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REQUEST FOR PROPOSALS:
GROUP HEALTH INSURANCE
NOVEMBER 2001
CITY OF SUNNY ISLES BEACH
MIAMI -DADE COUNTY
FLORIDA
OFFICE OF THE CITY MANAGER
BID # 01 -11 -01
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}lealth Insurance Proposal 2001
NOTICE OF REQUEST FOR PROPOSALS
CITY OF SUNNY ISLES BEACH
REQUEST FOR PROPOSALS NO. 01-11-01
GROUP HEALTH INSURANCE COVERAGE
Notice is hereby given that the City of Sunny Isles Beach is requesting
proposals for Group Health Insurance for its employees.
Sealed Bids will be received at City Hall until 3:00 P.M., Monday, December
10, 2001, at which time they will be publicly opened and read in the City Hall
Commission Chambers. The envelope containing the sealed bid must be clearly
marked
IMPORTANT BID ENCLOSED
GROUP HEALTH INSURANCE BID NO. 01 -11 -01
OPENING: 3:00 P.M. — Monday, December 10, 2001
Bids will not be accepted after 3:00 p.m., local time on December 10, 2001, under any
circumstances.
Specifications, instructions and proposal forms are available from the Office of the
City Clerk, City Hall, 17070 Collins Ave., Suite 250, Sunny Isles Beach, Florida, or by
calling (305) 947 -0606. There is no charge for the bid package.
No bidder may withdraw his /her proposal for a period of sixty (60) days following
the date of opening of these proposals.
The City reserves the right to accept or reject any or all proposals and may waive any
informality in any or all proposals.
Christopher Russo
City Manager
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Health Insurance Proposal 2001
SUNNY IS4FJ' CITY OF SUNNY ISLES BEACH, FLORIDA
0 17070 Collins Avenue, Suite 250,
Sunny Isles Beach, Florida 33160
yF 'D9w FLOR\OP sic (305) 947 -0606 Phone (305) 949 -3113 Fax
C O
JY CF SUN PN
REQUEST FOR PROPOSALS
FOR GROUP HEALTH CARE INSURANCE COVERAGE
1. Purpose. The purpose of this Request for Proposal is to seek qualified Group Health
Care Insurance Providers.
1.1 Procedure. Submit ten (10) sets of the complete proposal by the closing date and
time.
1.2. No reimbursement will be made by the City of Sunny Isles Beach for any costs
incurred in appropriation of the proposal or any presentation(s).
1.3. Property of City. All bids and accompanying documentation received from
bidders in response to this Request for Proposals shall become the property of the
City and will not be returned to the bidders. In the event of contract award, all
documentation and work product produced as part of the contract shall become
the exclusive property of the City. This subsection is applicable to Requests for
Proposals and Requests for Letters of Interest documents, which also become
property of the City.
1.4. By submission of a response hereunder, the respondent becomes responsible to
comply with the terms and conditions of the Purchasing Procedures Ordinance of
the City as may be amended from time to time. To the extent of any conflict, the
terms of this document control.
2. Background, The City of Sunny Isles Beach is estimated to have 15,000 residents. The
City of Sunny Isles Beach is located between the Atlantic Ocean and the Intracoastal
Waterway on the East and West and 193rd Street on the North and Haulover Beach Park
on the South. Our City standards stress a high quality of redevelopment with a focus on
creating visual corridors to the ocean, with access to the ocean as well as redevelopment
of Sunny Isles Boulevard and Collins Avenue with a focus on protecting the
environment, providing landscaping and developing aesthetically attractive structures.
The City of Sunny Isles Beach has adopted by Ordinance No. 2000 -105 a
Comprehensive Plan emphasizing aesthetic issues, and the City is in the process of
developing our land development regulations.
2.2. The City is seeking qualified Health Care Providers.
3. Qualification. Respondent must demonstrate the ability to perform service.
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Health Insurance Proposal 2001
(Describe evidence of qualifications, as the City deems necessary and desirable.)
4. Proposal.
4.1 The Contract is to be awarded on December 20, 2001 and work to be initiated on
February 1, 2002.
4.2 The first task will be to advise the City Manager with respect to providing service
shown in proposal.
4.3 Describe work in phases.
4.4 Cancellation of Request for Proposals. A Request for Proposals, or other
solicitation may be cancelled, or any or all respondents may be rejected in whole,
or in part, as may be specified in the solicitation, with City's sole discretion. The
reasons therefore shall be made part of the contract file. Each solicitation issued
by the City shall state that the solicitation may be cancelled and that any
respondent may be rejected, in whole or in part, within the sole discretion of the
City. Notice of cancellation shall be sent to all businesses solicited. The City
shall give any respondent the opportunity to compete on any re- solicitation or any
future procurement of similar items.
4.5 Correction or Withdrawal of Bids; Cancellation of Awards. In general, bids shall
be unconditionally accepted without alteration or correction, except as authorized
in this Ordinance. However, correction or withdrawal of inadvertently erroneous
bids before or after bid opening, or cancellation of awards or contracts based on
such bid mistakes, may be permitted, where appropriate. Mistakes discovered
before bid opening may be modified, or the bid may be withdrawn by written or
telegraphic notice received in the office designated in the invitation for bids prior
to time set for bid opening. After bid opening, no changes in bid prices or other
provisions of bids, prejudicial to the interest of the City, or fair competition, shall
be permitted. In lieu of bid correction, a low bidder alleging a material mistake of
fact may be permitted to withdraw its bid if:
A. The mistake is clearly evident on the face of the bid document but the
intended correct bid is not similarly evident; or
B. The respondent submits evidence, which clearly and convincingly
demonstrates that a mistake was made. All decisions to permit the correction
or withdrawal of proposal, or to cancel awards or contracts based on bid
mistakes, shall be supported by a written determination made by the
Purchasing Agent.
C. Notwithstanding the foregoing, the City Commission shall have the authority
to waive any and all irregularities in any and all respondents, or in the
alternative, reject any or all proposals.
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Health Insurance Proposal 2001
5. Critical Issues. Describe any particular critical issues relating to timeliness or emphasis
on particular problem areas, etc.
6. Submittals. Include the following in your response:
6.1 Cover sheet of this Request for Proposals.
6.2 An informative, narrative report introducing your firm and location of the office
that will be responsible for the project.
6.3 A Statement of Qualifications.
6.4 A resume detailing experience and recommendations from priori obs, if any.
6.5 Copies of the firm's professional licensures.
6.6 Any other forms that are required by the City and sample of similar work
performed by the firm.
6.7 Specification of how the final project will be submitted to the City, i.e., pad, GIF,
disk, etc.
7. Evaluation. Proposals will be evaluated using the following criteria. The criteria are not
listed in order of importance and additional criteria may be used. The City Manager will
have the final say on the evaluation criteria and will make the final selection in the best
interests of the City.
• Ability of professional personnel (including the capacity, ability and
20 points
skill of the provider to perform the contract; the character, integrity,
reputation, judgment, experience and efficiency of the provider);
• Relevant Experience (including professional licensure required when
15 points
service of a skilled nature as required by law to perform such service
and /or skill);
• Past Performance (including the quality of performance of previous
15 points
contracts);
• Recent, current and projective workloads (including whether the
10 points
provider can perform the contract within the time specified without
delay or interference);
• Fee proposal
15 points
• Association with Sunny Isles Beach firm
5 points
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Health Insurance Proposal 2001
■ Demonstration of legal capability
10 points
■ Demonstration of Experience and ability to use respondent in the 10 points
future
8. Performance. The respondent, upon award of any contract shall ensure that all items
supplied and /or work performed, comply with federal, state and local laws rules and
regulations as well as the terms of the contract.
9. Process. Respondent, upon award of the contract shall be responsible for management
and organization of all public hearings and meetings with City officials, citizens' and
business groups or other organizations as applicable. Any and all meetings and all costs
associated with responding to this process will be at respondent's expense with no
additional cost to the City.
9.1 Non - award. The City reserves the right in its sole and absolute discretion to reject
any and all respondents, to cancel and/or withdraw this RFP at any time.
9.2 Responsible, Responsive Bidder. The City reserves the right to award any
contract to any respondent which it deems to offer the best overall service and be
the most responsible responsive bidder thereby the City is not bound to award any
contract based solely on the lowest quoted price and no contract is created until it
is signed with the approval of the City Commission. The City, in its sole and
absolute discretion, also reserves the right to negotiate separately with competing
firms as it deems to be in the best interest of the City and as permitted by law.
9.3 Negotiation. In the event the lowest, most responsive and responsible respondent
for a project exceeds available funds, and the City Commission does not make
available additional funds, the City Manager is authorized, when time or
economic considerations preclude re- solicitation of proposals, to negotiate an
adjustment of the qualifying price as long as the scope of work is not changed
with the lowest, most responsive and responsible respondent, in order to bring the
proposal within the amount of available funds. Final negotiation shall be in
written form, as approved by the City Manager and the City Attorney.
9.4 One Response. If only one responsive respondent for commodity or contractual
service is received, in response to a Request for Proposals, an award may be made
to the single respondent, if the City Manager finds the price submitted is fair and
reasonable, and that other prospective respondent had reasonable opportunity to
respond, or there is not adequate time for re- solicitation. Further, the City
Manager reserves the right, if it is in the best interests of the City, to negotiate
with the sole respondent for the best terms, conditions and price. The City
Manager shall document the reasons that such action is in the best interest of the
City. Otherwise, the proposal may be rejected and:
A. New respondents may be solicited;
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Health Insurance Proposal 2001
B. The sole respondent may be rejected.
C. If the City Manager determines in writing that the need for the supply or
service continues, but that the price of the one respondent is unreasonable and
there is not time for re- solicitation or re- solicitation would likely be futile, the
procurement may then be conducted under Section 6(D) or Section 6(F), of
Ordinance 2001 -101, as appropriate.
10. Taxes. The Respondent is responsible for paying any and all taxes associated with the
agreement.
11. Termination of Agreement. If the respondent fails to perform the conditions of the
agreement as specified and as interpreted by the Manager, the Manager shall provide
written notice of such violation.
11.1 The City reserves the right to terminate the agreement, without cause, with a 30-
day calendar written notice unless otherwise provided in the contract.
11.2 Termination and cancellation of any agreement will not relieve the respondent for
work rest that was to be completed prior to the termination or cancellation of the
agreement.
11.3 If the agreement is terminated for cause, respondent will be removed from the
City's vendor list.
11.4 The City Commission shall have the right to terminate the agreement in the event
the respondent files any petition or proceeding for bankruptcy relief or is
adjudicated to be bankrupt or insolvent or fails to pay just debts as they ordinarily
become due.
11.5 This agreement may not be terminated by the respondent unless otherwise
provided in the contract.
12. Insurance Requirements.
12.1 General. The respondent, including service- related respondents, shall purchase
and maintain for the entire life of the Project, including any and all approved time
extensions, until its final acceptance by the City, such insurance as will protect the
respondent from claims under Workers' Compensation, disability benefit laws or
other similar employee benefit laws; from claims for damages because of bodily
injury, occupational sickness or disease, or death of respondent employees; from
claims insured by usual or unusual injury liability coverage; from claims or injury
to or destruction of tangible property and from claims insured by usual
Commercial General Liability coverage. This includes loss of use resulting
therefrom, any or all of which may arise out of the respondent's operations under
the Contract Documents, whether such operations be by the respondent, or any
sub contractor, or by anyone directly or indirectly employed by any of them or for
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Health Insurance Proposal 2001
whose acts any of them may be legally liable. The respondent's deductibles/self -
insured retentions shall be disclosed to the City and may be disapproved by the
City and may be reduced or eliminated at the sole discretion of the City. The
respondent is responsible for the amount of any deductible or self - insured
retention.
12.2 Requirements for Certificates of Insurance. Respondent shall provide the City
with all required Certificates of Insurance, which Certificates must be acceptable
to the City. Each Certificate of Insurance shall be provided to the City at least 15
days prior to coverage renewals requested by the City. The respondent shall
furnish complete copies of respondent's insurance policies, forms and
endorsements. If the respondent fails to obtain and maintain for the life of the
contract insurance required herby or to replace any such expired or cancelled
policies, the City may obtain and maintain such insurance with such company as
it deems satisfactory with those amounts expended by the City in payment of
premiums to be deducted by the City from the amounts due the respondent for
work covered by the contract.
13. Hold Harmless.
13.1 The City, its agents, employees and officials, both elected and appointed shall be
held harmless against all claims for bodily injury, sickness, disease, death or
personal injury or damage to property or loss of use resulting therefrom arising
out of performance of the agreement or contract, unless such claims are a result of
the City's sole negligence, as determined by the final arbiter of such claim.
13.2 The City, its agents, employees and official, both elected and appointed shall also
be held harmless against all claims for financial loss with respect to the provision
of or failure to provide professional or other services resulting in professional,
malpractice, or errors and omissions liability arising out of performance of the
agreement or contract, unless such claims are a result of the City's sole
negligence, as determined by the final arbiter of such claim.
14. Payment on Behalf of the City.
14.1 Respondent agrees to pay on behalf of the City, and to pay the cost of the City's
legal defense, as may be selected by the City, for all claims described in the Hold
Harmless paragraph 13 above, up through and including, all appellate levels.
14.2 Such payment on behalf of the City shall be, in addition to any and all other legal
remedies available to the City, and shall not be considered to be the City's
exclusive remedy.
15. Cone of Silence. You are hereby advised that this Invitation to Bid is subject to the
"Cone of Silence" in accordance with Miami Dade County Ordinance Nos. 98 -106 and
99 -1. From the time of advertising until the City Manager issues his recommendation,
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Health Insurance Proposal 2001
there is prohibition on communication with the City's professional staff. This ordinance
does not apply to oral communications at pre -bid conferences, oral presentations before
evaluation committees contract discussions made to City Commission during any duly
noticed public meeting, contract negotiations with the staff following the award of an
RFP, RFQ, RFI, or bid by any City Commission, or communication in writing at any
time with any City employee, official, or member of the City Commission unless
specifically prohibited. A copy of all written communications must be filed with the City
Clerk. Violation of these provisions by any particular bidder or proposer shall not be
considered for any RFP, RFQ, RFI, or bid for a contract for the provision of goods or
services for a period of one year.
Any questions or clarifications concerning this Request for Proposals /Invitation to
Bid shall be submitted in writing by mail or facsimile to Christopher J. Russo,
City Manager, 17070 Collins Avenue, Suite 250, Sunny Isles Beach, Florida
33160. Fax (305) 949 -3113. The bid title /number shall be referenced on all
correspondence. All questions must be received no later than fifteen (15) calendar
days prior to the scheduled bid opening date. All responses to
questions /clarifications will be sent to all prospective bidders in the form of an
addendum. NO QUESTIONS WILL BE RECEIVED VERBALLY OR AFTER
THE DEADLINE.
The City of Sunny Isles Beach reserves the right to accept any proposal or bid deemed to
be in the best interest of the City of Sunny Isles Beach, or waive any informality in any
proposal or bid. The City of Sunny Isles beach may reject any and all proposals or bids.
16. Public Entity Crimes.
Section 287.133, Florida Statues, provides that a person or affiliate, as defined in that
Section, who has been placed on the convicted vendor list following the conviction for a
public entity crime may not submit a bid on a contract to provide any goods or services to
a public entity may not submit a bid on a contract with a public entity for any contract for
construction or repair of a public building or a public work, may not submit bids on
leases of real property to a public entity, may not be awarded to perform work as a
contractor, supplier, subcontractor, or consultant under a contract with any public entity,
and may not transact business with any public entity in excess of the threshold of the
amount provided in Section 287.017 for CATEGORY TWO ($25,000) for a period of 36
months from the date of being placed on the convicted vendor list. Any such person or
affiliate convicted of a public entity crime shall provide written notice of such
conviction.
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Health Insurance Proposal 2001
INSTRUCTION TO BIDDERS
CITY OF SUNNY ISLES BEACH
REQUEST FOR PROPOSAL #01 -11 -01
GROUP HEALTH INSURANCE COVERAGE
1. Each proposal submitted must have clearly written on the face of the envelope, the
following information:
SEALED PROPOSAL
GROUP HEALTH INSURANCE
BID # 01 -11 -01
OPENING: 3:00 p.m., Monday, December 10, 2001
2. Proposals shall include all requested documentation.
3. Mail or deliver 2 original specimen contracts and I original proposal and 9 copies (total
of 10) which will include a listing of preferred providers and hospitals to:
Christopher Russo, City Manager
City of Sunny Isles Beach
17070 Collins Ave, Suite 250
Sunny Isles Beach, FL 33160
Note: We will not accept faxed proposals.
4. There can be no exclusions for pre- existing conditions.
5. The City reserves the right to accept or reject any or all proposals.
6. Proposals shall be publicly opened and no proposal received later than 3:00 p.m.,
Monday, December 10, 2001.
7. Any additional information can be obtained by calling the Human Resources Director,
Thomas Acquaro, or the City Manager, Christopher Russo.
8. The City of Sunny Isles Beach is tax exempt, Certificate #23- 00- 47713154C.
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Health Insurance Proposal 2001
GENERAL SPECIFICATIONS
CITY OF SUNNY ISLES BEACH
REQUEST FOR PROPOSAL #01 -11 -01
GROUP HEALTH INSURANCE COVERAGE
1. All options of PPO, POS & HMO or combination plans will be considered.
Co- payments, deductibles and any requirement of referrals must be specific.
Bid must include ten (10) copies of the complete listing of all participating
hospitals, primary care physicians and specialists.
2. All plans are to include a Prescription Plan with Generic, Brand, and
Formulary Options.
3. Insurance carriers must have a minimum A.M. Best rating of A -.
4. The attached Census information (Exhibit A) reflects our current enrollment.
January will be open enrollment for current employees to add or reduce the
number of dependents covered. There can be no exclusions for pre- existing
conditions. Rates are to be guaranteed for calendar year 2002. The City
Manager will form an employee advisory committee to assist in the bid
evaluation and recommendation process. One or more finalists may be
invited to make a presentation to the panel.
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Health Insurance Proposal 2001
PROPOSAL FORM
CITY OF SUNNY ISLES BEACH
REQUEST FOR PROPOSAL #01 -11 -11
GROUP HEALTH INSURANCE COVERAGE
We propose the following rate structure:
Group Health Insurance Program, consistent with the City specifications and details provided by
the bidder on attached sheets.
Cost per month, per employee:
employee
employee plus one
We propose the following for Prescription Drugs:
In Network, Generic Brand Name
Out of Network
PROPOSAL FORM
Business Name
Address
Signature
Name & Title
Phone #
employee plus two
employee plus three or more
Date
Fax #
Please provide the names and phone numbers of three references that use the Group Health
Insurance Plan that you have proposed.
Company Name Contact Person Phone
The City reserves the right to reject any and all bids.
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Health Insurance Proposal 2001
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR
OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1 . This sworn statement is submitted to
by
for
whose business address is
and (if applicable) its Federal Employer Identification Number (FEIN) is -_
(IF the entity had no FEIN, include the Social Security Number of the individual signing this sworn
statement:
2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a
violation of any state or federal law by a person with respect to and directly related to the transaction of
business with any public entity or with an agency or political subdivision of any other state or of the
United States, including, but not limited to, any bid or contract for goods or services to be provided to any
public entity or an agency or political subdivision of any other state or of the United States and involving
antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes
means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in
any federal or state trial court of record relating to charges brought by indictment or information after July
1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contenders.
4. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means:
a. A predecessor or successor of a person convicted of a public entity crime; or
b. An entity under the control of any natural person who is active in the management of the entity and
who has been convicted of a public entity come. The term "affiliate" includes those officers,
directors, executives, partners, shareholders, employees, members, and agents who are active in the
management of an affiliate. The ownership by one person of shares constituting a controlling interest
in another person, or a pooling of equipment or income among persons when not for fair market value
under an arm's length agreement, shall be a prima facie case that one person controls another person.
A person who knowingly enters into a joint venture with a person who has been convicted of a public
entity crime in Florida during the preceding 36 months shall be considered an affiliate.
5. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural
person or entity organized under the laws of any state or of the United States with the legal power to enter
into a binding contract and which bids or applies to bid on contracts for the provision of goods or services
let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The
term "person" includes those officers, directors, executives, partners, shareholders, employees, members,
and agents who are active in management of any entity.
Signature
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Health Insurance Proposal 2001
Date
NON - COLLUSIVE AFFIDAVIT
State of
)ss
County of
deposes and says that:
being first duly sworn,
(1) He /she is the Owner, Partner, Officer, Representative or Agent of the Bidder that
has submitted the attached Bid;
(2) He /she is fully informed respecting the preparation and contents of the attached
Bid and of all pertinent circumstances respecting such Bid;
(3) Such Bid is genuine and is not a collusive or sham Bid;
(4) Neither the said bidder nor any of its officers, partners, owners, agents,
representatives, employees or parties in interest, including this affiant, have in any
way colluded, conspired, connived or agreed, directly or indirectly, with any other
Bidder, firm, or person to submit a collusive or sham Bid in connection with the
Work for which the attached Bid has been submitted; or to refrain from bidding in
connection with such Work; or have in any manner, directly or indirectly, sought
by agreement or collusion, or communication, or conference with any Bidder,
firm, or person to fix the price or prices in the attached Bid or of any other Bidder,
or to fix any overhead, profit, or cost elements of the Bid price or the Bid price of
any other Bidder, or to secure through any collusion, conspiracy, connivance, or
unlawful agreement any advantage against the City of Sunny Isles Beach, or any
person interested in the proposed Work;
(5) The price or prices quoted in the attached Bid are fair and proper and are not
tainted by any collusion, conspiracy, connivance, or unlawful agreement on the
part of the Bidder or any other of its agents, representatives, owners, employees or
parties in interest, including this affiant.
Sworn to and subscribed before me this day of , 2001, by
who is personally known to me or has provided
as identification.
Notary Seal:
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Health Insurance Proposal 2001
Notary Signature
CITY OF SUNNY ISLES BEACH
EMPLOYEE CENSUS
EXHIBIT A
NOVEMBER 2001
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Health Insurance Proposal 2001
-16-
EMPLOYEE CENSUS
Gender
Birthday
Ins. Coverage
M
03/19/54
Single
M
09/10/58
Family
M
10/08/65
Family
M
09/13/73
Single
M
08/05/75
Family
F
05/12/39
Spouse
F
02/08/67
Single
M
07/08/76
Single
M
09/18/70
Single
M
08/27/53
Single
M
12/19/74
Single
M
07/26/67
Single
M
05/18/42
Spouse
F
12/26/52
Spouse
M
08/16/57
Family
M
05/17/73
Single
F
01/21/47
Single
F
02/13/70
Children
F
01/05/49
Single
M
05/11/61
Children
M
12/13/68
Single
M
05/29/48
Single
F
03/22/51
Family
M
06/04/57
Family
F
04/12/73
Children
F
10/20/73
Single
M
08/26/62
Family
F
11/20/57
Single
M
11/09/53
Family
M
07/07/71
Single
F
12/21/46
Family
F
12/20/50
Single
F
03/02/79
Children
F
06/15/43
Spouse
F
12/06/63
Single
M
08/12/53
Family
M
09/19/74
Single
M
10/10/70
Children
F
01/06/55
Children
F
07/22/78
Single
M
08/07/74
Spouse
F
10/10/69
Single
-16-
EMPLOYEE CENSUS
Gender
Birthday
Ins. Coverage
M
07/19/59
Spouse
F
04/23/74
Single
M
05/22/65
Single
M
02/04/49
Single
M
01/28/64
Children
M
08/18/47
Family
M
03/06/79
Single
M
02/02/67
Family
M
01/07/69
Single
M
02/02/69
Family
M
07/10/43
Family
M
05/31/57
Single
M
01/01/70
Single
F
08/10/70
Children
M
08/02/47
Children
F
08/29/46
Single
M
11/28/76
Single
M
03/19/52
Family
M
11/09/77
Single
M
12/31/73
Single
F
03/12/63
Family
M
02/11/70
Single
M
06/13/72
Single
F
12/21/64
Children
M
09/14/55
Family
M
01/17/64
Family
M
03/22/67
Family
M
11/27/41
COBRA- Spouse
F
03/29/72
Children
F
11/27/57
Children
M
05/07/78
Single
M
01/27/48
Single
F
07/05/61
Single
M
05/25/57
Single
F
01/02/56
Single
F
05/11/65
Children
M
07/04/64
Single
F
12/21/43
Spouse
M
12/27/53
Family
F
06/19/70
Single
M
05/16/73
Single
M
04/10/68
Children
-17-
EMPLOYEE CENSUS
Gender Birthday Ins. Coverage
NI 08/09/39 Family
1\1 09/21/76 Single