Please note that there are three places in the agreement document where the Fire Department
must fill in the name of the department. Two locations are on the first page and one on the
signature page. Here is a sample of what these locations look like in the actual document:
Header
AGREEMENT
UTAH RETIREMENT SYSTEMS
PUBLIC EMPLOYEES LONG-TERM DISABILITY PROGRAM AND
<<
NAME OF FIRE DEPARTMENT
>>
____________________________________________________________
First Paragraph
THIS AGREEMENT is made and entered into by and between
<< FIRE DEPT NAME >> a body corporate and political subdivision of the State of
Utah, for purposes of this agreement hereinafter referred to as the “EMPLOYER”, and
UTAH RETIREMENT SYSTEMS by and through the "PUBLIC EMPLOYEES LONGTERM DISABILITY PROGRAM" or “LTD Program”.
Last / Signature Page
Employer: <<
FIRE DEPT NAME
>>
By:______________________________
Signature
Print Name: _______________________
Title:_____________________________