R-2018-5861 - 9/13/2018 RESOLUTION NO. R-2018-5861
WHEREAS, the City of Round Rock (the "City") has duly advertised for proposals for
employer-paid group life and accidental death and dismemberment coverage and voluntary employee-
paid additional group life and accidental death and dismemberment coverage and commencing January
1, 2019; and
WHEREAS, Minnesota Life Insurance Company ("Minnesota Life") has submitted a proposal
to provide said services, and said proposal has been determined to be the most advantageous to the
City considering the price and other evaluation factors included in the request for proposals; and
WHEREAS, the City Council desires to accept the proposal of Minnesota Life and authorize
the Mayor to execute applications for coverage to Minnesota Life and other related documents required
for the implementation of said benefits, Now Therefore
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ROUND ROCK,
TEXAS:
That the proposal of Minnesota Life for provision of employer-paid group life and accidental
death and dismemberment coverage and voluntary employee-paid group life and accidental death and
dismemberment coverage is hereby accepted, as the proposal is determined to be the most
advantageous to the City considering the price and other evaluation factors included in the request for
proposals.
That the Mayor is hereby authorized and directed to execute on behalf of the City the
applications for coverage with Minnesota Life and other related documents required for the
implementation of said benefits, a copy of such documents being attached hereto as Exhibit "A" and
incorporated herein for all purposes.
The City Council hereby finds and declares that written notice of the date, hour, place and
subject of the meeting at which this Resolution was adopted was posted and that such meeting was
0112.1804-,00408934/ss2
open to the public as required by law at all times during which this Resolution and the subject matter
hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act,
Chapter 551, Texas Government Code, as amended.
RESOLVED this 13th day of September, 2018.
CRAIG M RGA ayor
City of Round Ro , Texas
ATTEST:
(AaW
SARA L. WHITE, City Clerk
2
Group Term Life Policyholder Application EXHIBIT
Minnesota Life Insurance Company-A Securian Company
"A" MINNESOTA LIFE
400 Robert Street North • St.Paul,Minnesota 55101-2098
Application is hereby made to Minnesota Life Insurance Company for a Group Term Life insurance plan providing life
insurance and other supplemental benefits as indicated below.
Applicant(policyholder)
City of Round Rock
Address(street,city,state,zip)
231 E. Main St, Ste. 100 Round Rock, TX 78664
Contact name Title Telephone number
Tyler Jarl Benefits Manager 512-341-3143
E-mail address Faxnumber
tjarl@roundrocktexas.gov 512-218-5493
Plan Design: Please indicate the Group Term Life plan by checking the appropriate boxes below.
The Accelerated Benefits Rider is always included.
Plan Design Policyholder Paid (Basic) Employee Paid (Supplemental)
Group Employee Term Life Z 91
Employee Accidental Death and Dismemberment ❑ 91
Employee Waiver of Premium ❑ ❑
Group Spouse Term Life ❑ ❑
Spouse Accidental Death and Dismemberment ❑ ❑
Spouse Waiver of Premium ❑ 0
Dependents Term Life Rider(Spouse and Child) ❑ ❑
Child Term Life Rider ❑ 0
Other: ❑ ❑
Non- Standard Uni-Nicotine Nicotine
Financials: ParticipatingParticipating Low Remit Cost Plus Rates Rates
Employee Basic ❑ ❑ ❑ ❑
Employee Supplemental* 0 ❑ ❑ ❑ 0 ❑
Spouse* 0 ❑ ❑ ❑ 0 ❑
AD&D* Z ❑ ❑ ❑ N/A N/A
Child* d ❑ ❑ ❑ N/A N/A
Packaged Dependents* ❑ ❑ ❑ ❑ N/A N/A
*Standard is Non-Participating
Who will administer this plan.? ❑ Minnesota Life Policyholder
If the policyholder administers the plan, the policyholder will maintain records (including beneficiary designations,
insurance amounts, and name and address changes) and provide Minnesota Life with monthly information (number
of insureds, total amount of insurance, premium rate and total premium)and annual participant data.
Minnesota Life Agrees To Provide:
1. Life insurance to those who have satisfied the eligibility and any underwriting requirements.
2. Enrollment materials necessary to implement the plan of insurance.
3. All underwriting, claims and actuarial services as necessary.
The Policyholder Agrees To Provide:
1. Employee information to Minnesota Life to facilitate preparation of enrollment materials and plan set-up if required.
2. Payroll deduction facilities to collect premiums from insured employees, accounting for such premiums and
remittance of such premiums to Minnesota Life.
3. Reasonable administrative assistance to Minnesota Life with regard to notification of insured terminations,
changes in payroll deduction authorizations and the distribution of materials to employees.
Either Minnesota Life or the Policyholder can terminate the group policy by giving the other party 31 days advance
written notice. This group policy is effective(date) January 1, 2019 and unless terminated by either
party, will remain in effect for a one year period and shall thereafter renew for additional one year periods.
FOR THE POLICYHOLDER
Policyholder Employer identification number
City of Round Rock 74-6017485
Signature Title Date
X Mayor
FOR MINNESOTA LIFE
Agent,broker or representative Agent,broker or representative license Minnesota Life agency number
Agency Signature Date
X
03-30565 Minnesota Life 1