Item C24BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: July 16, 2008 Division:. Emergency Services
Bulk Item: Yes X No Department: Fire Rescue
Staff Contact /Phone #: Claudia Wilkerson
305-289-6014
AGENDA ITEM WORDING: Approval by the Board, acting as Plan Administrator of the Length of
Service Award Plan (LOSAP) to begin 10-year disbursement of funds to one eligible participant,
Thomas P. Cullen, Jr. with a monthly benefit of $165.00 commencing August 1, 2008.
ITEM BACKGROUND: In June of 1999, the Board approved an Ordinance providing for the
creation of a Length of Service Award Plan, Mr. Thomas P. Cullen, Jr. is now eligible for benefits as of
August 01, 2008.
PREVIOUS RELEVANT BOCC ACTION: On June 9, 1999, the Board approved Ordinance
No. 026-1999 providing for the creation of a Length of Service Award Plan. Subsequently, annually
the Board has approved the current actuarial valuation and credit of an additional year of service.
CONTRACT/AGREEMENT CHANGES: Not applicable.
STAFF RECOMMENDATIONS: Approval
TOTAL COST: $330.00 F/Y 2008 BUDGETED: Yes X No
COST TO COUNTY: $330.00 F/Y 2008 SOURCE OF FUNDS: LOSAP Trust Fund
Account #14500 530360
REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year
APPROVED BY: County Atty N/A Purchasing _
DOCUMENTATION: Included X Not Required
DISPOSITION:
Revised ] !/06
Risk Management N/A
AGENDA ITEM #
Monroe County, .Florida Volunteer Firefighter and
Emergency Medical Services
Length of Service .Award Program
Benefit Certification Form
Date: Q
To: %DiYi eOL L-4-5-
From: Monroe County Board of County Commissioners
Fire Rescue Services,
A review of records maintained for the Length of Service Award Program (LOSAP) indicates
that you may be eligible for the following level of certification:
dYou have completed 10 ears of active service. You Y will be eligible for payment of
benefits upon reaching the age of 60.
❑ You have completed 10 years of active service AND have reached the minimum age of
60. You are eligible for immediate payment of benefits.
In order to complete our certification of your eligibility for benefits, we require that the
following information be provided:
NAME:
ADDRESS:
/ f `(
R4 w('t C--1.@ la(
DAy-e-
CITY: A4,11ev
V l L e-
ST:
ZIP:
SOCIAL SECURITY NUMBER:
DATE OF BIRTH:
(Note: In order to verify rite of birth, a copy of your driver license or certificate of
birth moist be included with this application.)
Name of Volunteer Department from which this application is submitted:
VED
I hereby certify that the information above is true and accurate to the best of our belief and
knowledge.
Signature of Applicant:
Signature of Departmen
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