Resolution No. 09804M
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RESOLUTION NO. 9804
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON APPROVING AND RATIFYING THE EXECUTION OF A
POLICY AMENDMENT WITH METROPOLITAN LIFE INSURANCE
COMPANY RELATING TO DOMESTIC PARTNERS AND APPROVING
AND AUTHORIZING THE EXECUTION OF A POLICY AMENDMENT
WITH METROPOLITAN LIFE INSURANCE COMPANY RELATING
TO DEPENDENT CHILDREN
WHEREAS, on December 17, 2007, the City Council of the City
of Vernon adopted Resolution No. 9497 ratifying and approving dental
care benefits with Metropolitan Life Insurance Company ("MetLife");
and
WHEREAS, on November 3, 2008, the City Council of the City
of Vernon adopted Resolution No. 9758 approving the renewal of dental
benefits with MetLife under Group Policy No. KM 05723438-G (the "Group
Policy") for active employees for the period January 1, 2009 through
December 31, 2009; and
WHEREAS, MetLife submitted a Policy Amendment effective
January 1, 2008 to add a Certificate Rider to the Group Policy
relating to the definition of "Domestic Partner" for all active full-
time employees and retired employees; and
WHEREAS, in order to meet the urgent need for said amendment
to the Group Policy, the Risk Manager executed a Policy Amendment on
May 21, 2008, subject to ratification by the City Council; and
WHEREAS, the City Council of the City of Vernon desires to
approve and ratify the actions taken by the Risk Manager in executing
the Policy Amendment on May 21, 2008; and
WHEREAS, MetLife submitted a Policy Amendment effective
November 1, 2008 to add a Certificate Rider to the Group Policy
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to re -define the cancellation date for dependent children so that
dependent children would be covered until the end of the month of
their 24th birthday; and
WHEREAS, the Risk Manager has recommended that the Policy
Amendment be approved and that he be authorized to execute the Policy
Amendment on behalf of the City.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF VERNON AS FOLLOWS:
SECTION 1: The City Council of the City of Vernon hereby
finds and determines that the recitals contained hereinabove are true
and correct.
SECTION 2: The City Council of the City of Vernon hereby
approves and ratifies the Risk Manager's execution of the Policy
Amendment effective January 1, 2008 on May 21, 2008, a copy of which
are attached hereto as Exhibit A and incorporated by reference.
SECTION 3: The City Council of the City of Vernon hereby
approves the Policy Amendment effective November 1, 2008, a copy of
which is attached hereto as Exhibit B and incorporated by reference.
SECTION 4: The City Council of the City of Vernon hereby
authorizes the Risk Manager to execute said Policy Amendment for, and
on behalf of, the City of Vernon and the City Clerk or Deputy City
Clerk is hereby authorized to attest thereto.
SECTION 5: The City Council of the City of Vernon hereby
directs the City Clerk, or her designee, to send one fully executed
Policy Amendment to MetLife.
- 2 -
1 SECTION 6: The City Clerk of the City of Vernon shall
2 certify to the passage of this resolution, and thereupon and
3 thereafter the same shall be in full force and effect.
4 APPROVED AND ADOPTED this 5th day of January, 2009.
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6 r
7 Name: Leonis C. Mal.burg
8 Title : Mayor / 44ator—P-r-G
9 ATTE,
1C
11 MANU LA GIRON, it, Clerk
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STATE OF CALIFORNIA )
) ss
COUNTY OF LOS ANGELES )
I, MANUELA GIRON, City Clerk of the City of Vernon, do hereby
certify that the foregoing Resolution, being Resolution No. 9804, was
duly adopted by the City Council of the City of Vernon at regular
meeting of the City Council duly held on Monday, January 5, 2009, and
thereafter was duly signed by the Mayor or Mayor Pro-Tem of the City of
Vernon.
(SEAL)
I
( MANUELA G RONJ City Clerk
- 4 -
EXHIBIT A
MetLife
Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166-0188
POLICY AMENDMENT
Group Policy No.: KM 05723438-G
Policyholder: City of Vernon
Effective Date: January 01, 2008
Metropolitan Life Insurance Company ("MetLife"), a stock company, issues this amendment to change the
following:
Add to Exhibit 2 of the policy the attached certificate form as:
Certificate Form Applies To Effective Date
Form G.8480 All Active Full -Time Employees and January 01, 2008
Retired Employees
This amendment is to be attached to and made a part of the policy. This amendment is subject to the terms
and provisions of the policy.
To be completed by the Policyholder:
Siqned at: Vernon CA Date: May 21, 2008
WILLARD G. YAMAGUCHI, RISK MANAGER
(Print Name and Title of Legal Representative)
KARINA RUEDA
(Print Name of Witness)
To be completed by Metropolitan Life Insurance Company:
Signed at: Kansas City, Missouri Date:05/07/2008
(City) (State)
(Signature of Authorized MetLife Representative)
PA99
C. Robert Henrikson
Chairman of the Board, President and
Chief Executive Officer
Dental Insurance
RV 05/07/2008
Me#Life
Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166-0188
CERTIFICATE RIDER
Group Policy No.: KM 05723438-G
Employer: City of Vernon
Effective Date: January 01, 2008
The certificate is changed as follows:
Under DEFINITIONS OF CERTAIN TERMS USED HEREIN, the definition of "Domestic Partner" is replaced
with the following:
Domestic Partner" means each of two people who are:
• of the same sex; and one of whom is an employee of the Policyholder, and who meet the requirements of
California law for establishment of a domestic partnership and have registered as domestic partners with
the California Secretary of State; or
• of the same sex; and one of whom is an employee of the Policyholder, and have entered into a legal
union, other than a marriage, that was validly formed in another jurisdiction, and that is substantially
equivalent to a domestic partnership as defined under California law, regardless of whether the legal union
bears the name domestic partnership; or
• of the opposite sex, and at least one person is over 62 years of age and is eligible for old -age Social
Security benefits, and one of whom is an employee of the Policyholder, and who meet the requirements of
California law for establishment of a domestic partnership and have registered as domestic partners with
the California Secretary of State.
This rider is to be attached to and made a part of the Certificate.
Form G.8480
Dental Insurance
All Active Full -Time Employees and Retired Employees
RV 05/07/2008
EXHIBIT B
Meftife
Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166-0188
POLICY AMENDMENT
Group Policy No.: KM 05723438-G
RP 1�1 CC H V R � D
), 111"Al 2 4 '1000
RISK M A N A C35, E M"ENT DEFT
Policyholder: City of Vernon
Effective Date: November 01, 2008
Metropolitan Life Insurance Company ("MetLife"), a stock company, issues this amendment to change the
following:
Add to Exhibit 2 of the policy the attached certificate form as:
Certificate Form Applies To Effective Date
Form G.8480 All Active Full Time Employees November 01, 2008
Form G.8480 Retired Employees November 01, 2008
This amendment is to be attached to and made a part of the policy. This amendment is subject to the terms
and provisions of the policy.
To be completed by the Policyholder:
Signed at: Date:
(City)
(State)
(Signature of Policyholder's Legal Representative) (Print Name and Title of Legal Representative)
(Signature of Witness) (Print Name of Witness)
To be completed by Metropolitan Life Insurance Company:
Signed at: Kansas City, Missouri Date:11/07/2008
(City) (State)
(Signature of Authorized MetLife Representative)
PA99
C. Robert Henrikson
Chairman of the Board, President and
Chief Executive Officer
Dental Insurance
RV 11 /07/2008
Mefti f e
Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166-0188
CERTIFICATE RIDER
Group Policy No.: KM 05723438-G
Employer: City of Vernon
Effective Date: November 01, 2008
The certificate is changed as follows:
1. The provision entitled, ELIGIBILITY FOR BENEFITS, is changed as follows:
p "��%
CITY AT"FORNEY
For All Active Full Time Employees
Personal Benefits Eligibility Date
If you are an Employee on November 01, 2008, that is your Personal Benefits Eligibility Date.
If you become an Employee after November0l , 2008, your Personal Benefits Eligibility Date is the
first day of the month coincident with or next following the date you become an Employee of the
Employer.
Dependent Benefits Eligibility Date
Your Dependent Benefits Eligibility Date is the later of your Personal Benefits Eligibility Date and the
date you first acquire a Dependent.
2. The provision entitled, WHEN BENEFITS END, is changed as follows:
A. All of your benefits will end on the last day of the calendar month in which your employment ends.
Your employment ends when you cease Active Work as an Employee. However, for the purpose
of benefits, the Employer may deem your employment to continue for certain absences. See
CONDITIONS UNDER WHICH YOUR ACTIVE WORK IS DEEMED TO CONTINUE.
B. If This Plan ends in whole or in part, your benefits which are affected will end.
C. Your Dependent Benefits will end on the earlier of:
1. the last day of the month that the Dependent ceases to be your Dependent; or
2. the date of your death.
Form G.8480
Dental Insurance
All Active Full Time Employees
RV 11/07/2008
The end of any type of benefits on account of a Covered Person will not affect a claim which is incurred before
those benefits ended.
The Dental Expense Benefits for a Covered Person may be continued in accordance with the Federal law called
COBRA. See the pages entitled NOTICE OF YOUR RIGHT AND YOUR DEPENDENTS' RIGHT TO CONTINUE
DENTAL BENEFITS.
This rider is to be attached to and made a part of the Certificate.
Form G.8480
Dental Insurance
All Active Full Time Employees
RV 11/07/2008
MOWe'
Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166-0188
CERTIFICATE RIDER
Group Policy No.: KM 05723438-G
Employer: City of Vernon
Effective Date: November 01, 2008
The certificate is changed as follows:
1. The provision entitled, ELIGIBILITY FOR BENEFITS, is changed as follows:
For Retired Employees
Personal Benefits Eligibility Date
ETIV 2 4 200f" �4
,DISK MANAGEMENT DEFT
If you are a Retired Employee on November 01, 2008, that is your Personal Benefits Eligibility Date.
If you become a Retired Employee after November 01, 2008, your Personal Benefits Eligibility Date is
the first day of the month coincident with or next following the date you become a Retired Employee
of the Employer.
Dependent Benefits Eligibility Date
Your Dependent Benefits Eligibility Date is the later of your Personal Benefits Eligibility Date and the
date you first acquire a Dependent.
2. The provision entitled, WHEN BENEFITS END, is changed as follows:
A. All of your benefits will end on the last day of the calendar month in which you are no longer an
eligible Retired Employee.
B. If This Plan ends in whole or in part, your benefits which are affected will end.
C. Your Dependent Benefits will end on the earlier of:
1. the last day of the month that the Dependent ceases to be your Dependent; or
2. the date of your death.
Form G.8480
Dental Insurance
Retired Employees
RV 11 /07/2008
D. If a Covered Person does not make a payment which is required by the Employer to the cost of any benefits,
those benefits will end; they will end on the last day of the period for which a payment required by the
Employer was made.
The end of any type of benefits on account of a Covered Person will not affect a claim which is incurred before
those benefits ended.
The Dental Expense Benefits for a Covered Person may be continued in accordance with the Federal law called
COBRA. See the pages entitled NOTICE OF YOUR RIGHT AND YOUR DEPENDENTS' RIGHT TO CONTINUE
DENTAL BENEFITS.
This rider is to be attached to and made a part of the Certificate.
Form G.8480
Dental Insurance
Retired Employees
RV 11 /07/2008
CITY CLERK'S OFFICE
INTEROFFICE MEMORANDUM
DATE: January 27, 2009
TO: Willard Yamaguchi, Chief Deputy City Attorney/Risk Manager
FROM: Nelly Giron, City Clerk
RE: Resolution No. 9804 - A Resolution of the City Council of
the City of Vernon Approving and Ratifying the Execution of
a Policy Amendment With Metropolitan Life Insurance Company
Relating to Domestic Partners and Approving and Authorizing
the Execution of a Policy Amendment With Metropolitan Life
Insurance Company Relating to Dependent Children
Transmitted herewith is a copy of Resolution No. 9804 referenced
above, which was approved by City Council on January 5, 2009.
Thank you.
NG : dj
c: Karina Rueda
Resolution No. 9804
Page 1 of 2
Rueda, Karina
From: Rueda, Karina
Sent: Wednesday, March 04, 2009 9:24 AM
To: Giron, Nelly
Subject: Metlife Contract Amendments
Tracking: Recipient Delivery
✓� "
Giron, Nelly pelivered: 3/4/2009 9:24 AM
Nelly,
Per Matt at Metlife, an email copy of the amendments is sufficient. I'm sending you the two amendments; one has an
original signature and the other is a copy because I don't know what happened to the original. You will forward to
Matt, correct?
-Karina
From: Matt Muler [mailto:mmuler@metlife.com]
Sent: Tuesday, March 03, 2009 5:27 PM
To: Rueda, Karina
Cc: Emily Asalone
Subject: RE: Contract Amendment
Hi Karina,
I do not need the fully executed amendment copy. Do you have the signed forms? If so you can e-mail those to me.
Thanks,
Matt Muler
Sales Representative
550 N. Brand Blvd., Suite 900
Glendale, CA 91203
Phone: 818-627-4368
Fax: 866-670-0309
Registered Representative
Metropolitan Life Insurance Company (MLIC), New York, NY 10166. Securities offered by Metlrife Securities, Inc.
(MSI) (FINRA/SIPC). MLIC and MSI are affiliates.
"Rueda, Karina" <KRueda a@ci.vernon.ca.us>
03/03/2009 05:00 PM
Matt,
To "Matt Muler' <mmuler@metlife.com>
"Emily Asalone" <easalone@metlife.com>
Subject RE: Contract Amendment
3/4/2009
Page 2 of 2
Our City Council recently approved two'amendments; one with the domestic partner language and one for the eligibility
for dependents. Do you need a copy of the fully executed amendments? If so, please provide a mailing address.
Thank you,
Karina
3/4/2009
MOW e
Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166-0188
POLICY AMENDMENT
Group Policy No.: KM 05723438-G
% % h 9iolo tt "t:
Y
Policyholder: City of Vernon
Effective Date: November 01, 2008
Metropolitan Life Insurance Company ("MetLife"), a stock company, issues this amendment to change the
following:
Add to Exhibit 2 of the policy the attached certificate form as:
Certificate Form Applies To Effective Date
Form G.8480 All Active Full Time Employees November 01, 2008
Form G.8480 Retired Employees November 01, 2008
This amendment is to be attached to and made a part of the policy. This amendment is subject to the terms
and provisions of the policy.
To be completed by the Policyholder:
Date: MARCH 3, 2009
WILLARD G. YAMAGUCHI
(Print Name and Title of Legal Representative)
RARINA RUEDA
(Print Name of Witness)
To be completed by Metropolitan Life Insurance Company:
Signed at: Kansas City, Missouri Date:11/07/2008
(City) (State)
(Signature of Authorized MetLife Representative)
PA99
C. Robert Henrikson
Chairman of the Board, President and
Chief Executive Officer
Dental Insurance
RV 11 /07/2008
Meftif e
Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166-0188
CERTIFICATE RIDER
Group Policy No.: KM 05723438-G
Employer: City of Vernon
Effective Date: November 01, 2008
The certificate is changed as follows:
1. The provision entitled, ELIGIBILITY FOR BENEFITS, is changed as follows:
For All Active Full Time Employees
Personal Benefits Eligibility Date
If you are an Employee on November 01, 2008, that is your Personal Benefits Eligibility Date.
If you become an Employee after November0l, 2008, your Personal Benefits Eligibility Date is the
first day of the month coincident with or next following the date you become an Employee of the
Employer.
Dependent Benefits Eligibility Date
Your Dependent Benefits Eligibility Date is the later of your Personal Benefits Eligibility Date and the
date you first acquire a Dependent.
2. The provision entitled, WHEN BENEFITS END, is changed as follows:
A. All of your benefits will end on the last day of the calendar month in which your employment ends.
Your employment ends when you cease Active Work as an Employee. However, for the purpose
of benefits, the Employer may deem your employment to continue for certain absences. See
CONDITIONS UNDER WHICH YOUR ACTIVE WORK IS DEEMED TO CONTINUE.
B. If This Plan ends in whole or in part, your benefits which are affected will end.
C. Your Dependent Benefits will end on the earlier of:
1. the last day of the month that the Dependent ceases to be your Dependent; or
2. the date of your death.
Form G.8480
Dental Insurance
All Active Full Time Employees
RV 11/07/2008
The end of any type of benefits on account of a Covered Person will not affect a claim which is incurred before
those benefits ended.
The Dental Expense Benefits for a Covered Person may be continued in accordance with the Federal law called
COBRA. See the pages entitled NOTICE OF YOUR RIGHT AND YOUR DEPENDENTS' RIGHT TO CONTINUE
DENTAL BENEFITS,
This rider is to be attached to and made a part of the Certificate.
Form G.8480
Dental Insurance
All Active Full Time Employees
RV 11 /07/2008
MetLife
Metropolitan Life Insurance Company
200 Park Avenue, New York, Now York 10166-0188
CERTIFICATE RIDER
Group Policy No.: KM 05723438-G
Employer: City of Vernon
Effective Date: November 01, 2008
The certificate is changed as follows:
1. The provision entitled, ELIGIBILITY FOR BENEFITS, is changed as follows:
For Retired Employees
Personal Benefits Eligibility Date
(�f q1 pz iTw
➢££ ¢. 20
If you are a Retired Employee on November 01, 2008, that is your Personal Benefits Eligibility Date.
If you become a Retired Employee after November 01, 2008, your Personal Benefits Eligibility Date is
the first day of the month coincident with or next following the date you become a Retired Employee
of the Employer.
Dependent Benefits Eligibility Date
Your Dependent Benefits Eligibility Date is the later of your Personal Benefits Eligibility Date and the
date you first acquire a Dependent.
2. The provision entitled, WHEN BENEFITS END, is changed as follows:
A. All of your benefits will end on the last day of the calendar month in which you are no longer an
eligible Retired Employee.
B. If This Plan ends in whole or in part, your benefits which are affected will end.
C. Your Dependent Benefits will end on the earlier of:
1. the last day of the month that the Dependent ceases to be your Dependent; or
2. the date of your death.
Form G.8480
Dental Insurance
Retired Employees
RV 11 /07/2008
D. If a Covered Person does not make a payment which is required by the Employer to the cost of any benefits,
those benefits will end; they will end on the last day of the period for which a payment required by the
Employer was made.
The end of any type of benefits on account of a Covered Person will not affect a claim which is incurred before
those benefits ended.
The Dental Expense Benefits for a Covered Person may be continued in accordance with the Federal law called
COBRA. See the pages entitled NOTICE OF YOUR RIGHT AND YOUR DEPENDENTS' RIGHT TO CONTINUE
DENTAL BENEFITS.
This rider is to be attached to and made a part of the Certificate.
Form G.8480
Dental Insurance
Retired Employees
RV 11 /07/2008
MetLife
Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166-0188
POLICY AMENDMENT
Group Policy No.: KM 05723438-G
Policyholder: City of Vernon
Effective Date: January 01, 2008
Metropolitan Life Insurance Company ("MetLife"), a stock company, issues this amendment to change the
following:
Add to Exhibit 2 of the policy the attached certificate form as:
Certificate Form Applies To Effective Date
Form G.8480 All Active Full -Time Employees and January 01, 2008
Retired Employees
This amendment is to be attached to and made a part of the policy. This amendment is subject to the terms
and provisions of the policy.
To be completed by the Policyholder:
Signed at: Vernon CA pate: May 21, 2008
WILLARD G. YAMAGUCHI, RISK MANAGER
(Print Name and Title of Legal Representative)
KARINA RUEDA
(Print Name of Witness)
To be completed by Metropolitan Life Insurance Company:
Signed at: Kansas City, Missouri Date:05/07/2008
(City) (State)
(Signature of Authorized MetLife Representative)
PA99
C. Robert Henrikson
Chairman of the Board, President and
Chief Executive Officer
Dental Insurance
RV 05/07/2008
Mefti f e
Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166-0188
CERTIFICATE RIDER
Group Policy No.: KM 05723438-G
Employer: City of Vernon
Effective Date: January 01, 2008
The certificate is changed as follows:
Under DEFINITIONS OF CERTAIN TERMS USED HEREIN, the definition of "Domestic Partner" is replaced
with the following:
Domestic Partner" means each of two people who are:
• of the same sex; and one of whom is an employee of the Policyholder, and who meet the requirements of
California law for establishment of a domestic partnership and have registered as domestic partners with
the California Secretary of State; or
• of the same sex; and one of whom is an employee of the Policyholder, and have entered into a legal
union, other than a marriage, that was validly formed in another jurisdiction, and that is substantially
equivalent to a domestic partnership as defined under California law, regardless of whether the legal union
bears the name domestic partnership; or
• of the opposite sex, and at least one person is over 62 years of age and is eligible for old -age Social
Security benefits, and one of whom is an employee of the Policyholder, and who meet the requirements of
California law for establishment of a domestic partnership and have registered as domestic partners with
the California Secretary of State.
This rider is to be attached to and made a part of the Certificate.
Form G.8480 Dental Insurance
All Active Full -Time Employees and Retired Employees
RV 05/07/2008