HomeMy WebLinkAboutFinal Agenda Packet virro
CITY OF RENTON
FIREMEN'S PENSION BOARD
Regular Meeting
7th Floor-Mayor's Conference Room
18-Jun-03
10:00 A.M.
1. CALL TO ORDER
2. APPROVAL OF MINUTES OF MAY 21, 2003
3. CORRESPONDENCE
Cost of Living Increase -Widows
4. MONTHLY STATEMENT TO 5/31/2003
5. MONTHLY BILLS AND PENSION PAYMENTS
6. OLD BUSINESS
Actuarial Study Review
7. NEW BUSINESS
8. ADJOURNMENT
.wNow
MINUTES
FIREMEN'S PENSION BOARD
CITY OF RENTON
May 21, 2003
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 10:05 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, Bill Henry and
Bonnie Walton; and Jill Masunaga, Finance Department Representative
MINUTE APPROVAL
MOVED BY BARILLEAUX, SECONDED BY HENRY, THE PENSION BOARD APPROVE
THE MINUTES OF THE APRIL 16, 2003, MEETING. CARRIED.
MONTHLY STATEMENT
The financial report as of April 30, 2003, was reviewed. Total cash/investment balance was
$5,188,411.69.69.
MONTHLY BILLS AND PENSION PAYMENTS
MOVED BY PARKER, SECONDED BY HENRY, THE BOARD APPROVE THE
PENSION/MEDICAL PAYMENTS FOR MAY 2003, IN THE TOTAL AMOUNT OF
$31,674.12. CARRIED.
OLD BUSINESS
Copy of the revised certificate of Fire Insurance Premium Distribution as submitted to the State
Treasurer was presented by the Board secretary Bonnie Walton, indicating a total of 105 paid
firemen employed in Renton as of December 31, 2002.
NEW BUSINESS
Finance Department representative Jill Masunaga distributed the Actuarial Valuation of
Firefighter's Pension Fund report, dated January 1, 2003. Mayor Tanner read a portion of the
report indicating that the current assets of the Fund are estimated to be sufficient to pay all future
Firemen's Pension Fund benefits.
' rwr ter'
ADJOURNMENT
MOVED BY PARKER, SECONDED BY BARILEAUX, THE MEETING OF THE
FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 10:18 a.m.
&iurt is J. tvc et
Bonnie I. Walton, City Clerk
Member and Secretary, Firemen's Pension Board
2
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CITY OF RENTON
CITY CLERK
MEMORANDUM
DATE: June 12, 2003
TO: Members, Firemen's Pension Board
FROM: Bonnie Walton, City Clerk/Board Secretary N"
SUBJECT: Cost of Living Increase Payable July 2003 - Widows
Washington State Law (RCW 41.18.104) requires that the Firemen's Pension Board meet each year
for the purpose of adjusting benefit allowances for widows of firemen pensioned prior to the LEOFF
Act (March, 1970). The Board must determine benefits according to the increase in the Consumer
Price Index (CPI) for the previous calendar year for the Seattle, Washington area as compiled by the
Bureau of Labor Statistics of the United States Department of Labor.
The Bureau has updated its form for this year and has reported a 1.8% increase in the CPI
percentage for Urban Wage Earners and Clerical Workers. A copy of the report is attached.
I recommend that the Board adopt the 1.8% increase, effective July 1, 2003, and paid July 31, 2003.
cc: Victoria Runkle
U.S. DEPARTMENT OF LABOR,BUREAU OF LABOR STATISTICS, FAX-ON-DEMAND Phone 415-975-4567 Note: To receive FAX-ON-
an explanation on how to compute a percentage change between any two periods request FAX-ON-DEMAND Code 9255. To request DEMAND
information on using the CPI as an escalator on rental - 're uest FAX-ON-DEMAND Code 9256 CODE 9250
CEATTLE-TACOMA-BREMERTON _
(-7771T/EiTTh Consumer Price Index,All Items, 1982-84=100 for Urban Wage Earners and Clerical Workers(CPI-W) SEMIANNUAL
6. 1ST 2ND ANNUAL
YEAR JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC HALF HALF AVERAGE
E
n.
1984 100.2 101.1 102.1 102.2 102.9 103.0 101.3 102.8 102.1
N 1985 103.4 104.2 104.0 104.2 104.1 104.8 103.9 104.5 104.2
1986 105.7 105.0 104.3 104.6 105.3 105.1 105.1 104.9 105.0 105.0
1987 108.4 106.4 107.4
1988 109.9 112.0 110.9
0 1989 114.7 117.6 116.1
1990 122.0 126.9 124.4
1991 130.2 132.4 131.3
1992 134.8 137.2 136.0
1993 138.9 141.1 140.0
1994 143.7 146.5 145.1
1995 148.3 150.4 149.3
`.' 1996 152.6 155.9 154.3
c
v, 1997 160.6 158.2 159.9 159.0
1998 162.2 161.9 162.8 163.8 164.9 164.9 162.1 164.4 163.2
1999 166.0 167.8 168.0 168.8 170.2 170.1 167.0 169.5 168.3
v 2000 171.6(R) 173.3(R) 174.5(R) 175.4(R) 177.5 177.0 172.8(R) 176.4 174.6
0 2001 179.2 179.4 181.3 181.5 183 1 181.1 179.6 181.9 180.8
0 2002 182.5 183.6 184 1 184.8 185.5 184.6 183.1 184.9 184.0
c:° 2003 186.2 187.0
a Table of over-the-year percent increases. An entry for Feb.2000 indicates the percentage increase from Feb. 1999 to Feb.2000(in this example 3.4 percent).
`.. 1985 3.2 3.1 1.9 2.0 1.2 1.7 2.6 1.7 2.1
e
o 1986 2.2 0.8 0.3 0.4 1.2 0.3 1.0 0.5 0.8
`" 1987 1.4 3.2 2.3
1988 3.3 3.3 3.3
1989 4.4 5.0 4.7
1990 6.4 7.9 7.1
(
1991 6.7 4.3 5.5
1992 3.5 3.6 3.6
1993 3.0 2.8 2.9
1994 3.5 3.8 3.6
1995 3.2 2.7 2.9
1996 2.9 3.7 3.3
1997 3.7 2.6 3.0
1998 2.7 2.5 2.8 2.6
1999 2.3 3.6 3.2 3.1 3.2 3.2 3.0 3.1 3.1
2000 3 4(R) 3 3(R) 3 9(R) 3.9 4.3 4.1 3 5(R) 4.1 3.7
2001 4.4 3.5 3.9 3.5 3.2 2.3 3.9 3.1 3 .
2002 1.8 2.3 1.5 1.8 1.3 1.9 1.9 1.6 1.8
[...1
2003 2.0 1.9
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R: Revised
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To: BONNIE From: BLS Fax-on-Demand - San Francis 6-12-03 12:19pm p. 1 of 3
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U.S. DEPARTMENT OF LABOR �« '
BUREAU OF LABOR STATISTICSsl
WELCOME TO THE BLS-SAN FRANCISCO
FAXBACK SYSTEM
The Bureau of Labor Statistics Information Office in San Francisco offers current national and local
statistical data 24 hours a day, 7 days a week through the BLS Fax-on-Demand service.
This service is also available in nine locations nationwide. The system in Washington D.C.
contains nationally produced documents. The regional systems contain all the national documents
and additional documents highlighting each region's States and metropolitan areas.
Atlanta 404 331-3415 Dallas 214 767-6970 Philadelphia 215 597-3282
Boston 617 565-2327 Kansas City 816 426-2481 San Francisco 415 975-4567
Chicago 312 353-1880 New York 212 337-2400 Washington D.C. 202 691-6325
National news releases are available within 2 hours of their release, usually by 8:30 A.M. Eastern
Time. CPI historical tables are updated within 4 hours of release, or 10:30 A.M. Eastern Time
TIPS FOR SUCCESSFUL FAX TRANSMISSION
• Make sure that your fax machine is turned-on and ready to receive.
• Set the resolution to FINE.
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[A11 material accessed through BLS Fax-on-Demand are official
government documents
Issued Status WHAT ' S NEW FROM BLS FAX - ON - DEMAND !
Apr. 23 Updated National BLS Ready Facts Catalog(doc. 1000)
Oct. 10 Updated Western Information Office in San Francisco(doc. 9000)
Issued Next News Releases Issued Monthly or Quarterly
May 2 June 6 Employment Situation(doc. 3010, 3015, 3020, 3025)
Apr. 10 May 14 Import-Export Price Indexes(doc. 2810,2815,2820, 2825)
Apr. 11 May 15 Producer Price Index(doc. 2510,2515,2520, 2525)
Apr. 16 May 16 Consumer Price Index(various documents)
Apr. 29 July 31 Employment Cost Index (National-doc. 4110,4115,4120,41 25)(West—doc. 9360)
May 1 June 4 Productivity and Costs(doc. 4510, 4515, 4520)
Apr. 22 May 13 Metropolitan Area Employment and Unemployment(doc. 3030, 3035, 3040, 3045)
Apr. 15 May 8 Regional and State Employment and Unemployment(doc. 3050,3055, 3060)
U.S. DEPARTMENT OF LABOR,BUREAU OF LABOR STATISTICS, FAX-ON-DEMAND Phone 415-975-4567 Note: To receive FAX-ON-
an explanation on how to compute a percentage change between any two periods request FAX-ON-DEMAND Code 9255. To request DEMAND
information on using the CPI as an escalator on rental agreement and other contracts request FAX-ON-DEMAND Code 9256 CODE 9250
SEATTLE-TACO MA-B REMERTOiV _
mi 05116/03 Consumer Price Index,ATlitems 19E2-84=1 W for All Urban Consumers(CPI-U) SEMIANNUAL
o. 1ST 2ND ANNUAL
YEAR JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC HALF HALF AVERAGE
e
al 1984 101.3 101.8 102.7 103.1 103.8 104.4 102.1 103.9 103.0
N 1985 104.8 105.4 105.3 105.6 105.6 106.3 105.2 106.0 105.6
1986 107.3 106.6 106 1 106.2 107.0 106.9 106.8 106.6 106.7 106.7
1987 108.2 110.3 109.2
ti 1988 111.9 113.8 112.8
0 1989 116.7 119.6 118.1
1990 124.2 129.4 126.8
1991 133.0 135.2 134.1
1992 137.8 140.2 139.0
1993 141.9 143.9 142.9
1994 146.4 149.2 147.8
N 1995 151.2 153.3 152.3
a 1996 155.6 159.4 157.5
iv
N 1997 165.0 161.9 164.1 163.0
' 1998 166.5 166.4 167.5 168.5 169.3 169.4 166.6 168.9 167.7
1999 170.6 172.2 172.7 173.4 174.7 174.4 171.6 174.0 172.8
iii
e 2000 176.1(R) 177.8(R) 179.2(R) 180.3(R) 182.1 181.5 177.3(R) 181.1 179.2
C=3
0 2001 184.0 184.2 186.3 186.8 187.9 186.1 184.4 186.9 185.7
2002 187.6 188.8 189.4 190.3 190.9 190.0 188.3 190.3 189.3
io
`.. 2003 191.3 192.3
mTable of over-the-year percent increases. An entry for Feb.2000 indicates the percentage increase from Feb. 1999 to Feb.2000(in this example 3.2 percent).
1985 3.5 3.5 2.5 2.4 1.7 1.8 3.0 2.0 2.5
0
is 1986 2.4 1.1 0.8 0.6 1.3 0.6 1.3 0.7 1.0
1987 1.5 3.4 2.3
1988 3.4 3.2 3.3
1989 4.3 5.1 4.7
1990 6.4 8.2 7.4
1991 7.1 4.5 5.8
1992 3.6 3.7 3.7
1993 3.0 2.6 2.8
1994 3.2 3.7 3.4
1995 3.3 2.7 3.0
1996 2.9 4.0 3.4
1997 4.0 2.9 3.5
1998 2.7 2.9 2.9 2.9
1999 2.5 3.5 3.1 2.9 3.2 3.0 3.0 3.0 3.0
2000 3.2 3 3(R) 3 8(R) 4.0(R) 4.2 4.1 3.3 4.1 3.7
2001 4.5 3.6 4.0 3.6 3.2 2.5 4.0 3.2 3.6
w 2002 2.0 2.5 1.7 1.9 1.6 2.1 2.1 1.8 1.9
H
z 2003 2.0 1.9
R: Revised
0
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• CITY t% RENTON - FIREMEN'S PENSIOWUND
CASH & INVESTMENT ACTIVITY REPORT
AS OF MAY 31, 2003
Fireman's Pension Fund Comparison of Cash and Investment Activity
7
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i 3 -
2 -
1
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1::12003 ■2002
`111' CURRENT 2003 2003 LAST YEAR 2002 2002
ACTIVITY: MONTH YTD BUDGET CURR MO YTD ADJ BUDGET
BEGINNING CASH/INV BALANCE $5,188,411.69 $5,312,164.41 $5,312,164 $5,376,956.92 $5,491,105.38 $5,491,105
RECEIPTS:
Property Taxes 0.00 0.00 $0 0.00 0.00 $0
Fire Insurance Premium Tax 63,087.83 63,087.83 $32,000 55,729.79 55,729.79 $32,000
Investment Interest 4,973.57 7,399.45 $115,000 5,448.56 9,568.60 $80,000
Interfund Loan Repmt/Golf Crs 0.00 0.00 $0 0.00 0.00 $0
DISBURSEMENTS:
Fire Pension 29,290.61 148,730.21 $355,000 27,076.29 143,244.79 $345,000
Office/Operating Supplies 0.00 0.00 $400 0.00 0.00 $400
Actuarial/Firemen's Pens 0.00 4,575.00 $4,000 0.00 0.00 $0
Repairs&Maintenance 0.00 0.00 $0 0.00 0.00 $0
Reimb General/Clerical&Acct 542.00 2,706.00 $6,500 525.00 2,625.00 $6,300
ENDING CASH/INV BALANCE $5,226,640.48 $5,226,640.48 $5,093,264 $5,410,533.98 $5,410,533.98 $5,251,405
CURRENT PREVIOUS LAST YEAR LAST YEAR
ACTIVITY: MONTH MONTH CURR MO PREV MO
CASH $152,102.42 $113,873.63 $80,844.13 $47,267.07
INVESTMENTS
CD's&State Investment Pool 749,767.46 749,767.46 749,767.46 749,767.46
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 $5,226,640.48 $5,188,411.69 $5,410,533.98• $5,376,956.92
The State Investment Pool interest 1.2261% 1.2381% 1.9379% 1.8773%
•
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FIREMEN'S PENSION BOARD
PENSION/MEDICAL PAYMENTS FOR JUNE, 2003
Recipient Pension Amt Medicals Total
ANKENY, Charlie(Captain) $28.48 28.48
ASHURST, James (Assistant Chief) $3,813.00 - 3,813.00
BANASKY, George (Captain) $753.57 753.57
BEATTEAY, Karlen (Widow) $129.89 129.89
BERGMAN, Claudette (Widow) $65.95 65.95
CHRISTENSON, Chuck(Firefighter) $206.98 206.98
COLOMBI, Jack(Captain) $293.12 293.12
CONNELL, Robert(Captain) $541.73 541.73
GOODWIN, Charles (Captain) $3,459.50 370.04 3,829.54
GOODWIN, Donald (Firefighter) $771.30 771.30
HAWORTH, Constance (Widow) $2,392.46 2,392.46
HAWORTH, Jack(Firefighter) $2,609.50 780.46 3,389.96
HENRY, Teresa A. (Widow) $180.14 180.14
HENRY, William, Jr. (Captain) $1,018.61 1,018.61
HURST, Gerald (Firefighter) $387.03 387.03
JONES, Gerald D. (Firefighter) $142.76 142.76
LAVALLEY, Theodele (Captain) $217.17 217.17
MC LAUGHLIN, JACK(Battalion Chief) $577.19 577.19
NEWTON, Gary (Lieutenant) $153.05 153.05
NICHOLS, Gerald (Battalion Chief) $222.35 222.35
PARKS, Arlene (Widow) $200.62 200.62
PARKS, John (Firefighter) $2,708.00 336.35 3,044.35
PHILLIPS, Bruce H. (Deputy Chief) $0.00 -
PRINGLE, Arthur(Captain) $316.81 316.81
PRINGLE, S. Joan (Widow) $2,055.38 2,055.38
RIGGLE, David E. (Firefighter D Step) $5.03 5.03
SMITH, Leroy (Firefighter) $280.23 280.23
STROM, Karl (Firefighter) $2,609.50 - 2,609.50
TODD, Franklin (Firefighter) $330.38 330.38
VACCA, Nick(Lieutenant) $189.17 189.17
WALLS, Kenneth (Firefighter D Step) $54.80 54.80
WALSH, David (Firefighter) $810.34 810.34
WALSH, Patrick (Captain) $739.37 739.37
WEISS, Larry (Battalion Chief) $389.61 389.61
WOOTEN, Marilyn E. (Widow) $137.59 137.59
Total Expenses: Pension/Medical 28,790.61 1,486.85 30,277.46
Prior Year Pension/Medical Payments:
Total Pension Payments for June, 2002 27,076.29
Total Medical Bills Reimbursed in June, 2002 720.02
Total Expenses: Medical/Pension 27,796.31
4_SUMMARY 2003 6/12/2003 8:17 AM
FIREMEN'S PENSION BOARD
MEDICAL BILLS TO BE REIMBURSED IN JUNE, 2003 PAYMENT
Page Name Pharmacy/Medical Facility Amount of Bill
2 Charles Goodwin Bartell Drugs 69.07
2 Charles Goodwin Bartell Drugs 6.84
2 Charles Goodwin Bartell Drugs 51.01
2 Charles Goodwin Bartell Drugs 11.51
3 Charles Goodwin Bartell Drugs 173.76
3 Charles Goodwin Bartell Drugs 6.84
3 Charles Goodwin Bartell Drugs 51.01
370.04
5 Jack Haworth Harbor Drug Co. 28.98
5 Jack Haworth Harbor Drug Co. 9.98
5 Jack Haworth Harbor Drug Co. 49.98
5 Jack Haworth Harbor Drug Co. 28.98
5 Jack Haworth Harbor Drug Co. 24.98
5 Jack Haworth Harbor Drug Co. 44.98
5 Jack Haworth Harbor Drug Co. 28.98
5 Jack Haworth Harbor Drug Co. 44.98
6 Jack Haworth Harbor Drug Co. 44.98
6 Jack Haworth Harbor Drug Co. 34.98
6 Jack Haworth Harbor Drug Co. 24.98
6 Jack Haworth Harbor Drug Co. 28.98
6 Jack Haworth Harbor Drug Co. 28.98
6 Jack Haworth Harbor Drug Co. 39.98
6 Jack Haworth Harbor Drug Co. 7.98
6 Jack Haworth Harbor Drug Co. 36.98
7 Jack Haworth Harbor Drug Co. 24.98
7 Jack Haworth Harbor Drug Co. 13.98
7 Jack Haworth Harbor Drug Co. 24.98
7 Jack Haworth Harbor Drug Co. 28.98
7 Jack Haworth Harbor Drug Co. 14.98
7 Jack Haworth Harbor Drug Co. 44.98
7 Jack Haworth Harbor Drug Co. 24.98
7 Jack Haworth Harbor Drug Co. 28.98
8 Jack Haworth Harbor Drug Co. 9.98
8 Jack Haworth Harbor Drug Co. 28.98
8 Jack Haworth Harbor Drug Co. 24.98
780.46
10 John Parks Toledo Pharmacy 115.25
10 John Parks Toledo Pharmacy 111.40
10 John Parks Toledo Pharmacy 91.70
10 John Parks Toledo Pharmacy 18.00
336.35
TOTAL 1,486.85
3_2003 FP Medical 6/12/2003 8:16 AM
Armr,
CITY OF RENTON
FIREMEN'S PENSION CLAIM FOR REIMBURSEMENT FORM
NAME d M k r� . ( _--roc) bcc) / A,•
DATE �5
AMOUNT OF CLAIM $ 137°, 0
Reason for medication/hospitalization/physician's exam:
• • t./t :=1:7:c4cei,(4,L,
L
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 that the City of
Renton.
All of the above are related to my disability from the Fire Department.
Signaturt,,Xiir- kir-c4,"
Note: Proper Documentation must accompany this claim form.
Mail forms to: City of Renton �'r
Finance Department—Fire Pension
1055 South Grady Way
Renton, WA 98055
Revised 12/24/02
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BARTELL DRUGS-
BARTELL DRUGS Wushington'a Own Drugstores
....... ..... Washington's Own Drugatorev� -
4700 NE 4TH STREET RENTON,WA 98059
4700 NE 4TH STREET RENTON,WA 98059
Rx# 45- 148168 E DR. GIROUX(FAX)
RX# 45- 158302 E DR. FLO DATE: 04/08/03 R (425) 899-3114
DATE: 04/03/03 R (206)386-9675 NAME: CHARLES GOODWIN
NAME: CHARLES GOODWIN 201 UNION AVE SE 99
201 UNION AVE SE 99 L ANTINE 5MG
GEMEIBk04IL 600MG TABLET(TEVA)-500 00597-0017-01 78231664
00093-067011p0 78414241 6T:
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XPS $51.01
XPS $69.07
REFILL 1 QUANTITY 100.00
REFILL 2 QUANTITY 180.00
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 I
REFILLS 24-48 HOURS IN ADVANCE
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•Washington's then Druptorc•••.,. =- -- 4700 NE 4TH STREET RENTON,WA 98059
4700 NE 4TH STREET RENTON,WA 98059
RX# N45 - 166000 E DR. DY
DATE 04/11/03 N (425)255-2273
RX# 45 - 160104 E DR. LORCH,GERALD S NAME. C ARLES GOODWIN
DATE: 04/03/03 R (206) 903-9510 20 ION SE 99
NAME: CHARLES GOODWIN 0 CODONE 5MG TABLET(ETH)
201 UNION AVE SE 99 581 7-0315-04 78641735
ALLOPURINOL 100MG TABLET(MYL)-100
00378-0137-0.1 78274241
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XPS $11
XPS $6.84 �,.Y V // Jam/
REFILL NO QUANTITY 30.00
REFILL YES QUANTITY 30.00 BARTELL DRUGS#45
425-793-1015
BARTELL DRUGS#45
425-793 - 1015 THANK YOU
THANK YOU WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU
WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR
WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU e REFILLS 24-48 HOURS IN ADVANCE
WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR l
REFILLS 24-48 HOURS IN ADVANCE
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4700 NE 4TH STREET
RENTON,WA 98059
RX# 45- 158301 E DR. FLO
DATE: 04/22/03 R (206)386-9675
NAME: ES GOODWIN
20 NION AV E 99 y
NORVASC 10M TABLET-90CT r BARTELL DRUGS
00069.1540-68 79452236 /�i. 2/' ��9aihtiu�OR''O1nDnsg,eores
HCl
4700 NE 4TH STREET RENTON,WA 98059
XPS $173.76 RX# 45- 148168 E DR. GIROUX(FAX)
DATE: 05/16/03 R (425)899-3114
NAME: CHARLES GOODWIN
REFILL 2 QUANTITY
90.00 201 UNION AVE SE 99
BARTELL DRUGS#45 PERSANTINEa25MG
425 -793 - 1015 00597-0017-0 17573501 /O/
THANK YOU
WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU XPS $51.01
WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR
REFILLS 24-48 HOURS IN ADVANCE
I REFILL NO QUANTITY 100.00
BARTELL DRUGS#45
I BARTELL ,DRk.- 425-793- 1015
THANK YOU
^- •--Washington's Own Drugstores•..m-..-----
4700 NE 4TH STREET RENTON,WA 98059 WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU
WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR
REFILLS 24-48 HOURS IN ADVANCE
RX# 45 - 160104 E DR. LORCH,GERALD S
DATE 04/22/03 R (206) 903-9510
NAME: CHARLES GOODWIN
201ON E SE 99
ALLGPURIN L 100MG TABLET(MYL)-100
00378.0137-01 79857236 el/
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XPS $6.84
REFILL YES QUANTITY 30,00
BARTELL DRUGS#45
425-793 - 1015
THANK YOU —'—` � � /
191
WE TRULY APPRECIATE YOUR BUSINESS. TO PROVIDE YOU / GCC
WITH THE BEST SERVICE POSSIBLE PLEASE ORDER YOUR
i,6L- --REFILLS 24-48 HOURS IN ADVANCE
l 7 370, 09
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CITY OF RENTON
PENSION CLAIM FOR'kEnineuFttOMENT.FORM
NAME
DATE •
AMOUNT OF CLAIM $
Reason for medication/hospitalization/physician's exam:
•
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 muEt accnrrioary this claim form.
PAie
. .
Harbor Drug Co.Prescriptions sHarbor lig Co.Prescriptions
316 8th St. Phone 360-532-3061 316 8th St. Phone 360.532.3061
Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978
WARNNG:State a Federal law pddistratderal Na drug b ry person War Ow idere brxtanpasoCed WARNING:Stab or Federal law pold7s translrdthis drug b any persm OW than Pg.nt brxlgm pmeobed
RX# 526877 R DR. MORRIS RX#C 529841 N DR. KONN
11/20/02 DS 12/6/02 JR
HAWORTH,JACK HAWORTH,JACK
BOX 864,OCEAN SHORES.WA 98551 BOX 864,OCEAN SHORES,WA 98551
ISOSORBIDE MONO. 30MG. ER LORAZEPAM 1 MG
QTY#30 NDC#59930-1502-01 I QTY#30 NDC#00781-1404-10 GENEV
$33.85 • $29.98
MAY REFILL DISC- $4.87 I 5 REFILLS DISC - $5.00
PRICE: $28.98 PRICE: $24.98
11110111 11110 1111111 HI 1111111 HIM ll I11111111 III III 111 11111111'II I!1 IIIIl!!I!0
�►, Harbor Drug Co.Prescriptions 4...7 Harbor Drug Co.Prescriptions
Iiif3Phone 360.532.3061 1L' 316 8th St. Phone 360.532.3061
qe Ho 8th St. _ Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978
Hoquiam,WA 98550 24 Hr.Rx Refill(360)536-9978 WNWNG:StalerFederamrpruf�dmtrrdrdwamagtoaypas«ldmrmangmadforwhompreermed
WARNING:arras a Federal law pdabrts Cada d this dug b any parson other tlien*ad br WW1=prescribed
RX#C 514978 R DR. MORRIS RX# 521534 R DR. MORRIS
11/27/02 DS 12/26/02 DS
HAWORTH,JACK HAWORTH,JACK
BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551
HYDROCOD/APAP 5/500MG LOVASTATIN 20 MG
QTY#30 NDC#52544-0349-05 ' QTY#30 NDC#00781-1210-60 GENEV
$12.35 $49.98
NO REFILLS DISC - $2.37 1 REFILLS DISC- $5.00
PRICE: $9.98 I PRICE: $44.98
III 1110111'1111111 1111111111111111''1111111111'1 111111111!1 i.1!Ii!11l III 11.1111'111111111 'HINT 111111111111111 I ll
Harbor Drug Co.Prescriptions t�" ��f Harbor Drug Co.Prescriptio s
316 8th St. Phone 360-532.3061 of 316 8th St.
Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-997e Hoquiam,WA 98550 24 Hr.Rx Ref�e3 60.532.3061
WARNINGVeba Federal lariPruCNbCrata of this drug b any person other than pawl whomA bed t WARNNG:Stabe Federal law pruybb transfer of the drugbay Derson oba NMP b�NMi 9 b8
RX# 521534 R DR. MORRIS RX# 526877 R DR. MORRIS
11/27/02 DS 1/20/03 DS
HAWORTH,JACK HAWORTH,JACK
BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551
LOVASTATIN 20 MG ISOSORBIDE MONO. 30MG. ER
QTY#30 NDC#00731-1210-60 GENEV QTY#30 NDC#59930-1502-01 •
$54.98 lac')
2 REFILLS DISC - $5.00 MAY REFILL $33.85
PRICE: $49.98
1111111,11E1111111111 q DISC - $4.87
4
PRICE: $28.98
II ►i6f��IIbliliar1lli 111 11 Jl1111111111111111llII II11111IH I ll
Harbor Drug Co.Prescriptions
Harbor Drug Co.Prescriptions 316 8th St. Phone 360.532.3061
316 8th St. Phone 360.532-3061 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978
- Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9976 WARNWG:StasrFederal bwpmlaestrasler drdsdrugb aeyperanotherdtan peeedMwhen prescnbed
WARNNG:State a Federal law prolrans Carder d Muer drug b any person other then patient for wlaa"per^» RX# 521534 R DR. MORRIS
RX# 526877 R DR. MORRIS
12/20/02 JR 1/25/03 LL
HAWORTH,JACK
HAWORTH,JACK BOX 864,OCEAN SHORES,WA 98551
BOX 864.00EAN SHORES,WA 98551 LOVASTATIN 20 MG
ISOSORBIDE MONO. 30MG. ER QTY#30 NDC#00781-1210-60 GENEV
QTY#30 NDC#59930-1502-01
$33.85 NO REFILLS $49.98
MAY REFILL DISC- $4.87 DISC $5.00
PRICE: $28.98 PRICE: $44.98
IIIIIIIIII111111IIII 111111111111111 1111 111011111111111111 IIIA 111E11 111111111 �1:ill 1111111 1111111111 iII!�II�II!IIIII
RECEIPT
RECEIPT
PA&CS
,n r �' ,t Harbor Drug.Prescriptions
Harbor Drug Co.Prescriptions
I 316 8th St. Phone 360532-3061 \Li 316 8th SL Phone 360.532-3061
Hoquiam,WA98550 24 Hr.Rx Refill(360)538.9978 . Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978
wwr+x:SmeavFedsawepmbsissirdri bsypasanorarrenpelentbrwpmpasabed WRMmxismorR&M rrad+ebtal4wobs mybaynssmansrmc.g.+arw+cmpacted.
RX# 535122 RR. MORRIS RX# 539887 N DR. MORRIS
3/29/03 JL 5/1/03 DS
HAWORTH,JACK HAWORTH,JACK
BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551
LOVASTATIN 20 MG CEPHALEXIN 500MG.-TEVA
QTY#30 NDC#00781-1210-60 GENEV QTY#40 NDC#00093-3147-05 LEMM
$49.98 $33.98
5 REFILLS DISC- $5.00 1 REFILLS DISC- $5.00
PRICE: $44.98 PRICE: $28.98
1 IMI I II1NI I0 OftOft01111111111N0I0NIIN0NBINfIINI I It III 1111110 III II 111111011111 11 11 11 110111111�111111
,1 Harbor Drug Co.Prescriptions _
-i' 316 8th St. Phone 360.532.3061 ,t ti. Harbor Drug Co.Prescriptions
Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 r ie' 316 8th St. Phone 360532.3061
R)(# 537658 N dt6d4,1,. IVI�r" w-b.d Hoquiam,WA98550 24 Hr.Rx Refill(360)538-9978
WARNING:SbcevFedeal law pdmlbOscferd4bdrug bsly posonother rIM pagentictshorn Pesated.
3/31/03 DS RX# 535122 R DR. MORRIS
HAWORTH,JACK 5/1/03 DS
BOX 864,OCEAN SHORES,WA 98551 HAWORTH,JACK
LEVOTHROID 100MCG. BOX 864,OCEAN SHORES,WA 98551
QTY#100 NDC#00456-0323-01 LOVASTATIN 20 MG
QTY#30 NDC#00781-1210-60 GENEV
$39.16
MAY REFILL DISC- $4.18 $44.95
PRICE: $34.98 4 REFILLS DISC- $5.00
VIII 1111IIINN111111111111 IINII II IINII 1111111 II I PRICEI $39.98
II
�1 t Harbor Drug Co.Prescriptions
1111 I 1111111!1.11 II 11�1 II 111 !II !I IlN��I! HIM!�!!
iii 316 8th St. Phone 360.532.3061 1!7
1 f Harbor Drug Co.Prescriptions
Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978
��l y�p� dINaan www rAay ,,,�,,,, „ 1� 316 8th SL Phone 360.532.3061
L`J� K Ut(• nVIVIV - Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978
4/17/03 DS WARNUI SlateerFederdlirrpdtl.e.sferdIftdN,b.yFa.adnerthaN,aledbrwhompa:ab.d.
HAWORTH,JACK RX# 519795 R DR. KONN
BOX 864,OCEAN SHORES,WA 98551 5/12/03 DS
LORAZEPAM 1 MG HAWORTH,JACK
QTY#30 NDC#00781-1404-10 GENEV BOX 864,OCEAN SHORES,WA 98551
NITROSTAT 1/150 SUBL
$29.98 QTY#25 NDC#00071-0570-13 P-D
1 REFILLS DISC- $5.00
PRICE: $24.98 MAY REFILL
Ill Ill 111111111Hill I111111011IINIIN11N11111111111 PRICE: $7.98
Harbor Drug Co.Prescriptions 11 11111111 111111 11 11 III I II it 11 11 11 IIIII I II
4. 316 8th St. Phone 360-532.3061
PIA Hoquiam,WA 98550 24ayHr.
avRx Refill(360)536-9978 /,Harbor Drug Co.Prescriptions
Mr >so-�l" UK.�" fra mP 316 8th St. Phone 360.532-3061
f(
4/21/03 DSHoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978
WARNING.Sate a Federal lawpd Dile transfer of eiis thug b any person ahem an pabera for whom pnwe bed
HAWORTH,JACK RX# 503264 R DR. MORRIS, RALPH
BOX 864,OCEAN SHORES,WA 98551
• 5/15/02 DS
ISOSORBIDE MONO.30MG. ER • HAWORTH,JACK
QTY#30 NDC#59930 1502-01 BOX 864,OCEAN SHORES,WA 98551
$33.85 ISOSORBIDE MONO. 30MG. ER
QTY#30 NDC#59930-1502-01
MAY REFILL DISC- $4.87
PRICE: $28.98 $41.85
VIII I01III10111I1111110 INIIN0aINNIItIINl1NII0NII1111 111 4 REFILLS DISC- $4.87
PRICE: $36.98
�_ 1 111111101111111111111111110111111110
RECEIPT
Y
u
316 8th S
1 Harbor Drug Co.P` ,1 I `�
If 316 scriptions � Harbor Drug Co.Prescriptions
Phone 360-532-3061 �L 316 8th St. Phone 360.5323061
Hoquiam,WA 98550 24 Hr.Rx Refill(360)5
W 38.9978 Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978
WAFTING:vborFsbral MwP�oti6btransbrottlisbspbany o
OwsnllerlhrlpNkrebrwbnpwobd. W/WJNR SIM orFederAlaw PatbCasteroil*drug tosp'D. arertmnpont brwhompMubel
RX#C 529841 R DR. KONN RX#C 534692 N DR. MORRIS
1/6/03 DS 2/18/03 JR
HAWORTH,JACK HAWORTH,JACK
BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551
LORAZEPAM 1 MG HYDROCOD/APAP 5/500MG
QTY#30 NDC#00781-1404-10 GENEV QTY#30 NDC#52544-0349-05
$29.98 $17.35
4 REFILLS
DISC - $5.00 NO REFILLS DISC- $2.37
PRICE: $24.98 PRICE: $14.98
Ili 11111111 I III IIII III I III IIII NEI Ilii HMI III III all 1111111 1111 U11111111 111 II 1111111111011111111 11 11
I
,1 Harbor Drug Co.Prescriptions
� iiii 316 8th St. Phone 360-532-3061 ft Harbor Drug Co.Prescriptions
Hoquiam.WA 98550 24 Hr.Rx Refill(360)538-9978 316 8th St. Phone 360-532-3061
WARNING:SU.,Federal lawn prohMsesMerof this drug b artyPelsmotherIsn pertfor whom gespbel
RX# 533203 N DR. RUYLEHoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978
WARNING:State or Federal law Pnrhlbss transfer of this bug b any Person other can pallets for whom promoted.
1/28/03 DS RX# 535122 N DR. MORRIS
HAWORTH,JACK 2/24/03 DS
BOX 864,OCEAN SHORES,WA 98551 HAWORTH,JACK
ERYTHROMYCIN OPTH OINT B&L BOX 864,OCEAN SHORES,WA 98551
QTY#4 NDC#24208-0910-55 LOVASTATIN 20 MG
QTY#30 NDC#00781-1210-60 GENEV
$15.50
2 REFILLS DISC- $1.52 $49.98
PRICE: $13.98 6 REFILLS DISC- $5.00
I II1i i IMO 011111111 1111III II REIM ill I III F PRICE: $44.98
.Ar-r-in aik IIII111111111IIllIII JI III I IIIII 11111111II11111I111111IO
X11 Harbor Drug Co.Prescriptions
316 8th St. Phone 360532.3061 t Harbor Drug Co.Prescriptions
WAWJPJ(k sbHroosqFueidaemrul,WA 98o-550 4HrbRxPerwRneafbilrlg(3lp6am0)6,538-9978
pesoaea t4 316 8th St. Phone 360-532-3061
RX#C 529841 R DR. KONN Hoquiam,WA 98550 24 Hr.Rx Refill(360)538.9978
2/12/03 DS wineeK a m- ww"Pr"crb'd
HAWORTH,JACK 3/15/03 PN
BOX 864,OCEAN SHORES,WA 98551 HAWORTH,JACK
LORAZEPAM 1 MG BOX 864,OCEAN SHORES,WA 98551
QTY#30 NDC#00781-1404-10 GENEV LORAZEPAM 1 MG
QTY#30 NDC#00781-1404-10 GENEV
rid
$29.98
3 REFILLS DISC- $5.00 $29.98
PRICE: $24.98 2 REFILLS DISC- $5.00
III II IIII 1 IIIII III 1 II 111111 II II IIIIIIIII1,11 PRICE: $24.98
II IIII 111111 II II 1111111 II 111111IIII II II11111111IIII II IIIII 1
:_ Harbor Drug Co.Prescriptions
V 316 8th St. Phone 360.532.3061 Harbor Drug Co.Prescriptions
Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978 316 8th St. Phone 360.532.3061
WARNING:State or Federal law prohbas transfer of this drug bony person other than patient tor whomere te Hoquiam,WA 98550 24 Hr.Rx Refill(360)538-9978
RX# 526877 R DR. MORRIS RX# 5268 7 R -drA me 21PS br-
2/17/03 DS 3/21/03 JR
HAWORTH,JACK HAWORTH,JACK
BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551
ISOSORBIDE MONO. 30MG. ER ISOSORBIDE MONO.30MG. ER
QTY#30 NDC#59930-1502-01 QTY#30 NDC#59930-1502-01
$33.85 $33.85
MAY REFILL DISC- $4.87 MAY REFILL DISC- $4.87
PRICE. $28.98 PRICE: $28.98
1iillliiill111111Ilill1110Il11IlIM11111111 IIII1E111II111111 OE1111101110.11111111!I!IIIIIIII111Ill IIIII
RECEIPT
RECEIoT
'Nee 1
- - - it
JACK HAWORTH
BOX 864
OCEAN SHORES,WA 98551 •C
411...-
0.
._
I._ Harbor Drug Co.Prescriptions
Ir' 316 8th St. Phone 360.5323061
WZ0:9HoaqFueidaemwWpAa98
tr5ar5rs0 a24
s 8HB rbRxP•Re
afliixll�36eB0a1)58-9978
P�a4ed
RX# 517642 N DR. KONN
5/17/03 LL
HAWORTH,JACK
BOX 864,OCEAN SHORES,WA 98551
HYDROCHLOROTHIAZ 25MG LED
QTY#100 NDC#00005-3752-34 LEDER
V $11.09
MAY REFILL DISC- $1.11
PRICE: $9.98
lip II II1 1111111101111111 111111111111I 11. 11
Harbor Drug Co.Prescriptions
'kTrf 316 8th St. Phone 360532.3061
waaaztsmHoaiamra,m.WA 98o-550ra,Z44:.7,„Refillr26ma0)r538.9978
wnmpes�uaa
RX# 526877 R DR. MORRIS
5/17/03 LL
HAWORTH,JACK
BOX 864,OCEAN SHORES,WA 98551
ISOSORBIDE MONO. 30MG. ER
QTY#30 N DC#59930-1502-01
$33.85
' MAY REFILL DISC- $4.87 r
PRICE: $28.98
IF 11 1111111111 11 11 11 II III II II II 1111111 I II
Harbor Drug Co.Prescriptions
316 8th St. Phone 360532.3061
IHoquiam,WA 98550 24 Hr.Rz Refill(360)538-9978
WARN.0 SIffieaF iamlawPA 9Itratlibdugb:P dMl4O fmwhomPied
RX#C 529841 R DR. KONN
5/17/03 LL
HAWORTH,JACK
BOX 864,OCEAN SHORES,WA 98551
LORAZEPAM 1 MG 41
QTY#30 NDC#00781-1404-10 GENEV
$29.98 '
NO REFILLS DISC- $5.00
PRICE: $24.98 0
11 11111111111IIii III 11111111111IIIIIIIIIIII
RECEIPT X
G
Pk,e 8
' • fire *we
CITY OF RENTON
FIREMEN'S PENSION CLAIM FOR REIMBURSEMENT FORM
NAME \0 h to ,L, P
DATE /) C7-00;3
J �
AMOUNT OF C IM $ 33 (p
Reason for medication/hospitalization/physician's exam:
_.5*TO 711 4 h 4 0-1# 4--Ed 1-e crA S-9
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.
AI • gra, r
Signature // iti �,,
Note: Proper Documentation must accompany this claim form.
PA+cI
• ' `rr' rr✓
TOLEDO PHARMACY
Box 249 Toledo, Wash. 98591
ANIMAL HEALTH SUPPLIES
GIFTS PRESCRIPTIONS
Phone 864-4100
TOLEDO 241 COWLITZ ST. JJ��jj/ -
TOLEDO,WA 98591 116A 74100Dt obi Eli
i^
BOX 626LTCILED7 WA '�859 i
NAME 1?. al-
R,-.4119794 Dr. J SUH ADDRE:S Coo/
hAMR_.yI�EN11--yy 10MG}} TAB _ '�-
NDC# 000 "4-542 L `
1-�;1 �#4.� CASH CHARGE ON ACCT. SEND WCALL
CASH BC /BC„ /-7-
Price: 128.06 - -10% 3 115. 25 o r
c 38..3c, (/ l am,
TOLEDO 241 COWLITZ ST. .3,'r- / / / ,7 )
_.thil 5yc., TOLEDO,WA 98591 EN7 1 00 +46/
0 �f„� Z \
BOX 626,TOLEDO WA '38591 ` c? �S !�L
Rx#238308 Dr. J RICHARDS y
OMEPRAZOLE 20MG CAP
NDC# 62175-0118-32 #30
CASH BC /BC k) -7:111C*4 ----
Price: 123.78 - -10% 3 1 1 1. 40 m
. 15),- -fr :
41 .
TOLEDO 241 COWLITZ9859 100
.p.yp(;M ",s TOLEDO,WA
98591 'S I1
BOX 626,_TOLEDO WA 98591
Rx#23e212 Dr.A ARONSK'r'
REMERON 30MG TAB
NDC# 00052-0107-30 #30
CASH BC /BCT
Price: 101.89 - -10% 3 91. 70 0
m
'5
TOLEDO 241 COWLITZ ST.
,jmr,r/,�C s TOLEDO,WA 98591 %6100
BOX j626,TOLEDO{FWA 98591
Rx#C24107'e Dr. J RICHARDS
ALPRAZOLAM 0.5MG TAB
NDC# 59762-3720-01 #90
CASH BC /BC
Price: 20.00 - -10% 3 18. 00
m
v
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