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.Arith.ema O.d <br />MayfSelc! Village <br />1'roposed E£fective Date: 04/0I/2009 13roker Name: f3GS <br />*assumes chamber membership <br />1$111C ACCeSS 3.0 Option 1 S8/15/25 rx <br />• p•nt. <br />ision <br />Total <br />Employee s 529.68 $ - $ - $ 529.68 <br />Employee/Spousc s 1,265.69 S - s - s 1,265.69 <br />Employce/Child S 972.32 S - 5 - S 972.32 <br />Employee/Children s 972.32 a - 5 - $ 972.32 <br />Fairtih, $ 1,775.18 $ - $ - $ 1,778.18 <br />liy signing this R.ttc Aut)iurizxtinn fi7nii, 1 agrce to thc npglicable rates and for thc attaclicd summary ol'benetiLti sclcc[ccl as of thc <br />offective date indicateci. <br />Autflori-r.cd group signature Datc <br />Undenvriling si??naeure I)ate <br />nW,- nr-Ii,>,.,,?y- -d-o:,? i* n1,m- oi„<<;:.,;. ..i moa s:?Oi <br />u. lii -d .n.?.-., f.n„J-a <br />AntS- Hluc Cnn.s os! Rlue "i<Id u tr.: V.i4e nen? ?+1'llunm?wn Innvmncr l'.tupunv. <br />A. mJqx:n:mi ii:.mna nl'ehF Itiuel'nae n?,A Hlur tihie{d A...-inn, <br />r?f. c-Y u..,i i+h:, ,i,aar n....wc,i-