Arroyo Grande City Council
February 27, 2024

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICIES AND PROCEDURES POLICY#: B-024 SUBJECT: SUBSTANCE ABUSE TESTING
ISSUED: 07/17/00 ~""""--'-.....__.. ___ _
EFFECTIVE: 07/17/00
CANCELLATION DATE: N/A
SUPERSEDES: NEW
POLICY
The City of Arroyo Grande acknowledges the problem of substance abuse (including alcohol) in our society. Furthermore, we see substance abuse as a serious threat to the safety of our employees, other individuals doing business with the City, and the general public. It also adversely affects the service and dependability that our citizens expect, as well as general levels of job performance. We are addressing this problem through our Substance Abuse Policy, which will ensure that the City remains a drug-free workplace.

Drug and alcohol addiction is a complex yet treatable disease. Our substance abuse program is targeted at alleviating the problem at all levels. Our pledge to eradicate substance abuse in the workplace reflects our firm belief that by building this commitment in the City, we will be strengthening our community.

While the City understands employees and applicants under a physician's care are required to use prescription and non-prescription drugs, abuse of such medications will be dealt with in the same manner as the abuse of illegal substances.

The ultimate goal of this Policy is to balance our respect for individual privacy with our need to keep a safe, productive drug-free environment. Our intention is to prevent substance abuse and to help and encourage those who use drugs or ·abuse alcohol to seek help in overcoming their problem.

The following is a general statement of the City's policy on substance abuse as contained in the City of Arroyo Grand e's Personnel Regulations, Section XI I - 7, DrugFree Workplace:

It is the policy of the City that a drug-free work place shall be maintained at all times.

The illegal manufacture, use, sale, distribution, or possession of alcohol or a controlled substance while on duty, subject to being called to duty, on City property or at a City work site is strictly prohibited and grounds for disciplinary action up to and including dismissal.

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a. Prescribed Treatment
Any employee who may be undergoing medically-prescribed treatment with a controlled substance that may limit the employee's ability to perform the job must report this treatment to his/her supervisor prior to beginning work.' Failure to report this to the supervisor may be grounds for disciplinary action. b. Law Enforcement Intervention
Any employee suspected of manufacturing, selling, distributing, or otherwise possessing alcohol and/or a controlled substance on City property or at a City work site shall, after the observer's consultation with and approval by the City Manager, be reported to. the appropriate law enforcement agency. Nothing in this section shall p~eclude an employee from reporting a crime to an enforcement agency in a timely manner.
c. Criminal Conviction
Employees will notify the City Manager of any criminal drug/alcohol statute arrest and/or conviction occurring in the work place no later than five (5) days after such conviction.
d. Employee-Assistance Programs
Employees requiring assistance may be referred to employee assistance, drug abuse, and/or rehabilitation programs.

Participation in these programs will not jeopardize future employment or advancement nor will it preclude disciplinary action for continued substandard job performance or rule infractions.
e. Confidentiality
To the extent feasible and practical, proceedings under this policy and all reports and records filed shall be confidential to the parties and agencies involved or requiring notification; and all reasonable effort shall be made to protect the privacy of the parties.
f. Discipline/Sanctions
In its enforcement of this policy, the City may invoke disciplinary action(s) up to and including dismissal.

PROCEDURE
A. PRE-EMPLOYMENT DRUG TESTING
As a condition of employment, all applicants of the City of Arroyo Grande must agree to and sign a statement indicating that they will .adhere to the City's Drug-Free Workplace Policy. All offers of employment will be conditioned on the applicant's taking and passing a screening test for evidence of improper drug use.

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Applicants will be required to voluntarily submit to a test at a laboratory chosen by the City, and by signing a consent agreement form to release the City from liability. Any applicant who tests positive or who refuses to undergo testing will not be employed by the City and may not reapply for at least 180 days.

B. ACTIVE EMPLOYEE SUBSTANCE ABUSE TESTING POLICY

1. Employees may be required to submit to drug and/or alcohol testing at a laboratory chosen by the City if there is reasonable suspicion of substance abuse.

Circumstances that could be indicators of a substance abuse problem and considered reasonable suspicion are:
i. Observed alcohol or drug abuse during work hours on City premises. ii. Apparent physical state of impairment.
iii. In.coherence.
iv. Marked changes in personal behavior that are otherwise unexplainable. v. Deteriorating work performance that is not attributable to other factors. vi. Information that an employee has caused or contributed to or has been in an accident while at work.
vii. Abnormal conduct or erratic behavior while at work. viii. A report of illegal drug use provided by a reliable source. ix. Evidence that a drug test has been tampered with during employment with the City.
x. Evidence that an employee has possessed, sold, solicited or transferred illegal drugs while working or while on City premises or while operating City vehicles, machinery or equipment. .
xi. Appearance, behavior, speech, or body odor (e.g. smell of alcohol use) or other physical symptoms or manifestations of being under the influence of a drug and/or alcohol.

2. Routine Fitness for Duty
Employees may be required to submit to a drug and/or alcohol test if the test is conducted as part of a routinely scheduled employee fitness-for-duty medical examination that is part of the City's established policy or that is scheduled routinely for all members of a job classification group.

Police Department personnel are subject to the fitness for duty evaluation process as dictated in Police Department General. Order 0216, Fitness-For-Duty Evaluations.

3. Follow-up Drug Testing
If the employee, in the course of employment, enters into a drug rehabilitation program, the City will require the employee to submit to a drug test as a follow up to such program. This testing may be conducted at least once a year for a twoPage 1152 of 1799 POLICY~ PAGE4
year period after the completion of the program. Advance notice of the follow up testing will not be given to the employee who is to be tested.

4. Workplace Accidents/Property Damage
Employees may be required to submit to a drug and/or alcohol test with regard to any workplace injury, which requires medical treatment away from the City, or when they do damage to City property.

5. Random Testing
For those positions the City determines are appropriate, or if an employee has previously tested positive, or if required by law, an employee may be required to submit to a random drug and/or alcohol test. A random test will not be announced in advance.

6. DOT Testing
Employees who are required to have commercial driver's licenses ("COL") for their position, are also covered under City of Arroyo Grande's Administrative Policies ~nd Procedures #8-009, Drug and Alcohol Testing Under DOT regulations.

C. DEFINITIONS
A. "Legal Drug," includes prescribed drugs and over-the-counter drugs, which have been legally obtained and are being used solely for the purpose for which they were prescribed or manufactured.

B. "Illegal Drug" is any drug (a) which is not legally obtainable; (b) which may be legally obtainable but has not been legally obtained; (c) which is being used in a manner or for a purpose other than as prescribed.

C. "Drug Paraphernalia" means any material or equipment designed to test, package, store or introduce into the human body an illegal drug.

D. "Under the Influence" means that the employee is adversely affected by an. illegal drug, alcohol or legal drug, which impairs safety or job performance in any detectable manner. The symptoms of being under the influence are not confined to those consistent with misbehavior, nor to obvious impairment of physical or mental ability, such as slurred speech or difficulty maintaining balance. ·
E. "Use" means the physical consumption of alcohol or any illegal drugs by any method.

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D. POLICY AND WORK RULE
The City's Policy is to employ a work force free from use of illegal drugs and the abuse of alcohol. The moderate use of alcohol while attending City-approved meetings/functions, for the required use in an employee's position, or in connection with business needs for employees whose job involves periodic entertainment of guests or others, is not prohibited by this policy. However, it is the obligation of such employees to do so responsibly and in moderation. Excessive consumption of alcohol and/or abuse of this provision will not be tolerated. Any employee determined to be in violation of this Policy is subject to disciplinary action which may include termination, even for the first offense. It is a Standard of Conduct of the City of Arroyo Grande that employees shall not use illegal drugs or abuse alcohol.

E. USE OF PRESCRIPTION AND NON-PRESCRIPTION MEDICATION
Each tested applicant or employee shall report, on a confidential basis to the Medical Review Officer (MRO) at the drug testing facility, the use of prescription or non-prescription medications both before and after being tested. A form will be provided to each employee and applicant to list such medications.

This form shall only be completed at the collection facility and not the City.

Additionally, such medications may be disclosed orally to the MRO after being tested, if contacted by the MRO. The employee or applicant should not disclose such medications or provide the form requesting such information to any City employee. However, employees should report to their supervisor the taking of any legal drugs which ·could impair job performance and/or the safety of the employee or others.

F. DRUG TESTING INFORMATION

1. The City will test for one or more of the following drugs:

Alcohol, Amphetamines (speed, eve, biphetamine, desoxyn, dexedrine, etc.), Cannabinoids (marijuana, hashish, hash, hash oil, etc.), Cocaine (coke, crack, etc.), Phencyclidine (PCP, angel dust.etc.) Methaqualone (quaaludes, etc.), Opiates (heroin, morphine, codeine, opium, etc.), Barbiturates (phenobarbital, butabarbital, etc.), Benzodiazepines librium, valium, activan, azene, diazepam, halcion, etc.), Methadone (dolophine, nethadose, etc.) Propoxyphene (designer drugs, etc.) Hallucinogens (LSD, acid, mushrooms, etc.) and Synthetic narcotics or metabolite of any of the substances listed in this paragraph.

2. Each applicant or employee has the right to consult the Medical Review Officer for technical information regarding prescription and non-prescription medications.

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G. POSITIVE DRUG TEST RESULTS
Any employee or job applicant who receives a positive confirmed drug test result may contest or explain the results to the Medical Review Officer and City within five working days after written notification of the positive test results. If an employee's or job applicant's explanation or challenge is unsatisfactory to the MRO and City, the MRO shall report a positive test result back to the City.

H. COUNSELING PROGRAMS
We encourage all employees who need assistance in dealing with alcohol or drug related dependency problems to seek counseling through the various private and public agencies that exist in our community. Employees who come forward to request treatment or a leave of absence for treatment will not be subject to discipline. Employees may not, however, escape discipline by first requesting such treatment or a l~ave of absence after being selected for testing or violating City policies and rules of conduct. Requests for voluntary treatment and related matters will be kept confidential in accordance with federal and state laws.

I. GROUNDS FOR TERMINATION OR DISCIPLINE

1. Illegal Drug Use
An employee bringing onto the City's premises or property, including parking lots, having possession of, being under the influence of or possessing in the employee's body, blood, or urine in any detectable amount, c;>r using, consuming, transferring, selling or attempting to sell "or transfer any form of illegal drug as defined above while on City business or at any time during the hours between the beginning and ending of the employee's work day, whether on duty or not, and whether on City or customer business, property or not, is subject to discipline including termination or suspension without pay from employment, even for the first offense. Failure to submit to the required drug test is grounds for termination or suspension without pay from employment.

2. Alcohol Abuse
Except as stated in Section D of this procedure, an employee who is under the influence of alcoholic beverages at any time while on City business or at any time during the hours between the beginning and ending of the employee's work day, whether on duty or not, and whether on City or customer business, property, or not, is subject to discipline including termination or suspension without pay from employment, even for the first offense. An employee shall be· determined to be under the influence of alcohol if his or her blood alcohol is at a level of .01 or higher. Failure to submit to the required drug and/or alcohol test is grounds for termination or suspension without pay from employment.

4. POLICY# 8-0ii
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3. Employer Action·
•
Any employee or job applicant whom the City is advised has a positive confirmed drug test, including for alcohol, will be subject to discharge even for the first 'offense.

J. CONVICTIONS FOR DRUG OR ALCOHOL RELATED OFFENSES
Based on the nature of the City's business, the City also requires any employee arrested for a drug-related offense immediately to notify the Management Assistant.

The City will review the individual circumstances involved to determine the appropriate course of action pending the outcome of the situation. An employee convicted of a drug or alcohol-related offense is required to immediately notify the City no later than five (5) days after such conviction. Further, off-duty conduct which may be viewed as a violation of this policy includes an employee's conviction for any drug-related offense, or any alcohol related offense which may have a bearing on an employee's continued suitability for the job.

K. SEARCHES AND INSPECTIONS
In enforcing the City's Drug-Free Workplace Policy, the City reserves the right at any time to inspect City property, including desks, lockers or other suspected areas of concealment. The City also reserves the right to search personal effects, such as purses and packages, upon entering or leaving the premises. No stigma should be attached to such routine inspections, and being selected for such an inspection does not suggest suspicion of a violation of any City rule: Searches of an employee's person and/or personal effects also may be requested when there is "reasonable suspicion" for such searches. Consent to inspections under the foregoing circumstances shall be a condition of employment or continued employment with the City. Any person who fails to cooperate in a properly requested inspection is subject to disciplinary action including immediate discharge.

L. OTHER CIRCUMSTANCES INVOLVING ILLEGAL DRUGS OR ALCOHOL This policy is not intended to address all circumstances in which involvement with illegal drµgs or alcohol warrants disciplinary action. Nothing in this policy shall be considered .as limiting the City's right to take corrective action, up to and including termination, for involvement with illegal drugs or alcohol not specifically addressed in this policy.

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PAGES
M. AT -WILL EMPLOYMENT
No provision herein is intended to modify the City's policy that employment rem.ains terminable at will at the option of the City or any employee. · N. COMPLIANCE WITH APPLICABLE LAW
. This policy may be subject to change and/or modification based upon applicable federal, state or local laws or regulations. Any questions regarding this policy should be directed to the City Manager or Management Assistant.

0. CONFIDENTIALITY
AIJ information, interviews, reports, statements, memoranda and drug-free test results through the City's drug testing program will be treated as confidential to the extent required by law, except as consented to by the employee or applicant.

P. ATTACHMENTS
1) Test Notification and Consent Form
Q. CROSS REFERENCES
1) City of Arroyo Grande Personnel Regulations
2) City of Arroyo Grande Administrative Policy and Procedure Manual Section #8-009, Drug and Alcohol Testing Under Dot Regulations
3) Arroyo Grande Police Department General Order #0216, Fitness-forDuty Evaluation ~ RICK TER80RCH

INTERIM CITY MANAGER

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Attachment 1

CITY OF ARROYO GRANDE

ALCOHOL AND/OR CONTROLLED SUBSTANCES

TEST NOTIFICATION AND CONSENT FORM
i PRE-EMPLOYMENT [ ] ! COMPANY POLICY TESTING [ ]
Employee/Applicant Name: ________________________ _
Department=------------------------------
You are hereby instructed to report to: San Luis Obispo Med-Stop, 283 Madonna Rd., Suite B, San Luis Obispo, CA within 48 hours of receipt of this form.

1. Type of test: [ ] Alcohol

2. Reason for test: [ ] Pre-Employment
[ ] Post-Accident
[ ] Return-to-Duty
] Controlled Substances
] Reasonable Suspicion
[ ] Follow-up

3. Date and Time Notified: ___ ....;./ ___ ....;./ ___ ------''----- a.m./p.m.

Date and Time Tested: ____ ! ___ / ___ _______ a.m./p.m.

I hereby acknowledge that I have been instructed to provide a urine, breath, blood or hair specimen to be used in testing for the presence of controlled substances and/or the presence of alcohol in my system as detailed above. I further acknowledge that I have received, read, and understand the City of Arroyo Grande's Drug-Free Workplace Policy which has been provided to me. I consent to this test(s) and authorize the release of test results to the Medical Review Officer (MRO) designated and to the City's designated representative. I understand that the results of the test(s) may be grounds for my not being hired or if already hired as grounds for my immediate discharge.

Date Employee/Applicant Signature
Date Company Representative
I refuse to submit to said test(s), and understand that my refusal will result in my immediate discharge or rejection of my employment application.

Date Employee/ Applicant Signature
Date City Representative
I

AN OPEN LETTER TO THE APPLICANTS AND EMPLOYEES OF THE

CITY OF ARROYO GRANDE
We at the City of Arroyo Grande are committed to creating and maintaining a drug-free workplace without jeopardizing valued but troubled employees' jobs and security, provided they are prepared to help us help them. We believe that the abuse of alcohol and use of illegal drogs endangers the health and safety of the abusers and all others around them.

City policy states that substance abuse will not be tolerated during working hours on or off the premises of the City including the parking lots. This prohibition includes the possession, use, sale or distribution of illegal drugs or alcohol or being under the influence of illegal drugs or alcohol while on the job or during the working day. The City has adopted a pre-employment drug-testing program as a method of maintaining a drug-free work environment. Employees also may be subject to drug testing in appropriate circumstances.

For applicants, a positive drug test will result in disqualification for further consideration for employment with the City. Employees who violate this policy in any other way are subject to disciplinary action, which may include termination.

All information, interviews, reports, statements and drug test results through the City's Drug-Free Workplace Program will be confidential to the extent allowed by law.

We at the City of Arroyo Grande are confident that you understand the need to protect the workplace as an environment that is secure and healthy for everyone.

______________________________________________________________________

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICIES AND PROCEDURES POLICY #: B-025
ISSUED: 09/17/2020
EFFECTIVE: 09/17/2020
CANCELLATION DATE: N/A
SUPERSEDES: 07/1/00
SUBJECT: PREGNANCY DISABILITY LEAVE
POLICY:

The City of Arroyo Grande (“City”) will provide Pregnancy Disability Leave ("PDL") for female employees for disabilities due to pregnancy, childbirth or a related medical condition. The following provisions set forth certain rights and obligations with respect to such leave. Rights and obligations which are not specifically set forth below are set forth in the California Fair Employment and Housing Act (CA-FEHA). Unless otherwise provided by his article, "Leave" under this article shall mean leave pursuant to PDL.

PROCEDURE:

A. EMPLOYEES ELIGIBLE FOR LEAVE
A woman who works for a covered employer is eligible for pregnancy disability leave regardless of the length of time she has worked for the employer. Further, an employee does not have to work full-time in order to be eligible.

B. REASONS FOR LEAVE
Pregnancy leave is required only when a woman is actually disabled by pregnancy, childbirth, or a related medical condition. This includes time off needed for prenatal care, severe morning sickness, doctor-ordered bed rest, childbirth, recovery from childbirth, and any related medical condition. A woman does not have to be completely incapacitated or confined to her bed to qualify as being disabled by pregnancy. However, as a general rule, a woman must be unable to perform one or more essential functions of her job without undue risk to herself or to -other persons or without undue risk to successful completion of her pregnancy. It is the medical opinion of the woman's physician or health care provider that determines whether she is disabled by pregnancy or a related medical condition.

C. AMOUNT OF LEAVE
An employee who is disabled because of pregnancy, childbirth, or a related medical condition is entitled to an unpaid leave for up to the number of hours she would normally work within four (4) calendar months (one-third of a year or 171/3 weeks). For a full-time employee who works 40 hours per week, “four months” means 693 hours of leave entitlement, based on 40

POLICY # B-025

PREGANCY DISABILITY LEAVE
PAGE 2
hours per week times 171/3 weeks. An employee who works less than 40 hours per week will receive a pro rata or proportional amount of leave.

Leave taken for pregnancy disability does not need to be taken in one continuous period of time.

Leave can be taken before or after birth or at any period of time the woman is physically unable to work because of the pregnancy or pregnancy-related condition. Multiple periods of leave will be totaled in computing the four months leave.

D. EMPLOYEE BENEFITS WHILE ON LEAVE

1. Group Health Insurance
Leave under this policy is unpaid. While on leave, employees will continue to be covered by the City's group health insurance, dental, vision, and life insurance to the same extent that coverage is provided while the employee is on the job

2. Payment of Premiums
Employees may make the appropriate contributions for continued coverage under the preceding benefit plans by payroll deductions (if the employee is using her accrued leave) or direct payments (if the employee is not using her accrued leave). The City will inform the employee whether the direct payments for premiums should be paid to the carrier or to the City, and when these premiums are due. Your coverage on a particular plan may be dropped if you are more than 30 days late in making a premium payment and you will be offered continuation coverage under COBRA. However, you will receive a notice at least 15 days before coverage is to cease, advising you that you will be dropped if your premium payment is not paid by a certain date. Employee contribution rates are subject to any change in rates that occurs while the employee is on leave.

3. Recovery of Premium if the Employee Fails to Return from Leave If an employee fails to return to work after her leave entitlement has been exhausted or expires, the City shall have the right to recover its share of health plan premiums for the entire leave period, unless the reason for failure to return is a circumstance beyond her control or the use of the separate right to 12 weeks of bonding leave under the California Family and Medical Leave Act (“CFRA”). The City shall have the right to recover premiums through deduction from any sums due the employee (e.g. unpaid wages, vacation pay, etc.).

4. Sick and Vacation Leaves
Sick and vacation leaves do not accrue while an employee is on unpaid pregnancy disability leave.

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PREGANCY DISABILITY LEAVE
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5. Employee Status During Leave
The employee retains employee status during the leave. The leave is not a break in service for purposes of longevity or seniority under any collective bargaining agreement or employee benefit plan. Benefits will be resumed upon the employee’s reinstatement in the same manner and at the same levels as provided when the leave began, without any new qualification period, physical exam, or other qualifying provisions.

E. SUBSTITUTION OF PAID ACCRUED LEAVES
While on leave under this policy, as set forth herein, an employee may elect to concurrently use paid accrued leaves. Similarly, the City may require an employee to concurrently use paid accrued leaves after requesting PDL.

1. Employee's Right to Use Paid Accrued Leaves Concurrently with PDL An employee may request the use of her accrued sick leave, vacation leave, administrative leave, compensatory time, and any other leave credits she has in order to received compensation during her unpaid pregnancy disability leave.

2. The City of Arroyo Grande's Right to Require an Employee to Use Paid Leave When Using PDL
Employees must exhaust their accrued leaves concurrently with PDL to the same extent that employees have the right to use their accrued leaves concurrently with FMLA and/or CFRA leave with the following exception:
a) Employees are not required to use accrued compensatory time earned in lieu of overtime earned pursuant to the Fair Labor Standards Act.

3. The City of Arroyo Grande's Right to Require an Employee to Exhaust FMLA Leave Concurrently with Pregnancy Disability Leave
If an employee takes a leave of absence for PDL and it is FMLA qualifying, the City may designate that leave as running concurrently with the employee's 12-week FMLA leave entitlement.

F. EMPLOYEE NOTICE OF LEAVE
Although the City recognizes that emergencies arise which may require employees to request immediate leave, employees are required to give as much verbal or written notice as possible of their need for leave. If leave is foreseeable, at least 30 days written notice (Request for or Report of Leave of Absence – Attachment 1) is required. If 30 days advance notice is not possible due to lack of knowledge of when leave or transfer will begin, or because of a change in circumstance, or because of a medical emergency, notice must be given as soon as practical.

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PREGANCY DISABILITY LEAVE
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Terms of the leave may be modified as a woman's changing medical condition dictates. Such notice may be orally given. If the City determines that an employee's notice is inadequate or the employee knew about the requested leave in advance of the request, the City may delay the granting of the leave until it can in its discretion, adequately cover the position with a substitute.

G. MEDICAL CERTIFICATION
Employees who request leave for PDL must provide written certification from the health care provider. The certification must include a statement that the employee is unable to work at all or is unable to perform the essential functions of her position, the expected duration of the disability and expected date of return to work (Certification of Health Care Provider for Pregnancy Disability Leave, Transfer and/or Reasonable Accommodation – Attachment 2).

1. Time to Provide Certification
When an employee's leave is foreseeable and at least 30 days notice has been provided, if a medical certification is requested, the employee must provide it before the leave begins. When this in not possible, the employee must provide the requested certification to the City within the time frame requested by the City (which must allow at least 15 calendar days after the employer's request), unless it is not practicable under the particular circumstances to do so despite the employee's diligent, good faith efforts.

2. Consequences for Failure to Provide an Adequate or Timely Certification If an employee provides an incomplete medical certification, the employee will be given a reasonable opportunity to cure any such deficiency. If an employee fails to provide a medical certification within the time frame established by this policy, the City may delay the taking of PDL until the required certification is provided.

3. Intermittent Leave or Leave on a Reduced Leave Schedule If an employee requests leave intermittently (a few days or hours at a time) or on a reduced leave schedule, the employee must provide medical certification that such leave is medically necessary. "Medically necessary" means there must be a medical need for the leave and that the leave can best be accomplished through an intermittent or reduced leave schedule.

H. REASONABLE ACCOMMODATION
The City will provide reasonable accommodation to a pregnant employee when requested, with the advice of her health care provider, related to her pregnancy, childbirth, or related medical condition.

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PREGANCY DISABILITY LEAVE
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I. REINSTATEMENT UPON RETURN FROM LEAVE

1. Right to Reinstatement
Upon expiration of leave and the City’s receipt of a Fitness for Duty to Return from Leave (Attachment 4) certification from the health care provider, an employee is entitled to be reinstated to her original or an equivalent position, so long as it was not eliminated for a legitimate business reason during her leave.

If the employee’s original position is no longer available, the employee will be assigned to an open position that is substantially similar in job content, status, pay, promotional opportunities, and geographic location as the employee’s original position.

If upon return from leave an employee is unable to perform the essential functions of her job because of a physical or mental disability, the City will initiate an interactive process with the employee in order to identify a potential reasonable accommodation.

2. Employee's Obligation to Periodically Report on Her Condition The employee may be required to periodically report on their status and intent to return to work. This will avoid any delays to reinstatement when the employee is ready to return.

3. Fitness for Duty Certification
As a condition of reinstatement, the employee must obtain and present a "Fitness for Duty to Return from Leave" (Attachment 4) from the health care provider that the employee is able to resume work. Failure to provide such certification will result in denial of reinstatement.

4. Failure to Return from Leave
Failure to return to work after the authorized four month leave period causes the pregnancy disabled employee to have no reinstatement rights.

J. REQUIRED FORMS
Employees must fill out the following applicable forms in connection with leave under this policy:

1. "Request for or Report of Leave of Absence" (Attachment 1) to be eligible for leave. On the form, the employee must indicate it is PDL leave.

2. Certification of Health Care Provider for Pregnancy Disability Leave, Transfer and/or Reasonable Accommodation - for the employee's disability due to pregnancy, childbirth, or a related medical condition. (Attachment 2)

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PREGANCY DISABILITY LEAVE
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3. Authorization for payroll deductions for benefit plan continuation coverage, should the employee have payroll deductions for benefits, and they wish to continue coverage. (Attachment 3)

4. "Fitness for Duty to Return from Leave Form". (Attachment 4) K. ATTACHMENTS

1. Request for or Report of Leave of Absence

2. Certification of Health Care Provider for Pregnancy Disability Leave, Transfer and/or Reasonable Accommodation

3. Authorization for Payroll Deductions for Benefit Plan Continuance

4. Fitness for Duty to Return from Leave
L. CROSS REFERENCES

1. City of Arroyo Grande Personnel Regulations

2. Applicable Memoranda of Understanding (MOU's)

3. City of Arroyo Grande Administrative Policies and Procedures # B-023, Family and Medical Leave Act and California Family Rights Act
_____________________________
Whitney McDonald
City Manager

POLICY # B-025

PREGANCY DISABILITY LEAVE
PAGE 7
ATTACHMENT 1
City of Arroyo Grande P.O. Box 550
Arroyo Grande, California 93421

REQUEST FOR OR REPORT OF LEAVE OF ABSENCE

NAME OF EMPLOYEE DEPARTMENT POSITION TITLE
TYPE LEAVE REQUESTED:
 VACATION
 REGULAR SICK LEAVE
 WORKER’S COMP LEAVE
 FAMILY DEATH LEAVE
 MILITARY LEAVE
 ANNUAL LEAVE
 JURY DUTY
 WITHOUT PAY

FIRST DATE ABSENT LAST DATE ABSENT

TOTAL NO WORKING HOURS

REASON FOR LEAVE

DATE SIGNATURE OF EMPLOYEE

DATE SIGNATURE OF DEPARTMENT DIRECTOR DATE SIGNATURE OF CITY

MANAGER

REMARKS

CITY OF

ARROYO GRANDE
ATTACHMENT 2

CERTIFICATION OF HEALTH CARE PROVIDER FOR PREGNANCY

DISABILITY LEAVE, TRANSFER AND / OR REASONABLE

ACCOMMODATION
Employee Name __________________ Date of Request ______________________ Department ______________________ Position Title ________________________ I certify that, because of this patient’s pregnancy, childbirth or a related medical condition (including, but not limited to, recovery from pregnancy, childbirth, loss or end of pregnancy, or post-partum depression), this patient needs (check all appropriate boxes):
 Time off for medical appointments.

Specify when and for what duration:
 A disability leave. (Because of patient’s pregnancy, childbirth or a related medical condition, patient cannot perform one or more of the essential functions of patient’s job or cannot perform any of these functions without undue risk to self, to successful completion of the pregnancy or to other persons.) Beginning (estimate):

Ending (estimate):
 Intermittent leave. Specify medically advisable intermittent leave schedule:

Beginning (estimate):

Ending (estimate):
 Reduced work schedule. Specify medical advisable reduced work schedule:

Beginning (estimate):

Ending (estimate):
 Transfer to a less strenuous or hazardous position or to be assigned to less strenuous or hazardous duties. Specify what would be a medically advisable position / duties:

Beginning (estimate):

Ending (estimate):

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PREGANCY DISABILITY LEAVE
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 Reasonable accommodation(s). Specify medically advisable needed accommodation(s). These could include, but are not limited to, modifying lifting requirements, or providing more frequent breaks, or providing a stool or chair.

Beginning (estimate):

Ending (estimate):

Name, license number and medical/health care specialty (printed) of health care provider.

Signature of Health Care Provider Date
Authority Cited: Government Code sections 12935, subd. (a), and 12945 Reference: Government Code sections 12945, 12945; FMLA, 29 U.S.C. §2601, et seq. and FMLA regulations, 29 C.F.R. § 825.

CITY OF

ARROYO GRANDE
ATTACHMENT 3

AUTHORIZATION FOR PAYROLL DEDUCTIONS FOR BENEFIT

COVERAGE CONTINUATION DURING PREGNANCY DISABILITY
LEAVE
I, authorize the City of Arroyo Grande to make deductions from income I will receive from accrued leave during my upcoming family/medical care leave which will commence on_________________________ and end on _________________________.

I authorize deductions to be made from income I will receive from accrued leave for the following benefits:
______________________________________________________________________ (list benefits which employee is entitled to contribute to during family/medical care leave) Date: ___________________
___________________________________
Employee’s Signature
POLICY # B-025

PREGANCY DISABILITY LEAVE
PAGE 10

POLICY # B-025

PREGANCY DISABILITY LEAVE
PAGE 11
ATTACHMENT 4

CITY OF ARROYO GRANDE

FITNESS FOR DUTY TO RETURN FROM LEAVE
To City of Arroyo Grande Employee: You must present this release to your supervisor before or on the day you return to work. You may not work without this release.

To: Treating Physician or Practitioner
Our employee began a period of medical care leave for his/her serious health condition on______________________________.

As a condition of returning to work, the employee must take a physical examination and have his/her physician complete this form. This form must be completed before the employee is allowed to resume his/her job duties.

1. Employee Name:__________________________________________

2. Employee’s Job Title:_______________________________________

3. Date of Physical Examination:_________________________________

4. With respect to your understanding as to what are the employee’s essential job functions, please check the source(s) where you received your information:
_____City job description
_____Discussion with the employee’s supervisor
_____Discussion with the employee
_____Other. Please explain:________________________________

5. Please indicate the status of the employee’s release to duty:
_____Fully, unrestricted duty. Please skip question 6 and proceed to #7. _____Modified duty. You must complete question 6.
_____Not released for any type of duty.

6. If you are releasing the employee to modified work duty, you must complete this section thoroughly.

A. Estimated date that employee will be able to return to full, unrestricted duty:_______________________.

B. Indicate the exact work restrictions which apply to the employee at this time on the attached chart.

7. I hereby certify that the forgoing facts are true and correct, and are executed under penalty of perjury in____________, California, this ______day of __________, 20___. ____________________________________ _______________________ Signature of Treating Physician or Practitioner Date
_____________________________________ _________________________ Print Name of Treating Physician or PractitionerTelephone Number

POLICY # B-025

PREGANCY DISABILITY LEAVE
PAGE 9
ATTACHMENT 4

CITY OF ARROYO GRANDE

FITNESS FOR DUTY TO RETURN FROM LEAVE
TO: DOCTOR

ADDRESS
FROM: HUMAN RESOURCES MANAGER
RE:

CAN THIS PATIENT RETURN TO WORK WITH NO RESTRICTIONS?  YES  NO DATE EMPLOYEE CAN RETURN TO FULL DUTIES____________________________________________________ IF NOT, PLEASE COMPLETE THE FOLLOWING:

This patient is physically able to perform the following functions:

I. In an 8-hour day, this patient can: (Circle full capacity for each activity) A. Sit - Number of Hours: 1 2 3 4 5 6 7 8
B. Stand - Number of Hours: 1 2 3 4 5 6 7 8
C. Walk - Number of Hours: 1 2 3 4 5 6 7 8
II. This patient is able to: Not at all Times/Day Times/Hr. Continuously A. Bend/Stoop ( ) ( ) ( ) ( )
B. Squat ( ) ( ) ( ) ( )
C. Crawl ( ) ( ) ( ) ( )
D. Climb ( ) ( ) ( ) ( )
E. Crouch ( ) ( ) ( ) ( )
F. Kneel ( ) ( ) ( ) ( )
G. Balance ( ) ( ) ( ) ( )
H. Push/Pull ( ) ( ) ( ) ( )
III. This patient can lift: Not at all Times/Day Times/Hr. Continuously A. Up to 10 pounds ( ) ( ) ( ) ( )
B. 11 to 24 pounds ( ) ( ) ( ) ( )
C. 25 to 50 pounds ( ) ( ) ( ) ( )
D. 51 to 100 pounds ( ) ( ) ( ) ( )
EXPECTED PERIOD OF DISABILITY: _________________________________________________________ DATE OF NEXT DOCTORS APPOINTMENT: ___________________________________________________ DOCTOR’S SIGNATURE DATE: _________________________

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICIES AND PROCEDURES POLICY#: B-026 SUBJECT: COBRA NOTIFICATION
ISSUED: ~07'-'-/~17-=-/0"-"0'------
EFFECTIVE: 07 /17 /00
CANCELLATION DATE: N/A
SUPERSEDES: NEW
POLICY:

It is the policy of the City of Arroyo Grande to offer continued employee health benefits in accordance with the Consolidated Omnibus Budget Reconciliation Act of 1985 ("COBRA") for eligible employees who qualify under the Act.

PROCEDURE:

The following is the notice that will be sent by certified mail to eligible employees regarding COBRA coverage:

Date
Name
Address
City
Zip
Dear:

It is important that all individuals covered under the City of Arroyo Grande's health plan take the time to read this notice carefully and become familiar with its contents.

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) gives you the opportunity to maintain identical health coverage when an event occurs that would terminate health coverage for an employee or dependent. You must submit a Group Continuation Coverage form, HBO - 85 (Attachment 2), the PERS Group· Continuation Plan form (Attachment 3), and the Notice of Right to Con.tinue Group Health Coverage (Attachment 1 ), to the Management Assistant within 60 days from the date of this notice of eligibility.

Coverage must be continuous and you will be required to pay premiums from the date your health benefit coverage ended.

Under COBRA, the City of Arroyo Grande is required to offer to covered employees and

POLICY#: B-026
PAGE2
covered family members the opportunity to elect temporary health care continuation coverage at group rates when coverage under the plan would otherwise end due to certain qualifying events. This notice is intended to inform you (and any spouse and covered dependents) in a summary fashion of your options and obligations under the continuation coverage provisions of the law.

Events pertaining to employees apply to all "qualified beneficiaries". A qualified beneficiary is anyone who is covered on the plan on the day of the COBRA event. An employee previously covered for self and family may decide to decline coverage for self but cover the spouse and/or one or more children. Each enrolled person has election rights under COBRA.

Qualifying Events
For covered employees:

If you are a covered employee in the City of Arroyo Grande's health plan, you may be entitled to elect continuation coverage if you lose your group health plan coverage for the following reasons:

1. Termination of y~ur employment; or

2. Your hours of employment are reduced.

For covered spouses:

If you are the spouse of a covered employee and are covered under the City of Arroyo Grande's health plan, you may be entitled to elect -continuation coverage if you lose group health coverage for any of the following reasons:

1. A termination of your spouse's employment, or a reduction in your spouse's hours of employment;

2. The death of your spouse;

3. Divorce or legal separation from your spouse;

4. Your spouse becomes entitled to Medicare (Part A or B); or

5. You spouse moves out of the household.

For covered dependent children:

If you are the dependent chifd of a covered employee and are covered under the City of Arroyo Grande's health plan, you may be entitled to elect continuation coverage if you lose group health coverage for any of the following reasons:

1. A termination of the employee's employment, or a reduction in the employee's hours of employment;

2. The death of the employee;

POLICY #: B-026
PAGE3

3. Parent's divorce or legal separation;

4. The employee becomes entitled to Medicare (Part A or B)

5. You cease to be a "dependent child" under the plan;
If a child is born to you or placed with you for adoption during the continuation coverage period, you may also elect continuation coverage for them with a corresponding change in premiums. Your coverage period will be determined according to the date of the qualifying event that gave rise to the covered employee's COBRA coverage.

Notification Requirements for Covered Employees, Spouses, and Dependents Under the law, the covered employee, spouse, or other family member has the responsibility to notify the City of Arroyo Grande's Management Assistant of a divorce, legal separation, death of the employee, or a child losing "dependent status" under the City of Arroyo Grande's health plan. To be eligible to receive this extension, this notification must be made within 60 days from the date of the qualifying event. Notice must be given to the Management Assistant in writing.

If this notification is not n:aade in a timely manner, then your rights to continuation coverage may be forfeited.

Election Period
Once the Management Assistant is notified that a qualifying event has occurred, they will notify covered individuals (also known as qualified beneficiaries) of their right to elect continuation coverage. Each qualified beneficiary has an independent election right and will have 60 days from the date of this notification to elect continuation coverage. An election may be made on behalf of a qualified beneficiary by a third party. This is the maximum election period; the plan does not allow an extension beyond what is required by law.

If a qualified beneficiary does not elect continuation coverage within this period, all rights to elect continuation coverage will end.

If a qualified beneficiary does elect to continue coverage and pays the applicable premium, the City of Arroyo Grande is required to provide the qualified beneficiary with coverage that is identical to the coverage provided under the plan . to similarly situated active employees, including the opportunity to choose among options during an open enrollment period. If coverage is changed or modified for similarly situated active employees, then continuation coverage may be similarly changed and/or modified.

If a covered employee or spouse of a covered employee elects COBRA without specifying whether the election is for self-only coverage, the election will be considered to be made on behalf of all other qualified beneficiaries with respect to that qualifying event.

POLICY #: B-026
PAGE4
Length of Coverage
· 18-Month- Period; If the event causing the loss of coverage is a termination of employment or a reduction in employment hours, then each qualified beneficiary will have the .opportunity to continue coverage for an 18-month period starting with the date of the qualifying event.

Disability Extension: The 18 months of continuation coverage may be extended to 29 months if the Social Security Administration determines that a qualified beneficiary was disabled during the first 60 days of continuation coverage. All qualified beneficiaries with respect to the same qualifying event as the disabled qualified beneficiary are entitled to the extension. It is the qualified beneficiary's responsibility to obtain this disability determination from the Social Security Administration, and the responsibility of any of the related qualified beneficiaries to provide a copy of the determination letter to the Management Assistant within 60 days of the date of determination and before the original 18 months of continuation qoverage ceases. If there is a final determination that the qualified beneficiary is no longer disabled, the Management Assistant must· be notified within 30 days by the qualified beneficiary, and any coverage extended beyond the maximum that would otherwise apply will be terminated for all qualified beneficiaries.

Secondary Events: An extension of the 18-month continuation period can occur, if during the 1.8 months of continuation coverage, a second. event takes place. Second events include divorce, legal separation, death, Medicare coverage, or a dependent child ceasing to be a dependent. The original 18 months of continuation coverage would be extended to 36 months from the date of the original qualifying event for the qualified beneficiary, spouse and/or dependent children. It is the responsibility of the qualified beneficiaries to notify the Management Assistant of the second event within 60 days of the event. Coverage cannot extend beyond 36 months from the original COBRA event.
36-Month Period: If the original qualifying event causing the loss of coverage was the death of the employee, divorce, legal separation, Medicare entitlement, or loss of "dependent status" of a dependent child under the City of Arroyo Grande's health plan, then each qualified beneficiary will have the opportunity to elect 36 months of continuation coverage from the date of the qualifying event.

California law permits an extension of COBRA benefits for some older employees and their spouses until they are eligible for health coverage through Medicare or another health plan.

The premium cannot exceed 213 percent of the current group rate.

Eligibility, Premiums and Conversion Rights
You do not have to show that you are insurable to elect continuation coverage. You must, however, be covered under the plan at the time of a qualifying event in order to be eligible to elect continuation coverage (except for children born or placed for adoption with a covered employee during the continuation coverage period). The plan administrator reserves the right to verify eligibility and terminate continuation coverage retroactively if you are determined to be ineligible or if there has been a material misrepresentation of the facts.

POLICY#: B-026
PAGES
A qualified beneficiary will have to pay all of the applicable premiums plus a 2% administration charge for continuation coverage. These premiums may be adjusted in the future if the applicable premium amount changes. In addition, if the continuation period is extended beyond 18 months due to Social Security Administration determination of disability, the premium for the 19th through the 29th month of coverage is 150% of the current plan rate for the disabled qualified beneficiary and any nondisabled qualified beneficiaries in the disabled beneficiary's coverage group. There is a grace period of (30) days for the regularly scheduled monthly premiums. This is the maximum grace period under the plan, as the plan does not provide for an extension beyond what is required by law.

Termination of Continuation Coverage
The law allows continuation coverage that has been elected and paid for to be terminated prior to the maximum continuation period for any of the following reasons: ·

1. The City of Arroyo Grande ceases to provide group health coverage to any of its employees; ·

2. Any required premium is not paid in a timely manner;

3. A qualified beneficiary becomes covered, after the d~te on which COBRA was elected, under another group health plan, including a governmental plan, that does not contain any exclusion or limitation with respect to any preexisting condition of such beneficiary;
. 4. A qualified beneficiary becomes entitled to Medicare on a date after the date of the COBRA election;

5. A qualified beneficiary who has extended coverage for up to 29 months due to a disability is determined by the Social Security Administration to be no longer disabled;
'

6. A qualified beneficiary notifies the plan administrator the he/she wishes to cancel continuation coverage;

7. The required maximum COBRA continuation coverage expires;

8. For cause, such as fraudulent claim submission, on the same basis that coverage could terminate for similarly situated active employees; or

9. You choose to let your coverage lapse. If you do not return the election form or premium payment within the applicable time frames, your rights to continued health and dental coverage will be forfeited.

Address Changes
In order to ensure that you receive information properly and efficiently, please· contact the Management Assistant at the address listed below of any address changes as soon as

POLICY #: 8-026
PAGE6
possible. Failure on your part to do so may result in delayed notification and loss of continuation coverage options.

Questions?
If you do not understand any part of the notice or if you have questions regarding the information or your obligations, please contact:

Management Assistant
P.O. Box550
Arroyo Grande, CA
93421
Phone: (805) 4 73-5410
ATTACHMENTS:
1) Notice of Right to Continue Group Health Coverage
~ INTERIM CITY MANAGER

POLICY #: B-026
PAGE7
ATTACHMENT #1

NOTICE OF RIGHT TO CONTINUE GROUP HEAL TH COVERAGE - COBRA The COBRA law intends that this notification be given to each of the covered individuals listed below. Should any of the eligible applicants reside at a different address, you must advise us immediately so that we may send them a notice and election form.

To: (name of covered employee; spouse and dependent children, address) From: Management Assistant
City of Arroyo Grande
P.O. Box 550
Date:
214 E. Branch St.

Arroyo Grande, CA
93421
Availability of Continuation Coverage
COBRA continuation coverage is available to covered employees, spouses and dependent children (called qualified beneficiaries) when coverage under a group health plan ceases due to a qualifying event. You are eligible to elect COBRA continuation coverage due to the following checked qualifying event:

1. The employee's termination of employment on:

2. The employee's reduction of hours on:

3. The employee's death on:

4. The employee's divorce or legal separation on:

5. The loss of dependent status of a dependent child as of:

6. The employee's entitlement to Medicare as of:

COBRA continuation coverage will also be available for dependent children who are born to or placed for adoption with a covered employee after termination of coverage under the City of Arroyo Grande's health plan if the covered employee elects to continue coverage. The dur~tion of such child's coverage will be determined according to the date of the qualifying event that gave rise to the covered employee's COBRA coverage.

POLICY #: B-026
PAGES
Election of Continuation Coverage
ATTACHMENT #1
Your coverage, and coverage for your spouse and dependents, under the City of Arroyo Grande's health plan will cease on (date of event) due to the reason indicated above unless prior to (date) (which is 60 days after the date of this notice), you complete the enclosed Election Form and send it to the Management Assistant at the City of Arroyo Grande.

You, your spouse and your dependents each have an independent right to elect COBRA.

However, you or your spouse may elect COBRA on behalf of the other spouse and/or your covered dependents.

Cost of Continuing Coverage
If you elect to continue coverage, you must, within 45 days of your election date, submit to the same address your check to cover the initial premium payment. The check for this initial premium payment must cover the number of full months from the date of termination, (date), to the time of your payment.
. After the initial payment, you must submit the same monthly payment on the 20th of each month until you are advised of a general change in the premium amount that applies to all participants in the City of Arroyo Grande's health plan. If you fail to submit the monthly payment within 30 days of its due date, your coverage will cease on that date and cannot be reinstated.

The initial cost for COBRA continuation coverage under the City of Arroyo Grande's health plan is:

1. Employee only

2. 1 Dependent only

3. Spouse and 1 dependent
Child

4. Family
Medical Dental Vision
(Dependents can be covered only if they were covered prior to the qualifying event.) Complete the following for those being continued for coverage:

POLICY#: B-026
PAGE 9.

Name-of Employee
Name of Spouse
Name of Dependent Children
Social Security # Date of Birth
Social Security # Date of Birth
Social Security # Date of Birth
Address of spouse and/or children (if different from employee) ATTACHMENT #1 ·
D I have read this form and notice of my rights and elect to waive my right to continuation coverage under this plan.

My first payment is enclosed: D Yes D No
You will receive my first payment within 45 days: D Yes D No D I am not currently eligible for coverage under another group plan, or Medicare.

Please Sign Here:

Applicant's Signature Date

IMPORTANT
To continue your coverage, the Management Assistant must receive:
• A completed copy of this notice by (date - 60 days from this notice date) • Your first payment within 45 days following the date you sign this form.

-=PERS

GROUP CONTINUATION

COVERAGE

CONSOLIDATED OMNIBUS BUDGET
RECONCILIATION ACT •COBRA•
PEFSHB085 (Rev. 5/89)
ATTACHMENT #2

PERS USE ONLY - DOCUMENT REFERENCE NUMBER

PUBLIC EMPLOYEES' RETIREMENT SYSTEM
1-EALlH EBERT SERVICES DIVISION
P.Q BOX 942714 SACPAMENTO, CA 942292714
(916) ~ TOO (916) 326-3557
INSTRUCTIONS FOR COMPLETING THIS FORM ARE ON THE REVERSE SIDE OF THE BLUE (ENROLLEE) COPY. PLEASE TYPE.

PART A: ORIGINAL QUALIFYING EVENT AND DATES

1. TYPE OF
ACTION

2. QUALIFYING EVENT 3. EVENT DATE 4. COBRA ENROLLMENT PERIOD EMPLOYMENT SEPARATION{TIMEBASE REDUCTION
0NEW
[)::HANGE

DIVORCE/LEGAL SEPARATION

CHILD CEASES TO BE A DEPENDENT

DEATH OF EMPLOYEE/RETIREE
FROM

DEPENDENT CONTINUATION - ORIGINAL ENROLLEE ELIGIBLE FOR MEDICARE TO PART B: ENROLLEE INFORMATION

5. COBRA ENROLLEE (MAY BE DIFFERENT THAN SUBSCRIBER) 6. SUBSCRIBER (EMPLOYEE/RETIREE)

SOCIAL SECURITY NUMBER I - - NAME

I SOCIAL SECURITY NUMBER I - NAME
STREET & NO.

CITY, STATE, ZIP PART D: DEPENDENT INFORMATION
DAY PHONE ( ) Zw 8. LIST ALL PERSONS TO DATE OF BIRTH
01 - I
MARRIED D YES ONO FAMILY Qc BE ENROLLED RELATlpN- BIRTH DATE s~ OMALED FEMALE t; 0 <o (FIRSl) (Ml) (l:ASl) MO. DAY YR. SHIP
PART C: CARRIER INFORMATION SELF

7. NAME AND ADDRESS OF HEALTH PLAN:

PLAN CODE: PREMIUM:$
PHONE: ( )
PART E: ENROLLMENT CHANGES

9. NAME OF PRIOR HEALTH PLAN 11. PERMITTING EVENT
CODE

12. PERMITTING EVENT DATE 13. EFFECTIVE DATE OF
CHANGE

10. PRIOR PLAN CODE I I I I I o1 I
PART F: ELECTION CERTIFICATION

14. I AGREE TO PAY THE PREMIUM FOR THE COVERAGE DIRECTLY TO THE CARRIER LISTED ABOVE. I UNDERSTAND THAT I AM

REQUIRED TO SEND THE INITIAL PAYMENT PRIOR TO THE EFFECTIVE DATE OF ENROLLMENT, AND AGREE TO MAKE FUTURE PAYMENTS IN A TIMELY MANNER AS REQUIRED BY THE CARRIER. I UNDERSTAND THAT FAILURE TO PAY THE PREMIUM WILL RESULT IN AUTOMATIC TERMINATION OF COVERAGE. I CERTIFY THAT THE INFORMATION PROVIDED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND ABILITY.

SIGNATURE OF COBRA ENROLLEE (SEE FEVERSE a= 8UE (X)F'( FOR PfWPCf INFORMATION) DATE SIGNED PART G: AGENCY INFORMATION

15. 16. HEALTH BENEFITS OFFICER'S SIGNATURE
AGENCYNAME·---------------~1
AGENCY CODE·----~- UNIT CODE. _____ _
PHONE ( ) _____ DATE RECEIVED ____ _
WHITE - HBD YELLOW - CARRIER GOLDENROD Page 1181 of 1799 - PRIOR CARRIER PINK - AGENCY BLUE - ENROLLEE ATTACHMENT #3
. .

PERS Group connnuauon Plan
Ex-Spouse or Dependent
Employee's Name ________________________ _
Ex-Spouse or Dependent's Name ___________________ _
MailingAddre~--------------------------
Qualifying Event
0 Divorce or legal separation
0 Termination of a child's dependent status
0 Death of the employee
Eection
0 I do not wish to enroll in a PERS group continuation plan. 0 I elect to enroll in a PERS group continuation plan.

Signature--------------------
Date ____________________ _
YOU MUST COMPLETE AND REnJRN nus FORM WITIUN 60-DAYS OF nus NOTICE TO:
(Agency to fill in return address)
PAGE 15·06

ATTACHMENT #3
· PERS Group continuation Plan · ·
Erilployee
Employee's Name-----'--------------------
Social Security Number ____________________ _
Mailing Address ___ ~----------~--------~
Qualifying Event
0 Termination of employment
· 0 Reduction in hours
Election
0 I do not wish to enroll in a PERS group continuation plan. 0 I elect to enroll in a PERS group continuation plan.

Signature
Date

YOU MUST COMPLETE AND RETURN TIIIS ELECTION FORM TO YOUR PERSONNEL omcE OR YOUR HEALTII BENEFITS OFFICER WITHIN 60-DAYS Of TIIIS NOTICE.

P#GE 15-05 Page 1183 of 1799

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY#: B-027 SUBJECT: ELECTED OFFICIALS RETIREMENT

BENEFITS
ISSUED: 06/27/00
EFFECTIVE: 06/27/00
CANCELLATION DATE: N/A
SUPERSEDES: NEW
POLICY:

The policy of the City is to provide retirement benefits to elected officials meeting the City's age and term of office requirements.

PROCEDURE:

A. Government Code Section 53201 (c) (2) prohibits a local agency that did not provide benefits to former elective members of a legislative body before January 1, 1994, from providing benefits after January 1, 1994, unless the members participate on a self-pay basis.

B. Government Code Section 53208.5 (b) prohibits any elective member of a legislative body whose service first commences on and after January 1, 1995, from receiving health and welfare benefits greater than the most generous schedule of benefits being received by any category of nonsafety employees.

C. Elected Officials not covered by the Public Employees' Retirement System (PERS) may receive retirement benefits from the City of Arroyo Grande for services provided during their term of office.

D. The City of Arroyo Grande elects to provide health insurance premiums comparable to premiums paid for other retirees.

E. To qualify for these benefits, the Elected Officials must be sixty-five (65) years or older and have served for at least fifteen two-year terms of office (total of 30 years).

INTERIM
R~ CITY MANAGER

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROC-=DURES POLICY#: B-028
ISSUED: 8/1 /14
~---------
EFFECTIVE: 8/1/14
CANCELLATION DATE:___..._N/ __ A"---
SUPERSEDES: New -------
POLICY:

SUBJECT: DISASTER RESPONSE
REPORTING FOR l;>UTY/RECALL
The purpose of this policy to clarify how City employees should respond to work in response to a disaster emergency. Major disasters or emergencies can occur with little or no warning, and may result in. severe conditions that require some or all City departments -to recall off-duty personnel to assist with th~ City's response. Some disasters/en:iergenoies may provide the opportunity for a planned or orderly recall of City employees, while other types of disaster/emergencies (i.e. a major earthquake) may result in extreme conditions that impact or prevent direct contact and may require emergency recall through the media or other methods.

PROCEDURE:

1. Disaster Service Workers
In the event of a local proclamation or a state and/or federal declaration of an . emergency; all full-time and part-time public employees, whether in technical . specialties or not, are considered essential and are deemed disaster service workers.

As such, employees:

A.- are provided the immunities, protections, and benefits as provided in the California Emergency Services Act and. the Master Mutual Aid Agreement (California J_abor Code, Division 4, Chapter 1, Section 3211.92); B. must remain on their jobs until authorized to leave; C. may be required to remain on their jobs after their shift ends; D. are expected to report to their normal work locations if at all possible and may be reassigned to other departments, other facilities, or to do work that they do not normally perform;
E. may be asked to cancel vacations that were approved before the disaster occurred; and

POLICY#: 8028

DISASTER RESPONSE REPORTING FOR DUTY
PAGE2
F. may be pre-identified, trained, and deployed to disaster areas, with the concurrence of their supervisors or managers.

2. Reporting to Work
A. The City of Arroyo Grande and its employees have a responsibility to staff their . positions and assist the City in the event of a declared disaster or emergency.

Upon declaration of an emergency (as declared by the City Manager or his/her designee and adopted by City Council resolution), which impacts the City, it shall be the duty of every City employee to report to work as further directed by the employee's respective department recall procedure.

B. For declared disasters or emergencies occurring during work hours, it shall be the duty of eve,.Y employee to respond to the disaster or emergency and to work towards its mitigation. This response to the disaster/emergency should be . further dir~cted by the employee's respective department recall procedure. This includes working overtime hours as deemed necessary and making every effort to be of assistance. ·
C. For disasters or emergencies occurring during non-work hours, it shall be the duty of every emplc;>yee, upon being recalled or made aware of the disaster/emergency recall, to report to work or attempt to report to work as further directed by the employee's respective department recall. procedure.

D. In the event that a major disaster or emergency occurs resulting in substantial widespread damage and/or risks to life and property, and electronic communications are impacted and prevent contact of the employee per the recall procedure, an employee shall report to work to determine the status of disaster work assignments. Alternatively, if the disaster or emergency prevents an employee from reporting to work in the City of Arroyo Grande, the employee may report to the labor pool area in the County facility nearest their home to assist or establish contact with their department and obtain instructions. · E. If the extent of the disaster is unknown and electronic communications are impacted and prevent contact of the employee per the recall procedure, employees must:

1. ~allow their respective department response plans.

2. Monitor local television news media, local radio stations, and· the City's Facebook and Twitter for instructions.

3. Attempt to make contact with City Hall or the Police Department for instructions.

4. Report for their next scheduled shifts if no emergency instructions are available.

POLICY#: 8028

DISASTER RESPONSE REPORTING FOR DUTY
PAGE3
F. When reporting to work in response to a disaster, all employees shall immediately complete ICS Form 211 to be eligible for possible Federal and State funding reimbursement. All employees will be provided ICS Form 214 in order to track all time worked on disaster related activities.

3. Recall Roster
A. The City will maintain a master recall roster of all full and part time personnel, including the Five Cities Fire Authority. This master- roster will be maintained on the City's network for limited authorized access to be used only in a test recall or an actual emergency.

B. It shall be the responsibility of the Administrative Services Depar:tment to maintain a complete and up to date roster based on city empl9yment status.

C. All City departments, including the Five Cities Fire Authority, shall forwar:d any changes in contact information regarding individual employees assigned to their respective department to the Administrative Services Department within 72 hours of being notified of the change.

D. The master recall roster shall be divided into individual department lists that include as a minimum the following:

1. Title/position (In department rank order)

2. Last name, first name

3. Residence address

4. Home telephone number

5. Mobile telephone number

6. Personal email address

4. Authority
The authority for declaring all employees to be Disaster Service Workers is set forth in California Government Code, Chapter 8 of Division 4· of Title 1, Section 3100.

City Manager

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: B-029
ISSUED: 09/17/2020
EFFECTIVE: 09/17/2020
CANCELLATION DATE: N/A
SUPERSEDES: 11/01/14
SUBJECT: INJURY AND ILLNESS PREVENTION

PROGRAM
POLICY:

It is the policy of the City to provide a safe work environment and to comply with General Industry Safety Orders Section 3203, which requires all employers to develop and implement an effective Injury and Illness Prevention Program. Specific elements of a safety program are required to be included in the City’s program.

PROCEDURE:

1. Safety Program Responsibilities
The Human Resources Manager is designated as the City’s Safety Program Administrator. Under the City’s Safety Program, all levels in the organization have a responsibility for safety.

A. Employee safety responsibilities include:

1. Knowledge and compliance with the Code of Safe Practices and specific work procedures or rules as they apply to their work activity.

2. Attendance at training sessions as scheduled and active participation and cooperation in the overall safety program, and adhering to safe work practices.

3. Recognition of hazards of the job, taking precautions to ensure the safety of themselves and others, and consistent application of safe work practices.

4. Immediately advising their Supervisor if the working conditions, tools or equipment are unsafe and reporting all incidents (vehicular or personal) regardless of severity to the Supervisor.

5. Use of all personal protective equipment as required.

6. Compliance with all safety instructions provided by Supervisors.

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7. Obeying all health and safety warning signs and standards.

8. No jumping from truck beds, platforms, fences, or other elevated places and no taking shortcuts in or over dangerous places.

9. Paying strict attention to their work and do not participate in practical jokes and other careless activities.

10. No wearing loose clothing and jewelry while working on or near equipment and machines.

B. Supervisory safety responsibilities include:

1. Knowledge and compliance with the Code of Safe Practices and specific work procedures and rules as they apply to their area of authority.

2. Attendance at training sessions as scheduled and active participation and cooperation in the overall safety program, and adhering to safe work practices.

3. Ensuring that employees, interns, volunteers and sub-contractors under their direction are aware of and comply with the Code of Safe Practices and specific work procedures or rules as they apply.

4. Investigation of accidents and near miss incidents in a timely manner, including documenting all aspects of the incident, identifying the cause and implementing the corrective actions to prevent reoccurrence.

5. Correction of any unsafe conditions or work practices observed during a site safety inspection in a timely manner.

6. Conducting and documenting safety meetings and training with employees and regularly scheduled safety inspections within their area of responsibility, including reviewing and training employees on new chemicals and/or equipment as required.

7. Disciplining employees, per the City’s Personnel Regulations, for violations of the Code of Safe Practices and specific work procedures or rules as they apply.

8. Ensuring that training, inspection, and investigation records and employee health and safety records are maintained and retained for the required time periods.

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C. Department Director/Manager safety responsibilities include:

1. Knowledge and compliance with the Code of Safe Practices and specific work procedures or rules as they apply to their area of authority.

2. Attending training sessions as scheduled, active participation and cooperation in the overall safety program, and adhering to safe work practices.

3. Ensuring that employees and contractors are aware of and comply with the Code of Safe Practices, and specific work procedures or rules and Cal-OSHA regulations.

4. Disciplining employees, per the City’s Personnel Regulations, for violations of the Code of Safe Practices and specific work procedures or rules as they apply.

5. Reviewing accident investigations in a timely manner, ensuring that all aspects of the incident are documented and implementing corrective actions to prevent reoccurrence.

6. Correcting in a timely manner any unsafe conditions or work practices observed during a site safety inspection.

7. Designating an employee within their Department to act as the Safety Committee member.

8. Ensuring safety training and inspections are occurring in their department.

9. Assisting in reviewing new chemicals and/or equipment as required.

10. Ensuring that areas under their direction are in compliance with the City’s health and safety practices, policies, and programs.

D. Safety Program Administrator, or designee, responsibilities include:

1. Developing, distributing and updating the Safety Policies and Procedures.

2. Ensuring safety training as required by Safety Policies and Procedures has been conducted.

3. Chairing the Safety Committee.

4. Conducting audits of City safety programs to evaluate compliance with Cal-OSHA requirements.

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5. Reporting to City Management regarding safety compliance status, new or upcoming regulations and other safety issues that require their attention.

E. Department Safety Committee Member responsibilities include:

1. Conducting Site Safety Inspections.

2. Attending Safety Committee meetings.

3. Participating in policy formulation.

4. Providing feedback to their supervisor regarding Safety Committee meetings, inspections, accidents, and hazardous conditions.

5. Acting as a department or division resource and liaison on safety matters.

2. Safety Program Communication
A. Initial Training:

Upon implementation, all employees will have this program reviewed with them. The program will be reviewed as an element of the new employee orientation and for contract employees working under the City’s direction and control.

B. Department Safety Meetings:

1. The department Supervisor along with the department Safety Committee member or their designee will conduct safety meetings.

Meetings may include information on the following subjects as applicable:
a. Review of Code of Safe Practices, policies or procedures. b. On the job or off the job safety information.
c. Feedback from employees on hazards, safety suggestions or concerns.
d. Review of previous accidents, causes and corrective actions. e. Recognition for compliance, good safety performance or attitude.

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C. Attendance:

Attendance at the safety meeting is considered a part of every employee’s job duties. All meetings will be documented in writing with: the date, safety topic, discussion items, video (if used) and employee attendance signature included.

The Department Supervisor will retain completed safety meeting documentation forms.

D. Safety Meeting Frequency:

Safety meetings will be conducted as follows:

Administrative – Semi-Annually
Recreation – Quarterly
Public Works – Twice monthly
Police – Quarterly and on an as-needed basis.

E. Employee Suggestions:

Employees will be afforded an opportunity to make safety suggestions and or express their concerns. This opportunity will be by means of an employee safety suggestion. Employee safety suggestions may be made anonymously but in any case no employee shall be disciplined, demoted or otherwise discriminated against for making a suggestion. Response to suggestions will be documented on the suggestion form and the employee notified as to the outcome. Anonymous suggestions will be considered as seriously as nonanonymous suggestions; responses shall also be documented on the suggestion form. Suggestions may be made to the Department Safety Committee member, the Supervisor, the Department Director and/or Safety Program Administrator.

Employees can also email safety suggestions or concerns to [email protected], call (805) 473-5410, or complete a safety suggestion form (Attachment 1) available in his/her department or on the shared drive in the Employee Resources folder under Safety. These suggestions can be made anonymously to the Human Resources Department.

Employees who have complaints pertaining to job safety should first discuss them with their immediate supervisor for review and investigation. If the supervisor and the employee cannot reach a resolution, the immediate supervisor should refer the employee to the department manager or director for final resolution.

When a resolution of the complaint is established, a written notice of the outcome should be provided to the employee and all supervisory personnel involved.

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F. Written Communications:

A regular area where written safety communications will be posted shall be established. Postings may contain information on: on-the-job or off-the-job safety topics, changes in safety procedures, accident causes, employee safety suggestions or other information as appropriate.

3. Safety Program Compliance
A. Disciplinary Action:

The City’s policy states that non-compliance and or willful violation of any rules or regulations may result in disciplinary action and/or termination. Disciplinary action will be administered and documented per the City’s Personnel Regulations and/or Policies and/or Memoranda of Understanding.

B. Accountability Program:

Central to maintaining safety program compliance is establishing accountability for safety. The Department Directors and Supervisors are responsible for specifically identified and assigned City safety activities. These activities include conducting job safety training, safety meetings, observation audits, accident investigations and attendance at training sessions. Performance in these and additional safety activities will be maintained and included for discussion and appropriate action including the annual performance appraisal review.

4. Identification, Evaluation and Prevention of Occupational Safety and Health Hazards A. Facility Safety Inspections:

The department safety coordinator will conduct a formal, documented facility safety inspection regularly. This inspection shall be documented on the appropriate Facility Inspection Form. The inspection will include an evaluation of work areas, machine guarding, exits, fire extinguishers, eyewashes, housekeeping and other specific Cal-OSHA requirements.

Correction of unsafe conditions will be documented on the Facility Inspection Form and a copy of the form shall be maintained on file in the department, as well as, with the Safety Program Administrator.

It will be the responsibility of the Department Director to:

1. Monitor progress on corrective actions that remain to be completed and conduct a follow-up to verify completion of corrective actions as required.

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2. Inform employees and City management of any serious finding or incomplete corrective action that may pose a serious risk of injury to employees, the public, or the environment in general.

B. Hazard Information:

Information as to job or site hazards will be extracted from accident investigations and site safety inspections/audits. This information will be used to improve the City’s training programs, safety meetings, etc.

Inspections shall be conducted whenever the employer is made aware of a new or previously unrecognized hazard.

C. Equipment Inspections:

Material handling equipment such as forklifts, hoists or other equipment will be inspected and maintained per the legal requirements. It will be the responsibility of the employee using the equipment to ensure these inspections are conducted and documented.

D. Insurance Company Inspections and Surveys:

The City’s workers’ compensation or property insurance carrier may conduct surveys of City facilities. The findings of these inspections are submitted to the City in writing along with recommendations for corrective action. These findings and recommendations will be tracked until fully implemented.

E. Chemical/Equipment/Procedure Inspection, Review and Approval:

Chemicals, equipment and procedures not currently in use or operation must be reviewed and approved by the Supervisor prior to their being purchased and/or implemented. The department shall not purchase non-approved chemicals or equipment. Replacement in kind is not considered as a “new” chemical/equipment/procedure.

Inspections shall be conducted when new substances, processes, procedures, or equipment are introduced to the workplace that represent a new occupational safety and health hazard.

5. Accident Investigation
A. Reporting:

Employees will report all accidents, industrial injuries or illnesses or incidents that could have resulted in an injury, illness or property damage (including near miss incidents) to their supervisor immediately. In the event that the Supervisor

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is unavailable, accidents or injuries shall be reported to the Department Director, his or her designee, or the Safety Program Administrator.

B. Investigation:

After ensuring the injured employee has received appropriate medical treatment, the supervisor shall conduct an accident investigation. The investigation shall include the factual details surrounding the event (e.g., who, what, when, where, witnesses, etc.), the probable cause of the event and corrective actions to prevent a reoccurrence of the incident. The investigation shall be documented on the City’s “Injury or Illness Event Report” form (Attachment 2). The supervisor will forward the completed report to the Department Director for review and concurrence. A copy of the “Injury or Illness Event Report” form shall be sent to the Human Resources Department.

The Department Director will review the report and follow-up with the Supervisor to ensure that the corrective actions have been implemented.

Within 24 hours of the incident being reported, the Supervisor or his/her designee will provide the injured employee with a Workers’ Compensation Injury Report Kit. The completed forms shall be immediately forwarded to Human Resources.

The Human Resources Manager or his/her designee shall complete the “Employer’s Report of Occupational Illness or Injury, Form 5020” and send it to the Workers’ Compensation carrier, if required.

The Supervisor shall immediately contact the Safety Program Administrator to report deaths or serious injury or illness (defined as any hospitalization unless the employee is only admitted for observation or diagnostic testing; serious degree of permanent disfigurement; amputation; loss of eye).

6. Correcting Unsafe or Unhealthy Conditions
Methods of correcting unsafe or unhealthy conditions will vary depending upon the degree of hazard and control of the work site. Minor hazardous situations, such as housekeeping, storage or other items shall be corrected without additional documentation. Hazardous conditions of a more serious nature will require a service request (Attachment 3), work to be stopped, or the equipment tagged and taken out of service until the proper corrective action can be taken. Hazards of an imminent nature will require emergency notifications and evacuation.

Hazard correction shall be documented on an individual basis using an investigation/corrective action report (Attachment 4), in companion with a facility safety inspection form. On a cumulative basis, hazard correction shall be documented using an identified hazards and correction record form (Attachment 5).

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Should an emergency situation arise which creates an imminent hazard, which cannot be immediately abated, all employees will be evacuated from the facility to a safe location until the situation is corrected. The evacuation will be carried out per the site's evacuation procedures.

7. Safety Training
A. New Hire Orientation:

All employees will receive a City orientation and a job safety orientation.

1. The City orientation will include:
a. Review of the Injury and Illness Prevention Program. b. Injury / Incident Reporting and Workers’ Compensation. c. Pre-designation of a medical doctor for work-related accidents.

2. The job orientation will include training on:
a. Code of Safe Practices.
b. Specific chemicals and handling procedures used as part of the job.
c. Hazardous Communication and Chemical Safety
d. Use of equipment as required.
e. Emergency Response / Evacuation Duties.
f. Employee Access to Medical / Exposure Information.

3. Additional specialized training will be conducted as necessary. The following are examples of some of the training classes:
a. Bloodborne Pathogens
b. Fire Extinguishers
c. CPR
d. Confined Space Entry
e. Forklift Operator Certification
f. Hazardous Materials Handling
g. HAZWOPER
h. Hearing Conservation/Heat Stress
i. Ergonomics
j. Police Department Personnel shall be P.O.S.T. certified as required.

B. Training and Instruction shall also be provided in the following situations.

1. Whenever new substances, processes, procedures, or equipment are introduced to the workplace and represent a new hazard. Any new

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substances or equipment shall include training that follows the manufacturer’s guidelines.

2. Whenever management becomes aware of a new or previously unrecognized hazard.

C. Contract Employees:

Contract employees under the direction and control of a City employee will attend the job safety training and safety classes. They will receive any specialized training as required by their job assignment, as would any employee.

D. Supervisor Training:

Supervisors will attend scheduled training sessions designed to familiarize them with the safety and health hazards to which their employees are exposed and to assist them in implementing the Safety Program.

8. Safety Committee
The City of Arroyo Grande has established a safety committee made up of employees, supervisors, and managers. This committee shall meet at least semi-annually and maintain written minutes. Committee members will report back to their departments on the activities of the committee. The purpose of this committee is to review action items from internal / external inspections, safety activity performance, implementation of new or revised safety policies or procedures, accident investigations, new equipment and other items relating to our Safety Program.

9. Safety Program Record Keeping
A. The Safety Program Administrator shall maintain record keeping and program documentation. Safety program documentation will include copies of:

1. Accident reports

2. OSHA Log

3. Insurance company surveys and recommendations

4. Site inspections

5. Employee training records

6. Safety committee meetings
B. Departmental supervisors shall maintain the records for:

1. Site Inspections

2. Accident reports

3. Employee Training Records

4. Department Safety Meetings

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10. Documentation
A. Training documentation shall include the employee's name, training date, type of training, instructor’s name and an outline of what was presented. This documentation will be maintained per the City’s record retention policy.

B. Records of inspections will include the date of the inspection, facility inspected, inspection findings and who conducted the inspection. These records will be maintained per the City’s record retention policy.

C. Copies of insurance company inspections and all other records will be maintained per the City’s record retention policy.

D. Medical and exposure records will be maintained per legal requirements and the City’s record retention policy.

11. Employee Access
In addition to copies provided to employees during the City’s orientation and on the City’s shared drive (S:\employee resources\Administrative Policies\B-029 Injury and Illness Prevention Program), employees have the right and opportunity to examine and receive a copy of the IIPP. Employees may elect to grant a designated representative access to the IIPP. A designated representative is an individual or organization to whom the employee has given written authorization to exercise a right of access to the IIPP. For purposes of this Program, a recognized or certified collective bargaining agent is automatically a designated representative.

A. Written Authorization
Employees seeking to grant a designated representative access to the agency’s IIPP shall submit a written request that contains the following information:

1. The name and signature of the employee authorizing a designated representative to access the Program on the employee’s behalf;

2. The date of the request;

3. The name of the designated representative (individual or organization) authorized to receive the Program on the employee’s behalf;

4. The date upon which the written authorization will expire (if less than one (1) year).

B. Access to the Program
The agency shall provide access to the Program by doing one of the following:

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1. Provide access in a reasonable time, place, and manner, but in no event later than five (5) business days after the request for access is received from an employee or designated representative.
a. Whenever an employee or designated representative requests a copy of the Program, the employer shall provide the requester a printed copy of the Program, unless the employee or designated representative agrees to receive an electronic copy of the Program.
b. One printed copy of the Program shall be provided free of charge.

If the employee or designated representative requests additional copies of the Program within one (1) year of the previous request and the Program has not been updated with new information since the prior copy was provided, the employer may charge reasonable, non-discriminatory reproduction costs (per Title 8 Section 3204(e)(1)(E)) for the additional copies, or;

2. Provide unobstructed access through a company server or website, which allows an employee to review, print, and email the current version of the Program. Unobstructed access means that the employee, as part of his or her regular work duties, predictably and routinely uses the electronic means to communicate with management or coworkers. If the employee does not have regular access to a computer, a verbal request for a copy for the employee can be submitted to the safety program administrator. If the employee is granting access to a designated representative, the written authorization can be delivered to the office of the safety program administrator.

The Program provided to the employee or designated representative need not include any of the records of the steps taken to implement and maintain the written Program.

If the agency has distinctly different and separate operations with distinctly separate and different Programs, the agency may limit access to the Program (or Programs) applicable to the employee requesting it. The agency shall communicate the right and procedure to access the Program to all employees. Nothing in this section is intended to preclude employees and collective bargaining agents from collectively bargaining to obtain access to information in addition to that available under this section.

Attachments

1. Safety Suggestion Form

2. Injury or Illness Report Form

3. Service Request

4. Investigation/Corrective Action Report

5. Identified Hazards and Correction Record form

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Cross References

1. City of Arroyo Grande Personnel Rules

2. City of Arroyo Grande Police Department Policy 1158, Injury and Illness Prevention. _________________________
Whitney McDonald
City Manager

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CODE OF SAFE WORK PRACTICES

EMPLOYEE SAFETY RESPONSIBILITIES
GUIDELINES AND RESPONSIBILITIES:

1. Knowledge of the job and specific work procedures or rules as they apply to their work activity.

2. Attendance at training sessions as scheduled and active participation and cooperation in the overall safety program.

3. Recognition of hazards of the job, taking precautions to ensure the safety of themselves and others, and consistent application of safe work practices.

4. Immediately advising their Supervisor if the working conditions, tools or equipment are unsafe and reporting all incidents (vehicular or personal) regardless of severity to the Supervisor.

5. Use all personal protective equipment as required.

6. Compliance with all safety instructions from Supervisors.

7. Obeying all health and safety warning signs and standards.

8. No jumping from truck beds, platforms, fences, or other elevated places and no taking shortcuts in or over dangerous places.

9. Paying strict attention to their work and not participating in practical jokes and horseplay.

10. Horseplay, scuffling, and other acts that tend to have an adverse influence on the safety or well-being of employees shall be prohibited. (Authorized Police Department personnel may participate in approved training that may include activities that can influence safety in a controlled manner).

11. No wearing loose clothing and jewelry while working on or near equipment and machines.

12. In the event of fire, sounding the alarm and evacuating along established escape routes.

13. Upon hearing a fire alarm, stopping work and proceeding to the nearest clear emergency exit. Gather at the designated refuge.

14. Only trained employees may attempt to respond to a fire or other emergency.

15. Materials, including flammables and combustibles, and equipment shall not be stored under egress stairways, block doors, exits, or fire extinguisher locations. Stairways, aisles, and emergency doors, shall be kept clear of items that can impair orderly evacuation

16. All spills shall be wiped up promptly, using appropriate materials.

17. Work areas shall be kept free of debris, and trash shall be placed in appropriate receptacles.

18. File cabinet drawers shall be opened one at a time and closed when work is finished.

19. Proper lifting and carrying techniques and appropriate equipment shall be used.

20. All electrical equipment shall be plugged into appropriate wall receptacles or into an extension of only one cord of similar size and capacity. Three-pronged plugs should be used to ensure continuity of ground.

21. Care will be taken to properly secure electric cables and cords to avoid trips and falls.

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22. Electrical appliances, such as coffee pots and microwaves, shall be inspected regularly to replace worn or fraying cords. All equipment such as fans, paper cutters, and shredders, shall be properly guarded to prevent cuts and abrasions.

23. Workers shall not handle or tamper with any electrical equipment, machinery, or air or water lines in a manner not within the scope of their duties, unless they have received instructions from his/her supervisor.

24. All equipment guards and other protective devices are in proper places and adjusted.

25. Use of ladders shall comply with all safety instructions and design specifications of the equipment, such as proper placement, secure support, adequate weight rating, allowable height, and appropriate working conditions. Chairs must not be used in lieu of a ladder or stepstool.

26. Work stations should be adjusted as appropriate for employee comfort and to relieve physical strain and unnecessary exertions, to the extent possible.

27. The contents of all containers shall be clearly identified on the labels.

28. Files, material, and supplies shall be stored in such a manner to prevent damage to the articles or injury to personnel when they are moved.

29. Weapons are not permitted in the work environment, with the exception of authorized Police Department personnel, who may possess, handle and utilize weapons in the course and scope of their duties.

30. Employees must wear a seat belt while operating City vehicles. Speed limits must be observed. (Authorized Police Department personnel may exceed speed limits when deemed necessary in the course and scope of their duties and as authorized by the California Vehicle Code).

31. Employees must wear appropriate clothing and footwear or safety shoes for each job assignment.

32. Supervisors, Managers, and Department Directors shall require employees to observe and follow rules and regulations as is necessary for the safe conduct of their work and shall take such action as is necessary to obtain compliance.

33. No one shall knowingly be permitted to work while the employee's ability or alertness is so impaired by fatigue, illness, or other causes that might unnecessarily expose the employee or others to injury.

34. Anyone known to be under the influence of drugs or intoxicating substances that impair the employee's ability to safely perform the assigned duties shall not be allowed on the job while in that condition.

CITY OF

ARROYO GRANDE
ATTACHMENT 1

SAFETY SUGGESTION FORM
The guidelines for our safety program includes providing the opportunity for all employees to make suggestions and recommendations concerning safety and health. (This form is for items not requiring a service request.) Date: ___________________
Name (optional): ____________________________________________ Department: _______________________________________________ Description of concern or idea: ___________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Causes or contributing factors: ___________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ POLICY #: B-029

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____________________________________________________________ ____________________________________________________________ Response to Employee:
____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Date of Response to Employee: __________________________________ Please return this form to the Administrative Services Department POLICY #: B-029

INJURY AND ILLNESS PREVENTION PROGRAM
PAGE 17
Your suggestion: ______________________________________________

Rev. July 2012
Injury or Illness Event Report
To be completed by the immediate supervisor within 24 hours of the event Submit to Human Resources or Risk Management.

ATTACHMENT 2

1. Name of employer: 2. Name of supervisor: 3. Division/Department:

4. Employee name: 5. Employee job title or position:

6. Date of Event: 7. Event Description:

8. Type of injury/illness: 9. Activity at time of injury/illness:
 Absorption, inhalation,
ingestion
 Animal, insect, plant
 Assault, pursuit, criminal act
 Bending, kneeling, standing,
squatting
 Burn
 Caught in, between, under
 Climbing, crawling
 Cut, puncture or scrape
 Electrical current
 Equipment, tools, machinery
 Flying or falling object
 Lifting, pushing, pulling
 Holding, carrying, throwing,
handling
 Twisting, reaching
 Repetitive motion, cumulative
trauma
 Running, jumping, kicking, walking
 Slip, trip, fall, misstep
 Struck by, against
 Vehicle use, collision, upset
Amputation
Bite, sting
Burn, scald
Cancer
Cardiovascular,
internal
Contusion, bruise
Cumulative trauma
Dermatitis, rash
Disease, bloodborne pathogen
Foreign body
Fracture
Hernia
Infection
Inflammation
Laceration
Mental disorder
Puncture
Strain/sprain
No physical injury

10. Identify the single or closest root cause, which if eliminated would have prevented the injury or illness from occurring (see definitions on next page)

EQUIPMENT
 Malfunction
 Safety guard(s) modified
 Safety guard(s) missing
 Improper use of tool or material
 Defective tool(s) used
 Improper protective equipment, clothing
 Defective protective equipment, clothing
 Inadequate protective equipment, clothing

WORK ENVIRONMENT
 Arrangement of equipment, work flow, tools
 Poor housekeeping – cleanliness and organization
 Third party causation
 Third party causation - suspect
 Weather related

POLICY/PROCEDURE
 Unsafe procedures or work practice
 Police/Fire Department training
 Policy and/or procedures missing
 Policy and/or procedures inadequate

TRAINING
 Employee was not trained for this task or assignment

SUPERVISION
 Policy and/or procedures not enforced
WORKER
 Continuous Trauma/Repetitive Strain
 Horseplay, unsafe behavior
 Short cuts, carelessness
 Distracted, inattentive
 Presumptive injury (safety officer)

11. Describe all steps recommended or taken to prevent a recurrence:

12. Comments:
 Attachments
Completed by (print name): __________________________________________________________ Date: _______________________________ Signature: _________________________________________________________________________ Phone #: ___________________________ POLICY #: B-029

INJURY AND ILLNESS PREVENTION PROGRAM
PAGE 18

Rev. July 2012
Equipment
Malfunction Includes any power and non-power equipment that failed to operate properly, broke during use, or malfunctioned.

Safety guard(s) modified Employee used a tool with proper safety guards in place, but modified to prevent proper operation.

Safety guard(s) missing Employee utilized a tool without the proper safety features.

Improper use of equipment or material Employee failed to use the equipment or material properly.

Defective tool(s) used Employee utilized a tool/equipment that was defective.

Improper protective equipment or clothing Employee utilized protective clothing or equipment not specific to the operation.

Defective protective equipment or clothing Employee had proper protective clothing or equipment, but was defective.

Inadequate protective equipment or clothing Employee lacked the proper protective clothing or equipment for the operation.

Work Environment
Arrangement of equipment, work flow, tools Area in which employee was operating was not orderly and contained noticeable hazards.

Poor housekeeping – cleanliness and
organization
Walking surface, water on floor, loose electrical cords, rugs not tacked down, improper or poor lighting, improper or poor ventilation, and signage.

Third party causation Injury caused by a third party. Employee followed all policies and procedures.

Third party causation – suspect Injury caused by suspect. Employee followed all policies and procedures.

Weather related Injury was a direct result of weather related conditions. Employee followed all policies and procedures.

Policy/Procedure
Unsafe procedures or work practice Employee failed to follow procedures or training.

Policy and/or procedures missing Agency does not have policy or training in place to address action/mechanism performed when injury occurred.

Policy and/or procedures inadequate Agency has inadequate policy or training to address action/mechanism performed when injury occurred.

Training
Employee was not trained for this task or
assignment Employee has not or did not receive training for the use, operation, or safe work practices.

Supervision
Policy and/or procedures not enforced Employee failed to follow policy/procedure.

Worker
Continuous Trauma/Repetitive Strain Injury caused over period of time, no acute traumatic incident occurred.

Horseplay, unsafe behavior Injury caused while engaging in horseplay or inappropriate behavior.

Short cuts, carelessness Employee showed lack of concern about the consequences of the action.

Distracted, inattentive Includes injuries caused by lack of attention to detail, surroundings, etc.

Presumption Injuries or Illness specific to certain classes of employees presumed to be compensable under state law. Example – skin cancer for lifeguards.

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ATTACHMENT 3
POLICY #: B-029

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CITY OF

ARROYO GRANDE
ATTACHMENT 4

CORRECTIVE ACTION REPORT
NOTE: Supervisors or Managers must complete this form within 24 hours of receipt of a hazard report or upon awareness of a new or previously unrecognized hazard.

Briefly describe hazard:
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Location of hazard:
______________________________________________________________________ Date reported: _____________________________________
Current situation is:

A. _____ Hazard has been fully corrected.

B. _____ Temporary corrections have been made, making the situation safe.

C. _____ Temporary corrections are not possible; the area has been secured to protect people from injury.

D. _____ Upon investigation, no hazard was found.

Briefly explain what was done:
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ If (B) or (C) were checked, what is the deadline for final corrections: _______________ Name of person completing report: _______________________ Date: _____________ Copy and distribute as follows:

1. Service Request and Corrective Action Report to appropriate Department Director

2. Correction Report to reporting employee, if applicable

3. Maintain original in Department files.

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CITY OF

ARROYO GRANDE
ATTACHMENT 5

IDENTIFIED HAZARDS AND CORRECTION
RECORD
Date of Inspection: Person Conducting Inspection:

UNSAFE CONDITION OR

WORK PRACTICE LOCATION PRIORITY PERSON ASSIGNED

CORRECTIVE ACTION

TAKEN (DATE)
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CITY OF ARROYO GRANDE ADMINISTRATIVE POLICIES AND PROCEDURES POLICY#: B-030 SUBJECT: BILINGUAL PAY
ISSUED: 12/04/17
EFFECTIVE: 12/04/17
CANCELLATION DATE: NIA
SUPERSEDES: 12/30/04
POLICY:

It is the policy of the City of Arroyo Grande to implement the bilingual pay provisions for those units who have bilingual pay included in their Memorandum of Understanding (MOU} for active employees.

PROCEDURE:

Any active employee whose classification is designated in their MOU for bilingual pay and who demonstrates the required skills shall receive compensation at the rate currently negotiated in respective MOU's.

The Department Director, with the approval of the City Manager, shall determine which employees, what mix of languages, and which job functions may be eligible for bilingual pay · based upon accessibility of the employee to the public, or other factors that could affect the use of these skills for public benefit. Pay for bilingual skills shall be restricted to the requirements as set out in the MOU and as approved by the Department Director and City Manager.

The employee shall use the following procedures when submitting a request for bilingual pay: ·

1. The employee shall submit a "Request For Bilingual Pay" form (Exhibit "A"} to their Department Director.

2. The Department Director shall review the request and confirm that the employee may be required to use bilingual skills. The request shall then be forwarded to the · City Manager for approval.

3. The City Manager's Office will coordinate the required testing to determine the level of fluency. An employee must meet the required skills as set forth in their MOU in order to receive bilingual pay.

4. A verbal and/or written exam shall be conducted to determine the employee's fluency in the designated language, based on:
a.. Comprehension - understanding of the spoken language.

POLICY#: B-030

BILINGUAL PAY
PAGE2
b. Fluency - clarity of expression, smooth flow of speech, knowledge of necessary vocabulary.
c. Expression- accurate expression of an idea or concept.

5. The exam shall consist of a structured oral interview which consists of general and job related questions. A written test may also be required. The testing shall be graded per the guidelines in the employee's respective MOU.

EXHIBIT HA"

REQUEST FOR BILINGUAL PAY
An employee who is functional in a second language, the use of which has been determined by the Department Director with the concurrence of the City Manager to be of benefit to the City, may apply for bilingual pay in accordance with provisions in their respective · Memorandum of Understanding. Fluency shall be certified by a test administered through the City Manager's Office.

Employee Name: ________________________ _
Department: __________________________ _
Position: ----------------------------
Language Requesting Bilingual Pay For: ________________ _ Level of Skill: __ Conversational Fluent --- __ Reading Writing --- ( check all that apply) Employee Signature Date
Department Director Approval Date
---------------------------------------------------------------------- ---------------------------------------------------------------------- City Manager's Office:

In order to receive bilingual pay, the employee listed above must have the following language skills per their Memorandum of Understanding:

TEST RESULTS:

I verify that the above listed employee
pay based on their test results.

Name of Rater (please print)
Signature of Rater
Approval:

City Manager
is eligible / is not eligible for bilingual
Date Tested
Date

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY#: B-031 SUBJECT: EMPLOYMENT SEPARATIONS
ISSUED: 8/7/18
EFFECTIVE 8/7 /18
CANCELLATION DATE: N/A
SUPERSEDES: NEW
-----
POLICY:

It is the policy of the City to provide objective, consistent Personnel processes in the handling of employee separations l;>oth voluntary and involuntary. This does not supersede or replace the Police Officers' Bill of Rights, Firefighters' Bill of Rights or any negotiated Memorandum of Understanding that may be applicable.

This policy shall be a guideline in handling employment separations, however, individual circumstances should be considered in each case. Departments are strongly encouraged to collaborate with Human Resources when employment separation issues arise.

PROCEDURE:

A. Voluntary Separation
A voluntary separation of employment occurs when an employee submits a written notice of resignation or retirement to his/her supervisor.

1. Employees are requested to give at least two (2) weeks notice of their intention to separate from the City.

2. The supervisor will forward the letter of resignation or intent to retire to Human Resources with any other relevant information.

3. The supervisor is responsible for looking through the Employee Separation Guide (Exhibit A) and completing relevant items.

4. The supervisor is responsible for providing the final Personnel Action Form to Human Resources prior to the employee's last day.

5. Human Resources will review the employee's post termination benefits and schedule an exit interview.

6. The employees' final pay_check will be issued with the next regular payroll.

B. Involuntary Separation
An involuntary separation of employment is a management initiated dismissal.

1. The supervisor must consult with Human Resources when they are considering terminating an employee, and should do so as early· in the process as possible.

POLICY NUMBER: B-031
PAGE2

2. The supervisor must provide Human Resources with written documentation identifying the reasons and evidence for the termination.

3. A meeting with the Department Director, Human Resources and City Manager is required prior to terminating an employee.

4. Human Resources will work with the Department Director to ensure any and all required due process procedures are followed prior to termination.

5. Human Resources will review the employee's post termination benefits.

6. Human Resources or other designee will attend the termination meeting with the employee.

7. The supervisor is responsible for looking through the Employee Separation Guide (Exhibit A) prior to the employee leaving the City premises.

8. The separated employee is not allowed in any of the secured City work areas unaccompanied. He/she will be accompanied by the supervisor while gathering personal items from their locker, desk or other work area.

9. The employees' final paycheck will be provided to them at the termination meeting, along with any applicable benefits information.

10. If applicable, Human Resources will mail COBRA documents to the employees' home address.

POLICY NUMBER: B-031
PAGE3

EMPLOYEE SEPARATION GUIDE
Exhibit A
The following will guide you through the various steps of the separation process. After the form has been completed please submit it to Human Resources with the employee's final PA.

Employee Name: Position: --------
Supervisor: Last Day of Employment: ___ _
Pre-separation steps:

D Retirement I Resignation Letter sent to Human Resources D Discussion with Human Resources, if applicable
D Documentation with reasons and evidence provided, if applicable D Conversation with Human Resources & City Manager, if applicable D Due process procedures, if applicable
All City property is turned in on or before employee's last day:

D Keys to City facilities
D Keys to City vehicles
D Access card
D City ID card
D City Credit Card
D Fuel Card
D Laptop or Computer Equipment
D Cell phone
D Uniforms
D Other: --------------~
Notification to support departments:
[) Submit IT Exiting Employee Checklist
D Return access card to Building Access I Security Company D Notify City Clerk - Form 700 Leaving Office Statement, if applicable D Complete final PA

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY#: B-032 SUBJECT: COMPLIANCE AND IMPLEMENTATION

PLAN FOR THE PATIENT PROTECTION
ISSUED: 10/10/19 AND AFFORDABLE CARE ACT
("ACA")
EFFECTIVE: 01/01/15
CANCELLATION DATE: N/A
SUPERSEDES: NIA ------
POLICY:

The City of Arroyo Grande ("City") is considered a "large employer" for the purposes of the Shared Responsibility Provisions (Section 4980H to Title 26 of the United States Code, the Internal Revenue Code) of the Patient Protection and Affordable Care Act ("ACA").

The Internal Revenue Service will assess a penalty on the City if (1) it fails to offer "substantially all" of its full-time employees (70% by January 1, 2015 and 95% by January 1, 2016) (and their dependents) the opportunity to enroll in minimum essential coverage or offers coverage to "substantially all" of its full-time employees (and their dependents) that is either "unaffordable" or does not provide "minimum value" and (2) any full-time employee receives a subsidy for coverage through the exchange ("Penalty").

This Administrative Policy ("Policy") establishes the "Look Back Measurement Method Safe Harbor" ("Look Back Safe Harbor") under ACA. The City establishes this Look Back Safe Harbor for the purposes of identifying "full-time" employees for the potential penalty calculation and determination. With regard to unrepresented non-management group employees only, this Plan will be used to determine eligibility for an offer of coverage effective January 1, 2015 (using the December 1, 2013 to November 30, 2014 standard measurement period) and continuing as detailed below for each year thereafter. For all represented and management group employees, qualification for health coverage shall . continue to be governed by the terms of any applicable Memorandum of Understanding or Management Resolution.

This Policy also establishes the Affordability Safe Harbors to determine affordability for the potential Penalty calculation and determination, and articulates the City's anti-retaliation policy in accordance with ACA's anti-retaliation provisions.

PROCEDURE:

Look Back Measurement Method Safe Harbor

1. Ongoing Employees: The City establishes the Look-Back Safe Harbor with regard to all ongoing employees as follows:

POLICY#: B-032

COMPLIANCE AND IMPLEMENTATION PLAN FOR THE AFFORDABLE CARE ACT ("ACA")
PAGE2
Standard Measurement Period: October 1st through September 30th (and continuing each year thereafter)
Administrative period: October 1st through December 31st (and continuing each year thereafter)
Stability period: January 1 through December 31 (starting January 1, 2015 and continuing each year thereafter)
If an ongoing employee's employment status changes (from full-time to less than full-time or vice versa) before the end of a Stability Period, the change in status will not affect the classification of that employee's status for the remaining portion of the Stability Period.

2. New Full Time Employees: On the start date of a new employee, the City will determine whether the employee is reasonably expected to be a full-time employee (i.e. the employee is expected to average at least thirty (30) hours of work per week over the initial measurement period). If the employee is reasonably expected to be a full-time employee, and not a variable hour or seasonal employee, the employee will be considered full-time for purposes of the penalty calculation and determination. Effective January 1, 2015, the City will offer health coverage to an unrepresented, non-management group employee who is reasonably expected to be a full-time employee within 60 days of that employee's start date.

Represented and management group employees will be offered coverage, if any, as set forth in their applicable memora_nda of understanding or resolution.

3. New Variable Hour Employees: If on the start date of a new employee, based on individual facts and circumstances, the City is unable to determine that the employee is reasonably expected to be employed an average of at least thirty (30) hours per week over the initial measurement period, then the employee is considered a variable hour employee.

The City establishes the following periods for new variable hour employees:

Initial Measurement Period:

Administrative period:

Stability period:

Twelve months (beginning on the first day of a full
pay period following the start date).

One month following the initial measurement
period.

Twelve months following the end of the
administrative period unless the new variable hour
employee does not measure as a full-time
employee during the initial measurement period,
then the stability period associated with the initial
measurement period must not exceed the
remainder of the standard measurement period
(plus any associated administrative period).

POLICY#: 8-032

COMPLIANCE AND IMPLEMENTATION PLAN FOR THE AFFORDABLE CARE ACT ("ACA")
PAGE3

4. New Variable Hour or Seasonal Employee's Change in Status During the Measurement Period: If a new variable hour or seasonal employee's position changes during the Measurement Period, and had. the employee started his or her employment in that new position, the City would have reasonably expected that new employee to average at least 30 hours of service per week, then for purposes of determining any penalty only, an employee will be considered a full-time employee on the earlier of (1) first day of the month following the change in employment status, or (2) the first day of the first month following the end of that employee's Initial Measurement Period (including any associated Administrative Period) if the employee averaged more than 30 hours of service per week during the Initial Measurement Period , or earlier if required by law, an applicable Memorandum of Understanding or Resoldtion.

5. Transitioning from New to Ongoing Employee: The City will measure the hours of a new variable hour employee during the first complete standard measurement period for which he/she is employed. This means that a new variable hour employee's status may be tested both under an initial measurement iperiod and at the same time be measured under the overlapping standard measurement period.
a. If an employee measures as full-time during the initial measurement period, he/she will retain full-time status for the entire associated stability period ( even if the employee does not qualify as full-time during the standard measurement period).
b. If an employee does not measure as full-time during the initial measurement period, but qualifies as full-time during the standard measurement period, the employee must be treated as full-time during the stability period associated with the standard measure11:1ent period (even if that means coverage must be offered before the end of the stability period associated with the initial measurement period).

6. Hours of Service Calculation: "Hours of service" means each hour for- which an employee is paid, or entitled to payment by the City for a period of time during which no duties are performed due to vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty or leave of absence. The City will calculate actual hours of service and hours for which payment is due.

7. Hours Based On Payroll Periods:. The City may calculate hours based on payroll periods. It has two options for doing so. The City may exclude the entire payroll period that contains October 1st (the first day of the Standard Measurement Period), as long as it includes the entire payroll period that contains September 30th (the last day of the Standard Measurement Period). Alternatively, the City may exclude the entire payroll period that contains September 30th (the last day of the Standard Measurement Period), as long as it includes the entire payroll period that contains October 1st (the first day of the Standard Measurement Period).

POLICY #: B-032
· COMPLIANCE AND IMPLEMENTATION PLAN FOR THE AFFORDABLE CARE ACT ("ACA")
PAGE4

8. Breaks In Service: When an employee experiences a break in service the employee will retain the status the employee had previously with respect to any stability period, except that an employee will be treated as a new employee:
a. if the employee resumes employment after a period of at least 13 consecutive weeks with less than an hour of service; or
b. if the employee's period of :no service (measured in weeks) is at least four consecutive weeks long and .exceeds the number of weeks of that employee's period of employment immediately preceding the period of no service.

9. Special Unpaid Leave: Special unpaid leave is defined only as unpaid leave under the Family and Medical Leave Act of 1993, unpaid leave under the Uniformed Services Employment and Reemployment Rights Act of 1994, or unpaid leave while on jury duty.

When an employee takes special unpaid leave, the City will determine the weekly average of hours of service by the employee for that portion of the measurement period that is not part of the special unpaid leave ("average weekly hours of service"). The City will then determine the average hours of service for the entire measurement period using one of the following two methods:
a. exclude the period of special: unpaid leave and apply the average weekly hours of service over the entire measurement period; or
b. credit the average weekly hours of service to the period of special unpaid leave.

Affordability Safe Harbors
The City intends to apply the Rate of Pay Safe Harbor to determine the affordability of the minimum essential coverage that it offers its full-time employees. The City in its sole discretion may also apply the Form W-2 Safe Harbor or Federal Poverty Line Safe Harbor.

These affordability Safe Harbors will be applied on a uniform and consistent basis for all employees in a reasonable category.

1. Rate of Pay Safe Harbor
a. The City measures whether the employee's required premium contribution for the calendar month for the lowest cost self-only coverage that provides minimum value exceeds the ACA Affordability Index percent of the monthly wage published by the IRS for the calendar year.
b. For hourly employees, the monthly wage is equal to 130 hours multiplied by the employee's hourly rate of pay as of the first day of the coverage period. I

POLICY#: 8-032

COMPLIANCE AND IMPLEMENTATION PLAN FOR THE AFFORDABLE CARE ACT ("ACA")
PAGES
c. For salaried employees, the monthly wage is the monthly salary as of the first day of the coverage period.
d. The City may not apply this safe harbor if it reduced the monthly wages of employees (hourly or salaried) during the calendar year. e. If rate of pay increases during the year, the City will use the lowest rate of pay for the year in the calculation.
f. The coverage offered by the City will be deemed affordable if the employee's monthly premium contribution is equal to or less than the ACA Affordability Index percent published by the IRS for the calendar year of the monthly wage.

2. Form W-2 Safe Harbor

3. a. The City measures whether the employee's required premium contribution for the full calendar year for the lowest cost self-only coverage that provides minimum value exceeds the. ACA Affordability Index percent published by the IRS for the calendar year of the Form W-2 wages (as reported in Box 1) for the employee for the calendar year in which coverage is offered. b. The coverage offered by the City will be deemed affordable if the employee's annual premium contribution is equal to or less than the ACA Affordability Index percent published by the IRS for the calendar year of the employee's Form W-2 wages as reported in Box 1.

Federal Poverty Line Safe Harbor
a. The City measures whether the employee's required premium contribution for the calendar month for the lowest cost self-only coverage that provides minimum value exceeds the ACA Affordability Index percent published by the IRS for the calendar year of the Federal Poverty Line ("FPL") for a single individual for the applicable calendar year divided by twelve. b. The coverage offered by the City will be deemed affordable if the employee's monthly premium contribution is equal to or less than the ACA Affordability Index percent published by the IRS for the calendar year of the monthly FPL for a single individual for the applicable calendar year.

Anti-Retaliation
It is the City's policy to comply in full wit~ Section 1558 of ACA, which prohibits retaliation against employees who report violations of Title I of ACA or who receive tax credits or costsharing reductions (under section 36B of the Internal Revenue Code or section 1402 of ACA) in connection with participation in the health insurance exchange.

POLICY #: B-032

COMPLIANCE AND IMPLEMENTATION PLAN FOR THE AFFORDABLE CARE ACT ("ACA")
PAGES

1. Protected Activity
a. "Whistleblowing" regarding Violations of Title I of ACA: ACA protects an employee, former employee, or applicant who reports, testifies (or is about to testify) in a proceeding, assists or participates (or is about to assist or participate) in a proceeding, objects to, or refuses to participates in any activity, policy, practice, or assigned task that the employee (or other person) reasonably believed to be in violation of Title I of ACA, including any order, rule, regulation, standard or ban under Title I of ACA. b. Title I of ACA includes but is not limited to consumer protections such as the following:
i. Elimination of lifetime; and annual limits on benefits by 2014; ii. Prohibition on rescissions of coverage;
iii. Elimination of pre-exi~ting condition exclusions;
iv. Coverage of preventive services and immunizations;
v. Extension of dependent coverage up to age 26;
vi. Development of uniform coverage documents; and
vii. Implementation of appeals processes for consumers. c. Receipt of Affordability Assistance: ACA also protects an employee, former employee, or applicant who receives a tax credit under Section 368 of the Internal Revenue Code or a cost-sharing reduction under Section 1402 of the Act as a result of enrolling in a qualified health plan offered by the health insurance exchange. In California, this state-run marketplace is known as Covered California.

2. Prohibited Retaliatory Conduct
Prohibited conduct includes but is not limited to discharge or otherwise retaliatory conduct, including intimidating, restraining, coercing, blacklisting, or disciplining an employee, former employee, or applicant with respect to compensation or any other terms, conditions or privileges of employment as a result of that individual's participation in a protected activity as defined in paragraph 2 above.

3. Complaint Procedure
a. Any City employee, former employee, or applicant who wishes to report a violation of Title· I of ACA, or who believes he or she has been subject to

POLICY #: 8-032

COMPLIANCE AND IMPLEMENTATION PLAN FOR THE AFFORDABLE CARE ACT ("ACA")
PAGE7
retaliation in violation of this policy should immediately notify Human Resources or the Director of Administrative Services. It is the City's policy that no City employee shall retaliate against any person who participates in a protected activity as defined by Section 1558 of ACA.
b. An employee, former employee, or applicant who believes that he or she has been retaliated against under this policy may file or have filed by any person on his or her behalf, a complaint with United States Department of Labor, Occupational Safety & Health Administration (OSHA) within 180 days after an alleged violation occurs. For more information on filing an OSHA complaint, visit www.osha.gov.

The City Manager, including his/her designee(s), may amend this Plan at his or her discretion.

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY#: B-033
ISSUED: 12/02/19
EFFECTIVE: 07 /29/16
CANCELLATION DATE: -----'--"N/'-'--A'---_
SUPERSEDES: NEW -------
POLICY:

SUBJECT: ALTERNATIVE 9/80 WORK

SCHEDULE
It is the policy of the City to allow the City Manager to authorize alternative work week schedules in departments in accordance with a Memorandum of Understanding, Personnel Regulations or Resolution. This will allow employees to work a flexible schedule while continuing to maintain operating efficiency, productivity and effective service to the public.

PROCEDURE:

1. PURPOSE
The alternative 9/80 work schedule will allow employees the flexibility to rearrange their work schedule to better meet their personal needs while also considering the needs of their department and the City. This policy will establish the guidelines for an alternative 9/80 work schedule.

2. ELIGIBILITY
The City Manager has the authority to authorize each Department Director to offer, at his/her discretion, the alternative 9/80 work schedule to individual employees or the entire department, depending on the staffing needs of their respective department. Every employee who is eligible to work the alternative 9/80 work schedule will need to submit the attached "Alternative 9/80 Work Week Authorization Form" that must be approved by their Department Director.

A Department Director, with the approval of the City Manager, may discontinue participation in the 9/80 by an individual or department if it is determined that service levels and coverage, costs, productivity and/or performance levels are not being maintained under the alternative 9/80 work schedule. Department Directors must give a full pay period notice to each employee should their alternative 9/80 work schedule be terminated. An employee may also terminate participation in the alternative 9/80 work schedule by providing at least one full pay period notice to his/her Department Director.

POLICY #: B-033
ALTERNATIVE 9/80 WORK SCHEDULE
PAGE2

3. REGULAR BUSINESS HOURS
City Hall will remain open to the public from 8:00 A.M. to 5:00 P.M., Monday through Thursday, with the exception of holidays. Hours of operation at other worksites will be established by the Department Director with approval of the City Manager.

Workday hours for each department or individual will be established by the Department Director with the approval of the City Manager.

4. PAY PERIOD
The City's pay period begins at 12:00 A.M. on Friday and ends at 11 :59P.M. on Thursday two weeks later.

5. 9/80 AL TERNA TE WORK SCHEDULE
The 9/80 alternate work schedule shall consist of eight (8) work days of nine (9) hours and one work day of eight (8) hours for a total of eighty (80) hours during a pay period.

For non-exempt employees, the eight (8) hour work day must be on the same day of the · week as the employee's regularly scheduled day off (flex day). Under the 9/80 schedule, one calendar week shall consist of 44 hours (four 9-hour days and one 8-hour day) and the alternating calendar week will consist of 36 hours (four 9-hour days and one day off).

The 9/80 schedule is consistent and repeats every two weeks. Departments must ensure that there is sufficient office or field coverage.

6. 9/80 FLSA WORK WEEK
The Fair Labor Standards Act ("FLSA") defines the work week as "a fixed and regularly recurring period of seven (7) consecutive 24-hour periods (168 hours}". The 9/80 work week begins on the employee's eight (8) hour workday, at exactly four (4) hours after the scheduled start time and ends 168 hours later, at the same time on the same day during the following week. This results in 40 straight time hours per FLSA work week, and 80 straight time hours per pay period. Once started, the work week must be consistent and cannot change without the supervisor's approval, as the change may incur overtime.

7. FLEX DAY
The flex day shall be an eight (8) hour day and will be scheduled on the same day of the week as the employee's 8-hour workday that occurs in the preceding and subsequent work weeks. Employees participating in a 9/80 work schedule will normally have alternate Fridays off. An employee will be assigned his/her regular day off by their Department Director.

POLICY#: B-033
ALTERNATIVE 9/80 WORK SCHEDULE
PAGE3
Once the Flex Day is designated, working on the Flex Day may incur overtime in one or more FLSA work weeks, therefore working on the Flex Day or making changes to the Flex Day requires management approval.

Temporary changes to the FLSA work week and/or the Flex Day to avoid overtime are not permitted.

8. OVERTIME
Non-exempt employees are subject to FLSA overtime if the employee exceeds more than forty (40) hours of work in the work week (not the calendar week).

9. HOLIDAYS/PERSONAL HOLIDAY
A holiday is an eight (8) hour day. If a holiday falls on a regularly scheduled workday, the employee will receive eight (8) hours of pay for the holiday. The employee must then charge one (1) hour to vacation, CTO or annual leave accruals if the holiday falls on a nine (9) hour scheduled workday. If a holiday falls on the employee's regular day off (flex day), the employee must take eight (8) holiday hours on another day during the same work week as the holiday, unless otherwise approved by their supervisor.

10. VACATION/SICK LEAVE/ANNUAL LEAVE
If paid leave is used for vacation leave, sick leave, or annual leave, the employee will be charged at nine (9) hours per day if that day is normally a nine (9) hour scheduled workday, or eight (8) hours if that day is an eight (8) hour scheduled workday.

11. BEREAVEMENT LEAVE
Bereavement leave for non-sworn employees is five (5) working days (at eight (8) hours per day) or forty (40) hours. Employees who are off work for the five (5) days and more than forty (40) hours will be required to make up the difference with vacation, CTO or annual leave accruals.

12. CONFERENCES/TRAINING CLASSES
If a non-exempt employee is required to work on their flex day for a training class or attendance at conferences, the employee may be asked to change their work schedule for that work week so that hours worked in the City work week do not exceed the regular schedule of 36 hours.

POLICY#: 8-033
ALTERNATIVE 9/80 WORK SCHEDULE
PAGE4

13. LUNCH BREAKS FOR NON-EXEMPT EMPLOYEES
Non-exempt employees may take their lunch break at any time on their nine (9) hour workdays; however, their lunch break must be taken after four (4) hours of work on the eight (8) hour day to avoid potential overtime.

14. EFFFECTIVE DATE
The 9/80 alternate work schedule will be made available commencing July 29, 2016. The City reserves the right to change or terminate the program at any time.

POLICY #: B-033
ALTERNATIVE 9/80 WORK SCHEDULE
PAGES

CITY OF ARROYO GRANDE
ALTERNATIVE 9/80 WORK WEEK AUTHORIZATION FORM
Employee Name: Date:

Department: Position:

Effective Date (must be the beginning of a pay period):

Regular Day off (Flex day): Alternating Fridays
Date of first regularly scheduled day off (flex day):

Work schedule for 9-hour days (i.e. 7:30 AM - 5:30 PM):

Work schedule for 8-hour day (i.e. 8:00 AM - 5:00 PM):

I understand that this change in my work week is voluntary; it is a privilege and not a right and may be changed or canceled by my Department Director or me by providing at least one full pay period notice. I agree to abide by the alternative 9/80 work week schedule policy.

I understand that I will not earn overtime as a result of my 9/80 schedule and that any overtime requires prior approval of my immediate supervisor.

I agree that I will not change my regular day off (flex day) or my start time on my alternating eight-hour workday without approval from my supervisor as it may trigger overtime.

I agree that I will take my lunch after four hours on my alternating eight (8) hour day as doing otherwise may trigger overtime. (I may take lunch at any time during my nine (9) hour days).

I agree that should a holiday fall on a day I am scheduled to work nine (9) hours, I will be required to supplement the eight (8)-hour holiday with the appropriate number of hours from accrued vacation, CTO, or annual leave hours.

I agree that should I be on vacation, sick leave, or bereavement leave, I will have to charge the number of hours that I would normally be scheduled to work on those days to these accounts. ·
The 9/80 work schedule must consist of one calendar week of four (4) nine-hour days and one (1) regular day off (flex day), and one calendar week of four (4) nine-hour days,

POLICY #: B-033
ALTERNATIVE 9/80 WORK SCHEDULE
PAGES
and one eight-hour day. The new work week will begin exactly 4 hours after the starting time of your eight (8)-hour day and end exactly one week later.

My 9/80 work week is as follows (list number of hours each day):

Work Week One
Fri Sat Sun Mon Tues Wed Thurs Pay
0 0 Period
Work Week Two = 80
Fri Sat Sun Mon Tues Wed Thurs Hours
0 0
I have received a copy of the Alternative 9/80 Work Schedule policy and agree to comply with the provisions of the policy. A copy of this agreement shall be placed in my personnel file.

Employee Signature: Department Director Signature:

Date: Date:

POLICY#: 8-034

INFANT-AT-WORK PROGRAM
PAGE 1

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: 8-034
ISSUED: 12/10/19
EFFECTIVE: 11/01/19
CANCELLATION DATE: ----=--a:N/'-'-A=----
SUPERSEDES: NEW -------
POLICY:

SUBJECT: INFANT-AT-WORK PROGRAM
It is the goal of the City of Arroyo Grande to provide a positive work environment that recognizes parents' responsibilities to their jobs and to their infants by acknowledging that, when an infant is able to stay with a parent, this benefits the family, the employer, and society. The City of Arroyo Grande Infant-at-Work Program allows new mothers or fathers to return to work sooner by allowing the new parents to bring their infant to work with them from eight weeks old until the child is 180 days old or begins to crawl, whichever comes first. This program in no way diminishes the rights afforded new parents under current leave laws. What we believe it provides is a unique alternative to parents of newborn babies that can benefit them and the City of Arroyo Grande.

PROCEDURE:

1. PURPOSE
The Infant-at-Work Program will allow employees the flexibility in child care arrangements to meet the personal needs of new parents while also considering the needs of their department and the City. This policy establishes the guidelines for an Infant-at-Work Program.

2. ELIGIBILITY
Parents - Full-time City of Arroyo Grande employees in good standing with the City of Arroyo Grande are eligible to participate in the program, subject to the specific job responsibilities of the parent and subject to ensuring the physical safety of the infant.

Employees currently involved in a performance improvement plan (PIP), disciplinary action and employees who have not completed their 12-month probation period are not eligible to participate. Employees may request a temporary, alternative work assignment if their current assignment is not suitable for participation in the program. The City of Arroyo Grande will attempt to accommodate such requests based on business and

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INFANT-AT-WORK PROGRAM
PAGE2
staffing situations at the time of the request but is not required to meet said requests.

Infants - Infants of full-time employees from eight weeks old up to the age of 180 days old or until the infant begins to crawl, whichever comes sooner, are eligible for the program, subject to the provisions of these Guidelines.

Alternate Care Providers - Parent must select two other City of Arroyo Grande employees to provide back-up care for the infant. The City will not assume responsibility nor will the Alternate Care Provider be acting on behalf of the City during the time the Alternate Care Provider provides back-up care for the baby. An Alternate Care Provider may not simultaneously participate in the program as a parent bringing his or her baby to work and as an Alternate Care Provider for another parent's child, except in rare situations subject to specific approval by the City of Arroyo Grande's Administrative Services Director.

3. PRE-PROGRAM MEETING ~J
/
' Each Participating Employee Parent shall complete and sign an "Individual Plan" Form (Attachment 1) setting forth an individualized care plan for the baby, which shall be submitted to the Participating Employee Parent's supervisor and Department Director for review and approval prior to birth. The Individual Plan shall set forth general information regarding the baby's care, including the days and times the baby will be present in the workplace, the names and schedules of_ the Participating Employee Parent's care providers, and the dates the Participating Employee Parent will begin and end the Program.

In reviewing the Individual Plan, the Supervisor and Department Director shall consider whether the Participating Employee Parent's duties and worksite are suitable for allowing a baby at work. The Individual Plan shall then be forwarded to the Human Resources Manager.

Before any infant is brought into the workplace, a meeting must take place between the parent and the Human Resources Manager. All parties must review, discuss, and approve the proposed Individual Plan. Approval will only be granted if a Participating Employee Parent's duties and worksite are suitable for allowing an infant at work. Upon approval by the Human Resources Manager, the Participating Employee Parent may bring the infant to the workplace on the beginning date stated in the Individual Plan. ·

4. REQUIREMENTS FOR CHILD CARE PROVIDERS
The parent will accept complete responsibility for the safety of the infant. If the parent's duties require that they leave their primary work site, the parent will take the infant with them. An employee may not take the infant anywhere in a City of Arroyo Grande vehicle.

A parent participating in this program may not leave the building (not even for a short

POLICY #: 8-034

INFANT-AT-WORK PROGRAM
PAGE3
time) without taking the infant with them.

The parent must provide all supplies and equipment needed to care for the infant at the work site and ensure that the area is kept in a clean and sanitary condition. Diapers must be changed only in a designated restroom or in quiet area locations and not in work areas.

When an infant accompanies a parent to work, used cloth diapers must be stored in a closed container and taken home daily. Used disposable diapers must be wrapped appropriately and discarded in an appropriate container provided by the parent and placed in an area not used by staff for office or meeting space. All supplies utilized by the parent must be maintained in a manner that is not disruptive to the work of other employees.

Parents must have day care or other arrangements in place by the time their baby is 180 days old or begins to crawl, whichever comes sooner._
There may be work circumstances that require a parent's full attention such that it may be necessary for parents to make other arrangements for child care during the utilization of this policy. Parents are expected to work closely with their supervisor and coworkers to ensure that all parties involved are aware of what duties can and cannot be reassigned and parents are expected to make alternate child care arrangements when required to do so.

In order for an Infant-at-Work program to be effective, all parties need to be sensitive to the needs of others. The employee must maintain acceptable work performance and ensure that the presence of the infant does not create any office disturbances. If problems arise that cannot be resolved, the employee understands that the program may be terminated for that employee.

If a baby is fussy for a prolonged period of time, causing a distraction in the workplace, or preventing the parent from accomplishing required work, the parent shall remove the infant from the workplace. The parent will be charged for time away from work according to leave time provisions of the City of Arroyo Grande or may be subject to pay deductions for missed work.

The City of Arroyo Grande will identify one or more locations on the premises that employees may use, if they so choose, while breastfeeding or otherwise feeding their infants, as well as a location or locations for changing and disposing of diapers. The location designated for breastfeeding or expressing of milk will be "a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public," in compliance with Sec. 4207 of the Patient Protection and Affordable Care Act (Amending Section 7 of the Fair Labor Standards Act) and other applicable California law, including Labor Code Section 1030, et seq ..

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INFANT-AT-WORK PROGRAM
PAGE4

5. INFANTS LOCATION DURING THE PROGRAM
Work Station - Each parent shall make her/his workstation suitable and safe for the baby and the baby shall be located primarily at that workstation or an area designated as an appropriate location by management during the work day.

Quiet Area - In the event that an infant becomes noticeably fussy or otherwise causes a distraction in the workplace or prevents the parent from accomplishing work, the parent must immediately take the infant to a quiet area until the infant calms down and is quieter.

If the infant does not calm down within 30 minutes while in the quiet area, the parent must remove the infant from the City of Arroyo Grande premises for the remainder of that day.

Other Employees (Non-Alternate Care Providers) - The infant may be in another employee's workspace for brief intervals if requested by the other employee and approved by the parent. Consideration must be taken to ensure that the environ.ment is safe for the infant at all times and that other employees are not disturbed. Parents may not ask employees who are not Alternate Care Providers to care for their infant at any time.

6. ILLNESS
A sick infant should not be brought to work. If the infant becomes sick during the day, the infant must be taken home by the parent immediately. The guidelines set forth in Attachment 4 of this policy are hereby adopted by the City of Arroyo Grande as a means for determining whether a baby is sick.

7. ALTERNATIVE CARE PROVIDERS
The parent shall choose two Alternate Care Providers who will care for the infant if the parent needs to attend a meeting, work with a customer, go to the restroom, or another situation in which the parent is unable to effectively care for the infant for a short time.

Each care provider will have previously signed an Alternate Care Provider Agreement form (Attachment 3). Each Alternate Care Provider shall obtain his/her immediate Supervisor's and Department Director's approval, as referenced in Attachment 3.

If a parent is going to be unable to care for their child at work for a period of less than 1.5 hours within an eight-hour period, the parent shall notify an Alternative Care Provider and place the infant in the Alternative Care Provider's care.

If the parent is going to be unable to care for their child at work for a period exceeding 1.5 hours within an eight-hour period, the parent shall make arrangements for the infant's care outside the City of Arroyo. Grande premises. An Alternate Care Provider in the workplace shall not be permitted to care for an infant for a period exceeding 1.5 hours within any eight-hour period.

POLICY #: 8-034

INFANT-AT-WORK PROGRAM
PAGES
Designated Alternate Care Providers should not be direct supervisors of or directly managed by a participating parent.

8. OTHER PERSONNEL CARING FOR INFANT
The City of Arroyo Grande understands that other personnel may ask the parent for permission to care for the infant for brief periods of time. This is acceptable at the discretion of the parent as long as the productivity of other personnel is not substantially reduced. Only the Alternate Care Providers are permitted to watch the infant if the parent is unable to care for the infant for a prolonged period of time (not to exceed 1.5 hours within any eight-hour period).

9. COMPLAINTS
All complaints related to this policy must be made directly to the parent's immediate Supervisor, Department Director, or the Human Resources Manager, by such means as may be provided. All complaints will be kept anonymous to the extent that is possible.

The employee, the immediate Supervisor, the Department Director, and the Human Resources Manager shall have final discretion to decide what should be done to resolve the complaint. (See Termination of Eligibility below.)
If the Participating Employee Parent is required to take some type of affirmative action to resolve the complaint, the Participating Employee Parent shall modify his or her Individual Plan to include the steps to be taken to resolve the complaint. The modified Individual Plan shall be re-submitted to the participating Employee Parent's Supervisor, Department Director and the Human Resources Manager for approval.

10. TERMINATION OF ELIGIBILITY
Participating parents have the right to terminate their individual agreement at any time.

The City of Arroyo Grande has the right to terminate an individual agreement at any time if a parent's performance declines or if organizational needs are not being met (i.e., complaints and/or disruptions to coworkers cannot be resolved). The employee must maintain acceptable work performance and ensure that the presence of the infant does not create any office disturbances.

This agreement may also be terminated if the parent becomes involved in disciplinary action, if the parent does not comply with the terms and conditions of their Individual Plan, or when complaints have been made that cannot be resolved. Eligibility may also be terminated at the sole discretion of the City of Arroyo Grande with written notice to the employee. When eligibility is terminated, the infant must be removed from the workplace.

The City of Arroyo Grande will i:lccommodate reasonable time (not to exceed 3 work days) needed for the parent to take the baby to an external care arrangement.

POLICY#: B-034

INFANT-AT-WORK PROGRAM
PAGES
If an Individual Plan, agreement or any other eligibility to participate in this Program is terminated, there shall be no right to further review or appeal of the City's decision.

11. OTHER
The City of Arroyo Grande's Infant-at-Work Program is a voluntary option for employees, subject to approval as outlined in these Guidelines, where it is compatible with job requirements.

Other affected employees may request a "baby-free" work environment. Such requests should be made through the employee's immediate Supervisor and the Human Resources Department. The City of Arroyo Grande will attempt to accommodate such requests based on business and staffing situations at the time of the request, by temporarily relocating the parent or the other employee after discussion with all parties to determine the most effective resolution.

Participation in the City of Arroyo Grande's Infant-at-Work Program is a privilege and not a right.

The City of Arroyo Grande expressly reserves the right to refuse participation in the Program if the requesting parent's position is deemed unsafe or unsuitable for the presence of a baby due to business reasons. The City of Arroyo Grande reserves the right to change or revise this Program and its Guidelines or to terminate the Program in part or in its entirely, with or without cause, requiring the parent to remove his/her baby from the workplace within a reasonable period of time (not to exceed 3 work days). Any changes will be conveyed to affected employees as soon as possible after any change or revision.

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INFANT-AT-WORK PROGRAM
PAGE7
ATTACHMENT 1

CITY OF ARROYO GRANDE

INFANT-AT-WORK PROGRAM

INDIVIDUAL PLAN

GENERAL INFORMATION
Name of ParenUEmployee: _______ _ Home Phone: ---------- Name of Infant: Infant's Date of Birth: ----------- Date Infant Enters Program: _______ _ Latest Date Infant Will Leave Program: _______ _
Days and Times Infant Will be Present in the Workplace: ____________ _

ALTERNATE CARE PROVIDERS
The following employees have agreed to be alternate care providers, who will provide care for my infant when I am unavailable (not to exceed 1.5 hours within an eight-hour period). #1: _____________ (Name)
#2: (Name)
Note: If you are on flexible hours, your care providers must work the same schedule that you do.

SPECIFIC INFORMATION
Include any other specific plan information or requirements in the space below (optional):

IN CASE OF EMERGENCY, PLEASE CONTACT:

Name: ----------- Re I at ions hip:---------
Home Phone:

Work Phone: ________
---------_
Cell Phone: _________ _
Name: ----------- Re I at ions hip:--------- Home Phone: ________ _ Work Phone:

Ce II Phone: _________
---------_

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INFANT-AT-WORK PROGRAM
PAGES

I UNDERSTAND THAT THIS PLAN IS SUBJECT TO MEETING WITH AND OBTAINING

APPROVAL FROM MY IMMEDIATE SUPERVISOR, THE DEPARMTEN DIRECTOR AND THE HUMAN RESOURSES MANAGER. I UNDERSTAND THAT, IF ANYTHING ABOUT MY PLAN

CHANGES, I WILL NEED TO MEET WITH AND RECEIVE APPROVAL FROM THESE SAME INDIVIDUALS TO DISCUSS THE CHANGES AND TO GET MY NEW PLAN APPROVED.

Submitted by:

Signature of Parent/Employee
Approved by:

Immediate Supervisor
Department Director
Human Resources Manager
Date
Date
Date
Date

PLEASE ATTACH YOUR SIGNED ALTERNATE CARE PROVIDER AGREEMENTS TO THIS INDIVIDUAL PLAN·.

POLICY#: B-034

INFANT-AT-WORK PROGRAM
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ATTACHMENT 2

CITY OF ARROYO GRANDE

INFANT-AT-WORK PROGRAM

PARENT AGREEMENT, CONSENT, AND WAIVER

AGREEMENT
By signing this Agreement, I certify that I have read the Infant-at-Work Program Guidelines. understand and agree to comply with the terms and conditions set forth in the Program Guidelines.

I further understand and agree that, in the event I fail to comply with such terms and conditions or otherwise fail to meet any Program criteria currently in the policy or that may be added to the policy and conveyed to me in writing, my Program eligibility may be terminated, requiring me to remove my baby from the workplace within a reasonable period of time (not to exceed 3 work days).

I acknowledge that the City of Arroyo Grande is offering participation in the Infant-At-Work Program as a courtesy to full-time City employees who are new fathers, mothers, and/or legal guardians and not as an employee benefit. Accordingly, I acknowledge that the City of Arroyo Grande reserves the right to cancel or retire the Program in part or in its entirety at any time, or any participant's eligibility with or without cause, thus requiring me to remove my baby from the workplace. In this event, I understand that the City of Arroyo Grande will provide me with a reasonable period of time for me to take my infant to a different care setting (not to exceed 3 work days).

Signature of Parent Date

CONSENT AND WAIVER
In consideration of the City of Arroyo Grande permitting me to bring my child to work with me in compliance with the Infant-at-Work policy, I hereby release, on my own behalf and on behalf of my child, _______ : (i) the City of Arroyo Grande; (ii) any entity affiliated with the City of Arroyo Grande; and (iii) any of the current or former owners, officers, directors, agents, representatives, insurers, attorneys, successors, assigns, and current employees, including any alternate care providers, if any, of the City of Arroyo Grande and the foregoing entities from any and all claims, liabilities, causes of action and demands of any kind or character, including negligence, whether vicarious, derivative or direct, that I, ______ , or any of my child's family members, heirs, or assigns now have or may hereafter have or assert against the City of Arroyo Grande growing out of, resulting from, or connected with this policy and/or with me bringing my child to work or his/her presence at work with me. This waiver does not preclude legal remedies for injury due to malice or egregious negligence.

Signature of Parent Date

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INFANT-AT-WORK PROGRAM
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ATTACHMENT 3

CITY OF ARROYO GRANDE

INFANT-AT-WORK PROGRAM

ALTERNATE CARE PROVIDER AGREEMENT
As a care provider, I understand and agree to the following:

I understand that I am volunteering to be an Alternate Care Provider, which does not relieve me of my responsibilities as an employee of the City of Arroyo Grande, nor does it entitle me to any additional conferred benefit or compensation. By signing this Agreement, I certify that I have read the Infant-at-Work Policy Guidelines. I understand and agree to comply with the terms and conditions set forth in the Policy Guidelines.

When necessary, I will provide care for _________ (infant's name) when __ _ __________ (parent) is unavailable. My care will not exceed 1.5 hours within any eight-hour period.

As a care provider, I know I must work the same hours as the infant's mother or father, so I must have the same work schedule that they have.

I understand that I must obtain my immediate Supervisor's, as well as my Department Director's, approval to participate in this program.

If the infant becomes disruptive to other employees, I will take the infant to a designated quiet area.

I understand that the parent may not leave the infant in my care if he/she is going to leave the building.

I understand that there is another designated care provider, ___________ _ [name], whom I may contact for assistance.

I understand that no other persons besides the parent, myself, and the other designated Alternative Care Provider are responsible for the baby once the baby has been placed in my care.

If another employee asks to take care of or hold the baby, I will first get the parent's approval.

I may decide, at any time, to no longer be an Alternate Care Provider. The City of Arroyo Grande is not requiring me to serve in this capacity. If I should decide that I no longer wish to be a care provider, I will attempt to give the parent at least two weeks' notice. I will also notify the Human Resources Manager of my decision to no longer be an alternate care provider.

I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND, AND AGREE TO THE TERMS OF THIS ALTERNATE CARE PROVIDER AGREEMENT.

Signature of Alternate Care Provider Date
Signature of Supervisor Date

POLICY#: 8-034

INFANT-AT-WORK PROGRAM
PAGE 11
Signature of Department Director

CONSENT AND WAIVER
Date
In consideration of the City of Arroyo Grande permitting me to voluntarily participate in the InfantAt-Work Program as an Alternate Care Provider, I hereby release, on my own behalf and on behalf of my family members, heirs, or assigns: (i) the City of Arroyo Grande; (ii) any entity affiliated with the City of Arroyo Grande; and (iii) any of the current o_r former owners, officers, directors, agents, representatives, insurers, attorneys, successors, assigns, and current employees, including any alternate care providers, if any, of the City of Arroyo Grande and the foregoing entities from any and all claims, liabilities, causes of action and demands of any kind or character, including negligence, whether vicarious, derivative or direct, that I, ______ _ _____ , or any of my family members, heirs, or assigns now have or may hereafter have or assert against the City of Arroyo Grande growing out of, resulting from, or connected with this policy. This waiver does not preclude legal remedies for injury due to malice or egregious negligence.

Signature of Alternate Care Provider Date

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INFANT-AT-WORK PROGRAM
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ATTACHMENT 4

GUIDELINES FOR EXCLUSION

OF SICK CHILDREN
From:

Guidelines for Exclusion of Children (or Staff Working With Children) Who Are Ill, As Recommended in
Caring for Our Children: National Health and Safety
Standards: Guidelines for Out-of-Home Child Care Programs (Third Edition) If the child has any of the following conditions and thus poses a risk of spread of harmful diseases to others, they shall not be brought to work. If they develop these conditions during the work day, the parent shall remove the child from the premises as soon as reasonably possible:

1. An acute change in behavior including lethargy/lack of responsiveness, irritability, persistent crying, difficulty breathing, uncontrolled coughing, noticeable (spreading) rash, or other signs or symptoms of illness until medical evaluation indicates inclusion in the facility.

2. Fever (temperature above 101 degrees Fahrenheit orally, above 102 degrees Fahrenheit rectally, or 100 degrees or higher taken auxiliary (armpit)) and behavior change or other signs and symptoms (e.g., sore throat, rash, vomiting, diarrhea).

3. Uncontrolled diarrhea, that is, increased number of stools, increased stool water, and/or decreased form that is not contained by the diaper until diarrhea stops; blood or mucus in the stools not explained by dietary change, medication, or hard stools.

3. Vomiting illness (two or more episodes of vomiting in the previous 24 hours) until vomiting resolves or until a health care provider determines the illness to be non-communicable, and the child is not in danger of dehydration.

4. Abdominal pain that continues for more than two hours or intermittent pain associated with fever or other signs or symptoms of illness.

5. Mouth sores with drooling, unless a health care provider or health official determines the condition is noninfectious.

6. Rash with fever or behavior change, until a health care provider determines that these symptoms do not indicate a communicable disease.

7. Purulent conjunctivitis (defined as pink or red conjunctiva with white or yellow eye discharge), until 24 hours after treatment has been initiated.

8. Untreated scabies, head lice, or other infestation.

9. Untreated tuberculosis, until a health care provider or health official states that the child can attend child care.

10. Known contagious diseases while still in the communicable stage (chicken pox, streptococcal pharyngitis, rubella, pertussis, mumps, measles, hepatitis A).

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: B-035 SUBJECT: LACTATION ACCOMODATION
POLICY
ISSUED: 09/21/2020
EFFECTIVE: 09/21/2020
CANCELLATION DATE: N/A
SUPERSEDES: NEW
POLICY:

The City of Arroyo Grande recognizes that breast milk is a beneficial food for growth and development of infants. In compliance with SB 142, this policy is to establish guidelines for promoting a breastfeeding-friendly work environment and supporting lactating employees of the City of Arroyo Grande for as long as they desire to express breastmilk.

The City supports the legal right and necessity of employees who choose to express milk in the workplace.

PROCEDURE:

1. LACTATION BREAK TIME
The City of Arroyo Grande will provide a reasonable amount of break time to accommodate any employee desiring to express breast milk for the employee’s infant child each time the employee has a need to express milk. The break time shall, if possible, run concurrently with any break time already provided to the employee. If the employee takes lactation breaks at times other than their provided break times, then the lactation break shall be unpaid or the employee may choose to use accrued leave.

Those desiring to take a lactation break at times other than their provided break times must notify a supervisor prior to taking such a break. Breaks may be reasonably delayed if they would seriously disrupt operations. Once a lactation break has been approved, the break should not be interrupted except for emergency or exigent circumstances.

2. LACTATION LOCATION
The City will provide a room or other appropriate location in close proximity to the employee’s worksite that is not in a bathroom to express milk in private. The room or location will meet the following requirements:
 Be shielded from view and free from intrusion while being used to express milk;  Be safe, clean, and free of hazardous materials;

POLICY #: B-035

LACTATION ACCOMMODATION POLICY
PAGE 2
 Contain a surface on which to place a breast pump and personal items;  Contain a place to sit; and
 Have access to electricity needed to operate an electric battery-powered breast pump.

An employee occupying such private area shall either secure the door or otherwise make it clear to others through signage that the area is occupied and should not be disturbed.

All other employees should avoid interrupting an employee during an authorized break under this section, except to announce an emergency or other urgent circumstance.

The City will provide access to a sink with running water and a refrigerator, or other cooling device, suitable for storing milk, in close proximity to the employee’s work area.

3. LACTATION ACCOMMODATION REQUESTS
Breastfeeding employees who wish to express milk during working hours must submit a completed and signed Lactation Accommodation Request Form to Human Resources at least five (5) business days in advance of the start of the request. Any additional breaks needed to express milk beyond the employee’s regular breaks/lunch breaks must be indicated on the form.

Following receipt of a request for lactation accommodation, the City will provide a timely written response to the employee in which the City will indicate if it is unable to provide the requested break time or a requested location for the purposes of expressing breast milk.

An employee who does not believe that the City is providing an appropriate lactation accommodation should immediately inform the Human Resources Department.

An employee who does not believe that the City is providing an appropriate lactation accommodation as required by state law has the right to file a complaint with the California Division of Labor Standards Enforcement/Labor Commissioner.

4. RETALIATION
California law expressly prohibits retaliation against lactating employees for exercising their rights. This includes those who request time to express breast milk at work and/or who lodge a complaint related to the right to lactation accommodations. To file a discrimination complaint, email [email protected].

Whitney McDonald
City Manager

POLICY #: B-035

LACTATION ACCOMMODATION POLICY
PAGE 3
LactationAccommodationRequest Form
In accordance with the City of Arroyo Grande’s Lactation Accommodation Policy (the Policy), breastfeeding employees will be provided breaks and a space to express milk during working hours. Employees must submit this completed and signed form to Human Resources at least five (5) business days in advance of the start of the request.

Employee’s Information
Name: Email Address:

Title/Position: Phone Extension:

Department: Office Location:

Employee Type: ☐Exempt ☐Non-Exempt Supervisor’s Name:

Lactation Accommodation Request
Start Date (Month, Day, Year): Number of
Daily Breaks Requested:

Estimated Length of Each Daily Break:

Will you be using your break(s) and/or lunch break to express milk? ☐Yes ☐No Do you need additional time beyond your break(s) and/or lunch break to express milk? ☐Yes ☐No Please check all dates that apply and enter the approximate times that you will take your breaks:
□ Monday □ Tuesday ☐Wednesday □ Thursday □ Friday □ Saturday □ Sunday Times: Times: Times: Times: Times: Times: Times:

By signing below, I hereby certify that I have read, understand, and agree to the terms of the Policy.

Employee’s Signature Date
By signing below, I hereby certify that I have read and understand the terms of the Policy, and I approve of this arrangement.

Supervisor’s Signature Page 1243 of 1799 Date

CITY OF

ARROYO GRANDE
ATTACHMENT 1
Remote Work Request/Agreement
Once completed, submit this form to your supervisor for consideration in accordance with the City’s Remote Work Policy. This request is a starting point for conversations between the employee and their supervisor about the feasibility and terms of a Remote Work Arrangement.

Name:

Job Title:

Department / Division:

Supervisor/Manager:

Level of Remote Work:

Level 1 - Fully Remote Level 2 – Structured Remote * Level 3 - Custom Remote ** *Structured remote is when employee works in a remote work environment based on a set schedule. **Custom remote is when an employee requests the ability to work remote on a case-by-case basis Proposed Work Schedule for Level 1 and Level 2 Requests Remote work hours can be fully remote, structured remote, or custom remote as approved by the supervisor/manager. Employees are required to adhere to the assigned work schedule and record all nonwork time (i.e. vacation/annual leave, sick leave, personal leave, etc.) on their timecard. Hourly employees who are subject to overtime (non-exempt employees) must take meal and rest breaks while working remotely, just as they would if they were reporting to work at the City worksite. Non-exempt employees may not work outside of their agreed upon work schedule without prior written authorization from their supervisor.

Pay Period Week 1 Pay Period Week 2
Day Work
Hours
Work
Location
Day Work
Hours
Work
Location
Monday Remote Onsite Monday Remote Onsite
Tuesday Remote Onsite Tuesday Remote Onsite
Wednesday Remote Onsite Wednesday Remote Onsite
Thursday Remote Onsite Thursday Remote Onsite
Friday Remote Onsite Friday Remote Onsite
Saturday Remote Onsite Saturday Remote Onsite
Sunday Remote Onsite Sunday Remote Onsite
Location of Remote Work Site
Address:
_______________________________ ________________________________

EMPLOYEE SIGNATURE DATE

CITY OF

ARROYO GRANDE
ATTACHMENT 1
Department Review

APPROVED AS REQUESTED
_______________________________ ________________________________ Supervisor Name/Signature DATE

_______________________________ ________________________________ Department Director/Signature DATE
_______________________________ _______________________________ Human Resources/Signature DATE

_______________________________ ________________________________ City Manager/Signature DATE
THIS AGREEMENT SHALL BEGIN ON _________________ AND WILL BE RE-EVALUATED ON _________________.

NOT APPROVED AS REQUESTED
_______________________________ ________________________________ Supervisor Name/Signature DATE

_______________________________ ________________________________ Department Director/Signature DATE
Employee meets the Eligibility Criteria identified in Section A. of the Remote Work Policy for the following reasons:

Director/Supervisor list of requirements/specific expectations for employee engaged in remote work (i.e. communication requirements):

CITY OF

ARROYO GRANDE
ATTACHMENT 1
Remote Work Policy Acknowledgement
Please read and initialize each acknowledgement statement below. _____ I acknowledge that my remote work schedule may not be changed without prior written approval from my supervisor.
_____ I acknowledge that requests to work overtime, utilize sick leave, request time off, or request a leave of absence must be approved in advance, in writing by my supervisor in the same manner as when working in a City office.
_____ I acknowledge that if I am sick while remote working, I am required to report hours worked, and I must use sick leave or other accrued time to cover the hours not worked. _____ I acknowledge that the City of Arroyo Grande assumes no risk or liability for injuries to any third parties or members of my family, guests, or others present at the remote work location.
_____ I acknowledge that I am responsible for designating a workspace to be utilized while remote working. I agree to maintain the space in a safe condition, free of hazards and other dangers to myself and to City equipment (laptop), and in a manner conducive to performing my duties.
_____ I acknowledge and agree to abide by all of the requirements of the Remote Work Policy.

REMOTE WORK EQUIPMENT
_____ I acknowledge that equipment provided by the City of Arroyo Grande for the purpose of facilitating remote work may be used: a) only at the regular remote work location noted above; b) only by me; and c) only for City business.
_____ I acknowledge that I may need to use my own equipment if the City does not issue equipment. If the City issues equipment, I will perform City work using only that equipment.
_____ I acknowledge that I am responsible for the repair and maintenance of any personal equipment that I provide.
_____ I acknowledge that if I am issued City equipment, I am responsible for ensuring that all City equipment is used properly, and that the City will provide repair for City equipment as needed.
_____ I acknowledge that in the event of any delay in repair or replacement of City equipment, or other circumstances that would make it impossible for me to work remote, my department shall request that I return to my primary City work location.

CITY OF

ARROYO GRANDE
ATTACHMENT 1
_____ I acknowledge receipt of the following City equipment to support my remote work:

Laptop (Including Tag #) ________________
Identify/list other laptop accessories – extension cord, etc. ________________

EXPENSES RELATEDTO REMOTE WORK
_____ I acknowledge that the City will not pay for, or reimburse, the following expense:
• Maintenance or repairs of privately-owned equipment.
• Utility costs associated with the use of electronics. • Costs associated with the occupation of the home/offsite work location. • Travel expenses associated with commuting to/from the City office. • Out-of-pocket expenses for supplies that are regularly available at the City office.

REMOTE WORK PROVISIONS
_____ I acknowledge that the remote work assignment is entirely voluntary and may be terminated by the remote worker or the City at any time. _____ I acknowledge that the duties, obligations, responsibilities, and conditions of my employment with the City are unchanged due to remote work. I acknowledge that my salary, retirement, benefits, and City sponsored insurance coverage are unchanged due to remote work.
_____ I acknowledge that I must accurately report all remote work hours worked, and that work hours and overtime compensation must conform to City policies and procedures, MOU provisions as applicable, and to the terms otherwise agreed upon by me and my supervisor.
_____ I acknowledge that individual tax implications related to remote work are my responsibility, and I understand that any questions in this regard should be posed to a tax expert, at my expense.
_____ I acknowledge that my supervisor or Department Director may establish remote work procedures to assist in the supervision of my work performance. _____ I acknowledge that the City is my sole employer during my scheduled work hours and that I may not perform work for another employer while working for the City.

CITY OF

ARROYO GRANDE
ATTACHMENT 1
Final Acknowledgement
_________________ I acknowledge that I remain obligated to comply with all City rules, policies, procedures, practices, and instructions (City Policies). Violation of City policies may result in preclusion from remote work and/or disciplinary action, up to and including termination of employment.

Employee Printed Name
Employee Signature
Date
Supervisor Printed Name
Supervisor Signature
Date
Director Printed Name
Director Signature
Date
City Manager Printed Name
City Manager Signature
Date
C: Human Resources/Personnel File

CITY OF

ARROYO GRANDE
ATTACHMENT 2
Remote Worker Self Inspection Safety Checklist
Employee’s Name Department
The following information is intended to assist the remote worker to ensure the remote worksite is safe.

Inspection (and the use of this checklist) should be done at least annually by the remote worker and forwarded to his/her supervisor for review. The individual department will maintain these records and send a copy of the record to Human Resources.

The following information is provided to make you aware of your responsibilities as a worker. Your initials by each item mean that you are aware of your responsibilities in these areas.

GENERAL WORK ENVIRONMENT
Work site is clean, orderly and safe. Materials or equipment are stored in such a way that sharp projectiles will not interfere with the walkway. Adequate headroom is provided for the entire length of any aisle or walkway. Aisles and passageways are kept clear.

There are standard stair rails or handrails on all stairways having four or more steps.

Employees are aware of all exits and all exits are kept free of obstructions.

All tools and equipment (both departmental and employee-owned) used by the employee at their home for City authorized work is in good condition.

Work area is adequately illuminated.

The work area ventilation system is appropriate for work being performed.

Comments (Please list any problems that were identified):

Date of inspection Signature of person performing inspection As the supervisor for this remote worker, I have reviewed this inspection and discussed any problems with the employee.

Date Signature of Supervisor
C: Human Resources/Personnel File

r CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES ..

POLICY#: C-001 SUBJECT:

ISSUED: 06l-01/.Q6 09lOV9]
EFFECTIVE: 06!01/.Q6 p9/01/9'7J
CANCELLATION DATE: N/A
SUPERSEDES: NEW 06/01/9~
POLICY:

PURCHASING PROCEDURES -
SUPPLIES & EQUIPMENT OVERTHE-COUNTER PURCHASES (LESS
THAN $2,000 l;50q)
The policy of the City of Arroyo Grande is to provide instructions for the acquisition of sueplies and equipment when~ amount of the purch~e is Less than ~~?;509l Purchases"ln e~cess ~f $7,500 ·shaU reqyi~e- ~ wrijten .qo11tract ~~rded py~;th~ .C~ pouncil ta t!Je. lowest~ ~ponsible.;~igderf
r· PROCEDURE:
..... ,
I

1. This is a new procedure reflecting the current policies relating to supply and equipment purchases.

2. The vast majority of purchases made on behalf of the City are under $2,000 7~50Q. This procedure has been developed to bring control and accountability to this significant category of purchases.

Competition, Specifications, and Quotations: Although competition is ensured by the formal bid process required for major acquisitions, it should also be the standard for smaller purchases. When practical, verbal or telephone quotations should be solicited from prospective vendors. The Quotation Evaluation Summary (Exhibit I) may be used to tabulate quotations as they are obtained.

The solicitation of competitive quotations is practical when the savings to be realized exceed the cost of obtaining the quotations. For example, at the low end of this purchasing category, it would not be practical to utilize any employee's time to obtain quotations on a screwdriver. However, at the high end of the range, it would be practical to obtain quotations for a video tape recorder.

Although a purchase price under saoo i.t~~O removes the requirement for written quotations. the resources used to obtain verbal or telephonic quotations could probably yield substantial savings. The use of competitive quotations, when Revised: September 1, 1997

POLICY#: C-001
PAGE2
reasonably practical, ensures the acquisition of sound value, guards against favoritism, and safeguards equal opportunities to compete for City business. -'- If quotations are solicited, specifications must be developed for the design and performance requirements of the item(s) to be purchased. For competitive quotations to be useful, they must be submitted for identical specifications. This . standard applies equally to verbal quotations, written quotations, formal bids, and formal proposals. The amount of detail included in the specifications is determined by the complexity of the item(s) to be acquired.

3. Authorization and Review: The Department is responsible for the maintenance of competitive purchasing and ethical conduct in the smaller supply and equipment acquisitions included in this procedure. Purchasing authority may be delegated by the Department Director to a member of his/her staff. The purchasing authority must ensure that competitive quotations are obtained whenever practical and that prospective suppliers are evaluated in an equitable manner. In addition, the purchasing authority should review all receipts, invoices, and payment vouchers to ensure that only authorized item(s) and quantities are purchased in the name of the City. Obviously, the quantities listed on invoices should coincide with the quantities indicated on corresponding receipts, and the employees receiving the items being purchased must sign all receipts.

Responsibility
Department
Authorized
Department
Employee
Department
Director and/or
Designee
Revised: September 1, 1997
Process Summary
Action

1. Identify equipment/supply need.

2. Develop specifications.

3. Solicit verbal/telephone quotations.

4. Evaluate quotations.

5. Authorize Department employee to make
purchase (or submit purchase order if
required).

6. Inspect item(s) to be purchased.

7. Sign for receipt of item(s).

8. Obtain itemized receipt.

9. Submit receipt to Department Director.
fa. Review vendor invoices for Department
purchases.

11. Distribute expenditures among Department
expense accounts.

12. Submit invoices to Finance Department.
[
rPage 1260 of 1799
,,
I
~
I
POLICY#: C-001
PAGE3
Finance Department
Revised: September 1, 1991

13. Process payment through Accounts
Payable system.

ROBERT L. HUNT

CITY MANAGER

City of Al ro Grande
J Written Quotations
Quotation Evaluation Summary
J Verbal/Telephone Quotations
Date Prepared: Deparbnent:

Prepared By:
supplier's Name Suppiier's Name Suppl~er's Name
Vendor
Telephone No.

Quoted By
Item Description Quantity Unit Unit 'l'otal Unit Total Unit Total No. Price Price Price Price Price Price
.

Total Quotation $ $ $
Cash Discount Terms
ll'.O.B.

Delivery Ti1ne from Receipt of order
~olicyi: C-001/002

CITY OF ARROYO GRANDE
POLICY#: C-002
--------
ISSUED: 06/01/96
EFFECTIVE: 06/01/96
CANcELLATIUl\fDATE: Biil91 - - - - ~r ___ .,_=:=_:..-:-;.."'5=*54= SUPERSEDES: NEW
------
POLICY:

ADMINISTRATIVE POLICY AND PROCEDURES
SUBJECT: PURCHASING .PROCEDURES - SUPPLIES
& EQUIPMENT OPEN MARKET
PURCHASES ($2,000 - $5,000)
The policy of the City of Arroyo Grande is to provide instrudions for the acquisition of supplies and equipment with a unit cost, or fiscal year contrad aggregate, between $2,000 and $5,000. Purchases in excess of $5,000 shall be made through a formal bid process in compliance with applicable State regulations.

PROCEDURE:

1. This is a new procedure refleding the current policies relating to supply and equipment purchases.

2. Open market purchases represent the mid-range of equipment and supply purchases, consisting of expenditures between $2,000 and $5,000. Although these purchases do not require a formal bid procedure, they do demand written documentation of a competitive evaluation and seledion process. This procedure contains instrudions for the solicitation, evaluation, and reporting of the written quotations required in these purchases.

3. Specifications: The first step, after the identification of a supply/equipment need and the determination that the purchase amount will require written quotations, is to develop specifications for the item(s) to be purchased. The amount of detail included in the specification is determined by the complexity of item(s).

4. Solicitation and Submission of Quotations: Written quotations for open market purchases may be solicited by either verbal or written request. As with the development of specifications, the complexity of the item(s) to be purchased will determine the best approach. Quotations may be received diredly by the operating department but are forwarded to the City Clerk's Office. Quotations must be retained for a period bf ninety days following receipt. Whenever possible, seledion must be made based upon at least three quotations.

Revised: September1, 1997

POLICY#: C-002
PAGE2

5. Selection of Lowest Responsible Quotation: All quotations received must be tabulated by the Department on the Quotation Evaluation Summary (Exhibit I). Selection of other than the lowest bidder, rejection of any or all quotations, and any exceptions to competition must be justified and documented in the staff report to the City Council.

Responsibility
Department
Vendor
Operating Department
Finance Department
Revised: September 1, 1997
Process Summary
Action

1. Identify equipment/supply need.

2. Develop specifications.

3. Solicit at least three written quotations.

4. Complete Quotation Evaluation Summary.

5. · Prepare staff report for Council approval
justifying any exceptions to competition or
selection of other than lowest bidder if
applicable.

6. Provide ordered supplies/equipment.

7. Submit invoice to operating Department.

8. Inspect shipment for conformance to
specifications.

9. Request payment to vendor by submission
of vendor's invoice to the Finance
Department.

10. Process payment through Accounts
Payable system.

ROBERT L. HUNT

CITY MANAGER

City of hLLvyo Grande
D Written Quotations
Quotation Evaluation Summary
D Verbal/Telephone Quotations
Date Prepared: Department:

Prepared By:

Supplier's Name Supplier's Name Supplier's Name
Vendor
Telephone No.

Quoted By
Item Description Quantity Unit Unit Total Unit Total Unit Total No. Price Price Price Price Price Price
Total Quotation $ $ $
Cash Discount Terms
F.O.B.

Delivery Time from Receipt of Order
Policy#: C-001/002

CITY OF ARROYO GRANDE
POLICY #: __ c_-0_0~3------------
ISSUED : __ ...,6,_./ 1_/,_,9....,6....__ ________ _
EFFECTIVE: __ ..... 61 ..... 1 .... 1_9._..6,__ __ _
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:

ADMINISTRATIVE POLICY AND PROCEDURES
SUBJECT: SPECIFICATIONS - STANDARDS

FOR BID SPECIFICATIONS FOR

USE IN PURCHASES
This policy details the important role of specifications and their development for use in purchases made on behalf of the City.

PROCEDPRE:

1. This is a new procedure reflecting the standards to be. used for the development of appropriate bid specifications.

Well-written specifications provide several benefits to the purchasing function. They help to ensure that maximum value is obtained; they enable all qualified suppliers.to·compete on an equal basis; and they minimize disputes centering upon whether delivered products are what was ordered. In addition, commonly accepted standard specifications facilitate cost-saving, cooperative purchases with other Departments and units of government.
2 . Defining Specifications. Specifications are a clear and complete description of the essential qualities that products should possess if they are to meet the acceptable purchase requirements of the City. A prospective vendor's goods or services must meet or exceed specification requirements if they are to be considered for purchase. Specifications may be in the form of written descriptions, drawings, industry standards, commercial designations, or other descriptive references . They become an integral part of the purchase or contract. 3_ Prepararation of Specifications. Responsibility for preparing specifications varies, depending upon the particular purchase to be made. For specialized departmental purchases, the specifications will be prepared by Department personnel and approved by the Department Director and City Attorney. For standardized products, specifications will be prepared by the requesting Department with review and apprpval by the City Attorney. Departments are to check with the City Clerk's Off ice for previously approved specifications for standardized products . For large-scale, Citywide equipment purchases ( i . e . , telephone system), the specifications will usually be prepared

POLICY #: C-003
PAGE 2
by a consultaµ.t retained for that purpose.

In all purchases, the estimated cost of the project may require additional approval of specifications by the City Manager and/or the City Council.

4. ·Preparing Specifications: Any City employee assigned the responsibility of preparing specifications should adhere to certain guidelines:

Use specification writing assistance wherever possible.

Keep specif.ications clear and accurate.

Update specifications regularly to reflect changes in
technology.

Avoid the use of unfair specifications that preclude or reduce competition.
"Specification writing assistance can come from several sources. :Previously used specifications, expertise of employees trained ··in the use or technology of the project being purchased, consultants, information from vendors, and agencies that _specialize in preparing and maintaining specifications can all .assist developing clear and concise purchase specifications. ~nformation from vendors must be used cautiously, as it can· preclude or diminish competition. The best approach is to compile and compare information from several prospective vendors. Agencies that may be able to provide assistance include the California State Department of General Services; the General Services Administration; the U.S. National Bureau of Standards; the American National Standards Institute, Inc.; the National Institute of Governmental Purchasing and Public Technology, Inc. (P.T.I.).

Most specifications can be classified into six categories. Five are .based upon product design features and one upon performance. The characteristics and relative merit of each are discussed below.

1. ~: These acceptable specifications cover all pertinent features and may incorporate words or phrases from industrial or governmental standard specifications. No
specific brands are mentioned.

2. Reference to Ind.ustrial or Governmental Standards: This category of specifications, which is also acceptable, specifies that the product should meet certain widely- accepted standards.

3. Performance: In this aqceptable type of specifications, design requirements may, and often do appear, but the emphasis is on performance requirements.

POLICY #: C-003
PAGE 3

4. Single Project: Specifications in this category designate only one manufacturer, brand, or trade name. The inherent denial of eompetition makes these specifications generally unacceptable.

5. EQY.a:l Product: This category of specifications names a specific brand and approves any o~her_brand that can be proved equal to the one named. The controversy, which can arise over what is 11 equal," makes .this type generally unacceptable.

6. Multi-Product: These specifications name two or more specific products. - Al though more open than single or equal product specifications, they also tend to unfairly limit competition. Use of this type of specification is also controversial and should be avoided. - .

The general rule derived from the above evaluation .is that written specifications should emphasize design and/or
performance requirements . Descriptions .of. each should ·be clear, accurate, and complete, outlining in detail.the.minimum qualities that a product or service must offer in.order to be considered.

Performance specifications are steadily becoming the preferred type for use in governmental purchasing. _As - the name indicates, these specifications establish the ·performance requirements a product is to meet. Using this concept, the end result is the primary consideration, and the vendor is g~ven the latitude in how he/she can accomplish it. Specifications that contain more performance requ~rements, and fewer design requirements encourage · ingenuity, innovation, and cost reduction; the essence of competition. Specifications containing more design requirements provide less latitude and can be so detailed that they virtually describe how the product is to be manufactured.

Generally, most specifications are a blend of design and performance requirements . For equipment and service purchases, performance should be stressed. For construction and public works projects, design requirements are essential where a structure or product is to be made to meet.the City's plans.

If brand name specifications are used, they should indicate beyond any doubt that the brand name is used merely as a specification and not as a statement of preference for the specific product cited. The intent must be further explained, in the Invitation to. Bid or Request for Proposal, by a statement such as:

POLICY #: C-003
PAGE 4
"Any manufacturers ' names, trade names, brand
names, or model numbers used in the
specifications are for the purpose of describing
and establishing general quality levels. Such
references are not intended to be restrictive.

Bids (or proposals) will be considered for any
brand which meets or exceeds the quality of the
specifications listed for any item."
Because brand name specifications may lessen objectivity and discourage competition, their use should be limited as much as possible.

5. Performance and Cost: Public contracting is predicted on the principle that the low price bid is the successful bid unless it is defective, not in compliance, or otherwise not the best or most advantageous bid. The burden is upon the purchaser, therefore, to disqualify a low bid and prove that another bid is in the best interest of the City. This requirement is a necessary protection of the public against favoritism, fraud, and wastefulness.

Among the ever-increasing number of methods used to evaluate competitive offers, there are several that analyze value, thereby calculating cost in terms of function. The essence of these approaches is to endeavor to relate performance and price. For example, if a Department is purchasing tires, the lowest bid price for the desired number of tires may not be the best value. If the bid specifications require guaranteed mileage rates, value can be calculated in terms of cost per mile or miles per dollar spent. Comparison of these relative values between vendors• bids would enable logical and
reasonable determination of the most advantageous bid.

Other factors that impact the relationship between performance and cost include maintenance statistics, service and
replacement parts costs, and trade-in or salvage value. When these factors are calculated for the entire life of the project to be purchased, the evaluation technique is known as lifecycle costing. The specifications should require the necessary information from each vendor to analyze value and contain an explanation of any performance/ cost evaluation to be performed.

POLICY #: C-003
PAGE 5
The disadvantages of this type of selection process include the isolation and definition of the essential performance factors, evaluation of project differences, the necessary role of estimating, and extensive record keeping; however, in purchases where value analysis will identify the truly most advantageous bid, and result in substantial savings, it should be undertaken.

ROBERT L. HUNT

CITY MANAGER

POUCY #: C-004
PAGE 1

CITY OF ARROYO GRANDE
POLICY #: C-004
ISSUED: 7/13/2016
EFFECTIVE: 7/13/2016
CANCELLATION DATE: NIA
SUPERSEDES: 06/01/96
POLICY:

ADMINISTRATIVE POLICY AND PROCEDURES
SUBJECT: REQUIR~MENTS AND PROCEDURES

FOR USE OF CITY CREDIT CARDS
The policy of the City is to use credit cards when necessary to accomplish City business.

PROCEDURE:

Credit cards will be issued in the name of the assigned employee. Assignment is based on the employee's need to purchase goods and materials for the City and/or to provide for City related travel. Not all employees will be assigned City credit cards. Cards may be revoked based on change or assignment and is not an entitlement or reflective of title or position. The employee will be fully responsible for all transactions until verification and payment by the City.

Employees are expected to safeguard the card and report any lost, stolen or misplaced credit card immediately to the card issuer (currently US Bank) and the City's Accounting Manager.

Department Directors may request credit cards for an employee by contacting the Accounting Manager or Director of Administrative Services. All approved cardholders will be required to sign the Cardholder Agreement Form to indicate that the employee understands the procedure and the responsibilities of the cardholder.

Credit cards can be a valuable tool for purchasing goods and services on behalf of the City and for accommodating employee travel. Employees issued city credit cards are expected to follow established purchasing and travel policies. In addition, employees may be periodically required to comply with internal control procedures designed to protect City assets. This may include being asked to produce the card to validate its existence and accountnumber.

POLICY #: C-004
PAGE2
Authorized Credit Card Use
• The Credit Card that each cardholder receives shall only be used by the cardholder. NO OTHER PERSON ·IS AUTHORIZED to use this card. The cardholder may make'transactions on behalf of others in the department/division.

However the cardholder is responsible for all purchases charged to their card. • The total value ·of a transaction shall not exceed a cardholders single purchase limit. Payment for a purchase SHALL NOT be split into multiple transactions to stay within the single purchase limit.
• The cardholder is responsible for maintaining all receipts of all card transactions an~ submitting these receipts to Accounts Payable for paym~nt. Itemized receipts are required for all purchases.
• Credit cards may be used for travel and training purposes due to the nature and length of travel and lodging of professional activities. Cardholders should consult the City's Travel Policy for more information.
• The employee issued the card is responsible for its protection and custody and shall immediately notify the issuing bank and the City's Accounting Manager if the card is lost or stolen.

Unauthorized Credit Card Use
The card shall not be used for the following:
• A single purchase that exceeds the cardholder's single purchase limit • Alcoholic beverages
• Cash advances
• Personal purchases or for personal identification
• Purchas~s of in-room movies during hotel/motel stays while on City businesses Pay1T1entProcedures
All charges '{Viii be billed directly to and paid directly by the City. The bank cannot accept any monies from employees directly; therefore any personal charges billed to the City could be considered misappropriation of City funds and could result in disciplinary action.

Employees will receive a Monthly Reconciliation Statement, which will report all activity during the statement period. Employees are responsible for all charges (but not for payment) on the card. Within 10 days of receiving the Monthly Reconciliation Statement, employees will prepare an I-Form identifying each purchase and the general ledger account(s) that should be charged for the purchase. In compliance with the City's purchasing policy, I-Forms should be routed for appropriate department approvals before being submitted to Accounts Payable.

POLICY#: C-004
PAGE3
Disputed Charges
Disputed items are purchases that, for various reasons, need to be reconsidered before final payment. Some examples of disputed charges are:
• A discrepancy of the dollar amount appearing on the statement from what your receipt indicates
• A purchased item that has not been received
• . A purchased item that was damaged when received
• An unauthorized transaction made on your card
• An unrecognized transaction appearing on your statement If there is a disputed item the cardholder should first contact the merchant to resolve the disputed purchase. If this cannot be resolved, the cardholder shall notify Accounts Payable. ·
Disputes need to be initiated within sixty (60) days of the bill date that the transaction first appeared. The earlier disputes are initiated, the quicker they will be resolved.

Prompt processing assures the taking of early pay discounts and the avoidance of late payment penalties.

Cardho/der Transfer/Separation
The credit card remains property of the issuing company. It may not be transferred to, assigned to, or used by anyone other than an authorized user of the City. Users of the credit card are accountable for the activity on the card. The issuer or the City may suspend or cancel user privileges at any time for any reason. If the user is in possession of a card, the user will surrender the credit card upon request to the City or to any authorized agent of the issuer.

Consequences of Unauthorized Use of Credit Card
Card user violations of this agreement or of any policy regarding the purchase of goods or services will be investigated and may result in any or all of the following actions, but not limited to: written warning, revocation of credit card privileges, cancellation of delegation of purchasing authority, disciplinary action, termination and/or criminal prosecution. Human error and extraordinary circumstances may be taken into consideration when investigating any violation of this agreement.

The City Manager, Director of Administrative Services or designees have the authority to investigate and to determine whether a violation of purchasing or credit card policy has occurred and to determine action deemed most appropriate pursuant to applicable law and/or City policy.

(
POLICY#: C-004
PAGE4

CARDHOLDER AGREEMENT FORM

EXHIBIT A
By signing below, I accept credit card number---------------- I have read and understand the City's Credit Card policy and agree to abide by the terms· of the policy.. I understand that any violation of the policy may result in any or all of the following actions, buf not limited to: written warning, revocation of credit card privileges, cancellation of delegation of purchasing authority, disciplinary action, termination and/or criminal prosecution.

If the card is lost, stolen or misplaced, I will immediately notify the issuing bank and the City's Accounting Manager.

Employee's printed name Signature/Date

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY#: C-005 SUBJECT: BUDGET AMENDMENTS
ISSUED: 07/01/00
EFFECTIVE: 07/01/00
CANCELLATION DATE: N/A
SUPERSEDES: 06/01/96
POLICY:

Through the adoption of the Annual Budget, the Departments set goals and objectives, assume responsibilities for accomplishing them, and determine appropriations necessary for achieving objectives and delivering services. Departments are provided with significant. flexibility in managing the resources allocated to them for these purposes; although detail line item budgets are prepared for each of the operating programs, formal budget control is maintained at the fund level by department.

Budget Authority

1. Council: The City Council has the sole responsibility for adopting the City's budget, and may amend, supplement, or reduce the budget at any time after its adoption by majority vote of the City Council.

2. City Manager: The City Manager has the authority to make or approve administrative adjustments to the budget as long as those changes do not impact budgeted year-end fund balances.

3. Financial Services Director: The Financial Services Director has the authority to make or approve administrative adjustmentsto all line item accounts at the department and program level as requested by the D·epartmental Director; to adjust off-setting revenue/expenditure accounts; and make adjustments based on policies, programs, and/or specific adjustments approved by the City Council. The City Council alone can authorize adjustments impacting or affecting budgeted year-end fund balances.

4. Department Directors: Department Directors have the authority to make administrative adjustments within their budget as long as those changes do not impact program totals.

POLICY#: C-005
PAGE2
Types of Adjustments and Approval Requirements

1. Routine: Adjustments within the same program and betwe~n major categories are considered to be routine requiring only the Department Director's approval and Financial Services verification. Typically this type of adjustment woulq move saving from one Services & Supplies account to another Services & Supplies account.

2. Unusual: The following types of adjustments are considered unusual and require approval by the City Manager, Financial Services Director, and Department Director. • Capital projects: All budget changes to_ the capital improvement pro.gram. • From Salary and Benefit codes: Using saving in staffing costs within the program level (whether regular salaries, part-time salaries, overtime, or benefits) to fund overages in non-staffing line items. Typically this type of adjustment is used to transfer savings resulting from_ staff vacancies to the Contract Service account where temporary staff costs are charged.
• To Salary and Benefit codes: Increasing staffing accounts with savings in other operating expenditures within the program.
• Within Salary and Benefit codes: Transfers between staffing and benefit accounts. An adjustment to move savings in the Overtime account to the Compensation Pay account is an example of this type of adjustment. • Equipment codes: Transfers either to or from equipment accounts. A typical adjustment of this type moves appropriations from a supplies and services account to an equipment account.

3. Rare: This type of adjustment will be considered only in the most extreme circumstances. A detailed written description of the circumstances must accompany the request.
• City Council approval of additional appropriations: As detailed in the Budget Amendment Request Section and the Budget Authority Section of this Policy, only the City Council may approve adjustments that impact budgeted year-end fund balances. A copy of the staff report presented to the City Council shall accompany this adjustment.
• Interdepartmental adjustments: Budget amendment using saving in one program area to offset overages in another program area. An example is a request by the Parks and Recreatton Director to transfer savings from the Parks Program to the Soto Sports Complex Program. Approval is required of the City Manager, FinanGial Services Director, and Department Director.

POLICY#: C-005
PAGE3
Budget Amendment Request
To ensure that all changes to the budget are correctly recorded and appropriately authorized, a standard Budget Amendment Request form is used to document all budget changes, including those approved by the City Council. As such, any City Council Agenda Item that amends the budget should be accompanied by a completed Budget Amendment Request form when submitted to the Director of Financial Services as part of the agenda review process. However, the Budget Amendment Request will not be included with the City Council Agenda packet.

PROCEDURE:

1. Initiating the amendment. The operating department requesting an amendment is responsible for completing the Budget Amendment Request. If the request requires a new program or account number, the Financial Services Department should be contacted prior to completing the form for the assignment of appropriate account numbers. Department Director approval of the request is required prior to its submission to the Department of Financial Services.

2. Financial Services review. All requests are to be submitted to the Financial Services ' Director to determine the affect of the change and to verify the account numbers. If required, the request will be forwarded for approval to the City Manager.

3. Implementation. After the Budget Amendment Request has been submitted and approved, the operating department should review the next Monthly Financial Report to ensure that the change has been processed.

PREPARING THE BUDGET AMENDMENT REQUEST:

The Budget Amendment Request is available either in multi-part, pre-numbered, paper form from Financial Services or as an Excel File on the shared network.

File Folder: Forms
File Name: Budget Amendment Request
To ensure accountability and to tract the number of adjustments, Financial Services will log and attach a pre-numbered paper format to all computer generated forms.

Detailed instructions are included in this Policy; however, the following highlights key areas to consider in preparing the form:

1. · More than one department. The signatures of all Department Directors are required if more than one department is affected.

2. More than one fund. Only one fund should be affected per form to ensure that any changes in ending fund balance for any of the funds, is readily apparent.

POLICY#: C-005
PAGE4

3. City Council approval. City Council approval of the amendment will be required under the following circumstances.
a. Total amendments for expenditures not equaling zero; in the samples provided, only Exhibit 1 requires City Council approval.

Budget Amendment Request Examples
Provided in Exhibits 1 and 2 are completed samples of the Budget Amendment Request form. As indicated in the samples, the request does not have to be typed; legible printing or computer generated forms are acceptable. As this form updates budgetary information in the Monthly Financial Reports, its timely completion is essential in maintaining the accuracy of these reports.

The following is a detailed description of how to complete the request form using the samples provided in Exhibits 1 and 2: ,

1. The name of the requesting Department should be entered in this section.

2. The name of the Fund affected should be entered in this box.

3. The account number of the Fund affected should be entered in this block.

4. The purpose of this block is to describe the account to be changed.

5. The account number should be indicated in these blocks under Account, Detail for revenues and Department, Object for expenditures.

6. The amount of the current budget should be entered in this block.

7. The amount of the proposed change should be entered in this block.

8. The revised budget amount based on the current amount and the proposed change should be entered in this block.

9. The total ·of all line item changes should be computed and entered in these boxes. If more than one account is to be amended, it is important to check that the total agree (cross-foot) both vertically and horizontally.

10. The purpose or justification for the budget amendment must be provided in this section. If the amendment is to reflect City Council approval of a supplemental appropriation, the date of City Council action should be referenced.

11. The requesting Department is responsible for completing the form and securing the necessary signatures. The following signatures are required in order to process the request.

POLICY#: C-005
PAGE5
a. Department Director-All Budget Amendment Request forms must be signed by the Department Director responsible for the budget accounts shown on the fom. ·
b. Financial Services Director-All Budget Amendment Request forms must haye the Financial Services Director's signature to indicate that the account numbers and budget amounts have been verified.
c. City Manager - The City Manager's signature is required for the following transfers:
(1) Interdepartmental Adjustments. Budget amendment using saving in one program area to offset overages in another program area. (2) Capital projects: All budget changes to the capital improvement program.
(3) From Salary and benefit codes: Using saving in staffing costs within the program level {whether regular salaries, part-time salaries, overtime, or benefits) to fund overages in non-staffing line items within the program.
(4) To Salary and benefit codes: Increasing staffing accounts with savings in other operating expenditures within the program.
(5) Within Salary and benefit codes: Transfers between staffing and benefit. accounts.
(6) Eguipment codes: Transfers to or from equipment codes to use or supplement other operating budget accounts.

Attachments (2)

INTERIM
R~· CITY MANAGER

EXHIBIT1

CITY OF ARROYO GRANDE

BUDGET AMENDMENT REQUEST

REQUESTING DEPARTMENT FUND AMENDED
Public Works (l) General Fund @

REVENUES
{!/)> ACCOUNT DESCRIPTION ~CCT. DETAIL rt;JCURRENT
BUDGET
~PROPOSED
:AMENDMENTS
Office of Traffic Safety Grant 0000 4481 $ - $ 10,000
TOTAL $ - $ 10,000

EXPENDITURES
@ (~EPT. CURRENT ~PROPOSED ACCOUNT DESCRIPTION OBJ. ~ BUDGET ~ENDMENTS Contract Services 4201 5303 $ 25,000 $ 10,000
.
<f) TOTAL $ 25,000 $ 10,000
PURPOSE lo
Receipt of Grant Fund, Council approved 5/9/2000.

I

DEPARTMENT DIRECTOR DATE DIRECTOR OF FINANCE

CITY MANAGER DATE ENTERED BY
NUMBER
No. 001
FUND NO.
010 U)
~AMENDED
BUDGET
$ 10,000
$ 10,000
j) AMENDED
..._ BUDGET
$ 35,000
$ 35,000
DATE
DATE
r

EXHIBIT2

CITY OF ARROYO GRANDE

BUDGET AMENDMENT REQUEST
. REQUESTING DEPARTMENT FUND AMENDED
Building and Fire (/) General Fund (_~..)

REVENUES
ACCOUNT DESCRIPTION ACCT. DETAIL CURRENT PROPOSED

BUDGET AMENDMENTS
TOTAL $ - $ - EXPENDITURES
(i) ACCOUNT DESCRIPTION ( rnEPT. OBJ. ~CURRENT ii_ BUDGET ~RO POSED
'Z IENDMENTS
Hazmat Safety 4211 5325 $ 6,000 $ 1,500
Contract Services . 4211· 5303 $ 12,000 $ (500)
Maintenance-Buildings 4211 5604 $ 30,000 $ (1,000)
.
<:!) TOTAL $
PURPOSE @_
48,000 $ -
Saving in two account are used to offset unanticipated increase in Hazmat program costs. -
(/Id)

DEPARTMENT DIRECTOR DATE DIRECTOR OF FINANCE

CITY MANAGER DATE ENTERED BY
NUMBER
No. 002
FUND NO.
010 (3~

AMENDED
BUDGET
$ -
$ -
~AMENDED
BUDGET
$ 7,500
$ 11,500
$ 29,000
$ 48,000
DATE
DATE
:

CITY OF ARROYO GRANDE
POLICY#: C-006
ISSUED: 04/01/99
EFFECTIVE: 04/01/99
CANCELLATION DATE: N/A
SUPERSEDES: 09/01/97
POLICY:

ADMINISTRATIVE POLICY AND PROCEDURES
SUBJECT: EVALUATION CRITERIA FOR

REPLACEMENT OF STANDARD

EQUIPMENT
Equipment is currently capitalized if the value of the item at the time of purchase exceeds .$500. Replacement of capital equipment must be authorized by the City Council. Criteria for evaluating when replacement should occur is listed below. The recommendation for replacement should be a composite evaluation utilizing the criteria listed coupled with the actual condition of the equipment.

PROCEDURE:
. CRITERIA FOR A REPLACEMENT OF .EQUIPMENT
A. General criteria:

The following criteria will be used when requesting replacement of capital equipment or other designated equipment.

1. Condition of the equipment

2. Age of equipment

3. Maintenance history of the equipment
B. Specific criteria:

1. Age - Standardized estimated useful life. which may vary depending on quality and usage.
a. Personal Computers - five years
b. Calculators - five years
c. Typewriters- eight years
d. Chairs - five years
e. Desks - fifteen years
f. Fax Machines - five years
g. Copiers - five years
Revised: Apr/11, 1999

POLICY#: C-006
PAGE2
h. Tables - fifteen years
i. Files Cabinets - fifteen years
j. Autos-Light Trucks -five years and/or 80,000 miles
k. Police Emergency (Patrol) Vehicles - three years and/or 100,000 miles

2. Maintenance History
a. Recommendation by maintenance personnel that equipment is not economically repairable or able to be updated (as in computers).

3. Condition
a. Hazardous or dangerous for the employee to use
b. Broken parts that are not adequately repairable
c. Chipped, marked, or damaged veneers, laminates, or exterior that is not repairable
d. No longer able to function in accord with its intended use due to damage, age, or altered requirements
ROBERT L. HUNT

CITY MANAGER

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: __.C_-0 .... 0.._7...__ ____ _ SUBJECT: EVALUATION CRITERIA FOR

REPLACEMENT OF SPECIALIZED
EQUIPMENT/MACHINERY ISSUED: _..._6 /....,l=/-9....,6....__ ___ _ EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:

Equipment is currently capitalized if the value of the item at the time of purchase exceeds $500. Replacement of capital equipment must be authorized by the City Council. Criteria for evaluating when replacement should occur is listed below. The reconnnendation for replacement should be a composite evaluation .utilizing the criteria listed coupled with the actual condition of the equipment.

General Criteria:
*
*
*
Age of the equipment
Maintenance history of the equipment
Condition of the equipment
Specific criteria:

Age - Standardized estimated useful life. which may va+y depending on gµality and usage.
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Dump Truck - 15 years
Service Truck (1 Ton and 5 Ton) - 15 years
Backhoe - 10 years
Generator - 20 years
Portable Generator - 10 years
Trash Pump - 15 years
Vibrating Rammer - 10 years
Boring Machine - 20 years
Valve Machine - 10 years
Tapping Machine - 20 years
Hydraulic Breaker - 15 years Hydraulic Sump Pump - 15 years Bank Saw - 20 years Cut Off Saw - 10 years
Radial Arm Saw - 20 years
Chain Saw - 4 years
Concrete Saw - 10 years
Table Saw - 20 years
Leak Detector - 20 years Hydraulic Hoist - 15 years
Pipe Locator - 15 years Hydraulic Impact Wrench - 10 years

POLICY #: C-007
PAGE .2
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Vactor Jet Rodder - 10 years
Gas Detector - 10 years Concrete/Asphalt Grinder - 15 years Walking Striper - .20. years Pesticide Sprayer, mobile - 10 years
Paint Shaker - .20 years
Tamper - 7 years Weed Eater/Brush CUtter - 4 years
Vibrating Roller - 15 years
Air Compressor, mobile - 10 years
Jackhammer - 5 years
Arc Welder - .20 years .~ire Changer - 10 years
Wheel Balancer - 15 years
1 11 Impact Wrench - 10 years
Hydraulic Jack - 10 years
Front-end Loader - 15 years
Motor Grader - .20 years Line Striper - .20 years Vehicle and Equipment Trailer - .20 years Crack Sealer - 15 years Asphalt Spreader Box - .20 years Small Equipment Trailer - 15 years
Concrete Mixer - .20 years
Brush Chipper - 15 years
Drill Press - .20 years
Hand-held Blower - 3 years
Maintenance Histoi:y
* Recommendation by maintenance personnel that equipment is not economically repairable
* Does not meet current safety needs
Condition
* Hazardous or dangerous for the employee to use
* Broken parts that are not adequately repairable
* Replacement parts not available
* No longer able to function in accord with its intended use due to damage, age, or altered requirements
ROBERT L. HUNT

CITY MANAGER
I
•'
! _,

CITY OF ARROYO GRANDE
POLICY#: C-008
-----~---
1 SS U ED: 10/1/09
EFFECTIVE: 10/1/09
CANCELLATION DATE: ~~--N/A
SUPERSEDES: 6/1/96
POLICY:.

ADMINISTRATIVE POLICY AND PROCEDURES
SUBJECT: EMPLOYEE PERSONAL

PROPERTY CLAIMS
The City shall reimburse employees for personal items lost or damaged while on duty in the . scope of his or her employment unless caused by employee's negligence, malfeasarice or __ ·· misfeasance. · · · ··-.·
PROCEDURE:

1. A memorandum shall be prepared by the employee requesting payment for the . replacement or repair of personal property lost or damaged and submitted to the Department Director or his/her designee.

2. A receipt or a written estimate indicating the amount of money required to replace or repair the employee's personal property shall be submitted with the memorandum.

3. The request shall be reviewed by the Department Director or his/her designee to verify that the item was damaged or lost while in the course of the employee's duties and was not due to the fault of the employee. If approved, the memorandum shall· be submitted by the Department Director or his/her designee, along with a completed Request for Payment "I" Form, to the Director of Administrative Services within thirty (30) working days of the date of loss.

4. The Director of Administrative Services has the responsibility of approving/disapproving all such payments to employees.

5. No such claim shall be authorized by the Director of Administrative Services unless:
a. The employee has complied with the rules and regulations of his/her department and the City relating to the use of personal property:
b. The item is eligible for replacement under the provi~ions of this policy and . procedure;

POLICY #: -A 031 C -D cf6

EMPLOYEE PERSONAL PROPERTY CLAIMS
PAGE2
c. The Director of Administrative Services has confirmed the loss or the necessity to repair the personal item as to the fact that the loss or damage did in fact occur in the scope of his or her employment while on duty without the fault of the employee; and
d. The Director of Administrative Services has confirmed the amount of the actual damage as to the cost of repair or replacement. .

6. If the Director of Administrative Services approves the claim, he/she shall sign the "I" Form ..

7. Employees are advised not to wear or have in their possession personal jewelry, watches, or other accessories with a value of over $300 during the course of their job duties and shall not wear any items or accessories while on-duty that are prohibited by the policies and procedures of their department. Any such items worn or possessed by an employee while on-duty that are lost or damaged shall not be eligible for reimbursement.

8. This Policy does not apply to damage to personal vehicles. See Policy A-010 - Use of City Vehicles.

St€ven Adams
City Manager

ARROYO GRANDE

REQUEST FOR PAYMENT
FORM "I" for Invoices, Subscriptions, & Miscellaneous Payments Vendor#
CLOSE PO:

Name:

Address:

City/State/Zip:

Yes
No
FY 00-00
Date Neededl llf possible
Check to be Mailed
Check to be Picked Up1-------1Picked up by:

ACH/EFT Payment
shared//FORMS-CITYWIDE/Blank I Form.xls ------
.r

TOTAL PAYMENT TO VENDOR
Authorized Signature(s}
$0.00

Gia im On The Treasury Of The

CITY OF ARROYO GRANDE
State Of California

INSTRUCTIONS TO CLAIMANTS
< 1 > Claim must be itemized showing names, dates, service rendered etc. 12> Claim must be signed by the claimant and the department ordering the delivery. 13> Claims for two or more ·departments must be separated. (4) No claims will be allowed unless the above has been complied with.

DATE 19 DESCRIPTION
.

TOTAL
The undersigned, under the penalty of perjury states: That the above claim and the items as therein set out are true and correct; that no~ thereof has been heretofore paid, and that the amount therein is jUStlr AMOUNT
.$
.
due, and that the claim Is presented within one year after the last item thereof has accrued. FINANCE DEPARTMENT USE ONLY
Signed: c!aimant -···-········--········ .. -· .. ·--·· .. ·-·--·-···---··-·-·--·-··-··· -...... ·--···-·· Appropriation ale

CLAIMANT - DO NOT WRITE BELOW
I HEREBY CERTIFY, under ~ally of pertury, and upon my own per- Budget unit sonal lmowledge, that the articles or semces raecified in the aliove claim were necessary and were ordered by me or use ~ the department and for the purpose indicated above; that the articles or services General Ledger a/C have been delivered or performed as stated hereon except as otherwise indicated above my name, and that I have not violated any of the llnJ:'. visions of Art. 4, Tille 1, Div. 4, of the Gov't, Code of the State of the ab~ claim fa approved for paJllll!Dt, subject California.

Signed and approved: to the availabWty of funds.
--·-·-··--·--···-·--··-··- Foreman or Deputy .. -·--- Sign Here.

Approved:
-·--······-·----·-------·-..----·-I Head of Department Approve Here.

Opinion of City Attorney
I, hereby declare that, in my opinion, the foregoing claim is legal, and . by. a proper charge - -------··· ·--·- . Policy #: C-008 City Attorney

CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY#: C-009 SUBJECT: FIXED ASSET POLICY
ISSUED: 01/02/2020
EFFECTIVE: 01/02/2020
CANCELLATION DATE: N/A
SUPERSEDES: N/A
POLICY:

It shall be the policy of the City of Arroyo Grande to establish accounting procedures to maintain control and cost information for all General Government Fixed Assets.

PROCEDURES:

1. The General Fixed Assets Account Group (GFAAG) is used to maintain control and cost information for all General Government Fixed Assets. Enterprise Funds Fixed Assets are recorded with the separate funds.

A. General fixed assets are recorded as expenditures in governmental funds at the time the assets are received and the liability is incurred. These assets are capitalized at cost in the General Fi~ed Assets Account Group. Enterprise fixed assets are recorded as assets within the fund when purchased and a liability is incurred.
1) General fixed assets are long-lived assets used in providing government services. They include: land & improvements, buildings, improvements, equipment and machinery, construction in progress and infrastructure. 2) Enterprise fixed assets are long-lived assets used in providing services for the funds particular activity to the public. They include: land & improvements, buildings, improvements, equipment and machinery, construction in progress, sewer and water lines, and infrastructure.

The City uses the most current edition of Governmental Accounting, Auditing, and Financial Reporting (GAAFR) by the Government Finance Officers Association (GFOA) as it is the authoritative guide in setting policy and establishing accounting procedures regarding fixed assets.

POLICY#: C-009
PAGE2

2. The capitalization of fixed assets should have three (3) attributes:

A. Tangible property.

B. Useful life of two (2) or more years.

C. Cost or assigned value of $5,000 or more for all assets.

3. Leased Assets:

A. Operating leased assets are not capitalized as these leases are usually short term and can be cancelled at anytime. The recording of an operating lease as a fixed asset is not required because the item is not purchased.

B. Capital leases must be capitalized if one or more of the following criteria are met and the chance of cancellation is low:
1) Ownership is transferred by the end of the lease term. 2) The lease contains a bargain purchase option.
3) The lease term is greater than or equal to 75% of the asset's service life. 4) The present value of the minimum lease payment is greater than or equal to 90% of the fair market value of the asset at the inception of the lease.

C. National Council of Governmental Accounting (NCGA) Statement No. 5 states · that a fixed asset must be capitalized if one or more of these criteria are met and a liability in the same amount should be recorded.

D. Capitalized lease items are capitalized at the beginning of the lease period; regardless of when the title transfers.

4. It is the responsibility of the Administrative Services Department to record, monitor and inventory all fixed assets.

5. Fixed assets may be acquired through a direct purchase, lease-purchase or capital lease, construction, eminent domain, tax foreclosures, donations, and gifts.

There can be different sources of funding when acquiring a fixed asset. Some examples are:

A. General Fixed Assets:
1) General Fund
2) Special Revenue Funds
3) Capital Projects Funds
4) Grants

POLICY #: C-009
PAGE3
B. Enterprise Funds:
1) Grants
2) Other Governments
C. If funds are provided by the specific source, a record should be made of the specific source. Such as:
1) General Obligation Bonds
2) Federal Grants
3) State Grants
4) Local Grants

6. Fixed assets are recorded at their "historical cost", which is the original cost of the asset. Costs include purchase price (less discounts or construction costs) and any other reasonable and necessary costs incurred to place the asset in its intended location and prepare it for service. Costs could include the following:

A. Sales Tax
B. Freight charges
C. Legal and title fees
D. Closing costs
E. Appraisal and negotiation fees
F. Surveying fees
G. Land-preparation costs
H. Demolition costs
I. Relocation costs
J. Architect and accounting fees
K. Insurance premiums and interest costs during construction

7. According to the NCGA, an estimate of the original cost is allowable. One method of estimating historical or original cost is to establish the average installed cost for a like unit at the estimated date of acquisition.

8. Expenditures for replacing a component part of an asset are not capitalized.

However, expenditures made to improve the operation of any asset or to add to it, Which is referred to as "betterments," are recorded as an asset in the same way as the original entry when recording the asset's acquisition.

9. Departments disposing of surplus, damaged, or inoperative equipment shall notify the Administrative Services Department. At no time should a fixed asset be sold, retired or removed from operations without notifying the department. When items are declared as surplus by a resolution, such as police vehicles, a copy of the resolution should be given to the Administrative Services Department to use as backup.

POLICY #: C-009
PAGE4

10. The transfer of fixed asset between departments requires notification to the Administrative Services Department.
11'. The NCGA has made the recognition of accumulated depreciation optional in the GFAAG and mandatory for Enterprise Funds. It is the City's policy to record depreciation for Enterprise Funds only.

12. The City has established recommended lives for capitalized assets. If the life of a particular asset is estimated to be different than these guidelines, it may be changed.

Asset Class
Buildings
Improvements
Equipment and Machinery
Useful Life
20 to 50 years.
20 to 50 years.
3 to 10 years.

Tree Impacts to Domestic Well Alternative at APN 007-781-055 Arroyo Grande, CA
Mike Harris 1 | Page
Memorandum
To: Mike Harris From: Sam Oakley
5940 Granite Glen Court Master Arborist WE-9474B
Granite Bay, CA 95746 Consulting Arborist #556
916.802.1659 415.407.6995
[email protected] [email protected]
Subject: Preliminary Tree Impacts to Domestic Well Alternative APN 007-781-055, Arroyo Grande, CA
Date: February 22, 2024
You, Mike Harris, have applied for a domestic well permit on the addressless parcel APN 007-781-055 on Noyes Road between Equestrian Way and Printz Road in Arroyo Grande, California. You intend to build a single-family residence on the parcel and have applied for a permit with the City of Arroyo Grande to install a domestic well. The proposed home location is shown approximately on Figure 1 based on our February 2, 2024, site-walk. The building site is the preferred location for the single-family residence as it is the most economical, flat, and accessible building location on the parcel. You have asked me to provide an assessment on the potential environmental impacts to the site based on the alternative to the domestic well and make recommendations based on the City’s proposed location for the service connection.

The City will be considering a resolution to deny your application for a permit for domestic well, which has been continued from October 24, 2023, for the following reasons. Approval of a domestic well within the City boundaries may be granted if it is determined that 1) the well will neither deplete nor contaminate the City water supply, and 2) service from the City is neither practical nor feasible. While it has been quantified that the City water supply will not be depleted nor contaminated, the City Staff has interpreted that the practical and feasible test is one based on whether it is practical and feasible for the City to provide a service connection from a City water service line to the private property boundary, which is an understandable position but does not take into account the nuances of the site. The subject parcel is adjacent to the City’s Reservoir No. 5 and the City has proposed as an alternative to the domestic well a service connection from Reservoir No. 5 to the private property boundary.

In their statement for the practical and feasible test, it can be assumed the City has not considered whether the proposed location for the service connection boundary creates inherent environmental impacts due to the location’s immediate proximity steep slopes, rare vegetation, wetland or riparian habitat, oak woodland, nor any other considerations such as

Tree Impacts to Domestic Well Alternative at APN 007-781-055 Arroyo Grande, CA
Mike Harris 2 | Page
fire safety, access, etc., which was acknowledged by City Staff to you in an email on October 21, 2021.

For my assessment, I am assuming that the waterline will be (Option 1) a straight line from the proposed location for the service connection at Reservoir No. 5 to the building site shown in Figure 1; Option 2’s path to the same building and service locations would follow a curved route to minimize the impact to the surrounding environment.

Figure 1: the proposed location for the single-family residence is shown in yellow (Building Site 1). The proposed domestic well would be in the vicinity of this location. The proposed location for the domestic water service connection proposed by the City is shown with a red arrow. The yellow location is approximately 800-feet from the proposed location for the City service connection and the most environmentally impactful water line would follow this path (Option 1), whereas the green path for the water line (Option 2) appears to be the least environmentally impactful but is approximately 2000-feet from the proposed service connection location and cuts through sensitive oak woodland habitat to a greater degree. The area between both building locations and the proposed service connection location is sensitive oak woodland habitat that is protected by City ordinance.

The City of Arroyo Grande protects any oak that measures twelve (12) inches in diameter when measured four feet and six inches from the base. Furthermore, 12.16.090 of City of Arroyo Grande’s Municipal Code stipulates that trees designated to remain during a property’s development shall be protected prior to and during construction by an enclosure at the dripline of the tree, and that no parking of vehicles or equipment or storage of materials shall be permitted within the dripline of the trees designated to remain. No machine trenching within a tree's dripline is be permitted.

I have reviewed the Option 1 proposal from Larry Nash Construction, dated 3/16/23, to assess the impacts of the proposed water line on the surrounding trees. The proposal considers only Option 1 as it is the most economical option for the waterline but the requirements from the contractor will be the same. They will need to clear and grub a long

Tree Impacts to Domestic Well Alternative at APN 007-781-055 Arroyo Grande, CA
Mike Harris 3 | Page
path of travel through protected and sensitive oak woodland habitat, trench, and install a 1- inch water line.

Based on the proposed locations for both the proposed service connection location at Reservoir No. 5 and the single-family residence, coupled with the existing sensitive oak woodland habitat conditions and the potential impact that the installation of the proposed water line would have on the sensitive habitat, I anticipate there to be severe impacts to a large swath of protected trees and oak woodland. Option 2’s impacts would be even greater than Option 1.

Best practices in tree protection would be to consider a far less impactful alternative, i.e., adopt a resolution to accept, rather than deny, a permit for domestic well. The installation of a domestic well is both categorically exempt from the California Environmental Quality Act under the Class 3 exemption, which applies to the construction and location of limited numbers of new, small facilities or structures, and it will have minimal impact to the surrounding protected oak woodland habitat.

I strongly urge the City of Arroyo Grande to reconsider in its practical and feasible test whether the proposed location for the service connection boundary creates inherent environmental impacts as was likely the intent of the determination of practicality and feasibility of the location of the service conection.

SUNRAY PL &
NOYES RD.

PREPARED FOR:

MIKE HARRIS

DEVCO DEVELOPMENT

AND ENGINEERING
ON BEHALF OF:

DIRECTIONAL DRILLING
24-0044

PROPOSAL

Proposal / Contract Number: 24-0044- Budget Number Date: 2/23/2024 Job Name: Waterline HDD Job Address: Sunray Place & Noyes Road, Arroyo Grande Ca.

Customer Contact:

Property Owner
Mike Harris
Sunray Place & Noyes Road, Arroyo Grande Ca.
[email protected]
PROJECT SCOPE OF WORK:
● Devco to delineate and provide their own valid USA North ticket. ● Devco to provide all equipment and manpower to excavate all bore pits for the boring operations. Devco will need access from the top road by the water tower to get equipment in to dig a receiving pit to pull the pipe in from before the pilot bore is completed.
● Devco to provide all equipment and manpower to backfill and compact all bore pits with the native soil after the completion of the bore.
● Devco to supply 900 feet of 4” HDPE DR17.
● Devco to provide a fusion tech and equipment to fuse 900 feet of HDPE DR 17. ● Devco to directional bore and pull 900 feet of (1) Devco provided 4” HDPE DR 17. ● Devco to leave the HDPE DR 17 pipe stubbed at both ends of the bore for the customer to pick up and tie in. $318.06 PLF OR ($286,260.00 Lump Sum)
Exclusions of this Proposal:
● Water Hydrant meter for the boring operations.
● Damage to any existing tree roots, trees, branches or any landscaping that Devco will be working around.
● Haul off of any drill mud from the property.
● Communication with Engineers, Arborists or Inspectors if changes are needed caused by unknowns. ● Dewatering and testing if groundwater is encountered. ● Dewatering of any kind if groundwater is encountered. ● Handling of Hazardous material, soil, liquids or any cost associated with it. ● Any Landscape or Hardscape Repair.
● Any Survey for easements if easements are not provided. . ● Any soil that is not conducive to directional drilling. ● Private Locator. .
● Damage to any mismarked and unmarked utilities, and unmarked sewers or septic tanks not located by a third party or Dig alert.
● Prevailing Wage Rates.
40625 Calle Fiesta, Temecula, CA 92591 Ph: (951)221-3633 www.DevelopmentAndEngineering.com CSLB #1105687 A & B License DVBE, SB-PW, SB-Micro #2034204 SDVOSB #J3QDZW55B215 PDBE #23001218 DIR #1001084629

Conditions of this proposal:
● Customer to provide a designated laydown yard for equipment & material within the jobsite area. ● Prices are based on minimum 10 hour daytime continuous working periods during normal work hours. ● Any deviation or added work, or anything out of Devco control, will result in Devco requesting a change order for the extra work in writing. Once the change order is agreed upon, Devco will commence work. ● The price provided is based on being able to work during normal weekday work hours 7am to 5:30pm, Monday through Friday.
● This proposal is based on the completion of the entire scope of work listed above under “Scope of Work”. Alterations or deviations, if any arise, from the above specifications or any postponements of the work by the customer or any other agencies will result in additional labor and material costs, and will become an extra charge to the project which will be billed as an extra to the job.
● All downtime caused by arborists or environmental agencies will be billed as an extra to the job. ● Any extra move on or move off of the job due to circumstances out of Devco control will be billed as an extra. ● Customer to provide any as-builds for the property work to assist with the directional boring process. ● Before the start of the project, the information requested on the 20 day Preliminary sheet must be completed and filled out entirely.
● Price is void after 30 days from the date on this proposal. ● The Customer is responsible for all permits and inspection fees if required for the work. ● Devco can pull encroachment permits and bill at cost plus 15% if the customer desires. ● All tie-ins are done by others. Devco will leave the pipe stubbed out at both ends of the bore. ● Devco to leave equipment onsite for the entire duration of the bore. The boring equipment cannot be moved once it is staged and the tooling is in the ground.
● Price is based on leaving all drill mud on the property. Devco will suck up all drill mud from the bore pits and spread out at the customer's designated locations on the property. ● Devco to supply all pulling heads for the HDPE pipe.
● Due to the amount of manpower and equipment that Devco will have onsite, and the existing soil conditions that will possibly be encountered, any failed attempts will be billed on a day rate of $19,084.00. ● Estimated time to complete the bore is (15) days. This is an estimated amount of days only. 40625 Calle Fiesta, Temecula, CA 92591 Ph: (951)221-3633 www.DevelopmentAndEngineering.com CSLB #1105687 A & B License DVBE, SB-PW, SB-Micro #2034204 SDVOSB #J3QDZW55B215 PDBE #23001218 DIR #1001084629

Payment Terms:

NET TERMS: 30 [Thirty] days from date of invoicing.

Mike Harris will be responsible for all court costs and attorney fees if needed to enforce this proposal / contract.

Mike Harris will be responsible for liquidated damages caused to Devco Development and Engineering for failure to pay within the NET TERMS.

LATE PAYMENT: If any payment is not received by the due date, a grace period of 10 [Ten] days will be allowed. After the grace period, a late payment penalty will be applied.

LATE PAYMENT PENALTY: In the event of a late payment, the outstanding amount will incur a penalty interest rate of 12% per annum (APR). Interest will be compounded daily on the outstanding balance from the due date until payment is received in full. The daily interest rate is calculated by dividing the annual rate by 365 days (366 days for leap years), applying this daily rate to the outstanding balance.

PAYMENT APPLICATION: All payments made under this clause will first be applied to any accrued interest and then to the principal amount.

Retention Policy:

Due to competitive pricing and turnaround time for payment, we kindly request that no retention be held for any reason. If retention is mandatory on the project, please contact our office for revised pricing before the start of the project.

Any alterations from the above scope of work involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the agreement contingent upon strikes, accidents, or delays out of Devco control. This proposal / contract agreement is subject to acceptance within 30 days, and will be void thereafter.

All Conditions of this proposal/agreement are deemed incorporated and part of any contracts between Mike Harris and Devco.

Acceptance of this proposal/contract agreement: 24-0044 This proposal/contract is based on soil conditions being conducive to Vacuum Excavating, and no representation is made to the possible success of Vacuum excavating due to the existing utilities, and unforeseen soil. The prices listed above are based on no geotechnical report being provided to Devco at the time of this bid. Devco will not be responsible for any damage to unmarked utilities, mismarked utilities, or unmarked sewer laterals or mains that were not marked out by Dig Alert or third party locating services, therefore not potholed by Devco.

The above prices, specifications and conditions are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above.

By signing this contract, the customer accepts all payment terms, liabilities, and responsibilities contained in this proposal / contract.
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CALIFORNIA PRELIMINARY NOTICE
(For use on Private or Public Works, This is not a lien) See California Civil Code section
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EVEN THOUGH YOU HAVE PAID YOUR CONTRACTOR
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40625 Calle Fiesta, Temecula, CA 92591 Ph: (951)221-3633 www.DevelopmentAndEngineering.com CSLB #1105687 A & B License DVBE, SB-PW, SB-Micro #2034204 SDVOSB #J3QDZW55B215 PDBE #23001218 DIR #1001084629

Cleath-Harris Geologists, Inc.
71 Zaca Lane, Suite 140
San Luis Obispo, California 93401
(805) 543-1413
Well impact discussion Noyes Road November 9, 2017
November 9, 2017
AGC Holding Corporation
c/o Keith Gurnee
108 Broad Street
San Luis Obispo, CA 93401
SUBJECT: Well Impact Discussion, Noyes Road Property
Arroyo Grande, California, APN 007-781-055
Dear Mr. Shetler:

Cleath–Harris Geologists (CHG) herein provides a discussion regarding potential impacts related to constructing and operating a water well on the Noyes Road property, APN 007-781-055, within the City of Arroyo Grande (Figure 1). There are no wells currently on this property. The productivity and quality of water from the proposed water well will not be known until the test well is constructed and tested. Until such a time, impacts can be generally discussed.

PROJECT DESCRIPTION
The proposed well would be located in the northwestern portion of the property east of the creek that follows Noyes Road (gps coordinates: 35.14592 North and 120.59114 West), at an elevation of about 200 feet above MSL. The proposed well is recommended to be drilled to 700 feet and completed to a depth of 600 feet with 8-inch diameter PVC water well casing with perforations opposite aquifer beds identified based on geophysical and lithologic logs of the borehole. The proposed well is expected to be 600 feet or less deep with perforations opposite aquifers that are encountered between 100 and 600 feet.

The well will be located maintaining setbacks to meet County Health guidelines. A 50-foot annular well seal should be placed according to State of California water well standards.

The well is anticipated to pump at about 50 gallons per minute (gpm). As a condition for allowing the well to be constructed in the City of Arroyo Grande, the City requires that production from the well be metered.

The produced water would be used to meet currently undefined demands for agricultural or domestic purposes consistent with current zoning. For this impact analysis, a residence and secondary residence could be constructed and avocadoes or citrus could be planted (current use is for range land). Such agricultural uses would be suitable for the valley floor and lower slopes that are outside of the riparian corridor. The domestic water demand for one residence and secondary residence is estimated at 1 acrefeet per year (AFY) with a consumptive use of 0.43 AFY. The non-riparian valley floor and lower slopes have an approximate area of 8 acres on the parcel where the well would be located. Avocadoes use about 2.1 feet of applied water per year. Full planting of the suitable land would require an

Well impact discussion Noyes Road 2 November 9, 2017
average of 17 AFY. The total water demand for the property would be 18 AFY, or an average continuous pumping rate of 11 gpm. Typical water production occurs during a portion of the day, and therefore, a 50 gpm yield from a well is desirable.

The City of Arroyo Grande has an interest in completing a well in this area for municipal use. While this well is not proposed for municipal use, the design of the well would conform to health codes applicable to municipal water wells, should a change of use be pursued. Water production from a municipal well could be significantly more than would be required for this parcel.

ENVIRONMENTAL SETTING
The environmental setting pertinent to this impact discussion related to the construction and the operation of a well includes a discussion of the geology, water resources, and a description of the well location environment.

Geology
The geology of the property is shown on the published geologic map, “Geology of the Arroyo Grande Quadrangle”, California Division of Mines and Geology Map Sheet 24. This geologic map indicates that the property is underlain by the Squire member of the Pismo Formation, a “massive white medium to coarse grained sandstone” and does not provide any geologic structural attitudes in the vicinity of the property. CHG geologic mapping indicates that the beds are very different than described on the published map or even in subsequent mapping for the Los Robles del Mar or City of Arroyo Grande projects. The sedimentary beds as mapped on the property include layers of sand and gravel separated by diatomaceous siltstone layers. These beds generally dip to the north-northwest at between 10 and 44 degrees.

The upper sandstone beds include, progressively with depth, a conglomeratic sandstone, a soft white sandstone, a hard resistant gray sandstone, a dark brown sandstone, a white cemented sandstone. This is underlain by diatomaceous shale and then a soft white fossiliferous (pecten shells) sandstone/siltstone. The underlying siltstone and claystone beds, above the deep Los Robles aquifer, are several hundred feet thick.

The most permeable sands/sandstone beds that can be encountered at a depth of less than 600 feet underlie the northern portion of the property. The proposed well near the existing northern entrance to the property would produce from these sandstone beds. Figure 1 shows the southern limit of these aquifers.

The deeper aquifer known as the “Los Robles aquifer” tapped by the City Well #10 on Deer Trail Circle underlies the property at depth below the aquifers described above and would not be accessible to a 600-foot well in the main part of the valley floor on the property. The “Los Robles Aquifer” is estimated to be at a depth of 1,000 feet in the vicinity of the south gate along Noyes Road.

Well impact discussion Noyes Road 3 November 9, 2017
Groundwater
The groundwater level is closest to ground surface along the valley floor. The creek following Noyes Road was dry when observed during this investigation. The groundwater level elevation is estimated to be approximately 130 to 150 feet above sea level (50-70 feet depth).

Groundwater quality beneath the property is not specifically known. In general, groundwater in this area is of good water quality for domestic and irrigation uses. Iron, manganese, arsenic and selenium are constituents of concern that have been found in some wells in the area.

Wells in the area that tap the same aquifer as the proposed well are located to the north and west of the proposed well. The City wells do not pump from the aquifer that would be tapped by the proposed well. The locations of the wells adjacent to the proposed well that share the groundwater source are shown on the attached aerial photograph.

IMPACTS
Potential impacts resulting from the construction and operation of the proposed well include geologic hazards, groundwater interference at adjacent wells, and reduction in flow in the adjacent tributary to Meadow Creek. Measures are discussed that could mitigate potential impacts.

Geologic Hazards
Geologic hazards at the well site could include seismic-induced slope stability and ground rupture, landslides, flooding, soil stability/erosion, and mineral hazards. These hazards are discussed in the 2015 Multi-Jurisdictional Local Hazard Mitigation Plan that includes the City of Arroyo Grande.

Seismic Hazards
No faults are mapped on published geologic maps in the proximity to the well site. The closest potentially active fault is the Wilmar Avenue fault, located near Highway 101. Therefore no fault rupture hazard is known to exist at the well location.

Seismic events will occur that can result in ground shaking in the proximity of the well site. Ground shaking from an earthquake will be most noticeable on the ridge top and to a lesser extent at the well location. As the well is largely below grade, no significant impact is anticipated due to ground shaking.

Liquefaction could occur within the alluvial sands from seismic events where groundwater levels are shallow (less than 50 feet). Groundwater at the well site is not known but is expected to be 70 feet below grade. Thus, a low potential for liquefaction exists.

Well impact discussion Noyes Road 4 November 9, 2017
Slope Stability/Landslide Hazard
No landslides are mapped on published geologic maps in the proximity of the well site. Therefore the potential for landslide impact is negligible.

Flooding Hazard
The well site is about 20 feet above the creek and appears to be outside of the floodway of a 100-year flood.

Soil Stability/Erosion Hazard
Soils in this area, when saturated, have limited weight bearing capacity and as a result may not support heavy vehicles. Road base should be placed on the drilling pad to stabilize the soils.

Erosion may occur where water flow is concentrated. Pumped water should be controlled to prevent erosion and erosion control measures should be placed where water flow across the well site is expected.

Mineral Hazard
No naturally occurring asbestos is present within the watershed of the proposed well location.

Groundwater Impacts
Groundwater impacts include pumping interference at adjacent wells and long term reliability. These impacts are best addressed upon completion of the well with information from the pumping test. This preliminary groundwater impact discussion utilizes previous studies. Three water studies that have been performed in the area were used for this preliminary evaluation of groundwater impacts from this proposed well:
 “Water Availability Study for Vesting Tentative Tract CO-92-058, AN 044-365-018, Oak Park Area, Arroyo Grande Fringe, San Luis Obispo County, California”, July 31, 1992, located across Noyes Road from the subject property;
 “Second Addendum to Groundwater Assessment, Proposed Subdivision 686 Erhart Lane, Oak Park Area, San Luis Obispo County, California”, November 23, 2015 for the Hurley Ranch subdivision (686 Erhart Lane, located west of Old Oak Park Road between Erhart and Vetter Lanes;
 Cumulative Projects Water Level Impact and Water Supply Assessment at the Sweet Springs Mobile Home Park, Arroyo Grande, California, December 16, 2016, located between Huasna Road and Corbett Canyon Road
The 1992 study established water use/consumptive use estimates for residences and identified wells and their pumping rates in the near proximity to the project site. It estimated the water use for a

Well impact discussion Noyes Road 5 November 9, 2017
combined and secondary unit combined was one acre-foot per year. The consumptive use, considering returnflow from on-site wastewater disposal systems, was estimated at 0.43 AFY. One of the wells was reported to produce 50 gpm.

The 2015 Hurley Ranch subdivision report included a pumping test that provided an estimate of drawdown with distance from a well in a similar aquifer pumping at 15 gpm. The drawdown after 72 hours at a distance of 100 feet was 1.5 feet.

The 2016 Cumulative Impacts analysis for the Sweet Springs Mobile Home Park subdivision modeled production from three proposed projects and developed a distance drawdown contour map. The findings of this model determined the drawdown with distance from the pumping well. The values for drawdown with distance would not apply to this proposed well, as the transmissivity of the formation will be different for this aquifer zone. However, this methodology could be used at the proposed well once the well has been drilled and tested to determine the aquifer parameters. This report also included an estimate of water use for avocadoes of 2.1 AFY per acre.

Pumping Water Level Drawdown Impacts
Pumping of groundwater from a well will cause short term water level declines (drawdown) at adjacent wells that tap the same aquifers. The closest well is at a distance of at least 300 feet from the proposed well site. The drawdown at adjacent wells cannot be known until the well is constructed and tested.

However, if the Hurley Ranch well pumping test is any indication, the drawdown associated with a 15 gpm pumping rate should be one foot or less at a well 300 feet or more distant at the end of three days of pumping. After the pump is turned off, recovery to the original static water level in the pumped well and the adjacent wells is expected to occur.

Reliability
The reliability of this water supply source relates to local groundwater level trends and the groundwater basin yield. This impact should be assessed once the well has been constructed and pumping test has been performed and analyzed. At the Hurley Ranch project (on Old Oak Park Road) well water levels between 1980 and 2012 were essentially the same. However, along Noyes Road, groundwater level records from adjacent private wells are not available. One water level measurement in 1992 at a well across Noyes Road found a depth to water of 16.83 feet (approximately an elevation of 155 feet). Once constructed, the water level in the proposed well can be measured and compared to this historic water level and other water levels recorded on well completion reports to determine if water levels have changed.

The safe groundwater yield from the Oak Park aquifers is estimated at 540 AFY (Los Robles del Mar project yield analysis). The Oak Park area has not been determined to be in overdraft. Groundwater production from the Oak Park area was estimated for the Hurley Ranch subdivision groundwater impact studies (April 22, 2016 letter to the City of Arroyo Grande and the June 2, 2015 Addendum) at 453-463 AFY. The estimated potential production of water from the proposed well, if added to the

Well impact discussion Noyes Road 6 November 9, 2017
production estimate from the Hurley Ranch documents, would result in a total production of 471-481 AFY, which is less than the Oak Park aquifer estimated safe groundwater yield.

CONCLUSION
This preliminary discussion of impacts from the proposed well provides findings related to impacts at the well site and groundwater impacts. Further analysis of the groundwater impacts should be performed once the well has been constructed and tested. The analysis could include a modeling analysis of groundwater level changes from pumping the new well at different rates (similar to the Sweet Springs Mobile Home Park cumulative projects analysis), should the City of Arroyo Grande pursue the possibility of using this well for municipal purposes.

Respectfully submitted,
CLEATH-HARRIS GEOLOGISTS, INC.

Timothy S. Cleath, Certified Hydrogeologist #81

Aquifer Boundary
1000 ft
2000 ft
0 1000 2000 ft
Proposed Well Site
Well
Proposed Well
Property Boundary
Explanation
Basemap source: San Luis Obispo County Building and
Planning Department Permit View
500 ft
Arroyo Grande City Limits
house/ building
structure
Figure 1
Distance from Proposed Well
Well Impact Study Discussion APN 007 781 055
* Known Wells within 1000 ft of
proposed well site.

Cleath-Harris Geologists, Inc.
71 Zaca Lane, Suite 140
San Luis Obispo, California 93401
(805) 543-1413
Well siting and preliminary design Noyes Road October 3, 2017 October 3, 2017
AGC Holding Corporation
c/o Keith Gurnee
108 Broad Street
San Luis Obispo, CA 93401
SUBJECT: Well Siting Study, Noyes Road Property
Arroyo Grande, California, APNs 007-781-055 and -056
Dear Mr. Shetler:

Cleath–Harris Geologists (CHG) herein provides recommendations related to siting and constructing a water well on the Noyes Road property, APNs 007-781-055 and 056, within the City of Arroyo Grande. The water well would be used as a test well/agricultural well and would require a permit from the City. There are no wells currently on this property.

The well site was selected based on property and geologic information. A base map was prepared from PG&E LiDAR data. A property plan was provided to establish constraints relative to sensitive habitat areas, roadways and other easements.

A geologic survey of the property was performed and a geologic map was prepared for the property that provides a much more detailed understanding than was available from the published geologic maps. The geology was further refined by preparing a geologic cross section using the mapping information and adjacent well completion reports and geophysical logs, including information for the wells at Los Robles del Mar property, the City of Arroyo Grande Deer Trail Circle well and the Arroyo Grande water tank test hole and for adjacent private water wells.

The main hydrogeologic criteria used for selecting a well site is to be able to complete a well of less than 600 feet depth into a sufficient thickness of permeable sand and gravel or sand beds to produce at least 50 gallons per minute of good quality water for irrigation. The property constraints and criteria limit potential well drilling sites to the valley floor adjacent to Noyes Road outside of riparian areas.

Geology
The property is underlain by sedimentary beds that are mapped as the Pismo Formation on the published geologic map, “Geology of the Arroyo Grande Quadrangle”, California Division of Mines and Geology Map Sheet 24. This geologic map indicates that the property is underlain by the Squire member of the Pismo Formation, a “massive white medium to coarse grained sandstone” and does not provide any geologic structural attitudes in the vicinity of the property. CHG geologic mapping indicates that the beds are very different than described on the published map or even in subsequent mapping for the Los Robles del Mar or City of Arroyo Grande projects. The sedimentary beds as mapped on the property include layers of sand and gravel separated by diatomaceous siltstone layers.

These beds generally dip to the north-northwest at between 10 and 44 degrees. Figure 1 is the geologic

Well siting and preliminary design Noyes Road 2 October 3, 2017 map of the property showing the specific layers. Figure 2 is a geologic cross section parallel to Noyes Road that is based on surface geologic outcrops with depth and log information from the nearby wells.

The upper sandstone beds, as shown on the geologic map and cross section, include, progressively with depth, a conglomeratic sandstone, a soft white sandstone, a hard resistant gray sandstone, a dark brown sandstone, a white cemented sandstone. This is underlain by diatomaceous shale and then a soft white fossiliferous (pecten shells) sandstone/siltstone. The underlying siltstone and claystone beds, above the deep Los Robles aquifer, are several hundred feet thick.

The most permeable sands/sandstone beds that can be encountered at a depth of less than 600 feet underlie the northern portion of the property. A well near the existing northern entrance to the property (where an emergency access road is proposed) would produce from these sandstone beds.

The deeper aquifer known as the “Los Robles aquifer” tapped by the City Well #10 on Deer Trail Circle underlies the property at depth below the aquifers described above and would not be accessible to a 600-foot well in the main part of the valley floor on the property. The “Los Robles Aquifer” is estimated to be at a depth of 1,000 feet in the vicinity of the south gate along Noyes Road.

Groundwater
The groundwater level is closest to ground surface along the valley floor. The creek following Noyes Road was dry when observed during this investigation. Groundwater elevations are estimated to be about 100-130 feet above sea level (40-70 feet depth underlying the valley floor).

Groundwater quality beneath the property is not specifically known. In general, groundwater in this area is of good water quality for irrigation. Iron, manganese, arsenic and selenium are constituents of concern that have been found in some wells in the area.

Potential Groundwater Development
The proposed well site should be within a 150’ radius of GPS coordinates 35.14592 North and 120.59114 West. This area is at an elevation of about 190 feet above MSL. The proposed well is recommended to be drilled to 700 feet and completed to a depth of up to 600 feet with 8-inch diameter PVC water well casing with perforations opposite aquifer beds identified based on geophysical and lithologic logs of the borehole. A 50-foot annular well seal should be placed according to California water well standards.

Respectfully submitted,
CLEATH-HARRIS GEOLOGISTS, INC.

Timothy S. Cleath, Certified Hydrogeologist #81

Property Boundary
Well
Test Hole
Explanation Geologic observations made 9/14/2017
0 250 500 750 ft
32 20
30 10
15 25
25 22
44 1. White Sandstone/Siltstone, fine grained, friable
iron oxide staining

2. Diatomaceous Shale

3. White, calcite cemented sandstone, medium
grained, contains fossils

4. Dark Brown Sandstone with rounded
pebbles and medium grained sand

5. Grey resistant sandstone bed, contains angular quartz grains and hematite, and some shell pieces.

6. White/ tan sandstone/siltstone, fine to medium grained sand, friable.

7. Beige conglomerate contains subrounded gravels 1-10cm in a siltstone/sandstone matrix.
1 Figure1
Geologic Map
AGC Holding Corporation
Cleath-Harris Geologists
Alluvium
2 1
3 2
4 5
6 7
Strike/Dip Measurement
Bedding Contact
20 B
A'
A
Noyes Rd.

Rancho Grande Tank
Test Hole
Proposed Well Site

250
200
150
100
50 0
-50
-100
-150
-200
-250
-300
-350
0 500 1000 1500 2000 2500 3000 3500
A A’
South North
Distance (feet)
Elevation (feet above sea level)
AG Well 10
-400
-450
-500
-550
-600
-650
-700
-750
20 50 0
Sandy Clay
Clayey Sand
Silty Sand
Clayey Silty Sand
Sand and Clay
Clayey Sand
Clayey Sand
Sandy Clay
Ohms
0 20 50
Ohms
710481 736652 (projected)
Diatomaceous Shale
Diatomaceous Shale
Dark Brown Sandstone
White Cemented Sandstone
Hard resistant Sandstone
Soft White Sandstone
Beige Conglomeratic Sandstone
Soft White Sandstone/Siltstone
White Siltstone
400
350
300
Fine-Coarse S&G
w/clay streaks
Sandy Clay
Fine-Coarse
Black S&G
Sandy Clay
Fine S&G
some Clay
Yellow Fine to
Coarse Sand
Sandy Clay
Sandy Clay
Fine to Coarse
S&G
Rancho Grande Test Hole
(projected)
Figure 2
Geologic Cross-Section A-A’
AGC Holding Corporationt
Cleath-Harris Geologists
Explanation
Perforated Interval
20 ohm line
*See Geologic map for Cross-Section Location
Horizontal Scale:1”=400’
V
WCR
ertical Scale: 1”=400’
Well Completion Report
Number
Sandstone
Siltstone
Sandstone
Siltstone
Property Boundary
Proposed Test Well
T.D. 600’
Sea level

City of San Luis Obispo, Public Works, 919 Pal m Street, San Luis Obispo, CA, 9340 1-3 218, 80 5.781. 7200, slocity.org City of San Luis Obispo, Public Works, 919 Pal m Street, San Luis Obispo, CA, 9340 1-3 218, 80 5.781. 7200, slocity.org

SLO Civil Design, LLC

615 Clarion Ct. Suite #2, San Luis Obispo CA 93401
T: 805-503-8059 E: [email protected]
February 26, 2024
PROJECT: Harris Domestic Well – APN 007-781-055
Permit# PPR23-000001
Property owners of APN 007-781-055, located at the corner of Equestrian and Noyes in the City of Arroyo Grande are requesting approval for the drilling of a domestic water well onsite to support the future residential development of a single-family home.

The city does not currently have a water service connection to the parcel where the well will be drilled and constructed, and a future residence is to be located.

Connecting to the existing city water system would require a private water line to cross two parcels, APN 007-781-056 and APN# 007-851-049. In addition, potential build sites for a residence on this parcel are up to a half mile away from existing city service lines making a connection impractical and infeasible based on cost and impacts to the existing terrain.

Land that exists between the city's recommended connection location and any viable build site that would support a single-family home is habitat to densely populated oak groves, slopes in excess of 30%, and soil that consists primarily of exposed rock and sandstone.

Constructing a water line that would connect the City’s proposed meter location to areas outside of the impacted landscape would require one of two methods:
.

1. Trench to the meter – in order to minimize impacts to the trees we would have to provide a connection route that would be around 2000’.

2. Boring to the meter could take a more direct path but would be significantly more expensive per linear foot to construct.

Attachments included in this memo provide cost estimates for each construction method outlined above.

Sincerely,
Richard Burde, PE
Principal Civil Engineer
C 88309
Enc.

ATTACHMENTS
Trenching Estimate – Nash Construction
Boring Estimate DEVCO

ESTIMATE
Client:

Estimate No: 02272024 Date: 27, February, 2024
Description Amount
$347,000.00
Total $347,000.00
1521 MORRO STREET
SAN LUIS OBISPO, CA 93401
805/295-1931
CONTRACTOR'S LIC. NO. 948781

HARRIS PROPERTY
Noyes Rd.

Arroyo Grande, CA 93420

LARRY NASH CONSTRUCTION
Estimates valid for 30 days. If you have any question please contact Larry Nash THANK YOU FOR YOUR BUSINESS.

To Include:

Mobilization of all trenching and compaction equipment
Clear and grub 2000LF of impacted Trenching area
Marking and adding hay bales around oak trees to City’s specifications
HAND Trench 2000LF through oak tree canopy line and install Schedule 40, 1-inch pipe from City tank *
Shade and compact trench to city specs
Install AC dike to prevent erosion on grade over 20% every 30ft Rock clause is in effect on this project to identify rock fields Includes 1-inch city water meter
Haul away all green waste and excess soil to certified location *2000LF of utility trenching through sandstone to be conducted with hand tools only, $10,000 per day, estimated 30 days
LF = Linear Feet
Does Not Include:

City permit fees or any special inspections or engineering

SUNRAY PL &
NOYES RD.

PREPARED FOR:

MIKE HARRIS

DEVCO DEVELOPMENT

AND ENGINEERING
ON BEHALF OF:

DIRECTIONAL DRILLING
24-0044

PROPOSAL

Proposal / Contract Number: 24-0044- Budget Number Date: 2/23/2024 Job Name: Waterline HDD Job Address: Sunray Place & Noyes Road, Arroyo Grande Ca.

Customer Contact:

Property Owner
Mike Harris
Sunray Place & Noyes Road, Arroyo Grande Ca.
[email protected]
PROJECT SCOPE OF WORK:
● Devco to delineate and provide their own valid USA North ticket. ● Devco to provide all equipment and manpower to excavate all bore pits for the boring operations. Devco will need access from the top road by the water tower to get equipment in to dig a receiving pit to pull the pipe in from before the pilot bore is completed.
● Devco to provide all equipment and manpower to backfill and compact all bore pits with the native soil after the completion of the bore.
● Devco to supply 900 feet of 4” HDPE DR17.
● Devco to provide a fusion tech and equipment to fuse 900 feet of HDPE DR 17. ● Devco to directional bore and pull 900 feet of (1) Devco provided 4” HDPE DR 17. ● Devco to leave the HDPE DR 17 pipe stubbed at both ends of the bore for the customer to pick up and tie in. $318.06 PLF OR ($286,260.00 Lump Sum)
Exclusions of this Proposal:
● Water Hydrant meter for the boring operations.
● Damage to any existing tree roots, trees, branches or any landscaping that Devco will be working around.
● Haul off of any drill mud from the property.
● Communication with Engineers, Arborists or Inspectors if changes are needed caused by unknowns. ● Dewatering and testing if groundwater is encountered. ● Dewatering of any kind if groundwater is encountered. ● Handling of Hazardous material, soil, liquids or any cost associated with it. ● Any Landscape or Hardscape Repair.
● Any Survey for easements if easements are not provided. . ● Any soil that is not conducive to directional drilling. ● Private Locator. .
● Damage to any mismarked and unmarked utilities, and unmarked sewers or septic tanks not located by a third party or Dig alert.
● Prevailing Wage Rates.
40625 Calle Fiesta, Temecula, CA 92591 Ph: (951)221-3633 www.DevelopmentAndEngineering.com CSLB #1105687 A & B License DVBE, SB-PW, SB-Micro #2034204 SDVOSB #J3QDZW55B215 PDBE #23001218 DIR #1001084629