HomeMy WebLinkAboutHR Advanced Disability; Elisha AdamsAGREEMENT FOR ADVANCED DISABILITY PENSION PAYMENTS
This Agreement is made as of the 26 day of JULY , 2023, by and between Elisha Adams
("Adams") and the City of San Rafael ("San Rafael").
RECITALS
WHEREAS, Adams has asserted that he was injured during the course and scope of his
employment for San Rafael; and
WHEREAS, Adams, as a result of his injuries, applied for Disability Retirement with the Marin
County Employees' Retirement Association ("MCERA") on June 14, 2023; and
WHEREAS, Adams 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 Adams
pending a determination of his eligibility for Disability Retirement by MCERA; and
WHEREAS, Adams acknowledges that he 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:
San Rafael will advance disability pension payments to Adams pursuant to the provisions
of Labor Code §4850.3 and §4850.4, in the amount of $5,266.69 per month payable from July 1, 2023
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 Adams during his period of employment from February 12, 2007 through June 20, 2023.
2. Adams 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
Adams - Agreement r
Final Audit Report
Created:
2023-07-26
By:
Jennifer Alcantara Qennifer.acantara@cityofsanrafael.org)
Status:
Signed
Transaction ID:
CBJCHBCAABAAuETrppTh1PjbgdQmBxZy3RGfgoWOibDq
2023-08-02
"Adams - Agreement for Advanced Disability Payments —GC" His
tory
Document created by Jennifer Alcantara (Jennifer.alcantara@cityofsanrafael.org)
2023-07-26 - 5:44:36 PM GMT- IP address: 199.88.113.8
Document emailed to elishaadams552@gmail.com for signature
2023-07-26 - 5:46:24 PM GMT
Email viewed by elishaadams552@gmail.com
2023-07-26 - 6:11:57 PM GMT- IP address: 166.137.163.35
00 Signer elishaadams552@gmail.com entered name at signing as Elisha R Adams
2023-07-26 - 6:24:32 PM GMT- IP address: 166.137.163.35
Document e-signed by Elisha R Adams (elishaadams552@gmail.com)
Signature Date: 2023-07-26 - 6:24:34 PM GMT - Time Source: server- IP address: 166.137.163.35
Document emailed to jgreyatty@aol.com for signature
2023-07-26 - 6:24:35 PM GMT
Email viewed by 19 Y Y@ re att aol.com
2023-07-31 - 5:23:59 PM GMT- IP address: 50.209.169.185
Signer jgreyatty@aol.com entered name at signing as John J Grey
2023-07-31 - 5:25:06 PM GMT- IP address: 50.209.169.185
Document e-signed by John J Grey (jgreyatty@aol.com)
Signature Date: 2023-07-31 - 5:25:08 PM GMT - Time Source: server- IP address: 50.209.169.185
Document emailed to Genevieve Coyle(genevieve.coyle@cityofsanrafael.org) for signature
2023-07-31 - 5:25:10 PM GMT
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