AGENDA TOWN OF GOLDEN BEACH EMPLOYEES PENSION PLAN  100 OCEAN BLVD. GOLDEN BEACH, FL33160  3RD FLOOR CHAMBERS October 30, 2024 3:00 p.m.  Join Zoom Meeting  https:/us02web.zoom.usi82001731277Ppwd-WKROSSCIFIZbRPuvg3DdaE8VdFcLd.1  Meeting ID: 8200173.1277 Passcode: 336576  CALL TO ORDER:  I. ROLL CALL: Chairperson Eric Fishman, Trustee Maria Camacho, Trustee David Block,  Trustee Marie Talley, Trustee Gio Diaz and Trustee Isaac Mendal  II. APPROVAL OF MINUTES:  Regular meeting of August 28, 2024 and Special meeting of October 2, 2024 David Block (Hotel, per diem, mileage & tolls; FPPTA 9/22-9/24. 2024)$1,268.80 Marie Talley (Hotel, per diem, mileage & tolls; FPPTA 9/21-9/25 2024) $1,707.84  III. RATIFICATION OF WARRANTS: Warrants No. 261 to 259  TOTAL:  $2,976.64 275.00 $ 1,250.00 $ 250.00 $ 1,775.00 $ 2,200.00 $ 1,500.00 $ 1,250.00 250.00 $ 5,200.00 750.00 100.00 $1,250.00 $ 250.00 $2,350.00  Southern Actuarial Services (DROP Statement) Benefits USA (Administration Fee; October) Benefits USA (Bookkeeping Fee; October)  TOTAL:  Marie Talley kegaratoncPPV/inaste Fundamentals Fall Trustee School) Sugarman, Susskind, Braswell & Herrera (Legal Fees; September)  Benefits USA (Administration Fee; September) Benefits USA (Bookkeeping Fee; September)  TOTAL:  IV. APPROVAL OF PAYMENTS FPPTA (2025 Membership)  FPPTA (Re-Cert; M. Camacho & D. Block) Benefits USA (Administration Fee; November) Benefits USA (Bookkeeping Fee; November)  TOTAL: V. NEW BUSINESS:  a. Approval of Disability Application for Joseph Bautista b. Election Results for Police Officer Vacancy Discussion on 2025 Meeting Dates  d. Appoint Secretary VI. OLDBUSINESS: Posted October 23, 2024    VII. REPORTS a. Attorney b. Investment Manager c. Chairperson d. Secretary e. Administrator VIII. PUBLIC COMMENTS IX. NEXT MEETING DATE: TBT  X. ADJOURN:  Notice is hereby given that two or more members oft the Town Council or other Town committees or boards may be in attendance at this meeting, which shall be open to the public at all times. Ifany person decides to appeal any decision made by the Board with respect to any matter considered at such a meeting, we will need aj proceeding ofthat meeting. And that, for such purpose, he may need to insure a verbatim record of thej proceedings, the record: is to include the testimony and evidence upon which that appeal is tol be based. F.S.S.286.0105. Any individual who believes he or she has a disability which requires ai reasonable accommodation in order toj participate fully and effectively in a meeting oft the Pension Board must sO notify the Town Clerk at (305)932-0744 at least 24 hours prior to the date ofthe meeting.  Posted October 23, 2024    RETIREMENT PLAN FOR EMPLOYEES OF THE  TOWN OF GOLDEN BEACH REGULAR MEETING August 28, 2024  Chairperson Fishman called the regular meeting of the Board of Trustees oft the Retirement Plan  for Employees oft the Town of Golden Beach to order at 3:00 p.m.  TRUSTEES PRESENT:  Chairperson Fishman, Trustee Camacho, Trustee Block and Trustee Talley OTHER AVAILABE BY TELEPHONE: Attorney Pedro Herrera  ABSENT:  Trustee Kessler and Trustee Bautista OTHERS PRESENT: Patterson of Benefits USA, Inc. by Trustee Camacho. NEW BUSINESS:  Scott Owens, Graystone Consulting, Lissette Perez, Town Clerk and Administrator Lauri Motion made by Trustee Fishman to approve the minutes as amended. Motion seconded  Discussion on Citrin Cooperman formerly Keefe Mccullough - Chairman Fishman said he spoke tol Ken Smith and Mr. Smith recommended that we find another auditing firm mainly because they are now a very large firm and the price will be significantly higher. Chairman Fishman would like to go out for RFP: as soon as feasibly possible and set up a special meeting if necessary. Trustee Camacho said the fiscal year end is September 30, 2024 and we need to geta new: auditor and have the audit presented at the February meeting. Attorney Herrera said we are fiduciaries to the plan and we should go out for RFP or RFQ. Attorney Herrera said we should review the Engagement Letter with the fees to see ifKeefe Mccullough will honori it. Town Manager Diaz: recommended ift the Board is going to change auditors, then it is in the best interest that the Town use the same auditing firm, he emphasized it should be done simultaneously. Town Manager Diaz said the last (2) audits have been difficult and late due to Motion made by Trustee Block for the Chairman to work with the Town Manager and the pension attorney to go out for RFQ. Motion seconded by Trustee Camacho. Trustee Talley Y, Trustee Fishman -Y, Trustee Camacho Y: and Trustee Block-Y. Town Manager Diaz said that Trustee Kessler resigned and was replaced with Isacc Mendel on August 28, 2024 and Marie Talley was designated to fill the retiree position. He added ift there is a tie vote iti is a "no" and the item will be placed on the next agenda since it was a failed vote  personnel changes at Benefits USA.  according to Robert Rules of Order.    Mayor Singer thanked the Board for their service and hard work for the employees of Golden  Beach.  RATIFICATION OF WARRANTS: Warrants No. 258 to 253 David Block (Registration Fee; Fall Trustee School) Sugarman, Susskind, Braswell & Herrera (Legal Fees; August 2024) Benefits USA (Administration Fee; August) Benefits USA (Bookkeeping Fee; August) First State Trust (Custodial Fees; 4/1-6 6/30/2024) Benefits USA (Administration Fee; July) Benefits USA (Bookkeeping Fee; July)  $ 850.00 $1,500.00 $1,250.00 a 250.00 $3,850.00 $1,548.88 $1,250.00 $ 250.00 $6,048.88 320.00 $ 275.00 $1,250.00 9 250.00 $2,095.00 $1,003.89 $1,003.89 $2,677.51 $2,677.51  TOTAL:  Sugarman, Susskind, Braswell & Herrera (Legal Fees; May/July 2024) $3,000.00  TOTAL:  Maria Camacho (Per diem for FPPTA Annual Conference) Southern Actuarial Services (DROP Statement; Herbello, R) Benefits USA (Administration Fee; June 2024) Benefits USA (Bookkeeping Fee; June 2024)  TOTAL: TOTAL: TOTAL: REPORTS  David Block (Hotel, Tolls & mileage; FPPTA 1/28-1/30/2024 United Members Insurance (Fid. Liability Ins; 6/5-6/5/2025)  Investment Manager Mr. Owens provided al briefoverview oft the economy for the quarter ending 6/30/2024. For the quarter, the Dow declined 1.3%, Russell Midcap fell3.3%, the S8 &P 500 rose 4.3%, and the Russell 2000 small-cap index fell 3.3%. Inflation has been gradually deaccelerating throughout the 2nd Quarter, the Fed continued its rate policy pause, the FED announced eleven rate hikes, for a total of5.25 percentage points. Mr. Owens mentioned five sectors posted positive returns however materials lagged at -4.5% while information technology was 13.8%. Mr. Owens reviewed the Executive Summary and provided an overview for Trustee Talley about Graystone'si role and what the Board ofTrustees role is. He added that the pension Trustee Block asked Mr. Owens ifthey could add additional information to the Executive Summary which would include 3, 5 and 10 yr periods for returns and remove the since inception figure. Mr. Owens said Graystone can provide that information at the next meeting. Mr. Owens provided information on an Emerging Market Investment Manager Search as requested by the Board however; they are now outperforming and he recommended we table for  plan uses active management.  now and look at the manager in the future.  2    Mr. Owens provided a report for the Quarter ended June 30, 2024. The market value was $16,561,703 compared to the market value of$16,497,327 on March 31, 2024. During the current Fiscal YTD, the portfolio generated 12.17% (gross-of-fees) and 11.57% (net offees) compared to the 7% assumed actuarial assumption rate oft return. AsofJune 30, 2024, the asset allocation was: 59.9% in equity, 23.8% in fixed income, 11.0% in alternative investments, and 5.3% in cash held in the Deposit & Disbursement account. The portfolio is in compliance with Mr. Owens provided al brief report on each manager noting that BlackRock Large Cap Value was negative - 0.63% but FYTD was 19.87%, Sawgrass returned less than the benchmark for the quarter however, the FYTD did well 22.54%, TSW did not met the benchmark, MDT was down -2.55%, Kayne Anderson was -5.63% for the quarter, BNYM Walter Scott International Growth was up 16.90% since inception date of9/1/2022. Lazard - EM Core Equity had a good quarter 5.94%, Genter Short Term Fixed Income was 0.96% they are fairly new to the portfolio, Madison - Fixed Income was 0.72% and FYTD was 4.79%. Mr. Owens said we have been getting a good yield from Fixed Income. Mr. Owens discussed in the future we should transition and invest the extra cash in Genter Core since there is a wider range of duration. Mr. Owens recommends that we reduce the cash by 4% and put in Madison-Fixed Income. American Core Reality has underperformed for the last year and there have been no distributions and office space has not done well. Trustee Block added that real estate is climbing back. Mr. Owens asked the board ift they wanted to discuss Sawgrass since they have been underpertorming. Trustee Mr. Owens provided a Mid Cap Value Investment Manager Search Summary for discussion. Thompson, Siegel, Walmsley is the current manager that we are looking to replace. Discussion ensued about Anchor, Earnest Partners and Kennedy. The trustees came to a consensus that Earnest Partners would be a good fit, the gross and net returns since inception were better than Motion made by Trustee Block to terminate TSW-Mid Cap Value as recommended by Graystone Consulting and move to Earnest Partner. Motion seconded by Trustee Trustee Fishman - Y, Trustee Talley - Y, Trustee Camacho - Y and Trustee Block-Y. Mr. Owens reported as of August 19, 2024 the total fund was valued at $17,092.46 and the total Attorney - Attorney Herrera said there was no legislative update at this time. Attorney Herrera said there has been discussion about additional death benefits however, there has been no formal action taken by the City to amend the ordinance to his knowledge. Trustee Fishman asked since Trustee Bautista is applying for disability can he stay on the board or should he be replaced. Attorney Herrera said that although Trustee Bautista is currently working and a sworn police officer it would better if he resigned and run an election to finish his unexpired term. Attorney Herrera mentioned that Trustee Talley is required to file the Financial Disclosure Form within 30 days oftaking office and Trustee Kessler needs to file Form IF within 60 days of  the designated ranges.  Fishman said he was satisfied with them at this time.  the other managers and the fees were reasonable.  Camacho. Motion passed. return was 15.7%.  leaving office.  3        RETIREMENT PLAN FOR EMPLOYEES OF THE  TOWN OF GOLDEN BEACH SPECIAL MEETING October 2, 2024  Chairperson Fishman called the special oft the Board of Trustees of the Retirement Plan for  Employees oft the Town of Golden Beach to order at 3:00 p.m.  TRUSTEES PRESENT:  Chairperson Fishman, Trustee Camacho, Trustee Block and' Trustee Talley OTHER AVAILABE BY ZOOM: Attorney Pedro Herrera  OTHERS PRESENT: NEW BUSINESS:  Lissette Perez, Town Clerk and Administrator Lauri Patterson of] Benefits USA, Inc. a. Approval of Engagement Letter from Caballero Fierman Llerena + Garcia Chairman Fishman asked ifeveryone had a chance to review the Engagement Letter for the new auditing firm. The trustees said yes. Chairman Fishman asked for ai motion to approve Motion made by Trustee Block to approve thel Engagement Letter dated September 15, 2024 from Caballero Fierman Llerena + Garcia. Motion seconded by Trustee Camacho. Trustee Talley - Y, Trustee Fishman -Y, Trustee Camacho- Yand' Trustee Block-Y.  the Engagement Letter.  Motion passed.  Attorney - There was no report. PUBLIC COMMENTS: NEXT MEETING DATE: TBD  Motion made by Trustee Block to adjourn the meeting at 3:25 p.m.    WARRANT NO. 261  For payment from the GOLDEN BEACH GENERAL EMPLOYEES  PENSION FUND,Accountt 676-90335-1-2-229  TO:  FIRST STATE  You are hereby authorized by the Board ofTrustees oft the Town of Golden Beach General Employees' Pension Fund to pay the amounts listed below for services rendered to the said Board ofTrustees, and to pay the persons  named below, hereby certified by the Board ofTrustees:  NAME & ADDRESS  AMOUNTS $2,976.64  David Block (Hotel, per diem, mileage & tolls; FPPTA 9/22-9/24 2024) $1,268.80 Marie Talley (Hotel, per diem, mileage & tolls; FPPTA 9/21-9/25 2024) $1,707.84  TOTAL:  Please mail David Block's check to: 240 South Island Drive Golden Beach, FL 33160 h Trustee  Trustee    WARRANT NO. 261  For payment from the GOLDEN BEACH GENERAL EMPLOYEES  PENSION FUND,Account* 676-90335-1-2-229  TO:  FIRST STATE  You are hereby authorized by the Board ofTrustees of the Town of Golden Beach General Employees' Pension Fund to pay the amounts listed below for services rendered to the said Board ofTrustees, and to pay the persons  named below, hereby certified by the Board ofTrustees:  NAME & ADDRESS  AMOUNTS $2,976.64  David Block (Hotel, per diem, mileage & tolls; FPPTA 9/22-9/24 2024) $1,268.80 Marie Talley (Hotel, per diem, mileage & tolls; FPPTA 9/21-9/25 2024) $1,707.84  TOTAL:  Please mail David Block's check to: 240 South Island Drive Golden Beach, FL 33160  DD Trustee  I  Trustee    CITY OF GOLDEN BEACH PENSION FUND TRAVEL AND EXPENSE REPORT Name: (Print): David Block Meeting Purpose: Fall Trustee School Meeting Location: Orlando A) Per Di am, if applicable: B) Daily: if applicable:  Date Begin 9/22/2024 End: 9/25/2024  From: y/a2  To: 9a4 No. Days x's$.=  80 320-240  $  Sunday Monday Tuesday Wednesday Thursday Friday Saturday Total  Hotel Break'ast Lunch Dinngt Airfire,Taxi, Etc... Parking Tcis Mic. Tral  $I705.39 $ $ $  $27,27  $  $  $  $  $  $  $  C Vileage- Private Vehicle- Mileage Star  End:  442 Total Miles  0.67 $/276./4  TOTAL EXPENSES (A) +( (B)+(C)=  1265V  Ihereby certify or aftirm that this travel expense report is ture and correct in every material matter; that the expenses were actu allyi incurred by me as necessary expenses; and that Ihave not hitherto received  for said expenses. TR.STEE K  payment  polilay DATE  SIGNATLRE  -  Islnlebere  F33160  db    9/28/24, 12:07 PM EXPRESE DATE Sep 26  American Express-SearchAdiwy,  203  ACCOUNTE ENDING Platinum Carde  nuguts CARD ME MBEF ELLEN BLOCK  57098  DESCRIPTION  AMOUNT $578.93  SIGNA ORLANDOI BONNET CREEK FTD DESK 14100 BONNET CRKF RESRTL LN ORLANDO FL: 32821-4023 (407)597-3600 PhdNcminENnN  SIGNIAI BYI HILTON BONORLANDOI FL Will appear on your Oct 15, 2024 statementas SIGNIABYH HILTON BONORLANDOFL CARD DAVIDBLOCK MEMBEPSHPREMARDSI POINTS 1Xon Other purchases TWNKYOUFORYOURSIN CHECK-IN September 22, 2024 ADDITIONAL INFORMATION 1946135 407-597-3600 LODGING  579  CHECK-OUT Seplember 25, 2024  minus 108,66 Foad  %05:37  Reimbose  "wMySNwwX.www.wUAPBRATaNsSaRN  1/1    9/28/24, 12:05PM AN EKERESS DATE Aug 10  American Express- SearchActivity  ACCOUNTE ENDING 57008 Platinum CardB  One  wyst  ELLEN BLOCK  Spa  DESCRIPTION  AMOUNT $235.13  SIGNA ORLANDO BONNET CREEK FTD DESK 14100 BONNET CRK RESRTI LN ORLANDO FL 32821-4023 (407)597-3600 PMdNcmiraN  SIGNIA BY HILTON BONORLANDO FL Will appear on your Aug 15, 2024 statement as SIGNIABYH HILTON BONORLANDOFL CARD DAVID BLOCK PRENMCSPONIS 1Xon Other purchases TWNKTOUFORYOURSTA: CHECK-IN August 9, 2024 ADDITONALI INFORMATION 19461354 407-597-3600 LODGING  235 CHECKOUT August9, 2024  MwMXwPNONwwwwAwwwTIEN  1/1    A  B  D  E  F G H  1 POSTEDD DATE TRANSACTION TRANSACTIONTIT TRANSACTION NL TRANSPON AGENCYNLANE AXLE DESCRIPTION/PLAZA NAME 2 9/25/2024 9/24/2024 5:09:44PM 42733864579 4.69E+10 Central Flc 008B 25R41710HNYOUNG (M)  DEBIT(-) CREDIT(+) $1.63 $1.16 $0.60 $0.35 $0.27 $0.69 $0.27 $0.60 $1.47 $0.43 $25.00 $0.35 $0.86 $3.53 $4.13 $1.63 $4.13 $3.53 $0.86 $0.35 $0.43 $27.27  3 9/24/2024 9/24/2024 8:41:35PM 42731494171 4.69E+10 Floridal Tur 60S 4 9/24/2024 9/24/2024 8:21:12PM 42731449713 4.69E+10 Florida Tur 60S 5 9/24/2024 9/24/2024 7:53:36F PM 42731380472 4.69E+10 Florida Tur 60S 6 9/24/2024 9/24/2024 7:51:00F PM 42731373233 4.69E+10 Florida Tur 60S 7 9/24/2024 9/24/2024 7:45:11F PM 42731361441 4.69E+10 Florida Tur 60S 8 9/24/2024 9/24/2024 7:40:26 PM 42731348951 4.69E+10 Florida Tur 60S 9 9/24/2024 9/24/2024 7:36:00PM 42731336586 4.69E+10 Floridal Tur 60S 10 9/24/2024 9/24/2024: 7:17:23PM 42731275613 4.69E+10 Florida Ture 60S 11 9/24/2024 9/24/2024. 7:12:54PM 42731263970 4.69E+10 Florida Tur 60S 12 9/24/2024 9/24/2024 8:57:18PM 2789108563 13 9/24/2024 9/24/2024 7:09:28PM 42731019844 4.69E+10 Floridal Tur 60S 14 9/24/2024 9/24/2024 7:01:56 PM 42730997551 4.69E+10 Florida Tur 60S 15 9/24/2024 9/24/2024 6:58:02PM 42730980026 4.69E+10 Florida Tur 60S 16 9/24/2024 9/24/2024 5:43:08PM 42730415861 4.69E+10 Florida Tur 60S 18 9/22/2024 9/22/2024 3:04:01 PM 42703271900 4.69E+10 Florida Tur 50S 19 9/22/2024 9/22/2024 1:44:36PM 42702826722 4.69E+10 Florida Tur 50S 20 9/22/2024 9/22/2024 1:40:53PM 42702670980 4.69E+10 Florida Tur 50S 21 9/22/2024 9/22/2024 1:33:50PM 42701713068 4.69E+10 Floridal Tur 50S 22 9/22/2024 9/22/2024. 1:30:37PM 42701650531 4.69E+10 Florida Tur 50S  2 SR91 POMPANO BCHMAIN: SBI MP65 2 SR91 LANTANAI MAIN SBI MP88 2 SR91 FORESTH HBLVN MAIN: SBI MP96 2 SR91 BELVEDERE RDI MAIN: SBI MP98 2 SR91 45TH STREET MAIN: SBI MP104 2 SR91 PGAI BLVDN MAIN: SB MP108 2 SR91. JUPITERI MAIN SBI MP113 2 SR91 STUART MAIN: SB MP133 2/SR91 BECKER RDI MAIN: SBI MP138 PAYMENT &A ADJUSTMENTS 2 SR91 PT STLUCIE MAIN SBI MP141 2 SR91 MIDWAY RD MAIN SBI MP150 2 SR91 FTI PIERCE MAIN: SB MP154 2 SR91 THREEI LAKES MAIN SBI MP236 2 SR91 THREEL LAKESI MAIN NBI MP236 2 SR91 FTI PIERCE MAINI NB MP154 2 SR91 MIDWAY RDI MAINI NB MP150 2 SR91 PTS STI LUCIE MAIN NBI MP141 2 SR91 BECKERF RDI MAIN NBI MP138  17 9/23/2024 9/22/2024 3:20:55PM 42710576940 4.69E+10 Central Flc 015B 2 SR 417 JOHNY YOUNG (M)  23 24 Total    Town of Golden Beach Retirement Plan  Name: (Print):  Marie Talley  Date Begin: 9/21/2024  Meeting Purpose: Fall Trustee School Meeting Location: Orlando Bonnet Creek  End:  9/25/2024  A) Per Diem, ifa applicable: B) Daily; if applicable: $1,019.96  From: 9/21/2024  9/25/2024 5d days  $400.00  9/22 9/23 $235.13 $235.13 $235.13  9/24 9/25  9121 Saturday $235.13  Sunday Monday Tuesday Wednesday Thursday Friday  Hotel Breakfast Lunch Dinner Airfare, Taxi, Etc... Parking Tolls Misc. Total  $17.50  $17.50 $4444Gas  Drclkl  $235.13 $235.13 $235.13 $1 17.50  $297.07 bA Mahye  C) Mileage- Private Vehicle- Mileage Start 53,403  End: 53,899 0.67 $  496 Miles x's$  $332.32  TOTAL EXPENSES (A) + (B)+( (C)= $1752.28  Ihereby certify or affirm that this travel expense  is ture report  rb134  and correcti in every material matter; that the  expenses were actually incurred by me as necessary expenses; and that Ihave not hitherto received payment  for said expenses. Address to mail check 2342 NW 67th Street Miami, FL: 33147 Use ZhAS-ly  Jautal  AeApr  Ochberl9024 DATE  TRUSTEE    X338O. 13NNO8  OGNVTHO NOITIH A8 VINSIS IHL ONISOOHO BOINOA MNVHI  VISSSE6L  woo"s SJOUOH HSIA eseajd 'sauunoo 611 uI sposeJ pue sjajo4  +009'9 ueyl ejow le Ke,s xeu. pnok yooq. JO sbujuiee. Jok ypayo 01 anoypeyo jos sinoy ZL UIyIA pajsod ae skels (B)SIOUOH UOIH  29'046$  3ONVIV8.. XVL 3LVIS WOOS 92OZ/VZ/6 XVI 000WOO8 420Z/V2/6 WOON. 1S309 V2OZ/V2/6 XVI ELVISI WOOS 4202/82/6 XVI 000WOO8 4202/E2/6 WOOR. 1s3n9 42OZ/E2/6 XVI3LVIS WOOU 4202/22/6 XV1000WOOS V202I22/6 WOO8. s3n9 V2OZI22/6 XVI3LVIS WOO8 4202/12/6 XVI000WOOH 4202/12/6 WOOR. 1S309 V2OZ/12/6  69'ELS v9Z1S 00'60ZS 69'ELS 49Z1S 00'602$ 69ELS 4921S 00'60Z$ 69'ELS 49ZLS 00'60ZS  14229291 SH31T0ML 14229291 S83170ML L922929L S83170ML 6188929L 6188929L 61889291 2OV99291 4O499291 4049929L 9EE29291 S831T0ML SEEZSZSL SH3170ML SEEZS2SL S83170ML  Idngoa Idndoa ldneoa Idnaoa Idnuoa ldnsoa  4202/92/6  29v09V6608 equnN uoewnyuos  eo #HH :ueld eed  3078 06VLOZVbVL VITH 00'60Z O/L 4202/92/6 WdooccE V202/12/6 20/806  VOISEWV. JO SILVIS GLINN  LV1EE THIWVIW ISI HIZ9MNZVEZ BISVW A3TTVI    SUN-PKSS TRANSACTION VIEW AGENCYI NAME  Account #24046410  Generated 09/26/2024 10:52AM  POSTED TRANSACTION) TRANSACTION TRANSACTION TRANSPONDER  DATE DATE  TIME NUMBER /LICENSE  LANE AXLE DESCAIPTION/PLAZA NAME DEBIT() CREDIT (4) BALANCE  PLATE  09/26/2024 09/25/2024 10:27:11AM 42743720145 PEN2MIC-FL Florida Turnpike Enterprise  60S 2 SR91 BECKERI RDI MAIN SBI MP138  $0.43 $1.63  $16.98 $17.41 $10.00 $19.04 $9.04 $10.20 $11.36 $11.96 $12.31 $10.00 $12.58 $2.58 $3.27 $3.54. $4.14 $5.61 $5.96 $6.82  09/26/2024 09/25/2024 08:59:58AM 42742298385 023803210110 Central Florida Expressway Authority 009B 2 SR417, JOHN YOUNG (M)  09/25/2024 09/25/2024 12:49:37PM 2789579092  PAYMENT& ADJUSTMENTS 60S 2 SR91 GOLDEN GLADES MAIN SBI MPO $1.16 60S 2 SR91 POMPANO BCHI MAIN SBI MP65 $1.16 60S 2 SR91 LANTANAI MAIN SBN MP88 60S 2 SR91 FOREST HE BLVMAIN: SBI MP96 $0.35 60S 2 SR91 BELVEDERE RDI MAIN SB MP98 $0.27 PAYMENT& ADJUSTMENTS 60S 2 SR91 45TH STREET MAIN: SBN MP104 $0.69 60S 2 SR91 PGAI BLVD MAIN SBI MP108 60S 2 SR91 JUPITER MAIN SBN MP113 60S 2 SR91 STUART MAIN SBI MP133 60S 2 SR91 PTSTLUCIE! MAIN SBI MP141 60S 2 SR91 MIDWAY RDI MAIN SBI MP150 60S 2 SR91 FTF PIERCE MAIN SBN MP154  09/25/2024 09/25/2024 11:45:14.AM 42736120870 023803210110 Florida Tumpike Enterprise 09/25/2024 09/25/2024 11:26:57AM 42735935056 023803210110 Florida Turnpike Enterprise 09/25/2024 09/25/2024 11:05:32AM 42735656518 023803210110 Floridal Tumpike Enterprise 09/25/2024. 09/25/2024 10:59:01 AM 42735632244 023803210110 Florida Turnpike Enterprise 09/25/2024 09/25/2024 10:57:02AM 42735629671 023803210110 Florida Turnpike Enterprise  $0.60  09/25/2024 09/25/2024 11:12:30AM 2789535128  09/25/2024 09/25/2024 10:52:47AM 42735621569 023803210110 Florida Turnpike Enterprise 09/25/2024 09/25/2024 10:49:11 AM 42735600606 023803210110 Florida Turpike Enterprise 09/25/2024 09/25/2024 10:45:59/ AM 42735585817 023803210110 Florida Turnpike Enterprise 09/25/2024 09/25/2024 10:30:58/ AM 42735530494 023803210110 Florida Turnpike Enterprise 09/25/2024 09/25/2024 10:24:17AM 42735512151 023803210110 Florida Turnpike Enterprise 09/25/2024 09/25/2024 10:18:04AM 42735487653 023803210110 Florida Turnpike Enterprise 09/25/2024 09/25/2024 10:14:41AM 42735467607 023803210110 Florida Turnpike Enterprise  $0.27 $0.60 $1.47 $0.35 $0.86 $3.53  Vector eCustomer  1of3    SUN-PISS TOIE TRANSACTION VIEW AGENCY NAME  Account #24046410  Generated 09/26/2024 10:52AM  POSTED TRANSACTION TRANSACTION TRANSACTION TRANSPONDER /LICENSE  CREDIT(  DATE DATE  TIME NUMBER  LANE AXLE DESCRIPTION/PLAZA NAME DEBIT() (+) BALANCE  PLATE  09/25/2024 09/25/2024 09:15:19AM 42735213968 023803210110 Florida Turnpike Enterprise  60S 2 SR91 THREELAKES MAIN: SBI MP236 $4.13  $10.35 $14.48 $16.11 $10.00 $16.97 $6.97 $11.10 $14.63 $14.98 $15.41 $16.88 $17.48 $17.75 $18.44 $18.71 $19.06 $19.66 $20.82  09/22/2024 09/21/2024 03:16:56PM 42697653445 023803210110 Central Florida Expressway Authority 014B 2 SR4 417, JOHNY YOUNG (M)  $1.63 $0.86  09/21/2024 09/21/2024 01:55:09PM 42691469603 023803210110 Florida Turnpike Enterprise  50S 2 SR91 MIDWAY RDI MAINI NBN MP150 PAYMENT& ADJUSTMENTS 50S 2 SR91 THREE LAKES MAINI NBI MP236 $4.13 50S 2 SR91 FTF PIERCE MAIN NBI MP154 50S 2 SR91 PTS STLUCIE MAIN NBI MP141 50S 2 SR91 BECKER RDI MAIN NBN MP138 50S 2 SR91 STUART MAIN NBN MP133 50S 2 SR91 JUPITER MAIN NBI MP113 50S 2 SR91 PGAE BLVD MAINI NBI MP108 50S 2 SR91 45TH STREET MAIN NBN MP104 $0.69 50S SR91 BELVEDERE RDI MAINI NBI MP98 $0.27 50S 2 SR91 FOREST HE BLVMAINI NBI MP96 $0.35 50S 2 SR91 LANTANAI MAINI NBI MP88 50S 2 SR91 POMPANOI BCHI MAIN NBN MP65 $1.16 50S 2 SR91 GOLDEN GLADES MAINI NBN MPO $1.16  09/21/2024 09/21/2024 03:43:51PM 2787043034  09/21/2024 09/21/2024 02:56:26PM 42691270870 023803210110 Floridal Turnpike Enterprise 09/21/2024 09/21/2024 01:58:17PM 42690633453 023803210110 Florida Turnpike Enterprise 09/21/2024 09/21/2024 01:08:29PM 42690308100 023803210110 Florida" Tumpike Enterprise 09/21/2024 09/21/2024 01:05:38PM 42690293332 023803210110 Florida Tumpike Enterprise 09/21/2024 09/21/2024 01:01:38PM 42690249886 023803210110 Florida Turnpike Enterprise 09/21/2024 09/21/2024 12:46:56PM 42690177282 023803210110 Florida Turnpike Enterprise 09/21/2024 09/21/2024 12:43:34PM 42690159404 023803210110 Florida Turnpike Enterprise 09/21/2024 09/21/2024 12:40:10PM 42690088823 023803210110 Florida Tumpike Enterprise 09/21/2024 09/21/2024 12:35:36PM 42690078299 023803210110 Florida" Turnpike Enterprise 09/21/2024 09/21/2024 12:33:40PM 42690080691 023803210110 Florida Turnpike Enterprise 09/21/2024 09/21/2024 12:28:00PM 42689986808 023803210110 Florida Turnpike Enterprise 09/21/2024 09/21/2024 12:09:57PM 42689836868 023803210110 Floridal Tumpike! Enterprise 09/21/2024 09/21/2024 11:53:00AM 42689658319 023803210110 Florida Tumnpike Enterprise  $3.53 $0.35 $0.43 $1.47 $0.60 $0.27  $0.60  Vectore eCustomer  20f3    -$44.44 Description 7-Eleven  Authorized Date  09/21/2024  Posted Date  09/23/2024  Status  Posted  Category  Gas >  Appears on your statement as  7-ELEVEN 37242 ORLANDO  FL  Transaction Type  POS DEBIT  Charged by  MARIE E TALLEY  Card number  453506--4567  Additional details  POS DEBIT  Merchant details  0 6 Magic Mall  ALDR 50  W. COLONIAL DR 50 5    TOWN OF GOLDEN BEACH EMPLOYEES' PENSION PLAN  c/OE Benefits USA, Inc. (954) 730-2068, Ext.206 38101 Inverrary Boulevard (800)452-2454, Ext.: 206  Suite 303 Lauderhill, FL33319  (954) 730-07381 Fax  Retired Employee Direct Deposit Authorization Agreement  Employee: Marie E. Talley Address: 2342 NW 67th Street City Miami  State FL  Zip Code 33147  Begin Direct Deposit  Change Direct Deposit Cancel Direct Deposit  (Please, attached a voided check)  1538  Marie &. Calley 2342, NW 67th Stret Miani, 3L 33147 Paytothe orderof  Dollars 6 Bnat  USAA FEDERAL SAVINGS BANK 1-800-531-2265 (210) 456-8000 WWW.USAA.COM Memo -  Jind Vaut Vaice Sroit Che Par Co CheMie  -  4538  Ihereby authorized Benefits USA, Administrator for the Toen ofGolden Beach Employees Pension Plani it Plan, (hereinafter the Company) to deposit any amounts owed me by initializing credits entries to my designated account at the financial institution (hereinafter the Bank)i indicated above. Further, lauthorize the Bank to accept and to credit any deposits provided by the Company to my account. Int the event the Company erroneously deposits extra funds to my account, Ifurther authorize the Company to debit my account for the amount necessary to correct the error. This authorization: is tor remain ine effect until the Company and the Bank have receiveda a written cancellation notice from me and have a reasonable opportunity to act oni it.  Signature  Date  PuA Jally    WARRANT NO.260  For payment from the GOLDEN BEACH GENERAL EMPLOYEES  PENSION FUND, Account# 676-90335-1-2-229  TO:  FIRST STATE  You are hereby authorized by the Board ofTrustees ofthe Town of Golden Beach General Employees' Pension Fund to pay the amounts listed below for services rendered to the said Board ofTrustees, and to pay the persons  named below, hereby certified by the. Board ofTrustees:  NAME & ADDRESS  AMOUNTS $ 275.00  1,250.00 250.00 1,775.00  Southern Actuarial Services (DROP Statement) Benefits USA(Administration Fee; October) Benefits USA(Bookkeeping: Fee; October)  TOTAL:  Trustee 1  Trustee    SOUTHERN ACTUARIAL SERVICES  pRe  Town of Golden Beach Employees' Pension Plan clo Ms. Lauri Patterson 3810 Inverrary Boulevard, Suite 303 Lauderhill, FL 33319  INVOICE  INVOICE NO: 745-0924 DATE: September 13, 2024 PAYMENT DUE BY: October 13, 2024  PROJECT 745-38  DESCRIPTION  FEE $275.00 $275.00  Preparation of the June 30, 2024 DROP statement, submitted  August 25, 2024  TOTAL DUE  Please remit payment electronically on or before the due date thati is shown above.  Payments should be transferred to: Wells Fargo Bank (routing number 061000227) Southern Actuarial Services account number 2000056055793  Please do NOT send payments via the U.S. Postal Service. lfyoua are unable tor remit payments electronically and you prefer to send ac check, please use ap private delivery service such as UPS or Fedex with tracking andi remit payment to:  Southern Actuarial Services Company, Inc. clo Carlos G. Carr 8275. Jett Ferry Road Atlanta, GA 30350  Payments are considered made when received, not when submitted. Also, please note that accounts become past due after the due date shown above and become delinquent after 60 days from the billing date. Clients with a delinquenta account may! be required to submit payment in advance before additional work will be performed. Ifyou have any questions concerning this invoice, please call (770)392-0980.  IZAPPRECIATEOIRBIS/NESSY    BENEFITS USA, INC. 3810 Inverrary Blvd., Ste. 303 Lauderhill, FL33319 9.5.55/057202085  INVOICE  INVOICE NO.: GBO 10-24  Bill To: Pension Fund  Town of Golden Beach Employees  Date October 2024 October 2024  Hours  Description  Unit Pr  Total $1 1,250.00 $ 250.00  Administration Fee Bookkeeping Fee  Fees Postage Etc. Bal Due  $ 1,500.00 $ $1,500.00    WARRANT NO. - 259  For payment from the GOLDEN BEACH GENERAL EMPLOYEES  PENSION FUND,Account# 676-90335-1-2-229  TO:  FIRST STATE  You are hereby authorized by the Board ofTrustees oft the Town ofGolden Beach General Employees' Pension Fund to pay the amounts listed below for services rendered to the said Board ofTrustees, and to pay the persons  named below, hereby certified by the Board ofTrustees: Marie Talley ReghtraomCPPTruse Fundamentals Fall Trustee School)  NAME & ADDRESS  AMOUNTS $ 2,200.00 > 1,250.00 250.00 $ 5,200.00  Sugarman, Susskind, Braswell & Herrera (Legal Fees; September) $ 1,500.00  Benefits USA(Administration Fee; September) Benefits USA (Bookkeeping Fee; September)  TOTAL:  Trustee  FTA  Trybtee    WARRANT NO. 259  For payment from the GOLDEN BEACH GENERAL EMPLOYEES  PENSION FUND,Account# 676-90335-1-2-229  TO:  FIRST STATE  You are hereby authorized by the Board ofTrustees oft the Town of Golden Beach General Employees' Pension Fund to pay the amounts listed below for services rendered to the said Board of Trustees, and to pay the persons  named below, hereby certified by the Board of Trustees: Marie Talley egMTAOmCFPTTuse Fundamentals Fall Trustee School) Sugarman, Susskind, Braswell & Herrera (Legal Fees; September)  1,500.00  NAME & ADDRESS  AMOUNTS $ 2,200.00 1,250.00 250.00 5,200.00  Benefits USA (Administration Fee; September) Benefits USA(Bookkeeping: Fee; September)  TOTAL:  Trustee  Trustee    SUGARMAN, SUSSKIND, BRASWELL & HERRERA  PROFESSIONAL, ASSOCIATION ATTORNEYS. ATLAW  Robert. A. Sugarmane Howard S. Susskind D. Marcus Braswell,, Jr. Pedro A. Herrera Kenneth R. Harrison, Sr. Veronica Ucros Madison J.1 Levine David) E. Robinson OfCounsel  Alhambra Circle 150 Coral Gables, Florida: Suite 725 33134 Toll Free (305)5 529-2801 (800) 329-2122 Facsimile (305) 447-8115 Board Certified Labor & Employment Lawyer  September 11, 2024 Invoice No. 190706  Board ofTrustees Town of Golden Beach Pension Board clol Benefits USA, Inc. 3810 Inverrary Boulevard, Suite 303 Lauderhill, FL: 33319  RETAINER STATEMENT  Retainer for the month of September, 2024 TOTAL AMOUNTDUE:  $1,500.00 $1,500.00    SUGARMAN, SUSSKIND, BRASWELL & HERRERA, P.A.  150 Alhambra Circle Suite 725 Coral Gables, Florida3 33134 Telephone:: 305-529-2801 Fax: 305-447-8115 www.sugarmansusskind.com  Town of Golden Beach Pension Board Benefits USA, Inc. 3810 Inverrary Boulevard Suite 303 Lauderhill, FL 33319  September 11, 2024 Invoice # 190706  Client.Matter GBPP:MEET InR Reference To: Meeting  Professional Services  Hrs/Rate 3.20 NO CHARGE $300.00/hr 3.20  Amount  8/28/2024 Attend meeting. Prepare for meeting.  For professional services rendered  $0.00 $0.00  Balance due    FPPTA FLORIDA PUBLIC PENSION TRUSTEES ASSOCIATION SINCE 1984 INVOICE 100 CIVIC CT HOMESTEAD, FL33030 United States  Invoice Date: 09/12/2024 Reference: Online Event Registration: Pension  Florida Public Pension Trustees Association 2946 WELLINGTON CIR TALLAHASSEE, FL32309 United States 8506688552  Lauri Patterson (Benefits USA, Inc.), Invoice Number: INV_12889  Fundamentals for New Trustees mi@tppta.org  Description  Quantity Unit Price Sales Tax Amount USD  Pension Fundamentals for New Trustees Program Pension Fundamentals For New Trustees (Marie Talley, Attendee)  $150.00  $150.00 $150.00 $150.00 (S0.00)  Sub Total TOTAL USD Amount Paid AMOUNT DUE: $150.00  DUE DATE: September 22, 2024 PAYMENT ADVICE To: Florida Public Pension Trustees Association 2946 WELLINGTON CIR TALLAHASSEE, FL: 32309 United States mj@fppta.org 8506688552  Customer: Invoice Number: Amount Due: Due Date:  Lauri Patterson INV_12889 $150.00 September 22, 2024    FPPTA FLORIDA PUBLIC PENSION TRUSTEES ASSOCIATION SINCE 1984 INVOICE Lauri Patterson (Benefits USA, Inc.) 100 CIVICCT HOMESTEAD, FL3 33030 United States  Invoice Date: 09/12/2024 Invoice Number: INV_12891 Reference: Online Event Registration: 2024F Fall Trustee School  Florida Public Pension Trustees Association 2946 WELLINGTON CIR TALLAHASSEE, FL3 32309 United States mj@fppta.org 8506688552  Description  Quantity Unit Price Sales Tax Amount USD  Registration Fee- Trustee Registration Fee (Marie Talley, Attendee) CPPT Certificate Program- Basic (Marie Talley, Attendee) Sunday Orientation Program- lame enrollingi int the CPPT program and entering Basic. Iwill attendt thet full orientation program as required.  $850.00 $1,200.00 $0.00  $850.00 $1,200.00 $0.00  (Marie Talley, Attendee)  SubTotal $2,050.00 TOTAL USD $2,050.00 Amount Paid AMOUNT DUE: $2,050.00  ($0.00)  DUE DATE: September 22, 2024 PAYMENT ADVICE To: Florida Public Pension Trustees Association 2946 WELLINGTON CIR TALLAHASSEE, FL: 32309 United States mj@ippta.org 8506688552  Customer: Invoice Number: Amount Due: Due Date:  Lauri Patterson INV_12891 $2,050.00 September: 22, 2024    BENEFITSUSA, INC. 3810 Inverrary Blvd., Ste. 303 Lauderhill, FL33319 (800)452-2454/(954)730-2068  INVOICE  INVOICE NO.: GBO 09-24  Bill To: Pension Fund  Town of Golden Beach Employees  Date September 2024 September 2024  Hours  Description  Unit Pr  Total $1 1,250.00 $ 250.00  Administration Fee Bookkeeping Fee  Fees Postage Etc. Bal Due  $ 1,500.00 $ $1,500.00    WARRANT NO.262  For payment from the GOLDEN BEACH GENERAL EMPLOYEES  PENSION FUND,Accountt 676-90335-1-2-229  TO:  FIRST STATE  You are hereby authorized by the Board ofTrustees ofthe Town of Golden Beach General Employees' Pension Fund to pay the amounts listed below for services rendered to the said Board ofTrustees, and to pay the persons  named below, hereby certified by the Board ofTrustees:  NAME & ADDRESS FPPTA (2025 Membership)  AMOUNTS $ 750.00 $ 100.00 $1,250.00 $ 250.00 $2,350.00  FPPTA (Re-Cert; M. Camacho & D. Block) Benefits USA (Administration Fee; November) Benefits USA(Bookkeeping Fee; November)  TOTAL:  Trustee  Trustee    BENEFITSUSA, INC. 3810 Inverrary Blvd., Ste. 303 Lauderhill, FL33319 005.54/05702095  INVOICE  INVOICE: NO.: GB 11-24  Bill To: Pension Fund  Town of Golden Beach Employees  Date November November  Hours  Description  Unit Pr  Total $ 1,250.00 $ 250.00  Administration Fee Bookkeeping Fee  Fees Postage Etc. Bal Due  $ 1,500.00 S $1,500.00    FPPTA FLORIDA PUBLIC PENSION TRUSTEES ASSOCIATION SINCE1 1984 INVOICE  Florida Public Pension Trustees Association 2946 WELLINGTON CIR TALLAHASSEE, FL3 32309 United States mj@ippta.org 8506688552  Golden Beach GE Pension Fund (Golden Beach GE Pension Fund) 3810 INVERRARYI BLVDS STE303 LAUDERHILL, FL33319 United States  Invoice Date: 10/21/2024 Invoice Number: INV_12943 Reference: Online Payment: Membership Dues  Description 2025 Membership: Pension Board  Quantity Unit Price Sales Tax Amount USD  $750.00  $750.00 $750.00 ($0.00) $750.00  Sub Total TOTAL USD $750.00 Amount Paid AMOUNT DUE:  DUE DATE: October 31, 2024 - PAYMENT ADVICE To: Florida Public Pension Trustees Association 2946 WELLINGTON CIR TALLAHASSEE, FL32309 United States mj@ippta.org 8506688552  Customer: Golden Beach GE Pension Fund Invoice Number: INV_12943 Amount $750.00 Due: Due Date: October 31, 2024    FPPTA FLORIDA PUBLIC PENSION TRUSTEES ASSOCIATION SINCE 1984 INVOICE Lauri Patterson (Homestead GE Pension Fund) 100CIVICCT HOMESTEAD, FL'33030 United States  Florida Public Pension Trustees Association 2946 WELLINGTON CIR TALLAHASSEE, FL: 32309 United States mi@ippta.org 8506688552  Invoice Date: 10/21/2024 Invoice Number: INV_12945 Reference: Online Payment: CPPT Recertification  Description Camacho  Quantity Unit Price Sales Tax Amount USD  CPPT Recertification (current period for 2025) for: David Block, Maria  2 $50.00  $100.00 $100.00 $100.00 ($0.00)  Sub Total TOTAL USD Amount Paid AMOUNT DUE: $100.00  DUE DATE: October 31, 2024 PAYMENT ADVICE To: Florida Public Pension Trustees Association 2946 WELLINGTON CIR TALLAHASSEE, FL 32309 United States mj@ippta.org 8506688552  Customer: Invoice Number: Amount Due: Due Date:  Lauri Patterson INV_12945 $100.00 October 31, 2024:    TOWN OF GOLDEN BEACH EMPLOYEES' PENSION PLAN APPLICATION FOR PENSION OR DISABILITY BENEFIT  PLEASE PRINT OR' TYPE:  BAVTISTA (last) tlr  1.a. Name of Employee: C. Date ofBirth:  JBEPH (first)  PRINCE (middle)  0  b. Social Security Number: sa?  Date Employed: 04.29.2013  b. Last Department You Worked For: e. Home Telephone Number: . Home. Address:  M/A  (address ands strcci (city, state, zip code)  & Permanent Address To Which Correspondence Should Be Sent (if different):  2.a. Are you currently married: Yes_ b. Name of Spouse/Benehciary, Social Security Number: d. Date ofE Birth: 3. Contingent Beneficiary: a. Name & Relationship: b. Social Security Number: Address:  No  (Ifyes, complete the following for your spouse. Ifno, complete for your beneficiary.)  (last)  (firet)  (middie)  Date ofMarriage: iz/eilis    4. Type ofRetirement: For Which You Are Applying (check one):  Normal Retirement Early Retirement Service Incurred Disability Non-Service Incurred Disability Deferred Vested Termination  5. Ip plan to retire on:  Ify you are applying for a Disability Benefit:  a. Date disability commenced:  7302024 bsyadtigee following:  b. Nature and cause of disability:_6n Dety Strength and Nerve Did yourdisability: result from of the  Boken  Am, wo  rigkt  any  YES NO  (1) Use of drugs, intoxicants or narcotics? (2) A fight, riot or civil insurrection? (3) While you were committing a crime?  (4) From an injury or disease sustained while you were serving in the (5) After your employment with the City terminated? V (6) While working for: someone other than the City and arising out  armed forces? ofs such employment?  NOTE: Records must be filed, including copies ofa doctor's opinion, medical records and other documentation to show that the disability is total and permanent, and if application is made for a service- incurred disability, copies of workers' compensation records and other documentation must also be filed to show the disability occurred while performing service-related duties. Also, thel Board ofTrustees may Ihereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement. may disqualify me for benefits. Ihave reviewed the Designation of Beneficiary! Form filed with the Board ofTrustees andI hereby certify its accuracy. IfI desire to change my designated beneficiary(es), 1 will file a new Designation of Beneficiary Form with this application. This application revokes any prior applications.  require yout to be examined by a doctor selected by thel Board  > e) u3te Raz  Kmh   Dater yfioley  R    TOWN OF GOLDEN BEACH EMPLOYEES' RETIREMENT PLAN  DISABILITY APPLICANT QUESTIONNAIRE IFYOUR CLAIM IS BASED ON ANINJURY, PLEASE ANSWER THE FOLLOWING QUESTIONS:  1.  Please describe exactly how you were injured, providing specifics as to:  a. b. C. d.  Date. 04/29/2023 Time. 3:0Am  Place. Outside OF Bank dF Arericg Zocatien - Sagcrestphvy  Provide names and addresses ofall witnesses.  OCEAN D6  fs.  e.  Nature of your injury or injuries.  Booken Arm, nerie pain. FiemgeHy Shot.  2. Was the injury reported to your department and if sO, state the date reported and to whom. 4/24/23 reported +8 t Comnand SMAF ofjolen Beach  3.  Please state whether you are claiming the injury to be: Total and Permanent. MMYes [JNo Service-related. [MYes [JNo Non-service related. [IYes MNo Provide your reasons for the above claims.  a. b. C. d.  GA Duly tjeryy Pain CAY Prvay AIM Griplharn)  warke  At randon  Catit Lest Hines, Whis  30 Ibs. 1  gain  Does not gllow he To  ACT  fitkoned wy Dutuies 48 4 peLicc OFAICVS    4.  Please specifically describe any and all previous conditions that you have had, even though they may not be directly associated with the condition on which your claim is based.  a.  Specifically state when you had these conditions.  N/A  b.  Provide names, addresses and phone numbers of all health care providers  (including chiropractors) whom you consulted or who treated you for the previous condition(s).  N/A  C.  Provide the diagnosis.  M/A  d.  Provide the prognosis.  S ture w4s  net reconnile  ASK  with inporcrenent,  e.  Provide the dates oft treatment.  MIA  f.  Provide the nature oftreatment.  M/P  g.  Provide the medications prescribed.  NIA  h.  Provide the names, addresses and telephone numbers of all persons who may have  knowledge of such condition.  MIA  5.  Please provide the names, addresses and telephone numbers of all physicians, surgeons, hospitals, chiropractors, osteopaths and other health care providers who have treated you for the condition upon which your claim is based and any condition that may be related to it.  a.  Provide a brief description ofwhat you were treated for.  Plesse SEE A7 TTAChEC  2    b.  Provide the diagnosis.  Provide the prognosis.  d.  Provide the dates oftreatment.  e.  Provide the nature oftreatment.  f.  Provide the medications prescribed.  g.  Provide the names, addresses and telephone numbers ofall persons who may have  knowledge of these conditions.  6. Have you ever been involved in an automobile or other vehicular accident? Ifso, please  provide: a. b. C.  N/A N/A N/A M/R  When the accident occurred. Where the accident occurred. How the accident occurred.  d. Whether you were injured.  N/A N/R  e.  How you were injured.  3    'pa.unooo A1 2IOYA "paunooo 11 MOH "paunooo 4! uoyw  'P o 9  t/n  luapiour ayyo uonduosap V  "B  :apinoid aseald fosJI gapiAoid a1eo yueay e Kq  quaureo. paunbar 4o14A b1a uapiooe Kinfur suods 'VoIsIIIOS TIEI E pey IOA3 nok OAEH L  4IM.  quaprooe a41 wroy Buggnsal saunfur ay jo a8paImouy  PABY Aeu 04A Te jo siaqunu auoydajal pue sassappe fsaueu ay apiAold 'ur  quouea.  HIM WM w/M W/M MIN  jo salea  'I  uouneanjoamgeN X paquosaid suopeoipay   I 4  sisou8oid sisouBeia  4/n  "nok 8 J  pajea.) 04M siapiAoid a.eO ypeay Ie jo siaqunu auoydajal pue sossa.ppe SOWIEN  w  sporeja gof juapiooe SI4, SEM    e. f. you.  How you were injured.  Names, addresses and telephone numbers of all health care providers who treated  g. h. i. .  Diagnosis. Prognosis.  Medications prescribed. Nature oftreatment. Dates oftreatment.  I.  Provide the names, addresses and telephone numbers of all persons who may have  knowledge oft the injuries resulting from the incident.  8. and provide: a.  Please provide the names, addresses and dates of all your prior and current employers,  The nature oft the work involved with each employment.  b.  The status (i.e. terminated, continuing, etc.) of each employment.  C.  State the basis or reason for such status.  5    9.  Please state whether you are now or ever have been self employed, and if so, state the  nature oft the work.  NA  10. Were you suffering any injury, disease, or disability at the time of the accident(s), incident(s), or condition(s) for which you are now applying for disability retirement? Ifso, what  was the nature of the injury, disease or disability? o  11. Describe all records of the accident(s) or incident(s) forming the basis of your application for disability retirement, including but not limited to, traffic accident reports, police reports, notice ofi injury reports, log books, hospital/clinic records, doctor's records, disciplinary records,  etc.  M/A  12. Provide the name and addresses of all health care providers who have advised you that you are permanently and totally incapable of performing useful and efficient service, either physically or mentally, as a (police officer or firefighter) as a result of the injury or condition for  which you seek disability retirement. James Mackenzic,MD 1901 Sw172,AVE aR33029  13. Provide the name and addresses of all health care providers who have advised you that you are not permanently and totally incapable of performing useful and efficient service, either physically or mentally, as a (police officer or firefighter) as a result oft the injury or condition for  which you seek disability retirement.  N/A  14. State the date on which you reached maximum medical improvement (MMI) for workers' compensation purposes, and provide the names and addresses of all health care providers who  have advised that you have reached maximum medical improvement (MMI).  puerse Sec PITAChEC.  6    15. Provide the names and addresses of all health care providers who have advised that you  have not reached maximum medical improvement (MMI). M/A  16. Is the injury which you are now claiming permanently and totally prevents you, physically or mentally, from performing useful and efficient service as a (police officer or firefighter) in any way related to any other injury, disease, condition or disability? If yes,  explain. plegsc Scc ATTAched  17. Has your sworn statement or deposition ever been taken in connection with any claim arising out of the injury or disability for which you seek disability retirement? Ifso, state the  date taken and by whom.  /A  18. Is there any other information known to you, your agents and attorneys, which might be  relevant to your application for disability retirement? Ifso, specify.  N/A  19. Have you ever applied for worker's compensation benefits in any jurisdiction? Ifso,  please state for each application: 1o  a.  The name and address of the employer.  b. C. d.  The date of the application. Determination of the application. The dates of receipt of benefits.  7    20. Describe in detail why you feel that you are permanently and totally unable physically or mentally, from performing useful and efficient service as a pocice dkficer  Plesse Scci ATTACIÉ  IFYOUR GAMISIASTDOMAIAES PLEASE ANSWER THE FOLLOWING OUESTIONS  21. Please describe the nature of your illness and how you became ill, providing specifics as tod date, time and place, and providing names and addresses ofall witnesses (ifapplicable).  - AA  22. Please state whether you are claiming the illness tol be:  a. b. C. d.  Total and permanent [1 Service-related (I Non-service related [1  Provide your reasons for the above claims.  23. Please specifically describe any and all previous conditions that you have had, even though they may not be directly associated with the condition on which your claim is based.  a.  Specifically state when you had these conditions.  &    b.  Provide names, addresses and phone numbers of all health care providers  (including chiropractors) whom you consulted or who treated you for the previous condition(s).  Provide the diagnosis.  d.  Provide the prognosis.  e.  Provide the dates of treatment.  f.  Provide the nature oft treatment.  Provide the medications prescribed.  h.  Provide the names, addresses and telephone numbers of all persons who may have  knowledge of such condition.  24. Please provide the names, addresses and telephone numbers of all physicians, surgeons, hospitals, chiropractors, osteopaths and other health care providers who have treated you for the condition upon which your claim is based and any condition that may be related to it.  a.  Provide a brief description of what you were treated for.  9    b.  Provide the diagnosis.  C.  Provide the prognosis.  d.  Provide the dates oft treatment.  e.  Provide the nature of treatment.  f.  Provide the medications prescribed.  g.  Provide the names, addresses and telephone numbers ofall persons who may have  knowledge oft these conditions.  25. Were you suffering any injury, disease, or disability at the time of the accident(s), incident(s), or condition(s) for which you are now applying for disability retirement? Ifso, what  was the nature oft the injury, disease or disability?  26. Provide the name and address of all health care providers who have advised you that you are permanently and totally incapable of performing useful and efficient service, either physically or mentally, as a (police officer or firefighter) as a result of the disease or disability  for which you seek disability retirement.  10    27. Provide the names and addresses of all health care providers who have advised you that you are not permanently and totally incapable of performing useful and efficient service, either physically or mentally, as a (police officer or firefighter) as a result of the injury or condition for  which you seek disability retirement.  28. State the date on which you reached maximum medical improvement (MMI) for workers' compensation purposes, and provide the names and addresses of all doctors who have advised  that you have reached maximum medical improvement (MMI).  29. Provide the names and addresses of all health care providers who have advised that you  have not reached maximum medical improvement (MMI).  30. Please provide the names, addresses and dates ofa all of your prior and current employers,  and provide:  a. b. C.  The nature oft the work involved with each employment.  The status (i.e. terminated, continuing, etc.) of each employment.  State the basis or reason for such status.  11    31. Please state whether you are now or ever have been self employed, and if so, state the  nature oft the work.  32. Is the disease or disability which you are now claiming permanently and totally prevent you, physically or mentally, from performing useful and efficient service as a (police officer or firefighter) in any way related to any other injury, disease, condition or disability? If yes,  explain.  33. Describe in detail why you feel that you are permanently and totally unable physically or  mentally, from performing useful and efficient service asa  34. Has your sworn statement or deposition ever been taken in connection with any claim arising out of the disease or disability for which you seek disability retirement? Ifso, state the  date taken and by whom.  35. Is there any other information known to you, your agents and attorneys, which might be  relevant to your application for disability retirement? Ifso, specify.  12    YOU ARE REQUIRED TO SUPPLEMENT THIS QUESTIONNAIRE IMMEDIATELY IN WRITING TO THE BOARD ATTORNEY WITH ANY NEW OR ADDITIONAL INFORMATION OBTAINED BETWEEN THE TIME OF SIGNING THIS QUESTIONNAIRE ANDFINAL DECISION BY THE BOARD OF TRUSTEES.  HEREBY CERTIFY THAT THE INFORMATION PROVIDED HEREIN IS TRUE WILLFULLY AND KNOWINGLY TO MAKE, OR CAUSE TO BE MADE, OR TO ASSIST, CONSPIRE WITH, OR URGE ANOTHER TO MAKE, OR CAUSE TO BE MADE, ANY FALSE, FRAUDULENT, OR MISLEADING ORAL OR WRITTEN STATEMENT OR WITHHOLD OR CONCEAL MATERIAL INFORMATION TO OBTAIN ANY BENEFIT AVAILABLE UNDER THE PENSION PLAN. IN ADDITION TO ANY APPLICABLE CRIMINAL PENALTY UPON CONVICTION FOR A VIOLATION DESCRIBED ABOVE, I MAY IN THE DISCRETION OF THE BOARD OF TRUSTEES, BE REQUIRED TO FORFEIT THE RIGHT TO RECEIVE ANY OR ALL BENEFITS TO WHICH I WOULD OTHERWISE BE ENTITLED. FOR PURPOSES HEREOF, "CONVICTION" MEANS A DETERMINATION OF GUILT THAT IS THE RESULT OF A PLEA OR TRIAL, REGARDLESS OF WHETHER  AND COMPLETE.  UNDERSTAND THAT IT IS A CRIME FOR A PERSON  ADJUDICATION IS WITHHELD.  DATED this (0 dayof_ september  2024  Print Name: Jaipfaboh  2h  13    TOWN OF GOLDEN BEACH EMPLOYEES RETIREMENT PLAN  AUTHORIZATION TO WAIVE CONFIDENTIALITY  OF MEDICAL RECORDS  To facilitate the Board of Trustees of the Town of Golden Beach Employees' Retirement Plan in carrying out its duty to review, discuss and determine my application for disability retirement, I hereby waive my right of confidentiality of my medical records and other medical evidence in the custody of the Board of Trustees or elsewhere. In SO doing, I understand such records will be discussed during one or more public meetings and will become public record. I understand that the Board will rely ypon this waiver and thatIwill not be able to withdraw same at a later date.  UsStH Puaz  Ge  &  doseph fautiha Print Full Name of Member XXX-XX- Social Security No.  alo/zy Date    Lauri Patterson From: Sent: To: Subject:  Bautstaegoldenpeacn.s (Joseph Bautista) Bautsaegoenbeacuy  Tuesday, September 03, 20247:29AM  Lauri Patterson Re: Trustee status  Thank you Lauri Ihere by resign. Sgt.. JOSEPH BAUTISTA Motor Unit Golden Beach Police Department 1Golden Beach Drive, Golden Beach, FL33160 (305)932-0744 Phone (305)932-2045 Fax bautsaPgoleenpeach.s  fle:l/var/mobileLbray/5MS/Attachmentsy/97/07/051CD5ACA884-4DE6-B4D/-809C7FE56A07/IMG.1778.neic  On Aug 30, 2024, at 4:11 PM, Lauri Patterson aun@beneitsusa.orpe wrote:  Good afternoon Trustee Bautista,  Iinformed the Board that I provided you the disability paperwork on August 28, 2024. After discussion between the trustees and Board attorney it was recommended that you resign from the Board and I would need to run an election Also, you will have to file the Financial Disclosure Form with 60 days ofl leaving We will be working together on your upcoming disability. Please feel free to  to have another PO serve your unexpired term.  office. You may reply to this email with your resignation.  contact me anytime. Kind regards, Bauri X. Patterson Benefits USA, INC. 3810 Inverrary Blvd. Suite 303 Lauderhill, FL 33319 Phone: 954-730-2068 Ext 213 Fax: 954-730-0738 Email: Lauri@benefitsusaorg    Lauri Patterson From: Sent: To: Subject:  eseugemansusenacon (Jessica De la Torre Vila) jess@sugarmansusskind.com>  Wednesday, October 23, 2024 1:34PM Lauri Patterson RE:2 2025 meeting dates  Hi Lauri... sorry to be the bearer of bad news but the following dates are NOT available:  February 12 or February 19, 2025  May 21, 2025 August 20, 2025 November 19, 2025  lam able to offer the following dates:  2/11 (virtually) 5/12 8/11 (virtually) 11/10  From: Lauri Patterson aun@beneftsusaorp Sent: Wednesday, October 23, 202410:49AM To:. Jessica De la Torre Vila jess@sugarmansusskind.com> Subject: FW:2025 meeting dates Good morning,  Please see the response from Chairman Fishman. Iwould like to add this to the agenda if possible.  Thank you @ Pawri X. Jatterson Benefits USA, INC. 3810 Inverrary Blvd. Suite 303 Lauderhill, FL 33319 Phone: 954-730-2068 Ext 213 Fax: 954-730-0738 Email: Lauri@benellsusa.org  1