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Agenda 10-11-16 Cl TY OF 90YNTON BEACH POLICE OFFICERS' PENSION FUND • 2100 North Florida lVango Road West Palm Beach, Florida 33409 Telephone: 954.636.7170 Toll Free Fax: 866.769.0678 AGENDA CITY OF BOYNTON BEACH POLICE OFFICERS' PENSION FUND loo E. Boynton Beach Blvd (Boynton Beach City Commission Chambers) Boynton Beach, Florida 334 October 11, 2016 at n:oo A. M. 1. CALL TO ORDER 2. ROLL CALL 3. PUBLIC DISCUSSION 4. CONSENT AGENDA a. Minutes from 7 -26 -16 Meeting b. Warrant Ratifications / Approvals 5. NEW / UNFINISHED BUSINESS a. Robert Kellman Disability Hearing 6. ATTORNEY'S REPORT 7. PLAN ADMINISTRATOR'S REPORT a. Audit- Update b. SunTrust Bank- Checldng Account New Signature Cards c. William Galbraith- Monthly Benefit Change 8. OPEN DISCUSSION 9. ADJOURNMENT io. NEXT MEETING DATE: November 16, 2016 at to A.M. IN COMPLIANCE OF STATE LAW, THE BOARD OF TRUSTEES FINDS THAT A PROPER AND LEGITIMATE PURPOSE IS SERVED WHEN MEMBERS OF THE PUBLIC HAVE BEEN GIVEN A REASONABLE OPPORTUNITY TO BE HEARD ON A MATTER BEFORE THE BOARD. THEREFORE, THE BOARD OF TRUSTEES HAVE DETERMINED AND DECLARED THAT THEY WILL A LOT FIFTEEN (15) MINUTES IN TOTAL FOR THIS PURPOSE; HOWEVER EACH PERSON IS LIMITED TO NO MORE THAN THREEWMINUTES TO COMMENT AT EACH MEETING. s CITY OF 80YNTON REACH N lywr. POLICE OFFICERS PENSION FUND r z 2100 North Florida Mango Road West Palm Beach, Florida 33409 Telephone: 954.636.7170 Toll Free Fax: 866.769.0678 W Warrants 26 -45 WARRANT WARRANT NUMBER: 026 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay. the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT Klausner, Kaufman, Jensen & Levinson $3937.50 7o8o NW 4th Street Plantation, Florida 33317 Re: This invoice is legal services rendered through 07 /31/16 The invoice is attached and the invoice number is 18586. Prepared &Requested by: Warrant Date: o8/o9/2016 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: Klausner, Kaufman, Jensen & Levinson A Partnership of.Professional Associations Attorneys At Law 7080 N.W. 4th Street Plantation, Florida 33317 Tel. (954) 916 -1202 wwwzobertdklausner.com Fax (954) 916 -1232 Tax I.D. 45- 4083636 BOYNTON BEACH POLICE OFFICERS' PENSION FUND July 31, 2016 i Attn: CHAIRMAN Bill # 18586 i 1500 GATEWAY BLVD., SUITE 220 BOYNTON BEACH, FL 33426 For Legal Services Rendered Through 07/31/16 CLIENT: BOYNTON BEACH POLICE OFFICERS' PENSION FUND : BBPOLBSJ MATTER: BOYNTON BEACH POLICE OFFICERS' PENSION FUND :150046 Professional Fees Date Attorney Description Hours :Amount 07/05/16 BSJ RESEARCH BUYBACKS AND 0.50 112.50 DISABILITY PENSIONS 07/06/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 MEDEXPRESS FOR REQUEST OF MEDICAL RECORDS. ON RONALD DAVIS: 07106/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 RIVERSIDE NEUROLOGY.DR. JAMES 1 MORGAN FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/06/16 BSJ PREPARATION CORRESPONDENCE TO 0:20 45.00 DR. RODOLFO TREJO M.D. FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07106/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 PENINSULA REGIONAL MEDICAL CENTER FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/06/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 MORRISON CHIROPRACTIC FOR i REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/06/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 MIDTOWN IMAGING FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. Continued. . . Client: BOYNTON BEACH POLICE OFFICERS' PENSION FUND July 31, 2016 Matter: 150046 BOYNTON BEACH POLICE OFFICERS' PENSION Page 2 i Professional Fees Continued..: Date Attorney Description Hours Amount 07/06/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 RESOLUTE PAIN SOLUTION DR, IAN SCHAJA FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/06/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 DR. BETH FROSCH M.D. FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/06116 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 MS. JULIE OLDBURY FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/06/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 BETHESDA MEMORIAL HOSPITAL FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/08116 BSJ OVERVIEW OF DR. KURLANDER 0.30 67.50 REPORT 07/08/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 BETHESDA RADIOLOGY FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/08/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 MRI SPECIALIST / DR. DANIUEL ! WILLIAMSON FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/08/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 MD NOW URGENT CARE FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/08/16 BSJ. PREPARATION CORRESPONDENCE TO 0.20 45,00. DR. ROBERT BRODNER M.D. FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07108/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 DR. ALLEN BENZER M.D. FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/08/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 i U.S. HEALTHWORKS MED GROUP FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/08/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 JUPITER MEDICAL CENTER FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. Continued. .. . Client: BOYNTON BEACH POLICE OFFICERS' PENSION FUND July 31, 2016 Matter: 150046 = BOYNTON BEACH POLICE OFFICERS' PENSION Page 3 i Professional Fees Continued... Date Attorney Description Hours Amount 07/11/16 BSJ REVIEW DR. KURLANDER REPORT; 0.50 112.50 TELEPHONE CALL WITH BOB DORN; :TELEPHONE CALL WITH TOBYATHOL 07111/16 BSJ REVIEW OF MEDICAL RECORDS FROM 0.10 22.50 MR[ SPECIALIST /DR. DANIEL WILLIAMSON ON RONALD DAVIS. 07/11/16 BSJ PREPARATION CORRESPONDENCE TO b.20 45.00 JUPITER OUTPATIENT SURGERY i CENTER FOR REQUEST OF MEDICAL I RECORDS ON RONALD DAVIS. 07/11116 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 NEURO IOM FOR REQUEST OF MEDICAL RECORDS ON RONALD DAVIS. 07/11/16 BSJ PREPARATION CORRESPONDENCE TO 0.20 45.00 DIAGNOSTIC CENTER OF AMERICA FOR REQUEST OF.MEDICAL RECORDS ON RONALD DAVIS. 07/11116 BSJ TELEPHONE CALL WITH BOB DORN 0.20 45.00 i REGARDING UPCOMING MEETING AND KELLMAN DISABILITY 07/12116 BSJ SET UP DROPBOX ACCESS FOR LAW 0.70 157.50 OFFICE.; UPLOAD IME REPORT 07/12/16 BSJ REVIEW MRI REPORTS /DAVIS 0.50 112.50 07/12/16 BSJ REVIEW OF MEDICAL RECORDS FROM 0.10 22.50 DIAGNOSTIC CENTERS OF AMERICA ON RONALD DAVIS. 07/14/16 BSJ TELEPHONE CALL WITH TOBY ATHOL; 1.20 270.00 EMAIL TO PAUL KELLEY, REVIEW AND RESPOND TO EMAIL FROM BOB DORN TELEPHONE CALL WITH BOB DORN; REVIEW AND RESPOND TO EMAIL FROM PAUL KELLEY; EMAIL TO JULIE c OLDBURY REGARDING EMPLOYMENT STATUS OF ROBERT KELLMAN AND WHETHER THERE IS A JOB AVAILABLE WITH OR WITHOUT REASONABLE ACCOMODATION 07/14/16 BSJ PREPARATION REVIEW OF MEDICAL 0.20 45.00 RECORDS RECEIVED FROM DR. ROBERTA. BRODNER M.D. ON RONALD DAVIS DISABILITY. I 07/15/16 BSJ REVIEW OF MEDICAL RECORDS 0.20 45.00 RECEIVED FROM DR. ALLEN BEZNER M.D. ON RONALD DAVIS DISABILITY. 07/16/16 BSJ REVIEW OF MEDICAL RECORDS 0.20 45.00 RECEIVED FROM DR. BETH FROSCH D.C. ON RONALD DAVIS DISABILITY. Continued ... Client: BOYNTON BEACH POLICE OFFICERS' PENSION FUND July 31, 2016 Matter: 150046 BOYNTON BEACH POLICE OFFICERS' PENSION Page 4 i Professional Fees Continued... Date Attorney Description Hours Amount 07/17/16 BSJ REVIEW EMAIL AND ATTACHMENTS 0.50 112.50 { FROM JULIE OLDBURY REGARDING ROBERT KELLMAN EMPLOYMENT STATUS 07/17/16 BSJ REVIEWAND RESPOND TO EMAIL 0.50 112.50 FROM PAUL KELLEY, EMAIL TO BOB DORN REGARDING MEETING DATE; EMAIL TO BOB DORN; TELEPHONE CALL WITH BOB DORN 07/19116 BSJ TELEPHONE CALL WITH CITY RISK 0.10 22.50 MANAGEMENT DEPARTMENT REGARDING FOLLOW UP RECORDS ON DAVIS 07/19/16 BSJ REVIEW OF MEDICAL RECORDS 0.20 45.00 RECEIVED FROM DR. DAVID CAMPBELL M.D. ON RONALD DAVIS DISABILITY. i 07/20/16 BSJ REVIEW NEWSPAPER ARTICLE 0.30 67.60 REGARDING REHIRE AFTER RETIREMENTAND FORWARD TO CITY OF BOYNTON BEACH 07/20/16 BSJ REVIEW FOLLOW UP MEDICAL 0.40 90.00 RECORDS FROM BOYNTON BEACH - DAVIS 07/21/16 BSJ TELEPHONE CALL WITH TOBYATHOL 0.30 67.50 REGARDING DAVIS 07/21/16 BSJ TELEPHONE CALLS WITH PENINSULA 0.50 112.50 REGIONAL MEDICAL CENTER REGARDING DAVIS. RECORDS; RESEARCH DATES OF SERVICE 07/21/16 BSJ REVIEW EMAIL FROM BOB DORN; 0.30 67.50 REVIEW PENSION PLAN DOCUMENT j REGARDING ROLLOVERS INTO PLAN 07/25/16 BSJ PREPARATION PREPARATION OF 0.20 45.00 MEETING MATERIALS FOR UPCOMING MEETING. 07/26/16 BSJ REVIEW OF MEDICAL RECORDS 0.20 45.00 RECEIVED FROM JUPITER OUTPATIENT SURGERY CENTER ON RONALD DAVIS DISABILITY. 07/26/16 BSJ REVIEW AGENDA PACKET AND FORMS; 2.00 450.00 CONFERENCE WITH BOB DORN REGARDING CHANGES 07/26/16 BSJ ATTEND MEETING 2.50 562.50 07/26/16 BSJ CORRESPONDENCE WITH. PAUL 0.50 112.50 KELLEY REGARDING DATE OF KELLMAN SPECIAL MEETING Continued .. . Sw - _.� Client: BOYNTON BEACH POLICE OFFICERS' PENSION FUND July 31, 2016 Matter: 150046 - BOYNTON BEACH POLICE OFFICERS' PENSION Page.5 Professional Fees Continued... Date Attorney Description Hours Amount 07/26/16 BSJ TELEPHONE CALL WITH TOBYATHOL; 0.10 22;50 RESEARCH BUY BACKS FOR CORRECTIONS OFFICERS 07/26/16 BSJ REVIEW OF MEDICAL RECORDS 0.20 45.00 RECEIVED FROM RESOLUTE PAIN SOLUTIONS DR. IAN SCHAJA D:O. ON RONALD DAVIS DISABILITY. Total for Services 17.50 $3,937.50 Costs Date. Description Amount PHOTOCOPIES thru 07 /31/16 36.25 Total Costs .$36.25 CURRENT BILL TOTAL AMOUNT DUE $ 3,97 Past Due Balance 5,33.1.90 AMOUNT DUE $9,305.65 r I WARRANT WARRANT NUMBER: .027 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION - NAME: AMOUNT Rackspace US, Inc. $825.00 P.O. Box 730759 Dallas, Texas 75373 Re: This invoice is server, firewall and hosting service rendered through 07/31/16. The invoice is attached and the invoice number is 1 o 1 537 2 03• Prepared &Requested by: Warrant Date: o8/09/2o16 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: PO Box 730754. aradowe. Dallas, TX 75373-0759 rrKMn,aanped.dauec�nwunr' iJs - - customer, Number. 8526! 't . Invoice Number. 10153TL * * ** *2224 S20354D2227 BOYNTON BEACH POLICE PENSION Invoice Date 05-' Attn To: BARBARA LADUE Invoice Currency. Cpl 1500 GATEWAY BLVD #220 BOYNTON BEACH, FL 33426 � onut Dae: $825" i euponReceipt j Please cut he l m a nd return top pauiion with payment y t Previous Balance as of 7/5/16: $825.0 - To t kw Gam' \ SA4 I wo l (_C 4 Payments: $ -828.0 credits: $0.0 Adjustments /Invoices: $0:0 . Balance Forward: $0.0 Current Invoice Charges: $825.0 Total Account Balance Due; $825.0 i INVOICE Page 1 �wivntbe . Sz zz :�.. ...br � • fi . � -. k. o- r.,� - � b .�a. ;._ - �4Y... .. � gXs V= Billing Cycle - August 2016 custom Monitoring Service Reference No. Descpption Qty UOM Unit Price To I Hosting Service 191119 (191114- monfrL.bbpdpensioncom) 1 Month $0.00 $0. Subtotal• $0. Fnewall Service Reference No. Description Qty UOM Unit Price To Hosting Service 191117 (191117- fwl.bbpdpension.com) 1 Month $94.00 $99. Subtotal: $99 Server Service Reference No. Description Qty UOM Unit ft ice Ta Hosting Service 191116 (191116- app1.bbpdpensionmm) I Month $726.00 $726 Subtotal.• $726 Total Before Tare $825 Sales Tax (0.00%): M Current Invoice Charges: $825 P. D. t wrackspac 3"a 3yo WARRANT WARRANT NUMBER: 028 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance, TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach: Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT Ronald Davis $70,149.5 Re: This invoice is for Mr. Davis total refund of all Buy -Back funds. Board approved this on the August g, 2016 meeting. The stated amount above is the gross amount. Prepared & Requested by: Warrant Date :.08 /15/2016 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: WARRANT WARRANT NUMBER: 029 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to 'pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified.by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT Daniel Griswold $6,000.00 Re This Warrant is for a partial lump -sum. DROP disbursement from Mr. Griswold's DROP account. Prepared & Requested by: Warrant Date: 08/15/2016 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: 3 i WWI 5tifl W a ; t _ ( � qrR. }♦ —M{ ��.y`f� .T AC a�^ �, � Fpx�y, ��Xt+'§ TS1 96� >�RT.'•MY�lIG�.:�`#�,',.'�.' YVAA'.:�M1Y� =���Y ^bi.9Yd, i /.. my �S yl W MW ft: `n r a , La s! <t wd PAY ?eu {manc'6 C euioc�zmanY3Ix�ttshe"otIg�ig sdtn. hale yea dad ��_� Y' ae P1� Q'iseTe�xreament Qp�vz� ; 9MAM=h Mcd WARRANT WARRANT NUMBER: - 029 For Payment from the:City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: - AMOUNT Daniel Grisw $6,000.00 Re: This Warrant is for a partial lump -sum DROP disbursement from Mr. Griswold's DROP account. Prepared & Requested by: Warrant Date: o8/15/2016 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted. By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: OW . OTM -w . W b �.. SOr x o p pct' a l l �a • ��: �+' �a�v���` 1ze�' i�' xegt�aas. sz. �s: �` s�ret������� .�- �?�..•���i.Ti,�+.��?���- p m 'diexusts zc �� �4 � Oxus jL #Sn $, a6�sv,>a. ciaxs afef�''X�, ` �C 3, �' 3i� .�,•SL��T7'1�`.�1V1$���`.���0� �I��S�1L�fir��NI�� `'�?qurc�a'� �caY nu�a3b�zas��tr�te'c� �� os�s ���eiztda�nt� �Er � YeinEmsn�;�se'�i`tts �.s a �Sl� ��, �'c pr 11�t�r�r fq5, �a4$�za��irt�ue�.ts;�ax'¢�c�zon df`�ki�54ertt Caen' �' �iisf���ie ; �u�nY� °�or�or2����aaacc oxosU�zs arclatcd�9 ��.�°bs�e... u[' �Ly�3 -.se�u#it�'Yi�ufnberX�±iIl:lte used �csT�Tq tof =aa8 ar�rtozc t���Szes���}'°3,�s_ `�e�r © �] } zsew. �.3rour'SO�aI��ek'.'�S�l�:����a� WARRANT WARRANT NUMBER: -030 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity. named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT .Daniel Griswold $ Re: This Warrant is for a re- occurring DROP disbursement from Mr. Griswold's DROP account. This amount will continue until stopped by the Plan Administrator or Board of Trustees. Prepared & Requested by: Warrant Date: 08/15/2oz6 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: n. � I //� {x � "'_'lf`�0�JK'.T• �T.�MYO` V6a.i/a1i11A M'•` .HiVlin:�v - / L A4 ow % - +��} : e 6b to ,1es.,sasa�atefz� tom_ ? h e t Ift =, e ia�ry fi or & 4 m bo �c�x ��r n� t _ . —� - - - - -E bac reedcI 7we.'ala�''e ea�nex�ta�a ;an zI A e PAW �� t��; �� �e M the ��f Ivu�� t�`��-����.. =� I_ r���� 5:��. s�?����u��all ;�ueh,��i�n�►z�s . ��e - �c�a� �FCn�y n�4rr as F��fe�:�4Y pokes �s� �etetc�wy 'ba�t� .tvr �tireu3uit s �s' a ,f� � xd?z'�e gr 6pn���Lar�r rr; g�fs�zo�m�zit'�s;Ffak�ta�rion�5 �rel3�nt'be��'fitsar�tsr�c �: or�rruonc�v� `ds�os�,�ed�o� @len{���c.: "�3i:ur`�octairse'cut3t3� du��11 =b� �eclst�l�9p'for'�on� �r:'e �£th�q kj���.*s �.�mlteet�du useof,�!our�l �c�y�p'�iu¢��!°S��fi9Y�1.te .e�ai:ori WARRANT WARRANT NUMBER: 0 For Payment from the City of Boynton Beach Police Officers Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees.. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT .Eric Jensen $7,920.00 =OE Re: This Warrant is for a partial. DROP disbursement from Mr. Jensen's DROP account. Mr. Jensen requests 20% in taxes on the amount. The net amount will be Prepared &Requested by: Warrant Date: o8/16/2016 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode 'Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: . a aty of o� 0>n Beaela 't' nt . . ..� �tptziepddzess �. �- - . NI:74taf�rks Sdetat- �`ttta� F+ d '11Ftd ai�raut� 6��a cul o It s 4 Q k 1n G � tc t 3 wo Yd bigtACE OT An* :.� road tm-I k `dso p fo JN VZlfhvc+ atd(f' tatx v,holfl GV�7IJtiier ����nszo�n,f�t►csnAf =t �0O� At t; Mortthly ItIQI'tsbursecttei�t m the at�wfi tt Fah month #�srn�o�d X11 # i .urgt{d to YT alb ` yotu can l benefit payirtept ' liis Will ro4l�ult nfY� QU send writ a tah a tb fhb. ��au A�trlmst5�'#oir�v.sto�thirs liii�eme�� _ Llet f have: my benteiit be 's shots �S acTmititsSttvly5racticabTe foTlo `" theo c3f`�lp stee`5 �f tHl tsriai w Ii< as ma 7INVORM nl i cy designate fhg Cg�so .(S) shi n tSti tfie > etr @fietat jr I7esi gafcc�i ortxt -A , b Yte i�iafy t¢ receive atiy , irxzi t ththiwy r +J.DRAI;IVQN�EA VSlf3X19�IN r Thy Board � : it lees. reciuir d to withtzoYd federal:#n�oinectaxe� one brut } rents Tfiiless_�y0 sbw fc4 request othecdlse on:the aonils}�bng SVnitcsld�u ElecttaiX.form `I}�e smeuni;fT�lel depgracls ort tb apfion yqu,seZet,n. SeCfiott ,above; and y4px hatoes dir the att o ietl yYttlihold ig Elec pn ` Yo u #t c�z?n alete Witt hQldtri 4.art form?nd,retuir�.�t t4'1�� �,: of � �t�ii�'Pt�tt$'t1i5 �oFn?,. , Elec �� '�'fIUR ��GNATUIiE . - - - -- i have read d uxldersfard kith of the b��negltc 4:i ii�' Debd RCtt�eraehon Plan a nd ap,� to be t3 A bQUni �y th�:.terms of'the p1au, I utitiers that the elections i :make oti �zs fbittt s�p�rsade atty� and all such elections I nay Have rtxarie pnor 'the dad o�inystguatitte`be`Low. • sacctAL s�r:rixfr� t�riii�3��t,cornc, riiort nrsclos�,��s�,�r�rr x!or local aecuriiy aucpb�r ;is xecJde�'fpr pu[pgg " es of ctcrmining :eligibty `for rtirm�ncnfS. a5 ptan tnembec, retiree, or fZen� &ciatx, #or: pita�'"g o retuemenf bdt8 its; foi Vefcficafion:of rdfxcnaefii bencfi�s fot:incomC repozfing of or otbet ioficb ofdisc�o aces tetattti'toaetirement beneffs', 'i'pint'soccal ndmbbr �irill.;l� pseSl solely fargae.�r'riiore of tEiese'�,ugiose$ The collbil mil ���i $fygJut sbGtst SeCUnty:tiutn�lbr ti autl�¢�et 5�fran t.f9:071(5)Ea)(2)(�3(lk}, �(Qruta�c�tutc�. .Pege`t ut� , WARRANT WARRANT NUMBER: 022 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT .Diagnostic Centers of America $10.00 8o1 SE Johnson Avenue #46 Stuart, FL 34995 Re: This Warrant is medical records for the Ronald Davis Disability case. Prepared &Requested by: Warrant Date: o8/18/2016 Robert: Dom, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: k `Y �g � i � x -� �d Yioc�ftatvn A3�Y 314544 �'sSlii.� - � ,�• t e "z gg��;; •;y �'Vcllmgtaa '�"�4Y 72��ipU'� �3i ., � ` vk g.q�q "+Ylyt�3tN,'S! [ire. rF �/�] d y ��y) Ly �l:�t1 3f �Y/p� I °!( ^YLYP f�j ��Yd'''��•t 1 S . 5 . • S } x * _ `• >_ .rec .} 7 a Y E : • '+ti } y � " j p � - a FT T ' r W; ��� .. 6 / � i PATff tkf 1ME� % � P TI NT �C ► 7 i�i4� r . T At$t C}t AR E -§,T E? s1D B F R AN1C 1 [E[ 1 AL RE�fli�Q :t�E� [S R R C A U. ❑ $ T ©P R tGE I1P TO 26 PAG E Y 1 TS CVi1 EP i ADbMTMVN �"+'�Sa�J", a nA - U P 4w, �t �..M� i; S .,,, a T TOTkL AI1t3tE;IN ,G1lIr, PLEASEEND ALL PAI+ I�1�ITS TO � ; DIAGNOSTIC CENTERS �?FAMERIA `804 SEQHNSON ANUS #4 , IJ , R FL S d THEME ARE:NO REC0. RDS IN OUR P0.3SESION DUE TOt © i3 lETO - OUR COMPAiIY MED[GAL RECORQS P-0 l��t`THES� RECORR3SARE NO LO G __ _.._.. .... . ORIGMAL RECORDS ARE IN SHE POSSESSION OF . . . . RECORI3 GUSTbptAN.. PR1 .... .. ME H -XMANA MfNnrJ&d"!i rs qms- VWptoadjdti oical Reaads +Gharpes for Records- vihsAacx Rev_#Yuf2m 15 - 2/2 c'2T9TEibSf !�� tulo a ,E;.SO 92 -£T 1tlt. WARRANT WARRANT NUMBER: 033 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT IRM $ 12.11. C/O Med Rec Payments P.O. Box 6700 Southeastern, PA 19398 -6700 Re: This Warrant is medical records for the Ronald Davis Disability case. The invoice number is 15 -0046 Prepared & Requested by: Warrant Date: o8/25/2016 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: t 'VtN Z01.+c5:5F.� � h F'AF`T a,u 81 155 IVwa 4th 5tre V n ?Manny FI 33157 z�x � � 1w r n y a s �,@ _ ty. )f, CISL- C1 'JLfI' l Tf3.3 < Y � - ... V. � JS n er 4 marsa R$u tgrtiwest4tht 6 81''ltatkt7n� t. 3 34 1 1 - ' , �- rJ396he i�ilawi6�f f�P NG 0 itx:�c��re prg�flfler re ±�o �' ©u� r,quest 'fc6i� n ttl.Ftards::.. t IDTPW I1 RGI la . ,�, �_ rt 6lratlhd Re evalee: {: <. Yatr req►,es��d Fe i`�s ��}��: ;1{otVAt� t1AilIS E s lets 7s�urtugfir €or providefi twee captessfhe ri twirl r e TteTZ t, w SurefereiiD Medla pagatd'terrCr °Mdta Feat $Q !30 `' 15- UE1�16 t Lfmat' Fee 0 OD ` Y.. A tuetotent = M i , :;, i M14t�5iT. tRM ant oe Trectang iHumber�NRSMXic58 a • �5ale�'rax 17 You can track and pay far �+AUr request '6 tine at' Irftlrgtlogy,alli ' t = Paid at Facility. Patel t47RMh (.`� M' '. BAL�ltl�Dt1E; _72 4 Reeards cocslstr o> -snore than 7S' es ma , ng A. $ _ v 'ori ttta- Payf�rs avaie ap(�rre besetitpnCD -RQM: : trr».rOting:com PAYMENT dancetlesf requests or 'unpard ituotcPS °mav be a can send tl check toi �'v 1 e.. iFtNt % Meet =Red Fayrnen#s sub echo a cattee(fattop fe_ - : • P Q..f3ox�f . southeastern, PA 19398 -6700 fR{N Tax ID (EIN):2 2588479 -. Please lviire the lirvarce n t� cheC Oe . I � ., - .< • - - " �;. reourn tfrds inv ©I�� Vvitli tie payment. By paying this Yt'voice, you ara represen ing ihatyou have revleYdecl.arld appeavedile.eharges and have agreed to #bent. A- y .4spyte re(atfif gto #hfs`itnrotr;� Traus #Iie presenferi bolore,payi119this invoice; Any dispci#e not so pre5.ptited is waived, Ai:di'spute:s must e tesotlred ley arbitration under -Federal Arpftrattdh �A-61 through on6 -or morn neutral arbitrators :before the Amer�oan Arbitration Association. Class <arb�tr�fioris . are trot pertmtteo; . pfsputes M5t be brough ar�ly iti:the claimant's I divfdual capacity and not as a repregeri #ative Of -a Mehiber or,P,lass An tratai may.npt consolfc(ate more than one persotr ..cl ir�TS:ngr rbside over art t'orm of class toceedtn 9 Y p P ease corttacit IRM 1 305- 31.3.4521 fc�r any 4 eAlons r varding this nyafce. f fRtV1 is h L medical copy request proces5tr or: SFL - Tt. -IN'E 'N 1br.t3ltllNf IMA ,[NG WARRANT WARRANT NUMBER: 024 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT ii0 10,000.00 m k Re: This Warrant is for a partial DROP disbursement for Mr. Charles King. Prepared &Requested by: Warrant Date: 08/25/2o16 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: Aug.24. 2016 8:35PM No. 7659 P. 2 City of Boynton Beneh police Officers' pension Fund RETURN OF CONTRIBUTIONS —ELE OF BENEFITS A. Amori , o (Please Print) Last name First name M.L .;ss Tclepltono . My Date of Birth Is' Social SectuityNuarbc B. FORM OF B ENEFIT Having received an estimate of my benefit under the City of Boynton Beach Police Offices' Pension Fund 1 elect to have MY account paid to me as follows: L Lump -Sum Payment $ My balance will be reduced by the amount l have Chosen to withdraw and a 20% tax withholding will apply. Other'penalties in accordance to the Pension Protecdon Act 2006 may apply. 2. Total Rollover to a Qualified. Plan $ 3. Partial Lump -Sure $ �Q f e� o u7 . 461 b My balance will befeduced by @te amount I have chosen to withdraw and a 20% tax withholding will apply. Other penalties in accordance to the Pension Protection Act 2006 tray apply. 4. Partial Rollover to a Qualified Plan $ S. Monthly Re- Occurring DROP disbursement in the amount of S Each month this srotmt will be disbrtrsed to you along with your monthly benefit payment. This amount will continue until you send written notice to the Plan Administrator to stop this disbursement C. WHEN BENEFIT Is PAID I eicct to have my bonofit begin as soon as administratively practicable following the Board of Trustee's receipt of this form. D. $LNEFICIA Y INFORMATION 1 hereby designate the person (s) shown on the Beneficiary Designation f0mi as my beneficiary to receive any benefits Which may be payable after my death, E. : FEDERAL INCOME TAX WITHHOLDING The Board of Trustees is required to withhold federal income taxes from your payments unless you specifically request otherwise on the accompanying Withholding Blection form. The amount withheld depends on the option you select in Section B, above, and your choices on the attached Withholding Election form. You mVST compfete. the Withholding Election form and return it to the Board of Trustees along with this form. F. YouR SIGNATURE I have read and u ndcrstattd the summary of the Davie Police Officers' Deferred Retirement Option Plan and agree to be bound by the terms of the plan, I understand that tiro elections I make on this form supersede any and all such elections I may h made prior to the date of m bc[ow. 6L; IItd SOCIAL SECURITY NUMBER COLLECTION DISCLOSURE STATRUENT Your social security number is requested for purposes of determining eligibility for retireMCnt benefits as it plan rucrubm, retiree or beneficiary; for procasrinz afretirearent bendfits; for verification ofretirement benefits; forineome reporting; or. for other notice or disclosures related to retireateat benefits. Your social security [umber will 'be used solely ror one or more orthose pprposos. Tho coitoction anA use of your social security number is auihori14d by Secttort 1 tS.071(5)(a)(2)(a)(1[), Florida Statutes, Pqe i ors WARRANT WARRANT NUMBER: 035 For Payment from the City of Boyntpn Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT Frank Rriganti $25,000.00 CM ��� -_ Re: This Warrant is for a partial one -time DROP disbursement for Mr. Frank Briganti. Prepared & Requested by: Warrant Date: o8/26/2o16 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: City of Boynton Beach Police Officers' Pension Fund .RETURN OF CONTRIBUTIONS --- ELECTION OF BENEFITS — A. ABOUT YOU lease Print):' r. s'e C 4 Last name First name M.I. Home address Telephone My Date of Birth Is; Social Security Number: B. FORM OF BENEFIT Having received an estimate of my benefit under the City of Boynton Beach Police Officers' Pension Fund I elect to have MY ccount paid to me as follows: 1 Lump -Sum Payment $ - J, 0oo My, balance will be reduced by the amount I have chosen to withdraw and a 20% tax withholding will apply. Other penalties in accordance to the Pension Protection Act 2006 may apply. �_i 2. Total Rollover to a Qualified Plan $ 3. Partial Lump -Sum $ My balance will be reduced by the amount I have chosen to i withdraw and a 20 %p tax withholding will apply. Other penalties in accordance to the Pension Protection Act 2006 may apply. 4. Partial Rollover to a Qualified Plan $ 5. Monthly Re- Occurring, DROP disbursement in the amount of $ Each month this amount `will be disbursed to you along with your monthly benefit payment. This amount will continue until you send written notice to the Plan Administrator to stop this disbursement. C. WHEN BENEFIT IS PAID I elect to have my benefit begin as soon as administratively practicable following the Board of Trustee's receipt of this form. D. BENEFICIARY INFORMATION I hereby designate the person(s) shown on the Beneficiary Designation form as my beneficiary to receive any benefits i which may be payable after my death. i E. FEDERAL INCOME TAX WITHHOLDING The Board of Trustees is required to withhold federal income taxes from your payments unless you specifically request otherwise on the accompanying Withholding Election form. The amount withheld depends on the option you select in Section B, above, and your choices on the attached Withholding Election form. You MUST complete the Withholding Election form and return it to the Board of Trustees along with this form. F. YOUR SIGNATURE x 4 f�c►es�j I have read and understand the summary of the 1 � Police Officers' Deferred Retirement Option Plan and agree to be bound b the terms of the plan. I understand that the elections I make on this form supersede any and all such elections I may h de pnAr to the da of my signature below. r. rgnature Date SOC SECURITY NUMBER COLLECTION DISCLOSURE STATEMENT Your social security number is requested for purposes of determining eligibility for retirement benefits as a plan member, retiree or beneficiary; for processing of retirement benefits; for verification cf retirement benefits; for income reporting; or for other notice or disclosures related to retirement bene s. Your social security number will be used solely for one or more of these purposes. The collec 'on and use of your social security number is uthorize b Section 119.071(5)(a)(2)(a)(II), Florida Statutes. VS ©4 7. ` � / ` 3 �� f Page : 01`2 WARRANT ' WARRANT NUMBER: 036 For Payment.from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police. Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity, named below, hereby certified by the Board of Trustees PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT Burgess Chambers & Associates, Inc $6,250.00 315 E. Robinson Street, Suite 690 Orlando, Florida 328oi Re: This Warrant is for third quarter of 2016 investment and performance monitoring and advisory fee. The invoice number is 16 -266 and the invoice is attached to this Warrant. Prepared & Requested by: Warrant Date: o9/o8 /2oi6 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: BURGESS CHAMBERS & ASSOCIATES, INC. Invoice ADVISORS S.E.C. REGISTERED 315 E. Robinson Street, Suite 690 Date Invoice # Orlando, Florida 32801 9/8/2016 16 -266 Bill To Boynton Beach Police Officers Pension do Precision Pension Administration, Inc 2100 N Florida Mango Rd West Palm Beach, florida 33409 I •I Description Amount Third Quarter 2016 Investment and Performance Monitoring and Advisory Fee per Contract 6,250.00 r Tote $6,250.00 Phone # Fax # (407} 644 -0111 (407) 644-0694 ,JAW .-hz WARRANT WARRANT NUMBER: 0 27 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person/entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT Klausner, Kaufman, Jensen & Levinson $2,006.52 708o NW 4�h Street Plantation, Florida 333 Re: This invoice is legal services rendered through o8/31/16. The invoice is attached and the invoice number is 18724. Prepared & Requested by: Warrant Date: 09/12/2016 Rob Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: Klausner, Kaufman, Jensen & Levinson A Partnership of Professional Associations Attorneys At Law 7080 N.W. 4th Street Plantation, Florida 33317 Tel. (954) 916 -1202 www.robertdUausner.com Fax (954) 916 -1232 Tax I.D.: 454083636 �1 BOYNTON BEACH POLICE OFFICERS' PENSION FUND August 30, 2016 Attn: C/O PRECISION PENSION ADMINISTRATION, Bill # 18724 INC. 2100 NORTH FLORIDA MANGO ROAD WEST PALM BEACH, FL 33,409 i For Legal Services Rendered Through 08/30/16 CLIENT: BOYNTON BEACH POLICE OFFICERS' PENSION FUND : BBPOLBSJ MATTER: BOYNTON BEACH POLICE OFFICERS' PENSION FUND :150046 Professional Fees Date Attorney Description Hours Amount 08/01116 BSJ REVIEW OF MEDICAL RECORDS FROM 0.10 22.50 PENINSULA REGIONAL MEDICAL CENTER ON RONALD DAVIS. 08/01/16 BSJ REVIEW OF CORRESPONDENCE FROM 0.10 22.50 MEDEXPRESS REQUESTING ADDITIONAL INFORMATION ON RONALD DAVIS. 08/02/16 BSJ REVIEW OF MEDICAL RECORDS FROM 0.10 22.50 BETHESDA MEMORIAL HOISPITAL ON j RONALD DAVIS. 08/04/16 BSJ REVIEW OF MEDICAL RECORDS FROM 0.10 22.50 i MEDEXPRESS ON RONALD DAVIS. 08/05/16 BSJ PREPARATION OF FILE MATERIALS 0.20 45.00 FOR UPCOMING MEETINGS 08/05/16 BSJ REVIEW AND REVISE STATEMENT OF 0.70 157.50 POLICY ON CREDIT CARD USE; EMAIL TO BOB DORN 08/08/16 BSJ REVIEW AND RESPOND TO EMAIL 0.10 22.50. FROM BOB DORN REGARDING MISCELLANEOUS MATTERS 08/08/16 BSJ REVIEW AND REVISE CONTRACT FOR 1.00 225.00 ACTUARIAL SERVICES - GRS 08/09/16 BSJ REVIEW MEETING PACKET, REVIEW 1.00 225.00 MINUTES OF 7 -26 -16 MEETING 08/09116 BSJ ATTEND MEETING 2.00 450.00 f Continued. . . Client: BOYNTON BEACH POLICE OFFICERS' PENSION FUND August 30, 2016 Matter: 150046- BOYNTON BEACH POLICE OFFICERS' PENSION Page .2 Professional Fees Continued... Date Attorney Description Hours Amount 08/10/16 BSJ REVIEW AND REVISE PROPOSED 1.00 225.00 ACTUARY CONTRACT; EMAIL TO PETE STRONG 08/10/16 BSJ TELEPHONE CALL WITH PETE 0.50 112.50 STRONG REGARDING CONTRACT PROVISIONS 08/12116 BSJ REVIEW OF MEDICAL RECORDS FROM 0.20 45.00 MD NOW URGENT CARE ON RONALD DAVIS. 08/15/16 BSJ REVIEW OF MEDICAL RECORDS FROM 0.20 45.00 MR[ SPECIALIST CD FILM ON RONALD DAVIS. 08/15/16 BSJ PREPARATION OF CORRESPONDENCE 0.10 22.50 TO ROBERT DORN WITH ADMINISTRATIVE BIDDERS COPY FOR HIS RECORDS. 08/15/16 BSJ TELEPHONE CALL WITH TOBYATHOL 0.30 67.50 REGARDING DROP INTEREST RATE; REVIEW EMAILANDATTACHMENTS REGARDING BROBERG BENEFITS 08/1.6/16 BSJ REVIEW EMAIL FROM BOB DORN 0.10 22.50 REGARDING KELLMAN COMMUNICATIONS 08/18/16 BSJ REVIEW OF MEDICAL RECORDS FROM .0.20 45.00 DR. RODOLFO TREJO ON RONALD DAVIS. 08/19/16 BSJ REVIEW STATUS OF DAVIS MEDICAL 0.30 67.50 RECORDS; REVIEW RELEASE FOR MIDTOWN IMAGING; EMAIL STATUS TO TORY ATHOL 08/22/16 BSJ REVIEW ADDENDUM TO RUSSELL 0.30 67.50 CONTRACT; DRAFT STATE LANGUAGE TO BE ADDED Total for Services 8.60 $1,935.00 Costs Date Description Amount 08/16/16 FEDEX TO R. DORN 13.02 08/26/16 MISCELLANEOUS PHOTOCOPIES OF MEDICAL 11.00 RECORDS RE RONALD DAVIS PHOTOCOPIES thru 08130/16 47.50 Total Costs $71.52 Continued ... .a& :. Client: BOYNTON BEACH POLICE OFFICERS' PENSION FUND August 30, 2016 Matter: 150046 - BOYNTON BEACH POLICE OFFICERS' PENSION Page 3 CURRENT BILL TOTAL AMOUNT DUE $ 2,006.52 i t i i I :i WARRANT WARRANT NUMBER: 038 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT Char1r.Q Ving $lo,000.00 Re: This Warrant is for a partial DROP disbursement for Mr. Charles King. Mr. King selected 20% tax on this withdrawal and his net disbursement will be $8,000.00 Prepared & Requested by: Warrant Date: 09/12/2016 g L Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee. Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax:' US Mail Date Entered into System: Entered By: t oy~at a i�a t bl c fficerW Vendog ftu AE MOUrIbil # l titttl; test .. M5 -D.atG:o rt + a is i mumber % EQ iuyi,Qk 33F��tx I a ing ebr anestizt �a W�IW4t o Orft i1 of nyntVn„I MhftliC_DOTMe ?=wm ruo I *dvta Way W uftdalomoIm U #. L. - �tnP . , � � �� _.. _ _ :. _ . :. .. 11�y�brc�.i f� davd$ �ll Jmve t'bMM. i 1 . E' Q?a1 }L gt May. bolo Zvi l .T r xnun T aye hv�ean t �v_'' ��ih�i�a��, a_ �!. n 'tRzEwi�tt�►.�d�'�r��tt�� �`? ��` ie�, ��rxs+ �sx�� ►c�brdaiiir�tv�i�;i�a�����a� 4 'Pare RA) "netl ft u 4i .... . Month! M f ombi.v t ofd fte dtsbed tic a14WotYj�r'tAelitynu�nt �srtoutvtfi dout'tn5iy ott� Kati. drltentoe its t )LMLIENEFIT M t elmt to Uvee r4y benefit s; i s s adn;asa niriis ra i :iii~a reab3a alto usciu Cie: Roard o ffamtce rwolptvf1his fm= B.EM- ff_ R I *ft Qesignare * ,poesents) Abut, di ifie Senel`ielaty. my'bo eficwq td Meiv0 wty b.meft xvliioti tiiy itya6e dtit �lte: oarcl 'of � staes is ol"TCltd. tgr viaM #e 1 income �t�ttes fry yourpa afs unless• XPA s �ieally ey t gthrsv*lse 4?> tle aeeo�n�rt . et, iUsxlfttg £lattn I'om The ar�tipnt Vi11}lsee a#on you ; sult ect on B, bade, anc bout s d 16 *w4 16d:'rtG wft 0e�k ft_u.. vW i's ' o** sw *wt Meodatfcf=gfld tetzim Irtathc�'l t�' pes,alcttigvAtiilldstoini. �. _P_UR; T ktave read. and �uclerstsnd: th Mwur,ary of �tlie 1. AP Police Officers! ,l7efet A. "; Rveil a}i ;.Optton:jaii:.S d sgme: to I D s g hoift t3y tii.��terms. irthe otw 1`it�o omgW, 4010— gi I make tih Yht ij ?T �uoot�et� ariy � a�) subli el�lloYts 3 it a h ye niaCle puos'ta .th : fe- og.`tt y s tst re 5slo v . .ate �OCIA. "SECVR13' NUSIBERCOLLECTIONDISCLQS>sRRST`A- MyIENT Yalu Soc�aFecprity ittrmlzer ts. rcc�uz5trg fot ilt;SCS xSQ tTZ�LrSYUii�gtg " ttgt¢sltty 'fUr rehrCmenfalet;ts, a earl trFeptk �gtie. f7t bet3etd3aiy,`ft ?x priioesssng of nedtseriieni SeiteFtsi forte eri ca orr of rctrrcmerif i:en tics£ £oe income ttporting; discIo rin q.494 ia. �eUre fin[ =¢ap f�is.; S`Otir �gcaal s uiy mbar tvttP Gb d sd�e fQr <15de:o� woo #t'"th opUrfses. The 1 00'- ibis od.a6 d:yWin "dial suciiettf ii'GtS bff:is atittSfted by WARRANT WARRANT NUMBER: 088 For Payment from the City of Boynton. Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT Charles Winu gober $10,000.00 Re: This Warrant is for a partial DROP disbursement for Mr. Charles King. Mr. King selected 20 %tax on this withdrawal and his net disbursement will be $8,000.00 Prepared & Requested by: Warrant Date: 09/12/2016 rn, Pl an Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: 1Y')!7+JET' ,A: DEFT YM-1 iefi rirtt3:: _. ..._ Y aft naYl n MIT, : Hahc tce3vdasiiznei 4rertiy a�3�nt 1e�QT�iE t]TTiGsx 3'ensi�tn av[. viy gG . W -to W-& 44 to ts7zivi� and a:# fax ttc>diu willpp1. Calfes #x araa.tpt0taazikciD6 uaap. " 1ra.° t�vidi> rt�pl�texfi�sxnacor .atitc��Pisi+�>�"►4 - 1, Rani Ck t #Qt etiz�al ti 1 :�. it nfl �y e-Z i l urseme t izt the a�itouu� a s 0.0 th $ 14 a s disbw ed ti �jv�r al6n -�v t yu, edit p m r : za ntvw�t 'iit ony. tiff t # -co ittan �totttxe t� tSt� r:z cr 69ft taf16stdPrif&AisbiMb9M. L elect C��av'er triiy, tiefiiefiC�S7��Itt ats �vt�n; as:atii�i�ustca�x�l�Tiraetcable fztllo,� �fi� B�'a�d �'�xcastet~'� rp�flf'this �x�u: hgi eb des [ fe the . ez n s &o� dit 4 $:caerielii , Designation. fotli . i . ' bene ®i ttI YeC iVe bear is v wbiohi�lqybv pa pt te alley The Daard 1. T,rirA= xs xeD rgd to: -w ©Zr� Tede l anco�e 3a�es �e4� y�i]x �a�*fi�� ►less you opec-i �oy. t4quest gthe ;use Qn. tl�e aG o ii�n� t t? iilxvtd RLAo #sip, �omI' The oh6o t y�?tlili�� �s;�s_r n� �e o,Ptiaa �vu, se]�x 3 $eetton B,. av , anc Your An�e ;0 41; ow - 4 ert Qn fo 1Y EleCtibiiformartd:re af'ta �Idfi�'t�±�Eh�Us �orn[t. '+O TTR�G T have read, and undsrstauii• the em=gy p the Dole: Pohee -officers' Po Wed Retire> a $. to bo. Uoui d Uy t firms o She Alan t ianders�r ilia# e e ecf[ous I male oti, toss a, s r de 04 aid a�� 4410. eiecho►ls mIa.y itt . 6 ,f'htlteo at rlatar &E1'axu. L '§QGIA# SECUFM'YNIItti BER-COMECl'IOiti DISCLOSURE.MATEMENT Xaiu Sacral tsct�rzfY tlgol Cr :is: ['tolled fob uipi� gs ct f�tn�iYau[g ¢k i"'jty - or retzrd�Fe�lt �m)Afitg As, g ri. pXentW., loft �f 6e tic� fit p rncesstng oIr 8preiiidnt$enefits; forxerilicatin:a . retiremerif tenets �OC`[nCDn30 rp110flingi 'OC fOC [JEf[CCIl0I1G� QTSC�OSUCS T�a�ea {0; rC Ylrp[►l�1tl anGfUS;, Xour sgcial. seaurlfytitio[ber W., e�. he Lailce�i�ii,uncl_ii�e. a�j?gizt�udiai s�clfi� nli[fibe�'is �titBo�iiid by ifieccicSt� ; 1, 1; 9. 07' 1: �5) �('. t'). tai.�a�(I�j:�`1yc�dsr�f�t�?t�s+ WARRANT WARRANT NUMBER: 039 For Payment from the City of Boynton Beach Police Officers' Pension FuVd Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity namedbelow, hereby certified by the Board of Trustees. _ PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION I NAME: AMOUNT SunTrust Bank $500.00 P.O.Box 791250 Baltimore, MD 21279 -1250 Re: This Warrant is for a credit card payment for Russell. Faine FPPTA pension conference charge. The credit card reference number is 24765o1JS2DYE7.JGD. Credit card statement is attached. ep ed & Requested by: Warrant Date: 09/23/2016 obe orn, Plan Administrator i APPROVED BY: i Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: 9 Transmitted By: 1 Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: . - 1'IiP1t`l5RCi'i1VPI5 -:: . _ . •'- . • ;•' Trans' Post m :Amount ' - Date ,• Date Reference Nurri(Ner McYctant Name'ot Transact' Descnption, Credit : Qharge 08 -04: ; 00;04..' • 7422307K9010TAGJH PAYMENT, - THANK YOU : '142. 0 TOTAL XWXXXXXXXX8221 $142.50- . 07 =20 ' 47.21 2476501JS2DYE•ZJGD FPPTA TALLAHASSEE FL RUSSELL FAINE ' TOTAL XXXICXXXXXXI�X4.817 tBC��¢0 . t•K} n !e {x,v '. v .J.r� u Finance-Charge- Average r[odTa . s ' e Detail Balanat - Rale liv vary) • Wr •� ,+P 1# Purchases 0.00 O'Z�87* 1{ _ - � Q�A� : Cash Advances 0.00. .05065y'o V 0.00 18.499'0 ' MINIMUM # PAYMENT ACCOUNT i a SUNTRUST $so.00 CARDMEMBER SERVICES YMEfT DU E DATE °.. .. �IEVIf BALANCE PO BOX 305183 ' . 1 .0946 -2016 $600.0 . NASHVILLE, TN 37230 -5183 AMOUNT ENCLOSED • "• Make chackP�Yablefn ; f�D,Oa change of Address? Please cheek box end complete reverse side SunTrusl8arik CONTROL ACCOUNT 7 b 3 r BOYHTON •BEACH CORP 1048 ATTN BARBARA LADUE 1500. GAYEWAY .BLVD ST.E 220 . Enclose this coupon with yourpaymeM end mail t0- BOY.NTON BEACH FL-33426 - II t 'I Irlf lu r Ir r11T l r r'li rlrrr I r I urr 11111' ill'. I' i��lll11' l' ITI�.' I' IPIIIII 'IIIIllI11��IilllUll�hll�:.. - 111 ll ill! ill l l I � 111 I l I it itl ll - . SUNTRUST BANK PO BOX 791250 BALTIMORE, - MD 21279-1250 1 1M CH £�E Y �31ii - Ess r Abbtl� WOO P �IU IKKi ifil Yt?I,1 3 dT?v T'�; P % R P STATE ous,u .'s PHONE A. o Pilo lb or 1 a���r ploto Ic+Elris tax In tT� upper €�"a g t�4 f mrA of this amormnt to .01"t3 PIS . � II t�Sll �l �e��l�OP�f.lf_J.Sl �a�sa Asut tssu,LtanC nn3 — - WARRANT j WARRANT NUMBER: _ 040 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUW Paul valerio $20,000.00 SM Re: This Warrant is a partial lump sum DROP distribution. A 2o% tax was withheld and he received a net distribution of $16,000.00. His balance as of 7/1/16 was $312,990.95. re pared & Requested by: Warrant Date: 09 /13 /2016 Robe orn, Plan Administrator APPROVED BY: i Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: �'i3� 1 Transmitted By: Mode Transmitted: E- Mail �'�J Fax: US Mail Date Entered into System: Entered By: City of Boynton Beach Police Officers' Pension Fund Sept t RETURN OF C ONTRIBUTIONS - -- ELECTION OF BENEFITS — p. A. ABOUT / YOU (Please Print) Last name M.I. WNW— Home address Telephone My Date of Birth Is Social Security Number,. B. FORM OFBENEFIT Having received an estimate of my benefit under the City of Boynton Beach Police Officers' Pension fund l elect to have #eit count paid to me as follows; Lump -Sutra Payment S My balance will be reduced by the amount I have chosen and a 20 % tax withholding will apply. Other penalties in accordance to the Pension Protection Act 2006 may apply. 2. Total Rollover to a Qualified Plan S 3. Partial Lump -Sum S r My balance will be reduced by the amount 1 have chosen to _ ' w and a 20 tax withholding ttes to accordance to the Pension Protection Act 2006 may apply. 4. Partial Rollover to a Qualified Plan $ 5. Monthly Re- Occurring DROP disbursement in the amount of S Each month this amount will be disbursed to you along with your monthly benefit payment. This amount will continue until you send written notice to the Plan Administrator to stop this disbursement. C. WHEN BENEFIT IS PAID I elect to have my benefit begin as soon as administratively practicable following the Board of Trustee's receipt of this form. D. BENEFICIARY INFORMATION I hereby designate the person(s) shown on the Beneficiary Designation form as my beneficiary to receive any benefits which may be payable after my death. E. FEDERAL INCOME TAX WITHHOLDING The Board of Trustees is required to withhold federal income taxes from your payments . unless you specifically request otherwise on the accompanying Withholding Election form. The amount withheld depends on the option you select in Section B, above, and your choices on the attached Withholding Election form. You ,*iu r complete the Withholding Election form and return it to the Board of Trustees along with this form. F. YOUR SIGNATURE i I have read and understand the summary of the Davie Police Officers' Deferred Retirement Option Plan and agree to be bound by the teams of the plan. I understand that the elections 1 make on this farm supersede any and all such elections I may ha ad e prior to the d to of my signature below. tgnature ate SOCIAL SECURITY NUMBER OLI ECEION DISCLOSURE STATEMENT Your social security number is requested for purposes of determining eligibility for retirement benefits as a plan member, retiree or beneficiary; for processing of retirement benefits; for verification of retirement benefits; for income reporting; or for other notice or disclosures related to retirement benefits. Your social security number will be used solely for one or more of these purposes. the collection and use of your social security number is authorized by Section 119.07[ {Sxay{2)(al(Itl. Florida Statutes. 3�d T o. Cd { WARRANT WARRANT NUMBER: 0 4 1 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity, named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME:. AMOUNT' Frank Dan sh $ 6,000.00 Re: This Warrant is for a re- occurring monthly. DROP disbursement for Mr. Frank Danysh to start on October 1, 2016 in the aforementioned amount. This payment will continue until stopped by the Member, Plan Administrator or the Board. Prepared & Requested by: Warrant Date: 09/26/2016 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System; Entered By: WARRANT WARRANT NUMBER: 042 For Payment:from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR.OBMGATION NAME: AMOUNT Data File Technologies $80.22 V,0. Box 801504 Kanas City, MO 64180 -1504 Re: This Warrant is for the Ronald Davis disability case to obtain medical records from the aforementioned company. The invoice for the records is attached. Prepared & Requested by: Warrant Date: 09/26/2016 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail - Fax: US Mail Date Entered into System: _ Entered By: _____ rom Daa�leT�chn�liages e .13 +J116Q� AMr GD.T T e5.. 4 ' S � r �. F� _ "^` � � t b °{ '�# p S '� 5 d3t�` . s x �� 'w " "`:. " `�'; 3 • =r ��.ta��lla �aGh�ja�tl4�a�. �.I., {`i, �, a•-x .k� ti a•., t* r� - . s� .7 .x � n r p t - �°:' Y a� �. "+ � - pg• �Qx t� iVa pY ECa t. 64 1ilf.f�L 71131t31� r ; , Entail: status GciaC "d • i � _...� a. __ 6_,,�� "`� -- .- _' ..,? � -� � .... � -�_ _� .fir- {���w< Res�uestvrli3iltT Regek+sst �rsfor' tt`t1Y frirn�aion F.. .. t 3EISr€f f:a 'fiz, a h `�i.'�..•., o .. (` La K6Wi7 Y f 1 ii)atV Xo" I ,; rtce -Na x ?: f tlted bialy t i � x n v y ,� y Gri�l#ltYfl # R tfty' 3 14irou q Si •,^;•w.,� .. 3�+3ti., -a... -- +m�+� f-warl '~e 6 Pads . I c ,. 1�, \ -- . � .. •w -- 'y` --- '�"°'ytx - fi.si• rcM --•+ - - -';• -- -- z•-- i.:M=-- -,.. -- - - :fir �•.�. ;6�+.� - '.`- -- F co � .i - °,�. w. _ _ __ ;: — 9,r�� !�PIB #I�."+':`''k` * k •?s.Yj�r� - Tiertns:`If JD d x Pay Your`TFwNc '�j t'z vkw -,da fi1et+~ htioL6- glWCiom 1 PLEASE htC}TfE_ N1oW REMfT 1{) ADDRESS SF-LqWt* lnrratcs # lilt(3t1 . � _ F�ayrnent Amouirf Rgmittanc� Infac;rlaf!on: �,. _ ar►eraf dcsstru'etians. - _ �_w�.,... a [7eiaFtl�Technadogie� -!*fc; *Please ch your dou,r}ents ttti(xtceiiaiely upon receipt as PO Hoy 801 04 fides are. hot available in Rur system �ftec, four inion his from.da% -` i :kj nsas Gty,• 9o of request '*Cancellations roru B ls1lless RattuestorsAreg[�QT a AZ 3t) f56 A eptet3. lf,yow hav any tes #ions bt tyou�jnyotC; R.case ' !'ttorce X84 j 43f =9'134 's entail= arservic�s�daia (itetevh�tt�di�gias Cz iTi if you chQOSeA PeX; 69 229 4;99 4 _ e PdY k�Y credid;a $ Oo Online Payrrierit ocassi prt3g fie rcll be mat! status @.datafilefeefmafgies;eona ;charged E1:N: 20 31 �8Z�7 11,E'1!li' E f [EI14 t t llll�iE�(�I(t{I I11 I EQI�tI(I�iCl[l l'E�(�Et E 10E'I] [[ -1 Ell WARRANT WARRANT NUMBER: 04. For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for. services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT Gabriel, Roeder, Smith & Company $2,173.00 P.O. Box 7800 Detroit, Michigan 48278 -oog Re: This Warrant is for Gabriel, Roeder, Smith & Company (GRS) for actuarial services . rendered to the Fund through 8/31/16. The invoice for the records is attached and the invoice number is 424276. Prepared &Requested by: Warrant Date: 10/03/2016 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: WARRANT WARRANT NUMBER: 044 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §18 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: - AMOUNT SunTrust Bank $56.48 P.O.Box 791250 Baltimore, MD 21279 -1250 Re: This Warrant is for a credit card payment for Robert Dorn, Plan for postage used to send items to auditor and to bank for deposit. There is a late charge also added bill for the entire account. The Credit. Card Company is sending items to the old . mailing address and this is the reason for the late payment charges. The credit card reference number is 2416407L3Q5ESEVHK. Credit card statement is attached. Prepared & Requested by: Warrant Date: 10/03/2016 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E -Mail Fax: US Mail Date Entered into System: Entered By: V15A . . 40% SUNTRUST Pagel of i . YOU B usiness Credit Card Statement :BILLING CYCLE-INFORMATION ACCOUNT SUMMARY Previous Balance $500 00 : Account Number Payments $0 00.. Total, Credit Limit $10,000.00' . i Credits _ . $Q.00 Avalfabfe'Credit $9,443.00 Purchases & Other Charges $5a 0 Available Cash . $9,443:00 ' Cash Advances' .. +:' $0.00.: AmountOver Credt Umif $0.00 ' F INANCE CHARGES' + 64 53 Amount past pue $50.00 New Balance $5.4$ ,r Days In Billing Cycle 31 ' Closing pate 0971 112 Minimum Payment pus $ Payment Due Date 10106/2016. Ccnf at Information Toll Free �,�1, O�IiI Collttct). .0.130 A9 . , Y40> fasa•IS74•z4 Y w rirlo 1Ft�F TRANSACTIONS Tr$ns Amount ' Rate• Rate Releren6e- Numb' 'Merchant Name or Transaction Description. Credit. Charge 06.30. IM 1 f64070051! fC °' - ' LISPS' t'30fi¢U27352t)8303 :'Fl 22.85 R08T DDRN TgTAL 7CXXXXX)tX00=4862 S22.95- mil 09 -1 t .: LATE CHARGE 29.00 P -11 09-11 'FINANCE CHARGE' PURCHASE$ :;S : CASH ADVANCE $0.00 4.53 F.inanoe Charge Avkrage Dgily. Pall Periodic FINANCE Corres�pondin ANNUAL Detail :�., aLatice Rate may vary} CHARGE. PERCENTAGE RATE Purchases ¢0 .48 -' .02873% V 4.6 10.49% Cash Advanoes +r•, 0.00' tom V 0,00 18.469: r Gombinad Annual P I>1,« toI' B il M ola 10.49'K I An r;; ' - .... 'r. ,• arc See wwsli for additlwMI 1111WI 90 6207 '2FD 1 11 D 7 Pape i of 1 4662 8600 VN 0007, 180011 O1AO62o7 718 VPLEASE DETACH HERE AND RETURN BOTTOM PORTION WITH YOUR PAYMENT? O . SUNTRUST MINIMUM PAYMENT ACCOUNT# $1 DO.00 XXXX XXXX XXXX 8221 CARDMEMBER SERVICES PAYMENT DUE DATE NEW BALANCE NASHV LLE TN 37230 -5183 10.06 -2016 $556.48 AMOUNT ENCLOSED Make check payable In ❑ ClanOe of Address? U.S. dollars to: Please check box and complete reverse side SunTrust [lank $ CONTROL ACCOUNT 79t1 BOYNTON BE CORP B109 ATTN BARBARA LADUE 1500 GATEWAY BLVD STE 220 Enclose this coupon with your payment and mail to: BOYNTON BEACH 'FL 33426 - 7233 111 1I'1"111111111111 Jill 11 111' ' ll {'1111' [if lnn1'll1' 118 111.111111 [Jill , 1'I111 SUNTRUST BANK PO BOX 791250 BALTIMORE, MD 21279 -1250 a am - .Aw WARRANT WARRANT NUMBER: 045 For Payment from the City of Boynton Beach Police Officers' Pension Fund Pursuant to §i8 -167 of the City Of Boynton Beach Ordinance. TO: Russell Investments You are hereby authorized by the Board of Trustees of the City of Boynton Beach Police Officers' Pension Fund to pay the amount(s) listed below for services rendered to the Board of Trustees and /or pay the person /entity named below, hereby certified by the Board of Trustees. PENSION BENEFITS, SERVICES RENDERED OR OBLIGATION NAME: AMOUNT RussellFame $266.10 ioo East Boynton Beach Blvd, Boynton Beach, FL Re :. This Warrant is Trustee reimbursement for expenses during the FPPTA pension Conference from 9/25/16 through 9/28/16. Reimbursement forms and invoices are attached. Prepared & Requested by: Warrant Date: 10/03/2ol6 Robert Dorn, Plan Administrator APPROVED BY: Chairman of the Board or Designee Trustee Secretary of the Board or Designee Trustee Date Transmitted: Transmitted By: Mode Transmitted: E- Mail Fax: US Mail Date Entered into System: Entered By: CITY OF BOYNTON BEACH, FLORIDA TRAVEL EXPENSE FORM Date Submitted 10/3/2016 Travelers Name Russell Faine Department Police Pension Travel Dates Sunday September 25 - Wednesday September 28 2016' Meeting Description FPPTA School Travel Destination Hyatt Regency Coconut.Point Departure Time and Date 9:25:16 Cad 1130 Return Time and Date 9.28.16 Q 230 Expenses Receipts must be attached for all expenses except for meals Dates of Travel 10/04/15 10/05/15 10/06/15 10107115 Sun, Mon. Tues. Wed. Thurs. Fri. Sat. Total Hotel $189.00 $189.00 $189.00 $567.00 Breakfast $ - Lunch Dinner $240.00 Registration Fee $500.00 $500.00 Ground Fare Parking Fee $ Tolls $11.10 Fuel $16.00 Plane Fare Rental Car $ - Books /Publications $ Mileage ($.555 /mile) * Effective January 1.2010 ('11ravelers receiving a caraAowance should refer to'Snshuctions for Completing .Travei Authorization Forth" as a mileage aCowance is no longerallom Total 15 pence $1,331.10. Beginning of Total Mileage Breakdown Trip:. Ending of Trip Mileage Beginning mileage 0 Ending mileage - - 0 Expense Recap Total Expenses Less payments made by direct payment or City credit card directly to vendor $1067.00 paid with pension CC Less amount paid by traveler Less amount p6=1 nadvance to traveler Balance due $266.10 jAccount# If balance due amount is in parenthesis the traveler owes the City money - attach check to this form; If the balance due amount does not have parenthesis the City owes the traveler money - this form must be in Finance by Tuesday at 5pm for check to be issued the following Friday Signatures I verify, that the expenses listed above were Incurred as necessary travel expenses In the performance of official City business and that this request for reimbursement Is true and correct as to every material matter. Employee Department Head or Designee Finance Director or Designee CAUsers)fainerXDesktoplTravel Expense for PENSION SCHOOLS.xlsx FPPTA7" FPPTA Online Payment'Confrmation . F16Rtf1A�L�R�TSfQN YRSf�•#5.�'�Si�Z1a�T.N�I ' • SIl�E1984 . Payment ID: 14421 Status: Paid Invoice(s) Paid: 20899 Amount Paid: $500.00 Date Paid: 7120/2016 9:23:15 AM Paid By: Russell Faine 0 Wner@bbf1.us Boynton Beach Police Pension Fund Check Number. Transaction ID: 1505890722 Authorization Code: 020564 Card Number. '*'*4517(Visa) Expiration: 712019 Name on Card: Russell Faine Comment: TS Act Reg: Boynton Beach Polio ension Fund (Russell Faine), Thank you for youi payment online. i.¢ ,`.*A If you have any questions, please contact our friendly staff at FPPTA 7— ELEVEN 2946 Wellington Circle East, Suite A' 24530 S TAMXA fI TRL Phone: 800-842-4064 { Tallahassee, Fl- 32309 BONITA SPRINGS FL 34134 Fax: 850-6W-8514 2399481510 STORE #: 34838 THANKS FOR SHOPPING 7- ELEVEN 1, 1 Gasoline 15.00 15.00 TOTAL.DUE 15,00 APPROVAL #: 028750 AUTH CODE: 0 APPROVAL. TIME: 112125 STORE #: 34838 TERM# :00073483801 08 REF# : 97000 96 064 9 AID: A0000000031010 ENTRY-. CHIP Visa Credit TC 5BDA7E25BOO791FO NO SIG REQUIRED APPROVED CUSTOMER AGREES TO PAY THE ABOVE TOTAL AMOUNT ACCORDING TO THE CARD HOLDERS AGREEMENT Date P";. TRY OUR DELI CENTRAL SANDWICH NTR ES AND DELICIOUS ENTREES T #01 OP05 TRN2041 09/28/2016 11:21.AM Hyatt Regency Coconut Point Resort & Spa FLAM 5001 Coconut Road Bonita Springs, FL 34134 H YAT T Tel: 239 - 444 -1234 R E G E N C Y' Fax: 239 - 390 -4344 RESORT www.coconutpoint.hyaft.com INVOICE Payee Russell Faine Room No. 1218 100 East Boyton Beach Blvd Boynton Beach FL 33435 Arrival -09 -25 -16 Departure 09 -28 -16 .Page No. 1 of 1 Confirmation No. 2172753001 Folio Window 1 Group Name FPPTA Folio No. 504383 Booking No. 32FXLWH8 Date Description Charges Credits 09 -25 -16 Package 189.00 09 -25 -16 Room State Sales Tax 20.79 09 -26 -16 Package 189.00 09 -26 -16 Room State Sales Tax 20.79 ! 09 -27 -16 Package 189.00 09 -27 -16 Room State Safes Tax 20.79 09 -28 -16 Room State Sales Tax Exempt -34.02 09 -28 -16 Room County Occ Tax Exempt -28.35 09 728 -16 Visa 567.00 Total 567.00 567.00 Guest Signature Balance 0.00 1 agree that my liability for this bill is not waived and I agree to be held personally liable In the event that the Indicated Thank you for your patronage. Our goal is to exceed your expectations, if we have not person, company or association fails to pay for any part or the fun amount of these charges. done so on this visit, we would appreciate your comments. Please contact Quality ' Assurance at qualitynaprn hyatt.com We would be delighted to assist you. Hyatt Gold Passport Summary Brian Kramer No Membership to be credited General Manager Join Hyatt Gold Passport today and start For inquiries concerning your bill please call 855- 869 -0846 earning points for stays, dining and more. Please remit payment to: Visit goldpassport.com Hyatt Regency Coconut Point 840904 Dallas, TX 75284 SU f'ktt:A.lti Tall. pillookkk Summary Statement RUSSELL FAINE i Statement Period: 09/01/201612:00:00 AM toW/30/2016 11:59:59. PM Customer# 4811020 Printed On: 40/0312016 10:10:48 AM You are enrolled in SunPass® Plus. i You saved $1.68 during this period by using SunPass ®. I Product Purchase. Activity: i � roduct Quantity Total Product Purchase Activity: ! $0.00 $0.00 $0.00 Account Activity Q t BEGINNING BALANCE {°`� $31.07 Total Replenishments and Adjustments f� ,h j �j,�} ry' S $0.00 Charges: TTOL Total Charges ENDING BALANCE (Beginning Balance + Total Replenishments + Adjustments -Total Charges) $19.97 Trans under Usa e Trans 01940266011.0 $11.40 For additional information related to charges, please view the Detail Statement on www.SunPass.com SUNPASS® is a registered trademark of the Florida Department of Transportation Page: 1 CITY OF BOYNTON BEACH POLICE OFFICERS' PENSION FUND • 2100 North Florida ,Tango Road West Palm Beach, Florida 33409 Telephone: 954.636.7170 Toll Free Fax: 866.769.0678 SUNTRUST BANK ACCOUNT A. BUSINESS SIGNATURE CARD B. PUBLIC FUNDS CUSTODIAN CERTIFICATION f +i SUNTRusT Business Account Signature Cant r.. r ;. x ; �r a _.. M'.', F_ . 034 1000108939793 .. -� x3 r w '�,. � r � ; _d ., ` �. '�. .�o Boynton Beach Police Pension Fund I ; 592182391 _ 1:1 1 W—v� 1. Toby AtholfChairman 2. Jason LLopfs-Secreta 3. Scott Caudell- Trustee 4. Joseph DeGiulio- Trustee 5. Russell Faine- Trustee S. Robert Dorn- Plan Administrator Date Oprxedv: ..afe.R 04 /'l 3/2010 "Poo �a t r umber 010189 ; Work Phone Nurtibe� . , ,.. ; .. Preppred i3y Maiftenance ❑ New ® Replacement ❑ Change SunTrust Bank ( "Bank ") It is agreed that all transactions between the Bank and the entity listed in the above Account Title ( "Depositor") shall be governed by the rules and regulations for this account and the above signed as the authorized agent(s) of the Depositor hereby acknowledge(s) receipt of such rules and regulations and the funds availability policy. The Depositor also acknowledges the funds availability policy has been explained. Check appropriate box for federal tax classification; check only one of the following seven boxes: ❑ Individual /sole proprietor or single- member LLC ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/Estate ❑ Limited liability company Enter the tax classification (C =C corporation, S =S corporation, P= partnership) Note. For a single- member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single- member owner. ❑ Other (see instructions) Exemptions: See instructions Exempt payee code (if any) Exemption from FATCA reporting code (if any) ® N/A (Applies to accounts maintained outside the U.S.) Certification —Under penalties of perjury, I, as authorized agent of the Depositor certify that: 1. 592182391 is the correct taxpayer identification number for the Depositor (or the Depositor is waiting for a number to be issued); and 2. The Depositor is not subject to backup withholding because: (a) the Depositor is exempt from backup withholding, or (b) the Depositor has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified the Depositor that it is no longer subject to backup withholding; and 3. The Depositor is a U.S. citizen or other U.S. person (defined in the instructions); and 4. The FATCA code(s) entered on this form (if any) indicating that the Depositor is exempt from FATCA reporting is correct. Certification Instructions. You must cross out item 2 above if the depositor has been notified by the IRS that the depositor is currently subject to backup withholding because the depositor has failed to report all interest and dividends on the depositor's tax return. Signature of U.S. Person X Toby Athol Chairman Date • Locations with DCOR scanning software submit with cover sheet via local scanner • Locations without DCOR scanning software send to Output Review, FL- Orlando -7021 630306 11115 Page 1 of 2 SunTrust Corporate Forms u� /� S ZUST PUBLIC FUNDS CUSTODIAN CERTIFICATION I certify that I am currently the Official Custodian of BOYNTON BEACH POLICE PENSION FUND (Name of Public Unit) 1000108939793 (Account Number) and l have official custody of the public funds of the above named public unit. Further, I have plenary authority, including control, over funds owned by the public unit which I have been appointed or elected to serve. I agree that the authorized signers currently on the existing bank records including the most recent resolution or signature card for the public unit will continue unless and until I otherwise notify the Bank. By: Chairman Title Toby Athol Name (printed) 10!11!16 Signature Date The foregoing instrument was acknowledged before me by who is personally known to me and /or has produced as identification. Witness my hand and official seal this day of 20 Notary Public My commission expires: Print Name: • Locations with DCOR scanning software submit with cover sheet via local scanner • Locations without DCOR scanning software send to Output Review, FL- Orlando -7021 316683 (4113) Page I of 1 SucTrust Corporate Forms .31a . IUD . a' .304 ... t I IAd S uNTRuST PUBLIC FUNDS CUSTODIAN CERTIFICATION I certify that 1 am currently the Official Custodian of BOYNTON BEACH POLICE PENSION FUND (Name of Public Unit) 1000108939793 (Account Number) and I have official custody of the public funds of the above named public unit. Further, l have plenary authority, including control, over funds owned by the public unit which I have been appointed or elected to serve. I agree that the authorized signers currently on the existing bank records including the most recent resolution or signature card for the public unit will continue unless and until I otherwise notify the Bank. By: Plan Administrator Title Robert Dorn Name (printed) 10!11!16 Signature Date The foregoing instrument was acknowledged before me by who is personally known to me and /or has produced as identification. Witness my hand and official seal this day of 20 i Notary Public My commission expires: Print Name: • Locations with DCOR scanning software submit with cover sheet via local scanner • Locations without DCOR scanning software send to Output Review, FL- Orlando -7024 318693 (4,13) Page 1 of 1 sur.Trust Corporate Forms Cl TY OF 90YNTON REACH POLICE OFFICERS PENSION FUND 2100 North Florida Mango Road _ y West Palm Beach, Florida 33409 Telephone: 954.636.7170 Toll Free Fax: 866.769.0678 WILLIAM GALBRAITH I I Mr. William Galbraith passed away on September 16, 2016. He is survived by his wife, Patricia who is also his beneficiary to his pension. Mr. Galbraith selected the 75% Joint and Last Survivor Annuity benefit option. Patricia Galbraith will receive starting in October /2016 a monthly benefit payment in the amount of $2,045.64. r CITY OF BOYNTON BEACH POLICE OFFICERS` RETIREMENT SYSTEM FINAL STATEMENT OF RETIREMENT BENEFITS February 13, 1996 Participant's Name: WILLIAM GALBRAITH II .Social Security #: You are eligible for a(n) NORMAL Retirement Benefit from the Plan. Your benefit is payable at the beginning of each month com- mencing February 1, 1996 The amount of your monthly benefit depends on the optional form of annuity which you choose. Please indicate the one optional form listed below which you elect to recieve: 1. MODIFIED CASH REFUND ANNUITY: This option provides monthly pay- j ments of $ 2952.18 to you as long as you live. if you should die before you have received an amount equal to your own contributions to the Plan, payments will continue to you:: beneficiary until your own contributions have been used up. monthly payments of $ _2905.12 to you as long as you live. If you should die before 120 monthly payments have been made, the monthly payment of 1 $ 2905.12 will continue to be made to your beneficiary until a total of 120 monthly payments have been made in all. 3. 100% SURVIVOR ANNUITY: This option provides monthly payments of $ 2659.91 to you as long as both you and your beneficiary are living. { After the death of either you or your beneficiary, monthly payments of I $ 2659.91 will continue for the life of the remaining person. 4. 66 -2/3% SURVIVOR ANNUITY: This option provides monthly payments of $ 2836.37 to you as long as both you and your beneficiary are living. After the death of either you or your beneficiary, monthly payments of $ 1890.89 will continue for the life of the remaining person. 5. 50% SURVIVOR ANNUITY: This option provides monthly payments of $ 2933.64 to you as long as both you and your beneficiary are living. After the death of either you or your beneficiary, monthly payments of $ 1466.82 will continue for the life of the remaining person. / . -5'a JOINT AND LAST SURVIVOR ANNUITY: This option provides monthly payments of $ 2727.52 to you as long as you live. Your bene- ficiary, if living at the time of your death, will then receive monthly I payments of $ 2045.64 as long as he /she lives. 7.- 50% JOINT AND LAST SURVIVOR ANNUITY: This option provides monthly payments of $ 2798.37 to you as long as you live. Your bene- ficiary, if living at the time of your death, will then receive monthly payments of $ 1399.19 as long as he /she lives. THESE. AMOUNTS ABOVE ARE BASED UPON THE FOLLOWING INFORMATION- Your Date of Birth: Date of Employment: 10/02/1975 Date of Termination: 01/31/1996 Years of Credited Service: 20 Avg Final Monthly Comp: $5,716.09 Beneficiary Name: PATRICIA C. GALBRAIT Date of Birth: s t aAD-