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Home My WebLink AboutRESO 9514DocuSign Envelope ID: DAE36141-2855-4763-BBD2-72236EC24BOB RESOLUTION NO. 9514 FIXING THE EMPLOYER CONTRIBUTION AT AN EQUAL AMOUNT FOR EMPLOYEES AND ANNUITANTS UNDER THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT WHEREAS, (1) WHEREAS, (2) WHEREAS, (3) RESOLVED, (a) RESOLVED, (b) RESOLVED, (c) RESOLVED, (d) WITH RESPECT TO A REGOCNIZED EMPLOYEE ORGANIZATION City of Palo Alto is a contracting agency under Government Code Section 22920 and subject to the Public Employees' Medical and Hospital Care Act (the "Act") for participation by members of Palo Alto Peace Officer Association and Government Code Section 22892(a) provides that a contracting agency subject to Act shall fix the amount of the employer contribution by resolution; and Government Code Section 22892(b) provides that the employer contribution shall be an equal amount for both employees and annuitants, but may not be less than the amount prescribed by Section 22892(b) of the Act; and That the employer contribution for each employee or annuitant shall be the amount necessary to pay the full cost of his/her enrollment, including the enrollment of family members, in a health benefits plan or plans up to a maximum of the PEMHCA Minimum per month, plus administrative fees and Contingency Reserve Fund assessments; and be it further City of Palo Alto has fully complied with any and all applicable provisions of Government Code Section 7507 in electing the benefits set forth above; and be it further That the participation of the employees and annuitants of City of Palo Alto shall be subject to determination of its status as an "agency or instrumentality of the state or political subdivision of a State" that is eligible to participate in a governmental plan within the meaning of Section 414(d) of the Internal Revenue Code, upon publication of final Regulations pursuant to such Section. If it is determined that City of Palo Alto would not qualify as an agency or instrumentality of the state or political subdivision of a State under such final Regulations, CaiPERS may be obligated, and reserves the right to terminate the health coverage of all participants of the employer. That the executive body appoint and direct, and it does hereby appoint and direct, People Strategy and Operations to file with the Board a verified copy of this resolution, and to perform on behalf of The City of Palo Alto all functions required of it under the Act. Adopted at a Regular meeting ofthe City of Palo Alto City Council at 250 Hamilton Ave, this 1st day of June, 2015. Signed: ~ (U M-A--- (President, Chai~ Att~ (Secretary or appropriate officer) CHANGE-BY GROUP, EQUAL, 1 FIXED (REV. 5/2015) DocuSign Envelope ID: DAE36141-2855-4763-BBD2-72236EC24BOB INSTRUCTIONS This resolution form is the approved form designated by the California Public Employees' Retirement System (CaiPERS). It should be used by a contracting agency subject to Public Employees' Medical and Hospital Care Act (PEMHCA) when the agency desires to change the monthly employer health contribution for employees and annuitants in accordance with Government Code Section 22892. The resolution is effective on the first day of the second month following the month in which the resolution is filed (date stamped as received by CaiPERS; See address below). WHEREAS, (1) RESOLVED, (a) RESOLVED, (b) RESOLVED, (c) RESOLVED, (d) RESOLVED, (d) should be completed with full name of the contracting agency and recognized employee organization. should be completed to specify the amount of the employer contribution toward the cost of enrollment for active employees and annuitants. The amount specified must be an amount equal to or greater than that prescribed by Section 22892(b). Commencing January 1, 2009, the employer contribution shall be adjusted annually by the Board to reflect any change in the medical component of the Consumer Price Index, and shall be rounded to the nearest dollar. should be completed with full name of the contracting agency. should be completed with full name ofthe contracting agency. requests the position title of the individual who handles the PEMHCA resolution for the contracting agency. should be completed with full name of the contracting agency. Because resolutions serve as a legally binding document, we require the original resolution, certified copy with original signatures, or a copy of the resolution with the agency's raised seal. For resolution processing, deliver to the following: Overnight Mail Service California Public Employees' Retirement System Health Contracts Unit 400 QStreet Sacramento, CA 95811-6210 Regular Mail California Public Employees' Retirement System Health Contracts Unit PO BOX 942714 Sacramento, CA 94229-2714 The certification shown following the resolution is to be completed by those individuals authorized to sign for the contracting agency in legal actions and is to include the name of the executive body; i.e. Board of Directors, Board of Trustees, etc., the location and the date of signing. CHANGE-BY GROUP, EQUAL, 1 FIXED (REV. 5/2015) DocuSign Envelope ID: DAE36141-2855-4763-BBD2-72236EC24BOB INTRODUCED AND PASSED: June 1, 2015 AYES: BERMAN, BURT, FILSETH, HOLMAN, KNISS, SCHARFF, SCHMID, WOLBACH NOES: ABSENT: DUBOIS ABSTENTIONS: ATIEST: City Clerk Mayor APPROVED AS TO FORM: APPROVED: QDocuSigned by: ~·!(/tf-r 39E7298FB2064DB ... Deputy City Attorney City Manager (l:DocuSigned by: L~73~=- Director of People Strategy & Operations "DocuSigned by: L.:'hl Pt!~,. B2ADF35ED7C5496 ... Director of Administrative Services CHANGE-BY GROUP, EQUAL, 1 FIXED (REV. 5/2015) Docu~ i $1<:1,111111 Certificate of Completion Envelope Number: DAE3614128554763BBD272236EC24BOB Status: Completed Subject: Please DocuSign this document: RESO 9514 PEMHCA Reso for Palo Alto Peace Officer Association.pdf Source Envelope: Document Pages: 3 Certificate Pages: 5 AutoNav: Enabled Envelopeld Stamping: Enabled Record Tracking Status: Original 6/4/20151:24:44 PM PT Signer Events Albert S Yang Albert. Yang@CityofPaloAito.org Deputy City Attorney Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 6/4/2015 2:52:02 PM PT ID: df2aa1 bb-61d1-4b61-8085-26dc55993a35 Lalo Perez Lalo.Perez@CityofPaloAito.org Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 6/4/2015 8:53:28 PM PT ID: 03fb1 c9d-e0ce-4eb5-a314-9802e3aed84b Kathy Shen Kathryn.Shen@CityofPaloAito.org Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 6/5/2015 2:09:53 PM PT ID: 1 b6634bb-8d07 -4 798-9b1 d-37eeba32aebf James Keene james.keene@cityofpaloalto.org City Manager City of Palo Alto Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 4/14/2015 5:40:07 PM PT ID: 44fe333a-6a81-4cb 7 -b 7d4-9254 73ac82e3 In Person Sign~r Events Editor Delivery Events Signatures: 4 Initials: 0 Holder: Kim Lunt kimberly.lunt@cityofpaloalto.org Signature Using IP Address: 45.37.102.216 I,OocuSigned by: ~t.. p, .. ~ 82AOF35ED7C5496 ... Using IP Address: 162.232.168.58 Signed using mobile Using IP Address: 108.208.197.191 Using IP Address: 199.33.32.254 Signature Status Envelope Originator: Kim Lunt 250 Hamilton Ave Palo Alto , CA 94301 kimberly.lunt@cityofpaloalto.org IP Address: 199.33.32.254 Location: DocuSign Timestamp Sent: 6/4/20151:35:21 PM PT Viewed: 6/4/2015 2:52:02 PM PT Signed: 6/4/2015 2:52:32 PM PT Sent: 6/4/2015 2:52:34 PM PT Viewed: 6/4/2015 8:53:28 PM PT Signed: 6/4/2015 8:54:17 PM PT Sent: 6/4/2015 8:54:19 PM PT Viewed: 6/5/2015 2:09:53 PM PT Signed: 6/5/2015 2:17:57 PM PT Sent: 6/5/2015 2:17:59 PM PT Viewed: 6/17/2015 5:19:45 PM PT Signed: 6/17/2015 5:19:59 PM PT Timestamp Timestamp