CBA with Teamsters 252 representing Juvenile Probation WASHINGTON TEAMSTERS WELFARE TRUST
SUBSCRIPTION AGREEMENT
COLLECTIVE BARGAINING AGREEMENT PROVIDING FOR PARTICIPATION IN TRUST
The Employer and Labor Organization below are parties to a Collective Bargaining Agreement providing for participation in the
above Trust. An enforceable Collective Bargaining Agreement must exist as a condition precedent to participation in the Trust.
Lewis County Juvenile Probation &Clerical Teamsters Local Union 252
Employer Name Labor Organization(Union)Name
360 NW North Street 217 East Main Street
Address Address
Chehalis WA 98532 Centralia WA 98531
City State Zip Code City State Zip Code
COLLECTIVE BARGAINING AGREEMENT
The parties' Collective Bargaining Agreement is in effect from: 01-01-2016 to: 12-31-2019
❑New Account ❑ Renewal—Account No. 126934 Approximate No. of Covered Employees 13
INFORMATION CONCERNING EMPLOYER'S BUSINESS
Employer EIN(Tax ID No.) 91-6001351
Employer is: ❑ Public Entity ❑ Corporation - State of ❑ Partnership ❑ Sole Proprietorship ❑ LLC
If Partnership or Sole Proprietorship,provide name/s of the owner or partners:
BENEFIT PLAN(S)DESIGNATED IN COLLECTIVE BARGAINING AGREEMENT
The Collective Bargaining Agreement provides that contributions will be made to the Trust on behalf of all employees for whom
the Employer is required to contribute under the Trust Operating Guidelines for the purpose of providing such employees and
their dependents with the following benefit plan(s): (The undersigned parties acknowledge the receipt of a copy of the Trust
Operating Guidelines which by this reference are made a part hereof.)
COVERAGE IN BARGAINING AGREEMENT (For renewals,list all coverages,not just changes) Monthly Rate
Medical Plan ❑A ❑B ❑ C El Z $986.36
❑A-$30,000 Employee/$3,000 Dependent
Life/AD&D ❑B -$15,000 Employee/$1,500 Dependent $
❑ C-$5,000 Employee/$500 Dependent
Weekly Time Loss ❑ E-$500 ❑A-$400 ❑ B-$300 ❑ C-$200 ❑ D-$100 $
Disability Waivers ❑Additional 9 months Disability Waiver of Contributions -Medical only $
Domestic Partners ❑ Domestic Partners–Medical $
Dental Plan ❑ A ❑ B ❑ C $130.50
Domestic Partners ❑ Domestic Partners–Dental $
Vision Plan ❑ EXT $14.90
Domestic Partners ❑ Domestic Partners–Vision $
Will there be any coverage changes before the Collective Bargaining Agreement's expiration? ❑ Yes 0 No. If yes,attach
a Subscription Agreement for each change.
EFFECTIVE DATE OF CONTRIBUTIONS-A Subscription Agreement must be submitted in advance of the effective date below.
Contributions above are effective(month,year)January 20 2016 based on employment in the prior month.
Important:Coverage is effective in the month following the month in which the contributions are due based on the Trust's eligibility
lag month. For example,contributions effective April based on March employment will provide coverage in May.
EXPIRATION OF COLLECTIVE BARGAINING AGREEMENT
Upon expiration of the above-referenced Collective Bargaining Agreement, the Employer agrees to continue to contribute to the
Trust in the same amount and manner as required in the Collective Bargaining Agreement until such time as the Employer and the
Labor Organization either enter into a successor Collective Bargaining Agreement, which conforms to the Trust Operating
Guidelines,or one party notifies the other in writing(with a copy to the Trust)of its intent to cancel such obligation five(5)days
after receiving notice, whichever occurs first. The Trust reserves the right to immediately terminate participation in the Trust
upon the failure to execute this or any future Subscription Agreement or to comply with the Trust Operating Guidelines as
amended by the Trustee from ti a to time.
For Employer /J it. t For Union
Title/Assn BO CC C`(a f et_ Date /0//rt//7 Title Executive Assistant Date
ELIGIBILITY TO PARTICIPATE IN TRUST
Eligibility for benefits is determined in accordance with the requirements established in the Collective Bargaining Agreement
provided such requirements are consistent with the Trust guidelines. To establish eligibility for benefits,Trust guidelines require
that eligible employees must have the required number of hours in a month and have the contractually required contributions paid
on their behalf. Eligibility will commence according to the Trust's lag month eligibility rule. Eligibility continues as long as the
employee remains eligible, has the contractually required number of hours per month, and has the required contributions made.
The Trust, however, will not recognize any contractual provision that conditions continued eligibility on having less than 40 or
more than 80 hours in a month. Eligibility will end according to the Trust's policy for employees who do not have the required
number of hours and contributions in a month and who do not qualify for an applicable extension of eligibility,if any,
Employees of a participating employer not performing work covered by the Collective Bargaining Agreement may participate in
the Trust only pursuant to a written special agreement approved in writing by the Trustees. The Trustees reserve the right to
recover any and all benefits provided to ineligible individuals from either the ineligible individual receiving the benefits or the
employer responsible for misreporting them(if applicable).
REPORTING OBLIGATION AND CONSEQUENCES OF DELINQUENCY
Employer contributions are due no later than ten (10)days after the last day of each month for which contributions are due, The
Employer acknowledges that in the event of any delinquency, the Trust Agreement provides for the payment of liquidated
damages, interest,attorney fees,and costs incurred in collecting the delinquent amounts.
TRUSTEES'AUTHORITY TO DETERMINE TERMS OF PLANS
The parties recognize that the detail of the benefit plans provided by the Trust and the rules under which employees and their
dependents shall be eligible for such benefits is determined solely by the Board of Trustees of the Trust in accordance with the
terms of the governing Agreement and Declaration of Trust (Trust Agreement). The Trustees retain the sole discretion and
authority to interpret the terms of the Trust's benefit plans, the plans' eligibility requirements, and other matters related to the
administration and operation of the Trust and its benefits plans. The Trustees may modify benefits or eligibility of any plan for
the purpose of cost containment,cost management,or changes in medical technology and treatment.
MECHANISM FOR HANDLING CONTRIBUTION INCREASES
The Trustees' authority shall include the right to adjust the contribution rates to support the benefit plans offered by the Trust and
to maintain adequate reserves to cover any extended eligibility and the Trust's contingent liability,
The parties recognize that it is the intent of the Trust not to provide employee benefit plans for less than the full cost of any such
plan. If the Collective Bargaining Agreement does not provide a mechanism for fully funding the designated benefit plans,the
Board of Trustees may substitute a plan then available that is fully supported by the employer's contribution obligations. The
disposition of any excess employer contributions will be subject to the collective bargaining process.
ACCEPTANCE OF TR UST AGREEMENT
The Employer and the Labor Organization accept and agree to be bound by the terms of the Trust Agreement governing the
Trust, and any subsequent amendments to the Trust Agreement. The parties accept as their representatives for purposes of
participating in the Trust the Trustees serving on the Board of Trustees and their duly appointed successors.
Provided, however,that in the event that either Section 2 or 3 of Article VIII of the Trust Agreement is amended to change or
modify an Employer's liability as specified therein, such amendment will not be deemed applicable to an Employer until such
time as the Employer enters into a successor Collective Bargaining Agreement after the expiration of the Employer's then current
Collective Bargaining Agreement.
APPROVAL OF TRUSTEES
This Agreement has been approved by the Board of Trustees of the Washington Teamsters Welfare Trust.
Date
Administrative Agent
Washington Teamsters Welfare Trust
SA 28(REV 02/15)