RESOLUTION NO. 2015-63 SOCIAL SECURITY NUMBER INFO,
RESOLUTION NO . 2015-63
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON APPROVING THE INDUSTRIAL DISABILITY
RETIREMENT APPLICATION OF BENJAMIN POTTER, A LOCAL
SAFETY MEMBER FORMERLY EMPLOYED BY THE CITY OF
VERNON (GOVERNMENT CODE SECTIONS 21154 AND 21156)
WHEREAS, the City of Vernon (hereinafter referred to as
"Agency") is a contracting agency of the Public Employees' Retirement
System; and
WHEREAS, the Public Employees' Retirement Law requires that
a contracting agency determine whether an employee of such agency in
employment in which he/she is classified as a local safety member is
disabled for purposes of the Public Employees' Retirement Law and
whether such disability is "industrial." within such meaning of such
Law; and
WHEREAS, on March 19, 2015, the City received notice that an
application for industrial disability retirement of Benjamin Potter
employed by the Agency in the position of Police Officer in the Vernon
Police Department was filed with the Public Employees' Retirement
System ("PERS") ; and
WHEREAS, by memorandum dated September 15, 2015, the
Director of Human Resources has recommended that the City Council
approve the industrial disability retirement of Benjamin Potter; and
WHEREAS, the City Council of the City of Vernon has reviewed
medical and other evidence relevant to such alleged disability.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF VERNON AS FOLLOWS :
SECTION 1 : The City Council of the City of Vernon hereby
finds and determines that the above recitals are true and correct .
SECTION 2 : The City Council of the City of Vernon finds
that this action is exempt from California Environmental Quality Act
( "CEQA" ) review, because it is a general policy and procedure making
activity that will not result in direct or indirect physical changes
in the environment, and therefore does not constitute a "project" as
defined by CEQA Guidelines section 15378 . Furthermore, even if it
were a project, because such activity will not have any effect on the
environment, this action would be exempt from CEQA review pursuant to
CEQA Guidelines Section 15061 (b) (3) , the general rule that CEQA only
applies to projects that may have a significant effect on the
environment .
SECTION 3 : Based on competent medical evidence, the City
Council of the City of Vernon hereby finds and determines that
Benjamin Potter is substantially incapacitated from the performance of
his usual and customary duties as a police officer for the City for a
permanent or extended and uncertain duration within the meaning of the
Public Employees' Retirement Law.
SECTION 4 : The City Council of the City of Vernon hereby
finds and determines that such disabilities are a result of injury or
disease arising out of and in the course of employment . Neither the
City Council of the City of Vernon nor Benjamin Potter has applied to
the Workers' Compensation Appeals Board for a determination pursuant to
Government Code Section 21166 whether such disability is industrial, and
that there is not a possibility of third-party liability.
SECTION 5 : Benjamin Potters' last day in paid status was
March 23 , 2015 , after exhaustion of all leaves, if any, under
Government Code Section 21164 and no dispute as to the expiration of
such leave rights exists . Benjamin Potters' permanent separation da.te
- 2 -
as a police officer for the City was March 23 , 2015 ,
SECTION 6 : Benjamin Potter is and has been receiving a PERS
service retirement effective March 23 , 2015 . Advanced Disability
Pension Payments will not be made .
SECTION 7 : Benjamin Potter is competent to act on his own
behalf in legally binding retirement matters .
SECTION 8 : The City Clerk shall notify Mr. Potter of the
City Council' s determination approving his application for industrial
disability retirement .
SECTION 9 : The City Clerk, or Deputy City Clerk, of the
City of Vernon shall certify to the passage, approval and adoption of
this resolution, and the City Clerk, or Deputy City Clerk, of the City
of Vernon shall cause this resolution and the City Clerk' s, or Deputy
City Clerk' s , certification to be entered in the File of Resolutions
of the Council of this City.
APPROVED AND ADOPTED this 15th day of September, 2015 .
W. Michael McCormick
Name :
Title : Mayor /:-Mayo PTo-Te
ATTEST :
P a4.
Ma la E . 4ala
City Clerk / .t� put Ci-ty_._.C1er-k-=mow,
APPROVED
AS TO FORM:
Zaynah Moussa-M ' ward, Deputy City Attorney
- 3 -
STATE OF CALIFORNIA
S3
COUNTY OF LOS ANGELES )
I, Maria E . Ayala , City Clerk / „DQpLt_y-.-C- ty--Clerk' of the City
of Vernon, do hereby certify that the foregoing Resolution, being
Resolution No . 2015-63, was duly passed, approved and adopted by the
City Council of the City of Vernon at a .regular meeting of the City
Council duly held on Tuesday, September_ 7.5, 2015, and thereafter was
duly signed by the Mayor or Mayor Pro-Tem of the City of Vernon.
Executed this ITI-`"day of September, 2015, at Vernon, California.
Marga E . Aya�
City Clerk / ,De pot-y—&i-t-y--C-1-e.r F
(SEAL)
4 -
TRANSMITTAL COMMUNICATION
CF L
4305 Santa Ne Avenue, Vernon,California 90058
Telephone(323)583-8811
September 21, 2015
Marilyn Keller
CaIPERS Benefit Services Division
Disability Retirement Section
P.O. Box 2796
Sacramento, CA 95312-2796
Re: Benjamin Potter
Social Security No.:
City of Vernon, Employer ID: 3431795727
Dear Ms. Keller:
Pursuant to the authority delegated to the City Council of the City of Vernon pursuant to Government
Code Section 21156, and based on competent medical evidence, the City Council of the City of Vernon
hereby finds and determines that Benjamin Potter, a retired local safety member of the California Public
Employees' Retirement System ("CalPERS"), is substantially incapacitated from the performance of his
usual and customary duties as a police officer for the City for a permanent or extended and uncertain
duration within the meaning of the Public Employees' Retirement Law.
A certified copy of Resolution No. 2015-63 regarding the City's determination on Mr.
Potter's application for an industrial disability retirement is attached hereto.
Very truly yours,
l
Z
Deborah R. Juarez
Records Management Assistant.
Enclosure
c: Teresa McAllister
Benjamin Potter
Excfusivei5 Industriaf
CERTIFICATE
STATE OF CALIFORNIA )
ss
COUNTY OF LOS ANGELES)
I , Maria E . Ayala, City Clerk of the City of Vernon, County
of Los Angeles, State of California, hereby certify that the
attached is a full and complete copy of :
RESOLUTION NO. 2015-63 - A Resolution of the City Council of
the City of Vernon Approving the Industrial Disability
Retirement Application of Benjamin Potter, a Local Safety
Member Formerly Employed by the City of Vernon (Government
Code Sections 21154 and 21156)
IN WITNESS WHEREOF, I have hereunto set my hand and affixed
the official Seal of the City of Vernon, County of Los Angeles,
State of California, on this 1r" day of September 2015 .
SEAL:
Maria E . AAaa
City erk
STAFF REPORT
aF v�R
,t.
a`N" jn i.z
4 e`I �ra ��YCLn iM01
f` p,I J1�gI
S'T'AFF REPORT
HUMAN RESOURCES DEPARTMENT
DATE: September 15,2015
TO: Honorable Mayor and City Council
FROM: Teresa McAllister,Director of Human Resources Department pt-j
RE: A Resolution of the City Council of the City of Vernon approving the
application for an Industrial Disability Retirement by Benjamin Potter
Pursuant to Government Code Section 21156
Recommendation
A. Find that approval of the attached resolution approving the application for an Industrial
Disability Retirement by Benjamin Potter is exempt from California Environmental
Quality Act ("CEQA") review, because it is a general policy and procedure making
activity that will not result in direct or indirect physical changes in the environment, and
therefore does not constitute a "project" as defined by CEQA Guidelines section 15378.
Furthermore, even if it were a project, because such activity will not have any effect on
the environment, this action would be exempt from CEQA review pursuant to CEQA
Guidelines Section 15061(b)(3), the general rule that CEQA only applies to projects that
may have a significant effect on the environment; and
B. Adopt the attached resolution approving the application for an Industrial Disability
Retirement, pursuant to Government Code section 21156, based on medical evidence that
Mr. Potter is substantially incapacitated from the performance of his usual and customary
duties as a Police Officer for the City of Vernon.
Background
Mr. Potter was hired as a Police Officer by the City of Vernon on June 18, 1990. Mr. Potter
retired as a Police Officer on March 23, 2015,
On March 19, 2015, the City of Vernon received notice that Mr. Wiles filed an application for an
Industrial Disability Retirement ("IDR"). In accordance with Government Code Sections 21154
and 21156, the City is required to determine the member's disability eligibility within six months
of the IDR request. A Workers Compensation Award is not sufficient evidence that a local
safety member is disabled for retirement purposes. There must be a specific finding under
Government Code Section 21166, by the employer, with respect to the disability for which the
Page 1 of 2
member will be retired. If it is determined that the member is disabled from the performance of
his or her duties, a resolution to that effect must be submitted to CalPERS.
On June 12, 2015, and on July 31, 2015, staff received medical reports from applicant's doctor
supporting a finding that due to orthopedic injuries sustained, Mr. Potter is substantially
incapacitated from performing his usual and customary job as a Police Officer with the City of
Vernon Police Department. Based upon an evaluation of this case and Mr. Potter's medical
reports, staff is recommending that the City Council approve the IDR application effective as of
Mr. Potter's retirement date of March 23, 2015.
Attachment(s)
1. Resolution
Page 2 of 2
RESOLUTION NO
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON APPROVING THE INDUSTRIAL DISABILITY
RETIREMENT APPLICATION OF BENJAMIN POTTER, A LOCAL
SAFETY MEMBER FORMERLY EMPLOYED BY THE CITY OF
VERNON (GOVERNMENT CODE SECTIONS 21154 AND 21156)
WHEREAS, the City of Vernon (hereinafter referred to as
"Agency" ) is a contracting agency of the Public Employees' Retirement
System; and
WHEREAS, the Public Employees' Retirement Law requires that
a contracting agency determine whether an employee of such agency in
employment in which he/she is classified as a local safety member is
disabled for purposes of the Public Employees' Retirement Law and
whether such disability is "industrial" within such meaning of such
Law; and
WHEREAS, on March 19 , 2015 , the City received notice that an
application for industrial disability retirement of Benjamin Potter
employed by the Agency in the position of Police Officer in the Vernon
Police Department was filed with the Public Employees' Retirement
System ( "PERS" ) ; and
WHEREAS, by memorandum dated September 15 , 2015 , the
Director of Human Resources has recommended that the City Council
approve the industrial disability retirement of Benjamin Potter; and
WHEREAS, the City Council of the City of Vernon has reviewed
medical and other evidence relevant to such alleged disability.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF VERNON AS FOLLOWS :
SECTION 1 : The City Council of the City of Vernon hereby
finds and determines that the above recitals are true and correct .
SECTION 2 : The City Council of the City of Vernon finds
that this action is exempt from California Environmental Quality Act
( "CEQA" ) review, because it is a general policy and procedure making
activity that will not result in direct or indirect physical changes
in the environment, and therefore does not constitute a "project" as
defined by CEQA Guidelines section 15378 . Furthermore, even if it
were a project, because such activity will not have any effect on the
environment, this action would be exempt from CEQA review pursuant to
CEQA Guidelines Section 15061 (b) (3) , the general rule that CEQA only
applies to projects that may have a significant effect on the
environment .
SECTION 3 : Based on competent medical evidence, the City
Council of the City of Vernon hereby finds and determines that
Benjamin Potter is substantially incapacitated from the performance of
his usual and customary duties as a police officer for the City for a
permanent or extended and uncertain duration within the meaning of the
Public Employees' Retirement Law.
SECTION 4 : The City Council of the City of Vernon hereby
finds and determines that such disabilities are a result of injury or
disease arising out of and in the course of employment . Neither the
City Council of the City of Vernon nor Benjamin Potter has applied to
the Workers' Compensation Appeals Board for a determination pursuant to
Government Code Section 21166 whether such disability is industrial, and
that there is not a possibility of third-party liability.
SECTION 5 : Benjamin Potters' last day in paid status was
March 23 , 2015 , after exhaustion of all leaves, if any, under
Government Code Section 21164 and no dispute as to the expiration of
such leave rights exists . Benjamin Potters' permanent separation date
- 2 -
as a police officer for. the City was March 23 , 2015 .
SECTION 6 : Benjamin Potter is and has been receiving a PERS
service retirement effective March 23 , 2015 . Advanced Disability
Pension Payments will not be made .
SECTION 7 : Benjamin Potter is competent to act on his own
behalf in legally binding retirement matters .
SECTION 8 : The City Clerk shall notify Mr. Potter of the
City Council' s determination approving his application for industrial.
disability retirement .
SECTION 9 : The City Clerk, or Deputy City Clerk, of the
City of Vernon shall certify to the passage, approval and adoption of
this resolution, and the City Clerk, or Deputy City Clerk, of the City
of Vernon shall cause this resolution and the City Clerk' s, or Deputy
City Clerk' s, certification to be entered in the File of Resolutions
of the Council of this City.
APPROVED AND ADOPTED this 151h day of September, 2015 .
Name :
Title : Mayor / Mayor Pro-Tem
ATTEST:
City Clerk / Deputy City Clerk
APPROVED AS TO FORM:
Zaynah Moussa-Mil rd, Deputy City Attorney
3
STATE OF CALIFORNIA )
ss
COUNTY OF LOS ANGELES )
I, City Clerk / Deputy City Clerk of the City
of Vernon, do hereby certify that the foregoing Resolution, being
Resolution No . , was duly passed, approved and adopted by the
City Council of the City of Vernon at a regular meeting of the City
Council duly held on Tuesday, September 15, 2015 , and thereafter was
duly signed by the Mayor or Mayor Pro-Tem of the City of Vernon.
Executed this day of September, 2015 , at Vernon, California.
City Clerk / Deputy City Clerk
(SEAL)
4 -
l :""��i
4305 Santa Fe Avenue, Vernon,California 90058
Telephone (323)583-8811
September 21, 2015
Marilyn Keller
CalPERS Benefit Services Division
Disability Retirement Section
P.O. Box 2796
Sacramento, CA 95812-2796
Re: Benjamin Potter
Social Security No.:
City of Vernon, Employer ID: 3431795727
Dear Ms. Keller:
Pursuant to the authority delegated to the City Council of the City of Vernon pursuant to Government
Code Section 21156, and based on competent medical evidence, the City Council of the City of Vernon
hereby finds and determines that Benjamin Potter, a retired local safety member of the California Public
Employees' Retirement System("CalPERS"), is substantially incapacitated from the performance of his
usual and customary duties as a police officer for the City for a permanent or extended and uncertain
duration within the meaning of the Public Employees' Retirement Law.
A certified copy of Resolution No. 2015-63 regarding the City's determination on Mr.
Potter's application for an industrial disability retirement is attached hereto.
V etyU2 ly yours,
Deborah R. Juarez
Records Management Assistant.
Enclosure
c: Teresa McAllister
Benjamin Potter
Ey,crusivei5 Industriaf