Backup Documents 12/08/2020 Item #16E 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 E I
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing_lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office CMG 04/08/21
4. BCC Office Board of County PT by JH/s/ 04/08/21
Commissioners
5. Minutes and Records Clerk of Court's Office � �'i�la` g= �`
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one Ate
addressees above,may need to contact staff for additional or missing information. f''i
Name of Primary Staff Sonja Sweet/Risk Management 239-252-8966 r
Contact/ Department
Agenda Date Item was December 8,2020 Agenda Item Number 16E1 T:
Approved by the BCC .=
Type of Document 5th Amendment to Plan Document/Summary Number of Original 1 f,
Attached Plan Description Documents Attached
PO number or account N/A
number if document is
to be recorded
INSTRUCTIONS& CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK N/A
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be SS
signed by the Chairman,with the exception of most letters,must be reviewed and signed
rt by the Office of the County Attorney.
jEki 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
r5 5. The Chairman's signature line date has been entered as the date of BCC approval of the SS
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's SS
r..l
r..r signature and initials are required.
In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
--� time frame or the BCC's actions are nullified. Be aware of your deadlines!
<u 8. The document was approved by the BCC on December 8,2020 and all changes made SS
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
I 6 E 1
MEMORANDUM
Date: April 14, 2021
To: Sonja Sweet, Manager
Risk Management
From: Teresa Cannon, Sr. Deputy Clerk
Minutes & Records Department
Re: 5' Amendment to Plan Document/Summary Plan
Description
Attached is a copy of the agreement referenced above, (Agenda Item #16E1) approved
by the Board of County Commissioners on Tuesday, December 8, 2020.
If you have any questions, please feel free to contact me at 252-8411.
Thank you.
Attachment
16E1
AMENDMENT#5
TO THE
PLAN DOCUMENT/SUMMARY PLAN DESCRIPTION
for the
COLLIER COUNTY GOVERNMENT EMPLOYEE BENEFIT PLAN
Group 2003021
Effective January 1.2021 the Collier County Government Employee Benefit Plan is amended as follows(ren
and italics mean change/addition,strrkeettt means deletion)
Within the "HEALTH PLAN QUALIFIERS" section, the "NEW HIRES AND NEW SPOUSES and
"EMPLOYEE WHO LEAVE AND RETURN TO EMPLOYMENT WITHIN THE CURRENT BENEFIT PERIOD"
subsections are replaced as follows
NEW HIRES AND NEW SPOUSES
All newly hired Employees. newly eligible Employees and newly covered spouses will be enrolled in the
Select-Prenrrwnrr Reward Level and will be required to complete Plan Qualifiers by September 30 orw►ll
Employees whose effective date of coverage is on or after October 1 will remain
in the Celeet P'crnrurn Reward Level and will have until September 30 of the following Benefit Period to
complete Plan Qualifiers.
EMPLOYEES WHO LEAVE AND RETURN TO EMPLOYMENT WITHIN THE CURRENT BENEFIT
PERIOD
Employees who leave employment and return within the current Benefit Period will be enrolled in the
Reward Level they were in as of the date of termination If the Employee returns after the current Benefit
Period the Employee will be placed in the Select-Pror r,inii Reward Level
Nothing in this amendment is deemed to change any other provision of the Plan Document of which it
becomes a part.
COLLIER GOVERNME
`•'(`'R1' 1,K. kI CLRh BY 01144(
Penny Taylor,Chairperson
RS _ TITLE
"- Attest 1 '.apan'S
°•t,
Approved to form and le lity
:-. fk"\ * Qe,l111
Assistant County Attorney