Board Of Aldermen

Delta Dental PPO plus Premier Network
You will get the best value from your Delta Dental Plan when you receive your dental
care from one of our PPO (greatest savings) or Premier network participating dentists:

¥ No Balance Billing: Because participating dentists accept Northeast Delta Dental's
allowed fees for services, you will typically pay less when you visit a participating
dentist.

No Claims Paperwork: Participating dentists will prepare and submit claims for you.

City of Nashua/NSD
Plan E

Outline of Coverage
Delta Dental Premier Network

Northeast Delta Dental

APPENDIX D

Dental Insurance Coverage

FIRST STEP RESPONSE: The grievance was submitted to me on

My response is as follows:

Signed Title: Date

SECOND STEP RESPONSE: The grievance was submitted to me on

My response is as follows:

Signed Title Date _

THIRD STEP RESPONSE: The grievance was submitted to me on

My response is as follows:

Signed _Title Date

FOURTH STEP RESPONSE: The grievance was submitted to me on

My response is as follows:

Signed es Title Date

eee RR ROR RE *

AIFSCME Council 93

OFFICIAL GRIEVANCE FORM

Employer _ 7 Date Submitted: Step 1
Local No. Dept. 25
Local Grievance No. 4 Class Action 3,
Grievant 4.
Title 5:
Address Work Phone

Home Phone
Immediate Supervisor Title
I Authorize AFSCME Local___ As My Representative To Act For Me In The Processing Of This Grievance.

Date Signature of Employee _ —

Signature of Union Rep. Title

AT EACH STEP, MAKE 3 COPIES OF THE GRIEVANCE
1 TO THE UNION. 1 TOMANAGEMENT. | WORKING COPY

STATEMENT OF GRIEVANCE

APPENDIX C

AFSCME Council 93 Grievance Form

AGREEMENT BETWEEN THE
BOARD OF PUBLIC WORKS REPRESENTING THE
CITY OF NASHUA, NEW HAMPSHIRE AND THE
AMERICAN FEDERATION OF STATE, COUNTY AND
MUNICIPAL EMPLOYEES, LOCAL #365

APPENDIX B
RUBBISH COLLECTION - PICKUP-GO HOME

APPENDIX A
CLASSIFICATION WAGE SCHEDULE

WITNESS THEREOF, the parties hereto have hereunto set their hands as of
20452021.

Signed, sealed and delivered in the presence of:
Nashua, New Hampshire City Employees City of Nashua, New Hampshire

Local #365, American Federation of
State, County & Municipal Employees

President, Local 365 - Mayor
Staff Representative AFSCME Council 93 Witness
Witnesses for the Union: Board of Public Works

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C. If any provisions of this agreement is or shall at any time be determined contrary
to law by a Court of Competent jurisdiction, then such provision shall not be applicable or
performed or enforced except to the extent permitted by law. In the event that any provision of
this agreement is or shall at any time be determined to be contrary to law by a Court of
competent jurisdiction all other provisions of this agreement shall continue in effect_and the
parties agree to negotiate on the stricken provision immediately thereafter.

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