HomeMy WebLinkAboutHR 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.
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A PROVED AS TO FORM:
s� ROBERT F. EPSTEIN City Attorney
ATTEST:
LINDSAY LARA, City Clerk
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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
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