HomeMy WebLinkAbout396_Establishing Trust Fund for Reserve Worker's CompBOOK 5137 PAGE 1660 753260
STATE OF OKLAHOMA
TULSA COUNTY
FILED OR RECORDED
88 NOV - 1 PM 4:04
JOAN HASTINGS
TULSA COUNTY CLERK
Ordinance No. 396
AN ORDINANCE ESTABLISHING A TRUST AND AGENCY FUND FOR THE
PURPOSE OF RESERVING FUNDS FOR PAYMENT OF WORKERS' COMPENSATION
CLAIMS PURSUANT TO AN AGREEMENT WITH THE OML MUNICIPAL ASSURANCE
GROUP; PROVIDING FOR DEFINITIONS; PROVIDING FOR TRANSFER OF
EARNED INTEREST; PROVIDING PAYMENT ONLY OF WORKERS' COMPENSATION
CLAIMS; PROVIDING FOR RELEASE OF FUNDS; PROVIDING FOR SUBMISSION OF
ANNUAL AUDITED FINANCIAL STATEMENT OF TRUST FUND; AND PROVIDING
AN EFFECTIVE DATE.
Be it ordained by the Council of the City of Owasso, Oklahoma
Section 1. Policy. The Council of the City of Owasso, Oklahoma hereby
deems it in the best interest of the City to stabilize workers' compensation premiums
by establishing a trust and agency fund for the purpose of reserving funds for future
payments of workers' compensation claims pursuant to an agreement dated
March 1, 1988, between the City and the OML Municipal Assur-
ance Group. Said agreement is made part of this ordinance (See Exhibit A.)
Section 2. Definitions. As used in this ordinance the following words and phrases
shall have the following meaning:
Group: The OML Municipal Assurance Group.
Plan: The OML Municipal Assurance Group Workers' Compensation Plan.
Trust and Agency Fund: the City of Owasso, Oklahoma - OML Municipal
Assurance Group Worker's Compensation Plan Trust and Agency Fund.
BOOK 5137 PAGE 1661
Section 3. Trust and Agency Fund. A. There is hereby created a trust and agency
fund for the purpose of reserving funds for future payment of workers' compensation
claims pursuant to an agreement dated March 1, 19 8V with the OML Municipal
Assurance Group. Said trust and agency fund shall be designated "the City of
Owasso, Oklahoma - OML Municipal Assurance Group Workers' Compensation
Plan Trust and Agency Fund."
B. The (appropriate city officer) shall transfer into the trust and agency fund
monies equal to the amount so designated and invoiced by the Group and approved
by the City Council. Said monies are to be held in trust for future payments of
workers' compensation claims as required by the Group or until released under the
terms of Section 6 herein.
C. In the event the City is unable to transfer the said amount invoiced into the
trust and agency fund upon approval by the council, then the (appropriate city
officer) shall take appropriate steps to make periodic payments into the trust and
agency fund in order that the amount invoiced is available for payment to the Group
by the next June 30.
Section 4. Earned Interest Transfer. The (appropriate city officer) may transfer
any interest earned from the trust and agency fund into the general fund (or other
appropriate fund as designated by the City Council).
Section 5. Workers' Compensation Claims. A. Only claims made by the Group
pursuant to the agreement dated March 1, 1988 ,XPM between the Group
and the City shall be paid from the trust and agency fund with the exception of
j earned interest. transfers as described in Section 5. herein.
BOOKS 5137 PAGE 1662
B. Upon presentation of a claim by the Group for any or all amounts in the trust
and agency fund, the (appropriate city officer) shall make payment forthwith to the
Group.
Section 6. Release
of Funds. In
the event that
the City receives written
notice of release from
the Group that
monies reserved in the trust and agency fund
are no longer needed,
the (appropriate
city officer) shall
transfer said monies to (the
general fund (or other
appropriate fund
as designated by
the City Council).
Section 7. Annual Audited Financial Statement. The City shall send to the Group
the Annual Audited Financial Statement of the Trust and Agency Fund no later than
January 1 following the end of each fiscal year.
Section 8. The effective date of this ordinance shall beSept. 6, 1988.
Mayor/ stacy P. Lamb
Attest: City Clerk / Jane Buchanan
Exhibit A to Ordinance No. 396.
BOOK 5137 PAGE 1663
APPLICATION AND AGREEMENT
to participate in the
WORKERS' COMPENSATION PLAN
of the
OML MUNICIPAL ASSURANCE GROUP
Article I.
For the purpose of this Application and Agreement:
(1) "Plan" means the Workers' Compensation Plan adopted by the Board of
Trustees to provide statutory benefits as required by the Oklahoma
Workers' Compensation Act;
(2) "Board of Trustees" means the Board of Trustees of the OML Municipal
Assurance Group;
(3) "Group" means the OML Municipal Assurance Group;
(4) "Member" means a city or town and any instrumentality of a city or
town in which an Oklahoma city or town has a beneficial interest
which is accepted for membership in the Plan; and
(5) "Annual fee" means the total amount of contribution determined by
the Board of Trustees required of a member for their participation
in the Plan.
Article II.
The undersigned hereby makes application for membership in the Plan and
agrees:
(1) To participate in the Plan from fiscal year to fiscal year according
to the schedule of fees set by the Board of Trustees and accepted by
the member pursuant to entering into this Agreement or any addendum
thereto;
(2) To pay its annual fees from funds appropriated for this purpose for
coverage according to the payment schedule established by the Board
of Trustees; and
(3) To comply with all requirements of the Oklahoma Workers' Compensa-
tion Act.
Article III.
The undersigned hereby adopts, subscribes and agrees to be bound by the
Workers' Compensation Plan and by all actions taken by the Board of Trustees
pursuant to its powers and duties set forth in the Agreement Establishing the
OML Municipal Assurance Group.
The undersigned agency also agrees to abide by and comply with all the terms
and conditions of the Agreement Establishing the OML Municipal Assurance Grouo
and the Plan, and with such rules and regulations as the Board of Trustees may
from time to time promulgate under such Agreement or Plan.
Article IV.
The undersigned grants to the Board of Trustees, or its designated agent, the
right to audit at all reasonable times such books and records of the under-
signed as necessary to determine or verify any monies owed for benefits
provided to the undersigned and its employees pursuant to this Agreement and
the Plan.
APPLICANT FOR MEMBERSHIP: ACCEPTED FOR MEMBERSHIP:
City of Owasso OPWA OEDA
Name of Participating Agency For the OML Municipal Assurance Group
Signature of authorized representative
Mayor Title
Title of authorized representative
March 1, 1988 3/8/88
Date
Affidavit Of Publication
STATE OF OKLAHOMA, TULSA COUNTY, as:
Bill R. Retherford, of lawful age, being duly sworn
and authorized, says that he is the publisher of the
Owasso, Reporter a weekly
newspaper printed in the City of Tulsa
Tulsa County, Oklahoma, a newspaper qualified to
publish legal notices, advertisements and publications as
provided in Section 106 of Title 25, Oklahoma Statutes 1971
and 1983 as amended, and thereafter, and complies with
all other requirements of the laws of Oklahoma with
reference to legal publications.
That said notice, a true copy of which is attached
hereto, was published in the regular edition of said
newspaper during the period and time of publication and
not in a supplement, on the following dates:
Subscribed and sworn to before
Notary Public
My Commission expires:
PUBLISHER'S FEE $66.75
Published in the Owasso Reporter, Owasso,
'plea County, Oklahoma, September 22,
1988.
ORDINANCE NO. 396
AN ORDINANCE ESTABLISHING A
TRUST AND AGENCY FUND FOR
THE PURPOSE OF RESERVING
FUNDS FOR PAYMENT OF WORK-
ERS' COMPENSATION CLAIMS PUR-
SCANT TO AN AGREEMENT WITH
THE OML MUNICIPAL ASSURANCE
GROUP; PROVIDING FOR DEFINI-
TIONS; PROVIDING FOR TRANSFER
OF EARNED INTEREST; PROVIDING
PAYMENT ONLY OF WORKERS'
COMPENSATION CLAIMS; PROVID-
ING FOR RELEASE OF FUNDS; PRO-
VIDING FOR SUBMISSION OF
ANNUAL AUDITED FINANCIAL
STATEMENT OF TRUST FUND; AND
PROVIDING AN EFFECTIVE DATE.
Be it ordained by the Council of the City
Section 1: Policy. The Council of the City
of Owasso,. Oklahoma hereby deems it in
the beet interest or the City to stabilize
workers cbrdpeneation premiums, by estab-
lishing a trust and agency fund for the pur-
pose orres ing funds for future payments
of workers compeasation claims pursuant
to an agreement dated March 1, 1988,
between the City and the OML Municipul
Assurance Group. Said agreement is made
pert of this Ordinance (See Exhibit A.)
Section 2. Definitious. As used in this
ordinance the following words and phrases
,hall have the following meaning:
Group: The OML Municipal Assurance
Group.
Plan: The OML Municipal Assurance
Group Wmkers Compensation Plan.
Trust and Agency Fund: The City of
Owasso, Oklahoma - OML Municipal Aasur-
ance Croup Workers Compensation Plan
Trust and Ageacy.Fudd.
Section 3: Trust end Agency Fund. A.
There is hereby created a'trust and agency
fund, for the purpose of reserving funds for
future.payment of workers mmpeneation
claims,parsuant to an agreement dated
March. 1, 1988, with the. OML Municipal
Assurance Group. Said trust and agency
fund shall be designated "the City of Owm-
ao, Oklahoma _'O ML Municipal Assurance
Group Worker Compensation Plan Trust
and Agency Fund."
B. The (appropriate city officer) shall
transfer into the trust and agency fund
monies equal to the amount so designated
and invoiced by the Group and approved by
the City Council. Said monies are to be held
in trust for future payments of workers
compensation claims as required by the
Group or until released under the terms of
Section 6 herein.
C. In the event the City is unable to
transfer the said amount invoiced into the
trust and agency fund upon approval by the
council, then the (appropriate city officer)
,hall take eppmpriate step, to make period-
ic payments into the trust and agency fund
in orde that the amount invoiced is avail-
able for payment to the Group by the next
June 30.
Section 4. Earned Interest Transfer. The
(appropriate city officer) may transfer any
interest earned from the trust and agency
fund into the general fund (or other appro-
priate fund as designated by the City Coun-
sill.
Section 5. workers Compensation
Claims. A. Only claims made by the Group
pursuant to the agreement dated March 1,
1958, between the Group and the City shall
be paid from the trust and agency fund with
the exception ofearned interest transfere as
described in Section 5. herein.
B. Upon presentation of a claim by the
Group for any or all amounts in the trust
and agency fund. the (aomuoriate City offi-
cer) shall make payment forthwith to the
Group.
Section 6. Release of Funds. In the event
that the City receives written notice of
release from the Group that monies
reserved in the trust and agency fund are
no longer needed, the (appropriate city offi-
cer) shall trensfer said monies to (the gener-
al fund (or other appropriate fund as desig-
nated by the City Council).
Section 7. Annual Audited Financial
Statement. The City shall send to the
Group the Annual Audited Financial State.
ment ofthe Trust and Agency Fund no later
than January 1 following the end of each
fiscal year.
Section S. The effective date of this ordi-
nance shall be September 6, 1958.
/s/ Stacy P. Lamb
Mayor
Attest
/s/Jane Buchanan
City Clerk
NN62
Municipal Assurance Group
16 N.W. 63rd Street • Suite 201 • Oklahoma City, OK 73116 • 405/842 -9461
May 17, 1988
Mr. Rodney Ray
City Manager
City of Owasso
P. 0. Box 29
Owasso, OK 74055
Dear Mr. Ray:
Enclosed is an invoice for renewal of your participation in the Workers' Compen-
sation Plan from July 1, 1988 to July 1, 1989. Because of the substantial increase
in funding required for your participation, you have the option of appropriating a
portion of your premium to a Special Budget Reserve Account (SBRA) pursuant to
guidelines adopted by our Board of Trustees. .
Your normal premium for the year beginning July 1, 1988 is $169,604.00. Our
guidelines allow the actual premium to be paid in this year to be limited to
$142,242.00, which is 130% of the premium you paid in the prior year. Applying
your 1987 -88 interest credit of $352.09, will leave a balance of $27,009.91 to fully
fund your premium. This amount must be appropriated to a Special Budget Reserve
Account (SBRA) where it will be available at any future time if needed to pay for
losses incurred in this fiscal year.
Your Loss Fund is $113,069.00. Remember that if your losses do not exceed this
amount, you are entitled to a refund of the balance based on rules adopted by the
OMLMAG Board.
To assist you in deciding whether to pay the premium in full or to establish an
SBRA we have enclosed the following:
1. OMLMAG Workers' Compensation Plan premium modifications guide-
lines, effective July 1, 1986;
2. A sample ordinance establishing a trust and agency fund for the
purpose of reserving workers' compensation premiums;
3. A flow chart identifying the actual steps involved in setting up such
an account; and
4. A list of journal entries required to accomplish such transactions.
Should you desire to utilize the SBRA method, you must adopt the necessary ordin-
ance and file with this office before July 1, 1988 a copy of such ordinances and
purchase orders for the premium to be paid and the premium to be reserved, along
with the 1988 -89 Renewal Participation Agreement also enclosed.
Inc UFfL Mu±ucipai Assurance Group is an interlocal Cooperation Act Agency of Cities and Towne : roviding:
Group Life & Health Benefits Plana • Comprehensive Municipal Liability Protection Plana • Workers' Compensation Coverage
Mr. Rodney Ray
May 17, 1988
Page 2
In the alternative, you may of course, choose to pay the entire normal premium or
take a standard policy with the State Insurance Fund.
Please remember that the city is credited with all interest earned on funds held in
your name by our Workers' Compensation Plan, and that you will receive a refund of
all Loss Fund amounts not needed for incurred losses.
Please advise us of what action you intend to take.
Yours truly,
Harold Pumford
Chief Executive Officer
H P: ds
Enclosure
cc: H. Faerber
P. Spinks
OMLMAG Insurance Contract
Example Journal Entries
Assumptions Used in Example:
1.. Contract premium for current fiscal year is 4130,000, 5110,000 to be paid directly to OMLYrAG
and 420,000 to be placed in trust 6 agency fund.
2. Entire premium is paid from Municipality's General Fund.
3. Municipality only budgeted $100,000 for the insurance contract in the General Fund.
Additional $30,000 to be appropriated from available fund balance in the General Fund.
4. Interest earned on trust t agency fund is deposited into the General Fund.
5. In the folloving fiscal year, OMLMAG submits a claim for 415,000 of the 5420,000 retained in the
trust k agency fund and releases the remaining 45,000 which is returned to the General Fund.
Example Journal Entries:
Transaction
A. Contract received and
supplemental appropriation
is approved for 430,000.
B. OMLMAG Contract is signed
and purchase orders for
$110,000 and 420,000 are
prepared and processed.
C. Purchase orders are
approved and invoices are
processed for payment.
Entry B Fund
A1. General
Accounts
Budgetary Fund Balance
Appropriations Control
Debit Credit
430,000
430,000
61. General Encumbrances 4130'000
Reserve for Encumbrances 4130,000
Cl. General Reserve for Encumbrances 4130,000
Encumbrances 4130,000
C2. General Expenditures 4130,000
Accounts Payable 4130,000
Trans action
Entry B
Fund
Accounts
Debit
Credit
D. Invoices are approved for
D1.
General
Accounts Payable
$910,000
payment & checks are pre-
Cash
$110,000
pared from General Fund for
$110,000 to OMLMAG & $20,000
D2.
General
Accounts Payable
$20,000
to Trust & Agency Fund.
Cash
$20,000
E. $20,000 is deposited by
El.
Trust & Agency
Cash
$20,000
Trust & Agency Fund.
Liability -Held for OMLMAG
$20,000
F. Interest of €1,500 is earned
F1.
General
Cash
$1,500
on Trust & Agency Fund &
Interest Income
$1,500
deposited in General Fund.
S. Folloving fiscal year,
G1.
Trust & Agency
Liability -geld for ONLMAG
$15,000
OMLMAG submits claim for
Cash
$15,000
$15,000 of Trust & Agency
Fund & releases rerafning
62.
Trust & Agency
Liability -Held for OMLMAG
45,000
$5,000.
Cash
45,000
63.
General
Cash
$5,000
Expenditures
$5,000
1
Page 1
1_ Municipality adopts an ordinance to
establish a trust & agency fund for
the purpose of retaining a portion of
OMLMRG's actuarially determined premium.
Ordinance outlines appropriation re-
quirements, fund establishment, claim
processing, interest earnings use and
annual reporting requirements.
2. When OMLMRG contract is submitted, the
municipality must determine whether
the full amount of the contract premium
has been appropriated. If so, then the
contract may be signed.
3. IF the full contract amount has not
been appropriated, the municipality
must determine if a transfer of existing
appropriation can be made to fund the
amount not appropriated. If so, then
a budget amendment must be processed
and approved by the governing body
(if fund to be charged is required
to maintain a legal budget). Upon
approval of the appropriation transfer,
the contract may be signed.
4. If r.1he full contract amount has not
been appropriated and a transfer of
existing appropriations cannot be made,
the municipality must identify excess
revenue or available reserves to
provide a supplemental appropriation
to ;'und the amount not appropriated.
Upon identification of the funding
source of the supplemental appropriation,
a budget amendment must be processed
and approved by the governing body
(if fund to be charged is required to
maintain a legal budget). Upon approval,
the contract may be signed.
If full amount of contract premium
cannot be appropriated by one of these
methods, the OMLMRG contract cannot
be signed.
Municipal Ordinance
Adopted
OMLMRG Contract
Submitted
Is Full Amount o
Contract Appropria
-by Municipality?
YES
OMLMRG
Contract
Signed
Can Transfer of
Existing Appropriation
be Made to Fund
Full Contract ?
Can
Appropr- iaticn
Be Lla.de Contract
from Ew:cess Cannot
Revenue, or Be Signed
YES
Prepare
Budget
Amendment
Governing Body
Approval of Budget
Amendment
Full Amount of
Contract is
Appropriated in
Budget Records
Page
5. Once the OMLMAG contract has been signed,
a L'rust & agency fund must be established
in accordance with the new ordinance to
retain the unpaid portion of the contract
premium.
G. Upon creation of the trust & agency fund,
the municipality must prepare purchase
orders and /or other proper claim documents
to encumber the full contract premium
against the appropriate budget accounts.
Separate purchase orders are prepared
for the amount to be paid directly
to OMLMAG and the amount to be paid
into the trust & agency fund.
7. Once the purchase orders and /or claim
documents have been prepared, they must
be .approved by the governing body and
processed for payment.
B. The check to OMLMAG for the portion of.
the premium to be paid directly to them
is prepared, signed and submitted to
OMLMRG.
9. The amount of premium to be retained
in the trust & agency fund is deposited
into the fund and recorded as both an
ass -zt and a liability in the agency fund.
R
Has Municipality Establish a Trust &
Created a Trust & Agency Agency Fund in Accounting
Fund for Unpaid Portion Records Solely for
Contract? Holding the Unpaid
Portion of Contract
YES
Prepare Purchase Orders
for Approval by
Governing Body
Purchase Order Purchase Order for
for Current Rmt Amount to be paid
to be paid to into Agency Fund
OMLMRG
Approved by Approved by
Governing Bady Governing Body
and Processed and Processed
for Payment for Payment
Check Submitted "mount Oeposite
to OMLMRG by Municipality
(in Agency Fund
Page 3
O. The amount retained in the Agency Fund,
may be invested by the Municipality in
accordance with stateA and local regulations.
The interest earninqs from investment
should be transferred to and recorded as
interest revenue in the Fund(s) designated
in the ordinance establishing the Trust
& Agency Fund.
NOTE: An agency fund does not report any
fund equity, revenues or expenditures.
They only maintain and report assets
and liabilities.
The principal portion of the contract
premium is retained in the agency fund
until the full amount or a portion of the
amount is either required by OMLMRG or
released by them.
If OMLMAG requires all or some of the
retained amount to be paid, a claim is
processed against the agency fund and
approved by the governing body. Once
approved, the claim is processed for
payment and the check submitted to
OMLMRG.
3. If OMLMRG releases all or some of the
retained amount in a subsequent contract,
the amount released should be returned
to the Fund(s) originally charged and the
expenditure accounts credited in proportion
to their original charges.
'I. On an annual basis, a copy of the
Municipality's audited financial
statements must be submitted to OMLMRG
with4n six months after the close of
the fiscal year. The financial statements
should include the financial information
of the above noted Agency Fund for the
fiscal year ended.
aim on R
nd Submi
by OMLMR
Principal
Portion of
Agency Fun
Retained in Agency
Fund and Held
for OMLMRG
GIs Full Amount orb
Portion of Agency Fund
Required by OMLMRG
min Future Years
Claim for Payment on
Agency Fund Approved
by Governing Body
Check Submitted
to OMLMAG
Amount Retained in Agency
Fund is Invested by
Municipality
Interest
Earnings
Transferred to
Fund(s) Designated in
Ordinance
Full Amount or Portion
of Agency Fund May Be
Released by OMLMRG
in New Contract
Amount Released is
Transferred to Fund(s)
Originally Charged
Accounts Originally
Charged are Credited
Proportionally
OMLMAG Workers' Compensation Plan
Premium Modification Guidelines
Effective July 1, 1986
On June 20, 1986, the Board of Trustees approved guidelines for modification of
renewal premiums in the Workers' Compensation Plan with the State Insurance Fund
(SIF).
These guidelines are effective for renewal premiums due on or after July 1, 1986.
Guidelines apply only to renewals. These guidelines do not apply to new members or
where there has been any gap in participation. Premiums as used herein is the term
to describe the total charge for a member to participate including the Toss Fund and
fees for administration, reinsurance and management of the Plan.
Guidelines deal first with premium decreases from one plan year to the next; and
second, with premium increases from one plan year to the next.
PREMIUM DECREASES
1. Renewal premium decreases shall be limited to a maximum reduction
of 10% in any one year. The reduction is in regard to the amount of
premium to be paid by the member to OMLMAG. Any portion of the
premium not required to fully fund the member's Loss Fund set by SIF,
plus fees will be held by OMLMAG in a "Rate Stabilization Reserve"
(RSR) for that member.
2. RSR balances will be applied to off set any future rate increases.
3. RSR balances are to be included for the purpose of allocating inter-
est earnings to members.
4. Should a member's RSR exceed more than five times the annual
normal premium due, then the premium to be paid may be reduced by any
excess in the RSR.
5. All premium payments, including ASR, must be paid in accordance
with payment schedules otherwise established for the Plan.
6. A member shall be entitled to a refund of any RSR balance upon
termination of their participation in the Plan.
PREMIUM INCREASES
Renewal premiums for any member shall be computed in the normal fashion; however,
members with increases shall have the option of paying a portion of the full premium
and budgeting additional funds in reserve to guarantee full payment of the premium
when:
1. Their renewal premium would be an increase of more than 30% over
the prior year; and
2. When the total current premium due exceeds $40,000.00.
Premium payments and funds held in reserve shall be in accordance with documenta-
tion and procedures acceptable to OMLMAG which shall include, at a minimum.
1. Premiums to be paid in any one year may be limited to a maximum
of 30% over the premium paid in the prior year; and
2. The balance of premium due in excess of 130% over the prior year
shall be appropriated by the member to a workers' compensation special
budget reserve account (SBRA) in accordance with procedures acceptable
to the Chief Executive Officer; and
3. If at any time the Chief Executive Officer determines that loss
payments for the member shall exceed that portion of the loss fund paid
by the member, the Chief Executive Officer shall requisition the remaining
balance due which had been set aside in the SBRA; and
4. Annually the member's SBRA will be evaluated. Accrued interest
earnings, prior year refunds or future rate stabilization reserves, if any,
will be credited to any SBRA before any other method of distribution of
funds; and
5. The Chief Executive Officer shall on annual renewal apprise each
member utilizing an SBRA of the status of their account; and
6. Each member shall take whatever reasonable action is required by
the Chief Executive Officer to present evidence that the SBRA is in tact
and available for payment to OMLMAG if required.
Harold 1Pumford, Chief Executive Officer
7 -23 -86
July 1, 1988 through June 30, 1989, and the Loss
stated in our Invoice, are accepted as an amendment t
0117LMAG for continued participation in the Workers' Cc
(Select and initial the appropriate boxes below)
A. ( ) 1. We wish to apply $ of our current Interest Credit
to a Rate Stabilization Reserve Account for our municipality, or
( ) 2. We will use $ of our current Interest Credit to
reduce our 1988 -89 Fee for Participation.
lip
1. We wish to apply $ of our Other Premium Credit
to a Rate Stabilization Reserve Account for our municipality, or
( ) 2. We will use $ of our Other Premium Credit to
reduce our 1988 -89 Fee for Participation.
C. ( ) We are going to pay $ in addition to our 1988 -89 Fee
for Participation for deposit to a Rate Stabilization Reserve Account
for us.
We will renew and establish a S.B.R.A. for 1988 -1989.
September 6, 1988
Date Signature of Authorized Representative
Stacy P. Lamb, Mayor
Printed Name and Title
NOTE: To renew your coverage for July 1, 1988, this statement must be returned
to OMLMAG by June 22, 1988 and payment of your Fee for Participation must be
received by July 1, 1988, or no later than July 10th.
Annual Premiums in excess of $5,000 may be paid quarterly. First quarter payment
is due July 1st. Premiums less than $5,000 must be paid in full by July 1st.
The OML Municipal Assurance Group is an Interiocal Cooperation Act Agency of Cities and Towns Providing:
Group Life & health 6encfi Ls Plans • Comprehensive Afunicipnl Linhility Prott¢-tion Plans • workers' Compensation Coverage