HomeMy WebLinkAbout4019 i •
RESOLUTION NO. 4,019
A RESOLUTION AUTHORIZING THE MAYOR AND
CITY CLERK TO EXECUTE FOR AND ON BEHALF
OF THE CITY A MASTER APPLICATION FOR
GROUP HOSPITALIZATION INSURANCE FOR CITY
EMPLOYEES WITH WASHINGTON NATIONAL IN-
SURANCE COMPANY; AND FOR OTHER PURPOSES.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF
DIRECTORS OF THE CITY OF LITTLE ROCK, ARKANSAS .
SECTION 1. The Mayor and City Clerk are hereby
authorized to execute for and on behalf of the City a Master
Application for group hospitalization insurance for City
employees with the Washington National Insurance Company
which Application is in form and substance as follows :
MASTER APPLICATION FOR GROUP INSURANCE
f
mode to WASHINGTON NATIONAL INSURANCE COMPANY, EVANSTON, ILLINOIS 60201
Name of Proposed Policyholder City of Little Rock
Main Address City Hall, Markham & Broadway Streets
Nature of Business of Organization Municipality
1 Eligible classifications are shown belowClasses of persons who are not eligible:
Total number eligible Males Females
Waiting period for eligible persons 1st day of the month following 60 days employment
[-i .tpplicable on policy effective date; [ not applicable on policy effective date.
ELIGIBLE CLASSIFICATIONS YO BE INSURED
Class Number
Description of eligible classifications (complete exactly and fully)
Class I All Full-Time Employees
INDICATE BELOW ALL OF THE COVERAGES FOR WHICH APPLICATION IS MADE
7c] Life Insurance kJ Maternity Benefit
® Allocated
p Accidental Death, Dismemberment [] Unallocated
❑ Disability Income [1 Other
.J Hospital Expense ❑ Diagnostic X-ray and Laboratory Expense
❑ Non-scheduled
[I Surgical Expense ❑ Scheduled
❑ Relative Value ❑ Relative Value
® In-Hospital Medical Expense ❑ Radiation Therapy Expense
❑ Relative Value
❑ Supplementary Accident ❑ Specified Diseases
❑ ® Major Medical
❑ ®Emergency First Aid Benefit for Dependents
❑ ❑
The effective date requested for this group insurance is July 1, 1968 hut it is agreed that the
group policy(ics) will not become effective unless and until this application is approved and accepted by Washington National
at its Home Office in Evanston, Illinois. An advance payment of $ has been tendered toward premium under
the policy(ies) herein applied for when and if issued.
Shoed at Little Rock, Arkansas this day of June ly 68
Witness Applicant City of Little Rock
Full Name . Proposed Policyhol cr)zitx_,4
By 1,--224„ait.tA-_,,
F 33(X)-i Title
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-2-
SECTION 2 . The City Manager and Director of Finance
are hereby authorized and directed to make payment of the
premiums provided for by said Application and pursuant to the
authority of Resolution No. 4,013 of the Board of Directors
in the amounts and periodically as statements are presented,
in keeping with the terms and provisions of said Application.
SECTION 3 , This Resolution shall be in full force
and effect from and after its adoption.
ADOPTED: July 1, 1968
ATTEST: I e A �,1 � � APPROVED:
/‘.14.0-4C.P
City Clerk .yor