CM-06-02-021Aetna Life Insurance Company
Application for Stop Loss Insurance
Application is hereby made to Aetna Life Insurance Company, of Hartford, Connecticut (herein
called Aetna) for a policy of Stop Loss Insurance, to be issued to the undersigned applicant.
Applicant
City of Round Rock
Address
221 E. Main Street Round Rock, Texas 78664
The form of the policy hereby applied for is that which has been prepared and designated by
Aetna as Form No. GR -88435 [TX].
Said Policy has been approved, and its terms are hereby accepted by the applicant.
Signed at
Round Rock, Texas
CACP
Applicant
City of Round Rock
Agent(s) of Record
(If countersignature laws require commission sharing with a duly Licensed Resident Agent in
another jurisdiction, the above designation will be modified to the extent required by law.)
GR -88435 -APP
NB520
CX -
TX
Ed. 9/98
rev: 12-18-98
CITY OF ROUND ROCK
INTEROFFICE MEMORANDUM
DATE: February 16, 2006
TO: City Manager Signature File
CM -06-02-021
FROM: Christine Martinez
City Secretary
SUBJECT: Aetna Stop Loss Insurance Application
This item was previously approved by Council on November
22, 2005.
Aetna requested a clean application from the City.
The request was received on February 15, 2006.
For authorization, please see R -05-11-22-9C2.
Thank you
Stop Loss Application
Howard Baker
Page 1 of 1
From: Rogers, Bobby [RogersB@aetna.com]
Sent: Wednesday, February 15, 2006 4:55 PM
To: Linda Gunther; Howard Baker
Cc: Marchino, Jeffrey
Subject: Stop Loss Application
«Stop Loss Contract..xls»
Howard, the original stop -loss contract had some language added by the City when it was sent back
to Aetna. We will need a "clean" copy for our records. Can you please have this signed? I know Linda
will be out of the office for a while so was hoping you can have this done. Thanks and call me with
any questions.
Bobby Rogers
Established Business Manager
Key -Select Accounts
South Texas
Phone (512) 716-3068
Cell: (512) 750-7936
Fax (860)754-0611
a
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Aetna
2/16/2006