HomeMy WebLinkAboutDocumentation_Regular_Tab 08C_10/10/2002 ii
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INTEROFFTCE MEMORANDUM
TO: Mlt. MICHAEL R. COUZZO, JR VILLAGE MANAGEA
FROM: JEFFERY CARPENTER NEWELL COMMUNITY DEVELOPMEN
SUBJECT: LIFT STATION LOCATED AT DOVER CIRCLE "SPECIAL E CEPTTON USE"
DATE: SEPT'EMBER 27, 2002
An application submitted to the Village oE Tequesta from Mathews Cor�sulting Inc., agent, for
Loxahatchee River Environmental Control District owner of the properry located on the corner of
Dover Road and Dover Circle for a"special exception use" in the R1 Residential District.
Section VII(2}(d), page 1124, "special exceptions", public utilities structures and buildings such as water
purnping plants, electric substa,tions, police and fire sta,tions...."
Staff has determined that the Lift Station that is located at Dover Circle falls under the "special
exception us�" criteria as outlined in the R2 Residential Zoning Requirements. They are as follows:
a) That the proposed use is a permitted special exception use. Sta,�'Ke,�onse: the lift station is a
special exception use w'rthin the 122 zan'tng district.
b) That the use is so designed located and praposed to be opera.ted so that the public health,
safety, welfare ar�d morals will be protected. St Ke� staff has determined that the above
criteria have been met.
c) That the use will not cause substantial injury to the vatue of other property in the neighbarhood
where it is to be located. Sta,�'res�ion.re: the design and landscaping of the lift station will not
cause substantial injury to the value of the surrounding property.
d) That the use will be compatible with adjoining developtnent and the proposed character of the
district af the district where it is to be located. St�,r�onse: the use is compatible.
e) That adequate lat�dscaping and screening is provided as required herein. Sta�Iies�ion,re: the
Community Appearance Board has appraved the landscape plan.
�} That adequate off-street parking and loading is provided and ingress is so desi�,med as to cause
miniznum interference with traffic on abutting streets. �tc�Ke.r�onse: the iift station is designed
to accommodate any maintenance vehicles that are required to service the unit.
� That the use conforms to all applicable regulations governing the dist�ict where located, except
as may othenvise 6e determined for planned developments. Sta�,rpon,ce: the use conforms to
the regulations that govern the district.
In conclusion, Staff recommends the approval of the special exception use to refurbish the Lift Station
lacated on Dover Cirele.
Sent By: ; 561 747 9g2g; qug ta 02 t3:38; Pa e a
tl�/14/'LbtlL tl1:44 Sb15/�b'L'L4 7EOl�STA p� 04
VILLAGE OF TEQUESTA
DFPAR I�' OF Gp�y �p�,
Post Office Box 3273
Z50 Tequeata Drive � Suite 305
� T�que��, Flodda 33469�4273
(561) 575�62Z0 • pax: (561) 575-6224
YILL�06 0! T��T�
THB t�ID�RBIOdED A�UEBTS a gp�=�, ��IOl1 tOR THS t�S 6E�CIaItD
BSLOq. BNOOLD THIB >PPLIC�TIOl1 H�E ApPROV�D. IT IB OeID'�BTpOD THJ►T IT
BH>i.L OlTG2 �QT'NORIZ6 TyAT PLRTIC�ILaB 083 DiSCAZBBD Zd Ty=B aPPL2Ci?ION
�ID �T COpDZTZO'N6 OR B�i►LtiU�RDB RaQUlitgp 8Y TH� VILL�IS OF ?bQE7BBT�.
Loxahatchee River
N� OF �PQLIC�HT: Ftzvironmental Control District D�g 8-15-02
�.
MAILIMO 11Z7D�ta8B: 2500 Jupiter Park Drive, Jupitex�FL 33458
BHONS !!OlIB88s ( HOMS) N/A c HoHIlf�S) 747-5700
LOT/P�RCSL �R6Td8: *See attached Warranty Deed
LOT: � corner lot 23gt,pCx 15 SUHDIViBIb�s Jupiter in the Pines
P6t0p3ftTZ CO�lTAOL aQl18E�t: *See attached Wa rran ty Deed '
�=�j�a Oes• existing lift station that was not placed in service.
b�CR2PTI0l1 OF Bp6CT�i, gXCgpTlph; __To rehabilitate an existin lift station
and place back in service. This will consist of lift station valve vault
driveway, and landscapinq
FROP�tTZ O�i�R: �X�atchee River �vironmental Control District
NOTS; 11PpLICLDiT 9M�i.L INCLt,iDg TE{g @'pLL0i1Il10 AITFI ?HB �PpLICa220l1:
1• CURRBIIT 60RVEY OR B ITS PI,l�1 OF PROPBRTY SHOiiIIIG STRUCTVRE6 B�Ip
B4"TaJIC]C8.
2- Di�NII1�8 TO 8CAL8 OP PROP08tD INPROVENSlIT6 R�QUIRIDIO BP�CI�L.
�ZCSPTIOa i?6S.
3• wRIT'r�1 APPROYAL �'ROM i'ROP]'iAT'Y Oq[1YR Z�' OTHiR TH�l1 ,PPLIC�NT.
4- A�IY OTt�ER DOCOl�SNTATION pFRTINl�lT To THis �PPLICATIO[i.
5. Tp�1TY-T�0 c TZ) COPI�s OF �LL suerlI�r!►L8.
6. �PPLIC�IOl1 Tis OF FIYg �aDgg� c�500. 00) DOLLARB. t oi.80
AE'PEtoPRiATB CONNt7N2 C 8011RD S SITB pl.Al! AEVI� FSYS. )
1LL�PLICA�IT' 6 6I0lI�TOR�: g- 2.� - a�-
Rayrled r.yc.
*See attached letter that provides written approval from LR�Cp that Mathews
Consulting is their agent for this project.
TNIS DOCUM�Mt �:'r.�..i •./
w,i �,.�:,i s. �: _:�._� a
.\Tf:_�::.'_Y '.i l `.Y�
Y. t?. : O.: .' . ,
13�'"f� WARRANTY DIIIiU ��'��'�-�••• rtoc,:u..�;,s:.!
m
T
_ THIS INDENTURE, made this �� �� day of ������� r
n:
1976 between Lawrence J. Zielinski and Kathryn J. Zielinski, t�is w fe.
c,
�
their successors anJ assigns, herein called GRANTOR and tlie
W
LOXAHATCHEE RIVER ENVIRONMENTAL CONTROL DISTRICT, an Agency oI
r the State of Florida, of tlie Counties of Palm Bcach and Martin
and State of Florida, their successors and assigns, herein
called GRANTGE.
WITNESSETf(:
That the GRANTOR for and in consideration of thc sum of
,� TEN DOLLARS (510.00), to it in hand paid by the said GRANTGE,
„t
;g together with all other covenants made by GRANTEE and contained
ry herein has granted, bargained and sold to tlie GRANTEE, thc
.��, following described parcel situate, lying anJ being in the
,� Village of Tequesta, Palm Beach County, Florida TO-WIT:
:` � Commencing at the Northeast corner of Lot 23,
Block 15 of Jupiter in the Pines, 5ection B
; as shown in Plat Book 26, Page 18 of Palm Beach
� ;'.�; County, Florida, proceed South 4.91 £eet to
�-o;y ;� the Point of Beginning; thence proceed South
- o r!�; 15.00 feet to a point; thence West 15.00 feet;
'-' .,, `- �': thence North 15.00 feet; thence East 15.00
�:`<% - feet to the Point of Beginning.
'•=? For the purposes of construction, use and maintenance
c-. � �
"' of a sewerage lift station, including lines, valves, pumps and
' appurtenances shown on those certain plans held in the offices
of GRANTEE and described as:
Loxahatchee River Environmental Control District
Water Management Program, Pollution Control
Facilities, Phase 2A, Lift Station �23, shown
on Sheet 66 of Barker, Osha and Anderson
" Engineers, Inc., Job 74-1042.
And it shall be lawful for the GRANTEE to opera[c, maintain
and repair said way as there shall be occasion.
And the GRANTEE, for itself, its successors and assigns
hereby covenants aith the GRANTOR to:
�� �=;T� cir- F I.�C7F.ILJA � " `�~� 11�r;UMf NTARI' =
IlV<.UMF.NTARY :.�,TAMP rnx I , _ 6j;�j p�Q� SUI't T/IX -
• niv7"nr nF"r�iiai � 1) �"�� -
�„- = �E�.,•,� i) 1. 5 G i ::. ��:�. «. ,�,< <, Iz 0 0. 5 5 �_
., ; ,.4 . . : . � ,. � �, -
.,.,,r. .
. ... =- ---......._ `�-��. ., nn.m nirs -
..___1 �
�I � �ci PA[E��O2 _
(a) �..close tl�e parcel conveyed ., a chain link fence of
good quality, adequate to restrain free and easy access by un-
authorized persons. '
(b) Provide adequatc screcning with landscapc matcri�ls.
(c) Restrict all electrical wiring to underground
installations.
AND TI1E CRANTOR hcreby covenants with thc GftANTtiL• tliat it
is lawfully seised and possessed on the aforedescribed tract or
parcel of land; tliat it has a good and lawful right to scll and
convey it; that it is free from all encumbrances; and tliat it will
warrant and forever defend the title and quiet possession thereto
against the lawful claims of all persons whomsoevcr.
IN WITNBSS WHGRGOr, thc GRANTORS havc hcrcunto set Chcir
hands and seals the Jay and ycar first abovc Nrittcn.
Signed, sealed�and delivcred
in the presence�of: /
`�; _ �'I �� \ '�A ; �--- _ ��L � C. (�..+ i � '
<.
Lawrence ' linski
�� , : %� ' i
, -- �
� .r �{ � �f �<<,, ,�. -..
� .-
•., As to Lawren� J. Z�e na i _
� `, � `. 1 ,
. _.�// � i .
� ; 11 . t •, c. <.'. _. '1 l 1, l I � � Cl. i_ .. ' Al� .
ath yn �. Zi linski
�' � /� �
;� tE �:( � .../ JYt' t t (.' —
� :� �- s to athryn :�. ielins
�;v�
:o • :z :
_i . •
-n � �� '-�
n U n rY
�, x z�.,, STATE OF FLORIDA
i: :'; _; :�,
w� o-,; COUNTY OF PAI.M BEACH
`,� �':�
°O ' I HEREBY CERTIFY that on this day, before me, an officer
��
v
� duly authorized in the State aforesaid and in the County
a£oresaid to take acknowledgments, personally appeared I.AWRENCE J.
ZIELINSKI and KATHRYN J. ZIELINSKI, his Wife, to me know to be
the persons described in and xho executed the foregoing instrument
and they acknowledged before me that they executed the same.
WITNESS my hand and official seal in the County and State
last aforesaid this/ � day of , A.D., 1976.
.. J �
/� , il. � /` , ..!�17
nrru � Otet ' U l�p�' •
_ �<<0�02505 eAtE1403 state of F1�
.� 1 ,, .. ... •., i, �.,
�� r „� A 0 My COIMIiST;.Of����5 �P .. .
v.•.�. '.•O'.
�� '��IN Notary vuene ;g�iai,s�1 �,rdlA� w�iri �, •
M�M�. S' My commh �iTe1e■ rsel4j' _
�. �. �.w `'-o ' .. � .� ��.
rr� ��i rr ;i�%: <Oi;IBi���� �
� ' �� �
��vIRON,�F�
4 9 �
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J �
Loxahatchee River District a ��J� °�
W :. . -�
� �'
0
2500 Jupiter Park Drive, Jupiter, Florida 334�8-8964 � � "
Telephone (561) 747-�700 Fax (561) 747-9929 ��- '' �' �� �.d
e-mail: osprey@loxahatcheeriver.org b -f-��"; 971 y
website: www.loxahatcheeriver.org
Richard C. Dent, Executive Director Award Winning
Regional Wastew¢ter Facility
AuguSt 14, 2002 Best in Nation, E.P.A.
Best in State, D.E.P.
Mr. Jeffery C. Neweil
Director of Community Development
Village of Tequesta
Post Office Box 3273
Tequesta, Florida 33469-0273
Re: Mathews Consulting, Inc.
Dear Jeff:
Please consider this letter as authorization for the firm of Mathews Consulting,
Inc., to represent the District in all matters concerning the design, permitting, and
construction of South Seabrook Road Sewer System, which is now under review
by the Village.
If you require any additional information, please feel free to call upon me.
Very truly yours,
`����
Paul P. Brienza, P.E.
Director of Engineering Services
PPB/Iml
Cc: David Mathews, P. E.
Vice President
Mathews Consulting, Inc.
Joseph O. EOLg Loiin� E. "Sn�" Holm« MaK H, Rostock RicLard C. Sheehan Sa er Thom
Bosrd Member Board Member Ch�irman Board Member Board bfembe� Jr.
�
� �
1 ,.,
' • � ' = �
emo
To: JoAnne Forsythe �
From: Daniel J. Gallagher
Date: 10/1 /2002
Re: Cigna HealthCare Group Benefits Proposal
Attached for your information is a copy of the Proposal from Cigna. The tofial cost of the health program
is within the budget figure of $485,000.00, provided for in the budget approved by Councif.
I recognize t�at any contract over $15,000.00 must be brought before Councii therefore, Mary Wolcott
should receive this information for inclusion on the agenda.
1
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�If�NA I-� �altll�are �
CICNA HealthCare Group Bene�ts Proposal
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�'iflag� of Tequesta �
250 Tequesta Drive �
Suite 304 i
Tequesta, FI. 334G9
SIC Code : 9111 z y �
G�oup Contact : Kim Bodin� '
Atcount Number : 31506$0 i
Tot�Al Eligible Employees: 70 rarticipating Subscribers : 70 �
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�mpluyer Cantributions : Empinytc Contribution : 10d°/'o
Dependent Contribution: 75% �
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Wsuting Period : 90 days
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Eligibility Definition : Active rrnployees working 30 hrs �
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Note: The Cjuotc�d rates ate subject to fina! Underwriting approval and, as noted velow, are subjeet tQ �
change in tlie ev��nt of ch�-uiges in benefits selected or chanKes in the risk tactors upon which the Quutcd '
Rates are bas�d_ In addition, the uoted Rates are sub�ect to re ulato a . ;
Q J g ry pprov;il. T�'requircd re:bulatory
approval has nnt been obtained on the proposed effecrive date, the healthplan shall usc rat�s that �re '
ecrosistent with iis �hc-n curr�nntly appmved raiing methodalo�;y and lhE quuted rates shall be effective �
immzdiatc;)y un Ih� date For which ihey are approved fc�r use. Thc: Qu�led lZates are guaranteed while the t
Cir�yup Scrvicr A t,�cem�`rtt mmains in cf!'cct unlil thc nex� atmivc.�rsary date, unless enrollmeirt changes hy �
15% in which ca;;e the C.1GNA Companies may chai�ge the t�uoted Rate. '
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]-i9V9TJ8]1-SiF-I R�visionl 1 of]5 ��/d
vi�la�r. of Teyucsia �
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Z00 � vua r� � on 'nn� in� ian
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CI�x�TA,. Hea1t��� e
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Proposed Benefits ,
Product: CI .('x�111 HealthCare POS '
Fffective Dste: XO/02/2002 ;
Benefits Sutnix��
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Categary Description ix► Nctwork t)ut of Nciwork
Mediesl Bcnc�t� �
CDInSUC:uiCC ' 7U°
PC:P Office Visit Copay � � Q ,
Specialic� Officc VisirCopay g��
Hospiral f P- Per Admir �opay gt pp � �� �
Hospital IP Copay P�v Day NA Nq .
Nospi[a) li' Coinsur�,ncc N�
Outpatient Facility Co�y � i
Outpatient C�inSUttmcc Hp �
Emergency Rn�m Gopay $SU �
Urgem Care Gopay g� ;
Skeiled Nursing Facilicy Copay �p i
Skil[ed Nursing Faci{iry Maximum Days �,p 60 i
Homa Health Car�; Copay ��� I
Home Healch C.arc Maxin�um Visirs Unfimited 4�
bM � lnctuded ;
Tjurablc Nledical Equipmcnf ncductible � �
Dur.�btc Mcdical tquipn�eal Muximum $3,5(10 Nn
�PA f etluticd ,
Eatarnai PmsFhctjc Appliances Da�Juctiblc Sp '
Extemal Prosth�tic Appliances Maximum �1,QQp NA
Chiro Meludcd •
Shorc Term R4hab Copay S20 i
Chiro Capdy $20 Np ,
5hon Term Rchab and Cliiro C:ombi�cd Maximun� 6p NA
Visi[s
Shorc Term Rchab Maximum Vis;t� Nq �U �
Self-ltr�errcd Chiro Maximum Viaits NA NA �
MRf, CT PrT Scans Copay • $50 �
Plan Deductiblc - [ndividual 53W ,
Plan I���ductible - Family �60b I
Out of 1'ocket M�cimum - Individual a ��p �� �
Ouf of Pockei M�.cimum - Family �2,U()0 54,000
[.i�etimc Maximum Unlimiterl $I,aqO,Wq i
PCL Admin Opcin� Exeludecl Excludad �
Infcrtiliry Excluclec9 :
Mcdicare C:C1E3: Rctirccs �=GS Admin pption NA �
Robus� Repvrting Package Excl��dcd !
working Wundcrs Includcd
24 I l�ur Hcnith Info Line Included
Well Awarc F'rogram included ;
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1-19v9U811-STF- I ltevisionl S �f 1$ .. , • � �
Villas� of TCC1t1C513 U8/0?/Q2 ;
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900 f�j �
%V3 ZZ�80 ZOOZ/£Z/60
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�I�l'�',,�. �-Iea1t���,re �
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Pro�osed Benefits ;
Product: CIGNA NealthCaze PQS �
Effective D�ite: 10/01 /2002 '
Benefits Sum»tary (GQnt.) �
Catcgory DeFCription In Networl: Uu! of Nctwork
Mqiiral Benefic4 (C(►ot_) Watl Being Ncwslenar Incluc[�f �
HeaNhy Babics Includ�{ ,
� rea��hy Rcwards Inc�uaec+ '
f.ifc Sourcc Organ Trans�lant Network includai �
Cuest Privileges Inelud� i
t.nngua�c Line includcd �
nru►�storc.Com Inclu�lcd ;
Dcrcription !n P1etwUric '
Pharmacy Benefih SS/S15/S35 i
C:0�3Y - GenCrjC $g I
Copay -13rt,nd S! 5 '
Non-Praferrod Copay • g;5
Mt�il drder - GrncriC Cop3y $10 �
Mail Otdex - I3rand Cop3Y S40 �
Mai l Order Copay - N on-preterrtci �� pU '
�ra) Contw�capiivcs G �
C'ontraceprfve Dcviccs Covered i ,
Tnsulin Needlas & Syringcs Co„cred i
Glucose rast sWp�L�rc� Covered ,
Pn.�natal Vitamins Covcrcd
Oral rertility llrugs Np� Covcred ;
)nsulin ('nvercd �
Generic Push Includcd
l�omtulary InCrnlivc I
Prescrlber Pancl U� �
MHISA Bcvefits Option 4- High j
Inpatiea� P�L1ayCopay $ �
lnpaiien� Max Namber nf Days MH/5A Gombincd 25 �
MtI Outp�ticnt Copay I to 20 Visirs �3p '
MI I putp�ticnt Max Number of Visils �p �
Oucpazient SA visiis t-2 C'opay �15 �
Ou�patient $A visirs 3-20 C�p:�y �r;p !
SA Outpatient Ma7t Numhrr pf Visirs ?� I
Group Thcrapy t�utpatienl �opay � � 5 i
Group Therapy MH/5A Combincd Marimum Visits �IO �
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I-19V9t7R11-SIF-I Revtsi�nl G �f 15 �8�OV�z ' ;'
ViI2aGe of TcqueSt:�
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L00 �j %d3 ZZ � 80 ZOOZ/CZ/80
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�Y�NA. � Iealth�zre �
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P�'o,pos�ed Benefits `
Product: G1GNA HealthCare POS
Effective D�te: l U/01/2002 . �
BenefitS Sarnnta (Cont. i
Cstegory 1)escription In Network
Visiou Rcn�ts i.ow Ptus �
�ye Exam Gopay �
Eye F.xum Frcquency (monfhs) � � �
tlardwarc Nqt Covcred �
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1-I�V�U811-SIF-I }tev�innl 7 of 15 0�/b2/0? I
village of Tequcst�t
i
800 � xv.t ct.:ao �nnzirzi�n
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�I�-�,7�_ H��,IthCar� �
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Pra�nosed Mer��cal .Itates �
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Site 7D :1�L816 T+�,816C, FLSifiI1
Graup Descr[piion : BRO'WARD, PAi,M 13F.ACN, MAl2'i'IN �
i
Tier Inforce Currcnt ltcnewa� Monthly �
Su�scribers Membzcs Katc Rate Premin�n Change%
Employer ._ 33 33 $2�533 $3�5.42 $11,398_83 !7% '
Em�a � Spousc � $ �lb $G31.�U $739.21 $5,913_65 17% '
EmP �' � 11 '� 78 546.l8 $6�9.03 $7,029_34 17%
Chilci(ten) .
Fmp + FamilY � 13 50 $b$5.7Q �$ I,U36_27 S 13,471 SO 17% i
Totai � 65 127 '
. 537,81331 �
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1-19V�LT31 i-Slt�-I Rcvisi�nI $ of 15 ps/U2/0?
Vllla�c of 7'eyucst.�
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BOO�j trv.a e�:an tnn�is�ian
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CIf'i�+�l`,�, �ea.�tll�aile ;
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.t'roposed Benef ts �
1'roduct: CIGNA PPO
Effective 17<<te: l O/0 i/� UO2
�enefits Sunu � .
Catcgoty Descriptian In Network Uut Network
Medicad l�enefits
Medical Cost Sharin� Inp:�tien� Goin,�rancc y�e/ �U% �
Checpateertt C�pinsaranr.� yq'Yn 7U% ,
PCP C'�aY S13.OQ N/A !
Hospi[al IP Deducliblt - Per nay N/A N/A ;
Hospital IP Deductible - Per Aclmil N/A N/A �
�It Ueducslbla N/A N/A ,
Plan D�uctible - [ndividual �3UU.UU $500.UU
I'lan Deductible - Fa�nily 5900.OQ � I.OU0.00 �
Out of Pocket Maxirsrum - Sndividuaf S 1,500.00 S3,OOO.001 '
Out of Yocka� Maritnum - Family 54500.00 S�,ppp,pp
Lifctinic Marimum �1.0U0_OUb.00 N/a �
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PUarmscy $e��i, i
RxPRiME Tw�7 icr Copay ;
Pharmacy Cosc Sharing Pharni9cy C.oinsurancc N/A 60°�0
Copay - Gcncric 57.Q0 N/A �
Capr�y - A�3nd $ I5.00 1�!/A '
Mail Ordtr G��+�y - Grnc.vic $i4.Qf) N/A �
Mail Ucder Copay - I3rand $3Q_(?q N/A �
Dtn� De�iuccible N/A S!(H).00 �
�01711U�3Cy C� Bh
Nccwork Mazch % y � �����
lnsulin ��Ve� N/A ,
Pnena[al vitamins Govtre�i '
Glucose T�st Stri�►slf,an��;�� Cevered I
Insulin Needlts & 5yrin�es G���( �
Mandatory C;eneric Cpvcre�l �
MH/SA BcncliLt '
{Meutal Healch -,1lcphal & '
Drug Abnse} �
MH/SA Gost Sharing Inpaticnt Coinsurance yU% lU°/n '
Outpaticnc Coinsuranca N/A SU%
Oulp�ticntGopay �15.W N/A �
lnpaticnt Dcduccible - I'er Admit N/A N/A �
lnpacient Ueduc�ible - Per nay N/A N/A '
Inpatlen[ Cal Year Maz ONy's 3p j� �
Inpacien� I .ifefim� Ma� DaYs N/A N/A ;
(h,tpaticn► Cal Ycar Ma.t D�ys (p �p �
Oulpiticnt Lifctinzc M�.r Uays �/� N�� ,
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1-19V9U�11-SIF•-1 Revisiont 9 of 15 0$/U2/02 �
Vill�gc �f Tequecta ;
OIOf� %V3 EZ�80 ZOOZ/£Z/60
,
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l�I��L'�T�4►. H��.lth��ar� '
,
�'�oposec� I�3enefits �
product: CIGN1� PPO ;
�,f�ective Date: IO/01/200� .
BCt1E�its $tllYltil (:pnt.} , �
Cxt or �
� Y Description in Ncfwork Out NctwortG
Vision BeneGry� None i
Misc�llaaen�s Benefits EPA Iucluded '
� Includt�d •
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1-19V9US11-SIF-I Revisinnl 10 0!'15 . 08/02/02 '
V�Ua�e ofTeqoesLi
,
�j� � %V3 CZ�80 ZOOZ/CZ/60
% �
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���'rl"�TA. � e�t�1�.�1.'� ;
Pro�o s��c� Mcdi�cal ant�' .Rx Rat�s
Mctlical and ttx Rates 1
.���� Iaforcc Currrnt ltencwsii M�ntl�ly �hapge i
Subscribers Mcmbers l�atr Ratc Prem ,
Lmpluyec: 1 1 $372.9=� $G52.6a $6�2.64 _. . 75% �
Emp+Spouse � l 2 $798.10 $1,396_68 $1,396_l58 75"/0
EIYi� •t- � U 0 $b89.95 $1,2�7.41 $0.00 75% ��
Child(ren) '
Emp I Family � 0 U $1,118_84 $1,957_9C 50.00 75°� �
'1'otal 2 3 �2,049.3� � ,
.�._._ , �
Retiree's only ;
Medi and Rz [tatac i
Z ,� Er Inforce Cnrrcnt Renewal � MottthLy Ch�ngc% �
Subscribers eni�+us Rate Rate Prcmiam '
F.mplayre 2 $295_40 SSl6.95 $],Q33.90 75"/0 �
Fmp •i• Spouse � U 0 $590_79 $1,033_$$ $fl.Up 75"/0
Lriip + F�mely 0 0 $RRC.19 � �$1,550.$3 U_00 75%� �
Tot�l 2 2 �1,03;.90 - '
, �
1-l9V9tJS11-SIF-1 Revisiotll 11 of15 y pg/d��� �
vill�gc of Tcqucsta �
ZTO � %V3 EZ�SO t00Z/EZ/BO
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Cz'�NA,. f��alt�I+�aa['e �
Medicart History Infox�natin�e ;
For .
T�illage of Teqteesta '
!
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I. II�ve thrre been any cl�ims a�er $10,dU0 in tl�e last 12 '
uionths? �
i
2. Ha� any crnployze misseci mare than 10 consecuhve ciays in —'
the last 131�totttl�s duc to jll��ess or injury? ;
3_ Are thait• a�ry c wi cmbou�g di sabili�ir:s" �
4- Have an�� utdividuals bzen di:��mosed, receivcx! treatment, or �
a[�e currc:ntly receiving lr�.�filent for any ofthe following �
corrdiaon�s i�t t�ie pasc three years A1coI,41/Dn�g abuse, C'ancer. j
Uiabetes. II� art t:onditions, Immune Systzm Di.wniers, Kidnzy ;
Ailme�its, L��c�- Diseases. Lung Coazditions, Obcsity, Organ �
Transplan�s"
N� lalown mc�iical Conditions cxi;�t. '
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]-l�)V9U811 Sll�-I Rc�isionl 12 of 15 U$/02/02 '. . �. .
V�71age �f T C(lUC5Li '
i
£i� � XV3 YZ�80 ZOOZ/SZ/60
I
��� i�.�. �ec"�tll��.y'� ,
i
��Z(jBYWrttlll� C011tllt�;GflCteS �
FOl' '
�tUage of T'equesta '
xThe rates ar�: guaranceed fur a peri�ci of 13 momhs while thc cantract xem ' in force. �
*'fhc employe�r coiltributes at least 50% tow� k1�e tc►tal cost of the pl�n_ ;
''�No seasnnal cmployees are covered under this plan.
*The currer,l waitin�; period is 90 days. •
*T1us quote assumes all �,Inyres are located in the neiworlc ar�a, and that ll einploye�s ar�: only eligible '
for the prc�du� t c�fferin�5 sp�ec�ed. ,
*'f'he GTGNA HealtUCare Companies n:tain the right to modify the ratcs and eneints set forth in this �
quotatiou. cu to decline to offc:r coverage ifany of ihz infomia.t�on up�n wt�ic � tliese tates c�r bc.-ncRts was �
based chauges or is not accnratc:_ '
*! f any in��m �ation set fordi ui rhis form ehanges at any time while eavc.-rage is providzd to you by CtGNA !
HealthCare Companies, yc�u rnus� notify us witi�i 30 days of thcse cha�i�es. ;
*There is a minimum participation of 5(1% reqttired. This will be bascd cm t total eligible c�mpinyees. ;
ideutified ss !0 empluyce�. ,
*lf a dccision i5 not reaCll�d within 60 d�ys fmm the date the [ates �tc�d/or fcc • sc:t fortii hereui at�e reccived, ;
�hcn Counect� �t General Life Insurancc C'ompany arzd its affiIi�ted ecrmpani s and entities (colleetively,
"CiGNA") reyetves thz ri�hL tn n:vise said rates at�d/or fees. �
� I �
If znrollmc�ni i�,cna.�es ar decreases by 15"/0 or morr: from the enmllmzut lssumptions u,tied i» establisl�ing !
the rau:s anei/�.r fees set farth hei�ein, CIGNA rrs�.nves the xigtit to ievise said �alc:s anrUor fees. ;
�CIGNA HealthCare is the exelusive provicicr ot healthcare covera�e to yo c�r►plc�yees. �
*Connce:ticut C�r.neral may canczl the policy as c�f �ny Pn-miuin Due L�ate if e numbcr of insttred
cmPloyees is less tliw 2S or less than 75�/0 of those eli�ble. I ';
�
*No Medicare cli�rihle retirees are covered uncier this p�lan. '
i
'�Medical His� ory Infonnatiou is accurdtc: ta the best of yottr l:nowledge ,
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I-19v9U811-SiF-1 Revisi�ni 13 of i5 , OR/02/U2 .. . �.
Villa;e of'X`equtsi�
�
i�TO � I
%V3 6Z�80 ZOOZ/�Z/BO
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�I�ir��_ � Eii�.t�1�.c�.Y� '
Underwritir�g C'o.atiragencies '
For
�ilCage of T'equestat (cont.) 1
*The iates icleritificd �re subject to i�egulatory approv�l. It; as of their prc�osed effecuve datc, regulatory .
approv�l is not obtained. the liealthplan shall usz rates consistent with its then cuaently approved raies and
the foregoin�? razzs shall hc effectiva automaiically upon approval. ;
;
'"7'he: employer inust co�rributc thc rame �lat dollar amount to each pL1n. '
*Uut ofNzc���ork benefit n�aximums are nduc:ed by In-Network utili•r:��inn_ �
'�Unoent Can is subject to plan c{cduct�ble and coinsuranec i f inember is out of xrc;:i. '
*Lm�rgc.-ncic•s a�e always coverecl !n-Network provlded rhac the , mezts CIGNA Hc�ithCarz's ;
standard definition of an L�mc.�ency. �
*All e�vc:n:d Out-of-Network services are subject to pIan dednctibfc and couisurance. �
�Out-af-Nenvork Chirupractic� DaiaUlz MedicaJ �quipmenit, External PrnSthctic Appliances, Isifcrtility,
Prescripiioa [Tnig, Vision, Meutal �Iealrh/Substancc Abuse and Organ Iian�lants are not covere:d ;
- *Short rchabilitation: If a �0 c�ption is selzcted participar,ts will be permitt��ci � m�xiirn�m uf 6U �
Out-c�f-Netwark visits reduced by tn-Netw�rk uulizarion_ ;
*At CIGNA uptipn, tl,is Rate Proposal, and ab►reements �u'isu�g fram diis pmposal, sliall bc v�id "ui rhz '
evc:nt t�F Fede�ral, State or Local action impacring the bcncfit levels quoted herrin en affecting ot�r ability to
meet our oyli.;ations ta yo�.t, to your employecs/our merxabei�s or to uur cnntr�ected providers_ f3y way of '
illustration, su�h lc��slation or el:ecuvvc actions wbich impuse controls or requiresnents thst aftect: our ;
ability �c� dctc;mtme tatzs; covered mcdicai e;cpenszs or service k�ernefits; providc.TS'delivery of care or the •
fees th�y charge or our cuntrac:�� with providers, may bc cicemed to so af�'ect nur coxitractual obligations. ;
Sh�ulci tivs lrippen, CIC�NA witt make a g�c! Faith et�i,rt ta work to n:ich a new agree�ient that equit�bly �
reflects rhe e�rcumstances as alterzcl by govemment action.
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1-19V9U811-�u'!!�•1 Rcvisionl 14of15 US(0?/02 . . .
V iilagc of Tequas � a �
�
C JT� IL�1 vO.7 R7 • on �nn� in� �en
��G1�T�:. .�-��alth��re .
(Inderwriting Conti�s�encies
�or
Yillage of ;fequesta (cont.)
The CIGNA HealthCare Companies reserve the riglu m aha�,ge tlie Quated Rates end/or Quoted Bc,�etits or to
decline t� offer c overa�re i� auy of ihe �oregoing infornaation is inaccutate or chan�es prior to the proposnci
Effectivz Datc indicated abovc, or if the quotcci rates and%r I'e:as arz not agrc.�ed to within 6U days of nceipt of
this sutnmary inlbrinatiou f�rm. Tf any of thc in£onuaticm idcntified abovc: changes �ith�r �rior to nc� proposed
Effeccivc Date or whiie cnverage is in elY'cct, you a�ree to natify us promptly of such change.
!'he "Underwrilm� Contingenc7es" set forth ab�ve 5hall survive exzcution nf any insurancc policy, application,
etc., issr�ed by C��nnectzcut C.eneraI Lifc irsurance Company or a�iy other CIGNA Hea.lthCare emnpany, and
shal! furtlier sun�ive the effzctivc date of any such policizs.
The ben�ts dis�layed in this summa�ra► Are, for lhe most parl, mwiular ben�lit packages u�ed to develop �
ibe r�i�s. plesse review the $enefrt Summary �nd its Att�cbments for informafaiou about the benefilx
available in your sitcs. �
i
"C1GNA Healthcare" refets to v�ous operating subsidiaries of CIGNA Corporaticm_ Products 9nd serviees •
arz pr�vided by thcsc 5ubsidiaries �nd not Uy CIGNA Goiporation_ Thesa subsicliaries include Cannecticut
Genc7al Life L�surance Coinp�ny, 'I"cl Dnig, I�ic_ s�nd its affiliates, GIGNA BehavFpral FIealth, Inc.. Intrac:prp.
and HMO or s�ice company subsidiaries �f GTGNA IIealth Carporarion snd CIGNA Dcntal I3ealth, fnc. '
�
C1ienL Si�ature Date I
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Clicnt Name " Title ,
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1-19V9U81 I-STF-! Itcvisionl 15 of 15 Q ����� n �
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::,,'; , ;:. ::,. RIGHT-OF-WAY
OVERHEAD
� POWER LINE
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; i oo� 8L 0 CK 3
LEGEND
Q SET PK-BRASS DISC LB • 2799
�� POWER POLE 6 GUY � �
� CENTERLINE
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P. C. PO I NT OF CURVATURE �� � �f
COV. COVERED � ',. '�� �`
CONC. CONCRETE �" �
�'N;:y--°' � ��
ELEV. ELEVAT I ON �,; ` .�A�,,,,
F. F. F I N I SH FLOOR }�I .
FP&L FLOAIDA POWER & LIGHT �:Q :
P. 0. C. PO I NT OF COMMENCEMENT
C. B. S. CONCRETE BLOCK STRUCTURE
SSCO SANITARY SEWER CLEAN-OUT
BST BELLSOUTH TELEPHONE
CTV CABLE TELEVISION
WIRE FENCE
�-� WOOD FENCE
a ASPHALT
AI�I�REW ZA I h0
I HEREBY CERTIFY TO EACH OF THE ABOVE THAT A SURVEY OF THE PROPERTY DESCRIBED
HEREON WAS MADE UNDER MY SUPERVISION AND THAT THE SURVEY MEETS THE
MINIMUM TECHNICAL STANDARDS SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL
LAND SURVEYORS IN CHAPTER 61Gi7-6, FLORIDA ADMINISTRATIVE CODE, PURSUANT TO
SECTION 472.027, FLORIDA STATUTES.
/ � � � � �� - ---- �!- ��; d - ---------
DATElOF F I�LD SURVEY Jp4ES 0' BR I�iV�
D� I LEW AI�� ;�SSOC i ATES, I NC.
F��R I DA LAND SUF�VEYOR N0. i652
THE PROPERTY DESCRIBED HEREON IS AS FURNISHED AND NO SEARCH OF THE PUBLIC
RECORDS OR DEVELOPMENT REGULATIONS HAS BEEN MADE BY THIS OFFICE. THIS SURVEY
IS NOT VALID UNLESS SEALED WITH AN EMBOSSED SURVEYOR'S SEAL.
'/� " � LL [L J Q O �, �, ., ,...k„` .,+, ,:, ' , '• .
) Q 0 0 O � N ti.. `� ��„ ,,,
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; � m � TER a� _ ����,� �szoo �aIVlARTI d�; �M ,1
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� ���. ---- _ � � x . . .. ,�,.�.��..y^.
�,,:.y : �'�; � � Co nty Line d ` .�VLi �r � .
�. : � U a t 2� � �lrl r q ��:.�:��.,,%:: N
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� a � ti �: ; � � O :�,�
• u � Russell St '�, •� , �►. �. �' ° ' t:: " C .. G
� / '�� p V� WOOOLAND DR ' UPITG . �
� ��FI� ► ��2'� �c _ PbPLAR RD N � RO �LfA�Y � .
�RON ROD � r t� ° d= � d f: , `;,," ;��,
i
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� � o ��° �� A Q,a a�� d '*n I�� �,� , T� - i..a- �0� ;'� '�,� ,�
CBS WALL a 0 L e �� �,cF V�LLA et t ... �, y;;;�� .';• ^
i. 5 WEST - Ai��l�. Q�a� W t._� �', ;�.
P� � O i� � ciR � al l: � a. �.
oo a 4� � r- akCY S rr � "�;� ��' ��.. �
�� � wv Irem aRidge a �� 1 c �bo� ° . O, M ' :+
� �° e � \o c, t°■w illow y Q "r R C , " � , • , '
m� � tre Cir � ■ 30 Nt 9� ��,.
L 0 T 14 � `^��� WOOd IAZAL A�.t' ��R � �,. ..:.
nn�s oo� ��R � ,
w
,�, Ave �r � i �, , ,
30 15 0 30 60 90 �'�' � � n titution �^ellia o� �� ,,..
> > �o � ■ ■ �� . oPP�. . ,..
GRAPH ► C SCALE / N FEET s—a R c� �� �° �,�� o � terwa R�" :
1" = 3�' � o'f EQU ESTA SC " � st Coral
:::: : - �> i ge � rgen � ;, ,� t ,
Beac t Brid e Rd � P � �
�' �� E Q�� iH Hall' Q �� Y��dRd �.c PI
i� �°'a �« ei hRd�'� � A `
e � � � N N 7 T NE R :
LOCA T I ON MAP
'` �, BLOCK 3
. o �
.�
:' �'' o
� -�- o
....,. , : .
,
'' ' L EGA L DESCR 1 P T l ON
L 0 T 2 4 LOTS i, 2, 3, 4. 5, 6 AND 7, BLOCK 3, JUP I TER HE 1 GHTS
ACCORDING TO THE PLAT THEREOF ON FILE IN THE OFFICE
;':. ':. .., ..:;:. ..: ..., .;. ,;, OF THE CLERK OF THE C I RCU I T COURT I N AND FOR PALM
BEACH COUNTY, FLORIDA, RECORDED IN PLAT BOOK 23.
,.. ;:',..,., ;: „',;,, ,, .. PAGE 69; TOGETHER W I TH A PARCEL OF LAND 40 FEET I N
CONC. DRIVE WIDTH MEASURED FROM EAST TO WEST. AND 140 FEET IN
ENCROACHMENT LENGTH MEASURFD FROM NORTH TQ SQUTH,...!YlMC lMMJFDIATE!y
�, �� �, �; [ i. 7' WEST� Wt5'i U� AND ADJACENT TO LOTS i TO 7, I NCLUS I VE. BLOCK 3,
JUPITER HEIGHTS. RECORDED IN PLAT BOOK 23, PAGE 69,
AS ABANDONED BY THE COMMISSIONERS OF PALM BEACH
""` COUNTY BY RESOLUTION R-76-1004 AND RECOFiDED IN
;
;.
OFFICIAL RECORD BOOK 2608, PAGE 1709, PUBLIC
" RECORDS OF PALM BEACH COUNTY. FLORIDA. WHI WAS THE
ces wA�� FORMER RIGHT-OF-WAY OF U.S. HIGHWAY ONE.
' 1.7' WEST
� ��� FOUND
� OQ, O IA N ROD LOT !3, B�OCK 3, JUPITER HEIGHTS, ACCORDING TO
THE PLAT THEREOF ON FILE IN THE OFFICE OF THE CLERK
„
t' °� ' ° OF THE CIRCUIT COURT IN AND FOR PALM BEACH COUNTY,
'� ��� ; ..�""'��: FLOR I DA, RECORDED I N PLAT BOOK 23, PAGE 69.
� i.
��+ ' �
' '� �°. ` '��� LOT 25, BLOCK 3, JUP I TER H I EGHTS, ACCOR I D I NG TO THE
.�.�' PLAT THEREOF ON FILE IN THE OFFICE OF THE CLERK OF THE
CIRCUIT COURT IN AND FOR PALM BEACH COUNTY, FLORIDA,
' �" RECORDED IN PLAT BOOK 23, PAGE 69. SUBJECT TO RIGHT-OF-WAY
�;,�:: �'�' , IN FAVOR OF AMERICAN TE�EPHONE AND TELEGRAPH COMPANY
-'"" " AS RECORDED IN DEED BOOK 812, PAGE 50, PUBLIC RECORDS
���� OF PALM BEACH COUNTY, FLOR I DA.
SURVEY�R' S NOTES:
i UTILITIES SHOWN HEREON ARE VISIBLE ABOVE GROUND
FEATURES. THEREFORE. ADDITIONAL SUB-SURFACE UTILITIES
OR STRUCTURES MAY EXIST.
2) PROPERTY CONTAINS 28800 SOUARE FEET, MORE OR LESS.
3) NO TITLE POLICY OR COMMITMENT AFFECTING TITLE OR BOUNDARY TO
THE SUBJECT PROPERTY HAS BEEN PROVIDED. IT IS POSSIBLE THERE
ARE DEEDS AND EASEMENTS, REC��OED OR UNRECORDED. WHICH COULD
AFFECT THIS SURVEY AND BOUNDARIES.
4) NO RESPONSIBILITY IS ASSUMED BY THIS SURVEY FOR THE CONSTRUCTION
OF IMPROVEMENTS, FROM BUILDING TIES AND DEMINSIONS SHOWN HEREON.
DRAWING REVISIONS: SURVEY 29 OCTOBER 85. UPDATE 24 DECEMBER 97.
(INTER-OFFICE USE ONLY)
TYPE OF SURVEY: BOUNDARY DAI L�Y
SCALE: i" = 30'
ELEVAT I ON DATUM: N. G. V. D. 1929 AND ASSOCIATES, INC. DRAWN BY: M. NOTT I NGHAM �
SURVEY I NG & MAPP I NG F I ELD BOOK: "TT. To r�oRK
FLOOD ZONE C. �ZQ�O�2 � I Q(� ej i 12 N. U. S. H 1 GHWAY No. i F I ELD BOOK i40/77
TE�UESTA, FLORIDA 33469
o�e i e nr �CAO I Alr ��i�i re PHONE: ( 561) 746-8424 JOB No . 85 1