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Home My WebLink AboutFinal Agenda Packet Noe 41100 CITY OF RENTON FIREMEN'S PENSION BOARD Regular Meeting 7th Floor-Mayor's Conference Room 15-Jan-03 10:00 A.M. 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF DECEMBER 18, 2002 3. CORRESPONDENCE Memo from Victoria Runkle, Finance &IS Administrator, regarding Fire Pension Actuarial Study and proposed agreement with Milliman USA 4. MONTHLY STATEMENT TO 12/31/02 5. MONTHLY BILLS AND PENSION PAYMENTS 6. OLD BUSINESS 7. NEW BUSINESS 8. ADJOURNMENT MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON December 18, 2002 Jesse Tanner, Mayor King Parker, Council Finance Committee Chair Bonnie Walton, City Clerk Ray Barilleaux, Fire Department Representative William Henry, Fire Department Representative William Larson, Fire Department Alternate The regular meeting of the Firemen's Pension Board was called to order by Chairman Jesse Tanner at 10:00 a.m. in the Mayor's conference room, 7th floor of Renton City Hall. In attendance were Board members Jesse Tanner, King Parker, Ray Barilleaux, and Bonnie Walton; and Jill Masunaga, Finance Department Representative. MINUTE APPROVAL MOVED BY PARKER, SECONDED BY BARILLEAUX, THE PENSION BOARD APPROVE THE MINUTES OF THE NOVEMBER 20, 2002, MEETING. CARRIED. CORRESPONDENCE A memo from Fire Chief Wheeler was read announcing that Ray Barilleaux has been reelected to serve a two-year term of office on the Board to expire on 12/31/04. MONTHLY STATEMENT The financial report as of November 30, 2002, was reviewed. Total cash/investment balance was $5,337,964.70. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY BARILLEAUX, SECONDED BY PARKER, THE BOARD APPROVE THE PENSION/MEDICAL PAYMENTS FOR DECEMBER 2002, IN THE TOTAL AMOUNT OF $30,046.15. CARRIED. OLD BUSINESS Jill Masunaga presented copies of the Local Government Investment Pool Investment Policy, dated September 2001, for review. It was noted by Barilleaux that the State Investment Pool interest rate is lower than the County interest rate. ADJOURNMENT MOVED BY PARKER, SECONDED BY BARII.JFAUX, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 10:19 a.m. )601t41A-e:NI /deter-ext.) Bonnie I. Walton, City Clerk Member and Secretary, Firemen's Pension Board low 40 CITY OF RENTON mill CITY OF RENTON Finance & Information Services Department JAN 0 9 2003 MEMORANDUM RECEIVED CITY CLERK'S OFFICE Date: January 8, 2003 To: Fire Pension Board: Mayor Jesse Tanner King Parker, City Council Bonnie Walton, City Clerk, Chair of the Firemen's Pension Board Ray Barilleaux, Ret Firefighter William Henry, Ret. Firefighter William Larson, Ret. Firefighter FROM: Victoria Runkle, Finance & IS Administrator SUBJECT: Fire Pension Actuarial Study Every two years, the City must conduct an actuarial study of the investments for the Fire Pension Board and the members of the fire pension system. As you may know, several years ago, prior to the stock market retraction, we made a decision to move all the Board's investments from stocks and bonds into Treasuries. At the time, Treasuries were paying a reasonable amount, the investments had been quite profitable, and the change made the pension monies guaranteed. We did this at that time because the actuarial study of four years ago stated we were fully funded at that level. The point of this discussion is that I believe we will, again, discover we are fully funded. The agreement with Milliman USA is attached. We are, at this time, contracting only to do the actuarial study. If we begin to have issues with long term care or nursing home costs, we can always do a study of those costs. However, given the number of members and the assets, we do not believe we will have an issue in these areas. I look forward to talking to you about these issues on Wednesday, January 15, 2003. VAR/dif Attachments:Consulting Services Agreement with Milliman USA,Inc. cc: Michael Webby,HR&RM Administrator Elaine Gregory,Fiscal Services Director Jill Masunaga,Finance Analyst Nov Oligulting Services Agreement CONSULTING SERVICES AGREEMENT This Agreement is entered into between Milliman USA, Inc. (Milliman) and City of Renton ("Plan Sponsor")as of January 1,2003. Plan Sponsor has engaged Milliman to perform actuarial and consulting services related to its Firefighters' Relief and Pension Fund. Such services may be modified or expanded from time to time. In consideration for Milliman agreeing to perform these services,Plan Sponsor agrees as follows: 1. Engagement Terms. Plan Sponsor acknowledges the obligation to pay Milliman for services rendered,whether arising from Plan Sponsor's request or otherwise necessary as a result of this engagement, at Milliman's fixed fee rates for standard services,plus standard hourly billing rates for the personnel utilized,plus all out-of-pocket expenses incurred for additional services. Milliman will bill Plan Sponsor periodically for services rendered and expenses incurred. All invoices are payable upon receipt. Milliman reserves the right to stop all work if any bill goes unpaid for 60 days. Furthermore, Milliman's engagement may be terminated upon ninety days written notice by Milliman or Plan Sponsor. Regardless of the reason for termination of services,Milliman shall be entitled to payment for services completed prior to such termination and Milliman shall retain any records it has relating to the Plan Sponsor plans for a period of at least three years from date of termination. If Milliman's assistance is reasonably required past termination, such services shall be provided at Milliman's then standard hourly rate unless another basis is agreed to by both parties. 2. Tool Development. Milliman shall retain all rights,title and interest(including,without limitation, all copyrights,patents, service marks,trademarks,trade secret and other intellectual property rights) in and to all technical or internal designs,methods, ideas,concepts,know-how, techniques, generic documents and templates that have been previously developed by Milliman or developed during the course of the provision of the Services provided such generic documents or templates do not contain any Plan Sponsor Confidential Information or proprietary data. Rights and ownership by Milliman of original technical designs,methods, ideas, concepts,know-how,and techniques shall not extend to or include all or any part of the Plan Sponsor's proprietary data or Plan Sponsor Confidential Information. To the extent that Milliman may include in the materials any pre-existing Milliman proprietary information or other protected Milliman materials,Milliman agrees that Plan Sponsor shall be deemed to have a fully paid up license to make copies of the Milliman owned materials as part of this engagement for its internal business purposes and provided that such materials cannot be modified or distributed outside the Plan Sponsor without the written permission of Milliman. 3. Limitation of Liability. Milliman will perform all services in accordance with applicable professional standards. The parties agree that Milliman shall not be liable to Plan Sponsor,whether in tort, contract or otherwise, for any damages in excess of five (5)times the total professional fees paid to Milliman during the 12 month plan year cycle during which the work in question is performed. In no event shall Milliman be liable for lost profits of Plan Sponsor or any other type of incidental or consequential damages. The foregoing limitations shall not apply in the event of the intentional fraud or willful misconduct of Milliman. The provisions of this Section will survive the expiration or termination of this Agreement. fpfa0630.doc-14 12 003 FPF 71/12 003 FPF 60 71 2002 0/CIH/mk `�r► Clulting Services Agreement 4. Disputes. Dispute Resolution Mediation. In the event of any dispute arising out of or relating to the engagement of Milliman by Plan Sponsor,the parties agree first to try in good faith to settle the dispute voluntarily with the aid of an impartial mediator who will attempt to facilitate negotiations. A dispute will be submitted to mediation by written notice to the other party or parties. The mediator will be selected by agreement by the parties. If the parties cannot agree on a mediator,a mediator will be designated by the American Arbitration Association at the request of a party. The mediation will be treated as a settlement discussion and therefore will be confidential. Any applicable statute of limitations will be tolled during the pendency of the mediation. Each party will bear its own costs in the mediation. The fees and expenses of the mediator will be shared equally by the parties. Arbitration. If the dispute has not been resolved within 60 days after the written notice beginning the mediation process(or a longer period,if the parties agree to extend the mediation),the mediation will terminate,and the dispute will be resolved by final and binding arbitration under the Commercial Arbitration Rules of the American Arbitration Association. The arbitration will take place in Seattle,Washington,before a panel of three arbitrators. Within 30 days of the commencement of the arbitration,each party will designate in writing a single neutral and independent arbitrator. The two arbitrators designated by the parties will then select a third arbitrator. The arbitrators will have a sufficient background in either employee benefits,actuarial science,or law to reasonably prepare them to decide a dispute. The arbitrators will have the authority to permit limited discovery,including depositions,prior to the arbitration hearing,and such discovery will be conducted consistent with the Federal Rules of Civil Procedure. The arbitrators will have no power or authority to award punitive or exemplary damages. The arbitrators may,in their discretion,award the cost of the arbitration,including reasonable attorney fees,to the prevailing party. Any award made may be confirmed in any court having jurisdiction. Any arbitration shall be confidential,and except as required by law,neither party may disclose the content or results of any arbitration hereunder without the prior written consent of the other parties,except that disclosure is permitted to a party's auditors and legal advisors. 5. No Third Party Distribution. Milliman's work is prepared solely for the internal business use of the City. Milliman's work may not be provided to third parties without Milliman's prior written consent.We understand that the City may wish to distribute some of Milliman's reports to its auditors in connection with the preparation of the financial statements of the Plan or of the City. We will consent to such distribution as long as each work product is distributed in its entirety. Milliman does not intend to benefit any third party recipient of its work product,including the auditor,and does not intend to create any legal duty from Milliman to the auditor even if Milliman's work product is so distributed. In the event that any audit reveals any error or inaccuracy in the data underlying this report,Milliman requests that the auditor notify Milliman as soon as possible. Milliman's work may include the preparation of certain government forms. Milliman consents to the release of these forms to the applicable agency. Any additional release of any Milliman work product by the Plan Sponsor requires prior written consent by Milliman. 6. Handling of Data and Other Confidential Information. Milliman shall use reasonable efforts to identify errors in data and obtain corrections to erroneous data,but Milliman cannot warrant the correctness of data supplied by Plan Sponsor or other parties,nor can Milliman be responsible for data not provided in a timely manner. Any information received from Plan Sponsor will be considered"Confidential Information." However, information received from Plan Sponsor will not be considered Confidential Information if(a)the information is or comes to be generally available to the public during the course of Milliman's work; (b)was independently developed by Milliman without resort to information from fpfa0630.doc-I5 12 003 FPF 71/12 003 FPF 60 71 2002 0/CIH/mlc Cbit"sulting Services Agreement the Plan Sponsor; or(c)Milliman receives the information from another source who is not under an obligation of confidentiality to Plan Sponsor. Milliman agrees that Confidential Information shall not be disclosed to any third party. 7. Status of Milliman. Milliman will provide the services covered by this agreement as an independent contractor. No other relationship to the Plan Sponsor nor the plan is implied or intended. Milliman shall not be deemed to be a"named fiduciary"or"plan administrator"as these terms are defined under ERISA or any similar or successor law. 8. Choice of Law. The construction, interpretation, and enforcement of this Agreement shall be governed by the substantive contract law of the State of New York without regard to its conflict of laws provisions. In the event any provision of this Agreement is unenforceable as a matter of law,the remaining provisions will stay in full force and effect. MILLIMAN USA, INC. CITY OF RENTON By: By: r... 411...44.4„Q., Name: Name: V i t 4 A . 400u4-u" Title: Title: ec..!AQC4 is / /J/ Date: Date: t b o3 fpfa0630 doc-16 12 003 FPF 71/12.003 FPF 60.71.2002.0/CIH/mlc erre Fee Worksheet Fee Schedule For Valuing Firefighters' Relief and Pension Funds Fees Our fee schedule for valuing Pension Funds is shown below. This schedule is subject to change if we are retained for a valuation more than three months from now. Our fee basis assumes that no personal presentation of the report is necessary. If you would like a personal presentation to interested parties, an additional charge would be made in accordance with our normal hourly fees. If you have any questions, please let us know. Actuarial Valuation of Base Fee: $3,500 $3500 Pension Benefits* Plus: $25 per member (0 7 S� $ 1451, ' Retiree Medical Study Base Fee: $3 0 $ Plus: $25 e member Long-Term Care Study Total Fe . $3,500 (Assu s Retiree Medical Study is also completed) Cash Flow Projections Total Fee: $500 (When performed ' conjunction with a valuation.Not at the standard valuation report inclu s a 10-year projection.) `C GASB Updates Total Fee: $500 annually '-e'5 Will charge at time of service Meetings Billed for actual time and expense ko Will charge at time of service (An estimate can be provided) Other* Billed for actual time and expense Will charge at time of service ($150-$350 per hour) 175 TOTALp�t5emSS�d P r10 ! $ -ht.). of * Our fees above allow for approximately one hour to review data. Additional charges could result from time spent in excess of one hour identifying and correcting unusual data issues, or for implementing nonstandard funding methods,etc. fpfa0630.doc-7 12003 FPF7I/12.003 FPF6071 2002 0/CIWmIc 2O03, ARDS, COMMISSIONS, AND CSIMITTEES BOARD OF ADJUSTMENT I HUMAN RIGHTS COMMISSION NISHIWAKI SISTER CITY 4"Wednesday,7:30 pm,Council Chambers 2^d Monday,6:30 pm,7"h fl.HR conf.room ADVISORY COMMITTEE Jay Wallace Edythe Gandy 2nd Tuesday,4:30 pm,7m fl.Council conf.room Vacant (Greg Guillen resigned) Vern Nichols No meetings in July and August Roger Richert* George Feighner Antonio Cube,Sr. Vacant (Svlva Coppock resigned) Ralph Evans Lari White Steve Dobson Vacant (Eric Cameron resigned) Charles Thomas Wyman Dobson Wayne Jones Glenda Williams James H. Jacques Sandel Demastus Larry Rude Richard Morris CIVIL SERVICE COMMISSION LEOFF BOARD Betty Vaughn 4"Tuesday,4:30 pm,7m fl.HR conf.room 4m Tuesdays,8:00 am,7M fl.HR conf.room Becky Gibbs William Larson Toni Nelson, City Council Ray Sled James Phelan King Parker, City Council Sonja Mejlaender Randall Rockhill Richard Anderson, Police Julie Brewer Richard Fisher Robert Deines, Fire James Matthew Jim Phelan, Member-at-Large PLANNING COMMISSION 1"&3m Wednesdays,7 pm,Council Chambers BOARD OF ETHICS LIBRARY BOARD Natalie Dohrn Convenes as necessary,5:30 pm,7'h fl HR 2^d Wednesday, 10 am,Highlands Library Eugene Ledbury room Gene Craig g Gerry Marsh Cynthia Colombi Ray Giometti Pastor Bonnie Chandler-Warren Judith Milligan Rosemary Quesenberry Vacant (Mr.Holt's term expired 12/31/02) Ken Ragland Jerrilynn Hadley Rosemary Parris Catherine Corman Eric Cameron Joy Poff Vacant (Cheryl Danza resigned) FIREMEN'S PENSION BOARD PARK BOARD I 'reduced from 9 to 7 members in 2002 2,d Tuesday,4:30 pm,#511 cont.room 3,4 Wednesday,10:00 am,Mayor's conf.room Cynthia Burns SENIOR ACTIVITY CENTER Mayor Jesse Tanner Troy Wigestrand ADVISORY COMMITTEE King Parker, City Council Ralph Evans 1"Monday,10 am,Senior Activity Center Bonnie Walton, City Clerk* Michael O'Donin Dinty Moore Ray Barilleaux, Ret. Firefighter Ronald Regis Ernie Scott William Henry, Ret. Firefighter Timothy Searing Fern Ziebell William Larson, Ret. Firefighter Marjorie Richter Ben Cheney Madeline Donckers .; ' HOUSING AUTHORITY "' MUNICIPAL ARTS COMMISSION Dick Tarasuk 2^d Monday,9 am,2900 NE 10th St Shirley Wasser-Kasen PhillipBeckley1st Wednesday,8 am,7th fl.Council conf.room No meeting in August Kay Johnson Vacant(Ms.Cunio's term expired 12/31/021 Helen Frick Gerald Marsh Virginia Corder Elaine Koehler Joyce Nakashima Paul Webb *Mary Ann Ellingson Lawrence Wood *Diana Hagen Mary Burns Haley Thomas Tasa, Housing Director* Jerri Everett Edie Mae Lawyer Michael O'Halloran Rose Warren HUMAN SERVICES COMMITTEE Eleanor Simpson Vivian Pappas 3rd Tuesday,3:00 pm,conf.room#511 Doug Kyes Louise Berto2zi Marilyn Whitley* Nancy Hoben Rolf Dragseth Renne Soling Margie Albritton Edythe Gandy Alice Watson-Campbell Ava Hammond Carol Chappelle Vacant(Kari Hollandsworth resigned) Pamela Wilson •Chair/Contact Laura Brock Updated 12/18/02 Robin Jones CITY brt RENTON - FIREMEN'S PENSIOF 'UND CASH & INVESTMENT ACTIVITY REPORT A. AS OF DECEMBER 31, 2002 �� RAFT 0Fireman s Pension Fund Comparison of Cash and Investment Activity 7 6 5 rm 0 0 0N 4 o I I' Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec ■2002 ■2001 CURRENT 2002 2002 LAST YEAR 2001 2001 ACTIVITY: MONTH YTD BUDGET CURR MO YTD ADJ BUDGET BEGINNING CASH/INV BALANCE $5,337,964.60 $5,491,105.38 $5,491,105 $5,515,007.70 $5,655,613.20 $5,655,613 RECEIPTS: Property Taxes 0.00 0.00 $0 0.00 0.00 $0 Fire Insurance Premium Tax 0.00 55,729.79 $32,000 0.00 50,702.71 $69,000 Investment Interest 850.77 104,362.21 $80,000 2,913.79 120,956.86 $65,000 Interfund Loan Repmt/Golf Crs 0.00 0.00 $0 0.00 0.00 $0 DISBURSEMENTS: Fire Pension 27,230.85 333,706.08 $345,000 26,301.11 323,127.39 $335,000 Office/Operating Supplies 75.08 206.76 $400 0.00 0.00 $370 Actuarial/Firemen's Pens 0.00 0.00 $0 0.00 6,860.00 $0 Repairs&Maintenance 0.00 0.00 $0 0.00 0.00 $0 Reimb General/Clerical&Acct 525.00 6,300.00 $6,300 515.00 6,180.00 $6,180 ENDING CASH/INV BALANCE $5,310,984.44 $5,310,984.54 $5,251,405 $5,491,105.38 $5,491,105.38 $5,448,063 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH $36,446.48 $63,426.64 $61,415.53 $85,317.85 INVESTMENTS CD's&State Investment Pool 949,767.46 949,767.46 849,767.46 849,767.46 Snohomish County Housing Authority 98,272.00 98,272.00 98,272.00 98,272.00 Treasury Strips&Zero Coupon Bonds 4,226,498.60 4,226,498.60 4,481,650.39 4,481,650.39 Corporate Bonds 0.00 0.00 0.00 0.00 Convertable Bonds 0.00 0.00 0.00 0.00 Mutual Funds 0.00 0.00 0.00 0.00 TOTAL CASH AND INVESTMENTS $5,310,984.54 $5,337,964.70 $5,491,105.38 $5,515,007.70 The State Investment Pool interest 1422 Y 1.54-4". 2 3114% 2 62m, FIREMEN'S PENSION BOARD PENSION/MEDICAL PAYMENTS FOR JANUARY, 2003 Recipient Pension Amt Medicals Total * ANKENY, Charlie(Captain) $89.48 89.48 * ASHURST, James (Assistant Chief) $3,813.00 - 3,813.00 * BANASKY, George (Captain) $815.03 815.03 * BEATTEAY, Karlen (Widow) $174.17 174.17 * BERGMAN, Claudette (Widow) $110.29 110.29 * CHRISTENSON, Chuck(Firefighter) $257.60 257.60 * COLOMBI, Jack(Captain) $349.41 349.41 * CONNELL, Robert(Captain) $594.48 594.48 * GOODWIN, Charles (Captain) $3,459.50 497.80 3,957.30 * GOODWIN, Donald (Firefighter) $816.42 816.42 HAWORTH, Constance (Widow) $2,392.46 2,392.46 * HAWORTH, Jack(Firefighter) $2,609.50 - 2,609.50 * HENRY, Teresa A. (Widow) $235.77 235.77 * HENRY, William, Jr. (Captain) $1,075.36 1,075.36 * HURST, Gerald (Firefighter) $429.17 429.17 * JONES, Gerald D. (Firefighter) $188.37 188.37 * LAVALLEY, Theodele (Captain) $274.81 274.81 * MC LAUGHLIN, JACK(Battalion Chief) $646.58 646.58 * NEWTON, Gary (Lieutenant) $205.26 205.26 * NICHOLS, Gerald (Battalion Chief) $287.07 287.07 * PARKS, Arlene(Widow) $255.10 255.10 * PARKS, John (Firefighter) $2,708.00 347.15 3,055.15 * PHILLIPS, Bruce H. (Deputy Chief) $26.67 26.67 * PRINGLE, Arthur(Captain) $373.56 373.56 PRINGLE, S. Joan (Widow) $2,055.38 2,055.38 * RIGGLE, David E. (Firefighter D Step) $51.33 51.33 * SMITH, Leroy (Firefighter) $320.76 320.76 * STROM, Karl (Firefighter) $2,609.50 - 2,609.50 * TODD, Franklin (Firefighter) $370.02 370.02 * VACCA, Nick (Lieutenant) $238.11 238.11 * WALLS, Kenneth (Firefighter D Step) $101.97 101.97 * WALSH, David (Firefighter) $854.76 854.76 * WALSH, Patrick(Captain) $787.73 787.73 * WEISS, Larry (Battalion Chief) $459.59 459.59 * WOOTEN, Edgar, Jr. (Fire Inspector) $180.12 180.12 Total Expenses: Pension/Medical 30,216.33 844.95 31,061.28 Prior Year Pension/Medical Payments: Total Pension Payments for January, 2002 29,698.27 Total Medical Bills Reimbursed in January, 2002 586.56 Total Expenses: Medical/Pension 30,284.83 * Includes a 3.0% cost of living increase effective January 1 per union contract. 4 SUMMARY 2003 1/9/2003 8:26 AM FIREMEN'S PENSION BOARD rr MEDICAL BLS TO BE REIMBURSED IN JANUARY, 2003 PAYMENT Page Name Pharmacy/Medical Facility , Amount of Bill 2 Charles Goodwin Bartell Drugs 48.33 2 Charles Goodwin Bartell Drugs 14.40 2 Charles Goodwin Bartell Drugs 48.88 2 Charles Goodwin Bartell Drugs 116.30 3 Charles Goodwin Bartell Drugs 48.33 3 Charles Goodwin Bartell Drugs 70.49 3 Charles Goodwin Bartell Drugs 76.67 3 Charles Goodwin Bartell Drugs 26.07 4 Charles Goodwin Bartell Drugs 48.33 497.80 6 John Parks Toledo Pharmacy 125.35 6 John Parks Toledo Pharmacy 115.25 6 John Parks Toledo Pharmacy 88.55 6 John Parks Toledo Pharmacy 18.00 347.15 TOTAL 844.95 3_2003 FP Medical 1/9/2003 8:22 AM �1ir►' "rrrr' %i:tk :.,ry..,'^,;',`1.�C!>.1. �u:..-.�:'�:: ':»r' S.�'{r .,v'y"�'�y-,.ic'F�td-saV.-' `rr:: �:y-<_'�:r:�:;,•'{:aki::.?•:: ai%:..:�$tj;�. ,�-'t'M .�Y vh�w�a:„ {�t l'��tv?cya �:a.. '�K'<- ak� ..v`,- �{n yp ^ [/��♦ry'{�� `� Ott:!•: :ti^:i{.4:-- •M VC. `P�'\-i't.-:U)--.�t =C'i,, , %3Y; I •.- :Vt4 •i�,..5; tn_.'<�;-'�.- �. tt '�. �,�; •wca r k i U15 M �. (VIN. SI> LA 1��R•n�t `'><<' t3 - ..._....:ot2::.:�1{`:•raz:^:�•..,,'•.-p'�.�±::'X,;: :a•:•.,,�w..�.:+.•.�..:.:�:,.T:,4ti x,.,v'=)::::•:w.=.�.......nw.::aC.v:•'-:;-+::•..�P:. :=4,...-,.-:wa:-a!:-:�::�:-a.:.•W..aY,T•>:av'+H•M'�'L�..:�. NAME **ArC.SA- Goo 4G ; AJ DATE /010f/ &)—. AMOUNT OF CLAIM $ 497- S) Reason for medication/hospitalization/physician's exam: C Gtis-ee -/ I have not been and will not be compensated by any other organization/Insurance Carrier or Medicare for the above mentioned claim for reimbursement other than the City of Renton. All of the above are related to my disability from the Fire Department. Signature Note: Proper Documentation must accompany this claim form. VA&6 „�,, /0z/.19-/d z o : 2,..,64- ..) 41A-L ‘,717,41,6”. 4,--t. earn 2 C 1-0/44 LES . .e67-zvc.)//v, A-e-- -41-4 BARTELL -DRUGS'� [BARTELL DRUGS. Washington's Own Drugstores Was ington9 Own OnstWorwwwwwwwww 4700 NE 4TH STREET RENTON,WA 98059 4700 NE 4TH STREET RENTON,WA 98059 Rx# 45 - 105202 E DR. GIROUX(FAX) Rx# 45 - 113946 E DR. LORCH,GERALD S DATE: 10/16/02 R (425)899-3114 (� DATE: 11/11/02 R (206) 903-9510 NAME: CHARLES GOODWIN r1�� NAME: CHARLES GOODWIN y� �� 201 UNION AVE SE 99 201 UNION AVE SE 99 PERSANTINE 25MG GEMFIBR ZIL 600MG TABLET(TEVA)-500 00597-0017-01 09459710 00093-0670 5 10239302 XPS $48.33 XPS $48.88 REFILL NO QUANTITY 180.00 REFILL YES QUANTITY 100.00 BARTELL DRUGS#45 BARTELL DRUGS#45 425-793 -1015 425 -793 -1015 THANK YOU THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24-48 HOURS IN ADVANCE REFILLS 24-48 HOURS IN ADVANCEI - I BARTELL DRUGS 1 BARTELL DRUGS ssmsWashington's Own Drugstores, ..... ...m......��9 shington's Own Drugstores 4700 NE 4TH STREET RENTON,WA 98059 4700 NE 4TH STREET RENTON,WA 98059 //6 •WSJ�OJ{ Rx# 45- 134552 E DR. LORCH,GERALD S Foot45 - 147723 E DR. LORCH,GERALD S DATE: 11/11/02 R (206)903-9510 DATE: 11/18/02 N (206)903-9510 NAME: CHARLES GOODWIN NAME: - • ES GOODWIN 201 UNION AVE SE 99 Y� 201 UNION AV E 99 ALLOINOL 100MG TABLET(MYL)-100 NORVASC 11 1. TABLET-90CT 003 8-0137 1 69815588 000.9-1540-68 ` 70990057 XPS $14.40 XPS $116.30 REFILL NO QUANTITY 100.00 REFILL NO QUANTITY 60.00 BARTELL DRUGS#45 BARTELL DRUGS#45 425-793 - 1015 425 -793 - 1015 THANK YOU THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU J�� J WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR al REFILLS 24-48 HOURS IN ADVANCEI - REFILLS 24-48 HOURS IN ADVANCE �/ V Y „). it ....„ / 77) : (211-ittem 6, ,s„ k...,....,,t, 4-4;:c7,24,,,,,,,, A„...4,:„.” r12tn: A- BARTELL DRUGS I BARTELL :DRUGS Washington':Own Drugstores --=+.arhtngton's Own Drugstores...,.. ...,. ...• ussussnnssnn4700 NE 4TH STREET RENTON,WA 98059 4700 NE 4TH STREET RENTON,WA 98059 RX# 45- 148168 E DR. GIROUX(FAX) Rx# 45- 124370 E DR. ROBERTS(FAX) DATE: 11/22/02 N (425) 899-3114 DATE: 12/01/02 R (206)625-7240 NAME: CHARLES GOODWIN NAME: CHARLES GOODWIN 201 UNION AVE SE 99 20,1:UNFON AVE SE 99 PERSANTINE 25MG ARBIDOPA/LEVODOPA 25MG/100MG TABL 00597-0017-01 10292347 1ft-3 3 00093-0293-01 70982476 .7(, (1 7 XPS $48.33 XPS $76.67 REFILL 5 QUANTITY 100.00 REFILL YES QUANTITY 150.00 BARTELL DRUGS#45 BARTELL DRUGS#45 425 -793 -1015 425 -793 - 1015 THANK YOU THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR L REFILLS 24-48 HOURS IN ADVANCE REFILLS 24-48 HOURS IN ADVANCE L I IARTELL DRUGS _ � BARTELL DRUGS- ��Warhtngton'sOwn Dragrtorcs 4700 NE 4TH STREET RENTON,WA 98059 st. u sWashington'sOwnDrugstores 4700 NE 4TH STREET RENTON,WA 98059 RX# 45- 112999 E DR. LORCH,GERALD S DATE: 12/21/02 R (206) 903-9510 Rx# 45- 149152 E DR. LORCH,GERALD S NAME: CHARLES GOODWIN DATE: 12/02/02 N (206)903-9510 201 UNION AVE SE 99 / NAME: CHARLES GOODWIN NIASPAN 500MG c)l0 -67 201 UNION AVE SE 99 /U i T G) 60598-0001-01 72160096 a TABLET 1 '0310-0105- a 70405568 XPS $26.07 XPS $70.49 REFILL NO QUANTITY 30.00 REFILL NO QUANTITY 60.00 BARTELL DRUGS#45 BARTELL DRUGS#45 425 -793 - 1015 425-793 -1015 THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU THANK YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU REFILLS 24-48 HOURS IN ADVANCE WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR I � REFILLS 24-48 HOURS IN ADVANCE ', _ I J A dd I . oto - /01/OLVd ZA-74-1 At&t;i 01144,6....d.---"" a . BARTELL DRUGS Washtngton'a Own Drugstores 4700 NE 4TH STREET RENTON,WA 98059 Rx# 45 - 148168 E DR. GIROUX(FAX) DATE: 12/21/02 R (425) 899-3114 NAME: CHARLES GOODWIN 201 UNION AVE SE 99 PERSANTINE 25MG Q 33 00597-0017-01 11632359 XPS $48.33 REFILL 4 QUANTITY 100.00 BARTELL DRUGS#45 425 -793 - 1015 THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR REFILLS 24-48 HOURS IN ADVANCE i 0., 3Y 4q9. P ISO 1.10 CITY OF RENTON FIREMEN'S PENSION CLAIM FOR REIMBURSEMENT FORM NAME \ h x 4, a 7,4h .� DATE \) an , -A) "9,0o3 f f5r' AMOUNT OF CLAIM $ �f'7. —Ca Reason for medication/hospitalization/physician's exam: "yY1 QdaC' 5 rO a I end re 1 4 d e'7'1 5- I have not been and will not be compensated by any other organization/Insurance Carrier or Medicare for the above mentioned claim for reimbursement other than the City of Renton. All of the above are related to my disability from the Fire Department. Signature _ Note: Proper Documentation must accompany this claim form. 4400 TOLEDO PHARMACY Box 249 Toledo, Wash. 98591 ANIMAL HEALTH SUPPLIES GIFTS PRESCRIPTIONS Phone 864-4100 DQE g 7/, ) , TOLEDO�� 241 COWLITZ ST. NAME Q JOHN PARKS TOLEDO,WA 99591 12/13/02 i 00 BOX 626 TOLEDO WA 98591 ADORE .V� � C��2(p Rx#22'7212 Dr.J RICHARDS n�r� 'iis p : NEXIUM 40MG CAP CASH 00186-5040-31 830 /BC., Price: 139.28 - -10% # 125.35 v • - '• '' TOLEDO 241 COWLITZ ST. PHARMACY TOLEDO,WA 98591 864-4100 JOHN PARKS 12/13/02 BOX 626 TOLEDO WA 98591 Rx#C2:32213 Dr. J RICHARDS AMBIEN 10MG TAB � � NDC# 00024-5421-31 #45 CPrASice 128.06 - -10% $ 115.25 2 r<'; TOLEDO 241 COWLITZ ST. PHARMACY TOLEDO,WA 98591 864-4100 JOHN PARKS 12/13/02 BOX TOL 626 EDO WA 98591 Rx#23212 Dr.A ARONSKY REMERON 30MG TAB NDC# 00052-0107-30 #30 CASH BC /BC., Price: 98.39 - -10% $ 88.55 TOLEDO 241 COWLITZ ST. P6141" ks TOLEDO,WA 98591 418, 100 BOX 626 TOLEDO WA 98591 1� 3 Rx#C233283 Dr.J RICHARDS ALPRAZOLAM 0.5MG TAB NDC# 59762-3720-01 #90 CASH BC /BC. Price: 20.00 - -10% $ 18.00 PA-(,,