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HomeMy WebLinkAbout11-Personnel cIty OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION From: EDWARD S. RAYA PERSONNEL Subject: RESOLUTION OF THE MA YOR&COMMON COUNCIL . . . EXPRESSING ITS INTENTION TO APPROVE AN AMENDMENT TO CONTRACT BE1WEEN THE BOARD OF ADMINISTRATION OF THE PUBUC EMPLOYEES' RETIREMENT SYSTEM AND THE CITY OF SAN BERNARDINO Dept: Date: APRIL 10, 1998 ORIGINAL Synopsis of Previous Council Action: On October 6, 1997, the Mayor and Common Council approved the Memorandum of Understanding between the City of San Bernardino and employees in the Middle Management Employees' bargaining unit of the City of San Bernardino represented by the San Bernardino Public Employees' Association (SBPEA). On December 1, 1997, the Mayor and Common Council approved a resolution amending Resolution 6413, Section Five and One-Half, for all non-safety management and confidential employees of the City of San Bernardino represented by the San Bernardino Confidential and Management Unit (SBCEA). On February 2, 1998, the Mayor and Common Council approved the Memorandum of Understanding between the City of San Bernardino and employees in the General Unit Employees' bargaining unit of the City of San Bernardino represented by the San Bernardino Public Employees' Association (SBPEA). Recommended Motion: Form Motion: That said Resolution be adopted. ~~ Contact person: Edward S. Raya Phone: 384-5161 Supporting data attached: Yes Ward: FUNDING REQUIREMENTS: Amount: $31.500 Source: (Acet. No.) Various (Acet. Description) Finance: ~k/~/~ Council Notes: t/ /2D I'll Agenda Item NO.....l .-1' CffY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION STAFF REPORT BACKGROUND Mid-Mana2:ement On October 6, 1997, the Mayor and Common Council approved the Memorandum of Understanding between the City of San Bernardino and employees in the Middle Management Employees' bargaining unit of the City of San Bernardino represented by the San Bernardino Public Employees' Association (SBPEA). Article ill, Section 5, fERS, of said MOU states in paragraph 4, "The City agrees to amend its PERS contract to pay the employer contribution for the Fourth Level 1959 Survivors' Benefit, contingent upon approval of a lower employer rate by the PERS Board ($3.50/month) and agreement with the other two (2) miscellaneous bargaining units. ~ement & Confidential On December I, 1998, the Mayor and Common Council approved a resolution amending Resolution 6413, Section Five and One-Half, subsection (1), to apply to all non-safety management and confidential employees of the City of San Bernardino represented by the San Bernardino Confidential and Management Unit (SBCEA), "The City agrees to amend its PERS contract to pay the employer contribution for the 4th Level of 1959 Survivors' Benefit, contingent upon agreement by the other miscellaneous bargaining units. " General Unit On February 2, 1998, the Mayor and Common Council approved the Memorandum of Understanding between the City of San Bernardino and employees in the General Unit Employees' bargaining unit of the City of San Bernardino represented by the San Bernardino Public Employees' Association (SBPEA). Article ill, Section 2, fERS, of said MOU states in fourth paragraph, "The City agrees to amend its PERS contract to pay the employer contribution for the Fourth Level 1959 Survivors' Benefit. " Pursuant to PERS regulations, the Mayor and Common Council must adopt a Resolution of Intention and an ordinance approving an amendment to the PERS contract. Also, an employee election must be held, giving each PERS member in the miscellaneous bargaining units a choice of receiving this benefit or not. The cost to each employee electing to be covered by this benefit will be $2.00 per month (nonrefundable). >, . >. . ANALYSIS The attached Resolution of Intention (Exhibit A) states the intention of the Mayor and Common Council of the City of San Bernardino to amend its contract with the Public Employees' Retirement System to provide Section 21574 (Fourth Level of 1959 Survivors' Benefit) for local miscellaneous members who elect to be covered. This benefit provides a monthly allowance to survivors of a member who dies prior to retirement. The benefit is paid in addition to the Basic Death Benefit. Eligible survivors are: . Spouse with two or more children; or three or more dependent children alone . Spouse with one dependent child; or two dependent children alone . One dependent child; or surviving spouse at age 60, or . Dependent parents. COSTING The cost to the City will be $3.50 per month per each employee electing to be covered by this benefit. Costing done during MOU negotiations was $31,500 for all miscellaneous groups. General Unit was $23,500 and Mid-Management and Management/Confidential groups were a total of $8,000. These costs were part of MOU negotiations that were approved by the Mayor and Common Council; the costs have already been included in the FY 97-98 budget and projections for FY 98-99 . RECOMMENDATION Based on the foregoing, it is recommended that the Mayor and Common Council adopt: . Resolution of the Mayor and Common Council of the City of San Bernardino expressing its intention to approve an amendment to contract between the Board of Administration of the Public Employees' Retirement System and the City of San Bernardino. r . 9 10 II 12 I 13 14 . is 161 171 I 181 19 e, ~(Q)[P)W RESOLUTION NO. 2 RESOLUTION OF THE MAYOR AND COMMON COUNCn.. OF THE CITY OF SAt'! BERNARDINO EXPRESSING ITS INTENTION TO APPROVE AN AMENDMENT TO 3 CONTRACT BETWEEN THE BOARD OF ADMINISTRATION OF THE PUBLIC EMPLOYEES' RETIREMENT SYSTEM AND THE CITY OF SAN BERNARDINO. 4 5 6 WHEREAS, the Public Employees' Retirement Law permits the participation of public agencies and their employees in the Public Employees' Retirement System by the execution of a contract, and sets forth the procedure by which said public agencies may elect to subject themselves 7 8 and their employees to amendments to said Law; and WHEREAS, one of the steps in the procedures to anlend this contract is the adoption by the governing body of the public agency of a resolution giving notice of its intention to approve an I amendment to said contract, which resolution shall contain a summary of the change proposed in said ! contract; and WHEREAS. the following is a statement of the proposed change: To provide Section 21574 (Fourth Level of 1959 Survivor Benefits) for local miscellaneous members. NOW, THEREmRE, BE IT RESOLVED, that.the governing body of the above agency does hereby give nOGce of intt'ntion to approve an amendment to the contraCt between said public agency and the Board of Administration of the Public Employees' Retirement System. a copy of said amendment being attached hereto. as Exhibit" A" and by this reference made a part hereof /1/ :0 //( 21 ,ill ,~ "i " ~-' i ,':{ I /;/ 24 tiI ,- -) 'i, 11/ 26 ,- -, I '/ 28 ':iDE dn'r~ir.:r~ ~/( t/w/r7 7 COUNCIL lVIEMBERS: 8 ESTRADA 9 LIEN 10 ARIAS 11 SCffiH~TZ 12 DEVLIN 13 AI"''DERSON 14 . MILLER 15 16 17 . 18 19 20 21 12 ~' _J 24 25 26 27 . 28 1 RESOLUTION OF THE MAYOR AND COMMON COUNCll. OF THE CITY OF SAN BERNARDINO EXPRESSING ITS INTENTION TO APPROVE AN AMENDMENT TO 2 CONTRACT BETWEEN THE BOARD OF ADMINISTRATION OF THE PUBLIC EMPLOYEES' RETIREMENT SYSTEM AND THE CITY OF SAN BERNARDINO. 3 4 I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and 5 6 Common Council of the City of San Bernardino at a of _, 1998, by the following vote, to wit: meeting thereof, held on the _ day AYES NAY~ ABSTAIN ABSENT RACHEL G. CLARK, City Clerk The foregoing Resolution is hereby approved this _ day of __, 1998. JUDITH V ALLES, Mayor City of San Bernardino' Approved as to form and legal content: JAt\fES F. PENMA.'i. City Attorney , i .' By: >.....-t<..-<o // -). , . /. i~---.. ~/ SDEdn~rifl:.res 2 . . . EXHIBIT A A.'VIE~DMENT TO CONTRACT BETWEEN THE BOARD OF ADMINISTRATION OF THE PUBLIC EMPLOYEES' RETIREMENT SYSTEM AND THE CITY COUNCIL OF THE CITY OF S.<\i~ BERNARDINO The Board of Administration, Public Ecpioyees' Retirement System, hereinafter referred to as Board, and the go',erning body of above public agency, hereinafter referred to as Public Agency, having entered into a contract effective March 1,1945, and witnessed February 6,1945, and as amended effecti-,e November i, 1949. September I, 1951, January I, 1952, July I, 1954, February I, 1965, February 24,1969, March 8, 1971, October 1,1973, October 28,1974, March 17, 1975, April 28, 1975, November 10, 1975, July 6, 1977, January 7, 1985, May 27, 1985, September 16, ]988, August 27,1990, August I, ]996, July 3,1997 and January ], 1998 which pro"ides. for participation of Public Agency in said System, Board and Public Agency hereby agree as follows: .' A. Pa:agraphs 1 through Bare- hereby stricken from said contract.as executed effective January ], ] 998, and hereby replaced by the following paragraphs numbered I through 13 inclusive: I. All words and tenns used herein which are defmed in the Public Employecs' Retirement Law shall have the meaning as defined therein unless otherwise specifically provided. "Nonna! retirement age" shall mean age 60 for local miscellaneous members and age 50 for local safety members. 2. Public Agency shall participate in the Public Employees' Retirement System from and after March 1. 1945 making its employees as hereinafter provided, members of said System subject to all provisions of the Public Employees' Retirement Law except such as apply only on election of a contracting agency and are not provided for herein and to all amendments to said Law hereafter enacted except those, which by express provisions thereof, apply only on the election of a contracting agency. 3. Employees of Public Agency in the following classes shall become members of said Retirement System except such in each such class as are excluded by law or this agreement: a. Local Fire Fighters (herein referred to as local safety members); . b. Local Police Officers (herein referred to as local safety members); PLEASE DO NOT SIGN "EXhIBIT ONL~lJ . c. Employees other than local safety members (herein referred to as local miscellaneous members). 4. In addition to the classes of employees excluded from membership by said Retirement Law, the following classes of employees shall not become members of said Retirement System: a. CROSSING GUARDS IDRED ON OR AFTER JANUARY 1, 1952; b. LIBRARY PAGES HIRED ON OR AFTER MARCH 17, 1975; c. LIFEGUARDS; d. SENIOR LIFEGUARDS; e. SUPERVISING LIFEGUARDS; r. RECREATION INTER..'iS; g. RECREATION AIDES; h. RECREATION LEADERS; i. SENIORRECREATIONLEADER~ . j. RECREATION SPECIALIST; k. LOCKER ATTENDANTS; I. VEHICLE OPERATORS; AND m. EXTRA RELIEF HEAVY LABORERS (EXTRA BOARD). . . 1 .. t 5. Prior to January I, 1975, those members who were hired by Public Agency on a temporary and/or seasonal basis not to exceed 6 months were excluded fror.! PERS membership by contract. Government Code Section 20336 superseded this contract provision by providing that any such temporary and/or seasonal employees are excluded from PERS membership subsequent to January I, 1975. Legislation repealed and replaced said Section with Government Code Section 20305 effective July I. 1994. 6. The percentage of final compensation to be provided for each year of credited prior and current service as a local miscellanem.ls member shall be determined in accordance \\ith Section 21353 of said Retirement Law (2% at age 60 Full). 7. The percentage of final compensation to be provided for each year of credited prior and current service as a local safety member shall be determined in accordance with Section 2 I 362 of said Retirement Law (2% at age 50 Full). 8. Public Agency elected and elects to be subject to the following optional prOVISions: a. b. . c. , Sections 2162~. 21626 and 21628 (Post-Retirement Survivor Allowance). Section 21222.1 (Special 5% Increase-1970). Legislation repealed said Section effective January I. 1980. Section 20042 (One-Year Final Compensation). i-LEASE DO NOT SIGi~ "E:Arilti\ i ONlV" d. Section 21024 (Military Service Credit as Public Service), Stattltes of 1974. . e. Section 21222.2 (Special 5% Increase-1971). Legislation repealed said Section effective January I, 1980. f. Section 21319 (Special 15% Increase for Local Miscellaneous Members). g. Section 21573 (Third Level of 1959 Survivor Benefits) for local fire members only. h. Section 20903 (Two Years Additional Service Credit) for local miscellaneous members only. J. Section 21635 (Post-Retirement Survivor Allowance to Continue After Remarriage) for local fire members only. J. Section 21574 (Fourth Level of 1959 Survivor Benefits) for local miscellaneous members only. 9. Public Agency, in accordance with Government Code Section 20790, ceased to be an "employer" for purposes of Section . 20834-. effective .on April 28, 1975. Accumulated contributions of PuHi~Agency shall be fixed"~"nd. determined. as.. provided in Government Code Section 20834, and acclI.!llulated contributions thereafter shall be held by the Board as provided in Government Code Section 20834. . 10. Public Agency shall contribute to said Retirement System the contributions determined by actuarial valuations of prior and future service liability with respect to local miscellaneous members and local safety members of said Retirement System. II. Public Agency shall also contribute to said Retirement System as follows: a. Per covered member. SO per month on account of the liability for the 1959 Survivor Benefits provided under Section 21573 of said Retirement Law. (Subject to annual change.) In addition, all assets and liabilities of Public Agency and its employees shall be pooled in a single account. based on term insurance rates. for survivors of all local fire members. b. Per covered member. S3.50 per month on account of the liability for the 1959 Survivor Benefits provided under Section 21574 of said Retirement Law. (Subject to annual change.) In addition. all assets and liabilities of Public Agency and its employees shall be pooled in a single account, based on term insurance rates. for survivors of all local miscellaneous memb..rs. . .. c. A reasonable amount, as fixed by the Board, payable in one installment within 60 days of date of contract to cover the costs of administering said System as it affects the employees of Public Agency, not including the costs of special valuations or of the periodic investigation and valuations required by law. . d. A reasonable amount, as fixed by the BOll1'd, payable in one installment as the occasions arise, to cover the costs of special valuations on account of employees of Public Agency, and costs of the periodic investigation and valuations required by law. 12. Contributions required of Public Agency and its employees shall be subject to adjustment by Board on account of amendments to the Public Employees' Retirement Law, and on account of the experience under the Retirement System as detennined.. by the 'periodic investigation and valuation required by said Retirement Law. 13. . Contributions required of Public Agency and its employees shall be paid by Public Agency to the Retirement System within fifteen days after the end of the period to which said contributions refer or as may be prescribed by Board regulation. . If more or less than the correct amount of contributions is paid for any pe:iod, proper adjustment shall be made in connection with. subsequent remitta:lces.. Adjustments 011- account of errors in. contributions required of any employe\" may be made by direct payments between the t.'ffiployee and the Board. " B. This amendment shall be effective~e ___ day of <::s . BOARD OF ADMfN1STRA TION~~ CITY COlJNCIL -1;. PUBLIC EMPLOYEES' RETIRE SYSTEM OF THE COOS ,,<<J CITY OF SAi'l BE~INO ,. ~ ,. ("~ ~'::=,,' """ -..c' ~ x; BY ~. BY ,;., KENNETH W. MARZI~ IEF PRESIDING Q1$iCER ACTUARIAL & EMPL R SERVICES DIVISION ::;:. - PUBLIC EMPLOYE~TIREMENT SYSTEM ';~:;' ').. " '-<, ~.v " .19_, -, " . Witn~sS'Date ~".. t::-: Attest: . Clerk AMENDMENT PERS-CON.70ZA IRev. 8\96) . . . CALIFORNIA PUBLIC EMPLOYEES' RETIREMENT SYSTEM Acnlllrial and Employer Services Division Public Agency Contract Services P.O. Box 942709 Sacramento, CA 94229-2709 (916) 326-3420 CERTIFICATION OF GOVERNING BODY'S ACTION I hereby certify that the foregoing is a true a:ld correct copy of a Resolution adopted by the of the (governing body) (public agency) on (date) Clerk/Secretary Title . PERS-CON.12 (rev. 1/96) . . . CALIFORNIA PUBLIC EMPLOYEES' RETIREMENT SYSTEM Actuarial and Employer Services Division Public Agency Contract Services P.O. Box 942709 Sacramento, CA 94229-2709 (916) 326-3420 CERTIFICATION OF COMPLIANCE WITH GOVERNMENT CODE SECTION 7507 I hereby certify that in accordance with Section 7507 of the Government Code the future annual costs as determined by the System Actuary and/or the increase in retirement benefit(s) have been made public at a public meeting of the (governing body) of the (public agency) on which is at least two weeks prior to the adoption of the (date) Resolution/Ordinance. Clerk/Secretary Title Date . PERS-CON-12A (rev. 1/96) . . . AGREEMENT TO POOL 1959 SURVIVOR BENEFITS ASSETS AND LIABILITIES BETWEEN THE BOARD OF ADMINISTRATION OF THE PUBLIC EMPLOYEES' RETIREMENT SYSTEM AND THE CITY COUNCIL OF THE CITY OF SAN BERNARDINO WHEREAS, Government Code Section 21574 provides for a single employer rate to be established to provide benefits under said Section on' account of members employed by contracting agencies electing to include the provision of said Section in their contracts; and WHEREAS, Government Code Section 21574, requires pooling of all assets and liabilities of all contracting agencies subject to said Section; NOW, THEREFORE BE IT AGREED, that assets and liabilities of the Cit'f of San Bernardino and its covered employees shall be pooled"'pursuant to the provisions' of Government Code Section 21574. BOARD OF ADMINISTRATION PUBLIC EMPLOYEES' RETIREMENT SYSTEM CITY COUNCIL OF THE CITY OF SAN BERi'lARDINO BY BY KENNETH W. MARZION. CHIEF PRESIDING OFFICER ACTUARIAL & EMPLOYER SERVICES DIVISION PUBLIC EMPLOYEES' RETIREMENT SYSTEM Date PERS.cON.;9 (Rev. 7,%) , . . . AGREEMENT TO POOL 1959 SURVIVOR BENEFITS ASSETS AND LIABILITIES BETWEEN THE BOARD OF ADMINISTRATION OF THE PUBLIC EMPLOYEES' RETIREMENT SYSTEM AND THE CITY COUNCIL OF THE CITY OF SAN BERi'lARDINO WHEREAS, Government Code Section 21574 provides for a single employer rate to be established to provide benefits under said Section on account of members employed by contracting agencies electing to include the provision of said Section in their contracts; and WHEREAS, Government Code Section 21574, requires pooling of all assets and liabilities of all contracting agencies subject to said Section; NOW, THEREFORE BE IT AGREED, that assets and iiabilities of the City of San Bernardino and its covered employees shall be pooled 'pursuant to the provisions of, Government Code Section 21574. BOARD OF ADMINISTRA nON PUBUC EMPLOYEES' RETIREMENT SYSTEM CITY COUNCIL OF THE CITY OF SAN BER1'\iARDINO BY BY KENNETH W. MARZION. CHIEF PRESIDING OFFICER ACTUARIAL & EMPLOYER SERVICES DIVISION PUBLIC EMPLOYEES' RETIREMENT SYSTEM Date PERS.cON.;9 (Rev, 7/96) " .. .' Jil!!!liERS . Actuarial & Employer Services Division P.O. Box 942709 Sacramento, CA 94229-2709 Telecommunications Device for the Deaf - (916) 326-3240 (916)326-3420 FAX (916) 658-1586 ----0:-.<- "'-:'.. , -' I, .;;:-: ~'. - _~ _.~_:'--r.rj._ ;... ,:t -.-r. -~-j_.4-' ~, ... .. - March 18,1998 EmployercCooe #0061 Reply to Section 220 Mr. Edward S. Raya Acting Director of Personnel City of San Bernardino 300 North D Street San Bernardino, CA 92418 Dear Mr. Raya: ./ Enclosed are two copies of the Resolution of Intention to amend the agency's contract to provide Section 21574 (Fourth Level of 1959 Survivor Benefits) for local miscellaneous members. Also enclosed are the following documents: Form CON-12, Certification of Governing Body's Action. / 1. ~ Form CON-12A, Certification of Compliance With Government Code Section 7507. /' 3. Form CON-24c, Fourth Level of 1959 Survivor Benefits Ballot. 4. Form CON-18, 1959 Survivor Benefits Certification of Employee Election. 5. Agreement to Pool1959 Survivor Benefits Assets and Liabilities. I.-- 6. Form CON-11A, Sample Ordinance. The sample Ordinance is a guide only and is included to allow sufficient time to prepare the Ordinance for a first and fina1 reading. The Resolution of Intention and accompanying documents should not be held pending fina1 reading of the Ordinance. )y" : ~overnment Code Section 7507 ~quires that the future annual costs of the proposed contract \" '. I amendment be made public at a public meeting at least two weeks prior to the adoption of the / 'I' >.J I fina1 Ordinance. The agency is to certify compliance on the enclosed Certification of i ~.\",' Compliance with Government Code Section 7507. _______ '-. The employer cost for the Fourth Level of 1959 Survivor Benefits1Sliso'per m;;;ji&per covered member. Agencies are billed annually and payments mayvary"depending on the funlli!lg1J;sei"\'e, level. In addition, members covered by the 1959 Survivor Benefits contribute $2.00permonth: California Public Employees' Retirement System Lincoln Plaza - 400 P Street - Sacramento, CA 95814 ( . . City of San Bernardino -2- March 18, 1998 After your governing body has adopted the Resolution ofIntention, the next procedure with respect to the 1959 Survivor Benefits is to allow each current member to make an individual election. Members in employment on the effective date of the iimendment may elect whether to // be covered. Participation is required of all future entrants into membership. The supervision ofV'" this election and the details of its conduct are under the control and direction of your agency. _ A ballot, Form CON-24c, including the summary of benefits is to be distributed to all eligible employees to complete and sign. The oriltinal ballots must be returned to this office alon2 with a listin in du licate, of the employees, their Social Security numbers and category miscellaneous, fire, police, etc.) wherein the employees are grouped according to those: 1) who e ected coverage; 2) who did not elect coverage; and 3) who did not return the ballot. Employees ~o~ballot.~!~i~_!lte--E!CJl.cri~d time limi~!i2~.!!.tereby elect not to be covered. _ The list should confirm the results of the election, which are certified on the enclosed Form CON-IS, 1959 Survivor Benefits Certification of Employee Election. NOTE: Anvemployees hired after the election or employed prior to or on the effective date of the amendment must also be given the opportunity to elect coverage. \!TWO copies of the Agreem~ttQ POQU.9~urvivor Benefits Assets and Liabilities are enclosed ! for signature. The agreement will acknowledge that pufiJ[cagencles subject to Section 21574 - I" will have all assets and liabilities pooled into a single account based on term insurance rates, for \ local miscellaneous members. . , --- In summary, the following documents must be returned to this office before we can forward the actual contracts and other final documents necessary to complete the proposed contract. DO NOT HOLD THESE DOCUMENTS PENDING ADOPTION OF THE FINAL ORDINANCE. ORIGINAL SIGNATURES ARE REOUIRED 1. Resolution of Intention, original or certified copy. ~ 2. Certific:.atio~ of Goveming Body's Action (CON-l2), original. 3. Certification of Compliance with Government Code Section 7507, (CON-12A), original or certified copy. 4. Fourth Level of 1959 Survivor Benefits Ballots (CON-24c). 5. 1959 Survivor Benefits Certification of Employee Election (CON-IS). 6. Summary listing of employees for 1959 Survivor Benefits. .' . . City of San Bernardino -3- March 18, 1998 7. Agreement to Pool 1959 Survivor Benefits Assets and Liabilities, two original or certified L_._. __ ."._ ._.._.._ copies. If your agency adopts the Resolution of Intention on May 4, 1998, the earliest date the final Ordinance may be adopted is May 24, 1998. There must be a 20 day oeriod between the adootion of the Resolution of Intention and the adoption of the final Ordinance. pursuant to Government Code Section 20471. THERE ARE NO EXCEPTIONS TO Tins LAW. The effective date of this amendment cannot be earlier than the first day of a payroll period following the effective date of the final Ordinance. Please do not retype the Amendment to Contract and/or agreement documents. Only documents provided by this offiee will be aeeepted. If you have a problem with any of the documents, please contact this offiee prior to presenting to your governing body for adoption. If you have any questions regarding this letter or the enclosed material, please do not hesitate to contact me at (916) 326-3625. Sincerely, EI~t~( r Employer Representative Public Agency Contract Services EW:jm Enclosures cc: San Bernardino Regional Office ENDER: _Complete items 1 and/or 2 for additional services. I also wish to receive the . Complete items 3, 48, and 4b. following services (for an . Print your name and address on the reverse of thill form so that we can return this extra fee): ~~m~u. g -Attach this fanntc the front of the mailpiece, or on the back if apace does not 1. 0 Addressee's Address I permit. -Write "Retum R9C6ipt Requ6StlKr on the mailpiece below the articl8 number. 2. 0 Restricted Delivery -The Return Receipt witt show to whom the article was delivered and the date S. delivered. PERS Consult postmaster for fee. _ 3. Article Addressed to: 4a. Article Number J MS ELLIE WRIGHT Z 770 733 916 E EMPLOYEE RBPRESEIlTATIVE 4b. Service Type i PUBLIC AGEIICY COIl1TRACT SERVICES 0 Registered IllI Certified a: .. PERS SECTION 220 0 Express Mail 0 Insured i POBOX 942709 0 Return Racaipt lor Merchandsa 0 COD " SACRAMENTO CA 94229-2709 7. DeteoIDeIlVery~.. A t;6 ~.- :J Q, '~-/, ~ 8. Addressee's nly;( ~... and fea is'1l! 4, r '^ <Il C' UNITED STATES POSTAL SERVICE II First-Class Mall Postaga & Fees Paid USPS Permit No. G-10 . Print your name, address, and ZIP Code in this box. OFFICE OF THE CITY CLERK P. O. BOX 1318 :IAN IlIiIlNAIlDlNO. CA 92402 ~ z no 733 916 Receipt for Certified Mail No Insurance Coverage Provided Do not use for International Mail (See Reverse) ~ - 1Illll'_ '" '" '" ~ Sent 10 Street and No. P.O., State and ZIP Code Postage $ Certified Fee , Spacial Deliverv Fee Restricted Deliverv Fee . Rerum fleceiptShowing to Whom & Date Delivered Return Aeceipt Showing to Whom, . Dale, and Addressee's Address TOTAL Postage $ & Fees Postmark or Date ., ~ ~ ::;: o o CO l'l E o "- lJ) a. , < . C I T Y 0 F- San Bernardino RACHEL C L ARK CITY CLERK June 23, 1998 Ms. Ellie Wright Employee Representative Public Agency Contract Services PERS (Section 220) P.O. Box 942709 Sacramento, CA 94229-2709 Dear Ms. Wright: Pursuant to your letter dated May 8, 1998, addressed to Mr. Edward S. Raya, Director of Human Resources, enclosed are the following described documents: 1. Amendment to Contract, two original executed sets. 2. Certified copy of Ordinance No. MC-I024, authorizing an amendment to contract between the Board of Administration of the Public Employees' Retirement System and the City of San Bernardino. 3. Original certification of Final Action Governing Body (CON-5). 4. Fourth Level of 1959 Survivor Benefits Ballots (CON-24c) 5. 1959 Survivor Benefits Certification of Employee Election (CON-IS). 6. Summary listing of employees for 1959 Survivor Benefits. t P. O. lOX 131'. SAN BERNARDINO, CA .2401 3QO NORTH '0' STREET, SAN BERNARDINO. CALIFORNIA 92418.0001 CI'I)I'4-1002 (ID')3'4.51D2 FAX.CI.I)3.4.11.1 TDD/TIY -(1.1)31.-1140 , . . Ms. Ellie Wright June 23, 1998 Page Two If you have any questions, do not hesitate to call me at (909) 384-5002, or you may call Mr. Raya, Director of Human Resources, at (909) 384-5161. Sincerely, fi_..(J_h.~~ ~. Clark City Clerk RGC:ecg Enclosures Pc: PERS San Bernardino Field Office Fred Wilson, City Admini~trator Barbara Pachon, Director of Finance Edward Raya, Director of Human Resources Valerie Ross, President, SBCMA (Confidential-Management Unit) Jeff Carr, Labor Relations Representative (General Unit) Malcolm Simmons, Labor Relations Representative (Mid-Management Unit) Bernard C. Kersey, General Manager Stacey R. Aldstadt, Deputy General Manager CALIFORNIA PUBUC EMPLOYEES' RETIREMENT SYSTEM Actuarial and Employer Services Division Public Agency Contract Services P.O. Box 942709 Sacramento, CA 94229-2709 (916) 326-3420 CERTIFICATION OF FINAL ACTION OF GOVERNING BODY I hereby certify that the Mayor and C.,...,n Council of the (governing body) City of San Bernardino adopted on June 15, 1998 (public agency) , by an affirmative vote of a majority of the members of said (date) Governing Body, Ordinance No. MC-I024 approving the (Ordinance or Resolution) attached contractual agreement between the Governing Body of said Agency and the Board of Administration of the California Public Employees' Retirement System, a certified copy of said Ordinance in the form furnished by said Board of Administration (Ordinance or Resolution) being attached hereto. ~cret~/- h. ~ City Clerk Title Date .~ I ~I /118 PERS-CON-' (Rev. 1196) CALIFO&~IA PUBLIC EMPLOYEES' RETIREMENT SYSTEM Actuarial and Employer Services Division Public Agency Contract Services Fourth Level 1959 Survivor Benefits Ballot (916) 326-3420 AARON, MARTY 545-94-8097 98 JUN It p CIV '11/:54 CITy or ~~,lt~,~/CE -'''Ifp:ROIN -_..0 Employee Name: Social Security Number: For use by members employed by CITY OF SAN BERNARDINO who are not covered by Social Security on the effective date of the enacting contract to elect to be covered by CalPERS 1959 Survivor Benefits or not to be covered by CalPERS 1959 Survivor Benefits. Please be advised that your election to be covered by the 1959 Survivor Benefits is irrevocable and will remain in effect until y~u retire, change employers, terminate your membership in CalPERS, or come under Social Security coverage. As an employee eligible to participate in this election, should you choose not to be covered by the 1959 Survivor Benefits at this time, you will be provided a second opportunity to elect the coverage within a three month oeriod beginninll nine months followinll the effective date of the aIlencv's contract for such coveralle. This second election will provide an opportunity to elect the 1959 Survivor Benefits, however, it will not provide an opportunity to cancel a previous election for 1959 Survivor Benefits coverage. BEFORE MAKING ELECTION PLEASE READ IMPORTANT INFORMATION ON PAGE 2 FAILURE TO EXECUTE AND RETURN THIS FORM TO YOUR AGENCY ON OR BEFORE FR mAY. .JUNE 1'. 1991L. SHALL BE DEEMED AN ELECTION NOT TO BE COVERED BY CalPERS 1959 SURVIVORBENEFlTS. Vote by marking only one of the spaces provided below which indicates your choice: .X I elect to be covered by CalPERS 1959 Survivor Benefits, as set forth in Section 21574. [ ] I elect not to be covered by CalPERS 1959 Survivor Benefits, as set forth in Section 21574. ~O(MflY\ Signature t, -/O-9f Date PER5-CON-24c(Rev. S197) Pace I CALIFORNIA PUBLIC EMPLOYEES' RETIREMENT SYSTEM Actuarial and Employer Services Division Public Agency Contract Services P.O. Box 942709 Sacramento, CA 94229-2709 (916) 326-3420 1959 SURVIVOR BENEFITS CERTIFICATION OF EMPLOYEE ELECTION I hereby certify the following local miscellaneous employees of the City of San Bernardino were given an opportunity to elect to be subject to Government Code Section 21574, Fourth Level of 1959 Survivor Benefits, as described in the Resolution of Intention adopted by said Agency's govemingbodyon APRIL 20 .19...1lL: Number of employees eligible Number employees electing to Number of employees electing to elect coverage be covered not to be covered 919 473 62 The attached list identifies the names and Social Security numbers of the CalPERS members eligible to elect such coverage and indicates the choices made. ~1)~ll.~ Cler or Secretary J1~ It/ ICjC)g . PERS-CON-18 (Rev. '191) . CITY OF SAN BERNARDINO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES EMPLOYEE SSNO. ELECT I NO ELECTINO RESP Aaron, Marty 516 91 8097 X Acosta, Joseph 569-48-6321 X Adame, Henry 566-56-1419 X Adams, Linda 541-66-7276 X Aguilar, Robert 557-56-9690 X Alarid, Gloria 573-943l61 X Aldstadt, Stacey 459-31-4821 X Alias, Efron 575-7lJ.522D X Allen, Rosemary 571-27-9274 X Allie, Norma 557-4&n19 X Alsop, Dawn 570-72-8515 X Alvarez, Oena ~7 X Alvarez, Josephine 553-42.()312 X Alvillar, Debra 551-96-7311 X Alvord, Mary 557-21-5554 X Andon, Albert 2n-12-7347 X Angiollilo, Leland 557-57-6:'Bl X Arellano, Adollo 565-94-11!1J7 X Arrieta, Con 573-11-9686 X Asperas, Edftha 611-84-1761 X Aspril, Richard 372~7 X Aston, Patricia 572-84-1 (l;6 X Avalos, Manuel 54B-5B-57llO X Baca, David 556-02-3839 X Baeza, Gilbert 554-82-Q891 X Baeza, John 548-lD-7156 X Banuelos, Jacinto 571-62-9381 X B_, Stephanie 526-59-3382 X Becenra, Anthony 54B-58-4703 X Beels, Joseph 54&9-3734 X Benitez, Ricardo 566,55 1897 X Biggs, Delborah 317-66-7656 X Black, Regina 553-33-1137 X Boggs, David 241..-z2 X Bogle, Ernie 429-3J.a7D4 X Botts, Jolenta 573-6B-57B6 X Bragg,Shartene 566-25-4915 X Brainard, Lyman 54B-56-547B X Bravo, Vincent 553-66-1959 X Briggs, Leticia 451.{l4.4()22 X Briones, Matthew 561-79-1847 X Brooks, Jimmie 548-29-2756 X Brooks, Richard 566 91 6750 X Brown, Andrew 553-66-374) X Brown, Robert 571-62-9743 X Browning, Penny 183-32-8322 X Buckner, Juanfta 57D-5D-56B2 X Budde, Paul 561-23-5244 X Buechler, Cynthia 55B-31-977B X Burckhafter, Adolph 434-64$67 X EMPLOYEE Burgett, Kim Bums, Curtis Bums, Margo Cabello, Sheree Cahoon,Eugene Caldera, Arthur Caldera, Kelly Carfos, Terri Carmichael, Jr., Ernest Carrillo, Ramon Carter, Charles Carter, Linda Carter, Vincent Caruso, Eleanor Casas, Richard Castellanos, Irma Castillo, Albert Castillo, George Castro, Miguel Castro, Ramona Cervantes, Cynthia Chacon, Jr., Raoul Chamberlain, Georgia Chartier, Mary Chavez, Gabriel Chavez, Joe ChenauK, Gary Chilcote, Bob Childress, Bill Chism, Jeffrey Clark, James Clark, Rachel Clatf_, Nancy Clay, Paula Clemenn, William Cline, Glenn Coleman. Paula Collette, Paul Colunga, Ruben Conway, Janice Cordova, Suzanna Cortez, Cecelia Cortez, Jesus Cox, Jr., Noah Cronin, Steve Croleau, Judy Dashoff, Robert Davis, James Davis, Roger De leon, Gilbert SSNO. SED 9B 0428 548-2S<l456 57D-02-5BS9 562-96-3742 54Ml2-565B ~ 78-56Sll 565-11.a154 549-31-5297 =-4636 546-76-7902 557-33-8929 436-19-1073 561.s;}.3l99 566-11-S040 571.a4-8501 563-21-6157 ~ 071-4B-05B2 573-11.a7B9 562-4&4505 566-7Q.424) 561-8J.3746 573-11-1644 570-8J.3788 56&5lJ.<:l445 546-11.as72 565-94-0210 559-29-6093 562-17-3100 546-11.a167 5BQ.8O. 7261 553-66-41.29 561-04-9626 559-92.oeeD 573-11-9696 573-1 :>9361 564-21-5126 022-26-7727 5B9-800B51 571-92-91391 ~17-7962 566-25-4011 567-56aOl5B 2~ 557~ 573-2&4712 560-02-2078 554.a2-3209 JB3.6O.2B20 573 91 1548 CITY OF SAN BERNARDINO 4TH lEVEL 1969 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPlOYEES I ELECT I NO ElECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X EMPLOYEE Del Amen, Art Delgado, Frank Dennis, Eleanor Dennis, Richard Diaz, Vince Doemner, Carol Doswell, Lorena Dowdy, Ernest Drennen, Robi Dubois, Rosemary Dunihue, David Dupree, Douglas Duran, Elias Duran, Ruben Dye, James Eads, Jr., Arthur Eckley, Michael Edgington, Mike Enna, Steven Estrada, Helen Estrada, Martin Farrell, Mark Farwick, Kenneth Felix, Michelle Flores, Monica Flores, Paul Flynn, Robert Fonseca, Rafaet Foster, George Franske, Lorelei Frye, Todd Funn, Wayne Gabaldon, Chartos Gabaldon, John Galarza, ApoIinar Galyardt, Susan Gamboa, Kathleen Gantes-Kosliw, Patricia Garcia, Johnny Garcia, Vikki Garcilazo, Grego Gardner, Helen Gardner, Scott Gartand, Mike Garrahan, Dennis Gaston, Ron Gauthier, Stephen Gerrard, Sheny Geny, Paul Gianni, Joe SSNO. 576-9&3152 570-76-9662 317-56-5016 553-66-1963 564-50- n77 297-38-7567 ~7366 54EXJ6.a756 sn-31-n49 553-11-6430 573-94-4164 573 91 '3:2';9 546-11-1074 569 18 99 15 378-86-2729 566-54-46ll9 555-27-8833 5n-2!>lln 335,46-3752 28346al99 561 81 11(5 545-92-5335 5n94-3514 545-61-5&E 567-37-6876 559-21-2548 323-30-6439 549-78-69n 547-70-1868 :J95-46.3I551 285-76-2271 13l-5O-3365 525 91 '550? 559-92-5666 564-25-35191 545.a7-8O&l 501-00-2297 569-Q6-8159 553-11~ 554-82-8120 567-35-eCXl6 546-56-1007 548 13 1301 567-37-81l68 564-96-3927 sn-88-452D 566 B8 9181 scs.axi683 556-25-6450 557$0145 CITY OF SAN BERNARDINO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X EMPLOYEE Giles, Patricia Gipson, Glen Goldsworthy, Barbara Gomez, Eileen Gomez, Josephina Gomez, Raul Gondos, Jim Gonzales, Albert Gonzales, Gregory Gonzaa, Mike Gonzalez, Art Gonzalez, Nancy Graham, De Andre Green, David Green, Jr., Joseph Greer, James Groves, Tina Grubbs, Michael Guajardo, Sylvia Guerrero, Regina Guillen, Roxana Hampton, Vernon Hankins, Trenton Harps, Robin Hartman, Lawrence Hays, Michael Heggi, Bruce Henry, Steven Heredia, Rachel Hernandez, Daniel Hernandez, Dave Hernandez, Edward Hernandez, Kristina Hiatt, Julie Higinbotham, Brad Hill, Jim Hott, Michael Housel, Valerie Houser, Dennis Hovertand, Margo Howell, James Huesca, Cartos Humphrey, Carolyn lnawat, Jun Irene, Santiago Jackson, Cheryl Jackson, John Jacobson, Judith Jensen, Julie Jimenez, Salvador SS NO. 570-76-71B2 568-52-7375 571-64-2434 568-47-2711 460-11-6591 559-S2-7295 571-82-9620 565-94-2445 561""-""'" 573-11-<l7BB 56:>41-3:51 54B-BB-91oo 547 -4Xi135 562-82-3362 56<l2-4769 568-94-2331 018 11?35e 264-B6-6669 54B-8B-5B79 55B-39-9416 147-llO-<l145 426-36-5998 564-99-4269 473-BD-5468 194-26-2BeO 56B-6B-0010 55&80-8471 571-82-7361 566-25-8858 568-52.a5D 572-13-0125 566-37-2666 561-43-1894 546-BB-94B1 173-46<1100 568-39-2842 561-43-6457 545-21-2147 552-41-6493 51Ch32-2541 56D-74al3B 525-78-4253 39111 ~ 493-86-7734 557-41-1439 547-23-8116 572-13-0157 565-64-7333 563-71.{l13l 559-23-B957 CITY OF SAN BERNARDINO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES I ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X EMPLOYEE Johns, Patricia Johnson, Albert Johnson, Catherine Johnson, Donakj Johnson, Jane Jones, Carl Jones, Edward Joyner, Angela Joyner, Bernilla Juarez, Hector Juarez, Saul Kain, Ronaid Karschner, Michael Kassel-Wilkes, Ann Kaulbach, Cha~es Keller, Theresa Kelley, Eddie Kenline, Josefina Kent, Rita Kersey, Bernie Kinney, Irene Klatt, Gene Klemm, Arno Klemm, Bernice Knutson, Lynn Koepsell, Sally Kuhns, Bill Landa, Bonnie Landon, Larry Lawlor, Lynda Lawson, Magi Lazio, Myra Lease, Joseph Ledbetter, steve Ledesma, G~lupe Lee, Barbara Lee, Gregory Leeper, Douglas Lemus, Richard Leon, Sr., Armando Lewis, Mike Linxwiler, Gerald Lopez, Frank Lopez, Mike Lowe, Mike Lugo, Antonio Macias, samuel Macias, Thomas Macon, Ken Macon, Waller SSNO. 562.13-5071 52&m-1750 562.06-7487 546-11-6407 212-56-5671 561-36-3:l67 267-02-4819 547-27.()182 488-56-2663 545-92-6&)6 569-92.a;13 ~ 2tJ3..48.<m3 56&37-1920 559-64-9693 487-82-97a6 56&52-3170 571-4EXXXl2 545-74-1998 SQ6.56-34S7 564-40-3483 568-74-9924 572~ 56'~ 545-21.368) 568-72-9373 568-27-0064 571-84-5906 567-54-8429 362-44-4492 562-17-3794 545-82-1066 550-13-3CXl5 561.Q4-9681 572-64-2451 565-94-1216 565-$-6116 568-17-5413 567-25-1253 557-21-3:)11 554-47-2919 313-38-9651 55B-48-8142 552-37-4975 570-76-7789 5S4-59-9626 550-78-7927 554-82-5591 548.Q6-9239 566-52-6639 CITY OF SAN BERNARDiNO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES I ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X EMPLOYEE Madrid, Leslie Maquinatez, David Marek, Thomas Marks, David Marquez, Daniel Marquez, Jr., Luciano Martin, Maurice Martin, Wenay Martinez, Anita Martinez, Mark Martinez, Ruben Martinez. Veronica Masters, Jack Mauren, Janet May, Rachel McConnaha, Mike McKnight, Maurice Medina, Sandra Mendoza, Cathi Mendoza, Robert Merrill, Lynn Mielke, Helen Miller, David Miller, Melanie Millslagle, Susan Miranda, Frank Mish_k, Dave Mftchell, Robert Molina, Linda Montague, Jr., Robert Montague, Robert Montana, John Morana, Jerry Marcos, Lori Moreno, Jr.. Frank Morgan, Michael Mosteller, Kenneth Munoz, Arturo Munz, Leonard Murad II, Leslie Murillo, Dana Murphy, John Nagy, Debra Nagy, Josie Navarro, Adolfo Ndlovu, Don Negrete, Joaquin Newbry, ScI1eri Newlin, George Newman, Ranay SSNO. 5132-17-2739 569-78-7247 56&52-4132 573-J3.$S8 545045673 571_1:395 5a:l-29-3586 5I32.as-al73 571.s2-8433 5e8-a6-42S5 5I32.o&a7Dl 546-57-4518 569-92-8618 =-s4-9197 554-a2-96S8 563-00-4173 569-17-2848 559-33-0847 566-94-6207 569-92-5079 561-25-8980 561-04-9693 563-31-2779 525-23-3100 553-11~7 548-88-7006 ~ 5I32.o&a287 551-740690 566-293lEi5 557-48--'3313 571~131 54&540078 567-76-8853 56Q.8O.8295 5a:l-2S-5103 571.s2-5229 557-70-2642 5132-74-7394 571.s2-8032 56iX:6-27D8 383-50-7152 563-29-1123 566-52-8641 56).S6.2813 17().a;.5638 555-82.a375 537-42-2847 568.s2-4l22 554-82-= CITY OF SAN BERNARDINO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES I ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X .X X X X X X X X X X X X X CITY OF SAN BERNARDINO 4TH lEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES EMPLOYEE SS NO. I ELECT I NO ElECTINO RESP Nistico, Paul 519 8S 5619 X NoIro, Dany 565 91 6844 X NoIro, Randy 545-27-6819 X Nunez, Rosario 57lJ.6O.0291 X Odell, Thomas ~-8136 X O'Neill, Susan 566-9O-326ll X Oppenheim, WIlliam 261-76-a562 X Ortiz, Rob 554-72-8284 X Pochon, Barbara 550-19-7'993 X Padilla, Guadalupe 56).62-1902 X Padilla, Vincent 562.{)6.8796 X Pallante, Richard 552-85-3328 X Parcon, Caesar 6'6-14<l2re X Parcon, E~lnda ~1-3645 X Parra, Michelle ElJ4.03.2661 X Patnode, Lisa 552.ss.<:fj59 X Payne, Howard ~7 X Pearson, Joe 557.s:3-5571 X Peck, Kim 546-11-9270 X Peipmeler, Cynthia 559-29-7515 X Pena,John 572-82-0769 X Perez, Dolores 545-49-5249 X Perez, Gilbert 545-67-8751 X Perkins, Randy 553-11-3:6' X Perkins, Richard 24Q.52-3522 X Perrier, Oscar 554-82-2Ol6 X Perry, John 565-52-8480 X Plasencia, Daniel 572-82-1224 X Ponce, David ~ X P~er, Gerald 550-6&0078 X P~er, Timothy 37DS).2417 X Pounds, William 551-84-4867 X Prewitt, Rose 547-94-1379 X Ramirez, Consuela 562-23-5131 X Ramirez, Gilbert 572-48-7393 X Ramirez, Mario 565 99 1284 X Ramos, AWred 56).62-1134 X Raya, Edward 557 91 696B X Razo, Elizabeth 553-11-8075 X Reed, Carol 215 11 533" X Regis, Julie 560 91 09f3J X Rennick, Maryann 570-76-5470 X Rhoden, Judith 558-82-3411 X Rice, Donna 551-90-1858 X Richardson, Iris 573-78-6659 X Riddle, Marvin 478-62-3874 X Riley, Ricarda Sl8-54-6838 X Riojas, Rocky 463-76-1472 X Rivera, Veronica 556-37-2784 X Roberts, SherTi 546-11-8454 X EMPLOYEE Robertson, Douglas Robinson, Stephen Robles, Esther Rodgers, Arlington Rodrick, Corilyn Rodriguez, Celio Rodriguez, John Rodriguez, Paul Rodriguez, Stanislaus Rodriquez, Richard Rogers, Gienzora Romero, Richard Roop, Ophelia Ross, Jr., Bumell Ross, Valerie Rouchl..u, Steven Rubi, Th...... Rubio, Jud~h Rutherford, Donna Sanchez, Anita Sanchez, April Sanchez, Cynthia Sanchez, Juan Sanchez, Patricia Sanchez, Sr., Anthony Sanders, Debby Sansone, VICtoria Sassoon, Lori Sayre, Kara Scherfenberg, Melissa Schuessler, Douglas Schultz, Stephen Schwab, Dean~Rutl1 Sealy, Bobbie Sepulveda, Cynthia Sepulveda, Jr., Robert Serafin, Deborah Sermeno, Debra Serrato, Raul Sharp, Jr., Clinton Shearer, William Shehab, Elias Shuker, Deborah SiMus, Gary Simental, Jose Simmons, Robert Sm~, Russell Sok-Vong, Kimeng Soler WMe, Sara Soria, Josefa SSNO. 500-82-1614 552-55-8Sa! 562.()6.3258 573-11-4757 sso. 7fl.<l826 726-07-778ll 566-82-4605 57tJ.<i9.3171 561-54-5666 548-31-2754 569-Q2-7lXl6 566 88 5664 313-52-3750 456-56-2421 25lJ.8O.5187 572-4&4387 553-66-4122 572-82-1485 545-92-9665 561-37-4143 545-11-7211 553-51-5346 56).91-7889 527-25-9625 see 88 8<126 533-82-a35B 566198114 0>e66-0197 570-31-1653 564 39 1845 322-50-1571 296-511816 563-ei5-1462 D37~ 55&57-4504 558 19 9633 548-15-1116 565-21-07B2 558-33-5471 346-36-3578 sso. 78-7597 565 91 0909 261-13-1237 56C).M.21178 553-66-3574 571-66-6732 5CXJ.6lN263 298-82-4112 13ll-36-4BS2 466-25-9327 CITY OF SAN BERNARDINO 4TH lEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES ELECT I NO ElECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X EMPLOYEE Solo, Victor Sowers, David Sowers, James Stachowski, David Stejskal, Joe Stevenson, David Stewart, Clara Stewart, SherTyI Stitt, Mark Stoker, David Stowers, Janice Strobel, Debbie Suarez, Jason Sutcliffe, Mary Suthertand, Unda Swalberg, Matlhew Taan, Patricia Taylor, EIveida Thaipejr, Theeravut Thomas, Daniel Thomsen, Neil Thomley, Thornas Tomboc, Ricardo Tonn, Terry Torbilt, Lou Torres, Rosemary Torres, Tina Turnipseed, Jon Upshaw, Mike Van Hayennast, John Van Nortwick, William Van Rossum, Nancy Vasquez, Raymond Villa, Richard Villalobos, Francisco Villalobos, Lisa Villegas, Roberta Vlasak, Janeen Vlasak, Joyce Vollucci, Joan Wages,Jan Wagner, Harold Wainright, Tim Wa~e, Allen Waldie, Jessie Walker, Anthony Walker, Joe Webb, Adam Wee Eng, Blanca Weeka, Kaith SSNO. 561-~ 557-3!H:Sll3 568-15-4D'> eel -28-9361 185 16 9317 565 66 6286 548-78-1914 D66 54-8566 565-94-1248 565 91 6476 557-96-0473 55&02-2CS9 5a).66..4746 253-96-2020 549-06-816D 547-45-77!10 567-3S-29CXl 556-31-2066 461916628 Si16 oe 9990 501 -6J-3849 545-72'{s24 545-96-2648 55&02-4661 55&02-=7 546-35-3186 560-51-7092 479 6D 6997 545-76-6250 565-21-4663 555-41-5796 565 66 45lS9 sm.61.al79 545-76-7865 ~125 ~ 56D-!lB-2773 559 66 9556 569-~ 559-52-0952 569-70-7047 566-45-0244 58I'Xl7-5lE6 550-21 ~7aO 614-22-4493 44l). 70-1 OS1 412-74-5190 569-56-9216 572-13-1329 570-31.00D5 CITY OF SAN BERNARDINO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES I ELECT I NO ELECT INO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X EMPLOYEE Weening, Sheny West, Goeffrey White, Frances Wilder, Arthur Wilder, Brenda Wilder, Denise Wilkinson, Ralph Williams, Charlie Williams, Sr., Ray Wilson, Frederick Wisdom, Stanley WOldruff, Deborah Woodail, Marie Woodmansee, Jr., Craig Woods, Susan Yavomicky, Mark York, Don Yzaguirre, Raymond Zamora, Anthony Zouiko, Phillip Zuniga, Aifred Zuniga, Jerry Aiexander, Evelyn Almazan, Betty Anderson, Edna Baker, Marcia Bateson, Robert Bellandi, Joe Bryson, Sadie Butler, Robert Caldera, Diane Carylye, Jr., Huston Chavez, Blanche Clay, William Connoe, Jeffrey Crawford, J. Curry, Michael D'Alessandro, Ronald De La Rea, Cipriano Dillard, Cecil Dixon, Marilyn Eic:l<hoff, David Froton, Barbara Fyvie, Anna Goss, Robert Griffin-Woodring, Connie Gross, Brent Hartzel, Unda Hickey, Fred Hurt. Gloria SS NO. 561~153 573-92-3338 569-78-9173 264-35.:J099 264-55-2934 573 9~ '3538 383-42-2276 420-62-91173 :Dl-42-7120 ~1 56754-6044 542-66-9aXl 566-11-7819 549-41-2210 563-19-5365 558-33-2503 573-13-6381 567-27-7317 556-35-2671 557-56- '7f153 559-92-6295 570-27-<1446 555S).1817 3J9.34.al15 212-52-3965 ~73 567-n~n 517-56-0822 564$96O;l 4lXll-1076 561 19 etS61 548-8O-092B 57D-33-8m 561~176 565-Q6-1881 565-66-9337 565-9Q.62Q2 561-3>5669 570-60-1033 ~169 571-66-9531 562-25-8894 021-26-0329 557-Si}.3722 548-88-2503 118 36-34<<) 5n-l33l88 562-M8489 573-94-2483 566-29-91112 CITY OF SAN BERNARDINO 4TH lEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES ELECT I NO ELECT INO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X CITY OF SAN BERNARDINO 4TH LEVEL 1969 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES EMPLOYEE SS NO. ELECT I NO ELECTINO RESP Jacquez. Mary 557-17-8107 X King, Laura 527-43-5144 X Kramer, John 553-70-6479 X Lair, April 56lJ.64.5631 X lee, Jeanette 569-3>1900 X Litras, Thomas 57O-5ll4:l101 X Losh, Randy 276-50-8699 X Martin, Curtis 427-94-2826 X McClintock, Kevin 115-44-9293 X McDonald, Joyce 552-76-SB55 X McDowell, Katrina 253-39-1001 X Mendoza, Aurora 561-76-CS76 X Menor, Betty !559-re-75S6 X Miller, Kathryn 571 -84-5841 X Moore, De Borah 559 811186 X Morrow,Debbie 567-21-5632 X Nagy, Robert 561-84-2553 X Nery, Erlinda 547-90-2916 X Pertstein, Stephen 01-32-7999 X Peterson, William 321-26-3815 X Phillips, Harold '568-54.aB70 X Phillipson, Karen 5ED-70-9234 X Ramos, Annie 566-56-5661 X Rangel, Elizabeth 566-17-9022 X Reynolds, Michael 54B-ID9276 X Riley, Hennan 556-46 B909 X Roberlson, Sheila 561-45-8337 X Robledo, Richard 573-74-5718 X Sayano, Klyomi 546-81-0112 X SChoultz, Pat 54B-58-aiS2 X Sio, Julito 571-8&8650 X Sneddon, Jane 546-56-7335 X Stone, Edward 566-5IJ.<XXl4 X Wingson, Henry 552-63-556B X Wrlghl, Priscilla 55754-4'39J X Abdullah, Aaliyah 573-94-2069 X Acebedo, Art 572-<54-1136 X AcosIa, Julia 461 98 5643 X Aguayo, Oliver 57O-5B.o759 X Alcarez, Tom 55&82-3115 X Alfter-Penier, Karin 552-64Sl33 X Allen, CMstin ~-4575 X Alvarado, Kathryn 553-11-3256 X Alvarez, Daniel 572-82-49CJl X Alvarez, Jesse 571-66-2921 X Alvarez, Ronald 561 E 9918 X Anderson, Mark 55B39-173:l X Andres, Mark 387-46-22Cll X Arciniega, David 573-94-4840 X Armendariz, Leo 564-40-4294 X EMPLOYEE Armstrong, Terri Arvizo, Michael Arvizo, Rebeca Atkinson, Linda Avila, Debra Avila. Ramon Ayala, Sandra Bare, James Bamos, AI Barta, Tim Bell, Jan Bell, Kimberly Bellinghausen, Cliff Bemben, Debra Bendix, M~chell Bene, Robert Bennecke, Robert Bergreen. Jan Bernal, Carmen Best, Ernie Betton, Joe Bibbee, Vincent Bishop, Elizabeth Blake, Anthony Blymiller, Ronald Bonelli,Jean Bowman, Jr., Richard Boyd, Karen Bradbury, Sherry Bradley, Jon Brandt, Larry Branson, Kimberly Brewster, Nancy Brown, Camille Brown, Ray Brown, Robert Brunson, Diane Bryden, William Burnett, Glenda Byrd, Russ Calloway, Tevie Camarena, Norma Cartos, Jorge Carter, Jr., Josh Castro, Bernard Castro, Dion Castro, Ramona Catchillar, Cynthia Ceballos, U_ Chan, David SSNO. 568-74-6731 C51-60-7!3ll6 C5B-60-11 n 548-29-5423 550 19 0994 557-48-3149 547-25-lXl99 55S-S7-2829 554-62-SS96 569-27-66B5 564-64-2779 553-11.aEl96 461 ~-333l 462-64$99 5<IlHlB- n46 553-54-"m 571).$.2168 550-43-5521 560-21-2241 557-n-!1017 561-7&-6536 564-25-803B 559-51-1141 5T.l-17-6EOl 561~ 559-4).(J327 566-59-5625 &14-10.3201 ~182 582-74-7606 561-84-67'96 sn.sl-775ll 569-78-5548 114 311927 548-25-4439 571~-9743 553-77-7478 557 -68-43B9 573-94-2212 55B-25-1703 561-9).2766 567-63-346) S6:1-31-<J392 571-66-6792 573-53-3375 54e>67-5249 52-4&45C5 251-17-6701 545-6&1864 567-35-44l1l CITY OF SAN BERNARDINO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES I ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X EMPLOYEE Chandler, Harold Chandler, Margaret Chapman, Dwight Chapman, Sheila Chavez, Anthony Chavez, Joanne Chavez, Robert Chavez, Sencio Chennautt, Michelle Cismowski, Shirtey Clark, Nancy Clark, Richard Clifford, Patrick Coar, Julie Cochrane, John Colburn, Maria Coleman, Thomas Conley, Gene Crabtree, Marilyn Craig, Mike Cravens, Robert Creager, Neil Daniel, Debra Davis, Patricia De Haan, Kristy De La Torre, George Deal, Betty Deleon, Mike Delgado,DoIores Delgado, Veronica Diamond, Margaret Diaz, Ar\1Jro Diaz, Michael Dillard, Helen Dobyns, Kathleen Dominguez, Irene Dooley, Jr., Leo Drake, Tom Durr, Sandra Dyck, Michelle Easland, Stephanie Elizalde, Clemente Elston, Rol>erl Empeno, Jr., Henry England, Lori Ann Epperheimer, Peter Erjavek, Edward Estrada, Ramon Evans, Tennie Fahnestock. Gary SSNO. 291~15 561-04-8079 546-11-6090 076-42-7111 568-47-7351 546-11-<i546 547~191 559-92-S5B4 62>2Q.3411 513-34-6488 551-74414) 565-94-CS72 569-43-9947 560-21-5624 376 11 '3S5e 546-11.0eB4 413 B1 0065 56B-$12DD 56B-M6BD3 33:>42-3743 457-52-2459 56B-9D-0625 550-23-1 D22 571.al-1697 551X12-361D 554-82-3610 396-32-5726 571-92-9153 551-54-2923 567-9&8276 551-33-8340 5~1447 572-57-8774 418-46-6163 559-31-4312 56fl-55.4632 214-66-7066 565-31-2676 274-32-7236 531-96-4729 546-43-94t5 547-49-9115 562-74-8623 547-84-4217 555-41-9711 562-31.0036 570-71-6360 569-56-5612 555 B5 0056 23D-6O-4232 CITY OF SAN BERNARDINO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X EMPLOYEE Fitch, Elliott Fitzgerald, Sean Fiveland, Jon Fleenor, Sherry Fogassy, Laszlo Fonzi. Jill Foster, Joanne Foster, Josephine Fox, Barbara Fox. Michael Fox, Shawn Franks, Jeffrey Freeman, Mark Freeman, Ron Freiberg, Mary Gabriel, Samuel Gagnon, Lee Gallagher, Char1ene Gandhi, Brent Garrity, Paul Gaskell, Gaye Glines, Elaine Gomez, Charile Gomez, Michael Gomez, Zina Gonzalez, Caries Gonzalez, Richard Good, Matthew Graham, Edle Granlley, Bruce Greenl.., Debra Greenleaf, Bonnie Guillen, Paul Guillermo, Amie Haddox, Lama Hamlin, James Hammons, George Hanson, Laura Harian, Liman Harper, Manuel Harris, Loretta Hartwill, Daryl Hastings, Meanie Henry, Michael Hem, Tressa Herrera, Caries Hinkley, Mark Hook,Susan Hoepfner, Gary Hosey, Tana CITY OF SAN BERNARDINO 4TH LEVEL 1969 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES SS NO. ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 5ffi 9<1 5962 551-49-3878 563-31-ll431 566-48-1947 565-94-3Se3 564-n-nes 020-28-5020 545-54.sll13 550-31-2500 563-27-(13) 563-19-$48 ~ 362- n-446B 381-70-7169 393-62-0416 552-64-6693 457-78-1314 563-23-<1964 573-96-0654 557-68-6633 223-80-1190 545-66-2750 564-78-1337 563-11~ 54B-453l4B ~1946 5n-64-5881 622.()2-01D3 54946-1073 569-5&2773 546-11-0664 4IT-66-4266 573-11-2147 566-71-7807 571-66-0703 42054-136D 526-94-4441 55D-63-53IT 330-~ 562-74-9222 573-11-3lB3 563-S0-1103 567-70-64:10 546-47-5531 556-41-9466 561-64-4:2ll8 033-52.aIT1 546-92-7494 563-11-33:)1 563-61.(573 EMPLOYEE Houts, Jr., Robert Hudkins, Michael Hull,Curry Humphreys, Doris Hynds, Debra Ingets, Janis Ingram, Virginia Itnyre, Mike Jaarsma, Shelley Jackson, Donald Jackson, Lillie Jacobs, Gary Jassim, AIi Jimenez, Mike Johns-Chandler, Hazel Johnson, Annie Johnson, Jon Johnson, Joyce Johnson, Judith Johnson, Mitton Johnson, Richard Joswiak, Kenneth Juarez, Sr., George Kaplan, Patricia Kassai, Pamela Ketth, William Kemp, William Kennedy, David Kennedy, Dean Kennedy, Stella Kennerly, Lana Kim. Youn Laforge, Arthur Lanto, Ellen leal, David Leffler, Dave Legardy, Ellen Leon, Donald Letson, Paul Lewis, David Lindberg,Robert Ltthen,Erica Lizarraga, Jesse loa, Adrienne Londean, Sylvia Long, James Lopez, Ben Lopez, Roberto Loukos, Mike Luna, Joel SSNO. 545-21.7846 5'I6-Q6.8041 435-9-3388 56S-88-1683 558-lJ4.2887 ~7052 !X5-42.7524 551-74<)187 573 19 9631 570-76-6601 547-aEHl929 481-72-7702 564-59-8919 55J..66.0664 SBs.09-5ll52 553-92-al92 CSl-62-6287 382-36-4211 62CHJ3.9194 558-58-6384 552-Q2-1412 37lJ..S.4.S299 545-51-31 DB 548-58-2198 565 9~ 3966 41~1123 548-25-1298 CXl2-36m74 45lJ.ID 7384 571-84-7341 573-11-0487 545-11-7519 377-4).1150 571-72-1875 546-76-6339 557-15-0697 546-19-4030 553-11-3139 091-46-S219 ~17D 547-45-7853 553-37-'lEl98 554-82-3552 56437-61511 549-54$767 S22-92.Q4S7 551 19 S865 54&55-1265 561-00-1 D29 572-33-0938 CITY OF SAN BERNARDINO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES I ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X CITY OF SAN BERNARDINO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES EMPLOYEE Macias, Jr., Tony Maffett, Phillip Magill, Diana Mariani, Christine Marquez, Consueto Marquez, Lenora Martin, Larry Martinez, Joseph Martinez, Portirio Martinez, Vincent Mathis, Michael Mayberry, Max Mazurier, Cecelia McAllister, Unda McCadney, Berlinda McGreevy, Richard McKinley, Celia McPeek, Tanya McPherson, Jack McRaven, Katheline Mena, Louie Mendoza, Abraham Miller, Don Miller, Paula Minor, Theresa Monk, Larry Moore, Charles Morales, Richard Morana, Jerry Moreno, Dennis Moreno, Jr., Frank Morgan, Michael Mosley, Steve Munoz, Arturo Munz, Leonard Murphy, Deanna Nagy, Josie Navarro, Adolfo Navarro, Ed Negrete, Jesus Neville, Michalle Newbry, Janine Newbry, Michael Newbry, Scheri Newcomer, Tori Nguyen, Minh Nunez, Rosario Odell, Thomas Olatunji, Ezekial Ortega, Annette SSNO. 547-70-1162 254-17-7770 553-43-7255 2Cl!-44-6761 556-37-1432 4:lO- n-7692 553-11-2902 569-~ 56ll-54$C6 546-04-7894 558-94-6270 553-23-5100 546-82-2!ll6 566-13-7124 431-13-69<l6 555-46-2073 567-57-8780 ED7'()7-4ll8O 55&41-40<13 547-82-64)6 560-62-4321 568-67-872D ~-41D1 166-42-4124 569-92- n44 557-68-6204 546-11-8047 564-82-4022 545-Q40078 555-46-1162 569-80-8295 5ElJ.25-5103 567-31-4783 557-70-2642 562-74-7394 198 €I) SJ92 568-52-6641 5ElJ.98-2813 564-82-2071 556-46-9566 561-1SGl53 532.Q6.64lJl 536-42-4621 537-42-2647 568-86-3725 553-87-= 57D-6D.Q291 363-42-8136 238-O6-5ll22 551 B8 seas ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X I EMPLOYEE SSNO. 338-54-4:224 559-31-8790 564S9.a788 ~-1902 562.{lfXl7S8 562-85-3328 567-al-1514 565-11-5644 561-35-9725 572-13-9627 562-74-6954 31~ 567-al-73n 54&45249 561-84-6228 545-74-1271 ~7574 240-52-3522 565-94-4746 070-38-6292 550-42-2672 568-54-8021 078-64-5710 1 Q5-42.{)2Q2 J94.46.;3616 563-47.Q066 564-82-1802 451 68 65<12 6Q5.1~7 571-49-3234 546-96-2673 558-52-3519 549-02-5453 557-83-2637 563-54-7707 211-58-8844 56Q.39.8143 567-47-4630 561-58-4a38 ~.c672 427-84-6S:l8 562-36-2932 553-11-2746 558-1 &9726 ll!&48-2168 568-52-2325 567-56-6068 564-21-9284 547-7tJ.3578 562.(16.S937 O'Shia, Dominque Oswan,philip Otterbein, Eudora Padilla, Guadalupe Padilla, Vincent Pallante, Richard Palmer, George Parish, Ruth Park, Margaret Parker, Ricky Pedroza, Joe Peelman, Sandra Penman, James Perez, Dolores Perez, Joe Perez, Nicholas Perkins, Lester Perkins, Richard Perry, Anita Phelps, Chris Pitts, Beulah Poole,BiII Powell, Sharon Price, Millicent Prieto, Eileen Prostler, Cheri Quiroz, Armando Ramirez, CeUa Ramirez, Manuel Reyes, Aileen Reynclds,David Rios, Marie Rnchea, Danny Robbins, Andrea Roberts, Clarence Robinson, ComeIius Rodriguez, Pamela Rodriguez, Tom Rogers, Jon Romo, Ronakt Rose, Edy Rose, John Royce, Aloya Ruiz, Anna Sabater, Wilfredo Saenz, Dee Sampson, Laverne Sandoval, Jesus Sandoval, Joseph Sapien, Tim CITY OF SAN BERNARDINO 4TH LEVEL 1969 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X EMPLOYEE Schilling, Karen Schwarz, Margaret Scott,Juanita Segura, Mercy Shaw, Brenda Shepherd, Melvyn Shipley, Steve Shi~ey.West, Rita Showalter, Ray Smail, Roger Smith, Jerry Snyder, Terry Solo, Martha South, Unda Stachowski, David Stanley, Michael Stanley, Robin Stecklair, Dean Stewart, Rick Stitt, Frederick Stordahl, Dean Stubbs, Donald Sutorus, Sleven Tarango, Mike Taylor, Ann Temple, Charles Thomsen, Irene Trejo, Delores Tucker, John Turner, Yoshimi Uribe, Leticia Ustation, Daniel Valdez, Tom Vallier, Donald Vasquez,Juan Velarde, Carta Vidana, Rudy Voce, Diane Vang, Seyha Wagdy, Anwar Walker, John Walker; Patricia Walkef, VICkie Wallace, Gregory Ward, Donna Ward, Janet WaI:son, Jim Whnlatch, Dennis Whittaker, Katherine Whittaker, Lisa SS NO. 561.76-1CJl9 573-7EHl488 286-18-3915 570-96-1700 572-82-4412 571-66-7172 562-06-6518 067-54-4237 ~7 561-840779 561-56-4386 562-64-6747 568-66-1315 11164-4642 CJl1.2B-9361 571-84-8336 CJl6-52-3920 17334-74l5 562-06-9262 565-12.7096 5D7~ 54&06-7975 ~1-62B6 569-13-1693 294 38-89l9 431-58-6511 561-9!l-Q674 564-59-<l667 52B-60-2D32 487.74-2486 553-27.2173 561-9J.Q482 548-23-8388 485-{)6.{)272 554-72-8976 549-73-7412 561 AA........ 561.74-1070 46J.63.6521 561-98'9BOO ~ 550-78-8064 53iXi6-2447 553-11-4118 557-68-3721 549-52-9891 570-57-3103 357-46-3341 565-29-1284 574-54-6197 CITY OF SAN BERNARDINO 4TH LEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES I ELECT I NO ELECTINO RESP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X EMPLOYEE Wilkinson, Steven Williams, Albert Williams, Cheri Williams, Dennell Williams, Eddie Williams, Ellis Williams, Venus Willison, Richard Willmarth, Rowland Wisdom, Gregg Wong, Sally Wood, Howard Worthy,lelia Yandell, Robert Ybamo, Ronnie Yelton, Stanley Zehm, Scott Zoulko, Daryl SSNO. 564-35-6121 549-74-7311 551-43-0272 553-11-1129 43l>~156 557-68-6535 511-92-8144 564-35-6121 ~ 569-21-9676 515947-1769 558 11 5439 368 54-8896 561-41~7 568-52-7527 553-66-4771 573-86-5011 512-64-5556 CITY OF SAN BERNARDINO 4TH lEVEL 1959 SURVIVOR BENEFITS ELECTION FOR MISCELLANEOUS EMPLOYEES I ELECT I NO ElECTINO RESP X X X X X X X X X X X X X X X X X X . .*,* FOR OFFICE USE ONLY - NOT A PUBLIC DOCUMENT * * -~ CITY OF SAN BERNARDINO - CITY CLERK'S OFFICE RECORDS & INFORMATION MANAGEMENT PROGRAM AGENDA ITEM TRACKING FORM Meeting Date/Date Adopted: <./ ~ J-O ~ q g Item No. -* ( ( Resolution/Ordinance No. q g ..- q K Ordinance Urgency: Yes Effective Date: Termination/Sunset Date: Ayes: to / No Vote: Nays: Absent: -D::;J .J Abstain: Date Sent to Mayor: l{'~.~, '=t 8' Date Returned from Mayor: Date of Clerk's Signature: Date Summary Returned from Attorney: Date of Mayor's Signature: Date Summary Sent to Attorney: Date Published: Meeting Type: Continued FromlTo & Item No. Date Seal Impressed: Date Sent for Sign~ure: Expi ration Date: Sj I d...' nil/) , Copies Distributed To: City Attornev & Others: To Whom: Date Returned: Exhibits Complete & Attached to Resolution/Ordinance: Rem i nder Letter Sent: Rem inder Letter Sent: Rem i nder Letter Sent: Request for Council Action & Staff Report Attached: Yes Updated Muni Code &/Or Resolution Codified Files: Yes B : D te: No No ,"~~::::",j./j,""/r,c<~;:;#, t;:~dd l/-C';,' A / ;,7"r; ~4'---' /~ ~ ,,'-- . V[ / J!-(/,. Y , Ready to File: / / V Date: DOCUMENT lOCA liON: FORMS/Agenda Item Tracking Form. CC Form No. 111 - UsI U~: 1(.'22/1997 ,6 dL>J ('7