LAKE CITY AREA FIRE PROTECTION DISTRICT · 2019. 12. 4. · LAKE CITY AREA FIRE PROTECTION DISTRICT AGENDA February 24, 2015 Regular Meeting 5:00 p.m. - Lake City Fire Station, 131

LAKE CITY AREA FIRE PROTECTION DISTRICT

A G E N D A February 24, 2015 Regular Meeting

5:00 p.m. - Lake City Fire Station, 131 N. Klenson Street

C A L L T O O R D E R

R O L L C A L L

MINUTES**

B I L L S P A Y A B L E

T R E A S U R E R ' S R E P O R T * *

F I R E C H I E F ' S R E P O R T

1. I N S U R A N C E - Proposal for Blanket Accident and S ickness Insurance ** 2. 2014 AUDIT - Proposal for Auditing Serv ices for 2014 and the Subsequent 4 Years .

A D J O U R N M E N T

** included in packet

131 N. Henson Street • P. O. Box 574 • Lake City, CO 81235 • (970) 944-2653 www.lakecityfiredept.org

R E C O R D OF PROCEEDINGS

Regular Meeting January 27,2015

Chairman Roberts called the regular meeting of the Board of Directors of the Lake City Area Fire Protection District to order at 5:02 p.m. Those Directors present were: Dennis Cavit, Joe Heam, Tim McKinney and Joe Wonnacott.

Also present were: Bill Hagendorf Fire Chief; Michelle Pierce, Secretary; Wayne Jones, and fu-efighters Kenny Athey, April Athey, Behnda Gianola, Wayne Jones, Darrin Hardy, Forest Gray, and Mike Tuttle, MINUTES OF PREVIOUS MEETING

Director Heam moved, Director Wonnacott seconded to approve the minutes of the December 30, 2014 regular meeting as circulated. The motion passed with all voting yes in a general vote. BILLS PAYABLE

Director McKinney moved. Director Cavit seconded to approve payment of the bills as circulated. The motion passed with all voting yes in a general vote. TREASURER'S REPORT

Director Wonnacott moved. Director McKinney seconded to approve the Treasurer's Report for the month ending December 31, 2014. The motion passed with all voting yes in a general vote. FIRE CHIEF'S REPORT

The Directors read the report submitted by Chief Hagendorf (see attached). FIREMEN'S PENSION FUND - Report of Financial Status of Fund

Secretary Pierce presented the 3"* quarter 2014 allocation report from FPPA showing a balance at that time of $82,085.74 for review. She stated that the 4* quarter allocation report would not be available until sometime in Febraary. Director Cavit presented his copy of the 2013 actuarial study for review as well. Chief Hagendorf explained the applicable provisions of bylaws regarding training hours and meeting attendance to the volimteer firefighters present. The volunteers present signed a receipt acknowledging that they had received copies of the ciurent bylaws, the spreadsheet detailing each firefighter's years of service and other information. There was some discussion with the firefighters regarding the pension fund and questions were answered. The Directors thanked the volunteers for their continuing service and dedication to the department. INSURANCE - Proposal for Accidental Death & Dismemberment Insurance

The Directors reviewed the proposal from Mountain West Insurance and Financial Services for accidental death and dismemberment insurance for the volunteer firefighters. It was noted that the update to the proposal for a blanket accident and sickness poUcy had not yet been received. After some discussion, the Directors agreed to consider this matter again at their next meeting. Secretary Pierce stated that she would follow up with Mountain West regarding the revised proposal. 2014 AUDIT- Request for Proposals

The Directors re\iewed a draft of a request for proposals for auditing services that was submitted by Secretary Pierce.

Director Cavit moved. Director McKinney seconded to approve the request for proposals for auditing services and to send it out to eight CPA firms that are currently working for other local governments in Lake City and in nearby communities. The motion passed with all voting yes in a general vote. SPECIAL DISTRICT PUBLIC DISCLOSURE DOCUMENT

Secretary Pierce reported on the District's compliance with CRS 32-1-104.8, which required the recording of a Special District Public Disclosure Document with the Hinsdale County Clerk by December 31, 2014. Secretary Pierce noted that the document had not been recorded until January 8, 2015 due to the clerk's office being closed on December 31' . 2014 ACCOMPLISHMENTS

Chief Hagendorf read a list of the fire department's accomplishments in 2014 (see attached).

R E C O R D OF PROCEEDINGS

Regular Meeting (2) January 27,2015

ATTENDANCE POLICY Director Heam asked for a review of the District's attendance policy in view of recent Director absences from

meetings. There was some discussion regarding the difference between excused and unexcused absences. The Directors agreed that a Director's absence should be noted as excused or unexcused in the meeting minutes as is currently being done.

Director Cavit stated that he would not be present for the Febraary meeting because he would be attending a real estate school.

BILLS PAYABLE TO AND FOR: AMOUNT FUND Bill Hagendorf - Contract Labor, Fire Chief 1,050.00 Gen. CenturyLink - Phone/DSL 125.75 Gen. City of Gunnison - 2015 Dispatch Fees 3,639.00 Gen. Gunnison County Electric Association, Inc. - Electricity 185.68 Gen. Hi Coimtry Carpet and Tile - Install Carpet 1,830.42 Gen. Michelle Pierce - Reimburse for Recording Fees, Special District Notice 51.00 Gen. Michelle Pierce - Reimburse for Quickbooks Subscription Renewal 199.95 Gen. Michelle Pierce - Contract Administration 500.00 Gen. Municipal Emergency Services, Inc. - Bunker Gear 1,902.39 Gen. NAPA Auto Parts - Battery & Core Deposit/Credit 354.42 Gen. NAPA Auto Parts - Socket, Ring Terminal, Black Plastic Nut 18.18 Gen. NAPA Auto Parts - Antifreeze, Power Service 45.76 Gen. NAPA Auto Parts - Battery, Safety Gloves 20.46 Gen. Silver World Publishing Co. - Notices Town of Lake City - 4* Quarter Water & Sewer

15.00 Gen. Silver World Publishing Co. - Notices Town of Lake City - 4* Quarter Water & Sewer 225.00 Gen. VISA - Carpet, Engraving. Station Supphes, etc. 3,042.10 Gen. ADJOURNMENT

There being no further business to come before the Board, Director Cavit moved. Director Heam seconded to adjourn die regular meeting at 6:17 p.m., but to meet again at the next regular meeting on Febraary 24, 2015. The motion passed with all voting yes in a general vote.

Chairman ATTEST:

Secretary

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LAKE CITY AREA FIRE PROTECTION DISTRICT Treasurer's Report January 31,2015

BEGINNING BALANCE 1/1/2015 RECEIPTS DISBURSEMENTS ENDING BALANCE 1/31/2015 GENERAL FUND CAPITAL RESERVE FUND CONTINGENCY RESERVE FUND

FIREMEN'S PENSION FUND FIREWORKS FUND

TOTALS

$29,217.99 $4,153.51 $287,234.06 $672.84 $49,517.56 $64.08 $84,718.84 $64.08

$12,032.75 $0.00 $462,721.20 $4,954.51

$13,301.59 $27.01 $2.57 $2.57 $0.00

$13,333.74

$20,069.91 $287,879.89 $49,579.07 $84,780.35 $12,032.75

$454,341.97

Petty Cash Checking Acct - M&M MM Acct - M & M MM Acct - ColoTrust Certificates of Deposit FPPA TOTAL

Respectfully submitted.

$25.00 $100.00

$270,360.18 $79,264.17 $20,000.00 $84,592.62

$454,341.97

Treasurer

Proposal for Professional Auditing Services Green & Associates, LLC

2700 East Bridge Street, Suite A Brighton, C O 80601

720-839-6458

Green & Associates LLC t 'eniiied !\ibli

TABLE OF CONTENTS

Transmittal Letter About the Firm Quality Control Commitment to Service Approach to the Engagement Resume of Engagement Team Fee Schedule Peer Review Report Letters of Reference

Green & Associates LLC C'ertifsed Accouiitauts &' Biisiiieiis Cousulfcuits

February 18,2015 Dear Lake City Area Fire Protection District: We appreciate the opportunity to propose our audit services for the period ending December 31, 2014 and subsequent periods. We can deliver an audit of your financial statements in accordance with Generally Accepted Auditing Standards in a quality and timely manner. We are confident that our firm and its staff possess the necessary skills and qualifications in order to provide you with services in the highest quality and timeliest manner possible. We have the staff and resources to meet the deadlines of your organization. Green «fe Associates, LLC was founded on the idea of offering quality audits at a reasonable price while providing service above and beyond most firms. We believe in immediately returning client inquiries and are available for questions throughout the year. We are also committed to meeting your timeline for the audit and being responsive to your priorities. We work with your team to minimize the disruption during the audit process. This is accomplished through prior planning, open communication, and consistency from year to year of the audit team. The consistency of the audit team greatly reduces the amount of time you spend updating new auditors on the nature of your entity while the clear communication reduces the time responding to requests for documentation and will expedite the entire audit process. This also eliminates most of the last minute surprises and allows you to plan your time more efficiently. We are confident that we can offer your organization the highest level of client care. We can commit to you that our firm's approach to client service will continue to surpass your expectations for years to come. Our qualifications and credentials are presented in the attached proposal for your convenience. We are confident that the services our firm can provide the Lake City Area Fire Protection District will demonstrate that we are highly qualified. We are committed to resolving issues promptly, responding to requests immediately and meeting with you regulariy. We believe that our firm can provide the Lake City Area Fire Protection District a high quality, efficient audit of their financial statements at a fair price. This proposal constitutes a firm and irrevocable offer for 60 days. Please call me regarding any questions that you may have. I look forward to hearing from you and hope that Green & Associates, LLC can be of service to you. Sincerely,

David B Green Managing Member

2700 E Bridge Street, Suite A Brighton, CO 80601

C, r (• e n & .\ s i i ,i u- s ' L L C PHONE (720) 839-6458 www.GreenCPAfirm.com

Certified Public Accountants & Business Consultants

About the Firm Green & Associates, LLC is located in Brighton, CO and was established with the primary focus to be in providing accounting and taxation services to not for profits and governmental clients. The firm consists of one auditor and one general accountant who are involved in the audits and accounting of governmental entities. The firm is a member of the Colorado Society of Certified Public Accountants, the AICPA and the Special Districts Association of Colorado in order to remain current on the areas affecting our clients. Based on the skill level and experience of the staff in place we are confident that we can provide the Lake City Area Fire Protection District with the services requested in the timeframe they are desired. Green «fe Associates, LLC and all members of the firm are independent of the Lake City Area Fire Protection District. The firm has not had any prior relationships with the Lake City Area Fire Protection District. Quality Control The firm is committed to the highest level of competency and requires each professional to undergo a minimum of 40 hours of continuing education in audit and accounting annually with at least 24 of those hours in the area of governmental and non-profit accoimting and auditing during the reporting period. All professionals associated with the firm are members of the Colorado Society of CPA's and the AICPA. The firm and all professional staff are properly licensed by the Colorado State Board of Accountancy to practice within the state of Colorado. The firm participates in the AICPA peer review program. During the most recent inspection dated January 31, 2014 the firm received the highest rating possible, a rating of "Pass." A copy of the report is attached to this proposal. The peer review consisted of audits performed under governmental auditing standards, 0MB A-133 and general governmental engagements. The firm carries professional liability insurance which exceeds the amounts required by the Colorado State Board of Accountancy. Neither the firm nor any staff member associated with the firm are under any disciplinary sanctions or investigations by the State Board of Accoimtancy, and have not been subject to any of the above in the past. The firm has not been subject of any Federal or State desk reviews. Commitment to Service The top priority at Green & Associates, LLC, is to provide our clients with the highest level of service and to help them identify and solve the problems facing their organization, enabling them meet or exceed their objectives. This is accomplished through a strict adherence to deadlines and by maintaining clear and open lines of communication to continue to meet the needs of our clients even as their business changes. In the course of carrying out an engagement we generate insights and develop information which results in improved controls and greater efficiencies leading to a higher level of financial reporting for our clients. At the conclusion of each engagement we provide a formal letter that will summarize any suggestions we may have.

Approach to the Engagement Our audit of your basic financial statements will be performed in accordance with Generally Accepted Auditing Standards (GAAS) as set forth by the American Institute of Certified Public Accountants (AICPA). Green & Associates, LLC takes a risk based approach to every audit and tailors its approach to each specific engagement. We start by gaining a thorough understanding of your entity, the risks affecting the entity and managements approach to addressing those risks. Once these areas are determined we look at each individual risk and determine its risk of material misstatement to the financial statements through either errors or fraud and whether that risk relates to specific assertions or to significant account balances, classes of transactions or disclosures. We will also discuss with your staff and review documentation within the organization to determine specific laws, regulations and contracts as they relate to the organization. We will compare this with our knowledge of the governmental industry and evaluate additional laws and regulations that may apply to the organization. Based on the results of our planning and risk assessment we will determine a specific audit approach to be applied to each area. Throughout the process of understanding your entity we will gain a thorough understanding of the internal controls that are in place. Based on our understanding of these controls we will assess their effectiveness and determine whether it is efficient to test these controls, and if effective rely on these controls, or if a testing methodology utilizing substantive tests would be more appropriate. To the extent that we perform substantive testing we will utilize statistical sampling to assist us in these procedures as considered necessary. Sample sizes are determined once planning is completed based on the risks identified in the audit area in order to achieve a high level of assurance. As part of every audit we utilize analytical procedures throughout the audit beginning in the planning phases extending through the final review of the financial statements. We will utilize the information from your accounting system to evaluate relationships and to look for trends that are natural to each set of accounts. Analytical procedures are utilized in combination with the reliance of internal controls and the performance of substantive testing. Typical analytical procedures applied include but are not limited to:

• Comparison to prior years balances • Comparison to expected balances based on our understanding of the entity • Assessment of relevant ratios as they relate to specific accounts • Comparison of budgeted balances to actual balances

We communicate closely and regularly with management and accounting staff during the audit process. From preliminary audit planning and field work, through delivery of reports and communication of internal control related materials, we strive to keep you informed. All proposed audit adjustments and management comments will be dehvered to management prior to the presentation of the audit to the Board. This gives them an opportunity to be discussed and ensures there will be no surprises. They will also be presented in a formal document when the audit is finalized. We believe this combination of communication, testing and planning results in an effective, cost efficient, independent audit, performed in a timely manner.

Resume of the Engagement Team David Green, CPA ^Engagement Partner) Colorado License Number: 23825 Education: Bachelor of Science, Accounting, Colorado State University. Licenses: Certified Public Accountant (Colorado) Professional Organizations: Colorado Society of Certified Public Accountants

Special Districts Association of Colorado American Institute of Certified Public Accountants

Continuing Education: David continually participates in ongoing continuing education that is focused on governmental and nonprofit auditing practices. He consistently obtains continuing education credits in excess of those required for licensure. This includes annual updates in the areas of GASB pronouncements, auditing standards and 0MB A-133 audit procedures. Special attention is given to areas with changes each year. This includes over 180 hours of continuing education over the past three years. Experience: Over 14 years of audit, taxation, general accounting and financial analysis experience in governmental, not for profit and for profit sectors. David has a wide range of governmental experience that includes extensive experience auditing all tj^es of municipalities and special districts including water, sanitation, and metro districts. David also has performed many engagements that are required to be performed under 0MB circular A-133. David has extensive knowledge of internal controls and their application in order to form a solid financial reporting system within organizations. Sample of Current Similar Clients, David Green engagement partner:

• Lake Fork Health District • Boulder Mountain Fire District • Wheat Ridge Sanitation District • High View Water District • Mountain Water and Sanitation District

Fee Schedule Our fees are based on the time spent on the engagements and are estimated based on our staff s previous experience in the industry. Our goal is to help you control your costs and to provide an effective independent audit in the most efficient manner possible. We are available year round to assist with basic inquiries that may arise or to undertake additional services if needed. We do not bill for basic inquiries that arise during the year and believe that this access to our firm is one of the core values it was founded upon. If significant additional services are desired they would be provided based on our standard hourly rates.

We believe that maintaining the continuity of staff on an engagement is a key item in the efficiency of an audit and which will minimize any disruption to the client. The consistency of staff can be assured from year to year because we are utilizing members with a vested interest in the firm. The engagement partner will be present during field work regardless of the number of staff that is employed within the firm. Because the engagement team has a vested interest in the success of the firm and its reputation their actions will always reflect the highest level of professionalism and dedication to quality. We make it a point to only take on engagements within the skill levels of the firm and that can be performed within the required deadlines and are confident that the Lake City Area Fire Protection District meets this criterion. Our Proposed fee for this engagement is $4,000 which includes an audit of the fmancial statements in accordance with GAAS and preparation of the fmancial statements. The fees represent a maximum not to exceed price for audit services and should an increase in fees become necessary based on additional work required this will be disclosed to management immediately and in writing. It is not anticipated that an increase in fees will be needed. The fees are based on the understanding that the overall condition of the Lake City Area Fire Protection District financial and accounting records are excellent and we will receive the support necessary for the preparation of requested schedules and other supporting documentation. The above fees represent a firm commitment good for 60 days. We would be available to begin audit procedures at time that is coordinated with your staff.

Blair and Associates pc

Cr.KTirii'.ii Pmujc A( (oiif^TA^Nrs ai^d CoNSl:n•A :̂Ts

System Review Report

To the Partners of Green and Associates LLC and the Peer Review Committee of the Colorado Society of CPA'S We have reviewed the system of quality control for the accounting and auditing practice of Green and Associates LLC (the firm) in effect for the year ended November 30, 2013. Our peer review was conducted in accordance with the Standards for Performing and Reporting on Peer Reviews established by the Peer Review Board of the American Institute of Certified Public Accountants. As a part of our peer review, we considered reviews by regulatory entities, if applicable, in determining the nature and extent of our procedures. The firm is responsible for designing a system of quality control and complying with it to provide the firm with reasonable assurance of performing and reporting in conformity with applicable professional standards in all material respects. Our responsibility is to express an opinion on the design of the system of quality control and the firm's compliance therewith based on our review. The nature, objectives, scope, limitations of, and the procedures performed in a System Review are described in the standards at www.aicpa.org/prsummary. As required by the standards, engagements selected for review included engagements performed under Government Auditing Standards. In our opinion, the system of quality control for the accounting and auditing practice of Green and Associates LLC in effect for the year ended November 30, 2013, has been suitably designed and complied with to provide the firm with reasonable assurance of performing and reporting in conformity with applicable professional standards in all material respects. Firms can receive a rating pass, pass with deficiency(ies) or fail. Green and Associates LLC has received a peer review rating of pass.

(Blkir ancCjLssociates,

c/o Robert B. Loveman, Treasurer 1905 Linden Dnve Boulder, CO 80304

September 25, 2011 To Whom It May Concern: We engaged David B. Green, CPA, LLC to audit our volunteer fire department financial statements for 2010. We are very pleased with the quality, timeliness, and professional approach Mr. Green exhibited throughout the audit process. In addition to all the routine audit iunctions performed, Mr. Green made himself available to our bookkeeper and me to assist in correctmg prior year adjusting journal entries, tying out the year-end 2009 detailed accounting ledgers to the audited 2009 fmal numbers and a variety of other consulting efforts on our behalf We found David to communicate clearly and work cooperatively with all necessary members of our department team. We would be pleased to discuss our experience in more detail upon request. We have engaged Mr. Green to audit our 2011 fmancial statements and look forward to working with him again. Very truly yours.

(s) Robert B. Loveman Boulder Mountain Fire Protection District By: Robert B. Loveman, Treasurer

Wheat Ridge Sanitation District P.O. Box 288

Wheat Ridge, CO 80034-0288 303-424-7252

[email protected]

November 18, 2011

Letter of Reference for David B. Green CPA LLC "

David Green was engaged by our district to audit our annual financial statements for 2009, 2010 and 2011. We have been very pleased with his services. He begins each year by promptly sending us his engagement letters, bank confirmations and other preliminary documents well in advance of when needed, allowing our board of directors time to deal with them. He schedules the field work at convenient times for us and finishes that work efficiently and timely with minimum disruption of operations, while doing what I perceive as a thorough job. He communicates regularly throughout the audit process, questions are pertinent. He sends an accurate draft of the financials for our review, including the Management Discussion and Analysis, in time enough for us to review it before deadline. Rarely do I find any changes needed to the financials. The M, D & A is quite complete requiring a minimum of my time to complete. Our board of directors appreciates his comments when he presents the audit at the board meeting. He has always met the statutory deadlines. We have found his fees to be reasonable and consistent.

Finally, it has been a pleasure working with him. In addition to the audit, he has helped with side accounting issues and questions in the ofTice.

David A. Sebern, CPA Manager of the Wheat Ridge Sanitation District

Blanket Accident Insurance Proposal for:

Lake City Area FPD

Presented By:

PROVIDENT Insuring America's Heroes Since 1928

Visit our website at: www.providentbenefits.conn

December 19, 2014

Plans of insurance for the

PROVIDENT Lake City Area FPD Insuring America's Heroes Since 1928

Benefits apply to Volunteer Members, Auxiliary Members, Community Volunteers and Part-Time Employees wfio work less than 30 cumulative hours per week while performing an activity of the organization.

Section 1: Death Benefits Plan 1 Plan 2 Plan 3 A. Covered Injury Death Benefit $25,000 $50,000 $75,000 B. Covered Illness Death Benefit $25,000 $50,000 $75,000 C. Optional HIV Positive Benefit $25,000 $50,000 $75,000 D. Bereavement Benefit - Covered Injuries Up to $2,500 $5,000 $7,500

Bereavement Benefit - Covered Illnesses Up to $2,500 $5,000 $7,500 E. Dependent Child Benefit (Per Child) - Covered Injury $10,000 $10,000 $10,000

Dependent Child Benefit (Per Child) - Covered Illness $10,000 $10,000 $10,000 F. Seat Belt Benefit $6,250 $12,500 $18,750

Section 11: Impairment Benefits Plan 1 Plan 2 Plan 3 A. Dismemberment Benefit* Up to $25,000 $50,000 $75,000 B. Vision Impairments Benefit* Up to $25,000 $50,000 $75,000 C. Cosmetic Disfigurement from Burns Benefit* Up to $25,000 $50,000 $75,000 D. Permanent Physical Impairment Benefit - Covered Injuries* Up to $25,000 $50,000 $75,000

Permanent Physical Impairment Benefit - Covered Illnesses* Up to $25,000 $50,000 $75,000 E. Felonious Assault Benefit Up to $6,250 $12,500 $18,750 F. Impairment Modification Benefit Up to $15,000 $15,000 $15,000

* Benefits payable are based on the percentage ofimpariment or loss as defined in the policy.

Section III: income Protection Plan 1 Plan 2 Plan 3 A. Maximum Weekly Total Disability Benefits** Up to $150 $200 $300

i. Minimum Weekly Total Disability Benefit $100 $100 $100 ii. Earned Income Replacement Benefit** Up to $50 $100 $200

B. Partial Disability Benefit Up to $150 $200 $300 C. First Week Disability Benefit** Up to $1,000 $1,000 $1,000 D. Cost of Living Adjustments Up to $450 $600 $900 E. Transition Benefit Up to $150 $200 $300 F. Retraining Benefit Up to $20,000 $20,000 $20,000

Benefits are payable in coordination with the Loss of Earnings Coverage as defined in the policy.

PAI-201-1007 (08.2011) This proposal is valid for 90 days. Page 2

December 19, 2014


Lake City Area FPD

Benefits apply to Volunteer Members, Auxiliary Members, Community Volunteers and Part-Time Employees wfio work less tfian 30 cumulative hours per week while performing an activity of the organization.

Section IV: Medical Expenses Plan 1 Plan 2 Plan 3 A. Medical Expense Benefit - Injury*** Up to $10,000 $15,000 $25,000

Medical Expense Benefit - Illness*** Up to $10,000 $15,000 $25,000 B. Plastic Surgical Expense Benefit*** Up to $10,000 $10,000 $10,000

***We will not pay covered medical expenses incurred by an Insured Person that are paid or payable under any other Valid and Collectible Insurance, including Workers' Compensation.

Section V: Family Ass is tance Plan 1 Plan 2 Plan 3 A. Weekly Hospital Confinement Benefit $70 $70 $105 B. Weekly Critical Care Benefit $140 $140 $210 C. Family Expense Benefit Up to $5,000 $7,500 $1,000 D. Rehabilitation Benefit Up to $5,000 $5,000 $5,000 E. Mental Stress Management Benefit Up to $10,000 $10,000 $10,000 F. Traumatic Incident Benefit Up to $2,500 $2,500 $2,500 G. Health Insurance Premium Benefit Up to $5,000 $7,500 $12,000

Section VI: Optional Auxiliary Person and/or Community Volunteer Coverage Plan 1 Plan 2 Plan 3

A. Covered Injury - Death, Dismemberment, Loss of Sight, Speech or Hearing Full Coverage Full Coverage Full Coverage B. Weekly Total Disability Benefit Up to Full Coverage Full Coverage Full Coverage C. Weekly Hospital Confinement Benefit Full Coverage Full Coverage Full Coverage D. Medical Expense Benefit Up to Full Coverage Full Coverage Full Coverage E. Special Illness Benefit Full Coverage Full Coverage Full Coverage

Section Vil: Organized League Athletics Coverage Plan 1 Plan 2 Plan 3 A. Covered Injury - Death, Dismemberment, Loss of Sight, Speech or Hearing Not Included Not Included Not Included B. Weekly Total Disability Benefit Up to Not Included Not Included Not Included C. Weekly Hospital Confinement Benefit Not Included Not Included Not Included D. Medical Expense Benefit Up to Not Included Not Included Not Included


Plans of insurance for the December 19, 2014

Lake City Area FPD

Benefits apply to Volunteer Members, Auxiliary Members, Community Volunteers and Part-Time Employees who work less than 30 cumulative hours per week while perfonming an activity of the organization.

P l a n 1 P l a n 2 P l a n 3

Annual Premium Summary Annual Annual Annual

Emergency Service Organization: Auxiliary Members & Community Volunteers: Organized League Athletics Coverage:

$1,351.00 Full Coverage

Not Included


Not Included


Not included

Annual Premium: $1,351.00 $2,205.00 $3,274.00 The annual payment option offers a one-year rate guarantee.

Installment Premium Summary 2 Installments 2 Installments 2 Installments



Not Included


Not Included


Not Included

Installment Premium: $1,261.00 $2,058.00 $3,056.00

The installment payment option offers a two-year rate guarantee which is paid each year for two years and represents a 6.7% discount off the annual premium.

Prepaid Premium Summary


2-Year Prepaid


Not Included

2-Year Prepaid


Not Included

$3,969.00

2-Year Prepaid


Not Included

$5,894.00 Prepaid Premium: $2,432.00

The prepaid payment option offers a two-year rate guarantee which is paid in full at the beginning of the policy term and represents a 10% discount off the annual premium.

Note: Premiums will vary based on the plan and/or payment option selected.



Lake City Area FPD

December 19, 2014

Disclosure Statement

Your insurance or benefits provider can offer you advice and guidance as you select the policy and provider most appropriate for your needs. At Provident Agency, in partnership with Unum, we offer compensation to your advisor for the important role these professionals play in the sale of our products and services. Provident Agency may also be eligible for additional incentive compensation from Unum based on in force block size and persistency. We support disclosure of advisor compensation so that customers can make an informed buying decision.

If you would like additional information about the compensation programs our company offers, you may go to www.proviclentbenefits.com. Should you have additional questions or want more specific information, please mail a written request to our main office at PO Box 11588, Pittsburgh, PA 15238. You may also fax your request to 412-963-0415. Your request must be on official letterhead and be signed by an officer of your organization.

Exclusions and Limitations

We will not pay benefits for loss caused by war or act of war. Disability claims resulting from athletic events will be limited to a maximum period of 1,092 days (156 weeks). In no event will benefits be payable to an Insured Person for more than one disability at the same time. If the Insured Person is covered under more than one Emergency Organization's Blanket Accident Policy issued by Provident Life & Accident Insurance Company, the total benefits payable will not exceed those payable under the policy that provides the greatest benefit. An Insured Person may reopen their claim at any time up to five years following a period of Total or Partial Disability for either injuries or illnesses for which payments were made under the policy.

This information is not intended to be a complete description of the insurance coverage available. The policy or Its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form 211 underwritten by Provident Life & Accident Insurance Company of Chattanooga, TN. This Insurance coverage Is administered by Provident Agency, inc. of Pittsburgh, PA and In California, Provident of Pennsylvania Insurance Agency, Inc. of Pittsburgh, PA.

PAI-201-1007 (08.2011) This proposal is valid for 90 days. Pages

Lake City Area FPD

PROVIDENT Insuring America's Heroes Since 1928 Benefit Explanations / Definitions / Exclusions Tliis proposal offers coverage to Volunteer Members, Auxiliary Members, Community Volunteers and Part-Time Employees who work less than 30 cumulative hours per week. Benefits apply while the Insured Person is perfonving an activity of the organization. Covered Injuries exclude organized league athletics, as separate coverage can be purchased. Covered Illnesses exclude Mental Stress, as it is covered in it's own section.

Section I: Death Benefits A. Covered Injury Death Benefit - This benefit is payable if an Insured Person sustains a Covered Injury that directly causes the loss of life.

B. Covered Illness Death Benefit - This benefit is payable if an Insured Person suffers a Covered Illness that directly causes the loss of life.

C. Optional HIV Positive Benefit - If Insured Person tests HIV Positive as a result of participation in a Covered Activity, the Insured Person may choose to receive the Optional HIV Positive Benefit in lieu of the Permanent Physical Impairment Benefit and/or Covered Illness Death Benefit or Covered Injury

D. Bereavement Benefit - If a Covered Injury or Illness Death Benefit is payable under this policy, an additional amount equal to 10% of the Principal Sum not to exceed $10,000 will be payable for expenses actually incurred directly associated with the Insured Person's death.

E. Dependent Child Benefit - If the Insured Person sustains a Covered Injury or a Covered Illness which results In the loss of the Insured Person's life, an additional $10,000 will be payable for each Dependent Child.

F. Seat Belt Benefit - If an Insured Person is wearing a property fastened seat belt and sustains a Covered Injury which results in the loss of the Insured Person's life, an additional amount equal to 25% of the Covered Injury Death Benefit or Covered Illness Death Benefit is payable.

Section II: Impairment Benefits A. Dismemberment, Loss of Speech or Hearing Benefit - If an Insured Person sustains a Covered Injury that directly causes a loss of speech, hearing or a

dismembennent as defined In the policy we will pay an amount equal to 6.25% up to 100% of the Principal Sum based on the level of loss or

B. Vision Impairment Benefit - Payable if the Insured Person suffers a permanent and Irrecoverable loss of sight as defined in the policy we will pay an amount equal to 2.75% up to 100% of the Principal Sum. Benefits are payable for partial loss of sight as well as total loss of sight.

C. Cosmetic Disfigurement from Bums Benefit - If an Insured Person as a result of a Covered Injury suffers a cosmetic disfigurement due to a burn that is classified as third degree or a full thickness bum, a benefit Is payable. The amount of the benefit will be based on a formula, which will be multiplied by the Principal Sum. The formula will take into account the area of the body which was burned.

D. Permanent Physical impairment (PPI) Benefit - If an Insured Person suffers a Covered Injury or Covered Illness which results in a Permanent Physical Impalmient of a body part(s), we will pay a PPI Benefit. The impalnnent percentage assigned by the physician Is multiplied by the Principal Sum to determine the benefit payable.

Death Benefit.

dismemberment.

PA(-201-1007 (08.2011) Page 6

E. Felonious AssauK Benefit - If an Insured Person is participating in a Covered Activity and sustains a Covered Injury caused by a criminal act of violence directed at the Insured Person, we will pay an additional benefit equal to 25% of the total benefit paid, not to exceed $50,000.

F. Impairment Modification Benefit - This benefit may be payable if an Insured Person's physical limitation or impairment poses a safety risk or inhibits the Insured Person's ability to maintain independence in their cun-ent transportation or living situation. This benefit is voluntary on the Insured Person's part and on our part. The maximum benefit payable is $15,000.

Section III: Income Protection A. Maximum Weekly Total Disability Benefits

Covered Injury - payable up to lifetime. Covered Illness - payable up to the greater of age 67 or five years.

A.i. Minimum Weekly Total Disability Benefit - Paid in addition to any benefit from any source.

A.ii. Earned Income Replacement Benefit - Payable up to the amount listed In the policy while the Insured Person is Totally Disabled and the Minimum Weekly Total Disability Benefit is payable. The amount payable shall be computed by determining the Insured Person's Weekly Earned Income then subracting the Minimum Weekly Total Disability Benefit and the Loss of Earnings Coverage (I.e. Workers' Compensation) as defined In the policy.

B. Partial Disability Benefit - If a Covered Injury or Covered Illness permits the Insured Person to return to any Reasonable Occupation but at a lower rate of Weekly Earned Income, or if the Insured Person Is receiving any Weekly Earned Income from any source, we will pay up to the Maximum Weekly Total Disability Benefit which would have been paid had the Insured Person been Totally Disabled. Payable up to the later of: 1.) age 67 or normal retirement age, whichever comes first; or 2.) 5 years.

C. First Week Total Disability Benefit - For the first week of total disability, we will pay a benefit of up to $1,000 in coordination with any Loss of Earnings Coverage (e.g. Workers' Compensation) to replace the Insured Person's Weekly Earned Income.

D. Cost Of Living Adjustments (COLA) - Adjustments are made at the greater of 5% or the CPI-U (up to 8%) on the anniversary date of the Covered Injury or Covered Illness for continuous disability. COLA are compounded annually not to exceed three times the Maximum Weekly Total Disability Benefit limit.

E. Transition Benefit - If an Insured Member is released to return to his or her primary employment after having received benefits under this policy for a Covered Injury or Covered Illness, and their position at their primary employer has been terminated due to the Covered Injury or Covered Illness, we will continue to pay disability benefits previously payable for a period of up to 26 weeks while the Insured Person actively seeks employment.

F. Retraining Benefit - Retraining will be voluntary on the part of the Insured Person and on our part. If the Insured Person and we agree upon a program of retraining In an Institution of higher learning, we will pay tuition and books as charged by the institution and as set forth in a written agreement between the Insured Person and us which can be periodically reviewed. Benefits for disability will continue as provided by the policy while the Insured Person Is actively participating in the program. The maximum benefit Is $20,000.

PAI-201-1007 (08.2011) Page 7

Section IV: Medical Expenses A. Medical Expense Benefit - if a Covered Injury or Covered Illness requires medical or surgical treatment, preventative Inoculation, fiospital confinement or

the employment of a trained nurse, we will pay the actual cost to the Insured Person. The benefit limit Is the maximum amount payable for each Insured Person as the result of any one Covered Injury or Illness. We will not pay these benefits in excess of maximum Medical Expense Benefit listed In the policy.

We will not pay covered medical expenses Incurred by an Insured Person that are paid or payable under any other Valid and Collectible Insurance, including Workers' Compensation.

B. Plastic Surgical Expense Benefit - An additional 25% of the Medical Expense Benefit may be used for Plastic Surgical Expense Benefit as the result of a Covered Injury, but not less than $10,000.

Section V: Family Assistance A. Weekly Hospital Confinement Benefit - If, due to a Covered Injury or Covered Illness, an Insured Person Is hospital confined as a resident patient for at

least a full day, we will pay 1/7 of the Weekly Hospital Confinement Benefit limit for each full day of hospital confinement, but not to exceed 730 days. If the Insured Person is confined in a hospital for at lease a full day, and requires outpatient physical therapy, rehabilitation and/or follow-up physician visits, the maximum number of days payable under this section will not exceed 730 days. If, due to a Covered Injury or Covered Illness, an Insured Person does not require confinement as a resident patient, but does require outpatient physical therapy, rehabilitation or follow-up physician visits, we will pay 1/7 of the Weekly Hospital Confinement Benefit limit for each day of such treatment, but not to exceed 365 days. We will only make one payment per day, regardless of the number of appointments the Insured Person attends.

B. Weekly Critical Care Benefit - If, due to a Covered Injury or Covered Illness, an Insured Person Is hospital confined to an Intensive Care, Trauma, Critical Care, Bum, or similar specialty unit, we will pay 2/7 of the Weekly Hospital Confinement Benefit listed in the policy for each full day of such confinement, but not to exceed 730 days.

C. Family Expense Benefit - If, as a result of a Covered Injury or Covered Illness, an Insured Person requires medical treatment that causes one or more of their immediate family to accompany the Insured Person for treatment or to help treat the Insured Person, we will pay reasonable expenses actually Incurred up to the Family Expense Benefit limit. Expenses may include, but are not limited to; loss of wages, out of pocket expenses, hotel accommodations, parking, and childcare.

D. Rehabilitation Benefit - Rehabilitation will be voluntary on the Insured Person's part and on our part. If the Insured Person and we agree upon a program of occupational rehabilitation in advance, we will pay for the program as set forth In a written agreement which can be periodically reviewed. Benefits for disability will continue as provided by the policy while the Insured Person is actively participating in the program.

E. Mental Stress Management Benefit - If, as a direct result of being actively engaged In a single emergency incident involving the organization or repeated active engagement In emergency Incidents Involving the organization, an Insured Person suffers a psychiatric or mental stress related Illness, we will pay a Mental Stress Management Benefit up to the limit in the policy and as defined in the policy. The Insured Person must be receiving care by a physician which Is appropriate for the condition causing the disability.

F. Traumatic Incident Benefit - We will pay the reasonable expenses for the services provided by a Traumatic Incident Stress Management Team If such sen/Ices are requested and authorized by the organization. Expenses must be incun-ed within one year of the traumatic Incident and are subject to the Traumatic Incident Benefit limit in the policy. The Traumatic Incident Benefit is the maximum that will be paid per accident regardless of the number of persons treated.

PA^201-1007 (08.2011) Page 8

G. Health Insurance Premium Benefit - If, as a result of a Covered Injury or Covered Illness, the medical or health insurance premiums previously paid the employer have been discontinued, and the Insured Person Incurs out of pocket costs for those medical or health insurance premiums, we will pay the out of pocket cost not to exceed the Health Insurance Premium Benefit limit in the policy.

Section VI: Optional Auxiliary Person and/or Community Volunteer Coverage

Coverage for Auxiliary Persons and Community Volunteers is offered with the full benefits of the policy as they meet the definition of Insured Person.

Section VII: Organized League Athletics Coverage

Coverage for Organized League Athletics is not Included In this proposal.

Definitions Auxiliary Person means any person who is a member of the auxiliary to the organization named on the Policy Schedule page at the time of Covered Injury. All recognized classes of membership are Included.

Community Volunteer is a non-member who helps the organization named on the Policy Schedule page and/or the auxiliary of the organization, in a non-emergency capacity such as fund raisers, banquets, etc.

Covered Activity means any activity, which is normal for an Insured Person and Includes travel directly to and from such activity. This includes all calls to active duty (as an Insured Person of the organization) that requires immediate action In the field of public safety as well as at the scene of an emergency regardless of the organization's involvement. Covered Activity also means all athletic events sponsored by the organization with the exception of Organized League Athletics unless such coverage is purchased.

Covered Injury means an accidental bodily Injury, which is sustained by any Insured Person during and/or resulting directly from a Covered Activity while this policy is In force.

Covered Illness means any disease, sickness or Infection, other than those related to psychiatric illness or mental stress, contracted or suffered by any Insured Person during or resulting from a Covered Activity while this policy is in force.

CPI-U means the Consumer Price Index for all Urban Consumers. It is published by the United States Department of Labor.

Dependent Child means any unmamed child of the Insured Person who was dependent upon the Insured Person and claimed on the Insured Person's most current federal income tax return or qualified court document showing at least 50% financial responsibility.

Emergency Volunteer Is a person present at the time of the emergency that has been specifically requested to assist by the Chief, Line Officer or other officer In charge of the emergency.

Insured Person means any person who is a member of the organization. All classes of membership may be Included, as well as any other party designated by the policyholder Including Volunteer Member, Career or Part-time Personnel, Emergency Volunteer, Auxiliary Member, Community Volunteer, Board Members, Trustees, Administrative Personnel, Junior Members, Members in Training or Probationary Members.

PAI-201-1007 (08.2011) Page 9

Loss of Earnings Coverage means any disability benefits received from: 1. ) any state disability benefits statute, including Workers' Compensation; 2. ) any formal written income continuance or group insurance plan; and 3. ) any disability benefits payable under mandatory no-fault automobile insurance.

Loss of Earnings Coverage does not include disability benefits received from individual disability Insurance paid for by the Insured Person, or any disability benefits payable under the United States Federal Social Security Act.

Permanent Physical Impairment is a physical impairment or functional abnormality of a body part or parts or loss of at least 10% which remains after maximum medical rehabilitation has been achieved and which is considered stable, or non-progressive by the examining physician at the time of evaluation.

Principal Sum is an amount equal to the Covered Injury Death Benefit or Covered Illness Death Benefit, whichever is applicable.

Reasonable Occupation means any occupation for which the Insured Person Is reasonably fitted based on education, training or experience and the Insured Person could expect to generate the lesser of $75,000 or at least 70% of Weekly Earned Income.

Review Date means each anniversary of the start of a disability.

Total Disability or Totally Disabled means that for the first five years from the date of a Covered Injury or Covered Illness, the Insured Person: 1. ) is not able to perform the substantial and material duties of his or her occupation; and 2. ) is receiving care by a physician, which Is appropriate for the condition causing the disability.

After five years from the date of a Covered Injury or Covered Illness, Total Disability or Totally Disabled means that, due to a Covered Injury or Covered Illness, the Insured Person:

1. ) is not able to engage In any Reasonable Occupation; and 2. ) is not working at any other occupation; and 3. ) is receiving care by a physician, which is appropriate for the condition causing the disability.

Traumatic Incident Stress Management Team means an organized group of mental health professionals and peer support individuals trained to provide support services to Emergency organization personnel. Such support services include traumatic incident stress defusing, debriefing, demobilization, stress reduction education, spousal support, one-on-one Interviews, or on the scene support.

Weekly Earned Income will be the greater of the Insured Person's: 1. ) Weekly Earned Income at the time the disability starts; or 2. ) average Weekly Earned Income for the period of one year prior to the start of disability for which a claim Is made.

If an employer other than himself employs the Insured Person, we will compute Weekly Earned Income from the Insured Person's regular, over-time and shift differential wages. Weekly Earned Income shall be substantiated by pay stubs, W-2 Forms, other employment records, tax records, and/or any other records which we may reasonably request. If the Insured Person is Self-Employed, we will compute Weekly Earned Income from the amount reported by the Insured Person on Page 1 of the IRS Form 1040 series, from Schedules C and F, and from qualifying income included on Schedule E which is included in the amount reported by the Insured Person on Page 1 of IRS Form 1040 series. Weekly Earned Income does not include rent, royalties, investment income, passive income, estate and trust Income and REIT/REMIC income regardless of the Insured Person's active Involvement in generating said fomis of income, or any other income not derived directly from the Insured Person's occupational activities.

PAI-201-1007 (08.2011) Page 10

Documents

LAKE CITY AREA FIRE PROTECTION DISTRICT · 2019. 12. 4. · LAKE CITY AREA FIRE PROTECTION DISTRICT AGENDA February 24, 2015 Regular Meeting 5:00 p.m. - Lake City Fire Station, 131