CM-2023-304 - 12/15/2023GROUP ANNUAL
RENEWAL AGREEMENT
1. Group Annual Renewal Information
Organization/Business Name: City of Round Rock Texas Legal Group Plan Number: 200103
Date organization joined Texas Legal: 12/1/2000 Renewal Terms: 1/01/2024—12/31/2024
Contact Name: Tyler Jarl Office Phone: (512) 218-5490
Address: 221 E Main Fax Number: (512) 218-5493
Round Rock, TX 78664 Email: tjarl@roundrocktexas.gov
Agency Name: N/A Account Manager: Henry Pena Jr
2. Enrollment and Plan Year Information
Enrollment refers to the time frame an employee may enter the Plan. Many Groups elect to establish an open or rolling enrollm ent
while others establish a specific window of time when employees are only permitted to enroll. Plan Year refers to the beginni ng 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: Your organization’s Plan Year is currently:
January — December January — December
Employees may enroll anytime Benefits renew each January
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 web-
site and other social media outlets for news and updates. Texas Legal organizes legal clinics, seminars, webinars and other mem-
bership events and meetings all designed to help educate members on various legal issues and how they relate to the Texas Leg al
membership. Please contact Texas Legal for more information.
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.)
THANK YOU FOR YOUR CONTINUED SUPPORT AND MEMBERSHIP
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 t o
employees and affiliates of such organization under the agreed upon terms. Please return the completed form to Texas Legal at
email address dygnacio@texaslegal.org or fax to 512-327-0163.
Volunteers, Members, etc. Count: ___231_______________ Employee Count: _1050__________________
Name : ________________________________________ Title : ____________________________
Signature: ______________________________________ Date: _____________________________
PAYROLL RATES: DIRECT BILL TO MEMBER:
( X ) SELECT Single: $7.00 SELECT Family: $9.00
( X ) PREFERRED Single: $12.00 PREFERRED Family: $16.00
( ) SELECT Single: $10.00 SELECT Family: $15.00
( ) PREFERRED Single: $20.00 PREFERRED Family: $30.00
City ManagerLaurie Hadley
12/15/2023
CM-2023-304
CORR 2024 Group Annual Renewal Agreement
Texas Legal
Final Audit Report 2023-12-18
Created:2023-12-07 (Central Standard Time)
By:Marilyn Jackson (mjackson@roundrocktexas.gov)
Status:Signed
Transaction ID:CBJCHBCAABAANMJSTyjQfYeh6bsdT1BaDFyoPG6pxMnJ
"CORR 2024 Group Annual Renewal Agreement Texas Legal" H
istory
Document created by Marilyn Jackson (mjackson@roundrocktexas.gov)
2023-12-07 - 2:49:09 PM CST
Document emailed to ssandre@scrrlaw.com for approval
2023-12-07 - 2:49:12 PM CST
Email viewed by ssandre@scrrlaw.com
2023-12-07 - 2:50:42 PM CST
Signer ssandre@scrrlaw.com entered name at signing as Stephanie L. Sandre
2023-12-07 - 2:51:21 PM CST
Document approved by Stephanie L. Sandre (ssandre@scrrlaw.com)
Approval Date: 2023-12-07 - 2:51:23 PM CST - Time Source: server
Document emailed to Marilyn Jackson (mjackson@roundrocktexas.gov) for approval
2023-12-07 - 2:51:24 PM CST
Email viewed by Marilyn Jackson (mjackson@roundrocktexas.gov)
2023-12-07 - 2:54:41 PM CST
Document approved by Marilyn Jackson (mjackson@roundrocktexas.gov)
Approval Date: 2023-12-07 - 2:56:37 PM CST - Time Source: server
Document emailed to Janiqua Mabry (jmabry@roundrocktexas.gov) for acceptance
2023-12-07 - 2:56:38 PM CST
Email viewed by Janiqua Mabry (jmabry@roundrocktexas.gov)
2023-12-07 - 3:35:38 PM CST
Document accepted by Janiqua Mabry (jmabry@roundrocktexas.gov)
Acceptance Date: 2023-12-11 - 8:49:50 AM CST - Time Source: server
Document emailed to madams@roundrocktexas.gov for approval
2023-12-11 - 8:49:52 AM CST
Email viewed by madams@roundrocktexas.gov
2023-12-14 - 4:19:53 PM CST
Signer madams@roundrocktexas.gov entered name at signing as Monique Adams
2023-12-14 - 4:20:05 PM CST
Document approved by Monique Adams (madams@roundrocktexas.gov)
Approval Date: 2023-12-14 - 4:20:07 PM CST - Time Source: server
Document emailed to madams@roundrocktexas.gov for delegation
2023-12-14 - 4:20:08 PM CST
Email viewed by madams@roundrocktexas.gov
2023-12-14 - 4:20:22 PM CST
Document signing delegated to Laurie Hadley (lhadley@roundrocktexas.gov) by madams@roundrocktexas.gov
2023-12-14 - 4:20:37 PM CST
Document emailed to Laurie Hadley (lhadley@roundrocktexas.gov) for signature
2023-12-14 - 4:20:37 PM CST
Email viewed by Laurie Hadley (lhadley@roundrocktexas.gov)
2023-12-14 - 10:00:07 PM CST
Document e-signed by Laurie Hadley (lhadley@roundrocktexas.gov)
Signature Date: 2023-12-15 - 11:30:59 AM CST - Time Source: server
Document emailed to Monique Adams (madams@roundrocktexas.gov) for approval
2023-12-15 - 11:31:00 AM CST
Email viewed by Monique Adams (madams@roundrocktexas.gov)
2023-12-18 - 9:37:35 AM CST
Document approved by Monique Adams (madams@roundrocktexas.gov)
Approval Date: 2023-12-18 - 9:37:53 AM CST - Time Source: server
Agreement completed.
2023-12-18 - 9:37:53 AM CST