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Documentation_Pension General_Tab 06_11/02/2009
~Ieindcg # „ mate: ~~ _ i : - ~ ~~ l~ai~ ~ Rem t® wept. ~e~d®~- ~1a1'~e: ~ ~ ~ ~ ~ r Address: ~~° ~, ~~'-~ r ~~~~~ Real®ffi emir Res~uest: (Please attach ~app~°®pr-a~ate d®~aaa~aentcata®ve) ~ ~ r; l ~hs>r~e tc Acc~sl.a~t I~T~. ~ u ~Z : ~' ~ ~ r ~~ ~ / ~ l,~ ~ ~A~cuant: ~ ~ ~ ~ ~ ~ 'I'®ta9 ~ ~. ~ ~ ~ ~ ~ ~~ Requested ~y: ~ ~ ~= Appr®ved I3y: (I~epartrxaent dead) ~pec~a~ Iirlst>r~act~®a2s: QIJES'I'S RECEIVED Ili ~'I1V~TCE ~Y Z'iJESI).AY AT So~O PM 1~II..I. ~Y AV.~I,.I,E F'®lt I)IST'RI~IJT'I®I~1 ~Y T~ F®I.I.OVVII~~ 1®'IO1~dI9~-~I AZ' lid®®I~o PLEASE PIS Y®IJIt It~~UES'I'S ACC®it~I1~GI~Y4 WP80\MyFiles\Check Request BUSINESS SERi/ICES C®NNECTI®N, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 September 8, 2009 Invoice No. 9-113 T®: General Employees' Pension iN\iC~iCE Attend Regular Quarterly Meeting on 8/3/09 and prepare minutes and synopsis. (Attendance at meeting 3 hours; preparation of minutes & synopsis 5-1/2 hours) 8-1/2 hours @ $33.98 Total Due .................................................................... $288.83 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 VILLAGE OF TEQUESTA BOARD OF TRUSTEE'S GENERAL EMPLOYEE'S PENSION TRUST FUND 345 TEQUESTA DRIVE TEQUESTA, FL 33469 1219 DATE 1~..' d~®~ ._._.,._ PAY TO THE ORDER OF ~-~~.t .(~Dl~_ ~C~',1,~ ~(~ ~~l ~f~1 ~ 17 ~ ~p~~ . ~~ . ~W (~7 Aa 1Y~-2,~1. ~ u-s~'L°C~ ~ ~ `ar(6l ~ ~~! ~ ~'U DOLLARS 8 av,~^~°~,~ ~ ~ ~ SUN~IMERICAN BANK' FOR Q~ 3 i~'OOL2L9~ x:06 13L24~: L/ ~~ ~ ~ 0000008 38 iii' Fle~d~~ # IID~ge ~~' ..n i ,, e y: l~i(~fl9 I~ ettaflrra~ ~® ~e~s~, y f ,. C -.~,+-~ afi~ ~.Y ?e' f F J J n ~4.,,~ rr ~P ~~; d ~e~®~ ~°®~ ~eq~es~: (~Ye~es~ ~aPt~a~h a~~~®~~-g~aPe ~~~aa~~~aPs~Pi®r~~ ~ o ~ -. ~~ _. ~ ~ ~ a ~ ~L~~TI'~~ ~~ £T_4rW~bC3Sl~, ~~© - ss ;t f Sri E 8 d I £]111Lll'LYiLL1lIl~< f Req~aesged ~y: ~~~~...~_~:~~:~: '._A° ., ~~n_1` A ~®~ed P~ ~y: ,~ ~ep~trnent I3ead~ Spec~a~ Ia~stnac~®a~: QL1ES'~'S C~I~I) Ili N.~1CE TIY ~'I.TESI).~Y A~' ~°0® ~lbd LL ~Y ~VL I,E F'®It DIS'T1tI~iJTI®N I3Y TIC F®LI,O~'VII~G ICI®~iI).~Y A~' Pd®®No PIJEASE I~ Y®jJ~t ~~JES~S ACC® I1~GI~Y! ~~ !" WP80WIyFiles\Check Request SHE ~W ®FFI~ES ®F ~E~~x ~ JENSEN, LLc ANN H. PERRY aperry@penyjensenlaw. com August 25, 2009 Via Emaii Village of Tequesta General Employees Pension Fund Lori McWilliams, Pension Coordinator 345 Tequesta Drive Tequesta, FL 33469 BONNI SPATARA JENSEN bsjensen@penyjensenlaw. com Re: Legal Services Provided Invoice #63275 Dear Lori: Enclosed please find the Firm's invoice for services rendered for the period that ended 8/1512009. Thank you for your payment of $2,524.50. Your current balance due is $1,607.78. If you have any questions, please do not hesitate to contact me. Sincerely, r l Bonni S. Jensen BSJladt Enclosure Copy to: Michael Rhodes, Chairman Via Email Only 400 EXECUTIVE CENTER DRIVE, SUITE 207•:• WEST PALM BEACH, FLORIDA 33401-2922 PH: 561.686.6550 •:• Fx: 561.686.2802 ,~ ~~ THE LAW OFFICES OF PERRY ~ JENSEN, LLC 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 August 24, 2009 In Reference To: For professional services rendered as follows: Client /File No.: 1012 Invoice #63275 Professional Services Attendance at Trustee Meetings 8/3/2009 BSJ Attend Attend meeting Attendance at Trustee Meetings SUBTOTAL: Forms 7/21/2009 BSJ Review Review Refund of Contributions Form and email from Lori McWilliams Forms 7/22/2009 KA E-mails E-mails with Lori McWilliams re: benefit payout form Telephone calls with Betty and message (detailed for Lori McWilliams Forms Hrs/Rate Amount 2.75 550.00 200.00/hr [ 2.75 550.00] 0.25 50.00 2oo.oomr 0.30 22.50 75.OOmr SUBTOTAL: j 0.55 72.50] Tequesta General Employees Pension Fund Page 2 Hrs/Rate Amount IRS Determination Letter 7/17/2009 BSJ Review and Revise 0.50 100.00 Review and revise letter to Margaret Saito 200.00/hr Prepare exhibit(s) IRS Determination Letter ADT Review and Revise 0.10 7.50 Review and revise Appendix F Schedule 2 per attorney markup 75.00/hr IRS Determination Letter KA Prepare 2.00 150.00 Prepare Documents to submit in response to Internal Revenue Service 75.00/hr letter of 6/15/09 Draft list of exhibits IRS Determination Letter ItA Review and Revise 0.50 37.50 Review and revise cover letter in response to Internal Revenue Service 75.00/hr letters dated 6/15/09 per attorney markup IRS Determination Letter 8/11!2009 BSJ Correspondence with 0.25 50,00 Correspondence with Internal Revenue Service -Request for 200.00/hr Extension of Time to respond to 2nd request IRS Determination Letter SUBTOTAL: [ 3.35 345.00] IRS Matters -General 7/24/2009 BSJ Correspondence with 0.25 50.00 Correspondence Memorandum to Administrator re: Notice 1036-P - 200.00/hr new withholding tables IRS Matters -General SUBTOTAL: [ 0.25 50.00] In_v.Mgr -Dana 8/6/2009 ADT E-Mail 0.10 NO CHARGE E-Mail to Board of Trustees Exhibit A from Contract 75.00/hr Inv Mgr -Dana SUBTOTAL: [ 0.10 0.00) Investment Policy Guidelines 7/28/2009 BSJ Review 0.25 50.00 Tequesta General Employees Pension Fund Page 3 Hrs/Rate Amount Review Investment Policy Guidelines 200.00/hr Review Fla. Stat. §112.661 and SB538 E-mail to Dave West at Bogdahn Consulting re: changes and suggestions for Investment Policy Guidelines Investment Policy Guidelines SUBTOTAL: [ 0.25 50.00] Meeting Notices and Agendas 7/29/2009 KA E-Mail 0.20 15.00 E-Mail to Betty Laur & Lori McWilliams the disability language to be 75.00/hr printed on the meeting notice and agenda Meeting Notices and Agendas SUBTOTAL: [ 0.20 15.00] Misc Matters 7/21/2009 BSJ Telephone Call 0.10 20.00 Telephone call with Keith Davis re: rehire after retirement 200.00/hr Misc Matters 8/6/2009 ADT Telephone Call 0.10 NO CHARGE Telephone call to Michelle Gload re: complete Contracts for Fund (left 75.00/hr message} Misc Matters SUBTOTAL: [ 0.20 20.00] Plan Document 8/5/2009 ADT E-Mail 0.20 NO CHARGE E-Mail to Board of Trustees current Pension Plan Document 75.00/hr Plan Document 8/13/2009 BSJ Attend 1.75 350.00 Attend Village Council meeting 200.00/hr Plan Document SUBTOTAL: [ 1.95 350.00] For professional services rendered 9.60 $1,452.50 Additional Charges Tequesta General Employees Pension Fund Page 4 Qtv/Price Bill File 7/17/2009 PJ UPS Delivery 1 19.53 United Parcel Service Invoice No.: OOOF49280309 19.53 Tracking #1ZF4928019393247452 to /from Internal Revenue Service Bill File 8/15/2009 PJ Photocopies$ 543 135.75 Copy Charges 0.25 Bill File SUBTOTAL: [ 155.28] Amount Total additional charges $155,28 Total amount of this bill $1,607.78 Previous balance $2,524.50 Total payments ($2,524.50) Balance due $1,607.78 i/ILLAGE OF TEC~UESTA BOARD OF TRUSTEE'S GENERAL EN1PL09(EE'S PENSION TRUST FUND 345 TEQUESTA DRIVE TEQUESTA, FL 33469 Ps4Y T® TSiE ®R®ER ®F_ .:~. SUNAMERICAN SANK 250 T~eq~ues^le Dr., Suite 101, Tequaela, R 33499 ~y~7e ®03 1.X3 ~ V ~~ ~. 1J~_ ~`~'`'`~ ~~ ]0 1 2 L4ii° 1:06?0 L3 ~ 24~: 1214 ~~ ~~ 63-1312/870 DATE ~ >>~°~ ~~ ~ ~ o© ®®LL~~S ~ oa~,ba~~~~s ~/ ~.~ //f %~ffy C.Y' `~ L'~v''~` G: o`er NA /_-~- 0000008 38 3ii° 6 ~ ~:~ ~ ~-~~~~5 Vendor # Date: ~ ~,c~ ~ Mail Return to Dept. Vendor I~Iame: ;, ~ ~-~~ _~~ {~ ~- ~ ~ C i ~ ~ ~ r, ~, ~_ ~~~~ ~ . ~: t~~ ~ ~~~ ~ f ~' r' i ` f v ~• Address: ~~ L; ~„ ,` ?~~, R/eason for Request: (Please attach appropriate documentation) (, ~., L~- ~; '"a.- ~ C/4~ ~ ~.'~. •'~'?"i,~ - °d°7 ,~~ ~r ' ~ '` ' I""C ~'' ` ~ _ _ ~; ~!" ~ i. f t j ?,.fr: ! z E{ r °7 j~ ~ ~d `4 . r.C..a' ~~'~..~~ ~~ ~r~~'Y~t ~`}- ry ~: se._ ~~ -~=''l "~~ `,[ "~~."'11~~' ~ 4~'Of '~,/ )~~ ~~~ Chazge to Account No. _ Q~ ~ Da~..~i 5~/, 3 a oAmount: Total ~ ~~ f ~`~' ~~~~ Requested By: f t~ ~°`~,: ~ Approved By: (Department Head). . Special Instructions: RE~IUESTS RECEIVED IN FII~IANCE BY TUESDAY AT 5:00 PM WILL BY .AVAILABLE. FOR DISTRIBUTION BY THE FOLLOWING MONDAY AT NOON.. PLEASE PLAN YOUR REQUESTS ACCORDINGLY! WP80\Myfii~u\Chtck . Requast The Stuart News ~ St. Lucie News Tribune Indian River Press Journal ~ The Jupiter Courier ebasiian Sun ~ TC Palm ~ Treasure Coast Business Journal PAGE # 5 BILLING DATE 1 08 31 0 ^B BILLED ACCOUNT NAME AND ADDRESS LORI MCWILLIAMS VOT PENSION BOARDS 345 TEQUESTA DR TEQUESTA FL 33469 Vzs/U1/Uy - Utj/jl/Uy VU'1' Y~lySlUN 13UARDS TOTALAMOUNT DUE °UNAPPUED AMOUNT 3 TERMS OF PAYMENT -- - 336.00 NET DUE END OF MONTH CURRENT NETAMOUNT DUE 22 30 DAYS 60 DAYS - OVER 90DAY5 - 336.00 .00 .00 .00 6 BILLED ACCOUNT NUMBER 7 ADVERTISER/CLIENT NUlv1BER 15614928 9 REMfRANCE:ADDR€SS -' SCRIPPS-TREASURE COAST PO BOX 630807 CINCINNATI, OH 45263-0807 0101,7D42~9DDDDD336DD1 PLEASE 9)ETACH AN® RETURNI UPPER P®RT909t9 !!119TH V®UR REdM9TTANCE 10 DATE - 11 ~NENlSPAPER REFERENCE - 13 14 DESCRIPtlON-OTHER COMMENTS/CHARGES - ~ 15 16 SAU SIZE BILLED UNITS 17 18 -- TIMES RUN _ - RATE. 19 -- GROSSAMOUNT --~NETAMOUNT 07/31 ----- ---------- ----- BALANCE FORWARD .00 08/09 _ 2291055 ----------------------------- 82 members wanted ---------- 2x7I --------- 1 ----------- 168.00 ----------- 168.00 --- ------------ LOUR ~ 14I 12.00 08/16 --- 2294504 ----------------------------- 82/MEMBERS WANTED ---------- 2x7I --------- 1 ----------- 168.00 ----------- .00 COUR 14I 12.00 ----- ------------- 100% CHAR DISC - -100.000 -168.00 08/23 -- 2294504 ----------------------------- 82/MEMBERS WANTED -------- -- 2x72 --------- 1 ----------- 168.00 ----------- 168.00 COUR i4I 12.00 ~~~ ~~ o tA~ WILLI4GE CL RICE e0F~10~ STe4TElV1E101T ®F /#CC®l1NT AGING OF PAST DUE AMOUNTS. A SERVICE CHARGE OF 1'la°k PER MONTH WILL BE ADDED TO PAST DUE BALANCES. SdIT"' - -• 21 CURRENTNETAMOUNTDUE 22~--:` ~-.300AY5'--- - i ~: _' ~~ioAr, ~ ~'- ~~~ "UNAPPUEDAMOUNT,. 23 TOTALAMOUNTDUE ~ ~ 772-223-9191 FAX 772-600-1474 REMITTANCE ADDRESS: i~ Scripps Treasure Coast Scripps-Treasure Coast •' News a ers Toll Free 1-877-560-9191 Po Box 630807 P P T'(-'Narr~nr„t~r••r(nlcn ~.-.r.~. !';,,.-;....ter; nu n['f~'1 nom -- INVOICE NUMBER 25 - -~ ADVERTISERiNFORMATION _ 1 BiLUNG PERIOD 6 -; BILLED ACCOUNT NUMBER 7 AL))tERTISER CUENTNUMBER 2 AAVERTIS~R CU NAME 1704209 08/01/09 - 08/31/09 15614928 VOT PENSION BOARDS v.•wr.Nncu auwu~na aro n~ciuaea In coEal amount aue FED ID# 59-1093327 Billing Code Legend on reverse side FORM 102 VILLAGE OF TEQUESTA BOARD OF TRUSTEE'S GENERAL EMPLOYEE'S PENSION TRUST FUND 345 TEQUESTA DRIVE TEQUESTA, FL 33469 PAY TO THE StC ~ (, S ORDER jOF PP ~/ _~ ~-t-t..r-~r~ $UNAMERICAN BANK ?50 Tequeam Dc. Sala 101. Tequesle, R 39A6B ~~~~ FOR C~ y ~-~~~~~°~>~_n,~ ~ n , ~ ~~''~~T'DOL2~711' i:0670L3L24~: 1217 C~ ..,~.. i L1 ~Q~ 63-1312/670 DATE °•~' J[ rT" ~ ~~~~~ V ~~ -~. y9 ~ P , ~ , 0000008 38 311' r ~~~~~~ld ~Ll' ll ~~ l4~ J1~4~" ~~ ~,llll1Ld~,~ ~ lV L:d~ l~ ~~ndQ3fl ~ ~~~~, ~ _~ ~ ~ °~- ~°',1 `,' ~~~fl R~t11E"Y~& t® D~~Dt. _. . Vcnd®fl- Nye. , ~.~~~. , ,,~~ r .:~~~ ,~~~ ~- ,.~..~ , Ufa. ;; ,,~. ~ ~~ ~..,~~' F. ! c,~~__.~ .d Address. ~ v a."~'~ ~ ~ ~-~a~ ~.~° ~a~ ~ ~ r J F ~ ~; tr .. .. _ ~ ~ t 1 ~ N ~ Reas®n $°or Request: (Please attach apps-®preate d®Ca~~ae~tcatt®r~~ ~'°i~.a^ -~ i H~>.~ ~ ~ v , q. ."/~ ,..~- ~,R~"'-"(.may-,/i ~r .~ '~ f J s''s.~~ ,~-~ ~' :~, r `¢ _. ~ 'ed. S~. v ~ `~.irr ^~~./~f4.f ~..if 3'Pr' i4'f._/~ L ~;~~f}..p ~-~-~-F~'.2.~ I ~" ~ E ~~.L'r- b'",-~ ~.:,.:: ~~~rge to Acc®unt N®. ~~ ~ ~ ~'~, ~a ~ ~ u ~:~; -~t' ~~ 'A&xnount: .°~, t < <~'. ~~ ~: ,.° Requested By: ~~°~<- ~ =G~:~. ~` •~ ~~ ;'"'~'~=i.~~- :.~ 0~ Approved By: ~' department Bead) Speciafl Instructions: REQUESTS ItECEIVEI) IN FINANCE BY T'iJESI)AY AT' 5:00 PM i~VILL BY AVAILABLE. F®It I)ISTItIBU'I'I®N BY TI~IE F®LLOVVING M®NDAY AT N®®Ne PLEASE PI~AI~ Y®UIt ItEQUES'I'S ACC®RDI1o1GLY! WP80UV(yFiles\Check Requese d7~11~~~~ ~~RVI\.b~~ ~®A~Il~l~0.sTlin~, I~. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 5C 1-694-1591 July 17, 2009 Invoice No. 9-91 TO: General Employees' Pension ENV®iCE Office work for week ended July 10, 2009 .........................3.75 hrs Office work for week ended July 17, 2009 ...........................3.75 hrs 7-1 /2 hours @ $33.98 Total Due .................................................................... $254.85 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 rl ~ c' !~ ' ~$ „Y8 V ~ 1 .1 ~'~ ~ ~'.I_ J `fl i{~ ~ q~ 1 ~~ _~ /~~ e~a. ~ v. .,~,~„- 61d 11 ~~ I f~61 II ~~ ~' I. _ ~~~ ~ .~ ~I /~ ~, ~~ ~I •~ w `°~~ ® I ~ \ ~ ~ ®_ ) ~ { r ; ."\~p [ c I ~~ ~`/ .. ~~ i O •W '` ' x _, O I J f \V .., tea' O ~ 't I~ ~ry O i O t ® li ~ ; e , ~ ff 4j T~~ 1`S ' ® l Y`d ~ f ~ ~ ~^ ^ "~ s 1 " ss~~ V/ ~ ~ ~ ~ 1 LI ~~ ~ ~ ~ ~ (~ , •-a LL B° --~ i O i ® ~ C~ +~. W m Q ~ ~ ('7 SJ ~ ~ r ~ ~~ ~~~ff11 p~p Q ~ ~~`1` M ~ +~ ~. Y.A k,b N LL i,i~ i ~ W W ~ ~ ~'1i ~ ' ~~ c s ^ ~ r'lJ IJJ v aa ~ i ~ y 1 .-! / ( ~y ~ .~. ~ !r v ly!~.~ FFF~ ~ [.1 ® W y ~' ~ ~ y i/ eYe,s, W = ~ r` ~` ~~ ~! uJ ®w ~ --s ~ ~; ~®~ O ~ ~ i;~ ~ ® + .~ ~' REQUESTS RECEIVED IN FINANCE BY TUESDAY AT 5:00 PM WILL BY AVAILABLE FOR DISTRiRi1Ti(1N RV Ti-~G' Fnr r nwrwr_ t~nrntvn ~ v ~ •r ~rnniv BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 July 31, 2009 Invoice No. 9-97 TO: General Employees' Pension INVOICE Office work for week ended July 24, 2009 .........................3.75 hrs Office work for week ended July 31, 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 VILLAGE OF TEQUESTA BOARD OF TRUSTEE'S GENERAL EMPLOYEE'S PENSION TRUST FUND 345 TEQUESTA DRIVE TEQUESTA, FL 33469 ~~v t®-r~ E ~ ~. ~ t ~l ~~ ~ ®R®~R ®F ~~ ~` Su~rAn~Exlc.~t ~A 250 Teq~res~ Dc, Suite 101, Tequesle, R 33489 F~ ~ ~ ~ ~ ''~~~-`fi ~~ 20611' x.06 70 ~ 3 L 24~: 1206 ~S" 63-1312/670 ®ATE i n~~ _r~1 ~ i ~~A c~~ ®®LL~~S ~ ~~ d~aan° 0000008 38 311' ~Iea~d®g # I~a~te: ~ E . ,-, ~, Dail Retwn to Dept. Ve~ado~° h1e~ .~~ R ~ ~ `_ Reas®~ for Request: (lease attach appropriate d®~a~araentation) .~ ~~~ f ~:. ~ ~ ~~ ~~ u { ' ~ _. i .,c.. ~,~ ~' - _. ,,.; ~19ar~e t® t~c~®llfl'&t ~®. X44 `.~ . E ~~:~.. ~-;~ ~>' ~ ~. ~ ~~TH'AC3C~.Elt: f TOta] ~az.1 cam- ~p ~~ ~~~ -~° Requested )~y ,"~~_~ _;~~ _ ~ ~ - ~ ,~ ~~` ~ ' ~ ~ ~'~ ~~°t~' 4 Approved y: ~epartrnent Head) Special Instructions: I~QiJESTS I~CEIYI'JD IN I'INANCE >3Y TiJI';SI)AY AT 5000 PNI WILI.I3Y A~AILAT3I..E F'Oit I)ISTRIII[J'I'ION ~Y THE FOI.I.,OVVING Z~IONDAY AT NOONe PLEASE PL, Y®IJIZ 1tEQ~JESTS AC'C®RDII~GI~Y! WP80\MyFiles\Check Request B~~E ~I~ic~s n~~~c~i®n~, inc. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 August 14, 2009 Invoice No. 9-103 T®: General Employees' Pension !~!!!~lCE ~, .a ~~; -r. Office work for week ended August y 2009 ......................3.75 hrs Office work for week ended August 14, 2009 ......................3.75 hrs ~~~~ ~z-.~9-hours @ $33.98 Total Due .................................................................... $254.85 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 V9LLAGE OF TE(~UESTA EOARD OF TRUSTEE'S 1213 GENERAL EWIPLOYEE'S PENSION TRUST FUND 345 TEQUESTA DRIVE TEQUESTA, FL 33469 ~ 63-1312/670 ®~T~ { 18 ~ PAIf 'T® T9iE ~~ir~-~~'~S ~~~"' t~ i ~ ~ ~~o-~, I L~`J D®~~~RS ~ ~~ ~~.. ~ --~,, ~a 0000008 38 311' ~` '~~ ~~ ~~~~~Qir~ ~~ ~~~~~~~~ ~~~Q,~ ~~~~~ ~le~d~g # Oate: ~:~,; ~~. ~~ ~~ .d.- ~~ ~"~ l~aa~ Rem ~ Oept. ~1end®H'~~A'pe: ~?-s~.~w~,~ d.~~.ti, 1~_L-' ;~ ~~.y:r a~t. `~`~~' ~t~-'~~~E~.o. Address: ~.r-~., ~~L%~.a~ ~~~^~.~f.~% ;ra~..~-F:,.~~~'.a --~~~" F 7 t Real®~ for Request: (Please attach app~°®p~-i~ted®c~cnaenta~3ti®n) ~, /~ ~ ~ ~w ~ z ~~ ~f ~-~i 'C ......~%' _,E.l.: ~ ;~ i i 1 p ~;:'~~ 1~'.~,,~"t;,~j br~p Tiyt`.~/1,;~ `f ~~' , ..;, ",,/y.~ d. i%° ~~,....... Q:har~e t® ACC®~t man, ~,G~'v;~,~~ ~e~':. ~/, ~l'i.~ 'fin®ttnt: as ~~` ~~~ °~ Requested ~y: ~~....~_~ ~ ~~j ;~c:,.e~...:~~..,.,~ Approved ~y: (I)epartrr-er-t Dead) Speceal Instructaoras: QUEST'S 1~ECEIi~D IN ~NANCE ~Y T'UESDAY AT' So00 P1VI Vi~ILL ~Y AVAILABLE F®It I)ISZ'IgI~UTi®N ~Y 'I'I~E F'®LLOVVING 1VI®NDAY AT' NO®N. PLEASE PLAN Y®Uit ~QLTE~'T~ ACC®~IN~I~Y1 WPSOVNyFiles~Check Request ~tJSINESS SERVICES C®IVNECTI®IV, INCo 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 August 28, 2009 Invoice No. 9-109 TO: General Employees' Pension II~V~iCE Office work for week ended August 21, 2009 ......................3.75 hrs Office work for week ended August 28, 2009 ......................3.75 hrs 12.50 hours @ $33.98 Total Due .................................................................... $254.85 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 VILL~4GE ®~ TEQUESTA S®ARD OF TRUSTEE'S GENERQ-L EAAPL®YEE'S PENSI®N TRUST FUND 345 TEQUESTA DRIVE TEQUESTA, FL 33469 P,4`l T~ THE ®R®ER ®F_ ~.~E SUN1~MlERICA~i BAMC ~` lil 250 Tequesta Dc, Sutta 101, Tequesta, FL 334M I~ F®R ~~. ~ -~ ~- ~ ~'~ ~~~' 0~2L611s ~:0670L3~24~: 1216 ~1 F1 ~/~(~ 63-1312/670 ~~.c~. ~ ~~ . ~~ ~®~ ®®LLARS ~ ecunNFe~Nes I~ci scan F, _ ,r r,~ 0000008 38 311° ~ ~ ~~~ willp — - - - Mix � I wiv,(oj!, me I I I a Q! gnal"I I k(t, Us I a I IN BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 September 11, 2009 Invoice No. 9-115 TO: General Employees' Pension INVOICE Office work for week ended September 4, 2009 ................3.75 hrs Office work for week ended September 11, 2009 ................3.75 hrs 7.50 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 TEQUESTA BOARD OF TRUSTEE'S 1218 GENERAL EMPLOYEE'S PENSION TRUST FUND 345 TEQUESTA DRIVE TEQUESTA, FL 33469 q-~31yg/p DATE ~''~~ ~ ~ . ~ ~ PAY TO-THE ~ ..~~, ORDER OF ~ ~ l nos ~ ^ (~ ~ ~ ~~C~trc-~v" \ ~ '~ ~.. ~~ ~~ ~ ~ ~© `°-----DOLLARS B , ;~~. v V ~} ° '~ SUNAMERICAN BANK i;'~ '~~~ 250 Tequ.~M.~e~Dc, Sib 101, Tsquaet~, R 39488 >. ~ FOR ~. l~.~c7G ~ ? h ~~ ~" i ~ 1~ L 2 1811' x:06 70 ~ 3 ~ 24~: 0000008 38 311' \Iendor # Date: ~ -- a 5 = ® Mail ~ ltetngn to 13ept: ~~ a ~lendog lllame: ode: -; .. ,~, ~. ~ 1 ~~.n~~.er°~~c> ~Q -~,1 Address: _ Z~~j '~-~.~~,~~ _ ~~~ Reason for Request: ~Plecese attach crpprvpraete docasmentataon) ~~ ~ ~ ~rr~ r charge to Accour-t ATo: ~ 6 ~ , p 6 ~ , 5 ~ / , 3 0 ~ ',mount: Total 0`1 ~ y • ~ ~J Requested I3y: -1_ Approved By: r1-- (Department Head) Specaal Instructioaps: BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 September 25, 2009 TO: General Employees' Pension INVOICE Invoice No. 9-120 Office work for week ended September 18, 2009 ................3.75 hrs Office work for week ended September 25, 2009 .................3.75 hrs 7.50 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 TEQUESTA BOARD OF TRUSTEE'S GENERAL EMPLOYEE'S PENSION TRUST FUND 345 TEQUESTA DRIVE TEQUESTA, FL 33469 PAY TO THE ~ _ _ ORDER ®F '`a. ex~ ~ P_1C' ~-„7-..~ ~~-. i_ ~.l ~ ~1 .~"~ ~~ ~~~~,`_~ ~~ SUNAMERICAN BANK 250 Tequeete Dc, State 101 Tequeste, R 334ti0 ;. ~~~~ ~ 11~ ~~ .pi~.~.~670L3~24i: 1220 ~~ ~'°' '~ `~~~' 63-1312/670 DATE '- l ~°~ ~~ ~~'~ D®LLARS B o °~~~,~` ~~ ,~ ~~~~ ~~-~--rte ~ _--~ ~---- --------------_---------___--- 0000008 38 311 V J~11.dll.d~~~ ~~ ~1T'r~~.J~~ 1~1 ~...~1~g`e~~ ~FU~a~~ G Vendor # ~ Date: ~ -~ ~ ._ t~ ~ ~ IiRail ~ Return t® Y)eptl~ A VeH~d®L d ~M1OpEAe. / V i ~ SYY U ~f.~I/~9JI • II A~ l d.~ it viA /1 A~. J Address: ~-~ ~ ~~ ~,,r ~~ ,, ~~~ ~ ~ ~~ Real®n for Request: (Please attach appropriate docaanaerttation) ~laarge to Account I~To. _C~ ~ ~ , lJ ~ U,,~ /, d ~ ~Arnocaa~t: Requested 13y: °~~ ~ ~.t.~ A raved ~ ; J Pp . Y L'~',~-~- ` (Department ~-Iead) Special Instriacti ores: WP80UNyFileslCheck Request BUSINESS SERVICES CONNECTION, INC. 260 Riverside Drive, Palm Beach Gardens, FL 33410 561-694-7963 Fax: 561-694-1591 September 30, 2009 TO: General Employees' Pension Invoice No. 9-125 INVOICE Office work for week ended September 30, 2009 ................3.75 hrs Office work for week ended October 2, 2009 ........................0.00 hrs 3.75 hours @ $33.98 Total Due .................................................................... $127.43 Please make check payable to: Business Services Connection, Inc. 260 Riverside Drive Palm Beach Gardens, FL 33410 VENDOR # d0~ (O _P.O. # _-._ INV. DATE D ~ INV. # ~ l°L~ c . # i v, ~ . ~ ~ DE A MENT HEAD DATE RECD. FINANCE APP. VILLAGE OF TEQUESTA BOARD OF TRUSTEE'S GENERAL EMPLOYEE'S PENSION TRUST FUND 345 TEQUESTA DRIVE TEQUESTA, FL 33469 PAl( T® T9iE ®~®ER ®F_ ~-'~~~ nee ~~~,..~ V '~SUNAMERICAN BA `~j 250 Tequesta Dr., SuiEe 707, Tequeate, FL 3389 F®F3 ~// ~ i.~ rr~~Ca ~~~®' ~ II L`22 11' ~:0670L3L2~.i: 1221 ~ 63-1312/670 ®ATE ~_. ~~ ~~nec_ ~ 1~ ~~~ 7 C~ ~ 0000008 38 311' ~~ <, ~~~~~~~ ~~ ~~~~~~~~ Q.~~~.~ Q~~~~~ ~Iel:>td®~ # ~Ies~d®~ I~la~e: mate: ~ ~ /~ ~/ bail ~ Return t® Y~ept. Address: _ ~ 1 ~J ~ ~°'Z.~~t ~~~°~ (~-~. tf ~~ Real®~ fmr Request: (Please attach ap~popracate docunaentataon) jf ~_ q~ F~ ~ ~ ~ d E ~ ~~ Char; ge to Accouait IiTo. ~ ~~ ~ o ~~~~, ~~ y ~ C%~' ~ .A>~®~t: Requested ~y:;~~ ~-- ~~.,~,~ ~,~s d~ Specie al Ir~structi ®ns: 'T'otal (Department T-Tead) ~ o I~.e n ~ ~ ,. , 1 ~ .,c.~ a b~ M~~; ~ ~ Il~QUES'Y'S I~CEIVEID IN ~'ITV.CE ~Y ~'UES®A~ ~'I' Sr®® PTVd ALL ~Y AVA~LA~LE F®lt DIS'I'RI~U1'I®I~ ~~ 'I'II F®I~I,~VVI~TG IVI®Nl)AY AB' 1`1®®I~1e PLEASE PIJ YiJlt 1tEQUES'TS ACC®~II~GI~Y! WP80\MyFiles\Check Request -~~~~ 11505 Fairchild Gardens Ave., Ste. 202 Palm Beach Gardens, FL 33410 Tel: (561) 626-6797 Fax: (561)626-6970 INVOICE To: Village of Tequesta ATTN: Merlene Reid 345 Tequesta Drive Jupiter, FL 33469 Customer Date Terms Inv. No. T0052-069 08/10/09 Due Upon Receipt 19290 Description Charges PRM34 Premium Due: Fiduciary Liability Village of Tequesta General Employees Pension Fund Policy Period: 10/01/09 - 10/01/10 Policy #: 103505325 PRM34 FHCF Surcharge: $4, 097.00 $40.97 Invoice Total: $4,137.97 TRAVELERSJ~ September 17, 2008 This is an Agent Bill Policy. ATTN: Ellen Jones GEHRING GROUP INC (OCJZ86) 11505 FAIRCHILD GARDENS AVE SUITE 202 PALM BEACH GARDENS, FL 33410 Donna M Corona 4631 Woodland Corporate Blvd. PO Box 31967 (33631-3967) TAMPA, FL 33614 Phone: (813) 890-4069 Fax: (800) 265-1498 Email: DCORONA~travelers.com This is the Renewal for: VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND 345 Tequesta Drive TEQUESTA, FLORIDA 33469-0273 Product Type: FRIP NEW Policy Number: 103505325 Total Policy Premium: $8,275.94 Policy Period: October 01, 2008 to October 01, 2010 Billing Period: October 01, 2008 to October 01, 2010 Trans Effective Date: October 01, 2008 Liability: $2,000,000.00 Deductible: $5,000.00 Commission-Percentage: 15.00°k Special Commission: $.00 Gountersignature Branch: Countersignature Agent: Countersignature Commission: $0.00 Countersignature Rate: 0°~ Premium Years Agreement Year 1 Year 2 Year 3 Basic $3,808.00 $3,808.00 $.00 Recourse $289.00 $289.00 $.00 Surcharge: $40.97 $40.97 $.00 Tax: $.00 $.00 $.00 Combined Premium: $4,137.97 $4,137.97 $.Op Comments: Thank you for placing your business with us. PE-002 06-98 POLICY DISCLOSURE NOTICE - TERRORISM RISK INSURANCE ACT OF 2042 On December 26, 200?, the President of the United States signed into law amendments to the Terrorism Risk Insurance Act of 2002 (the "Act"), which, among other things, extend the Act and expand its scope. The Act establishes a program under which the Federal Government may partially reimburse "Insured Losses" (as defined in the Act) caused by "acts of terrorism". An "act of terrorism" is defined in Section 102(1) of the Act to mean any act that is certified by the Secretary of the Treasury - in concurrence with the Secretary of State and the Attorney General of the United States - Lo be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United Stales in the case of certain air carriers or vessels or the premises of a United States Mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. The Federal Government's share of compensation for Insured Losses is 85% of the amount of Insured Losses in excess of each Insurer's statutorily established deductible, subject to the "'Program Trigger", (as defined in the Act). In no event, however, will the Federal Government or any Insurer be required to pay any portion of the amount of aggregate Insured Losses occurring in any one year that exceeds $100,000,000,000, provided that such ]nsurer has met its deductible. If aggregate Insured Losses exceed $100,000.000,000 in any one year, your coverage may therefore be reduced. Please note that no separate additional premium charge has been made for the terrorism coverage required by the Act. The premium charge that is allocable to such coverage is inseparable from and imbedded in your overall premium, and does not include any charge for the portion of tosses covered by the Federal Government under the Act. The charge is no more than one percent of your premium. Issuing Company. Travelers Casualty and Surety Company of America Policy Number: 103505325 ILT-1018 Rev. 01-08 Printed in U.S.A. Page 1 of I :~i2008 The Travelers Companies, Inc. All Rights Reserved I ~~~~~~~~~ PENSION AND WELFARE FUND FIDUCIARY RESPONSIBILITY INSURANCE POLICY `:13ECl:.ARATlUNS Travelers Casualty ar-d Suret~r Comgatty vi America ~ Travelers Casualty smct Surety Company of tHir-ois Sraveler.s-Casualty and Swetq Cotrtpeiiy Naperville, lilinoie 's~&3-8 Hartford, Connecticut 96183 (A stock insurance company, herein called the Company) 1. DESIGNATED TRUST OR PLAN PQL~Y NUMBER VILLAGE OF TEGIUESTA GENERAL EMPLOYEES PENSION FUND (See Name of Designated Trust or Plan Endorsement) (See Governmental Plan Endorsementy 103505325 2. Mailing Address 345 Tequesta Drive TEQUESTA, FLORIDA 33469-0273 (Number, Street, Town, County, State, Zip Code) 3. Policy Period From OCTOBER 01, 2008 To OCTOBER 01, 2010 12:01 a_m. Standard Time at the Mailing Address Stated in Item 2. 4. Annual Aggregate Limit of Liability 5, Premium for fhe Policy Period 38 275.94 52,000,000.00 Premium Payable Current Each Anniversary 54,097.00 x,097.00 6. Insurance Representative Michael R. Couzzo, Jr. 7. Designated Fiduciaries Capacity 8. Endorsements made a part of this policy (Designated by Endorsement Number) ILT-1018 01-08, F-2817 09-98, F-1280 02-95, F-1449 09-x, F-2100 07-90, ILT-1067 01-08, ILT-5018 07-04 ® g, The premium for this policy has been paid by the Trust or Plan. The Company has the right of recourse pursuant to Condition (10). Endorsement (F-12811) is attached to eliminate re~urse. Premium for elimination of recourse: ;289,00 (included in Item 5) ~ In advance ® Each installment NOTICE: A state surcharge may apply. Please refer to your billing statement. Countersigned by (if required) Authorized Company Representative F-1191-8 (OS-98) Page 1 of 4 ,... 7RAVELERSJ Travelers Casualty and Surety Cor~any PENSION AND WELFARE FUND FIDUCIARY RESPONSIBILITY INSURANCE POLICY and Surety Company of America Travelers Casualty and Surety Company of Illinois . ,"...~• ~~ ~~ ~~~ W ~ w narooro, ~:onnecucut t>bi fi3 Naperville, Illinois BOSp-8458 THIS IS A CLAIMS MADE POLICY IN CONSIDERATION of the payment of the premium stated in the Declarations and subject to all of the terms, conditions, and limitations of this Polic the Company agrees as follows: INSURING AGREEMENT. The Company will pay ~ tx~lf of the Insured all sums which the Insured shall become legally obligated to pay as Damages on account of any claim made against the Insured for any Wrongful Ad and the Company she{I have the right and duty to defend such claim against the Insured seeking such Damages, even if arty of the allegations of the claim are groundless, false or fraudulent, and may make such investigation and settlement of any claim as it deems expedient, lwt the Company shall not be obligated to pay any claim or judgment or to defend any suit after the applicable Vimtt of the Company's liability has been exhausted by payment of judgments or settlements. EXCLUSIONS. This insurance does not apply to any claim: (1) Arising out of any dishonest, fraudulent or criminal act, or willful or reckless violation of any statute, but this exclusion does not apply to a claim upon which sutt may be brought by reason of any alleged dishonesty on the part of the Insured, unless: (a) A judgment or other final adjudication thereof adverse to the Insured shall establish that acts of active deliberate dishonesty committed by the Insured was material to the cause of action so adjudicated or (b) The claim is a claim by or on behalf of a fidelity insurer against a natural person whose dishonesty has resulted in a Ins which has been paid under a fidelity bond. (2} Arising out of libel or slander; (3) Arising out of bodily injury, sickness, disease or death, or loss of, injury to, destruction of, or loss of use of, any tangible property, including loss of currency, coins, bank notes, bullion, travelers checks, register checks, money orders, and all negotiable and non- negotiable instruments or contracts representing money, (4} Arising out of the Insured's failure to comply with any law concerning Workers' Compensation, Unemployment Insurance, Social Security or Disability Benefds, or any similar ~w; (5) Arising out of the failure to procure or maintain adequate insurance or bonds on assets or property of the Trust ~ Employee Benefit Plan designated in the ~clarations; (6) Arising out of liability of others assumed by the Insured under any contract or agreement, either oral or written, except in accerdar>ce with the Agreement and Declaration of Trust; (7) Arising out of the Insured gaining in fact any personal profit or advantage to which such Insured was rmt legally entitled ar for the return by the Insured of any remuneration paid in fact to such insured if payment of such remuneration shall be held by the courts to have been in vitiation of law; (8) For the failure to collect contributions owed to the Trust or Employee Benefd Plan described in the Declarations from employers unless such failure is due to the negligence of the Insured w for the return of any contributions to an empk>~r if such amourrts are or could be chargeable tp the Trust or Employee Benefd plan, but this exclusion shelf not apply to the Company's obligation to defend such claim nor pay the costs and expenses thereof. fll. DEFINITION OF INSURED. Each of the following is an Insured to the extent set forth below: (1) The Trust or Employee Benefd plan designated in the Declarations and any additional Trust or Employee Benefd Plan created during the policy period by the sole sponsor referred to in Item (2) below, or by any interest owned or controlled by said sole sponsor, provided written notice of such is given to the Company within 90 days, F-1191-B (05-98) (2) An employer who is the sole sponsor of such Trust or Employee Benefd Plan. (3) Any natural person who at any time hobs or shalt have held the Position of: (a) Trustee of such Trust or Employee Benefit Plan. (b} Director, officer or employee of such Trost or Employee Benefit Phan or of such sole sponsor employer. (a) Any other person or organization designated in the Declarations as a Fiduciary. (5) Any other Trust or Employee Benefit Plan of any firm hereafter acquired through consolidation, merger or takeover by the sole sponsor or by any intermit owned or c~trolled by said sole sponsor, provided: (a) written notice of such acquisttion is given to the company within 90 days of the effective date of such acquisition, and (b) The Insured pays the C~rtpany an additional premium computed pro-rata from the date of such acquisttion to the end of the Policy Period, and (c) That specific Application on the Comparys form in use at the time of acquisition is trade to the Company as soon as practicable after the aforesa~ notice is given. The insurance applies separately to each Insured against whom claim is made or suit is brought except with respect ko the application of the limits of liability, and it shall also apply to ~ estates, heirs and personal representatives of persons insured hereunder. IV. OTHER DEFINITIONS. (1) "Wrongful Act" means a breach of fiduciary duty by the Insured in the discharge of duties as respects the Trust or Empbyee Benefd Plan designated in the Declarations; the term includes any negligent act, error or omission of the Insured in the "Administration" of "Employee Benefits". "Adrrrinistration" as used herein shall mean: (aj Giving counsel to employees with respect to Err~loyee Benefits; (b) Interpreting Er-rploYee BenefHs; (c) Handling records in connection with Employee Benefits; (d) Effecting enrollment, termination cx cancellation of empbyees under an Employee Benefits program. "Employee Benefits" as used herein shall mean the Trust or Empk>yee Benefit Plan designated in the Declarations, Workers' Compens~ion Insurance, Unemployment Insurance, Social Security or Disability Benefits. (2) "Insurance Representative" means the person designated in the Decorations as the exclusive agent to as on behalf of the Insureds, individualry or ctilectivetyr, in all matters relating to insurance under this poly. (3) "Damages" shall mean sums of money payable as compensarion for loss or in discharge of an obligation of an Insured to make good a shortage in the Insured Trust yr Employee Benefit Plan. The word "Damages" shall rrot include: (a) Fines, penalties, taxes or punitive ar exemplary damage. (b) Benefits due or to become due under the terms of the Trust or Plan, unless and to the extent that recovery for such benefds is based upon a Wrongful Ad and is payable as a persmtal obligation of an Insured. V. POLICY PERIOD: TERRITORY. This insurance applies only to claims first made during the policy period described in the Declarations within the United States of America, its territories or possessions or Canada; provided the Insured at the effective date of this insurance had no lorowledge of or coin not have reasonably foreseen any circumstances which might result in such claim. Page 2 of 4 Vt. LIIUiITS O!= t.3la,BILITY. Reg2~dless of the num~er of persons err orgar=izations brnging claims or suits against the Insured and regardless of the number of persors or organizations insured hereunder, the total limit of the Company's liability to pay Damages because of alt claims made against the Insured during any single policy year shall not exceed the amount shown in the Declarations as "Annual Aggregate Limit of Liability', regardless of time of payment. If the policy period described in the Declarations is for a term of more than one year, said "Annual Aggregate Limit Liability' shall apply separatety to each consecutive annual period. VII. CLAIMS MADE EXTENSION CLAUSE, If, during the policy period hereof, the Insured shall first become aware of any Wrongful Act which may subsequently give rise to a claim against arty Insured and shall during the policy period hereof give written notice to the Company of such Wrorxlful Act, then any such claim which is sutxaequently made against the Insured arising out of such Wrongful Act shad for the purposes of this policy be deemed to have been fast made against the Insured during the policy period, VIII. SUPPLEMENTARY PAYMENTS. The Company wid pay in addition to the limits of liability shown in the Declarations ail casts, charges and expenses incurred by the Company in the investigation, settlement, defense and negotiation of any claim caning within the terms of this insurance, but, in the event of any judgment in excess of the amount of the aggregate limit available under this po{icy, the Companys liability for the costs and expenses incurred by it a with Its consent shall be such proportion thereof as the amourrt of the aggregate limit available under this policy bears to the amount paid to dispose of the claim. In no event shall the Company be obligated to pay any claim or judgment or to defend or continue the defense of any suit after the aggregate limit of khe Companys liability has been exhausted by payment of judgments or settlements. The Company will pay in addition to the Limits of Liability shown in the Declarations reasonable expenses incurred try the Insured at the Companys request. IX. CONSENT 70 SETTLE. The Company may, with the written consent of the Insured, make such settlement a such compromise of any claim a suit as the Company deems expedient, and if the Insured shall refuse to consent to the settlement of any claim a suit recommended by the Company, based upon a judgment ~ a bonafide offer of settlement, the Insured shall thereafter negotiate a defend such claim ~ suR independentty of the Company and on said tnsored's own behalf, and in such event the Damages and expenses accruing or determined through litigation or otherwise in excess of the amount fa which settlement could have been made as so recommended by the Company shall not be recoverable under this policy. X. EXTENSIONI CLAUSE !t is agreed that at any time prior to termination or cancellation of this policy as an entirety, whether by the Insured a by the Company, the Insured may give to the Company notice that It desires to be insured for an additional period of twelve (12) months after the effective date of termination or cancellation, at an additional premium of 2596 of the premium hereunder, for claims made against the Insured during the said twelve (12) month period by reason of a Wrongful Act -a committed a alleged to have been committed prig to the effective date of termination a cancellation and which would be otherwise insured by this policy, subject to the fdknving proviskxis. (a} Such additional period shall be deemed part of the policy period and not an addition thereto- (b) Such additiona! period of time shall terminate fathwfth on the effective date of any other insurance ob#airx=d by the Insured or its sucxessors in business, replacing in whole a in part the insurance afforded by this pdicy. Where such other pdicy provides no coverage for loss sustained prior to its effective dale, it shah n~ be deemed to be a rep cement of this pdicy. If the policy period described in the Declarations is fa a term of more than one year, the maximum premium for this extensbn shall be 2596 of the equivalent annual premium. x!. COtVDITIC3NS. (1j Insureds Duties in The Event Of Occurrence, Claim Or Suit It is a conditior, precedent to the application of ail insurance afforded herein that: (a) In the event the Insured shall first become aware. of any claim or allegation of a Wrongful Act, or any occurrence which might reasonably give rise to such claim or allegation of a Wrongful Act, written notice containing particulars sufficient to identify the Insured and any claimant and also reasonably obtainable information with respect to the time, place and circumstances thereof, and the names and addresses of the injured parties and of available witnesses, shall be given by or fa the Insured to the Company or any of its authored agents as soon as practicabk:; (b} !f claim is made or sutl is brought against an Insured, the Insured a Insurance Representative shall imm~iately forward to the Company every demand, notice, summons or other process received; (c) The Insured shall cooperate with the Com~ny and, upon the Company's request, assist in making settlements, in the conduct of suits and in enforcing any right of contribution or indemnity against any person a organzation who may be liable to the Insured because of an act with respect to which Insurance is afforded under this policy; and the Insured shall attend hearings and trials and assist in securing and giving evidence and obtaining the attendance of witnesses. The Insured shall rwt v~untarily assume or admit any liability, nor, except at said Insured's own ccet, voluntarily make any payment, assume any obligations or incur any expense withouk the Companys prior written consent. (2) Action Against The Company. No action shall lie against the Company unless, as a condition precedent thereto, there shall have been full compliance with all of the terms of this policy, nor until the amount of the Insureds obligation to pay shall have been finalty determined either by judgment against the Insured after actual trial a by written agreement of the Insured, the chaimant and the Company. Any person or organization or the legs! representative thereof who has secured such judgment or written agreement shall thereafter be entdted to recover under this policy to the extent at the insurance afforded by this l~wY• ~ Pin ~ aganization shall have any right under this policy to join the Company as a party to any action against the Insured to determine the Insured's liability na shall tl1e Company be impleaded by the Insured or sold Insured's legal repres~tative. Bankruptcy a inscafvency of the Insured or of the insured'a estate shall not relieve the Company of any of its obligations hereunder. (3) Other Insurance. This insurance shall apply only as excess insurance over any other valid and collectible insurance available to the Insured. (4) Subrogation. In the event of any payment under this policy, the Company shall be subrogated to all the Insured's rights of recovery therefor against any person or organization and the Insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The Insured shad do n~hing after kxs to prejudice such rights. (5) Changes. Notice to any agent a knowledge possessed by any agent a by any other person shall not effect a waiver or a change in any part of this poly or estop the Company from asserting any right under the terms of this policy, nor shall the terms of this pocky be waived nr changed, except by endorsement issued to lam a part of the policy. (6) Assigrunerd. Assignment of interest under this policy shall not bind the Company until ds consent is endorsed hereon; if, however, the Insured shall become incompetent a die, such Insurance as is afforded by this policy shall apply to the Insured's ~l representative as an Insured, but only while acting within the scope of said Insured's dufies as such. (7) Cancellation. F-1191-B (OS-98) Page 3 of 4 This policy may be cancelled on behalf of the Insureds at any time by written notice to the Company. This policy may ado be cancelled on behalf of the Company by mailing to the Insurance Representative at the address of the Trust or Plan shown in the Declarations, written notice stating when, not less than thirty (30) days thereafter, the cancellation shall become effective, The mailing of such notice shall be sufficient proof of notice, and this policy shall terminate at the date and hour specified in such notice. If this policy shall be cancelled by the Insureds the Company shall retain the customary short rate proportion of the premium hereon- If this policy shall be cancelled by or ~ behalf of the Company, the Company shall retain the pro-rata proportion of the premium hereon, Payment or tender of any unearned premium by the Company shall not be a condition precedent to the effectiveness of cancellation, but such payment shall be made as soon as practicable. (8) Declarations. By acceptance of this policy, each Insured agrees that the statements in the Application attached to this policy are said Insured's agreements and representations, that this policy is issued in reliance upon the truth of such representations and that this policy embodies all agreements existing between said Insured and the Company or arty of its agents relating to ttds insurance. {9) Authorization. By acceptance of this policy, the lnsurance Representative agrees to act on behalf of all Insureds with respect to the payment of premium and the receiving of any return premiums that may tie due under this pogcy, and the receiving of all notices of cancellation, non-renewal or change of coverages and the Insureds agree chat they have, individually and collectively, delegated this authority exclusivety to the Insurance Representative. Nothing herein shall relieve each Insured from giving any notice to the Company that is required under Condition (1) of the policy. (10) Recourse. In the event that an Insured breaches any fiduciary obligation imposed by the Employee Retirement Income Security Act of 1974, as it may be an~nded from time to time, it is agreed that the Company has the ngM of recourse against any such insured for any amount paid by the Company on account of such a breach of fiduciary obligation, but the Company shall have no such right of recourse it this policy has been purchased by an Employer or by an Employee organization. (11) Liberalization Clause. !f during the period Chat insurance is in force under this policy, or within 45 days prior to the incef#ion date thereof, on behalf of the Company there be adopted, or filed with and approved or accepted by the insurance supervisory authorities, all in ccorrrformity with law, any changes in the form attached to this policy by which this form or insurance could be extended or broadened without increased premium charge by endorsement of substitution of form, then such extended or broadened insurance shall inure to the benefd of the Insured hereunder as though such endorsement or substitution of (orm had been made. IN WITNESS WHEREOF, the Company has caused this policy to be signed by its authorized Company officers at Hartford, Connecticut, and signed on the Declarations page by a duly authorized person on behalf of the Company. ~ ~+ Executive Vice Presi~nt ---~_,~ ~---- ~~ ~. Corporate Secretary F-1191-B (t35-98) Page 4 of 4 FIDUCIARY RESPONSIBILITY ~~~~~~~~~ INSURANCE POLICY _:,.., RENEVVAI„ s~ERTiFlCATE , ::. .. I?Y R 'f ~ ~ rave~ers Casualty ana surety company ofi America LJ Travelers Casualty and Surety Company of Illinois ^ Travelers Casualty and Surety Company Naperville, Illinois 60563-8458 Hartford, Connecticut 06183-9062 (stock Insurance Companies, herein called the Company.} The following Items from the Declarations are changed as indicated. All other Items remain the same.. DESIGNATED TRUST OR PLAN POLICY NUMBER 103505325 VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND (See Name of Designated Trust or Plan Endorsement) (See Governmental Plan Endorsement) POLICY PERIOD From To October 01, 2008 October 01, 2010 RENEWAL PREMIUM $8,275.94 PREMIUM PAYABLE CURRENT EACH ANNIVERSARY $4,097.00 $4,D97.00 In consideration of the stated renewal premium, the policy is renewed for the Policy Period indicated. ® The premium for this policy has been paid by the Designated Trust or Plan. The Company has the right of recourse pursuant to Condition (10). Endorsement (F-1280) is attached to eliminate recourse. Premium for elimination of recourse: $289.00 (Included in stated renewal premium) Payable [] In Advance ®Each Installment Endorsements attached to this policy at renewal (Designated by Endorsement Number): ILT-1018 01-08, F-2817 09-98, F-12$0 02-95, F-1449 09-00, F-2100 07-90, ILT-1067 01-08, ILT-5018 07-04 Countersigned by (if required) F-1207-B (D9-98) .. TRAVELERS) IMPORTANT NOTICE REGARDING INDEPENDENT AGENT AND BROKER COMPENSATION For information about how St. Paul Travelers compensates independent agents and brokers, please visit www.StPaulTravelers.com, or you may request a written copy from Marketing at One Tower Square, 2GSA, Hartford, Connecticut 06183 ILT-1037 (~~-EIS) PENSION AND WELFARE FUND FIDUCIARY RESPONSIBILITY INSURANCE POLICY FLORIDA AMENDATORY ENDORSEMENT To be attached to and form part of: Policy No: 103505325 Issued to: VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND (See Name of Designated Trust or Plan Endorsement) (See Governmental Plan Endorsement) A. Section XI. CONDITIONS, (7) Cancellation is replaced by the following: Cancellation of Policy: This Policy terminates in its entirety upon occurrence of any of the following: 1. Cancellation For Policies In Effect 90 Days Or Less If this Policy has been in effect for 90 days or less, the Company may cancel this Policy by mailing or delivering to the Insurance Representative written notice of cancellation, accompanied by the reasons for cancellation, at least: (1) 10 days before the effective date of cancellation if the Company cancels for nonpayment of premium. (2) 30 days before the effective date of cancellation if the Company cancels far any other reason, except the Company may cancel immediately if there has been: (a) A material misstatement or misrepresentation; or (b) A failure to comply with underwriting requirements established by the insurer. 2. Cancellation For Policies In Effect For More Than 90 Days If this Policy has been in effect for mare than 90 days, the Company may cancel this Policy only far one or more of the following reasons: (1) Nonpayment of premium; (2} The Policy was obtained by a material misstatement; (3) There has been a failure to comply with underwriting requirements within 90 days of the effective date of coverage; (4) There has been a substantial change in the risk covered by the Policy; or (5) The cancellation is for all Insureds under such policies for a given class of Insureds. If the Gompany cancels this Policy for any of these reasons, the Company will mail or deliver to the Insurance Representative written notice of cancellation, accompanied by the reasons for cancellation, at least: (a) 1 a days before the effective date of cancellation if cancellation is for the reason stated in (1) above; or (b) 45 days before the effective date of cancellation if cancellation is for the reasons stated in (2), (3}, (4) or (5) above. B. The following Condition is added: NONRENEWAL A. If the Company decides not to renew this Policy the Company will mail or deliver to the Insurance Representative written notice of nonrenewal, accompanied by the reason for nonrenewal, at least 60 days prior to the expiration of this Policy. B. Any notice of nonrenewal will be mailed or delivered to the Insurance Representative's last mailing address known to the Company. If notice is mailed, proof of mailing will be sufficient proof of notice. FLORIDA AMENDATORY ENDORSEMENT F-2817 (09-98) Includes copyrighted material of The Insurance Services Office, Inc. POLICY NO. 103505325 ELIMINATION OF RECOURSE ENDORSEAAENT (To tie attached to and form part of Pension and Welfare Fund Fiduciary Responsibility Insurance Policy) It is agreed that: 1. The premium for this policy has been paid by the Designated Trust or Plan. The Company has the right of recourse pursuant to Condition (10) of the policy. 2. In consideration of a separate premium paid to the Company from funds other than from assets of the Designated Trust or Plan, the Company waives such right of recourse. This endorsement farms a part of the policy to which attached, effective on the inception date of the pa{icy unless otherwise stated herein. (f"he information below is required only when this endorsement is issued subsequent to the preparation of the policy) Endorsement effective: OCTOBER 01, 2008 Policy No.: 049 FF 143545325 BCM fVame of Designated Trust or Plan: VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND (See Name of Designated Trust or Plan Endorsement) (See Governmental Plan Endorsement) Countersigned by (Authorized Representative) F-1280 (025) ISSUED BY: Travelers Casualty and Surety Company of America POLICY NO: 103505325 ISSUED TO: VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ELIMINATION OF RECOURSE ENDOSORSEMENT (GOVERNMENT PLANS) In consideration of the payment of a separate premium, notwithstanding Section XI. CONDITIONS.. (10) Recourse. the Company shall have no right of recourse against any Insured. Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, exclusions or limitations of the above-mentioned policy, except as expressly stated herein. This endorsement is part of such- policy and incorporated therein. This endorsement is effective at the Inception Date stated in ITEM 2 of the Declarations or effective at 12:01 A.M. on October 01, 2008, if indicated herein. Complete the following only when this endorsement is not prepared with the policy or is to be effective on a date other than the Inception Date of the policy. Accepted by: On behalf of the entity named in ITEM 1 of the Declarations. Authorized Company Representative F-1449 (09-00) ENDORSEMENT To be attached to and form part of: Policy No.: 103505325 Issued to: VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND (See Name of Designated Trust or Plan Endorsement) (See Governmental Plan Endorsement) It is agreed that: 1. The Policy is amended as follows: (a) III. DEFINITION OF INSURED is deleted in its entirety and the following substituted.: 111. DEFINITION OF INSURED Each of the following is an insured to the extent set forth below: (1) The Trust or Employee Benefit Plan Designated in the Declaration and designated herein: Village of Tequesta General Employees' Trust Fund Village of Tequesta Public Safety Officers' Pension Trust Fund (2) Any natural person who at any time holds or shall have held the position of: (a) Trustee of such Trust or Employee Benefit Plan (b) Director, Officer or Employee of such Trust or Employee Benefit Plan. The insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the application of tfie limits of liability and it shall also apply to the estates heirs, and personal representatives of persons insured hereunder." (b) ll. Tfie following is added to Section II Exclusions: based on, arising out of, directly or indirectly resulting from, in consequence of, or in any way invalving, investments in debt obligations of the State shown in ITEM 2 of the Declarations or of any political or governmental agency in such State: based on, arising out of, directly or indirectly resulting from, in consequence of, or in any way involving, inadequate funding of the Designated Trust or Plan. based on, arising out of, directly or indirectly resulting from, in consequence of, or in any way involving, actual or alleged seepage, pollution or contamination of any kind. GOVERNMENTAL PLAN ENDORSEMENT F-2043 (11-89) Page 1 of 2 {c) Adding are additional Section as follows: Xll DEDUCTIBLE AMOUNT Five Thousand and OONOODollars ($5,000.00) (hereinafter referred to as Deductible Amount) shall be deducted from the amount of each claim covered hereunder, inGuding all expense incurred, and the Company shall be liable only in excess of such Deductible Amount. Claims based on or arising out of the same Wrongful Act or interrelated Wrongful Acts of one or more of the Insureds shall be considered a single claim and only one Deductible Amount shat! be applied to each single claim. Subject to Section IX, CONSENT TO SETTLE, of the attached policy, the Company may pay any part or alt of the Deductible Amount to effect settlement of any claim or suit and upon notification of the action taken, the Insured shall promptly reimburse the Company for such part of the Deductible Amount as has been paid by the Company. The Deductible amount shall be uninsured. 2. This Endorsement forms part of the policy to which attached, effective on the incep#ion date of the policy unless otherwise stated herein. Endorsement effective: OCTOBER 01, 2008 By (Authorized Representative) Accepted by: {Insurance Representative) GOVERNMENTAL PLAN ENDORSEMENT F-2043 (11 ~9) Page 2 of 2 PENSION AND WELFARE FUND FIDUCIARY RESPONSIBILITY INSURANCE POL[CY DEFENSE WITHIN AGGREGATE END©RSEMENT To be attached to and part of: Policy No.: 103505325 Issued to: VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND (See Name of Designated Trust or Plan Endorsement) (See Governmental Plan Endorsement) It is agreed that: 1. Section VIII, SUPPLEMENTARY PAYMENTS is eliminated in its entirety and replaced with: "The Company will pay as part of the Limit of Liability shown in the Declarations all costs, charges, and expenses incurred by the Company in the investigation, settlement, defense, and negotiation of any claim coming within the terms of this insurance. The Gampany will pay as par! of the Limit of Liability shown in the Declarations reasonable expenses incurred by the Insured at the Company's request." This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein. Endorsement effective: OCTOBER 01, 2008 Countersigned by Authorized Representative Accepted By: Insurance Representative F-2100 (07-90) PENSION AND WELfiARE FUND FIDUCIARY RESPONSIBILITY INSURANCE POLICY AMEND EXTENSION CLAUSE ENDORSEMENT To be attached to and form part of Policy No: 103505325 Issued to: VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND (See Name of Designated Trust or Plan Endorsement) (See Governmental Plan Endorsement) It is agreed that: 1. Section X. EXTENSION CLAUSE is deleted in its entirety and replaced by the following: X. EXTENSION CLAUSE It is agreed that at any time prior to termination or cancellation of this policy as an entirety, whether by the Insured or by the Company, the Insured may give to the Company notice that it desires to be insured for an additional period of (12) months after the effective date of termination or cancelfation, at an additional premium of 100% of the premium hereunder, for claims made against the Insured during the said month period by reason of a Wrongful Act committed or alleged to have been committed prior to the effective date of termination or cancellation and which would be otherwise insured by this policy, subject to the following provisions: (a) Such additional period shall be deemed part of the policy period and not an addition thereto; (b) Such additional period of time shall terminate forthwith on the effective date of any other insurance obtained by the Insured or its successors in business, replacing in whole or in part the insurance afforded by this policy. Where such other policy provides no coverage for loss sustained prior to its effective date, it shall not be deemed to be a replacement of this policy. If the policy period described in the peclarations is for a term of more than one year, the percentage of premium shall be calculated from the equivalent annual premium. 2. Nothing contained herein shall vary, alter, or extend any of the terms, conditions, and limitations of the Policy except as stated above. This endorsement forms part of the policy to which it is attached, effective on the inception date of coverage unless otherwise stated herein. Complete Only When This Endorsement Is Not Prepared With The Policy Or Is Not 70 6e Effective With The Poficy. Effective Date of this endorsement: October 01, 2008 By: Accepted by: (Insurance Representative) F-2849 (09-98) ISSUED BY: Travelers Casualty and Surety Company of America POLICY NO: 103505325 ISSUED TO: VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND It is agreed that; THiS ENDORSEMENT GRANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM ENDORSEMENT 1. The following section is added to this Policy: CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORLSM If aggregate insured lasses attributable to Cert~ed Acts of Terrorism exceed $100 billion in a program year (January 1 through December 31) and the insurer issuing this Policy has met the deductible under the Terrorism Risk Insurance Act: a. the insurer will not be responsible for the payment of any portion of the amount of such losses that exceeds $100 billion; and b. insured losses up to $100 billion will be subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for any loss which would otherwise be excluded under this Policy. 2. The following is added to the Definitions section of this Policy: "Gert~ed Act of Terrorism" means an act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State and the Attorney General of the United States, to be an act of terrorism pursuant to the federal Terrorism Risk Insurance Act. The criteria contained in the Terrorism Risk Insurance Act for a Certified Act of Terrorism include the following. a. the act resulted in insured losses in excess of $5 million in the aggregate, attributable to ail types of insurance subject to the Terrorism Risk Insurance Act; and b. the act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to inllucnce the policy or affect the conduct of the United States Government by coercion. Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, exclusions or limitations of [he above-mentioned policy, except as expressly stated herein. This endorsement is part of such policy and incorporated therein. This endorsement is effective at the Inception Date stated in ITEM 2 of the Declarations or effective at 12:01 A.M. on Ocher O1, 2008, if indicated herein. Complete the following only when this endorsement is not prepared with the policy or is to be effective on a daft other than the Inception Date of the policy. Accepted by: On behalf of the entity named in ITEM 1 of the Declarations. Authorized Company Representative :t 2008 The Travelers Companies, Inc. All Rights Reserved ILT-1067 Ed.O1lU8 ISSUED BY: Travelers Casualty and Surety Company of America POLICY NO; 103505325 ISSUED TO: VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. CANCELLATION/NONRENEWAL -FLORIDA FULL CANCELLATION -INSURER It is agreed that: 1. The policy provisions regarding cancellation by the Company are deleted and replaced with the following: A. CANCELLATION OF POLICIES IN EFFECT FOR 90 DAYS OR LESS (a) if this Policy has been in effect for 90 days or less and is not a renewal of a policy we issued, we may cancel this Policy for any reason by mailing or delivering to the entity named in Item 1 of the Declarations written notice of cancellation including the reason for cancellation at least 10 days before the effective date of cancellation if we cancel for nonpayment of premium or at least 20 days before the effective date of cancellation if we cancel for any other reason. B. CANCELLATION OF POLICIES IN EFFECT FOR MORE THAN 90 DAYS If this Policy has been in effect for more than 90 days, or is a renewal of a Folicy we issued, we may cancel only for one or more of the following reasons: (a) Nonpayment of premium; (b) Material misstatement; (c) Failure to comply with underwriting requirements established within 90 days of the effectuation of coverage; (d) Substantial change in risk; or (e) When cancellation applies to all insureds within a given class. We will mail or deliver written notice of cancellation including the reason for cancellation, under this item B., to the entity named in Item 1 of the Declarations at least: (1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or (2) 45 days before the effective date of cancellation if we cancel for a reason described in B.(b) through (e) above. 2. The following is added and supersedes any other provision to the contrary: NONRENEWAL A. if we decide not to renew This Policy, we will mail or deliver written notice of nonrenewal including the reason for nonrenewal, to the entity named in Item 1 of the Declarations at least 45 days before its expiration date, or its anniversary date if it is a Policy written for a term of more than one year or with no fixed expiration date. 3. Proof of mailing is sufficient proof of notice. Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, exclusions or limitations of the above mentioned policy, except as expressly stated herein. This endorsement is effective at the inception date stated in the Declarations and this endorsement is part of such policy and incorporated therein. 1LT-5018 (07-04) S'~PALJL T~tAV~i.ERS September 18, 2008 VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND 345 Tequesta Drive TEQUESTA FLORIDA 33449-0273 Re: Policy Number: 103505325 Policy Type: FRIP NEW Expiration Datc: October 01.2008 Undciwriting Company; Travelers Casualty and Surety Comaany of America Our records indicate that the above referenced policy (the "Policy") will expire on the expiration dale shown above We have not yet received important underwriting information needed to determine what renewal terms, if any, to offer. Certain state laws require an insurer to advise the insured prior to the policy expiration date when it proposes a change in renewal premium, a change in policy provisions, or nonrenewal of the policy. Because we are presently unable to propose renewal terms, applicable state laws and regulations require us to provide this .notice to state that the above referenced Policy is not being renewed. Tkis does not mean that we no longer want to insure you; rather, we do not have the information needed to evalu~e your account We hope that you will contact your agent or broker at your earliest convenience to ensure that we receive all relevant underwriting information. We are obligated to tell you, however, that neither the continued evaluation of any infan;nation received to date nor any request for or receipt of any additional information will obligate us to renew the Policy on any terms, and that the Policy will expire as set forth above unless we expressly state otherwise in writing after the date of this letter. Thank you for your time and consideration. We look forward to receipt of your renewal application and Supporting materials. If you have any questions, please contact your insurance agent or broker. Sincerciy, Donna M Corona cc: Ellen Jones GEHRING GROUP INC (OCJZ86) 11505 FAIRCHILD GARDENS AVE SUITE 202 PALM BEACH GARDENS, FL 33410 CLT-SI03 (2-02) r-~ tsti•8 (s-soy STPAUL September 18, 2008 Ellen .cones GEARING GROUP INC (OCJZ86) lI_`+i15 FAIRCHILD GARDENS AVE SUITE 202 PALM BEACH GARDENS, FL 33410 Donna M Corona 4631 Woodland Corporate Blvd. PO Box 31967 (33631-3967) TAMPA, FL 33614 Phone: (813) 890069 Fax: (800) 265-1498 Email: I)CORONALa~traveters. wm COPY ~F NOTICE SENT TU INSURED Re; Named Insured: VILLAGE OF TEQUESTA GENERAL EMPLOYEES PENSION FUND Policy Number: 103505325 Policy Typc: FRH' NEW Expiration Date: October 0,1 2008 Underwriting Company: Travelers Casualty and Surety Comuanv of America Our records indicate that the above referenced policy (the "Polity") will expire on the expiration date shown above. We have not yet received important underwriting information needed to determine what renewal terms, if any, to offer. Certain state laws require an insurer to advise the insured. prior to the policy expiration date when it proposes a change in renewal premium, a change in policy provisions, or nonrenewal of the policy. Because we are presently unable to propose renewal terms, applicable state laws and regulations require us to provide this notice to state that the above referenced Policy is not being renewed. This does not mean that we no longer want to insure you; rather, we do not have the information needed to evaluate your account We hope that you will contact your agent or broker at your earliest convenience to ensure that we receive all relevant underwriting information. We are obligated to tell you, however, that neither the continued evaluation of any information received to date nor any request for or receipt of any additional information will obligate us to renew the Folicy on any terms, and that the Policy will expire as set forth above unless we expressly state otherwise in writing after the date of this letter. Thank you for your time and consideration. We look forward to receipt of your renewal application and supporting materials. If you have any questions, please contact your insurance agent or broker. 5incercly, Donna M Corona ILT-5103 (2-02) POLICY NO. 103505325 PENSION AND WELFARE FUND FIDUCIARY RESPONSIBILITY INSURANCE POLICY NAME OF DESIGNATED TRUST OR PLAN ENDORSEMENT It is agreed that as of the effective date hereof the complete name of the Designated Trust or Plan under the attached policy is: Village of Tequesta General Employees' Trust Fund Village of Tequesta Public Safety Of'f'icers' Pension Trust Fund This endorsement forms part of the policy #o which attached, effective on the inception date of the policy unless otherwise stated herein. Endorsement effective: OCTOBER 01, 2008 Policy No,: 049 FF 103505325 BCM By (Authorized Representative) Accepted by: Insurance Representative Name of Designated Trust or Plan Endorsement F-1658 (03-86)