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HomeMy WebLinkAboutResolution 95-212 08/21/1995 - Resolution N®. 95-212 ~.C.s. of tho City of Potaluma, California 1 2 RESOLUTION AMENDING THE CLASSIFICATION PLAN 3 TO ESTABLISH THE POSITION CLASSIFICATION 4 BUYER 5 DESIGNATED TO UNIT 4, (PROFESSIONAL) 6 7 8 BE IT RESOLVED that the Classification Plan and 9 Compensation Plan, as originally adopted pursuant to Resolution 10 No. 90-209 N.C.S., and the classification titles and 11 specifications as adopted by Resolution No. 90-147 N.C.S., are 12 hereby amended by establishing the classification of Buyer, (as 13 attached hereto and marked Exhibit "A" and made a part hereof). 14 15 BE IT FURTHER RESOLVED that this action is taken 16 pursuant to Personnel Code 2.04.020 and Personnel Rules and 17 Regulations (Rule IV, Section 5) for classifications included in 18 the Competitive Service of the Personnel System, that the notice 19 of this action has been properly posted and that the City Manager 20 recommends this action. 21 22 NOW THEREFORE, BE IT RESOLVED that the Resolution No. 23 90-147 N.C.S., as amended, is hereby amended to include 24 establishment of the classification of Buyer and assigning this 25 classification to Unit 4 (Professional), effective August 21, 26 1995 at a salary range of $18.00 - $18.90 - $19.84 - $20.84 27 $21.88. Under the power and authority conferred upon this Council by the Charter of said City. REFERENCE: I hereby certify the foregoing Resolution was introduced and adopted by the Apprfovemd as to Council of the City of Petaluma at a (Regular) ) meeting on the ...-----21St--...... day of .............~.4!~St- 1995.., by the following vote: City Attorney AYES: Hamilton, Stompe, Maguire, Read, Barlas, Yice:lViayor Read, Mayor Hilligoss NOES: None ABSENT: None _ w ~ ~ f~' ATTEST : ~ - '^l._.~..-•-•--••---.......--•---•--...-.. City Clerk ~-(.i~ayor Council File..-_ CA 10-85 Res. No....~5-212......... N.C.S. CITY OF PETALUMA COMPENSATION PLAN FOR UNIT 4 - (PROFESSIONAL) FISCAL YEAR 1995 - 1996 9'S - ~-l ~ acs TABLE OF CONTENTS GENERAL Section 1. Term of Agreement COMPENSATION Section 2. Salary Section 3. Retirement Contribution Section 4. Overtime Section 5. Call Back Pay Section 6. Stand By Pay Section 7. Rates of Pay On Permanent Transfer To A New Classification Section 8. Temporary Work Out of Classification Section 9. Compensation for Clothing Loss Section 10. Vacation, Payment of Section 11. Sick Leave, Payment at Retirement Section 12. Deferred Compensation Section 13. Retiree Benefit Payments Section 14. Health/Dental Care Cash Back INSURANCE Section 15. Health Insurance Section 16. Dental Insurance Section 17. ' Life Insurance Section 18. Disability Insurance Section 19. Vision Insurance Section 20. Other Health & Welfare Payments LEAVES Section 21. Vacation Section 22. Sick Leave Section 23. Bereavement Leave Section 24. Holidays Section 25. Military Leave Section 26. Leave of Absences Without Pay Section 27. Jury Leave Section 28. Compensatory Time Off Section 29. Family Medical Leave OTHER Section 30. Retirement Section 31. Grievance Procedure ~5- a- ~JG S GENERAL Section 1. Term of Agreement This compensation plan shall be for a one (1) year term for the fiscal year commencing July 3, 1995 through June 30, 1996. COMPENSATION - Section 2. Salary The City shall adopt the following salary ranges for each of the employees in the following classifications during the term of this compensation. plan. UNIT 4 (PROFESSIONAL) EFFECTIVE JULY 3, 1995 I II III IV V Assistant Planner $18.00 $18.90 $19.84 $20.84 $21.88 Associate Civil Engineer $24.43 $25.65 $26.93 $28.28 $29.69 Associate In Civil Engineering $23.43 $24.60 $25.83 $27.12 $28.48 Associate Planner $20.17 $21.18 $22..24 $23.35 $24.52 Plans Examiner $20.98 $22.03 $23.13 $24.29 $25.50 Program Coordinator $20.01 $21.01 $22.06 $23.16 $24.32 Recreation Coordinator $12.11 $12.'71 $13.35 $14.02 $14.72 EFFECTIVE JANUARY 1, 1996 I II III IV V Assistant Planner $18.36 $19.28 $20.24 $21.25 $22.32 Associate Civil Engineer 24.92 26.16 27.47 28.84 30.29 Associate In Civil Engineering 23.90 25.09 26.35 27.66 29.05 Associate Planner 20.58 21.61 22.69 23.82 25.01 Plans Examiner 21.40 22.47 23.59 24.77 26.01 Program Coordinator 20.41 21.43 22.50 23.62 24.80 Recreation Coordinator 12.35 12.97 13.62 14.30 '15.01 Section 2A Upon receipt by the Personnel Office of an employee's Certification as a Registered Civil Engineer he/she shall be advanced to the classification of Associate Civil Engineer at the beginning of the next pay period. Section 3. Retirement Contributions The percentage of each employee's contribution previously paid by the City prior to the adoption of this Compensation Plan as the Employer Payment of Member Contribution (EMPC) shall instead be paid to the employee who shall then pay that amount to PERS. For purposes of withholding, the City shall defer that portion of the employee's contribution paid to PERS through Section 414(h)(2) of the Internal Revenue Code pursuant to City of Petaluma Resolution 90-363. Therefore, for calculation of base salary at retirement, the employee shall now have an increased base salary that will include the total amount of the employee's contribution to PERS previously paid as EPMC The employee's contribution will be withheld from the employee's pay by the City, and the City will make the employee's payment of the employee contribution directly to PERS on behalf of the employee. The employee may not make an election to take this amount in salary and/or to make the payment to PERS. The tax exemption does not apply to FICA/social security. The following is an example of the application of IRC 414(h)(2) as applied to a miscellaneous employee. An employee makes $1,000 per month base salary. Under the prior contract the employee was not responsible for paying 7% of the required 7•°s employee contribution. The City was responsible for paying 7% ($70.00), which was a City responsibility that was in addition to the $1,000 base salary. Under the 414(h)(2) method, the EPMC will revert to salary and the employee's base salary will now be $1,070. Of this 7% (approximately $75.00) will be paid to PERS from the $1,070. The full 7o will be tax exempt and this means the employee will pay taxes on $995.00. Section 4. Overtime A. General. All hours worked in excess of eight (8) in any one day or in excess of forty (40) in any work week shall be compensated for at the overtime rate which shall be one and one-half (1.5) times the regular rate of pay. Overtime shall not be pyramided or compounded. For those employees that work an adjusted work week through the Voluntary Reduction In Hours Program, overtime will be based on the signed Agreement between the City and the Employee. B. Minimum. Any employee required to work overtime shall, in no case, be compensated for less than one hour for such overtime. C. Payment for Work During Leaves. When it becomes necessary by an emergency to have employees work during legal holidays or the period such employees are entitled to vacation leave, such employees working on such legal holidays and during periods of G vacation shall be entitled to receive additional remuneration at the rate of one and one-half times their regular rate of pay. Section 5. Call Back Pay 1. An employee who is called back to work in an emergency situation after having completed his/her regular shift and left the city premises shall receive a minimum of two (2) hours work or two (2) hours pay, at the overtime rate. To the extent an employee is paid overtime premium pursuant to the overtime schedule under Section 4 (Overtime) listed above, he/she shall not be paid overtime premium under the call-back section for the same time worked. This paragraph shall not apply to employees who are called in early for a shift, i.e., when they work continuously from the time they are. called in until their regular shift begins. Section 6. Stand-By If, in an emergency situation, an employee in this unit is asked to. leave work before the end of his/her scheduled work day with the expectation that he/she will be called back to work to finish. the remainder of their work day .at a later time, but the employee is not in fact called back to work that day, the City agrees to compensate the employee for the full normal working day. In exchange, up until the time that the employee's regular shift is scheduled to end, such employees wil'1 be on stand-by status, without any entitlement to any extra compensation. Except as so specified, employees in this unit are not required to work on a stand-by basis Section 7. Rates of Pay On Permanent Transfer To A New Classification. 1. When an employee is promoted, he/she shall be paid the hourly rate next higher to his/her own within the pay grade for the classification to which he/she was promoted 2. When an employee is transferred from one classification to another classification in the same pay grade, his/her hourly rate shall remain the same. 3. A permanent or probationary employee who is transferred to a class with a lower salary without a break in service will receive the same rate of pay he/she received prior to the transfer. Such salary shall not be increased until the time that a higher salary of the .class to which 'he/she was transferred equals or exceeds his/her salary. Such transfer may be departmental or inter- departmental, and may be made by appointment from an employment . list, temporary appointment, reclassification of position, or reorganization of department, and shall be in accord with-the personnel rules and regulations. The provision of this rule does not apply in cases of disciplinary demotion, demotion in lieu of layoff, or voluntary demotion. When a person is involuntarily assigned to a lower classification he/she shall receive the lower rate of pay, effective the first day assigned to that classification. Section 8. Temporary Work Out of Classification 1. An employee holding a classified position may temporarily be assigned the duties of another position in a higher classification. The employee shall receive either the next higher step in the classification to which he/she is assigned or a 5% increase, whichever is greater. This payment shall begin upon completion of the first 10 continuous workdays in that assignment. An employee assigned to a position at an equal or lower classification shall remain at the current rate of pay. Section 9. Compensation for Clothing Loss The City Manager is authorized to provide compensation to City employees for loss or damage to their clothing which occurs during the course of carrying out an official duty. A request for compensation hereunder shall be submitted in writing, in detail, to the City Manager via the department head concerned. The amount of compensation, if any, shall be at the discretion of the City Manager. Section 10. Vacation, Payment at Termination Employees who terminate employment shall be paid in a lump sum for all accrued vacation leave earned prior to the effective date of termination not to exceed two (2) years accumulation. Section 11. Sick Leave, Payment of In the event of the death or retirement of an employee who has completed ten (10) or more years of continuous service with the City, the employee shall be paid or shall receive to his benefit fifty percent (50%) of his accumulated but unused sick leave not to exceed 480 hours. The employee may elect not to receive this benefit and instead place all sick leave hours into the PERS Sick Leave Conversion Benefit. L/ q~-a,la WIGS Section 12. Deferred Compensation The City of Petaluma shall make available to the members of this unit the City's Deferred Compensation Plan. Section 13. Retiree Benefit Payments RETIRED Employees An employee with twenty (20) years of service and who is age 50 or older and who retires on a service retirement during the term of this agreement, will be eligible for $95.00 per month beginning on the retirement date. The payment will decrease in the amount of $5.00 per year to $0.00 after 20 years if the retired employee continues in the PEMCHA plan as a retiree. Should the retired employee not continue in the PEMCHA plan as a retiree. Should the retired employee not continue in the PEMCHA plan, he/she will be eligible for the full $100.00. It is the responsibility of the retiree to notify the City in writing that he/she is not being covered by the PEMCHA plan and the City will commence payment of the $100.00 at the beginning of the month following the receipt of written notice by the retiree. Section 14 Health/Dental Care Cash Back An eligible employee may request cancellation of the employee's City paid medical and/or dental insurance coverage under Section 125 of the IRS Tax Codes upon presentation to the City of satisfactory proof that he/she has medical and/or dental insurance coverage from another source. Such a request may be made during the open enrollment for PEMCHA medical elections but will be, in all cases, subject to the terms and conditions and cancellation requirements of the particular plan. When the employee has demonstrated such coverage to the City's satisfaction, the City will request cancellation of the employee's medical and/or dental coverage, subject to the terms and conditions of the particular policy. Upon actual cancellation of the employee's medical coverage, and commencing on the date of cancellation of such policy, the City will instead pay to the eligible employee, on a monthly basis, an amount equal to 50a of the "equivalent monthly cost", as defined herein, of insurance coverage of said employee. In determining the "equivalent monthly cost" of such coverage, the City shall calculate the monthly premium amount which would be paid by the City on the employee's behalf under the Health Plan of the Redwoods plan, based on the employee's coverage level (e.g. self, self plus spouse, self plus spouse plus children) at the time of such cancellation. However, if the actual monthly cost of the employee's current plan coverage is less than the monthly HPR cost, then the lower figure shall be used. In the event coverage is cancelled only for the employee's spouse or dependent children, the reimbursement will be 50% of the cost difference between the old and new levels of coverage (as calculated using the HPR plan). Upon such cancellation of the employee's dental coverage, the City will instead pay to the eligible employee, on a monthly basis, an amount equal to 50% of the City's internally generated estimated monthly cost of the self-funded dental costs. Any employee cancelling coverage will be required to meet all rules and conditions of the particular plan, including, but not limited to, all rules and conditions governing administration, cancellation, and re- enrollment eligibility by requesting a cash payment pursuant to this section, such employee .understands and agrees as a condition of receipt of this payment, that re-enrollment eligibility into any plan is not guaranteed. INSURANCE Section 15. Health Insurance ACTIVE Employees The City shall provide the Public Employees' Medical Health Care Act (PEMCHA) for members of Unit 4. The premium paid by the City toward this program shall be in the amount of $100.00 per month per employee. Section 16. Dental Insurance The City shall provide for a group Delta Dental Insurance Program for City employees and dependents in this Unit. Additionally, the City shall contribute toward an Orthodonture plan $1,000 per child at a 500 co-payment rate. The City shall pay, during the period of this Compensation Plan the full premium toward the City group dental insurance coverage program. Section 17.. Life Insurance The City shall provide for a group term life insurance program for City employees in this Unit. The City shall pay, during the course of the Compensation Plan, the insurance premium towards employee only coverage for such insurance in the principle sum of $25,000. Section 18. Disability Insurance Long-Term Disability Insurance The City shall provide for a long-term disability plan. The premium to be paid for by the City. Short Term Disability Insurance The City agrees that employees in this unit may, on a purely voluntary basis and at their own expense, participate in AFLAC's short-term disability insurance, as long as the number of employees electing to participate in the program meets the minimum participation standards set by the carrier. Section 19. Vision Insurance The City shall provide a Vision Plan for employees and dependents. The premium shall be paid for by the City. Section 20. Other Health and Welfare Payments The City shall provide to the active members of Units 3 and 4 additional monthly health and welfare payments equal the PEMCHA Health Plan of the .Redwoods premium amounts less $100.00. LEAVE Section 21. Vacation A.l. Amounts All regular employees of the City of Petaluma, after working one full year are entitled to the equivalent of eighty (80) hours of vacation with pay in the year following the year in which vacation is earned. All regular employees of the City of Petaluma, after five (5) years of continuous service with the City, and beginning with the sixth year, shall be entitled to the equivalent of one hundred twenty (120) hours of vacation per year. After ten (10) years of continuous service with the City, eight (8) hours of vacation shall be added for each year of continuous service to a maximum of two hundred (200) hours of vacation. A.2. Voluntary Leave Plan Accruals under the Voluntary Leave Plan shall be prorated to the work week equivalent hours. B. Scheduling The times during a calendar year in which an employee may take his/her vacation shall be determined by the department head with due respect for the wishes of the employee and particular regard for the needs of the service. If the requirements of the service are such that an employee cannot take part or all of his/her annual vacation in a particular calendar year, such vacation shall be taken during the following calendar year. C. Deferral Any eligible employee with the consent of the head of his/her department and the Personnel Office may defer five (5) working days of his/her annual vacation to the succeeding calendar year subject to other provisions of this rule. A written report of each deferred vacation signed by the appropriate department head and the Personnel Officer noting the details shall be kept on file with the Personnel Officer. Vacation time accumulated in excess of two years shall be lost. In the event one or more municipal holidays fall within an annual vacation leave, such holidays shall not be charged as vacation leave and vacation leave shall be extended accordingly. Section 22. Sick Leave A. General Sick leave with pay shall be granted to all employees as set forth in this section. Sick leave is not a right which an employee may use at his/her discretion, but rather, shall be used only in case of personal illness, disability or the serious illness or injury of an employee's family member which requires the employee's attention. The term family members shall include: spouse, children, parents, spouse's parents, brothers, sisters or other individuals whose relationship to the employee is that of a dependent or near dependent. B.1 Accrual Sick leave shall accrue to all full.-time employees at the rate of eight hours for each month of continuous service. No employee shall accumulate more sick leave in any year than provided. B 2. Voluntary Leave Plan Accruals under the Voluntary Leave Plan shall be prorated to the work week equivalent hours. C. Notification Procedures In order to receive compensation while absent on sick leave, the employee shall notify his/her immediate superior or the Personnel Office prior to or within four hours after the time set for beginning his/her daily duties as may be specified by the head of his/her department. When absence is for more than three days duration, the employee may be required to file a physician's certificate with the Personnel Office stating the cause of the absence. D. Relationship to Workers Compensation Benefits shall be payable in situations where miscellaneous employee's absence is due to industrial injury as provided in California State Workers' Compensation Law. During the first. three (3) work days when the employee's absence has been occasioned by injury suffered during his/her employment and he/she receives Workers' Compensation, he/she shall receive full pay. Following this period sick leave may be a supplement to the Workers' Compensation benefits provided the employee. Compensation is at his/her regular rate for a period not to exceed six months, or until such sick leave is exhausted, or the disability is abrogated, or that employee is certified "permanent and stationary" by a competent medical authority. The City shall pay him/her the regular salary, based on the combination of the Workers' Compensation benefit plus sick leave. Sick leave for industrial injury shall not be allowed for a disability resulting from sickness; self-inflicted injury or willful misconduct. The City may retire any employee prior to the exhaustion of accumulated sick leave, at which time all accrued but unused sick leave shall be abrogated, subject only to the limitations provided under this Memorandum of Understanding. E. Sick Leave Transfer Policy Employees wishing to donate hours of sick leave to another employee may do so by sending a written request, approved by their department head, to the Personnel ~ , , Office naming the individual to receive the sick leave and the amount donated, with the following restrictions: 1. Employees who wish to transfer sick leave must retain a minimum of 160 hours of sick leave to be eligible to transfer sick leave. 2. All such transfers of sick leave are irrevocable. 3. The employee receiving the sick leave transfer must have zero (0) hours of accrued sick leave, vacation and CTA leave on the books. 4. Employees may not buy or sell sick leave. Only the time may be transferred. 5. Employees may not transfer sick leave upon separation of service. 6. Transfer of sick leave shall be allowed between Units 1,4, 8 and 9. 7. No more than ninety (90) workdays of Sick Leave may be received by an employee for any one illness or injury. Section 23. Bereavement Leave A.1 In the event of the death of an employee's spouse, mother, step- mother, mother-in-law, father, step-father, father-in-law, brother, sister, child, including an adopted child, grandchild and grandparent, an employee who attends the funeral shall be granted time off work with pay. The amount of time off work with pay shall be only that which is required to attend the funeral and make necessary funeral arrangements, but in no event shall it exceed three (3) working days. These three (3) days shall not be chargeable to sick leave. An additional two (2) days required for necessary funeral arrangements may be charged to the employee's sick leave and any additional time beyond these two days may be charged to accumulated vacation or leave without pay. Such bereavement leave shall not be accruable from fiscal year to fiscal year, nor shall it have any monetary value if unused. A.2. Voluntary Leave Plan Accruals under the Voluntary Leave Plan shall be prorated to the work week equivalent hours. Section 24. Holidays A. FIXED HOLIDAYS: The City shall observe eleven (11) fixed-date holidays. These holidays shall be established for the City's fiscal year as determined by City Council resolution. °15- ~-I ~ NHS B. FLOATING HOLIDAY: During the Fiscal Year the City will authorize one (1) "Floating Holiday" per employee, which may be taken by the employee at a time selected by the employee, subject to operational requirements and approval determined by the City. Employees hired between July 1, and December 31, will be eligible for a "Floating Holiday" during the course of the Fiscal Year. C. VOLUNTARY LEAVE PLAN: Holidays taken during the Voluntary Leave Plan shall be prorated to the work week equivalent hours under the voluntary leave plan. Employees on a Voluntary Leave for a fixed period will not be paid for any holidays falling within the fixed leave period. Section 25. Military Leave Military leave shall be arranged in accordance with the provisions of State Law. All employees entitled to military leave shall give the appointing power an opportunity within the limits of military regulations to determine when such leave shall be taken. Section 26 Leave of Absence Without Pay A. The City Manager may grant a regular or probationary employee leave of absence without pay pursuant to State and Federal Law. Good cause being shown by a written request, the City Manager may extend such leave of absence without pay, or seniority, or benefits for an additional period not to exceed six (6) months. No such leave shall be granted except upon written request of the employee setting forth the reason for the .request, and the approval will be in writing. Upon expiration of a regularly approved leave or within a reasonable period of time after notice to return to duty, the employee shall be reinstated in the position held at the time leave was granted. Failure on the part of an employee on leave to report promptly at its. expiration, or within a reasonable time after notice to return to duty, shall be cause for discharge. B. Employees may reduce their workweek upon approval of their Department Head and the City Manager under a Voluntary Leave Without Pay plan, not to exceed 20% of their annual work schedule. Medical premiums will continue to be paid by the City and employee as if working a full schedule. Section 27. Jury Leave Every classified employee of the City who is called or required to serve as a trial juror shall be entitled to absent himself from. his ll duties with the City during the period. of such service or while necessarily being present in court as a result of such call. Under such circumstances, the employee shall be ,paid the difference between his full salary and any payment received by him, except travel pay, for such duty. This compensation shall not extend beyond twenty (20) working days. Section 28. Compensatory Time Off Employees may receive, in lieu of being paid for overtime, compensatory time off at a mutually agreeable time between the City and the employee subject to the operation requirements of the City and with approval determined by the City. No employee may earn more than two hundred forty (240) hours of Compensatory Time Off per fiscal year. In addition, no employee may retain on the books more than forty hours of unused Compensatory Time at any given point during the fiscal year. Amounts submitted in excess of these limits shall be paid at time and one-half. Section 29. Family Medical Leave Act Pursuant to the Family and Medical Leave Act of 1993, FMLA leave may be granted to an employee who has been employed for at least twelve (12) months by the City and who has provided at least 1,250 hours of service during the twelve (12) months before the leave is requested. The leave may be granted up to a total of twelve (12) weeks during the fiscal year for the following reasons: A. Because of the birth of a child or placement for adoption or foster care of a child; B. In order to care for the spouse, son, daughter, parent, or one who stood in place of a parent of the employee, if such spouse, son, daughter, parent, or "in loco parentis" has a serious health condition; C. Because of a serious health condition that makes the employee unable to perform his employment functions. The employee must provide the employer with thirty (30) days advance notice of the leave, or such notice as is practicable, if thirty (30) days notice is not possible. The employee must provide the employer with certification of the condition from a health care provider. The employer, at employer expense, may require a second opinion on the validity of the certification. Should a conflict arise between health providers, a third and binding opinion, at employer expense will be sought. l~ An employee seeking FMLA leave must first us e. paid sick time (if applicable) and vacation before going on unpaid leave. The total amount of family leave paid and unpaid will not exceed a total of twelve (12) weeks. In any case in which a husband and wife entitled to family leave are both employed by the employer, the aggregate number of workweeks of leave to which both may be entitled may be limited to twelve (12) weeks during any Fiscal Year if such leave is taken because of the birth of a child or placement for adoption ~r foster care of a child. The employee will be responsible for his share of the health insurance cost during the leave. If the employee does not return from the leave, he is responsible for the total insurance premium paid by the employer. OTHER Section 30. Retirement The City of Petaluma's retirement plan under the Public Employees' Retirement System shall consist of the following items: Miscellaneous Employees: 20 @ 60 Options: 1959 Survivors Benefit (1st .Level) One year Final Compensation Unused Sick Leave Credit Military Service Credit as Public Service Section 31. Grievance Procedure A. Purpose of Rule (1) To promote improved employer-employee relations by establishing grievance procedures on matters for which appeal or hearing is not provided by other regulations. (2) To afford employees individually or through qualified employee organization a systematic means of obtaining further consideration of problems after every reasonable effort has failed to resolve them through discussions. (3) To provide that grievances shall be settled as near as possible to the point of origin. (4) To provide that appeals shall be conducted as informally as possible. B. Matters Subject To Grievance Procedure The Grievance procedure shall be used to process and resolve grievances arising out of the interpretation, application, or enforcement of the express terms of this compensation plan. C. Informal Grievance Procedure. An employee who has a problem or complaint should first. try to get it settled through discussion with his immediate supervisor without undue delay. If, after this discussion, he does not believe the problem has been satisfactorily resolved, he shall have the right to discuss it with his supervisor's immediate supervisor, if any, in the administrative service. Every effort should be made to find an acceptable solution by informal means at the lower possible level of supervision. If the employee is not in agreement with. the decision reached by discussion, he shall then have the right to file a formal appeal in writing within ten (10) calendar days after receiving the informal decision of his immediate superior. An informal appeal shall not be taken above the appointing power. D. Formal Grievance Procedure (levels of review through chain of command) (1) First level of review The appeal shall be presented in writing to the employee's immediate supervisor, who shall render his/her decision and comments in writing and return them to the employee within five (5) calendar days after receiving the appeal. If the employee does not agree with his/her supervisor's decision, or if no answer has been received within five (5) calendar days, the employee may present the appeal in writing to his/her supervisor's immediate superior. Failure of the employee to take further action within five (5) calendar days after receipt of the written decision of his/her supervisor, or within the total of fifteen (15) calendar days if no decision is rendered, will constitute a dropping of the appeal. (2) Further level or levels of review as appropriate The supervisor receiving the appeal shall review it, render his/her decision and comments in writing, and return them to the employee within five (5) calendar days after receiving the appeal. If the employee does not agree with the decision, or if no answer has been received within five (5) calendar days, employee may present the appeal in writing to the department head. Failure of the employee to take further action within five (5) calendar days after receipt of the decision is rendered, will constitute a dropping of the appeal. (3) Department Review The department head receiving the appeal of his/her designated representative, should discuss the grievance with the employee, his/her representative, if any, and with other appropriate persons. The department head shall render his/her decision and comments in writing, and return them to the employee within five (5) calendar days after receiving the appeal.. If the employee does not agree with the decision reached, or if no answer has been received within five (5) calendar days after receipt of the decision or within a total of fifteen (15) calendar days if no decision is rendered, will constitute a dropping of the appeal. ~y ~5-~~ ~C5 (4) City Manager The City Manager receiving the appeal or his designated representative should discuss the grievance with the employee, his/her representative, if any, .and with other appropriate persons. The City Manager may designate a fact finding committee, officer not in the normal line of supervision, or Personnel Board to advise him concerning the appeal. The City Manager shall render a. decision in .writing to the employee within twenty (20) calendar days after receiving the appeal. (5) Conduct Of Grievance Procedure (a) The time limits specified above may be extended to a definite date by mutual agreement of the employee and the reviewer concerned. (b) The employee may request the assistance of another person of his/her own choosing in preparing and presenting his/her appeal at any level of review. (c) The employee and his/her representative may be privileged to use a reasonable'amount'of work time as. determined by the appropriate department head in conferring about and presenting the appeal. (d) Employees shall be assured freedom from reprisal for using the grievance procedures. ~ ' . REQUEST FOR FAMILY/MEDICAL LEAVE Employee Name: Date of Request: Department: Position Title: Hire Date: I request a Family/Medical Leave for the following reason (check one): A. The birth of a child and/or in order to care for such child. B. The placement of a child for adoption or foster care. C. In order to care for an immediate family member because such family member has a serious health condition. Circle one: CHILD SPOUSE PARENT (Must submit "Physician Certification" within 15 davs). D. My o~,m serious health condition that makes me unable to perform the functions of my position. (Must submit `.'Physician Certification" within 15 days). METHOD OF LEAVE REQUESTED Consecutive Leave Intermittent or Reduced Leave Schedule (Specify Schedule Below) Date leave is to begin: Expected duration of leave: If the duration of my family/medical leave (total of paid and unpaid time) does not exceed 6 months, I will be returned to my same, equivalent or comparable position. Employee's Signature Date q5 -a~a ~~s 4~~ALU~9 I ~`V o~ 4, , _ City of Petaluma 11 English Street Posr Uffice Box 61 Petaluma, California 94953 1858 Employer Response to Employee Request for Family or Medical Leave Date: T0: (Employee's Name) FROM: (Personnel Director) SUBJECT: Request for Family/Medical Leave On ,.you notified us of your need to take family/medical (date) leave due to: (check one) the birth of your child, or the. placement of a child with you for adoption or foster care; or _ a serious health condition that makes you unable to perform the essential functions of your job; or _ a serious health condition affecting your `spouse, child, parent., for which you are needed to provide care. You notified us that .you need this leave beginning on and that (date) you expect leave to continue until on or about (date) Except as explained below, you have a right under the FMLA for up to 12 weeks of unpaid leave during the Fiscal Year for :the reasons listed above: Also, your health benefits must be maintained during any period of unpaid leave under the same conditions as if you continue to work,. and you must be reinstated to the same or an equivalent job with the same pay, benefits and terms and conditions of employment on your return from leave. If you do not return to work following FMLA leave for a reason other than: (1) continuation, recurrence, or onset of a.serious health condition which would entitle you to FMLA leave; or (2) other circumstances beyond your control, you may be required to reimburse us for our share of health insurance premiums paid on your behalf during your FMLA leave. This is to inform you that: (check appropriate boxes; explain where indicated) I„ You are eligible not eligible for leave under the FMLA. II. The requested leave will will not be counted against your annual FMLA leave entitlement. III. You _will will not be required to furnish medical certification of a serious health condition. If required, you must. .furnish certification by (must be at least 15 days after you are notified of this requirement) or we may delay the commencement of your leave until the certification is submitted. C~ a..,b o... IV. You may elect to s~~bstiti~te accrued paid leave for unpaid F`iLA leave. We caill _will not require that you substitute accrued paid leave to unpaid FifLA leave. If paid leave will be used the following conditions will apply: V. If you normally pay a portion of the premiums for your health insurance, these payments will continue during the period of FMLA leave. Arrangements for payment have been discussed with you and is agreed that you will make premium payments as follows: (Set forth dates, e,g,, the 10th of each month, or pay periods, etc, that specifically cover the agreement with the employee.) You have a minimum 30-day (or, indicate longer period, if applicable) grace period in which to make premium payments. If payment is not made timely, your group health insurance may be cancelled, provided we notify you in writing at least 15 days before that date that your health coverage will lapse, or at our option, we may pay your share of the premium daring FMLA leave, and recover these payments from you upon .your return to work. We _will will not pay share of health insurance premiums while you are on leave, We _will will not do the same with other benefits (e.g., life insurance, disability insurance, etc.) while you are on FMLA leave. If we do pay your premiums for other benefits, when you return from leave you _will will not be expected to reimburse us for the payments made on your behalf. VI. You _will _will not be required to present a fitness-for-duty certificate prior to being restored to employment. If such certification is required but not received, your return to work may be delayed until the certification is provided. VZI. You _are _are not a "key employee" as described in 825.218 of the FMLA regulations. If you are a "key employee", restoration to employment may be denied following F~1LA leave on the grounds that such restoration will cause substantial and grievous economic injury to us. We _have _have not determined that restoring you to employment at the conclusion of FMLA leave will cause substantial and grievous economic harm to us , VIII. While on leave, you _will _will not be required to furnish us with periodic reports every of your status and intent to return to work. If the circumstances of your leave change and you are able to return to work earlier than the date indicated on the reverse side of this form, you _will will not be required to notify us at least two work days prior to the date you intend to report for work. IX. You _will _will not be required to furnish recertification relating to a serious health condition. 95 -a-~ ~ S PHYSICIAN OR PRACTITIONER CERTIFICATION SERIOUS HEALTH CONDITION Employee's Name: Patient's Name (if other than employee): Diagnosis: Date condition commenced: Duration of Medical Leave; From: To: Regimen of treatment to be prescribed (indicate nu~aber of visits, general nature and duration of treatment, including referral to other provider of health services. Include schedule of visits or treatment if it is med- ically necessary for the employee to be off work ~z an intermittent basis or to work less than the employee's normal schedule o'f hours per day or days per week.): By Physician or Practitioner By other provider of health services, if referred by Physician or Practitioner: Check Yes or No in the space below as appropriate. I. Yes_ No_ Is inpatient hospitalization of the family member (patient) required? II. Yes_ No_ Does (or will) the patient require assistance:for basic medical, hygiene, nutritional needs, safety or .transportation? III.: Yes No_ After review of the employee's signed statement, is the employee's presence necessary or would it be beneficial for the care of 'the patient? (This may include psychological comfort.) IV. Estimate the period of time care is needed or the employee's presence would be beneficial: V. When Family Leave is needed to care for a seriously ill family member, the employee shall state the care he or she will provide and an estimate of. the time period during which this care will be provided, including a schedule if leave is to be taken intermittently or on a reduced leave schedule. Employee's Signature: Date: Signature of Physician or Practitioner: Date: Type of Practice (Field of Specialization, if any) ~'S - a-I a- nl C S CITY OF PETALUMA FITNESS FOR DUTY TO RETURN FROM LEAVE CERTIFICATION On the Employee began a period of family/medical care (mo/day/yr) from the City of Petaluma for Based on mv_ (diagnosis) examination of on (employee's name) (date of examination) I certify that he/she is medically/psychologically fit to return to work with the following limitations: (list limitations if applicable) Date: Signature of Physician or Practitioner Type of Practice (Field of Specialization, if any) CITY OF PETALUMA AUTHORIZATION FOR PAYROLL DEDUCTIONS FOR BENEFIT COVERAGE CONTINUATION DURING FAMILY/MEDICAL CARE LEAVE I authorize the City of Petaluma to made deductions from income I will receive from accrued leave during my upcoming family/medical care leave which will commence on and end on (date leave will start) (date Leave will end) I authorize deduction to be made from income I will receive from accrued leave for the following benefits: Employee's Signature Date c~~r-~la- WIGS CITY OF PETALUMA INTEROFFICE MEMORAI~IDUM To: Personnel Department From: SUBJECT: REQUEST FOR WAIVER/CANCELLATION OF MEDICAL/DENTAL COVERAGE This is to verify that I am currently covered by my spouse's insurance. As a result, I would like to cancel/waive my insurance coverage effective. on the following: A letter verifying coverage by my spouse's employer is attached. As per the current MOU, upon cancellation/waiver of my insurance coverage, I request the amount I am eligible to be paid. I qualify for an amount based on the party rate, because I have number of dependents. I understand that if I cancel my insurance I am subject to the re-enrollment policy of the P~fCI3A Health Plan as provided by the City. Employee's Signature Date