Reso 2016-885RESOLUTION NO. 2016-885
A RESOLUTION OF THE BOARD OF DIRECTORS OF THE COSTA MESA SANITARY DISTRICT ELECTING TO
CEASE TO BE SUBJECT TO THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT
WHEREAS, (1) Government Code Section 22938 provides that a contracting agency which has elected
to be subject to the Public Employees' Medical and Hospital Care Act (the "Act") may
cease to be so subject by proper application by the contracting agency; and
WHEREAS, (2) Costa Mesa Sanitary District (Non -PERS Board of Directors) is a contracting agency under
Government Code Section 22920 and subject to the Act;
Now, Therefore be it
RESOLVED, (a) That the Costa Mesa Sanitary District elects to cease to be subject to the Act;
and be it further
RESOLVED, (b) That coverage under the Act shall cease on December 31, 2016..
Adopted at a regular meeting of the Costa Mesa Sanitary District at the Costa Mesa
Sanitary District Headquarters, this 23rd flay of June, 2016.
Signed:
IF
Signed: 1 `4
Secretary
TERMINATION -ALL OR ALL BY GROUP (REV. 5/2015)
INSTRUCTIONS
This resolution form is the approved form designated by the California Public Employees' Retirement System
(CaIPERS). It should be used by a contracting agency subject to the Public Employees' Medical and Hospital Care
Act (PEMHCA) when the agency desires to terminate coverage under the Act.
If the resolution is filed within 60 days of premium rate notification of any year, coverage will cease on the last
day of December (31) following the filing (date stamped as received by CaIPERS; See address below).
WHEREAS, (2) should be completed with full name of the contracting agency.
RESOLVED, (a) should be completed with full name of the contracting agency.
RESOLVED, (b) provides for the date that coverage under PEMHCA will cease -- the last day of
December (31).
Note that Section 599.515 (e) of the California Administrative Code (Board's Regulations) prohibits a new
contract for Public Employees' Medical and Hospital Care coverage within five years of termination date.
Because resolutions serve as a legally binding document, we require the original resolution, certified copy
with original signatures, or a copy of the resolution with the agency's raised seal.
Upon receipt by the California Public Employees' Retirement System, the termination resolution is
IRREVOCABLE.
For resolution processing, deliver to the following:
Overnight Mail Service
California Public Employees' Retirement System
Health Contracts Unit, EAMD
400 Q Street
Sacramento, CA 95811
Regular Mail
California Public Employees' Retirement System
Health Contracts Unit, EAMD
PO BOX 942714
Sacramento, CA 94229-2714
The certification shown following the resolution is to be completed by those individuals authorized to sign for
the contracting agency in legal actions and is to include the name of the executive body; i.e. Board of Directors,
Board of Trustees, etc., the location and the date of signing.
TERMINATION - ALL OR ALL BY GROUP (REV. 5/2015)