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Home My WebLink AboutDocumentation_Pension Public Safety_Tab 15B_08/11/2005~(-~) VILLAG E O F T EQUE STA RISK MAN AG EME NT Memo Ta Gwen Carlisle ,- `~f1 From: Daniel J. Gallagher Dates 7/18/2005 Ree Pension Plans -Fiduciary Liability Coverage Our Fiduciary Liability Coverage for both pension plans expires on October 1, 2005. In order to allow ample time to obtain renewal quotes, we should complete our renewal application by August 11, 2005. Attached is a copy of a partially completed renewal application. When you get a moment I would like to discuss certain items contained in this application. Acordia 501 South Flagler Drive Suite 600 West Palm Beach, FL 33401 Voice: 561.655.5500 Fax: 561.655.5509 www.acordia.com July 12, 2005 Dan Gallgher ~'"; Village of Tequesta P.O. Box 3273 Tequesta,. FL 33469-0273 RE: General Employees Pension & Public Safety Pension #103505325 Exp. 10/1/OS Dear Dan: Enclosed please find a partially completed renewal application based on our information in file. I have highlighted areas you need to complete, but please correct any other information. In addition to the application I will need the following: • Schedule of Investments for All Plans • Most recent CPA Audited Financial Statement on the Municipality • Most recent CPA Audited Financial Statement on the Plans • Actuarial Report for the Plans Please return to me no later than 8/11/05 to allow ample time to obtain you renewal quote. If you have any questions, please don't hesitate to call me. Sincere urs, Pamela I,. Nelson CIC Account Executive/WPB Enc. A V"Jells Fargo Contpary nmembe.orme ~siayai rre,,,ro,k. ST~,A~l~, FIDUCIARY LIABILITY INSURANCE TR~iV~L.ER~ Agent/ Broker Code: N me and License Number: p jU .C~L_ ,/i!-1~~5~ ~ Policy Number: g ~. O3,Sp 3~ GENERAL INFORMATION _. 1. Name & Address of Insured (Spo sor Organization): ~~ ~ ~j"G 5. Annual Sales or Revenues: ¢i-'G~- IG S/~I~G ~ Ofit=i~~'~ ~'iv c'l~~ 7~t,;, ~ ~yYV ~ 6. Is this a Publicly Tr ded Entity?: _~~'~1~~~' ~~ ~ ^ Yes ~ No ~~ ~~' r-- ~ ~l_ ,,~ 3 c -~~~ 7. Years in Busipes [ 2. Descriptio~f Named Insured's Business: ~ ~'* l~ ~ ' 8. Sponsorship: L /'. ' r tl /_ I ~~ ^ Single Employer or Controlled Group of Corporations EIN#: ~~°- F, ~ t "C ~ ~ SIC Code: ^ Multi-Employer (Collectively-bargained) ^ Multi-employer 3. Total Number of Employees or Members: ^ Multiple Employer ^ Church Governmental ^ Other (Explain) 4. Maximum number of individuals in your workforce in the following capacities over the past 12 months: Temporary: Leased: Independent Contractors: !' ror Stngle >rmployer/Controlled Group of Corporations or Governmental Sponsors indicate employees. For all other sponsors use total members. INSURANCE INFORMATION I. Expiring Fiduciary Liability Coverage: ~ 4. Premium Payable: Limit 4 Deductible ,~ ~t'1 ~ ~ Annually EfUExp ate - ,$" Premium ~~~Q ~' ^ Three Years Installment Insurer •i~ fiy ^ Three Years Prepaid 2. Coverage Requested: Limit _ Premium to be Paid By: Deductible Etl/Exp uuttr / ~L f ~~.~ ~ Q F; ^ Employer or Union Trust or Plan 3. Insurance Representative (The individual acting as the exclusive agent to act (Endorsement will be issued to eliminate recourse on insureds who are un behalf of the Insureds in matters of this insurance): fiduciazies if the premium is paid by the Employee Benefit Plan. Premium for this endorsement must be paid from funds other than the assets of the Employee Plan.) LOSS INFORMATION 1. Has any plan, entity or person proposed for this insurance been: Yes (a) Accused or found guilty or held liable for a breach of fiduciary duty, or a violation of ERISA, or any similar state, local ^ or foreign law? ^ (b) Accused or found guilty of any criminal act? 2. Has any fiduciary liability or fidelity coverage for any plan, entity or person proposed for this insurance ever been O refused, canceled or non-renewed? ~ PRIOR COVERAGE (select one) I. ^ New Policy with no prior similar coverage: Yes No theraany~acLc or•• circtunsiartces.~vl~xresult in a_claim_un_der the proposed policy? ^ ^ II. ^ New Policy with prior similar coverage with another insurer (Attach a copy of the pnor appTi'caYi'tm~for----_._~ request for continuity of coverage): FLP-1002 FL (OS-00) Page 1 of 3 (a) Prior similar coverage has been continually in effect since / / At the time of original ~. application to the insurer who wrote such coverage, were there any facts or circumstances which might _. _~ have resulted in a c`laiinbeillg'made-against any insured? O ^ ..: __ _~...._._z---.~.-----. (b) Are there any pendinp~claims~--_----. - __._.. _. _-.. __._....e~ ^ ^ (c)~uing the past f ve years, have any claims been brought against any plan, entity or person proposed for ^ ` this. insurance? PRIOR C4YERAGE (continued) _. III. Renewal Policy of the Company: (a) Prior similar coverage has been continually in effect with Travelers Property Casualty or any current or former affiliates since~~/~/_~. (b) Prior to obtaining coverage wrth Travelers Property Casualty or any current or former affiliates, similar coverage has been continually in effect with another insurer since / / (If Yes to any question above, attach details including type and amount of claim and whether any insurance responded.) --- PLAN DATA Complete Chart for all plans for which coverage is requested For each plan listed, indicate in the corresponding column the applicable letter(s) and number. Plan T e Column 2 Fund Status Column 4 Plan Status Column 8 Defined Benefit (DB) . 1. Trust A -Active Defined Contribution (DC) 2. Trust and Insurance F -Frozen Welfare Benefit Plan (VV) 3. Insurance M -Merged Other (O) -Attach Explanation 4. Funded exclusively from general assets T -Terminated of the Sponsor (unfunded) S -Sold (Spun-ofI) 5. Funded partially from insurance and If any plan has been merged, terminated artiall from assets of the S nsor or sold, indicate date of transaction. 1. Full Plan Name 2. Plan T e 3. Report Year 4. Fund Status 5. Asset Value 000 6. Annual Contributions 7. No. of Partici ants 8. Plan Status ~~~ f? ~ Ci~2f'l. ~.. cs ~ ~s ~ - I Sob o ~z ~ ~ ' `~ ~ S A 1 .l'l, f ' r' e ` ~ r= ` C7 :~'~ .i~v u z O DSO ..3,~ ~ .~ ~' / (o A -,~ * List any additional plans on a separate attachment Total assets of all plans to be covered under this policy: S ~, ~~D, ~ ®o Total number of plan trustees and other employees who act in a fiduciary capacity: / Plan Underwriting Questions Ye: No I. Has the IRS withdrawn or threatened to withdraw the tax exempt status of any plan? If Yes, explain. ^ 2. Has any plan experienced an event reportable to the PBGC within the past three years? If Yes, explain. ^ 3. Has any plan been the subject of an investigation by the DOL, IRS or similar foreign regulatory agency in the O last three years ? If Yes, explain. 4. Does the plan(s) conform to the standards of eligibility, participation, vesting and other. provisions of ERISA or ^ similar foreign law? If No, explain. 5. Has any plan filed for exemption from a prohibited transaction? If Yes, attach copy of filing and DOL response. ^ 6. Has an actuary certified that the plans are adequately funded in accordance with ERISA's minimum funding ~ ^ standard? If No, explain. ~ 7. Is each plan reviewed periodically to assure there are no violations of prohibited transactions or party-in-interest ^ rules of ERISA? If No, explain. H l i d as any p an rece ve 8. an adverse opinion as to its financial condition by an independent public accountant? If Yes, ^ attach copy of plan audit. 9. Does any plan hold employer securities or employer real property in violation of ERISA or in excess of ERISA ^ limits? If Yes, explain. FLP-1002 FL (OS-00) Page 2 of 3 10. Is any plan loan, lease or debt obligation in default or classified as uncollectible? If Yes, explain. ^ 11. Are there any outstanding delinquent plan contributions? If Yes, explain. O 12. Does any plan invest in or provide an option to invest in employer securities? If Yes, explain. ^ 13. In the past two years have there been any plan amendments or do you anticipate any plan amendments that will ^ result in a reduction in benefits? If Yes, explain. 14. Has any plan been merged with another plan, terminated or sold within the past two years or aze any anticipated _ ^ d to be merged, terminated or sold in the next 12 months? If Yes, explain. 's 15. If any plan has been ternunated, were benefits secured with the purchase oC annuities? If Yes, please provide the ^ ( name of the insurance carrier(s). 16. Dces the employer, committee of employer representatives, or union board of trustees have final say over the ^ 0/ determination of whether benefits will be paid under any health and welfare plan sponsored by this Insured? IlYVESTMENT'ADVISORS '. Please list all outside professional investment advisor(s) utilized by the plan(s) listed on page 2. If any plan does not utilize outside professional investment advisor(s), please attach a schedule of each plan's investments. CURRENT INSURANCE COVERAGES Poli Limit Deductible Insurance Co. Eff. Date Premium Directors & Officers Errors 8t Omissions O,~u ~ (9 Em to ent Practices e ~~ ~ _l-t' Fideli /Crime ~ . `' /.~,~ Workers Com . 0 Commercial GL ' ' ' •~ p _. RE UIRED ATTACHMENTS For Single Employer Plans or Controlled Groups of Corporations: • Coverage limit requests of $1,000,000 or greater attach: 1. Sponsor financial statements, 2. Form 5500's for each pension pian with attached schedules A, B, C, E (ESOP) & G as applicable, and 3. Plan financial statements for each pension plan. Information requests may vary from the above based on specific account or industry characteristics. The undersigned declares that the statements set herein are true to the best of his or her knowledge and belief. The undersigned agrees that this application and attachments form the basis of the contract should a policy be issued and shall be deemed attached to and form part of a policy. The Company is hereby authorized to make any investigation and inquiry in connection with this application. Attention: /nsureds in FL Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insu ante act, whit 's cri e, and subjects such person to criminal and civil penalties. r Signed by TrusteelFiduciary: Dated: ~ '.3 ~-T Print Name: ~~Ob ~ ~ w ~~ Title: ~~ v1' ~~ FLP-1002 FL (OS-00) Page 3 of 3 VILLAGE OF ~',QUESTA, FY.ORIDA STATBl1~NT OF CHANGES IN FIDUCIARY NBT ASSB'fS FiDUCtARY FUNDS FISCAL YEAR ENDBD SF.P'IBMBIDt 30, 2004 Pensiaa Tent ADDITIONS ~ Contributions: Employs ~ S 176,537 gmPloYa 123,800 State 124A~ Total contributions 424.823 Investment income Net spprooiaticn in fair value of investments 123,341 Investment earnings ~.~ 190,209 Lela inveetrncnt expenses 60,973 Net investment income 129.236 'I'mo ~~ SS4,059 DEDUCTIONS Pension benefits 26,740 Total deductions ~7~ Net increase 527,319 Net assets held in trust for pension benefits: Net assets, beginning 2,300,091 Net assets, ending S 2.8 See notd to basic financial statements. -25- VILLAGE OF TEQUESTA, FLORIDA NOTES TO BASIC FINANCIAL STATEMFIVI'S (Continued) NOTE I2. VILLAGE EMPLOYEES' RETIREMENT SYSTEM (Continued) PUN DESCRlPT70NAND CONTRIBUTION INFORMATTON (Contint~od) b. Gersrnl F,aiploytsr' Pewsfos TYatst Fruad (Continued) I+tindiej Pdicy (Corttimted) 'The General Employees' 1?bnsion Trust Pond does not issue aepetate stand alone financial staoementa. Thertfot+e, included below is the Statement of Fiduciary Net asseb and the Statement of Changes in Fiduciary Nd Assets as of and for the year ended September 30; 2004. GENERAL EMPLOYEES' PENSION TRUST FUND STATEMENT OF FIDUCIA1Y NET ASSETS SEPTEMBER 30, 2004 ~°~ 5437,365 Due from °~ f1°~ ?71 Total assets 440.136 L1ABII.TTIFS _ _ NET ASct?rc Accounts payable 6,425 Net assets held in trust for pension benefits S 433,711 GENERAL EMPLOYEES' PENSION TRUST FUND STATBN1EhtiT OF CHANGES 1N FIDUCIARY NET ASSETS FISCAL YEAR ENDED SEPTEMBER 30, 2004 ADDTITONS Contributions 5123,715 Investment loos, net 1( 0~) Total additions 113,461 DEDUCTIONS Pension benefits 13.694 Total deductions 13,694 Net increase 99,767 Net assets bell in tract for pension benefits: Net assets, beginning 333 944 Net assets, ending S 433,711 -52- 0 VQ.LAGE OF TF.QIIESTA, FLORIDA NfyI'FS TO BASIC FINANCIAL STATEMFNT$ (Continued) NOTE 12. VII.I,AGE EMPLOYEES' RETlZtEMENT SYSTEM (Continued) PLlN DESCRIPTION AND CONTRIBUTION INFORMATION (Continued) a Pabltc S~etr t~'Teers' ?last Faasd (Continued) Finding Policy (Continued) POLICE OFFICERS' PENSION FUND 5TA'IEI-~JI' OF C~iA[dGBS IIV FIDUCdARY NET ASSETS FISCAL YEAR ENDED SP.PTEMBER 30.2004 ADDITIONS Comributions S 114,331 Investment income, scat 26.819 Total additions 141,150 DEDUCTIONS Pension benefits - Total deductions - Na ioct+ease 141,150 Na assets held in mist for pension benefits: Net assns. begitsning 358,058 Na assns. onding S 499.208 b. tienaral EasQl'oraes' PeAaioa Trust Fwrd Plan Dacriptlon ~Y 8 employee who completea tat or more years of ctedited service snd attains age 62, or completes 30 years of credited servicx tegar+dless of age, is eligible for normal retirement betsefita. The monthly amount of normal retirement income fora ®eoenl ets>ployee is equal to the rnsmber of years of credited service multiplied by 296 of his average highest compensation Early retirement may be taken after a general employee has attained the age of 50 and has ben years of credited eervioe. In the event of early tetittmeat. benefits aro actuarially rednoed to take into account the ®enaal ettsployee's yosmg~er age and earlier consmenoement of retittinteat benefits. Such tedssction shall not exceed 596 per year. Disability benefits can be retxived for total and pernsaoent disabilities as daertmned by the Board of Trssstees. If the passion is granted. the benefit amamt shall be as follows: -50- VII.LAGE OF TEQUESTA, FLORIDA NOTES TO BASIC FINANCIAL STATE[~.N'IS (Continued) NOTE 12. VILLAGE EMPLOYEES' RETIREMENT SYSTEM (Continued) PLIN DESCii<IPT70NAND CONTRIBUTIONINPOiRMAT70N (Continued) a Psbdc Sa~j O~'teers' Thirst i'iasd (Cominued) Fendlns Pdky (Continued) Fl1tEFIGHTERS' P1~SION FUND STATF1vlENT OF CHANGES IN FmIJCiARY NET ASSETS FISCAL YEAR BNDBD SEP'I'II~48ER 30, 2004 ADDTITONS Contribudons S 186.777 Investment income. aet 112,671 Total additions 299,448 DEDUCTIONS Pension benefits 13.046 Total deductions 13.046 Na increase 286.402 Na assets bald in irast for pension benefits: Na asses, beginning 1,608,089 Na assets, ending S 1,894,491 ~~ ~~ The Polio Offwers' Pension Fond (part of the Public Safety Offioexa' Trust Fend) does not iaane separate stand alone financial statements. Therefore. included below is the Statement of Fiduciary Net asses and the Statement of Changes; in Fiduciary Na Aasas as of and for the year ended September 30, 2004. POLICE OFFICERS' PENSION FUND STAT6MFM t7F FIDUCIARY NET ASSETS 5EPi'E1148ER 30, 2004 ~~~c~ Investments 5493,361 Due from other funds 7,851 Total easels 501.2]2 Aocou~s payable 2,004 Net assets held in float for pension benefits ~ 4~ -49- 1