HomeMy WebLinkAbout1982-05-27 - Resolution No. 82-17RESOLUTION NO. 82-17
RESOLUTION OF THE BOARD OF DIRECTORS OF THE YORBA LINDA COUNTY WATER DISTRICT
AMENDING RESOLUTION NO. 81-21 JOINT POWERS AGREEMENT AND
BY-LAWS FOR PROGRAM CSDA WORKMAN COMPENSATION INSURANCE
AMENDMENT TO JOINT POWERS AGREEMENT
AND BYLAWS
WHEREAS this District has previously signed a Joint
Power's Agreement providing for a collective self-insurance
program for worker's compensation benefits which is known
as Program CSDA; and
WHEREAS Bylaws for said Program CSDA is attached to
said Joint Powers Agreement; and
WHEREAS the parties hereto desire to amend said Joint
Powers Agreement and said Bylaws as follows;
NOW, THEREFORE, IT IS AGREED that said Joint Powers
Agreement and the Bylaws attached thereto are amended as
follows:
(1) Paragraph (4) of the Joint Powers Agreement is
amended to provide that the Agreement shall become effective
on July 1, 1982, providing that upon that date districts having
a combined worker's compensation premium based on manual rates
of at least ;150,000 have executed the Agreement and this
Amendment.
(2) Paragraph (8) of the Joint Powers Agreement is amended
to state a date of June 30, 1983, rather than June 30, 1982.
(3) Paragraph (2) of Article I of the Bylaws commencing
with the word "Only" on page 2, line 9, and ending with the
words "special district" on line 12, page 2 is deleted and
r I
the following is substituted therefor:
"Only one member from any district may serve
on the Committee at the same time. An effort
will be made to seek representation on the
Committee from various types of special
districts."
(4) Paragraph (1) of Article IX on page 18 of the Bylaws
is amended by changing the date "January 1, 1982" to "July 1,
1983".
(5) All of the terms and conditions of said Joint Powers
Agreement and of said Bylaws shall remain in full force and
effect except as herein specifically amended.
Dated: July 1, 1982.
YORBA LINDA COUNTY WATER
District
B / u. Lt,~: - ✓
Jr~ President
cretary
I IF NIA SPECIAL DIS ICTS
ASSOCI `PION--PROG
1
By
xecutive secretary
-2-
A4-;l
January 1979
r
DEPARTMENT OF INDUSTRIAL RELATIONS
SELF-INSURANCE 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 N/A.
Workers' Compensation Insurance must be maintained until certificate is effective.
To the Director of Industrial Relations
The undersigned, an employer, hereby applies for a Certificate of Consent to Self-Insure the payment of Workers'
Compensation as provided by Section 3700, Labor Code of California.
The following information is submitted, under 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 YORBA LINDA COUNTY WATER DISTRICT
(Show na a eaactl as it is in the Charter or other official documents)
4612 Plumosa Street (P.O. Box 309)
2. Principal office address (include county) Yorba Linda , eA 9 2 6 8 6 [@Lca Gaunt-yJ,
Person in charge of Self-Insurance Program CALIFORNIA SPECIAL DISTRICTS ASSOCIATION
4. Type of Public Entity Special District
(Chanered Cit). General Law City, Special District, etc )
5. Joint Pooling or Joint Powers Agreement: Yes No ❑
If a Member provide:
Effective Date of JPA Membership 7 / 1 / 8 2
JPA Entity Name CALIFORNIA SPECIAL DISTRICTS
Name of JPA Manager Mr. Donald W. McMurchie
_
Address ___555 Capitol Mall, Suite 1001
Sacramento, CA 95814
6. Currently insured? YesU No O
If yes: Current Yearly Premium approx. $11,367
Prior JPA Membership? Yes ❑ No a
ASSOCIATION--PROGRAM CSDA
Telephone 91 ) 444-3317
7. Current Yearly Incurred Losses (FY or CY) Unknown--State Compensation Insurance Fund
Paid and Unpaid Liability
8. Claims Self-Administered? Yes ❑ NoU
If yes: Name of individual Claims Administrator
Address
Telephone
9. Claims Agency Administered? Yes?CX No ❑
If yes: Name of Agency Self-Insurance Administrators . Inc .
Address of Agency 3580 Fifth Avenue, San Diecro, CA 92103
Telephone (714) 297-5211
10. Total Number of Employees: 36
11. Number of Public Safety Officers (Law enforcement, policemen, firemen, etc.) R71tilP
12. Name of Individual responsible for safety and accident prevention.
Name Arthur C. Korn Title Assistant General Manager
Address P.O. Box 309 4622 P1 u►nosa Dr. Yorha Linda Telephone 714 777-301 R
A
0 AGREE:ME:NT a
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 begranted orcontinued
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 furthcr agrecd that, following revocation or invalidation of said certificate, the applicant will
pay fees and expenses as provided in the rules and regulations.
I. `M . Roy_Knauf t the undersigned, certift, under penalty of perjury, that 1 am acquainted with the
trrint or Friel
afjncrs of said applicant employer to which the representations and statements set forth in the foregoing application,
attachments, exhibits. and addenda relate: that I have read said application, attachments, exhibits, and addenda, know
the contents thereof and that said representations and statements therein contained are true to the best of my knowledge,
information, and belief.
Subscribed and sealed at '
Secthis --LO-day of 19 P
Attest:
fs'da/
tr;1e_t'argr
USignature (AuthoriEEd by Resolution)
Title President - Board of Directors
(SEAL OF APPLICANT)'
RESOLUTION
Attach copy(ies) of Governing Body's Resolution or minutes of the meeting whereby self-
insured status for workers compensation liabilities was authorized and that certain persons
(by job title) were authorized to act for the Body in this regard.
Secretary
I, Jean F- Mathews, , the undersigned Cke+h of the said
tPnnt of Typel
a public entity, hereby certify that I am thh rrP(ctArAe said public entity, that the foregoing is a full, true and correct
copy of the resolution duly passed by the Board of Dirert-nrc , thereof at a meeting of said authority
Authority --Governing Body
held on the day and at the place therein specified, and that said resolution has never been revoked, rescinded, or set
aside, and is now in full force and effect.
IN WITNESS WHEREOF, I HAVE SIGNED BY NAME AND AFFIXED THE SEAL OF THIS
Yorba Linda County Water Di"Tl_~ t 6 DAY OF 19
entity /
(SEAL. OF APPLICANT)' SIGNATURE: Qirn-N
'Note seal is required to be affixed twice.
-2-
M M
RESOLUTION NO. 82-17
RESOLUTION OF THE BOARD OF DIRECTORS OF THE YORBA LINDA COUNTY WATER
DISTRICT AMENDING RESOLUTION NO. 81-21-JOINT POWERS AGREEMENT AND BY-
LAWS FOR PROGRAM CSDA WORKMAN COMPENSATION INSURANCE
Passed and adopted this 27th day of May 1982 by the following called vote:
Ayes: Directors Lindow, Clodt, Cromwell Armstrong and Knauft
Noes: none
Absent None
ATTEST:
President
Secretary