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CM Advanced Disability; Eric CogbillAGREEMENT FOR ADVANCED DISABILITY PENSION PAYMENTS This Agreement is made as of the.M7a day of .4M/,L , 2015, by and between Eric Cogbill ("Cogbill") and the City of San Rafael ("San Rafael") RECITALS WHEREAS, Cogbill has asserted that he was injured during the course and scope of his employment for San Rafael; and WHEREAS, Cogbill, as a result of his injuries, has applied for Disability Retirement with the Marin County Employees' Retirement Association ("MCERA"); and WHEREAS, Cogbill has requested advanced disability pension payments from San Rafael pursuant to Labor Code §4850.4; and WHEREAS, San Rafael has agreed to make advanced disability pension payments to Cogbill pending a determination of his eligibility for Disability Retirement by MCERA; and WHEREAS, Cogbill is aware of his responsibilities pursuant to Labor Code §4850.4, including the repayment of funds to San Rafael of any funds advanced to him; AGREEMENT NOW, THEREFORE, the parties agree as follows: 1. San Rafael will advance disability pension payments to Cogbill pursuant to the provisions of Labor Code §4850.3 and §4850.4, in the amount of $4161.88 per month payable from April 10, 2015 through the first day of retirement. This amount is based upon MCERA's estimate of the monthly amount payable as calculated based upon 50% of the estimated highest average annual compensation earnable by Cogbill during his period of employment from March 1, 2012 through February 28, 2015. 2. Cogbill agrees that he 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 §4850.4. 3. Cogbill agrees that if his application for Disability Retirement is granted by MCERA, and he receives a retroactive benefit payment, that he 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 him. 4. Cogbill further agrees that in the event that his application for Disability Retirement is denied by MCERA, he will, within fourteen (14) calendar days of the date of said final denial, meet with San Rafael to agree upon a repayment plan, absent which the matter will be submitted for 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. CITY OF SAN RAFAEL - '—yZ0'6-qW"4 el�� �- 4'' NANCY MACAE, City Manager ERIC 0. 1 APPROVED AS TOFORM: ROBERT Attorney ESTHER C. :•' 'r City Clerk