CM-2021-013 - 1/8/2021Texas Legal
1. Group Annual Renewal Information
Organization/Business Name: City of Round Rock
Date organization joined Texas Legal: January 1, 2020
Contact Name: Tyler Jarl
Address: 222 E. Main Street
Round Rock, Texas 78664
2. Enrollment and Plan Year Information
GROUP ANNUAL
RENEWAL AGREEMENT
Texas Legal Group Plan Number: 2000-103
Renewal Terms: 1/01/2021-1/1/2022
Office Phone: 512-218-5490
Fax Number:
Email: tjarl@roundrocktexas.gov
Account Manager: Anna Gallego
Enrollment refers to the time frame an employee may enter the Plan. Many Groups elect to establish an open or rolling enrollment
while others establish a specific window of time when employees are only permitted to enroll. Plan Year refers to the beginning and
ending (renewal) of the consecutive 12 month period of membership. Groups have the option of establishing their Plan Year and
enrollment terms as they see fit.
Your organization's enrollment is currently:
January — December
Employees may enroll anytime
Your organization's Plan Year is currently:
January — December
Benefits renew each January
3. Membership Dues/Premiums
Texas Legal membership dues/premiums billed directly to the organization as collected through payroll deduction or direct bill to
employee. (Please select the desired options below.)
PAYROLL RATES-
( ) SELECT Single: $7.00 SELECT Family: $9.00
DIRECT BILL TO MEMBER:
( ) SELECT Single: $10.00 SELECT Family: $15.00
( ) PREFERRED Single: $12.00 PREFERRED Family: $16.00 I ( ) PREFERRED Single: $20.00 PREFERRED Family: $30.00
4. Education and Membership Services
Texas Legal encourages Groups to schedule routine, if not annual, membership visits to ensure members are kept educated about the
Plan. Members may also stay connected to Texas Legal by subscribing to the monthly e-newsletter, frequently visiting the website and
other social media outlets for news and updates. Texas Legal organizes legal clinics, seminars, webinars and other membership events
and meetings all designed to help educate members on various legal issues and how they relate to the Texas Legal membership.
Please contact Texas Legal for more information.
5. Agreement
I am signing, on behalf of the above named organization/business to renew the Group's annual membership. I acknowledge no changes
have been made to our membership, unless indicated above, and agree to continue making the legal benefits available to employees
and affiliates of such organization under the agreed upon terms Please return the completed form to Texas Legal at email address
agallego@texaslegal.org or fax to 512-327-0163
Volunteers, embers, etc Co nt: _ Employee Count.
Name : �S 1 �C- Title
r
Signature: "`�Z— Date:
1
THANKO• YOUR CONTINUEDSUPPORT
ROUND ROCK
TEXAS
City of Round Rock
Agenda Item Summary
Agenda Number:
Title: Consider executing Group Annual Renewal Agreement with Texas Legal for an
employee paid voluntary benefit.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 1/8/2021
Dept Director: Valerie Francois
Cost: $0.00
Indexes:
Attachments: LAF-Group Annual Renewal Agreement
Department: Human Resources Department
Text of Legislative File CM-2021-013
No cost to the City of Round Rock
City of Round Rock Page 1 of 1