Okaloosa County BOCC — August 18, 2015 — Metlife Contract Renewal Form

CONTRACT/LEASE RENEWAL FORM July 30, 2015 Metlife Attn: Larry Guarcello 4010 W Boy Scout Boulevard, Ste. 950 Tampa, FL 33607 RE: Employee Dental Insurance Dear Mr. Guarcello The Okaloosa County Board of County Commissioners agrees to renew the subject contract/lease, # C14-2203-RM for an additional term. The contract renewal period wil be Oct. 1. 2015 to Sept. 30, 2016 . The annual budgeted amount for this contract is $242,606.44 . All other terms and conditions of the original agreement shall remain in full force and effect through the duration of this renewal. If you are in agreement, please sign below and return this form along with a current Certificate of Insurance listing Okaloosa County as co-insured (if applicable). COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE Dept. Director Contractor; /-cuurmae &m‘m&lflo Signature: ';fig;\_fig:fi@% Approved By: M Date: 8\\3-!\‘5 Approved By: Date: ( QL= Approved By: Title: A;counr-l— Esce e ware (as prescribed below on item 1) Nathan D. Boyles, Chairman / / Date: Date: 6‘ G (5‘ County Department Instructions: 1) Obtain signatures from Department Director, authorized Company Representative and then 2) 3) Purchasing Director <$25K and less, County Administrator <$50K and less or Board >$50K, as necessary. If Board approval is required, the Chairman and County Administrator's signatures are required. Make sure the company provides a cumrent Certificate of Insurance. (If applicable). Keep a copy of this form for your records. Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fox: 850- 689-5998. Metropclitan Life Insurance Company 4150 N Mulberry Drive, Suite 300 Kensas City, MO 64116 July 23, 2015 BENEFITS ADMINISTRATOR THE OKALOOSA COUNTY BOARD OF C GUNTY COMMISSIONERS 601 A NORTH PEARL STREET CRESTVIEW, FL 32536 Re: Customer # 05919435 Dear Benefits Administrator: We have completed our annual renewal evaluation of your group coverage with MeiLife or its affiliates. Our analysis takes into consideration a variety of elements that include overall industry trends in claims incidence, shifts in employee composition as well as other financial or premium related issues that have a bearing on our cost structure. After carefu! consideration of the above factors, we have established our pricing for the upcoming policy year. Following are both your current and renewal rates, which will be effective on October 1, 2015, Coverage Current Rates Henewal Rates™ Rate Basis DENTAL $20.840 $21.880 Employee $60.450 $63.470 Employee + Dependents Billing statements on and after October 1, 2015 will reflect the renewal rates. Rates are guaranieed for twelve (12) months subject to the terms, conditions and provisions of your group insurance policy. Any additional coverages not specifically mentioned in this letter that are active at the time of the renewal will have their rates continued through the coming year. Itis our expressed intent to provide the best possible retationship of benefit costs to the products we provide to your group. Please be assured that our analysis has been completed with this in mind. We appreciate the opportunity to provide your employee benefits and lock forward to continuing our relationship. If you have any questions regarding our assessment, please do not hesitate to contact us at 800 ASK-4-MET. Sinceraly, MetLife Renewal Underwriting ce CORPORATE BENEFITS OF THE EMERALD COAST INC TAMPA SALES OFFICE