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• <br />• <br />• <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: Humana PPO <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: <br />_$250.23 employee $475.43_ employee plus child(ren) <br />$500.45 employee plus one $800.72 employee plus family <br />We propose the following for Prescription Drugs: <br />In Network, Generic $10 Brand Name $25 <br />Out of Network _In- Network Non - formulary $35 <br />PROPOSAL FORM <br />Business Name Brown & Brown, Inc. <br />Address <br />8000 Governors Sq. Blvd; #400 <br />Mi4mi Leak es , FL 33016 <br />Signature <br />r <br />Name &Title (" xY Date I lc <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 />&krenuj fo <br />The City reserves the right to reject any and all bids. <br />UP No. 01 -11 -01 Grp Health Ins. Bid Package <br />- 12— <br />