Agenda packet — Livingston City Council, January 20, 2026 (part 2 of 2)

Retiree HRA Service Agreement – Rev. 7.2015 Page 1 of 5 Health Reimbursement Arrangement for Retirees
Service Agreement
for
The undersigned Employer, ________________________________________________________, hereby appoints MidAmerica Administrative & Retirement Solutions, Inc. (“MidAmerica”) to provide administrative services on behalf of
(the “Plan”), including processing Participant claims for eligible health care expense reimbursements.

The Employer shall provide to MidAmerica any and all information which is necessary in order for MidAmerica to fulfill its obligations hereunder. Administrative Services are described in Appendix A.

MidAmerica shall at all times adhere to the terms and conditions of the Employer's Health Reimbursement Arrangement.

This Service Agreement may be cancelled by the Employer at any time upon written notice to MidAmerica. In the event of such termination, MidAmerica shall complete claims that are in process, but shall otherwise follow the instructions of the Employer with respect to the transition of claims processing.

Hold Harmless Agreement and Indemnity. MidAmerica and the Employer agree that they will each be responsible for the prompt and complete performance of the services each has agreed to provide under this Agreement, as set forth above. In addition to these undertakings, the parties assume the following responsibilities:
(a) Hold Harmless Agreement of MidAmerica: MidAmerica shall indemnify and hold harmless the Employer, any member of the governing board, and Employees from every claim, demand or suit which may arise out of, be connected with, or be made due to the negligence of MidAmerica or failure of MidAmerica to meet the requirements of this Agreement. However, this indemnification shall not cover any claim, demand, or suit based on erroneous information provided by the Employer or Employees or their willful misconduct or negligence. MidAmerica’s liability hereunder shall be limited to actual damages and out-of-pocket legal fees and expenses only. (b) Other Providers: If the services provided by MidAmerica under this Agreement were previously provided by the Employer or a third party, the Employer agrees that MidAmerica shall not be responsible for any failure of the prior Plan document or administrative services to comply with the requirements for employer-provided medical reimbursement Plan under Code Sections 105 and 106 and regulations issued thereunder, and as a health reimbursement arrangement as described in IRS Notice 2002-45 and Revenue Ruling 2002-41, other applicable law, or the prior Plan. This does not exempt or diminish MidAmerica’s responsibility as the active administrator and other responsibilities as described herein and required under IRS regulations. MidAmerica is also not responsible for the accuracy and completeness of participant and payroll data provided by the Employer or any third party provider. Employer agrees that MidAmerica and its affiliates and employees will be indemnified by any responsible third parties from any claim asserted against any of them for any of these reasons, and will further be indemnified from any cost and expense they incur, including reasonable attorney’s fees, due to the assertion of such a claim, or by the Employer if not adequately indemnified by third parties.

Nothing herein will prevent the assertion of any claim directly against any third party by MidAmerica or the Employer.

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Retiree HRA Service Agreement – Rev. 7.2015 Page 2 of 5 Fees, Payment, Other Revenue. MidAmerica will charge fees for its services in accordance with the Fee Schedule on the Adoption Agreement and will bill these fees to the Employer or to the Participants as provided in the Fee Schedule, or as specifically instructed by the Employer in writing. If the Employer agrees to pay the fees, but either (a) does not do so within 60 days from the date of the Fee Invoice, or (b) the Employer instructs MidAmerica to pay the fees from Plan contributions and MidAmerica accepts such instructions, the fees will be paid out of contributions and, if necessary, allocated to Participant accounts.

If fees are Employer paid, such fees shall be invoiced to Employer on a quarterly basis by MidAmerica following the end of the quarter.

The Fee Schedule shall remain in effect in the amounts described in Fee Schedule for a term of three (3) Plan years in which MidAmerica is providing administrative services. Thereafter, any changes to the fee agreement will be supplied to the Employer 60 days prior to the effective date of the changes.

Notices and Communications.
(a) Notices. All notices provided for herein shall be sent by confirmed facsimile, or guaranteed overnight mail with tracing capability or by first class United States mail, with postage prepaid, addressed to the other party at its respective address set forth below or such other addresses as either party may designate in writing to the other from time to time for such purposes. All notices provided for herein shall be deemed given or made when received. (b) Addresses. The MidAmerica address for notices as described above is MidAmerica Administrative & Retirement Solutions, Inc., 2855 Interstate Drive, Suite 115, Lakeland, FL 33805. The Plan/Employer address for notices as described above is .
(c) Communications. The Employer agrees that MidAmerica may communicate confidential, protected, privileged or otherwise sensitive information to the Employer through a named contact designated by the Employer (“Named Contact”) and specifically agrees to indemnify MidAmerica and hold it harmless; (i) for any such communication directed to the Employer through the Named Contact attempted via fax, mail, telephone, e-mail or any other media, acknowledging the possibility that such communication may be inadvertently misrouted or intercepted; and (ii) from any claim for the improper use or disclosure of any health information by MidAmerica where such information is used or disclosed in a manner consistent with its duties and responsibilities hereunder.

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Retiree HRA Service Agreement – Rev. 7.2015 Page 3 of 5 Assignment. Some or all of the rights and duties of MidAmerica hereunder may be assigned to an affiliate of MidAmerica, or to any successor through merger, reorganization, or sale of assets. Some or all of the duties of MidAmerica may also be performed by others under subcontract to MidAmerica, without the release of MidAmerica for responsibility for such services. MidAmerica may, by letter or other writing, agree to extend this Agreement to any other Plan of the Employer or Plans sponsored by affiliates of the Employer. Otherwise, no party may assign this Agreement nor any rights or duties hereunder without written consent from the other party.

Confidentiality. Except as noted herein, MidAmerica will not disclose to any third party any of Employer’s information that is of a confidential nature, including employee-specific information.

MidAmerica agrees to the HIPAA Business Associate Addendum for any program subject to HIPAA.

MidAmerica agrees to amend this Agreement as is necessary from time to time to comply with the requirements of the privacy rules under HIPAA or other legislation.

Standard of Care; Erroneous Payments. MidAmerica shall use reasonable care and due diligence in the exercise of its powers and the performance of its duties under this Agreement. If MidAmerica makes any payment under this Agreement to an ineligible person, or if more than the correct amount is paid, MidAmerica shall make a diligent effort to recover any payment made to or on behalf of an ineligible person or any overpayment. However, MidAmerica will not be liable for such payment, unless MidAmerica would otherwise be liable under another provision of this Agreement.

Compliance; non-waiver. Failure by the Employer or MidAmerica to insist upon strict performance of any provision of this Agreement will not modify such provision, render it unenforceable, or waive any subsequent breach. No waiver or modification of any of the terms or provisions of this Agreement shall be valid unless in each instance the waiver or modification is accomplished pursuant to the amendment provisions of Assignment Section.

Compliance with the law. The Employer is responsible for the Plan's compliance with all applicable federal and state laws and regulations. The Employer acknowledges that MidAmerica is not providing tax or legal advice and that the Employer shall be solely responsible for determining the legal and tax status of the Plan.

Severability. If any term of this Agreement is declared invalid by a court, the same will not affect the validity of any other provision, provided that the basic purposes of this Agreement are achieved through the remaining valid provisions.

Mandatory Arbitration. Any controversy or claim arising out of or relating to this Agreement may be properly submitted to binding arbitration in accordance with the rules of the American Arbitration Association. Judgment on the award rendered by the arbitrators may be entered in any court having jurisdiction. The cost and expenses of arbitration, including the fees of the arbitrators, shall be borne by the losing party or in such proportions as the arbitrators may determine. The successful party shall recover as expenses all reasonable attorney’s fees incurred in connection with the arbitration proceeding or any appeals therefrom.

Entire Agreement; Governing Law. This Agreement (including the Appendix) is the full Agreement of the parties with respect to the subject matter hereof and supersedes all prior agreements and representations between the parties. Any waiver, modification or amendment of any provision of this Agreement shall be effective only if in writing and signed by both parties. This Agreement shall be construed, enforced, and governed by the laws of the State of Florida.

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Retiree HRA Service Agreement – Rev. 7.2015 Page 4 of 5 By the signature of its authorized agent below, MidAmerica Administrative & Retirement Solutions, Inc. hereby agrees to provide all administrative services called for under the herein referenced Plan for the Employer and charge only those fees permitted under the Plan.

Name of Employer:

Signature:

Print Name:

Title:

Date:

Signature:

Print Name: Brad Hope
Title: Managing Partner, Public Sector
Date:

MidAmerica Administrative & Retirement Solutions, Inc.

Signature:

Print Name: Maria S. Sullivan
Title: Deputy City Attorney
Date:

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Retiree HRA Service Agreement – Rev. 7.2015 Page 5 of 5 Appendix A
Health Reimbursement Arrangement for Retirees
Administrative Services
This is an outline of the standard services offered by MidAmerica Administrative & Retirement Solutions, Inc. to administer a Health Reimbursement Arrangement for Retirees. MidAmerica will customize this standard service offering to accommodate Plan design.  Post contributions to participant accounts in accordance with the terms of the Plan and any additional information provided by the Plan Sponsor.
 Deposit funds to the selected funding choices of the Plan based on the latest allocation instructions.
 Daily valuation of the funding choices, including earnings, for the Plan and each Plan participant's account.
 Daily post and process all transfers among the funding choices to the appropriate Plan and Plan participant account.
 Daily post and process all distributions, forfeitures, and withdrawals from the appropriate Plan participant account.
 Prepare quarterly participant statements of account balances and distribute to each participant.  Prepare quarterly Plan reports of transactions for distribution to the Plan Sponsor and Plan participants. The Plan Sponsor and Plan participants will have access to account and Plan level information daily through MidAmerica’s website. Participants and employer are able to print customized statements and reports via the website.
 Prepare and distribute claim forms. Claim forms are available at any time via MidAmerica’s website, www.mymidamerica.com, or upon request by calling the toll-free customer service line at (800) 430 - 7999.
 Claims adjudication services administration for the Plan. MidAmerica reviews all claims for eligibility before processing. HRA claims are processed weekly.  Issue distribution checks to participants every Friday. Direct deposit is available for claims payment.
 Toll-free telephone access for employer and participants of each Plan to communicate with a service representative who can answer questions about the Plan and a participant's account.  To ensure proper monitoring and support of the program on an ongoing basis, MidAmerica will provide the following additional services at no additional cost:
 A quarterly review of the investment performance experienced by the Plan, if necessary  Periodic meetings with employees to explain the program and answer questions, if necessary  Additional supplies of employee brochures to explain the program to newly eligible employees
 Implementation and compliance support provided on an as-needed basis

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“Business Associate” means MidAmerica.
“Covered Entity” means .
“HIPAA Privacy & Security Rule” shall mean the Standards for Privacy of Individually Identifiable Health Information or the HIPAA Security Standards found at 45 CFR Parts 160-164. “Protected Health Information” or “PHI” means any information, whether oral or recorded in any form or medium: (i) that relates to the past, present or future physical or mental condition of an individual; the provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual; and (ii) that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual, and shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.501. “Designated Record Set” shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.501.
“Treatment” shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.501.
“Payment” shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.501.
“Health Care Operations” shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.501.

2. Obligations of Business Associate.

2.1 Use or Disclosure of PHI. MidAmerica agrees not to use or disclose PHI, other than as permitted or required by the Agreement or as Required By Law.

2.2 Prohibited Uses and Disclosures. MidAmerica shall not use PHI other than as permitted by the HIPAA Privacy & Security Rule or this Addendum. MidAmerica shall not disclose PHI in any manner that would

EXHIBIT A

HIPAA BUSINESS ASSOCIATE ADDENDUM
THIS HIPAA BUSINESS ASSOCIATE ADDENDUM (“Addendum”) supplements and is made a part of the MidAmerica Service Agreement (“Agreement”) by and between MidAmerica Administrative & Retirement Solutions (“MidAmerica”), which is acting as the Business Associate to a health plan covered by the HIPAA Privacy & Security Rule, and (“Covered Entity”), and is effective as of
(the Addendum Effective Date").

RECITALS:

WHEREAS, Covered Entity wishes to disclose certain information to MidAmerica pursuant to the terms of the Agreement, some of which may constitute Protected Health Information (“PHI”) (as hereinafter defined); and WHEREAS, the parties intend to protect the privacy and provide for the security of PHI disclosed to Business Associate pursuant to the Agreement in compliance with the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (“HIPAA”) and regulations promulgated thereunder by the U.S. Department of Health and Human Services (“HIPAA Privacy & Security Rule”) and other applicable laws; and
WHEREAS, the HIPAA Privacy & Security Rule (as hereinafter defined) requires the parties to enter into a contract containing specific requirements prior to the disclosure of PHI; NOW THEREFORE, in consideration of the mutual promises below and the exchange of information pursuant to this Addendum, the parties agree as follows:

1. Definitions.

Unless otherwise defined, terms used in this Addendum have the same meaning as those terms in the HIPAA Privacy & Security Rule.

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constitute a violation of the Privacy Rule if disclosed by the Covered Entity, except that MidAmerica may disclose PHI in a manner permitted pursuant to this Addendum.

2.3 Appropriate Safeguards. MidAmerica shall implement appropriate safeguards as are necessary to protect the confidentiality of PHI or to prevent its use or disclosure of PHI other than as permitted by this Addendum or the HIPAA Privacy & Security Rule.

2.4 Reporting of Improper Use or Disclosure. MidAmerica shall report to Covered Entity any use or disclosure of PHI other than as provided for by this Addendum of which it becomes aware. MidAmerica further agrees to mitigate, to the extent possible, the harmful effects of the unauthorized disclosure.

2.5 Disclosure to Agents. In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), MidAmerica agrees to ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of MidAmerica agree to the same restrictions, conditions, and requirements that apply to MidAmerica with respect to such information.

2.6 Access to PHI. MidAmerica agrees to provide individuals with access to their PHI, as held in a Designated Record Set by MidAmerica, in order to meet the requirements under 45 CFR 164.524.

2.7 Amendment of PHI. MidAmerica agrees to make any amendment(s) to PHI it holds in a Designated Record Set, as directed by the Covered Entity pursuant to 45 CFR 164.526.

2.8 Accounting Rights. MidAmerica agrees to document and provide a description of any disclosures of PHI and information related to such disclosures as would be required for Covered Entity to respond to a request by an individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528.

MidAmerica agrees to provide such information to Covered Entity, or to an individual at the direction of the Covered Entity, in order for Covered Entity to comply with the accounting requirements in 45 CFR 164.528.

2.9 Governmental Access to Records. MidAmerica shall make its internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the U.S. Department of Health and Human Services (the “Secretary”) for purposes of determining Covered Entity’s compliance with the HIPAA Privacy & Security Rule within a reasonable time of a request for the same.

2.10 Covered Entity's Right to Restrict. MidAmerica agrees to comply, upon communication by Covered Entity, with any restrictions to the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR 164.522.

2.11 HIPAA Security Standards. MidAmerica agrees to comply with the HIPAA Privacy & Security Rule with respect to any Electronic PHI (“EPHI”) that MidAmerica holds on behalf of the Plan. a. MidAmerica agrees to use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to EPHI to prevent use or disclosure of PHI other than as provided for by the Addendum.
b. MidAmerica agrees to implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the EPHI that it creates, receives, maintains, or transmits on behalf of Covered Entity, as required in the HIPAA Privacy & Security Rule.
c. MidAmerica agrees to ensure that any agent, including a subcontractor, to whom it provides EPHI agrees to implement reasonable and appropriate safeguards to protect such information. d. MidAmerica agrees to report to Covered Entity any security incident under the HIPAA Privacy & Security Rule of which it becomes aware, including the identities of any individual whose EPHI was breached.

2.12 Responsibilities If Security Breach. MidAmerica shall notify Covered Entity immediately if there is a breach by either MidAmerica or one of its agents of unsecured PHI, as defined in, and consistent with, the HITECH Act and any regulations or guidance issued thereunder, including 45 CFR Part 164, Subpart D. Such notification shall:
a. Be made in writing to the Covered Entity's Privacy Officer or other designated party. b. Be made within sixty (60) days of discovery.

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c. Include the names of the individuals whose information was breached, the circumstances surrounding the breach, the date of the breach and date of discovery, the information breached, any steps the individuals should take to protect themselves, the steps MidAmerica (or its agent) is taking to investigate the breach, mitigate losses, and protect against future breaches, and a contact person for more information. If requested by MidAmerica, Covered Entity shall allow MidAmerica to approve the content of any notification in advance.

If requested by Covered Entity, MidAmerica shall notify the individuals involved, or the media or the US Department of Health and Human Services, as applicable, in accordance with the HITECH Act, and regulations or guidance issued thereunder, including 45 CFR Part 164, Subpart D. For purposes of this provision, MidAmerica is considered an independent contractor of Covered Entity.

3. Permitted Uses and Disclosures by Business Associate.

3.1 Disclosures Generally. Except as otherwise provided in this Addendum, MidAmerica may use or disclose PHI to perform functions, activities, or services for, or on behalf of, Covered Entity as specified in the Agreement, provided that such use or disclosure would not violate the HIPAA Privacy & Security Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity.

3.2 To Carry Out Covered Entity Obligations. To the extent MidAmerica is to carry out one or more of Covered Entity’s obligations under Subpart E of 45 CFR Part 164, MidAmerica agrees to comply with the requirements of Subpart E that apply to the Covered Entity in the performance of such obligations.

3.3 Management and Administration.
a. MidAmerica may use PHI for the proper management and administration of MidAmerica or to carry out the legal responsibilities of MidAmerica. b. MidAmerica may disclose PHI for the proper management and administration of MidAmerica, provided that disclosures are: (a) required by law or (b) MidAmerica obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it is disclosed to the person, and the person notifies MidAmerica of any instances of which it is aware in which the confidentiality of the information has been breached.

3.4 Data Aggregation and De-Identification. Except as otherwise limited in this Addendum, MidAmerica may use PHI to provide Data Aggregation services to Covered Entity or to de-identify PHI. Once information is de-identified this Addendum shall not apply.

3.5 Required By Law. MidAmerica may use or disclose PHI as required by law.

4. Termination.

4.1 Material Breach. A breach by MidAmerica of any material provision of this Addendum shall constitute a material breach of the Agreement and shall provide grounds for termination of the Agreement by Covered Entity. In the event of such breach, Covered Entity shall provide MidAmerica with written notice of the breach and thirty (30) days in which to cure the breach. If the breach is not cured within thirty (30) days, Covered Entity shall terminate the Agreement.

4.2 Effect of Termination. Upon termination of the Agreement for any reason, MidAmerica shall return or destroy all PHI that MidAmerica or its agents or subcontractors still maintain in any form, and shall retain no copies of such PHI. If return or destruction is not feasible, MidAmerica shall continue to extend the protections of Section 2 of this Addendum to such information, and limit further use or disclosure of such PHI to those purposes that make the return or destruction of such PHI infeasible.

5. Amendment.

5.1 Amendment to Comply with Law. The parties acknowledge that state and federal laws relating to data security and privacy are rapidly evolving and that amendment of this Agreement may be required to provide for procedures to ensure compliance with such developments. The parties specifically agree to take such action as is necessary to implement the standards and requirements of HIPAA, the HIPAA Privacy & Security Rule and other applicable laws relating to the security or confidentiality of PHI. Upon the request of either party, the other party agrees to promptly enter into negotiations concerning the terms of an amendment to this Addendum

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embodying written assurances consistent with the standards and requirements of HIPAA, the HIPAA Privacy & Security Rule or other applicable laws.

5.2 Amendment of Addendum. This Addendum may be modified or amended by mutual agreement of the parties at any time without amendment of the Agreement.

6. Conflicts. The terms and conditions of this Addendum will override and control any conflicting term or condition of the Agreement. All non-conflicting terms and conditions of the Agreement will remain in full force and effect.

7. Relationship of Parties. The parties intend that MidAmerica is an independent contractor and not an agent of Covered Entity.

Covered Entity Health Plan
Name of Employer: __________________________________
Signature:__________________________________________
Print Name: ________________________________________
Title: ______________________________________________
Date: ______________________________________________
MidAmerica Administrative & Retirement Solutions
Signature:__________________________________________
Print Name: Brad Hope
Title: Managing Partner
Date: _____________________________________________
Signature:__________________________________________
Print Name: Maria S. Sullivan
Title: Deputy City Attorney
Date: _____________________________________________

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Your HRA distributions may be deposited directly into your account or joint account with your spouse at your bank or other financial institution. To sign up, please complete this form, and return it to the address listed at the bottom.

Your Employer:

EMPLOYEE INFORMATION:

Name: Social Security Number:

Street Address:

City, State Zip:

E-mail Address: Phone Number:

AUTHORIZATION:

I authorize MidAmerica Administrative & Retirement Solutions to deposit my HRA reimbursement directly into my account until I give further written notice to MidAmerica. I understand that it may take up to 72 hours from the time MidAmerica processes my payment for the funds to post to my designated bank account. Also, I grant MidAmerica the right to correct any electronic funds transfer resulting from an erroneous overpayment by debiting my account to the extent of such overpayment.

Your signature Date
Bank Account Information
Bank Name: Bank Telephone Number:

Bank Address:

Account Type: (check one) Checking Savings
(Attach voided check) (Attach Bank Verification Letter) Transit Routing Number Account Number
Type of transaction (check one):

New request for Direct Deposit
Change current Direct Deposit information
Cancel Direct Deposit
Submit completed form and attachments to:

City of Livingston
Attn: Human Resources
1416 C Street
Livingston, CA 95334
Health Reimbursement Arrangement
(HRA) Direct Deposit Form
Authorization for Direct Deposit
P.O. Box 24927 Lakeland, FL 33802
855.329.0095 ♦ Fax 863.577.4460 ♦ www.MyMidamerica.com
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MidAmerica
Administrative & Retirement Solutions
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Health Reimbursement Arrangement
Data & Contributions
Plan Sponsor Portal
You will receive a secure login for our Plan Sponsor portal at www.myMidAmerica.com, which can be accessed at any time to generate reports and review transactions. If you do not have a secure login, please contact your dedicated Account Manager. If you are unaware of your appropriate contact, please call (855) 329-0095. At plan year end, you will receive statements which will recur annually thereafter and also be available at the Plan Sponsor portal. Please note that you do not have to log in to upload your contribution, forfeiture, or census data.

Data Requirements
Why am I asked to provide my participants’ personal email addresses? Personal email addresses are critical so that communications with the participant are uninterrupted in the event of retirement or separation from service. We want to provide valuable account information, important plan details and periodic updates to your participants as efficiently as possible, and in the way they prefer to receive them.

How can I upload data?

1. Go to www.myMidAmerica.com

2. Select Upload File from the top right-hand corner, then select For Employers/Partners

3. From the Employer Upload Site landing page, select your form type (Contributions, Forfeiture or Census)

4. Complete the series of identifying questions. Please note if you have selected the Contributions form, you must enter a funding amount.

5. Upload the appropriate Data Requirements Template (Contributions, Forfeiture or Census) using the blue upload button located below the comments section.

Tips for Filling out the Data Requirements Spreadsheet
• Populate all fields, including preferred fields.
• Participant Eligibility Date is the date that the participant enters the plan. This date can be different from the contribution date.

HRA Type Eligibility Date
Retiree-Only HRA Date of retirement or separation from
service
Integrated HRA
An HRA that’s integrated with your group health plan. First day of the medical plan year.

Defined Contribution HRA
An HRA that allows you to contribute to the employee’s account while they are actively employed but restricts access to funds until after they retire.

Date of plan entry.

Quick Tip
You must use the Data
Requirements Spreadsheet
U.S. BENCOR/MidAmerica
provides. Data is not
accepted in any other
format.

DIIBENCOR
ISi MidAmerica

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If the participant is currently an active employee, simply select “active” from the dropdown on your template. If they were previously retired and have been rehired, simply state “rehired” along with the rehire date. If you are unsure how to determine the eligibility data, please contact your Account Management team at [email protected].
• Date of Separation applies to those employees who have retired or separated employment. If the individual is still currently employed with you, simply indicate “active.” • Date of Coverage Termination applies to integrated plans that may have participants who are still active, or retirees who stay on the group’s plan in retirement, who have terminated their group coverage. Report the date that the participant (active employee or retiree) is no longer enrolled in your employer sponsored group health coverage. This date is required to properly administer the participant’s account as the plan’s reimbursements may change once group coverage is terminated. • Percent Vested applies to plans that have a vesting schedule in place. Simply use this dropdown to indicate what percent the employee is vested. If no vesting schedule applies, leave the field blank. If you are unsure of your plan’s vesting schedule, please refer to your Adoption Agreement, beginning on page 3. • Class assignment can be found in your Adoption Agreement beginning on page 3. The document will provide the eligible class and what defines it, as well as the employment status. In the below example, any employee meeting the criteria in the “Defined As” section would be labeled as “RetA” on the Data Requirements Spreadsheet.

To access your Adoption Agreement, locate your plan documents by logging into your account at www.myMidAmerica.com and selecting Forms & Reports from the choices at the top. Next, select Forms. If you still have questions about the eligible class, please email us at [email protected].

Census and Employment Status Change Updates
If there are changes to your census information, you can use your Data Requirements Spreadsheet to make updates.

This includes participant census changes such as last name, address, phone number and email, as well as employment status changes such as when a participant retires or separates. You can also use the spreadsheet to update any participants who have separated from employment without reaching 100% vesting. Once that information is received, U.S. BENCOR/MidAmerica is then able to forfeit their balance back to the employer.

To accurately process these requested changes, we can only accept the information in the format provided on the Data Requirements Spreadsheet. You may upload the completed spreadsheet with your contributions online at www.myMidAmerica.com. Be sure to check the box on the contribution upload site indicating that census changes are Vesting Schedule Parti cipants shall own their accmmt balance in accordance with the following vesting schedule:

D l 00% Immediate
I lxl 100°/4 1100n Rerlre1ne11 t n1eetin° t11e E111ulover's eli 0 ible reaL1ire1nents fur redre1nent I D 100% upon Sepm~tion ofSe,-,-ice D Other ________________________________ _
D l 00% upon death (can be selected in addition to "other" above) H Ith Rdrnbursc::ment rrangemenl for Rcti
EIJefhl!' C'!lJ B~W ..;:C:.;;:i;.:.f.;;.;te;;;;n:.c·a;;..;:;S.;;.:.;.:;.;:.;;;;_ __________________________ ---1 Dl'flnt'11 as: Anv c:ifeterui servi lover

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included. If you are not sending in contribution funding at the time you are submitting changes, simply leave all columns of the spreadsheet that do not apply blank and upload using the Census Upload option located on the Employer Upload Site landing page.

Funding
We encourage you to submit funding through ACH or wire, as it is the most efficient and secure method. Funds submitted in this manner will be given priority when processing and will not be subjected to a 3-day check hold. The wire or ACH must include the Plan ID followed by plan type. If you do not have your Plan ID, please contact your Account Representative or log into the Sponsor Portal. The Plan ID will be listed on the Dashboard under Plan Selection.
• ACH ROUTING NUMBER: 063100277
• WIRE ROUTING NUMBER: 026009593
• ACCOUNT NUMBER: 005561906347
• TITLE ON ACCOUNT: AUL Health Benefit Trust / MidAmerica Administrative & Retirement Solutions, LLC • BANK NAME: Bank of America, N.A.
• BANK BRANCH: Lakeland, FL
• BANK PHONE NUMBER: (863) 616-5318
• REFERENCE: [PLAN ID]: HRA
Make hard copy checks payable to: AUL Health Benefit Trust and enter your Plan ID in the memo section.

To send hard copy checks, mail to:

U.S. BENCOR/MidAmerica
Attn: Contributions Processing
PO Box 149
Lakeland, FL 33802-0149
Need your funding to get to us quickly?
Submit your funding through ACH or wire! It is the quickest and most secure way to fund your account.

PO Box 149 Lakeland, FL 33802-0149 | 855.329.0095 | www.myMidAmerica.com -

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Data Requirements
SSN Last Name First Name Address City State Zip Home Phone Home Email * This is the date new employees become eligible to participate in the plan. This date may be prior to the first co ** Do not add dates of prior separation if employee is rehired. Only include date if employee is truly separted. ***This date only applies to HRAs for active employees who are enrolled in group health coverage and retirees w ****Refer to your Adoption Agreement to determine Class Name Contribution/Employee Status Change Template
Required Information Sample Enter your information here Submission Date: 1/1/2019
Account Name: Your Plan HRA Plan
Plan ID NIS123G5
Plan Type: HRA
Contact Name: FIRST LAST NAME
NOTE : In providing this data, the Employer understands that participation in the HRA plan is mandatory for all participants in ultimately an Employer determination and must be uniformly applied by Class. Although the Employer may take allowable non Contact Email: [email protected]
Contact Number: (123) 123-1234

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Participant
Eligibility Date* Date of Birth Date of Hire
Date of
Separation**
Date of Coverage
Termination*** HRA Deposit Amount
Class (Act-A, ActB, Ret-A, Ret-B,
etc.)****
ntribution date. For Retiree HRA's, this is the date the participant separates from service. For Active HRA's, t who stay on your group's plan in retirement
the employee/retiree Classes the Plan applies to. Individuals within Employee Classes cannot have a cash option. Where ndiscriminatory factors into account in determining Employee Classes, Participants cannot have an individual choice.

STANDARD DATA
~
MidAmerica
Administrative & Retirement Solutions

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Vesting Status Status Change Date Note
this is the date the participant enters the eligible health plan. e both a HRA and Special Pay Plan apply to the same Employee Class, the allocation to either Plan is

UPDATE/CHANGE

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STAFF REPORT
AGENDA ITEM: Resolution of the City Council of the City of Livingston (1) Approving the Revised Measure V Regional Project Application Changes, (2) Authorizing the City to apply 10% leveraging funds to the North Main Street Rehabilitation and Main & Davis St Traffic Signal Reconfiguration funding applications, and (3) Authorizing Staff to submit the revised applications to MCAG for programming.

MEETING DATE: January 20, 2026
PREPARED BY: Jose A. Ramirez, City Manager
REVIEWED BY: Jose A. Ramirez, City Manager

RECOMMENDATION
Staff recommends that the City Council adopt Resolution No. 2026- , (1) Approving the Revised Measure V Regional Project Application Changes, (2) Authorizing the City to apply 10% leveraging funds to the North Main Street Rehabilitation and Main & Davis St Traffic Signal Reconfiguration funding applications, and (3) Authorizing Staff to submit the revised applications to MCAG for programming.

BACKGROUND
On January 12, 2026, the Measure V East Side Regional Projects Committee met to review the Programming Capacity for FY28/29 and FY 29/30, the submitted funding requests were discussed, and to provide a recommendation for programming to the MCAG Governing Board.

During the meeting, the funding requests submitted by the City of Livingston were discussed. The regionality and the timing for programming of the North Main Street Rehabilitation Project and the Main & Davis St Traffic Signal Reconfiguration Project Study Report (PSR) were discussed by the committee. While not the entire committee agreed on the regional nexus that was presented by City Staff and Mayor Pro Tem Samra. The committee came to a consensus that, if programming was moved to programming window and leveraging funds were applied by the City to the funding requests, then the North Main Street Projects could be included in the committee’s recommendation to the MCAG Governing Board.

DISCUSSION AND RECCOMENDATION
At the January 6, 2026, City Council Meeting, MCAG and City staff presented a discussion and direction item which resulted in City Council directing the programming adjustment for the Transit Center funding to a later programming year (FY 29/30) and reprioritizing the Candidate Project funding requests.

At the January 12, 2026, Measure V East Side Regional Projects Committee Meeting, the committee discussed the need for the North Main Street corridor projects to include City leveraging funds in the request to move forward as part of the committee recommendation. After some discussion Mayor Pro Tem told the committee that a resolution would be prepared and presented at the next City Council Meeting proposing to add 10% City leveraging funds to the

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revised funding requests as well as proposing the programming in the FY 28/29 and FY 29/30 fiscal years.

The following is a summary of the project and the funding revisions:

1. North Main Street Rehabilitation – for rehabilitation of pavement on the North Main Street/Livingston Cressey Way corridor, which is a regionally significant corridor providing a connection between SR 99 (via Campbell Blvd), Santa Fe Road (another regionally significant corridor) and SR 140 (via Main St South/Lincoln Blvd).

Funding and Programming Summary:

Phase Programming
Year
Measure V
Request
10%
Leveraging Est Total Cost
PSE FY 28/29 $ 227,700 $ 25,300 $ 253,000
CON FY 29/30 $ 3,181,500 $ 353,500 $ 3,535,000
Totals: $ 3,409,200 $ 378,800 $ 3,788,000

1. Main & Davis St. Traffic Signal Reconfiguration - Project funding being requested for the Davis Intersection Project is for a Project Study Report (PSR) to evaluate the intersection, its operation, and identify improvements that can increase safety and improve intersection operation. Based on what is identified in the PSR, other funding mechanisms may be used to fund improvements, reducing the sole reliance on Regional Measure V Funding.

Funding and Programming Summary:

Phase Programming
Year
Measure V
Request
10%
Leveraging Est Total Cost
PSR FY 28/29 $ 202,500 $ 22,500 $ 225,000
Totals: $ 202,500 $ 22,500 $ 225,000
Staff recommends that the revised funding requests be submitted to MCAG for programming and that the City budget for the 10% leveraging funds in the appropriate fiscal year from available transportation funds in that programming year.

FISCAL IMPACT
There is no direct fiscal impact at this time associated with this item.

In Fiscal Year 28/29, a total leveraging amount for both projects of $47,800 will need to be budgeted.

In Fiscal Year 29/30, a total leveraging amount of $353,500 will need to be budgeted.

These local leveraging funds can be committed from the City’s Local Measure V allocation, SB1/RMRA allocation, or other available local funds.

Staff time was used to prepare and process this agenda item.

ATTACHMENTS

1. Resolution No. 2026-______

2. Revised Measure V Regional Project Funding Requests
-
-- ~--~~-------~~--~
-
-

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RESOLUTION NO. 2026-

A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF LIVINGSTON (1) APPROVING THE REVISED MEASURE V REGIONAL PROJECT APPLICATION CHANGES, (2) AUTHORIZING THE CITY TO APPLY 10% LEVERAGING FUNDS TO

THE NORTH MAIN STREET REHABILITATION AND MAIN & DAVIS ST TRAFFIC SIGNAL RECONFIGURATION FUNDING APPLICATIONS, AND (3) AUTHORIZING

STAFF TO SUBMIT THE REVISED APPLICATIONS TO MCAG FOR PROGRAMMING WHEREAS, MCAG issued a “Call for Projects” on September 3, 2025, for candidate regional projects eligible for Measure V regional funding for the FY 28/29 – FY 29/30 Funding Cycle; and WHEREAS, on December 2, 2025, the Livingston City Council approved the Measure V Regional Project Applications for FY 28/29 – FY 29/30 for the City of Livingston; and WHEREAS, on January 6, 2026, the Livingston City Council approved the programming adjustment for the Transit Center funding to a later programming year (FY 29/30) and reprioritize the Candidate Project funding requests; and
WHEREAS, on January 12, 2026, the Measure V East Side Regional Projects Committee met to determine project funding recommendations for the MCAG Governing Board; and WHEREAS, the Measure V Committee recommended the City’s North Main Street Rehabilitation and Main & Davis St. Traffic Signal Reconfiguration contingent these projects are programmed in the FY 28/29 and FY 29/30 and the City leverages 10% of the project costs; and WHEREAS, the City Council desires to leverage 10% of the project costs for the North Main Street Rehabilitation and Main & Davis St. Traffic Signal Reconfiguration using other local funding sources such as the City’s Local Measure V Funds, SB 1/RMRA Funds, or other available local funds; and
WHEREAS, the estimated total cost for design and construction for the North Main Street Rehabilitation Project is $3,788,000 with a corresponding 10% local share of $378,800; and WHEREAS, the estimated total cost for the project study report for the Main & Davis St. Traffic Signal Reconfiguration Project is $225,000 with a corresponding 10% local share of $22,500; and WHEREAS, the City Council hereby authorizes the submittal of revised funding applications for the North Main Street Rehabilitation and Main & Davis St Traffic Signal Reconfiguration subject to the required programming years and a 10% local share.

NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Livingston hereby:

1. Finds that the foregoing recitals are true and correct and incorporated by reference.

2. Approves the programming years FY 28/29 – FY 29/30 for the funding allocations for the North Main Street Rehabilitation and Main & Davis St Traffic Signal Reconfiguration projects.

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3. Approves a 10% local share of the estimated project costs for the North Main Street Rehabilitation and Main & Davis St Traffic Signal Reconfiguration of $378,800 and $22,500, respectively.

4. Directs the City Manager to submit the revised project applications for funding programming by MCAG.

5. This resolution will become effective immediately.

I hereby certify that the foregoing Resolution No. 2026- is a full, true and correct copy of a resolution duly passed and adopted by City Council of the City of Livingston at a regular meeting thereof duly held on 20th day of January 2026, by the vote recorded as follows:

AYES:

NOES:

ABSTAIN:

ABSENT:

By: ______________________________
Jose A. Moran, Mayor
of the City of Livingston
ATTEST:
___________________________________
Monica Cisneros, Deputy City Clerk
of the City of Livingston

APPROVED AS TO LEGAL FORM
____________________________________
Marc Tran, City Attorney

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Regional Project Candidate Evaluation Form
Regional Project Forms must be returned to MCAG no later than October 3, 2025 Submit all materials to [email protected]
Project Name North Main Street Rehabilitation
Lead Agency City of Livingston
Point of Contact
Request Type
☐ Additional funds for existing Implementation Plan project ☐ New project: Project Study Report or equivalent
☒ New project: Project development phase (Environmental, Design, or Right-of-Way) ☒ New project: Construction
☐ Project Changes: (e.g. Funding Reduction; Scope Change, funding transfer between phases or projects; Project Deletion)
Only portions of this form are required for project changes: Project Description, Estimated Cost and Schedule, and “Fundability” under Project Merits; all documents listed must be submitted.

Regional Transportation Plan (RTP)
Is this project in the current RTP? If yes, which page? ☐ Yes, page ________ ☒ No See pdf pages 44 – 52 in this document for the current Tier I (fiscally constrained) project list:
https://www.mcagov.org/DocumentCenter/View/4000/2023-RTP-FTIP-Amend-32823?bidId= See pdf pages 122 – 124 in this document for the Tier II (unfunded) project list:
https://www.mcagov.org/DocumentCenter/View/3599/MCAG-2022-RTP-SCS-Appendices-G---L?bidId= The proposed project improvements are limited to rehabilitation of the existing roadway to increase its useful life. The proposed project has been included in the City’s candidate RTP projects for 2026.

Anthony Chavarria
tCMeasureV

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Regional Qualification
How does this project meet the definition of “regional” as defined in the Measure V Expenditure Plan and Regional Projects Policies (2021)?
This project meets the definition of regional based on the following criteria.

Regional Roadway System: This corridor connects Highway facilities to regional agriculture, commercial, and industrial activity centers. The corridor is actively used as a throughfare for shipping goods through the region. Foster Farms uses this corridor to access their facilities.

Projects located in, or directly benefitting more than one jurisdiction: This corridor is functionally classified as a Minor Arterial on the current CRS maps. This corridor is utilized as a regional connection to SR-99 facilities along with other jurisdictions (parts of unincorporated communities in Merced County).
(1) State Highway System ☐ Yes ☒ No
(2) Regional Transportation System/Regional Roadway System ☒ Yes ☐ No (3) Project is located in, or directly benefitting, more ☒ Yes ☐ No than one jurisdiction*
(4) Mass Transit (Bus/Rail/Air)** ☐ Yes ☒ No
(5) Other - Request Regional Project Committee Vote for ☐ Yes ☒ No Regional Qualification
Additional Information:

Regional Transportation System: Refer to Chapter 3 in the 2022 RTP/SCS. Example projects include carpool, vanpool, or active transportation projects that connect urban areas and other major activity centers. Facilities that are not included in the regional transportation system are considered to primarily serve local transportation needs.

Regional Roadway System: The regional roadway system consists of State and Interstate Highways, as well as local routes which connect urban areas and other major activity centers. Facilities that are not included in the regional road system are considered to primarily serve local transportation needs. *Projects located in, or directly benefitting more than one jurisdiction: Road projects must be located entirely on roadways that are classified above “Minor Collector.” This functional classification is shown on the California Road System (CRS) map, as approved by the Federal Highway Administration, which can be found here:
https://caltrans.maps.arcgis.com/apps/webappviewer/index.html?id=026e830c914c495797c969a3e5668538 Additionally, projects in this category require a resolution of support from all involved jurisdictions. **Mass Transit (Bus/Rail/Air): These projects require a resolution of support from the sponsor jurisdiction and the transit provider or infrastructure owner, unless the sponsor jurisdiction owns the infrastructure.

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Companion Documents: The Measure V Regional Projects Policies and the East and West Side Project Programming and Funding Availability documents can be found at:
https://www.mcagov.org/315/Measure-V
Staff Contact: Please contact Elizabeth Forte at [email protected] with any questions.

Project Description (or reason for project change)
Include project purpose, scope, limits, and current status. Project merits are discussed in the following pages and can be discussed in detail there. Attach additional pages if necessary.

Estimated Cost and Schedule
Check the box for the phase(s) requesting funding, but include the entire project’s estimated cost and schedule. All project costs should be shown in year of expenditure (escalated) dollars and include all support costs. More detail (e.g. detailed cost estimates) may be provided with additional pages, if available.

If requesting a Project Study Report (PSR), only information for the PSR phase is required in this table.

The Project Merits section of this form is optional, as many project elements cannot be determined before the initial study. Please include the project map, resolution(s), and any other relevant information listed in the Document Checklist for a PSR request.

Project Phase Estimated
Start
Estimated
Completion
Measure V
Funding Request
Total
Estimated Cost
Project Study Report
(PSR) ☐ N/A
Environmental
(PA&ED) ☐ N/A
Design (PS&E) ☒ June 2028 June 2029 $ 227,700 $ 253,000 Right-of-Way ☐ N/A
Construction ☒ June 2029 June 2030 $ 3,181,500 $ 3,535,000 Totals: $ 3,409,200 $ 3,788,000
Note: The City is proposing to provide $378,800 (10% in matching funds) to demonstrate their commitment to the project. These funds will be committed from other transportation funds. The 10% is applied as follows:
• PSE $ 25,300.00
• CON: $ 353,500.00
The City of Livingston (City) proposes to rehabilitate the pavement on the North Main Street/Livingston Cressey Way corridor. Rehabilitation improvements would begin at the intersection of North Main Street and Campbell Boulevard continuing North to the intersection of Olive Avenue. The improvements would include non-capacity increasing roadway rehabilitation treatments to the existing roadway.

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Project Merits
Describe how the project meets the following criteria. You may expand on the sample questions in each category to include applicable information for your project:

Fundability
How do you expect to fully fund the project? Are you leveraging other fund types? Improvements to the Main Street corridor have been phased into segments. The proposed project is the northern segment of those improvements spanning from Campbell Blvd to Olive Avenue. The City is requesting $3,409,200 from Regional Measure V to fund the design and construction of the proposed improvements. The City will be providing a 10% match in the amount of $378,800 for purposes of leveraging.

Connectivity
Does your project have Complete Streets/Active Transportation components, or does it create regional connections?
This project will maintain the existing regional connectivity of Main Street/Livingston Cressey Way.

This corridor connects the City to the unincorporated community of Cressey and connects to the Santa Fe corridor.

Reduce Emissions
Will the project result in a reduction in Vehicle Miles Traveled or Single-Occupancy Vehicle use? This project is a pavement rehabilitation project and will not have a reduction of VMT or Single Occupancy Vehicle use. There may be minor emissions reductions that would occur from providing a smooth travel surface which provides a more consistent traffic movement pattern through the project area.

Safety
How does the project improve safety?
By providing a rebuilt structural section for the roadway the undulation that currently exists will be replaced with a smooth surface reducing the potential for vehicular conflicts with other motorists, bicyclists, or pedestrians. Additionally, safety will be increased by enhancements to the crosswalk striping utilizing high visibility markings in place of just limit lines.

Asset Management
Describe how the project protects, maintains, or improves existing transportation assets.

The construction of this project will extend the roadway’s useful life preserving the existing facilities.

Economic Development
How will your project support the local (or larger-scale) economy? This project supports the movement of goods through the region as it is a key access point for trucking to and from Foster Farms. Deliveries and shipping use this corridor to access SR-99 and the facility.

Community Support
Describe community engagement involved in the development of this project or project selection.

The community continually vocalizes its support for projects that improve the transportation facilities within the City’s existing infrastructure.

Other Information

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This candidate regional project form, the project map, and all necessary resolutions are required to be submitted during this call for projects. Additional items required are shown below. Further documentation will be required prior to funding any awarded phases.

PSR* Environmental Design ROW Construction**
Application X X X X X
Project Map X X X X X
Resolution X X X X X

PSR X X X X
Final
Environmental
Documents
X X
Funding
Strategy X X
*Projects with a total cost over $1 million require a Project Study Report or equivalent unless categorized as road maintenance/rehabilitation.
**Projects under a total cost of $1 million are exempt from submitting a Construction Funding Strategy.

Document Checklist
Please provide links to the following documents or note the attachment. If not applicable, please type NA in the text box.

Project Map
Council/Board Resolution(s)
Project Study Report ☒ Yes ☐ No
Final Environmental Documents ☐ Yes ☒ No
Funding Strategy ☒ Yes ☐ No
Please include links to any additional supplemental files that pertain to your project below:

Project Location Map Included
Resolution 2026- will be submitted to MCAG once it is signed.

N/A
N/A
Escalated Project Estimate Included

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Oct 03, 2025 - 11:41am V:\COL\645\13\cad\exhibits\2025\Hammatt-campbell-jul23.dwg CAL IFORNIA 99 OLIVE TREE APARTMENTS HARVEST GARDEN APARTMENTS FOSTER FARMS FOODSERVICEKWIK SERV YAMATO COLONY ELEMNTARY SCHOOL LEGEND D MEASURE V APPLICATION AREA: PAVEMENT REHABILITATION OLIVE AVENUE PAVEMENT REHABILITATION IMPROVEMENTS WALNUT AVENUE NOTE: CONCEPTUAL DRAWING. FINAL DESIGN HAS NOT BEEN COMPLETED AND MAY DIFFER FROM WHAT IS SHOWN IN EXHIBIT.

OWN BY: CR
0,1[: 09 30 25 City of Livingston - North Main Street Rehabilitation Project Map Gouveia Engineering, Inc.• 456 Sixth Street • Gustine,
Page
California 95322 • (209) 854-3300
166 of 186
Date: Prepared By: DGR/LR
Item
No.

I.
1 1 LS $ 120,000.00 $ 120,000.00
2 1 LS $ 100,000.00 $ 100,000.00
3 1 LS $ 50,000.00 $ 50,000.00
4 201,500 SF $ 12.00 $ 2,418,000.00
5 1 LS $ 50,000.00 $ 50,000.00
6 1 LS $ 75,000.00 $ 75,000.00
7 1 LS $ 70,000.00 $ 70,000.00
8 1 LS $ 100,000.00 $ 100,000.00
$ 2,983,000.00
$ 298,300.00
$ 3,281,300.00
II. Design Engineering/Surveying/Permitting $ 253,000.00 III. $ 253,000.00
TOTAL $ 3,787,300.00
City of Livingston
Main Street Rehabilitation - Measure V Application

BUDGETARY ENGINEER'S ESTIMATE
9/30/2025
Item Total
Construction Engineering and Survey's Services and
Construction Observation
Estimated
Quantity Unit Price
Contingency (Approx. 10%)
Construction Total:

Traffic Control Plan
Construction
Construction Subtotal:

Utility Lid Adjustments
SWPPP Preparation, Implementation, and Post CON
Roadway Rehabilitation
Repair Traffic Loops
Furnish and Apply Thermoplastic Striping and Markings
Item Description
Mobilization/Demobilization
Concrete Repairs

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Regional Project Candidate Evaluation Form
Regional Project Forms must be returned to MCAG no later than October 3, 2025 Submit all materials to [email protected]
Project Name Main & Davis St Traffic Signal Reconfiguration Lead Agency City of Livingston
Point of Contact
Request Type
☐ Additional funds for existing Implementation Plan project ☒ New project: Project Study Report or equivalent
☐ New project: Project development phase (Environmental, Design, or Right-of-Way) ☐ New project: Construction
☐ Project Changes: (e.g. Funding Reduction; Scope Change, funding transfer between phases or projects; Project Deletion)
Only portions of this form are required for project changes: Project Description, Estimated Cost and Schedule, and “Fundability” under Project Merits; all documents listed must be submitted.

Regional Transportation Plan (RTP)
Is this project in the current RTP? If yes, which page? ☐ Yes, page ________ ☒ No See pdf pages 44 – 52 in this document for the current Tier I (fiscally constrained) project list:
https://www.mcagov.org/DocumentCenter/View/4000/2023-RTP-FTIP-Amend-32823?bidId= See pdf pages 122 – 124 in this document for the Tier II (unfunded) project list:
https://www.mcagov.org/DocumentCenter/View/3599/MCAG-2022-RTP-SCS-Appendices-G---L?bidId= Regional Qualification
How does this project meet the definition of “regional” as defined in the Measure V Expenditure Plan and Regional Projects Policies (2021)?
This project meets the definition of regional based on the following criteria.

Regional Roadway System: This intersection is located in a roadway corridor that connects Highway facilities to regional agriculture, commercial, and industrial activity centers. The corridor is actively used as a throughfare for shipping goods through the region.

Anthony Chavarria
tCMeasureV

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If requesting a Project Study Report (PSR), only information for the PSR phase is required in this table.

Project Phase Estimated
Start
Estimated
Completion
Measure V
Funding Request
Total
Estimated Cost
Project Study Report
(PSR) ☒ June 2028 June 2029 202,500 225,000
Environmental
(PA&ED) ☐
Design (PS&E) ☐
Right-of-Way ☐
Construction ☐
Totals: 202,500 225,000
Note: The City is proposing to provide a $ 22,500 (10% in leveraging funds) to demonstrate commitment to the project. These funds will be committed from other transportation funds.

This commitment will be applied to the PSR phase of the project.

The City of Livingston (City) is seeking funding to evaluate the intersection of Main St/Livingston Cressey Way and Davis Street for improvements to increase pedestrian safety and improve intersection operation. The existing intersection is a signal-controlled intersection. The Main Street legs have two lanes of thru traffic in each direction along with a left turn pocket. Davis Street has a single thru lane in each direction with a dedicated right turn lane on the eastern leg Infront of the gas station. The proposed Project Study Report would evaluate the existing intersection condition and propose improvements to the signal and lane configuration to benefit the operation of the intersection.

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Project Merits
Describe how the project meets the following criteria. You may expand on the sample questions in each category to include applicable information for your project:

Fundability
How do you expect to fully fund the project? Are you leveraging other fund types? The City is actively seeking $ 202,500 in measure v funds for evaluating this intersection for improvement. The City will be providing leveraging funds for this phase of 10%, amounting to $22,500. Completing this PSR will allow the City to identify other funding mechanisms (Measure V, CMAQ, HSIP, etc.) to fund the selected project alternative if possible.

Connectivity
Does your project have Complete Streets/Active Transportation components, or does it create regional connections?
Improvements that would be identified for implementation into this intersection will improve community accessibility to commercial activity centers adjacent to the intersection. Active Transportation Improvements identified in the MLRSP would be incorporated into the selected project alternative.

Reduce Emissions
Will the project result in a reduction in Vehicle Miles Traveled or Single-Occupancy Vehicle use? Increasing the efficiency of the intersection will result in emissions reductions. These reductions would be in the form of less idle time while waiting for the signal to change. These reductions can be accounted for once improvements for the intersection are identified.

Safety
How does the project improve safety?
Examining the SWITRS database for the past 10 years this intersection has seen a number of accidents including at least 2 that involved pedestrians. One of the pedestrian accidents resulted in a pedestrian fatality. The MLRSP identified this intersection for curb ramp improvements to increase safety and accessibility. As part of the examination of the intersection and the selection of possible improvements, intersection crossing safety will be one of the main factors that is evaluated.

Asset Management
Describe how the project protects, maintains, or improves existing transportation assets.

The PSR will identify improvements that will expand the intersections useful life and allow continued efficient operation.

Economic Development
How will your project support the local (or larger-scale) economy? This project supports the movement of goods through the region as it is a part of a key access corridor for trucking to and from Foster Farms.

Community Support
Describe community engagement involved in the development of this project or project selection.

The community continually vocalizes its support for projects that improve the safety of transportation facilities within the City’s existing infrastructure.

Other Information

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PSR* Environmental Design ROW Construction**
Application X X X X X
Project Map X X X X X
Resolution X X X X X

Document Checklist
Please provide links to the following documents or note the attachment. If not applicable, please type NA in the text box.

Project Map
Council/Board Resolution(s)
Project Study Report ☐ Yes ☒ No
Final Environmental Documents ☐ Yes ☒ No
Funding Strategy ☐ Yes ☒ No
Please include links to any additional supplemental files that pertain to your project below:

Project Location Map Included
Resolution 2026- will be submitted to MCAG once it is signed.

N/A
N/A
N/A
Final-Local-Roadway-Safety-Plan

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Oct 03, 2025 - 10:58am V:\COL\645\13\cad\exhibits\2025\Hammatt-campbell-jul23.dwg VILLA'S MEXICAN GRILL

MAYRITA'S RESTAURANT
LEGEND
D MEASURE V APPLICATION AREA: TRAFFIC SIGNAL RECONFIGURATION

KWIKSERV

TRAFFIC SIGNAL

RECONFIGURATION

DAVIS ST
NOTE: CONCEPTUAL DRAWING. FINAL DESIGN
HAS NOT BEEN COMPLETED AND MAY DIFFER FROM WHAT IS SHOWN IN EXHIBIT.

OWN BY: CR
0,1[: 09 30 25 City of Livingston - Main & Davis St Traffic Signal Reconfiguration Project Map Gouveia Engineering, Inc.• 456 Sixth Street • Gustine,
Page
California 95322 • (209) 854-3300
173 of 186

STAFF REPORT
AGENDA ITEM: Resolution To Provide Direction For The Type Of 4th Of July Festival The City Council Wants Held In 2026
MEETING DATE: January 20, 2026
PREPARED BY: Jacquie Benoit, Recreation Superintendent
REVIEWED BY: Jose A. Ramirez, City Manager

RECOMMENDED COUNCIL ACTION
Provide directions to staff regarding the 2026 4th of July Festival in Livingston.

BACKGROUND/DISCUSSION
For the past several decades, the City of Livingston funds and hosts the 4th of July Festival (“Festival”). The size of the event varies depending on funding available and whether fireworks can be obtained. In 2023, Recreation Superintendent Benoit secured a 3-year commitment with Pyro Spectacular for a lower-level but impactful show. The contract expired in 2025. However, Pyro Spectacular is available for the 2026 July Festival. The show's costs have increased by 10% due to the tariffs. Staff seeks direction to pursue a contract with Pyro Spectacular. As a reminder, 2026 is the United States of America’s 250th Anniversary.

The Festival is a 3-day event featuring a carnival, food and merchandise vendors, a beer garden, live entertainment, and a fireworks show on the 4th of July. City Council has the discretion to set the size and amenities of the Festival.

For many years, Julio Valadez and a group of volunteers would direct and manage the Festival because Mr. Valadez’s team can devote more time to organizing the Festival than the Recreation Department. Currently, the Recreation Department consists of two full time employees. Given the small size of the Department and large undertaking of the Festival, Mr.

Valadez and his team are necessary for hosting the Festival. In 2025, the expense for a 1-day event was $39,500.00. This did not include Police Department or Public Works overtime.

Staff would like to list three (3) options for consideration and are open to the Council's recommendations.

1. A one-day event on the 4th of July includes a fireworks show, a beer garden, 2 bands, and a DJ. Organized and run by a volunteer group or recreation department.

2. A three-day event was held in the past, either with volunteer coordination or with a paid event coordinator.

3. No event.

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FISCAL IMPACT
Budget for this event will be brought to council for approval in the 26/27 budget.

ATTACHMENTS
None.

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RESOLUTION 2026-

A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF LIVINGSTON TO PROVIDE DIRECTION FOR THE TYPE OF 4th OF JULY FESTIVAL THE CITY COUNCIL WANTS HELD IN JULY 2026
WHEREAS, the 4th of July Festival has been an event held and paid for by the city for several decades. The size of the event has varied depending on funding available and if fireworks could be obtained; and
WHEREAS, in 2023, Recreation Superintendent Benoit was able to get a 3-year commitment for a lower-level but impactful show. 2025 was the last year of the contract.

A new contract will be brought to council in the near future should this be the direction council provides; and
WHEREAS, for many years, the festival has been directed and managed by a group of volunteers led by Julio Valadez. He has been able to provide an event level that, given the workload, the Recreation Department cannot; and
WHEREAS, The festival hosted a 3-day event featuring a carnival, food and merchandise vendors, a beer garden, and live entertainment; and WHEREAS, City Council has the discretion to set the size and impact of this event. Staff would like the council to understand that as Recreation Programs grow, the responsibilities of a 2-person full-time department are beyond capacity; and WHEREAS, staff has listed three (3) options for consideration and are open to the council's recommendations:

1. A one-day event on the 4th of July includes a fireworks show, a beer garden, 2 bands, and a DJ. Organized and run by a volunteer group or recreation department.

2. A three-day event was held in the past, either with volunteer coordination or with a paid event coordinator.

3. No event.

NOW, THEREFORE, BE IT RESOLVED, that the City Council of the City of Livingston does hereby recommend
______________________________________________________________________ ______________________________________________________________________.

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AYES:

NOES:

ABSENT:

ABSTAIN:

By: ______________________________
Jose A. Moran, Mayor
of the City of Livingston

ATTEST:

___________________________________
Monica Cisneros, Deputy City Clerk
of the City of Livingston

APPROVED AS TO LEGAL FORM

____________________________________
Marc Tran, City Attorney

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STAFF REPORT
AGENDA ITEM: Annual Discussion on Council Appointments to Boards, Commissions, and Committees and Give Direction on Whether Council Wants to Keep Current Appointments
MEETING DATE: January 20, 2026
REQUESTED BY: Jose A. Moran, Mayor
RECOMMENDED COUNCIL ACTION:

Annual Discussion on Council Appointments to Boards, Commissions, and Committees and Give Direction on Whether Council Wants to Keep Current Appointments.

BACKGROUND:

Every year, the council reviews and reappoints the City Council to City’s Boards, Commissions, and Committees. Last appointments were made in 2025.

DISCUSSION:

Mayor Moran requested that this item be added to discuss current council appointments to boards, commissions, and committees, to give the council the opportunity to make changes to their appointments if there is a scheduling conflict. Council will focus on the following items for discussion:

1. Review and discuss Council’s Appointments to City Boards, Commissions, and Committees.

2. Discussion from City Council on whether they want to keep or change current appointments.

3. Make new appointments by motion (if needed).

FISCAL IMPACT:

There is no fiscal impact.

ATTACHMENTS:

1. Appointment list

2. Information on City Boards, Commissions, and Committees.

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Robert Wallis
• Special City Selection Committee of the San Joaquin Valley Air Pollution Control Board – Robert Wallis, Representative and Japjeet Uppal, Alternative. • City Council Liaison - Livingston Planning Commission – Jason Roth and Alternate Robert Wallis.
• Utility Stakeholders Committee – Japjeet Uppal and Robert Wallis.

Jason Roth
• Merced County Local Agency Formation Commission (LAFCO) Jason Roth, Representative. • Merced County Mosquito Abatement District Board of Directors – Gurpal Samra, Representative and Jason Roth, Alternate.
• City Council Liaison - Livingston Planning Commission – Jason Roth and Alternate Robert Wallis.

Japjeet Uppal
• Central Valley Division League of California Cities – Jose Moran, Representative and Japjeet Uppal, Alternate.
• Special City Selection Committee of the San Joaquin Valley Air Pollution Control Board – Robert Wallis, Representative and Japjeet Uppal, Alternative. • City Council Liaison - Parks, Recreation and Arts Commission – Jose Moran and Alternate Liaison Japjeet Uppal.
• Merced Integrated Regional Water Management Plan (MIRWMA) – Japjeet Uppal, Representative and Robert Wallis, Alternate Representative. • Utility Stakeholders Committee – Japjeet Uppal and Robert Wallis.

Gurpal Samra
• Merced County Mosquito Abatement District Board of Directors – Gurpal Samra, Representative and Jason Roth, Alternate.
• Merced County Association of Governments (MCAG) Governing Board – Gurpal Samra, Representative and Jose Moran, Alternate.

Jose Moran
• Central Valley Division League of California Cities – Jose Moran, Representative and Japjeet Uppal, Alternate.
• Merced County Association of Governments (MCAG) Governing Board – Gurpal Samra, Representative and Jose Moran, Alternate.
• City Council Liaison - Parks, Recreation and Arts Commission – Jose Moran and Alternate Liaison Japjeet Uppal.

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APPOINTMENTS TO CITY BOARDS, COMMISSIONS AND

COMMITTEES

MERCED COUNTY ASSOCIATION OF GOVERNMENTS (MCAG)

GOVERNING BOARD

ABOUT THE GOVERNING BOARD AND MEETINGS
The 11- member MCAG Governing Board includes a supervisor from each of the five county districts and an elected official from each of the six incorporated cities in Merced County: Atwater, Dos Palos, Gustine, Livingston, Los Banos, and Merced.

Board meetings are held the third Thursday of every month at 3:00 p.m. at varied locations throughout Merced County.

ABOUT MCAG
Merced County Association of Governments (MCAG) is an association of city and county governments, with members who meet to solve regional problems such as transportation, solid waste, and air quality.

This Association of Governments is where the cities and the county come together as equal partners to solve problems that can only be accomplished by working together.

MCAG was formed through a Joint Powers Authority (JPA) signed by member jurisdictions in November, 1967. As a regional collaborative agency, MCAG serves in a number of transportation planning roles in Merced County based on local, state, and federal designations. These designations offer increased funding for MCAG activities, primarily in transportation planning for the unincorporated areas of Merced County.

MERCED COUNTY LOCAL AGENCY FORMATION COMMISSION
(LAFCO)

MEETINGS
The meetings are held on the third Thursday of each month, except for November and December, when the two months are combined and one meeting is held on the second Thursday of December. The meetings are from 10:00 a.m. until approximately 12:00 p.m. and are held in the Board Chambers of the County Administration Building at 2222 “M” Street, Merced.

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Contact Kim Zinke at LAFCo’s Office at (209) 385-7671 if you have any questions. ABOUT LAFCO
The Local Agency Formation Commission (LAFCo) is an independent commission created by the State to promote the wise use of land resources while providing for the present and future needs of a community.

LAFCo Commissioners have a responsibility to exercise their independent judgement while making decisions concerning appropriate local governmental boundaries and service providers.

To guide their decisions, the Merced LAFCo Commission has adopted the following four goals:

1. Planned, well-ordered, and efficient development patterns.

2. Governmental services are delivered efficiently and effectively.

3. The need to provide for urban development is balanced with the conservation of open space and prime agricultural lands.

4. Urban land use patterns maximize the opportunity for local jurisdictions to provide their fair share of regional housing needs for all income levels.

These goals were created to carry out the State's legislative intent codified within the Cortese-KnoxHertzberg Local Government Reorganization Act (CA Govt Code § 56001) of 2000: “The Legislature recognizes that the logical formation and determination of local agency boundaries is an important factor in promoting orderly development and in balancing such development with sometimes competing state interests of discouraging urban sprawl, preserving open space and prime agricultural lands, and efficiently extending government services. The Legislature also recognizes that providing housing for persons and families of all incomes is an important factor in promoting orderly development."

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CENTRAL VALLEY DIVISION LEAGUE OF CALIFORNIA CITIES

MEETINGS
The Central Valley Division membership meetings are held quarterly, splitting our meetings between the northern and southern cities.
2021 Central Valley Division Quarterly Meetings
March 11th,
June 10th
September 9th
December 9th
Location varies. The meetings start at 6:00 p.m.

For event information and opportunities to support the Central Valley Division please contact Stephen Qualls at [email protected]

ABOUT CENTRAL VALLEY DIVISION
The Central Valley Division includes 25 cities in Calaveras, Merced, Madera, San Joaquin, Stanislaus, and Tuolumne counties and provides members with the opportunity to exchange ideas and information and share the advantages of cooperative advocacy.

Angels Camp
Atwater
Ceres
Chowchilla
Dos Palos
Escalon
Gustine
Hughson
Lathrop
Livingston
Lodi
Los Banos
Manteca
Merced
Modesto
Newman
Oakdale
Patterson
Ripon
Riverbank
Sonora
Stockton
Tracy
Turlock
Waterford
The division is guided by an executive committee under the leadership of a division president. Elected city officials and professional city staff attend division meetings throughout the year to share what they are doing and advocate for their interests in Sacramento.

Division members also participate in the development of League policy through representation on:
• The League Board of Directors;
• Policy Committees;
• The Annual Conference Resolution Committee; and
• The Annual Conference Program Committee

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MERCED COUNTY MOSQUITO ABATEMENT DISTRICT BOARD OF

DIRECTORS

MEETINGS
Meetings are held the 3rd Tuesday of every month at 4:00 p.m. Location varies.

MISSION
Merced County Mosquito Abatement District is dedicated to improving the quality of life for our local community by providing best management practices of mosquito control and disease prevention. We are a special district that is publicly funded with the goal of preventing mosquito borne diseases throughout Merced County. The commitment to our work is shown through our detailed surveillance, proven treatment programs and our constant efforts to control the mosquito population. It is our responsibility and honor to provide such preventative services in the most cost effective, environmentally responsible manner possible. We find it extremely important to educate the public on what we do and how residents can help make a difference. Public outreach and our education campaign are other services we offer in addition to mosquito control. We thoroughly enjoy engaging with the public and are grateful to have been serving Merced County since 1946.

District Board of Directors are responsible for reviewing financial statements, spending, payment authorizations, review contracts and audits, etc.

SPECIAL CITY SELECTION COMMITTEE OF THE SAN JOAQUIN

VALLEY AIR POLLUTION CONTROL BOARD

MEETINGS
Once a Year. They don’t have a date or time yet.

ABOUT THE SAN JOAQUIN VALLEY AIR POLLUTION CONTROL DISTRICT The San Joaquin Valley Air Pollution Control District is made up of eight counties in California’s Central Valley: San Joaquin, Stanislaus, Merced, Madera, Fresno, Kings, Tulare and the San Joaquin Valley Air Basin portion of Kern.

The Valley Air District is governed by an fifteen member Governing Board consisting of representatives from the Board of Supervisors of all eight counties, one Health and Science member, appointed by the Governor, one Physician, appointed by the Governor and five Valley city representatives.

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The Air District’s Mission
The San Joaquin Valley Air District is a public health agency whose mission is to improve the health and quality of life for all Valley residents through efficient, effective and entrepreneurial air quality management strategies. Our Core Values have been designed to ensure that our mission is accomplished through commonsense, feasible measures that are based on sound science.

The Air District’s Vision
Healthful air that meets or exceeds air quality standards for all Valley residents. The District is a leader in air-pollution control. Valley residents take pride in our collective efforts to continuously improve air quality.

Core Values
Protection of Public Health – The District shall continue to strive to protect the health of Valley residents through efforts to meet health-based state and federal ambient air-quality standards, based on science and prioritized where possible using health-risk reduction strategies.

Active and Effective Air Pollution Control Efforts while Seeking to Improve the Valley’s Economic Prosperity and Grow Opportunities for All Valley Residents – District staff shall work diligently to adopt and fully implement cost-effective air pollution-control measures, provide meaningful incentives for reducing emissions, and develop creative alternatives for achieving emissions reductions.

Outstanding Customer Service – District staff shall work to provide excellent customer service for stakeholders in activities including: rule and plan development; permitting and emissions inventory functions; compliance activities; financial and grant-funding transactions; and responses to public complaints and inquiries.

Ingenuity and innovation - The District values innovation and ingenuity in meeting the challenges we face. Examples of this spirit of innovation include developing programs that provide new incentives for emissions reductions, and providing alternate compliance strategies that supplement traditional regulatory efforts and generate more emissions reductions than could otherwise be reasonably obtained.

Accountability to the public – The District serves, and is ultimately accountable to, the people of the Valley for the wise and appropriate use of public resources, and for accomplishing the District’s mission with integrity and honesty.

Open and transparent public processes – The District shall continue to provide meaningful opportunities for public input and be responsive to all public inquiries.

Recognition of the uniqueness of the San Joaquin Valley – The Valley’s meteorology, topography and economy differ significantly from those in other jurisdictions. Although it is valuable to review and evaluate efforts of other agencies, we must consistently look for solutions that fully consider the Valley’s unique needs.

Continuous improvement –The District works to continually improve its internal operations and processes, and strives to streamline District operations through optimally utilizing information technology and human resources.

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Effective and efficient use of public funds – The District shall continually strive to efficiently use all resources and to minimize costs associated with District functions.

Respect for the Opinions and Interest of All Valley Residents – The District shall respect the interests and opinions of all Valley residents and fully consider these opinions, seeking collaboration with federal, state, and local agencies, agriculture, businesses, community groups and residents in carrying out the District’s mission.

Robust Public Outreach and Education on Valley Air Quality Progress and Continuing Air Quality Efforts – As we move forward in achieving our mission, the District shall continue its ongoing efforts to educate the public about air quality, and the significant clean air investments and air quality progress that have been made in the Valley.

CITY COUNCIL LIAISON – LIVINGSTON PLANNING COMMISSION
The Planning Commission acts in an advisory capacity to the City Council on land-use and development issues. Responsibilities of the Planning Commission include:
• Interprets, administers, and enforces the provisions of the City's Zoning Ordinance and other land use regulations, in such a way as to carry out the intent and purpose of the General Plan as interpreted on the official Zoning Map;
• Acts on Variances from the provisions of Title 5 regarding the development of land, construction, enlargement or alteration of any building or structure; • Acts on Use Permits, Variances, and Parcel Maps. It revokes Use Permits as necessary; provides interpretations of zoning ordinance;
• Provides recommendations to the City Council on Site Plan & Design Reviews, Rezonings, Tentative Maps, Development Agreements and General Plan Amendments.

The Planning Commission meets on the second Tuesday of each month at 7:00 p.m. Planning Commission meetings are held at the City Council Chambers, 1416 C Street, Livingston, CA 95334.

CITY COUNCIL LIAISON – PARKS, RECREATION AND ARTS

COMMISSION
The Parks, Recreation and Arts Commission acts in an advisory and volunteer capacity in the development of parks, recreation and art opportunities for Livingston residents. In their capacity, the Parks, Recreation and Arts Commission shall:
• Recommend to the City Council a Parks and Recreation Master Plan. If directed by the City Council, the commission shall recommend to the City Council a Parks, Recreation and Arts Master Plan, either in lieu of or in addition to, the Parks and Recreation Master Plan. After any initial Master Plan has been

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adopted by the City Council, the commission shall periodically review the Master Plan and make appropriate recommendations to the City Council.
• Recommend to the City Council individual Park Master Plans for each park in the City of Livingston. • Constructively encourage public recreational and art activities in Livingston. • Recommend projects, legislation, policies, funding allocations, and other measures, programs, or activities for the development of park, recreation and art opportunities in Livingston. • Act in an advisory capacity to the City Council in all matters pertaining to recreation. • Act in an advisory capacity to the City Council in all matters pertaining to art or art programs within the City.
• Carry out projects, programs, or activities as directed by the City Council. • Consider the annual budget for recreation during the annual budget process and make recommendations with respect thereto to the City Council. • Initiate, sponsor, and promote involvement, activities and contributions by the private sector for the development of parks, recreational and art activities in the City. • Assist in the planning of a Recreation Program for City residents, promote and stimulate public interest therein, and solicit the cooperation of school authorities and other public and private agencies interested therein. (Ord. 633, 2-20-2018)
The Parks, Recreation and Arts Commission holds monthly meetings on the fourth (4th) Thursday of every month at City Hall's Council Chambers at 6pm.

UTILITY STAKEHOLDERS COMMITTEE
Meetings
As needed.

About the Committee
The Utility Stakeholders Committee is an ad-hoc committee that is comprised of residents, business and elected officials that represent different sectors of the community. The primary purpose of the committee is to analyze and have fruitful discussions that will lead to the most optimal utility rates.

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Livingston City CouncilJanuary 20, 2026

Livingston City Council
January 20, 2026