HomeMy WebLinkAbout1974-12-03; City Council; Resolution 35541
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RESOLUTION NO3554
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF CARLSBAD, CALIFORNIA, APPROVING
GROUP LIFE INSURANCE POLICY NO. 311713-A
WITH STANDARD INSURANCE COMPANY AND THE
LIST OF ELIGIBLE EMPLOYEES AND AUTHOR-
IZING THE CITY MANAGER TO SIGN THE POLICY
ACCEPTANCE AND THE ELIGIBILITY LIST.
The City Council of the City of Carlsbad, California,
does hereby resolve as follows:
1. That Group Life Insurance Policy No. 311713-A with
Standard Insurance Company and the list of eligible employees,
a copy of which is attached hereto marked Exhibit A and incorpor-
ated herein by reference, is hereby approved.
2. That the City Manager is hereby authorized and di-
rected to sign the policy acceptance and the eligibility list for
and on behalf of the City of Carlsbad.
PASSED, APPROVED AND ADOPTED at a regular meeting of the
City Council of the City of Carlsbad, California, held on the
3rd day of December , 1974, by the following vote, to wit:
AYES: Councilmen Frazee, Chase, Lewis, McComas and Skotnicki
NOES : None
ABSENT: None
,.-\
" ROBERT C. FRAZEE, Mdyor
ATTEST :
(SEAL)
... ;-:e r ,
PO L I CY N L‘ Ll B E R
PO L f c Y OV/N E R
EFFECTIVE DATE
CITY OF CLL~LS IUD
July I, 1974
IN!TIAL POLICY TERM July 1, 1974 to Se?,renber I, 1376
DUE DATES Ju~>J 1, 1974 aid the first day
of each calendar mnth thereafter
PCLICY DELiVERED IN California and coveriled by :he laws of th:L s:ate.
STANDARD INSURANCE COhlPANY agrees to pay the Se!iefics provided by this po!icy, ill accordarice with the provisions
of this policy.
The consideratiqn for this policy is the application of the Policyowner and the paynent by the Poricyownzr of premium as
provided herein.
This policy is iswd for the Initid1 Policy Term shown above, ending on the first day Zker the end of silcli policy Ierm at
12:Ol A.M. Standard Time al the l’olicyowner’s address. At t!ie end of the Initial Po!icy Tzrni it may be renewed for
successive renewal pcriods by the payment of the premium on each renewal dale, provided the numbcr of pcI‘S4JIlS iasurcil on
each rencwai date is neither less than the hliniinu~n t’articipation ?:umber nor less th::!.; t!ic hlinirnurit P~ticipatiwi I’C:L!III~~C
(shown in the Poiicy Data) of the total nuniber eligible. The length of each reiiewai period shall be dxermined by Star\d.-.,d,
but shall not be less than 12 months in any case. . .-.
This policy, the application of !he Policyowner, if any, and the iridividual applications, if any, of the Menbcrs constitute the
entire contract between the parties, and any statement made by the Policyowner or-by any person insurzd unaer this policy shall, in the absence of fraud, be deemed a representation ad not a warranty. No suc!: s;a!en:ent s?iaII be used in defense !o a
claim hereunder unless it is contained in a wriiten applicatior: signed by the Policyownei or thc Meaber, a copy of which has
been furnished to the Polic;lowr:cr, the person insured or the beneficiary.
No change in this policy shall be vaiid unless approved by xi executive officer, of Standard and evidenced by endoiszmtnt
hereon, or by amendment hereto SigRCd by the Policyowner and by an executive office: of Standard. No agent has a1:k;Cty
::I ciiange this poky or to waive any of its provisions.
-- .’ :.: ,-<,t.i:)iis :)ri this and the following pages are a part of tliis policy. On the follorvir?g p:qs the term “group pO1iil
.. : ... :;:!iI
I. .
and the term “group insurance” refers to the insurance under t!?is group pelicy unless clearly ~nd~caic.:
. ..
STANDARD 1 NSU R ANCE COMPANY
BY
Sccrctary Predcn:
L7&
Registrar
G E r?! E R A L DE F i N IT1 ONS
Exployer nicais clic Cicy of Carlsbad and scch nfiiliaLcd cornpanics or org"atioris 3s sid bc approvcd in kvriiirig by thc
Policyowncr and S t.iiidard.
Basic Annual Eariliiigs means annud basic wasc or salary (not including ovcrtimc, bonuses, coinmissions and 0th cxcra
conipcnsation). Cllxiges in basic ~itiual earnings LCC~USC of changes in basic wagc or salary slid1 bc cffccrivc on the first day
of thc calendar nionth coinciding with or next following the date of change in basic wagc or salary. It' tjic Mcnibcr is not
actively. at work on the date on which an iiicreasc iti basic annual earnings wouid otlicrwisc be effective, such incrcase shall be
dcfcrred until the ncxt day on which the Mcmtwr is both cligibIe and actively at work. At thc commciiccmcnt of any pcriod
of total disabiliij or at thc timc of any other los~, basic annual earnings sliail be the Mcmbcr's basic annual csrnj;lg as of the
first day of tlic calcndar month in which the disability commences or otiicr loss occurs. Any cliaiigc in basic wa;:: or salary
approvcd aficr total disability begas or aftcr any oilier loss occurs s!:all not bc considcrcci as a part of basic a:inua! c~rnirigs. ,
A Mcmbcr is considcrcd to bc activcly at work oiliy whcii hc is prcscnt a;id nc:ivcly cmp!oycd in a full-timc pcrinancnt
capacity at tlic Employcr's usual plncc of business ant! has coinplctcd one full day of such cniployincrit imnicdiatcly. prior to
the datc his insuritncc or an iiicrcasc in his insurnncc is to Le cliective. ,
Section 1. SCHEDULE CF [NSURANCE
I93
Gxsic Insurancc
Additional InsuraJicc
An eligible Mciiibcr who tlcsircs to bc iiisurcJ Tor Additioi!al Insurancc must apply ii~ v;riti!12 lor chc iiisuraricc aitd apc
to makc tlic rcqiiirctl contributions to thc Policy owner.
Additional Insurancc for an cliSiblc lilcinbcr LccoIncs cffcctivc on thc appropriate foliowiiig dntc, providc-d lie is activcly A:
work on such date: .I..
1. tIic datc hc Lccomcs cligiblc if hc npplics On or bcforc t!mt date;
2. tlic datc hc rxi;lkcs npp1ic:itioii iflic applics wit1ii:i 31 days aftcr the d:itc Iic is first c1i;iI)Ic; or
3. the datc oi approval of cvidciicc of insurability satislactory to S:andard Ii!sarcricc Company, furnished at dic
Mcmbcr's cspctise, if he applics more than 31 duys afrci die date hc is first cligibic.
liisurancc on .any cligiblc Mcnibcr who is not actively a: work o:i tlic dax wlicn hi, irlsaxiiicc \\oEtd otlicrwisc bcc0inc
clicctivc bccomcs cffcctiw oii tlic ricst following clay on wliicL 11; ib Lo:h eligible diid activc!y ac vioik.
299B
Section 3. CESSATION OF INSURANCE
A Member's iiisurancc automatical!y ccascs on thc carliest of the fol!owing chtcs:
405
The amount of iiisaraiice which rcniains in forcc Lindcr :his provisio:i for any Member shall in no citse Le iiicreascd i)r
decreased during the continuance of his total. disability.
Written notice of death of a Member whose insurance is being continued under chis provision must be furnishcd to Standard
ar its home office within twelve months after the date of death. if notice of deadi as required is iioi so turnislied. Standard
shall not be liable for any payment on account of such dcazh. .-
A Member's rights cndcr this provision will automatic;illy and imniediately cease:
1) When he ce,!scs to be totally disabled,
2) At the end of any twelve month term if proof of total disability is not received daring the lasr threc "xi> of chat
3) When he faiis to submit to any medical examination rcqtiired by Standard, or
4) When an ii.dividual policy has been issued to him undcr the provision hereof enticled Conversion of Life Insurance.
term,
5298
.I.
b .
c.
6.
wil! bc ciicit!cd, rvithout cvidciicL of i;:sg:>bi;icy! to an indivicl.:;21 policy df !it2 ii1s:.:ra1:cc oi! ;he
disxbiliry or doublc indcrr;!?ity Lcnefiis.
The fo1lo;ving conditions and provisions ivili appiy to thc iildkidx.?! ps!icj 0; life i;isi,rx,lcc.:
1 j tlic ?.{embe: may select any form of individual policy, exccpc cerrli insuxncc, then c;u>inti:aAv :;sc:d by 5c;ndard at
the age and for the amount :ipplicd for,
2) chc prcinium for the individt;ai policy tviil bc the preniii:in iipp!icabie io tlic clxx oi':icL ti) ts:!~ic!: c!:c
and to the form and amount of the individual policy at ihc b!emler's attaincd sgc ;rie;~rcsi bi:thday;
d-tc of the individual policy, ai;d
3) the amount of the individuz! policy will be cqual to (or at the option of the Mcmbcr less chi::: :!-IC amount of the
Member's life insurance or the reduction in thc amount of life insurancc, as :he cast niay bc, on shcvcr of the datcs
in a, b, c or d above is app!icabie. However, if the Member's life insurance ceases becai.isc of the discontinurrnce of the
group policy five years or more after the effective date of ihe Mcmber's insurance the arnount of the individual poIicy
may not exceed the lcsscr of
a) die amount of the Mcmbcr's life insurancc at thc date oi ccssation of such insur'iiicc, rcittrccd by aity lifc insiirancc
for which he may becon:: eligible under any group policy issued or reinstated by Staridard or by any othcr insurer
within thirty-one days after such cessation, and
b) 52,000.
2. Any individual policy so issued shall become effective on the date of expirarion of the thirty-one day period during which
application may be madc. However, if the Member should die during such thirty-one day period, Standard will pay.
whether or not the Member has made application for such individual policy, the maximum amount of life insurance for
which an individual policy could have been issued.
In no event, however, will payment be made under this provis;on ;f payment is made urtdcr the LifL Insurance Benefit
Provision entitled Insuring Chase or Benefits in Event of Diszbilicy.
3. If an individual policy is issued to a Member in accordance Miit!i the provisions of this subsecrion, slic!~ Member shall nor
thereafter become insured under the group policy unless hc shall, at his own expense, fiirnish evidence of insurability
satisfactory to Standard, any ocher provisions of thc group po!icy to the contrary notwit1istandii:g.
522C
Scai:dar-tl xdl ~2.)’. subject to the terms of &e group policy. ttic 3riio~nc s?:ciCiti! i,~ sdch 135s in :.lc:u~.in::ce with the
S~hcdilie of iiisiirancc and the Sci;(:(!ill:: of !:ic!trnnities, provided how-ircr, rL:ic cvcit c1:or;gh huih lobs rcsL:l:s from accidciical
botii!y iRjuiy, 20 payment will Sct made for any loss caused directly or indirectly by an); o’the :s:!owin; ~r.3 na paynent will
be made for any ioss ii the acc:dcr:r is cause:! dirzctly or indirectly by any oi:!;e iooi!L-,vi,is:
r.
a) an); iiiiilriccci3n. war, or xt of war. U’nr irisjudes declared or r?ndrc!arcd wx, rvhe~her cid or in:2rxsio:;3i, and any
b) saicide or iiijuiies inteii:ionai:y inflicted by the Meniher, while siiie or insane.
c) comrriii:ing or actrmpting to conimit sn ~SSRUI: or felony, OK piiticipatiiig in ;I 1;iolc:it disorcicr.
d) hernia of an); kind, stroke, corcxmry occliision or rupture, any scIi-ad!iiir:ist:rcu urug, poisoa or c-i;cniic:,l compound,
bodily oi mental infirmity, sickness, disease OK infection esis:ing a: rhc tir:;e of the accident. 0: niedicai 0: surgical
treatmezit ior any of the forcsoing.
subsca;.,tiai arined conflici ~vitk organized forces of a military r.:~iure.
.. 1,
SCHEDULE OF INDEhqNiTIES
, Benefit for LOSS of
Life .................................................. The Principal Scm
Both Hands or Both Feet or Sight of Both Eyes ........................... The Principal Sum
One Hand and One Foot ...... , ................................ The Principal Sum
Either HanC or Foot and Sight of One Eye .............................. The Principal Sum
Either Hand or Foot .................................... One-Haif The Priccipal Sun!
Sight of Ont? Eye ...................................... One-Half The Principal Scrn
Loss shall mean, with regard to hands and feet, actual severance through or above wrist or ankle joints: wiih regard to eyes,
entire and irrecoverable loss of sight.
..
KO inore than the Principal Sum shall be paid for ail losses tli:ough one accident.
A,cidentaI death and dismembern:cnt insurance under the group poIicy is not in lieu of and does not afiect any requirement
for coverage by workmen’s compefisation insurance.
510
Section 6.
A Payment fif Ba:.teiits
Ai! j:ci!cfiI.s n-zx+:ii:c! i:i thc group ?:,!icy s!ia!! l)c p.!itI ;IS stared iu this section ~pon receipt of uri:ecii proof on Standard's
foriris or if scch :s;i:is arc not :ur:iis!:cd i)y Scaildiirtl, wi;lriii I5 days afccr ilcrnai:ci thcrsfor, tl;en upsn rxeipt of written [' ,. ?.
ozcurrence, characrer and estci7.t of tile event for which cl;iiiii is mad.?.
!os> of life providcd by tl:e firoi1p poiicy will be paysblc in aciortiaiice with thc LczeSciary designation
i-spzcting such p:~y:?~cnt wliicli rnny b;: prescribed hercin ~i!tf cf!sctivc at the tiillc of paymcnt. Any other
s i?npaid at the i!iscred >blembcr's death may, at the opiion of S.;anda:d, be paid ei:her to the beneficiary
or :o ;hc P,ierl?bci-'s cst;ttc. rill other indemnities wili be payable to the inburcd 5;Ic:nbci.
611A
B. Proof of Loss
Writtcn proof of' losz iiiust be furnished to StantLirc! ii; case of claim for loss for w\iic!i this po!icy provides any pcrioJic
payment coiidilSc1jt upon continuiirg loss, vv.it!iiil 90 d~ys after the first month OK lesser period for which Standard may be
liable, and in cas- of c!ain for any other loss,' within 90 days after the date of such loss. In die even: of ctaini for total
disability subscycea: written proofs of coiitincnncc of total disability must be furnished to Standard, at the Member's
expense, at such i:irervals as Standard mag reasoilably require. Failure to furnish such proof within the time r2 uired shall not
invalidate nor reduce any claim if it was not reasonably possibie to give proof within such the, p:ovide% such proof is
furnished as soon 2s reasonably possibk and in no event, except in the absence of legal capaci:y of The illember, later thm
onc year from rhc time proof is otherwisc required.
Standard shall have the right to reqgire as part of the proof of 103s with respect io Long Term Disability Insurance
satisfactory evidence (a) that the Member has made ap lication for all Deductible Benefits, (b) that he has furnished all
required proofs for such benefits and (c) of the amount o such benefits payable.
606%
P
C. Physical Examination and Autopsy
Standard at its own expense shall have the right and opportunity to examine the person of any individr;al whose injury or
sickness is the basis of claim when and as often as it may reasonably require during the pendency of a claimhereunder and to
make an autopsy in case of death, where it is not forbidden by law.
605 C
D. Beneficiary Provisions
Death benefits, if included in the group policy, will be paid to the beneficiary(ics) designated to reccive them. \Vfien more
than one class of beneficiary is named, payment will be made to those in the highest beneficiary class: the classes ranking in
the order: primary, first contingent, second contin ent, etc. Shodd one beneficiary class include mors than one person, any
If no designated beneficiary survives the Member the benefits will be paid to the first surviving class of the following classes of
successive preference beneficiaries: The Member's (a) spouse; jb) children; (c) parents; but if no class survives, the benefits will be paid to the Member's executors or administrators. If two or more persons become entitled to benefits as preference
bencficiarics, they shall share equally. Standard may reiy on an affidavit or ocher evidence deemed satisfactory to ir in
determining the identity or the nonexistence of beneficiaries not identified by name, and any payment made by Standardin
reliance thereon shall to the extent of such payment be a valid discharge of Standard's obligations.
The beneficiary(ics) may be designated (or changed) by the Member at any the. The designation or change will take effect as of the date it is sigiicd except that it wil! not apply to any payment made by Scandard before receiving the designation or
chairgo. A benet;ciacj- designation or changtt Iilust bc made, dated and signed Ly the Mcmber in a written iiistrumcnt relating
to the insurnncc provided under the group policy incl dcliverctl to the Poliiy;~~~~:icr during the lifctiiiie of thc hlcnibcr. A
writrcii bcncfizi:iry clcsigiiatiori dxtcil :iuJ signcd by tlic MulciiiLcr ~~iicicr ;i prrvio~ts policy wiI! bc ;!cccp[c;! ;IS :A 1xricfici;iry
desi.i;ii~tioii uii:icr the group policy ii ths previous policy rclaics to the same po!icyou;iicr group ~IIS:!~:~~ICC progr:ii:i 2s rhc
groiip policy, ant{ if tlie insurancc uiiticr tlic group policy rcphccs all or pii:~ of tIIc iiisuraiicc !)rCVic)iJS!y iii iorcc tinder that
program.
benefits payable to that class will be paid in equal s R ares to the surviving bcncficinries of r!iat class unless otherwise provided.
.. r cjy *.b:-,,:n 15 days after tlir: ?:?cmb::r, and bcfcrc duc prcxji nf :he .,:andard’h liomc c:ffic-, :hc proceeds \-;ill bc paid as if that .> hxs b::c:1 rcc’:ve:;
?’lie amount p~y.!i..!c LO a hc:loi’.ciaiy may bc Faid in ii?jt;!iinents over 3 period of years upon mutual agreement wi:h
Standard. To the ex:<;:: pcrrr.i:cc:c! by law ;iinoei!ts I?J~~?>!c ;a beneficiaries shall no: be subject to the claims of~riy creditor
or any representative of such crcdiror, or to any IcgaI ?recess agaixst a beneficiary.
!f a:i individul! poliiv I:.s beer., i;sged as 2 ies::it i;: applicaiion made in accoduice with the Eenefit Provision enEitIed
r ... * .- ,nversicn of Life iiiburai:ce the desigaation by chc hicm’ozr of a beneficiary tinder s::ch iridividua1 policy oth’ei than the
beneficiary of record of the ?vfe:n5er under thz grou; ?o!icy, vdi, notwithstanding any or’ncr prcvisions of this Szction to the
contrary, effect a cha::pe of be:-:eiiiary under die gra-p poiicy to the beneficiary of record ur.dei such individual policy.
Ii an indemnity oi the ~~OUP 2alicy shall be a!>!? to rhc estxte of the insurrc! X.cmber, or to an insured Mernbzr or
tznericisry who is a xiinor 0;- oci~ciw~se nst LO :znt to give a valid rei,case, Stni:daid rmy pay such indemniiy up to ail
amoiitit not escee2;r.g SjOO to a:iy relative bj: t!ooti 3r coiinection by marriige of rhe insured hiember or beneficiary who is
clcemed by Standarc! ta be eqaitably encicled &ereto. Any payment made by S:ada:d in good faith pursuan: to :his
provision shall fu!Ly disihargc S:anciaid to the exsznt of such payment.
7 .-
x
60bD
E. Assignment
The Membci’s certiGcate is non-assignabk and [he insurance and benefits are non-assignable.
Section 7. TIME LIMITS ON LEGAL ACTIONS AND CERTAlN DEFENSES
After the group policy has been in force for two years, its validity sball not be contcsted, except for non-paymenr of
premiums. No stdtement by any Member made in XI application €or life insurance shall be used to reduce or deny a life
insurance claim after the insurance with respect to which claim has been made has been in force for two or more years. No
statement, except a frauddent misstatemenc, by any Member made in an application for insurance other than !ife insurance
shall be used to reduce or deny a claim after the insurance with respect to which claim has been made has been in force for
two or more years.
No action at law or in equity shall be brought to recover on the group olicy prior to the expiration of 60 days after written
proof of loss has been furnished in accordance with the requirements o P this poIicy. No such action shall be brought after the
expiration of three years after the time wiitteil proof of loss is reqnired to be furnished.
7 L2
Section 8. MISSTATEMENT OF INFORMATION
In the event of the misstatement of the age of any Member, there will be made an equitable adjustment of the premiums oc of
benefits or of both, sxh adjustment to be based on the difference between the total premiums paid and the total premiums
which would have Seeipaid had the information been correctly stated.
802
s. ca.iL . ,I. diii .,’ ! L::i.; cotnpuicd ;in ;ivcc L;c insiirancc pi-cniiuin rntc pcr $1 ,000 of lifc itistiziincc ;IS of :lit cf<cc:i,.,c d;itc of his
poiicy, iisiii; :tic [nitial sciledilie of L.ik Ii:s::r,iiicc Prcrulunis xt Fodi in Sccriori 13 iicrcor‘. Sici ;ivci.np prciniutn raic is
s!~o\vii Iii ti:: poiicy data as tiic i;iiLiI prciiiiiiin rate for iifc iiisui.nr:;c.
UpOii any renewal of this policy, or viIic~i~)vcr ihc ter-ins of t!iis pdicy xc changcd, citlicr the I’oiicyo\viicr, or Standard rnny
recia& a recomputation-as of SUCII ciatc 0: tlic nvcragc Iifc insL;rancc pr-ciniuin rate per SI ,000 ociik ~:ISU~-~IICC, using for sui11
rccomputntioii such schcdulc of lifc iiisuraiice prcniiilms as may then Lc deterniiiicd by Stnildard and thc iiiiiouni of
itisuraricc rhcn in force ;it thc rcspcctivc atcnincd ages of thc insurcc! McriiLcrs on such dntc.
I lie initial prcrniuin rdtcs far ail odic: covoragcs iiicludcc! in tiiis policy are sliown it: ttic poiicy data. ~pon mutual agreement
Lstwecii thc Policyowiicr and Standard, or upon thirty-one il:iys written iioticc to the I’trlicyowncr, Standard may cliarigc arty
om or morc of said premium ratc‘s, cffcctive oil any reiic,wnl date or on the dntc of nriy cliaiigc iri the terms of this policy.
Instead of the mcthocs of dctcrniiiiation arid computation of prcmiun; clm-gcs aL.ovc prov’icicd, prc1i:ium chnrgcs Inn)- bc
dctcrrniiicd and coinpstcti by any mctliod niuiually agreeable to Staticlard ant1 thc I’olicyowiicr wliich produccs
approximately tlic samc total aniount.
..
“I”
399A
.a
..
B. Premium Adjustments
,--.
Prciriiurn adjusttr.ents invotvir:g rcturn of unearned prcmiui.:
months ininediatcly preccdiiig the dare of receipt by Standarc; (.I CviJCilce that suc!i ;idjCS:mcnts should be madc.
the t’olicyowiicr shsj! i;c lirnited to rhc period of twclve
901 0
C. Payment of Pr2miurns
Premiums are due wid payable oil the duc dates sliown on the f:oi:t or this policy.
A!; premiums falling due under this policy, inclilding adjustnicn ts thcreoi, if any, are pyahle ,by the Policyowner on or
before their respective Jue dates direct to Standard at its Home OfFice. The payme;: of :lily premium shall not maintain rhe
insur;ince under this policy irr force beyond the date immediately precedirrg the next due date, except as providcd in the
p:ovision entitled Grace Period.
On written requcLt of the Policyowner, approved by Standa:d, premium payments may, ii IiOt then so payable, be changed at
any premium due date of this policy so as to be payable annually, semi-annually, quarteriy, or monthly.
90lC
D. Grace Period
A grace period of 31 days will be granted for the payment of premiums accruing after the first premium, during which grace
period the policy shall continue in force but the Policyowner shall be liabIe to Standard for the payment of the premiums
accruing for the period the policy continues in force.
If written notice is given by the Policyownel: to Standard that this policy shall bc discontiriucd as of a premium duc date or
before the end of the grace period, this policy shall be discontinued as of the date specified in the notice or the date of
receipt of the notice, whichever is later.
9030
Sectlcrl 10. CERII FI CATES
Section 11. RECORDS AND REPORTS
St~ridarc! shall havc the right and oppo'tuijity at all reasonable times to inspect the payrolls and other rccords of thc
Policyovmcr for ;??y purpose relzting to iristirancc under this policy.
1100
Section 12. DlVI DENDS
During the period this policy is in force, it sha!i be creditell wivir!i its share of the divisible sLrp!us in t!.c form of dividcnds as
declared by Standard.
1204
SCC!iCr, 12.
Rctir:; Amount Sone I\ casic iilsiirance-0.73
Ad i! it io na I In s~x mc e - 1 -0 C Preifiiurn Fucror
Ath::~rd
%e
16
17
13
19 20
21
22
23
2 4
25
26
27
2s
29
30
31 32
. 33 34
35
36 37
35
39 40
Md!~.:hlj~
I'icry? um
5 .I)
.!5
.IS .?5
.16
.16
.17
.17
.i8
.I8
.19
.19
.20
20
21
.21
.22
.24
.25
.27
.29
.31
.33
.35 .38
46 .6 1
47 .67
4s -73 49 .so
50 .88
51 .95
52 1.04 53 1.12
54 1.21
55 1.32
71
72
73 74
75
76
77
78
73
80
56 1.43 81
58 1.6s 83 59 -1.83 84
61 2.16
57 1.55 82
60 1.99 85
62 2.34
63 2.55 64 2.76
65 3.00
b!:mth!y
Prea iii G;
$ 3.26
3.54
3.64
4.16
4.52
4.30
5.30 5.74
6.22
6.73
7.28
7.87
5.50
9.18
9.91
10.69
11.52
12.41
13.36
14.37
*At Nearest Birthday
lJ09
SCHEDULE OF DEPENDENTS LlFE INSUHAKCE
The aino:iiic of iasurnricc oii cach Jcpciit1c:i: s!iall bc cqual to oric-half of thc Fncc Amourit of insur.l:lcc on tl;c iifc of thc
Mcrnbcr or tlic appropri:iic amount sliowri bciow, wiiichcvcr is less.
Classification of Dcpcndciits
S['O"SC
Cliilcl whilc agc 14 days and under G inoiiths
Arnoaiit of Irisurancc
.. 91,500.00
100.00
1,500.00 Child wiiiIc agc G moil ths and undcr 21 ycars
IJEP-!E.FIC[AI<Y. Paymciit of ;uiy iiisuraiicc uiicicr this Supplcmciit sha!! be niadc to the Mcnibcr if living. otlicrv&c payR1Cllt
will bc made hi equal shuts to the surviving Lciicfkiarics of tile 'riiSl:esc rank listcd: (;I) spousc of tlie Meinbcr; (b) lawful
living cliildrcn of the Mcmbcr; (c) f;itlicr aiid niotlicr of tlic Mciiibcr; (d) csccutoi's or adn~iiiistrata:.~ of tlic McmLcr; but in
ariy casc Standard may, in licu of pnymcnt to tlic Mcmbcr's cxccutors or ndministrators, pay an amount nat to cxccccl $500
of thc irisurancc to ariy rclativc by blood or coiiiicction by marringc of thc Mcmbcr appcariiig to Staiidxd to bc cquicably
cntitkd to such payincnt.
WAIVER OF PREMlUiM. Standard will waivc thc paymcnt oi any piciniums falling due for a Mcmbcr's Dcpcidcnts Life
Insurancc in any period during which iilsurai1cc oii thc Efc of the blcmbcr rcmains in forcc witbout p3j'iTiCIit of prciiiiums as a
rcsuIt of his disability.
INDIVIDUAL TERMINATION OF D5PEiVDENTS LIFE INSUI?ANCE. Iiisui;incc witli rcspcct to a hlcnibcr's dcpcndctir
shalf autornatically ccasc on thc cxlicst of tlic followiiig datcs: (Ij Fivc inoiitlis aftcr tlic clatc of dcatli of thc Mcinkcr; (2)
Tfic date the hlcmbcr's lifc iiisurnncc tcrniinatcs if such tcrmiiiation is duc to n:iy c:iusc otlicr tlian tlic tlcatli of thc Mcrnbcr:
(3) Tlic date tlic: dcpcndciit bccoincs n Xlcnlbcr as cfcfincd i.11 :lie grotip policy; (4) 'L'lic d;itc thc dcpcnclcnt Lccolllcs a full
time rncmbcr of tlic militnry (Iiiiid. scii or air) forccs of any country: (5) Tile tiate a child dcpciidciit attairls I;is 21st birtliday
or inarrics, whiclievcr is sooncr; (6) Tlic datc of ksal scpar:itiori or divorcc of'n s1)otisc dcpcndcnt ffoin the Menibcr; (7) Tht
datc of cxpiratioii of thc 1;ist pcriod fdr \vhich tlic Mcinbcr made a :cc,nirctf Cui) xibution on accouni of dcpcric1cii:s lifc
insuraiicc; or (8) Thc dxtc of discontiiiuuiicc of tlic group policy.
PI(1VILEGE OF CONVEljSlOK OF A SPOUSE'S INSURANCE. The Initial Coiivcrsion Date shall bc t!ic i!a:c of ccssacion of
tiic i1isLI:aiicc on tlic Iifc of tli~ Mcinhcr's S~OUSC.
S TAN9AED INSUPAXC E COZPi'XY
T. 0. Box 711
Portland, Oregon 97207
.,
c
Tom 1564A 9/70
ACCEPTANCE 0% GROUP INSUUWCE POLICY
Group Policy No. 3 11 7 13-A
issued to
Yo1 icyowner CITY OF ChSiLSBAD
is hereby approved and the terns thereof are hereby accepted. --._
Dated 12-9-74 B~ City Nanager
Form 1755