HomeMy WebLinkAbout20100907 - VIII-C-4
City Council Memorandum
To: Mayor Hicks & City Councilmembers
From: David M. Osberg
Date: September 2, 2010
Item: 2011 Voluntary Programs
Council Action Requested:
It is recommended that the City Council take action approving the following Voluntary programs
for a limited time, to assist with the 2011 Budget situation:
a.) Voluntary Retirement
b.) Voluntary Separation
c.) Voluntary Reduction in Hours
d.) Voluntary Furlough
Background Information:
The City Council and City employees have been advised on serveral occassions the difficult
situation associated with the 2011 Budget. With declining market values, elimination of State
Aid's from the 2011 Budget, and shrinking revenues, preparation of the 2011 Budget is proving to
be one of the more difficult in recent years. As a result, Staff has prepared four different
voluntary programs for the City Council to consider, to assist with a reduction in labor costs in
the 2011 Budget.
a.) Voluntary Retirement: A full time employee with five years of service, who is eligible for a
full or reducted pension through PERA immediately upon retirement would be eligble. As an
incentive, the City would make a one time payment of $10,000 to be paid directly or contributed
to a post employment health savings account.
b.) Voluntary Separation: A regular status, full or part time employee with five or more years of
service, who voluntarily leaves their employment with the City would be eligible for a one time
payment of $10,000. The payment would either be made directly to the employee, or to a post
employment health savings account.
c.) Voluntary Reduction in Hours: A regular status, full time employee who agrees to a voluntary
reduction in hours from 40 hours per week to 32 hours per week will be granted a one time
payment of $2,000 made directly to the employee.
d.) Voluntary Furlough: All regular status, part time and full time employees will be offered the
opportunity to participate in the voluntary furlough program.
The City Council will be asked to approve those who will be granted the voluntary retirement
retirement and voluntary separation, while Staff will approve the voluntary reduction in hours.
Please keep in mind, that any positions granted the voluntary separation or volutnary retirement,
will be based on the understanding that the vacancy created, will not be filled. Thus, not all who
sign up for either of those programs are assured of having their application approved, and the
benefit granted. The voluntary reduction in hours is based on the expectation that it will remain a
permanent reduction in hours, and not restored to a full time statusat the conclusion of 2011, nor
in the immediate future. The final decision on each of these programs will be based on the
number of requests received, an employee's critical skills or the business needs of the City.
Financial Impact:
The financial impact on the 2011 Budget is not yet known at this time. As noted above, the
expectation is such, that those who are granted early retirement or early separation, those
positions would not be filled, thus the City achieving the financial benefit with those personnel
costs (after payment of the incentive benefit). The voluntary furlough savings in 2009 was
approximately $80,000. By the end of 2010 it is expected a similar savings will be achieved. The
proposed 2011 Budget currently includes a savings of $80,000 with the voluntary furlough
program.
Advisory Commission Discussion:
N/A
Council Committee Discussion:
Members of the Finance Committee (Councilmembers Schultz, Alongi and Slavik) offered their
support of these programs at a meeting conducted on August 4,2010. The full City Council
supported these concepts at a Special Meeting conducted on Monday August 9, 2010, and
directed Staff to prepare the programs for City Council consideration and approval at the meeting
on September 7, 2010.
Attachments:
Information regarding each of the four programs and the necessary documentation and
forms that will be distributed to the employees.
City of Hastings
2010 Voluntary Programs
The City of Hastings (“City”) continues to experience a variety of factors that impact the
financial health of the City, and to assist in addressing the situation a number of approaches are
being considered for implementation. These include: increasing revenues, cutting
programs/expenses, labor reductions, and tax increases. Currently, there exists a significant gap
between projected revenues and projected expenses for the 2011 budget.
One approach being implemented by the City is to offer a number of voluntary programs to
eligible employees for a limited time only. This includes options for voluntary Retirement,
voluntary Early Separation (non-retirement eligible), voluntary Reduction in Hours, as well as
continuation of the voluntary Furlough program.
Employee eligibility for existing separation benefits (vacation, compensatory time, sick leave [if
eligible], and insurance continuation) will continue in effect. The incentives offered in the plans
described below are in addition to any existing separation benefits available.
If you are viewing this document electronically, you can go the appropriate program by putting
your curser over the section below and pressing the CRTL key while left clicking on your mouse.
Programs
I.
Voluntary Retirement..........................................................................................................3
II.
Voluntary Separation..........................................................................................................4
III.
Voluntary Reduction in Hours.............................................................................................5
IV.
Voluntary Furlough.............................................................................................................6
Participation Applications
A.
Voluntary Retirement/Separation Incentive Program Participation Application...................7
B.
Voluntary Reduction in Hours Incentive Program Participation Application........................9
C
. 2011 Voluntary Furlough Participation Application..........................................................11
D.
2010 Voluntary Retirement/Separation Program Participation Agreement and General
Release Form...................................................................................................................13
In order to accept this offer and participate in any of these programs, an eligible employee must
submit a properly completed participation application (attached), to Dave Osberg no later than
October 22, 2010. If your participation application for voluntary retirement or separation is
approved, you must complete the Participation Agreement and Release Form and will have 14
days to rescind your offer. If you have any questions about your specific situation as it relates to
participation in this program, please do not hesitate to contact Dave Osberg at 651-480-2326 or
dosberg@ci.hastings.mn.us.
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I. Voluntary Retirement
a. Eligibility Retirements
(
A full-time employee with five5) years or more of continuous employment with
the City of Hastings;
The employee must be eligible for a reduced or full pension through PERA
immediately upon retirement.
The program Participation Application must be completed and submitted to Dave
Osberg by October 22, 2010. The Participation Application must be approved by
the City Administrator. If the City Administrator does not approve the
application, the employee is not considered eligible to participate in the program
and is not entitled to any benefits of that program. The last working day must be
no later than December 31, 2010.
b. Consideration for Participation in Program
Each employee who accepts the City’s offer to participate in this program, and whose
application for participation is approved by the City Administrator, will receive a one-
$
time payment of 10,000 within thirty (30) calendar days of their last working day. The
employee may elect to have this payment made directly to the employee, subject to all
applicable taxes, or may elect to have this payment contributed to a post-employment
health savings account for medical expenses on a tax-preferred basis.
c. Other Considerations
c. 1. Participation in the program is strictly voluntary.
c. 2. To accept this offer, you must sign the Participation Agreement and Release,
which waives your right to pursue any existing legal claim(s) against the City of
Hastings and its employees, officers, or Board members, as described therein.
The Participation Agreement and Release will be provided to you after you are
approved to participate in the program.
c. 3. The City reserves the right to exclude any employee from the early retirement
incentive program based on the number of requests received, an employee’s
critical skills, or business need.
c. 4. Employees that participate in the early retirement incentive program may not be
subsequently rehired by the City as a benefit-earning employee.
c. 5. All payments made are subject to customary payroll deductions, including all
applicable taxes.
c. 6. Once the Participation Application is submitted and approved by the City
Administrator, participation and retirement is non-revocable following the 14 day
rescission period.
c. 7. This program is available for positions which would not be filled upon
retirement.
II. Voluntary Separation
a. Eligibility Requirements
a. 1. A regular status, full or part-time employee with five(5) years or more of
continuous employment with the City of Hastings.
a. 2. The program application, including the attached release agreement, must be
completed and submitted to Dave Osberg by October 22, 2010. The Participation
Application must be approved by the City Administrator. If the City
Administrator does not approve the application, the employee is not considered
eligible to participate in the program and is not entitled to any benefits of that
program. The last working day must be no later than December 31, 2010.
b. Consideration for Participation in Program
Each employee who accepts the City’s offer to participate in this program, and whose
application for participation is approved by the City Administrator, will receive a one-
$
time payment of 10,000 within thirty (30) calendar days of their last working day. The
employee may elect to have this payment made directly to the employee, subject to all
applicable taxes, or may elect to have this payment contributed to a post-employment
health savings account for medical expenses on a tax-preferred basis.
c. Other Considerations
c. 1. Participation in the program is strictly voluntary.
c. 2. To accept this offer, you must sign the Participation Agreement and Release,
which waives your right to pursue any existing legal claim(s) against the City of
Hastings and its employees, officers, or Board members, as described therein.
The Participation Agreement and Release will be provided to you after you are
approved to participate in the program.
c. 3. The City reserves the right to exclude any employee from the voluntary
separation incentive program based on the number of requests received, an
employee’s critical skills, or business need.
c. 4. Employees that participate in the voluntary separation incentive program may not
be subsequently rehired by the City as a benefit-earning employee.
c. 5. All payments made are subject to customary payroll deductions, including all
applicable taxes.
c. 6. Once the Participation Application is submitted and approved by the City
Administrator, participation and retirement is non-revocable following the 14 day
rescission period.
c. 7. This program is available for positions which would not be filled upon
separation.
III. Voluntary Reduction in Hours
a. Eligibility Requirements
a. 1. All regular status, full-time employee with the City of Hastings.
a. 2. The program Participation Application must be completed and submitted
to Dave Osberg by October 22, 2010. If approved by the City
Administrator, the implementation date of the reduced work schedule
will be effective the beginning of the next payroll period following
approval.
b. Consideration for Participation in Program
Each employee who accepts the City’s offer to participate in this program, and
whose application for participation is approved by the City Administrator, will
receive a one-time payment of $2,000. This payment will be paid directly to the
employee and is subject to all applicable taxes.
c. Other Considerations
c. 1. Participation in the program is strictly voluntary.
c. 2. To accept this offer, you must sign the Participation Application.
c. 3. Reduction in hours will be from 40 hours a week, full-time status to 32
hours a week, part-time status.
c. 4. The City reserves the right to exclude any employee from the voluntary
reduction in hours program based on the number of requests received, an
employee’s critical skills, or business need.
c. 5. Reduction in hours will impact qualification for insurance options
available to full-time employees of the City of Hastings. This includes,
but is not necessarily limited to: health insurance, certain life insurance,
and long-term disability insurance.
c. 6. All payments made are subject to customary payroll deductions,
including all applicable taxes.
c. 7. Once an employee is approved for participation in this program, the
employee’s new part time schedule becomes permanent. Future changes
in the employee’s scheduled hours will only be made through the City’s
normal budgeting and staffing review processes. By accepting this offer,
an employee voluntarily and permanently forfeits any real or perceived
entitlement, right, or expectation to a full-time position with the City.
IV. Voluntary Furlough
a. Eligibility Requirements
a. 1. All regular status, part and full-time employees with the City of Hastings.
a. 2. Please complete the Participation Application and submit to Melanie Mesko Lee
by October 22, 2010. The City will continue to accept voluntary furlough
commitments throughout 2011 if an employee determines that he/she are able to
furlough some time in 2011.
b. Other Considerations
b. 1. Employees may take the furlough time at any time throughout 2011 to achieve
cost savings.
b. 2. Supervisors have been instructed to approve unpaid furlough time off at any time
the employee wishes to take it unless it will create a severe staffing hardship or
cause the City to incur additional overtime costs that would keep the City from
saving money on the unpaid leave.
b. 3. Furlough hours will not count as hours worked, for purposes of computing
overtime.
b. 4. Time cards will be notated with a FURLOUGH (UNPD) row.
b. 5. Benefit eligibility and City contribution to insurance will remain the same.
b. 6. All vacation and sick accrual will continue to accrue at the employees current
levels, even in pay periods where unpaid furlough leave is taken. Employees will
still be expected to manage their leave balances through out the year. Maximum
accumulation caps will remain in effect.
b. 7. If an employee takes 40 hours off in a single pay period, they may choose to
spread out their health insurance deduction over additional paychecks, by
reducing the health insurance deduction by ½ for that pay period when furlough
time was taken. The next two paychecks will be “catch up” deductions for the
other ½ of the employee share. Health insurance is the only deduction that is
eligible for this and employees must request that it be done by emailing Becky in
Finance. This is not automatic.
b. 8. Changes to ICMA deductions can be made, please forward the form to Connie in
Finance before the start of the pay period you wish to change. Each change
needs to be initiated by the employee.
b. 9. For employees in their “High Five Years”, PERA will allow you to buy back
service credit. Employees will be contacted to see if they are interested in this
program. Interested parties will then be billed by PERA for the employee
contribution and once paid the City will make the appropriate employer
contribution.
CITY OF HASTINGS
A.
Voluntary Retirement/Separation Incentive Program Participation Application
Employees interested in participating in this program must complete this Participation
Applications & submit to City Administrator Dave Osberg by October 22, 2010
Name: Position Title:
Date of application:
I voluntarily accept the City’s offer to participate in the City of Hastings’ voluntary
retirement/separation incentive program, effective upon the City Administrator’s confirmation
that I am eligible to participate in that program and my completion and submission of the
Participation Agreement and Release Form which the City will provide me if I am determined
eligible to participate in the voluntary retirement/separation program. I understand that, once my
acceptance of this offer becomes final, the City of Hastings (“City”) will:
1. Within thirty (30) days of the effective date of my retirement or resignation, make a one-
time $10,000 payment, subject to all applicable taxes, to be paid (employee must select
one option):
directly to me; or
into a post-employment health savings account which offers tax benefits
2. Within thirty (30) days of the effective date of my retirement or resignation, pay out
vacation (if eligible, a maximum of 300 hours or other maximum amount contained in a
collective bargaining agreement which covers my position) and compensatory time
accruals at my current rate of pay. This payment will be paid directly to me, and is
subject to all applicable taxes.
3. Within thirty (30) days of the effective date of my retirement or resignation, pay out all
sick leave (maximum of 50% of 960 hours or other maximum amount contained in a
collective bargaining agreement which covers my position) at my current rate of pay.
This payment will be paid directly to me, and is subject to all applicable taxes;
4. Benefits Continuation
If the City hired me before 1993, I will remain eligible for continued coverage under
the City’s current medical insurance program, for a period not to exceed 10 years or
until I become eligible to receive Medicare, whichever occurs first.
In accordance with Minnesota Statutes, Section 471.61, the City will offer me
benefits continuation at the point of my separation from the City’s employment or
eligibility for continuation. I understand and agree that it will be my responsibility to
pay the full cost associated with the continuation of benefits in a timely manner.
-continued-
Voluntary Retirement/Separation Incentive Program Participation Application
In return and as consideration for the above-described benefits, to which I am not otherwise
entitled, I understand and agree that I will: (1) resign or retire effective on the date listed below;
and (2) sign and agree to be bound by the Participation Agreement and General Release Form
waiving my rights to pursue any legal claim against the City of Hastings, its employees, City
Councilmembers, officers and other representatives, as described in that Release. The
Participation Agreement and General Release Form will be provided to me after this application
form has been submitted and the City Administrator has approved my eligibility to participate in
the voluntary retirement/separation program.
I agree that if my application for an early retirement/separation incentive is approved by the City
Administrator, I will resign or retire from my employment with the City of Hastings on:
. (All employees’ that agree to participate in the early retirement/separation program
must voluntary resign from their positions no later than December 31, 2010).
I have read and understand all the information in the voluntary retirement/separation
program which the City has provided me. I further understand that the City Administrator
retains the sole discretion to determine whether I am eligible to accept the City’s offer to
participate in the voluntary retirement/separation program based on the number of
applications received, the potential cost savings or lack thereof, an individual employee’s
critical skills, or the business needs of the City.
Employee Signature Date
Received:
David M. Osberg Date
Status of Participation Application by City Administrator:
Approved Denied
*program approved by the City Council on September 7, 2010
CITY OF HASTINGS
B.
Voluntary Reduction in Hours Incentive Program Participation Application
Employees interested in participating in this program must complete this Participation
Applications & submit to City Administrator Dave Osberg by October 22, 2010
Name: Position Title:
Date of application:
I voluntarily accept the offer to participate in the City of Hastings’ voluntary reduction in
work hours incentive program, effective upon the City Administrator’s determination that I am
eligible to participate in said program. I understand that, if I am found eligible to participate in
the program, the City of Hastings (“City”) will make a one-time $2,000 payment directly to me,
within thirty (30) calendar days of the effective date of this agreement. This payment will be
subject to all applicable taxes.
In return, and as consideration for the payment described above, I understand and agree
that I am voluntarily giving up any right, whether created by a collective bargaining agreement,
personal employment contract, or otherwise, and/or expectation to a full-time position of
employment with the City, and will hereafter be considered a part-time employee of the City, as
described below. My new employment status will become effective on a date determined by the
City, but no later than on or before December 31, 2010.
I understand and agree that if the City Administrator determines that I am eligible to
participate in the voluntary reduction in work hours incentive program, I will be assigned to 32
hours in a one week period and my status will change to part-time, rather than my previously
scheduled full-time 40 hours per week assignment. I further understand that this reduction will
impact my ability to qualify for the insurance options available to full-time employees of the City
of Hastings. This includes, but is not necessarily limited to: health insurance, certain life
insurance, and long-term disability insurance. I also understand that, once my change to part-
time status becomes effective, it is permanent. The City retains sole discretion to make changes
to my scheduled employment status at a future date, including but not limited to further reduction
in hours, or increase to full-time scheduled hours.
I understand that once my application is accepted by the City of Hastings, that I have
fifteen (15) calendar days from the day I sign this agreement in which to change my mind and
rescind it. In order for this rescission to be effective, it must be in writing and delivered to Dave
Osberg, City Administrator within fifteen (15) days from the date I sign this agreement. I
understand that my delivery of a written rescission can be either by hand by 4:00 p.m. on the last
day or by certified mail return receipt requested, postmarked by the last day.
-continued-
Voluntary Reduction in Hours Incentive Program Participation Application
I further understand that the City Administrator retains the sole discretion to approve or deny any
applications based on the number of applications received, the potential cost savings or lack
thereof, an employee’s critical skills, or the business needs of the City.
Employee Signature Date
Received:
David M. Osberg Date
Status of Participation Application by City Administrator:
Approved Denied
Effective Date:
*program approved by the City Council on September 7, 2010
City of Hastings
C. 2011 Voluntary Furlough Participation Application
In both 2009 and 2010, the City requested voluntary furloughs from all regular Full-time and
Part-time employees as one measure to help resolve General Fund shortfalls during difficult
economic times. The City has been very pleased with the generous response from employees
who have voluntarily furloughed hours during these challenging budget times. In preparation for
the 2011 budget, voluntary furloughs have again been included as one of a number of cost-saving
measures.
The 2011 voluntary furlough program is very similar to the 2009 & 2010 programs. Below is a
sign up form for those who choose to participate. If all employees take 20 hours of voluntary
furlough in 2011, the City projects there will be $80,000 achieved in savings. As such, we are
asking all employees to consider a voluntary furlough commitment of 20 hours in 2011. As work
continues on developing the 2011 budget, it would be helpful to have these forms submitted by
October 22, 2010. Certainly, the City will continue to accept voluntary furlough commitments
throughout 2011 if an employee determines that he/she are able to furlough some time in 2011.
Employee Name
Commit to furlough number of hours during the 2011 calendar year.
I understand that I am voluntarily committing to a furlough and
intend to comply by December, 31, 2011.
If for some reason, and unforeseeable qualifying event occurs, I will contact Administration.
Signature Date
by checking this box, I am agreeing to the information on the form and am submitting it
electronically
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CITY OF HASTINGS
D.
2010 Voluntary Retirement/Separation Program Participation Agreement and General
Release Form
I,
(Employee: print or type your Name) , the
undersigned Employee (“Employee”) of the City of Hastings (“City”), voluntarily accept the
City’s offer to participate the 2010 Retirement or Separation Incentive Program (“Incentive
Program”) and hereby execute this General Release of All Claims (“Release”) in consideration of
the City’s offer of participation in the Incentive Program.
A. Retirement or Resignation
By signing this Participation Agreement and Release, I will retire or resign from my position
of employment with the City on or before December 31, 2010 in exchange for the payments
and benefits provided under the Incentive Program. I understand that by participating in the
Incentive Plan and signing this Agreement, I may not return to, or be considered for future,
employment in any position of employment with the City that is entitled to non-salary
employee benefits. My retirement or resignation from my position of employment with the
City is effective on , 2010.
B. Benefits Paid under the Incentive Plan
In exchange for, and in consideration of, my participation in the Incentive Program and
voluntary retirement or resignation, the City has offered to provide me the following
benefits:
1.
A one time $10,000 payment, subject to all applicable taxes, be paid (employee
must select one option):
directly to me; or
into a post-employment health savings account, for my benefit, which
may offers tax benefits
2.
The City will pay out all vacation (maximum of 300 hours or other maximum
amount contained in a collective bargaining agreement which covers my
position) and compensatory time accruals at my current rate of pay. This
payment will be paid directly to me, and is subject to all applicable taxes;
3.
The City will pay out all sick leave (if eligible, maximum of 50% of 960 hours
or other maximum amount contained in an collective bargaining agreement
which covers my position) at the employee’s current rate of pay. This payment
will be my current rate of pay. This payment will be paid directly to me, and is
subject to all applicable taxes;
4.
Benefits Continuation
If the City hired me before 1993, I will remain eligible for continued
coverage under the City’s current medical insurance program for a period
not to exceed 10 years or until I become eligible to receive coverage under
Medicare, whichever occurs first.
In accordance with Minnesota Statutes, Section 471.61, the City will offer
me benefits continuation at the point of my separation from the City’s
employment or eligibility for continuation. I understand and agree that it
will be my responsibility to pay any costs associated with the continuation
of benefits costs in a timely manner.
All payments made pursuant to this Agreement will be made by the City within thirty (30)
days of the date on which my retirement or resignation becomes effective, or within thirty
(30) days of the date on which the Release contained herein becomes irrevocable, whichever
is later.
-continued-
2010 Voluntary Retirement/Separation Program Participation Agreement and General
Release Form
C. My Acknowledgement of the Consideration and Purpose of the Release
I acknowledge and admit that I would not be eligible for the aforementioned payments and
benefits under the Voluntary Retirement/Separation Incentive Program unless I sign (and do
not rescind) this Participation Agreement and Release.
I acknowledge and admit that I have received and reviewed information regarding the Early
Retirement Incentive Program that was authorized by the City Council. These materials
include descriptions of who is eligible for the Incentive Program and the time limitations
under the Incentive Program. The City has encouraged me to seek counsel from a financial
advisor and lawyer before signing this agreement.
I understand that the materials regarding the Incentive Program which the City provided me
constitute an offer to participate in that program, and that by signing this Participation
Agreement and Release, I am accepting that offer. In the event that the terms of the City’s
offer or my acceptance thereof described herein differ with any other description of said
offer or acceptance, this Participation Agreement and Release control.
I have at least 45 calendar days to consider whether to sign the Participation Agreement and
Release. I understand that I may knowingly and voluntarily agree to waive the 45 calendar
day consideration period by electing to sign the Release before the 45 calendar days have
passed. The City has encouraged me to take my time and carefully evaluate my
circumstances before deciding if signing this agreement is the right thing for me to do.
D. What I Am Releasing
In consideration for the payments and benefits under the Incentive Program, I fully release
and discharge the City of Hastings, its officers, directors, employees, agents, attorneys, or
other official representative from any and all claims, charges, complaints, administrative
proceedings, grievances brought pursuant to a collective bargaining agreement, and other
liabilities of any kind, known or unknown (each a “claim”). I understand that by releasing
the City of Hastings from each and every claim, I am releasing all of my rights to bring any
claim against the City of Hastings based on any action, decision or event occurring prior to
my signing this Agreement, including, without limitation, the terms and conditions of my
employment with the City of Hastings and the ending of my employment. Except as
permitted by law, I will not commence any proceeding relating to any claim, and if the law
permits me to commence such a proceeding, I agree that I may not seek or recover any
monetary damages or other relief as a result of any such proceeding.
My release includes, but is not limited to, any claim based upon the Age Discrimination In
Employment Act, 29 U.S.C. §§621, et seq.; federal, state or local employment
discrimination laws, regulations or requirements, including, but not limited to Title VII of
Civil Rights Act, 42 U.S.C. §§2000e, et seq.; the Americans with Disabilities Act 42 U.S.C.
§§12101, et seq.; Section 1983 of the Civil Rights Act, and the Minnesota Human Rights
Act, Minn. Stat. Ch. 363; the Minnesota Government Data Practices Act, Minn. Stat. Ch.
13; any other statute, provision of the United States Constitution, provision of the
Constitution of the State of Minnesota, ordinance, or regulation; any contract, quasi-
contract or promissory estoppel; any tort, including wrongful discharge, misrepresentation,
fraud, infliction of emotional distress, retaliation or defamation; or any other legal or
equitable theory of liability.
-continued-
2010 Voluntary Retirement/Separation Program Participation Agreement and General
Release Form
I also release and waive any rights and claims I may have under the Veterans Preference
Act, Minn. Stat. 197.46.
Employee initials
E. What I am Not Releasing
I am not releasing any claims for post-termination benefits, such as retirement benefits,
under the provisions of any employee benefit plan. I also am not waiving any rights I have
with regard to events that occur after the date that this Release becomes irrevocable. I am
also not waiving or releasing workers compensation benefits with the exception of claims
under Minnesota Statute 176.82.
F. If I Want to Rescind this Participation Agreement and Release
I understand that I have fifteen (15) calendar days from the day I sign this Participation
Agreement and Release in which to change my mind and rescind it. In order for this
rescission to be effective, it must be in writing and delivered to David M. Osberg, City
Administrator within fifteen (15) days from the date I sign this Agreement. I understand that
my delivery of a written rescission can be either by hand or by certified mail return receipt
requested, postmarked by the last day of the recession period at 4:30 pm.
I acknowledge that if I rescind this Agreement and/or Release, the City will not be obligated
to provide me with any benefit described in Paragraph B of this Agreement.
/ /2010
Employee Signature Date Signed
Witness*
* Witness signature does not need to be notarized
Received:
David M. Osberg Date
Status of Participation Agreement and Release Form
14 day rescission period FROM: TO:
Employee DID DID NOT withdraw agreement Date:
City Council Action: Approved Participation Denied Participation
Date:
-continued-
2010 Voluntary Retirement/Separation Program Participation Agreement and General
Release Form
Notes: