~v ~ -C~~.: ~~~, hf G~ /-'~. 5 ~.~ Reason for Request: (Please attach appropriate documentation) 0 ~~L~ Charge to Account No. ~~ ~-•C C(% 5~'~ j ~ ~~ 'Amount: ~' f,~~ f , ~' Total ~ ,> _ ~ i / , ~;''~ t Requested By: :~~~-~,~..,~ Approved By: ~ °`"' (Department Head) Special Instructions: REQUESTS RECEIVED IN FINANCE BY TUESDAY AT 5:00 PM WILL BY AVAILABLE. FOR DISTRIBUTION BY THE FOLLOWING MONDAY AT NOON. PLEASE PLAN YOUR REQUESTS ACCORDINGLY! WP80\MyFiles\Check Request 1 Yl'11V SoN, PERRY 8L JENSEN, Pa~e 400 E:xECU11VE CENTER DRIVE, SurTE 207 -WEST PALM BEACH, FLORIDA 33401-2922 JILL HANSON^ mjhanson ~ hpjlaw.com ANN H. PERRY aperry®hpjlaw.com BONNI SPATARA JENSEN bsjensen ®hpjlaw.com •A150 ADMITTED IN N.Y. Via Email Village of Tequesta General Employees Pension Fund Lori McWilliams, Pension Coordinator 345 Tequesta Drive Tequesta, FL 33489 Dear Lori: November 20, 2008 TELEPHONE (561) 686-6550 FACSIMILE (561) 686-2802 Re: Hanson, Perry & Jensen Invoice #62749 Enclosed please find the Firm's invoice for services rendered for the period that ended November 15th, 2008. Thank you for your payment of $1,469.31. Your current balance due is $1,501.84. If you have any questions, please do not hesitate to contact me. Sincerely, :~--, ~ j' I / Bonni S. Jensen BSJ/adt Enclosure Copy to: Michael Rhodes, Chairman Via Email Only u f HANSON, PERRY & JENSEN, P.A. 400 Executive Center Drive Suite 207 West Palm Beach, FL 33401-2922 Invoice submitted to: Tequesta General :Employees Pension Fund Lori McWilliams, Pension Coordinator -Via Email 345 Tequesta Drive Tequesta FL 33469 Copy to: Betty -Laur /Michael Rhodes, Chair -Via Email November 20, 2008 In Reference To: For professional services rendered as follows: Client /File No.: 1012 Invoice #62749 Professional Services Hrs/Rate Amount Administrator 10/20/2008 KA E-Mail 0.25 18.75 E-Mail Independent Contract Agreement and Resolution to Salem and to 75.00/hr Lori McWilliams and Betty Laur Administrator KA Review & revise 0.25 18.75 Review and revise Independent Contract Agreement per attorney markup 75.00/hr Administrator 10/22/2008 KA Telephone calls 0.15 11.25 Telephone calls with Lori McWilliams and Betty Laur re: Contract for 75.00/hr Administrator Administrator 10/31/2008 1<A Review & revise 0.25 18.75 Review and revise Independent Contractor Agreement 75.00/hr Administrator SUBTOTAL: [ 0.90 67.50] Attendance at Trustee Meetings 10/31 /2008 KA Prep Atty Rept 2.00 150.00 Prepare Attorney Report, Handouts, and Folder for upcoming Meeting - 75.00/hr 11 /3 Attendance at Trustee Meetings Tequesta General Employees Pension Fund Page 2 Hrs/Rate Amount 11/3/2008 BSJ Attend ~ 3.00 600.00 Attend meeting 200.00/hr Attendance at Trustee Meetings SUBTOTAL: [ 5.00 750.00] Auditor's InQUIrV Letter 10/23!2008 -KA Review & revise 0.50 37.50 Review and revise Auditor's Inquiry Letter Response per attorney markup 75.00/hr Auditor's Inquiry Letter - SUBTOTAL: [ 0.50 37.50] IRS Determination Letter 11/6/2008 ADT Review 0.45 33.75 Review computer files for Pension Plan Document in preparation for 75.00/hr completion of Application for Determination IRS Determination Letter SUBTOTAL: [ 0.45 33.75] Misc Matters 11/4/2008 BSJ Research 0.35 70.00 Research 2007 Cumulative List; backup documentation 200.00/hr Misc Matters SUBTOTAL: [ 0.35 70.00] Plan Document 10/27/2008 BSJ Draft 2.00 400.00 Draft Amendments to Investments Ver 112 200.00/hr Plan Document SUBTOTAL: [ 2.00 400.00] Summary Plan Description 10/29/2008 KA Review & revise 0.50 37.50 Review and revise per markup -add actuary data 75.00/hr Summary Plan Description 10/30/2008 KA E-Mail. 0.25 18.75 E-Mail revised Summary Plan Description to Trustees, Lori, Betty and 75.00/hr Jody Summary Plan Description Tequesta General Employees Pension Fund Page 3 Hrs/Rate Amount SUBTOTAL: [ 0.75 56.25] For professional services rendered 9.95 $1,415.00 Additional Charges Qtv/Price Bill File 10/14!2008- FiPJ UPS Delivery 1 4 59 United Parcel Service Invoice No.: OOOF49280428 4 59 . Tracking #1ZF492800395191287 . to /from Audrey Chamberlain (Bogdahn & Associates) -Addendum to Investment Manager Agreement Bill File 11 /15/2008 HPJ Photocopies$ 329 82 25 Copy Charges 0 25 . Bill File SUBTOTAL: [ 86.84] Total additional charges $86.84 Total amount of this bill $1,501.84 Previous balance $1,469.31 Total payments ($1,469.31) Balance due $1,501.84 Wishing you a safe and Happy Thanksgiving. ~g~LA~E ~~ ~I'E~~JES~~°A ~~EC~ O~JES°~° Vendor # Date: ~ .- .;~:? ~.~-. a'_=r ~ %' IVlail fl~eturn to Dept. .~f ~.- Vendor Marne: ..~ ~"~• ~,> ,j/~/j f `~ G `~ ~ ~il_.~!"" *1..~' :'"Les ' 1 11 R.7~`~ ~ ~ ~.ti ,~f~..!a~?.~..C -?i.r' ~/ ,TJ"I' Address: ~"L c'' ~,..,~,:_~- ~.r ~ .,; ,~ ~~~1 ,1,~; ~ ~.;~ ~!/,~,,.~ :~-..~ LL :~~ rl ;.-: Reason for Request: (Please attach appropriate documentation) 0 - .. 1 ~~fy.~,J.,t`r>`L--2L,~, f /j/~,.~~'A•-G ' ~.v..-- ~~ ~ , J:.._.~ !#"&' v 'E.br~..,.,, Charge to Account No. 'Amount: Total •~ ~~. G1 Z'`~ , <.;Z ,, <_ : , ~ .- ,} F , ~-< Requested By: ~ ~-~~2.d A roved B ~"=~'~~! `' PP Y' (Department Head) Special Instructions: REQUESTS RECEIVED IN FINANCE BY TUESDAY AT 5:00 PM WILL BY AVAILABLE. FOR DISTRIBUTION BY THE FOLLOWING MONDAY AT NOON. PLEASE PLAN YOUR REQUESTS ACCORDINGLY! WP80\MyFiles\Check Request Agenda -General Employees' Pension Trust Fund Board Meeting fVovember 3, 2008 8 11. Consideration of approval of the updated Summary Plan Description. (Tabled from August 4, 2008 quarterly meeting) Board Member Gload asked on page one the meaning under Salary of "all tax deferred items of income". Attorney Jensen explained it meant the employee's money that was tax deferred if they paid into this plan, a 457 plan, or a cafeteria type program. Ms. Gload responded she would choose to make the deduction out of her base compensation to send to it. A question had come up about this, and it had been interpreted very differently, and she had found it to be confusing. Attorney Jensen advised she would work with Ms. Gload to come up with clearer language. Chair Rhodes stated this would then be an agenda item for the next meeting. 12. Consideration of approval of incorporation of the mandatory Hart Act provisions into the pension plan and decision on the buy back provision. (Tabled at August 4, 2008 quarterly meeting) Due to the late hour and the Public Safety Board waiting to hold their meeting, this item was skipped. 13. Consideration of filing for an IRS determination letter (Tabled at August 4, 2008 quarterly meeting) MOTION: Board Member Mangum moved to file for an IRS Determination Letter. Secretary Hansen seconded the motion, which carried by unanimous 5-0 vote. 14. Minutes no longer in summary form; synopsis provided Due to the late hour and the Public Safety Board waiting to hold their meeting, this item was skipped. VIII. CONSENT AGENDA MOTION: Board Member Hansen moved approval of the Consent Agenda. Board Member Gload seconded the motion, which carried by unanimous 5-0 vote. Therefore, the following items were approved on the Consent Agenda: 15. Ratification Of Invoices Paid Since Last Quarterly Meeting: • Business Services Connection, Inc. - Office work-weeks ended 10/3 & 10/10/08 $ 254.85 • Business Services Connection, Inc. - HH~soN, 1'E~Y ~ JENSEN9 ~..~. 400 EXECUTIVE CENTER DRIVE, SUITE 207 -WEST PALM BEACH, FLORIDA 33401-2922 JILL HANSON* mjhanson ~+hpjlaw.com ANN H. PERRY aperry ®hpjlaw.com BONNI SPATARA JENSEN bsjensen ~ hpjlaw.com •AlSO ADMITTED IN N.Y. Via Email Transmission Lori McWilliams Village of Tequesta 345 Village Drive Tequesta, Florida 33469 Dear Lori: January 16, 2009 TELEPHONE (561 j 686-6550 FACSIMILE (561 j 686-2802 Re: Village of Tequesta General Employees' Pension Trust Fund IRS Determination Letter Our File No.: 1012.0053 Attached please find Forms 2848 and 8717 which will have to be submitted to the IRS to obtain a Determination Letter with regard to the above Fund. We would like to request the attached documents be executed by the Chairperson of the Fund as quickly as possible and returned to us no later than January 26th, 2009 with the User Fee of $1,000.00 payable to the IRS. Time is of the essence in this matter as we have to have everything submitted by the end of this month. If you have any questions, please feel free to contact me. AHP/adt Enclosures as noted Sincerely, HANSON, PERRY &JENSEN, P.A. Ann .Pent' H:\Tequesta GE 1012\IRS Determination Letter\Administrator - Req for $.wpd ~s Form 2$4,8 Power of Attorney OMB No. 1545-0150 and Declaration of Re resentative For iRS Use Only (Rev. June 2008) p ~o ~~~~` - Type or print. - See the separate instructions. Received by: Name Power of Attorney Telephone Caution: Form 2848 will not be honored for any purpose other than representation before the IRS. Function 1 Taxpayer information. Taxpayer(s) must sign and date this form on page 2, tine 9. Date / / Taxpayer name(s) and address Social security number(s) Employer identification number Village of Tequesta General Employees' Pension Trust Fund 345 Tequesta Drive Tequesta, Florida 33469 59 6044081 Daytime telephone number Plan number rrf applicable) ( 561 ) 575-6200 001 hereby appoint(s) the following representative{s) as attorney(s)-in-fact: 2 Representat Name and address must sign and date this form on page 2, Part II. Bonni S. Jensen, Esquire, Hanson, Perry & Jensen, PA 400 Executive Cerrter Dr, Ste 207, West Palm Beach, FL Name and address CAF No- ----------------------------------------- Telephone No. 561-686-6550 Fax No. __________. 561-686-2802_--___-- ._.._ Check if new: Address ^ Telephone No. ^ Fax No. ^ CAF No. -----•--------•---------------------•---- Telephone No. .....-----.---•---..._..-•---._... Fax No. -- ----•------------••----•---•-------••- Check if new: Address ^ Telephone No. ^ Fax No. ^ Name and address CAF No. ____________________ Telephone No_ ---•----------•--------------•--.. . Fax No. ----•----••----•-----•---•- ----...._. Check if new: Address ^ Telephone No. ~ Fax No. ^ to represent the taxpayer(s) before the Internal Revenue Service for the following tax matters: 3 Tax matters Type of Tax (Income, Employment, F~ccise, etc.) or Civil Penalty (see the instructions for line 3) Tax Form Number (1040, 941, 720, etc.) Year(s) or Period(s) (see the instructions for line 3) Determination Letter 5300 4 Specific use not recorded on Centralized Authorization File (CAF). If the power of attorney is for a specific use not recorded on CAF, check this box. See the instructions for Line 4. Specific Uses Not Recorded on CAF . - ^ 5 Acts authorized. The representatives are authorized to receive and inspect confidential tax information and to perform any and all acts that I (we) can perform with respect to the tax matters described on line 3, for example, the authority to sign any agreements, consents, or other documents. The authority does not include the power to receive refund checks (see line 6 bebw), the power to substitute another representative or add additional representatives, the power to sign certain returns, or the power to execute a request for disclosure of tax returns or return information to a third party. See the line 5 instructions for more information. Exceptions. An unenroiled return preparer cannot sign any document for a taxpayer and may only represent taxpayers in limfted situations. See Unenrolled Return Preparer on page 1 of the instructions. An enroited actuary may only represent taxpayers to the extent provided in section 10.3(d) of Treasury Department Circular No. 230 (Circular 230). An enrolled retirement plan administrator may only represent taxpayers to the extent provided in section 10.3(e) of Circular 230. See the line 5 instructions for restrictions on tax matters partners. In most cases, the student practitioner's (levels k and I) authorky is limited (for example, they may only practice under the supervision of another practitioner). List any specific additions or deletions to the acts otherwise authorized in this power of attorney : . . . . ... . . . . . ........ ... _..... _. _ _.. _ _ _ _. _ _ 6 Receipt of refund checks. If you want to authorize a representative named on line 2 to receive, BUT NOT TO ENDORSE OR CASH, refund checks, initial here and list the name of that representative below. Name of representative to receive refund check(s) - For Privacy Act and Paperwork Reduction Act Notice, see page 4 of the instructions. Cat. No. 11990) Form 2848 (Rev. 5-2009) 1 Farm 8717 (Rev. June 201767 DeperUr~t of the Treawry Internal Revenue Service User Fee for Employee Pian Determination, Opinion, and Advisory Letter Request - Attach to determination letter application. For OMB No. 1545-1772 tRS Use Onty Amount paid 1 Name of plan sponsor (employer 'rf single-employer plan) Village of Teouesta ' 2 Sponsor's employer identification number 3 Plan number ~-'~~.~;~ -' ~,=a ~+ ' . 59 ; 6044081 001 4 Plan name Village of Tequesta General Employees' Pension Trust Fund Caution. !f you qualify for the exemption from user fees for small business employers, complete only the certification below (see the instructions on page 2 for details). For all other applications, leave the certification blank and check the appropriate box in column A or B of line 5. Certification I certify that tl)e applicatiog f d urination letter on the qualified status of the plan listed above meets the conditions for exemption fro ser fees ~~ c~ib d ill section 620 of the Economic Growth and Tax Relief Reconciliation Act of~001.' Sign Here - ~ -t- ~ ~°~°~ ~~.-.`~°~'~_ Date - ' l :~ .~..a '~ Type or print name and title - ~ ~ i-) ~ if..< ~.-, ~ ,`~,i~ ( ~,~ ~ f , lL ~ Fee Sc hedule Form Submitted A with Demo 5 and/or Demo 6: B no Demo 5 and no Demo 6 5a Form 5300: ^ $ 1 800 ~ $ 1 000 b Form 5307: ^ $ 1,000 ^ $ 300 c Form 5310: ^ $ 1,800 ^ $ 1,000 d Form 6406: Notapplioable ^ $ 300 e Multiple employer plans (Form 5300): (1) 2 to 10 Forms 5300 submitted ^ 1 $ 2,300 ^ 1 $ 1,500 {2) 11 to 99 Forms 5300 submitted ^ 2 $ 2,300 ^ (2) $ 1,500 (3) 100 to 499 Forms 5300 submitted ^ 3 $ 15,000 ^ 3 $ 10 000 m ~ (4) Over 499 Forms 5300 submitted ^ (4) $ 15,000 ^ (4) $ 10,000 = f Multiple employer plans (Form 5310): (1) 2 to 10 employers maintaining the plan ^ 1 $ 2,300 ^ 1 $ 1,500 ~ (2) 11 to 99 employers maintaining the plan ^ 2 $ 2 300 ^ 2 $ 1,500 a ~ (3) 100 to 499 employers maintaining the plan ^ 3 $ 15 000 ^ 3 $ 10,000 ~ (4) Over 499 emplo ers maintainin the plan ^ (4) $ 15 000 ^ (4) $ 10 000 o g Volume submitter ~ ~ 4 ~. _ • - ' ~ (1) . Specimen plan 1 ^ $ 9 000 r (2) Lead specimen plan (see Rev. Proc. 2005-16) . ^ 2 $ 9,000 U (3) Specimen plan identical to lead specimen plan (see Rev. Proc. 2005-16) ^ (3) $ 200 L ~ h Master & Prototype (M&P): (1j Mass submitter -per basic plan document with one adoption agreement ^ 1 $ 9,000 (2) Mass submitter -per each additional adoption agreement ^ 2 $ 650 (3) Sponsor's identical adoption of M&P Mass submitter basic plan document -per adoption agreement ^ 3 $ 200 (4) Sponsor's minor modfication of M&P Mass submitter basic plan document -per adoption agreement ^ (4) $ 650 (5) Nonmass submission by M&P sponsor -per adoption agreement ^ (5) $ 9,000 (6) Advisory letter for additional optional provisions -per Mass submitter basic plan document . ^ (6) $ 650 m Addition of new adoption agreement for approved plan -per Mass submitter adoption agreement. ^ $ 650 (6) Assumption of sponsorship of an approved M&P plan 8 200 (9) Mass submitter/s onsor - er trust document in excess of 10 . ^ 9 $ 650 i Grou trust ^ $ 750 L IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIP ~J VILLAGE OF TEQUESTA BOARD OF TRUSTEE'S GENERAL EMPLOYEE'S PENSION TRUST FUND 345 TEQUESTA DRIVE TEQUESTA, FL 33469 PAY TO THE ~~ ORDER OF ~$UN~IMERICAN 13AI~11C ~ ?80 TM~{MM! Oc, BwMs 101. lYWrh6 FL 9910Y FOR / S d~'t~rFrt ~rtet.;~~ l~~pC' ~~ i~'00 L L64~~' x:06 ~ 3 ~ 24~: 1164 DATE ~~'~ ~~ ~~~ ~-t3tvsm i $ ~ ~~~~ ~~"''r~~~`~'' DOLLARS B ~ ~~ ~\ ,~ ~ ,r. ~~±~ j ~. ;,._.. , r M, ,- _~! -- 0000008 38 3~~'