Common use of INSURANCE AND PENSION Clause in Contracts

INSURANCE AND PENSION. When you have questions regarding eligibility, benefits, or how to file a claim, please contact the fund office at the following address, where the staff will be pleased to assist you: MEDICAL/VISION CLAIMS ZENITH AMERICAN SOLUTIONS XX XXX 000 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DENTAL DELTA DENTAL OF COLORADO XX XXX 000000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 PENSION ZENITH AMERICAN SOLUTIONS PO BOX 1327 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DO NOT GO SUSPENDED!!! REMEMBER, IF YOU LEAVE THE INDUSTRY FOR ANY REASON (termination, lay-off, leave of absence, etc.) apply for your withdrawal card. This must be done within 30 days from the last day worked. This protects your union status in the event you should ever return to the industry. Failure to get a withdrawal card will result in SUSPENSION from the Union and a reinstatement fee will be charged. If you leave the industry IT IS YOUR OBLIGATION TO GET A WITHDRAWAL CARD! The withdrawal card will be issued at no cost, the only requirement being that your initiation fee be fully paid and your dues must be paid for the month in which you request the withdrawal card. The withdrawal card is good indefinitely and allows you to become a member of any local union affiliated with the United Food and Commercial Workers International Union without payment of any additional fee(s). Withdrawal card must be deposited with the union office within 30 days after returning to work or it becomes null and void and the reinstatement fee must be paid. All persons returning to work with a withdrawal card must fill out a new application and authorization. WITHDRAWAL CARD REQUEST FORM It is your responsibility to request in writing If your employment terminates, or you are on a leave of absence for 30 days or more, you should request a Withdrawal Card to stop your dues. Failure to request the card will result in mandatory payment of reinstatement fees upon your return to work. Name (Print) Date Employee ID # Home phone ( ) Employed by Company Facility # Home Address City State Last Day Worked Reason for Leaving (Please check one) Zip Termed, pending grievance 🞏 Termed, leaving company 🞏 Going to non-union position 🞏 Medical Leave [maternity, disability, worker comp] and expect to return 🞏 LOA [personal, military] and expect to return to work 🞏 Retiring from company 🞏 Return this Request for Withdrawal Card to UFCW Local 7. Dues must be paid for month in which you request withdrawal card. Refund any advance dues 🞏 Apply any advance dues upon my return to work 🞏 Please give this to your Union Representative or place in an envelope and mail to: UNITED FOOD AND COMMERCIAL WORKERS LOCAL NO. 7 0000 XXXX 00XX XXXXXX, XXXXX 000 XXXXX XXXXX XX 00000

INSURANCE AND PENSION. When you have questions regarding eligibility, benefits, or how to file a claim, please contact the fund office at the following address, where the staff will be pleased to assist you: MEDICAL/VISION CLAIMS ZENITH AMERICAN SOLUTIONS XX XXX 000 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DENTAL DELTA DENTAL OF COLORADO XX XXX 000000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 PENSION ZENITH AMERICAN SOLUTIONS PO BOX 1327 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DO NOT GO SUSPENDED!!! REMEMBER, IF YOU LEAVE THE INDUSTRY FOR ANY REASON (termination, lay-lay- off, leave of absence, etc.) apply for your withdrawal card. This must be done within 30 days from the last day worked. This protects your union status in the event you should ever return to the industry. Failure to get a withdrawal card will result in SUSPENSION from the Union and a reinstatement fee will be charged. If you leave the industry IT IS YOUR OBLIGATION TO GET A WITHDRAWAL CARD! The withdrawal card will be issued at no cost, the only requirement being that your initiation fee be fully paid and your dues must be paid for the month in which you request the withdrawal card. The withdrawal card is good indefinitely and allows you to become a member of any local union affiliated with the United Food and Commercial Workers International Union without payment of any additional fee(s). Withdrawal card must be deposited with the union office within 30 days after returning to work or it becomes null and void and the reinstatement fee must be paid. All persons returning to work with a withdrawal card must fill out a new application and authorization. WITHDRAWAL CARD REQUEST FORM It is your responsibility to request in writing If your employment terminates, or you are on a leave of absence for 30 days or more, you should request a Withdrawal Card to stop your dues. Failure to request the card will result in mandatory payment of reinstatement fees upon your return to work. Name (Print) Date Employee ID # Home phone ( ) Employed by Company Facility # Home Address City State Zip Last Day Worked Reason for Leaving (Please check one) Zip Termed, pending grievance 🞏 Termed, leaving company 🞏 Going to non-union position 🞏 Medical Leave [maternity, disability, worker comp] and expect to return 🞏 LOA [personal, military] and expect to return to work 🞏 Retiring from company 🞏 Return this Request for Withdrawal Card to UFCW Local 7. Dues must be paid for month in which you request withdrawal card. Refund any advance dues 🞏 Apply any advance dues upon my return to work 🞏 Please give this to your Union Representative or place in an envelope and mail to: UNITED FOOD AND COMMERCIAL WORKERS LOCAL NO. 7 0000 XXXX 00XX XXXXXX, XXXXX 000 XXXXX XXXXX XX 00000

INSURANCE AND PENSION. When you have questions regarding eligibility, benefits, or how to file a claim, please contact the fund office at the following address, where the staff will be pleased to assist you: MEDICAL/VISION CLAIMS ZENITH AMERICAN SOLUTIONS XX XXX 000 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DENTAL DELTA DENTAL OF COLORADO XX XXX 000000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 PENSION ZENITH AMERICAN SOLUTIONS PO BOX 1327 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DO NOT GO SUSPENDED!!! REMEMBER, IF YOU LEAVE THE INDUSTRY FOR ANY REASON (termination, lay-off, leave of absence, etc.) apply for your withdrawal card. This must be done within 30 days from the last day worked. This protects your union status in the event you should ever return to the industry. Failure to get a withdrawal card will result in SUSPENSION from the Union and a reinstatement fee will be charged. If you leave the industry industry. IT IS YOUR OBLIGATION TO GET A WITHDRAWAL CARD! The withdrawal card will be issued at no cost, the only requirement being that your initiation fee be fully paid and your dues must be paid for the month in which you request the withdrawal card. The withdrawal card is good indefinitely and allows you to become a member of any local union affiliated with the United Food and Commercial Workers International Union without payment of any additional fee(s). Withdrawal card must be deposited with the union office within 30 days after returning to work or it becomes null and void and the reinstatement fee must be paid. All persons returning to work with a withdrawal card must fill out a new application and authorization. WITHDRAWAL CARD REQUEST FORM It is your responsibility to request in writing If your employment terminates, or you are on a leave of absence for 30 days or more, you should request a Withdrawal Card to stop your dues. Failure to request the card will result in mandatory payment of reinstatement fees upon your return to work. Name (Print) Date Employee ID # Home phone ( ) Employed by Company Facility # Home Address City State Last Day Worked Reason for Leaving (Please check one) Zip Termed, pending grievance 🞏 Termed, leaving company � � Going to non-union position  🞏 Medical Leave [maternity, disability, worker comp] and expect to return 🞏 LOA [personal, military] and expect to return to wor k 🞏 Retiring from compa ny 🞏 Return this Request for Withdrawal Card to UFCW Local 7. Dues must be paid for month in which you request withdrawal card. Refund any advance d ues 🞏 Apply any advance dues upon my return to  work 🞏 Please give this to your Union Representative or place in an envelope and mail to: UNITED FOOD AND COMMERCIAL WORKERS LOCAL NO. 7 0000 XXXX 00XX XXXXXX, XXXXX 000 XXXXX XXXXX XX 00000

INSURANCE AND PENSION. When you have questions regarding eligibility, benefits, or how to file a claim, please contact the fund office at the following address, where the staff will be pleased to assist you: MEDICAL/VISION CLAIMS ZENITH AMERICAN SOLUTIONS XX XXX 000 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DENTAL DELTA DENTAL OF COLORADO XX XXX 000000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 PENSION ZENITH AMERICAN SOLUTIONS PO BOX 1327 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DO NOT GO SUSPENDED!!! REMEMBER, IF YOU LEAVE THE INDUSTRY FOR ANY REASON (termination, lay-lay- off, leave of absence, etc.) apply for your withdrawal card. This must be done within 30 days from the last day worked. This protects your union status in the event you should ever return to the industry. Failure to get a withdrawal card will result in SUSPENSION from the Union and a reinstatement fee will be charged. If you leave the industry IT IS YOUR OBLIGATION TO GET A WITHDRAWAL CARD! The withdrawal card will be issued at no cost, the only requirement being that your initiation fee be fully paid and your dues must be paid for the month in which you request the withdrawal card. The withdrawal card is good indefinitely and allows you to become a member of any local union affiliated with the United Food and Commercial Workers International Union without payment of any additional fee(s). Withdrawal card must be deposited with the union office within 30 days after returning to work or it becomes null and void and the reinstatement fee must be paid. All persons returning to work with a withdrawal card must fill out a new application and authorization. WITHDRAWAL CARD REQUEST FORM It is your responsibility to request in writing If your employment terminates, or you are on a leave of absence for 30 days or more, you should request a Withdrawal Card to stop your dues. Failure to request the card will result in mandatory payment of reinstatement fees upon your return to work. Name (Print) Date Employee ID # Home phone ( ) Employed by Company Facility # Home Address City State Zip Last Day Worked Reason for Leaving (Please check one) Zip Termed, pending grievance 🞏 Termed, leaving company � � Going to non-union position  🞏 Medical Leave [maternity, disability, worker comp] and expect to return 🞏 LOA [personal, military] and expect to return to wor k 🞏 Retiring from compa ny 🞏 Return this Request for Withdrawal Card to UFCW Local 7. Dues must be paid for month in which you request withdrawal card. Refund any advance d ues 🞏 Apply any advance dues upon my return to  work 🞏 Please give this to your Union Representative or place in an envelope and mail to: UNITED FOOD AND COMMERCIAL WORKERS LOCAL NO. 7 0000 XXXX 00XX XXXXXX, XXXXX 000 XXXXX XXXXX XX 00000

INSURANCE AND PENSION. When you have questions regarding eligibility, benefits, or how to file a claim, please contact the fund office at the following address, where the staff will be pleased to assist you: MEDICAL/VISION CLAIMS ZENITH AMERICAN SOLUTIONS XX XXX 000 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DENTAL DELTA DENTAL OF COLORADO XX XXX 000000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 PENSION ZENITH AMERICAN SOLUTIONS PO BOX 1327 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 NOTES NOTES DO NOT GO SUSPENDED!!! REMEMBER, IF YOU LEAVE THE INDUSTRY FOR ANY REASON (termination, lay-off, leave of absence, etc.) apply for your withdrawal card. This must be done within 30 days from the last day worked. This protects your union status in the event you should ever return to the industry. Failure to get a withdrawal card will result in SUSPENSION from the Union and a reinstatement fee will be charged. If you leave the industry IT IS YOUR OBLIGATION TO GET A WITHDRAWAL CARD! The withdrawal card will be issued at no cost, the only requirement being that your initiation fee be fully paid and your dues must be paid for the month in which you request the withdrawal card. The withdrawal card is good indefinitely and allows you to become a member of any local union affiliated with the United Food and Commercial Workers International Union without payment of any additional fee(s). Withdrawal card must be deposited with the union office within 30 days after returning to work or it becomes null and void and the reinstatement fee must be paid. All persons returning to work with a withdrawal card must fill out a new application and authorization. WITHDRAWAL CARD REQUEST FORM It is your responsibility to request in writing If your employment terminates, or you are on a leave of absence for 30 days or more, you should request a Withdrawal Card to stop your dues. Failure to request the card will result in mandatory payment of reinstatement fees upon your return to work. Name (Print) Date Employee ID # Home phone ( ) Employed by Company Facility # Home Address City State Last Day Worked Reason for Leaving (Please check one) Zip Termed, pending grievance 🞏 Termed, leaving company 🞏 Going to non-union position 🞏 Medical Leave [maternity, disability, worker comp] and expect to return 🞏 LOA [personal, military] and expect to return to work 🞏 Retiring from company 🞏 Return this Request for Withdrawal Card to UFCW Local 7. Dues must be paid for month in which you request withdrawal card. Refund any advance dues 🞏 Apply any advance dues upon my return to work 🞏 Please give this to your Union Representative or place in an envelope and mail to: UNITED FOOD AND COMMERCIAL WORKERS LOCAL NO. 7 0000 XXXX 00XX XXXXXX, XXXXX 000 XXXXX XXXXX XX 00000

INSURANCE AND PENSION. When you have questions regarding eligibility, benefits, or how to file a claim, please contact the fund office at the following address, where the staff will be pleased to assist you: MEDICAL/VISION CLAIMS ZENITH AMERICAN SOLUTIONS XX XXX 000 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DENTAL DELTA DENTAL OF COLORADO XX XXX 000000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 PENSION ZENITH AMERICAN SOLUTIONS PO BOX 1327 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 NOTES NOTES DO NOT GO SUSPENDED!!! REMEMBER, IF YOU LEAVE THE INDUSTRY FOR ANY REASON (termination, lay-off, leave of absence, etc.) apply for your withdrawal card. This must be done within 30 days from the last day worked. This protects your union status in the event you should ever return to the industry. Failure to get a withdrawal card will result in SUSPENSION from the Union and a reinstatement fee will be charged. If you leave the industry IT IS YOUR OBLIGATION TO GET A WITHDRAWAL CARD! The withdrawal card will be issued at no cost, the only requirement being that your initiation fee be fully paid and your dues must be paid for the month in which you request the withdrawal card. The withdrawal card is good indefinitely and allows you to become a member of any local union affiliated with the United Food and Commercial Workers International Union without payment of any additional fee(s). Withdrawal card must be deposited with the union office within 30 days after returning to work or it becomes null and void and the reinstatement fee must be paid. All persons returning to work with a withdrawal card must fill out a new application and authorization. WITHDRAWAL CARD REQUEST FORM It is your responsibility to request in writing If your employment terminates, or you are on a leave of absence for 30 days or more, you should request a Withdrawal Card to stop your dues. Failure to request the card will result in mandatory payment of reinstatement fees upon your return to work. Name (Print) Date Employee ID # Home phone ( ) Employed by Company Facility # Home Address City State Last Day Worked Reason for Leaving (Please check one) Zip Termed, pending grievance 🞏 Termed, leaving company � � Going to non-union position  🞏 Medical Leave [maternity, disability, worker comp] and expect to return 🞏 LOA [personal, military] and expect to return to wor k 🞏 Retiring from compa ny 🞏 Return this Request for Withdrawal Card to UFCW Local 7. Dues must be paid for month in which you request withdrawal card. Refund any advance d ues 🞏 Apply any advance dues upon my return to  work 🞏 Please give this to your Union Representative or place in an envelope and mail to: UNITED FOOD AND COMMERCIAL WORKERS LOCAL NO. 7 0000 XXXX 00XX XXXXXX, XXXXX 000 XXXXX XXXXX XX 00000

INSURANCE AND PENSION. When you have questions regarding eligibility, benefits, or how to file a claim, please contact the fund office at the following address, where the staff will be pleased to assist you: MEDICAL/VISION CLAIMS ZENITH AMERICAN SOLUTIONS XX XXX 000 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DENTAL DELTA DENTAL OF COLORADO XX XXX 000000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 PENSION ZENITH AMERICAN SOLUTIONS PO BOX 1327 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 NOTES DO NOT GO SUSPENDED!!! REMEMBER, IF YOU LEAVE THE INDUSTRY FOR ANY REASON (termination, lay-off, leave of absence, etc.) apply for your withdrawal card. This must be done within 30 days from the last day worked. This protects your union status in the event you should ever return to the industry. Failure to get a withdrawal card will result in SUSPENSION from the Union and a reinstatement fee will be charged. If you leave the industry industry. IT IS YOUR OBLIGATION TO GET A WITHDRAWAL CARD! The withdrawal card will be issued at no cost, the only requirement being that your initiation fee be fully paid and your dues must be paid for the month in which you request the withdrawal card. The withdrawal card is good indefinitely and allows you to become a member of any local union affiliated with the United Food and Commercial Workers International Union without payment of any additional fee(s). Withdrawal card must be deposited with the union office within 30 days after returning to work or it becomes null and void and the reinstatement fee must be paid. All persons returning to work with a withdrawal card must fill out a new application and authorization. WITHDRAWAL CARD REQUEST FORM It is your responsibility to request in writing If your employment terminates, or you are on a leave of absence for 30 days or more, you should request a Withdrawal Card to stop your dues. Failure to request the card will result in mandatory payment of reinstatement fees upon your return to work. Name (Print) Date Employee ID # Home phone ( ) Employed by Company Facility # Home Address City State Last Day Worked Reason for Leaving (Please check one) Zip Termed, pending grievance 🞏 Termed, leaving company � � Going to non-union position  🞏 Medical Leave [maternity, disability, worker comp] and expect to return 🞏 LOA [personal, military] and expect to return to wor k 🞏 Retiring from compa ny 🞏 Return this Request for Withdrawal Card to UFCW Local 7. Dues must be paid for month in which you request withdrawal card. Refund any advance d ues 🞏 Apply any advance dues upon my return to  work 🞏 Please give this to your Union Representative or place in an envelope and mail to: UNITED FOOD AND COMMERCIAL WORKERS LOCAL NO. 7 0000 XXXX 00XX XXXXXX, XXXXX 000 XXXXX XXXXX XX 00000

INSURANCE AND PENSION. When you have questions regarding eligibility, benefits, or how to file a claim, please contact the fund office at the following address, where the staff will be pleased to assist you: MEDICAL/VISION CLAIMS ZENITH AMERICAN SOLUTIONS XX XXX 000 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 DENTAL DELTA DENTAL OF COLORADO XX XXX 000000 XXXXXX, XX 00000-0000 TELEPHONE: 000-000-0000 PENSION ZENITH AMERICAN SOLUTIONS PO BOX 1327 0000 X. 00xx XXXXXX, #000 XXXXXX, XX 00000-0000 TELEPHONEPHONE: 000-000-0000 TOLL FREE: 0-000-000-0000 NOTES DO NOT GO SUSPENDED!!! REMEMBER, IF YOU LEAVE THE INDUSTRY FOR ANY REASON (termination, lay-off, leave of absence, etc.) apply for your withdrawal card. This must be done within 30 days from the last day worked. This protects your union status in the event you should ever return to the industry. Failure to get a withdrawal card will result in SUSPENSION from the Union and a reinstatement fee will be charged. If you leave the industry industry. IT IS YOUR OBLIGATION TO GET A WITHDRAWAL CARD! The withdrawal card will be issued at no cost, the only requirement being that your initiation fee be fully paid and your dues must be paid for the month in which you request the withdrawal card. The withdrawal card is good indefinitely and allows you to become a member of any local union affiliated with the United Food and Commercial Workers International Union without payment of any additional fee(s). Withdrawal card must be deposited with the union office within 30 days after returning to work or it becomes null and void and the reinstatement fee must be paid. All persons returning to work with a withdrawal card must fill out a new application and authorization. WITHDRAWAL CARD REQUEST FORM It is your responsibility to request in writing If your employment terminates, or you are on a leave of absence for 30 days or more, you should request a Withdrawal Card to stop your dues. Failure to request the card will result in mandatory payment of reinstatement fees upon your return to work. Name (Print) Date Employee ID # Home phone ( ) Employed by Company Facility # Home Address City State Last Day Worked Reason for Leaving (Please check one) Zip Termed, pending grievance 🞏 Termed, leaving company 🞏 Going to non-union position 🞏 Medical Leave [maternity, disability, worker comp] and expect to return 🞏 LOA [personal, military] and expect to return to work 🞏 Retiring from company 🞏 Return this Request for Withdrawal Card to UFCW Local 7. Dues must be paid for month in which you request withdrawal card. Refund any advance dues 🞏 Apply any advance dues upon my return to work 🞏 Please give this to your Union Representative or place in an envelope and mail to: UNITED FOOD AND COMMERCIAL WORKERS LOCAL NO. 7 0000 XXXX 00XX XXXXXX, XXXXX 000 XXXXX XXXXX XX 00000