Request for Proposals for City of Apache Junction. Group Term Life Insurance

Transcription

1 Request for Proposals for City of Apache Junction Group Term Life Insurance

2 REQUEST FOR PROPOSALS City of Apache Junction Group Term Life Insurance The City of Apache Junction ( City ) is seeking responses to its Request for Proposals (RFP) from insurance carriers for group term life insurance. Copies of the RFP are available at the Office of the City Clerk, 300 E. Superstition Blvd., Apache Junction, Arizona 85219, Monday through Friday 8:00 a.m. to 5:00 p.m., excluding holidays. Proposals in response to this request must be received by the Office of City Clerk on or before the time and date specified. The mere fact that the proposal was dispatched will not be considered; the consultant must ensure that the proposal is actually received. Any proposals received after the closing time will be returned unopened. Submittals may not be faxed or electronically transmitted. Proposals shall include one signed original and three hard copies. In addition, two copies of the proposal shall be submitted in electronic format on a diskette or CD. The sealed response package will be accepted until 2:00 P.M. on Wednesday, April 20, 2011, and should be addressed to: Office of City Clerk City of Apache Junction 300 E. Superstition Blvd Apache Junction, Arizona A label must be affixed to the envelope stating: Proposal Term Life Insurance. Questions regarding the city may be directed to Ms. Elizabeth H. Riley, Human Resources Director at Questions regarding the terms and conditions of this request for proposal should be directed to the consultant to the City, Jim Loeb at (623) (jloeb@irims.net). Page 2 of 9

3 I. BACKGROUND The City of Apache Junction and the Apache Junction Water District are seeking proposals for term life insurance. The City has 233 employees and annual payroll of $12,027,633. The Apache Junction Water District has thirteen employees and annual payroll of $589,798. Coverage Listed is a summary of coverage provided by the current carrier. Please refer to the coverage summary for further information. The summary may not fully represent the exact terms and conditions as outlined in the policy. Quote life insurance premiums, including options requested on a per $1,000 basis and estimate annual premium based on the enclosed census information. Anniversary Date of Coverage: July 1st Coverage Limits: Basic Life One times base salary including AD&D with a maximum of $150,000. Waiver of Premium if totally disabled Dependent life $1,000 on children and $2,000 on the spouse. Quote new voluntary portable life Maximum of $300,000 for employee, 50% of employee amount up to $150,000 for spouse and $10,000 children The City desires to receive proposals for group term life insurance, guaranteeing rates for a minimum of two years with options to renew in one-year increments for an additional three years for a total of five years. Coverage should be quoted on a zero commission basis. Should your proposal include commissions or fees paid to any agent or broker, you must disclose on the proposal forms to whom paid, in what amount or percentage of premium and what services are to be provided by the agent or broker. The City pays the total cost of the basic life insurance plan. Employees pay for the cost of dependent life insurance. The current basic term life rate is.19 cents per thousand plus.03 for accidental death and disability. The dependent life rate is.86 per member. Page 3 of 9

4 Standard Insurance has been the carrier since 2006 and prior to 2006 it was Assurant (Fortis) since Standard Insurance premium and claims experience is attached. II. INTENT OF THE REQUEST FOR PROPOSALS The intent of this solicitation is to select an insurance carrier to provide life insurance benefits for city employees and their dependents. III. PROJECT DESCRIPTION Scope of Work 1. Offer basic life and portable voluntary life benefits including accidental death & dismemberment (AD&D) for City employees and their dependents 2. The Offeror takes full responsibility for monitoring compliance of policy provisions, contract terms and conditions regarding eligibility, limits of protection, and other provisions of the contract 3. Attend open enrollment, benefit fairs, staff, and other meetings to provide appropriate service to the City and covered employees 4. Provide premium and loss experience summaries and detail no less frequently than annually and when requested by the City IV. EVALUATION AND SELECTION PROCESS A Selection Committee will review all eligible proposals using the selection criteria set forth in V below. V. PROPOSAL EVALUATION Each proposal will be evaluated on the following criteria: 1. Cost of coverage to the City and employees 2. Ability of offeror to meet or exceed coverage specification standards and service requirements 3. Responsiveness to proposal questions 4. Financial strength of the offeror Page 4 of 9

5 Limitation The City reserves the right to accept or reject any or all proposals and to waive any formality or irregularity as a result of this request, to negotiate with all qualified sources, or to cancel, in part or in its entirety, this RFP if found in the best interest of the City. This RFP does not commit the City to award a contract, nor to procure or contract for services or goods. All proposals become the property of the City and are open to public inspection. Page 5 of 9

6 VI. LIFE INSURANCE QUOTATION FORM Insurer Monthly Employee Basic Life - City Paid Flat Rate RatePer $1,000 Primary Life Coverage Accidental Death and Dismemberment Total Rate Estimated Total Annual Premium based on payroll of: $12,617,431 Spouse and Children optional life Unit Cost per $2,000 spouse and $1,000 children Unit Cost $ Voluntary Portable Life for Employee and/or Spouse (complete the below table) Include disability waiver and A.D.&D in quoted rates. It is desirable coverage be guarantee issue at time of employment, be portable and have a two-year rate guarantee. 24-Month Rate Guarantee Age Group Tobacco Free Tobacco Use Uni-smoker Under Page 6 of 9

7 State the maximum coverage available according to the following schedule: Guarantee Issue Maximum Benefit Employee Spouse Child(ren) What is the minimum enrollment required to institute the voluntary life program? Will you guarantee rates for: 2 Years Year 3 Year 4 Year 5 Basic Life guaranteed Spouse/Children Voluntary If no, what not to exceed percentage or amount would you agree to for years, 3, 4 and 5 on basic life and 2,3,4 and 5 on spouse/children and voluntary portable life? Disclose any commissions or fees proposed to be paid to any agent or broker in conjunction with the above proposal and state what services will be provided for the compensation paid. State your current rating by the following rating agencies. Rating As of: A.M. Best Standard & Poor s Moody s Date: Signature of Authorized Representative Page 7 of 9

8 VII LIFE INSURANCE QUESTIONS All responses to the following questions are to apply equally to basic and voluntary life insurance unless you identify how the provisions apply separately to each area. For those areas that have separate provisions, note provisions for basic life with B and voluntary with V. Number and respond to the questions in the same order as presented. 1. Will you allow the City and District to select flat rate for basic life and either smoker/non-smoker or unismoker age rated for voluntary life should it be offered? 2. Will you agree to combining of the City and District under a master contract or agree to the same terms and conditions should separate contracts be issued? 3. The City currently provides basic life of one times salary for all employees with a maximum of $100,000. Will you provide coverage on a guaranteed issue basis at time of hire? 4. Is your basic life portable? If yes, would terminating employee have to port basic life to be able to port the optional life portion? 5. Does the employee have to elect Voluntary life for the spouse to participate in voluntary life? If yes, what restrictions apply? 6. Does the employee or spouse have to purchase voluntary life in order to purchase voluntary children coverage? 7. May a spouse port their life insurance at time of loss of eligibility (e.g. employee dies, divorces or terminates)? 8. State any limitations or restrictions on when an employee and/or spouse is not allowed to port coverage (e.g. employee does not port, age, retirement, etc.)? 9. Does the voluntary life coverage include accidental death and dismemberment? 10. State the procedure, method and time Page 8 of 9

9 frame for payment of life claims. 11. How soon are death payments made after receipt of proper documentation? 12. What interest rate is paid on funds from the time of death to payment of the claim? 13. State your limitations on coverage for reservists? 14. Does your definition of dependent include dependent full time students to the age of 26? If no, what is it? 15. State any variances of your program from the current plan. 16. What is the reduction in insurance at the following ages: 65-69; 70-74; 75 and over? 17. For your proposed plan(s), provide a summary of plan features and attach copy of proposed group policy and certificate of coverage (both hard copy and pdf). Date Signature of Authorized Representative Page 9 of 9

10 APACHE JUNCTION CITY OF GROUP POLICY EXPERIENCE REPORT TERM LIFE AD&D INS DEPENDENT LIFE 07/01/ /01/2006 THROUGH THROUGH 01/31/ /31/2011 EARNED PREMIUMS $20,365 $155,575 PAID CLAIMS 0 61,950 CHANGE IN IBNR RESERVES , TOTAL INCURRED CLAIMS ,517 LESS PREMIUM TAX 407 3,111 OTHER EXPENSE AND RISK CHARGES 3,511 33, TOTAL EXPENSE AND RISK CHARGES 3,918 36,410 BALANCE 16,591 50,648 LREYNOLD 1Q 900 SW Fifth Avenue Portland OR Tel Standard Insurance Company A subsidiary of StanCorp Financial Group, Inc.

11 City of Apache Junction Census Annual Marital Birth Date Gender Job Title Salary Status 07/01/1972 F Clerical 34,823 S 01/27/1946 M Clerical 69,721 M 12/25/1974 M Recreation Coord 47,655 M 09/21/1954 M Clerical 92,309 M 07/26/1952 M Clerical 101,716 M 05/12/1954 M Clerical 73,787 M 05/07/1979 M Clerical 56,647 M 12/31/1964 F Clerical 49,704 M 07/27/1962 M Clerical 77,178 M 10/27/1976 F Clerical 48,630 M 04/09/1960 M Law Enforcement 89,902 M 11/26/1965 F Clerical 56,970 M 09/01/1972 M Recreation Coord 49,704 M 04/22/1964 F Clerical 56,647 M 06/30/1962 M Clerical 56,647 M 10/18/1962 M Clerical 61,350 M 04/15/1948 M Clerical 67,828 M 08/01/1966 F Clerical 73,787 M 07/09/1961 M Clerical 100,000 M 01/20/1961 M Clerical 67,719 M 02/26/1978 F Clerical 41,393 M 11/26/1960 F Clerical 57,224 M 02/16/1963 M Clerical 66,847 M 04/30/1950 M Law Enforcement 97,799 M 11/28/1972 M Clerical 76,959 M 11/15/1973 F Clerical 73,787 M 09/27/1957 M Streets Maintenance 61,350 M 03/27/1959 M Abatement Coordinator 63,967 M 12/16/1951 M Water Supervisor 62,250 M 01/12/1968 M Clerical 67,037 M 08/10/1958 F Clerical 95,839 M 07/21/1961 M Law Enforcement 89,902 M 12/03/1958 M Clerical 91,075 M 01/03/1970 M Clerical 107,169 M 04/21/1972 M Clerical 117,959 M 11/19/1971 M Recreation Coord 46,625 M 02/10/1960 M Clerical 101,716 M 06/26/1955 M Clerical 108,741 M 05/05/1977 F Recreation Facilities 57,224 M 05/16/1958 M Clerical 76,959 M 10/03/1946 F Clerical 36,165 M 11/07/1961 M Law enforcement 72,192 M 10/10/1968 M Street Crew Leader 42,860 M 09/11/1960 M Parks Maintenance 40,319 M 03/09/1950 F Clerical 33,727 M

12 04/09/1966 M Parks Maintenance 30,028 M 06/30/1977 M Clerical 40,499 M 05/16/1961 M Mechanic 56,537 M 12/30/1958 M Law enforcement 66,362 M 02/15/1953 M Law enforcement 49,704 M 12/24/1969 M Public Works 32,039 M 04/21/1953 F Custodian 32,039 M 07/01/1957 F Clerical 32,337 M 03/18/1982 M Law enforcement 54,434 M 10/18/1963 F Clerical 27,884 M 09/03/1953 F Park Ranger 41,933 M 02/03/1958 M Public Works 32,032 M 10/13/1960 M Law enforcement 54,434 M 04/23/1959 F Clerical 41,210 M 06/07/1955 F Clerical 34,668 M 01/28/1973 M Mechanic 37,500 M 02/17/1982 M Law enforcement 52,189 M 12/08/1969 M Law enforcement 49,704 M 04/07/1966 F Clerical 36,320 M 07/06/1960 M Law enforcement 72,192 M 11/15/1958 M Law enforcement 72,192 M 06/16/1978 M Recreation Leader 25,078 M 02/05/1950 F Clerical 30,555 M 09/01/1981 M Computer Technician 39,113 M 01/12/1962 F Code Compliance 51,612 M 02/06/1969 M Law enforcement 67,165 M 07/01/1981 M Law enforcement 52,189 M 05/26/1963 M Water Utility 46,155 M 08/20/1960 M Law enforcement 63,967 M 12/01/1962 M Public Works 38,657 M 07/13/1980 M Law enforcement 47,655 M 11/26/1960 M Parks Maintenance 44,830 M 05/28/1942 M Facilities Maintenance 30,028 M 09/08/1961 M Traffic Signal 46,155 M 03/14/1971 M Law enforcement 49,704 M 12/12/1964 M Law enforcement 81,678 M 01/17/1973 M Law enforcement 47,655 M 06/23/1967 M Telecommunications 32,337 M 01/17/1971 M Law enforcement 49,704 M 04/14/1970 F Recreation Leader 25,078 M 10/13/1950 M Public Works 40,319 M 04/18/1963 M Public Works 30,028 M 09/24/1974 F Detention Officer 37,228 M 02/12/1978 M Law enforcement 45,691 M 12/23/1947 M Clerical 63,967 M 06/18/1947 M Parks Maintenance 35,535 M 10/25/1963 F Clerical 48,752 M 03/27/1967 F Clerical 39,511 M 01/27/1963 F Clerical 33,482 M

13 03/15/1947 M Law enforcement 72,330 M 09/23/1948 M Law enforcement 54,071 M 03/24/1947 M Code Compliance 41,210 M 02/15/1967 F Clerical 28,581 M 03/04/1966 M Street Light Technician 37,500 M 12/23/1970 F Clerical 46,625 M 04/14/1964 F Clerical 37,714 M 10/19/1978 M Law enforcement 50,038 M 07/06/1961 F Telecommunications 39,800 M 01/16/1969 M Law enforcement 75,801 M 12/06/1951 F Clerical 35,535 M 10/30/1974 F Clerical 48,140 M 04/26/1986 M Law enforcement 49,704 M 10/03/1965 M Clerical 55,158 M 01/23/1977 M Law enforcement 52,189 M 05/25/1955 M Public Works 35,535 M 09/18/1951 F Clerical 41,210 M 01/09/1955 F Clerical 44,703 M 12/31/1972 M Law enforcement 68,885 M 12/29/1957 M Kennel Assistant 22,327 M 08/16/1951 F Victim Assistant 40,319 M 12/05/1950 M Public Works 41,210 M 12/13/1963 M Law enforcement 82,226 M 05/15/1970 F Telecommunications 32,337 M 11/02/1956 M Water Utility 44,253 M 07/31/1961 M Law enforcement 54,434 M 11/21/1968 M Law enforcement 52,189 M 03/08/1975 F Recreation Assistant 30,028 M 10/12/1948 M Water Utility 31,408 M 01/29/1972 M Law enforcement 53,526 M 03/29/1979 F Clerical 38,159 M 09/27/1985 M Law enforcement 45,691 M 06/08/1966 M Parks Maintenance 23,869 M 12/09/1958 M Animal Control Officer 47,563 M 08/20/1954 M Clerical 45,689 M 07/13/1959 M Clerical 25,261 M 08/10/1975 M Law enforcement 52,189 M 06/10/1986 F Clerical 25,261 M 01/15/1973 F Clerical 40,091 M 09/28/1949 F Clerical 56,970 M 10/18/1955 M Clerical 46,155 M 12/29/1948 M Public Works 42,039 M 07/07/1969 M Law enforcement 63,967 M 07/23/1954 F Park Ranger 40,205 M 03/20/1946 M Law enforcement 67,165 M 03/08/1982 M Recreation Assistant 32,666 M 06/09/1955 M Law enforcement 56,774 M 03/12/1963 M Parks Maintenance 35,535 M 04/02/1970 M Law enforcement 63,967 M

14 09/12/1948 M Water Utility 37,156 M 01/23/1960 M Law enforcement 81,883 M 12/05/1957 M Parks Maintenance 42,039 M 01/21/1950 M Facilities Maintenance 40,319 M 01/11/1957 M Police 46,625 M 02/04/1979 M Clerical 39,800 M 08/01/1969 F Clerical 34,922 M 12/28/1962 M Telecommunications 36,586 M 05/22/1953 F Clerical 52,500 M 11/23/1978 F Telecommunications 36,586 M 12/31/1956 M Director-Chief of Police 110,000 M 11/03/1971 M Clerical 69,721 M 03/24/1965 M Clerical 76,401 M 04/09/1978 F Clerical 40,795 M 09/10/1974 F Clerical 27,884 M 08/02/1983 F Telecommunications 32,337 M 09/26/1971 M Law enforcement 49,704 M 11/25/1984 M Law enforcement 45,691 M 10/11/1985 M Detention Officer 35,693 M 12/09/1985 F Community Resource 41,393 M 04/05/1956 M Public Works 30,028 M 09/23/1985 M Law enforcement 45,691 M 12/31/1966 M Police Recruit 40,384 M 07/24/1958 F Clerical 30,555 M 04/06/1950 M Clerical 83,720 S 06/28/1957 M Clerical 113,417 S 05/27/1954 F Clerical 50,434 S 04/29/1951 F Clerical 108,741 S 10/27/1950 F Clerical 97,799 S 08/11/1956 F Clerical 59,083 S 08/29/1949 M Clerical 94,034 S 07/04/1958 M Clerical 101,716 S 05/01/1963 F Clerical 52,602 S 08/09/1960 M Clerical 116,717 S 09/01/1966 M Park Ranger 47,655 S 10/24/1953 F Clerical 106,089 S 12/11/1982 F Recreation Coord 47,655 S 03/12/1953 F Clerical 50,577 S 03/25/1963 M Clerical 112,767 S 04/28/1965 M Clerical 54,864 S 03/24/1980 M Recreation Coord 47,655 S 05/10/1956 M Mechanics Assistant 35,413 S 03/29/1952 F Clerical 27,681 S 06/06/1984 M Law enforcement 45,691 S 03/30/1980 F Crime Scene 44,253 S 08/25/1961 F Telecommunications 43,296 S 07/29/1961 F Telecommunications 43,296 S 01/07/1977 M Parks Shop Technician 37,882 S 01/20/1983 M Law enforcement 47,655 S

15 09/12/1988 M Water Utility 26,540 S 11/21/1953 F Clerical 41,210 S 06/05/1968 F Telecommunications 55,158 S 12/27/1955 F Clerical 32,904 S 05/08/1986 M Public Works 24,896 S 12/13/1979 M Park Ranger 35,434 S 06/13/1966 F Clerical 33,919 S 09/12/1970 M Law enforcement 69,215 S 12/17/1948 M Detention Officer 41,815 S 12/22/1969 M Law enforcement 63,967 S 09/22/1954 M Heavy Equipment 49,971 S 04/06/1948 M Clerical 54,864 S 02/16/1985 M Law enforcement 45,691 S 11/08/1977 F Clerical 35,366 S 03/26/1959 F Clerical 40,091 S 02/17/1962 F Clerical 31,091 S 11/17/1948 F Clerical 38,939 S 07/19/1966 F Telecommunications 43,296 S 06/11/1956 M Detention Officer 35,693 S 11/24/1949 F Clerical 48,752 S 12/25/1981 M Clerical 47,655 S 12/30/1956 M Public Works 23,869 S 10/08/1979 M Parks Maintenance 42,982 S 07/21/1956 M Street Crew Leader 48,630 S 03/15/1951 F Clerical 27,681 S 07/04/1955 F Clerical 55,423 S 12/16/1979 M Recreation Assistant 32,666 S 10/26/1948 M Water Utility 37,156 S 02/03/1956 F Clerical 48,752 S 05/29/1952 F Clerical 56,970 S 07/11/1950 F Clerical 36,159 S 02/03/1962 M Parks Maintenance 31,319 S 01/06/1955 F Clerical 34,823 S 06/30/1988 M Recreation Leader 24,044 S 12/08/1961 M Parks Maintenance 35,535 S 10/12/1963 F Clerical 25,333 S 03/17/1982 F Clerical 47,655 S 03/15/1982 M Law enforcement 47,655 S 05/30/1972 M Law enforcement 72,192 S 01/25/1966 F Clerical 52,902 S 12/03/1955 M Public Works 32,666 S 12/25/1973 M Law enforcement 45,691 S 07/27/1950 F Law enforcement 52,902 S 02/06/1984 M Law enforcement 53,526 S 11/17/1966 M Clerical 45,677 S 07/03/1962 M Parks Maintenance 37,063 S 01/29/1980 M Law enforcement 51,842 S 02/12/1953 M Parks Maintenance 42,039 S 03/03/1966 M Law enforcement 58,821 S

16 11/03/1964 F Animal Control Officer 35,434 S 12/22/1960 M Security Worker 26,296 S 10/14/1976 F Recreation Assistant 34,070 S 04/07/1988 M Recreation Leader 16,831 S 04/27/1963 F Police 52,902 S 12,617,431 Males 160 Married 166 Females 86 Single

17 STANDARD INSURANCE COMPANY A Stock Life Insurance Company 900 SW Fifth Avenue Portland, Oregon (503) CERTIFICATE GROUP LIFE INSURANCE Policyholder: City of Apache Junction Policy Number: A Effective Date: July 1, 2006 A Group Policy has been issued to the Policyholder. We certify that you will be insured as provided by the terms of the Group Policy. If your coverage is changed by an amendment to the Group Policy, we will provide the Policyholder with a revised Certificate or other notice to be given to you. This policy includes an Accelerated Benefit. Death benefits will be reduced if an Accelerated Benefit is paid. The receipt of this benefit may be taxable and may affect your eligibility for Medicaid or other government benefits or entitlements. However, if you meet the definition of "terminally ill individual" according to the Internal Revenue Code Section 101, your Accelerated Benefit may be non-taxable. You should consult your personal tax and/or legal advisor before you apply for an Accelerated Benefit. Possession of this Certificate does not necessarily mean you are insured. You are insured only if you meet the requirements set out in this Certificate. If the terms of the Certificate differ from the Group Policy, the terms stated in the Group Policy will govern. "We", "us" and "our" mean Standard Insurance Company. "You" and "your" mean the Member. All other defined terms appear with the initial letter capitalized. Section headings, and references to them, appear in boldface type. GC190-LIFE/S399

18 Table of Contents COVERAGE FEATURES...1 GENERAL POLICY INFORMATION...1 BECOMING INSURED...1 PREMIUM CONTRIBUTIONS...2 SCHEDULE OF INSURANCE...2 REDUCTIONS IN INSURANCE...3 OTHER BENEFITS...3 OTHER PROVISIONS...4 LIFE INSURANCE...5 A. Insuring Clause...5 B. Amount Of Life Insurance...5 C. Changes In Life Insurance...5 D. Repatriation Benefit...5 E. When Life Insurance Becomes Effective...5 F. When Life Insurance Ends...6 G. Reinstatement Of Life Insurance...7 DEPENDENTS LIFE INSURANCE...7 A. Insuring Clause...7 B. Amount Of Dependents Life Insurance...7 C. Changes In Dependents Life Insurance...7 D. Definitions For Dependents Life Insurance...7 E. Becoming Insured For Dependents Life Insurance...8 F. When Dependents Life Insurance Ends...9 ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE...9 A. Insuring Clause...9 B. Definition Of Loss For AD&D Insurance...9 C. Amount Payable...9 D. Changes In AD&D Insurance...9 E. AD&D Insurance Exclusions...9 F. Additional AD&D Benefits...10 G. Becoming Insured For AD&D Insurance...11 H. When AD&D Insurance Ends...12 ACTIVE WORK PROVISIONS...12 CONTINUITY OF COVERAGE...12 PORTABILITY OF INSURANCE...13 WAIVER OF PREMIUM...14 ACCELERATED BENEFIT...15 RIGHT TO CONVERT...16 CLAIMS...17 ASSIGNMENT...19 BENEFIT PAYMENT AND BENEFICIARY PROVISIONS...20 ALLOCATION OF AUTHORITY...22 TIME LIMITS ON LEGAL ACTIONS...22 INCONTESTABILITY PROVISIONS...22 CLERICAL ERROR AND MISSTATEMENT...23 TERMINATION OR AMENDMENT OF THE GROUP POLICY...23 DEFINITIONS...24

19 Index of Defined Terms Accelerated Benefit, 15 Active Work, Actively At Work, 12 AD&D Insurance, 24 Air Bag System, 10 Annual Earnings, 24 Automobile, 10 Beneficiary, 20 Child, 25 Class Definition, 1 Contributory, 25 Conversion Period, 17 Dependent, 7 Dependents Life Insurance, 25 Disabled, 25 Earnings Period, 4 Eligibility Waiting Period, 25 Employer(s), 1 Evidence Of Insurability, 25 Group Policy, 25 Group Policy Effective Date, 1 Group Policy Number, 1 Injury, 25 Insurance (for Accelerated Benefit), 16 Insurance (for Right to Convert), 17 Insurance (for Waiver Of Premium), 14 L.L.C. Owner-Employee, 25 Leave Of Absence Period, 4 Life Insurance, 25 Loss (for AD&D Insurance), 9 Maximum Conversion Amount, 4 Member, 1 Minimum Time Insured, 4 Noncontributory, 26 P.C. Partner, 26 Physician, 26 Policyholder, 1 Pregnancy, 26 Prior Plan, 26 Proof Of Loss, 18 Qualifying Event, 17 Qualifying Medical Condition, 15 Recipient, 21 Right To Convert, 16 Seat Belt System, 10 Sickness, 26 Spouse, 26 Supplemental Life Insurance, 26 Totally Disabled, 14 Waiting Period (for Waiver Of Premium), 14 Waiver Of Premium, 14 War, 9 You, Your (for Right To Convert), 17

20 COVERAGE FEATURES This section contains many of the features of your group life insurance. Other provisions, including exclusions and limitations, appear in other sections. Please refer to the text of each section for full details. The Table of Contents and the Index of Defined Terms help locate sections and definitions. GENERAL POLICY INFORMATION Group Policy Number: A Type of Insurance Provided: Life Insurance: Supplemental Life Insurance: Dependents Life Insurance: Accidental Death And Dismemberment (AD&D) Insurance: Policyholder: Employer(s): Yes Not applicable Yes Yes City of Apache Junction City of Apache Junction Group Policy Effective Date: July 1, 2006 Policy Issued in: Arizona BECOMING INSURED To become insured for Life Insurance you must: (a) Be a Member; (b) Complete your Eligibility Waiting Period; and (c) Meet the requirements in Life Insurance and Active Work Provisions. The requirements for becoming insured for coverages other than Life Insurance are set out in the text. Definition of Member: Class Definition: Eligibility Waiting Period: You are a Member if you are: 1. An active employee of the Employer; and 2. Regularly working at least 32 hours each week. You are not a Member if you are: 1. A temporary or seasonal employee. 2. A leased employee. 3. An independent contractor. 4. A full time member of the armed forces of any country. None You are eligible on one of the following dates, but not before the Group Policy Effective Date: If you are a Member on the Group Policy Effective Date, you are eligible on the first day of the calendar month following 30 consecutive days as a Member. Printed 05/05/ A

21 If you become a Member after the Group Policy Effective Date, you are eligible on the first day of the calendar month following 30 consecutive days as a Member. Evidence of Insurability: Required: a. For late application for Contributory insurance. b. For reinstatements if required. c. For Members and Dependents eligible but not insured under the Prior Plan. PREMIUM CONTRIBUTIONS Life Insurance: AD&D Insurance: Dependents Life Insurance: Noncontributory Noncontributory Noncontributory SCHEDULE OF INSURANCE SCHEDULE OF LIFE INSURANCE For you: Life Insurance Benefit: Repatriation Benefit: For your Spouse: Dependents Life Insurance Benefit: $2,000 1 times your Annual Earnings, rounded to the next higher multiple of $1,000, if not already a multiple of $1,000. The maximum amount is $100,000. The expenses incurred to transport your body to a mortuary near your primary place of residence, but not to exceed $5,000 or 10% of the Life Insurance Benefit, whichever is less. The amount of Dependents Life Insurance for your Spouse may not exceed 100% of the amount of your Life Insurance. For your Child: Dependents Life Insurance Benefit: $1,000 The amount of Dependents Life Insurance for your Child may not exceed 100% of the amount of your Life Insurance. SCHEDULE OF AD&D INSURANCE For you: AD&D Insurance Benefit: The amount of your AD&D Insurance Benefit is equal to the amount of your Life Insurance Benefit. The amount payable for certain Losses is less than 100% of the AD&D Insurance Benefit. See AD&D Table Of Losses. Seat Belt Benefit: The amount of the Seat Belt Benefit is the lesser of (1) $10,000 or (2) the amount of AD&D Insurance Benefit payable for loss of life. Printed 05/05/ A

22 Air Bag Benefit: The amount of the Air Bag Benefit is the lesser of (1) $5,000; or (2) the amount of AD&D Insurance Benefit payable for Loss of your life. Career Adjustment Benefit: Child Care Benefit: Higher Education Benefit: AD&D TABLE OF LOSSES The tuition expenses for training incurred by your Spouse within 36 months after the date of your death, exclusive of board and room, books, fees, supplies and other expenses, but not to exceed $5,000 per year, or the cumulative total of $10,000 or 25% of the AD&D Insurance Benefit, whichever is less. The total child care expense incurred by your Spouse within 36 months after the date of your death for all Children under age 13, but not to exceed $5,000 per year, or the cumulative total of $10,000 or 25% of the AD&D Insurance Benefit, whichever is less. The tuition expenses incurred per Child within 4 years after the date of your death at an accredited institution of higher education, exclusive of board and room, books, fees, supplies and other expenses, but not to exceed $5,000 per year, or the cumulative total of $20,000 or 25% of the AD&D Insurance Benefit, whichever is less. The amount payable is a percentage of the AD&D Insurance Benefit in effect on the date of the accident and is determined by the Loss suffered as shown in the following table: Loss: Percentage Payable: a. Life 100% b. One hand, one foot or sight of one eye c. Two or more of the Losses listed in b. above 50% 100% No more than 100% of your AD&D Insurance will be paid for all Losses resulting from one accident. REDUCTIONS IN INSURANCE If you reach an age shown below, the amount of insurance will be the amount determined from the Schedule Of Insurance, multiplied by the appropriate percentage below: Life Insurance And AD&D Insurance: Age Of Member 65 through 69 65% 70 through 74 50% 75 or over 35% Percentage OTHER BENEFITS Waiver Of Premium: Yes Printed 05/05/ A

23 Accelerated Benefit: Yes OTHER PROVISIONS Limits on Right To Convert if Group Policy terminates or is amended: Minimum Time Insured: 5 years Maximum Conversion Amount: $2,000 Leave Of Absence Period: Continuity Of Coverage: Insurance Eligible For Portability: For you: Life Insurance: 60 days Yes Yes Minimum combined amount: $10,000 Maximum combined amount: $300,000 For your Spouse: Dependents Life Insurance: Yes Minimum combined amount: $5,000 Maximum combined amount: $100,000 For your Child: Dependents Life Insurance: For you: Yes Minimum combined amount: $1,000 Maximum combined amount: $5,000 AD&D Insurance: Yes Minimum combined amount: $10,000 Maximum combined amount: $300,000 Annual Earnings based on: Partners, L.L.C. Owner-Employees, Sole Proprietors, S- Corporation Shareholders and P.C. Partners: Annual compensation during the Employer's prior tax year (or the Policyholder's prior tax year if you are a P.C. partner). Earnings Period for Commissions (see Definitions): All other Members: Earnings in effect on your last full day of Active Work. The preceding 12 calendar months. Printed 05/05/ A

24 LIFE INSURANCE A. Insuring Clause If you die while insured for Life Insurance, we will pay benefits according to the terms of the Group Policy after we receive Proof Of Loss satisfactory to us. B. Amount Of Life Insurance See the Coverage Features for the Life Insurance schedule. C. Changes In Life Insurance 1. Increases You must apply in writing for any elective increase in your Life Insurance. Subject to the Active Work Provisions, an increase in your Life Insurance becomes effective as follows: a. Increases Subject To Evidence Of Insurability An increase in your Life Insurance subject to Evidence Of Insurability becomes effective on the date we approve your Evidence Of Insurability. b. Increases Not Subject To Evidence Of Insurability 2. Decreases An increase in your Life Insurance not subject to Evidence Of Insurability becomes effective on the first day of the calendar month coinciding with or next following the date you apply for an elective increase or the date of change in your classification, age or Annual Earnings. A decrease in your Life Insurance because of a change in your classification, age or Annual Earnings becomes effective on the first day of the calendar month coinciding with or next following the date of the change. Any other decrease in your Life Insurance becomes effective on the first day of the calendar month coinciding with or next following the date the Policyholder or your Employer receives your written request for the decrease. D. Repatriation Benefit The amount of the Repatriation Benefit is shown in the Coverage Features. We will pay a Repatriation Benefit if all of the following requirements are met. 1. A Life Insurance Benefit is payable because of your death. 2. You die more than 200 miles from your primary place of residence. 3. Expenses are incurred to transport your body to a mortuary near your primary place of residence. E. When Life Insurance Becomes Effective The Coverage Features states whether your Life Insurance is Contributory or Noncontributory. Subject to the Active Work Provisions, your Life Insurance becomes effective as follows: 1. Life Insurance subject to Evidence Of Insurability Life Insurance subject to Evidence Of Insurability becomes effective on the date we approve Printed 05/05/ A

25 your Evidence Of Insurability. 2. Life Insurance not subject to Evidence Of Insurability a. Noncontributory Life Insurance Noncontributory Life Insurance not subject to Evidence Of Insurability becomes effective on the date you become eligible. b. Contributory Life Insurance You must apply in writing for Contributory Life Insurance and agree to pay premiums. Contributory Life Insurance not subject to Evidence Of Insurability becomes effective on: (i) The date you become eligible if you apply on or before that date. (ii) The date you apply if you apply within 31 days after you become eligible. Late application: Evidence Of Insurability is required if you apply more than 31 days after you become eligible. 3. Takeover Provision a. If you were insured under the Prior Plan on the day before the effective date of your Employer's coverage under the Group Policy, your Eligibility Waiting Period is waived on the effective date of your Employer's coverage under the Group Policy. b. You must submit satisfactory Evidence Of Insurability to become insured for Life Insurance if you were eligible under the Prior Plan for more than 31 days but were not insured. F. When Life Insurance Ends Life Insurance ends automatically on the earliest of: 1. The date the last period ends for which a premium was paid for your Life Insurance; 2. The date the Group Policy terminates; 3. The date your employment terminates; and 4. The date you cease to be a Member. However, if you cease to be a Member because you are working less than the required minimum number of hours, your Life Insurance will be continued with premium payment during the following periods, unless it ends under 1 through 3 above. a. While your Employer is paying you at least the same Annual Earnings paid to you immediately before you ceased to be a Member. b. While your ability to work is limited because of Sickness, Injury, or Pregnancy. c. During the first 60 days of: (1) A temporary layoff; or (2) A strike, lockout, or other general work stoppage caused by a labor dispute between your collective bargaining unit and your Employer. d. During a leave of absence if continuation of your insurance under the Group Policy is required by a state-mandated family or medical leave act or law. e. During any other scheduled leave of absence approved by your Employer in advance and in writing and lasting not more than the period shown in the Coverage Features. Printed 05/05/ A

26 G. Reinstatement Of Life Insurance If your Life Insurance ends, you may become insured again as a new Member. However, 1 through 4 below will apply. 1. If your Life Insurance ends because you cease to be a Member, and if you become a Member again within 90 days, the Eligibility Waiting Period will be waived. 2. If your Life Insurance ends because you fail to make a required premium contribution, you must provide Evidence Of Insurability to become insured again. 3. If you exercised your Right To Convert, you must provide Evidence Of Insurability to become insured again. 4. If your Life Insurance ends because you are on a federal or state-mandated family or medical leave of absence, and you become a Member again immediately following the period allowed, your insurance will be reinstated pursuant to the federal or state-mandated family or medical leave act or law. (REPAT) LI.LF.OT.3 A. Insuring Clause DEPENDENTS LIFE INSURANCE If your Dependent dies while insured for Dependents Life Insurance, we will pay benefits according to the terms of the Group Policy after we receive Proof Of Loss satisfactory to us. B. Amount Of Dependents Life Insurance See the Coverage Features for the amount of your Dependents Life Insurance. C. Changes In Dependents Life Insurance 1. Increases You must apply in writing for any elective increase in your Dependents Life Insurance. Subject to the Active Work Provisions, an increase in your Dependents Life Insurance becomes effective as follows: a. Increases Subject To Evidence Of Insurability An increase in your Dependents Life Insurance subject to Evidence Of Insurability becomes effective on the date we approve that Dependent's Evidence Of Insurability. b. Increases Not Subject To Evidence Of Insurability 2. Decreases An increase in your Dependents Life Insurance not subject to Evidence Of Insurability becomes effective on the first day of the calendar month coinciding with or next following the date you apply for an elective increase. An increase in your Dependents Life Insurance because of an increase in your Life Insurance becomes effective on the date your Life Insurance increases. A decrease in your Dependents Life Insurance because of a decrease in your Life Insurance becomes effective on the date your Life Insurance decreases. D. Definitions For Dependents Life Insurance Dependent means your Spouse or Child. Dependent does not include a person who is a full-time member of the armed forces of any country. Printed 05/05/ A

27 E. Becoming Insured For Dependents Life Insurance 1. Eligibility You become eligible to insure your Dependents on the later of: a. The date you become eligible for Life Insurance; and b. The date you first acquire a Dependent. A Member may not be insured as both a Member and a Dependent. A Child may not be insured by more than one Member. 2. Effective Date The Coverage Features states whether your Dependents Life Insurance is Contributory or Noncontributory. Subject to the Active Work Provisions, your Dependents Life Insurance becomes effective as follows: a. Dependents Life Insurance Subject To Evidence Of Insurability Dependents Life Insurance subject to Evidence Of Insurability becomes effective on the later of: 1. The date your Life Insurance becomes effective; and 2. The first day of the calendar month coinciding with or next following the date we approve the Dependent's Evidence Of Insurability. b. Dependents Life Insurance Not Subject To Evidence Of Insurability 1. Noncontributory Dependents Life Insurance Noncontributory Dependents Life Insurance not subject to Evidence Of Insurability becomes effective on the later of: i. The date your Life Insurance becomes effective; and ii. The date you first acquire a Dependent. 2. Contributory Dependents Life Insurance You must apply in writing for Contributory Dependents Life Insurance and agree to pay premiums. Contributory Dependents Life Insurance not subject to Evidence Of Insurability becomes effective on the latest of: i. The date your Life Insurance becomes effective if you apply on or before that date; ii. The date you become eligible to insure your Dependents if you apply on or before that date; and iii. The date you apply if you apply within 31 days after you become eligible. Late Application: Evidence Of Insurability is required for each Dependent if you apply more than 31 days after you become eligible. c. While your Dependents Life Insurance is in effect, each new Child becomes insured immediately. d. Takeover Provision Each Dependent who was eligible under the Prior Plan for more than 31 days but was not insured must submit satisfactory Evidence Of Insurability to become insured for Dependents Life Insurance. Printed 05/05/ A

28 F. When Dependents Life Insurance Ends Dependents Life Insurance ends automatically on the earliest of: 1. Five months after you die (no premiums will be charged for your Dependents Life Insurance during this time); 2. The date your Life Insurance ends; 3. The date the Group Policy terminates, or the date Dependents Life Insurance terminates under the Group Policy; 4. The date the last period ends for which you made a premium contribution, if your Dependents Life Insurance is Contributory; 5. For your Spouse, the date of your divorce; 6. For any Dependent, the date the Dependent ceases to be a Dependent; and 7. For a Child who is Disabled, 90 days after we mail you a request for proof of Disability, if proof is not given. (SP & CH) LI.DL.OT.4 A. Insuring Clause ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE If you have an accident, while insured for AD&D Insurance, and the accident results in a Loss, we will pay benefits according to the terms of the Group Policy after we receive Proof Of Loss satisfactory to us. B. Definition Of Loss For AD&D Insurance Loss means loss of life, hand, foot, or sight which meet all of the following requirements: 1. Is caused solely and directly by an accident. 2. Occurs independently of all other causes. 3. With respect to Loss of life, is evidenced by a certified copy of the death certificate. 4. With respect to all other Losses, occurs within 365 days after the accident and is certified by a Physician in the appropriate specialty as determined by us. With respect to a hand or foot, Loss means actual and permanent severance from the body at or above the wrist or ankle joint. With respect to sight, Loss means entire, uncorrectable, and irrecoverable loss of sight. C. Amount Payable See Coverage Features for the AD&D Insurance schedule. The amount payable is a percentage of the AD&D Insurance Benefit in effect on the date of the accident and is determined by the Loss suffered. See AD&D Table Of Losses in the Coverage Features. D. Changes In AD&D Insurance Changes in your AD&D Insurance will become effective on the date your Life Insurance changes. E. AD&D Insurance Exclusions No AD&D Insurance benefit is payable if the accident or Loss is caused or contributed to by any of the following: 1. War or act of War. War means declared or undeclared war, whether civil or international, and Printed 05/05/ A

29 any substantial armed conflict between organized forces of a military nature. 2. Suicide or other intentionally self-inflicted Injury, while sane or insane. 3. Committing or attempting to commit an assault or felony, or actively participating in a violent disorder or riot. Actively participating does not include being at the scene of a violent disorder or riot while performing your official duties. 4. The voluntary use or consumption of any poison, chemical compound, alcohol or drug, unless used or consumed according to the directions of a Physician. 5. Sickness or Pregnancy existing at the time of the accident. 6. Heart attack or stroke. 7. Medical or surgical treatment for any of the above. F. Additional AD&D Benefits Seat Belt Benefit The amount of the Seat Belt Benefit is shown in the Coverage Features. We will pay a Seat Belt Benefit if all of the following requirements are met: 1. You die as a result of an Automobile accident for which an AD&D Insurance Benefit is payable for Loss of your Life; and 2. You are wearing and properly utilizing a Seat Belt System at the time of the accident, as evidenced by a police accident report. Seat Belt System means a properly installed combination lap and shoulder restraint system that meets the Federal Vehicle Safety Standards of the National Highway Traffic Safety Administration. Seat Belt System will include a lap belt alone, but only if the Automobile did not have a combination lap and shoulder restraint system when manufactured. Seat Belt System does not include a shoulder restraint alone. Automobile means a motor vehicle licensed for use on public highways. Air Bag Benefit The amount of the Air Bag Benefit is shown in the Coverage Features. We will pay an Air Bag Benefit if all of the following requirements are met: 1. You die as a result of an Automobile accident for which a Seat Belt Benefit is payable for Loss of your life. 2. The Automobile is equipped with an Air Bag System that was installed as original equipment by the Automobile manufacturer and has received regular maintenance or scheduled replacement as recommended by the Automobile or Air Bag manufacturer. 3. You are seated in the driver's or a passenger's seating position intended to be protected by the Air Bag System and the Air Bag System deploys, as evidenced by a police accident report. Air Bag System means an automatically inflatable passive restraint system that is designed to provide automatic crash protection in front or side impact Automobile accidents and meets the Federal Vehicle Safety Standards of the National Highway Traffic Safety Administration. Automobile means a motor vehicle licensed for use on public highways. Career Adjustment Benefit The amount of the Career Adjustment Benefit is shown in the Coverage Features. Printed 05/05/ A

30 We will pay a Career Adjustment Benefit to your Spouse if all of the following requirements are met: 1. You are insured for AD&D Insurance under the Group Policy. 2. You die as a result of an accident for which an AD&D Insurance Benefit is payable for Loss of your life. 3. Your Spouse is, within 36 months after the date of your death, registered and in attendance at an accredited institution of higher education or trades training program for the purpose of obtaining employment or increasing earnings. No Career Adjustment Benefit will be paid if you have no surviving Spouse. Child Care Benefit The amount of the Child Care Benefit is shown in the Coverage Features. We will pay a Child Care Benefit to your Spouse if all of the following requirements are met: 1. You are insured for AD&D Insurance under the Group Policy. 2. You die as a result of an accident for which an AD&D Insurance Benefit is payable for Loss of your life. 3. Your Spouse pays a licensed child care provider who is not a member of your family for child care provided to your Child(ren) under age 13 within 36 months of your death. 4. The child care is necessary in order for your Spouse to work or to obtain training for work or to increase earnings. No Child Care Benefit will be paid if you have no surviving Spouse. Higher Education Benefit The amount of the Higher Education Benefit is shown in the Coverage Features. We will pay a Higher Education Benefit to your Child if all of the following requirements are met: 1. You are insured for AD&D Insurance under the Group Policy. 2. You die as a result of an accident for which an AD&D Insurance Benefit is payable for Loss of your life. 3. Your Child is, within 12 months after the date of your death, registered and in full-time attendance at an accredited institution of higher education beyond high school. The Higher Education Benefit will be paid to each Child who meets the requirements of item 3 above, for a maximum of 4 consecutive years beginning on the date of your death. No Higher Education Benefit will be paid if there is no Child eligible to receive it. G. Becoming Insured For AD&D Insurance 1. Eligibility You become eligible for AD&D Insurance on the date your Life Insurance is effective. 2. Effective Date The Coverage Features states whether AD&D Insurance is Contributory or Noncontributory. Subject to the Active Work Provisions, AD&D Insurance becomes effective as follows: a. Noncontributory AD&D Insurance Noncontributory AD&D Insurance becomes effective on the date you become eligible. Printed 05/05/ A

31 b. Contributory AD&D Insurance You must apply in writing for Contributory AD&D Insurance and agree to pay premiums. Contributory AD&D Insurance becomes effective on the later of: (i) The date you become eligible if you apply on or before that date. (ii) The first day of the calendar month coinciding with or next following the date you apply, if you apply after you become eligible. H. When AD&D Insurance Ends AD&D Insurance ends automatically on the earlier of: 1. The date your Life Insurance ends. 2. The date your Waiver Of Premium begins. 3. The date AD&D Insurance terminates under the Group Policy. (FB NO DEP REQD_ALCOHL EXCL_SEAT AIR COMBO) LI.AD.OT.5 ACTIVE WORK PROVISIONS If you are incapable of Active Work because of Sickness, Injury or Pregnancy on the day before the scheduled effective date of your insurance or an increase in your insurance, your insurance or increase will not become effective until the day after you complete one full day of Active Work as an eligible Member. Active Work and Actively At Work mean performing the material duties of your own occupation at your Employer's usual place of business. You will also meet the Active Work requirement if: 1. You were absent from Active Work because of a regularly scheduled day off, holiday, or vacation day; 2. You were Actively At Work on your last scheduled work day before the date of your absence; and 3. You were capable of Active Work on the day before the scheduled effective date of your insurance or increase in your insurance. LI.AW.OT.1 A. Waiver Of Active Work Requirement CONTINUITY OF COVERAGE If you were insured under the Prior Plan on the day before the effective date of your Employer's coverage under the Group Policy, you can become insured on the effective date of your Employer's coverage without meeting the Active Work requirement. See Active Work Provisions. B. Payment Of Benefit The benefits payable before you meet the Active Work requirement will be: 1. The benefits which would have been payable under the terms of the Prior Plan if it had remained in force; reduced by 2. Any benefits payable under the Prior Plan. LI.CC.AZ.1 Printed 05/05/ A

32 PORTABILITY OF INSURANCE A. Portability Of Insurance If your insurance under the Group Policy ends because your employment with your Employer terminates, you may be eligible to buy portable group insurance coverage as shown in the Coverage Features for yourself and your Dependents without submitting Evidence Of Insurability. To be eligible you must satisfy the following requirements: 1. On the date your employment terminates, you must be able to perform with reasonable continuity the material duties of at least one gainful occupation for which you are reasonably fitted by education, training and experience. (If you are unable to meet this requirement, see the Right To Convert and Waiver Of Premium provisions for other options that may be available to you under the Group Policy.) 2. On the date your employment terminates, you are under age On the date your employment terminates, you must have been continuously insured under the Group Policy for at least 12 consecutive months. In computing the 12 consecutive month period, we will include time insured under the Prior Plan. 4. You must apply in writing and pay the first premium directly to us at our Home Office within 31 days after the date your employment terminates. You must purchase portable group life insurance coverage for yourself in order to purchase any other insurance eligible for portability. This portable group insurance will be provided under a master Group Life Portability Insurance Policy we have issued to the Standard Insurance Company Group Insurance Trust. If approved, the certificate you will receive will be governed under the terms of the Group Life Portability Insurance Policy and will contain provisions that differ from your Employer's coverage under the Group Policy. B. Amount Of Portable Insurance The minimum and maximum amounts that you are eligible to buy under the Group Life Portability Insurance Policy are shown in the Coverage Features. You may buy less than the maximum amounts in increments of $1,000. The combined amounts of insurance purchased under this Portability Of Insurance provision and the Right To Convert provision cannot exceed the amount in effect under the Group Policy on the day before your employment terminates. C. When Portable Insurance Becomes Effective Portable group insurance will become effective the day after your employment with your Employer terminates, if you apply within 31 days after the date your employment terminates. If death occurs within 31 days after the date insurance ends under the Group Policy, life insurance benefits, if any, will be paid according to the terms of the Group Policy in effect on the date your employment terminates and not the terms of the Group Life Portability Insurance Policy. AD&D benefits, if any, will be paid according to the terms of the Group Policy or the Group Life Portability Insurance Policy, but not both. In no event will the benefits paid exceed the amount in effect under the Group Policy on the day before your employment terminates. (WITH DL REF_WITH ADAD REF) LI.TP.OT.1 Printed 05/05/ A