Res. No. 015-03-11564RESOLUTION NO. 15 -03 -11564
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY
OF SOUTH MIAMI, FLORIDA DECLARING THAT IT IS THE POLICY OF
THE CITY TO ALLOW "DOMESTIC PARTNERSHIP" COVERAGE
ELIGIBILITY AS PART OF THE CITY'S HEALTH INSURANCE AND
BENEFITS PROGRAM WHICH IS PROVIDED TO ALL FULL TIME
EMPLOYEES.
WHEREAS, it is in the best interest of the City to be responsive to the needs of its
employees and to treat all of its employees fairly and equitably; and
WHEREAS, the City recognizes that long -term committed relationship foster economic
stability and emotional and psychological bonds; and
WHEREAS, the City wishes to support such long -term committed relationships by
providing employment benefits to City employees for their domestic partners; and
WHEREAS, studies conducted in the private and public sectors have shown that
domestic partner legislation and/or policies have a positive impact upon employees and have not
created an undue burden on employers adopting such legislation or policies; and
WHEREAS, it is necessary and appropriate that legislation be enacted to legally
recognize the existence of domestic partnerships and to provide equality of treatment for those
partnerships;
NOW, THEREFORE, BE IT ORDAINED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA:
SECTION 1.
That it is the Policy of the City of South Miami to allow "domestic partnership" coverage
eligibility as part of the City's health insurance and benefits program which is provided to all full
time employees.
Res. No. 15 -03 -11564
Page Two - Domestic Partner Resolution
SECTION 2.
The administration will set forth the procedure implementing the Domestic Partnership
benefit.
SECTION 3.
This Resolution shall be effective immediately after the adoption hereof.
PASSED AND ADOPTED THIS 21st DAY OF January, 2003.
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CITY CVfRK
CITY ATTORNEY
APPROVED:
CA
MAY
Commission Vote:
5 -0
Mayor Feliu:
Yea
Vice Mayor Russell:
Yea
Commissioner Bethel:
Yea
Commissioner Wiscombe:
Yea
Commissioner McCrea:
Yea
Neighborhood Health Partnership
Declaration of Domestic Partnership
We, and . hereby declare that we are
Domestic Partners and hereby declare that we meet the following criteria of Domestic
Partnership:
1. We have lived, in a close and committed personal relationship of mutual caring and
support in a common permanent residence for a duration of at least six (6) months;
2. We do not have a blood or other relationship that would bar marriage under the laws of
the state of Florida;
3. We are IS years of age or, older and we are mentally competent to enter into a contract in
the state of Florida;
4. Neither of us is currently legally married to another person under either statutory or
common law, and if previously married, a legal divorce or annulment has been obtained
or the former spouse is deceased;
5. We are providing documentation with this Declaration showing that we are financially
dependent upon each other for the welfare and financial obligations of our household. At
least THM (3) of the following must be checked and copies of the documentation
must be attached to this Declaration.
_ documents showing joint ownership or leasing of a residence (Examples:
mortgage, lease, deed);
documents showing sharing of household expenses, which must include TWO (2)
of the following: (i) automobile title showing common ownership; (ii) statement from a
joint checking, savings or investment account; or (iii) statement from a joint credit
account;
a will or life insurance policy which designates the other partner as the primary
beneficiary, or
other documentation acceptable to Neighborhood Health Partnership that
demonstrates our financial interdependence.
We understand that:
1. Neighborhood Health Partnership reserves the right to request at periodic intervals: (i)
reaffirmation of our Domestic Partnership; and (2) submission of updated documentation
to verify that out Domestic Partnership has not terminated.
2. if the Domestic Partnership no longer meets all of the criteria attested to in this Affidavit,
we must file a Declaration of Termination of Domestic Partnership within thirty (30)
days of such change.
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3. Upon the Termination of the Domestic Partnership, health plan coverage of the Domestic
Partner who is not the employee and any dependents of the Domestic Partner who is not
the employee shall cease.
4. Any knowing misstatements in this Declaration may subject us to loss of coverage,
criminal penalties, or any other remedies available under the law of the State of Florida.
5. The filing of this Declaration may have tax and other legal or financial consequences.
Acknowledgments
1. We certify that any and all representations that we have made and information that we
have provided as part of this Declaration as evidence of our Domestic Partnership are true
and accurate and that any documents attached hereto or provided upon request are
authentic.
2. We affirm that the assertions in this Declaration are true and correct to the best of out
knowledge and belief.
Signature of Employee or Partner
Print Name
Signature of Employee or Partner
Print Name
Date Date
SWORN TO AND SUBSCRIBED BEFORE ME
this day of
Notary Public
My Commission expires:
0575078x2
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