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• <br />• <br />U <br />PROPOSAL FORM <br />CITY OF SUNNY ISLES BEACH <br />REQUEST FOR PROPOSAL #01 -11 -11 <br />GROUP HEALTH INSURANCE COVERAGE <br />We propose the following rate structure: <br />Group Health Insurance Program, consistent with the City specifications and details provided by <br />the bidder on attached sheets. <br />Cost per month, per employee: Humana HMO opt. 2 <br />$191.04_ employee _$382.01 employee plus one <br />_$362.97 employee plus child(ren) _$611.33 employee plus family <br />We propose the following for Prescription Drugs: <br />In Network, Generic $10 Brand Name $20 <br />Out of Network _$35 In- network non preferred <br />PROPOSAL FORM <br />Business Name Brown & Brown, Inc. <br />Address 8000 Governors Square Blvd.; #400 <br />Miami Lakes FL 33016 <br />Signature <br />Name & Title R. Hollander / Exec. V. President Date /f< 7r <br />Phone # 305- 364 -7818 <br />Fax #305-822-5687, <br />Please provide the names and phone numbers of three references that use the Group Health <br />Insurance Plan that you have proposed. <br />Company Name Contact Person Phone. <br />4e_ -k ,*e n [.QS ro -v 1/n,,, <br />The City reserves the right to reject any and all bids. <br />Rfp No. 01 -11 -01 Grp Health ins. Bid Package <br />-12- <br />