Resolution No. 05-49 CITY OF TIGARD, OREGON
RESOLUTION NO. OS-
41
A RESOLUTION EXTENDING CITY OF TIGARD'S WORKERS' COMPENSATION COVERAGE TO
VOLUNTEERS OF THE CITY OF TIGARD
WHEREAS, the City of Tigard acknowledges the valuable service rendered by City of Tigard volunteers;
and
WHEREAS, the City of Tigard participates in the City County (CIS) Insurance Services Group Self-
Insurance
elfInsurance Program; and
WHEREAS, it is required that a resolution be passed by the Tigard City Council in order to extend
workers' compensation to City of Tigard volunteers.
NOW,THEREFORE,BE IT RESOLVED by the Tigard City Council that:
SECTION 1: Pursuant to ORS 656.031., workers' compensation coverage will be provided to
classifications listed on the attached Volunteer Election Form(Exhibit A).
SECTION 2: A roster of active volunteers will be updated monthly for reporting purposes.
SECTION 3: Unanticipated volunteer projects not addressed Herein will be added to the City of Tigard's
coverage agreement by endorsement and advance notice to CIS, allowing at least two weeks
for processing. It is hereby acknowledged that worker's compensation for unanticipated
volunteer projects cannot be backdated.
SECTION 4: This resolution shall be updated annually.
SECTION 5: This resolution is effective immediately with the City's membership in the CIS Workers'
Compensation Self-Insurance Services Group established retroactively to July 1,2005.
PASSED: This q day of 2005.
f /
Mayor- ity of Tigard
ATTEST:
City Recorder-City of Tigard
RESOLUTION NO. 05 - �
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Exhibit A
VOLUNTEER ELECTION FORM
CIS, ability to provide workers' compensation coverage for volunteers is directly related to each
entity's ability to keep verifiable records of the names and hours worked by participants. Claims
adjusters will verify coverage at the time a claim is filed.
Public Safety Volunteers
The following volunteer positions are reported in NCCI Classification Code 8411V, using an assumed
monthly wage of no less than $800 per volunteer per month (regardless if one day or 30 are worked) for
contribution payment and calculation of benefits. This assumed monthly wage may be increased at the
employer's discretion in increments of$100.
City County Insurance Services
Volunteer Election Form for Coverage Year 71112005 to 6/3012006
Multiply (1) x (2) = Estimated Assumed Payroll
NCCI (1) (2) (3)
Volunteer Category Code Est. No. of Assumed 2005-06 Estimated
Volunteer Monthly Assumed Payroll
Months* Wage
Reserve Police Officers (12 ea.) 8411 V 144 $4,140 $590,400
TOTAL: $590,400
"Using last year's rosters, estimate the number of volunteer months for each position and enter the total on the appropriate
line in Column(1). Some volunteers are not active every month,i.e.,one volunteer firefighter may be active five months out of
the year, two volunteer firefighters may be active 12 months out of the year, and five volunteer firefighters may be active only
one month out of the year. Thus,the number of volunteer firefighter months would be 34.
Non-Public Safe Volunteers--Assumed wage must be at least $7.25 per hour or $800 per person
per month minimum.
Unpaid boards, commissions, and councils: CIS has designated Class Code 8742V for this type of
exposure. If they are only reimbursed for expenses, receive no remuneration and you wish to provide
a do so using an aggregate $2,500 assumed annual payroll
compensation benefits you may g gg ,
workers compe , Y
amount for each board, commission and council you elect to cover. Please call if you have questions
or need advice.
City County Insurance Services
Volunteer Election Form for Coverage Year 7/1/2005 to 6130/2006
Unpaid Boards, Commissions and Councils
Type 2005-06 Estimated
(Planning Commission or Budget Committee, etc.) Assumed Payroll
($2,500 each)
Budget Committee $2'500
Library Board $2,500
Planning Commission $2,500
18 Other Miscellaneous Committees, Boards, Task Forces--see attached $45,000
TOTAL: $52,500
i
RESOLUTION NO. 05 -
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Public officials: CIS has designated Class Code 8742V for this type of exposure as well. Coverage for
this exposure is available based on an assumed monthly wage of$800 per month per public official.
City County Insurance Services
Volunteer Election Form for Coverage Year 7/1/2005 to 6/30/2006
Multiply (1) x (2) = Estimated Assumed Payroll
(1) (2) (3)
Position No. of Assumed 2005-06
(Mayor, etc.) Months Monthly Estimated
per year Wage Assumed
($800) Payroll
Mayor 12 $800 $9,600
City Councilors (4 ea.) 48 $800 $38,400
TOTAL: $48,000
InmeteslCommunite Service Workers: If your entity uses workers from the correctional system (i.e.,
community service workers, inmates on work release, peer review crews, etc.), it is important to clarify
in writinq who will provide workers' compensation coverage for these workers prior to work inception.
CIS recommends you obtain a Certificate of Coverage for Workers' Compensation from the sentencing
court or make arrangements to provide coverage through your own entity. If you are responsible for
providing the workers' compensation coverage, be sure to keep monthly time records for these
workers and report them using Oregon minimum wage. CIS has designated Class Code 7720V for this
type of exposure.
City County Insurance Services
Volunteer Election Form for Coverage Year 7/1/2005 to 6/30/2006
Multiply (1) x (2) x (3) x (4) = Estimated Assumed Payroll
NCCI (1) (2) (3) (4) (5)
Volunteer Category Code Est. No. of No. of No. of Oregon 2005-06
Volunteers Hours Months Minimum Estimated
per month per per Wage Assumed
month year ($7.25) Payroll
Car Transport 7720V 1 4 12 $7.25* $348
Community Service Supr. 7720V 1 10 6 $7.25* $435
Juvenile Court Offenders 7720V 5 3.3 12 $7.25* $1,436
PEER Court 7720V 8 4.7 12 $7.25* $3,271
TOTAL: $5,490
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Miscellaneous: Assumed payroll for all other volunteer elections should be computed at Oregon
minimum wage using actual hours worked and reported in the appropriate NCCI classification code with
a "V" added to the end. Unanticipated volunteer projects or exposure can be added throughout the
coverage year (1) by endorsement, (2) with advance notice to CIS, and (3) allowing two weeks for
processing. Coverage of this type cannot be backdated.
City County Insurance Services
Volunteer Election Form for Coverage Year 7/112005 to 6/30/2006
Multiply (1) x (2) x (3) x (4) = Estimated Assumed Payroll
NCCI (1) (2) (3) (4) (5)
Volunteer Category Code Est. No. of No. of No. of Oregon 2005-06
Volunteers Hours Months Minimum Estimated
per month per per Wage Assumed
month year ($7.25) Payroll
Photographer 4361V 1 2.5 4 $7.25 $73
Graffiti Removal Maint. 5474V 12 1.25 4 $7.25 $435
Painting Services Interior 5474V 10 10 1 $7.25 $725
Library Volunteers-Travel 7380V 12 3.5 12 $7.25 $3,654
Office Assistance 8810V 5 30.8 12 $7.25 $13,398
Library Volunteers 8810V 100 14.6 12 $7.25 $127,020
Tigard Safety Town 8868V 20 33.5 2 $7.25 $9,715
DARE Camp 9015V 60 40 2 $7.25 $34,800
Park Landscape Maint. 9102V 100 1.6 9 $7.25 $10,440
Earth Day Celebration 9402V 50 3 1 $7.25 $1,088
Temporary Sign Removal 9402V 4 1.6 12 $7.25 $557
Make A Difference Day 9402V 200 1.5 1 $7.25 $2,175
Storm Maintenance 9402V 25 5 4 $7'25 $3'625
Street Clean Up Program 9402V 25 2 12 $7.25 $4,350
Water Hydrant Maint. 9402V 10 2.5 4 $7.25 $725
Door to Door Distribution 9410V 5 5 2 $7.25 $363
Election Ballot Collectors 9410V 5 1 2 $7.25 $73
TOTAL: $213,216
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Ti ard's Miscellaneous Boards Committees and Task Forces-- 18 Groups
• Action Committee—Community Character& Quality of Life
• Action Committee—Growth and Growth Management
• Action Committee— Public Safety
• Action Committee—Schools, Education and Youth
• Action Committee--Transportation &Traffic
• Action Committee— Urban & Public Services
• Mayor's Blue Ribbon Task Force
• Building Appeals Board
• Committee For Citizen Involvement
• Downtown Task Force
• Intergovernmental Water Board
• Mayor's Appointment Advisory Council
• Park & Recreation Advisory Board
• Planned Development Code Review Committee
• Tigard Beyond Tomorrow Vision Task Force
• Transportation Financial Strategies Committee
• Tree Board
• Youth Forum
Lm%HADOCSllnsurance105-06 Renewal=cis we volunteer resomion.doc
RESOLUTION NO. 05 - L/Gf
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