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AMENDMENT #5 - APPLICATION FOR GROUP COVERAGE FOR POLICY #50703 - CONVERT APPEALS PROCESS TO GREAT-WEST STANDARD, DO NOT INCLUDE DORA HOGAN'S NAME ON ANY CORRESPONDENCE, EFFECTIVE 1/1/2008 (NOTE: PER HUMAN RESOURCES, GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY SIGNATURE NOT NECESSARY) (ASSISTANT CITY MANAGER SIGNED 3/6/2008)