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Home My WebLink AboutAgreement_General_11/10/2016 (19) GREAT -WEST LIFE &. ANNUITY INSURANCE COMPANY A Stock Company 8.515 East Orchard Road Greenwood Village, C + Foraetvice, call 1-800-701-8255 Group Fixed Deferred Annuity Contract Non- Participating PLAN SPONSOR Village of Tequesta CONTRACTHOLDER Village, of Tequesta and the Trustee /s of the Village of Tequesta 401(a) Plan as Identified on the Group Annuity Contract Application. PLAN Village of Tequesta 401(a) Plan - CONTRACT NUMBER 98781 -02 CONTRACT DATE September 12, 2016 or the later of the dates signed by all parties, or the later of the dates signed by all parties. Great -West Life & Annuity Insurance Company ( "Great- West ") agrees to pay annuity benefits on behalf of Participants who choose an annuity payment option under this Group Fixed Deferred Annuity Contract ( "Contract "). The-provisions on the following pages, together with the Application for this I Contract, and other documents referenced in Section 10.2, are part of this Contract. Signed for Great -West Life & Annuity Insurance Company and effective on the Contract Date. Secretary President This Contract is a legal contract between Contractholder, Plan Sponsor and Great -West Life & Annuity Insurance Company. PLEASE READ THIS CONTRACT CAREFULLY. GFAC 10 FRI Rolston 1: Sep 12, 20182:10 PM 98181Q Village of Tepuesto TABLE OF CONTENTS mEoT%J01' DEFINITIONS .................................................................................................................. 4 SECTION 2. OWNERSHIP PROVISIONS ............................................................................................. 6 2.1 Ownership of the Contract ------------------------------------'G 2 .z Transfe and Assignmen ................................................................................................................. 8 23 Trus ................................................................................................................................................ 8 SECTION 3. PARTICIPANT ACCOUNT VALUE ............................. .................................................... 7 31 Fixed Account Value ........................................................................................................................ 7 3.2 Transaction Date .-----------------------------------------.7 SECTION 4. CONTRIBUTIONS AND DEPOSITS TO PARTICIPANT o 4.0 Limitations on Salary Contributions ................................................................................. 8 4`3 Deposits to Participant Accounts --------------.---------------�8 **mmcanvn'rconmounnns and uopoano------------------------------o SECTION 6. CONTRACT CHARGES AND FEES ................................................................................ y 5.1 Contract Maintenance Charge .......................................................................................................... S 5.n Contrac Termination --------------------------'-_-8 5.3 Fees Imposed by Investment Option Provider .--------------------------'e 5.*uemice Charges and ----_--_'_-._- g ��---- `'--_--_-----� 5 .5 Paymen of Charges and Fees . ............................................................. ........................................... e SECTION 6. PARTICIPANT ALTERNATE PAYEE AND BENEFICIARY TRANSFERS AMONG INVESTMENT OPTIONS OFFERED sY THE PLAN .............. .............................................. 10 SECTION 7. DISTRIBUTIONS FROM PARTICIPANT ACCOUNTS ................................................... v1 � 71 Distribution Requirements .............................................................................................................. 11 � 7.2 Rollovers ........................................................................................................................................ 11 7.3 Establishment of Alternate Payee Account ---------------11 7 .4 _-...... -- ..................... 11 7.s Distributions afte the Participant's Death ............................................................... ... .................... 11 7;8Plan-to-Plan Transfers ................................................................................................................... 11 7JT�ns��fmmaGoxammen�|P�n�x��Pu�haoeo [Pennh��aGamkmC�d�s 12 � ------ � SECTION 8. PAYMENT OPTIONS ...................................................................................................... 1a 8.1 Dk�hbuVonotooPa�c�on�Bona�c��orA8oma�Payoe 13 � 8.2 Conditions -----------' uonomonsor ................................................................................................................... 13 8.3 Total or Partial Op8on---------------------------. 13 8:4 Periodic -_------_------_--,-------'_--'13 � 8.5 Annuity Payment Options -'--_--------------------------'1D 8.O Election cf ---.----.----------^--_----_-_-14 8.7 Misstatemen u[ Age or Death ... .................................................................................................... 14 SECTION 9. CONTRACT TERMINATION .......................................................................................... 15 9.1 Notice of Contract Termination and Selection of Termination OpVonV$ ................................ .... ... 15 9.2 Contract Termination Provisions .................................................................................................... 15 9.3 Contract Termination due m Plan Termination ............................................................................... 15 � SECTION 1� GENERAL PROV��wS 16 � .----._----------_---_---._.. 101 Contract 16 � � ~~---------------__-------------_----'-_' 10 .2 Entire Contract ................................ ............................................................................................ 1O 1O3 Contrac t Modification ................................................................................................................... 1G 10.4 Modification o[ Fixed Account Options ......................................................................................... 16 opACmpm Page Re�is;w 1; Sep 12,20m213 PM 9878"2 Wa mTequosta � 10.5 Restorations ................. .................................................. .. ................................ ............................. 16 10.6 Plan Provisions ............................................................................................. ............................... 17 10.7 Non - Participating .......................................................................................... ............................... 17 10.8 Currency and Contributions and Deposits ..................................................... ............................... 17 10.9 Notices .......................................................................................................... ............................... 17 10.10 Disclaimer ................................................................................................... ............................... 17 10.11 Representations .......................................................................................... ............................... 17 10.12 Non - Waiver ................................................................................................. ............................... 17 10.13 Information .............. ............................... . .................................................... ............................... 17 GFAC 10 FFiI Page 3 Revlslon 1: Sep 12.2018 713 PM 98781 -02 Vfpnao of Tmuesla SECTION 1. DEFINITIONS Administrative Offices --8515 East Orchard Road, Greenwood Village, CO 80111. Alternate Payee — any spouse, former spouse, child or other dependent of a Participant or any other person recognized under applicable law who is recognized by a Qualified,Domestic Relations Order as having a right to receive all or a portion of the benefit payable under a Plan with respect to such Participant. Annuitant — the,person upon whose life the payment of an annuity is based. Annuity Commencement Date — the date annuity payments begin to an Annuitant. Applicable Tax — the amount of tax, if any, charged by a state or other governmental authority. Beneficiary— a person or entity named by the Participant to receive all or a portion of the Participant's account at his or her death. Business Day— any day and during the hours on which the New York Stock Exchange is open for trading. Code —the Internal Revenue Code of 1986, as amended'from time to time, or any future United States Internal Revenue law that replaces it, including corresponding Treasury. Regulations and Internal Revenue Service guidance. Contributions — salary reduction contributions, Participant after -tax contributions, employer contributions, or other contributions made to the Plan by or on behalf of a Participant under the Code. Deposits — rollovers, plan to plan transfers, Transfers, or other amounts, other than Contributions, paid into the Participant Account under the Plan. Distributions— amounts paid to a Participant, Beneficiary or Alternate Payee, pursuant to the terms of the Plan and the Code. Fixed Account— an investment option, the assets of which are part of the General Account of Great - West. Fixed Account Value — the sum of the Fixed Accounts. General Account — Great - West's assets other than those held in any segregated investment account. Great -West— Great -West Life & Annuity Insurance Company, located at the Administrative Offices. Guaranteed Interest Rate — the minimum interest rate on an annual effective basis, if any, described on a Fixed Account rider(s). Participant —.an individual eligible to participate in the Plan with assets in a Participant Account. Participant Account —a separate record in the name of each Participant, Beneficiary or Alternate Payee, which reflects his or her share in the Fixed Account(s). Participant Account Value — the sum of the Fixed Account Value credited to the Participant Account. GFAC 10 FFII Page 4 RevWwi 1: Sep 12, 2016 2:17 PIA 08781 -02 VNage 01 Teguosla Participant Effective Date — the date on which the first Contribution or Deposit is credited to a Participant Account. Payee — a person entitled to receive all or a portion of the value of the Participant Account. Plan — The name of the plan as noted on the first page of the Contract. Plan Sponsor— an entity maintaining the Plan on behalf of Participants, Alternate Payees and Beneficiaries.. In a multiple employer plan, the Plan Sponsor shall be considered the entity maintaining the multiple employer plan on behalf of participating employers and the participating employers Participants, Alternate Payees and Beneficiaries. Qualified Domestic Relations Order— a domestic relations order that creates or recognizes the existence of an Alternate Payee's.right to, or assigns to an Alternate Payee the right'to receive all or a portion of the benefits payable with respect to a Participant and that complies with the requirements of the Code and ERISA, if applicable, and is approved by the Plan. Request— an inquiry or instruction in a form satisfactory to Great -West. A valid Request must be: (1) received by Great-West at its Administrative Offices.in good order; and -(2) submitted in accordance with the provisions of this Contract, or as required by Great -West. The.Request is subject to any action taken by Great -West before the Request was processed.. Stait -Up Costs — the amounts incurred by Great -West in acquiring and implementing the plan, which may include but are not limited to restorations, commissions or other costs. Transfer —the reinvestment or exchange of all or a portion of the Participant Account balance from one investment option or provider under the Plan to another. GFAC 10 FF11 Page 5 Revision 1: Sep 12.20162:13 PM 68761 -02 Y11a6a of Tegwsta SECTION 2. OWNERSHIP PROVISIONS 2.1 Ownership of the Contract Contractholder is the owner of the Contract and is identified on the first page of the Contract. Plan Sponsor and Contractholder have certain rights and privileges as set forth under this Contract. 2.2 Transfer and Assignment The interests of the Contractholder and Plan Sponsor in this Contract may not be transferred, sold, assigned, pledged, charged, encumbered, or in any way alienated; however, if the Plan is consolidated or merged with another plan or if the. assets and liabilities of the Plan are transferred to another plan, the Contract may be assigned to the new Plan Sponsor and /or trustee. 2.3 Trust The Contract may be used in lieu of a trust agreement for purposes of satisfying Code sections 401(a), 401(f) and 457(8) and no portion of the amount contributed to the Contract, plus earnings thereon, may be used for or diverted to any purpose other than the exclusive benefit of Participants and their Beneficiaries prior to the satisfaction of all liabilities to them. GFAC 10 FFII Page 6 Re&ion 1: Sep 12, 2016 213 PM 88781 -02 WIago of toquesta SECTION 3. PARTICIPANT ACCOUNT VALUE 3.1 Fixed Account Value The Fixed Account Value in the Participant Account.is calculated as follows: (a) all Contributions and Deposits to a Fixed Account option made by or on behalf of the. Participant, Alternate Payee and Beneficiary; plus (b) all interest credited to the Contractholder's assets in the Fixed Account on an annual effective basis pursuant to the Guaranteed Interest Rate applicable to the Fixed Account; less (c) any amounts transferred or distributed -from the Fixed Account; less (d) any applicable charges, fees and Applicable Tax, if any. 3.2 Transaction Date All Requests, Contributions and Deposits received in good order with all required documentation at Great - West's Administrative Offices prior to the close of business of the New York Stock.Exchange will be processed as of the date received, and if received after the close of business of the New York Stock Exchange will be processed on the next Business Day. However, Great -West shall not be liable for the results of any delay or interruption due to causes or conditions beyond its control including, without limitation, labor disputes, riots, war and war -like operations including acts of terrorism, epidemics, explosions, sabotage, acts of God, failure of power, fire or other casualty, natural disasters or disruptions in orderly trading on any relevant exchange or market, including disruptions due to extraordinary market volume that result in substantial delay in receipt of correct data. GFAC 10 FFII Page 7 Revision 1: Sep 12, 2016 2:13 PM 8878102 Village of Tequosta SECTION 4. CONTRIBUTIONS AND DEPOSITS TO PARTICIPANT ACCOUNTS 4.1 Contributions Prior to the termination of the contract and unless otherwise described in a Fixed Account rider(s), Contributions may be made at any time, pursuant to the terms of the Plan. Great -West shall not be responsible for determining the amount of Contributions to be made for any Participant. The Contribution amounts will be allocated to Participant Accounts pursuant to the accompanying Contribution report. The Contribution report must be submitted in a manner acceptable to Great -West and shall be conclusive and binding on the Plan and on any person or entity claiming an interest under the Contract. When the Contribution report does not coincide with the Contribution received and the inconsistency is not resolved within a period of time required under the law, Great - West may return the Contribution. Great - West's prior approval may be required before a Contribution may be made that causes a Participant Account Value to exceed $1,000,000. 4.2 Limitations on Salary Reduction Contributions Each Participant's salary reduction Contributions, if any, must satisfy any limitations imposed by the Plan or the Code. 4.3. Deposits to Participant Accounts Deposits will be accepted insofar as they are permitted under the terms of the Plan and applicable Code requirements. 4.4 Allocation of Contributions and Deposits Contributions and Deposits, less Applicable Tax, ii any, will be allocated in the Participant Account when received by Great:West at its Administrative Offices, subject to Section 3.2 of this Contract_ Contributions and Deposits Will be allocated as directed by the Participant among any number of currently offered Fixed Account options available under the Contract. If the offered Fixed Account options are changed, Contributions and Deposits may be redirected and the account balance may be reallocated subject to the terms of the accounts selected. GFAC 10 FFII Page 8 Revision 1: Sep 12.2016 213 FM 93781 -02 V age of Tequesta SECTION 5. CONTRACT CHARGES AND FEES 5.1 Contract Maintenance Charge An annual contract maintenance charge may apply. However, if the Participant Effective Date is after January 1, the initial contract maintenance charge for that Participant Account will apply during the calendar quarter after the Participant's one -year anniversary (calculated from the Participant Effective Date) and will be pro -rated for the remainder of the year. The deduction. of the contract maintenance charge will be pro -rated among the applicable Fixed Account Value on the date of deduction. Whenever . a deduction for a contract maintenance charge is made from a Fixed Account, Great -West will reduce the Participant Account Value in an amount equal to the deduction. 5.2 Contract-Termination Charge Upon termination of the Contract by Plan Sponsor, a contract termination charge based upon a percentage of the original Start-Up Costs may apply. 5.3 Fees Imposed by Investment Option Provider Any and all fees imposed by the provider of any investment option offered by the Plan and invested in by the Participant, Alternate Payee and Beneficiary, including but not limited to redemption fees, shall be deducted from the Participant Account Value. 5.4 Service Charges and Fees Great -West and Plan Sponsor may enter into an agreement for services to the Plan not.otherwise provided.under this Contract. Charges and fees for these services will be described in the agreement. 5.5 Payment of Charges and Fees Any fees imposed by the providers of any investment option, all charges and fees may be billed directly to Plan Sponsor. If Plan Sponsor does not elect to have such charges and fees billed to Plan Sponsor, such charges and fees shall be deducted from the Participant Account Value. In all instances where Plan Sponsor has elected to be billed for any fees and charges and any of the fees or charges are unpaid after the date billed; as disclosed in and pursuant to the procedures in the fee disclosure and/or service agreement for the Plan, Plan Sponsor and Contractholder hereby instructs Great -West to debit Participant Accounts. Great -West may continue to deduct charges and fees quarterly from Participant Accounts unless and until Plan Sponsor provides Great -West with written instructions to reinitiate billing. Great -West may change any charges and fees upon not fewer than 30 days advance written notice to Plan Sponsor. GFAC 10 FFII Page 9 Revision It Sup 12, 20102 PM 98781 -02 Wlago of Toguesta SECTION 6. PARTICIPANT -, ALTERNATE PAYEE -, AND BENEFICIARY- DIRECTED TRANSFERS AMONG INVESTMENT OPTIONS OFFERED BY THE PLAN Upon receipt of a satisfactory Request meeting all of the requirements of this section, Great -West will process a single -sum Transfer of all or a portion of a Participant Account in the Plan. Transfers must: (a) satisfy the terms of the Plan in accordance with'the appropriate provisions of the Code; and (b) satisfy any restrictions in.the attached Fixed Account rider(s), and any trading restrictions imposed by the investment option provider, including but not limited to mutual fund restrictions on market timing or excessive trading. GFAC 10 FRI Page 10 Revision 1: Sep 12.26162:13 PM 96761 -02 VUNo of fegwSM SECTION 7. DISTRIBUTIONS FROM PARTICIPANT ACCOUNTS 7.1 Distribution Requirements Notwithstanding any provision herein to the contrary, Distributions to a.Payee may only be made in accordance with the terms of the Plan and applicable Code sections and any terms of the Fixed Account dder(s), and will be tax reported under the applicable rules in effect on the date of Distribution. Great -West will rely on information provided by Plan Sponsor or its designee with respect to the timing and amount of any benefit payable to a Payee under this Contract. Great-West will not process any Distributions to a Payee without Plan Sponsor or its designee instructions. 7.2 Rollovers If the Payee of an eligible rollover Distribution elects to have the Distribution paid directly to a specified eligible retirement plan, as defined in Code section 402(c)(8)(B), then the Distribution will be paid to that eligible retirement plan in a direct rollover. If the Plan provides for mandatory Distributions under Section 401(a)(31)(B) of the Code, such Distributions shall be sent to the IRA provider selected by Plan Sponsor pursuant to the Plan Sponsor's or its designee's instructions, 7.3 Establishment of Alternate Payee Account A Request in connection with a Qualified Domestic Relations Order (QDRO) must be approved by Plan Sponsor, except as otherwise agreed. Great -West will make payment to the Alternate Payee and /or establish a Participant Account on behalf of the Alternate Payee named in such order. The Alternate Payee shall be treated as a surviving spouse for purposes of Code section 401(a)(9) and shall be responsible for submitting a Request to begin Distributions in accordance with the Code. 7.4 Required Minimum Distributions during the Participant's Lifetime Participants are required by the Code to begin receiving required minimum Distributions as of their required beginning date, which is April 1 of the calendar year following the later of: (a) attainment of age 70 %; or (b) retirement, or such other date as may be prescribed in the Code. Required minimum Distributions made under this Contract will only be made in a manner consistent with Code section 401(a)(9). It is the Participant's or Plan Sponsor's responsibility to Request payments in accordance with the minimum distribution requirements. Great -West is not responsible for any penalties resulting from a failure to Request timely payments in the proper amount. 7.5 Distributions after the Participant's Death If the Participant dies, the amount payable on death will be the Participant Account Value net of any outstanding loan balance. Distributions to Beneficiaries must begin on or before the designated Beneficiary's required beginning date in a manner and amount consistent with Code section 401(a)(9) as it is in effect at the time of the Distribution. It is the Beneficiary's responsibility to Request payments and to pay any penalties resulting from a failure to Request timely payments in the proper amount. A Beneficiary may not receive more than the Participant Account Value. 7.6 Plan -to -Plan Transfers A Participant or Beneficiary may direct that all or a portion of the Participant Account Value be transferred in a single sum to a contract under another Plan Sponsor's plan. Such transfers will be permitted provided: (a) Both the transferor and transferee plan provide for such transfers, and the transfer satisfies the terms of the Plan and applicable provisions of the Code; GFAC 10 FFII Page 11 Rev"mS 1: Sep 12, 2016 213 PM 98781 -02 Wne of TegM90 (b) In the case of a transfer for a Participant, the Participant_is an employee or former employee of the Plan Sponsor (or the business of the Plan Sponsor) for the receiving plan; (c) In the case of a transfer for a Beneficiary, the Participant was an employee or former employee of the Plan Sponsor (or the business of the Plan Sponsor) for the receiving plan; (d) Great -West receives a satisfactory Request for such transfer; and (e) The restrictions, if any, contained in the attached Fixed Account rider(s), if any, allow such transfer. 7.7 Transfers from a Governmental Plan for the Purchase of Permissive Service Credits If the Plan so provides, a Participant may direct that all or a portion of the Participant Account Value be transferred in a single sum to a qualified defined benefit plan that is a governmental plan (as defined in Code section 414(d)). Such transfers will be permitted provided: (a) . The transfer satisfies the terms of the Plan in accordance with the appropriate provisions of the Code; (b) Great -West receives a satisfactory Request for such transfer; and (c) The restrictions, if any, contained in the attached Fixed Account rider(s) allow such transfer; GFAC 10 FFII Page 12 Re*�an 1: Sep 1$ 2018 2:13 PIA 93781 -02 V?Jage of Teguesta SECTION 8. PAYMENT OPTIONS 8.1 Requests for Distributions to a Participant, Beneficiary or Alternate Payee As long as the Participant Account Value is greater than zero and as allowed by the Plan and Code, a Request may be made to: (a) Elect an annuity payment option, provided such Request is made at least 30 days before the Annuity Commencement Date; (b) Elect a non - annuity payment option and designate the date payment shall commence; or (c) Change from one payment option to a different payment option, if allowed under the terms of the payment option selected. 8.2 Conditions of Payment Approved Distributions shall be effective on the later'of: (a) the date elected subject to any restrictions of the Plan and Code and any Fixed Account rider(s); or (b) the date of the Request. 8.3 Total or Partial Lump Sum Payment Option if, based upon information provided by Plan Sponsor, the Payee is entitled to a Distribution under the applicable terms and provisions of the Plan and the Code sections governing the Plan, all or a portion of a Participant Account may be applied to a lump sum payment option selected by the Payee. Subject to the provisions of any attached Fixed Account rider(s), the amount to be distributed is: (i) the amount requested as a lump sum; less (ii) the Applicable Tax if any, as of the date of the amount distributed, and (iii) any applicable fees and charges. 8.4 Periodic Payment Options If,. based upon information provided by Plan Sponsor, the Payee is entitled to a Distribution under the applicable terms and provisions of the Plan and the Code. sections governing the Plan, all or a portion of a Participant Account may be applied to a periodic payment option selected by the Payee, subject to_ any restrictions in a Fixed Account rider(s). Charges and fees will continue to apply. An Applicable Tax, if any, may apply. Periodic payment elections are subject to the administrative procedures of Great -West in effect at the time of the election and the periodic payment options Great -West makes available at the time of Distribution. If a Participant is receiving periodic payments, such payments will cease as of receipt by Great -West of notice of the Participant's death. The deceased Participant's Beneficiary may then elect a payment option under this Section 9 meeting all the requirements of Code section 401(a)(9). 8.5 Annuity Payment Options If, based upon information provided by Plan Sponsor, the Payee is entitled to a Distribution under the applicable terms and provisions of the Plan and the Code sections governing the Plan, all or a portion of a. Participant.Account may be applied to an annuity payment option selected by the Payee, so long as the requirements of Code section 401(a)(9).are met. Thereafter, this Contract shall no longer be applicable with respect to amounts in the annuity payment option. The amount to be applied to an annuity payment option is: (i) the portion of the Participant Account Value elected by Payee subject to any restrictions in a Fixed Account rider(s), less (ii) Applicable Tax, if any, less (iii) any fees and charges described in the Contract. GFAC 10 FFII Page 13 Revision 1: Sep 12.2Dl6 2:13 PM SB78102 Village of Tequeslo The minimum amount that may be applied under the elected annuity option is $5,000. If any payments to be made under the elected annuity payment option will be less than $50, Great -West may make the payments in the most frequent interval that produces a payment of at least $50. Great -West will issue a certificate to each Annuitant describing the benefits payable under the elected annuity payment option. 8.6 Election of Annuity Options An Annuitant is required to elect an annuity payment option. The Annuitant must Request an annuity payment option or change an annuity payment option no later than 30 days prior to the Annuity Commencement Date. To the extent available under the Plan, the available annuity payment options are: Income for Single Life Only Income for Single Life with Guaranteed Period Income for Joint Life Only Income for Joint Life with Guaranteed Period Income for a Specific Period Any other form of annuity payment permitted under the Plan, if acceptable to Great -West. The annuity option that will always be available is the Income for Single Life Only Annuity. If this annuity option is elected, Great -West will make payments to the Annuitant at a frequency specked in the annuity certificate for the duration of the Annuitant's lifetime. Payments will cease pursuant to the terms of the certificate: Minimum Monthly Payment for Each $1,000 of Participant Account Value Applied to Purchase a Lifetime Monthly Annuity Age of Lifetime Monthly Payee Payment 50 $4.00 55 4.28 60 4.66 65 5.20 70 5.98 75 7.16 8.7 Misstatement of Age or Death Great -West may require adequate proof of the age and death of any Payee before processing a Request for or making any payment. If the age of the Payee has been misstated, the payments established for him /her under the applicable payment option will be made on the basis or his /her correct age. If payments made pursuant to an annuity payment option were too large because of a.misstatement of age, Great -West may deduct the difference from the next payment or payments with interest. If payments were too small, Great =West may add the difference to the next payment with interest. Any interest payable will be made at the rate required by law. GFAC 10 FRI Page 14 Revision 1: Sep 12.20182:13 PM 58781.02 Villegeaf Tepuesla SECTION 9. CONTRACT TERMINATION 9.1 Notice of Contract Termination and Selection of Termination Option(s) Either Great -West or Plan Sponsor may terminate this Contract with advance written notice to the other party or parties. The contract termination date shall be the seventy -fifth (75`") day after the date written notice is received in the Administrative Offices in good order. If the seventy-fifth (75'") day is not a Business Day, the contract termination date shall be the Business Day immediately following the seventy -fifth (75'") day. Prior to the contract termination date, Great -West and Plan Sponsor may agree to an alternate contract termination date. Contract termination may not occur on the date selected by Plan Sponsor unless Great -West has received all required information. In such event, Great -West shall maintain Participant Account Values until Great -West receives all required information in good order. 9.2 Contract Termination Provisions Plan Sponsor shall direct Great -West to pay the Participant Account Values as described below. Fixed Account(s) : Great -West will remit the Fixed Account Value pursuant to the Fixed Account rider(s) contract termination option selected. Plan Sponsor and Contractholder hereby instructs Great -West to deduct any outstanding charges and fees, including the contract termination charge, if applicable, due to Great -West from the amount remitted from any of the Fixed Accounts. 9.3 Contract Termination due to Plan Termination If Plan Sponsor terminates the Plan, it shall notify Great -West of such Plan Termination and that final Contributions have been remitted to Great -West. Upon notice of Contract Termination Due to Plan Termination, Plan Sponsor agrees to provide any and all information and instructions Great -West requires to properly comply with Plan Sponsor's notification of Plan Termination and subject to the provisions of the Fixed Account rider(s). Plan Sponsor acknowledges that the amount distributed from the Contract upon Plan Termination shall be equal to the balance of each Participant Account as reflected in the records of Great -West on the date of Distribution subject to the provisions in the Fixed Account rider(s), less all outstanding charges or fees, including an applicable contract termination charge, and reduced by any required income tax withholding or other applicable fees due upon Distribution. Plan Sponsor shall file any and all required Forms 5500. If the Plan is abandoned, orphaned or if Plan Sponsor cannot be located or Plan Sponsor fails to provide appropriate representations and instructions to Great -West in connection with termination of the Plan, Great -West is authorized to accept notices, representations and instructions from the Plan administrator or trustee, the bankruptcy trustee for Plan Sponsor, the U.S. Department of Labor,, if applicable, or an authorized and appropriate representative of Plan Sponsor. Great -West may also utilize any procedures promulgated by the U.S. Department of Labor, if applicable, or other applicable regulatory agencies for abandoned or orphaned plans including the facilitation of Distributions to Payees performed by a Qualified termination Administrator, as that term is defined under Federal law and regulations promulgated thereunder, or comparable person as allowed by applicable law. GFAC 10 FFII Page 15 Re&iw 1: Sep 12.2018 213 PM 98781 -02 Vdage a'Te7uesta SECTION 10. GENERAL PROVISIONS 1.0.1 Contract Great -West has issued this Contract to Plan Sponsor and Contractholder in consideration of the Application and payment of the initial Contribution or Deposit. 10.2 Entire Contract This Contract, including the Application, amendments, endorsements, letter agreements, specification page, if any, and Fixed Account or other rider(s), if any, constitute th entire contract between Plan Sponsor and Great -West. All statements in the Application, in the absence of fraud, have been accepted as representations and not warranties.. Only the President, Vice - President, or the Secretary of Great -West, or their authorized designees, can agree on behalf of Great -West to modify any provisions of this Contract. One or more provisions of this Contract may be clarified by letter agreement, amendment or other writing executed by both Great -West and Plan Sponsor. 10.3 Contract Modification Great -West may modify this Contract from time to time to conform it to changes in tax or other law, including applicable regulations and rulings, without consent of Plan Sponsor or any other person. Great -West will provide notice and a copy of any such modification to Plan Sponsor as soon as reasonably practicable. Plan Sponsor and Great -West may, by written agreement, make other modifications to this Contract, subject to the approval of the appropriate state department of insurance, if applicable.. No such modification will, without the written consent of Plan Sponsor, affect the terms, provisions, or conditions of this Contract, which are or may be applicable to Contributions or Deposits made prior to the date of such modification. 10.4 Modification of Fixed Account Options Great -West may offer new or cease offering existing Fixed Account options, or make other changes to the Fixed Account options as Great -West deems necessary, and subject to the approval of the state insurance department, if applicable. If Great -West changes material provisions its Fixed Account options, Great- West -will provide at least sixty (60) calendar days written notice to the Plan Sponsor. This notice shall'explain any Fixed Account change(s), communicate the timeline and effective date of any Fixed Account change and explain Plan Sponsor's right to opt out of any Fixed Account change. Plan Sponsor's absence of an objection to such notice will be considered consent to the change(s). If Great -West replaces Fixed Account options and does not receive an objection from the Plan Sponsor, Transfers between account options as disclosed in the notice will be completed by Great - West as of the effective date of the change. Such allocation will be in effect until such time as Great- West receives a written Request for a different allocation. If Plan Sponsor provides written objection to Great -West within the sixty (60) calendar day notice period, Great -West will not make the Fixed Account change at issue. If Plan Sponsor objects to the Fixed Account change, Great -West may terminate this Contract by providing written notice pursuant to Section 9.1 of this Contract. 10.5 Restorations Great -West may agree to restore any back -end load charges, market value adjustments, or other investment charges deducted from plan assets under a prior investment option. GFAC 10 FRI Page 16 Rawson 1: Sop 12, 2016 2:13 PM 98781 -02 Wage of Tequova 10.6 Plan Provisions In all cases, the plan document shall determine (subject to the Code) the specific features of the Plan, which may include the availability of certain types of investment options, Distributions, loans, and other features allowed but not mandated by the Code. Any provision of this Contract which deals with a feature not included in the Plan shall not apply. 10.7 Non - Participating This Contract is Non - Participating, meaning that it is not eligible to share in Great - West's divisible surplus. 10.8 Currency and Contributions and Deposits All amounts to be paid to or by Great -West must be in currency of the United States of America. All Contributions and Deposits to this Contract must be made payable to Great -West or to a designee acceptable to Great -West. 1.0.9 Notices Any notice or demand by Great -West to or upon Plan Sponsor or any Payee may be given by mailing it to that person's last known address as stated in Great - West's file via the United States Postal Service or last known email address or facsimile number on file. An application, report, Request, election,, direction, notice or demand by Plan Sponsor or a Payee will be made in a form satisfactory to Great -West. When Great -West requires it, Plan Sponsor will obtain the,signature of the Payee on forms provided by Great -West. Great - West.must first approve any written materials developed by any other person describing this Contract. 10.10 Disclaimer Nothing contained In this Contract shall be construed to be tax or legal advice, and Great -West assumes no responsibility or liability for any costs, including but not limited to taxes, penalties or interest incurred by the Plan, Plan Sponsor or any other Payee arising out of a determination of liability. Great -West shall not be held liable for the negligence, willful. misconduct, or failure to perform of any third party. 10.11 Representations Great -West shall be entitled to rely and act solely on the reports, directions, proofs, notices, elections, and other information fumished to it by Contractholder, Plan Sponsor, Participant, Alternate Payees, Beneficiaries or their respective agent, and such acts shall be conclusive and binding as to all persons or corporations claiming an interest hereunder. 10.12 Non - Waiver The waiver by Great -West of any breach of any term or condition in this Contract will not be deemed a waiver of any prior or subsequent breach. 10.13 Information 'Plan Sponsor shall furnish all information that Great -West may reasonably require for the administration of this Contract. Great -West shall not be responsible for any obligation underthis Contract until it receives all requested information in a form acceptable to Great -West. GFAC 10 FFII Page 17 Revision 1: Sep 12,2016 2:13 PIA 98781.02 Wago of Tequesta GREAT -WEST LIFE & ANNUITY INSURANCE- COMPANY A Stock Company 8515 East- Orchard Road Greenwood Village, CO 80111 Forinquiries,'information or resolution of complaints, call 1- 800=701 - 8255. . Fixed Account This Guaranteed Interest Fund ( "GIF ") Fixed Account rider ( "Rider") is part of the Great -West Life & Annuity Insurance Company ( "Great- West ") Contract to which it'is attached. Guaranteed Interest Fund The GIF is a Fixed Account that is part of the General Account of Great -West. All or a portion of Contributions and Deposits may be allocated to the, GIF. Definitions Competing Fund- any of the following types of funds offered by the Plan Sponsor: (a) any stable value fund; or (b) any fund with a known or periodically declared rate of interest; or (c) any money market fund; or (d) any bond fund with a duration. of 3 years or less Plan Sponsor initiated .Event — an action that materially impacts assets in the GIF as it relates to the Plan, including but not limited to a: spin -off; sale; merger, full or partial plan termination, including Distribution of assets performed by a Qualified Termination Administrator, as that term is defined under Federal law and regulations promulgated thereunder, or comparable person as allowed by applicable law; terminating union in a multi - employer plan; terminating participating employer in a multiple employer plan; termination by a political subdivision of a governmental 457(b) plan or a layoff of at least 20 % of work force in any twelve month period. General For the purposes of the references in the•Rider, Great -West shall use a comparable source if applicable information is unavailable on the United States Federal Reserve Website. Credited Interest Rate Interest earned on the GIF value is compounded,daily to the effective annual interest rate. Unless otherwise. described in the Rider, the interest rate to be credited to the Contractholder's assets in the GIF during the calendar quarter will be determined by Great -West prior to the last day of the previous calendar quarter and shall be reset at least quarterly. Great -West shall notify Plan Sponsor, Participants, Alternate Payees and Beneficiaries invested• in the GIF at least thirty (30) calendar days in advance at the address on file with Great -West should the credited interest rate be reset more frequently than quarterly. All reset credited interest• rates shall be declared in advance.. " Guaranteed Interest Rate The effective annual interest rate will never be less than 0 %. Guaranteed. Interest Fund Value The value of the Contractholder's assets in the GIF in respect of the Participant Account will be determined as the value of (a) minus (b) where: GIF 10 FFII FL Page 1 Revision 1: Sep 12.2016 2:13 PM 96781 -02 Wage of Tequasta (a) is the sum of Contributions and Deposits by and on behalf of Participants, Alternate Payees and Beneficiaries allocated to the GIF plus interest credited to the Contractholder's assets in the GIF; and (b) is the sum of any amounts distributed plus any amounts transferred from the GIF, as well as charges and fees and Applicable Tax, if any. Limitations Great -West shall defer processing Distribution or Transfer Requests if transactions cannot be executed or settled due to the closing or disruption of financial markets or exchanges. Great -West shall resume the processing Distributions and Transfers once the disruption is resolved. Plan Sponsor shall not offer Competing Funds, as defined above, unless mutually agreed upon by Great -West and Plan Sponsor. Should the Plan Sponsor offer a Competing Fund without Great - West's agreement, or should an existing Plan investment option become a Competing Fund and remain available to the Plan without Great - West's prior agreement, and Great -West learns of such Competing Fund, Great - West shall suspend all Transfers out of the GIF upon at least thirty (30) calendar days advance written notice to the Participants, Alternate Payees and Beneficiaries invested in the GIF at the address on file with Great -West. This Transfer restriction shall remain in effect until the Competing Fund is removed, as an eligible Plan investment option, or as otherwise mutually agreed. Excessive Trading Based on Great - West's excessive'trading policy; Great -West shall restrict a Participant, Alternate Payee or Beneficiary from making a Transfer into the GIF for up to thirty (30) calendar days from the date of the most recent Transfer from the GIF. Contributions and Deposits, other than Transfers, will be allowed into the GIF during the thirty (30) day period. Plan Sponsor Initiated Events Plan Sponsor shall provide notification to Great -West at least thirty (30) calendar days in advance of a Plan Sponsor Initiated Event. Unless a Plan Sponsor Initiated Event causes Great -West to require Plan Sponsor to make an election of a. Contract Termination Option in this Rider with respect to the GIF assets affected by the Plan Sponsor Initiated Event or when Great -West and Plan Sponsor otherwise agree, Great West shall remit the lesser of the Participant Account Value invested in the GIF or the Participant Account Value invested in the GIF as reduced by the Market Value Adjustment Factor formula as. described in Contract Termination Option 1 in this Rider upon any Participant, Alternate Payee or Beneficiary Distribution, including a plan to plan Transfer or transfer from a governmental plan to purchase service credits, that occurs within 12 months after the date-Great-West recognizes the Plan Sponsor Initiated Event ( "Event Date'). The Event Date shall be the Calculation Date for purposes of calculating the Market Value Adjustment Factor. If the average of the 3 year and 5 year Treasury Constant Maturity rates, as of the Event Date, is 300 basis points or more above the lowest weekly average of the 3 and 5 year Constant Maturity Treasuries over the previous 104 weeks from the Event Date, the Market Value Adjustment period above shall apply thirty -six months after the Event Date. If the Market Value Adjustment Factor is positive, a Market Value Adjustment shall not be assessed. Any Plan Sponsor choosing to remove the GIF as an eligible Plan investment option but not declare a contract termination date, may Transfer the Group Contractholder's GIF value upon election of Contract Termination Options 1 or 2 as identified in this Rider below, based on mutually agreed upon dates. References to contract termination date shall not apply. GIF 10 FFII FL Page 2 Rovfsbn f: Sep 12, 2016 2:13 PM 96761 -02 Wage of Tegwsu Contract Termination At least sixty (60) calendar days before the contract termination date, Plan Sponsor must notify Great -West, in writing, of its selection from among the Contract Termination Options described below. Great -West shall remit all GIF amounts pursuant to the Plan Sponsor elections. Contract Termination Options 1. Lump Sum Payment with Market Value Adjustment— The Market Value Adjustment will be calculated as of the date Great -West receives notice of contract termination in good order, or another date as mutually agreed ( "Calculation Date "). Within seven (7) Business Days after the contract termination date, Great -West will remit the lesser of the total Participant Account Values of the Contractholder's assets in the GIF ( "book value ") or the book value of the GIF adjusted by the Market Value Adjustment Factor described below. If Great -West receives the difference between any reduced MVA and book value from Plan Sponsor prior to the contract termination date, Great -West will remit the book value. Market Value Adjustment (MVA) = MVAF x (book value) The Market Value Adjustment Factor (MVAF) is: MVAF = (.1 + i ) 1 (1+f +1.0W Where: i is the Three (3) Year Treasury Constant Maturity rate as published in United States. Federal Reserve Website on. the later of the Contract Date and the last Business Day of the week two (2) years prior to the Calculation Date. J is the Three (3) Year Treasury Constant Maturity rate as published in United States Federal Reserve Website on the last Business Day of the week prior to the Calculation Date. 2. Payment at Book Value — Great -West shall remit the total Participant Account Values of the Contractholder's assets in the GIF ( "book value ") pursuant to a) or b) below. Great -West shall not reset the credited interest rate on the Contractholder's assets in the GIF after the contract termination date. (a) Great -West will remit the book value no later than twelve (12) months after the contract termination date. Unless Plan Sponsor retains Great -West as the Plan recordkeeper, no Plan loans shall be made from the GIF assets and Contributions and Deposits will not be accepted into the GIF after the contract termination date. A percentage of Transfers, including plan to plan transfers or transfers from a governmental plan to purchase service credits from the Participant Account shall be restricted as of the contract termination date. Great -West shall notify Participants, Alternate Payees and Beneficiaries invested in the GIF of this restriction at least thirty (30) calendar days.in advance, at the address on file with Great -West. In the event such notice is provided to a Participant, Alternate Payee or Beneficiary fewer than thirty (30) days before the contract termination date, the restriction shall not take effect for such GIF 10 FFII FL Page 3 Rovision 1: Sep 12.20162:18 PM 9878102 Wage of Tequesm Participant, Alternate Payee or Beneficiary sooner than thirty (30) days from the date of such notice. Distributions may be made from the GIF at any time. No Plan Sponsor Transfers shall be allowed after the contract termination date. Option a) shall apply only if, on the date Great -West receives notice of contract termination in good order, the average of the 3 year and 5 year Treasury Constant Maturity rates is less than 300 basis points above the lowest weekly average of the 3 and 5 year Constant Maturity Treasuries over the previous 104 weeks from notice. Great -West shall use published rates from the United States Federal Reserve website. Otherwise, option (b) shall apply. Numerical Example: On the date notice of contract termination is received by Great -West in good order, the average of the 3 year and 5 year Treasury Constant Maturity rates is 4.00 %. Over the previous 104 weeks from notice, the lowest average of the 3 year and 5 year Treasury Constant Maturity rates from the United States Federal Reserve website was 225 %. Since 4.00% is less than 300 basis points above 2.25 %, option a) applies. (b). Great -West will remit the book value no later than thirty -six (36) months after contract termination date. Unless Plan Sponsor retains Great -West as the Plan recordkeeper, no Plan loans shall be made from the GIF assets and Contributions and Deposits will not be accepted into the GIF after the contract termination date. Participant, Altemate Payee and Beneficiary Transfers, including plan to plan transfers or transfers from a governmental plan to purchase service credits, shall be restricted to a percentage of Participant Account assets in the GIF pursuant to the following schedule: Months from % of contract termination date Transfers Allowed 0 -12 0% 13 -24 a total 25% of Participant GIF assets as of January 1 B1 in the year of the 13'" month. 25 -36 a total of 33% of Participant GIF assets I as of January 1 51 in the year of the 25'" month. Great -West shall notify Participants, Alternate_ Payees and Beneficiaries invested in the GIF of this restriction at least thirty (30) calendar days in advance, at the address on file with Great -West. In the event notice is provided to a Participant, Alternate Payee or Beneficiary fewer than thirty (30) days before the contract termination date, the restriction shall not take effect for such Participant, Alternate Payee or Beneficiary sooner than thirty (30) days from the date of such notice. Distributions may be made from the GIF at any time. GIF 10 FFII FL Page 4 Revislw 1: Sep 12.26t6 213 PM 98781 -02 Visage &Tequesta No Plan Sponsor Transfers shall be allowed Option b) shall apply only if, on the date Great -West receives contract termination notification in good order, the average 3 year and 5 year Treasury Constant Maturity rates is 300 basis points or more above the lowest weekly average of the 3 and 5 year Constant Maturity Treasuries over the previous 104 weeks from notice. Great -West shall use published rates from the United States Federal Reserve website. Numerical Example: On the date notice of contract termination is received by Great -West in good order, the average of the 3 year and 5 year Treasury Constant Maturity rates. is 6.00 %. Over the previous 104 weeks from notice, the lowest average of the 3 year and 5 year Treasury Constant Maturity rates from the United States Federal Reserve website. was 2.50 %. Since 6.00% is more than 300 basis points above 2.50 %, option b) applies. 3. Payment in 20 Quarterly Installments — Great -West will remit the total Participant Account Values of the Contractholder's assets in the GIF ( "book value ") in twenty quarterly installments with the first installment comprising 1/20 In of the book value, on the date remitted, that payment being made no later than ninety (90) calendar days after contract termination date. 'The remaining payments shall be incrementally remitted in fractional amounts of remaining book value each quarter over the succeeding nineteen quarters (e.g. 1/19, 1/18...1/1) until the total book value is remitted. Unless Plan Sponsor retains Great -West as the Plan recordkeeper, no Plan loans shall be made from the GIF assets and Contributions and Deposits will not be accepted into the GIF after the contract termination date. No Plan Sponsor or Participant, Alternate Payee or Beneficiary Transfers including plan to plan transfers or transfers from a governmental plan to purchase service credits shall be allowed. Distributions may be made from the GIF at any time. 4. Any other termination option allowable under applicable law as mutually agreed upon in writing by Great -West and Plan Sponsor. Signed for Great -West Life & Annuity Insurance Company on the Effective Date of the Group Annuity Contract. President GIF 10 FFII FL Page 5 Revision is Sep 12, 2016 2:13 PA7 66781 -02 Wage of Tegwsm GREAT -WEST LIFE & ANNUITY INSURANCE COMPANY A Stock Company 8515 East Orchard Road - Greenwood Village, CO 80111 For service, c411 1-800-701-8265 Letter Agreement This Letter Agreement is attached to and made part of the Great -West Life 8 Annuity. Insurance Company Contract (GFAC 10 FFIQ, pursuant to Section 10.02 "Entire Contract ". This Letter Agreement supersedes and replaces any other previous Letter Agreements or representations. Great -West Life & Annuity Insurance Company ( "Great- West ") and Village of Tequesta ( "Plan Sponsor") agree to the following clarifications and modifications of the Great - West's Group Fixed Deferred Annuity Contract ( "Contract "), Contract Number 98781 -02. 1. Contract Maintenance Charge — The Contract Maintenance Charge as described in the Contract is $ 2. Contract Termination Charge — The Contract Termination Charge described in the Contract is This Letter Agreement shall become effective on the Contract Date. This Letter Agreement may be modified at any time upon mutual consent of both parties. FRI 10 Ltr Agrmt tlevscnl; Sep 12.20162AFM 96761 -02WageofTe4uesta Pagel GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY A Stock Company 8515 East Orcharci Road Greenwood Village. CO 80111 For sent/ call 1-800-701-8255 ------_------- — ------ APPLICATION FOR GROUP ANNUITY CONTRACT .. ...... .. ----------__- . . ..... SECTION A, PLAN SPONSOR . ............... .... .... . . ................ . .. . ..... NAME OF PLAN SPONSOR FEDERAL TAX 10 0 Village of Tequesta 54 6044081 ADDRESS SITUS 345 Tequesta Dr Tequesta FL 33469 FL y ZiP "IX. TELEP 6rW FAX TYPE OF ENTITY 561-768-0415 Government FULL LEGAL NAME OF PLAN Village of Tequesta Deferred Comp"abon Plan SECTION S. CONTRACTMOLDER . tRUS'TEE IF DIFFE RENT THAN THE PLAN SPONSCW_R i�ACiAZZi Tia hcaNe ... . ....... — ---------- ADDRESS SITUS. it ?4*"We STRE,fj TELEPHONE # FAX # TYPE OF ENTITY: SECTION C. PRODUCT INFORMATION Fixed Annuity SECTION D. �PLAN INFORMATION ❑ 401(a) Plan. ![1 401 (k) Plan 0 457(b) Governmental Plan ERISA Q Nor-ERISA Q ERISA Q Non-ERISA . ...... .... . ... ... ..... . . ... .. ... . . .. ...... - — _----__ _ ..... . ..... . ... . .... ............. . . . SECTION E. DEFAULT INVESTMENT OPTION Guaranteed interest Fund No Default Investment Option (Money returned to payee as required by law) 2 Other Investment Option. ..... . ...... . . .... . .... _....____.__..... Y._ . ........... . ....... . .. ....... ........ . . . . ........ . .. . . SECTION F. FIXED ACCOUNTS .. ....... ... . . . . . ...... ... ....... . .. . Guaranteed Interest Fund SECTION G. SERIES ACCOUNTS SECTION H. SEPARATE ACCOUNTS ..................... None None . .... . .. . .... _....,.-,.-- — - --------- - . . ..... .... ... - — ---- SECTION 1. AGREEMENT AND SIGNATURES ...... . ..... . ............. ____ ...... 'AGREEMENT: By signing this Application, Plan Sponsor and Contractholder, if other than Plan Sponsor, understand, accept, and otherwise agree to the provisions of the attached Group Annuity Contract, certify and otherwise represent that the information contained on this application is true and correct to the best of their knowledge, and agree to notify Great-West of any changes to the information provided above ✓ 11-10-2016 `mow Signature of Plan Sponsor Date Signature of trustee [.)are if different than Man Sponsor Village Manager ........ ... .. . .. . . ......... Title Title 6AC A 10 FFII FL Rev*W 1, SW 9 20164:55 RIM, %?V.01 VAa"if`req:*Ms Page 1 of 2 FRAUD NOTICE NOTICE: Any person who knowingly and with intent to injure. defraud, or deceive any insurer files a statement of claim or an application containing any false Incomplete, or misleading Information is guilty of a felony of the third degree REPLACEMENT INFORMATION: By Employer WIII this group annuity contract replace any existing contract? Yes ❑ No ❑ By Agent To the best of your knowledge will this group annuity contract replace any existing contract? Yes ❑ No ❑ I FLORIDA license agent: Licensed Agent Signature Agent Name (printed typed or stamped) Agents Florida license identification number Date GAC A 10 FRI FL gev�gnn Page 2 of 2 ?. $p 17, 2016 2 ?7 PIA 987814)2 V�i 2 aOe M TeQuefta