HomeMy WebLinkAboutAgenda Packet 02-01-2000City of Cape Canaveral
CITY COUNCIL REGULAR MEETING
CITY HALL ANNEX
:CA-.TAY.Aof 111 Polk Avenue, Cape Canaveral, Florida
VERALTUESDAY
February 1, 2000
7:00 P.M.
AGENDA
CALL TO ORDER:
PLEDGE OF ALLEGIANCE:
ROLL CALL:
INTERVIEW: William M. Young, applicant to the Business and Cultural
Development Board
CONSIDERATIONS:
1. Motion to Approve: Regular City Council Minutes of January 4 and January 18, 2000.
ORDINANCES — Second Readinq:
2. Motion to Adopt: Ordinance No. 01-2000, Amending Code, Section 110-1, Definitions,
by Amending the Definitions of Wall.
3. Motion to Adopt. Ordinance No. 02-2000, Vacating And Abandoning A Twelve Foot
(12') Wide Right -Of -Way Located South Of Johnson Avenue,
Adjacent To Lot 5 And Lots 11 Through 13, Block 76, Avon By
The Sea, Extending South To The City's Corporate Limits.
RESOLUTIONS:
4. Motion to Approve: Resolution No. 2000-04, establishing a reclaimed water connection
fee schedule.
5. Motion to Approve: Resolution No. 2000-05, approving employee payroll deductions fol
supplemental insurance according to Federal Section 125 pre-tax
regulations.
REPORTS:
6. City Manager's Report
105 Polk Avenue • Post Office Boz 326 • Cape Canaveral, FL 32920-0326
Telephone (407) 868-1200 • FAX (407) 799-3170 • http://fcn.state.ft.us/cape/
Cape Canaveral City Council
Regular Meeting Agenda
February 2, 2000
Page 2
AUDIENCE TO BE HEARD:
Comments will be heard on items that do not appear on the agenda of this meeting. Citizens will limit their
comments to five (5) minutes. The City Council will not take any action under the "Audience To Be Heard"
section of the agenda. The Council may schedule such items as regular agenda items and act upon them in
the future.
REPORTS CONTINUED:
ADJOURNMENT:
Pursuant to Section 286.1015, Florida Statutes, the City hereby advises the public that: If a person decides
to appeal any decision made by the City Council with respect to any matter considered at this meeting, that
person will need a record of the proceedings, and for such purpose that person may need to ensure that a
verbatim record of the proceedings is made, which record includes the testimony and evidence upon which
the appeal is to be based. This notice does not constitute consent by the City for the introduction or
admission into evidence of otherwise inadmissible or irrelevant evidence, nor does it authorize challenges c
appeals not otherwise allowed by law. Persons with disabilities needing assistance to participate in any of
these proceedings should contact the City Clerk's office (868-1221) 48 hours in advance of the meeting.
PLEASE COMPLETE BOTH SIDES OF APPLICA
CITY OF CAPE CANAVERAL, FLORIDA
APPLICATION TO SERVE ON CITY BOARD
Applicant Name: 140, Home Telephone:8e/9 Z
Home Address:
Business: gym law&wow_, Business Telephone: ?rxj% A T zr
Office Address: 1oZ �,p���,p , j¢ �� �
Brief Description of Education and Experience: / void
Are you a registered voter?
Yes ✓ No
l
0
Have you been a resident of the City for 12 months or longer'? Yes ✓ No
Do you currently hold a public office? Yes No s/
Are you presently employed by the City?
At the present time, do you serve on a City Board?
Yes No ✓
Yes No ✓
At the present time, do any of the following relatives of yours serve on the City Council: father, mother, son,
brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife, grandparent, grandchild, father-in-law,
law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, st
stepsister, half brother or half sister?
Yes No ✓
At the present time, do any of the following relatives of yours serve on any other City board, commission or
district: spouse, parent, child, grandparent or sibling of the whole or half blood?
Yes
Please specify which City Board you are interested in serving on:
(Indicate Preference, 1st, 2nd, 3rd, etc.)
Beautification Board
Board of Adjustment*
fr
r�Business and Cultural Development Board
Code Enforcement Board*
Community Appearance Board*
No
Construction Board of Adjustment & Appeals*
Library Board
Planning and Zoning Board*
Recreation Board
FORM.
in-
er,
'Members of these Boards are required to complete Financial Disclosure Forms upon appointment to said Board and prior to July 15th of each year
'ollowing the initial appointment while still a member of said Board.
City of Cape Canaveral, Florida
City Board Application
Page 2
Please list what you feel are your qualifications to serve as a member on one of the City's Boards:
Would you consider serving on another City Board other than the one(s) you have selected on the front of this form?
Yes No 1/
Applicant's signature:
Date: �
PLEASE NOTE: 1. Initial appoin ent to any, City Board is subject to City Council approval following a I,brief
interview before the City Council at a regularly scheduled meeting.
2. Your application will remain effective for one year from the date of completion.
3. If you should have any questions regarding the completion of this application, pease
contact the City Clerk's Office at 868-1221.
PLEASE RETURN COMPLETED APPLICATION TO THE CITY CLERKS
FICE
CAPE CANAVERAL CITY HALL, 105 POLK AVENUE, CAPE CANAVERAL, FL I329,
20
Dear Friends and Neighbors,
Help Cape Canaveral fulfill its mission as a safe, clean affordable
residential beachside community, with tree -lined streets and a
revitalized A1A. Board Members are a critical part of local
government and citizen input is vital to the policy and decisions
making process.
A description of all the City Boards and an application is available in
his
packet. Also in this packet is an application for the Citizens Observer
Patrol. Your completed application for a City Board will be placed
as an
item on a City Council or Board Agenda to interview you if here is
vacancy in your area(s) of interest. The City Clerk's office will cont ctou
regarding your application with the date and time of your interview. y
1f you would like to submit your name for consideration to serve on a boar
Please complete the attached form and return it the City Clerk's O ice 105
Avenue, Cape Canaveral, FL 32920. City Hall hours are 8:30 to S. 00 p,M Polk
BRIEF DESCRIPTION OF CITY BOARDS
Boards meet in the City Hall Annex, 111 Polk Avenue, except the Library Board which meets in
the Library Meeting Room.
BEAUTIFICATION BOARD: (City Code, Section 2-181) - 7 members, 2 , 2 year
alternates
terms. Duties: Plan and propose to the City Council landscaping and beautification programs.
Board meets the second Tuesday of every month, at 7:00 p.m.
BOARD OF ADJUSTMENT: (City Code, Section 110-26) - 5 members, 2 alternates, 3 year
terms. Duties: Grant special exceptions and variances; hear appeals regarding decisions made by
the Building Official. Board meets on an "as needed" basis.
BUSINESS & CULTURAL DEVELOPMENT BOARD: (City Code, Section 22-26)- 5
members, 4 alternates, 2 year terms. Members shall be residents of the City or employed in full-
time position at a place of business or employment within the City. Duties: Prepare a commercial
development plan to be submitted to the City Council; determine unmet commercial needs of the
citizens of Cape Canaveral; and encourage in any manner the development of business,
commerce, industry, culture and tourism in the City. Board meets the third Wednesday of every
month, at 7:00 p.m.
CODE ENFORCEMENT BOARD: (City Code, Section 2-246) - 7 members, 2 alternate, 3
year terms. Duties: Examine cases presented by the City's Code Enforcement Officer; also
empowered to levy fines against citizens violating City codes. Board meets every month, on the
Thursday following the second the regular Council meeting, at 7:30 p.m.
COMMUNITY APPEARANCE BOARD: (City Code, Section 22-36) - 5 members, 2
alternates, 3 year terms. Applicants must also be qualified by reason of training or experience in
art, architecture, community planning, land development, real estate or other relevant business or
profession, or by reason of civic interest. Duties: Establish a harmonious appearance for
proposed buildings or structures in the community. Board meets the first and third Monday of
every month, at 7:00 p.m.
CONSTRUCTION BOARD OF ADJUSTMENT & APPEALS: (City Code, Section 82-32) -
5 members, 2 year terms. Must be member of the building industry. Duties: Responsible for
basis.
hearing appeals of the decisions of the City's building Official. Board meets on an "as -needed"
LIBRARY BOARD: (City Code, Section 46-26) - 5 members, 2 alternates, 2 year terms. Must
be a resident of the City. Duties: Advise and consult with the Librarian on the operation of the
Library. Board meets the second Tuesday of every month at the Cape Canaveral Library, at 2:00
p.m.
PLANNING AND ZONING BOARD: (City Code, Section 58-26) - 5 members, 2 alternates, 2
year terms. Duties: Act in an advisory capacity to the City Council in matters relating to zoning
and land use. Board the 2nd and 4th Wednesday of every month, at 7:30 p.m.
RECREATION BOARD: (City Code, Section 54-26) - 7 members, 2 alternates, 2 year terms.
Duties: Advise the City Council on matters pertaining to public parks and recreation. Board
meets on the 4th Monday of every other month, at 5:00 P.M.
G:',DptyCIk\BOARDSTISTS\Board Descriptions. doc
Meeting Type: Regular
Meeting Date: 02-01-00
AGENDA
Heading
Ordinances - 2' Reading
section practice.
Item
2
No.
to
Section 110-470.
AGENDA REPORT
CITY COUNCIL OF THE CITY OF CAPE CANAVERAL
SUBJECT: ORDINANCE NO. 01-2000, AMENDING CODE SECTION 110-1, DEFINITION OF WALL
DEPT./DIVISION: P&Z/GROWTH MANAGEMENT
Requested Action:
City Council consider approval of this ordinance, amending the definition of "wall" to conform to current code
section practice.
Summary Explanation & Background:
The P&Z Board recommended the change of the definition of wall to conform with the recent code revision
to
Section 110-470.
I recommend approval at first reading.
Exhibits Attached:
Ordinance No. 01-2000/Existing Code
City Man r' Mce
Department P&Z/GROWTH MANAGEMENT
g:/admin/ /meeting 000/ -00/ - OOO.doc
ORDINANCE NO. 01-2000
AN ORDINANCE OF THE CITY OF CAPE CANAVERAL, BREVARD
COUNTY, FLORIDA, AMENDING CODE SECTION 110-1, DEFINITIONS,
BY AMENDING THE DEFINITIONS OF WALL; PROVIDING FOR
SEVERABILITY; PROVIDING FOR REPEAL OF CONFLICTING
ORDINANCES; AND PROVIDING FOR AN EFFECTIVE DATE.
BE IT ORDAINED BY THE CITY COUNCIL OF CAPE CANAVERAL FLORIDA, as
follows:
SECTION 1. Section 110-1, Definitions, is hereby amended by deleting the
definition of "Walt' and adopting the following in lieu thereof:
WaH means a structure forming a physical barrier, which is constructed of
concrete or masonry composite.
SECTION 2. SEVERABILITY. If any section, paragraph, phrase, or word of this
Ordinance is held to be unconstitutional or invalid, such portion shall not affect the
remaining portions hereof, and it shall be construed to have been a legislative intent to
pass this Ordinance
without such unconstitutional or invalid part.
SECTION 3. CONFLICTING PROVISIONS. Any ordinance, or parts of an
ordinance, in conflict herewith is repealed.
SECTION 4. EFFECTIVE DATE. This Ordinance shall take effect immediately
upon its adoption.
City of Cape Canaveral
Ordinance No. 01-2000
Page 2
ADOPTED BY the City Council of the City of Cape Canaveral, Florida, this
day of , 2000.
Rocky Randels, MAYOR
ATTEST:
Sandra O. Sims, CITY CLERK
Approved as to Form:
Kohn Bennett, CITY ATTORNEY
`�• FLOR I DA
TAY
Published Daily
STATE OF FLORIDA
COUNTY OF BREVARD
Before the undersigned authority personally appeared MAUREEN FARR who on
oath says that she is LEGAL ADVERTISING CLERK
of the FLORIDA TODAY , a newspaper published in Brevard County,
Florida; that the attached copy of advertising being a LEGAL NOTICE
in the matter of
CITY OF CAPE CANAVERAL
in the Court
ORDINANCES 01 & 02-2000
was published in the FLORIDA TODAY NEWSPAPER
in the issues of JANUARY 22, 200
Affiant further says that the said . FLORIDA TODAY NEWSPAPER
is a newspaper in said Brevard County, Florida, and that the said newspaper has heretofore
been continuously published in said Brevard County, Florida, regularly as stated above, and
has been entered as periodicals matter at the post office in MELBOURNE
in said Brevard County, Florida, for a period of one year next preceding the first publication
of the attached copy of advertisement; and affiant further says that she has neither paid
nor promised any person, firm or corporation any discount, rebate, commission or refund
for the purpose of securing this advertisement for publication in said newspaper.
�- ll 40")J -
(Signature of Affiant)
Sworn to and subscribed before me this 22nd day of JANUARY 2000.
Pair PLe�i �Ll:dl]A L BRAUD FFICIAL NOTARY L
C067ivt =OH Mu
)7 X MBER
CD840684
' R� Uy OC3!+ Ml3SICt#EXPIRES
�F t.0 AWAY 4,20;?1 (Signature of Notary Public)
LINDA L. BRAUD `
(Name of Notary Typed, Printed or Stamped)
Personally Known or Produced Identification
Type of Identification Produced
ity of Cape Canaveral
R A N D U M
To: Sandra Smith, CMC, City Clerk
From: Dennis E. Franklin, CBO, Building Official
Re: Recommendation to City Council: Amending Section 110-1,
Definitions of "Wall" of the Cape Canaveral Code of Ordinances.
------------------------------------------------------------------------------------------------------------
At the Planning & Zoning Board meeting held on January 12, 2000, the Board
reviewed a proposed ordinance change to the above referenced city code section
to change the definition of a "wall". By unanimous vote, the Board members
recommended approval to the City Council. Please schedule this item on an
upcoming City Council meeting agenda.
105 Polk Avenue • Post Office Bog 326 • Cape Canaveral, FL 32920-0326
Telephone (407) 868-1200 • FAX (407) 799-3170 9 http://fcn.state.fl.us/cape/
110-1
CAPE CANAVERAL CODE
ated and maintained for the purpose of providing
space for and otherwise servicing mobile homes
and trailers.
D-auel trailer. See the definition of "recreation-
al vehicle."
Utility access easement means an easement
less than 20 feet wide, dedicated and used for
utilities and utility vehicles. The term does not
qualify as an alley pursuant to chapter 98 per-
taining to subdivisions.
Vacant means a building or parcel of land that
is neither occupied nor used.
Variance means a relaxation of the terms of
this chapter when such variance will not be
contrary to the public interest and when, owing to
conditions peculiar to the property and not the
result of the actions of the applicant, a literal
enforcement of this chapter would result in un-
necessary and undue hardship. As used in this
chapter, a variance is authorized only for height,
area, size of structure or size of yards and open
spaces; establishment or expansion of a use oth-
erwise prohibited shall not be allowed by variance
nor shall a variance be granted because of the
presence of nonconformities in the zoning district
or used in an adjoining zoning district. jos'✓
Wall means a structure forming a physical
barrier which is so constructed that less than 50
percent of the vertical surface from ground level
to its top is open to permit the transmission of
light, air and vision through such surface in a
horizontal plane.
Wall, concrete boundary, means a structure
constructed using concrete, either poured or in
block form, along the property boundary or within
the setback and used as a dividing line between
parcels of property in a residential zone, specifi-
cally excluding townhouse interior party walls.
Yard means all open space on the same lot as
the principal building, which space is unoccupied
and unobstructed by buildings from the ground
upward, except as otherwise provided. The term
generally applies to the area from each lot line to
the principal building and its attached porches,
sheds, carports, garages and storage areas.
(Code 1981, § 632.01; Ord. No. 7-96, § 1, 6-18-96;
Ord. No. 9-97, § 1, 9-2-97; Ord. No. 19-98, §§ 1-3,
6-16-98; Ord. No. 30-98, § 1, 10-20-98)
Cross reference—Definitions and rules of construction
generally, § 1-2.
Secs. 110-2-110-25. Reserved.
ARTICLE II. BOARD OF ADJUSTMENT*
DIVISION 1. GENERALLY
Sec. 110-26. Established; composition; qual-
ifications.
(a) A board of adjustment is established, which
shall consist of five members and two alternate
members appointed by the city council.
(b) Members and alternate members of the
board of adjustment shall have been residents of
the city for at least one year prior to their appoint-
ment. Members and alternate members shall be
registered voters.
(c) Members of the board of adjustment shall
be appointed for staggered terms of three years.
In addition, the chairman of the planning and
zoning board or his duly authorized representa-
tive shall be an ex -officio member of the board of
adjustment.
(Code 1981, § 645.13; Ord. No. 49-93, § 1, 1-4-94)
Sec. 110-27. Proceedings.
(a) The board of adjustment shall adopt rules
necessary to the conduct of its affairs and in
keeping with this chapter. Meetings shall be held
at the call of the chairman and at such other
times as a majority of the board of adjustment
may determine. The chairman or, in his absence,
the acting chairman may administer oaths and
compel the attendance of witnesses. All meetings
shall be open to the public.
*Cross reference Boards, committees, commissions, §
2-171 et seq.
Supp. No. 6 CD110:14
§ 110-469 CAPE CANAVERAL CODE
triangular area bounded on two sides by the
street right-of-way lines and on the third side by
a straight line drawn between two points on the
street right-of-way line located 25 feet from the
point of the intersection of the street right-of-way
lines.
(Code 1981, § 641.25)
Cross references—Property maintenance requirements,
§ 34-97; streets, § 66-26 et seq.; traffic and vehicles, ch. 74.
Sec. 110-470. Fences, walls and hedges.
(a) Fences, walls and hedges may be permitted
in any yard, except as specified in section 110-469,
provided the following height restrictions shall
apply:
(1)
(2)
(3)
In any residential district (R-1, R-2 or
R-3), no fence, wall or hedge in any side or
rear yard shall be over six feet in height or
over four feet in height if within 25 feet of
any yard abutting any public right-of-
way.
In any commercial (C-1) and industrial
(M-1) districts, no fence, wall or hedge in
any side or rear yard shall be over eight
feet in height or over four feet in height if
within 25 feet of any yard abutting any
public right-of-way. When the boundary of
a commercial or industrial zoning district
abuts any residential zoning district, the
maximum height of a fence, wall or hedge
shall be six feet.
In any district, the planning and zoning
board may provide an exemption allowing
a fence of six feet in height within 25 feet
of any yard abutting any public right-of-
way if the applicant can demonstrate that
an ascertainable and definable hazard
will be reduced by the construction of the
six-foot fence. The applicant must also
demonstrate that the additional height
will not cause a visual obstruction to
motorists deemed hazardous by the plan-
ning and zoning board. A written request
for an exemption shall be filed at least 21
days prior to the planning and zoning
board meeting at which it is to be consid-
ered, and notice of the meeting shall be
mailed to all property owners within a
300 -foot radius of the property for which
an exception is sought. The applicant shall
pay a fee as set forth in appendix B to this
Code.
(b) No wall shall be built along unimproved
property boundaries until and unless the owner
has obtained and paid for a building permit for
the principal structure.
(c) All concrete boundary walls are to be fin-
ished by stuccoing or painting in neutral colors at
the time they are constructed.
(d) No words or symbols, other than street
addresses and names of occupants in residential
districts, shall be permitted on exterior boundary
walls. If there are such nonallowed words or
symbols, they shall be covered within seven days
of notification to the owner by the city.
(e) Reserved.
—
(Code 1981, § 641.27; Ord. No. 8-99, 1, 7-6-99)
Cross references—Property maintenanc stand , §
34-97; building code, § 82-31 et seq.; swimming pool code, §
82-246 et seq.; housing code, § 82-271 et seq.
Sec. 110-471. Exceptions to height regula-
tions.
The height limitations contained in article VII
of this chapter do not apply to spires, belfries,
cupolas, antennas, water tanks, solar panels, ven-
tilators, chimneys, elevator equipment, air condi-
tioning or other necessary equipment room usu-
ally required to be placed above the roof level and
not intended for human occupancy.
(Code 1981, § 641.29)
Sec. 110-472. Access.
Every building shall be on a lot fronting on a
public street or on an approved private street or
with legal access to a public street and shall have
a safe and convenient access for servicing, fire
protection and required offstreet parking. All lots
upon which structures are built shall have a
minimum access width of 15 feet to a public
right-of-way or an approved private right-of-way.
(Code 1981, § 641.31)
Supp. No. 7 CD110:60
Meeting Type: Regular
Meeting Date: 02-01-00
AGENDA
Heading
Ordinances - 2" a Reading
Suites.
Item
3
No.
I recommend approval.
AGENDA REPORT
CITY COUNCIL OF THE CITY OF CAPE CANAVERAL
SUBJECT: ORDINANCE NO. 02-2000, VACATING AND ABANDONING A 12 -FOOT RIGHT -017 -
WAY
DEPT./DIVISION: GROWTH MANAGEMENT
Requested Action:
City Council consider the vacation of a 12 -foot right-of-way as petitioned by Mr. Mills for Flores Ocean
Suites.
Summary Explanation & Background:
See attached staff report and related documentation.
I recommend approval.
Exhibits Attached:
Correspondence/Ordinance No. 02-2000
City M er' Office /,
Department GROWTH MANAGEMENT
ORDINANCE NO. 02-2000
AN ORDINANCE OF THE CITY OF CAPE CANAVERAL, FLORIDA,
VACATING AND ABANDONING A TWELVE FOOT (12') WIDE RIGHT-OF-
WAY LOCATED SOUTH OF JOHNSON AVENUE, ADJACENT TO LOT 5
AND LOTS 11 THROUGH 13, BLOCK 76, AVON BY THE SEA,
EXTENDING SOUTH TO THE CITY'S CORPORATE LIMITS,; RESERVING
AN EASEMENT FOR PUBLIC UTILITIES; REPEALING PRIOR
INCONSISTENT ORDINANCES; PROVIDING FOR SEVERABILITY; AND
PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, the City Council of the City of Cape Canaveral has received a petition
to vacate and abandon a twelve foot (12') right-of-way located South of Johnson Avenue
adjacent to Lot 5 and Lots 11 through 13, Block 76, Avon by the Sea, extending South to
the City's corporate limits; and
WHEREAS, the Council has determined that all owners of the abutting property
have joined in the request for this vacation; and
WHEREAS, public utilities are presently located within said property; and
WHEREAS, the City finds that the best interests of its citizens will be served by the
closing, vacating, and abandoning of said property retaining a public utility easement
across the entire vacated right-of-way.
NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF
CAPE CANAVERAL, as follows:
SECTION 1. That twelve (12") right-of-way more fully described as follows:
A portion of the 12 foot wide Alley lying adjacent to Lot 5, and Lots 11
through 13, Block 76, AVON BY THE SEA, according to the plat thereof as
recorded in Plat Book 3, Page 7, of the Public Records of Brevard County,
Florida, being more particularly described as follows:
Begin at the Northwest corner of said Lot 11; thence S 13021'57" W along the
Westerly lines of said Lots 11 through 13, a distance of 163.48 feet, to the
Southwest corner of said Lot 13; thence S 88❑00'01"W, along the Westerly
extension of the South line of said Lot 13, a distance of 6.22 feet, to a
point on the centerline of said 12 foot wide Alley; thence N13❑21'57"E,
along said centerline, a distance of 27.24 feet, to a point on the Easterly
extension of the South line of Lot 5 in said Block 76; thence S 87057'22" W,
along the Easterly extension, a distance of 6.22 feet, to the Southeast corner
of said Lot 5; thence N 13021'57" E, along the Easterly line of said Lot 5, a
distance of 136.18 feet, to the Northeast corner of said Lot 5; thence N 87❑44'
13" E, a distance of 12.46 feet, to the POINT OF BEGINNING.
City of Cape Canaveral
Ordinance No.
Page 2
shall be and is hereby vacated, abandoned, and closed on the effective date of this
Ordinance, pursuant to Section 66-36 of the Code of Ordinances of the City, provided,
however, that an easement is reserved for public utilities access.
SECTION 2. All ordinances or parts of ordinances in conflict herewith are hereby
repealed to the extent of the conflict.
SECTION 3. If any provision of this Ordinance is for any reason held invalid or
unconstitutional by any court of competent jurisdiction, such provision shall be deemed a
separate, distinct, and independent provision and such holding shall not affect the validity
of the remaining provisions of this Ordinance.
SECTION 4. This Ordinance shall be effective immediately upon adoption by the
City Council of the City of Cape Canaveral, Florida.
ADOPTED by the City Council of the City of Cape Canaveral, Florida, this
day of , 2000.
Rocky Randels, MAYOR
ATTEST:
Sandra O. Sims, CITY CLERK
APPROVED AS TO FORM:
Kohn Bennett, CITY ATTORNEY
\\Cape-nt\cityclerk\CityClk\Ordinances\VACATING 12 FOOT RIGHT OF WAY - South of Johnson Avenue.doc
ly of Cape Canaveral
) R A N D U M
To: Sandra Smith, CMC, City Clerk
From: Dennis E. Franklin, CBO, Building Officialo,�7
Re: Recommendation to City Council: Request to Vacate a 12 ft.
Alleyway Lying Westerly of Lots 11,12 & 13, Block 76, Avon by the
Sea (Adjacent to Flores Ocean Suites, 443 Johnson Avenue) -
Petitioner is Edwin Mills, Authorized Agent.
At the Planning & Zoning Board meeting held on January 12, 2000, the Board
reviewed the above referenced proposed alleyway vacation. By unanimous
vote, the Board members recommended approval to the City Council. Please
schedule this item on an upcoming City Council meeting agenda.
105 Polk Avenue 9 Post Office Bog 326 • Cape Canaveral, FL 32920-0326
Telephone (407) 868-1200 • FAX (407) 799-3170 • http://fcn.state.fl.us/cape/
Memo
To: Planning & Zoning Board
From: Dennis E. Franklin, CBO, Building Official
Date: 11/04/99
Re: Vacation of public alleyway
V. Edwin Mills of Beach Mapping and Surveying, represent Flores
Ocean Suites and has applied for the vacation of an alleyway adjacent
to their property on Johnson Avenue. I have reviewed the information
package submitted, and believe all is in order, and find no reason the
board should not approve this request.
0 Page 1
BEACH MAPPING AND SURVEYING
99 GEORGE KING BLVD. SUITE NO. 3
P.O. BOX 542
CAPE CANAVERAL, FL 32920
(407)783-4174 PH. (407)783-1058 FX.
SEPTEMBER 08, 1999
THE CITY OF CAPE CANAVERAL
501 POLK AVENUE
P.O. BOX 326
CAPE CANAVERAL, FL 32920
ATTN: MR. DENNIS FRANKLIN, CHIEF BUILDING OFFICIAL
RE: REQUEST FOR VACATION OF PUBLIC RIGHT-OF-WAY.
DEAR MR. FRANKLIN:
I
ON BEHALF OF MY CLIENT, FLORES OCEAN SUITES, I HEREBY REQUEST THAI
THE CITY OF CAPE CANAVERAL VACATE A PORTION OF THE ALLEY LYING
WESTERLY OF LOTS 11, 12 AND 13, BLOCK 76, AVON -BY -THE SEA Ar -
RECORDED IN PLAT BOOK 3, PAGE 7, PUBLIC RECORDS OF BREVARD COUNTY,
FLORIDA (A 12 FOOT RIGHT-OF-WAY RUNNING SOUTH TO NORTH BETWEEN
GRANT AVENUE AND JOHNSON AVENUE).
THIS PORTION OF THE ALLEY IS UNIMPROVED AND SERVES AS ACCESS TO
ABUTTING PROPERTIES.
AS PETITIONER, ALL REASONABLE COSTS FOR ADVERTISING, ADMINISTRATION
AND RECORDING WILL BE PAID BY US (NOTE THAT THE ENGINEERING HAS
ALREADY BEEN PREFORMED ON THIS SITE).
PLEASE PLACE THIS "REQUEST FOR VACATING" ON THE EARLIEST AGENDA FORM
PLANNING AND ZONING BOARD HEARING.
SINCERELY,
V. EDWIN MILLS, P.L.S.
PRESIDENT, BEACH MAPPING AND SURVEYING
VEM\amc
C:\WP\DOC\BSB
BEACH MAPPING AND SURVEYING
99 GEORGE KING BLVD. SUITE NO. 3
P.O. BOX 542
CAPE CANAVERAL, FL 32920
(407)783-4174 PH. (407)783-1058 FX.
SEPTEMBER 08, 1999
THE CITY OF CAPE CANAVERAL
501 POLK AVENUE
P.O. BOX 326
CAPE CANAVERAL, FL 32920
ATTN: MR. DENNIS FRANKLIN, CHIEF BUILDING OFFICIAL
RE: REQUEST FOR VACATION OF A PORTION OF A 12 FOOT ALLEY, LY
BETWEEN GRANT AND JOHNSON AVENUES, BLOCK 76, AVON—BY—THE—SEA.
DEAR MR. FRANKLIN:
I, V. EDWIN MILLS, WILL BE ACTING AS PETITIONER FOR THE P.
STYLED ACTION. THIS LETTER WILL SERVE AS AN AFFIDAVIT FROM
OWNER AUTHORIZING ME TO ACT IN THIS CAPACITY.
;SINICERLY,
V. EDWIN MILLS
BEACH MAPPING AND SURVEYING
STATE OF FLORIDA SUBSCRIBED AND SWORN BEFORE ME THIS
COUNTY OF BREVARD 8TH DAY OF SEPTEMBER, 1999
BY !.Y• /
OHN D. DORO FLORES OCEAN SUITES
W IS PERSONALLY KNOWN TO ME
NOTARY PUBLIC, COMMISSION NO.
C:\WP\DOC\BSB1 BIER`!
i
EXPIR5 FEB
,
bowmTHROUGH
,,,� .uru' *pNpING CO INC
Retum to:
CdH[Attantic Ti(le�
926 K CourtohBy r1Rvy., Suite 25
Merritt Istand, FL 32953
CFN 9 )5JC29 C4 -0t -BG W.19 PT
uF�aaR,�-Ie 3823 / 0873
, / 1 0 1 L -)Sandy Crawford
>„_party AppraiaeYG Furcal NO' cW1kcfCovrte.0+uvmdCoa++ty
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Geed: 2.U -CC nt Tu: 0.90
000 _ ..
CHIS wAT(FhtiTY r+Rnn roada this X6 day Of A•1ARCH 19?0 by
%XTI0h1RT1'1 13RAL]Ftl AND ELIZABETH X. SHILLITO, AS TRUSTEE OF 114E ELIzAIinTrt K. o:1ILLITO
REVOCABLE TUVST, DATED DECENTJSR 10. 14:01
heroIlia rt'la c:allad Grantol•, to
�WEL'T u. CORPORA7,0N.of F:.ORtDA, A 'r'[;rRI3A CORPt•)C�,�ICN
hcreinul,er Called Orar.tv:, and vhoori pout orrice > ddraQY 1G
021 K. Eula Drive, Orlando, FL 32603
w1TrrN.Bnr.TH1 TLat the Grantor, fur and in con9ideration of Citic uur of $10.00
and other valuable conuideraticnd, receipt whereof is hereby aukno.ladqud. hveyliy
barguino, aLllu, ;aliens, remieea, roleaeca, conveys and contirmv urto th,a Ginntee
011 that certain land ait.uato in BRZYIARG County, Florida, '41z'
LOTS 11, 12, A110 13, 'ALOCX 7,;, AVOtt-BY•THE•BCA, ACCORDII;4J To THE PLAT • HUzor•,
1%3 RYCORDaD Itr PLAT BOOK 3, rAGE 7, P;, -LIC RUCOIDS Of $REVA&O C!aRJTy, r1, 4 V ,
Tr,Gr.THI•::t WZT11 ALL T111: RIOH'P, TITLE AND INTEREST IN TT[AT pLATtED !1TR C: vvllio
ZMT OF SAID LOTS AND SnOWI; ON DI'HZ MID I'I.AT OY AVON-DY-"'XZ-9TCA SYS OCEA4
no1rl.F.tJARDr TO09THER WITH ALL TIX RIO:rr, TITLE AND IMEREST ICT T4WSZ L3\ITDJ
I.YIIrO EAST OF SAID LOTS A.110 LY111O BFTW?N TTIE ZAST Sl'DZ OF SAID D)C"''T
Continued
T00=11UR with all the toiiemcnta, horcditalnonts And appurte lances 0%ec!to
belonging or in any wise appertaining.
_ TO NAVE AND :o 1tOLD , the sa^e in too Pimple fcruver.
ANU the Orantor huroby aovennnts with said Orontce that the GrdntOr if)
fully ueimi of naid land in fee ai:op101 that L•lie Grazi:or hag Seed right and
1r+D4ittl nuthority to Gell +and convey Bail land and hard -I warrar.to tine title to
ome agai
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de
will h
ad and wifnat tlia lawful olaima of all yerecno
aabd lov'aa*nc-
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year and uubua4ent yaarv, reatsict.lone, limltationn, eav«pant::, rad uaaenRintlt oC
rccura, i.0 any.
Nitneaoctl by+
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Thi Corcyoing inotruu.ont was aCkr.'•ule,dgnd bafora
Tru th1A day oC T,aR_at 1959 by ANTtANETTE BRADZCE
who irJ/are•pe-roonally known to ma or who had/have Produced
as iduntifio �\fW1pfU11!llij `�
Notary public CA'l
Typelprint name of WOtar'Y:
2 r _ < cxmniaulon expirCal
zz-s•ros�l� 1 � LIC} >f ; t.y �.
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as inntrtG•. e
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AVON-BY-TH. 3EA.
VMFEFTY PUZA;H1990 HdACIN IS NOT HOMESTEAD PROPERTY OF THE (JMN'rQK3 • t;AIil
JTORF RESIDE AT THE ADDItt:%+SE:; LI.TLU BELOW THEIR 2IGIIA'T.'5166_.
IGTARY Afr TO: CLI%A14R'1"+I K. 3HILLIT0, TFIISTEE II�`�If`,'�AIf�f�,I��I�fy����l,���
CFN 9
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wirlT•r or SA;:RAh79!'U
t I13R5PY CERTIFY THAT O:t TII'C9 DAY. D=FOR>v Ml:, AN OFFICER GULP AUT::ORI:;ED TO
,1DT1I,lfSTER 0A.T11G AILD TAKH AC}( OWLGDG(IENT3, YliRSOF1i1LL1 AFPIAR6D EL CZ K.
911ILLITO, AS TRUST::« OF TILE ELI I)STH K, SH:"','TO REVOCABLE TRUST, DAT
--7mu R 19. 197 ;Z1, OWN TO MV TO 88 THE FTH"ON D""'Dun IN ;UM .h:0 $XSCUT141Z
FORF.00I27C I1(�TRUh1E11T, W1iC ACiNOWLEDOR9 DEFER£ MS 'C}{dT 1/91:� 'XECJI£G THE
s vuE. IM/cHY, ISHAS PROCUCED4)a+.0o'&4-- 'lUla+,cOi AS
IDENTII.71:ATION AND Diu/D4D-44ff TAKE A.,, OATH. WITNESS MIC IUUm ACID OFFICIAL SEA:,
It7 Z•Hg COUNTY AND STATE LAST AFL`H897'.:0 THIS XfkDAY OF MAIJ.C11 1596.
1•IOTp11 + FUDLIC
NORMA J. NETIMAN /Joamlr Nilo''►"''�
COMM. *1068486 IUr>t71Fe.4 ir�ti�F°'
NOTARY DUDU
�ACNMIf.IRU COUM"7' ',
'J85Ci11'd@'1MID
I}IVORNSDa'.eG? r
80YARY� U90C
SEPTEMBER 17, 1999
THE CITY OF CAPE CANAVERAL
501 POLK AVENUE
P.O. BOX 326
CAPE CANAVERAL, FL 32920
ATTN: MR. DENNIS FRANKLIN, CHIEF BUILDING OFFICIAL
RE: REQUEST FOR VACATION OF A PORTION OF A 12 FOOT ALLEY, LYING'
BETWEEN GRANT AND JOHNSON AVENUES, BLOCK 76, AVON -BY -THE -SEA.
DEAR MR. FRANKLIN:
PATRICIA K. DELANEY
770 S. BANANA RIVER DRIVE
MERRITT ISLAND, FL 32952
I, PATRICIA K. DELANEY, BEING THE OWNER OF PART LOTS 14 & 15, BLOCK
76, AVON -BY -THE -SEA, AS DESCRIBED IN OFFICIAL RECORDS BOOK 1982,1
PAGE 443, PUBLIC RECORDS OF BREVARD COUNTY, FLORIDA, DO HEREBY',
ATTEST THAT I APPROVE OF THE ABOVE RIGHT-OF-WAY VACATING REQUEST.
-7
r
j
B AT ICI DEL EY
STATE OF FL RIDA
COUNTY OF 10M(u
THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME THIS_ DAY'
OF b c- % b -u-
19—q 'i , BY ��a-f'r < c4 c, De- 10 -vi e-'
WHO IS PERSONALLY KNOWN TO ME V OR WHO HAS PRODUCED THE
FOLLOWING IDENTIFICATION:
MY COMMISSION EXPIRES:
j. BIER"(
PUeCO MISSION # CC4=665
EXPIRES -FEB 23.2001
o 50NOW THR�•1
,,,�eoW>*lGCO ' NOTARY P LIC, STATE OF FLORIDA
C:\WP\DOC\BS`~
SEPTEMBER 17, 1999
THE CITY OF CAPE CANAVERAL
501 POLK AVENUE
P.O. BOX 326
CAPE CANAVERAL, FL 32920
ATTN: MR. DENNIS FRANKLIN, CHIEF BUILDING OFFICIAL
RE: REQUEST FOR VACATION OF A PORTION OF A 12 FOOT ALLEY, LYI
BETWEEN GRANT AND JOHNSON AVENUES, BLOCK 76, AVON -BY -THE -SEA.
DEAR MR. FRANKLIN:
BARBARA J. FLOYD & WALTER P. GODFREY, JR.
433 JOHNSON AVENUE
CAPE CANAVERAL, FL 32920
WE, BARBARA J. FLOYD & WALTER P. GODFREY, JR., BEING THE OWNERS 0
LOT 5, BLOCK 76, AVON -BY -THE -SEA AS RECORDED IN PLAT BOOK 3, PAG
7 OF THE PUBLIC RECORDS OF BREVARD COUNTY, FLORIDA, DO HEREB
ATTEST THAT WE APPROVE OF THE ABOVE RIGHT-OF-WAY VACATING REQUEST
BY WALTER P. GOD
STATE OF F RIDA
COUNTY OF e GcX-Z�
THE FOR GOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME THIS DA
OF a��-ri ,
19'Rl�ll , BY ��-{l Ju -r �- r-(
WHO IS PERSONALLY KNOWN
FOLLOWING IDENTIFICATION:
MY COMMISSION EXPIRES:
Goad
OR WHO HAS PRODUCED T
j. BIERY
it P(!e`� C15S10N # CC6236"
_ o_Ot4,A I Sl FE9 23.2001 '
tXf
�y► �,swmc50Nc'NGco �+c NOTARY P IC, STA OF FLORIDA
C: \WP\DOC\SQL
12/01/1555 17:54 407-783-1058
BEACH MAPPING
BEACH MAPPING AND SURVEYING
99 GEORGE KING BLVD. SUITE NO. 3
P.O. BOX 542
CAPE CANAVERAL, FL 32920
(321)783-4174 PH. (321)783-1058 FX.
DECEMBER 01, 1999
THE CITY -OF CAPE CANAVERAL
501 POLK AVENUE
P.O. BOX 326
CAPE CANAVERAL, FL 32920
2
ATTN: MR. DENNIS FRANKLIN, CHIEF BUILDING OFFICIAL
RE: REQUEST FOR VACATION OF PUBLIC RIGHT-OF-WAY, UTILITIES
EASEMENTS.
DEAR MR. FRANKLIN:
PAGE 02
THERE ARE NO UTILITIES PLANNED WITHIN THE PORTION OF THE PROPERTY
THAT WE PROPOSE TO VACATE. THIS INCLUDES WATER, SEWER, GAS, CABLE
TELEVISION AND POWER, IF IT BECOMES NECESSARY TO CREATE EASEMENTS
FOR THOSE OR ANY OTHER UTILITIES, WE WILL ADDRESS AND GRANT SAID
EASEMENTS AS NECESSARY.
SINCERE Y,
V. EDWIN MILLS, P.L.S.
PRESIDENT, BEACH MAPPING AND SURVEYING
VEM\amc
C:\WP\DOC\BSBUTL
December 3, 1999 SSA
Mr. Dennis E. Franklin, CBO
Building Department - City of Cape Canaveral
105 Polk Avenue
Cape Canaveral, FL 32920
RE: Request for vacation of a portion of the alley lying westerly of Lots 11, 12 and 13, Block 76,
Avon -By -The -Sea as recorded in Plat Book 3, Page 7, Public Records of Brevard County,
Florida (12 foot right-of-way running south to north between Grant Avenue and Johnson
Avenue)
Dear Mr. Franklin:
Stottler Stagg & Associates, Architects, Engineers, Planners, Inc. (SSA) has received and reviewed the
"Request for Vacation" as referenced above.
Based upon the review of the documents received and field inspection of the subject alleyway, SSA, as
City Engineer for the City of Cape Canaveral, recommends approval of the above -referenced "Request for
Vacation".
If you have any questions, or you require further assistance in this matter, please contact our office.
Sincerely,
� a.
ohn A. Pekar, PE
Vice President - City Engineer
STOTTLER SrAGG & ASSOCIATES ARCHITECTS o ENGINEERS - PLANNERS, INC.
8680 North Atlantic Avenue P. 0. Box 1630 Cape Canaveral, Florida 32920 Tel 407-7831320 Fax 407-783.7065
11c. #AAC000329 #EB0000762 #LB0006700
d:1N. WOeds%r.VdLhanW vacate aky.doc
•
MEMORANDUM
TO: Dennis Franklin
Building Official
FROM: Ed Gardulski
Public Works Director
DATE: December 6, 1999
RE: Vacation of Alley
Reviewed the easement located within Block 76, Lots 5, 11, 12, 13, 14, 15,
Section 23, Township 24 South, Range 37 East, City of Cape Canaveral. Did not find any
current or future need of this easement by the City of Cape Canaveral. As Public Works
Director, I concur with the vacation of the 12 -foot alley.
City of
Cocoa, Florida
UTILITIESIPUBLIC WORKS DEPARTMENT
600 School S=et Cocoa, Florida 32922
Serring the Community PHONE (407) 639-7671 FAX (407) 639-7663
January 4, 2000
City of Cape Canaveral
Post Office Box 326
Cape Canaveral, FL 32920- 326
Attn: Greg Mullins
Re: VACATION OF 12400T WIDE ALLEYWAY, BLOCK 76
TWP. 24, RNG 37, SEC. 23, AVON BY = SEA
Dear Mr. Mullins:
The City of Cocoa has no objection to the vacation of the referenced alleyway, which lies west of
lots 11 through 15 and east orlots 5 and 10.
You may call Debbie Strene4ky at (321) 639-7657 if you have any questions.
Sincerelv,
PLJ-1UAW"V-
��i
James Duncan, P.E.
Engtnecrtng Dtvtston 14
JD/dis
720 1[at;no/&r .Arcs.
Melbourne. Florida _ 9
Tel 407-2i4-.,.,'00
Fix 407-2 �4- 1.07
TIME WARNER
COMMUNICATIONS
December 16, 1999
City Of Cape Canaveral
P O Box 326
Cape Canaveral, FL 32920-0326
ATTN: Mr. Greg Mullins
Dear Mr. Mullins:
9
Time Warner Communications has received and reviewed your request to vacate the
easement (legal notice attached) pursuant to the petition filed by the City Of Cape
Canaveral.
Time Warner Communications has no objection to vacating 6 feet
of 12 foot easement, provided TWC has access to maintain it's facilities on
exsisting FPL pole lines.
If you have any questions or require additional information, please call me at (407)242-
2926.
Sincerely,
Robert F. Walton
Construction Manager
TIME WARNER COMMUNICATIONS
RFW/pkg
cc: File
Tine Warner ENertahmi w-.4hr,use Parnrerrhip - Florida Division
II City Gas Company
of Florida
December 9, 1999
CITY OF CAPE CANAVERAL
Greg Mullins
Post Office Box 326
Cape Canaveral, Florida 32920-0326
Brevard Di sior
4180 South U S. 1
Rockledge, FL 32955-530s
Tel: (407) 636-4644
Fax: (407) 633- 732
www.nd com
NU! Corporation (NYSE: 1
RE: Request for vacation of City leased 12' public allerivay located in Block 76, Lot Numbers
5, 11, 12, 13, 14 and 15, Cape Canaveral
Dear Mr. Mullins:
Please be advised that CITY GAS CO1,tPANY OF FLORIDA has no objections to vacation of the alleyway as
described above.
If further information is required, please feel free to contact this office.
Very truly yours,
NUI CITY A ANY OF FLORIDA
Je Pierce
bution Superintendent
evard Division
JP:gt
Companies and Affiliates:
Gas Company of Florida
ibethtown Gas
)n Gas
h Carolina Gas
NUI Capital Corp.
NUI Energy
NUI Energy Brokers
NUI Energy Solutions
NUI Environmental Group
TIC Enterprises,
Utility Business Sen
Valley Cities
Waverly
:.r
ff
City Gas company
WiOf monva
December 9, 1999
CITY OF CAM CANAVERAL
Greg Mullins
Post Office Box 316
Capc Canaveral, Florida 32920.0326
Brevard sion
4180 South 5, 1
Rockledge, FL 3295 -5309
Tel: (4o7) 63 -4644
Fiat: (407) 63 -6733
Nu! Corporallon
RE: Request for cation of City leased 12' public ailervay bated in Black 76, Lot Numbers
S. 11, 12. 13, 14 and 15, Cape Canaveral
Drtir Mr. Mullins:
_. Please bo advised that CITY GAS CONVANY OF FLORIDA Ims no objections to vacation of the alleyway as
described above.
If further ittform3don is required, please feel free to contact flus ofEc:.
Very truly yours,
NtJt CITY
.�j-AVweKANY OF FLORIDA
ion Superintendent
Division
JP:gt
"A Compania and AfBtia m- NUI Capital corp.
ry G" Company of Florida NUI Energy
Elizab4t G"G"NUI F.n&W Droksm
KOMVk10Gasas NUI Enorgy Solutlona
North Ctucftna Gas NUIEmargy
5niviremiental amup
rul)
TIC EMWPH ea. L C
Utility euatnasa Sa—Moss
valley cltwa COS
WwvRrN G, n
Endoaed you will_ tired 'agreamanffi, fr m the requesting Parties, to provide Florida Power and
Idght Canapany with any and all easements whith may be required to provide the inquired
easement covervo.tbr L=PL's exisdng tedri!deoi Which are in the area of ft- alley easaraint
adjecarittD Lots S, 41,12, and 13. all part of'9lcck 719, AVON-BY THESEA aoeordnW.to #tee plet a
-thei sof, ss racordad ifi'Pfat Book $:,at Page 7 of the Pub90 Records of Brevard.Caurrty, Ficxd
At this. Urrie, l have no objectiicn to the easernent as described -above, beft:vacated.
Skie efy,
Bal-york
Corasrtctlon Sarvicae
._.: s::.... >. fi�1.e'L pair„ _.... ii:.ew:�. J Y?.Y..o. ._ L.,(�:S:i••..+e_...t.1��v,-iCf�i?:�ZMa�itfil(.7K�.�.Y�ti(�i!'n.__•,SLiti'L++.�. ...... la._s z�. ��:ei'i '��.-'::i: l.: :•e.
c�06-99'04:28P L'arcvn Corporat1 4077913OZ73
2701MONgM AC.
MERPM MAND, FL 32M
I3i� doo�aamt � as�aar'ru�oatm i+oti� Ftecida Rower ad Li�C �Y'�.�
"=7 be i0go3re d m GWM. or pe+epae�d Fri; ' + is tlw.na �. eta e
pd.1� of nd mL%mtto Loi S a-Bla& 74 AVON-AY$i- 5FA. 2=m%Hn6 m
dri oit lhre.rf, s �.eee�iai.I& Pie soc c 3; 31W 7 orlU Rao #se 9* et Boov id C.Wasyl — ,
. Noory '
. +rjo�,r
DacD6799 04:28P Larcon Corporation
�': '; ��� �': iii �:!� +iir':y+.�.5:! � �•
73 j�y�' • �1 �: �
1.
PL!:, ',•
14
• � �x �0 v+td�lt � aDep
' . L Vllz
4077830273
279 Parte RID.
M6RRrrr ISLAND, FL 32M
Des Bd�:
?bis aocsa mit to eealma nysgsooasat tv yrw* F W,* P wa ad Lit l ai p w1* a
' amt aatay be aatgtra�d m � aeistat� ar peepas+ed I�?'L �► !ma � tiss nsa of the Qi.�
' do ammusVOt of w w im of and ad, a0_ Lm 11,12,13 ad2la k 74, AV@f$Y-Mff.-&EA,
:: ;. xtoedt�a�tltlp{�z as recoeded !a ft look 3. PW y ofahc Atblie ]eaae=ds*f3nwd Calm y.
BellSouth Telecommunications, Inc. 561468-9970
Room 213 Fax 561466-4705
3300 Okeechobee Road
Fort Pierce, Florida 34947
December 6, 1999
Mr. Greg Mullins
City of Cape Canaveral
P.O. Box 326
Cape Canaveral, Florida 32920-0326
RE: Flores Condominium Alley/Easement Vacate
Dear Mr. Mullins:
® BFLLSOUTH
Billie C. Greenlief
General Manager— Network Operations
Indian River Division
You have recently requested that BellSouth vacate a 12' alley/easement on the western property
line of the Flores Ocean Condominiums that is presently under construction at 443 Johnson
Avenue,-Geeea-Beaef r. Co -f -o- Cnn a-c.w-(-Q--� - "'o-
BellSouth
'c
BellSouth Telecommunications claims no further interest in the alley/easement, and has no
objection to the vacation of said alley/easement in so long as the customer conduit is extended to
the pole located at the SW property line as illustrated in the BICS(Building Industry Consultants)
package issued to the developer, Larcon Development Corporation.
Copies of this letter will be forwarded to the condominium owner (Sweet D. Corporation) and the
developer(Larcon Development Corporation) per your request.
If you have any questions, please contact Eileen Ravita at 407-633-7376.
Yours truly,
Billy Greenlief
General Manager
cc: Sweet D Corporation
P.O. Box 536098
Orlando, FI. 32853
- cc: Larcon Development Corporation
69 N. Orlando Avenue
Cocoa Beach, FI. 32931
SKETCH TO ACCOMPANY DESCRIPTION
NOT A BOUNDARY SURVEY
PROPOSED ALLEY VACATION
N
SCALE: I" =30'
JOHNSON AVENUE
(48" R1GNT OF WAY)
POINT OF
COMMEXCF'MENT-F
N.8744'13'E N.W. CORNER OF LOT 11
t2.46'
M.E. CORNER OF LOT S
N. UNE OF LOT 11
S.E. CORNER OF LOT 5
S. UNE OF LOT 5
Q
ry
E
SA
o Qe
4
W-TBIT 'A"
3
RET I OF 2
LOT 11
o �
0
W
N
LOT 12 r�
0
LOT 13 a
�o
S.W. CORNER OF LOT 13
S. UNE OF LOT 13
1 w.
9-17-99 LDRAWN BY.• DJG J
NO_ 990122 SCALE- 1=J0'
LOT 14
SEE SHEET 2 SURVEYOR'S CERTIFICA
AND SURVEYOR'S NOTES.
PREPARED AND CERTIFIED FOR:
SWEET D CORPORAT70N
DESCRIPTION
NOT A BOUNDARY SURVEY
DESCRIPTION:
A portion of the 12 foot wide Alley lying adjacent to Lot 5, and Lots 11 through 13,
Block 76, AVON BY THE SEA according to the plat thereof as recorded in Plot Book 3,
Page 7 of the Public Records of Brevord County, Florida, being more particularly
described as follows:
Begin at the Northwest corner of said Lot 11; thence 51321 57"W, along the
Westerly lines of said Lots 11 through 13, o distance of 163.48 feet, to the Southwest
corner of said Lot 13,• thence S88'00'01 "W, along the Westerly extension of the
South line of said Lot 13, a distance of 6.22 feet, to a point on the centerline of said 12
foot wide Alley; thence N13'21'57 E, along said centerline, a distance of 27.24 feet, ` ,
to a point on the Easterly extension of the South line of Lot 5 in said Block 76; thence
58757'22'W, along said Easterly extension, a distance of 6.22 feet, to the Southeast
corner of said Lot 5, thence N13'21'57 E, along the Easterly line of said Lot 5, a
distance of 1J6.18 feet, to the Northeast comer of said Lot 5; thence N8744'13 E, a
distance of 12.46 feet, to the POiNT OF BEGINNING; Containing 0.04 acres, more or
less.
SURVEYOR'S NOTES:
1. TI -11S 1S NOT A SURVEY.
2. The bearings shown hereon ore based on a bearing of N8744'13 E along the
North line of Lot 11.
J. • = Denotes change in direction (no corner found or set).
SEE SHEET 1 FOR THE SKETCH TO ACCOMPANY THIS DESCRIPTION.
�IBIT "A"
[EET 2 OF 2
PARED BY:
LEN
ngineering, Inc.
SURVEYORS - ENGWERS
-106 DIXIE LANE (P.O. BOX 321321)
,OA BEACH, FLORIDA 32932-1321
s, _. Li& (407)783-7443 FAL' (407)783-5902
:ERTIFICATE OF AUTHORIZATION ILB266
NO. 990122
DATE. 9-17-99
SURVEYOR'S CERTIFICATION:
I hereby certify that the attached Property Description was prepay d
under my direction, in accordance with all applicable requirements of
the Minimum Technical Standards,' for land surveying in the State of
Florida, described in Chapter 61G17-6, Florida Administrative Code
pursuant to Chapter 472.027, Florida Statutes.
ALLEN
Not valid without the signature rcuacrci anLmv
and the original raised seal of a PROFESS 06KL SURVf
Florida licensed surveyor and mapper. AOPPER
FLORIDA REGISTRATION
PREPARED AND CERTIFIED FOR:
SWEET D CORPORATION 4
4262
)1-Y) 03: 19P Lar-curi Cur--pur-aL rurr 4C)77F330273 p.
,TATE OF FLORIDA
COUNTY OF BREVARD
I HEREBY CLRTIFY the toregoitlg illstiument %vas acknowledged before me by JUIUI .
aoup.1j.Prcsidenj , as to me known to be the persons w-io on behalf of Swect D Co Drat on of
t lvrida , a corporation, who signed the forcgoing inst�-imnent and severally acknowledged the
ete.Cgtioon f to be their free act and deed for the uses and purpOWS therein mentioned and is
/per�otiaIlly known t be or who has produced a5
ltszntif- a ion and who (lid (did not) take wi oath.
WITNESS may hand and official seal at (2y ('t'LL-A L , said County wid. State,
This -dayo' 106'6
NOTARY I' LIC
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Meeting Type: Regular
Meeting Date: 02-01-00
AGENDA
Heading
Resolutions
Summary Explanation & Background:
Item
4
I recommend approval.
No.
Resolution No. 2000-04
City M er' Office
AGENDA REPORT
CITY COUNCIL OF THE CITY OF CAPE CANAVERAL
SUBJECT: RESOLUTION NO. 2000-04, ESTABLISHING A RECLAIMED WATER CONNECTION EE
DEPT./DIVISION: WATER RECLAMATION/PUBLIC WORKS
Requested Action:
City Council consider approval of this resolution establishing the reclaimed water connection fees.
Summary Explanation & Background:
This resolution establishes the reuse connection fee. No changes have been made to said fee, and it wil� be
reviewed again during the budget adoption process.
I recommend approval.
Exhibits Attached:
Resolution No. 2000-04
City M er' Office
Department WATER RECLAMATION/PUBLI
WORKS
g:/admi meeting/2 /02- /-04.doc
RESOLUTION NO. 2000-04
A RESOLUTION OF THE CITY OF CAPE CANAVERAL, BREVARD COUNTY,
FLORIDA; ESTABLISHING A RECLAIMED WATER CONNECTION FEE
SCHEDULE WITHIN THE CITY OF CAPE CANAVERAL, FLORIDA
PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, Section 78-177 of the Code of Ordinances -of the City of Cape
Canaveral provides for the establishment of a reclaimed water connection fee; and
WHEREAS, the City of Cape Canaveral has constructed a reclaimed water
transmission and distribution system to provide public access irrigation of commercial
areas and residential lawns; and
WHEREAS, the City of Cape Canaveral has secured grant funding and budgeted
appropriate funds to defray the cost of providing reclaimed water connections to
customers.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Cape
Canaveral, Florida, as follows:
SECTION 1. The following reclaimed water connection fee is hereby established;
a) Single Family, Townhouse, Duplex And Triplex Unit
$50.00 per unit
b) Multi -Family -Apartment Complexes, Condominium Developments and Mobile
Home Parks
$200.00 for each required backflow device, or
$100.00 for each existing backflow device installed by the property owner
c) Commercial And Industrial
$200.00 for each required backflow device, or
$100.00 for each existing backflow device installed by the property owner
SECTION 2. City Council shall annually review this reclaimed water connection
fee schedule.
\\Cape-nt\,r.*clerk\CityClk\Rewlutiom\FEES\Reclaimed Water Connection 2000.doc
City of Cape Canaveral
Resolution No. 2000-04
Page 2
SECTION 3. If any provision, paragraph, word, section or article of this
resolution is invalidated by any court of competent jurisdiction, the remaining
provisions, paragraphs, words, sections, and articles shall not be affected and shall
continue in full force and effect.
SECTION 4. The resolution shall become effective upon adoption.
ADOPTED BY the City Council of the City of Cape Canaveral, Florida, this 1 st
day of February, 2000.
Rocky Randels, MAYOR
ATTEST: FOR AGAINST
Sandra 0. Sims, CITY CLERK
APPROVED AS TO FORM:
Kohn Bennett, CITY ATTORNEY
Larry Weber
Richard Treverton
Burt Bruns
Buzz Petsos
Rocky Randels
11Cape-M1\cityclerklCityClk\Resolutions\FEES\Reclaimed Water Connection 2000.doc
RESOLUTION NO. 2000-05
A RESOLUTION OF THE CITY OF CAPE CANAVERAL, BREVARD
COUNTY, FLORIDA; AUTHORIZING AN EMPLOYEE FUNDED
SUPPLEMENTAL INSURANCE CAFETERIA PLAN WITHIN THE
CONTEXT OF SECTION 125 OF THE INTERNAL REVENUE CODE;
PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, The City Council wishes to adopt a cafeteria plan within the context
of Section 125 of the Internal Revenue Code for the benefit of the City's eligible
employees.
NOW, THEREFORE, BE IT RESOLVED, by the City Council of the City of Cape
Canaveral, Brevard County, Florida, as follows:
SECTION 1. The City of Cape Canaveral hereby adopts the Flexible Benefits
Plan, consisting of the flexible benefits plan document, the Adoption Agreement, and
component benefit plans and policies as attached.
SECTION 2. This Resolution shall take effect immediately upon its adoption.
ADOPTED BY the City Council of the City of Cape Canaveral, Florida, this 1 st
day of February 2000.
ATTEST:
Sandra 0. Smith, CITY CLERK
APPROVED AS TO FORM:
Kohn Bennett, CITY ATTORNEY
Rocky Randels, MAYOR
FOR AGAINST
Larry Weber
Richard Treverton
Burt Bruns
Buzz Petsos
Rocky Randels
\\Cape-nt\cityclerk\CityClk\Resolutions\CONTRACT\Supplemental Insurance and Section 125.DOC
01-21-00
SANDRA O SMITH
CITY OF CAPE CANAVERAL
105 POLK AVENUE PO BOX 326
CAPE CANAVERAL, FL 32920
Dear SANDRA O SMITH:
Welcome to AFLAC's FLEX ONE Cafeteria Program. Enclosed in this packet are the
necessary forms to establish a cafeteria plan with the assistance of FLEX ONE .
1) Flexible Benefits Plan Document - containing the Adoption Agreement and Table of
Contents. Each separate document should be executed and one copy sent to AFLAC
FLEX ONE for our records.
2) Corporate Resolution - to be executed and kept by Employer.
3) Summary Plan Description - One copy should be distributed to each eligible
employee (regardless of whether they actually choose to participate) by the employer.
4) Salary Redirection Agreement
5) Once the Plan is In Operation - Pertinent Information.
You should carefully review the Flexible Benefits Plan Document and Summary Plan Description
to verify that all of the information concerning benefits offered; eligibility, plan administration and funding
have been correctly produced.
Due to the complexity of cafeteria plans, we recommend that you consult with your accountant, attorney
or other tax advisor concerning the plan provisions, administration and operation before executing the
plan documents. You should note that these documents are only documents typical of a plan intended
to qualify as a Section 125 cafeteria plan with the terms and conditions thereof, and that they may need
to be modified to conform to your individual circumstances.
AFLAC has developed these documents with legal counsel and it is AFLAC's intent and belief
that the documents in form satisfy the requirements of Code Section 125. However, AFLAC is not in
the business of offering legal counsel or tax advice, and thus AFLAC cannot and does not make any
representations about the legal or tax effect of these documents upon any particular employer.
Therefore, it is each employer's responsibility to determine, with the assistance of the employer's own
FLEX ONE' • Flexible Benefit Management • A Service of American Family Life Assurance Company of Columbus (AEUOG297AA
Worldwide Headquarters: 1932 Wynnton Road • Columbus, Georgia 31999 • (706) 323-3431 �)
legal counsel, the suitability of these particular documents and the legal and tax effect of these plan
documents upon the employer and its employees.
Since AFLAC has no control over your subsequent modification and/or administration of the
Plan, and the Internal Revenue Service will not render an opinion as to a plan's qualified status under
IRS Code Section 125, AFLAC makes no representation (express or implied) as to your Plan's
qualification under IRS Code Section 125 and related provisions as it is adopted and subsequently
amended. Furthermore, you as sponsoring employer bear sole responsibility for amending your plan
(as- necessary) to comply with future tax law changes, for meeting all reporting and disclosure
requirements imposed by federal law, and for the daily administration of your plan.
If your Company is related to any other company through stock ownership or otherwise (e.g.,
partnership, relatives owning other company, etc.), you may need to consider the employees of the
affiliated company for purposes of nondiscrimination testing even if the affiliated company does not
adopt this plan, or adopts an entirely separate plan. In addition, if the requirements of IRS Code
Section 414(b), (c), (m) or (o) are satisfied, the employees of the affiliated company may be able to
participate in this plan. You should consult with your tax advisor concerning the potential impact of IRS
Code Section 414(b), (c), (m) and (o).
Please note that your cafeteria plan will not be effective until your plan is adopted, and the Plan
Documents must be signed PRIOR TO THE EFFECTIVE DATE. Once you have executed the Flexible
Benefits Plan Document and Corporate Resolution, if applicable, you need to send an executed copy of
the Adoption Agreement to FLEX ONE so your adoption of the cafeteria plan can be verified. Note that
while the Plan and related documents are copyrighted, AFLAC gives you limited permission to copy the
documents as necessary for distribution to your employees for use solely in the operation of your own
cafeteria plan.
FLEX ONE will send you an Employer's Administration Manual which details your
responsibilities as Plan Administrator of your cafeteria plan.
AFLAC will make its best efforts to provide employers information from time to time about
developments concerning Section 125 plans. However, for reasons stated above, it is the employer's
responsibility to maintain the qualified status of the Section 125 plan, in form and in operation. Should
you have any questions concerning the FLEX ONE cafeteria Program, you may contact us at
1-800-323-5391 between the hours of 8:30 a.m. and 7 p.m. Eastern time, Monday through Friday.
Sincerely,
Cheryl M. Moss
Second Vice President
Director of Administration/Compliance
PROC297A.4
ONCE THE PLAN IS IN OPERATION
New Employees should be enrolled into the Cafeteria Plan as they become eligible and satisfy
any applicable waiting period by distributing a Summary Plan Description (SPD) and Salary Redirection
Agreement to them at least thirty (30) days prior to their eligibility and notifying your AFLAC
representative as to their eligibility. (Note: if your employees are eligible to participate as of the date
they commence employment, you need to distribute the SPD and Salary Redirection Agreement to
them on their first day of work, and permit them to enroll in the plan during the next thirty (30) days).
Rehired Employees who previously participated in the Cafeteria Plan and were permitted to
terminate their participation upon their termination of employment will be unable to re -enroll in the
Cafeteria Plan until the next anniversary date.
A Change in Family Status will enable a current participant to change or terminate a Salary
Redirection Agreement. It will also enable an employee who is otherwise eligible to be a participant, but
who failed to complete a Salary Redirection Agreement during the enrollment period, to become a
participant and file a Salary Redirection Agreement. However, the election under the new Salary
Redirection Agreement must be made on account of and be consistent with the Change in Family
Status. For this purpose, a Change in Family Status is defined as:
* the employee's marriage or divorce;
* the birth or adoption of an employee's child;
* the death of an employee's spouse or child;
* the commencement or termination of employment by the employee or employee's
spouse;
* a change of employment status from full-time to part-time (or vice versa), by the
employee or employee's spouse, or if either take an unpaid leave of absence from
work;
* a significant change in health benefits coverage attributable to the employment of the
employee's spouse.
Significant Increase In Premiums or Significant Curtailment in Coverage under a health
plan by an independent, third -party provider (e.g., an insurance company) will permit affected
participants to revoke a prior election, and in lieu thereof, receive on a prospective basis, coverage
under another health plan with similar coverage. The Plan Administrator needs to inform affected
participants as to such significant changes, after which affected participants will have thirty (30) days to
elect alternative coverage.
Payroll Instructions will be more thoroughly reviewed with you or your payroll specialist by the
AFLAC representative. In general, however, any qualified pre-tax benefit (e.g., accident or health
insurance, group term life insurance, medical or dependent care reimbursement) may be funded by
employee salary redirection on a dollar for dollar basis. After-tax qualified benefits (e.g., cash or
benefits treated like cash that do not defer the receipt of compensation) must be funded with employee
contributions after taxes are withheld. Therefore, the amount redirected from an employee's salary for
after-tax benefits will exceed the premium by the amount of applicable federal, state, or local income
and employment taxes.
5500's and Summary Annual Report - All employers are required to file a Form 5500 (with
schedules) within seven months after the end of the plan year. Employers with more than 100
participants are also required to distribute a Summary Annual Report to plan participants within nine
months after the close of the plan year if you are subject to ERISA. Upon request, FLEX ONE will
assist you with the 5500 filing to satisfy Code Section 6039D only. A separate Form 5500 may need to
be filed to satisfy any ERISA imposed obligations.
PROC297B.5
Nondiscrimination Testing is at the very core of the legal requirements imposed by Section
125 of the Internal Revenue Code. Each cafeteria plan sponsor must ensure that its plan satisfies all
applicable nondiscrimination requirements imposed by the Internal Revenue Code. Failure to satisfy
these requirements will cause adverse tax consequences to highly compensated employees and could
possibly disqualify the plan. At a minimum, each plan sponsor should undertake nondiscrimination
testing near the beginning and end of each plan year, and whenever there is a substantial change in the
participation and/or elections under the plan.
Summary Plan Description - All plan administrators are required to give each eligible
employee a copy of the summary plan description within 120 days of the effective date of the initial plan
year and within 90 days of the effective date of coverage for all subsequent plan years. If an employer
makes a change in the plan, the employer must -provide the employees with summary of the changes
Summary of Material Modifications (SMM) within seven months after the ending date of the plan year.
Regulations require that the Summary Plan Description (SPD) display both the Employer Tax
Identification (EIN) number and a Plan Identification Number (PIN). You should assign a PIN beginning
with the number 501 (Item 4). If this is the first ERISA plan number assigned, the PIN number will be
501. Otherwise, the PIN will be the next available number (e.g. 502, 503, etc.). More elaborate
instructions and filing requirements for all of these documents will be included in the Employer's
Administration Manual. However, you and/or your plan administrator bear sole responsibility for
administering the plan and fulfilling all reporting and disclosure obligations.
Certain Insurance Premiums which cover the employee (or employee and tax
dependents/family) may be included in the FLEX ONE Plan Documents if adopted as part of your
benefits plan. These include:
Group Term Life Insurance covering the employee (Eligible under IRS Code Section 79) that is
equal to or less than $50,000;
Individual and group Medical, Dental, Hospital Indemnity, Cancer Insurance, Vision, Hearing and
other qualified premiums.
Use caution when including disability income policies within the FLEX ONE Plan since this
could make the benefits taxable at the time of claim.
Continuation of Coverages - Health benefits offered through a cafeteria plan may be subject
to the continuation coverage provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985
("COBRA"). This law provides that for all employers of 20 or more employees (including employees of
affiliated companies, part-time employees, and certain self-employed and leased employees) on a
typical business day, covered participants must be allowed the opportunity to continue employer
sponsored health benefits should their coverage under the employer's program cease for any reason
except termination for gross misconduct.
All health coverages elected under the cafeteria plan (including unreimbursed Medical Expense
Reimbursement Coverage) are eligible for continuation. Coverages not eligible for continuation include:
Group Term Life, Disability, Accidental Death and Dismemberment and Group Travel Accident
Insurance.
The right to continuation of coverage begins upon the occurrence of certain events. Such
events include a loss or change in the employee's or employee's dependents coverage due to:
a. death of the covered employee;
b. termination of the covered employee (for reasons other than gross misconduct);
C. reduction in the employee's hours of employment;
d. divorce or legal separation of the employee;
e. the employee becoming entitled to Medicare; or
f. a dependent's loss of dependent status under a medical plan.
PROC297B.5
The law requires that the covered individual be extended the opportunity to maintain
continuation coverage for 3 years unless the loss of coverage was attributable to the covered
employee's termination of employment or reduction in hours. In that case, the required continuation
coverage period is 18 months. For an employee or family member who is disabled within sixty (60)
days of the employee's termination or reduction in hours, the continuation coverage period is 29
months.
The health plan administrator is required to provide notification of the right to continuation of
benefits to all eligible employees and their dependents. Employees have 60 days from the date the
notification of the right to continue is given to formally continue their coverage. The continuation will be
at the employee's expense as no employer contribution is required. Employees have 45 days from the
date on which they give notice of their intent to continue coverage to pay the required premiums. The
cost of the benefits must be at the regular premium rate, but may include up to a 2% handling fee.
If you have questions regarding COBRA or its effects on the coverage for your employees,
please contact your Legal Advisor or other Tax professional for information.
aaoczs7e.s
ADOPTION AGREEMENT FOR:
CITY OF CAPE CANAVERAL
FLEXIBLE BENEFITS PLAN
ESTABLISHMENT OF THE PLAN
The Employer named below established as set forth herein, a Flexible Benefits Plan (the "Plan") as of
the Effective Date consisting of this Adoption Agreement, the Plan Document and the Benefit Plans and
Policies specifically referred to herein including the Dependent Care Expense Reimbursement Plan
and/or an Medical Care Expense Reimbursement Plan. The purpose of the Flexible Benefits Plan is to
provide eligible Employees a choice between cash and the specified welfare benefits described in this
Adoption Agreement. Pre-tax Premium elections under the Plan are intended to qualify for the exclusion
from income provided in Section 125 of the Internal Revenue Code of 1986.
EMPLOYER INFORMATION
1) Name and Address of Employer/ CITY OF CAPE CANAVERAL
Plan Administrator: SANDRA O SMITH
105 POLK AVENUE PO BOX 326
CAPE CANAVERAL, FL 32920
2) Employer Telephone Number: (321) 868-1220
3) Employer's Federal Tax
Identification Number: 59-0974636
4) 125 Start Date: 02/01/00
5) Effective Date of this Plan: 02/01/00
6) Last Day of the Plan Year: 09/30/00
Subsequent Plan Years: 10/01-09/30
7) Name and Address of the Plan SAME
Service Provider:
8) Name and Address of registered SANDRA O SMITH
agent for service of legal CITY CLERK
process:
01/06/99 version
1
Copyright January 1, 1990
PROC297B.5
9) Affiliated Employers which will participate in the Plan:
10) Employer's type of business: OTHER
2
PROC297B.5
ELIGIBILITY
All Employees employed by the Employer shall be eligible to participate under the Plan except the
following: (Describe)
An eligible Employee may become a Participant in the Plan:
( ) Immediately, upon his first day of employment (but not prior to the Effective Date of the Plan
( ) On the day following commencement of employment
( ) On the first day of the month following days of employment
( X } ON THE 1ST DAY OF MTH FOLLOWING DATE OF EMPLOYMENT
provided the Employee completes a Salary Redirection Agreement. However, eligibility for
coverage under any given Benefit Plan or Policy shall be determined by the terms of that
Benefit Plan or Policy, and reductions of the Employee's Compensation to pay Pre-tax or
After-tax Premiums shall commence when the Employee becomes covered under the applicable
Benefit Plan or Policy.
An eligible Employee may become a Participant in the Dependent Care and/or Medical Expense
Reimbursement Plan(s):
( ) Immediately, upon his first day of employment (but not prior to the Effective Date of the Plan).
( ) On the day following commencement of employment.
( ) On the first day of the month following days of employment,
( ) OTHER
provided the Employee completes a Salary Redirection Agreement selecting such benefits.
BENEFITS PROVIDED UNDER THE PLAN
The Employer elects to offer to eligible Employees the following Benefit Plans and Policies subject to
the terms and conditions of the Plan. These component Benefit Plans and Policies are specifically
incorporated herein by reference. The maximum Pre-tax Premiums a Participant can contribute via the
Salary Redirection Agreement is the aggregate cost of the applicable Benefit Plans or Policies selected
minus any Nonelective Contribution made by the Employer. It is intended that such Pre-tax Premium
accounts shall, for tax purposes, constitute an Employer contribution, but may constitute Employee
contributions for state insurance law purposes. [A copy of these plans should be attached as an
appendix.]
( X)
Group Medical Insurance.
( X)
Vision Care Insurance.
( X)
Disability Income -Short Term (A&S).
( X)
Cancer Insurance.
( )
Accidental Death and Dismemberment.
( X)
Group Dental Coverage.
( X)
Group Term Life Insurance.
( )
Disability Income -Long Term (LTD).
( )
Intensive Care Insurance.
( X)
Accident Insurance
( )
Hospital Indemnity Insurance (HIP)
( )
Specified Health Event
3
PROC297B.5
Medical Care Expense Reimbursement described in Section 5.01(b) of the Plan, not to exceed
0 per Plan Year pursuant to the
CITY OF CAPE CANAVERAL
Medical Care Expense Reimbursement Plan.
Dependent Care Expense Reimbursement described in Section 5.01(c) of the Plan not to
exceed $5,000 per Plan Year or $2,500 for married filing separate returns pursuant to the
CITY OF CAPE CANAVERAL
Dependent Care Expense Reimbursement Plan.
Opt -out Option: Additional taxable compensation for certain participants who opt -out of certain
coverages (as described in enrollment materials).
THE FUNDING AGENT
The Employer selects the following Funding Agent for the Plan (check one):
The Employer, which will comply with the requirements of Section 7.02 of the Plan.
The Flexible Benefits Trust created concurrently with the execution of the Plan, which shall
receive contributions under the Plan in accordance with Section 7.03 of the Plan.
ADMINISTRATIVE EXPENSES
Administrative Expenses incurred in operating the Plan shall be paid by (check one):
The Employer, except as otherwise noted in the Plan.
The Participants, except as otherwise noted in the Plan.
EMPLOYER'S ACKNOWLEDGMENT
As evidenced by the formal execution of this Adoption Agreement, the undersigned Employer adopted
and established this Plan on the Effective Date as the Flexible Benefits Plan of the undersigned
Employer. In doing so, the undersigned Employer acknowledges that this Adoption Agreement and this
Plan are important legal instruments with significant legal and tax implications.
The Employer also acknowledges that it has read this Adoption Agreement and the Plan in their entirety,
has consulted independent legal and tax counsel other than representatives of American Family Life
Assurance Company of Columbus (AFLAC), to the extent considered necessary, and accepts full
responsibility for participation of Employees hereunder and the operation of the Plan. The Employer
acknowledges that as sponsor, and the Plan Administrator it shall have sole responsibility to comply with
all filing, reporting, and disclosure requirements imposed by the Department of Labor, Internal Revenue
Service, or any other government agency, specifically including, but not limited to creating, filing, and
distributing Summary Annual Reports, Form 5500's, and Summary Plan Descriptions. Furthermore, the
Employer further acknowledges that it shall bear sole responsibility for amending the Plan as necessary
to ensure compliance with applicable tax, labor, and other laws and regulations.
It is also understood and agreed that American Family Life Assurance Company of Columbus (AFLAC),
and its Subsidiaries, agents, and representatives, are not providing legal or tax advice to the
undersigned Employer in connection with this Plan and that no representations are made by it with
respect to the operation of the Flexible Benefits Plan pursuant to the documents provided by American
Family Life Assurance Company of Columbus (AFLAC) to the Employer.
4
PROC2978.5
This Plan shall be construed and enforced according to the Internal Revenue Code of 1986, as
amended from time to time, the applicable regulations thereto and the laws of the state of the principal
place of business of the Employer.
IN WITNESS WHEREOF, the Employer has caused this
on the day of :alit , VP , 1.bCC to ratify the adoption
Effective Date.
WITNESS:
Corporate Officer
•
5
Plan and Adoption Agreement to be executed
of the Plan adopted and effective as of the
Employer:
By:
Title:
Date:
PROC2978.5
ARTICLE II - ELIGIBILITY AND PARTICIPATION
4
2.01
TABLE OF CONTENTS
4
FLEXIBLE BENEFITS PLAN
PREAMBLE
4
ARTICLE I - DEFINITIONS 1
1.01
"Affiliated Employer" 1
1.02
"After-tax Premium(s)" 1
1.03
"Anniversary Date" 1
1.04
"Benefit Plan(s) or Policy(ies)" 1
1.05
"Board of Directors" 1
1.06
"Change in Family Status" 1
1.07
"Code" 1
1.08
"Compensation" 1
1.09
"Dependent" 1
1.10
"Dependent Care Expense Reimbursement" 1
1.11
"Earned Income" 1
1.12
"Effective Date" 1
1.13
"Eligible Employment Related Expenses" 1
1.14
"Eligible Medical Expenses" 2
1.15
"Employee" 2
1.16
"Employer" 2
1.17
"ERISA" 2
1.18
"Highly Compensated Individual" 2
1.19
"Key Employee" 2
1.20
"Medical Care Expense Reimbursement" 2
1.21
"Nonelective Contributions" 2
1.22
"Participant" 2
1.23
"Plan" 2
1.24
"Plan Administrator" or committee 3
1.25
"Plan Year" 3
1.26
"Pre-tax Premium(s)" 3
1.27
"Qualified Benefit" 3
1.28
"Qualifying Employment -Related Expenses" 3
1.29
"Qualifying Individual" 3
1.30
"Qualifying Services" 3
1.31
"Reimbursement Account(s) or Account(s)" 3
1.32
"Salary Redirection Agreement" 4
1.33
"Spouse" 4
1.34
"Student" 4
1.35
"Trustee" 4
ARTICLE II - ELIGIBILITY AND PARTICIPATION
4
2.01
Eligibility to Participate
4
2.02
Entry Date
4
2.03
Termination of Participation
4
2.04
Eligibility to Participate in Reimbursement Benefits
4
2.05
Qualifying Leave Under Family Leave Act
5
ARTICLE III - PREMIUM ELECTIONS
5
3.01
Election of Premiums
5
3.02
Initial Election Period
5
3.03
Annual Election Period
5
3.04
Change of Premium Election
6
3.05
Termination of Election
6
PROC297B.5
ARTICLE IV - PREMIUM PAYMENTS AND CREDITS
AND DEBITS TO ACCOUNTS
7
4.01
Source of Premium Payments 7
4.02
Allocations Irrevocable During Plan Year 7
4.03
Reduction of Certain Elections to Prevent Discrimination 7
4.04
Modification of Amounts Withheld due to Premium Increases 7
4.05
Medical Care Expense Reimbursement 7
4.06
Dependent Care Expense Reimbursement 8
ARTICLE V - BENEFITS
D
5.01
Qualified Benefits
8
5.02
Cash Benefit
9
5.03
Repayment of Excess Reimbursements
9
5.04
Termination of Reimbursement Benefits
10
5.05
COBRA Coverage
10
5.06
Coordination of Benefits Under Health FSA
10
ARTICLE VI -
PLAN ADMINISTRATION
10
6.01
Allocation of Authority
10
6.02
Provision for Third -Party Plan Service Providers
11
6.03
Fiduciary Liability
11
6.04
Compensation of Plan Administrator
11
6.05
Bonding
11
6.06
Payment of Administrative Expenses
11
6.07
Funding Policy
11
6.08
Disbursement Reports
11
6.09
Reporting and Disclosure Obligations
11
6.10
Indemnification
11
6.11
Substantiation of Expenses
12
6.12
Reimbursement
12
6.13
Annual Statements
12
ARTICLE VII -
FUNDING AGENT
12
7.01
Funding of the Plan
12
7.02
The Employer as Funding Agent
12
7.03
Trust as Funding Agent
12
ARTICLE VIII - CLAIMS PROCEDURES
12
8.01
Application to Plan Benefits
12
8.02
Procedure if Benefits are Denied Under the Plan
13
8.03
Requirement for Written Notice of Claim Denial
13
8.04
Right to Request Hearing on Benefit Denial
13
8.05
Disposition of Disputed Claims
13
ARTICLE IX -
AMENDMENT OR TERMINATION OF PLAN
13
9.01
Permanency
13
9.02
Employer's Right to Amend
13
9.03
Employer's Right to Terminate
14
9.04
Determination of Effective Date of Amendment or Termination
14
PROC297B.5
ARTICLE X - GENERAL PROVISIONS
14
10.01
Not an Employment Contract
10.02 Applicable Laws
14
10.03
Post -Mortem Payments
14
10.04
Nonalienation of Benefits
14
10.05
Mental or Physical Incompetency
14
10.06
Inability to Locate Payee
14
10.07
Requirement for Proper Forms
14
10.08
Source of Payments
14
10.09
Multiple Functions
14
10.10
Tax Effects
15
10.11
Gender and Number
15
10.12
Headings
15
10.13
Incorporation by Reference
15
10.14
Severability
15
10.15
Effect of Mistake
15
10.16
Provisions Relating to Insurers
15
15
ARTICLE XI - CONTINUATION COVERAGE UNDER COBRA
15
11.01
Continuation Coverage After Termination of Normal Participation
11.02
Who is a "Qualified Beneficiary"
16
11.03
Who is not a "Qualified Beneficiary"
16
11.04
What is a "Qualifying Event"
16
11.05
What Benefit is Available Under Continuation Coverage
16
11.06
Notice Requirements
16
11.07
Election Period
17
11.08
Duration of Continuation Coverage
17
11.09
Automatic Termination of Continuation Coverage
17
17
PROC2978.5
PREAMBLE
The Employer hereby establishes a Flexible Benefits Plan ("Plan") for its Employees for
purposes of providing eligible Employees with the opportunity to choose from among the fri nder the rovisionsflof
available under the Plan. The Plan is t CaretExpense Reimbursement ended to qualify as a fPlan (' DCReteria plan U) is intended to qualify
Code Section 125. The DependenExpe
as a Code Section 129 dependent care` assistance
plan, and the Code SectionMedical Care a penseRe mbursement
se
Plan ("Health FSA") is intended to quality as a FSA ns are separate written
lans
plan. Although printed within this document, the
iscrHm elation requaeme iimposed by Se tions
for purposes of administration and all reporting and nond
105 and 129 of the Code and all applicable provisions of ERISA. The DCR and Medical Care Expense
Reimbursement Plans are available only if designated on the Adoption Agreement.
FLEXIBLE BENEFITS PLAN
ARTICLE I
DEFINITIONS
1.01 "Affiliated Employer" means any Employer within the context of Code Section 414(b),
(c),or (m) of the Code which will be treated as single employer for purposes of Code Section 125.
1.02 "After-tax Premium(s)" means amounts withheld from an Employee's Compensation
pursuant to a Salary Redirection Agreement to purchase coverages available under the Adoption
Agreement on an after-tax basis.
1.03 "Anniversary Date" means the first-day of any Plan Year.
1.04 "Benefit Plan(s) or Policy(ies)" means those Qualified Benefits available to a Participant
under the Adoption Agreement.
1.05 "Board of Directors" means the Board of Directors of the Employer. The Board of
Directors, upon adoption of this Plan appoints the Committee to act on the Employer's behalf in all
matters regarding the Plan.
1.06 "Change In Family Status" means, and is limited to, a Participant's marriage or divorce;
the death of a Participant's spouse or child; the birth or adoption of a Participant's child; the termination
of employment (or commencement of employment) of the Participant's spouse; a change in
employment status from full-time to part-time (or vice versa) by the Participant or the Participant's
spouse; an unpaid leave of absence by either the Participant or the Participant's spouse; a significant
change in the health coverage of the Participant or the Participant's spouse's attributable to the
spouse's employment; or such other events as may be described by the Internal Revenue Service from
time to time as a Change in Family Status.
1.07 "Code" means the Internal Revenue Code of 1986, as amended.
1.08 "Compensation" means the cash wages or salary paid to an Employee by the Employer.
1.09 "Dependent" means any individual who is a tax dependent of the Participant within the
purview of Code Sec.152(a), or who is determined to be an alternative receipt of a Plan Participant
under an order determined to be a qualified medical child support order (QMCSO) by the Plan
Administrator, provided however, that in the case of a divorced Employee Dependent shall be defined
as in Code Section 21(e)(5) (e.g., dependent of the parent with the custody) for purposes of the
Dependent Care Expense Reimbursement Plan.
1.10 "Dependent Care Expense Reimbursement" shall have the meaning assigned to it by
Section 5.01(c) of the Plan.
1.11 "Earned Income" means all income derived from wages, salaries, tips, self-employment,
and other Employee Compensation (such as disability or wage continuation benefits), but does not
include (a) any amounts received pursuant to any dependent care assistance program under Section
129 of the Code, (b) any amount received as a pension or annuity, or (c) workers compensation.
1.12 "Effective Date" means the effective date of the Plan specified in the Adoption
Agreement.
1.13 "Eligible Employment Related Expenses" means those Qualifying Employment -Related
Expenses (as defined below) paid or incurred incident to maintaining employment after the date of the
Employee's participation in the Dependent Care Expense Reimbursement Plan and during the Plan
Year, other than amounts paid to:
(a) an individual with respect to whom a Dependent deduction is allowable under Code Sec.
151(a) to the Participant or his Spouse;
1
PROC297B.5
(b) the Participant's Spouse; or
(c) a child of the Participant who is under 19 years of age.
1.14 "Eligible Medical Expenses" means those expenses incurred by the Employee, or the
Employee's Spouse or Dependents, after the date of the Employee's participation in the Medical Care
Expense Reimbursement Plan and during the Plan Year otherwise allowable as deductions under Code
Sec. 213 (without regard to the limitations contained in Sec. 213(a)), but shall not include i)expenses for
qualified long term care services (as defined in Code 7702B(c); or ii) an expense incurred for the
payment of premiums under a health insurance plan. For purposes of this Plan, an expense is
"incurred" when the Participant or beneficiary is furnished the medical care or services giving rise to the
claimed expense.
1.15 "Employee" means any individual who is considered to be in a legal employer-employee
relationship with the Employer for federal withholding tax purposes. Such term includes "former
employees" for the limited purpose of allowing continued eligibility for benefits hereunder for the
remainder of the Plan Year in which an employee ceases to be employed by the Employer. The term
"Employee" shall not include any leased employee (as that term is defined in Code Section 414(n) or
any self employed individual who receives from the Employer "net earnings from self employment"
within the meaning of Code Section 401(c)(2) unless such individual is also an Employee.
1.16 "Employer" means the organization(s) named in the Adoption Agreement, provided,
however, that when the Plan provides that the Employer has a certain power (e.g.,. the appointment of a
Plan Administrator, entering into a contract with a third parry insurer, or amendment or termination of the
plan) the term "Employer" shall mean only that entity named on the first line of the Adoption
Agreement, and not any Affiliated Employer. Affiliated Employers who sign the Adoption Agreement
shall be bound by the Plan as adopted and subsequently amended unless they clearly withdraw from
participation herein.
1.17 "ERISA" shall mean the Employee Retirement Income Security Act of 1974, as amended.
1.18 "Highly Compensated Individual" means an individual defined under Code Section
125(e), 129(d)(2), or 105(h)(5), as amended, as a "highly compensated individual" or a "highly
compensated employee."
1.19 "Key Employee" means an individual who is a "key employee" as defined in Code
Section 125(b)(2), as amended.
1.20 "Medical Care Expense Reimbursement" shall have the meaning assigned to it by
Section 5.01(b) of the Plan.
1.21 "Nonelective Contribution (s)" means any amount which the Employer in its sole
discretion may contribute on behalf of each Participant to provide benefits for such Participant and his
or her Dependents, if applicable under the Plan. The amount of Nonelective Contribution for each
Participant may be adjusted upward or downward in the contributing Employer's sole discretion. The
amount shall be calculated for each Plan Year in a uniform and nondiscriminatory manner based upon
the Participant's dependent status, commencement or termination date of the Participant's employment
during the Plan Year, and such other factors as the Employer shall prescribe. Except as otherwise
provided in the Adoption Agreement in no event will any Nonelective Contribution be disbursed to a
Participant if the cost of the benefit(s) elected is less than the Nonelective Contribution allocable
thereto. Any excess shall be returned to the Employer.
1.22 "Participant" means an Employee who becomes a Participant pursuant to Article II.
1.23 "Plan" means the Adoption Agreement, the Flexible Benefits Plan and (if applicable) the
related Trust created by this document.
2
PROC2976.5
1.24 "Plan Administrator" or committee means the person(s) appointed by the Employer
with authority and responsibility to manage and direct the operation and administration of the Plan. If no
such person is named, the Plan Administrator shall be the Employer.
1.25 "Plan Year" means the twelve month period specified in the Adoption Agreement
provided, however, that a period of less than twelve months may be a Plan Year for the initial Plan Year,
the final Plan Year, and a transition period to a different Plan Year.
1.26 "Pre-tax Premium(s)" means any amount withheld from the Employee's Compensation
pursuant to a Salary Redirection Agreement which is intended to be paid on a pre-tax basis. This
amount shall not exceed the premiums attributable to the most costly Benefit Plan of Policy options
afforded hereunder, and for purposes of Code Section 125, shall be treated as an Employer contribution
(this amount may, however, be treated as an Employee contribution for purposes of state insurance
laws).
1.27 "Qualified Benefit" means any benefit excluded from the Employee's taxable income
under Chapter 1 of the Code (other than Sections 106(b),117, 124, 127, or 132), and any other benefit
permitted by the Income Tax Regulations (i.e., any group -term life insurance coverage that is includable
in gross income by virtue of exceeding the dollar limitation on nontaxable coverage under Code Sec.
79). Long-term care insurance is not a "Qualified Benefit".
1.28 "Qualifying Employment -Related Expenses" means those expenses that would be
considered to be employment-related expenses under Section 21(b)(2) of the Code (relating to
expenses for household and dependent care services necessary for gainful employment) if paid for by
the Employee to provide Qualifying Services. Such expenses must not be paid or payable to a child of
the Employee who is under age 19 at the end of the year in which the expenses are incurred or an
individual for whom the Employee or Employee's spouse is entitled to a personal tax exemption. as a
dependent.
1.29 "Qualifying Individual" means:
(a) a Dependent of the Participant who is under the age of thirteen (13);
(b) a Dependent of a Participant who is mentally or physically incapable of caring for himself or
herself; or
(c) the Spouse of a Participant who is mentally or physically incapable of caring for himself or
herself.
1.30 "Qualifying Services" means services relating to the care of a Qualifying Individual that
enable the Participant or his Spouse to remain gainfully employed which are performed:
(a) in the Participant's home; or
(b) outside the Participant's home for (1) the care of a Dependent of the Participant who is
under age 13, or (2) the care of any other Qualifying Individual who resides at least eight (8)
hours per day in the Participant's household. If the expenses are incurred for services provided
by a dependent care center (i.e., a facility that provides care for more than 6 individuals not
residing at the facility), the center must comply with all applicable state and local laws and
regulations.
1.31 "Reimbursement Account(s) or Account(s)" shall be the funding mechanism by which
amounts are withheld from an Employee's Compensation and retained for future Medical Care Expense
Reimbursement or Dependent Care Expense Reimbursement. These amounts may either be retained
by the Employer, sent to a third party plan administrator, and/or kept in trust for Employees. No
money shall actually be allocated to any individual Participant Account(s); any such Account(s) shall
be of a memorandum nature, maintained by the Administrator for accounting purposes, and shall not be
3
PROC297B.5
representative of any identifiable trust assets. No interest will be credited to or paid on amounts
credited to the Participant Account(s).
1.32 Salary Redirection Agreement" means the actual or deemed agreement pursuant to
which an eligible Employee or Participant enrolls in the specific component Benefit Plans or Policies
with Pre-tax Premiums or After-tax Premiums in accordance with Article III.
1.33 "Spouse" means an individual who is legally married to a Participant, but for purposes of
the Dependent Care Expense Reimbursement Plan provisions, shall not include an individual legally
separated from the Participant under a divorce or separate maintenance decree, nor shall it include an
individual who, although married to the Participant, files a separate federal income tax return,
maintains
a separate, principal residence from the Participant during the last six months of the taxable year, and
does not furnish more than one-half of the cost of maintaining the principal place of abode of the
Qualifying Individual.
1.34 "Student" means an individual who, during each of five (5) or more calendar months
during the Plan Year, is a full time student at any college or university, the primary function of which is
the conduct of formal instruction, student
body in attendance ch routinely
at he location where tsculty and curriculum and
educational activities are
normally has an enrolled stude y
regularly presented.
1.35 "Trustee" (if applicable) means the person(s) or institution (and their successors) named
on the signature page attached hereto, who have assented to being so named by their signature to this
Agreement, otherwise empowered to hold and disburse the funds that are created hereunder.
ARTICLE II
ELIGIBILITY AND PARTICIPATION
2.01 Eligibility to Participate. Each Employee who meetsthe criteria
Ent set
forth in thei Adoption
Agreement shall be eligible to participate in the Plan as of any applicable Entry
the
benefits elected in the Adoption Agreement shall be subject to the additional requirements, if any,
specified in the applicable Benefit Plan or Policy. The provisions of this Article are not intended to
override any eligibility requirement(s) or waiting period(s) specified in the applicable Benefit Plans or
Policies.
2.02 Entry Date. Each eligible Employee shall become a Participant in the Plan on the Entry
Date specified in the Adoption Agreement provided that he has satisfied the requirements of the
Adoption Agreement.
2.03 Termination of Participation. Participation shall terminate on the earliest of: i) the date
an Employee ceases to be an Employee (except as otherwise provided in Section 3.05 for COBRA
coverage ); ii) when an Employee ceases to meet the eligibility requirements of Section 2.01 of this
Plan, iii) the date this Plan is amended to exclude the Employee or is terminated: iv) the effective date
of the Employee's election not to participate pursuant to Sections 3.03 or 3.04.
Subject to any specific limitations for any particular benefit which the Participant has elected, (a)
participation shall be continued during a leave of absence for which the Participant continues to receive
a salary from his or her employer and (b) participation shall be suspended during an unpaid leave of
absence.
2.04 Eligibility to Participate in Reimbursement Benefits. An Employee, who is otherwise
an Eligible Participant pursuant to Sections 2.01 and 2.02 shall be eligible to receive Medical and/or
Dependent Care Expense Reimbursements (if selected by the Employer in the Adoption Agreement) if;
(i) the additional Eligibility criteria (if any) set forth in the Adoption Agreement for the Reimbursement
benefits have been satisfied; and (ii) a Salary Redirection Agreement is property executed and
submitted on which the aforementioned benefit(s) have been selected.
4 PROC297B.5
2.05 Qualifying Leave Under Family Leave Act. Notwithstanding any provision to the
contrary in this Plan, if a Participant goes on a qualifying unpaid leave under the Family and medical'.
Leave Act of 1993 (FMLA), to the extent required by the FMLA, the Employer will continue to maintain'
the Participant's medical coverage (as defined in Code 5000) on the same terms and conditions as
though he were still an active Employee (i.e., the Employer will continue to pay its share of the premium
to the extent the Employee opts to continue his coverage). If the Employee opts to continue his
coverage, the Employee may pay his share of the premium with after-tax dollars while on leave (or pre-
tax dollars to the extent he receives compensation during the leave), or the Employee may be given the
option to pre -pay all or a portion of his share of the premium for the expected duration of the leave on a
pre-tax salary reduction basis out of his pre -leave Compensation by making a special election to that
effect prior to the date such Compensation would normally be made available to him (provided,
however, that pre-tax dollars may not be utilized to fund coverage during the next plan year), or via
other arrangements agreed upon between the Employee and the Administrator (e.g., the Administrator
may fund coverage during the leave and withhold amounts upon the Employee's return). Upon return
from such leave, the Employee will be permitted to reenter the Plan on the same basis the Employee
was participating in the Plan prior to his leave, or as otherwise required by the FMLA.
ARTICLE III
PREMIUM ELECTIONS
3.01 Election of Premiums. A Participant may elect any combination of Pre-tax Premiums or
After-tax Premiums to fund any Benefit Plan or Policy available under the Adoption Agreement, provided
however, that only Qualified Benefits (other than group term life insurance coverage in excess of
$50,000) may be funded with Pre-tax Premiums. Participants may also be permitted to elect additional
cash compensation by opting out of certain coverages to the extent described in the Adoption
Agreement under "opt -out Option".
3.02 Initial Election Period.
(a) Currently Eligible Employees. An Employee who is eligible to become a Participant in this
Flexible Benefits Plan as of the Effective Date must complete, sign and file a Salary Redirection
Agreement with the Plan Administrator during the election period (as specified. by the Plan
Administrator) immediately preceding the Effective Date in order to become a Participant on the
Effective Date. The elections made by the Participant on this initial Salary Redirection Agreement shall
be effective, subject to Section 3.04, for the Plan Year beginning on the Effective Date.
(b) New Employees and Employees Who Have Not Yet Satisfied The Flexible Benefit Plan's
Waiting Period. An Employee who becomes eligible to become a Participant in this Flexible Benefits
Plan after the Effective Date must complete, sign and file a Salary Redirection Agreement with the Plan
Administrator during the sixty (60) day period prior to the day the Employee first becomes eligible to
participate in this Plan. If an Employee is eligible to participate in this Flexible Benefits Plan on the date
he is first hired, a Salary Redirection Agreement must be completed, signed, and filed with the Plan
Administrator within thirty (30) days from the date of hire. The elections made by the Participant on this
initial Salary Redirection Agreement shall be prospectively effective as of the first pay period coinciding
with or immediately following the date that the Salary Redirection Agreement is filed (or if later, the date
of the employee's eligibility under the Flexible Benefits Plan) and, subject to Section 3.04, ending on the
last day of the Plan Year in which such participation began. Coverage under the component Benefits
Plan or Policies will be effective in accordance with the eligibility requirements contained in such
Benefits Plans or Policies.
(c) An eligible Employee who fails to complete, sign and file a Salary Redirection Agreement
with the Plan Administrator in accordance with paragraph (a) or (b) above during an initial election
period may become a participant on a later date in accordance with Section 3.03 or 3.04.
3.03 Annual Election Period. Each Employee who is a Participant in this Plan or who is
eligible to become a Participant in this Plan shall be notified, prior to each Anniversary Date of this Plan,
of his right to become a Participant in this Plan, to continue participation in this Plan, or to modify or to
cease participation in this Plan, and shall be given a reasonable period of time in which to exercise such
right: such period of time shall be known as the annual election period. An Election shall be made
5
PROC297B.5
i
by submitting a Salary Redirection Agreement to the Plan Administrator during the election period, and s
Year beginning on the Anniversary Date. A Participant or Employee
shall be effective for the entire Plan k
who fails to complete, sign and file a Salary Redirection Agreement as required by this Section 3.03
shall be deemed to have elected to continue the same coverages under the Benefit Plans or Policies I
funded by the same coverages under the Benefit Plans or Policies funded by the same election (e.g.,
ij
either Pre-tax Premiums or After-tax premiums adjusted to reflect any increase or decrease al 4
premium/cost) then in effect for such Participant or Employee. Notwithstanding the foregoing, annual
elections for participation in the Medical Care and Dependent Care Expense Reimbursement Plans must
direction Agreement prior to the beginning of each Plan Year -- no
be made by submitting a Salary Rej
deemed elections shall occur under such Plans.
1
3.04 Change of Premium Election.
(a) A Participant may change or terminate his or her Pre-tax Premiums elected on the Salary
Redirection Agreement within thirty (30) days of the occurrence of a change in Family Status, but only if
such change or termination is made on account of, and is consistent with, the change in Family Status.
Provided, however, that no Participant shall be allowed to reduce his election for Health or Dependent
Care reimbursement to a point where the annualized contribution for such benefit is less than the
amount already reimbursed. Any change in an election affecting annual Plan Contributions to the Health
FSA pursuant to this Section also will change the maximum FSA Benefits for the period of coverage
remaining in the Plan Year. Such Maximum Health FSA Benefits for the period of coverage following an
ser of: a) the maximum annual amount specified in the Adoption
election change shall be the les
Agreement for Health FSA benefits less any Health FSA reimbursements prior to the change in Family
Status; and b) the sum calculated by adding the balance remaining in the Participant's Health FSA as of
the end of the portion of the Plan Year immediately preceding the change in election, to the total Plan
Contributions scheduled to be made by the Participant during the remainder of such Plan Year.
An Employee who is eligible to become a Participant but declined to become a Participant during the
initial election period pursuant to Section 3.02(a) or (b) may become a Participant and file a Salary
Redirection Agreement with respect to Pre-tax Premiums within thirty (30) days of the occurrence of
change in Family Status, but only if the election under the new Salary Redirection Agreement is made
on account of and is consistent with, the change in Family Status. Elections made pursuant to this
Section 3.04 shall be effective for the balance of the Plan Year in which the election is made beginning
on the first day of the pay period next following the day the new Salary Redirection Agreement is filed
with the Plan Administrator, other than as provided in Section 3.04(b), below.
(b) A Participant may revoke a prior election with respect to Pre-tax Premiums and in lieu
thereof, receive on a prospective basis, coverage under another health plan with similar coverage if any
independent, third -party provider of medical benefits previously elected by the Participant either
significantly increases the premiums for such coverage, or significantly curtails the coverages available
under such plans, during the Plan Year coverage period. A Participant otherwise entitled to make an
alternate election under this Section must do so within 30 days of receipt of a written notice from the
Plan Administrator of the significant change in cost or composition of the benefit originally elected.
Such revocation and new election shall be effective on the first day of the payroll period coincident with
or immediately following the date the Participant files his new Salary Redirection Agreement with the
Plan Administrator.
3.05 Termination of Election. Except as otherwise provided in Section 2.03, Termination of
employment shall automatically revoke any Salary Redirection Agreement. Except as provided below
for COBRA continues, if revocation occurs under this Section 3.05, no new election with respect to
Pre-tax Premiums may be made by such Participant during the remainder of the Plan Year. Except as
otherwise provided in the applicable Benefit Plans or Policies, individuals who elect to continue group
health coverage pursuant to Section 5.05 and Article XI, and who are subsequently rehired during the
same Plan Year will be reinstated upon reemployment with the same election(s) such individual had
before termination.
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PROC297B.5
ARTICLE IV
PREMIUM PAYMENTS AND CREDITS AND DEBITS TO ACCOUNTS
4.01 Source of Premium Payments. The Employer shall withhold from a Participant's
Compensation on a Pre-tax or After-tax basis (as elected on the Salary Redirection Agreement) an
amount equal to the contributions required from the Participant (less any applicable Nonelective
Contribution) for coverage of the Participant, or the Participant's spouse or dependents, under the
Benefit Plans or Policies elected by the Participant and maintained by the Employer as noted in the
Adoption Agreement under this Plan. The component Benefit Plans or Policies, and required Employee
contributions thereunder shall be set forth on an annual schedule. Amounts withheld from a
Participant's Compensation as Pre-tax Premiums or After-tax Premiums shall be applied to fund benefits
as soon as administratively feasible. The maximum amount of Pre-tax Premiums plus any Nonelective
Contribution made available by the Employer for the benefit of each Plan Participant shall not exceed
the aggregate cost of the benefits elected.
4.02 Allocations Irrevocable During Plan Year. Except as provided in Sections 3.04, 3.05,
4.03, and 4.04, neither (i) the insurance coverages nor amounts withheld therefor elected under Section
5.01(a), nor (ii) the amount to be credited to a Participant Account during the Plan Year pursuant to
Sections 4.05 and 4.06, nor (iii) the allocation of such amounts to the appropriate Account(s) of the
Participant, can be changed during the Plan Year.
4.03 Reduction of Certain Elections to Prevent Discrimination. If the Plan Administrator
determines, before or during any Plan Year, that the Plan may fail to satisfy for such Plan Year any
requirement imposed by the Code or any limitation on Pre-tax Premiums allocable to Key Employees or
to Highly Compensated Individuals, the Plan Administrator shall take such action(s) as he deems
appropriate, under rules uniformly applicable to similarly situated Participants, to assure compliance with
such requirement or limitation. Such action may include, without limitation, a modification or revocation
of a Highly Compensated Individual's or Key Employee's Salary Redirection Agreement without the
consent of such Employee.
4.04 Modification of Amounts Withheld due to Premium Changes. Except as otherwise
provided in Section 3.04(b), if the cost of a health plan provided by an independent, third party provider
increases or decreases during a Plan Year, then any Participant who has elected to participate in such
health plan shall be required to make a corresponding change in his or her premium payments, and the
Plan Administrator shall increase or decrease, as the case may be, the Pre-tax Premiums or After-tax
Premiums (as applicable) under each affected Participant's Salary Redirection Agreement.
4.05 Medical Care Expense Reimbursement.
(a) Debiting and Crediting of Accounts. Each Participant's Medical Care Expense
Reimbursement Account ("Account") will be credited with amounts withheld from the Participant's
Compensation for Medical Care Expense Reimbursement pursuant to the Salary Redirection
Agreement. The Account will be debited for reimbursement amounts disbursed to the Participant in
accordance with Article V of this document. The entire amount elected by the Participant on the Salary
Redirection Agreement as an annual amount for the Plan Year for Medical Care Expense
Reimbursement less any reimbursements already disbursed shall be available to the Participant at any
time during the Plan Year without regard to the balance in the Account (provided that the periodic
premiums have been paid). Thus, the maximum amount of Medical Care Expense Reimbursement at
any particular time during the Plan Year will not relate to the amount which a Participant has had
withheld up to that time. In no event will the amount of medical expense reimbursement benefits in any
Plan Year exceed the annual amount specified for the Plan Year in the Salary Redirection Agreement
for Medical Care Expense Reimbursement. Any amount allocated to the Account shall be forfeited by
the Participant and restored to the Employer if it has not been applied to provide Medical Care Expense
Reimbursement by the ninetieth (90th) day following the end of the Plan Year for which the election was
effective. Amounts so forfeited shall be used to offset administrative expenses.
(b) Source of Payments. All Medical Care Expense Reimbursement benefits derived
hereunder shall be paid exclusively from the amounts in each Employee's Medical Care Expense
7
PROC2978.5
Reimbursement Account funded by amounts withheld from the Employee's wages pursuant to the
Salary Redirection Agreement for Medical Care Expense Reimbursement and any Nonelective
Contributions allocated thereto. In the event that an Employee's reimbursement request for Medical
Care Expense Reimbursement benefits exceeds the amount currently available in the Employee's
Medical Care Expense Reimbursement Account, the Employer shall pay the excess amount up to the
amount elected by the Participant on the Salary Redirection Agreement for Medical Care Expense
Reimbursement less any reimbursements already disbursed. Future premium payments by the
Employee shall then go to the Employer as reimbursement for the money so advanced on behalf of the
Employee.
(c) Employer Risk. If an Employee terminates employment before the Employer has been
reimbursed for the money it has advanced on behalf of the Employee, the entire unreimbursed portion
shall be deemed to be an "administrative expense" to be refunded to the Employer by any unused
Account balance(s) (if any) as provided in Section 4.05(a).
4.06 Dependent Care Expense Reimbursement.
(a) Crediting and Debiting of Accounts. Each Participant's Dependent Care Expense
Reimbursement Account ("Account") will be credited with amounts withheld from the Participant's
Compensation for Dependent Care Expense Reimbursement pursuant to the Salary Redirection
Agreement. The Account will be debited for reimbursement amounts disbursed to the Participant in
accordance with Article V of this document. In the event that the amount in the Account is less than
the amount of reimbursable benefit requests at any time during the Plan Year, the excess part of the
reimbursement will be carried over into following months (within the same Plan Year), to be paid out as
the Account balance becomes adequate. In no event will the amount of Dependent Care Expense
Reimbursement benefits exceed the amount withheld pursuant to the Salary Redirection Agreement for
any Plan Year. Any amount allocated to the Account shall be forfeited by the Participant and restored to
the Employer if it has not been applied to provide Dependent Care Expense Reimbursement for the
Plan Year by the ninetieth (90th) day following the end of the Plan Year for which the election was
effective. Amounts so forfeited shall be used to offset administrative costs.
(b) Source of Payments. All Dependent Care Expense Reimbursement benefits derived
hereunder shall be paid exclusively from the amounts in each Employee's Dependent Care Expense
Reimbursement Account funded by amounts withheld from the Employee's wages pursuant to the
Salary Redirection Agreement for Dependent Care Expense Reimbursement, and any Nonelective
Contributions allocable thereto.
ARTICLE V
BENEFITS
5.01 Qualified Benefits. The maximum benefit a Participant may elect under this Plan shall
not exceed the Sum of i) the Aggregate Premium for all Insurance Premium Payments under 5.01(a);ii)
the Maximum Medical Care Expense Reimbursement under 5.01(b); and iii) the Maximum Dependent
Care Reimbursement under 5.01(c). The Qualified Benefits available for election are one or more of the
following:
(a) Insurance Premium Payment. The Employer shall withhold from a Participant's
Compensation an amount equal to the contributions required from the Participant (less any applicable
Nonelective contribution) for coverage of the Participant, or the dependent coverage of the Participant's
spouse or Dependents, under the Benefit Plans or Policies elected by the Participant and maintained by
the Employer as noted in the Adoption Agreement. The benefits are subject to the terms and conditions
of the applicable Benefit Plans or Policies specifically referred to in the Adoption Agreement and
incorporated herein into this Plan.
(b) Medical Care Expense Reimbursement. If pursuant to the Adoption Agreement, the
Employer has elected to maintain a Medical Care Expense Reimbursement Plan, payment shall be
made to the Participant in cash as reimbursement for Eligible Medical Expenses incurred by the
Participant or his Dependents while he is an Employee, during the Plan Year for which the Participant's
election is effective. These expenses must also be expenses which --
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PROC297B.5
(1) are not covered, paid or reimbursed from any other source; and
(2) meet the criteria of tax -deductibility as a medical or dental expense under Section 213
of the Code, as amended and the regulations thereunder, and
(3) meet any limitations imposed by applicable regulations promulgated under Code Section
125; and
(4) will not be taken as a deduction from income on the Participant's federal income tax
return in any tax year; and
(5) do not exceed the lesser of (a) the maximum annual amount allocable to Medical Care
Expense Reimbursement specified in the Adoption Agreement, or (b) the annual amount
that the Employee has elected to have withheld for Medical Care Expense
Reimbursement; less previous Medical Care Expense Reimbursements made during the
Plan Year; and
(6) are verified in writing to the satisfaction of the Administrator that a covered expense has
occurred and the reimbursement for which meet the substantiation requirements of
Section 6.11.
(c) Dependent Care Expense Reimbursement. If pursuant to the Adoption
Agreement, the Employer has elected to maintain a Dependent Care Expense Reimbursement Plan,
payment shall be made to the Participant in cash as reimbursement for Eligible Employment Related
Expenses incurred by him or her while an Employee, during the Plan Year for which the Participant's
election is effective, provided that the substantiation requirements of Section 6.11 have been complied
with. No payment otherwise due a Participant hereunder shall exceed the smallest of:
(1) the Participant's Earned Income for the applicable month; or
(2) the Earned Income of the Participant's Spouse for such month (Note: a Spouse
of a Participant who is not employed during a month in which the Participant incurs
Eligible Employment Related Expenses and who is either incapacitated or a Student
shall be deemed to have Earned Income in the amount of $200 per month per
Qualifying Individual for whom the Participant incurs Eligible Employment Related
Expense(s), up to a maximum amount of $400 per month); or
(3) the annual amount the Participant has elected to have withheld from his Compensation
for Dependent Care Expense Reimbursement less any prior Dependent Care Expense
Reimbursements during the Plan Year; or
(4) Five Thousand Dollars ($5,000), or, if the Participant is married and files a separate tax
return, Two Thousand Five Hundred Dollars ($2,500) (or any future aggregate limitations
promulgated under Code Section 129) less any prior reimbursements during the Plan
Year.
5.02 Cash Benefit. Employees who elect not to receive coverage under certain Employer
sponsored plans may be entitled to additional cash compensation as described in the Adoption
Agreement under "Opt -out Option". To the extent that a Participant does not elect under a Salary
Redirection Agreement to have the maximum amount of his Compensation contributed as a Pre-tax
Premium or After-tax Premium hereunder, such amount not elected shall be paid to the Participant in
the form of normal Compensation payments; provided however, that Nonelective Contributions may not
be received in the form of cash compensation.
5.03 Repayment of Excess Reimbursements. If, as of the end of any Plan Year, it is
determined that a Participant has received payments under this Plan that exceed the amount of Eligible
Reimbursement Expenses that have been substantiated by such Participant during the Plan Year, the
Plan Administrator shall give the Participant prompt written notice of any such excess amount, and the
Participant shall repay the amount of such excess to the Employer within sixty (60) days of receipt of
such notification.
PROC297B.5
5.04 Termination of Reimbursement Benefits. Coverage under the Medical Care Expense
Reimbursement and/or Dependent Care Expense Reimbursement Plan(s) shall cease as of the date on
which a Participant is no longer employed by the Company or when a premium payment has not been
made for any reason. Provided, however, that Participants shall have the right to submit Claims for
reimbursement for Eligible Employment -Related Expenses arising during the Plan Year at any time until
ninety (90) days after the end of the Plan Year for which the election had been in effect, and to receive
reimbursement hereunder. Participants in the Medical Reimbursement Plan shall have the right to
submit claims for reimbursement for Eligible Medical Expense arising during the Plan Year and before
the- date of separation from service at any time until ninety (90) days after the end of the Plan Year for
which the election had been in effect, and to receive reimbursement hereunder. Unless a COBRA
election is made, Participants shall not be entitled to receive reimbursement for Medical Care expenses
incurred after coverage ceases under this Section, and any unused reimbursement benefits at the
expiration of the 90 -day period following the close of the Plan Year shall be treated in accordance with
Sections 4.05 or 4.06.
5.05 COBRA Coverage. Each Benefit Plan or Policy made available under Article V that is
considered to be a "group health plan" under Code Sec. 4980B, because employees and their families
are provided with health care benefits within the meaning of Code Sec. 212(d)(1), including the Medical
Care Expense Reimbursement Benefit, shall contain the necessary provisions required by Code Sec.
4980B and ERISA Sec. 601, to assure that such benefits may be continued on or after the occurrence
of the qualifying events defined in Code Sec. 4980B(f)(3).
5.06 Coordination of Benefits Under Health FSA. The Health FSA is intended to pay
benefits solely for otherwise unreimbursed medical expenses. Accordingly, it shall not be considered a
group health plan for coordination of benefits purposes, and its benefits shall not be taken into account
when determining benefits payable under any other plan.
ARTICLE VI
PLAN ADMINISTRATION
6.01 Allocation of Authority. Except as to those functions reserved within the Plan to the Employer,
the Plan Administrator appointed pursuant to the Adoption Agreement shall control and manage the
operation and administration of the Plan. The Plan Administrator shall have the exclusive right to
interpret the Plan and to decide all matters arising thereunder, including the right to construe and
interpret possible ambiguities, inconsistencies, or omissions in the Plan and the Summary Plan
Description issued in connection with the Plan. All determinations of the Plan Administrator with
respect to any matter hereunder shall be conclusive and binding on all persons. Without limiting the
generality of the foregoing, the Plan Administrator shall have the following powers and duties:
(a) To require any person to furnish such reasonable information as he may request for the
purpose of the proper administration of the Plan as a condition to receiving any benefits
under the Plan;
(b) To make and enforce such rules and regulations and prescribe the use of such forms
as he shall deem necessary for the efficient administration of the Plan;
(c) To decide on questions concerning the Plan and the eligibility of any Employee to
participate in the Plan and to make or revoke elections under the Plan, in accordance
with the provisions of the Plan;
(d) To determine the amount of benefits which shall be payable to any person in
accordance with the provisions of the Plan; to inform the Employer, insurer or Trustee
(if any), as appropriate, of the amount of such benefits; and to provide a full and fair
review to any Participant whose claim for benefits has been denied in whole or in part;
(e) To designate other persons to carry out any duty or power which may or may not
otherwise be a fiduciary responsibility of the Plan Administrator, under the terms of the
Plan;
10
PROc2978.5
M To keep records of all acts and determinations, and to keep all such records, books of
account, data and other documents as may be necessary for the proper administration
of the Plan;
(g) To prepare and distribute to all Employees information concerning the Plan and their
rights under the Plan;
(h) To do all things necessary to operate and administer the Plan in accordance with its
provisions;
6.02 Provision for Third -Parry Plan Service Providers. The Plan Administrator, subject to
approval of the Employer, may employ the services of such persons as it may deem necessary or
desirable in connection with the operation of the Plan and to rely upon all tables, valuations, certificates,
reports and opinions furnished thereby. Unless otherwise provided in the service agreement, obligations
under this Plan shall remain the obligation of the Employer.
6.03 Fiduciary Liability. To the extent permitted by law, neither the Plan Administrator nor any
other person shall incur any liability for any acts or for failure to act except for their own willful
misconduct or willful breach of this Plan.
6.04 Compensation of Plan Administrator. Unless otherwise determined by the Employer
and permitted by law, any Plan Administrator who is also an employee of the Employer shall serve
without compensation for services rendered in such capacity, but all reasonable expenses incurred in
the performance of their duties shall be paid by the Employer.
6.05 Bonding. Unless otherwise determined by the Employer, or unless required by any
Federal or State law, the Plan Administrator shall not be required to give any bond or other security in
any jurisdiction in connection with the administration of this Plan.
6.06 Payment of Administrative Expenses. Unless otherwise indicated in the Adoption
Agreement, all reasonable expenses incurred in administering the Plan shall be paid by the Employer,
provided, however that each Participant shall bear the monthly cost (if any) charged for the maintenance
of any Reimbursement Account unless otherwise paid by the Employer.
6.07 Funding Policy. The Employer shall have the right to enter into a contract with one or
more insurance companies for the purposes of providing any benefits under the Plan and to replace any
of such insurance companies or contracts. Any dividends, retroactive rate adjustments or other refunds
of any type which may become payable under any such insurance contract shall not be assets of the
Plan but shall be the property of, and shall be retained by the Employer to provide future Benefit Plan or
Policy benefits.
6.08 Disbursement Reports. The Plan Administrator shall issue directions to the Employer
concerning all benefits which are to be paid from the Employer's general assets pursuant to the
provisions of the Plan.
6.09 Reporting and Disclosure Obligations. Unless specified otherwise, it shall be the
Employer and Plan Administrator's sole responsibility to comply with all filing, reporting, and disclosure
requirements, imposed by the Department of Labor and/or Internal Revenue Service, specifically
including, but not limited to creating, filing and distributing Summary Annual Reports, Form 5500's, and
Summary Plan Descriptions. Furthermore, the Employer and Plan Administrator shall be required to
amend the Plan as is necessary to ensure compliance with applicable tax and other laws and
regulations.
6.10 Indemnification. The Plan Administrator shall be indemnified by the Employer against
claims, and the expenses of defending against such claims, resulting from any action or conduct relating
to the administration of the Plan except claims arising from gross negligence, willful neglect, or willful
misconduct.
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PROC297B.5
6.11 Substantiation of Expenses. Each Participant must submit a written Request for
Reimbursement form to the Plan Administrator to receive reimbursements from his Medical or
Dependent Care Expense Reimbursement Account(s), on a form provided by the Plan Administrator
accompanied by a written statement/bill from an independent third party stating that the expense has
been incurred, and the amount thereof. The forms shall contain such evidence as the Plan
Administrator shall deem necessary as to substantiate the nature, the amount, and timeliness of any
expenses that may be reimbursed.
6.12 Reimbursement. Reimbursements shall be made as soon as administratively feasible
after the required forms have been received by the Plan Administrator. Reimbursements of less than
$15 may be carried forward and aggregated with future reimbursements until the reimbursable amount
is greater than $15, provided, however, that • the entire amount of reimbursable reimbursements
outstanding at the end of the Plan Year shall be reimbursed without regard to the $15 threshold limit.
Such forms and documentation must be submitted by the fourth (4th) Friday of the month in order to
receive a reimbursement in the following month. Year-end expense reimbursements must be submitted
to the Plan Administrator within 90 days of the close of the Plan Year for which the Salary Redirection
Agreement is effective, and during which such expense was incurred, in order to be eligible for
reimbursement. Likewise, if a Participant terminates participation in the Plan with a credit balance in
any Reimbursement Account, such Participant shall be entitled to submit to the Plan Administrator any
Requests for Reimbursement for reimbursable expenses incurred prior to such cessation of Participation
at any time within 90 days after the close of the Plan Year for which the Salary Redirection Agreement
is effective.
6.13 Annual Statements. The Plan Administrator shall furnish each Participant with an annual
statement, showing the amounts paid or expenses incurred by the Employer in providing Medical and/or
Dependent Care Expense Reimbursement during the previous calendar year and the respective
Reimbursement Account balance(s) on or before January 31 following the close of the applicable Plan
Year.
ARTICLE VII
FUNDING AGENT
7.01 Funding of the Plan. The Plan shall be funded with amounts withheld from
Compensation pursuant to Salary Redirection Agreements and by Nonelective Contributions by the
Employer.
7.02 The Employer as Funding Agent. If the Employer is designated the Funding Agent in
the Adoption Agreement, the Employer will immediately apply all such amounts, without regard to their
source, to pay for the welfare benefits provided in the Adoption Agreement and shall comply with all
applicable regulations promulgated by the Department of Labor ("D.O.L.") taking into consideration any
enforcement procedures adopted by the D.O.L.
7.03 Trust as Funding Agent. If a Trust is designated Funding Agent in the Adoption
Agreement, an appropriate Trust Agreement shall be attached at the end of this Plan.
ARTICLE VIII
CLAIMS PROCEDURES
8.01 Application to Plan Benefits. The provisions of this Article do not apply to: i) individual
policies or ii) group policies not subject to ERISA. If applicable, these provisions apply to claims for
benefits only to the extent that no claims procedure is specified for such benefit in the applicable Benefit
Plan or Policy. If a claims procedure is otherwise available under the applicable Benefit Plan or Policy,
this Article shall not apply to benefits under the component Benefit Plan or Policy, but shall only apply to
issues germane to the pre-tax benefits available under this Plan (i.e., such as a determination of: a
Change in Family Status; significant change in premiums charged; or eligibility and participation matters
under this Flexible Benefits Plan document). This Article shall be the claims procedure applicable to the
Medical Care Expense Reimbursement and the Dependent Care Expense Reimbursement Plan(s).
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PROC297B.5
8.02 Procedure if Benefits are Denied Under the Plan. Any Employee, beneficiary, or his
duly authorized representative may file a claim for a benefit to which the claimant believes that he is
entitled, but that has been previously denied by the Plan Administrator. Such a claim must be in writing
and delivered to the Plan Administrator in person or by mail, postage paid. Within ninety (90) days after
receipt of such claim, the Plan Administrator shall send to the claimant, by mail, postage prepaid, notice
of the granting or denying, in whole or in part, of such claim, unless special circumstances require an
extension of time for processing the claim. In no event may the extension exceed ninety (90) days from
the end of the initial period. If such extension is necessary, the claimant will be given a written notice to
this effect prior to the expiration of the initial 90 -day period. The Plan Administrator shall have full
discretion to deny or grant a claim in whole or in part. If notice of the denial of a claim is not furnished
in accordance with this Section 8.02, the claim shall be deemed denied and the claimant shall be
permitted to exercise his right to review pursuant to Sections 8.04 and 8.05.
8.03 Requirement for Written Notice of Claim Denial. The Plan Administrator shall provide a
written notice to every claimant who is denied a claim for benefits under this Article. Such written
notice shall set forth in a manner calculated to be understood by the claimant, the following information:
(a) The specific reason or reasons for the denial;
(b) Specific reference to pertinent Plan provisions on which the denial is based;
(c) A description of any additional material or information necessary for the claimant to
perfect the claim and an explanation of why such material is necessary, and
(d) An explanation of the Plan's claim review procedure.
8.04 Right to Request Hearing on Benefit Denial. Within sixty (60) days after the receipt by
the claimant of written notification of the denial (in whole or in part) of his claim, the claimant or his duly
authorized representative may make a written application to the Plan Administrator, in person or by
certified mail, postage prepaid, to be afforded a review of such denial; may review pertinent documents;
and may submit issues and comments in writing.
8.05 Disposition of Disputed Claims. Upon receipt of a request for review, the Plan
Administrator shall make a prompt decision on the review matter. The decision on such review shall be
written in a manner calculated to be understood by the claimant and shall include specific reasons for
the decision and specific references to the pertinent plan or insurance policy provisions on which the
decision was based. The decision upon review shall be made not later than sixty (60) days after the
Plan Administrator's receipt of a request for a review, unless special circumstances require an extension
of time for processing, in which case a decision shall be rendered not later than one hundred twenty
(120) days after receipt of a request for review. If an extension is necessary, the claimant shall be
given written notice of the extension prior to the expiration of the initial sixty (60) day period. If notice of
the decision on the review is not furnished in accordance with this Section 8.05, the claim shall be
deemed denied and the Claimant shall be permitted to exercise his right to a legal remedy.
ARTICLE IX
AMENDMENT OR TERMINATION OF PLAN
9.01 Permanency. While the Employer fully expects that this Plan will continue indefinitely,
due to unforeseen, future business contingencies, permanency of the Plan will be subject to the
Employer's right to amend or terminate the Plan, as provided in Sections 9.02 and 9.03, below. Nothing
in this Plan is intended to be or shall be construed to entitle any Participant, retired or otherwise, to
vested or nonterminable benefits.
9.02 Employer's Right to Amend. The Employer reserves the right to amend the Plan at
any time and from time -to -time, and retroactively, if deemed necessary or appropriate to meet the
requirements of Code Section 125, or any similar provisions of subsequent revenue or other laws, to
modify or amend in whole or in part any or all of the provisions of the Plan. All amendments shall be
made in writing and shall be approved by the Board of Directors (or a duly authorized officer of the
Employer) in accordance with its normal procedures for transacting business. Such amendments may
apply retroactively or prospectively. Each Benefit Plan or Policy shall be amended in accordance with
13
PROC297B.5
the terms specified therein, or, if no amendment procedure is prescribed, in accordance with this
section. Any amendment made by the Employer shall be deemed to be approved and adopted by any
Affiliated Employer.
9.03 Employer's Right to Terminate. The Employer reserves the right to discontinue or
terminate the Plan without prejudice at any time and for any reason without prior notice. Such decision
to terminate the Plan shall be made in writing and shall be approved by the Board of Directors (or a duly
authorized officer of the Employer) in accordance with its normal procedures for transacting business.
Affiliated Employers may withdraw from participation in the plan, but may not terminate it.
9.04 Determination of Effective Date of Amendment or Termination. Any such
amendment, discontinuance or termination shall be effective as of such date as the Employer shall
determine. Subject to Sections 4.05(a) and 4.06(a) (if applicable), no amendment, discontinuance or
termination shall allow the return to any Employer of any Reimbursement Account balance nor its use
for any purpose other than for the exclusive benefit of the Participants and their beneficiaries.
ARTICLE X
GENERAL PROVISIONS
10.01 Not an Employment Contract. Neither this Plan nor any action taken with respect to it
shall confer upon any person the right to continue employment with any Employer.
10.02 Applicable Laws. The provisions of the Plan shall be construed, administered and
enforced according to applicable Federal law and the laws of the State of the principal place of business
of the Employer to the extent not preempted.
10.03 Post -Mortem Payments. Any benefit payable under the Plan after the death of a
Participant shall be paid to his surviving spouse (if any), otherwise, to his estate. If there is doubt as to
the right of any beneficiary to receive any amount, the Plan Administrator may retain such amount until
the rights thereto are determined, without liability for any interest thereon.
10.04 Nonalienation of Benefits. Except as expressly provided by the Administrator, no
benefit under the Plan shall be subject in any manner to anticipation, alienation, sale, transfer,
assignment, pledge, encumbrance or charge, and any attempt to do so shall be void. No benefit under
the Plan shall in any manner be liable for or subject to the debts, contracts, liabilities, engagements or
torts of any person.
10.05 Mental or Physical Incompetency. Every person receiving or claiming benefits under
the Plan shall be presumed to be mentally and physically competent and of age until the Plan
Administrator receives a written notice, in a form and manner acceptable to it, that such person is
mentally or physically incompetent or a minor, and that a guardian, conservator or other person legally
vested with the care of his estate has been appointed.
10.06 Inability to Locate Payee. If the Plan Administrator is unable to make payment to any
Participant or other person to whom a payment is due under the Plan because he cannot ascertain the
identity or whereabouts of such Participants or other person after reasonable efforts have been made to
identify or locate such person such payment and all subsequent payments otherwise due to such
Participant or other person shall be forfeited one year after the date any such payment first became
due.
10.07 Requirement for Proper Forms. All communications in connection with the Plan made
by a Participant shall become effective only when duly executed on any forms as may be required and
furnished by, and filed with, the Plan Administrator.
10.08 Source of Payments. The Employer, the Trust fund (if selected as Funding Agent), and
any insurance company contracts purchased or held by the Employer or funded pursuant to this Plan
shall be the sole sources of benefits under the Plan. No Employee or beneficiary shall have any right
to, or interest in, any assets of the Employer upon termination of employment or otherwise, except as
provided from time to time under the Plan, and then only to the extent of the benefits payable under the
Plan to such Employee or beneficiary.
14
aaocss7s.s
10.09 Multiple Functions. Any person or group of persons may serve in more than one
fiduciary capacity with respect to the Plan.
10.10 Tax Effects. Neither the Employer, its agents, the Plan Administrator, nor the Trustee
makes any warranty or other representation as to whether any Pre-tax Premiums made to or on behalf
of any Participant hereunder will be treated as excludable from gross income for local, state, or federal
income tax purposes. If for any reason it is determined that any amount paid for the benefit of a
Participant or Beneficiary are includable in an Employee's gross income for local, federal, or state
income tax purposes, then under no circumstances shall the recipient have any recourse against the
Plan Administrator or the Employer with respect to any increased taxes or other losses or damages
suffered by the Employees as a result thereof. The Plan is designed and is intended to be operated as
a "cafeteria plan" under Section 125 of the Code.
10.11 Gender and Number. Masculine pronouns include the feminine as well as the neuter
genders, and the singular shall include the plural, unless indicated otherwise by the context.
10.12 Headings. The Article and Section headings contained herein are for convenience of
reference only, and shall not be construed as defining or limiting the matter contained thereunder.
10.13 Incorporation by Reference. Except for the Medical and Dependent Care Expense
Reimbursement Plan(s), the actual terms and conditions of the separate component Benefit Plans or
Policies offered under this Plan are contained in separate, written documents governing each respective
benefit, and shall govern in the event of a conflict between the individual plan document, and this Plan
as to substantive content. To that end, each such separate document, as amended or subsequently
replaced, is hereby incorporated by reference as if fully recited herein. The provisions of the Medical
and Dependent Care Expense Reimbursement Plan(s) are reproduced herein, but shall constitute
separate plans for purposes of all applicable Code and ERISA provisions.
10.14 Severability. Should any part of this Plan subsequently be invalidated by a court of
competent jurisdiction, the remainder thereof shall be given effect to the maximum extent possible.
10.15 Effect of Mistake. In the event of a mistake as to the eligibility or participation of an
Employee, or the allocations made to the account of any Participant, or the amount of distributions
made or to be made to a Participant or other person, the Plan Administrator shall, to the extent it deems
possible, cause to be allocated or cause to be withheld or accelerated, or otherwise make adjustment
of, such amounts as will in its judgment accord to such Participant or other person the credits to the
account or distributions to which he is properly entitled under the Plan. Such action by the
Administrator may include withholding of any amounts due the Plan or the Employer from Compensation
paid by the Employer.
10.16 Provisions Relating to Insurers. No insurer shall be required or permitted to issue an
insurance policy or contract that is inconsistent with the purposes of this Plan, nor be bound to take any
action not in accordance with the terms of any policy or contract with this Plan. The insurer shall not be
deemed to be a party to this Plan, nor shall it be bound to interpret the construction or validity of the
Plan. The insurer shall be protected from its good faith reliance on the written representations and
instructions of the Trustee and the Plan Administrator, and shall not be responsible for the initial or
continued qualified status of the Plan.
ARTICLE XI
CONTINUATION COVERAGE UNDER COBRA
The following provisions shall be applicable to the Medical Care Expense Reimbursement Plan,
and any other group health plan (as defined by Code 4980B and 5000(b)(1) and the regulations
promulgated thereunder) subject to COBRA that does not otherwise contain COBRA provisions. The
intent of this Article is to extend continuation rights required by COBRA. To the extent greater rights
are provided for hereunder, this Article shall be void.
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11.01 Continuation Coverage after Termination of Normal Participation. During any Plan
Year during which the Employer is subject to Code Section 4980B, each person who is a Qualified
Beneficiary shall have the right to elect to continue coverage under the Medical Care Expense
Reimbursement Plan (or other group health plan subject to COBRA) upon the occurrence of a
Qualifying Event that would otherwise result in such person losing coverage hereunder. Such extended
coverage under the plan is known as "Continuation Coverage."
11.02 Who is a Qualified Beneficiary". A "Qualified Beneficiary" is any person who is, as of
the day before a Qualifying Event, (a) an Employee of the Employer (including persons who are
considered to be "employees" within Code Sec. 401(c), directors and independent contractors) covered
under a health plan offered under the Plan as of such day (such persons are called "Covered
Employees"), (b) the Spouse of the Covered Employee, or (c) a Dependent of the Covered Employee.
A Covered Employee can be a Qualified Beneficiary only if the Qualifying Event consists of termination
of employment (for any reason other than gross misconduct) or reduction of hours of the Covered
Employee's employment. A child born to or placed for adoption with a Covered Employee during
Continuation Coverage will also be a Qualified Beneficiary. A retiree or other former Employee actively
participating in the Plan by reason of a previous period of employment will be treated as a "Qualified
Beneficiary".
11.03 Who is not a "Qualified Beneficiary". A person is not a Qualified Beneficiary if, as of
such day, either the individual is covered under the
e If theCare Expense Reimbursement election of Continuation Coverby
lan (or
other group health plan subject to COBRA) by virtue o
another person and is not already a Qualified Beneficiary by reason of a prior Qualifying Event, or is Furthermore, an individual
entitled to Medicare coverage under Title XVIII of the Social Security Act.
who fails to elect Continuation Coverage within the election period provided in Section 11.07, below,
shall not be considered to be a Qualified Beneficiary.
11.04 What is a "Qualifying Event". Any of the following shall be considered as a "Qualifying
Event":
(a) death of a Covered Employee;
(b) termination (other than by reason of gross misconduct) of the Covered Employee's
employment or reduction of hours of employment;
(c) divorce or legal separation of a Covered Employee from the employee's spouse;
(d) a Covered Employee's becoming entitled to receive Medicare benefits under Title XVIII
of the Social Security Act; or
(e) a dependent child of a Covered Employee ceasing to be a Dependent.
In the case of any person treated as a Covered "Employee" but who is not a common-law
employee, termination of "employment" means termination of the relationship that originally gave rise to
eligibility to participate in the Medical Care Expense Reimbursement Plan (or other group health plan
subject to COBRA.)
11.05 What Benefit is Available under Continuation Coverage. Each person who is eligible
to elect to continue coverage under Article XI shall have the right to continue the level of coverage in
effect for the Covered Employee on the day before the Qualifying Event (or a lesser level of coverage).
If a Qualified Beneficiary of another group health plan maintained by the Employer is prevented from
receiving a previous level of Benefits due to a change in plan Benefits or plan termination , such
individual will be entitled to elect any available level of coverage under the Medical Care Expense
Reimbursement Plan. A premium for Continuation Coverage shall be charged to Employees and
Qualified Beneficiaries in such amountsand shall be payable at such times as are established by the
Plan Administrator and permitted by applicable law,
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11.06 Notice Requirements.
(a) When an Employee becomes covered under this Medical Care Expense
Reimbursement Plan (or any other group health plan subject to COBRA), the Plan Administrator must
inform the Participant (and spouse, if any) in writing of the rights to continued coverage, as described in
Article XI.
(b) The Employer shall give the Plan Administrator (if different from the Employer) written
notice of a Qualifying Event within thirty (30) days of the occurrence thereof.
(c) Within fourteen (14) days of receipt of the Employer's notice, the Plan Administrator
shall furnish each Qualifying Beneficiary with written notification of the termination of regular coverage
under the Medical Care Expense Reimbursement Plan (or any other group health plan subject to
COBRA), as well as a recital of the rights of any such Beneficiary to elect Continuation Coverage, as
required by Code Sec. 4980B and ERISA Sec. 601, in accordance with the terms of this Plan.
(d) In the case of a Qualifying Event described in Section 11.04(c) or (e), a Covered
Employee or a Qualified Beneficiary who is a Spouse or Dependent of such Employee must notify the
Plan Administrator within sixty (60) days of the occurrence thereof. The Plan Administrator shall give
written notification of Conversion Coverage rights to any other affected Qualified Beneficiaries within
fourteen (14) days of receipt of the notice described in this Section 11.06(d).
Notwithstanding any of the foregoing, notification to a Qualified Beneficiary who is a spouse of a
Covered Employee is treated as notification to all other Qualified Beneficiaries residing with that person
at the time notification is made.
11.07 Election Period. Any Qualified Beneficiary entitled to Continuation Coverage shall have
60 days from the date of the notice required by Section 11.06, in the case of occurrence of a Qualifying
Event, in which to return a signed election to the Plan Administrator indicating the choice to continue
benefits under this Plan.
11.08 Duration of Continuation Coverage. Except as otherwise provided in this Plan,
Continuation Coverage shall extend for a period of 18 months after the date that regular coverage
ceased due to occurrence of the initial Qualifying Event described in Section 11.04(b), unless during
such 18 -month period a subsequent, Qualifying Event occurs, in which case, another election to extend
coverage for 18 months shall be available to the Beneficiary. Except as otherwise provided in this
Section, in the case of a Qualifying Event not described in Section 11.04(b), Continuation Coverage
shall extend for a period of 36 months after the date that regular coverage ceased due to the
occurrence of the Qualifying Event. In the case of a Qualified Beneficiary who is determined, under title
II or XVI of the Social Security Act to have been disabled within 60 days of a Qualifying Event described
in Section 11.04 (b), Continuation Coverage with respect to such event shall extend for a period of 29
months after the date that regular coverage ceased due to the occurrence of the Qualifying Event if the
Qualified Beneficiary has provided notice of such determination within sixty (60) days after the date of
such determination and before the end of the initial 18 month Continuation Coverage period. In the
event a Covered Employee becomes entitled to Medicare coverage, the period of Continuation
Coverage for a Qualified Beneficiary, other than the Covered Employee for such Qualifying Event or any
subsequent Qualifying Event, shall not terminate for a period of 36 months from the date the Covered
Employee becomes entitled to Medicare benefits. In no event, however, shall Continuation Coverage
extend more than 36 months beyond the date of the original Qualifying Event.
11.09 Automatic Termination of Continuation Coverage. Continuation Coverage shall
automatically cease if (a) the Employer no longer offers the particular group health coverage to any of
its employees (b) the required premium for Continuation Coverage for a particular coverage is not paid
within 30 days of the date due or within 45 days after the initial election of Continuation Coverage made
pursuant to Section 11.07 (whichever is later), (c) an electing Qualified Beneficiary becomes covered
under another group health plan other than a group health plan which may limit a Qualified Beneficiary's
coverage because it involves a pre-existing condition, or (d) an electing Qualified Beneficiary becomes
eligible to receive benefits under Medicare.
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IN WITNESS WHEREOF, the Employer has executed this Flexible Benefits Plan, Medical Care
Expense Reimbursement Plan, and/or Dependent Care Expense Reimbursement Plan (as noted in the
Adoption Agreement), the date and year first written below, to be effective as set forth in the Adoption
Agreement.
WITNESS
Corporate Officer
Employer:
By:
Title:
Date: ilclk I SUPC (D
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