HomeMy WebLinkAboutCORRESPONDENCE - RFP - P682 BENEFITS (2)The union Labor Lda
lneutance company
MIX= Na PentAvenueSouth
New Ypi6 New York 10010
212 bSb 0186
877 7T 271 F
112 88J J4b8 fax
w Wilke a Corn
Group Insurance and Health Services Reeuest
It ie understood and agreed that
a This request is based on the proposal dated December 2001and any additional quotations
provided after that date
e This request must be received and approved by The Union Labor Life Insurance Company
at Its Home Office in Washington, D C before the program can become effective on
JANUARY 1 2002
a The Union labor Life Insurance Company reserves the right to contract any prior carrier for
the purposes of obtaining factual date required for its underwriting review of this request for
coverage and the carrier is authorized to release such data
a No agent or broker is authorized to make modify or waive any of The Union Labor Life
Insurance Company s rights or requirements
4, All printed booklets contrary or certificates must receive the express written approval of
l he Union Labor Life Insurance Company
O The following agent/broker of record will receive commissions upon receipt of an
a AhorLatlon letter from the Trustees.Amencan Stop Loss
Premiums will be paid in advance on* monthly basis A check for $ 23 000, accompanies
this request and will be applied toward the first premium payment
Grcun Applicant CITY OF FORT COLLINS
Address
TA) ID No
Sig^iature C I A4 C
to Name
mes a, O'Neill II, CPPO,FNIGP
Director of Purchasing &
51ue Risk Management
[)ate
tAt L . i3
Title
Date