Employee Benefits 7120 Bodega Avenue Sebastopol, CA 95472 707-823-8469 Phone 707-823-3018 Fax Karen Cano, CPPAssistant Administrative Services Director Email staff. Payroll Forms W4 2010 DE4 2009 I9 Expires 08/31/2012 Living Wage Ordinance COBRA General Notice HIPAA Privacy Notice Employee Safety and Health Standards ICMA 457 Deferred Compensation Enrollment Form 457 Deferred Compensation Quick Enrollment Form 457 Deferred Compensation Deferral Change Form 457 Deferred Compensation Information Change Form 457 Deferred Compensation Catch Up Packet RHS Retirement Health Savings Plan INSURANCES AFLAC Salary Redirection Agreement AFLAC Claim Form Anthem Blue Cross 2009/10 Benefit Summary Anthem Blue Cross 2009/10 Prescription Summary Anthem Blue Cross Evidence of Coverage Booklet July 1, 2009 Anthem Blue Cross Overage Dependent Verification Kaiser 2009/10 Plan Summary Kaiser Student Verification Child Care Election Child Care Reimbursement Dental Insurance Explanation of Benefits 2009/10 EAP Employee Assistance Program Lincoln Financial Life Insurance Policy Lincoln Long Term Disaibility Insurance Policy Police PORAC Long Term Disability Insurance Application & Plan Summary Police PORAC Long Term Disability Insurance Policy Workers Compensation Claim Form Workers Compensaiton Injury Treatment Facilities WC Predesignated Treating Physician Administrative Policies / Resolutions Administrative Policy No. 5 Part-time Employees Administrative Policy No. 20 FMLA Accruals Administrative Policy No. 21 Voluntary Time Off Administrative Policy No. 22 Vehicle Authorization Administrative Policy No. 25 Accrual Usage Resolution No. 5710 Insurance Coverages Resolution No. 5734 Insurance Coverages Links Anthem Blue Cross Insurance Kaiser Insurance ICMA Internal Revenue Service CalPERS Retirement Social Security Administration
