HomeMy WebLinkAboutDocumentation_Pension General_Tab 14_11/02/2009BOARD OF TRUSTEES
Village of Tequesta General Employees
Pension and Trust Fund
ADMINISTRATIVE RULES
Approved:
TABLE OF CONTENTS
PART 1 -GENERAL PROVISIONS
1.1 Purpose ................
1.2 Definitions ......................................................
Pension Board ..............................................
Pension Code ..............................................
Pension Fund ..............................................
Municipality ................................................
Definitions of the Ordinance .................................. .
PART 2 -ADMINISTRATION ............................................ .
2.1 Board Creation ...................................................
2.2 Terms of Office ..................................................
2.3 Election Procedure ............................................... .
Setting Date for Election of Employee-Trustees ................... .
Sixty (60) Day Notice of Vacancy .............................. .
Employee-Trustees . .................................. .
Village Trustee ........................................
Fifth Trustee ......................................... .
Election of Employee Trustees ................................ .
Notice of Candidacy ................................... .
Certified List of Eligible Candidates ....................... .
Election Judges .......................................
Election Procedure .................................... .
Election Results ...................................... .
Run-off Election ...................................... .
Election Challenges ................................... .
Certification of Election Results .......................... .
Mid-Term Vacancies .........................................
Declaring Vacancy .....................................
Filling of Vacancies .................................... .
Employee-Trustee ............................... .
Vil lage-Trustees ................................. .
Calendar Days ........................................
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PART 3 -COMPENSATION AND EXPENSES ............................... 6
3.1 Compensation and Reimbursement of Expenses ........................ 6
3.2 Reimbursement of Expenses ........................................ 6
3.3 Refund of Employee Contributions ................................... 6
3.4 Payment practices ................................................ 6
PART 4 -MEETINGS ................................................... 7
4.1 Meetings ....................................................... 7
4.2 Emergency Meetings .............................................. 7
Approved:
4.3 Location of Meetings .............................................. 7
4.4 Time of Meetings ................................................. 7
4.5 Notice of Meetings ................................................ 8
4.6 Open Meetings; Exceptions ......................................... 8
4.7 Order of Business ................................................ 8
4.8 Minutes ........................................................ 8
4.9 Quorum ........................................................ 8
PART 5 -PENSION BOARD OFFICERS AND EMPLOYEES .................... 9
5.1 Officers ........................................................ 9
5.2 Employees ...................................................... 9
5.3 Duties of the Chairperson .......................................... 9
5.4 Duties of the Secretary . ........................................... 9
PART 6 -RECORD KEEPING AND REPORTING REQUIREMENTS ............. 10
6.1 Minutes of Meetings .............................................. 10
6.2 Correspondence File ............................................. 10
6.3 Investment File .................................................. 10
6.4 Litigation File ................................................... 10
6.5 Annual Report by the Pension Board ................................. 10
6.6 Record keeping as to Employee Participants . ......................... 10
6.7 Record keeping as to Retirees ...................................... 11
6.8 Record keeping as to Separated Members ............................ 12
6.9 Confidentiality . ................................................. 12
6.10 Florida Public Records Law or Freedom of Information Act Requests. ...... 12
PART 7 -ADJUDICATION RETIREMENT PENSION CLAIMS .................. 13
7.1 Appeal procedures ............................................... 13
7.2 Subpoenas ..................................................... 14
PART 8 -INVESTMENT POLICIES ....................................... 15
8.1 Purpose ....................................................... 15
PART 9 -INCOME DEDUCTION ORDERS ................................. 16
9.1 Income Deduction Orders ......................................... 16
Assignment of Benefits Upon Divorce .......................... 16
Filing of Claims ............................................ 16
Definitions ................................................ 16
Alternate Payee ...................................... 16
Income Deduction Order ............................... 16
Designation of Representative ................................ 16
Payment of Benefits Pending Trustees' Decision .................. 16
ADMINISTRATIVE RULES -SIGNATURE PAGE ............................ 17
Approved:
APPENDIX "A"
EXHIBIT "A" Expense Policy ....................................... 18
APPENDIX "B"
EXHIBIT "B" Expense Report /Voucher .............................. 19
APPENDIX "C"
Employee Application for Membership . .............................. 20
Vested Terminated Employee ...................................... 21
APPENDIX "D" Application for Benefits .................................... 22
Acknowledgments . ................................................... 25
APPENDIX "E" Vested Terminated Employee . ............................. 27
Approved:
PART 1 -GENERAL PROVISIONS
1.1 Pur ose. The purpose of these rules is to establish uniform procedures for the
implementation of Ordinance No. 585, Exhibit A of the Village of Tequesta and
applicable provisions of Chapter 112 of the Florida Statutes and the administration
of the Village of Tequesta General Employees Retirement Plan. These rules are
also promulgated for the benefit of and to provide guidance to retirement plan
members, participants and beneficiaries and are available for inspection at the
office of the Retirement Plan.
1.2 Definitions. As used in these rules, the terms set forth below shall have the
following definitions and meanings, except when the context of the rule specifies
and requires a different meaning.
1) Pension Board. "Pension Board" shall mean the Board of Trustees of the
Village of Tequesta General Employees Retirement Plan as established
under Village Ordinance No. 585, Exhibit A.
2) Pension Code. "Pension Code" means the provisions contained in
Village Ordinance No. 585, Exhibit A.
3) Pension Fund. "Pension Fund" shall mean the pension fund established
pursuant to Village Ordinance No. 585, Exhibit A for the benefit of the
participants and beneficiaries of the Fund.
4) Municipality. "Municipality" shall mean the Village of Tequesta,
Florida.
5) Definitions of the Ordinance. The definitions contained in Village
Ordinance No. 585, Exhibit A shall be deemed to be the definitions
incorporated in these Rules.
Approved:
PART 2 -ADMINISTRATION
2.1 Board Creation. The Village of Tequesta General Employees Retirement Plan
is created pursuant to Village Ordinance No. 585, Exhibit A. The composition of the
Pension Board is to be governed by the provisions of the ordinance.
2.2 Terms of Office.
a) Each employee trustee of the Village of Tequesta General Employees
Retirement Plan shall serve a two year term of office.
b) The resident members appointed by the Village Council shall serve a two
year term at the pleasure of the Council so long as the trustee remains a
resident of the Village.
c) The fifth trustee shall serve a two year term of office.
2.3 Election Procedure.
a) Setting Date for Election of Employee-Trustees. At least sixty (60) days
before the end of the term of each Employee-Trustee, the Board of Trustees
should set the date, for an election to be held, if possible, thirty (30) days
before the term expires. At the same time, the Board of Trustees should set
the date, for arun-off election to beheld, if possible, ten (10) days before the
term expires.
b) Sixty (60) Day Notice of Vacancy. At least sixty (60) days before the end of
each Trustee's term, the administrative manager/pension coordinatorforthe
plan should take the following action:
1) Employee-Trustees. Notice of the election and run-off election should
be given by posting a Notice on all bulletin boards in the department
where notices to employees are posted, and by requesting the
department to publish the notice in any newsletter delivered to
employees. The Notice shall include:
A) The date the Employee-Trustee's term expires;
B) A declaration that the expiring position is for an
employee Trustee;
C) A request for candidates to submit a written
notice of their candidacy to the Board of
Trustees by a date certain (no later than forty-
five (45) days before the Employee-Trustee's
term expires); and
Approved:
D) The date, of the election and, if necessary, the
run-off election.
2) Village Trustee. Notice shall be given in writing to the Mayor and
Village Clerk. The Notice shall include:
A) The date the Village Trustee's term expires;
B) A request for the Village to appoint a Trustee
before the Village Trustee's term expires.
3) Fifth Trustee. Notice shall be posted in writing. The Notice shall
include:
A) The date the Fifth Trustee's term expires;
B) A request for the remaining four (4) trustees to select by
majority vote a fifth (5th) Trustee.
c) Election of Employee Trustees
1) Notice of Candidacy. Each prospective candidate must submit his or
her name to the Board of Trustees in writing no later than forty-five
(45) days before the date of the election, or by such other time as set
by the Board of Trustees.
2) Certified List of Eligible Candidates. Before the election, the Board of
Trustees shall certify those candidates who are full-time employees
who are eligible to be elected as an Employee-Trustee. These are
the only candidates eligible for election, there shall be no write-in
candidates. If only one candidate is certified, the election will not be
held and the certified candidate will be deemed elected.
3) Election Judges. At the same time as the list of eligible candidates
has been certified, the Board of Trustees shall appoint two (2) non-
candidates to be election judges.
4) Election Procedure. Election for Employee-Trustees shall be by
secret mail ballot. Each official ballot shall be embossed with the
stamp of the Board of Trustees and mailed to each currently
employed participant in the Village of Tequesta General Employees
Retirement Plan. As soon as the mail has been received on the
election date, the ballots shall be counted in public. Ballots not clearly
marked and any ballots with more votes than vacant positions shall
not be counted, but shall be kept separately. If more than one trustee
position is vacant, then each employee shall vote for two trustees. All
Approved:
ballots shall be turned over to the Board of Trustees by the judges
with a tally of the election results.
5) Election Results -The top vote getter shall fill the vacant Employee-
Trustee position. In the event there are 2 vacant Trustee positions,
the top two vote getters shall fill the vacant positions.
6) Run-off Election. In the event of a tie which will affect the outcome of
the election, then the 2 candidates who are tied shall be in the run-off
election.
7) Election Challenges. Any challenge to an election must be given in
writing to the Board of Trustees within five (5) days of the date of the
election, or run-off election, as applicable. A challenge shall not stop
a run-off election from being held.
8) Certification of Election Results.
A) The Board of Trustees shall certify the election results.
B) The Board of Trustees shall resolve all challenges to an
election and may schedule a new election, if deemed
appropriate, or take other action to resolve any
challenges.
d) Mid-Term Vacancies.
1) Declaring Vacancy. If a Trustees resigns, is removed or becomes
ineligible to serve, the Board of Trustees shall declare, by resolution,
the office of the Trustee vacated.
2) Filling of Vacancies.
A) Employee-Trustee. If the vacancy occurs less than
ninety (90) days before the Trustee's term was due to
expire, the vacancy shall be filled at the next regular
election as provided in these Rules and Regulations.
Otherwise, the vacancy shall be filled for the unexpired
portion of the term by a new election as provided in
these Rules and Regulations. The Board of Trustees
may reduce the time required for notice of the election,
notice of candidacy, or any other time limits to expedite
a new election.
Approved:
B) Village-Trustees. The Board of Trustees shall notify the
Mayor and Village Clerk in writing of the vacancy and
request the appointment of a Successor Trustee.
e) Calendar Days. All days are calendar days.
Approved: 5
PART 3 -COMPENSATION AND EXPENSES
3.1 Compensation and Reimbursementof Expenses. Pension Board Trustees are
not entitled to receive any compensation for service performed as trustees.
3.2 Reimbursement of Expenses. A Trustee shall be reimbursed only for expenses
properly and actually incurred in the performance of his or her duties with the Plan
in accordance with the Village of Tequesta General Employees Retirement Fund
Statement of Policy for Trustee Expenses, attached as Exhibit"A". Reimbursement
shall be requested by completing the report of travel expenses form attached as
Exhibit "B".
3.3 Refund of Employee Contributions.
a~Members who are eligible for a refund of contributions in lieu of any benefit
under the plan shall submit the application for the refund. Upon the Finance
Department receiving and verifying all the required data, refunds shall be
made between meetings and ratified at the following meeting.
b) Interest on Refunds
1. Effective with refunds uaid after June 12, 2008, interest on
refunds of contributions will be paid at 3% per annum. For
periods of less than one vear interest will be credited for a partial
vear based upon months.
2. Interest is calculated based on total amount of contributions
before taxes or withholding.
3. Distributions will be made within 30 days of the Fund providing
the Special Tax Notice to the member, or sooner if the Special
Tax Notice is signed by the member and returned to the Board of
Trustees.
3.4 Payment practices.
a) No payments shall be made without the approval of the Board of Trustees,
except refunds of employee contributions in accordance with the above.
b) Two signatures are required for all disbursements.
Approved:
PART 4 -MEETINGS
4.1 Meetings.
a) The Pension Board shall hold quarterly meetings in February, May, August
and November of each year. These meetings will be held on the first
Monday of the designated month. In the event that the regular meetings
cannot proceed on the first Monday of the designated month, the meeting
will be re-scheduled at the earliest possible date convenient to all of the
Pension Board Trustees.
b) The Pension Board may agree to meet more than four times a year. The
Pension Board may agree to meet either monthly or bi-monthly if, in the
Pension Board's determination, such meetings are necessaryforthe prudent
and efficient administration of the affairs and activities of the Pension Fund.
4.2 Emergency Meetings.
a) The Chairperson of the Village of Tequesta General Employees Retirement
Plan may call special meetings in emergency or unforseen situations, upon
reasonable notice to all of the Pension Board's trustees. The reasons for
such emergency meetings shall include but not be limited to:
1) discussion of pending or threatened litigation;
2) discussion of investment activity;
3) discussion of pension fund applications;
4) discussion of retirement pension requests.
b) Any Pension Board trustee may request an emergency meeting by serving
written notice upon all other trustees at least seven (7) days prior to the date
of the emergency meeting.
4.3 Location of Meetings.
Unless otherwise specified, all meetings of the Village of Tequesta General
Employees Retirement Plan will be held at the Village Hall in the Council
Chambers. Changes in the location of the meeting will be posted at least 7 days
prior to the meeting.
4.4 Time of Meetings. The meeting time will be rotated with the Public Safety Board
meetings. Beginning with the November 2009 X996 meeting, the General
Emplovees' Board will meet at 8:00 a.m. and the Public Safety
' Board will meet at 1:00 gm ~A~--a-~ The Boards will
alternate times with each quarterly meeting. The next quarterly meeting of the
General Employees' Board, will be scheduled for February 2009 ~~ at 1:00 em
X99-a-m- with the General Emolovees' Board meeting at 8:00 am
~3@. This time rotation will continue until further notice by the Boards.
Approved:
4.5 Notice of Meetings.
a) Notice of all regularly scheduled meetings shall be posted at least 7 days
prior to the meeting.
b) Notice of any emergency meetings will be posted as far in advance of the
meeting as is reasonably practicable under the circumstances.
4.6 Open Meetings; Exceptions. All Pension Board meetings are open to the public
except for discussion of those matters which are the subject of statutory exceptions
to §286.011(8), Florida Statutes, the "Florida Sunshine Law".
4.7 Order of Business.
a) All meetings of the Village of Tequesta General Employees Retirement Plan
shall be conducted under an agenda.
b) The rules of procedure to be followed at such meetings will be Robert's
Rules of Order, unless Robert's Rules of Order conflict with the Pension
Code orthe Rules of the Village of Tequesta General Employees Retirement
Plan.
4.8 Minutes. Minutes of all Retirement Plan Board meetings shall be kept in
accordance with the record keeping provisions set forth in Part 4 of these Rules.
4.9 Quorum.
a) A quorum of the Village of Tequesta General Employees Retirement Plan
shall consist of at least three trustees. The approval of any and all Pension
Board business shall require the affirmative vote of three (3) trustees at any
given meeting.
b) Each trustee in attendance at a meeting shall be entitled to one (1) vote per
item requiring a vote.
Approved:
PART 5 -PENSION BOARD OFFICERS AND EMPLOYEES
5.1 Officers. The officers of the Village of Tequesta General Employees Retirement
Plan shall be: the chairperson and secretary. Pension Board may elect other
officers as deemed necessary. The officers shall be elected annually at the October
meeting of the Board or the next meeting immediately following October, if there is
no October meeting.
5.2 Employees. The Pension Board may, in its discretion, hire employees to carry out
certain duties and functions of the Pension Board. The duties of any such
employees and compensation will be specified in the minutes of the Pension Board
meeting establishing the employment relationship. The Board may also retain the
services of an Administrator, Legal Counsel, Consultant, Actuary. Investment
Manager and other service providers pursuant to an agreement under terms
acceptable to the Board.
5.3 Duties of the Chairperson. The Chairperson shall preside over all functions and
duties of the Pension Board, unless such functions or duties are specifically
delegated to other trustees, employees or agents of the Pension Board. The
Chairperson shall preside over all meetings of the Pension Board and execute all
orders, certifications and other documents necessary to carry out the affairs and
activities of the Pension Board.
5.4 Duties of the Secretary. The Secretary shall be responsible for the performance
of the following duties and functions:
a) Preside over any and all meetings in the absence of the Chairperson;
b) Execute any and all documents on behalf of the Pension Board;
c) Certify the authenticity of all resolutions or documents of the Pension Board;
d) Maintain the financial records of the Fund in the Finance Department;
e) Be the custodian of all Pension Board records, minutes of meetings and
documentation;
f) Record and transcribe the minutes of all regular, special and emergency
meetings of the Pension Board;
g) Perform all other duties necessary to the administration of the Pension
Board, at the direction of the Pension Board.
h) The duties contained initems c-g may be delegated to a pension coordinator
as selected by the Board.
Approved:
PART 6 -RECORD KEEPING AND REPORTING REQUIREMENTS
6.1 Minutes of Meetings. The Secretary shall keep and maintain minutes of all
public meetings and shall keep and maintain separate minutes of matters heard in
closed session.
6.2 Correspondence File. The Pension Board shall maintain a general
correspondence file with copies of all correspondence sent or received by the
Pension Board, including contracts entered into by the Board with legal counsel,
investment managers and other persons employed or retained by the Pension
Board.
6.3 Investment File. The Pension Board shall maintain on an annual basis, an
investment file containing all documentation and correspondence relating to
investment activity each year.
6.4 Litigation File. The Pension Board shall maintain a separate file as to all
matters in litigation. If the litigation involves the denial of retirement pension, the
litigation may be maintained as a part of the applicant's file.
6.5 Annual Report by the Pension Board.
a) The Pension Board shall also submit an annual report to the Municipality as
to the general condition of the Pension Fund.
b) The annual report shall contain the following information:
1. The assets of the Pension Fund
2. The estimated receipts during the next succeeding calendaryearfrom
the deductions of the salaries of employees and all other sources;
3. The estimated amount required during the next calendar year to pay
all pensions and other obligations of the Pension Fund and to meet
the annual requirements of the Pension Fund for the Village's portion
or the financing of the Pension Fund.
c) The Actuarial Valuation may serve as this annual report.
6.6 Record keeping as to Employee Participants.
a) A file shall be maintained on each active employee who is a participant and
member of the Pension Fund. Records shall be maintained in the Finance
Department as a part of his or her personnel file. Each active member's file
should contain, if available, the following documentation:
Approved: 10
1. Application for Membership (attached as Appendix "C");
2. A record of the participant's contributions and service credits on an
annual basis;
3. Yearly creditable service reports received from the Village (if any);
4. Copies of any orders and decisions of the Pension Board denying a
retirement pension filed by the participant;
5. Designation of beneficiary form;
6. All correspondence from the participant and a copy of any
correspondence to the participant.
6.7
b) Each participant shall be required to complete a Designation of Beneficiary
Form.
Record keeping as to Retirees.
a) Retiree. A file shall be maintained on all retired members of the Pension
Fund. Each retired member's file should contain the following
documentation.
1. Application for retirement benefits (attached as Appendix "D");
2. Documentation as to Benefit Computations
a. Date of Birth;
b. Date of Hire;
c. Date of Retirement;
d. Creditable Service Records;
e. Applicable Pension Rates;
f. Salary attached to the job held by the pension applicant;
g. All documents previously maintained pursuant to 6.6 above.
h. Certificate of marriage, if applicable, and personal information
on spouse.
b) Vested deferred retiree. A file shall be maintained on all vested deferred
retirees of the Pension Fund. Each file should contain the following
documentation.
1. Application forvested deferred retirement (attached as Appendix "E");
2. Documentation as to Benefit Computations
a. Date of Birth;
b. Date of Hire;
c. Date of Retirement;
d. Creditable Service Records;
e. Applicable Pension Rates;
f. Salary attached to the job held by the pension applicant;
g. All documents previously maintained pursuant to 6.6 above.
Approved: 11
h. Certificate of marriage, if applicable, and personal information
on spouse.
Upon reaching normal or early retirement, the member will need to complete an
Application for retirement benefits (attached as Appendix "D") to initiate the payment
of benefits.
6.8 Record keeping as to Separated Members. A file shall be maintained on each
participant and Pension Fund member who withdraws from the Pension Fund.
Each file should contain the following documentation:
a) Written application withdrawing from the Pension Fund and requesting a
refund of contributions;
b) Service date documentation;
c) Documentation as to how refund was computed;
d) Copy of canceled check or other documentation indicating payment of
refund;
e) All documents previously maintained pursuant to 6.7 above.
6.9 Confidentiality. To the extent permitted bylaw, all records of the Pension Board
shall be considered confidential and not subject to disclosure to the general public.
6.10 Florida Public Records Law or Freedom of Information Act Requests. Any request
for information or to review documentation made pursuant to the Florida Public
Records Law or the Freedom of Information Act shall be handled by the Pension
Board's legal counsel. A copy of the request for information should be immediately
sent to the Pension Board's legal counsel.
Approved: 12
PART 7 -ADJUDICATION RETIREMENT PENSION CLAIMS
7.1 Appeal procedures.
a) The applicant for benefits under these Rules and Regulations may, within
twenty (20) days after being informed of the denial of his request for pension
benefits, appeal said denial by filing a reply to the proposed order with the
pension's coordinator. If no appeal is filed within the time period, then the
proposed order shall be final.
b) The board of trustees shall hold a hearing within forty-five (45) days of the
receipt of the appeal. Written notice of said hearing shall be sent by certified
mail to the applicant at the address listed on his application ten (10) days
prior to the hearing.
c) The procedures at the hearing shall be as follows:
1) All parties shall have an opportunity to respond, to present physical
and testimonial evidence and argument on all issues involved, to
conduct cross-examination, submit rebuttal evidence, and to be
represented by counsel. Medical reports and depositions may be
accepted in lieu of live testimony, at the board's discretion.
2) All witnesses shall be sworn.
3) The applicant and the board shall have an opportunity to question all
witnesses.
4) Formal rules of evidence and formal rules of civil procedure shall not
apply. The proceedings shall comply with the essential requirements
of due process and law.
5) The record in a case governed by this subsection shall consist only of:
A) A tape recording of the hearing, to be taped and
maintained as part of the official files of the
board of trustees, by the pension's secretary.
B) Evidence received or considered.
C) All notices, pleadings, motions and intermediate
rulings.
D) Any decisions, opinions, proposed or recommended
orders or reports by the board of trustees.
d) Within thirty (30) days after the hearing, the board shall take one of the
following actions:
1) Grant the pension benefits by overturning the proposed order by
majority vote.
Approved: 13
2) Deny the benefits and approve the proposed order as a final order,
after making any changes in the order that the board feels is
necessary.
A) Findings of fact by the board shall be based on competent,
substantial evidence on the record.
B) Within twenty (20) calendar days after rendering its order, the
board of trustees shall send by certified mail a copy of said
order to the applicant.
C) The applicant may seek review of the order of the board of
trustees by filing a petition for writ of certiorari with the circuit
court within thirty (30) days.
7.2 Subpoenas.
a) The Pension Board has the power to subpoena witnesses or documentation
in all proceedings under these rules and regulations. The Pension Board
shall retain a copy of each subpoena that is issued. The Pension Board will
also issue a check with each subpoena for mileage or witness fees as
provided by law on any subpoena that the Pension Board initiates on its own
behalf.
b) At the request of any applicant in a retirement pension proceeding, the
Pension Board will execute and issue subpoenas. The subpoena shall be
prepared on a form acceptable to the Pension Board. The Pension Board
will not be responsible for the payment of any mileage or witness fees as
required by law. Such fees that be the responsibility of the person
requesting the subpoena.
Approved: 14
PART 8 -INVESTMENT POLICIES
8.1 Pur ose. The Board of Trustees ("Trustees") of the Village of Tequesta General
Employees Retirement Plan ("Fund") has the power and authority to invest and
reinvest the moneys of the fund, and to hold, purchase, sell, assign, transfer, and
dispose of any securities and investments held in the fund, including the power and
authority to employ counseling or investment management services. Attached as
Exhibit "F" is a copy of the Investment Policy Statement of the Board.
Approved: 15
PART 9 -INCOME DEDUCTION ORDERS
9.1 Income Deduction Orders.
a) Assignment of Benefits Upon Divorce The prohibition against attachments,
garnishment, execution or any other legal process shall also apply to a
domestic relations order, unless such order is determined to be an income
deduction order as defined by Florida Statutes §§61.1301, 61.046(4) and
61.076, and such benefit is only for purposes of alimony and/or child support.
b) Filing of Claims All claims for benefits under an income deduction order shall
be filed, in writing, with the Board of Trustees along with a copy of the
income deduction order.
c) Definitions
1) Alternate Payee -The term "alternate payee" means any spouse,
former spouse, child or other dependent of a Participant who is
recognized by a domestic relations order as having a right to all, or a
portion of, the benefit payable under the Plan with respect to the
Participant.
2) Income Deduction Order-The term "income deduction order" means
any judgment, decree or order which relates to child support or
alimony payments to a spouse (or former spouse), child, or other
dependent of a Participant, made pursuant to a state domestic
relations law.
d) Designation of Representative The Participant and the alternate payee(s)
may designate an attorney or other representative to receive notices and
communications from the Trust Fund instead of the Participant or the
alternate payee. This designation must be in writing and must be signed by
the Participant or by the alternate payee.
e) Payment of Benefits Pending Trustees' Decision. Pending a decision by the
Board of Trustees whether an income deduction order should be honored,
any amount which would be payable to the alternate payee(s) if the income
deduction order was honored shall be accounted for separately.
Approved: 16
• Village of Tequesta General Employees Retirement Plan
ADMINISTRATIVE RULES - SIGNATURE PAGE
Chairman
Trustee
Trustee
BSJ/adt
• Administrative Rules Addendum
October 20, 2009
• Approved:
Seceetary
s
Trustee
WITNESS al to Trustees
17
APPENDIX "A"
EXHIBIT "A"
ATTACH EXPENSE POLICY
Approved: 18
APPENDIX "B"
EXHIBIT "B"
ATTACH EXPENSE REPORT /REIMBURSEMENT VOUCHER
Approved: 19
APPENDIX "C"
Village of Tequesta General Employees Retirement Plan
Employee Application for Membership
System: ()General Employees ()Police & Fire check One {Social Security No:
Employee:
Last Name
First
Initial
Date of Birth Sex Employment Date
Employee's
Beneficiary:
First Name Middle Initial Last Name
Date of Birth Relationship to Employee
I hereby apply to the Village of Tequesta General Employees Retirement Plan for
membership in the retirement system and accept all terms and conditions of said plan, as
prescribed by the Board of Trustees.
Date
Signature of Employee
Approved: 20
Vested Terminated Employee
Dept.
Employee Name:
S.S. #:
SeX: Date of Birth: Date Hired: Termination Date:
LAST 5 YEAR WAGE OF EMPLOYEE Employee
Beneficiary:
Date of Birth:
Relationship:
Approved: 21
APPENDIX "D"
APPLICATION FOR BENEFITS
PLEASE PRINT OR TYPE:
1. a. Name of Employee:
b. Social Security Number:
c. Date of Birth:
d. Home Telephone Number:~~
(Area Code)
(Attach birth certificate or other proof)
e. Home Address:
f. Permanent address to which check and correspondence should be sent:
2. a. Are you currently married? Yes No
If yes, please complete the following:
b. Name of Spouse:
c. Spouse's Social Security Number:
d. Spouse's Date Of BII lh: (Attach birth certificate or other proof)
e. Date of Marriage:
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3. Name(s) and Date(s) of Birth of Child(ren):
Name Date of Birth
4. Names of Your Living Parents:
a. Mother:
b. Father:
5. a. Date of hire by the Village of Tequesta as a Sworn Police Officer:
b. Current Position in the Department:
6. I plan to retire on:
7. Type of retirement which you are receiving:
Normal Retirement
Early Retirement
Line-of-Duty Disability
Non-Line-of-Duty Disability
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8. If you are applying for a disability retirement, please complete the following:
a. Date disability commenced:
b. Nature and cause of disability:
c. Did your disability result from any of the following: Yes No
(1) Use of drugs, intoxicants or narcotics?
(2) Due to a fight, riot, civil insurrection or crime?
(3) From an injury or disease sustained while you
were serving in any armed forces?
(4) After your employment with the Village terminated?
(5) While working for anyone other than the Village and
arising out of such employment?
d. A copy of my doctor's medical opinion is attached:
NOTE: If you are applying for a disability benefit, records must be filed to show that
the disability is total and permanent. If application is made for aline-of-duty
disability, copies of workers' compensation records must also be filed to
show that the disability occurred in the line-of-duty. Also, the Board of
Trustees may require you to be examined by a doctor selected by the Board.
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Acknowledgments
I hereby certify that the above statements are true and correct to the best of my
knowledge. I understand that a false statement may disqualify me for benefits.
I have reviewed the Designation of Beneficiary Form filed with the Board of Trustees
and I hereby certify its accuracy. if I desire to change my designated beneficiary(ies), Iwill
file a new Designation of Beneficiary Form with this Application.
I hereby authorize the release of any and all medical records including but not
limited to the complete history records in possession of all doctors listed below concerning
my illness and/or treatment.
I hereby waive my right of confidentiality of my medical records and other medical
evidence in order that my application for disability benefits may be properly processed. I
understand that in so doing, such records will be discussed during one or more public
meetings and will become public record. I understand that the Board(s) will rely upon this
waiver and that I will not be able to withdraw same at a later date.
I agree to cooperate fully with the Board of Trustees of the Village of Tequesta
General Employees Retirement Plan in making available to the Board, or authorized
agents of the Board, information which reasonably relates to the initial payment of or
continuing eligibility for payment of benefits from the Fund.
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I hereby agree to indemnify and hold harmless the Village of Tequesta General
Employees Retirement Plan from and against any and all claims, demands, or causes of
action of any kind or nature resulting from or in connection with Village of Tequesta's
release of the results of the undersigned's annual physical to the Pension Plan and from
and against any resulting losses, costs, expenses, reasonable attorneys' fees, liabilities,
damages, orders, judgments, or decrees in connection therewith.
Dated this day of , 20 , A.D.
Signature of Participant:
Participant, please sign above
WITNESS:
Printed name of Participant
Signature of W itness Printed name of W itness
Sworn to and subscribed before me this day of , 20_
by
Personally known to me -OR-
Produced identification (Please indicate type of identification produced on space provided below):
NOTARY PUBLIC
Printed, typed or stamped name of Notary:
[ notary seal ]
My Commission Expires:
Approved: 26
APPENDIX "E"
Village of Tequesta General Employees Retirement Plan
Vested Terminated Employee
Dept.
Employee Name:
Sex: Date of Birth:
Date Hired: Termination Date:
LAST 5 YEAR WAGE OF EMPLOYEE
S.S. #:
Employee:
Beneficiary:_
Date of Birth:
Relationship:
BSJ/ka
October 20, 2009
H:\Tequesta GE 1012\Plan Docs & Rules\ADMIN RULES\2009\2009 Admin Rules.wpd
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