City Beverages Enrollment - Web Book - Ready - Flipbook - Page 20
CITY BEVERAGES 401(K) PLAN
Investment Election/Change Form
Mr. Kent Birckhead
City Beverages, LLC
10928 Florida Crown Drive
Orlando, FL 32824
Certified Benefits Corp
1111 Douglas Avenue
Altamonte Springs, FL 32714
SECTION 1: Investment Option Election – this investment election will be applied to all contribution types.
You may select from the following list of Model Investment Portfolios, Target Date Funds or Mutual Funds.
□
Future Contributions
□
Existing account balance
□
Both Future and Current
Percentage to be
Allocated
_____.0%
Additional Investment Options:
Cohen & Steers Instl Realty – CSRIX
Percentage to be
Allocated
_____.0%
Moderately Conservative
_____.0%
Dodge & Cox Global Bond – DODLX
_____.0%
Moderate
_____.0%
Fidelity Advisor Intl Sm Cp I – FIXIX
_____.0%
Moderately Aggressive
_____.0%
JP Morgan Mid Cap Growth R6 - JMGMX
_____.0%
Aggressive
_____.0%
Target Date Funds
Vanguard Target Retirement Inc Inv - VTINX
Vanguard Target Retirement 2020 - VTWNX
Vanguard Target Retirement 2025 - VTTVX
_____.0%
_____.0%
_____.0%
Invesco Oppenheimer Discovery R6 - ODIIX
Invesco Oppenheimer Intl SmMd R6 - OSCIX
PIMCO Income Instl - PIMIX
Invesco Stable Value Trust I – QJQKQ
American Funds Bond Fund R6 - RBFGX
American Fnds American Bal R6 - RLBGX
_____.0%
_____.0%
_____.0%
_____.0%
_____.0%
_____.0%
Vanguard Target Retirement 2030 - VTHRX
_____.0%
American Fds New Perspective R6 - RNPGX
_____.0%
Vanguard Target Retirement 2035 - VTTHX
_____.0%
Vanguard Equity-Income Adm - VEIRX
_____.0%
Vanguard Target Retirement 2040 - VFORX
_____.0%
_____.0%
Vanguard Growth Index Fund; Adm -VIGAX
_____.0%
Vanguard Target Retirement 2045 - VTIVX
Vanguard 500 Index Admiral - VFIAX
_____.0%
Vanguard Target Retirement 2050 - VFIFX
_____.0%
Vanguard Federal Money Mkt - VMFXX
_____.0%
Vanguard Target Retirement 2055 - VFFVX
_____.0%
Vanguard Materials Idx Admiral - VMIAX
_____.0%
Vanguard Target Retirement 2060 - VTTSX
_____.0%
Vanguard Mid-Cap Val Idx Adm - VMVAX
_____.0%
Vanguard Target Retirement 2065 - VLXVX
_____.0%
Vanguard Short-Term Treasury Idx - VSBSX
_____.0%
Vanguard Small Cap Val Idx Adm - VSIAX
_____.0%
Vanguard Devlpd Mkts Idx Adm - VTMGX
_____.0%
Model Investment Portfolios
Conservative
TOTAL MUST EQUAL 100%
Automated Investment Strategies – (To be used only if more than one investment option is chosen.) Please choose
one of the following options (if no selection is made and more than one investment option is chosen above, the
account will be rebalanced annually). Please note that rebalancing will occur only if the initial allocation changes
by two percentage points or more.
❑ Do Not Rebalance
❑ Monthly
❑ Quarterly
❑ Semi-Annually
❑ Annually
SECTION 2: Signature – Review to make sure that you have completed each section fully. Please return this form
to your employer.
Employee Name (printed):______________________________________ SSN: ___________________________
Employee Signature: __________________________________________ Date: ___________________________
Employer Signature: __________________________________________ Date: ___________________________
Special 404 (c) Regulations Section and Notice of Limited Liability. This plan intends to comply with ERISA 404 (c) and Title 29 of CFR 2550.404 c-1. Plan Fiduciaries may be
relieved of liability for any losses that may result from participant’s investment instruction.