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Home My WebLink About2008-189THE CORPORATION OF THE MUNICIPALITY OF CLARINGTON BY-LAW 2008-189 Being a By-law to authorize an agreement between the Corporation of the Municipality of Clarington and Great West Life Assurance Company, Ontario, for the Provision of Employee Group Benefits. THE CORPORATION OF THE MUNICIPALITY OF CLARINGTON HEREBY ENACTS AS FOLLOWS: 1. THAT the Mayor and Clerk are hereby authorized to execute, on behalf of the Corporation of the Municipality of Clarington and seal with the Corporation Seal, a contract between, Great West Life Assurance Company, Ontario, and said Corporation; and 2. THAT the contract attached hereto as Schedule "A" form part of this By-law. By-law read a first and second time this 27th day of October, 2008. By-law read a third time and finally passed this 27th day of October, 2008. IE �H�Bg ACCIDENT INSURANCE APPLICATION Name of Client: Municipality of Clarington Address: 40 Temperance Street Bowmanville Ontario L1C 3A6 Plan Type: Basic We hereby accept the plan design and benefits proposal that was issued by Chubb Insurance Company of Canada. Effective date of plan: February 1, 2009 Clarington Dated at , the loth day of November , 20 os Signature of authorized person: 3' ernethy Title Mayor Patti'f-I, 3arrie,'tMunicipal Clerk PLEASE SIGN AND RETURN THIS FORM DATA REQUIRED FOR POLICY ISSUANCE 1. Contact person: Jackie Forsey Title: Compensation and Benefits Supervisor_ Phone Number: 905-623-3379 ext.248 Fax: 905-623-0608 2. Names and address of any additional companies, subsidiaries or affiliates to be named in the policy: n/a 3. Name and address of Broker/Consultant: n/a 4. Eligibility wording for all employees: See attached file 5. Are booklets required? Yes N� �� 6. Draft booklet wording required? Yes No 7. Are Quebec employees to be insured? Yes NS If so how many French booklets are required? APPLICATION FOR GROUP INSURANCE We 77teCor_arution0 "the,'ffuniei alitt=o C'lur•irt-tort (ii)sea rull legal name) (the applicant)apply to THE GREAT-WEST LIFE ASSURANCE COMPANY for the group insurance described in this application. We agree that no insurance will take effect until all of the following conditions have been met: 1. this application must be accepted and the effective date approved by Great-West Life at its Bead Office; 2. a binder premium must be paid;and 1 100%of the eligible participants must apply. WE DECLARE that all statements,representations and answers made in this application are consideration for and a basis of the contract(s)of insurance between us and Great-West Life. We declare these statements,representations and answers to be true, full and complete. We agree that no other statement,representation or information will be binding upon or affect the rights of Great- West Life. We agree to give Great-West Life,on request, full information on each participant insured or eligible for insurance, including information required for assessment of claims. Clarington Dated at this JjQ day of X gvember 20 Q Witness ppli t Im Abernethy by Signature of Producer/Agent Si re e Mayor _t ff-``.. r L. Barrie Liiicipal Clerk Form 211 -Wife 5t L k f I 3 i_ 1 ELECTION TO REMIT ONTARIO RETAIL SALES "TAX ON EMPLOYEE CONTRIBUTIONS TO GREAT-WEST LIFE Business Name: l ice co i)o•ution ofa ie;ytinicinnlit,01'awini lotz Date Pursuant to Regulation 1013 made under the Ontario Retail Sales Tax Act, we hereby elect to remit to Great-West Life the Ontario Retail Sales'fax collected fi•om our employees in connection with insurance provided to them under Policy No. or in connection with benefits provided under a benefits plan administered by Great-West Fife under Contract No. Such election will apply for the duration of the policy referred to above during which time Great-West Life will remit this tax to the Minister. afore Name Jim Abernethy Title Mayor S i gii atur* " Name Patti L, Barrie Title Municipal Clerk 1=ortn 2.I I r APPLICATION FOR GROUP INSURANCE We The Corporation of the Municipalith of Clarinfgon (insect full legal name) (the applicant)apply to THE GREAT-WEST LIFE ASSURANCE COMPANY for the group insurance described in this application. We agree that no insurance will take effect until all of the following conditions have been met: 1. this application must be accepted and the effective date approved by Great-West Life at its Head Office; 2. a binder premium must be paid; and 3. 100%of the eligible participants must apply. WE DECLARE that all statements,representations and answers made in this application are consideration for and a basis of the contract(s)of insurance between us and Great-West Life. We declare these statements,representations and answers to be true,full and complete. We agree that no other statement,representation or information will be binding upon or affect the rights of Great- West Life. We agree to give Great-West Life,on request,full information on each participant insured or eligible for insurance, including information required for assessment of claims. Clarington Dated at this 10 day of November 204 . Witness ppli t ---,Tim Abernethy by Signature of Producer/Agent Si ;re e Mayor °t;f IL. Barrie _--""Nltr iicipal Clerk t Form 2.11 ELECTION TO REMIT ONTARIO RETAIL SALES TAX ON EMPLOYEE CONTRIBUTIONS TO GREAT-WEST LIFE Business Name: The Corporation of the iVlunicipnlitp ol'C'lmrington Date Pursuant to Regulation 1013 made under the Ontario Retail Sales Tax Act,we hereby elect to remit to Great-West Life the Ontario Retail Sales Tax collected from our employees in connection with insurance provided to them under Policy No. or in connection with benefits provided under a benefits plan administered by Great-West Life under Contract No. Such election will apply for the duration of the policy referred to above during which time Great-West Life will remit this tax to the Minister. ature Name Jim Abernethy Title Ma or Sigriatur� Name Patti L. Barris Title Municipal Clerk Form 2.11 (";re'afVU111"e"t Life