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HomeMy WebLinkAbout3392_CCv0001.pdf RESOLUTION NO . 3332 A RESOLUTION OF THE CITY OF REDLANDS ESTABLISHING A SELF-INSURED RETENTION PROGRAM AND CREATING AN INSURANCE TRUST FUND WHEREAS, it is necessary for the City of Redlands to establish a self-insured retention program to satisfy general liability insurance .requirements: of the City, and WHEREAS, it is necessary to accumulate reserve funds in support of this program, BE IT HEREBY RESOLVED as follows ; 1. That an Insurance Trust Fund be created. 2 . That charges to the various funds for liability insurance coverage be accumulated in the Insurance Trust Fund. 3 . That reserves established in this fund be used only to satis- fy claims against the City or to satisfy expenses .incurred in conjunction with the liability insurance program of the City. 4. That all funds in said Insurance Trust Fund shall be held in an inactive account, or all, or part of said funds may be invested in a manner provided by law in the State of California. 5 . That all interest paid for such investments shall be credited to the Insurance Trust Fund. BE IT FURTHER RESOLVED, that the Finance Director be authorized to establish an imprest cash account with the insurance carrier to facili- tate payment of small claims not exceeding $2,500 .00 . The balance in this account will not exceed a two-month cost experience. This resolution shall take effect on the 16th day of August , 1977. ADOPTED, SIGNED and APPROVED this 17th, day o,fr... gust, 1.977 . " a'^ ATTEST: Mayor Cit f 'Rends 83 Ci§ ger APPROVED FOR FORS. City Attor y DEPATU'M�rt4y OF INDUSTR)AL IZELIVW;- �'!1'f-h1iurcncc Plans A 4-61 -91003 Fourth Street, Room 8- a Januaty 1979 Satrame"to CalifOrllla 95§,44 DEPARTMENT OF MDUSTR IAL RE LATIONS SELF-INSURkiCE PLANS APPLICATION FOR A CERTIFICATE OF CONSENT TO SELF-INSURE for Public Entities Read instructions before completing. All questions must be answered. If not applicable use symbol NIA, Workers`Compensation Insurance must be alaintained until certificate is effective. To the Director of Industrial Relations The undersigned, an employer, hereby applies for a Certificate of Convent to Self-AInsure the payment of Workers'Compensation as provided by Section 3700,I-abor Code of California. The following information is submitted, u.nder penalty of perjury,for the purpose of procuring a Certificate of Consent to Self-Insure, which may be given upon proof, satisfactory to the Director of Industrial Relations, of ability to self-insure and to pay compensation that may become due to employees. 1. Official Name of Applicant (Show nkme exactly as it is in the Charter of other official doctiments) 2. Principal office address(include county) .-_IQqqj_on Stree(r__.-Redlands, San Bernardino, CA 3. Person in charge of Self Insurance Program __9,, L. Archbold, Finance Director 4. City Type of Public Entity G-e- T�1.e-r-.......q-I Law......- - ......... (Chartero-1 City,General I-iw City,Special District,etc.) S. joint Pooling or Joint Powers Agreement: Yes Pilo If a Member provide: Effective Date of JPA Membership Prior to JPA Membership Yes 0 No C] JPA Entity Name ----------- Nai-neofJPA Manager Address ......----............ Telephone 6. Currently insured? Yes L-1 No RI If yes:Current Yearly Premium JAN. - NOV. 1978: 7. Current Yearly Incurred Losr,-s (FY) ----- -.$12-1,_-3_M..,_$.0- Pa i .$12-1, 3-M-8.0- Paki and Unp--e 1,wflity 8. Claims Self-Administered? Yes [I No If yes.- Narne of individual Claims Administrator ....... Telephone 9. Claims Agency Administered? Yes s, No If ves.- Name of Agesicy ........... Address of Agency ---18 0 Q......1% -A,4 CA— Telephone 213 - 556 ...... 10. Total Nurnberof Employees: 11. Number of Public Safety Officers(Law eriforcernent,policemen,firemen, 12. Name of Individual responsible for safety and accident prevention, Name H. L. Archbold -Title Address ------- 92373 AGREEMENT This application is filed with the understanding and the agreement of the applicant herein that a Certificate of Consent to Self-Insure, if granted, will be accepted subject to the authority of the Director of Industrial Relations to prescribe the rules and regulations upon which said Certificate of Consent to Self-Insure shall be granted or continued and subject to the full right and authority of the said Director of Industrial,Relations to prescribe new and additional rules and regulations. It is further agreed that,following revocation or invalidation of gaid certificate,the applicant will pay fees and expenses as provided in the rules and regulations. - _A.KcM)�Qld ------the undersigned,certify unde=r penalty ofPerjury,that I am acquainted with (Prtnt(it Type) the affairs oFsaid applicant employer to which the representations arid staternents_,,et forth in the foregoing application, attachments,exhibits,and addenda relate:that I have readsaidqppfication,attachments,exhibits,andaddenda,know the contents thereof and that said representations and statements therein contained are true to the best of my knowledge,information,and belief. Subscribed andsealedat_.Md1and.;q,__CA t is ___day of. _,Tan_uary___ 19 7 9____ h Attest: 1'—)2, z Z signature(AuthorizQd by Re solutk)n) -s-ignature Title _-DirccLnancp....... (SEAL OF APPLICANT)* RESOLUTION Attach cupy(ies)of Governing Body's Resolution or minuif_,s of the meeting whereby Self- insured status for workers canipensation liabilities was authorized and that certain persons (by job title)were authorized to act for the 11>dy in this regard. 1,Pe ggy 11.11 --A--.- the undersigned Clerk of the said City--c f a public entity, hereby certify bhit I arra the Clerk of the said public entity, that the foregoing is a full,true and correct copy of the resolution duly passed by the ----------------------thereof ata meeting of said authority Authcm'y--Govornirt-,R� xly field on the day aod at the place therein 5pecified, and that said resolution has never been revoked, rescinded, or set aside,and is now in full force and effect. IN WITNESS WHEVEOF,I HAVE SIGNED BY NAXIE AND AFIXED THE SEAL OF THIS _Ct... .... ..... TRIS ry ig f'"fity (SEAL OF APPLICANT)* SIGNAT URE: *Note seal is required to be affixed twice.