HomeMy WebLinkAboutHR Advanced Disability; James BellamyAGREEMENT FOR ADVANCED DISABILITY PENSION PAYMENTS
This Agreement is made as of the 0 day ofD^ �, 2Z2 U, by and between James Bellamy
("Bellamy") and the City of San Rafael ("San Rafael")
RECITALS
WHEREAS, Bellamy has asserted that he was injured during the course and scope of his
employment for San Rafael; and
WHEREAS, Bellamy, as a result of his injuries, applied for Disability Retirement with the
Marin County Employees' Retirement Association ("MCERA") on August 22, 2022; and
WHEREAS, Bellamy 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 Bellamy
pending a determination of his eligibility for Disability Retirement by MCERA; and
WHEREAS, Bellamy 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 Bellamy pursuant to the
provisions of Labor Code §4850.3 and §4850.4, in the amount of $5,598.14 per month payable from
November 15, 2022 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 Bellamy during his period of employment from October 6, 2003 through
October 15, 2022.
Payments
Final Audit Report
2022-11-14
Created: 2022-11-03
By: Rhonda Castellucci (rhonda.castellucci@cityofsanrafael.org)
Status: Signed
Transaction ID: CBJCHBCAABAAB12N4DOARw9ckxWkh7B7wpQokCCsZeSR
"Bellamy - Agreement for Advanced Disability Payments" History
Document created by Rhonda Castellucci(rhonda.castellucci@cityofsanrafael.org)
2022-11-03 - 10:59:52 PM GMT- IP address: 199.88.113.8
Document emailed to jgreyatty@aol.com for signature
2022-11-03 - 11:01:53 PM GMT
Email viewed by jgreyatty@aol.com
2022-11-09 - 11:24:44 PM GMT- IP address: 98.37.28.51
0o Signer jgreyatty@aol.com entered name at signing as John Grey
2022-11-09 - 11:30:00 PM GMT- IP address: 98.37.28.51
6�1-0 Document e-signed by John Grey (jgreyatty@aol.com)
Signature Date: 2022-11-09 - 11:30:02 PM GMT - Time Source: server- IP address: 98.37.28.51
Document emailed to bellamy518@yahoo.com for signature
2022-11-09 - 11:30:04 PM GMT
aL-'j Email viewed by bellamy518@yahoo.com
2022-11-09 - 11:48:54 PM GMT- IP address: 67.160.254.248
Signer bellamy518@yahoo.com entered name at signing as James Bellamy
2022-11-09 - 11:50:14 PM GMT- IP address: 67.160.254.248
Document e-signed by James Bellamy (bell amy518@yahoo.com)
Signature Date: 2022-11-09 - 11:50:16 PM GMT - Time Source: server- IP address: 67.160.254.248
-71 Document emailed to jim.schutz@cityofsanrafael.org for signature
2022-11-09 - 11:50:17 PM GMT
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