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HR Advanced Disability Pension PaymentsAGREEMENT FOR ADVANCED DISABILITY PENSION PAYMENTS This Agreement is made as of the U Qday of,"?020, by and between Buffy Paxson ("Paxson-) and the City of San Rafael ("San Rafael") RECITALS WHEREAS, Paxson has asserted that she was injured during the course and scope of her employment for San Rafael, and WHEREAS, Paxson, as a result of her injuries, has applied for Disability Retirement with the Marin County EmploNees' Retirement Association ("MCERA" ); and WHEREAS, Paxson has requested advanced disability pension payments lion San Rafael pursuant to Labor Code §4850.4; and WHEREAS, San Rafael has agreed to make advanced disability pension payments to Paxson pending a detennination of her eligibility for Disability Retirement by MCERA; and WHEREAS, Paxson is aware of her responsibilities pursuant to Labor Code §4850.4, including the repayment of tends to San Rafael of any funds advanced to her; AGREEMENT NOW, THEREFORE, the parties agree as follows: San Rafael will advance disability pension payments to Paxson pursuant to the provisions of Labor Code §4850.3 and §4850.4, in the amount of S4,773.22 per month payable li-om August 12, 2020 through the first day ofretirement. -]'his amount is based upon MCERA-s estimate of the monthly amount payable as calculated based upon 50% of the estimated highest average annual compensation eainable by Paxson during her period of employment fi-om December 9, 2002 through August 15, 2020. 2. Paxson agrees that she will fully cooperate in providing San Rafael with medical information and in attending all statutorily required medical examinations and evaluations set by San Rafael, and fully cooperate with the evaluation process established by MCERA, as required by Labor Code ti4850.4. 3. Paxson agrees that if her application for Disability Retirement is granted by MCERA, and she receives a retroactive benefit payment, that she shall, within fourteen (14) calendar days of receipt of said payment refund to San Rafael an amount equal to the advanced disability pension payments made to her. 4. Paxson further agrees that un the event that her application for Disability Retirement is denied by MCERA, she will, within fourteen (14) calendar days of the date of said final dental, meet with San Rafael to agree upon a repayment plan, absent which the matter will be submitted fbr a local agency administrative appeals remedy that includes an independent level of resolution to determine a reasonable repayment plan, as required by Labor Code $4850.4. IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first hereinabove written. CI ' OF S M - flw"44 e &LO 6c��- _L JI SC UTZ, Cit tanager BUFFY PA N A PROVED AS TO FORM: s� ROBERT F. EPSTEIN City Attorney ATTEST: LINDSAY LARA, City Clerk 7 PXA RAF,gF Z 0 WITH p 5 CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: Human Resources Project Manager: Shibani Nag Extension: 3069 Contractor Name: Buffy Paxson Contractor's Contact: Contact's Email: buffypaxson717@me.com ❑ FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION COMPLETED REVIEWER DEPARTMENT DATE Check/Initial 1 Project Manager a. Email PINS Introductory Notice to Contractor Click --re to ❑ enter a date b. Email contract (in Word) and attachments to City Click here to N/A Attorney c/o Laraine.Gittens@cityofsanrafael.org enter a date. ❑ 2 City Attorney a. Review, revise, and comment on draft agreement Click here to and return to Project Manager enter a date. ❑ b. Confirm insurance requirements, create Job on Click here to N/A PINS, send PINS insurance notice to contractor enter a date. ❑ 3 Department Director Approval of final agreement form to send to 8/16/2020 ❑ contractor 4 Project Manager Forward three (3) originals of final agreement to 8/24/2020 contractor for their signature 5 Project Manager When necessary, contractor -signed agreement ❑X N/A agendized for City Council approval * *City Council approval required for Professional Services ❑ Agreements and purchases of goods and services that exceed Or $75,000; and for Public Works Contracts that exceed $175,000 8/27/2020 Date of City Council approval PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 6 Project Manager Forward signed original agreements to City e-mailed Attorney with printed copy of this routing form 9/2/2020 7 City Attorney Review and approve hard copy of signed agreement 8 City Attorney Review and approve insurance in PINS, and bonds N/A (for Public Works Contracts) 9 City Manager / Mayor Agreement executed by City Council authorized �,/ - �6 )/N1 official91 n 10 City Clerk Attest signatures, retains original agreement and forwards copies to Project Manager I 09111/ 0/41 -GL %_, %