Agenda packet — Beaumont City Council, December 2, 2025 (part 4 of 9)

Special Event Ord - Page 1 of 1

THE PRESS -ENTERPRISE

KEEP YOUR EYES ON'I III(
Mcom
The Press -Enterprise
3512 14 Street
Riverside, California 92501
(951) 368-9229
City of Beaumont
550 E. 6th Street
Beaumont, California 92223
Publication: The Press -Enterprise

PROOF OF PUBLICATION OF
Ad Desc: 0011763899
FILE NO. 0011763899

PROOF OF PUBLICATION
I am a citizen of the United States. I
am over the age of eighteen years and
not party to or interested in the above -
entitled matter. I am an authorized
representative of THE PRESS -
ENTERPRISE, a newspaper of
general circulation, printed and
published daily in the County of
Riverside, and which newspaper has
been adjudicated a newspaper of
general circulation by the Superior
Court of the County of Riverside, State
of California, under date of April 25,
1952, Case Number 54446, under
date of March 29, 1957, Case Number
65673, under date of August 25, 1995,
Case Number 267864, and under date
of September 16, 2013, Case Number
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the annexed is a printed copy, has
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person(s) requesting publication, and
not in any supplement thereof on the
following dates, to wit:
11107/2025
I certify (or declare) under the penalty
of perjury that the foregoing is true and
correct.

Date: November 7, 2025.

At: Riverside, California
C tit> a��
Signature
Legal Advertisement
NOTICE IS HEREBY GIVEN that the Beaumont City Council will conduct a public hearing to consider the matter below. The City Council Public Hearing will be held at 6:00pm on Tuesday, November 18, 2025, at 550 E. 6 th Street, Beaumont, California 92223, to receive testimony and comments from all Interested persons regarding the adoption of the following matter(s):

AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF BEAUMONT, CALIFORNIA, AMENDING CHAPTER 9.03 "REGULATION OF SPECIAL EVENTS" OF THE BEAUMONT MUNICIPALCODE TO REVISE SPECIAL

EVENT CLASSIFICATIONS AND REMOVE LIMITATIONS ON PERMIT

FREQUENCY
The proposed ordinance would revise the thresholds for malor and minor special events with a revision to the adopted fee schedule for consistency. A copy of the proposed ordinance Is available at the Beaumont Civic Center, 550 East Sixth Street, Beaumont, California.

Public comments can be made in person, using the public comment phone I1ne or by written email. Phone-in comments will be accepted by calling the designated public comment phone line (951) 922-4845 prior to the corresponding item. Public comments shall not exceed three minutes unless otherwise authorized by City Council. Written comments can be emcalled to NicoleWa:BeaumontCa.gov with "Public Comment" in the sublect Ilne. Public comments accepted via email will be read aloud during the corresponding item of the meeting sublect to a three minute time limit. Comments can be submitted any time prior to the meeting as well cis during the meeting until the end of the corresponding item.

This meeting will be conducted in person and also and will be recorded for live streaming. All City of Beaumont public meetings will be mcacle available vita live streaming and made available on the City's official YouTube webpage. Please use the following Ilnk during the meeting for live stream access: BeaumontCa.gov/Livestream The Press -Enterprise
Published: 11/7/25

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Special Event Ord - Page 1 of 1

BEAUMONT
-C A L I F O R N A -
Staff Report
TO: City Council
FROM: Jennifer Ustation, Finance Director
DATE: December 2, 2025
SUBJECT: Annual Report Filing Required Under Senate Bill 165 — Local Agency Special Tax and Bond Accountability Act
Description: This Annual Report is submitted in accordance with Senate Bill 165 — the Local Agency Special Tax and Bond Accountability Act, which requires local agencies to annually disclose the amount of special tax and bond proceeds collected and expended, along with the status of any authorized public improvements funded with those revenues. This report provides a transparent summary of the City of Beaumont's Community Facilities District (CFD) activity for Fiscal Year 2024-25, including special tax levies, debt service payments, administrative costs, and the completion or ongoing status of public infrastructure projects, ensuring continued accountability and compliance with Government Code Sections 50075.3 and 53411.

Background and Analysis:

Senate Bill 165 ("SB 165"), known as the Local Agency Special Tax and Bond Accountability Act, was filed with the Secretary of State on September 19, 2000. The Act applies to any local special tax or bond measure approved by voters on or after January 1, 2001, and enacted under Government Code Sections 50075.1 or 53410.

The City of Beaumont administers several Community Facilities Districts (CFDs) whose bonds fall within this requirement.

SB 165 mandates:

1. A statement of the specific purposes of the special tax or bond measure;

2. That collected proceeds be applied only to those authorized purposes;

3. The establishment of separate accounts for such proceeds; and

4. An annual report filed by the chief fiscal officer containing:

O (a) The amount of funds collected and expended; and
O (b) The status of any authorized project.

This report satisfies the annual filing requirement of Government Code Sections 50075.3 and 53411.

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The City of Beaumont administers a large, multi -district Mello -Roos program consisting of more than 30 Improvement Areas across multiple CFDs, each authorized to finance specific infrastructure and public facilities. The attached FY 2024-25 SB 165 Annual Report provides detailed revenue, expenditure, and project -funding status for each district.

Fiscal Impact:

There is no fiscal impact associated with receiving and filing this report.

The estimated cost to prepare this report is $450.

Recommended Action:

Receive and file report.

Attachments:

A. City of Beaumont SB 165 FY 2024-25 Report

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Ci SPICER

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CITY OF BEAUMONT
Annual Report
Fiscal Year Ending
June 30, 2025
Senate Bill 165
Annual Report On Voter Approved Debt
Section 53411
of 1154

Table of Contents
Sections

1. Introduction of Bond Accountability Act (Senate Bill 165)

2. Community Facilities

3. Community Facilities

4. Community Facilities

5. Community Facilities

6. Community Facilities

7. Community Facilities

8. Community Facilities

9. Community Facilities

10. Community Facilities

11. Community Facilities

12. Community Facilities

13. Community Facilities

14. Community Facilities

15. Community Facilities

16. Community Facilities

17. Community Facilities

18. Community Facilities

19. Community Facilities

20. Community Facilities

21. Community Facilities

22. Community Facilities

23. Community Facilities

24. Community Facilities

25. Community Facilities

26. Community Facilities

27. Community Facilities
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
District
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
No. 93-1
Improvement Area 3
Improvement Area 6A1
Improvement Area 7A1
Improvement Area 7B
Improvement Area 7C
Improvement Area 7D
Improvement Area 8
Improvement Area 8A
Improvement Area 8B
Improvement Area 8C
Improvement Area 8D
Improvement Area 8E
Improvement Area 8F
Improvement Area 9
Improvement Area 10A
Improvement Area 11
Improvement Area 12A
Improvement Area 14
Improvement Area 14A
Improvement Area 14B
Improvement Area 16
Improvement Area 17A
Improvement Area 17B
Improvement Area 17C
Improvement Area 17D
Improvement Area 18
1 2
3 4
5 6
7 8
9 10
11 13
15 16
17 18
19 20
21 22
23 24
25 26
27 28
29 SPICERig,

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Local Agency Special Tax and Bond Accountability Act Report

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Table of Contents

28. Community Facilities District No. 93-1 Improvement Area 19A

29. Community Facilities District No. 93-1 Improvement Area 19C

30. Community Facilities District No. 93-1 Improvement Area 20

31. Community Facilities District No. 2016-1

32. Community Facilities District No. 2016-2

33. Community Facilities District No. 2016-3

34. Community Facilities District No. 2016-4

35. Community Facilities District No. 2019-1

36. Community Facilities District No. 2021-1
30 31
32 33
34 35
36 37
38 SPICERig,

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Local Agency Special Tax and Bond Accountability Act Report

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1. Introduction Page 11
Bond Accountability Act (Senate Bill 165)
Senate Bill 165 (SB 165) shall be cited as the Local Agency Special Tax and Bond Accountability Act (the "Act"). This Act requires that any local special tax/local bond measure subject to voter approval contain a statement indicating the specific purposes of the special tax, requires that the proceeds of the special tax be applied to those purposes, requires the creation of an account into which the proceeds shall be deposited, and requires an annual report containing specified information concerning the use of the proceeds. The Act only applies to bonds issued on or after January 1, 2001, in accordance with Sections 50075.1 and 53410 of the California Government Code.

Some of the requirements of the Act are handled at the formation (bond issuance) of the Special Tax District and others are handled through annual reports. This section of the report intends to comply with Sections 50075.3 and 53411 of the California Government Code that states:

The chief fiscal officer of the issuing local agency shall file a report with its governing body no later than January 1, after the bonds have been issued and at least once a year thereafter. The Annual report shall contain all of the following:
(a) The amount of funds collected and expended.
(b) The status of any project required or authorized to be funded as identified in subdivision (a) of Section 50075.1 and Section 53410.

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Local Agency Special Tax and Bond Accountability Act Report

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2. Community Facilities District No. 93-1 Improvement Area 3 Page 2 Community Facilities District No. 93-1 Improvement Area 3 Local Agency Refunding Bonds, Series 2019A
Location
Community Facilities District No. 93-1 Improvement Area 3 (the "CFD No. 93-1 IA 3") is comprised of 508 single family homes and approximately 170.40 gross acres. CFD No. 93-1 IA 3 is generally located adjacent to the north side of Interstate 10 and south of Oak Valley Pkwy (Fourteenth Street).

Authorized Facilities and Bonds
CFD No. 93-1 IA 3 was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water Facilities, Ring Ranch Rd., and Oak View Dr.); Joint Facilities - (Noble Creek Sewer Trunk Main and Noble Creek Sewer Force Main); Individual Facilities - (Three Rings Ranch - Collector Sewer, Oak Valley Greens — Oak View Drive Water and Collector Sewer, Oak Valley Greens — Future Facilities, and Mountain Meadows - Channel). CFD No. 93-1 IA 3 has one series of bonds, the Local Agency Refunding Bonds, Series 2019A.

Funds Collected and Expended
The table below shows the amount of special taxes collected and the expenditures made to fund the authorized facilities and incidental expenses of CFD No. 93-1 IA 3 from July 1, 2024, through June 30, 2025.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$243,297
Less: Delincuency as of 6/30/2025
$2,143
Total Special Taxes Collected
$241,154
2025 Expenditures
Bond Interest — 3/1/2025
$31,725
Bond Interest — 9/1/2025
$31,725
Bond Principal — 9/1/2025
$145,000
Administrative ExDenses(1)
$30,000
Total Expenditures
$238,450
Ending Special Tax Fund Balance
$2,704
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 3. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 3.

The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 3.

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City of Beaumont
Local Agency Special Tax and Bond Accountability Act Report

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3. Community Facilities District No. 93-1 Improvement Area 6A1 Page 13 Community Facilities District No. 93-1 Improvement Area 6A1 Special Tax Refunding Bonds, Series 2017A
Location
Community Facilities District No. 93-1 Improvement Area 6A1 (the "CFD No. 93-1 IA 6A1 ") is comprised of 954 single family homes and approximately 299.22 gross acres. CFD No. 93-1 IA 6A1 is generally located east of Manzanita Park Rd., north of Eagles Nest Dr., and south of E 1S, St.

Authorized Facilities and Bonds
CFD No. 93-1 IA 6A1 was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Transportation Facilities, Domestic Water Facilities, Recycled Water Facilities, Sewer Transmission and Treatment Facilities, Traffic Signals and Street Lighting Facilities, Public Safety, Public Works and Administrative Facilities, Watershed Management and Storm Drain Facilities, Facility Fees, Planning, Engineering and Environmental Reports and Appurtenant Facilities, Utilities, and Fees and Permits); Joint Facilities - (Lower Potrero Sewer No. 1 — Seneca Springs, Southern Trunk Main, Lower Potrero Sewer System and Appurtenant Facilities, including Engineering Reports and Studies, Utilities, and Fees and Permits); Individual Facilities - (Transportation Facilities, Domestic Water Facilities, Recycled Water Facilities, Sewer Transmission and Treatment Facilities, Traffic Signals and Street Lighting Facilities, Public Safety, Public Works and Administrative Facilities, Watershed Management and Storm Drain Facilities, Community Parks and Multipurpose Trails, Planning, Engineering and Environmental Reports and Appurtenant Facilities, including Engineering Reports and Studies, Utilities, and Fees and Permits). CFD No. 93-1 IA 6A1 has one series of bonds, the Special Tax Refunding Bonds, Series 2017A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$2,392,870
Less: Delincuency as of 6/30/2025
$7,780
Total Special Taxes Collected
$2,385,090
2025 Expenditures
Bond Interest -3/1/2025
$394,118
Bond Interest -9/1/2025
$394,118
Bond Principal — 9/1/2025
$1,550,710
Administrative Exoenses (1)
$30,000
Total Expenditures
$2,368,946
Ending Special Tax Fund Balance
$16,144
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 6A1. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 6A1. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 6A1.

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Local Agency Special Tax and Bond Accountability Act Report

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4. Community Facilities District No. 93-1 Improvement Area 7A1 Page 14 Community Facilities District No. 93-1 Improvement Area 7A1 2015 Local Agency Refunding Revenue Bonds, Series A
Location
Community Facilities District No. 93-1 Improvement Area 7A1 (the "CFD No. 93-1 IA 7A1") is comprised of 537 single family homes and approximately 147.56 gross acres. CFD No. 93-1 IA 7A1 is generally located southwest of the Potrero Blvd. and Highland Springs Ave. intersection.

Authorized Facilities and Bonds
CFD No. 93-1 IA 7A1 was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water System, Utilities, and Fees and Permits); Joint Facilities - (Lower Potrero Sewer No. 2); Individual Facilities - (Transportation Facilities, Sewer Treatment Plant, Westside Fire Station, Electrical Utility Substation, Electrical Utility Extensions, San Timoteo Watershed Management Projects, Domestic Water System, Recycled Water System and Appurtenant Facilities, including Engineering Reports and Studies, Utilities, and Fees and Permits). CFD No. 93-1 IA 7A1 has one series of bonds, the 2015 Local Agency Refunding Revenue Bonds, Series A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$707,934
Less: Delincuency as of 6/30/2025
$10,625
Total Special Taxes Collected
$697,309
2025 Expenditures
Bond Interest — 3/1/2025
$205,438
Bond Interest — 9/1/2025
$205,438
Bond Principal — 9/1/2025
$260,000
Administrative Expenses (1)
$30,000
Total Expenditures
$700,876
Ending Special Tax Fund Balance
($3,567)
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 7A1. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 7A1. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 7A1.

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Local Agency Special Tax and Bond Accountability Act Report

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5. Community Facilities District No. 93-1 Improvement Area 7B Page 15 Community Facilities District No. 93-1 Improvement Area 7B Special Tax Bonds, 2018 Series A
Local Agency Refunding Bonds, Series 2021A
Location
Community Facilities District No. 93-1 Improvement Area 7B (the "CFD No. 93-1 IA 7B") is comprised of 283 single family homes and approximately 85.98 gross acres. CFD No. 93-1 IA 7B is generally located southwest of the Potrero Blvd. and Four Seasons Blvd. intersection.

Authorized Facilities and Bonds
CFD No. 93-1 IA 7B was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, City Transportation Facilities, Sewer Treatment Capacity, Citywide Facilities, Regional Park, and Facility Fees and Permits); Individual Facilities - (Potrero Blvd). CFD No. 93-1 IA 7B has two series of bonds, the Special Tax Bonds, 2018 Series A and the Local Agency Refunding Bonds, Series 2021A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$295,918
Less: Delincuency as of 6/30/2025
$604
Total Special Taxes Collected
$295,314
2025 Expenditures
Bond Interest — 3/1/2025
$48,540.00
Bond Interest — 9/1/2025
$48,540.00
Bond Principal — 9/1/2025
$170,000.00
Administrative ExDenses(1)
$20,000.00
Total Expenditures
$287,080
Ending Special Tax Fund Balance
$8,234
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 93-1 IA 7B. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 7B.

District
Series
Initial Deposit
Amount to
Improvement Fund
Expended
Amount
June 30, 2025
Balance(2)
Project
Status
CFD No. 93-1 IA 7B
2018A
$2,009,555.99
$2,009,522.30
$33.69
On•oin•
2) Balance includes interest.

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Local Agency Special Tax and Bond Accountability Act Report

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6. Community Facilities District No. 93-1 Improvement Area 7C Page 16 Community Facilities District No. 93-1 Improvement Area 7C Local Agency Refunding Bonds, Series 2021A
Location
Community Facilities District No. 93-1 Improvement Area 7C (the "CFD No. 93-1 IA 7C") is comprised of 391 single family homes and approximately 146.12 gross acres. CFD No. 93-1 IA 7C is generally located south of Eagle Nest Dr. and 0.37 miles west of Highland Springs Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 7C was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, City Transportation Facilities, Sewer Treatment Capacity, Citywide Facilities, Regional Park, and Facility Fees and Permits); Individual Facilities - (Potrero Blvd). CFD No. 93-1 IA 7C has one series of bonds, the Local Agency Refunding Bonds, Series 2021A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$135,016
Less: Delincuency as of 6/30/2025
$566
Total Special Taxes Collected
$134,450
2025 Expenditures
Bond Interest — 3/1/2025
$14,338
Bond Interest — 9/1/2025
$14,338
Bond Principal — 9/1/2025
$75,000
Administrative Exoenses (1)
$30,000
Total Expenditures
$133,676
Ending Special Tax Fund Balance
$774
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 7C. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 7C. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 7C.

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City of Beaumont
Local Agency Special Tax and Bond Accountability Act Report

Page 328 of 1154 ends

7. Community Facilities District No. 93-1 Improvement Area 7D Page 17 Community Facilities District No. 93-1 Improvement Area 7D 2018 Special Tax Bonds
Location
Community Facilities District No. 93-1 Improvement Area 7D (the "CFD No. 93-1 IA 7D") is comprised of 296 single family homes and approximately 89.90 gross acres. CFD No. 93-1 IA 7D is generally located west of Highland Springs Ave. and southwest of Breckenridge Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 7D was formed to finance the costs of constructing and acquiring certain public facilities. The authorized facilities financed include, but not limited to the following: City Program; Gravity Sewers on 1St St., California Ave., and Highland Springs Rd.; Sewer Force Main; Lift Stations on Highland Spring Rd. and Portero Rd.; and the Portero Bridge. CFD No. 93-1 IA 7D has one series of bonds, the 2018 Special Tax Bonds.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$234,676
Less: Delincuency as of 6/30/2025
$1,413
Total Special Taxes Collected
$233,263
2025 Expenditures
Bond Interest — 3/1/2025
$63,675
Bond Interest — 9/1/2025
$63,675
Bond Principal — 9/1/2025
$85,000
Administrative Excenses (1)
$20,000
Total Expenditures
$232,350
Ending Special Tax Fund Balance
$913
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 93-1 IA 7D. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 7D.

District
Series
Initial Deposit
Amount to
Improvement Fund
Expended
Amount
June 30, 2025
Balance
Project
Status
CFD No. 93-1 IA 7D
2018
$3,269,022.24
$3,269,022.24
$0.00
Com.lete
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Local Agency Special Tax and Bond Accountability Act Report

Page 329 of 1154 ends

8. Community Facilities District No. 93-1 Improvement Area 8 Page 8 Community Facilities District No. 93-1 Improvement Area 8 Special Tax Refunding Bonds, Series 2017A
Location
Community Facilities District No. 93-1 Improvement Area 8 (the "CFD No. 93-1 IA 8") is comprised of 946 single family homes and approximately 237.82 gross acres. CFD No. 93-1 IA 8 is generally located northwest of the N Highlands Springs Ave. and Starlight Ave. intersection.

Authorized Facilities and Bonds
CFD No. 93-1 IA 8 was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Water Quality Basin, Domestic Water System, Transportation System, Utilities, and Fees and Permits); Joint Facilities - (Upper Potrero Sewer Lift Station and Upper Potrero Sewer Trunk Main and Force Main); Individual Facilities - (Annexation Area Sewer, Sewer Trunk Main -On Site, Streets and Storm Sewers, 5% Construction Contingency, Fourteenth Street, Loop Road Extension, Utilities, and Fees and Permits). CFD No. 93-1 IA 8 has one series of bonds, the Special Tax Refunding Bonds, Series 2017A.

Amount
Description
FY 2024-25 Revenues
Special Taxes Levied
$673,373
Less: Delincuency as of 6/30/2025
$2,932
Total Special Taxes Collected
$670,441
2025 Expenditures
Bond Interest — 3/1/2025
$75,820
Bond Interest — 9/1/2025
$75,820
Bond Principal — 9/1/2025
$485,000
Administrative ExDenses(1)
$30,000
Total Expenditures
$666,640
Ending Special Tax Fund Balance
$3,801
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 8. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 8.

The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 8.

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City of Beaumont
Local Agency Special Tax and Bond Accountability Act Report

Page 330 of 1 ends

9. Community Facilities District No. 93-1 Improvement Area 8A Page 19 Community Facilities District No. 93-1 Improvement Area 8A Special Tax Refunding Bonds, Series 2017A
Location
Community Facilities District No. 93-1 Improvement Area 8A (the "CFD No. 93-1 IA 8A") is comprised of 409 single family homes and approximately 84.46 gross acres. CFD No. 93-1 IA 8A is divided into two non-contiguous zones. Zone 1 is generally located west of N Highland Springs Ave., north of E Oak Valley Pkwy, and east of Starlight Ave. Zone 2 is generally located west of N Highland Springs Ave., south of Starlight Ave., and east of Xenia Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 8A was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Transportation Facilities, Engineering and Geotechnical Reports, Westside Fire Station, Emergency Preparedness Facility, Recycled Water Facilities, and Facility Fees and Permits); Individual Facilities - (Prepaid Capacity Fees, Preliminary Engineering, and Prepaid Traffic Signal Fees). CFD No. 93-1 IA 8A has one series of bonds, the Special Tax Refunding Bonds, Series 2017A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$518,705
Less: Delinquency as of 6/30/2025
$3,671
Total Special Taxes Collected
$515,034
2025 Expenditures
Bond Interest — 3/1/2025
$81,061
Bond Interest — 9/1/2025
$81,061
Bond Principal — 9/1/2025
$321,422
Administrative Expenses (1)
$30,000
Total Expenditures
$513,544
Ending Special Tax Fund Balance
$1,490
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 8A. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 8A. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 8A.

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City of Beaumont
Local Agency Special Tax and Bond Accountability Act Report

Page 331 of 1154 ends

10. Community Facilities District No. 93-1 Improvement Area 8B Page 10 Community Facilities District No. 93-1 Improvement Area 8B Special Tax Refunding Bonds, Series 2017A
Location
Community Facilities District No. 93-1 Improvement Area 8B (the "CFD No. 93-1 IA 8B") is comprised of 192 single family homes and approximately 50.12 gross acres. CFD No. 93-1 IA 8B is generally located northeast of Carnation Ln., south of Snapdragon Way, and southwest of Starlight Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 8B was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, TUMF Facilities, Regional Park Facilities, Engineering and Geotechnical Reports, Sewage Treatment Facilities, Recycled Water Facilities, Domestic Water Well, Facility Engineering, and Fees and Permits); Individual Facilities - (Prepaid Engineering and Formation Costs and Prepaid Citywide Fees). CFD No. 93-1 IA 8B has one series of bonds, the Special Tax Refunding Bonds, Series 2017A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$455,820
Less: Delincuency as of 6/30/2025
$5,907
Total Special Taxes Collected
$449,913
2025 Expenditures
Bond Interest — 3/1/2025
$83,134
Bond Interest — 9/1/2025
$83,134
Bond Principal — 9/1/2025
$255,000
Administrative ExDenses(1)
$30,000
Total Expenditures
$451,268
Ending Special Tax Fund Balance
($1,355)
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 8B. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 8B. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 8B.

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Page 332 of 1 ends

1 1 . Community Facilities District No. 93-1 Improvement Area 8C Page 111 Community Facilities District No. 93-1 Improvement Area 8C Special Tax Refunding Bonds, Series 2017A
Special Tax Bonds, 2018 Series A
Local Agency Refunding Bonds, Series 2020A
Location
Community Facilities District No. 93-1 Improvement Area 8C (the "CFD No. 93-1 IA 8C") is comprised of 689 single family homes and approximately 161.56 gross acres. CFD No. 93-1 IA 8C is generally located north of Snapdragon Way, east of Cherry Ave., south of E Oak Valley Pkwy, and west of Starlight Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 8C was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, TUMF Facilities, Regional Park Facilities, Westside Fire Station, Sewage Treatment Facilities, Recycled Water Facilities, Engineering and Geotechnical Reports, San Timoteo Watershed Management Projects, Domestic Water Facilities, Facility Engineering, and Fees and Permits); Joint Facilities - (Southern Trunk Main); Individual Facilities - (Prepaid Engineering and Formation Costs, Prepaid Citywide Fees, and Cherry Storm Drain Channel). 8th St. (Soft Costs, Street, Storm Drain, Sewer and Dry Utilities); 8th St. (off -site Sewer); PA 16/17 Loop St. (Soft Costs); Xenia Ave. (Soft Costs); PA 18/22 Entry (Soft Costs, Street, Sewer and Dry Facilities); Starlight Ave. (Soft Costs, Street, Storm Drain, Sewer and Dry Utilities); Major Streets and Detention Basins Grading; P/A 1/4 Entry (Soft Costs, Street, Curb/Gutter, Sidewalk and Sewer); Cherry Ave. (Soft Costs, Street, Curb/Gutter, Storm Drain and Dry Utilities); and Highland Springs Ave. (Soft Costs, Street, Curb/Gutter, Storm Drain and Dry Utilities). CFD No. 93-1 IA 8C has three series of bonds: the Special Tax Refunding Bonds, Series 2017A; the Special Tax Bonds, 2018 Series A; and the Local Agency Refunding Bonds, Series 2020A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$1,605,367
Less: Delincuency as of 6/30/2025
$6,311
Total Special Taxes Collected
$1,599,056
2025 Expenditures
Bond Interest — 3/1/2025
$543,793
Bond Interest -9/1/2025
$543,793
Bond Principal — 9/1/2025
$472,250
Administrative Expenses (1)
$30,000
Total Expenditures
$1,589,836
Ending Special Tax Fund Balance
$9,220
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

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Page 333 of 1154 ends

1 1 . Community Facilities District No. 93-1 Improvement Area 8C

Page 112 ends

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 93-1 IA 8C. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 8C.

District
Series
Initial Deposit
Amount to
Improvement Fund
June 30, 2025
Balance
Project
Status
CFD No. 93-1 IA 8C
2018A
$16,404,065.90
$0.00
Complete
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12. Community Facilities District No. 93-1 Improvement Area 8D Page 13 Community Facilities District No. 93-1 Improvement Area 8D Special Tax Refunding Bonds, Series 2017A
Special Tax Bonds, Series 2018A
Location
Community Facilities District No. 93-1 Improvement Area 8D (the "CFD No. 93-1 IA 8D") is comprised of 279 single family homes and approximately 44.45 gross acres. CFD No. 93-1 IA 8D is generally located north of E Oak Valley Pkwy, east of Cherry Ave., and west of Starlight Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 8D was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Oak Valley Pkwy and Highland Springs Ave., Recycled Water Facilities, and Facility Fees and Permits); Individual Facilities - (San Timoteo Sewer).

Cougar Way (Soft Costs, Street, Curb/Gutter, Sidewalk, Storm Drain and Dry Utilities); PA 35/38 Entry (Soft Costs, Street, Sidewalk, Sewer and Dry Utilities); Oak Valley Pkwy (Soft Costs, Street, Sidewalk, Storm Drain and Dry Utilities); PA 42/43 Entry (Soft Costs, Street, Curb/Gutter, Storm Drain, Sewer and Dry Utilities); PA 1/4 Entry (Soft Costs, Street, Curb/Gutter, Sidewalk and Sewer); Cherry Ave. (Soft Costs, Street, Curb/Gutter , Storm Drain and Dry Utilities); Highland Springs Ave. (Soft Costs, Street, Curb/Gutter, Storm Drain and Dry Utilities). CFD No. 93-1 IA 8D has two series of bonds, the Special Tax Refunding Bonds, Series 2017A and the Special Tax Bonds, Series 2018A.

Descri . tion _
Amount
FY 2024-25 Revenues
Special Taxes Levied
$491,715
Less: Delinquency as of 6/30/2025
$1,828
Total Special Taxes Collected
$489,887
2025 Expenditures
Bond Interest — 3/1/2025
$182,224
Bond Interest — 9/1/2025
$182,224
Bond Principal — 9/1/2025
$97,268
Administrative Expenses (1)
$30,000
Total Expenditures
$491,716
Ending Special Tax Fund Balance
($1,829)
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

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Page 335 of 1 ends

12. Community Facilities District No. 93-1 Improvement Area 8D

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Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 93-1 IA 8D. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 8D.

District
Series
Initial Deposit
Amount to
Improvement Fund
June 30, 2025
Balance
Project
Status
CFD No. 93-1 IA 8D
2018A
$7,322,774.46
$0.00
Complete
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Page 336 of 1154 ends

13. Community Facilities District No. 93-1 Improvement Area 8E Page 15 Community Facilities District No. 93-1 Improvement Area 8E 2018 Special Tax Bonds
Location
Community Facilities District No. 93-1 Improvement Area 8E (the "CFD No. 93-1 IA 8E") is comprised of 372 single family homes and approximately 108.03 gross acres. CFD No. 93-1 IA 8E is generally located northwest of the intersection of N Highland Springs Ave. and Cougar Way.

Authorized Facilities and Bonds
CFD No. 93-1 IA 8E was formed to finance major public improvements which include, but not limited to the following: Design and Construction of Cherry Ave., Brookside Ave., Highland Springs Ave. and related Street Improvements; Landscaping costs in and around CFD No. 93-1 IA 8E; widening of Pennsylvania Ave; and Design, Engineering and Plans for Phase II of State Route 60/Portero Blvd. interchange. CFD No. 93-1 IA 8E has one series of bonds, the 2018 Special Tax Bonds.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$722,449
Less: Delincuency as of 6/30/2025
$3,729
Total Special Taxes Collected
$718,720
2025 Expenditures
Bond Interest — 3/1/2025
$272,725
Bond Interest — 9/1/2025
$272,725
Bond Principal — 9/1/2025
$140,000
Administrative Exoenses (1)
$30,000
Total Expenditures
$715,450
Ending Special Tax Fund Balance
$3,270
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 93-1 IA 8E. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 8E.

District
Series
Initial Deposit
Amount to
Improvement Fund
June 30, 2025
Balance
Project
Status
CFD No. 93-1 IA 8E
2018
$11,605,720.71
$0
Com.lete
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Page 337 of 1154 ends

14. Community Facilities District No. 93-1 Improvement Area 8F Page 16 Community Facilities District No. 93-1 Improvement Area 8F 2020 Special Tax Bonds
Location
Community Facilities District No. 93-1 Improvement Area 8F (the "CFD No. 93-1 IA 8F") is comprised of 294 single family homes and approximately 80.32 gross acres. CFD No. 93-1 IA 8F is generally located southeast of the intersection of Cherry Ave. and Brookside Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 8F was formed to finance major public improvements which include, but not limited to the following: Landscaping and related Improvements within the right-of-way along Starlight Dr., Cougar Ave., and Highland Springs Ave.; Design and Construction of Cherry Ave., Brookside Ave., and Highland Springs Ave. and related Street Improvements; Landscaping costs in and around CFD No. 93-1 IA 8F; widening of Pennsylvania Ave.; and Design, Engineering and Plans for Phase II of State Route 60/Portero Blvd. interchange.

CFD No. 93-1 IA 8F has one series of bonds, the 2020 Special Tax Bonds.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$658,712
Less: Delincuency as of 6/30/2025
$0
Total Special Taxes Collected
$658,712
2025 Expenditures
Bond Interest — 3/1/2025
$251,150
Bond Interest -9/1/2025
$251,150
Bond Principal — 9/1/2025
$120,000
Administrative Expenses (1)
$30,000
Total Expenditures
$652,300
Ending Special Tax Fund Balance
$6,412
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 93-1 IA 8F. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 8F.

District
Series
Initial Deposit
Amount to
Improvement Fund
June 30, 2025
Balance
Project
Status
CFD No. 93-1 IA 8F
2020
$12,334,439.83
$0.00
Com.lete
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Page 338 of 1154 ends

15. Community Facilities District No. 93-1 Improvement Area 9 Page 17 Community Facilities District No. 93-1 Improvement Area 9 Local Agency Refunding Bonds, Series 2019A
Location
Community Facilities District No. 93-1 Improvement Area 9 (the "CFD No. 93-1 IA 9") is comprised of 69 single family homes and approximately 13.56 gross acres. CFD No. 93-1 IA 9 is generally located northwest of the intersection of Cougar Way and Sunnyslope Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 9 was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water System, Transportation System, City Wastewater Treatment Plant, and San Timoteo Watershed Improvements); Joint Facilities - (Upper Potrero Sewer System); Individual Facilities - (Local Streets, Sanitary Sewer, and Storm Drain System). CFD No. 93-1 IA 9 has one series of bonds, the Local Agency Refunding Bonds, Series 2019A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$58,455
Less: Delincuency as of 6/30/2025
$0
Total Special Taxes Collected
$58,455
2025 Expenditures
Bond Interest — 3/1/2025
$5,850
Bond Interest — 9/1/2025
$5,850
Bond Principal — 9/1/2025
$25,000
Administrative Exoenses (1)
$20,000
Total Expenditures
$56,700
Ending Special Tax Fund Balance
$1,755
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 9. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 9.

The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 9.

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Page 339 of 1154 ends

16. Community Facilities District No. 93-1 Improvement Area 10A Page 18 Community Facilities District No. 93-1 Improvement Area 10A Local Agency Refunding Bonds, Series 2019A
Location
Community Facilities District No. 93-1 Improvement Area 10A (the "CFD No. 93-1 IA 10A") is comprised of 147 single family homes and approximately 40.07 gross acres. CFD No. 93-1 IA 10A is generally located north of the intersection of Cougar Way and Palm Ave., east of Lemon Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 10A was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water System, Transportation System, City Wastewater Treatment Plant, and San Timoteo Watershed Improvements); Joint Facilities - (Upper Potrero Sewer System); Individual Facilities - (Local Streets, Sanitary Sewer, and Storm Drain System). CFD No. 93-1 IA 10A has one series of bonds, the Local Agency Refunding Bonds, Series 2019A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$168,527
Less: Delincuency as of 6/30/2025
$2,309
Total Special Taxes Collected
$166,218
2025 Expenditures
Bond Interest — 3/1/2025
$20,925
Bond Interest — 9/1/2025
$20,925
Bond Principal — 9/1/2025
$95,000
Administrative Excenses (1)
$30,000
Total Expenditures
$166,850
Ending Special Tax Fund Balance
($632)
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 10A. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 10A. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 10A.

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Page 340 of 1154 ends

17. Community Facilities District No. 93-1 Improvement Area 11 Page 19 Community Facilities District No. 93-1 Improvement Area 11 Local Agency Refunding Bonds, Series 2019A
Location
Community Facilities District No. 93-1 Improvement Area 11 (the "CFD No. 93-1 IA 11") is comprised of 140 single family homes and approximately 38.21 gross acres. CFD No. 93-1 IA 11 is generally located southeast of the intersection of Cougar Way and Beaumont Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 11 was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water Facilities, Ring Ranch Rd., and Oak View Dr.); Joint Facilities - (Noble Creek Sewer Trunk Main and Noble Creek Sewer Force Main); Individual Facilities - (Three Rings Ranch - Collector Sewer, Oak Valley Greens — Oak View Drive Water and Collector Sewer, Oak Valley Greens — Future Facilities, and Mountain Meadows - Channel). CFD No. 93-1 IA 11 has one series of bonds, the Local Agency Refunding Bonds, Series 2019A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$117,298
Less: Delincuency as of 6/30/2025
$878
Total Special Taxes Collected
$116,420
2025 Expenditures
Bond Interest — 3/1/2025
$13,075
Bond Interest — 9/1/2025
$13,075
Bond Principal — 9/1/2025
$60,000
Administrative ExDenses(1)
$30,000
Total Expenditures
$116,150
Ending Special Tax Fund Balance
$270
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 1 1. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 11. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 11.

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Page 341 of 1 ends

18. Community Facilities District No. 93-1 Improvement Area 12A Page 120 Community Facilities District No. 93-1 Improvement Area 12A Local Agency Refunding Bonds, Series 2019A
Location
Community Facilities District No. 93-1 Improvement Area 12A (the "CFD No. 93-1 IA 12A") is comprised of 108 single family homes and approximately 29.99 gross acres. CFD No. 93-1 IA 12A is generally located south of Brookside Ave. and east of Lemon Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 12A was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water System, Transportation System, City Wastewater Treatment Plant, and San Timoteo Watershed Improvements); Joint Facilities - (Upper Potrero Sewer System); Individual Facilities - (Local Streets, Sanitary Sewer, and Storm Drain System). CFD No. 93-1 IA 12A has one series of bonds, the Local Agency Refunding Bonds, Series 2019A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$117,299
Less: Delincuency as of 6/30/2025
$0
Total Special Taxes Collected
$117,299
2025 Expenditures
Bond Interest — 3/1/2025
$13,075
Bond Interest — 9/1/2025
$13,075
Bond Principal — 9/1/2025
$60,000
Administrative Ex)enses (1)
$30,000
Total Expenditures
$116,150
Ending Special Tax Fund Balance
$1,149
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 12A. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 12A. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 12A.

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Page 342 of 1154 ends

19. Community Facilities District No. 93-1 Improvement Area 14 Page 121 Community Facilities District No. 93-1 Improvement Area 14 Special Tax Refunding Bonds, Series 2017A
Location
Community Facilities District No. 93-1 Improvement Area 14 (the "CFD No. 93-1 IA 14") is comprised of 1,937 single family homes and 4 commercial properties on approximately 534.21 gross acres. CFD No. 93-1 IA 14 is generally located northeast of the Interstate 10 Freeway, south of Brookside Ave., and north of Oak Valley Pkwy.

Authorized Facilities and Bonds
CFD No. 93-1 IA 14 was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water Facilities, Ring Ranch Road, and Oak View Drive); Joint Facilities - (Noble Creek Sewer Trunk Main and Noble Creek Sewer Force Main); Individual Facilities - (Three Rings Ranch - Collector Sewer, Oak Valley Greens — Oak View Drive Water and Collector Sewer, Oak Valley Greens — Future Facilities, and Mountain Meadows - Channel). CFD No. 93-1 IA 14 has one series of bonds, the Special Tax Refunding Bonds, Series 2017A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$639,569
Credit to Levy (1)
$453
Less: Delinquency as of 6/30/2025
$3,616
Total Special Taxes Collected
$636,406
2025 Expenditures
Bond Interest — 3/1/2025
$70,984
Bond Interest — 9/1/2025
$70,984
Bond Principal — 9/1/2025
$455,000
Administrative Exoenses (2)
$30,000
Total Expenditures
$626,968
Ending Special Tax Fund Balance
$9,438
') Credit is from a prepaid parcel.
2) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 14. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 14. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 14.

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Page 343 of 1154 ends

20. Community Facilities District No. 93-1 Improvement Area 14A Page 122 Community Facilities District No. 93-1 Improvement Area 14A Special Tax Refunding Bonds, Series 2017A
Location
Community Facilities District No. 93-1 Improvement Area 14A (the "CFD No. 93-1 IA 14A") is comprised of 1,290 single family homes and approximately 314.99 gross acres. CFD No. 93-1 IA 14A is divided into two non-contiguous areas. Both areas are generally located northeast of the Interstate 10 Freeway and south of Brookside Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 14A was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water Facilities, Transportation System, Wastewater Treatment Plant, and San Timoteo Watershed Improvements); Joint Facilities - (Upper Potrero Sewer System); Individual Facilities - (Local Streets, Sanitary Sewer, and Storm Drain System.). CFD No. 93-1 IA 14A has one series of bonds, the Special Tax Refunding Bonds, Series 2017A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$1,137,034
Credit to Levy (1)
$932
Less: Delinquency as of 6/30/2025
$4,833
Total Special Taxes Collected
$1,133,133
2025 Expenditures
Bond Interest — 3/1/2025
$148,104
Bond Interest -9/1/2025
$148,104
Bond Principal — 9/1/2025
$800,000
Administrative Expenses (2)
$30,000
Total Expenditures
$1,126,208
Ending Special Tax Fund Balance
$6,925
1) Credit is from a prepaid parcel.
2)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 14A. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 14A. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 14A.

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Page 344 of 1154 ends

21. Community Facilities District No. 93-1 Improvement Area 14B Page 123 Community Facilities District No. 93-1 Improvement Area 14B Special Tax Refunding Bonds, Series 2017A
Location
Community Facilities District No. 93-1 Improvement Area 14B (the "CFD No. 93-1 IA 14B") is comprised of 311 single family homes and approximately 90.87 gross acres. CFD No. 93-1 IA 14B is generally located northeast of Interstate 10 Freeway and is divided into three non-contiguous areas. The most northern area is south of Brookside Ave and bordered by Hannon Rd. and Union St. The most southern portion is west of Oakview Dr. and north of Oak Valley Pkwy. The most eastern area is south of the intersection of Oak View Dr. and Brookside Ave. with Oak View Dr. making up its western border.

Authorized Facilities and Bonds
CFD No. 93-1 IA 14B was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water System, Transportation System, Oak View Dr., and Ring Ranch Rd.); Joint Facilities - (Noble Creek Sewer and Three Rings Sewer); Individual Facilities - (Oak Valley Greens Water and Sewer Facilities and Marshall Creek Channel).

CFD No. 93-1 IA 14B has one series of bonds, the Special Tax Refunding Bonds, Series 2017A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$307,420.00
Less: Delinquency as of 6/30/2025
$1,002.00
Total Special Taxes Collected
$306,418.00
2025 Expenditures
Bond Interest -3/1/2025
$54,100
Bond Interest — 9/1/2025
$54,100
Bond Principal — 9/1/2025
$166,160
Administrative Expenses (1)
$30,000
Total Expenditures
$304,360
Ending Special Tax Fund Balance
$2,058
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 14B. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 14B. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 14B.

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Page 345 of 1154 ends

22. Community Facilities District No. 93-1 Improvement Area 16 Page l 24 Community Facilities District No. 93-1 Improvement Area 16 2015 Local Agency Refunding Revenue Bonds, Series D
Location
Community Facilities District No. 93-1 Improvement Area 16 (the "CFD No. 93-1 IA 16") is comprised of 241 single family homes and approximately 59.25 gross acres. CFD No. 93-1 IA 16 is generally located northwest of the intersection of Desert Lawn Dr. and Oak Valley Pkwy.

Authorized Facilities and Bonds
CFD No. 93-1 IA 16 was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water Facilities, Transportation System, City Wastewater Treatment Plant, Municipal Electrical Facilities, Fire Station, San Timoteo Watershed Improvements, and Facility Fees and Permits); Joint Facilities - (San Timoteo Sewer — Upper Oak Valley); Individual Facilities - (City Transportation System and Wastewater Treatment Plant). CFD No. 93-1 IA 16 has one series of bonds, the 2015 Local Agency Refunding Revenue Bonds, Series D.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$605,714
Less: Delincuency as of 6/30/2025
$4,191
Total Special Taxes Collected
$601,523
2025 Expenditures
Bond Interest — 3/1/2025
$89,847
Bond Interest — 9/1/2025
$89,847
Bond Principal — 9/1/2025
$390,000
Administrative ExDenses(1)
$30,000
Total Expenditures
$599,694
Ending Special Tax Fund Balance
$1,829
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 93-1 IA 16. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 16.

District
Series
Initial Deposit
Amount to
Improvement Fund
Expended
Amount
June 30, 2025
Balance(2)
Project
Status
CFD No. 93-1 IA 16
2015D
$1,738,484.10
$1,636,867.83
$106,248.69
On•oin•
(2) Balance includes interest.

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Page 346 of 1 ends

23. Community Facilities District No. 93-1 Improvement Area 17A Page 25 Community Facilities District No. 93-1 Improvement Area 17A Local Agency Refunding Bonds, Series 2021A
Location
Community Facilities District No. 93-1 Improvement Area 17A (the "CFD No. 93-1 IA 17A") is comprised of 488 single family homes and approximately 132.12 gross acres. CFD No. 93-1 IA 17A is generally located southwest of the intersection of Desert Lawn Dr. and Champions Dr.

Authorized Facilities and Bonds
CFD No. 93-1 IA 17A was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water System, Transportation System, City Wastewater Treatment Plant, Municipal Electrical Facilities, Fire Station, San Timoteo Watershed Improvements, and Facility Fees and Permits); Joint Facilities - (San Timoteo Sewer No. 2 — Upper Oak Valley); Individual Facilities - (City Transportation System and Wastewater Treatment Plant). CFD No. 93-1 IA 17A has one series of bonds, the Local Agency Refunding Bonds, Series 2021A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$753,264
Less: Delincuency as of 6/30/2025
$8,801
Total Special Taxes Collected
$744,463
2025 Expenditures
Bond Interest — 3/1/2025
$61,634
Bond Interest — 9/1/2025
$61,634
Bond Principal — 9/1/2025
$585,000
Administrative ExDenses(1)
$30,000
Total Expenditures
$738,268
Ending Special Tax Fund Balance
$6,195
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 17A. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 17A. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 17A.

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Page 347 of 1 ends

24. Community Facilities District No. 93-1 Improvement Area 17B Page 126 Community Facilities District No. 93-1 Improvement Area 17B Local Agency Refunding Bonds, Series 2020A
Location
Community Facilities District No. 93-1 Improvement Area 17B (the "CFD No. 93-1 IA 17B") is comprised of 390 single family homes and approximately 112.72 gross acres. CFD No. 93-1 IA 17B is generally located west of Desert Lawn Dr. and north of Oak Valley Pkwy.

Authorized Facilities and Bonds
CFD No. 93-1 IA 17B was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Oak Valley Pkwy and Highland Springs Ave., Recycled Water Facilities, and Facilities Fees and Permits); Individual Facilities - (San Timoteo Sewer). CFD No. 93-1 IA 17B has one series of bonds, the Local Agency Refunding Bonds, Series 2020A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$738,717
Less: Delincuency as of 6/30/2025
$1,923
Total Special Taxes Collected
$736,794
2025 Expenditures
Bond Interest -3/1/2025
$128,139
Bond Interest — 9/1/2025
$128,139
Bond Principal — 9/1/2025
$445,000
Administrative Exoenses (1)
$30,000
Total Expenditures
$731,278
Ending Special Tax Fund Balance
$5,516
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 17B. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 17B. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 17B.

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Page 348 of 1154 ends

25. Community Facilities District No. 93-1 Improvement Area 17C Page 127 Community Facilities District No. 93-1 Improvement Area 17C 2018 Special Tax Bonds
Location
Community Facilities District No. 93-1 Improvement Area 17C (the "CFD No. 93-1 IA 17O") is comprised of 216 single family homes and approximately 54.06 gross acres. CFD No. 93-1 IA 17C is generally located west of the Interstate 10 Fwy and north of Oak Valley Pkwy.

Authorized Facilities and Bonds
CFD No. 93-1 IA 17C was formed to finance major public improvements which include, but not limited to the following: Champion Dr. (Soft Costs, Street and Dry Utilities); Desert Lawn Dr. (Soft Costs, Street and Dry Utilities); Tournament Hills Storm Drain; Oak Valley Pkwy (Soft Costs, Street, Curb/Gutter and Dry Utilities); Tournament Hills Sewer; Gabion Rock; and Concrete Arch Culvert. CFD No. 93-1 IA 17C has one series of bonds, the 2018 Special Tax Bonds.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$514,863
Less: Delinquency as of 6/30/2025
$1,113
Total Special Taxes Collected
$513,750
2025 Expenditures
Bond Interest -3/1/2025
$189,938
Bond Interest — 9/1/2025
$189,938
Bond Principal — 9/1/2025
$100,000
Administrative Expenses (1)
$30,000
Total Expenditures
$509,876
Ending Special Tax Fund Balance
$3,874
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 93-1 IA 17C. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 17C.

District
Series
Initial Deposit
Amount to
Improvement Fund
June 30, 2025
Balance
Project
Status
CFD No. 93-1 IA 17C
2018
$8,325,282.90
$0.00
Com.lete
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Page 349 of 1154 ends

26. Community Facilities District No. 93-1 Improvement Area 17D Page 128 Community Facilities District No. 93-1 Improvement Area 17D Special Tax Bonds, Series 2024
Location
Community Facilities District No. 93-1 Improvement Area 17D (the "CFD No. 93-1 IA 17D") is comprised of 268 single family homes and approximately 62.22 gross acres. CFD No. 93-1 IA 17D is generally located north of Oak Valley Pkwy and east of Omeara Way.

Authorized Facilities and Bonds
CFD No. 93-1 IA 17D was formed for the purpose of financing the acquisition and construction of Public Infrastructure Facilities, which include, but not limited to: Transportation Facilities; Wastewater Treatment Facilities; Fire Station Facilities; Domestic Water Facilities; Recycled Water Facilities; Regional Park Facilities; Emergency Preparedness Facilities; and Sewer System Facilities. CFD No. 93-1 IA 17D has one series of bonds, the Special Tax Bonds, Series 2024.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$550,849
Less: Delinquency as of 6/30/2025
$1,094
Total Special Taxes Collected
$549,755
2025 Expenditures
Bond Interest -3/1/2025
$150,139
Bond Interest — 9/1/2025
$235,000
Bond Principal — 9/1/2025
$85,000
Administrative Expenses (1)
$30,000
Total Expenditures
$500,139
Ending Special Tax Fund Balance
$49,616
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 93-1 IA 17D. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 17D.

District
Series
Initial Deposit
Amount to
Improvement Fund
Expended
Amount
June 30, 2025
Balance(2)
Project
Status
CFD No. 93-1 IA 17D
2024
$8,863,651.89
$8,825,117.44
$38,534A5
On.oin.

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Page 350 of 1154 ends

27. Community Facilities District No. 93-1 Improvement Area 18 Page 129 Community Facilities District No. 93-1 Improvement Area 18 2015 Local Agency Refunding Bonds, Series C
Location
Community Facilities District No. 93-1 Improvement Area 18 (the "CFD No. 93-1 IA 18") is comprised of 194 single family homes and approximately 74.53 gross acres. CFD No. 93-1 IA 18 is generally located northeast of the Interstate 10 Fwy and south of Brookside Ave.

Authorized Facilities and Bonds
CFD No. 93-1 IA 18 was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic Water Facilities, Transportation System, City Wastewater Treatment Plant, Municipal Electrical Facilities, Fire Station, San Timoteo Watershed Improvements, and Facility Fees and Permits); Joint Facilities - (San Timoteo Sewer No. 2 — Upper Oak Valley); Individual Facilities - (Transportation System and Wastewater Treatment Plant). CFD No. 93-1 IA 18 has one series of bonds, the 2015 Local Agency Refunding Bonds, Series C.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$414,784
Less: Delincuency as of 6/30/2025
$0
Total Special Taxes Collected
$414,784
2025 Expenditures
Bond Interest — 3/1/2025
$60,303
Bond Interest — 9/1/2025
$60,303
Bond Principal — 9/1/2025
$260,000
Administrative Exoenses (1)
$30,000
Total Expenditures
$410,606
Ending Special Tax Fund Balance
$4,178
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 18. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 18. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 18.

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Page 351 of 1154 ends

28. Community Facilities District No. 93-1 Improvement Area 19A Page 30 Community Facilities District No. 93-1 Improvement Area 19A 2015 Local Agency Refunding, Series B
Location
Community Facilities District No. 93-1 Improvement Area 19A (the "CFD No. 93-1 IA 19A") is comprised of 546 single family homes and approximately 140.94 gross acres. CFD No. 93-1 IA 19A is generally located south of the Interstate 10 Freeway and west of Tukwet Canyon Pkwy.

Authorized Facilities and Bonds
CFD No. 93-1 IA 19A was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Domestic and Recycled Water System, Facility Fees, Plans, Studies and Permits); First Priority Joint Facilities - (San Timoteo Sewer No, 1A — Lower Oak Valley and San Timoteo Sewer No. 3 — Beaumont Mesa); Second Priority Joint Facilities — (Oak Valley Pkwy, Cherry Valley Blvd, Champions Dr., and Palmer Ave.); Individual Facilities - (Transportation Facilities, Domestic Water, Recycled Water, Sewer Transmission and Treatment, Traffic Signals and Street Lighting, Public Safety, Public Works and Administrative, Watershed Management and Storm Drain, Facility Fees, Plans, Studies and Permits, Planning, Engineering and Environmental Reports, Community Parks, and Multipurpose Trails Maintenance). CFD No. 93-1 IA 19A has one series of bonds, the 2015 Local Agency Refunding, Series B.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$1,543,078
Less: Delincuency as of 6/30/2025
$9,718
Total Special Taxes Collected
$1,533,360
2025 Expenditures
Bond Interest — 3/1/2025
$281,331
Bond Interest -9/1/2025
$281,331
Bond Principal — 9/1/2025
$935,000
Administrative Expenses (1)
$30,000
Total Expenditures
$1,527,662
Ending Special Tax Fund Balance
$5,698
')Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 19A. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 19A. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 19A.

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Page 352 of 1154 ends

29. Community Facilities District No. 93-1 Improvement Area 19C Page 31 Community Facilities District No. 93-1 Improvement Area 19C Special Tax Refunding Bonds, Series 2017A
Local Agency Refunding Bonds, Series 2021A
Location
Community Facilities District No. 93-1 Improvement Area 19C (the "CFD No. 93-1 IA 19O") is comprised of 669 single family homes and approximately 283.47 gross acres. CFD No. 93-1 IA 19C is generally located northeast of Oak Valley Pkwy and west of Harmon Heights.

Authorized Facilities and Bonds
CFD No. 93-1 IA 19C was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, TUMF Facilities, Non-TUMF Transportation Facilities, San Timoteo Watershed Management Facilities, Engineering and Environmental Reports, Sewage Treatment Facilities, Recycled Water Facilities, Hannon Tank, Domestic Water Well, Facility Engineering, Fees and Permits, Transportation Facilities, and Wastewater and Recycled Water Facilities); Individual Facilities - (BCVWD Fees, Oak Valley Pkwy Improvements, Palmer Ave. Improvements, Storm Drain and Water Quality Facilities, BCVWD Frontage Fees, Prepaid Engineering and Formation Costs, Prepaid Citywide Fees, Traffic Signals, Bridges and Overpasses, Police and Administrative Facilities, General Plan Update, Wastewater Administration, Regional Park Facilities, and Emergency Preparedness Facilities). CFD No. 93-1 IA 19C has two series of bonds, the Special Tax Refunding Bonds, Series 2017A and the Local Agency Refunding Bonds, Series 2021A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$1,643,036
Less: Delinquency as of 6/30/2025
$5,927
Total Special Taxes Collected
$1,637,109
2025 Expenditures
Bond Interest — 3/1/2025
$228,616
Bond Interest — 9/1/2025
$228,616
Bond Principal — 9/1/2025
$1,122,811
Administrative Expenses (1)
$30,000
Total Expenditures
$1,610,043
Ending Special Tax Fund Balance
$27,066
')Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 19C. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 19C. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 19C.

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Page 353 of 1154 ends

30. Community Facilities District No. 93-1 Improvement Area 20 Page 32 Community Facilities District No. 93-1 Improvement Area 20 Local Agency Refunding Bonds, Series 2021A
Location
Community Facilities District No. 93-1 Improvement Area 20 (the "CFD No. 93-1 IA 20") is comprised of 106 single family homes and approximately 30.04 gross acres. CFD No. 93-1 IA 20 is generally located south of Potrero Blvd and west of Manzanita Park Rd.

Authorized Facilities and Bonds
CFD No. 93-1 IA 20 was formed to finance major public improvements which include, but not limited to the following: Critical Facilities - (City Program, Potrero Boulevard and Fourth Street Extension, Sewer Treatment Facilities, San Timoteo Recovery Wells, High School Bike and Pedestrian Facilities, and Facilities Fees and Permits); Joint Facilities - (Lower Potrero Sewer and Southern Truck Main). CFD No. 93-1 IA 20 has one series of bonds, the Local Agency Refunding Bonds, Series 2021A.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$250,730
Less: Delincuency as of 6/30/2025
$0
Total Special Taxes Collected
$250,730
2025 Expenditures
Bond Interest — 3/1/2025
$21,605
Bond Interest — 9/1/2025
$21,605
Bond Principal — 9/1/2025
$175,000
Administrative Expenses (1)
$30,000
Total Expenditures
$248,210
Ending Special Tax Fund Balance
$2,520
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement/Construction Funds of CFD No. 93-1 IA 20. All improvements funded by these bond series are complete. There were no Improvement/Construction Funds associated with the refunding of the bonds in CFD No. 93-1 IA 20. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 93-1 IA 20.

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Page 354 of 1154 ends

31. Community Facilities District No. 2016-1 Page
33 Community Facilities District No. 2016-1
2019 Special Tax Bonds
Location
Community Facilities District No. 2016-1 (the "CFD No. 2016-1") is comprised of 372 single family homes and approximately 101.85 gross acres. CFD No. 2016-1 is located southwest of the Interstate 10 Fwy and is divided into two non-contiguous areas. The southern area is generally located west of Tukwet Canyon Pkwy and north of Oak Valley Pkwy. The northern area is located east of Tukwet Canyon Pkwy and north of Champions Dr.

Authorized Facilities and Bonds
CFD No. 2016-1 was formed to finance major public improvements which include, but not limited to the following: Sewer System Improvements; Storm Drain Improvements; Dry Utilities Infrastructure; Street Improvements; and Gas Line Relocation. CFD No. 2016-1 has one series of bonds, the 2019 Special Tax Bonds.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$587,089
Less: Delincuency as of 6/30/2025
$6,514
Total Special Taxes Collected
$580,575
2025 Expenditures
Bond Interest — 3/1/2025
$180,244
Bond Interest — 9/1/2025
$180,244
Bond Principal — 9/1/2025
$185,000
Administrative Expenses (1)
$30,000
Total Expenditures
$575,488
Ending Special Tax Fund Balance
$5,087
)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 2016-1. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 2016-1.

Series
Initial Deposit I
Amount to
Improvement Fund
Expended
Amount
June 30, 2025
Balance(2)
Project
Status
District
CFD No. 2016-1
2019
$8,637,028.95
$8,636,131.48
$937.47
On.oin.
(2) Balance includes interest.

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Page 355 of 1 ends

32. Community Facilities District No. 2016-2

Page 34 ends

Community Facilities District No. 2016-2
2019 Special Tax Bonds
Location
Community Facilities District No. 2016-2 (the "CFD No. 2016-2") is comprised of 527 single family homes and approximately 109.40 gross acres. CFD No. 2016-2 is generally located east of Cherry Ave, south of Cougar Way, and west of Starlight Ave.

Authorized Facilities and Bonds
CFD No. 2016-2 was formed to finance major public improvements which include, but not limited to the following: Development Impact Fees ("DIF"); DIF Facilities; and Cherry Avenue Facilities. CFD No. 2016-2 has one series of bonds, the 2019 Special Tax Bonds.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$674,220
Less: Delinquency as of 6/30/2025
$2,977
Total Special Taxes Collected
$671,243
2025 Expenditures
Bond Interest — 3/1/2025
$208,750
Bond Interest — 9/1/2025
$208,750
Bond Principal — 9/1/2025
$220,000
Administrative Excenses (1)
$30,000
Total Expenditures
$667,500
Ending Special Tax Fund Balance
$3,743
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 2016-2. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 2016-2.

District
Series
Initial Deposit
Amount to
Improvement Fund
Expended
Amount
June 30, 2025
Balance(2)
Project
Status
CFD No. 2016-2
2019
$10,410,089.99
$10,399,711.65
$10,851.42
On.oin.
(2) Balance includes interest.

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Page 356 of 1154 ends

33. Community Facilities District No. 2016-3 Page 135
Community Facilities District No. 2016-3
2023 Special Tax Bonds
2025 Special Tax Bonds
Location
Community Facilities District No. 2016-3 (the "CFD No. 2016-3") development is expected to include 704 single family homes and comprises approximately 152.92 gross acres. CFD No. 2016-3 is generally east of Starlight Ave., west of Highland Springs Ave., and south of Cougar Way.

Authorized Facilities and Bonds
CFD No. 2016-3 was formed to finance major public improvements which include, but not limited to the following: Development Impact Fees ("DIF") and DIF Facilities. CFD No. 2016-3 has two series of bonds, the 2023 Special Tax Bonds and the 2025 Special Tax Bonds.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$896,734
Less: Delincuency as of 6/30/2025
$11,598
Total Special Taxes Collected
$885,136
2025 Expenditures
Bond Interest — 3/1/2025
$216,625
Bond Interest — 9/1/2025
$346,397
Bond Principal — 9/1/2025
$220,000
Administrative Expenses (1)
$30,000
Total Expenditures
$813,022
Ending Special Tax Fund Balance
$72,114
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 2016-3. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 2016-3.

District
Series
Initial Deposit
Amount to
Improvement Fund
Expended
Amount
June 30, 2025
Balance(2)
Project
Status
CFD No. 2016-3
2023
$8,250,000.00
$7,128,571.18
$1,121,428.82
Ongoing
CFD No. 2016-3
2025
$5,888,636.70
$5,888,636.70
$0
Complete
(2) Balance includes interest.

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Page 357 of 1154 ends

34. Community Facilities District No. 2016-4 Page 36
Community Facilities District No. 2016-4
2019 Special Tax Bonds
Location
Community Facilities District No. 2016-4 (the "CFD No. 2016-4") is comprised of 346 single family homes and approximately 86.52 gross acres. CFD No. 2016-4 is generally located northwest of the intersection of Breckenridge Ave. and Highland Springs Ave.

Authorized Facilities and Bonds
CFD No. 2016-4 was formed to finance major public improvements which include, but not limited to the following: Lower Potrero System Improvements, including Lift Station; Lower Potrero Sewer No. 2, including Southern Trunk Main; Potrero Blvd. Bridge and Road Improvements; and Highland Springs Ave. Bridge and Road Improvements. CFD No. 2016-4 has one series of bonds, the 2019 Special Tax Bonds.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$278,642
Less: Delincuency as of 6/30/2025
$1,347
Total Special Taxes Collected
$277,295
2025 Expenditures
Bond Interest — 3/1/2025
$77,938
Bond Interest — 9/1/2025
$77,938
Bond Principal — 9/1/2025
$90,000
Administrative Ex)enses (1)
$30,000
Total Expenditures
$275,876
Ending Special Tax Fund Balance
$1,419
1)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 2016-4. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 2016-4.

District
Series
Initial Deposit
Amount to
Improvement Fund
Expended
Amount
June 30, 2025
Balance)
Project
Status
CFD No. 2016-4
2019
$4,077,629.35
$4,052,200.04
$26,588.71
On.oin.
(2) Balance includes interest,
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35. Community Facilities District No. 2019-1 Page l 37
Community Facilities District No. 2019-1
2020 Special Tax Bonds
Location
Community Facilities District No. 2019-1 (the "CFD No. 2019-1") is comprised of 118 single family homes and approximately 30.32 gross acres. CFD No. 2019-1 is divided into two non-contiguous zones. Zone 1 is generally located southwest of the intersection of Carnation Ln. and Xenia Ave. Zone 2 is generally located northeast of the intersection of Cherry Ave. and Mary Ln.

Authorized Facilities and Bonds
CFD No. 2019-1 was formed to finance major public improvements which include, but not limited to the following: Design and Construction of Highland Springs Ave and related Street Improvements; Design and Construction of Cherry Ave. and related Street Improvements; Design and Construction of Storm Drain Improvements along Cherry Ave.; and Design and Construction of Sewer Improvements along Cherry Ave. CFD No. 2019-1 has one series of bonds, the 2020 Special Tax Bonds.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$147,415
Less: Delincuency as of 6/30/2025
$1,246
Total Special Taxes Collected
$146,169
2025 Expenditures
Bond Interest — 3/1/2025
$37,244
Bond Interest — 9/1/2025
$37,244
Bond Principal — 9/1/2025
$50,000
Administrative Expenses (1)
$20,000
Total Expenditures
$144,488
Ending Special Tax Fund Balance
$1,681
)Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 2019-1. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 2019-1.

District
Series
Initial Deposit
Amount to
Improvement Fund
June 30, 2025
Balance
Project
Status
CFD No. 2019-1
2020
$2,119,549.25
$0.00
Com.lete
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36. Community Facilities District No. 2021-1 Page
38 Community Facilities District No. 2021-1
2024 Special Tax Bonds
Location
Community Facilities District No. 2021-1 (the "CFD No. 2021-1") is comprised of 529 single family homes and approximately 102.77 gross acres. CFD No. 2021-1 is generally located south of Champions Drive, east of Tukwet Canyon Parkway, and north of Oak Valley Parkway.

Authorized Facilities and Bonds
CFD No. 2021-1 was formed to finance major public improvements which include, but not limited to the following: roadway, sewer, domestic and reclaimed water, dry utilities, storm drain, curb and gutter, medians, traffic signals and any other facilities permitted, parks, trails, police facilities, fire facilities, library facilities, public community facilities, appurtenances and appurtenant work, and development impact fees that are used by the City to construct infrastructure including design, engineering, and planning costs associated therewith.

CFD No. 2021-1 has one series of bonds, the 2024 Special Tax Bonds.

Description
Amount
FY 2024-25 Revenues
Special Taxes Levied
$1,043,370
Less: Delincuency as of 6/30/2025
$5,226
Total Special Taxes Collected
$1,038,144
2025 Expenditures
Bond Interest — 3/1/2025
$356,000
Bond Interest — 9/1/2025
$356,000
Bond Principal — 9/1/2025
$200,000
Administrative Ex3enses(1
$30,000
Total Expenditures
$942,000
Ending Special Tax Fund Balance
$96,144
1) Amount allocated to Administrative Expenses and may not have been expended in its entirety.

Project Status
The requirements of the Act apply to the Improvement Fund of CFD No. 2021-1. The following table shows the initial amount deposited to the Improvement Fund, the amount expended, the June 30, 2025, Improvement Fund balance, and the project status. The amounts levied pay the administrative expenses, debt service (principal and interest), and remaining facilities eligible to be financed for CFD No. 2021-1.

District
Series
Initial Deposit
Amount to
Improvement Fund
Expended
Amount
June 30, 2025
Balance2)
Project
Status
CFD No. 2021-1
2024
$14,342,289.14
$14,216,805.86
$137,545.38
On•oin.
2) Balance includes interest.

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BEAUMONT
-C A L I F O R N A -
Staff Report
TO: City Council
FROM: Kari Mendoza, Administrative Services Director
DATE: December 2, 2025
SUBJECT: Participation Agreement with the Voluntary Employee Benefits Association (VEBA)
Description: Consideration of transition to a new medical pool with Keenan and Associates due to dissolution of the existing medical pool administered by Fire Risk Management Services
Background and Analysis:

The City of Beaumont negotiates employees' medical and dental benefit renewals on an annual basis. In October 2025, new proposals were received from the City's contracted insurance broker, Keenan and Associates, due to our current benefit pool provider, Fire Risk Management Services (FRMS), dissolving as a Joint Power Agreement. As a result of the dissolution, all participating agencies must transition to an alternative medical provider before the dissolution to ensure uninterrupted coverage. Therefore, staff sought to find the best and affordable options for uninterrupted benefits.

Kennan and Associates solicited competitive quotes from multiple carriers and presented the staff with three medical alternatives. Those options included Kaiser as a single source, BlueShield as a single source and a combined Kaiser/Blue Shield option offered through VEBA. Consistent with past practice and in alignment with labor group preferences, staff sought to maintain at least two medical plan choices for employees.

In consideration of all options presented, and in alignment with existing health care options, staff assessed that VEBA provides the most cost-effective and stable medical choices for our employees and their families.

While Guardian remained the most competitive for dental coverage, EyeMed provided a 15% savings in comparable vision insurance and Lincoln provided a 12% savings in life and disability insurance.

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Fiscal Impact:

There are no additional fees associated with our VEBA membership. The City cafeteria plan allotment is set by MOU, so there are no direct cost savings. All personnel benefit costs are fully budgeted. The commission on the VEBA medical coverage is 3%, which is paid direct from the carriers to VEBA. Keenan and Associates commission varies bason on the ancillary benefit but does not exceed 15%.

The estimated cost to prepare this report is $400.

Recommended Action:

Authorize the City Manager to sign the participation agreement with VEBA; Authorize the City Manager to sign Eyemed application; and Authorize the City Manager to sign Lincoln application.

Attachments:

A. VEBA Participation Agreement
B. VEBA Administrative Policies and Procedures
C. EyeMed Application
D. Lincoln Application

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YOUR HEALTH, OUR PURPOSE

VOLUNTARY EMPLOYEES BENEFITS ASSOCIATION (VEBA)

PARTICIPATION AGREEMENT
(NON -COLLECTIVE BARGAINING UNIT)
This PARTICIPATION AGREEMENT ("Agreement"), is entered into by and between the VOLUNTARY EMPLOYEES BENEFITS ASSOCIATION ("VEBA"), a tax exempt voluntary employee benefits trust under Internal Revenue Code, Section 501(c)(9), and the City of Beaumont, California ('Employer").

RECITALS

1. WHEREAS, VEBA has been established for the purpose of providing health and welfare benefits, as defined in Sections 3543.2 and 53200 of the California Government Code, for the employees of eligible employers (as defined by VEBA's governing documents described at Section 2 herein) and their dependents; and

2. WHEREAS, the Employer has established a policy providing eligible employees with health and welfare benefits sponsored by VEBA; and

3. WHEREAS, the VEBA wishes to enter into an agreement with the Employer to provide health and welfare benefits.

AGREEMENT
In consideration of the mutual promises and covenants contained herein, the parties agree as follows:

1. Term.

The initial term of this Agreement shall begin on the Effective Date set forth in Exhibit A and shall continue in effect until terminated pursuant to Section 8 of this agreement.

2. Incorporation of Agreement Establishing the VEBA and VEBA Administrative Policies and Procedures.

The Employer, its employees and their dependents hereby agree to be bound by the terms contained in the documents entitled "Restated Agreement and Declaration of Trust Establishing the Southern California Schools Voluntary Employees Benefits Association" Participation Agreement

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("VEBA Agreement"), and VEBA Administrative Policies and Procedures, incorporated herein by this reference.

3. EMPLOYER'S ELIGIBILITY RULES.
a. As a condition of participation in VEBA, the Employer will establish or modify any written policies governing the provision of health and welfare benefits to employees so that such documents comport with all provisions of the VEBA Agreement and this Agreement and, in the absence of such modification, hereby agree that the specific provisions of the VEBA Agreement and this Agreement shall supersede any terms of the Employer's policies which conflict with either Agreement.
b. This Agreement shall not take effect until the Employer provides VEBA with a copy of any and all policies governing the eligibility of employees and their dependents to receive health and welfare benefits by virtue of their present or former employment with the Employer. The Employer shall immediately provide VEBA with copies of any future changes to such policies.

4. Plan Changes and Waiver of Duty to Bargain for Plan Changes. a. The VEBA reserves the right to amend or modify any of the benefits plans. If contributions and reserves of the VEBA are not adequate in the judgment of the Directors of the VEBA to provide benefits, pay administration expenses, and maintain reasonable reserves, the Directors may amend or modify any of the benefit plans provided that such action shall not be taken until after the Employer is provided at least forty-five (45) days advance written notice of such changes. b. The Employer agrees to waive during its participation in the VEBA any right to negotiate over the content of any benefit plans sponsored by VEBA, the insurers, or the claim administration for existing health and welfare benefits.

5. Selection of Benefit Plans and Election Forms.
a. The Employer shall select one or more VEBA-approved benefits plans to offer its employees or former employees using one or more forms provided by VEBA ("Election Form"), which is attached hereto as Exhibit A and incorporated into this Agreement as if fully set forth here, which shall be submitted to the VEBA prior to the effective date of this Agreement.
b. The choices specified in the Election Form may be changed on or after the effective date of this Agreement, and on or after the first day of each subsequent Plan Year (as defined at Exhibit A), however, all changes will be made upon the sole discretion of VEBA. Changes may be requested by delivering a signed, amended Election Form to VEBA. Following approval by VEBA, all changes will become effective the first day of the second calendar month following receipt by the VEBA, Participation Agreement

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or the first day of a later month specified in the amended Election Form. c. If the Employer's policies governing employee, or former employee eligibility for benefits requires employees to pay a portion of the contribution, the Employer is solely responsible for the collection of the employee contributions. The Employer is responsible for payment to the VEBA of the full contribution for each employee receiving benefits under one of the plans specified in the Election Form. d. The Employer will be notified in writing of applicable rates and benefit and eligibility rules changes at least forty-five (45) days prior to their effective date. e. The Employer shall attach as Exhibit B, a copy of all Employer health and welfare benefit plan eligibility provisions for VEBA review and approval. The provisions of this Agreement, the VEBA Agreement, the benefit plans, and the Uniform Eligibility Rules of VEBA shall supersede any conflicting provisions of any Employer policies or practices.

6. Contribution and Reports.
a. The Employer shall prepare and submit to the VEBA monthly or tently by such date as the VEBA prescribes a current list on a form to be supplied by the VEBA, of all current or former employees who are covered under each Plan annotated to add newly enrolling employees or former employee and to delete employees or former employees who are no longer eligible.
b. Contributions for employees and/or former employees covered pursuant to each respective Plan shall be paid by the Employer on a monthly or tenthly basis in the amount per employee specified for each employee included on the monthly list referred to in Section 6(a).
c. Contributions to the VEBA are due on the first day of the month and shall be considered delinquent if not received by the 21st day of the month in which the contributions were first due, or if postmarked later than the 20th day of the month in which the contributions were first due. Liquidated damages and interest shall be charged to delinquent contributions in accordance with the VEBA Agreement. d. Actual amounts to be contributed, pursuant to this section, are set out as an attachment to this Agreement and are labeled Exhibit C. Unless otherwise modified by the VEBA, according to the terms of Section 4, a revised Exhibit C shall be forwarded by the VEBA to the Employer annually, for incorporation into this Agreement.

7. Distribution of Materials.
a. The Employer agrees to distribute to employees, enrollment forms, benefit descriptions, benefit certificates, provider directories, claim forms, and other forms Participation Agreement

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or documents usually supplied in connection with the enrollment process. b. The Employer understands and agrees that it will assume complete responsibility for administering COBRA continuation benefits for employees and eligible dependents in accordance with the requirements of Public Health Service Act §2202, 42 U.S.C. 300bb and following, and will completely indemnify and hold harmless VEBA with regard to same. These duties include, but are not limited to, the provision of an initial COBRA notice to each Participant and his or her spouse and eligible dependents, and the provision of subsequent COBRA notices upon the occurrence of qualifying events. Also, the Employer shall notify VEBA of termination, reduction in hours, or death of any employee, as required by law.

8. Termination.
a. The Employer may terminate their participation in the VEBA by providing notice to the VEBA one hundred twenty (120) days prior to the end of the plan year. b. Termination notices received by the VEBA are non -rescindable. In addition, an Employer will be prohibited from reapplying for VEBA membership for a period of three (3) years subsequent to terminating membership in VEBA. c. The VEBA may terminate this Agreement if the Employer fails to fulfill its obligations under this Agreement, or at any time the Employer fails or refuses to make all payments required hereunder, within twenty (20) days after service of a written notice from the VEBA demanding payment.
d. Following termination of this Agreement, the VEBA shall be responsible for payment of eligible claims of covered individuals incurred on or before the termination date only in accordance with the terms and specifications of the VEBA Agreement and of each applicable Plan.
e. The parties acknowledge that, after termination of participation, neither the employees nor the Employer shall retain any right or interest in the VEBA Fund or any of its assets and shall not be entitled to any share of the reserves maintained by the VEBA Fund upon their withdrawal from participation.

9. Waiver of Claims.

The Employer hereby waives any claim against the Directors, agents or employees of the VEBA for any loss, cost or expenses, including attorneys' fees, alleged to arise from or relate to the Directors', agents' or employees' good faith discharge of responsibilities under the VEBA Agreement or this Agreement.

10. Arbitration.

The parties agree that any controversy or claim arising out of or relating to the Participation Agreement

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interpretation or application of this Agreement, or any breach thereof, including any claim that this Agreement is, in whole or in part, invalid, illegal or otherwise voidable or void, shall be submitted to arbitration in accordance with the Rules of the American Arbitration Association and judgment upon the award may be entered in any court with jurisdiction.

11. Severability.

If any provision of this Agreement or application thereof is held invalid, the invalidity shall not affect other provisions or applications of the Agreement which can be given effect with the invalid provision or application, and to this end the provisions of this Agreement are declared to be severable.

12. Notice.

Any written notice required by or pertaining to this Agreement shall be sent to the noticed party by prepaid first class mail, at the address listed below:

If to the VEBA:

Ca1VEBA
c/o VEBA General Manager
[email protected]
1843 Hotel Circle South, Suite 100"
San Diego, CA 92108

13. Agreement Ratification.

VEBA
4146 If to the Employer:

City of Beaumont
City Manager
550 E. 6th Street
Beaumont, CA 92223
This Agreement shall not be effective until it has been ratified by the Employer and verification of such ratification is provided to the VEBA.

By: Dated:

Name: Laura Josh
Title: VEBA General Manager
City of Beaumont
By:

Name:

Title:

Dated:

Participation Agreement

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Date of ratification by Governing Board of the Employer (if applicable):

YOUR HEALTH, OUR PURPOSE

EXHIBIT A

BENEFIT PLAN ELECTION FORM
(NON -COLLECTIVE BARGAINING UNIT)
This BENEFIT PLAN ELECTION FORM ("Election Form") is submitted to the VOLUNTARY EMPLOYEES BENEFITS ASSOCIATION ("VEBA"), a tax exempt voluntary employee benefits trust under Internal Revenue Code, Section 501(c)(9), by the City of Beaumont, California ("Employer").

Pursuant to the terms of the Participation Agreement executed between the parties, the following information represents the benefit election information for the Employer. The benefit plan election may only be changed in accordance with Paragraph 5 of the Participation Agreement.

EFFECTIVE DATE: The Participation of the Employer in the VEBA shall be effective on January 1St, 2026.

PLAN YEAR: The first plan year shall begin on the effective date and end on December 31St, 2026. All subsequent plan years shall begin on January 1 of each year and end on the next following December 31.

PAYMENTS: Payments made to VEBA shall be made on a monthly basis.

PLAN ELECTIONS:

EE
EE + SP
EE + CH
EE + FAM
Sunrest PPO*
$1,536.00
$2,996.00
$2,750.00
$4,180.00
Journey HMO w/HRA*
$1,072.00
$2,459.00
$1,819.00
$3,099.00
Alliance HMO*
$940.00
$2,156.00
$1,595.00
$2,717.00
Kaiser DHMO
$969.00
$1,773.00
$1,574.00
$2,094.00
Participation Agreement

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EE
EE + SP
EE + CH
EE + FAM
Kaiser HMO
$1,129.00
$2,067.00
$1,835.00
$2,443.00
Guardian Dental (PPO)
$55.89
$108.17
$130.31
$179.86
Guardian Dental (HMO)
$17.31
$34.24
$12.39
$29.23
$48.46
Vision EyeMed
$6.87
$12.63
$19.98
1�
Participation Agreement

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YOUR HEALTH, OUR PURPOSE

EXHIBIT B

ELIGIBILITY

EMPLOYER SHALL ATTACH BENEFITS ELIGIBILITY PROVISIONS FOR VEBA BOARD REVIEW AND APPROVAL.

Participation Agreement

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CALIFORNIA SCHOOLS
•
BA
California Schools
Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures

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California Schools
Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures
Table of Contents
I Introduction 5
II Purpose of VEBA 6
III Underwriting Rules
Guidelines and Rules for VEBA Participation 8
Waiver of Coverage 8
Rate Structures 9
What Employers and Bargaining Units May Select Within VEBA 11 IV Employer Participation Provisions
Eligible Employers 12
Required Participation Documents 12
Documenting Practices for Collective Bargaining Units 13 Documenting Practices for Non -Collective Bargaining Units 13 Additional Eligibility Rules for Charter Schools Where No Fringe Benefits Collective Bargaining Agreement Exists 13
Role of Employer in Certifying Enrollment 13
Transmission of Eligibility Information 13
Premium Payments 13
Annual Renewal 14
Verification Procedures (Revised 5/17/2013, 6/29/2016 and 8/30/2017) 14 VEBA's Involvement in the Collective Bargaining Process 16 Plan Changes 16
Termination of Participation in VEBA 17
V Employee/Dependent Participation Provisions
Eligibility 18
Dual Coverage Exclusion Option 18
Eligible Employees 19
Full -Time Employees 19
Part -Time Employees 19
Employees on Employer -Approved Leave of Absence 19
School Board Members 19
Qualified Charter School Employees 19
Employee Organization/Association Staff Members 20
Retirees 20
Military Reservists Called to Active Duty 21
Employees of Private Employers Directly Associated with VEBA 21 Employees of Other Public Sector Employers 21
Eligible Dependents (Revised 9/28/2019) 21
Special Dependent Categories 22
Guardianship 22
Adoption 22
Grandchildren 22
Handicapped Child 22
Domestic Partner Coverage 23
Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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California Schools
Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures
VI Timing of Employee and Dependent Coverage
Effective Date of Coverage
New or Newly Eligible Employees 24
School Board Members 24
Open Enrollment Period 24
Adding Newly Eligible Dependents After an Employee's
Coverage Effective Date 24
New Marriage 25
Newborn Coverage 25
Adoption 25
Court -Ordered Coverage 25
Domestic Partner Coverage 26
Special Enrollment Option (HIPAA) 26
Termination of Coverage
Employee/Retiree 27
Dependent(s) 27
Cessation of Required Employee Contribution 28
Retroactivity 29
Employee Responsibility to Notify of Eligibility Changes 29 Consequences of Continuing Coverage for Ineligible Dependents 29 VII Provisions Related to Domestic Partner Coverage
Domestic Partner Coverage (Revised 9/28/2019) 30
Possible Tax Implications of Domestic Partner Coverage 30 Eligibility 31
Cessation of Domestic Partner Coverage 33
Modification or Termination of Policy (Revised 9/28/2019) 34 VIII Provisions Related to VEBA Post -65 Retiree Plan
Eligible Employees/Dependents 35
Enrollment Conditions 35
Termination of Coverage 36
IX Federal and State Regulations and Regulatory Resources Member Appeals 37
Converting Coverage to an Individual Policy Directly with the Carrier 37 Continuation Coverage for Retired Certificated Employees and Spouses (Ed. Code Section 7000 also known as AB528) 37
Medicare Secondary Payer Program 38
Consolidated Omnibus Budget Reconciliation Act (COBRA) 38 Employers Who Must Comply 38
Individuals Eligible to Elect COBRA Continuation Coverage 39 COBRA Qualifying Events 39
Secondary Qualifying Event 40
Loss of Coverage in Anticipation of a Qualifying Event 41 Extension of COBRA Due to Qualification for Social Security Disability 41 The Types of Plans to Which COBRA Applies 42
Flexible Spending Accounts (FSAs) 43
Alternative Coverage 44
Notifications 44
Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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California Schools
Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures
Election Period and Time Frames 49
Incapacitation 51
Terminating Events 51
COBRA Premiums 52
Health Insurance Portability and Accountability Act (HIPAA) Certificate of Coverage 53
Special Enrollment Provisions 54
X Exhibits 56
Ten -Tier Rate Structure Exhibit A
Domestic Partner Documents Exhibit B
Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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California Schools
Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures
Section I
Introduction
A. The purpose of this document is to provide written guidance to Employer's and their Benefits Administrators as to the rules, regulations, policies, procedures and practices of the California Schools Voluntary Employees Benefits Association (VEBA). It is not intended for distribution to VEBA Members.

B. The VEBA Administrator is the Custodial Agent designated by the VEBA Board of Directors responsible for the administration of the VEBA.

C. Plan booklets and Carrier Contracts provide detailed descriptions of the benefits and provisions of the VEBA Plans. Nothing in this document shall override the benefits and provisions described in the Carrier Contracts and Plan booklets.

D. The provisions in this document control to the extent that they are not contrary to applicable law.

E. Throughout this document, certain words or terms are capitalized and indicate a defined term or a heading.

Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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5 California Schools
Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures
Section II
Purpose of VEBA
A. VEBA is a voluntary, joint labor-management benefits organization. VEBA is a tax- exempt organization, established pursuant to a Trust Agreement and administered by a Board of Directors consisting of representatives of management and labor. Through VEBA, Employers and Employee Organizations/Associations work to resolve employee benefits issues seeking to provide quality health and welfare benefits at the lowest possible cost. Employers, Employee Organizations/Associations, and their Employees benefit through reduced costs and quality coverage for several reasons including:

1. Greater quality control and oversight through uniformity of plan design, purchase, and administration

2. Better plan design and more flexibility

3. Wider choice of benefits

4. Periodic member satisfaction measurement surveys

5. Lower administrative costs through combined buying power

6. Rate stability

7. Containment of future cost

8. Risk pool and buying power for both small and large groups

9. The power of cooperative shared governance
B. Health Improvement Initiatives
The California Schools VEBA is committed to offering innovative initiatives and resources to help members better manage their health. The following describes VEBA's objectives in the Health Improvement Initiatives programs:

1. Encourage prevention and early detection of disease

2. Provide disease management programs to empower members to better manage chronic conditions and illnesses

3. Provide the opportunity for members to get the right critical care treatment from the best providers available
Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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6 California Schools
Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures

4. Provide members greater access to health evaluation services and education programs on health -related topics

5. Coordinate activities with the member's physician when it makes reasonable sense to do so
C. VEBA does not participate as a party in Collective Bargaining between Employers and Employee Organization/Associations. Board Practices and Policies and Procedures affecting Collective Bargaining are established only in areas required to comply with legal, contractual, or sound actuarial advice.

Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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7 California Schools
Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures
Section III
Underwriting Rules and Regulations
A. Guidelines and Rules for VEBA Participation

1. VEBA's benefits programs pool contributions and claim experience in order to seek to deliver the best possible benefits to Employees and their families. This method avoids large swings in costs that can occur with individual Employers with smaller populations.

2. In order to deliver equity among various Employers and Bargaining/Non- Bargaining Employee Units, VEBA has established rules for determining the premium rates that will be paid into this pool. The VEBA policy reflects the following beliefs:
a. Health care contributions for participating members should be reasonably affordable
b. Employers which pay the full cost (or nearly the full cost) of benefits should pay a lower rate
c. High health plan participation helps to spread the risk d. Opt -outs for cash (or other incentives) and/or high payroll deductions increase risk by driving healthy Employees and their Dependents out of the pool
e. Employer health programs with low Employee participation rates may hurt VEBA's pool and, therefore, may not be appropriate candidates for participation
B. Waiver of Coverage
The following outlines provisions pertaining to Waiver of Coverage for Active Employees. All other Underwriting Guidelines and Rules continue to apply.

1. Non -Contributory
Medical coverage is mandatory for Eligible Employees if no Employee contribution is required under at least one VEBA medical plan (excluding Kaiser) offered by the Employer and Employee Organizations/Associations. An Employer and Employee Organization/Association must not allow Employees to waive non- contributory coverage, whether single or family, except under certain conditions approved in advance by the VEBA Board of Directors. If waivers are approved, the rate tiers for each medical plan for each Bargaining/Non Bargaining unit, as Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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8 California Schools
Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures
applicable, will reflect the waivers.

Coverage through military benefits, Tri-Care, does not change the rule stated above.

2. Contributory
Eligible Employees may waive medical coverage, whether single or family, if the VEBA plan(s) (excluding Kaiser) offered by the Employer and Employee Organizations/ Associations require an Employee contribution. The rate tiers for each Plan for each Bargaining/Non Bargaining unit, as applicable, will reflect the waivers.

3. Waivers for Cash or Other Benefits
Waivers/Opt-outs for cash or other benefits are not allowed whether contributory or non-contributory except as provided in Section C.2.d. below.

C. Rate Tier Structures

1. VEBA provides an incentive to Employers and Bargaining/Non-Bargaining Employee Units by lowering premiums based on increasing Employer's contribution towards the health coverage. See Section X, Exhibit A for the current Rate Tier Structures.

2. The following is an overview of Employer contribution requirements for rates and plan availability:
a. Employers and each Bargaining/Non-Bargaining Employee Unit, for which Employers pay the minimum 65% of the family premium (for full- time, active Employees) may choose to offer one Kaiser plan, one UnitedHealthcare Performance HMO Package, and one UnitedHealthcare California Choice Plus PPO plan. Employer contributions between 50% and 65% will be considered for VEBA participation subject to underwriting approval.
b. Employer/Bargaining Unit participation in the VEBA where Employee contributions are greater than 35% of family coverage will be at the sole discretion of the VEBA Board. VEBA is under no obligation to offer any plans where employee contributions are greater than 35% of the family rate.

Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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9 California Schools
Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures
c. Direct incentives will be offered to improve Employee benefit risk practices by providing lower premiums for Employers and their Employee Units that negotiate higher Employer contributions and comply with all underwriting policies.
d. There are higher premium rates for Employers and their Employee Units that have VEBA-grandfathered cash -out programs in place. It is expected that the premium surcharge for these plans will grow significantly over the next several years due to the increasing risk being experienced in those plans. Any Employer entering the VEBA after January 06, 2010, must eliminate any cash -out and waiver programs as a condition of VEBA participation.
e. Bargaining/Non-Bargaining Employee Units will be rated on their individual Employer contribution levels, so it is possible for individual Employee Units to have different premium rates within the same Employer. (It will be possible for Employee Units within a single Employer to have different premium rates for identical benefits if they have negotiated different contribution levels.)

3. The total premium rate per Employee Unit is based on the following three factors that determine the assigned rate tier for UnitedHealthcare Performance HMO Packages:
a. The percentage of the family premium paid by the Employer for a non - Kaiser HMO plan
b. Whether the Employer pays cash or other benefits to Employees of the Employee Unit who waive all or part of medical coverage for themselves or dependents
c. The percentage of active Employees and early retirees enrolled in non - Kaiser plans

4. The total premium rate per Employee Unit is based on the following three factors that determine the assigned rate tier for the UnitedHealthcare California Choice Plus PPO plan:
a. The percentage of the family premium paid by the Employer for the UnitedHealthcare California Choice Plus PPO plan
b. Whether the Employer pays cash or other benefits to Employees of the Employee Unit who waive all or part of medical coverage for themselves or dependents
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c. The percentage of Employees covering family members in the UnitedHealthcare California Choice Plus PPO plan
D. What Employers and Bargaining Units May Select Within VEBA

1. The Employer and Bargaining/Non-Bargaining Unit may choose to offer plans to active Employees where the Employee contribution is not more than 35% of the family rate for the plan selected. At an Employee Unit level, the Employer may offer the following:
a. One Kaiser benefit plan for active Employees and non -Medicare retirees b. One UnitedHealthcare Performance HMO Package for active Employees and non -Medicare retirees (San Diego County only) c. One UnitedHealthcare Full Network plan for active Employees and non - Medicare retirees (outside the UnitedHealthcare Performance HMO network only)
d. One UnitedHealthcare California Choice Plus PPO Option for active Employees and non -Medicare retirees (California only)
e. VEBA Medicare Supplement
f. UnitedHealthcare Group Medicare Advantage (HMO)
g. Kaiser Senior Advantage

2. For non -California Employees, Retirees, and Dependents, as permitted by state law, a package of UnitedHealthcare Out -of -Area Plans includes the Choice Plus PPO Out -of -Area plan, the EPO Out -of -Area plan, and the N/D PPO Out -of -Area plan.

3. For newly participating Employers and Bargaining/Non-Bargaining Units, all eligible plan elections must be reflected in the Participation Agreement executed by the Employer and each participating Employee Unit. Subsequently, plan elections must be made for each renewal period. The most closely -related in- force plan(s) will be continued automatically if plan elections are not made by the stated due date, (See Annual Renewal in Section IV).

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Section IV
Employer Participation Provisions
A. Eligible Employers
Eligible Employers, who wish to provide benefits under this Plan for their Eligible Employees, are: School Employers (including County Offices of Education, Community College Districts and Qualified Charter Schools), Private Employers Directly Associated with VEBA, and Employee Organizations/Associations located in California. Other California Public Sector Employers may be approved for participation at the VEBA Board' s discretion.

B. Required Participation Documents
Implementation of a VEBA Plan(s) requires that the following documents be executed before the coverage effective date. Implementation by an Employer without the required documentation requires prior written approval from the VEBA Co -Chairs:

1. For School District Employers, School Board Motion (Resolution of the Governing Board)
Before or concurrent with the implementation of the benefit plan(s), evidence of governing board ratification of an Employer's participation in VEBA, and a copy of the Collective Bargaining Agreement(s), Memorandum of Understanding (MOU), or Employer Policy Statements (as applicable), should be forwarded to the VEBA Administrator. Failure to receive the required documents will be reported to the VEBA Board of Directors if they are not received within 60 days of the implementation date

2. Participation Agreements
To participate in the VEBA, a VEBA Participation Agreement must be executed between the VEBA, the Eligible Employer and each participating Employee Unit, as shown below. VEBA medical plans must be offered as the exclusive medical plan within the Employee Unit participating in the VEBA:
a. Collective Bargaining Unit
b. Non -Collective Bargaining Unit
c. Charter School
d. Employee Organization/Association
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e. Private Employers Directly Associated with VEBA
C. Documenting Practices for Collective Bargaining Units Employers will provide to VEBA, Collective Bargaining Agreements for each participating Bargaining Unit and any internal documentation that describes any special eligibility provisions. Such documents will be attached to the Participation Agreement for Collective Bargaining Units.

D. Documenting Practices for Non -Collective Bargaining Units Employers will provide to VEBA, Memorandums of Understanding (MOUs) or any internal documentation that describes any special eligibility provisions. Such documents will be attached to the Participation Agreement for Non -Collective Bargaining Units.

E. Additional Eligibility Rules for Charter Schools Where No Fringe Benefits Collective Bargaining Agreement Exists
In the absence of a Collective Bargaining Agreement that specifies terms and conditions, a Qualified Charter School, approved by the VEBA Board for participation, will be allowed to enroll in the VEBA plans and programs only as long as its Employees are covered by the same policies and procedures for eligibility as those Employees of the sponsoring School Employer.

F. Role of Employer in Certifying Enrollment
Each Participating Employer is directly responsible for the accuracy and administration of their enrollment in VEBA. The Employer should take all necessary steps to ensure that only Employees/Dependents legally entitled to coverage under VEBA are enrolled as part of that sponsoring organization's benefits plan.

G. Transmission of Eligibility Information
The VEBA Administrator transmits eligibility information to the VEBA carriers weekly.

To ensure that identification cards and enrollment materials are received by the Employee prior to the coverage effective date, accurate and complete enrollment materials are due to the VEBA Administrator by the 15th of the month prior to the coverage effective date. New hire information should be transmitted to the VEBA Administrator as soon as completed.

H. Premium Payments

1. Premium billings are generated by the VEBA no later than the 25th of the month prior to the month of coverage. Corrections to the bill should be made by the Employer's administrator and forwarded with the Employer contributions to the Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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VEBA Administrator. Employer contributions are due and payable to the VEBA Administrator on the first day of the coverage month. The premiums to be paid to VEBA will at all times be governed by the executed Participation Agreement and any amendments thereto between the Employer and VEBA.

2. VEBA and Employers recognize that regular and prompt payment of contributions to the VEBA is essential to the maintenance and effectiveness of the benefits plan.

Employer contributions not paid by the 20th of the coverage month are subject to liquidated damages in the amount of 2% of the unpaid balance plus interest at the interest rate which is 2% higher than the most recent quarterly investment rate paid to School Employers in San Diego County.

I. Annual Renewal

1. VEBA-approved benefits plans shall be selected in accordance with VEBA Policies and Procedures and the terms of applicable Collective Bargaining Agreements, Memorandums of Understanding, and/or Employer Policy Statements.

2. Employer/Employee Units must submit plan selections for the coming plan year no later than 60 calendar days prior to the effective date of renewal. Plan selections must be submitted in a VEBA-approved format and require Employer and Employee Unit(s) signatures as applicable.

3. In order to avoid cessation of benefits, if appropriately submitted plan selections are not received by such date, coverage will be continued under the plans most closely -related to the current year's selections. Any changes/exceptions received after 60 calendar days prior to the effective date of renewal will require VEBA Board approval.

5. Upon proper notification of the selected plans, the VEBA Administrator will provide to the Employer/Employee Unit(s), forms known as Exhibit Cs on which will be listed the requested plan selections and applicable premium rates for the coming plan year. Exhibit Cs also require sign -off by the Employer and each Employee Unit as applicable.

J. Verification Procedures (Revised 5/2013)

1. The Board of Directors for the California Schools VEBA may, at its discretion, instruct the VEBA Administrator or other Board designee, to complete an annual review of the benefits program practices used by a Participating Employer to ensure compliance with the VEBA Establishment Agreement, VEBA Board Practices, the Participation Agreement, and the guidelines contained in the VEBA Administrative Policies and Procedures. Any corrective action required as a result of the failure to comply by a Participating Employer will be at the discretion of the Board of Directors as outlined in the VEBA Establishment Agreement and the Participation Agreement.

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2. Furthermore, to ensure that enrolled Dependents meet the requirements of the VEBA, Participating Employers must cause a Dependent Eligibility Verification Audit to be conducted.

3. An Employer may meet this requirement by complying with the following:
a. The Employer may contract with a Company that demonstrates, to the VEBA Administrator, administrative capability of conducting such Audit, or
b. The Employer may conduct a self -audit by receiving pre -approval of their Audit plan from the VEBA Administrator.

4. To meet VEBA standards, the entity conducting the Audit must obtain from the Employee, legal documents sufficient to verify that the Dependent is eligible for coverage; i.e., marriage certificate, Domestic Partnership documents, birth certificate, applicable court documents certifying adoption, guardianship or legal custody, medical certification for an over -age disabled child, etc.

5. An Employer may give Employees the opportunity to delete no -longer eligible Dependents prior to conducting the Verification Audit.

6. Dependent Eligibility Verification Audits must be completed in accordance with the following timeframes:
a. Within the first twelve (12) months of participation for Employers new to VEBA;
b. Once every five years for Employers having completed an approved Audit with an ineligible dependent rate of less than three percent (3%) (Revised 6/2016);
c. Once every year for Employers having completed an approved Audit with an ineligible dependent rate of equal to or greater than three percent (3%) (Revised 6/2016).

7. When determination is made that an employee or dependent has failed to provide documentation supporting enrollment in a VEBA program or the documentation indicates that the member does not qualify, the employer will issue termination instructions to the VEBA within 90 days of the completion of the audit. Continued coverage of those individuals who are not qualified beneficiaries under Federal law may subject the non -qualified beneficiary and the employer to significant financial risk. Failure to adequately enforce Federal enrollment guidelines may result in:
a. Employee or dependent being denied coverage at the time of a catastrophic event (Revised 8/2017);
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dependent (Revised 8/2017);
c. Termination of participation in VEBA for the non -compliant employer (Revised 8/2017);
d. Financial indemnification sought by VEBA from the Employer (Revised 8/2017);
e. Increased premium rates paid to the VEBA (Revised 8/2017).

Options to be pursued for non-compliance will be at the discretion of the VEBA Board. (Revised 8/2017)

8. The audit results are final and outcome cannot be changed. At the completion of the audit, a final report will be issued to the contract signatories. The Employer will have 90 days to address those found ineligible before noncompliance options are pursued. (Revised 8/2017)
K. VEBA's Involvement in the Collective Bargaining Process The California Schools VEBA does not participate as a party in Collective Bargaining between Employers and Employee Organizations/Associations. Certain aspects of coverage by the VEBA may affect bargaining issues. As a general rule, VEBA's contracts with health care insurers do not permit midterm modifications in VEBA's plan of benefits.

Employers, Employee Organizations/Associations, and insurance committees are encouraged to contact the VEBA Administrator for clarification of any VEBA rules, regulations, or policies that may affect Collective Bargaining.

L. Plan Changes
The Board of Directors reserves the right to change or modify VEBA's benefits plans in the event the contributions to VEBA or its reserves are insufficient. The Board also reserves the right to refuse any contributions from any Employer under any Collective Bargaining Agreement or Participation Agreement that contains terms inconsistent with the VEBA Establishment Agreement.

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M. Termination of Participation in the VEBA

1. An Employer may terminate participation in the VEBA by giving written notice received at VEBA no later than 120 days prior to the end of the current plan year. Because VEBA endeavors to provide the highest quality services to all its members including adequate administrative support to the member Employers at renewal, VEBA does not recognize conditional terminations. A conditional termination (one that reserves the right to rescind the termination and reestablish VEBA membership) will be rejected. The termination notice does not have to specify a reason for termination, but must be signed by all parties to the Participation Agreement. Inadequate or incomplete termination notices will be rejected and coverage renewed for the coming plan year.

2. An Employer will be prohibited from reapplying for VEBA membership for a period of three years subsequent to terminating membership in the VEBA.

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Section V
Employee/Dependent Participation Provisions
A. Eligibility

1. An individual is eligible for benefits under the VEBA Plan(s) as defined in the provisions set forth in the respective Collective Bargaining Agreement and/or Employer's Administrative Policy, including Memorandums ofUnderstanding. In the absence of such an Agreement and/or Policy this document shall govern eligibility as specified below.

2. Dual Coverage Exclusion Option
In recognition of current budgetary concerns of School Districts and their Employee Organizations/Associations, and upon agreement of the District and the applicable Employee Organization/Association, the VEBA will allow the exclusion of dual coverage under VEBA medical plans for an Employee who is legally married to an Employee of the same School District and for an Employee who has a Domestic Partner who is an Employee of the same School District. Dual Coverage is defined as an individual who is covered under a VEBA medical plan both as an Employee and as a Dependent. Election of this Dual Coverage Exclusion Option is subject to the following:
a. To authorize implementation of this Exclusion Option, a copy of the Collective Bargaining Agreement, Memorandum of Understanding, or Employer's Administrative Policy, as applicable, must be provided to the VEBA
b. Effective dates for School Districts and their Employee Organizations/Associations who elect this Exclusion Option on or after September 1, 2009, will become concurrent with the start of the following Plan Year
c. No retroactivity will be allowed
d. In the event the Employee/Retiree carrying the coverage as the subscriber under this Exclusion Option loses Eligibility for coverage, the Employee/Retiree covered as a Dependent must be allowed to become the subscriber, provided such Employee/Retiree meets the VEBA's definition of Eligible Employee/Retiree
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B. Eligible Employees
Except under the conditions specified in A.2., above, Eligible Employees of Employers participating in the California Schools VEBA are as follows:

1. Full -Time Employees
An Employee is considered a Full-time Employee if the Employee's services fall within the definition set forth in the respective Collective Bargaining Agreement.

If the Employee is not covered by a Collective Bargaining Agreement, he or she will be considered a Full-time Employee if he or she meets the Employer's definition.

2. Part -Time Employees
An Employee is considered a Part-time Employee if the Employee's services fall within the definition set forth in the respective Collective Bargaining Agreement.

If the Employee is not covered by a Collective Bargaining Agreement, he or she will be considered a Part-time Employee if he or she meets the Employer's definition.

3. Employees on Employer -Approved Leave of Absence
An Employee on Employer -approved paid Leave of Absence is entitled to benefits under this Plan. An Employee on Employer -approved unpaid Leave of Absence is eligible to continue coverage subject to the provisions of this Plan and this document, but may be subject to self -pay provisions.

4. School Board Members
Duly elected School Board Members are considered Employees of Participating Employers and, as such, are entitled to benefits under this Plan. As specified under the Employer Policy, the School Board Member may be subject to self -pay provisions.

5. Qualified Charter School Employees
a. Charter School Employees and their Dependents may be eligible for benefits under this Plan if such coverage is allowed under any Collective Bargaining Agreement, Memorandum of Understanding, Charter School Contract between the sponsoring School Employer and the Charter School, or a direct contract between the Charter School and the VEBA.

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b. Additionally, to be eligible for benefits, the VEBA Carrier Contract and the VEBA Administrative Policies and Procedures must allow for such coverage.
c. To be eligible for VEBA participation, the Charter School must execute a VEBA Participation Agreement, must not offer non-VEBA medical programs to its Employees, and must adhere to the Underwriting Rules and Regulations of VEBA. For Charter Schools that have selected the sponsoring School Employer as the Employer for collective bargaining purposes, Employee and Dependent eligibility will be governed by the collective bargaining rules and regulations in effect between the Employee Organization/Association and the sponsoring School Employer. For Charter Schools that have selected the Charter School as the Employer for collective bargaining purposes, to ensure that the Charter School policies are in conformance with the VEBA Underwriting Rules and Regulations, the Charter School must provide its eligibility rules to the VEBA in a format acceptable to the VEBA. Charter School participation is subject to the sole discretion of the VEBA Board.

6. Employee Organization/Association Staff Members
Employees of Employee Organization/Association offices and their Dependents may be eligible for benefits under the VEBA plan(s). To qualify for participation in VEBA, the Employee Organization/Association must execute a VEBA Participation Agreement, and must adhere to the underwriting rules and regulations of the VEBA. No non-VEBA medical plans may be offered.

7. Retirees
Retirees may be entitled to continue benefits through participating Employers for themselves and their Eligible Dependents if such coverage is allowed under the Collective Bargaining Agreement, Memorandum of Understanding, Employer's Administrative Policy, the Carrier Contracts, and all applicable administrative requirements. A Retiree may be required to pay the premium due to continue coverage. If the Retiree fails to pay the appropriate premium as required and/or otherwise fails to comply with Plan provisions, the Retiree will not be eligible to participate in the VEBA Plan(s). If Retiree coverage is allowed to terminate, reinstatement will not be permitted.

Additionally, a VEBA Post -65 Retiree Plan is offered directly through VEBA under conditions specified in Section VIII.

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8. Military Reservists Called to Active Duty
If an Employee is participating in a VEBA benefits plan at the time that he/she is called up for active duty, that Employee and/or Dependent may continue benefits for up to twenty-four (24) months. The Employee may be responsible for premium payment.

9. Employees of Private Employers Directly Associated with VEBA Employees of Private Employers Directly Associated with VEBA and their Dependents may be eligible for benefits under the VEBA plans(s). To qualify for participation in VEBA, such Private Employers must execute a VEBA Participation Agreement and must adhere to the underwriting rules and regulations of the VEBA.

No non-VEBA medical plans may be offered. Private Employer participation is subject to the sole discretion of the VEBA Board.

10. Employees of Other Public Sector Employers
Employees and their Dependents may be eligible for benefits under the VEBA plans(s). To qualify for participation, such Public Sector Employer must be approved by the VEBA Board, execute a VEBA Participation Agreement, and must adhere to the underwriting rules and regulations of the VEBA. No non- VEBA medical plans maybe offered. Other Public Sector Employer participation is subject to the sole discretion of the VEBA Board.

C. Eligible Dependents

1. A Dependent is eligible for benefits pursuant to the Collective Bargaining Agreement, Memorandum of Understanding, or Employer's Administrative Policy applicable to the Eligible Employee. The term Dependent is defined in the contractual provisions of the elected insurance Plan Document. This Document, Carrier Contracts, Collective Bargaining Agreements, or Employer Policy may limit Dependent coverage. Acceptable documentation of Dependent eligibility may be required; i.e., marriage/birth certificates, etc.

2. An Employee's spouse or an Employee's same -sex partner or opposite -sex partner (whether through marriage, civil union, or domestic partnership approved by the State of residence) is eligible for coverage as a Dependent on the Employee's plan. (Revised 9/2019)

3. Except under the conditions indicated in A.2. above if an individual and his or her spouse/same-sex partner/opposite-sex partner are both Eligible Employees, each shall be eligible for coverage as both an Employee and as a Dependent. (Revised 9/2019)
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4. If both parents of an Eligible Child are Employees, such Child shall be eligible as a Dependent of each parent.

5. A Child of an Employee/spouse/Domestic Partner is eligible for coverage on the Employee's plan from birth to the end of the month in which the Child reaches age

26. Eligible Children include a natural child, step child and other Special Dependent Categories specified below.

6. Special Dependent Categories
a. Guardianship
VEBA allows the enrollment of a Child for whom the Employee is named legal guardian. Guardianship must be supported by a Court Order, a copy of which must be attached to the enrollment or change form submitted at the time of enrollment. To obtain coverage, a Dependent must be properly enrolled within 31 days of the effective date of the Court Order, or wait until the next Open Enrollment Period to enroll for coverage. A Dependent is not entitled to enroll for coverage under temporary guardianship orders or fost- adopt placements.
b. Adoption
VEBA allows the enrollment of a Child placed for adoption if necessary enrollment procedures are completed by the Employee within 30 days of placement for adoption. A copy of the placement document must be submitted to the VEBA Administrator with the enrollment form. VEBA will also allow the enrollment of a Child within 30 days of the adoption being finalized. A copy of the formal court order must be submitted to the VEBA Administrator with the enrollment form.
c. Grandchildren
Grandchildren are not eligible as Dependents under the VEBA plan if permanent legal guardianship has not been established.
d. Handicapped Child
Under conditions specified by Carrier Contracts and upon acceptable physician certification, an Employee's Dependent Child who is incapable of self-sustaining employment by reason of mental retardation or physical handicap, incurred prior to age 26, and who is primarily dependent upon the Employee for support and maintenance is eligible for coverage beyond the maximum age limitation of this Plan.

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e. Domestic Partner Coverage
VEBA offers Domestic Partner Coverage under either of the following two eligibility provisions:
(1) Employees/Retirees may qualify for Domestic Partner Coverage by having registered the Domestic Partnership with the State of California and providing to the VEBA a copy of the registration (2) An Employee/Retiree who has not registered the Domestic Partnership with the State of California may qualify for Domestic Partner Coverage by filing a Declaration of Domestic Partnership with the VEBA
See Section VII for Domestic Partner eligibility and enrollment provisions and Section X, Exhibit B for enrollment and disenrollment forms.

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Section VI
Timing of Employee and Dependent Coverage
A. Effective Date of Coverage
Provided appropriate enrollment forms are submitted within the required timelines, coverage will become effective in accordance with the following:

1. New or Newly Eligible Employees
Coverage will become effective for Eligible Employees and their Eligible Dependent(s) on the first of the month following the date of initial eligibility or on the first working day, if so enumerated in the Employer's VEBA Participation Agreement, subject to the contractual provisions of the elected insurance plan.

Different effective dates may be collectively bargained subject to the VEBA's approval.

2. School Board Members
If coverage is desired, School Board Members must enroll in the VEBA Plan(s) within 31 days of the Employer's first entering the VEBA Plan(s), within 31 days of assuming office, or at any Open Enrollment period. Board Members will be considered Management Employees with respect to the application of Employer enrollment rules as defined in the Participation Agreements with VEBA.

3. Open Enrollment Period
Eligible Employees may enroll for coverage and/or add Eligible Dependents at times other than those specified above during an Open Enrollment Period. Open Enrollment Periods are limited to one per calendar year unless there has been a collectively bargained change in benefits. A change in the Employer's Open Enrollment Period requires the prior approval of the Participation Agreement signatories and the VEBA Co -Chairs, and such a request must be in compliance with the executed Participation Agreement.

4. Adding Newly Eligible Dependents after an Employee's Coverage Effective Date Newly Eligible Dependents may be enrolled under a covered Employee's Plan in accordance with the following requirements and timelines; however, if the Employee opts to enroll a new Dependent and the addition affects a contract -type (single to two-party, or two-party to family coverage) a premium increase will be required. The premium increase is effective the first of the month following the effective date of coverage if the effective date of coverage for the new Dependent is the second day or after of the preceding month. A full current month's premium is due for a newly added Dependent whose coverage is effective on the first day of Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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any given month.
a. New Marriage
The new spouse of an Employee may be enrolled in VEBA on the 1st of the month following the date of marriage, unless another effective date has been collectively bargained. However, except as provided under the Special Enrollment Option in A.5 below, unless the Employer and VEBA are notified within 31 days of the date of marriage, the new spouse may not be enrolled for coverage until the next Open Enrollment Period. An acceptable copy (as determined by the Employer) of a certificate of marriage must be attached to the enrollment form.
b. Newborn Coverage
In accordance with California law, a newborn is automatically covered as of his or her birth date to the end of the birth month. If the Employee elects to continue coverage past the end of the newborn's birth month, the Employee must enroll the newborn by completing and submitting the appropriate enrollment form and copy of the birth certificate within the first 31 days of the date of birth. (See Plan booklet for administrative procedures to acquire this coverage.)
c. Adoption
Coverage for a child placed for adoption becomes effective the date of placement if appropriate enrollment forms are submitted within 30 days of the date of placement, or, on the date the adoption becomes final if enrollment forms are submitted within 30 days of finalization. A copy of the formal Court Order must accompany the enrollment form. d. Court -Ordered Coverage
The Knox Keene Act (part of the Health and Safety Code) and the Insurance Code require regulated plans to enroll children or a spouse under a member's plan without regard to Open Enrollment periods if ordered by a court, provided that a request for coverage is made within 30 days of the Court Order. Although VEBA is exempt from Knox Keene and certain Insurance Code provisions, VEBA will honor the late enrollee provisions imposed on other plans by this legislation.

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e. Domestic Partner Coverage
Enrollment of Domestic Partners and/or child(ren) of Domestic Partners must occur within very specific time frames. See Section VII for more detailed information and requirements.

5. Special Enrollment Option (HIPAA)
a. Under the Health Insurance Portability and Accountability Act (HIPAA), an Employee/Domestic Partner or his/her Dependent(s), who initially declined to enroll in an Employer's health plan, must be allowed to enroll during the Plan year if they meet the below described conditions:
(1) The Employee gains a Dependent through marriage, birth, adoption, or placement for adoption
(2) The Employee, spouse, Domestic Partner, or other Dependent(s) loses other coverage through another employer (e.g., due to legal separation, divorce, death, termination of employment, reduction in hours, termination of contributions for coverage by the other employer, or completion of the maximum COBRA continuation period)
(3)
The Employee must make a request to the Employer to exercise this Special Enrollment Option. The Employee must request coverage within 30 days of the event as noted above
b. Coverage is effective as of the date of the event (i.e., birth, adoption, or placement for adoption), except for marriages. Coverage for a spouse in the event of marriage is effective on the first of the month following the date of the request.
c. Members otherwise eligible for a VEBA Plan who choose to disenroll from another plan do not qualify for this Special Enrollment Option and are treated as late enrollees. As such, the Employee or his/her Dependents may not enroll in the Plan except during the annual Open Enrollment Period (unless he or she qualifies for the special 30 -day enrollment period cited earlier).
d. For additional HIPAA provisions and requirements see Section IX E.

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Administrative Policies and Procedures
B. Termination of Coverage
Coverage for an Employee/Retiree and his/her Dependent(s) will terminate in accordance with provisions of the applicable Collective Bargaining Agreement, Memorandum of Understanding, Employer Administrative Policy, or subject to the contractual provision of the insurance plan. Different termination dates may be collectively bargained subject to the VEBA's approval. (For termination provisions of the VEBA Post -65 Retiree Plan see Section VIII.)

1. Employee/Retiree
Subject to the continuation provisions of COBRA and Education Code Section 7000 et seq., unless a different termination date is specified in the Collective Bargaining Agreement, Memorandum of Understanding, or Employer's Administrative Policy, an Employee's/Retiree's eligibility for VEBA benefits ceases at the end of the month in which one of the following events occurs:
a. The Employee's/Retiree's Employer ceases to participate in the VEBA b. The Employee enters full-time military, naval, or air service and is not part of a call back to active duty of military reservists
c. The required contributions are no longer made to the Plan d. The Employee/Retiree is no longer eligible under the contractual provisions of the Carrier Contract
e. The Employee/Retiree ceases to be eligible for benefits under the Collective Bargaining Agreement, Memorandum of Understanding, or Employer's Administrative Policy
f. Retiree coverage that terminates may not be reinstated unless the Retiree requalifies for coverage as an active Employee

2. Dependent(s)
Subject to the continuation provisions of COBRA and Education Code Section 7000 et seq., unless a different termination date is specified in the Collective Bargaining Agreement, Memorandum of Understanding, or Employer's Administrative Policy, Dependent coverage ceases at the end of the month in which one of the following events occurs:
a. The Employee, Retiree or former Employee ceases to be eligible for coverage
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b. The Dependent ceases to be eligible as a Dependent as set forth in the provisions of the elected insurance contract, Collective Bargaining Agreement, Memorandum of Understanding, or Employer's Administrative Policy c. The Employee's, Retiree's, or former Employee's spouse becomes ineligible for coverage when the Employee and spouse become legally divorced, legally separated, or the Employee/Retiree dies. The termination date will occur as follows:
(1) The last day of the month in which the divorce decree is final (2) The last day of the month in which legal separation is determined (3)
The last day of the month in which the Employee's/Retiree's death occurs
d. Coverage for a Child, including the Child of a Domestic Partner, will terminate at the end of the month in which the child reaches age 26 unless the Child qualified under the Special Dependent Categories specified in Section V C.6.d. above.
e. Domestic Partner coverage will cease in accordance with Section VII.

3. Cessation of Required Employee Contribution
Employees may be required to pay a portion of the cost of their benefits pursuant to the applicable Collective Bargaining Agreement, Memorandum of Understanding, or Employer's Administrative Policy. Coverage will terminate at the end of the last month for which the required Employee contribution was made for Employee and/or Dependent coverage. If coverage is allowed to terminate, the Employee will not have the opportunity to again enroll for coverage until the next Open Enrollment Period.

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C. Retroactivity
Retroactive enrollment/disenrollment is limited to 60 days by the Carrier Contract. The VEBA Administrator may grant exceptions in cases where the Employee has completed all necessary enrollment/disenrollment steps and an error on the part of the Employer, Carrier, or VEBA Administrator prevented proper enrollment or disenrollment. Effective January 2014, in accordance with the Patient Protection and Accountability Act (PPACA), no retroactivity will be allowed.

D. Employee Responsibility to Notify of Eligibility Changes An Employee should notify the Employer of any eligibility changes that will result in termination of coverage for the Employee or any of their Dependents within 10 days of the event leading to the loss of eligibility. The Employer should immediately notify the VEBA Administrator to facilitate proper disenrollment of the Employee or Dependent.

E. Consequences of Continuing Coverage for Ineligible Dependents

1. In situations where benefits have been paid or overpaid to ineligible beneficiaries, e.g., benefits continue to be paid for a spouse following a divorce which has not been disclosed to the Employer, the member is responsible for the cost of benefits from the appropriate coverage termination date had the loss of eligibility been properly reported.

2. At the discretion of VEBA, the member will be required to make payment in accordance with one of the following:
a. Pay to the Carrier, the cost of all services rendered, or b. Pay to VEBA, premium payments in an amount equivalent to the COBRA premiums from the date the dependent became ineligible through the end of the COBRA coverage period. These payments shall not be considered COBRA qualifying payments as such because no retroactive COBRA shall be granted

3. Failure to pay these premiums may result in severe financial consequences to the member, including but not limited to, Federal tax implications, State tax implications, and financial exposure to the VEBA Trust.

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Section VII
Provisions Related to Domestic Partner Coverage
A. Domestic Partner Coverage

1. An Employee/Retiree may provide coverage for an eligible Domestic Partner and/or the Partner's Eligible Children by submitting appropriate enrollment forms within required timelines.

2. The VEBA will make coverage available for both same- and opposite -sex Domestic Partners. Under current California law, eligibility for Domestic Partner coverage must be expanded to include both same- and opposite -sex partners. (Revised 9/2019)

3. If an Employee/Retiree chooses to enroll his/her Domestic Partner, he/she will be able to choose from the medical and, if applicable, dental or vision care plans offered by insurers who have agreed to provide coverage for Domestic Partners.

4. Under the VEBA Plans, the coverage for a Domestic Partner and his/her Eligible Children is the same available to the legally married spouse of an Employee/Retiree and subject to the same terms and conditions.

B. Possible Tax Implications of Domestic Partner Coverage

1. An Employee who provides Domestic Partner coverage will have added to his/her taxable income for purposes of federal income taxation, the fair market value of the health coverage accorded the Domestic Partner and/or his/her Dependents, (less any contribution paid by the Employee for this coverage) subject to withholding, unless it can be demonstrated that the Domestic Partner and/or his/her Dependents qualify as a Dependent of the Employee for federal income tax purposes.

2. State taxes may apply if the Employee and Domestic Partner fail to register with the state of California or other applicable state where they reside.

3. An Employee may want to consult an attorney concerning any possible income tax implications of providing Domestic Partner coverage.

4. Neither the District nor the California Schools Voluntary Employees Benefits Association or any employee or agent can definitely identify the tax consequences.

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C. Eligibility
VEBA offers Domestic Partner Coverage under either of the following two eligibility provisions:

1. Employees/Retirees may qualify for Domestic Partner Coverage by having registered the Domestic Partnership with the State of California and providing to the VEBA, a copy of the registration.
a. For Domestic Partners registered with the State of California, a properly completed enrollment form and copy of the registration endorsed as filed by the California Secretary of state must be submitted to the Employer/Plan Administrator within required timelines outlined below. b. An Employee may enroll his/her Domestic Partner and/or the Partner's Eligible Dependent Children by submitting the required enrollment forms for Domestic Partner Coverage within
(1) 31 days of the date of hire, or
(2) For a continuing Employee newly eligible to enroll for benefits coverage, within 31 days of attaining eligibility, or
(3)
(4) The Employer's annual Open Enrollment Period; the effective date must coincide with the beginning of the Employer's Plan Year Within 31 days of registration with the State of California, or

2. An Employee/Retiree who has not registered the Domestic Partnership with the State of California may qualify for Domestic Partner Coverage by fulfilling the following requirements and filing a Declaration of Domestic Partnership with the VEBA. (See Section X, Exhibit B for Domestic Partner forms.) Enrollment under this eligibility provision may only be accomplished during the Employer's annual Open Enrollment Period.
a. The Employee and his/her Domestic Partner must
(1) Both be at least 18 years old, and
(2) Not legally married to anyone, and
(1) Have had at least twelve complete months between the date of the termination of any prior marital status or domestic partner relationship and the date of the domestic partner application is submitted, and
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(3)
Reside in the same residence, with the intent to reside together permanently, and
(4) Have the mental competence to contract, and are not related by blood to the degree that would bar marriage under California law, and
(5)
Have resided together continuously for the twelve complete months preceding their application for coverage, and
(6) Have agreed to be jointly responsible for basic living expenses, including food, shelter, and other expenses of the joint household, and
(7)
(8)
Have terminated any prior domestic partnership at least twelve complete months prior to application for coverage, and
Have filed a fully complete application, together with attachments. b. The Application must be accompanied by any one of the following to establish joint residence:
(1) Copies of driver's licenses for both individuals which contain the same address, or
(2) Mortgage documents or deed containing the names of both individuals, or
(3) Rental lease agreement containing the names of both individuals c. The Application must be accompanied by any one of the following to establish financial interdependence:
(1) Joint checking or savings account, or
(2) Credit cards with the same account number in both names, or (3)
Common ownership of real property or a common leasehold interest in real property, or
(4) Common ownership in a motor vehicle, or
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(5)
Joint wills in which one partner is the primary beneficiary under the other partner's will, or
(6) Designation of both partners as authorized signatories on safe deposit boxes, or
(7) Designation of the Domestic Partner as the beneficiary under the Employee's life insurance Plan
D. Cessation of Domestic Partner Coverage

1. The Employee and/or the Domestic Partner has a responsibility to notify the Employer/Plan Administrator of the termination of the Domestic Partnership within (30) days of the first to occur of the following:
a. The death of the Domestic Partner
b. The date on which any of the criteria of a Domestic Partnership relationship is no longer met
If the Employee fails to make the required notification, the Employee will be liable for any expenses incurred by the VEBA with respect to the former Domestic Partner or his/her Dependents after the termination of the Partnership and must reimburse the VEBA for the value of those benefits. The VEBA shall have the right to recover attorney fees and costs incurred in collecting such expenses from the Employee.

2. Coverage for a Domestic Partner and his/her Eligible Dependent Children will cease on the first to occur of the following:
a. The end of the month in which the death of the Domestic Partner occurs b. The end of the month in which one or more of the criteria of Domestic Partnership is no longer met
c. The end of the month for which a required Employee contribution is made for coverage for a Domestic Partner or his/her Dependents d. Under current law, a Domestic Partner and his/her Dependents are not eligible for COBRA continuation coverage upon cessation of VEBA coverage; however a limited conversion plan may be available through the medical plan carrier.

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The VEBA makes a COBRA -type continuation coverage option available to California -registered Domestic Partners who would otherwise lose VEBA coverage. A formal joint request must be made to the VEBA by the Employer and Employee Organization(s), as applicable, for this coverage option to be implemented.

VEBA Domestic Partner continuation coverage is not COBRA continuation coverage: however, the VEBA will mirror COBRA qualifying events, enrollment, and termination provisions. Employers will be responsible for facilitating notification, billing and collecting premiums and must report eligibility and termination dates to the VEBA within required timelines for reporting COBRA participants.

E. Modification or Termination of Policy
The VEBA Board of Directors in the exercise of its sole and unreviewable discretion expressly retains the sole and unfettered right at any time and from time to time to interpret this policy to apply this policy, to terminate this policy, to modify this policy, to change or add to the eligibility requirements of this policy, to change or add or decrease the VEBA programs in which Domestic Partners may participate, and to cease providing some or all VEBA benefits to Domestic Partners upon thirty days advance notice, as permitted by applicable law. (Revised 9/2019)
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Section VIII
Provisions Related to VEBA Post -65 Retiree Plan
A. VEBA makes a medical plan option available to certain individuals enrolled in and eligible to receive Medicare A & B benefits.

Eligible Employees/Dependents are as follows:

1. Former Employees that have separated from a VEBA-Participating Employer

2. Active, part-time, non -benefited Employees employed by a VEBA-Participating Employer

3. Eligible Dependents (including surviving spouses) of former Employees and active, part-time, non -benefited Employees specified above Participation in this option may be on a self -pay basis and must be paid monthly to the VEBA on a timely basis.

B. Eligible Employees/Dependents may enroll in the VEBA Post -65 Retiree Plan under the following conditions:

1. All enrollees must have Medicare A & B benefits in effect upon activating enrollment

2. The Employee's employer must be a VEBA-Participating Employer at the time of application for enrollment in the VEBA Post -65 Retiree Plan

3. The Employee/Dependent must reside in the CMS -approved service area of the Plan selected

4. Application for enrollment in the VEBA Post -65 Retiree Plan must be submitted as follows:
a. For separating Employees (and/or their Dependents) eligible and enrolled to receive Medicare A & B benefits at the time of the Employee's separation from employment, application must be made within 31 days of such separation
b. For separated Employees (and/or their Dependents) who, at the time of the Employee's separation from employment, have not yet met eligibility requirements to receive Medicare A & B benefits (i.e., age, etc.), application must be made within 31 days upon first becoming eligible to enroll for Medicare benefits
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c. For active, part-time, non -benefited Employees (and/or their Dependents), application must be made within 31 days of first becoming eligible and enrolled to receive Medicare A & B benefits
d. For Employees/Dependents enrolled in Employer continuation coverage programs (i.e., COBRA, early retirement plans, etc.), application must be made within 31 days of ceasing such continuation coverage e. Upon carrier approval, a Special Enrollment Period may be available, to Eligible Employees/Dependents of an Employer who joins the VEBA after the initial offering of the Plan
C. Termination of Coverage

1. Coverage under the Plan will terminate on the first to occur of the following:
a. the end of the month for which the last required contribution is made b. upon termination of Medicare A & B
c. upon assignment of Medicare A & B benefits to another carrier d. upon no longer residing in a CMS -approved service area of the Plan selected

2. In the event that an Employer terminates VEBA participation, coverage for an Employee/Dependent enrolled in the Plan prior to such termination will remain in effect.

D. VEBA also makes a voluntary dental plan option available to individuals who elect to enroll for medical coverage. The coverage is not available on a stand-alone basis, but available only as an add-on to the medical coverage. Eligibility and enrollment in the dental plan is subject to the same terms and conditions listed above except that Medicare A & B benefits eligibility is neither applicable nor required.

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Section IX
Federal and State Regulations and Regulatory Resources
A. Member Appeals

1. The VEBA Board does not make medical judgments.

2. VEBA Board reviews are limited to determining whether Carrier Contracts are being effectively adhered to by contracting providers.

3. The Carriers providing benefits to VEBA members will administer appeals from adverse benefit determinations in accordance with the requirements mandated by the Health Care Reform Act. Refer to Carrier Plan Documents for appeal/dispute resolution procedures.)
B. Converting Coverage to an Individual Policy Directly with the Carrier If medical insurance provided through a group policy terminates for any reason other than termination of the policy by VEBA, the individual may have issued, without medical examination, an individual policy of insurance, provided application is made and premium paid to the insurance company for such policy within 31 days after the termination of insurance. This conversion plan is obtained directly through the carrier and is not subject to the rules and regulations of VEBA or the Employer and costs and coverage may vary significantly.

C. Continuation Coverage for Retired Certificated Employees and spouses (Ed. Code Section 7000 also known as AB528)
In accordance with California Education Code Section 7000, et. seq., upon retirement and/or expiration of COBRA coverage, a Participating School Employer must allow a certificated Retiree and eligible spouse to have the option of continuing medical and dental coverage if the Retiree meets the following criteria:

1. The employee retired from the Employer as a member of any public employee retirement system

2. If an individual is the surviving spouse of a certificated employee/retiree, that individual also is eligible to continue coverage

3. Coverage will be provided at the individual's own expense

4. A retiree or surviving spouse who elects coverage under this provision and who subsequently terminates coverage for any reason will be prohibited from obtaining coverage at a later date
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D. Medicare Secondary Payer Program

1. By law, employer health plans generally must pay the Medicare -related benefits first, before Medicare does, for the following individuals:
a. Active employees over age 65 and over -age -65 spouses of active employees of any age
b. Medicare -disabled beneficiaries who are receiving employer health coverage by virtue of the plan participant's current employment status c. Certain employees and dependents suffering from end -stage renal disease

2. Failure to conform to these Medicare Secondary Payer rules can result in substantial civil and tax penalties being imposed against an employer, including a private cause of action by employees.

E. Consolidated Omnibus Budget Reconciliation Act (COBRA)

1. Congress enacted the Consolidated Omnibus Budget Reconciliation Act (COBRA) in 1985. With the intent of shifting medical costs from the federal government to the private sector, COBRA includes the requirement that most employers allow individuals who would otherwise lose their employer -provided health coverage, due to certain Qualifying Events, the right to continue that coverage for specified periods of time to allow the individual a transition period to obtain other coverage.

COBRA became effective the first day of a plan year on or after July 1, 1986 and has had numerous legislative revisions since then.

2. The Internal Revenue Service (IRS) issued Proposed COBRA Regulations in 1987 and in 1998, providing some guidance to the COBRA law, but the first "Final" COBRA Regulations were not issued until February 1999. Additional "Final" Regulations have been issued in 2001 and 2004. For topics not addressed in the Final Regulations, the plan and the employer "must operate in good faith compliance with a reasonable interpretation of the statue."

3. Employers Who Must Comply
a. Employers who had 20 or more employees on 50 percent of its typical business days during the preceding calendar year must comply with COBRA. COBRA Regulations specify that both full- and part-time employees count regardless of their eligibility for the group health plan.

Part-time employees are counted as a fraction of full time.

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b. The IRS has responsibility for auditing employers to determine an employer's compliance with COBRA Continuation Coverage requirements.

Non-compliance penalties may be assessed.

4. Individuals Eligible to Elect COBRA Continuation Coverage a. An individual eligible for COBRA Continuation Coverage is known as a Qualified Beneficiary. A Qualified Beneficiary is an individual who was covered under the employer's group health plan the day before a COBRA Qualifying Event takes place and includes the following:
(1) A covered employee
(2) The covered spouse of the employee
(3) The covered dependent child of the employee. (If the covered employee elects COBRA Continuation Coverage, any child born to, or placed for adoption with, the covered employee during the period of COBRA Continuation Coverage is also considered a Qualified Beneficiary if the child is enrolled on the Plan)
b. Each Qualified Beneficiary (covered individual) who would otherwise lose coverage due to certain Qualifying Events has the same rights under the group health plans as a "similarly situated active employee". c. When a Qualifying Event occurs, each Qualified Beneficiary is entitled to make a separate election with regard to continuing any or all of the group health insurance benefits he/she was receiving immediately before the Qualifying Event.

5. COBRA Qualifying Events
COBRA must be offered if a Qualifying Event occurs that causes a loss of coverage under the group health plan. A loss of coverage means the individual ceases to be covered under the same terms and conditions as in effect immediately before the Qualifying Event and includes any increase in the employee premium or contribution if the increase is tied to a Qualifying Event. (The loss of coverage does not need to occur immediately after the Event.) The actual date of the Event is generally accepted as the Qualifying Event Date; however, OBRA of 1989 amended COBRA time frames to allow Employers to use the loss of coverage date as the date of the Qualifying Event. Whichever date is used, it is essential that employers apply that date consistently.

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a. The following Qualifying Events, that would cause a covered employee and his/her covered dependents to lose coverage, entitles each individual to COBRA Continuation Coverage for 18 months from the date of the Event:
(1) The employee's termination of employment for any reason other than "gross misconduct". (The IRS has not provided a definition of gross misconduct and has stated that they do not plan to provide one) (2) The employee is laid off
(3) Reduction in hours of the employee, i.e., full-time to part-time, strike
(4) Leave of absence, except that a FMLA leave of absence (Family and Medical Leave Act) becomes a Qualifying Event on the last day of the leave if the employee does not return from the leave (5)
The Employer's bankruptcy
b. The following Qualifying Events, that would cause a covered dependent to lose coverage, entitles that dependent to COBRA Continuation Coverage for 36 months from the date of the Event:
(1) The employee dies
(1) The employee legally separates or divorces
(2) The dependent child ceases to be eligible as a dependent (3) Employee's Entitlement to Medicare. (Medicare entitlement is an original Qualifying Event in a limited number of circumstances. A retiree plan with a Medicare entitlement loss of coverage provision would be an example of when Medicare Entitlement would be considered an original Qualifying Event for the spouse and or/other dependents of the retiree

6. Secondary Qualifying Event
a. A Secondary Qualifying Event means another Qualifying Event occurring during the initial 18 months of COBRA Continuation Coverage.

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b. A Secondary Event allows a Qualified Beneficiary (other than the employee) who has COBRA Continuation Coverage to extend coverage, under certain circumstances, from 18 months to 36 months measured from the original Qualifying Event.
c. A Secondary Event is an employee's termination, layoff, strike, reduction of hours, or leave of absence followed by:
(1) The death of the employee
(2) Divorce or legal separation from the employee
(3) Employee's entitlement to Medicare if such entitlement would cause a loss of coverage under the group health plan
(4) Dependent child ceases to be eligible as a dependent

7. Loss of Coverage in Anticipation of a Qualifying Event a. If coverage is reduced or eliminated in anticipation of a COBRA Qualifying Event, the reduction or elimination is disregarded for COBRA purposes. b. Once the employer receives notice of the event, the plan is required to make COBRA available. The COBRA coverage would begin the date of the Qualifying Event. The span of time between the loss of coverage and Qualifying Event does not matter.
c. There is no requirement for the employer to provide coverage in the period between the loss of coverage and the Qualifying Event.

8. Extension of COBRA Continuation Coverage Due to Qualification for Social Security Disability
a. COBRA coverage may be extended from 18 to 29 months for a Qualified Beneficiary, and his/her covered family, who is deemed by the Social Security Administration to have been disabled before the end of the first 60 days of COBRA continuation coverage.
b. If one member of the covered family qualifies for the 29 months, the entire covered family qualifies for the 29 months.
c. Each family member retains Qualified Beneficiary status during the extensions period.

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d. If a second Qualifying Event occurs during the extension period, a Qualified Beneficiary (other than the employee) retains the right to an extension of the maximum coverage period to 36 months. (Medicare entitlement is often a Secondary Event during this extension period.)
e. The individual must notify the employer of the Social Security Disability determination before the expiration of the 18 months and within 60 days of the date the disabled individual receives it.

9. The Types of Plans to Which COBRA Applies
a. COBRA applies to a plan maintained by an employer or employee organization to provide health care, whether directly or through insurance reimbursement or otherwise. Health care includes the diagnosis, cure, mitigation, treatment, or prevention of disease, and any other undertaking for the purpose of affecting any structure or function of the body. b. Dental, vision, prescription drug coverage, mental health coverage, Health FSAs, as well as medical plans must be offered as COBRA coverage at the time of the Qualifying Event or at other times that active employees could add one or more of these plans.
c. Life insurance and group disability insurance are not required to be offered as COBRA coverage.
d. When a Qualifying Event occurs, each Qualified Beneficiary (covered individual) has the opportunity to continue, under COBRA, the group health insurance benefits he/she was receiving immediately before the Qualifying Event.
e. The coverage offered under COBRA cannot differ from the prior coverage and cannot be based on evidence of insurability.
f. How the coverage must be offered to individuals depends on the type of plan the Qualified Beneficiary was covered under immediately prior to the Qualifying Event.
(1) One plan
(a) When the only option available to active employees is a combined Plan including medical, dental, and vision, and the active Employee must take all or none, then
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(b) The only option that must be made available to Qualified Beneficiaries is the combined Plan
(2) Separate plans
(a) When benefits are provided under separate Plans, i.e., active employees may select medical only, dental only, medical and vision, etc., then,
(b) A Qualified Beneficiary may elect under COBRA, any or all of the Plans they had before the Qualifying Event, and, (c) The employee and each of his/her covered Dependents have independent election rights and therefore, may continue different combinations of Plans

10. Flexible Spending Accounts (FSAs)
a. Health FSAs are a group health plan as defined by the Internal Revenue Code (IRC) and therefore are subject to COBRA Continuation Coverage requirements. However, "the IRS and Treasury believe that the purposes of COBRA are not furthered by requiring an employer to offer COBRA...if the amount that the employer could require to be paid for the COBRA coverage for the plan year would exceed the benefit that the Qualified Beneficiary would receive..."
b. Situations in which an employer is required to offer the Health FSA under COBRA are limited. Under the following two-step test, if the health FSA satisfies two conditions it does not need to be offered beyond the Plan year in which the Qualifying Event took place.
(1) Benefits under the Health FSA are excepted benefits under HIPAA, and
(2) The maximum payments for a year of COBRA equals or exceeds the maximum benefit available under the Health FSA
c. The Health FSA does not need to be offered at all if the Health FSA meets the following third test:
(1) The plan passes the above two-step test, and
(2) The Qualified Beneficiary has a zero or over -spent Health FSA account balance
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11. Alternative Coverage
a. Alternative Coverage is coverage provided to a Qualified Beneficiary after a Qualifying Event that is not COBRA coverage. This may be a requirement of a state or local law, a retirement plan, industry practice, a severance agreement, collective bargaining agreement or plan procedure. b. If the Alternative Coverage is not as good as or better than the coverage the Qualified Beneficiary had the day before the Qualifying Event, then COBRA must be offered side by side to the Alternative Coverage. c. If an event, such as the death or divorce from the covered employee would end the right of a spouse or dependent child to receive the Alternative Coverage, then that event is a Qualifying Event and COBRA must be offered for 36 months from that Event. This is regardless of whether the Event occurs within the initial 18 -month period or whether the Alternative Coverage is as good as COBRA.

12. Notifications
The COBRA law requires employers and/or plan administrators to notify Qualified Beneficiaries of their COBRA rights. Under VEBA, COBRA Notifications are the responsibility of Participating Employers. Enforcement of COBRA Notification provisions falls under the Department of Labor (DOL). The DOL has issued Notification Regulations and included sample Notifications; however, employers must customize their Notices and are responsible to keep them updated. Employers should always mail Notifications —never hand them to the employee or other Qualified Beneficiary.
a. General Notice
(1) The purpose of the General Notice is to acquaint employees and other covered Qualified Beneficiaries with the COBRA law, their Notification obligations and their possible rights to COBRA Continuation Coverage in the future.
(2) Employers/plan administrators were required to provide the General Notice to all covered employees (and spouses) when the plan became subject to COBRA.
(3)
The General Notice must also be sent to all new plan enrollees and their spouses at the time of commencement of coverage under the plan and not later than
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(a) ninety days from commencement of coverage, or
(b) ninety days from the date the plan was required to comply with COBRA, or
(c) the first date on which the employer/plan administrator is required to furnish the notice of the Qualifying Event
(4) When a Qualifying Event occurs within the first 90 days of coverage, the Qualifying Event Election Notice will satisfy the General Notice requirement if it is sent by the 90th day. (5)
The General Notice should be sent first class mail to both enrollee and spouse at last known address. If all covered family members reside at the same address, a single notice will suffice. Notification to the spouse is deemed notification to all individuals residing with the spouse.
b. Notice from the Qualified Beneficiary to Plan Administrator (1) The Regulations require the covered employee or other Qualified Beneficiary to notify the employer/plan administrator of the following Qualifying Events:
(a) Divorce or legal separation
(b) Dependent child ceases to be a dependent
(c) Secondary event
(d) Deemed to be disabled by Social Security Administration (e) Within 30 days if deemed no longer disabled by Social Security Administration
(2) The Notice is required to be given within 60 days from the later of:
(a) The Qualifying Event date
(b) The loss of coverage date
(a) The date the Qualified Beneficiary is informed through the Plan's Summery Plan Description or General Notice of both the obligation to report the Event, and the plan's procedures for providing such a Notice.

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c. Qualifying Event Election Notice
(1)
The purpose of the Qualifying Event Election Notice is to inform each Qualified Beneficiary that they have rights to continue their group health insurance coverage under COBRA.
(2) The Department of Labor has issued some drafting guidelines for the Qualifying Event Election Notice and the Federal courts have expanded upon these requirements; however it remains the employer's responsibility to formulate and generate these notices. (3)
The employer/plan administrator is required to notify all Qualified Beneficiaries of their COBRA rights within 44 days of the date their learn of the Event.
(4) The Qualifying Event Election Notice should be sent first class mail to all Qualified Beneficiaries (for example, employee and spouse) at the last known address. If all Qualified Beneficiaries reside at the same address, a single notice will suffice, as long as it is addressed to include all Qualified Beneficiaries. If a Qualified Beneficiary in a family lives at a different address, a separate Notice needs to be mailed to that Beneficiary at that address. Although not required, some form of documentation of mailing is advisable.
d. Notice of Unavailability
(1) The 2004 Final Regulations require that employers generate a Notice of Unavailability of continuation coverage to provide an explanation as to why a Qualified Beneficiary is not entitled to COBRA continuation coverage.
(2) When applicable, this Notice of Unavailability is sent after the Qualified Beneficiary has informed the employer of the following Events:
(a) Divorce or legal separation
(b) Dependent child ceases to be a dependent
(c) Secondary events
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(d) Social Security disability
(3)
This Notice must be in writing and must be sent within 44 days from the date of the occurrence.
e. Extension Notice
There are three ways a Qualified Beneficiary can extend his/her COBRA coverage. Although the Extension Notice is not specifically required, the DOL recommends that Employers generate a notice regarding the extension of COBRA coverage. The Extension Notice should inform the Qualified Beneficiary of the new continuation coverage time frame, monthly premium rates (especially in disability cases), premium due date and the reason coverage can be cancelled prior to the end of the maximum coverage period. (1) The Extension Notice is applicable to:
(a) Secondary Events
(b) Special Medicare Entitlement
(c) Disability Extension
(2) The Extension Notice should be sent when the employer/plan administrator is informed of a COBRA extension.
f. Open Enrollment Notification
COBRA Beneficiaries have the same rights under the Plan as active employees. This includes rights during open enrollment periods. The Open Enrollment Notification should inform COBRA Beneficiaries of the Open Enrollment Period, the options available, and the monthly premium rates for those options. COBRA Beneficiaries include:
(1)
(2)
(3)
Qualified Beneficiaries in their 60 -day election period Qualified Beneficiaries who have elected but have not yet paid Qualified Beneficiaries who have elected and paid
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g.

Notification of Plan Changes
The Employee Retirement Income Security Act of 1974 (ERISA) requires that plan benefit changes, premium rate changes, and other modifications to the plan be communicated to all plan participants, including COBRA participants. According to the Department of Labor, the notification of plan and/or benefit modifications should be sent to COBRA participants "within 60 days after the change has been adopted by the plan." The IRS regulations state that notification of rate changes must be provided to Qualified Beneficiaries prior to charging them the new rate. h. Right to Convert Notice
The purpose of the Right to Convert Notice is to advise COBRA participants that their COBRA coverage is coming to an end and they have the right to elect an individual conversion policy if such an option is available under the group health plan. Employers/plan administrators are required to notify all Qualified Beneficiaries of their right to elect a conversion option within 180 days prior to the expiration of their COBRA coverage. The Notice should be sent first class mail to last known address.
i. Notice of Insignificant Premium Underpayment
J•
(1) The 1999 Final Regulations mandate that before a plan can terminate COBRA coverage for an insignificant underpayment (a payment that does not quite total the full monthly premium amount), the plan must provide a notice to the Qualified Beneficiaries. The 2001 Final Regulations state, "a shortfall is not significant if it is no greater than the lesser of $50 or 10 percent of the required amount". (2) The Notice must inform the Qualified Beneficiaries of the amount of the underpayment and the fact that coverage will terminate if the balance of the payment is not received. The plan must give the Qualified Beneficiaries at least 30 days from the date of the Notice to make the payment. The Notice should be sent first class mail to last known address.

Disclosure to Health Care Provider
The purpose of this Disclosure is to more completely inform health care providers of the Qualified Beneficiary's coverage status, so as to avoid situations where services are denied because only partial information was conveyed. The plan is responsible for complete information whenever a health care provider inquires as to a Qualified Beneficiary's coverage status. The plan must inform the health care provider that the Qualified Approved 3/21/2012 Revised 9/19/2012, 5/17/2013, 6/29/2016, 8/30/2017 and 9/28/2019

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Beneficiary does not have current coverage, but will have retroactive coverage if COBRA is elected and subsequently paid for by the appropriate dates. It is allowable for a third party to elect COBRA for a Qualified Beneficiary.
k. Notice of Early Termination of Coverage
(1) An employer/plan administrator is required to send a Notice of Early Termination of Coverage to an affected Qualified Beneficiary if his/her coverage will be terminated prior to the 18-, 29-, or 36 - month continuation period.
(2) The Notice must be sent as soon as administratively practicable after the termination decision is made and must explain why and when the coverage is being terminated and must describe any right to other coverage that is available.
(3)
COBRA Regulations allow plans to include the Notice with the HIPAA Certificate.

13. Election Period and Time Frames
In accordance with COBRA statutes, employers/plan administrators, and Qualified Beneficiaries have specific time frames in which to accomplish certain tasks. a. Qualifying Events
(1) It is the employer's responsibility for knowing when an employee's voluntary or involuntary termination of employment, reduction of hours, strike, layoff, or leave of absence occurs
(a) The employer/plan administrator has 44 days from the Qualifying Event Date to generate a Qualifying Event Notice to all Qualified Beneficiaries. The Notification is deemed made on the date it is sent. The Notice should be sent first class mail. Documentation of mailing is advisable
(b) To make a timely election to accept COBRA continuation coverage, each Qualified Beneficiary has the later of 60 days from the date of the Qualifying Event or the datethe COBRA Qualifying Event Notice is sent by the employer/plan
administrator. The election is deemed made on the date it is sent to the employer/plan administrator
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(2) For Events such as the employee's divorce, legal separation, a dependent child ceasing to be eligible, Social Security Disability, and Secondary Events:
(a) It is the employee's or other Qualified Beneficiary's responsibility to notify the employer/plan administrator within 60 days from the latter of the Qualifying Event date, the loss of coverage date, the date the Qualified Beneficiary is informed of both the obligation to report the Event and the plan's procedure for providing such notice
(b) If the employee or other Qualified Beneficiary fails to report the Event within the proper time frame, the Qualified
Beneficiary loses the right to continuation coverage
b. Retroactive Premium Payment Period
The COBRA law prohibits employers from requiring the payment of any premium before the 45th day (from the election date). The employer may require that all retroactive premiums be due by the 45th day to bring the Qualified Beneficiary current.
c. Prospective (Monthly) Premium Payment Period
For prospective premiums, COBRA participants are allowed a minimum, 30 -day grace period each and every month. If the plan allows a grace period longer than 30 days, COBRA participants must also be allowed the longer grace period.
d. Insignificant Underpayment Grace Period
If a Qualified Beneficiary underpays the premium by an insignificant amount, the plan can accept the amount as payment in full or seek the rest of the payment. Before canceling the Qualified Beneficiary's coverage for underpaying by an insignificant amount, the plan must send a notice to the Qualified Beneficiary and give at least a 30 -day grace period form the date of the notice to pay the balance of the premium.

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14. Incapacitation
According to several courts decisions, when a Qualified Beneficiary becomes incapacitated during or prior to a period of time in which the Qualified Beneficiary must take an action, the affected period of time is suspended until the person is no longer incapacitated, or has an executor appointed (in the event the Qualified Beneficiary dies before becoming no longer incapacitated).

15. Terminating Events
The COBRA law lists specific times when continuation coverage may be terminated. The nine Terminating Events that follow are the only times when an employer may cancel COBRA coverage and be in compliance with the law.

Coverage may be cancelled at the earliest of the following:
a. Eighteen months from the Qualifying Event date for individuals whose coverage ended because of a termination or reduction of hours b. Twenty-nine months from the Qualifying Event date for individuals whose coverage ended because of a termination or reduction of hours, and the continuation coverage was extended to 29 months due to a Qualified Beneficiary's Social Security Disability determination
c. Thirty-six months from the Qualifying Event date for individuals whose coverage ended because of the death of the employee, divorce/legal separation, a dependent child ceasing to be a dependent or the employee's Medicare entitlement
e. Thirty-six months (for spouse and dependent child only) from the date of the employee's Medicare entitlement (where insurance coverage is not lost) that precedes a termination or reduction of hours by 18 months or less f. The first day for which timely payment is not made to the plan. Timely payment was described in Prospective Premium (IX 12. c. above) and Insignificant Underpayment Grace Period (IX I2. d. above) g.

The date on which the Qualified Beneficiary first becomes, after the date of the election, covered under another group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition of the beneficiary other than an exclusion or limitation which does not apply to, or has been satisfied under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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h. The date on which the Qualified Beneficiary first becomes, after the date of the election, entitled to Medicare
i. The date the Employer ceases to maintain any group health plan J•
In the case of individuals receiving the 11 -month Disability Extension due to a Qualified Beneficiary being deemed disabled by the Social Security Administration, coverage may terminate the first of the month 30 days after the date of the final determination that the Qualified Beneficiary is no longer disabled. The 1999 Proposed Regulations clarify that if a Qualified Beneficiary is deemed no longer disabled, this would terminate the COBRA coverage for all Qualified Beneficiaries who were entitled to the disability extension
k. According to the 1999 Final Regulations, the group health plan can terminate "for cause" the coverage of a Qualified Beneficiary receiving COBRA on the same basis that the plan terminates "for cause" the coverage of a similarly situated non -COBRA beneficiary

16. COBRA Premiums
a. In accordance with COBRA statute, the person paying the COBRA premium has the right to make premium payments in monthly installments.

The 1999 Final Regulations state that the plan can allow other options, in addition to monthly payments. Such options might be weekly, quarterly or semi-annual payments.
b. Employers are allowed to charge COBRA participants up to 102 percent of the applicable premium for continuation coverage. According to the COBRA statute, applicable premium means, "the cost to the plan for such period of the coverage for similarly situated Beneficiaries with respect to whom a qualifying event has not occurred (without regard to whether such cost is paid by the employer or employee)".
c. Generally, COBRA premiums cannot be more than 102 percent of the premium for active employees. However, if a Qualified Beneficiary is disabled and continuing his/her coverage under COBRA for 29 months, the employer is allowed to charge the disabled Qualified Beneficiary up to 150 percent of the applicable premium from the 19th to the 29th month. If the disabled individual is part of the coverage, family members may also be charged up to 150 percent if the disabled individual is part of the coverage.

If the disabled individual is not part of the coverage then the plan may only charge the usual COBRA rate of up 102 percent.

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Administrative Policies and Procedures
E. Health Insurance Portability and Accountability Act (HIPAA)

1. Certificate of Coverage
a. Under HIPAA, this Plan is required to furnish a certificate of coverage to Employees and Dependents in the event that coverage ceases. The purpose of this certificate is to provide documentation of prior coverage. HIPAA assumes that the Employee will present the certificate to the ensuing health care plan as evidence of prior coverage; the ensuing plan may also request that the certificate be mailed to it directly. Depending on the circumstances, that plan may waive all or part of any pre-existing coverage exclusions if the certificate is presented to the health plan on a timely basis. A certificate of creditable coverage will be issued to:
(1)
An individual, who is entitled to elect COBRA continuation coverage, at a time no later than when a notice is required to be provided for a qualifying event under COBRA
(2) An individual, who loses coverage under a group health plan and who is not entitled to elect COBRA continuation coverage, within a reasonable time after coverage ceases
(3)
An individual, who has elected COBRA continuation coverage, either within a reasonable time after the Plan learns that COBRA continuation coverage ceased or, if applicable, within a reasonable time after the individual's grace period for the payment of a COBRA premium ends
b. The certificate will contain information required by law or regulation. The certificate will reflect a maximum of 18 months of creditable coverage not interrupted by a break in coverage of 63 days or more.
c. An individual also may request a certificate within 24 months of losing coverage. That request should be directed to the VEBA Administrator. d. Issuing Notices
(1) Whenever a participant terminates coverage for any reason, the Employer will issue a certificate of coverage. Some of the events triggering this notice requirement are:
(a) Termination of employment
(b) Change to a non -benefit -eligible position
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(c) Termination of COBRA (for any reason)
(d) Termination of subscriber or dependent coverage at annual re -enrollment
(e) Dependent child no longer meets the eligibility definition under the plan
(2) The notice will be issued in the same timeframe that the Employer uses to issue COBRA letters. The Employer will certify the period of continuous coverage ending on the termination date of coverage. "Continuous" means that the coverage period does not have any breaks exceeding 62 calendar days. The names of any Dependents should be included on the form if that information is reasonably available to the employer.
(3) Employers also must issue certificates to individuals who request them within 24 months following their cessation of coverage. e. Receiving Notices
(1) When an Employee first becomes eligible for benefits, the Employee may present to the Employer a certificate of coverage from prior employment. The Employer will send a copy of the certificate to the VEBA Administrator. The copy will be routed to the insurance carrier for determination of the remaining period for preexisting condition limitations. The insurance carrier will respond to the individual in writing within two weeks if any portion of the six-month preexisting condition period remains. No response from the insurance carrier is required if the entire preexisting period will be offset by the certificate of coverage.
(2) In the event that an Employee or Dependent is not issued a Certificate of Coverage by the prior employer, the Employer may call the other plan and obtain information over the phone. That information can be sent to the VEBA Administrator and will be forwarded to the insurance carrier for review.

2. Special Enrollment Provisions
a. Under HIPAA, an Employee or his or her Dependent(s), who initially declined to enroll in VEBA, must be allowed to enroll during the Plan Year if they meet the below described conditions:

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Administrative Policies and Procedures
(1) The Employee gains a Dependent through marriage, birth, adoption, or placement for adoption
(2) The Employee, spouse, or other Dependent(s) loses other coverage through another employer (e.g., due to legal separation, divorce, death, termination of employment, reduction in hours, termination of contributions for coverage by the other employer, or completion of the maximum COBRA continuation period)
b. The Employee must make a request to the Employer to exercise this special enrollment option. The Employee must request coverage within 30 days of the event as noted above.
c. Coverage is effective as of the date of the event (i.e., birth, adoption, or placement for adoption), except for marriages. Coverage for a spouse in the event of marriage is effective on the first of the month following the date of the request.
d. Employees otherwise eligible for a VEBA plan who choose to disenroll from another plan do not qualify for this special enrollment option and are treated as late enrollees. As such, the Employee or his or her Dependent may not enroll in the Plan except during the annual Open Enrollment Period (unless he or she qualifies for the special 30 -day enrollment period cited earlier).

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55 California Schools
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Administrative Policies and Procedures
Section X
Exhibits
Exhibit A
Ten -Tier Rate Structure
Exhibit B
Domestic Partner Documents
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Voluntary Employees Benefits Association (VEBA)
Administrative Policies and Procedures
Exhibit A
Ten -Tier Rate Structure Effective 01/01/2012
Each of the following charts outlines three questions that, when answered, determine the applicable rate tier for either the HMO or PPO plan.

HMO Rate Tiers
Three Questions
Bargained/Non-
Bargained Unit Status
Points

1. For this bargained/non-bargained unit, what
of the family rate in the UHC
Performance HMO Network 1 does the
district contribution cover (after any
mandatory coverages) - assumes that
singles and two-party receive at least this
%?
96%-100%
87%<96%
78%<87%
69%<78%
61%<69%
53%<61%
45%<53%
<45%
7 points
6 points
5 points
4 points
3 points
2 points
1 point
0 points

2. For this bargained/non-bargained unit, are
any employees paid cash or given other
benefits if they waive all or part of the
medical coverage (e.g., waive dependent
coverage or waive coverage entirely)?
Yes
No
-1 point
1 point

3. Is active employee enrollment for UHC
(HMO and PPO combined) at least 45% of
those taking medical?
100% in UHC
At least 45% but less than 100%
Less than 45% in UHC
3 points
2 points
0 point
Total the points (should total from 0 to 11)
The total points link directly to the rates.
10-11 points Tier X
9 points Tier IX
8 points Tier Vlll
7 points Tier VII
6 points Tier VI
5 points Tier V
4 points Tier IV
3 points Tier III
2 points Tier II
0-1 points Tier I

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Administrative Policies and Procedures
PacifiCare PPO Rate Tiers
Three Questions
Bargained/Non-
Bargained Unit
Status
Points

1. For this bargained/non-bargained unit, what % of the 96%-100%
7 points
family rate in the PPO does the district contribution
87%<96%
6 points
cover (after any mandatory coverages) - assumes that
78%<87%
5 points
singles and two-party receive at least this (1/0?
69%<78%
4 points
61%-69%
3 points
53%<61%
2 points
45%<53%
1 point
<45%
0 points

2. For this bargained/non-bargained unit, are any
Yes
-1 point
employees paid cash or given other benefits if they
waive all or part of the medical coverage (e.g., waive
dependent coverage or waive coverage entirely)?
No
1 point

3. Is dependent enrollment (number of 2 -party and family 60%+
2 points
compared to the total enrolled in PPO) at least:
50%<60%
1 point
Total the points (should total from 0 to 11)
The total points link directly to the rates.
10 points Tier X
9 points Tier IX
8 points Tier Vlll
7 points Tier Vll
6 points Tier VI
5 points Tier V
4 points Tier IV
3 points Tier III
2 points Tier II
0-1 points Tier I

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California Schools
Voluntary Employees Benefits Association (VEBA)
Exhibit B
Health Coverage For
Domestic Partners
An Employee may provide coverage for an eligible Domestic Partner and/or the Partner's Eligible Dependent Children by submitting appropriate enrollment forms within required timelines.

Eligibility
VEBA offers Domestic Partner Coverage under either of the following two eligibility provisions:

1. Employees may qualify for Domestic Partner Coverage by having registered the Domestic Partnership with the State of California and providing to the VEBA, a copy of the registration.

2. An Employee who has not registered the Domestic Partnership with the State of California may qualify for Domestic Partner Coverage by meeting the requirements of, and filing, a Declaration of Domestic Partnership with the VEBA.

Possible Tax Implications of Domestic Partner Coverage

2. State taxes may apply if the Employee and Domestic Partner fail to register with the state of California or other applicable state where they reside.

3. An Employee may want to consult an attorney concerning any possible income tax implications of providing Domestic Partner coverage.

4. Neither the District nor the Southern California Schools Voluntary Employees Benefits Association or any employee or agent can definitely identify the tax consequences.

Enrollment Process and Timelines
For Domestic Partners registered with the State of California, a properly completed enrollment form and copy of the registration endorsed as filed by the California Secretary of state must be submitted to the Employer/Plan Administrator within the following required timelines:

1. 31 days of the date of hire, or

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2. for a continuing Employee newly eligible to enroll for benefits coverage, within 31 days of attaining eligibility, or

3. within 31 days of registration with the State of California, or

4. the Employer's annual Open Enrollment Period; the effective date must coincide with the beginning of the Employer's Plan Year.

An Employee who has not registered the Domestic Partnership with the State of California may enroll under this option only during the Employer's Annual Open Enrollment period by submitting the required forms and attachments to the Employer/Plan Administrator. (See the attached Declaration of Domestic Partnership form for requirements.) Cessation of Domestic Partner Coverage
The Employee and/or the Domestic Partner have a responsibility to notify the Employer/Plan Administrator of the termination of the Domestic Partnership within (30) days of the first to occur of the following:

1. The death of the Domestic Partner

2. The date on which any of the criteria of a Domestic Partnership relationship is no longer met
If the Employee fails to make the required notification, the Employee will be liable for any expenses incurred by the VEBA with respect to the former Domestic Partner or his/her Dependents after the termination of the Partnership and must reimburse the VEBA for the value of those benefits. The VEBA shall have the right to recover attorney fees and costs incurred in collecting such expenses from the Employee.

Coverage for a Domestic Partner and his/her Eligible Dependent Children will cease on the first to occur of the following:

1. The end of the month in which the death of the Domestic Partner occurs

2. The end of the month in which one or more of the criteria of Domestic Partnership is no longer met

3. The end of the month for which a required Employee contribution is made for coverage for a Domestic Partner or his/her Dependents
Under current law, a Domestic Partner and his/her Dependents are not eligible for COBRA continuation coverage upon cessation of VEBA coverage; however a limited conversion plan may be available through the medical plan carrier.

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Voluntary Employees Benefits Association (VEBA)
Declaration of Domestic Partnership
I, , submit this Declaration of Domestic Partnership to establish (Name of Employee)
as my Domestic Partner (as this term is defined
(Name of Domestic Partner)
below) for the purpose of qualifying for any benefits that the District may extend to employees in a Domestic Partnership.

I, , declare and acknowledge as follows:
(Name of Employee)
I and are Domestic Partners.
(Domestic Partner)
"Domestic Partners" means two adults of the same or opposite sex who have chosen to share their lives in an intimate and committed relationship, reside together, and share a mutual obligation of support for the basic necessities of life.

Specifically, I declare and acknowledge that I and my Domestic Partner named above meet all of the following criteria:
• Are both at least 18 years old, and
• are not legally married to anyone, and
• have had at least twelve complete months between the date of the teiiuination of any prior marital status or domestic partner relationship and the date the domestic partner application is submitted, and
• reside in the same residence, with the intent to reside together permanently, and • have the mental competence to contract, and are not related by blood to the degree that would bar marriage under California law, and
• have resided together continuously for the twelve complete months preceding application for coverage, and
• have agreed to be jointly responsible for basic living expenses, including food, shelter, and other expenses of the joint household, and
• have terminated any prior domestic partnership at least twelve complete months prior to application for coverage, and
• have filed a fully complete application, together with attachments.

This Application must be accompanied by any one of the following to establish joint residence:
• Copies of driver's licenses for both individuals which contain the same address, or • Mortgage documents or deed containing the names of both individuals, or • Rental lease agreement containing the names of both individuals.

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This Application must be accompanied by any one of the following to establish financial interdependence:
• Joint checking or savings account, or
• Credit cards with the same account number in both names, or • Common ownership of real property or a common leasehold interest in real property, or • Common ownership in a motor vehicle, or
• Joint wills in which one partner is the primary beneficiary under the other partner's will, or • Designation of both partners as authorized signatories on safe deposit boxes, or • Designation of the Domestic Partner as the beneficiary under the Employee's life insurance plan.

I acknowledge that:
• I cannot file another Declaration of Domestic Partnership for a new Domestic Partnership until at least twelve months after a Statement of Termination of Domestic Partnership has been filed. • If requested, I will provide to the District's Plan Administrator or designated representative documents establishing the existence of my Domestic Partnership relationship. • Neither the District nor the Southern California Schools Voluntary Employees Benefits Association is providing legal advice and that I have been advised to consult an attorney regarding the possible legal implications of filing this Declaration of Domestic Partnership. • I have an obligation to file a Statement of Disenrollment, Death, or Termination of Domestic Partnership with the District's Plan Administrator or designated representative within [30] days of the earliest of (a) the death of my Domestic Partner; (b) the date on which any of the criteria of a Domestic Partnership relationship is no longer met. I further understand that the effective date of the end of the Domestic Partnership relationship is the earliest of (a) the death of my Domestic Partner; (b) the date on which I file a Statement of Disenrollment, Death or Termination of Domestic Partnership with the District's Plan Administrator or designated representative; (c) the date on which the Domestic Partner notifies the Plan of the termination of the Domestic Partnership; (d) the date on which one or more of the criteria of Domestic Partnership are no longer met. • I understand that I am responsible for the reimbursement of any expenses incurred as a result of any false or misleading statement contained in this Declaration of Domestic Partnership, including claims paid under any benefit plans in which I enroll my Domestic Partner and/or child(ren) of a Domestic Partner. The Plan shall have the rih,t to recover attorney fees and costs incurred in collecting such expenses from me.

I declare, under penalty of perjury, that the foregoing is true and correct that this Declaration was executed on at , California.

Dated:
(Signature)
(Name of Employee)
(Address)
(City, State, ZIP Code)
(Name of Domestic Partner)

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Voluntary Employees Benefits Association (VEBA)
Domestic Partner
Health Care Enrollment Statement
To enroll , and/or his or her eligible
dependent
(Name of Domestic Partner)
children, if any, in the District's group health care coverage that, subject to certain limitations, covers District employees and their Domestic Partners, I declare and acknowledge my understanding that:
• The options under the group health coverage currently available to employees who choose to enroll their Domestic Partners and/or child(ren) of Domestic Partners may be more limited than those available to other employees (i.e., limited to medical, dental, and vision coverage only).
• All group health coverage is governed by the terms of the underlying plan(s) ("Plan"). • If I choose to enroll only the child(ren) of my Domestic Partner, I understand that my Domestic Partner may not subsequently enroll in the group coverage until a future District annual enrollment period.
• The effective date of coverage may only coincide with the District's annual health care re -enrollment date next following the timely receipt of my signed election. • Unless my Domestic Partner and/or child(ren) of my Domestic Partner also are considered my dependent for tax purposes under Section 152 of the Internal Revenue Code, the Internal Revenue Service currently treats as imputed income to the employee the value of the health coverage provided the Domestic Partner's dependents, if any, less any contribution paid by the employee for this coverage. I reviewed the examples of imputed income amounts for group health coverage detailed in the cover letter to this Statement.

I understand that I should consult an attorney concerning the income tax implications of filing this Statement and that neither the District, the Southern California Schools Voluntary Employees Benefits Association nor any employee or agent can definitely identify the tax consequences.
• I have an obligation to file a statement of Disenrollment, Death or Termination of Domestic Partnership with the District's Plan Administrator or designated representative within [30] days of the earliest of (a) the death of my Domestic Partner, or (b) the date on which any of the criteria of a Domestic Partner relationship is no longer met.

Page 434 of 1154 ends

California Schools
Voluntary Employees Benefits Association (VEBA)
• Regardless of whether the requisite Statement of Disenrollment, Death or Termination of Domestic Partnership has been filed, the effective date of the end of the Domestic Partner relationship, and, therefore, the date on which coverage of my Domestic Partner and his or her dependent children, if any, will end, according to the terms of the Plan, is the earliest of:
the date on which my Domestic Partner dies;
the date on which my Domestic Partner and I terminate our Domestic Partnership;
the date on which one or more of the criteria of Domestic Partnership are no longer met; or
the date on which I file a Statement of Disenrollment, Death, or Termination of Domestic Partner with the District's Plan Administrator or designated representative.

I affirm that the statements in this Statement are true to the best of my knowledge.

DATED:
(Signature)
(Name of Employee)
(Address)
(City, State, ZIP Code)

Page 435 of 1154 ends

California Schools
Voluntary Employees Benefits Association (VEBA)
Statement of Disenrollment, Death, or
Termination of Domestic Partnership
, makes and files this Statement of Disenrollment, Death or (Name of Employee)
Termination of Domestic Partnership in order to cancel the Declaration of Domestic Partnership previously filed.

I wish to cancel, effective immediately, the Declaration of Domestic Partnership previously filed with respect to
(Name of Domestic Partner)
-OR-
The Domestic Partner relationship between me and
(Name of Domestic Partner)
ended on
(Date of Termination)
-OR-
My Domestic Partner, , died on
(Name of Domestic Partner) (Date of Death)
For Termination of Group Health Coverage of Domestic Partnership I understand that, if my Domestic Partner has previously been covered by the District's group health coverage, the effect of filing this Statement of Disenrollment, Death or Termination of Domestic Partnership is that my Domestic Partner, and/or his or her eligible dependent children, if any, will no longer be covered by the District's group health coverage, in accordance with the terms of the underlying plan(s) ("Plan").

I further acknowledge that it is my responsibility to mail a copy of this signed statement to my Domestic Partner/former Domestic Partner, named above.

I affirm that the statements in this Statement are true to the best of my knowledge.

DATED
(Signature)
(Name of Employee)
(Address)
(City, State, Zip Code)

Page 436 of 1154 ends

Docusign Envelope ID: 6A02C1FD-DB8B-43AA-8158-1C70A93B7BE6 Lincoln
Financial Group
The Lincoln National Life Insurance Company
Group Insurance Service Office
8801 Indian Hills Drive, Omaha, NE 68114
Phone: 800-423-2765 Fax: 877-573-6177

APPLICATION FOR GROUP INSURANCE
is made to THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (the Company).

A. Group Name & Address
Applicant's Full Legal Name (exactly as to be shown in Group Policy) City of Beaumont
Main Office Address (physical location and group situs state) Street Address
550 E 6th Street
E -Mail Address (if available)
[email protected]
City
Beaumont
Phone
+1 (951) 769-8528
State Zip
CA 92223
Fax
B. Requested Insurance
The following Group Insurance is applied for as specified in the sold case proposal(s). Complete the requested Effective Date for each.

Group Insurance
Requested
Effective Date
Group Insurance
Requested
Effective Date
n Life & AD&D
01 /01 / 2026
❑ Voluntary Life
__/_/
a Short Term Disability (STD)
01 /01 / 2026
❑ Voluntary Life & AD&D
01 /01 /26
x Long Term Disability (LTD)
01 /01 / 2026
❑ Voluntary AD&D
.__/-/
❑ Dental
//
❑ Voluntary Short Term Disability
//
❑ Accident

❑ Voluntary Long Term Disability
_/_/_
_l_l
❑ Critical Illness
_/_/_
❑ Voluntary Dental
_/_/
❑ Hospital Indemnity
//
C. Business Information
Nature of Business (Please specify)
Government
Business is Organized as (Select one)
n Corporation n Partnership n Proprietorship
n Labor Union n Association n Trust Other Government
Financial Risk (If Yes to any part, please explain below.) Has Applicant ever filed for bankruptcy? n Yes [J No
Does Applicant anticipate ceasing or materially reducing active business operations? Has Applicant opted out (or do they anticipate opting out) of Workers' Compensation? x
Years in Business Federal Tax ID No.
113
95-60000676
n Non -Profit Organization
❑ Yes
❑ Yes
No
No
Explanation:

Binder payment submitted: Amount $ (if applicable)
GL2-APP.01/18 CA
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. (01/21)

Page 437 of 1154 ends

Docusign Envelope ID: 6A02C1FD-DB8B-43AA-8158-1C70A93B7BE6 D. Replacement Insurance
Will all or part of this insurance replace any similar insurance? If Yes, provide details of the prior plan below and enclose a copy of each inforce contract to be replaced. [l Yes ❑ No
Insurance Type
Prior Carrier Name
C;iiarrlian
Prior Plan
Effective Date
03 /01 / 2006
Termination
Date
12 /31 /2025
/
- //
- //
E. Fraud Warning/State Disclosure(s)

A PERSON MAY BE COMMITTING INSURANCE FRAUD IF HE OR SHE SUBMITS AN APPLICATION CONTAINING A FALSE OR

DECEPTIVE STATEMENT WITH THE INTENT TO DEFRAUD (OR KNOWING THAT HE OR SHE IS HELPING TO DEFRAUD) AN INSURANCE COMPANY. THE FALSITY OF ANY STATEMENT IN THIS APPLICATION SHALL NOT BAR THE RIGHT TO RECOVERY UNDER THE POLICY

UNLESS SUCH FALSE STATEMENT WAS MADE WITH ACTUAL INTENT TO DECEIVE OR UNLESS IT MATERIALLY AFFECTED EITHER THE ACCEPTANCE OF THE RISK OR THE HAZARD ASSUMED BY THE INSURER.

F. Agreement
The Applicant applies for group insurance. The information in this Application is true and correct to the best of the Applicant's knowledge and belief. It forms the basis for this request for group insurance. Omission or misstatement of known information on this Application could affect the validity of any insurance issued and cause the denial of an otherwise valid claim. The Applicant understands that the requested group insurance will:
(a) be issued only if the requested insurance is legally permissible; (b) be issued under a group Policy or Policies in the language customarily used by the Company; (c) be subject to the Company's usual underwriting requirements (including Evidence of Insurability, if applicable); (d) be subject to all exclusions, limitations, and other provisions of the Policy; and (e) take effect on the date determined by the Company, in accord with the provisions of the Policy.

The Applicant understands that no agent or broker has the authority to guarantee the acceptability of the requested insurance. The effective date of insurance for which an employee is required to submit satisfactory Evidence of Insurability will be determined in accord with the Policy's terms, and will be subject to any Active Work requirement. The Applicant agrees not to:
(a) collect or pay premiums (other than the Binder Premium, if any) for such insurance, before receiving the Company's notice of approval; or
(b) distribute material describing Policy coverage to persons to be insured, without the Company's prior written consent.

If dental insurance is requested, the Applicant agrees to provide employees and dependents notice of any applicable continuation rights, required by federal COBRA law or any similar state continuation law. Premium rate quotes were based on data submitted to the Company. Final premium rates will be determined by the actual composition of the group. This application and the Binder payment, if any, constitutes the consideration for any Policy issued. After receipt of the Policy, payment of the premium is deemed acceptance of the Policy's terms and provisions, including its exhibits, riders, endorsements, or amendments, if any. If this Application is approved, it will be made a part of any Policy issued.

Writing Agent
Or Broker's Signature
Typed or Printed Name Mars
AttAYSIA.i1LMA, SIA/ Iw4S
iawn Swims
License Number L259462 State (:A
Signed by Applicant's Authorized Representative:

Signature
Typed or Printed Name Gus Romo
Title Interim City Manager
State Signed Date / /
Must be signed prior to Effective Date
GL2-APP.01/18 CA (01/21)

Page 438 of 1154 ends

Docusign Envelope ID: 6A02C1FD-DB8B-43AA-8158-1C70A93B7BE6

PARTICIPATION AGREEMENT
The Lincoln National Life Insurance Company (herein called the Company) Complete only if applying for coverage under The Lincoln National Life Insurance Company Voluntary Insurance Trust.

Note: Do not complete in AK, AL, FL, ME, MN, MS, NY, SD, TX, VT, WA or WI.

Application is hereby made to become a Participating Employer under The Lincoln National Life Insurance Company's Voluntary Insurance Trust, based on the following statements plus the attached application for group insurance coverage. The Group Employer named below (herein called the Employer) understands that if Voluntary Group Term Life and AD&D or Disability Income insurance is requested and approved, such Employer will become a Participating Employer under The Lincoln National Life Insurance Company Voluntary Insurance Trust, sitused in Kansas City, Missouri. The Employer agrees to the terms of the Trust Agreement, each group policy issued to the Trust under which the Employer's employees become insured, and any amendments to them. The Employer understands that group certificates will be supplied and agrees to distribute them to each employee enrolled in the program. After receipt of the group certificates, payment of premium is deemed acceptance of the policy's terms.

The Employer agrees to be responsible for all premiums payable with respect to any of my employees who will be insured under the policy. The Employer agrees to honor and administer on a timely basis the written payroll deduction request of each participant, in the amount required to pay the necessary premium to keep coverage in -force. Payroll deductions will be remitted to the Company on a timely basis, in accord with the billing schedule agreed upon. The Employer agrees to promptly furnish the Company any information reasonably required to administer the coverage and claims under it.

The Employer understands that participation in the program may be terminated at any time by giving prior written notice to the Company. The effective date of termination will be the date the notice is received by the Company's Group Insurance Service Office, or on any later date stated in the notice. The Employer understands that the Company may terminate the Employer's participation based on the following circumstances:
a) at the end of the grace period during which the required premium has not been paid; b) on any premium due date on which participation in the program falls below a minimum level of 10 employees; c) on any premium due date when the Employer has failed to perform any duties related to the policy in good faith; d) on any premium due date after the premium rate has been in effect for at least 12 months (or any longer Rate Guarantee period agreed upon by the Company).

The Employer understands that the Company may change any premium rate:
a) when there is a change in the terms of the policy, or in the factors bearing on the risk assumed; b) when the policy liability is changed as a result of a change in federal, state or local law; c) when a division, subsidiary or affiliate is added, removed, or relocated; d) when the number of insured employees has changed by 25% or more since the Rate Guarantee period began; e) on any premium due date after the expiration of the Rate Guarantee period agreed upon by the Company.

SIGNATURE
I have read and understand the agreement above and will comply with the agreement as stated. I have reviewed, understand and agree to the proposal, rate structure, and enrollment strategy presented to me by the Company representative. I understand that no agent, broker or field representative has any right to bind the requested coverage, alter the terms of the policies or enrollment materials, adjust any claim for benefits, or waive any of the Company's rights or requirements.

Group Employer Name & ID City of Beaumont 1042033
Gus Romo
Printed Name of Authorized Company Officer Signature of Authorized Company Officer Interim City Manager
Title Date
VPA2007

Page 439 of 1154 ends

(02/20)

Docusign Envelope ID: 6A02C1FD-DB8B-43AA-8158-1C70A93B7BE6 nLincoln
Financial Groups.

Employer Authorization
The Lincoln National Life Insurance Company
8801 Indian Hills Drive
Omaha, NE 68114-4066
Toll free: 800-423-2765
Employer Name ("Employer"):

Group ID:

Employer Business Phone:

City of Beaumont
1042033
+1 (951) 769-8528
Third Party Entity Name ("Third Party"):

Third Party Business Phone/ Email Address:

Effective Date:
01/01/2026
Employer has selected the Third Party identified above to provide services in connection with the insurance coverage with The Lincoln National Life Insurance Company ("Lincoln"). Third Party services provided to the Employer may include, but are not limited to, the following: benefit administration, electronic enrollment, billing, premium remittance, or additional support for the Employer's benefit plans. In order to facilitate these services, Employer, as Lincoln's customer and on behalf of the employees ("Insureds"), authorizes and directs Lincoln to:

Exchange Insureds' non-public personal information, protected health information, or other confidential information of the insured ("Insured Information"), with the Third Party through verbal, written or electronic means; Accept premium payments and member adjustments from the Third Party on behalf of the Employer.

Employer is responsible for the services provided by the Third Party. Employer further agrees to be responsible for the accuracy of the information provided by the Third Party to Lincoln. Any technology payment made by Lincoln directly to the Third Party is done on behalf of the Employer to support the use of technology. Employer will hold Lincoln harmless in the event of any claims, liability, and damages arising from the services the Third Party provides to the Employer.

Employer has been provided a copy of Lincoln's Privacy Practices Notices. Employer will communicate this information to the parties responsible for assuring compliance with these policies by both Employer and the Third Party.

If Insured Information is exchanged pursuant to this authorization, Employer will take reasonable steps to ensure that the Third Party: (i) takes precautions to protect the confidentiality of the Insured Information, in accordance with all federal and state laws; (ii) preserves privacy of the Insured Information in the handling, transmission, storage, use, and eventual destruction of data; and (iii) cooperates with Lincoln to establish a secure methodology to transmit Insured Information.

Employer may revoke or amend this Employer Authorization ("Authorization") at any time by providing written notice of revocation to Lincoln, Attn: Case Management, 8801 Indian Hills Drive, Omaha, NE 68114, except to the extent that Lincoln has previously taken action in reliance on the Authorization. Employer is also responsible for providing Lincoln with written notice of termination of the Third Party relationship and understands that Lincoln may require periodic validation from the Employer confirming that this Authorization remains in effect. This Authorization shall expire 24 months from the effective date indicated above.

The undersigned, as an authorized representative and designated contact for the Employer with the authority to name additional designated parties, hereby agrees with and consents to the terms and conditions set forth in this Authorization:

Signed:

Employer's Representative Name: Gus Romo
Title: Interim City Manager
Date:

LCN-1882056-082817

Page 440 of 1154 ends

(06/17)

Close
ObCusign Envelops ID: AC2113A7-2A71-4DE9-9878-8MDF5545242 Application for Vision Care Benefits
LJndel yr tten by Fidelity Security Life I nsurtiln'._,G Company Kansas City, Missouri 64111
eve
Med
I. GROUPINFORMATION
Group Name: City of Beaumont - CA
DEA Name (If other than above):

Tax IDS: 95-5100.06776
Business Physical Address: 550 E, 6th St.
(Street Address)
Mailing Address Serne
(Street Addy+ )
Day -to -Day Contact Name: Shay Norville
Beaumont CA
I; Glt3r) (State)
(city)
Title:
922e
(State) (Zip)
Payroll Benefits Supervisor
Phone Number ) 951-769-S520 E -Mail Address: ehaynr beaurnontca.gov Type of Business: ❑ Proprietorship ❑ Corporation 0 Other (Specify): Local Government PLEASE NOTE THE FOLLOWING TYPE BUSINESSES REQUIRE PRIOR CARRIER APPROVAL:
_I P,'E°VS'!A ❑ PEO ❑ Trust ❑ Union ❑ VEBA
Service Area: ❑ National (U.S.— does not include Puerto Rico) q State Specific* ❑ National (U.S.— does include Puerto Rrca)
*Italy subsidiary or affiliated companies are to be insured or any EmployeesiMembers are working or residing in a slate other than the business address above, please list those states:
ca
❑ Casino/Indian Tribe
Number of employees/members with language preferences other than English for oral or written communications Spanish Chinese Other
Oral i Written Oral Written Oral Writt
GROUP DI SPLAY NAME (Your Group Name as it should appear to your EruployeesiMernbe:rs) Company Name: icily ofee motrn-CA
(Maximum of 40 characters., irctucfing capital ati n, punctuation and spacing.) II. GROUP BILLING
Billing Physical Address:

Primary Contact Name:
550 E 6th Street
(Street Actress)
Shay Norville
Beaumont
Ca 9222;
Cityj (State)
Title: Payroll Benefits Supervisor
OP)
Phone Number. ( ) 951-769-8529 E -Mail Address: [email protected] Do you have any additional subsidiaries„ afiroted companies, dMsions that use arlc filer name and will be covered by this plan AND rep separate billing invokes? ❑ Yes Q Na if Yes, please attach and send a separate page signed by ycki with the fai'iolnring intimation: Na Address, Billing Contact Name and Phone Number
III. PREMIUMS'
Pi' ease 'r d_rcate the percentage or premium contrr uteri by the Group and the Employee/Member for both EmployeealemberandDependents, the total ter"each row gust equal 100%.

EmploveeiMembers:

Dependents_
Group Contribution
7500

75.00 EmploveeNlember Contribution

Page 441 of 1154 ends

BEAUMONT
-C A L I F O R N A -
Staff Report
TO: City Council
FROM: Kari Mendoza, Administrative Services Director
DATE: December 2, 2025
SUBJECT: Side letters Increasing the Cafeteria Plan for Police Management, Police Officers Association (POA), Managers/Professional/Technical and SEIU Local 721.

Description: Side letters with all memorandums of understanding increasing the cafeteria plan along with updating CaIPERS language in POA and Police Management units to ensure CaIPERS compliance.

Background and Analysis:

In October 2025, staff initiated "meet and confer" discussions per the memorandums of understanding (MOUs) requirements to address 2026 medical insurance renewal rates.

In November 2025, the City Council authorized staff to draft side letters establishing an increase to the cafeteria plan contribution from $1,915 per month to $2,144 per month effective January 1, 2026.

Staff also incorporated new fiscal year 2026 classifications into each recognized bargaining unit's classification table and added those eligible new classifications to the Safety Boot and Shoes policy, allowing eligible classifications to receive annual reimbursement for the purchase of safety boots.

In the POA and Police Management MOUs, CaIPERS related language has been updated to ensure compliance with CaIPERS requirements for reporting holiday pay.

These changes were requested by CaIPERS following an audit and are reflective of existing practices. The clarifying language does not result in any additional cost for the City.

Fiscal Impact:

The total projected increase is $169,196.82 annually. The impact on FY 25-26 budget will be approximately $85,000.00 with each department capturing these costs in their respective budgets.

Page 442 of 1154 ends

The cost to prepare this staff report is estimated to be $400.

Recommended Action:

Authorize the City Manager to sign the MOU side letters to increase the cafeteria plan Police Management, Police Officers Association (POA),
Managers/Professional/Technical and SEIU Local 721.

Attachments:

A. Police Management Side Letter # 5
B. Police Officers Association Side Letter # 7
C. Managers/Professional/Technical Unit Side Letter # 5 D. SEIU Side Letter # 3

Page 443 of 1154 ends

SIDE LETTER #3 TO THE
2022-2026

MEMORANDUM OF UNDERSTANDING

BETWEEN

THE CITY OF BEAUMONT

AND BEAUMONT POLICE MANAGEMENT UNIT
On March 1, 2022, the City of Beaumont ("City") and the Beaumont Police Management Unit entered into a Memorandum of Understanding that is effective from January 1, 2022 through June 30, 2026 ("MOU").

The City and the Police Managers Unit met and conferred in good faith and have agreed to the terms of this side letter to the MOU, which shall operate prospectively from the date it is both approved by Police Management Unit and ratified by the City Council.

This side letter shall amend and replace Article IV (I) and Article V(G) of the MOU with the following:

ARTICLE IV: POLICE MANAGEMENT UNIT SPECIFIC BENEFITS
I. EDUCATIONAL INCENTIVE: CCR 571(a)(2) and CCR 571.1(2) define Peace Officer Standard Training (POST) Certificate Pay as compensation to local police officers and public safety dispatchers who obtain POST certification. Each employee shall be eligible for special compensation, separate from their base pay rate, reportable to Ca1PERS periodically as earned, if they obtain the following:

1. Management P.O.S.T. Certificate an additional 2.5%.

ARTICLE V: SALARY AND BENEFITS
G. CAFETERIA PLAN: Effective with the ratification of this agreement by the City Council on the first pay period ending after January 1, 2026, the City shall contribute two - thousand one hundred forty-four dollars ($2,144) per month to each unit member for the cafeteria benefit plan detailed in this section.

1. Said contribution shall be used to provide for health insurance for the employee.

Employee shall be covered by health insurance with a CITY approved health plan unless the employee provides proof to the CITY the employee is covered by another acceptable health plan as determined by the CITY's Human Resource Department.
9737390.1 BE023-005

Page 444 of 1154 ends

2. The balance may be used for any of the following or any combination thereof:
a. Health Insurance for employee's spouse and/or dependents; b. Dental Insurance for employee's spouse and/or dependents; c. Eye care plan for employee, spouse and/or dependents.

3. There is no cash -back of the remaining contributions amount, if any, to the employee after payment of the selected premiums(s). The employee shall be responsible for the remaining payments(s) through payroll deduction, of any premiums selected which are in excess of the monthly contribution amount.

4. Employees who elect to not participate in the Cafeteria Plan and can show adequate proof of an approved health plan, shall have the option to have an amount equal to the 2023 employee only (single) monthly medical premium rate of $667.63 paid to the employee. If taken as cash payment, the amount is not to be considered as pensionable compensation for the purposes of Ca1PERS. Such alternative health plan coverage must be verified initially and thereafter on an annual basis by signing a verification that complies with the Affordable Care Act, which will be provided to the City Alternative health plan coverage must be maintained until the next available CITY open enrollment period. Employees hired after January 1, 2023, will not have the option to receive the cash payment in lieu of health care.

5. Cafeteria Plan Reopener: If the combined premiums for Healthcare, Dental, and Vision insurance increase more than 5% from their January 2026 rates, then the parties agree to meet and confer about increasing the Cafeteria Plan Contribution.

The parties agree to hold additional reopeners in this regard if, subsequent to triggering the initial meet and confer, measuring the combined premium increases (cumulative to the triggering date) for the subsequent year(s) shows subsequent premium increases of more than 5%.

ARTICLE VI: HOURS AND WORHING CONDITIONS
A. HOLIDAY ACCRUAL: The CITY allocates fourteen (14) eight -hour days per year accrued at 4.31 hours per pay period (one hundred twelve (112) hours per year). Holiday pay is special compensation defined by CCR 571(a)(5) and CCR 571.1.(4). Recognized holidays currently include:

New Year's Day
Martin Luther King Jr Day
Veterans Day
Thanksgiving
9737390.1 BE023-005

Page 445 of 1154 ends

President's Day
Memorial Day
Independence Day
Labor Day
Indigenous People's Day
Friday after Thanksgiving
Christmas Eve
Christmas Day
Day After Christmas
New Year's Eve
An employee may request payment of banked holiday pay, to be paid by separate check. An Employee's base pay plus any special compensation that qualifies as pensionable compensation reportable to CALPERS is used to calculate the rate of holiday pay. This includes POST, FTO, Motorcycle, Traffic, K9, Training and Notary. Holiday pay accrued and paid witiin the period earned is reportable for Classic members under CCR 571(a)(5). Banked holiday pay exceeding the maximum accrual limit and paid out after the period earned is not reportable. Banked holiday pay for PERRA members is not reportable if eligible to be used as time off in lieu of compensation.

Requests for cash payment pursuant to this section shall be submitted to the Human Resources department quarterly. Such requests must be submitted by March 1, June 1, September 1 or December 1 to be paid on the first full pay period in March, June, September or December. In order for the banked holiday time to be reportable to Ca1PERS the cash out must occur in the period it was earned as required per CCR 571(a)(5).

Employee may maintain a maximum of two hundred twenty-four hours (224) of banked holiday pay. Any excess holiday hours, above the maximum accrual, as of December 31St of any year, will be paid to employees in January of the next year using the rate of pay in effect prior to any Memorandum of Understanding increase in January.

If an employee may maintain a maximum of two hundred twenty-four hours (224) of banked holiday pay. Any excess holiday hours, above the maximum accrual, as of December 31St of any year, will be paid to employees in January of the next year using the rate of pay in effect prior to any Memorandum of Understanding increase in January.

Those employees assigned to a flex schedule will deduct the scheduled hours from their holiday accrual leave bank (E.g. An employee that is normally scheduled to work a 4/10 will deduct 10 hours holiday accrual from their leave bank on a holiday off).

A holiday shall cover a twenty-four (24) -hour period beginning at 12:00 a.m. and ending at 11:59 p.m.

All other terms of the MOU, as amended, shall remain in full force and effect.

For the City of Beaumont: For BPOA:

City Manager Date
City of Beaumont
BPOA President Date
BPOA Vice President Date
9737390.1 BE023-005

Page 446 of 1154 ends

SIDE LETTER #7 TO THE
2022-2026

MEMORANDUM OF UNDERSTANDING

BETWEEN

THE CITY OF BEAUMONT

AND BEAUMONT POLICE OFFICERS' ASSOCIATION
On January 4, 2022, the City of Beaumont ("City") and the Beaumont Police Officers' Association ("BPOA") entered into a Memorandum of Understanding that is effective from January 4, 2022 through June 30, 2026 ("MOU").

The City and BPOA met and conferred in good faith and have agreed to the terms of this side letter to the MOU, which shall operate prospectively from the date it is both approved by BPOA and ratified by the City Council.

This side letter shall amend and replace Article VII(L) along with the CITY -recognized classifications of the MOU with the following:

ARTICLE IV: POA SPECIFIC BENEFITS
G. POST CERTIFICATE INCENTIVE: CCR 571(a)(2) and CCR 571.1(2) define Peace Officer Standard Training (POST) Certificate Pay as compensation to local police officers and public safety dispatchers who obtain POST certification. Each employee shall be eligible for special compensation, separate from their base pay rate, reportable to Ca1PERS periodically as earned, if they obtain the following:

1. Intermediate P.O.S.T. Certificate — One additional 2.5% step.

2. Advanced P.O.S.T. Certificate —Additional 5%, compounded with the above.

3. Supervisor P.O.S.T. Certificate — One additional 2.5% step, compounded with the above.

The employee shall receive the salary increase effective the date noticed on the certificate after submission of the documentation showing completion. The Police Department shall notify an employee of POST correspondence and it is the employee's responsibility to submit said documents in a timely manner to receive full benefits of the salary increase.

H. EDUCATIONAL INCENTIVE: Each employee shall receive a salary increase as indicated, if they obtain the following:

1. AA or AS Degree — One additional 2.5% step.

2. BA or BS Degree —Two additional 2.5% steps, compounded with the above. 9737390.1 BE023-005

Page 447 of 1154 ends

3. Master's Degree — One additional 2.5% step, compounded with the above.

The employee shall receive the salary increase effective the date noticed on the degree after submission of the documentation showing completion. It is the employee's responsibility to submit said documents in a timely manner to receive full benefits of the salary increase. Pursuant to CCR 571.1(2) educational pay is not consider pensionable compensation.

I. EVALUATION/POSITION DESCRIPTION: Each employee shall be subject to an "Employee Evaluation" and any updated position description on or about their anniversary date of each calendar year. Probationary employees shall be subject to an evaluation at six (6), twelve (12) and eighteen (18) months.

ARTICLE V: SWORN CLASSIFICATION SPECIFIC BENEFITS
F. FIELD TRAINING PREMIUM PAY: Any employee at the rank of Police Officer/Corporal who is a Police Officer Standards and Training (POST) certified Field Training Officer and is assigned a trainee for the purposes of initial or remedial field training, shall be eligible for special compensation, separate from their base pay rate, reportable to Ca1PERS periodically as earned in the amount of 5% (two addition 2.5% steps) G. MOTORCYLCE PATROL / TRAFFIC DETAIL PREMIUM: Any employee at the rank of Police Officer/Corporal who is assigned to the Traffic Division, as either a Motor or Commercial Enforcement Officer shall be eligible for special compensation, separate from their base pay rate, reportable to Ca1PERS periodically as earned in the amount of 5% (two addition 2.5% steps).

H. K9 OFFICER PAY: Any employee, who is a certified "K9 Officer" and is assigned a canine shall be eligible for special compensation, separate from their base pay rate, reportable to Ca1PERS periodically as earned in the amount of 5% (two addition 2.5% steps).

The CITY and the POA have met and conferred over how much off duty time is spent by a K9 Officer in the car, feeding and grooming of the canine. The CITY and POA have determined that the K9 Officer spends 15 hours per month on these off duty tasks and have also agreed that the K9 Officer shall be paid for those 15 hours per month at the greater of $15 per hour, or the California minimum wage, and at time and one-half.

Pursuant to Ca1PERS, the feeding and grooming of the canine is not consider pensionable compensation.

ARTICLE VI: SUPPORT CLASSIFICATION SPECIFIC BENEFITS
I. NOTARY CERTIFICATION: The CITY reserves the right to identify which classifications and how many notary certificates are issued. When any employee takes and passes the Secretary of State Notary Examination, and begins to notarize documents, he or she shall be eligible for special compensation, separate from their base pay rate, reportable to 9737390.1 BE023-005

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Ca1PERS periodically as earned in the amount of 5% (two additional 2.5% steps). All documents and/or correspondence is to have the CITY's mailing address as the contact address for any and all notary supplies, certification, and/or notifications. Upon expiration if it is not renewed the employee will lose such increase.

ARTICLE VII: SALARY AND BENEFITS
L. CAFETERIA PLAN: Effective with the ratification of this agreement by the City Council on the first pay period ending after January 1, 2026, the City shall contribute two -thousand one hundred forty-four dollars ($2,144) per month to each unit member for the cafeteria benefit plan detailed in this section.

1. Said contribution shall be used to provide for health insurance for the employee. Employee shall be covered by health insurance with a CITY approved health plan unless the employee provides proof to the CITY the employee is covered by another acceptable health plan as determined by the CITY's Human Resource Depai linent.

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O. BILINGUAL PAY: Employees who have been certified using a CITY designated language proficiency test as being fluent speaking or interpreting (not reading or writing) in sign language or other secondary languages shall be eligible for special compensation, separate from their base pay rate, not reportable to Ca1PERS, in the amount of one dollar and fifty cents ($1.50) per hour premium pay, if the need for fluency is necessary in the current job and approved by the Department Head and City Manager. Each certified employee may be required to be recertified as a condition of continued receipt of premium pay. Authorization and continuation of premium pay will be at the sole discretion of the City Manager.

ARTICLE VIII: HOURS AND WORKING CONDITIONS
A. HOLIDAY ACCRUAL: The CITY allocates fourteen (14) eight -hour days per year accrued at 4.31 hours per pay period (one hundred twelve (112) hours per year). Holiday pay is special compensation defined by CCR 571(a)(5) and CCR 571.1.(4). Recognized holidays currently include:

New Year's Day
Martin Luther King Jr Day
President's Day
Memorial Day
Independence Day
Labor Day
Indigenous People's Day
Veterans Day
Thanksgiving
Friday after Thanksgiving
Christmas Eve
Christmas Day
Day After Christmas
New Year's Eve
An employee may request payment of banked holiday pay, to be paid by separate check. An Employee's base pay plus any special compensation that qualifies as pensionable compensation reportable to CALPERS is used to calculate the rate of holiday pay. This includes POST, FTO, Motorcycle, Traffic, K9, Training and Notary. Holiday pay accrued and paid within the period earned is reportable for Classic members under CCR 571(a)(5). Banked holiday pay exceeding the maximum accrual limit and paid out after the period earned is not reportable. Banked holiday pay for PERRA members is not reportable if eligible to be used as time off in lieu of compensation.

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If an employee may maintain a maximum of two hundred twenty-four hours (224) of banked holiday pay. Any excess holiday hours, above the maximum accrual, as of December 315t of any year, will be paid to employees in January of the next year using the rate of pay in effect prior to any Memorandum of Understanding increase in January.

A holiday shall cover a twenty-four (24) -hour period beginning at 12:00 a.m. and ending at 11:59 p.m.
9737390.1 BE023-005

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ATTACHMENT A
The CITY recognizes the following classifications:

Community Services Officer
Property Evidence Technician
Dispatch Supervisor
Public Safety Dispatcher I
Lead Dispatcher
Public Safety Dispatcher II
Lead Support Service Specialist
Support Service Specialist I
Police Corporal
Support Service Specialist II
Police Officer
Support Service Specialist Supervisor
Police Sergeant
9737390.1 BE023-005

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All other terms of the MOU, as amended, shall remain in full force and effect.

For the City of Beaumont: For BPOA:

City Manager Date
City of Beaumont
BPOA President Date
BPOA Vice President Date
9737390.1 BE023-005

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SIDE LETTER #5 TO THE
2022-2026

MEMORANDUM OF UNDERSTANDING

BETWEEN

THE CITY OF BEAUMONT

AND MANAGERS/PROFESSIONAL TECHNICAL AS INDIVIDUALS
On January 1, 2022, the City of Beaumont ("City") and the Manager/Professional/Technical as Individuals ("MPT") entered into a Memorandum of Understanding that is effective from January 1, 2022 through June 30, 2026 ("MOU").

The City and MPT met and conferred in good faith and have agreed to the terms of this side letter to the MOU, which shall operate prospectively from the date it is both approved by MPT and ratified by the City Council.

This side letter shall amend and replace the CITY recognized classifications and Article IV(C) and Article V(J) of the MOU with the following:

The CITY recognizes the following classifications:

Assistant Director of Community Services
Principal Engineer
Assistant Director of Finance
Principal Management Analyst
Assistant Director of Public Works
Project Manager (CIP)
Budget Analyst
Public Information Officer
Building Grounds Maintenance Supervisor
Public Works Manager
Chief Building Official
Purchasing Manager
Customer Services Supervisor
Recreation Manager
Deputy City Clerk
Senior Engineer
Economic Development Manager
Senior Management Analyst
Environmental Compliance Program
Specialist
Senior Planner
Executive Assistant
Street Maintenance Supervisor
Grounds/Parks/Facilities Manager
Transit Manager
HR/Risk Analyst
Transit Supervisor
Information Technology Manager
Vehicle Maintenance Supervisor
Payroll/Benefits Supervisor
Wastewater Collections Supervisor
Planning Manager
Wastewater Plant Supervisor
Police Services Manager

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ARTICLE IV, SECTION C: SAFETY BOOTS AND SHOES
C. SAFETY BOOTS AND SHOES: The CITY shall provide each eligible employee with an annual allowance of up to three hundred dollars ($300.00) per calendar year for reimbursement of the purchase of safety boots and/or shoes. The type of acceptable footwear will be defined in the CITY's Dress Code Policy. Employees in the following classification series, which require the wearing of durable, reinforced protective work boots or shoes for personal safety to help protect against the impact or punctures due to the nature of the job duties, are eligible:

Assistant Director of Community Services
Building/Grounds Maintenance Supervisor
Chief Building Official
Chief Plant Operator
Environmental Compliance Program Specialist
Grounds/Park/Facilities Manager
Principal Engineer
Project Manager (CIP)
Public Works Manager
Senior Engineer
Street Maintenance Supervisor
Transit Manager
Transit Supervisor
Vehicle Maintenance Supervisor
Wastewater Collections Supervisor
Wastewater Plant Supervisor
It will be the responsibility of the employee to submit receipts with his/her request for reimbursement to the Human Resources department in order to receive reimbursement.

The CITY shall provide this reimbursement on a quarterly basis in January, April, July, and October for the preceding three (3) month period. In years of hire and separation, the amount will be prorated and overpayment to the employee will be refunded to the CITY by date of separation.

ARTICLE V: SALARY AND BENEFITS
J. CAFETERIA PLAN: Effective with the ratification of this agreement by the City Council on the first pay period ending after January 1, 2026, the City shall contribute two -thousand one hundred fourty-four dollars ($2,144) per month to each unit member for the cafeteria benefit plan detailed in this section.

1. Said contribution shall be used to provide for health insurance for the employee.

Employee shall be covered by health insurance with a CITY approved health plan unless the employee provides proof to the CITY the employee is covered by

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another acceptable health plan as determined by the CITY's Human Resource Department.

All other terms of the MOU, as amended, shall remain in full force and effect.

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For the City of Beaumont:

City Manager
City of Beaumont
Date Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date

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Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date

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Date
Date
Date

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SIDE LETTER #3 TO THE
2021-2026

MEMORANDUM OF UNDERSTANDING

BETWEEN

THE CITY OF BEAUMONT

AND GENERAL UNIT EMPLOYEES
On January 1, 2021, the City of Beaumont ("City") and the SEIU General Unit Employees (SEIU) entered into a Memorandum of Understanding that is effective from January 1, 2021, through June 30, 2026 ("MOU").

The City and SEIU met and conferred in good faith and have agreed to the terms of this side letter to the MOU, which shall operate prospectively from the date it is both approved by SEIU 721 General Unit Employees and ratified by the City Council.

This side letter shall amend and replace the CITY -recognized classifications in Attachment A and Article 13.1 (C) of the MOU with the following:

The CITY recognizes the following classifications:

Accountant
Engineering Development Technician I
Account Technician I
Engineering Development Technician II
Account Technician H
Facility Maintenance Worker
Administrative Assistant I
GIS Analyst
Administrative Assistant II
Human Resources/Payroll Technician
Animal Control Officer I
IT Analyst I
Animal Control Officer II
IT Analyst II
Assistant Engineer
Lead Building Grounds Maintenance Worker
Assistant Planner
Lead Bus Driver
Associate Engineer
Lead Street Maintenance Worker
Associate Planner
Lifeguard
Building Grounds Maintenance Worker
Management Analyst I
Building Inspector
Management Analyst II
Building Permit Technician I
Mechanic
Building Permit Technician II
Pool Manager
Building Plans Examiner
Procurement Contract Specialist
Bus Driver
Public Works Inspector
Buyer
Records Technician
Communications Specialist
Recreation Coordinator
Community Enhancement Officer I
Recreation Specialist
Community Enhancement Officer II
Street Maintenance Worker
Customer Service Coordinator I
Wastewater Collection System Worker I
Customer Service Coordinator II
Wastewater Collection System Worker II

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Beaumont City CouncilDecember 2, 2025

Beaumont City Council
December 2, 2025