Item C56
BOARD OF COUNTY COMMISSIONERS
AGENDAITEMSU~Y
~
Meeting Date: Seotember 19 & 20. 2001
Division: Management Services
Bulk Item: Yes -X- No
Department: Grouo Insurance
AGENDA ITEM WORDING: Approval to renew with The Hartford Life Insurance for our
Group Life and Accidental Death & Dismemberment proe:ram for FY 2002 (October 1. 2001 -
September 30. 2002.
ITEM BACKGROUND: This is the 3M and final renewal of a Life Insurance Policv that was
orie:inallv secured in FY 2002. Rate remains the same.
PREVIOUS REVELANT BOCC ACTION: Approved acceptine: The Hartford Life Insurance
Companv on September 8.1999 and approvine: rider on Mav 17. 2000.
CONTRACT/AGREEMENT CHANGES: Term onlv (October 1.2001 - September 30.2002)
STAFF RECOMMENDATIONS: Approval
TOTAL COST: $146.000
BUDGETED: Yes -1L No
COST TO COUNTY: $146.000
REVENUE PRODUCING: Yes
No -X AMOUNT PER MONTH_ Year
APPROVED BY: County Atty _
DIVISION DIRECTOR APPROVAL:
OMB/Purchasing _ Risk Management _
JfJ ~~~~
' James L. Roberts <::J
DOCUMENTATION:
Included X
To Follow_
Not Required_
DISPOSITION:
AGENDA ITEM # / -{!. ::;-/.0
/fe II IS eel
Revised 2/27/01
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: September 19 & 20. 2001
Services
Bulk Item: Yes ----X- No
Division:
Management
Department: Administrative Services
AGENDA ITEM WORDING: Approval to renew with Hartford Life Insurance for our Group Life
and Accidental Death & Dismemberment program for FY 2002 (October 1,2001- September 30,
2002).
ITEM BACKGROUND: This is the 3rd and final renewal of a Life Insurance Policy that was
originally secured in FY 2000. Rate Remains the same.
PREVIOUS REVELANT BOCC ACTION: Approved accepting Hartford Life Insurance Company
on September 8,1999, and approving rider on May 17,2000.
CONTRACT/AGREEMENT CHANGES: Term only.
ST AFF RECOMMENDATIONS: Approval
TOTAL COST:
$146.000
BUDGETED: Yes ~ No
COST TO COUNTY: $146,000
REVENUE PRODUCING: Yes No x AMOUNT PER MONTH Year
APPROVED BY: County Atty ftil OMBlPurchasin~ Risk Management L.J. R '
DIVISION DIRECTOR APPROVAL: o/~~Q._
#' James L. Roberts
DOCUMENTATION:
Included L
To Follow_
Not Required_
DISPOSITION:
AGENDAITEM#~t.
Revised 2/27/01
~il..~
~I'
ARTHUR J. GALLAGHER & CO. - BOCA RATON
CitILLtGHt=.R Bc!\JEFIT SER\'<:ES
August 1,2001
Ms. Sheila Barker
Senior Director - Human Resources
5100 West College Road
Public Services Bldg #208
Key West, FL 33040
RE: Monroe County Board of County Commissioners
Life/AD+D Policy #303613
Dear Sheila:
This letter will serve as notification that Hartford Life will continue the current Basic Life rate of
.39/1000 and the current AD+D rate of .02/1000 for the policy year October 1,2001 through
September 2002.
At your convenience, I would like a written confirmation of your acceptance prior to September
1, 2001. This will then be forwarded to Hartford Life in order to satisfy their compliance
responsibilities.
Please contact me at (561)995-6706 ext 603 with any questions.
Sincerely,
~W
Rick Capizzi
Benefit Consultant
Gallagher Benefit Services
0'-18 Boca P:ace, 2255 Glades Road, Suite 400E, Boca Raton, Florida 33431-7379
561/995-6706 . Fax 561/995-6708
RIDER
This rider is attached to and made a part of Group Policy No. GVL-O 16007 issued by the HARTFORD LIFE AND
ACCIDENT INSURANCE COMPANY to the POLICYHOLDER,
TRUSTEE OF THE PUBLIC EMPLOYERS INDUSTRY GROUP VOLUNTARY LIFE AND DISABILITY
INSURANCE TRUST
It is understood and agreed that the policy is amended to include the following:
Participant:
-/
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
Account Number:
303613
Participation Requirements:
The Participant shall meet and maintain the following minimum participation requirements, in order to become a
Participant and remain a Participant under the policy:
I. 20 or more eligible employees;
2. 100 % minimum employee participation on a non-contributory basis; and
3. 75% minimum employee participation on a contributory basis.
The initial monthly premium rates are as follows:
Basic Life Insurance
Accidental Death. Dismemberment
And Loss of Sight Benefit
$ .39 for each $1,000 of Basic Life Insurance
$ .02 for each $1,000 of Principal Sum
RA TE GUARANTEE PERIOD:
Basic Life Insurance
Basic Accidental Death. Dismemberment and Loss of Sight Benefit
. Until October 1,2001
Until October 1,2001
PREMIUM DUE DATES:
Monthly on the first of each month.
Subject to the Rate Guarantee period shown above, Hartford Life has the right to change premium rates on any premium
due date if:
I. written notice is delivered to the Participant's last address on record; and
2 _ the change is effective at least 31 days after the date of notice.
The rate guarantee described above (the "Rate Guarantee") supersedes only those provisions appearing elsewhere in this
policy which give Hartford Life the right to change the premium rates, and then, only for the period of time stated for the
Rate Guarantee. However, Hartford Life may change the premium rates during the Rate Guarantee period if there is a
change in the policy, or if there is a 10% increase or decrease in the number ofInsured Persons, or if the Policyholder
adds or deletes a subsidiary or affiliated business entity. Hartford Life may also change the premium rates during the
Guarantee Period if there has been a material misstatement in the reported experience during the pre-sale process. The
Rate Guarantee in no way affects, amends or supersedes any other provision in this policy.
Grace Period
Hartford Life will allow the Participant a 45 day grace period for the payment of all premiums after the first. During this
45 day period, the policy will stay in force. If the owed premium is not paid by the 45th day, participation in the policy
will automatically terminate. Premium is due for each day the policy is in force under the terms of this Grace Period. If
the Participant gives Hartford Life written advance notice of an earlier cancellation date, termination will occur on the
earlier date. Premium is due for each day the policy is in force for each Participant.
Calculation
Premiums may be calculated by multiplying the rate times the applicable numbers of units of coverage.
GR-11711(A) Rev. 7-'97
Ifany insurance is added, increased or becomes effective after a Participant's inclusion in the policy, premium charges
will begin on:
I. the day the coverage is effective, if it is also the frrst day of a month; or if not
2. the first day of the next month. .
For insurance which is terminated, premium charges will stop as of the first day of the next month. Premiums may be
calculated by any other method which both Hartford Life and the Participant agree to in writing.
Experience Rating
Any credit amount due the Participant because of experience rating will be allowed him on the Participant Anniversary
Date and, at the Participant's request, will be: "
1. paid to him in cash; or
2. used to reduce his premiums; or
3. used to provide additional insurance for covered persons.
Any credit amount shall be determined by the rating plan or plans used by Hartford Life.
Termination Date for Participants
Coverage fora Participant will terminate on the first to occur of:
I. if applicable to such Participant's insurance coverage(s), the day following the Grace Period if a premium is due but
unpaid;
2. the date a premium is due but unpaid;
3. the date such Participant withdraws from the Trust by giving written notice to Hartford Life;
4. the date such Participant elects to terminate coverage, by giving/written notice to Hartford Life;
5. the date such Participant fails to maintain the applicable participation requirements; or
6. the date Hartford Life terminates the policy in its entirety or with respect to any Participant in accordance with the
provisions of the policy.
Hartford Life may also terminate the Participant's coverage on any premium due date after such coverage has been in
force for 12 months by giving the Participant 31 days written notice.
Policy Termination
Hartford Life may terminate the policy on any premium due date after the policy has been in force for 12 months by
giving the Policyholder 31 days written notice.
Incorporation Provision
The Booklet-certificate(s) attached to this Rider and which is (are) listed below, is (are) hereby incorporated in and made
a part of the policy. The terms found in the Booklet-certificate(s) will control the benefit amounts and provisions; rules
of eligibility for individual employees and dependents; termination of insurance rules; exclusions; and other general
policy provisions pertaining to ERISA, claims and state insurance law requirements.
The following Booklet-certificate(s) is (are) attached to this Rider:
303613(GVL) I
Nothing herein contained sha1l be held to vary, waive, alter, or extend any of the terms, conditions or provisions of the
policy, other than as herein stated.
GR-I 171 I (A) Rev. 7-'97
This Rider is signed by the HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY to take effect as of
October 1,1999.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY
~~
.#P
Lynda Godkin, Secretary
Lowndes A. Smith, President
Countersigned by
Registrar
t
GR-11711(A) Rev. 7-'97
RIDER
THIS RIDER IS A REPLACEMENT IN ITS ENTIRETY TO RIDER GR-11711(A) Rev., REVISED MARCH 30,
2000 EFFECTIVE OCTOBER 1,1999.
This rider is attached to and made a part of Group Policy No. GVL-OI6007 issued by the HARTFORD LIFE AND
ACCIDENT INSURANCE COMPANY to the POLICYHOLDER,
TRUSTEE OF THE PUBLIC EMPLOYERS INDUSTRY GROUP VOLUNTARY LIFE AND DISABILITY
INSURANCE TRUST
It is understood and agreed that the policy is amended to include the following:
Participant:
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
Account Number:
303613
Participation Requirements:
The Participant shall meet and maintain the following minimum participation requirements, in order to become a
Participant and remain a Participant under the policy: r
1. 20 or more eligible employees;
2. 100 % minimum employee participation on a non-contributory basis; and
3. 75% minimum employee participation on a contributory basis.
The initial monthly premium rates are as follows:
Basic Life Insurance
Accidental Death. Dismemberment
And Loss ofSiQht Benefit
5.39 for each 51,000 of Basic Life Insurance
5 .02 for each $1,000 of Principal Sum
RATE GUARAl'\TEE PERIOD:
Basic Life Insurance
Basic Accidental Death. Dismemberment and Loss of SiQht Benefit
Until October 1,2001
Until October 1,2001
PREMIUM DUE DATES:
Monthly on the first of each month.
Subject to the Rate Guarantee period shown above, Hartford Life has the right to change premium rates on any premium
due date if:
I. written notice is delivered to the Participant's last address on record; and
2. the change is effective at least 31 days after the date of notice.
The rate guarantee described above (the "Rate Guarantee") supersedes only those provisions appearing elsewhere in this
policy which give Hartford Life the right to change the premium rates, and then, only for the period of time stated for the
Rate Guarantee. However, Hartford Life may change the premium rates during the Rate Guarantee period if there is a
change in the policy, or if there is a 1 O~'O increase or decrease in the number of Insured Persons, or if the Policyholder
adds or deletes a subsidiary or aftlliated business entity. Hartford Life may also change the premium rates during the
Guarantee Period if there has been a material misstatement in the reported experience during the pre-sale process. The
Rate Guarantee in no way affects, amends or supersedes any other provision in this policy.
Grace Period
Hartford Life will allow the Participant a 45 day grace period for the payment of all premiums after the first. During this
45 day period, the policy will stay in force. If the owed premium is not paid by the 45th day, participation in the policy
will automatically terminate. Premium is due for each day the policy is in force under the terms of this Grace Period. If
the Participant gives Hartford Life written advance notice of an earlier cancellation date, termination will occur on the
earlier date. Premium is due for each day the policy is in force for each P~rticipant.
GR-I17II(A) Rev. 7-'97
. ".
Calculation
Premiums may be calculated by multiplying the rate times the applicable numbers of units of coverage.
Ifany insurance is added, increased or becomes effective after a Participant's inclusion in the policy, premium charges
will begin on:
1. the day the coverage is effective, if it is also the first day of a month; or ifnot
2. the first day of the next month.
For insurance which is terminated, premium charges will stop as of the first day of the next month. Premiums may be
calculated by any other method which both Hartford Li fe and the Participant agree to in writing.
Experience Rating
Any credit amount due the Participant because of experience rating will be allowed him on the Participant Anniversary
Date and, at the Participant's request, will be:
I. paid to him in cash; or
2. used to reduce his premiums; or
3. used to pro,;ide additional insurance for covered persons.
Any credit amount shall be determined by the rating plan or plans used by Hartford Life.
Termination Date for Participants
Coverage for a Participant will terminate on the first to occur of:
I. if applicable to such Participant's insurance coverage(s), the day following the Grace Period if a premium is due but
unpaid;
2. the date a premium is due but unpaid;
3. the date such Participant withdraws from the Trust by giving written notice to Hartford Life;
4. the date such Participant elects to terminate coverage, by giving written nOlice to Hartford Life;
5. the date such Participant fails to maintain the applicable participation requirements; or
6. the date Hartford Life terminates the policy in its entirety or with respect to any Participant in accordance with the
provisions of the policy.
Hartford Life ma;-' also terminate the Participant's coverage on any premium due date after such coverage has been in
force for 12 months by giving the Participant 31 days written notice. .'
Policy Termination
Hartford Life may terminate the policy on any premium due date after the policy has been in force for 12 months by
giving the Policyholder 31 days written notice.
Incorporation Provision
The Booklet-certificate(s) attached to this Rider and which is (are) listed below, is (are) hereby incorporated in and made
a part of the policy. The terms found in the Booklet-certificate(s) will control the benefit amounts and provisions; rules
of eligibility for individual employees and dependents; termination of insurance rules; exclusions; and other general
policy provisions pertaining to ERISA, claims and state insurance law requirements.
The following Booklet-certificate(s) is (are) attached to this Rider:
303613(GVL)IRev
'Kothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions or provisions of the
policy, other than as herein Slated.
GR-11711(A) Rev. 7.'97
4 4 4~
This Rid~r is signed by the HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY to take effect as of
October I, 1999.
HARTFOR:D LIFE AND ACCIDENT INSURANCE COMPANY
~~
1.:..\(1a Godkin, Sec-rt'uwJj
Countersigned by
Jio AJL- dPoJ-t
Diane Zipoli, Registrar
GR-I 1711(A) Rev_ 7-'97
#P
Lowndes A. Smith, President
..
Name of Policyholder: TRUSTEE OF THE PUBLIC EKPLOYBRS GROUP VOLu~ARY LIPE
k~ DISABILITY INSURANCE TRUST
Policy Nwnbers:
GVL-016007
Effective Date:
),-1-94
Place of Delivery:
Rhode Island
BAlt'l'POltt) LIYB INSURANCE COKPANY
Hartford Plan, Hartford, Connecticut 063.15
(A stock insurance company, herein called The Hartford)
Agrees vith the Policyhold~r to insure certain persons vho are entitled to the
3.nsurance provided by thi s pol1 cy.
This policy is issued in consideration of the application of the Policyholder,
and of the payment by the Participant Employers of premium as pro~ided herein.
A Participant Employer's first premium is du~ and payable on the effective date
of such employer's inclusion under the Plan. Subject to the policy's gr.ace
period provision, a11premiums aft~r tbe first must be paid vhen or before they
are due.
Signed for The Hartford:
~~
~~,~
_.-#~
\o-.llk. A. ~ 1"rr.rI....:
Countersigned
'by................. t.................
Registrar
Table of Contents
Agreet:i.en t to I.csure -...,..... - . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . _. 1
De fin i t ion ............... - . . . . . . . .. .. . . .. . . . . .. .. . .. . .. . .. .. _ _ . .. . . . . . . . .. .. . . .. . .. .... 2
Participant Employers ......... -. .. ........... . ....... ... .. . . ... . . _. 3
Incorporation Provision ...... -.. . ....... . . . . ...... . . ... _.. .. . . . . _.. 5
P r em i ums .............. - . ... . . . . . . - - .. . ... ... ... _ ... . _ ... . .. . . .. .. . . .. ... . . . . .. . . . .. . . . . . ... ... 6
Policy Provisi ons ............... - . . . . . . . . . . . . _ . . . . . . _ . . . . . . . . _ . . . .. B
GR-1l710(Ol)A
1
OEfINlTIO:'iS
Trustee means Shawmut Bank toC21..e<! in Rhode Island.
Tru~t Agr~mer.t means the t:ust agreemlmt Qetwe= Hartford Life Ufe and Accident Il'Isu~nce Company
and st,awrnut Bank for the: purpose of i::lplementing g.'"Oup insun:T1ce coverage for the beIlefit of employees
of employers and $ole pl'Qprietors partiei~ti.n~ in the Tn:.st.
TruSt means the: trust crc:eted under the f:crr.lS of the Trust Agreecne.'lt.
2
GR.-l J 7l0(06)A Rev. 7.'97
P ARTI CIP A1'1TS
In GcncnJl
An entity may be iocluded as B. Participant if the Policyholder and Hartford tife so agree. H~1tford Life
will kup a list of aCl:cpted PQrticipants and rhc effective dates of coverage for eae"'.
The Policyholder may 3.Ct (or or on behalf of all Participants io all matters oftbe policy. TIle (ol1owin~ wi1l
be binding O':l all Participants:
(I) all agreements between Hmf'ord Life and rlle Policyholder;
(2) nll notices from Hanford Life to tie Policyholder; and
(3) ~1I notices (Tom the Policyholder to J'bTtfo~d L~fe.
AI) employee of a Participa...'lt will be deemed to be an employee of the Policyholder fOT insurance purposes.
A Panicip:11l.t's premium is due and payable on the etr-ective date of his inclusion under the policy. Subject
to the Grace Period, if applicable to such P~c;ipl:1lt's insurance covcn.ge(s), all Participant premium aft~r
the first must be paid when or be:fore they are d\Je.
For tbe pllIpOse oflhis insurance. tie term Participant shall mean:
(I) an employer who:
(a) has the required number ofemp)oy~s in his tmpIOy;-and
(b) elec-.s to participate in Md' rnaJ~es required premium contributions, on behalf of his
. employ~s, to the G:oup Voluntary Life 3nd. Disal)ility IlJsuri!JlCc Trusr; or
(2) a sole proprjer.or wilo elects to PUticipate in and m~es req'Jired premium CQotr.ib\1tions to the
Group VOIUllt3ry Life and DisabHity Inwrance Trust
In order to become 2 Participanr, ao entil)' fl'llJst:
. (1) make r.ee~so...)' applic3uon tbr membership ;1) the Finance, 171Sura.:lce and Real Esut.e
lndu~ Group Volunt.ary Ufe and Disabiliry Insur:Jnce TnJst;
(2) be acc!pted by Hartford Life for $Uch membership; a!ld
(3) satisfy the 3pplicabla Employee Par.icip3.\ion R.equjr~r:nts.
EmployeePartielpation Requiremenb
Each emplo)'eT shall meet end mainrain rhe minimum empIO)'t:e and dependent participation requirc:tDeJ:lts,
jf applicable, in order t.o become a P2rticiPMt ~nd remain a ParticipaTlt under the policy. TIle p;nieipation
requ..imnents arc shown on Rider Farm GR.-l J711(A)~. 7-'97.
Effective Date for PuJ'ticlp:lnts
The effective cbtc of inclusion of a Participanr. unci..,- the policy is show;] 01) 1h e R,ider applic;.ble to such
Participant
3
GR- J 11] O(06)A Rev. 7-'97
PARTICIPANTS
(continued)
Tl:rmioatjon l>3te for P3rtiCiP3"ts
Coverage for a Pa."t.icipmt will terminal\:: On the first to occ'Jr of:
(1) if applicable to such Particip.lIlt's inSIJraTlce cove."3ge(s),. the day following tOe Graee Period if
. a premium is due but unpaid:
(2) the date a premium is due but unpaid;
(3) the date ,uell Pmicip:lnt withdraws from rhe Trust by giving v..ritt.en notice to HMtford Life;
(4) the dote sucb Panicip;mt eLee:ts to terminate eovl:r"ilge, by gh,ing Wl'iL"eFlllorice to Hsrtforcl
Life:;
(5) the dat.e such Participant fails to maintain the applicable participatioD requi:e:neot::; Or
(6) the ~ H3Itford Life: terminates the policy in its entirety or wi~ r(:spect to a.YJ.Y Participant 1I1.
aec<>rdarlce with the provisions of'the policy.
4.
GRrl I 1JO(06)A Rev. 7~97
"
It'JCORPORATrON PROVlS10N
Booklet-CertiCicntc:
The Booldet-cmificate(s).. and the endorsement formes) listed 00 Rider Form OR-Il' 11 (A) Rev. 7-'97 2.roe
hereby incor.porated in. aod rnude a piUtof, this policy.
The terms found in the Bool<let-etttifieate(s) will control:
(I) the cove1Clge provisions;
(2) the eli.gibilit)' and effective date ofinsuraoce rulesj
(3) the termin:l.tion of insurance rules;
(4) excl~iotls; and
(5) oilier generAl policy provisions pertaining to $':3.te and (eder3J in~lJranCe requirements.
Schedule ofInsur!nc:e
'IJ1e schedules of ;nsurnlce applicable to each Participant are shown in the Booklet-certificates. Each
schedule of inSlJr31lCC will conrra! tlte benefit <l1Tl.ounts,
maximum limics end any other amount.s and limits which apply.
MOlllllJy Premium Rates
111e monthl)' premium rates 1.0 be charged 9.1ld provisjon~ l:.pplicab!e '.0 premium$ arc s]10W/'l O':lI))C arnched
Rickr Form GR-ll7) I (A) Rev. 7-'97, ~pHcable to each P:nucip::l!1t.
Premium Payments
Premium paym.eOl"$:
(1) are due and payable io full to a "lace designated by Hutford tifej or
(2) v..;th resp<<t CO rJle initial premium payment, premjum paym~t.5 may be made. to 2.l)
authorized agent of Hartford Life.
Pa)'TlJetlt of prerniruns for a period before it is due will not guarantee the insurance {or tllat period.
s.
GR-ll1JO(06)A Rev. 7.'97
POLICi PROVISIONS
'Entire Contnd
The contract betw~n the parties cotlsists of:
(I) the policy;
(2) the applications, if any, of each Iosured person; and
(3) the application of each ?a.:tieipnnt.
AU s~ernents made by the policyholder, POl.rticipants, and persons ir.Is~:ed under the poliey are tr\le tnd
co::npl~e to the best ofthc:: knQ'\llledge and belief of the ~Ol)(s) mal{ing them. No .sear.ement wit! be used
in ar..y contest unless it is in writing and :a. copy of it is given to the person who m~~ it, or to "-is
benefici!1)'.
lneon~bbilit)'
Except for non.-p<1ymenl of preJTI i\Jm, the insunnce p:'ovidOO. by the policy cantlot be contested nfter S'.Jch
insurance has b6e:n in effect for a period of2 years.
Change In Tbe Po\ky
No ch~ge may bt rntde unless approved in writing by the Presid.e:nt, or a Vice Presic!enr.; or 211 Assistant
Vice president; Of a Su:retary; or an Assistant Secretary of Ha.rt!x:lrd Life. No other person may cb~e or
waive a....y part of the policy. Any Approved chC!11ge shall be added 10 the policy writing.
IhllY cb;mge to St3.~ or federaJ lsw, including but no! limited to the Federal Social Security Act. affects
Hmford Life's liability under the policy, Hanford Life may change tile poliey or rIle premh:ms, or both.
Such chUlge:
(I) .....ill be effe<:tive as ofthe date of the cha.nse to the st3t.e or fedetallaw;
(2) will not be made until Hanford Life gives ea::h Pa.rticipant:; I days notice.
Right to AmeJId
Notwithstanding tJ~e above, after the policy has been in. force fOT 12 month!, Hartford Life roay cbMge any
or all of the policy's provisions by notifying L:he Policyhojdef. Hartford life must give the Policyholder at
teast 31 days adv,:nce wrir:en notice of any ch~gc.
Termin2ti"n of polley
Hartford r~ife may terminzt.e this policy on any prcmium d>Je date zfter tlle policy ha.s been in force for 12
months by giving the Pol i.cj'b older :; 1 days written Mr.lee,
CT3.eC Period
H9Itford Life will allow the Polieyho IdeT a 31 da.y g:-a.ee period for th.t pa.yment of all pl"C.ITIiums a.."ter the
flrsr. During this 3) day period, the policy will stay in force. If the owed premium is not paid by the 31st
da.y, participation in t..;.e policy will automatically terminate. Premium is du.: for ea.c;h dtly the policy is in
foret. W\d er the terms of this Or~ Period, If the Poli:yholdc:r gives li.arlford Life writt.en adVWice notice
ofa:n earlic:r c.aocella.tion date terminatio:l will OCCIlr. on tbe eulier ~c. Premium is due for each day the
poli=)' is in force for ee.ch Particip!ttlt.
Certific:ate
~rtford. )~ife will h-lve a certificate of coverage prepared for each p~ejpant. The Booklet~oertifie:rte will.
~laio the iTrtporta.....t features ofrl1e polic)'.
.6
GR-11710(OG}A R,cv. 7.'97
POLTCY PROYIStOl.'iS
(Continued)
Data To Be Furnished
The Policyhoida and. Partitipant will give: Hartford tife all information Hartfocd Lue nccd~ regarding
rn:ttcrs Pc:.rWlljl\g r.o the insurance.
At an)' reASOnable time:
(1) while the poliey is in force; and.
(2) for 1 year after that,
H3T.tford Life roa.y inspect =y of :he Policyholder's Of Participant's doeum=nts, books C11 records whicb
roa.y affect tbe insura1)ce or premiums oftl,is policy. Tfthe Policyholder or Participa:lt gives Hurford Life
any jDCOJ'T'ec:t information: the relevant facts will be determined. to establish jf insl.'1'BneC is in effect and in
wbat a.rnount. .
No person will:
(1) be deprived ofil'\Sllrar.ee to which he is o~herwjse entitled; or
(2) have insurance to which he is oOt eDtlth:d,
boc.:tU5C ofzny misstatcrner.t of fact by the Policyholder or Farticipam. Any required adj\1Sln)ent may be
~e in premiuJ:1s or benefi~.
No Replacement (or Worl(ers' COlTlpensntion
The policy dQes Dot replace Workers' Comper.sztion or aff~t any requircm.eot for WorKC':"s' Compc:o~tio:l
coverage.
Time Period
All periods be,gi.n 8J'Id end at 12:0 I A.M., standard time, at dIe Poli cyh 01 del's :1ddress.
JurlJdic:tion
This policy is governed by the laws of the State where it is deliverC<!.
7
(jR-U710(06)A~. 7.'97