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HARTFORD
AMENDMENT TO GROUP POLICY GL-207759 PROCESSED ON FEBRUARY 24, 2015. ANY CHANGES
BETWEEN THIS POLICY AND THE PREVIOUSLY ISSUED POLICY ARE EFFECTIVE FEBRUARY 1,
2015. ALL OTHER TERMS, CONDITIONS AND DATES REMAIN UNCHANGED.
Name of Policyholder: CITY OF NASHUA, NEW HAMPSHIRE
Policy Number: Effective Date: Place of Delivery:
GL-207759 January 1, 1997 New Hampshire
Anniversary Dates: Premium Due Dates:
January 1 of each year, beginning in 2016. Monthly, on the first day of each policy month.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY
200 Hopmeadow Street, Simsbury, Connecticut 06089
(A stock insurance company, herein called Hartford Life)
Agrees with the Policyholder to insure certain persons who are entitled to the insurance provided by this policy. This
policy is issued in consideration of the application of the Policyholder, and the payment of the first premium. The
first premium is due and payable on the effective date of the policy. Subject to the policy's grace period provision, all
premiums after the first must be paid when or before they are due.
Signed for Hartford Life:
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Terence Shields, Secretary Michael Concannon, Executive Vice President
Table of Contents
Agreement to Insure
Participant Employers
Incorporation Provision
Schedule of Insurance 3
Premiums
Policy Provisions
NY BeE WP Re
GR-11383-HLA(1) PI-1.00
