HomeMy WebLinkAboutCDP 03-12; ADAMS STREET SFR NORTH; Planning CommissionCity of Carisbad PURCHASE ORDER NUMBER:
P U RC HA S E O R D E R (NUMBER TO APPEAR ON INVOICES, PACKING SLIPS, ETC
POF-19-56 TIME IS OF THE ESSENCE ON THIS PURCHASE ORDER P136882
SHIP TO: P.E.M. FLEET MAINTENANCE DIV.
CITY OF CARLSBAD
2480 IMPALA DRIVE
CARLSBAD, CA 92010
VENDOR: DOWNTOWN FORD SALES
525 N 16TH STREET
SACRAMENTO, CA 95811
MAIL INVOICE IN DUPLICATE TO:
CITY OF CARLSBAD
ATTN: ACCOUNTS PAYABLE
1635 FARADAY AVENUE
CARLSBAD, CA 92008-7314
ACCEPTANCE OF THIS ORDER IS EXPRESSLY
LIMITED TO THE TERMS AND CONDITIONS
HEREIN AND ON THE REVERSE SIDE.
PAYMENT TERMS ARE NET 30.
ORDER DATE: VENDOR #: TELEPHONE #: SHIP TO ID#:
01/28/2019 V000209 (916) 442 - 6931 CSDFLE
QUANTITY UNIT DESCRIPTION
VEHICLE GOVERNMENT PRICED PER
STATE CONTRACT 1-18-23-23A
AND BUILT PER SPECIFICATIONS ON
ATTACHED QUOTE NO. CARLSBADPD62
1.00 2019 FORD EXPLORER
1.00 EXTRA KEY W/PROGRAMMING
1.00 PROGRAM 1 KEY
1.00 DELIVERY FEE
1.00 CA TIRE TAX
1.00 DMV DOC FEE
DOWNTOWN FORD SALES TO PROVIDE ALL DOCUMENTS
REQUIRED TO REGISTER THE VEHICLE WITH THE DMV
(APPLICATION FOR REGISTRATION OF NEW VEHICLE TO BE
COMPLETED AND SIGNED BOTH FRONT AND BACK)
THE CITY OF CARLSBAD WILL COMPLETE THE REGISTRATION
TRANSACTION WITH THE DMV
"*`ADDRESS OF REGISTRATIONITITLE DOCUMENTS SHOULD BE:
CITY OF CARLSBAD
1635 FARADAY AVENUE
CARLSBAD, CA 92008-7314
P136882; DOWNTOWN FORD SALES; 1/28/2019
General Industrial Safety Order 5194 requires Material Safety Data
Sheets (MSDS) be supplied, for applicable items, with the initial order
CITY OF CARLSBAD
PURCHASING DEPARTMENT
1635 FARADAY AVENUE
CARLSBAD, CA 92008-7314
REQUISITION #:
R55811
UNIT PRICE
36, 844.38
299.00
100.00
695.00
7.00
85.00
REQUESTER:
AMY HAZEN
EXTENDED PRICE
36, 844.38
299.00
100.00
695.00
7.00
85.00
To conform with I.R.S. regulations your Social Security Number or
Federal Tax I.D. Number must be included on your invoice.
PURCHASING OFFICER
TI-IIC (1Rf1GR IC \/(1If11AlITl-I(ll IT 41 ITI-I(1R17Ff1 CI(_AIATI IRF
"*DELIVERY OF VEHICLE TO:
CITY OF CARLSBAD
2480 IMPALA DRIVE
CARLSBAD, CA 92010-7226
���
P136882; DOWNTOWN FORD SALES; 1/28/2019
General Industrial Safety Order 5194 requires Material Safety Data
Sheets (MSDS) be supplied, for applicable items, with the initial order
CITY OF CARLSBAD
PURCHASING DEPARTMENT
1635 FARADAY AVENUE
CARLSBAD, CA 92008-7314
Tax
PO Total
2,878.61
40, 908.99
ITo conform with I.R.S. regulations your Social Security Number or I
Federal Tax I.D. Number must be included on your invoice.
�� ��-, '/a � �� 9
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PURCHASING OFFICER
TNIC (1Rf1GR IC \/(llfl 1A/ITF-Illl IT AI ITI-If1R17F11 CI(_N4TI IRF
TERMS AND CONDITIONS
1. THERE IS NO ACKNOWLEDGEMENT COPY OF THIS PURCHASE ORDER. ANY DISCREPANCIES IN PRICE, QUANTITIES, ITEMS OR DELIVERY,
MUST BE PHONED TO THE BUYER AT OUR PURCHASING DEPARTMENT WITHIN 48 HOURS OF YOUR RECEIPT OF THIS PURCHASE ORDER.
2. ALL ARTWORK, SPECIFICATIONS, TOOLS, EQUIPMENT AND OTHER ITEMS FURNISHED TO VENDOR, OR PAID FOR BY BUYER SHALL REMAIN
BUYER'S PROPERTY, BE SAFELY KEPT BY VENDOR IN GOOD AND USABLE ORDER AND BE PROMPTLY RETURNED TO BUYER UPON REQUEST.
3. VENDOR IS PERFORMING AS AN INDEPENDENT CONTRACTOR AND, THUS, SHALL HOLD THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES
HARMLESS FROM LIABILITY OF ANY NATURE OR KIND, ON ACCOUNT OF ANY INVENTION, ARTICLE, OR PROCESS USED AND FOR WORK
OR LABOR PERFORMED UNDER THIS CONTRACT.
4. FREIGHT: CHARGES FROM ROUTING OTHER THAN THE ROUTING SPECIFIED WILL BE CHARGED TO YOUR ACCOUNT. A PACKING LIST
SHOWING OUR PURCHASE ORDER NUMBER MUST ACCOMPANY EACH CASE OR PARCEL.
5. REJECTIONS: IF ANY OF THE GOODS ARE FOUND AT ANY TIME TO BE DEFECTIVE IN MATERIAL OR WORKMANSHIP, OR OTHERWISE
NOT IN CONFORMITY WITH THE REQUIREMENTS OF THE ORDER, BUYER, IN ADDITION TO ANY OTHER RIGHTS WHICH IT MAY HAVE
UNDER WARRANTIES OR OTHERWISE, SHALL HAVE THE RIGHT TO REJECT AND RETURN SUCH GOODS AT VENDOR'S EXPENSE WITHIN
A REASONABLE LENGTH OF TIME. SUCH GOODS SHALL NOT BE REPLACED WITHOUT WRITTEN AUTHORIZATION FROM BUYER.
6. RESPONSIBILITY FOR SUPPLIES: VENDOR SHALL BEAR THE RISK OF LOSS OF OR DAMAGE TO THE ARTICLES COVERED BY THIS
ORDER UNTIL DELIVERY OF SAID SUPPLIES AT THE LOCATION DESIGNATED BY BUYER OR AT SUCH OTHER PLACE AS MAY BE
DESIGNATED HEREIN, REGARDLESS OF F.O.B. POINT OR THE POINT OF INSPECTION. VENDOR SHALL ALSO BEAR THE RISK OF
LOSS OR DAMAGE TO ITEMS COVERED BY ORDER AFTER BUYER GIVES VENDOR NOTICE OF REJECTION.
7. CHANGES: BUYER MAY BY WRITTEN AND/OR VERBAL ORDER AT ANY TIME PRIOR TO FINAL DELIVERY AND WITHOUT NOTICE
TO SURETIES, MAKE CHANGES WITHIN THE GENERAL SCOPE OF THIS ORDER, IN ANY OF THE FOLLOWING: APPLICABLE
DRAWINGS, DESIGNS, OR SPECIFICATIONS, METHOD OF SHIPMENT OR PACKING AND PLACE OR TIME OF DELIVERY. TO THE
EXTENT SUCH CHANGE CAUSES AN INCREASE OR DECREASE IN THE COST OR TIME REQUIRED FOR PERFORMANCE OF THIS ORDER,
AN APPROPRIATE EQUITABLE ADJUSTMENT IN THIS ORDER SHALL BE MADE, AND CLAIM BY VENDOR FOR ADJUSTMENT MUST BE
ASSERTED WITHIN FIFTEEN (15) DAYS OF RECEIPT OF THE CHANGE. FAILURE TO AGREE TO AN ADJUSTMENT SHALL NOT
EXCUSE THE VENDOR FROM PROCEEDING WITH THIS ORDER As CHANGED.
8. BUYER SHALL HAVE THE RIGHT TO CANCEL AT ANY TIME FOR VENDOR'S BREACH OF ANY PROVISIONS OF THIS ORDER,
INCLUDING FAILURE TO MEET THEIR STATED DELIVERY SCHEDULE. ALL OR ANY PORTION OF THIS ORDER MAY BE CANCELLED
BY BUYER IF VENDOR, IN BUYER'S JUDGMENT, IS FAILING TO MAKE SUFFICIENT PROGRESS SO AS TO ENDANGER PERFORMANCE
OF THIS ORDER IN ACCORDANCE WITH ITS TERMS.
9. IF VENDOR BREACHES THIS AGREEMENT AND FAILS TO DELIVER THE GOODS AND MATERIALS PROVIDED FOR HEREIN WITHIN
THE TIME ABOVE SET FORTH, OR BY FAILING TO MAKE SUFFICIENT PROGRESS SO AS TO ENDANGER PERFORMANCE OF THIS
ORDER, THEN BUYER MAY TERMINATE THIS CONTRACT AND PURCHASE THE GOODS AND MATERIALS FROM WHATEVER SOURCE AND
VENDOR SHALL BE LIABLE TO BUYER FOR THE DIFFERENCE IN PRICE WHICH BUYER IS OBLIGATED TO PAY, PLUS ALL OF ITS
COSTS AND EXPENSES IN ENFORCING ITS RIGHTS HEREUNDER, INCLUDING REASONABLE ATTORNEY'S FEES. FURTHER, BUYER
MAY OFFSET ANY SUCH COSTS OR EXPENSES AGAINST ANY OF THE MONIDES WHICH MAY BE OWING TO THE VENDOR.
10. VENDOR AGREES TO COMPLY WITH APPLICABLE FEDERAL AND CALIFORNIA LAWS, INCLUDING, BUT NOT LIMITED TO, THE
CALIFORNIA FAIR EMPLOYMENT AND HOUSING ACT BEGINNING WITH GOVERNMENT CODE SECTION 12900 ET SEQ AND WITH
LABOR CODE SECTION 1735. IN ADDITION, THE CONTRACTOR AGREES THE CONTRACTOR AGREES TO REQUIRE LIKE
COMPLIANCE BY ALL SUB CONTRACTORS EMPLOYED.
11. VENDOR SHALL GUARANTEE THAT ALL GOODS COVERED BY THIS ORDER MEET ALL REQUIREMENTS FOR THE BUYER IN
CONFORMANCE WITH ALL FEDERAL AND STATE LAWS INCLUDING THE FAIR LABOR STANDARDS ACT AND CALIFORNIA
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION.
12. THIS AGREEMENT IS GOVERNED AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF CALIFORNIA, INCLUDING
THE UNIFORM COMMERCIAL CODE AND THE PUBLIC CONTRACT CODE.
13. IN THE EVENT THIS PURCHASE ORDER RESULTS FROM A BID OR A QUOTATION, THE GENERAL PROVISIONS OF THAT BID OR
QUOTATION ARE INCORPORATED HEREIN AND FORM A PART OF THIS PURCHASE ORDER.
Administrative Order No. 77
Administrative Order No. 77
Date: December 2, 2014
To: All City Departments
From: Steven Sarkozy, City Manager
Subject: City of Carlsbad Patient Protection and Affordable Care Act Procedure
PURPOSE
The City of Carlsbad ("City") is considered a"large employer" for the purposes of the Shared
Responsibility Provisions (Section 4980H to Title 26 of the United States Code, the Internal
Revenue Code) of the Patient Protection and Affordable Care Act ("ACA"). The City is also
considered a"large employer" for the purpose of Section 6056 to Title 26 of the United States
Code and, therefore, is subject to the reporting requirements referenced therein.
Starting January 1, 2015, the Internal Revenue Service will assess a penalty on the City if (1) it
fails to offer "substantially all" of its full-time employees (and their dependent children up to
age 26) the opportunity to enroll in minimum essential coverage or offers coverage to
"substantially all" of its full-time employees (and their dependent children up to age 26) that is
either "unaffordable" or does not provide "minimum value" and (2) any full-time employee
receives a subsidy for coverage through the exchange ("Penalty").
Starting in 2016, the IRS will require the City to report the identity of, number of, and coverage
offered to, full-time employees, subject to certain potential alternative reporting, or face
penalties.
This Procedure establishes the "Look Back Measurement Method Safe Harbor" ("Look Back Safe
Harbor") under the ACA. The City establishes this Look Back Safe Harbor as to all employees for
the purposes of identifying "full-time" employees for IRS reporting requirements related to the
Employer Mandate.
This Procedure also establishes the Affordability Safe Harbors to determine affordability of
coverage offered, if any, to "full-time" employees for the Employer Mandate and reporting
requirements.
Nothing in this Procedure shall be construed as the City's determination of eligibility for health
coverage as to any employee. Qualification for health coverage shall continue to be governed
by the terms of any applicable collective bargaining agreement, memorandum of
understanding, regulation, or other applicable contract.
Page 1 of 10
Administrative Order No. 77
LOOK BACK MEASUREMENT METHOD SAFE HARBOR
The City adopts the Look Back Safe Harbor in order to determine the Hours of Service of all
employees. Hours of Service are measured during the specified measurement period, subject
to the rules set forth hereunder. If the employee averages 30 Hours of Service per week over
the course of the specified measurement period, the City will report to the IRS the employee's
status as full-time under the ACA for the months during the stability period associated with that
measurement period, subject to the following rules. If the City reports an employee to the IRS
as full-time for this purpose, the employee does not become full-time for any other purpose.
Hours of Service Calculation: "Hour(s) of Service" means each hour for which an
employee is paid, or entitled to payment, for the performance of duties for the City and
each hour for which an employee is paid or entitled to payment for a period of time
during which no duties are performed due to vacation, holiday, illness, incapacity
(including disability), layoff, jury duty, military duty or leave of absence.
For Hourlv Emplovees: The City will calculate actual Hours of Service from records of
hours worked and hours for which payment is made or due.
For Non-Hourlv emplovees: The City will apply one of the following three methods on a
reasonable and consistent basis:
a. calculate actual Hours of Service from records of hours worked and hours for which
payment is made or due;
b. calculate Hours of Service using a days-worked equivalency (8 hours per day for each
day employee is credited with an Hour of Service); or
c. calculate Hours of Service using a weeks-worked equivalency (40 hours per week for
each week employee is credited with an Hour of Service).
Bona fide Volunteer: The City is not required to determine Hours of Service for a bona
fide volunteer. A bona fide volunteer is an individual whose only compensation from
the City is in the form of (a) reimbursement (or reasonable allowance) for reasonable
expenses incurred in the performance of volunteer service; or (b) reasonable benefits
and nominal fees, customarily paid by similar entities in connection with the
performance of services by volunteers.
2. On�oin� Emplovees: An ongoing employee is an employee who has been employed for
at least one complete measurement period. The City establishes the Look-Back Safe
Harbor with regard to all ongoing employees as follows:
Page 2 of 10
Administrative Order No. 77
3.
Standard Measurement Period:
Administrative period:
Stabilitv period:
July 1 through June 30 (starting July 1, 2013 and
continuing each year thereafter)
July 1 through July 31 (starting July 1, 2014 and
continuing each year thereafter)
August 1 through July 31 (starting August 1, 2014
and continuing each year thereafter)
The City will use these periods only for reporting purposes and, if necessary,
determining potential penalties and these periods will not be used to determine
whether an employee qualifies for an offer of coverage. If an ongoing employee's
employment status changes (to full-time or not full-time or vice versa) before the end of
a stability period, the change in status will not affect the classification of that
employee's status for the remaining portion of the stability period.
New Emplovees and Emplovees Hired After Julv 1. 2013: For an employee hired after
July 1, 2013, and when the City hires a new employee, the City will determine which of
the following applies:
a. New Seasonal Emplovees: An employee who is hired into a position for which the
customary annual employment is six months or less is a seasonal employee,
provided that by the nature of the position an employee in this position typically
works for a period of six months or less, and that period begins each calendar year in
approximately the same part of the year, such as summer or winter. The City will
measure a new seasonal employee's Hours of Service using the initial measurement
period indicated in paragraph 5 below.
b. New Non-Seasonal Emplovees: On the start date of a new non-seasonal employee,
the City will determine (based on the facts and circumstances at the employee's
start date) whether the employee is reasonably expected to be a full-time employee.
The City will look at the following factors to determine whether an employee is
reasonably expected to be a full-time employee:
�
�
iv.
whether the employee is replacing a full-time employee;
extent to which Hours of Service of ongoing employees in the same or
comparable positions have varied above and below an average of 30 Hours
of Service per week during recent measurement periods;
whether the job was advertised or communicated to the employee as
requiring an average of 30 or more Hours of Service per week;
whether the job was documented (through a contract or job description) as
requiring an average of 30 or more Hours of Service per week.
Page 3 of 10
Administrative Order No. 77
No single factor is determinative.
c. New Full Time New Emplovee: If the City reasonably expects (pursuant to paragraph
3.b above) that the employee will average at least 30 Hours of Service per week,
then the employee will be a full-time employee. The City will measure a new full-
time employee's Hours of Service under monthly measurement periods pursuant to
paragraph 4 below until the employee becomes an ongoing employee.
d. New Part-Time Emplovee: If the City reasonably expects (pursuant to paragraph 3.b
above) that the employee will average less than 30 Hours of Service per week during
the initial measurement period, then the employee will be a part-time employee.
The City will measure a new part-time employee's Hours of Service using the initial
measurement period indicated in paragraph 5 below.
e. New Variable Hour Emplovee: If the City cannot determine (pursuant to paragraph
3.b above) whether the employee is reasonably expected to be employed on
average at least 30 Hours of Service per week during the initial measurement period
because the employee's hours are variable or uncertain, then the employee will be a
variable hour employee. The City may not take into account the likelihood that the
employee may terminate employment before the end of the initial measurement
period. The City will measure a new variable hour employee's Hours of Service using
the initial measurement period indicated in paragraph 5 below.
4. New Full Time Emplovees: New full-time employees are measured under a monthly
measurement period until they become ongoing employees. The City has two options
for calculation of Hours of Service under a monthly measurement period for any
reasonable category of employees:
a. The City may calculate actual Hours of Service for each calendar day of the month. If
the employee averages at least 130 Hours of Service, the employee will be
considered full-time for that month.
b. The City may calculate Hours of Service using weekly periods (e.g. Sunday through
Saturday) by: (1) including the week that includes the first day of the calendar
month and excluding the week during which the last day of the calendar month falls
(unless that week ends with the last day of the calendar month, in which case that
week is included); or (2) excluding the week that includes the first day of the
calendar month (unless �rst day of the calendar month is a Sunday, in which case
that week is included) and including the entire week during which the last day of the
calendar month falls.
i. If the month has 4 weekly periods, an employee with at least 120 Hours of
Service will be considered full-time for that month.
Page 4 of 10
Administrative Order No. 77
If the month has 5 weekly periods, an employee with at least 150 Hours of
Service will be considered full-time for that month.
5.
New Variable Hour. New Seasonal, and New Part-Time Emplovees: The City establishes
the following periods for new variable hour, new seasonal, and new part-time
employees:
Initial Measurement Period:
Administrative period:
Stabilitv period:
Twelve months (beginning on the first of the
month following the new employee's start date
unless the employee starts on the first day of the
month, in which case it begins on the start date).
One month following the initial measurement
period.
Twelve months following the administrative period
unless the new variable hour, part-time or seasonal
employee does not measure as a full-time
employee during the initial measurement period,
then the stability period associated with the initial
measurement period must not exceed the
remainder of the standard measurement period
(plus any associated administrative period)
G. New Variable Hour, Seasonal, or Part-Time Emplovee's Chan�e in Status Durin� Initial
Measurement Period: If a new variable hour, seasonal or part-time employee's position
changes during the Initial Measurement Period, and had the employee started his or her
employment in that new position, the City would have reasonably expected that new
employee to average at least 30 Hours of Service per week, then for purposes of
identifying a full-time employee for reporting purposes only, an employee will be
considered a full-time employee on the earlier of (1) the first day of the fourth full
calendar month following the change in employment status, or (2) the first day of the
first month following the end of that employee's initial measurement period (including
any associated administrative period) if the employee averaged 30 or more Hours of
Service per week during the initial measurement period, or earlier if required by law, an
applicable memorandum of understanding, regulation, contract or procedure.
7. Transitionin� from New to On�oin� Emplovee: The City will measure the Hours of
Service of a new variable hour, seasonal or part-time employee during the first
complete measurement period for which he or she is employed. This means that a new
variable hour, seasonal or part-time employee's Hours of Service will be measured both
under an initial measurement period and, at the same time, will be measured under the
overlapping standard measurement period.
Page 5 of 10
Administrative Order No. 77
a. If an employee's Hours of Service measure as full-time during the initial
measurement period, he/she will retain full-time status for the entire associated
stability period (even if the employee does not qualify as full-time during the
standard measurement period).
b. If an employee's Hours of Service do not measure as full-time during the initial
measurement period, but do measure as full-time during the standard measurement
period, the employee must be treated as full-time during the stability period
associated with the standard measurement period (even if that stability period
starts before the end of the stability period associated with the initial measurement
period).
8. Calculatin� Hours of Service Based On Pavroll Periods Under the Look Back Safe Harbor:
The City may calculate Hours of Service based on payroll periods when calculating Hours
of Service over any measurement period. It has two options for doing so. The City may
exclude the entire payroll period that contains July 1(the first day of the standard
measurement period), as long as it includes the entire payroll period that contains June
30 (the last day of the standard measurement period). Alternatively, the City may
exclude the entire payroll period that contains June 30 (the last day of the standard
measurement period), as long as it includes the entire payroll period that contains July 1
(the first day of the standard measurement period).
9. Breaks In Service: When an employee experiences a break in service without providing
at least one Hour of Service, the employee will retain the status the employee had
previously with respect to any stability period, except that an employee will be treated
as a new employee:
a. if the employee resumes employment after a period of at least 13 consecutive
weeks with less than an Hour of Service; or
b. if the employee's period of no service (measured in weeks) is at least four
consecutive weeks long and exceeds the number of weeks of that employee's period
of employment immediately preceding the period of no service (after application of
averaging Special Unpaid Leave as set forth in paragraph 10).
10. Special Unpaid Leave: Special Unpaid Leave is defined only as unpaid leave under the
Family and Medical Leave Act of 1993, unpaid leave under the Uniformed Services
Employment and Reemployment Rights Act of 1994, or unpaid leave on account of jury
duty. When an employee takes Special Unpaid Leave, the City will determine the
weekly average of Hours of Service by the employee for that portion of the
measurement period that is not part of the Special Unpaid Leave ("Average Weekly
Hours of Service"). The City will then determine the average Hours of Service for the
entire measurement period using one of the following two methods:
Page 6 of 10
Administrative Order No. 77
a. exclude the period of Special Unpaid Leave and apply the Average Weekly Hours of
Service over the entire measurement period; or
b. credit the Average Weekly Hours of Service to the period of Special Unpaid Leave.
AFFORDABILITY SAFE HARBORS
The City intends to apply the Rate of Pay Safe Harbor to determine the affordability of the
minimum essential coverage that it offers its full-time employees. The City in its sole discretion
may also apply the Form W-2 Safe Harbor or Federal Poverty Line Safe Harbor. These
affordability safe harbors will be applied on a uniform and consistent basis for all employees in
a reasonable category.
1. Rate of Pav Safe Harbor
a. The City measures whether the employee's required premium contribution for the
calendar month for the lowest cost self-only coverage that provides minimum value
exceeds 9.5 percent of the monthly wage.
b. For hourly employees, the monthly wage is equal to 130 hours multiplied by the
lower of the employee's hourly rate of pay as of the first day of the coverage period
or the employee's lowest hourly rate of pay during the calendar month.
c. For salaried employees, the monthly wage is the monthly salary as of the first day of
the coverage period. However, if the monthly salary is reduced, including due to a
reduction in work hours, the safe harbor is not available.
d. The coverage offered by the City will be deemed affordable if the employee's
monthly premium contribution is equal to or less than 9.5 percent of the monthly
wage.
2. Form W-2 Safe Harbor
a. The City measures whether the employee's required premium contribution for the
full calendar year for the lowest cost self-only coverage that provides minimum
value exceeds 9.5 percent of the Form W-2 wages (as reported in Box 1) for the
employee for the calendar year in which coverage is offered.
b. For an employee who is not offered coverage for an entire calendar year, the City
must adjust that employee's Form W-2 wages to reflect the period for which
coverage was offered. To adjust wages, the Form W-2 wages are multiplied by a
fraction equal to the number of calendar months the City offered coverage over the
number of calendar months in the period of employment during the calendar year.
Page 7 of 10
Administrative Order No. 77
c. The coverage offered by the City will be deemed affordable if the employee's annual
premium contribution is equal to or less than 9.5% of the employee's Form W-2
wages as reported in Box 1(or as adjusted for an employee who is not offered
coverage or an entire calendar year).
3. Federa) Povertv Line Safe Harbor
a. The City measures whether the employee's required premium contribution for the
calendar month for the lowest cost self-only coverage that provides minimum value
exceeds 9.5 percent of an amount determined by dividing the Federal Poverty Line
("FPL") for a single individual for the applicable calendar year by twelve.
b. The City will use the FPL in effect within six months before the first day of the plan
year.
The coverage offered by the City will be deemed affordable if the employee's
monthly premium contribution is equal to or less than 9.5 percent of the monthly
FPL for a single individual for the applicable calendar year.
ANTI-RETALIATION PROVISION
It is the City's policy to comply in full with Section 1558 of the Affordable Care Act (ACA), which
prohibits retaliation against employees who report violations of Title I of ACA or who receive
tax credits or cost-sharing reductions (under section 366 of the Internal Revenue Code or
section 1402 of ACA) in connection with participation in the health insurance exchange.
1. Protected Activitv
a. "Whistleblowing" regarding Violations of Title I of ACA: ACA protects an employee,
former employee, or applicant who reports, testifies (or is about to testify) in a
proceeding, assists or participates (or is about to assist or participate) in a
proceeding, objects to, or refuses to participate in any activity, policy, practice, or
assigned task that the employee (or other person) reasonably believed to be in
violation of Title I of ACA, including any order, rule, regulation, standard or ban
under Title I of ACA.
b. Title I of ACA includes but is not limited to consumer protections such as the
following:
i. Elimination of lifetime and annual limits on benefits by 2014;
ii. Prohibition on rescissions of coverage;
iii. Elimination of pre-existing condition exclusions;
iv. Coverage of preventive services and immunizations;
v. Extension of dependent coverage up to age 26;
vi. Development of uniform coverage documents; and
vii. Implementation of appeals processes for consumers.
Page 8 of 10
Administrative Order No. 77
c. Receipt of Affordability Assistance: ACA also protects an employee, former
employee, or applicant who receives a tax credit under Section 36B of the Internal
Revenue Code or a cost-sharing reduction under Section 1402 of the Act as a result
of enrolling in a qualified health plan offered by the health insurance exchange. In
California, this state-run marketplace is known as Covered California.
2. Prohibited Retaliatory Conduct
Prohibited conduct includes but is not limited to discharge or otherwise retaliatory
conduct, including intimidating, restraining, coercing, blacklisting, or disciplining an
employee, former employee, or applicant with respect to compensation or any other
terms, conditions or privileges of employment as a result of that individual's participation
in a protected activity as defined in paragraph 2 above.
3. Complaint Procedure
a. Any City employee, former employee, or applicant who wishes to report a violation of
Title I of ACA, or who believes he or she has been subject to retaliation in violation of
this policy should immediately notify either his or her supervisor, or the City Manager.
It is the City's policy that no City employee shall retaliate against any person who
participates in a protected activity as defined by Section 1558 of ACA.
b. An employee, former employee, or applicant who believes that he or she has been
retaliated against under this policy may file or have filed by any person on his or her
behalf, a complaint with United States Department of Labor, Occupational Safety &
Health Administration (OSHA) within 180 days after an alleged violation occurs. For
more information on filing an OSHA complaint, visit www.osha.gov.
REVISIONS/UPDATES TO ACA PROCEDURE
Human Resources is responsible for providing supervisors with automated reports summarizing
part-time hours worked.
This Procedure is subject to change as regulations and guidance are issued relating to the ACA.
The City Manager, including his or her designee(s), may amend this Procedure at his or her
discretion.
LEGAL AUTHORITY
Title 26 United States Code section 4980H, (Internal Revenue Code); Shared Responsibility for
Employers Regarding Health Coverage, 26 CFR Parts 1, 54 and 301, 79 Fed. Reg. 8544 (Feb. 12,
2014); Title 26 United States Code section 6056, (Internal Revenue Code); Information
Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under Employer
Sponsored Plans, 26 CFR Parts 301 and 602, 79 Fed. Reg. 13231 (March 10, 2014).
Page 9 of 10