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Request for Proposal
Your company has been selected to provide a proposal for HUMAN
RESOURCES ADMINISTRATION services for the CITY OF RIDGECREST. All
proposals must be submitted according to the submission guidelines below.
Please NOTE:
This information has been submitted to your company for the
purposes of providing a proposal ONLY. This information is to be treated as
highly confidential and must not be used or shared with any other companies or
individuals. This information is not to be shared with any brokers, agents,
agencies, or any outside parties without the prior written consent of the CITY OF
RIDGECREST.
Please submit all communications to:
CITY OF RIDGECREST RACHEL J FORD
100 W CALIFORNIA AVE. RIDGECREST, CA 93555
760-499-5002
Proposal Submissions Guidelines Please submit 3 of each of the following:
Hard copies of HUMAN RESOURCES ADMINISTRATION proposal no
later than July 30, 2011.
o Proposal to include list of services and pricing including setup fees,
administrative fees as a percentage of gross wages, outline of all
employer taxes, workers compensation rates etc.
Benefits Proposal including:
o All available benefits including overview of coverage and rates
Completed RFP Questionnaire (attached)
Marketing packages including collateral about HUMAN RESOURCES
ADMINISTRATION
HUMAN RESOURCES ADMINISTRATION Company Overview including
o HUMAN RESOURCES ADMINISTRATION accomplishments and
pertinent Press Releases
o Key executive Bios
o Accreditations
o Independent (third party) accounting procedure review
Client references including company name, contact and phone number
Client List
Letter or recommendations (if available)
Company Profile Established 1963 Line of work LOCAL GOVERNMENT SIC Code 9199
Ownership PUBLIC AGENCY Number of employees 188 Annual Gross Wages $6,279,380 BASE SALARY RATE
Payroll Distribution 7720 SAFETY/ANIMAL CONTROL $2,131,820 8810 CLERICAL $1,719,637 9410 MUNICIPAL NON MANUAL $998,548 9420 MUNICIPAL (WWT/MNTC) $1,209,443 9422 STREETS $219,932
Other Items - Attached Scope of Work
3 Years loss runs Organizational Chart
Employee census Summary Section 125 Cafeteria plan description
Health – CalPERS major medical Dental – Self-Insured Vision – Self-Insured Supplemental Health - AFLAC 457 Deferred Compensation – ICMA-RC Term Life Insurance – UNUM & MetLife
This Page Intentionally Left Blank
RFP Questionnaire 1. When was your company founded?
2. How many Clients are currently using the company?
3. Please give a brief description of the types of clients you serve.
4. Please describe your current Workers’ Compensation offering including
carrier information, policy administration, and safety services.
5. How many employees is your company currently administering?
6. How many employees are part of the actual PEO group (in-house
administrative group)?
7. Please describe the 2010 performance of your Large Group Health Plan (if
offered).
8. Please describe your current Time and Attendance tracking offering.
9. Please submit a sample of the following:
a. New hire packet
b. Payroll job costing report
10. Does your company have any Spanish-speaking employees or materials
available for assistance with Spanish-speaking employees?
11. What is your company’s Involvement in NAPEO?
12. Is your company a member of any Trade Associations or the Better
Business Bureau?
13. Is there any training offered (safety, HR, etc.)?
14. Are training costs included in the annual fee for service? If not, what is the
cost for training services.
15. What is your mission statement?
16. What is your company’s experience with Public Sector Clients?
17. What is your company’s experience working with California Public
Employee Retirement System (CalPERS)?
18. Please describe your customer service levels.
19. What is your company’s experience or level of accessibility (i.e. electronic,
telephonic, in-person)?
20. Please outline your company’s procedures and recommendations for on-
site presence.
21. What is your company’s experience in California?
22. Does your company have a plan for emergency response after normal
working hours? If so, please outline the plan including methods of
communication, response time, availability, and unscheduled on-site visits.
23. Please describe your experience managing a Section 125 Cafeteria Plan
and third party administration of individual health plans.
City of Ridgecrest is accepting bids for a full service firm to perform administrative functions in areas of Human Resources and Risk Management. The functions listed below occur on annual or monthly basis and are generally intermittent in nature. This RFP is for administrative services as outlined in this scope of work.
Scope of Work Recruitment/Employment Administration
• Administer Recruitment Process including advertising, application review, applicant communications, assessment testing, interview assistance, contingent job offer, backgrounds, new hire packets, and employee orientation
• Administer forms and publications for employees including but not limited to handbooks, personnel rules and policies, mandated notifications, health and dental benefits, safety training, etc.
• Maintain City’s Diversity and Affirmative Action Plan • Produce and File Annual State and Federal Affirmative Action Plan
reports. Health Plan/Benefits Administration
• Organize and Assist with Annual Open Enrollment Processing, Employee Health Fair, Consulting Services.
• Provide On-Going Enrollment Services for employees • Provide Benefits Knowledgebase & Decision Support Tools for Employees • Provide and maintain Employee Benefits Communications/Forms • Assist in the design, implementation and administration of new and
existing programs • Make recommendations for items of negotiation with benefit plan providers
including, but not limited to, plan design, cost (rates), and quality of services
• Review and analyze all benefit plan provider agreements for compliance with all applicable federal and state laws, statutes and regulations and the City agreement
• Assist HR in the preparation and/or review and updating of benefit plan documents and benefit summary plan descriptions for self-funded benefit plans
• Regularly and timely communicate to the City changes and proposed changes in state and federal laws, statutes and regulations that may impact the City’s employee benefit plans and programs. Recommend procedures and/or policies the City should implement to comply with federal and state statutes and regulations
• Administer City’s self-insured dental plan enrollment, forms, claims, and billing.
• Provide research and responses to technical questions posed by HR staff
Life Insurance Administration
• Administer Enrollments into City sponsored MetLife term Life Insurance Benefit • Coordinate bi-weekly adjustments and reconciliations • Provide claims assistance to employees and/or beneficiaries as needed.
COBRA Benefits • Administer Qualifying Events determinations & Election Processing • Provide Initial Notification Services to eligible employees • Provide Monthly Premium Billing, Collection, and reconciliation as needed. • COBRA Health Care Continuation • Enrollment & Eligibility Administration FMLA Administration
• Administer Enrollment • Maintain Forms and Notifications in compliance with State and Federal
law • Assist Payroll with Monitoring FMLA Time used. • Generate Annual Reports
FLSA Administration
• Monitor, Update, and Maintain Council Adopted Classification Specification Plan as needed
• Monitor City Compensation Plan and make recommendations as necessary to maintain standard compensation rates.
• Update and maintain Administrative and Personnel Policies and Procedures
• Monitor and assist with State and Federal Law Compliance ADA Administration
• Update and maintain Administrative and Personnel Policies, Procedures, Classification Specifications to ensure compliance with ADA Requirements.
• Administer and document the ADA Interactive Process as needed. • Conduct Job Analysis of current and new classification specifications to
identify essential functions. • Provide forms, analysis, and recommendations for reasonable
accommodation as needed.
Human Capital Management (HCM) • Provide Human capital management and succession planning support and
training. • Assist with Performance management and evaluations. • Provide assistance, technically and creatively, in the on-going
development and preparation of various employee communication materials
• Provide Absence and Protected Leave Management, Tracking, and Reports (FLSA, FMLA, CFRA, SDI, FEHA, ADA, PFL)
Risk Management
• Provide Third Party Workers Compensation Claims Administration • Provide Monthly Loss Run Reports for Workers compensation and Liability
Claims. • Provide Annual OSHA 300 Log • Assist with renewals and communications with the City’s Self-Insurance
Plan & Joint Powers Authority Excess Coverage Pool • Provide Regulatory Compliance and Administration of State and Federal
Labor Laws • Provide DOT Federal Compliance Assistance • Provide Workplace Violence Prevention Training • Provide Bi-Annual Ethics Training for elected/appointed officials,
management, and classifications identified in the City’s Code of Ethics • Provide Sexual Harassment Training for all elected & appointed officials,
management, supervisors, and other staff as identified by Administration. • Provide legal assistance as needed for analysis and
Retirement Processing
• Assist employees with processing application for CalPERS retirement, disability retirement, or employer generated industrial disability retirement
• Assist staff with resolutions and staff reports, documentation, and processing of industrial disability retirement applications and determinations in compliance with CalPERS regulations.
General Administration
• City intends to maintain one part-time clerical staff member to serve as a direct contact for employees and a liaison between the contractor and the City employee’s. Contractor is to work with HR clerical staff to ensure proper record retention and maintenance of all mandated personnel files.
• Assist Payroll with information and regulatory reports as needed. • Provide regular on-site visits to meet with individual employees. • Maintain confidentiality of employee personal information and health data.
This Page Intentionally Left Blank
Page: 1 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2007-2008
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00327.67 327.670.000.00
327.67 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
327.67
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008072196First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2007-2008
02/14/2008
02/21/2008
02/21/200802/19/2008
Fiscal Year:
Incident Desc: left thumb was punctured when he picked up a manila envelope which had a expended taser dart inside.Body Part PunctureNature:Thumb Cause: Cut - Object Lift Or Handled
$0.00Recoveries $0.00Net Incurred 327.67
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-03 Public ServicesCity of Ridgecrest
2008075113First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2007-2008
04/15/2008
05/09/2008
05/06/200805/06/2008
Fiscal Year:
Incident Desc: was opening school bus entrance door when her thumb got pinched tearing skin off.Body Part PunctureNature:Thumb Cause: Caught In Or Between
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.0031,883.71 31,883.710.000.00
17,061.58 0.009,881.56 0.00
0.00 0.000.00 0.000.00 0.00
4,940.57 0.00
17,061.58
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
9,881.560.000.000.00
4,940.57
488-05 PoliceCity of Ridgecrest
2009087898Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2007-2008
06/10/2008
05/28/2010
04/06/200904/01/2009
Fiscal Year:
Incident Desc: EE was arresting suspect. Suspect had several bandages on both arms and during search ee found pills in pocket when asked what the pills where suspect indicated they were antibotics for MRSABody Part All Other Specific InjuriesNature:Multiple Body Parts Cause: Absorption, Ingestion, Inhalation Noc
$0.00Recoveries $0.00Net Incurred 31,883.71
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 2 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2007-2008
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.001,500.52 1,500.520.000.00
1,066.09 0.000.00 0.000.00 0.000.00 0.00
434.43 0.000.00 0.00
1,066.09
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.00
434.430.00
488-02 Administrative ServicesCity of Ridgecrest
2008071138Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2007-2008
01/22/2008
05/22/2008
01/23/200801/23/2008
Fiscal Year:
Incident Desc: While ee was maning the office and answering a high volume of calls he felt pain in his chest with irregular heartbeat and felt that his blood pressure spikedBody Part All Other Specific InjuriesNature:Multiple Upper Extremities Cause: Misc - Other Than Physical Cause
$0.00Recoveries $0.00Net Incurred 1,500.52
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00304.84 304.840.000.00
304.84 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
304.84
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008077716Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2007-2008
06/30/2008
08/28/2008
07/15/200807/11/2008
Fiscal Year:
Incident Desc: While employee was reaching inside file folder she cut her left pinky finger on a 2" prong fastenerBody Part LacerationNature:Finger(s) Cause: Injury - Reaching
$0.00Recoveries $0.00Net Incurred 304.84
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00176.34 176.340.000.00
176.34 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
176.34
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-01 AdministrationCity of Ridgecrest
2008075493Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2007-2008
05/13/2008
08/28/2008
05/19/200805/15/2008
Fiscal Year:
Incident Desc: was stacking eight foot tables outside, he turned and heard a pop, injuring left ankle.Body Part SprainNature:Ankle Cause: Injury - Twisting
$0.00Recoveries $0.00Net Incurred 176.34
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 3 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2007-2008
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00179.81 179.810.000.00
179.81 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
179.81
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-01 AdministrationCity of Ridgecrest
2008075039Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2007-2008
05/02/2008
05/29/2008
05/06/200805/05/2008
Fiscal Year:
Incident Desc: was getting out of her chair when she stepped incorrectly twisting her left ankleBody Part SprainNature:Ankle Cause: Injury - Twisting
$0.00Recoveries $0.00Net Incurred 179.81
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00300.68 300.680.000.00
300.68 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
300.68
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008073241Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2007-2008
03/14/2008
04/29/2008
03/17/200803/14/2008
Fiscal Year:
Incident Desc: In pursuit of suspect was assisting Ofc. Sparks over a fence when Ofc Sparks' knee hit Sgt. McLaugling in the eyeBody Part LacerationNature:Eye(s) Cause: Struck - Other Worker
$0.00Recoveries $0.00Net Incurred 300.68
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-02 Administrative ServicesCity of Ridgecrest
2008070671First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2007-2008
01/09/2008
01/10/2008
01/10/200801/09/2008
Fiscal Year:
Incident Desc: filing papersBody Part LacerationNature:Thumb Cause: Cut - Object Lift Or Handled
$0.00Recoveries $0.00Net Incurred 0.00
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 4 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2007-2008
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485016,604.5013,247.38 29,851.880.000.00
4,037.70 16,454.500.00 0.00
9,209.68 0.000.00 0.000.00 150.000.00 0.00
20,492.20
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.009,209.68
0.00150.00
0.00
488-05 PoliceCity of Ridgecrest
2008073551Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2007-2008
03/22/200803/25/200803/24/2008
Fiscal Year:
Incident Desc: While cleaning outside dog kennels, she slipped on wet surface twisting right ankle and fellBody Part SprainNature:Ankle Cause: Slip/Fall - Same Level
$0.00Recoveries $0.00Net Incurred 29,851.88
Fiscal Year Total:
Fiscal Year TotalRecoveries
Net Incurred
10 0.000.000.000.000.000.000.00
39,909.2123,454.71 16,454.509,881.569,881.56 0.009,209.689,209.68 0.00
0.000.00 0.00584.43434.43 150.00
0.00 4,940.574,940.5764,525.4547,920.95 16,604.50
0.000.000.000.000.000.000.00
64,525.450.00
MedicalTDPD
Voc RehabExpenses
4850
Fiscal Year : 2008-2009
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-03 Public ServicesCity of Ridgecrest
2009084810First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
01/05/2009
04/01/2009
01/13/200901/13/2009
Fiscal Year:
Incident Desc: While securing wheel chair with metal tiedown ee's left ring finger nail jammed causing it to liftBody Part CrushingNature:Finger(s) Cause: Caught In Or Between
$0.00Recoveries $0.00Net Incurred 0.00
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 5 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2008-2009
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00534.53 534.530.000.00
534.53 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
534.53
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-04 Parks and RecreationCity of Ridgecrest
2008079011Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
08/11/2008
09/30/2008
08/12/200808/12/2008
Fiscal Year:
Incident Desc: When stacking chairs they became unbalanced tumbling down on ee hitting her right sideBody Part ConcussionNature:Skull Cause: Struck - Lifted/Handled Object
$0.00Recoveries $0.00Net Incurred 534.53
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008082304First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
10/26/2008
12/04/2008
10/31/200810/31/2008
Fiscal Year:
Incident Desc: EE was in pursuit of a suspect when he jumped over a fence falling in a hole and twisting his left kneeBody Part SprainNature:Knee Cause: Injury - Jumping
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.002,541.89 2,541.890.000.00
2,532.15 0.000.00 0.000.00 0.000.00 0.009.74 0.000.00 0.00
2,532.15
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.009.740.00
488-05 PoliceCity of Ridgecrest
2008083250Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
11/19/2008
08/28/2009
12/01/200811/26/2008
Fiscal Year:
Incident Desc: When ee got up from her desk she tripped over a file box sitting on the floorBody Part ContusionNature:Multiple Upper Extremities Cause: Slip/Fall
$0.00Recoveries $0.00Net Incurred 2,541.89
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 6 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2008-2009
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.001,926.48 1,926.480.000.00
1,504.85 0.00281.08 0.00
0.00 0.000.00 0.000.00 0.00
140.55 0.00
1,504.85
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
281.080.000.000.00
140.55
488-05 PoliceCity of Ridgecrest
2009087289Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
03/13/2009
05/19/2010
03/20/200903/18/2009
Fiscal Year:
Incident Desc: Patrol Officer performing regular duties of the job.Body Part StrainNature:Multiple Body Parts Cause: Injury - Holding/Carrying
$0.00Recoveries $0.00Net Incurred 1,926.48
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2009091193First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
05/06/2009
08/20/2009
06/29/200906/26/2009
Fiscal Year:
Incident Desc: dog was loose and big volunteer when she came in through the doorBody Part LacerationNature:Lower Leg Cause: Struck - Animal/Insect
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.0026,975.15 26,975.1515.0015.00
294.79 0.002,830.30 0.00
12,000.00 0.000.00 0.00
11,850.06 0.000.00 0.00
294.79
0.00
0.000.000.000.00
15.00
0.000.000.000.00
15.000.00
2,830.3012,000.00
0.0011,850.06
0.00
488-03 Public ServicesCity of Ridgecrest
2009092511Indemnity
üAccount:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
04/19/2009
05/19/2010
08/05/200907/30/2009
Fiscal Year:
Incident Desc: when ee was stepping out of jacuzzi the plastic stairs gave way causing him to fall 3-4 feetBody Part StrainNature:Lower Back (muscle) Cause: Slip/Fall - Stairs
$0.00Recoveries $0.00Net Incurred 26,975.15
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 7 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2008-2009
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00286.99 286.990.000.00
286.99 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
286.99
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008078985Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
07/19/2008
11/26/2008
08/12/200808/12/2008
Fiscal Year:
Incident Desc: When transferring kitten into Cat Cage kitten bit ee on left index fingerBody Part PunctureNature:Finger(s) Cause: Struck - Animal/Insect
$0.00Recoveries $0.00Net Incurred 286.99
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00267.22 267.220.000.00
267.22 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
267.22
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008081209First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
09/12/2008
10/27/2008
10/07/200810/03/2008
Fiscal Year:
Incident Desc: Canine handler was performing training while ee was playing the role of the agitator when K9 "Nitto" bit down he went through the protective gear causing puncture woundBody Part PunctureNature:Hand Cause: Struck - Animal/Insect
$0.00Recoveries $0.00Net Incurred 267.22
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.0097.71 97.710.000.00
97.71 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
97.71
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2009091194First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
05/28/2009
08/25/2009
06/29/200906/26/2009
Fiscal Year:
Incident Desc: when escorting involved party out the dog bite eeBody Part LacerationNature:Lower Leg Cause: Struck - Animal/Insect
$0.00Recoveries $0.00Net Incurred 97.71
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 8 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2008-2009
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00300.50 300.500.000.00
300.50 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
300.50
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2009091195Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
05/30/2009
11/06/2009
06/29/200906/26/2009
Fiscal Year:
Incident Desc: upon contacting female suspect and during a brief struggle suspect bit eeBody Part LacerationNature:Hand Cause: Struck Or Injured By
$0.00Recoveries $0.00Net Incurred 300.50
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00379.52 379.520.000.00
379.52 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
379.52
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2009086888First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
03/06/2009
05/26/2009
03/12/200903/10/2009
Fiscal Year:
Incident Desc: while moving the small dog when ee opened cage dog bitBody Part PunctureNature:Wrist Cause: Struck - Animal/Insect
$0.00Recoveries $0.00Net Incurred 379.52
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00460.85 460.850.000.00
460.85 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
460.85
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-04 Parks and RecreationCity of Ridgecrest
2009089380Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
04/29/2009
08/20/2009
04/29/200905/13/2009
Fiscal Year:
Incident Desc: after 2 days of roto-tilling areas in the park, employee experienced pain in lower back. thought it would go away but is still in pain. twisting, pushing, pulling tillerBody Part StrainNature:Lower Back (muscle) Cause: Injury Rep. Motion
$0.00Recoveries $0.00Net Incurred 460.85
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 9 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2008-2009
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00558.57 558.570.000.00
558.57 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
558.57
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-03 Public ServicesCity of Ridgecrest
2009085077Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
01/20/2009
04/01/2009
01/27/200901/20/2009
Fiscal Year:
Incident Desc: employee was moving a rolling trash dumpster and a wheel broke causing employee to strain his backBody Part StrainNature:Lower Back (muscle) Cause: Injury - Pushing/Pulling
$0.00Recoveries $0.00Net Incurred 558.57
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00120.68 120.680.000.00
120.68 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
120.68
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-03 Public ServicesCity of Ridgecrest
2009088592Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
04/20/2009
08/21/2009
04/21/200904/21/2009
Fiscal Year:
Incident Desc: when ee was removing pipe bolt broke support arm spun and struck ee in the back of the head and across the shoulders.Body Part ContusionNature:Multiple Body Parts Cause: Strike - Object Lifted/Handled
$0.00Recoveries $0.00Net Incurred 120.68
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485029,236.60763.40 30,000.000.00333.21
403.40 24,596.600.00 0.000.00 0.000.00 0.00
360.00 4,640.000.00 0.00
25,000.00
0.00
0.000.000.000.000.00
333.210.000.000.000.000.00
0.000.000.00
5,000.000.00
488-03 Public ServicesCity of Ridgecrest
2010111210Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
01/05/200912/10/201012/09/2010
Fiscal Year:
Incident Desc: injured his neck when he bent forward to reach down and to get the clipboard and the seatbelt locked but he kept on going.Body Part StrainNature:Multiple Body Parts Cause: Injury - Reaching
$0.00Recoveries $0.00Net Incurred 30,000.00
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 10 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2008-2009
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00210.18 210.180.000.00
210.18 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
210.18
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008078421Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
07/25/2008
10/21/2009
07/30/200807/29/2008
Fiscal Year:
Incident Desc: exposure to the sunBody Part CancerNature:Other Facial Soft Tissue Cause: Absorption, Ingestion, Inhalation Noc
$0.00Recoveries $0.00Net Incurred 210.18
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485012,080.0569.95 12,150.000.000.00
69.95 11,930.050.00 0.000.00 0.000.00 0.000.00 150.000.00 0.00
12,000.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.00
150.000.00
488-05 PoliceCity of Ridgecrest
2010109627Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
02/24/200911/03/201010/22/2010
Fiscal Year:
Incident Desc: tested positive for TB exposure after she came in contact with an exposed victim.Body Part All Other Specific InjuriesNature:Body Systems & Multi Body Sys Cause: Absorption, Ingestion, Inhalation Noc
$0.00Recoveries $0.00Net Incurred 12,150.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00259.01 259.010.000.00
259.01 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
259.01
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008080408Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
09/08/2008
11/05/2008
09/12/200809/16/2008
Fiscal Year:
Incident Desc: A suspect slammed the door on EE's right handBody Part ContusionNature:Hand Cause: Caught In Or Between
$0.00Recoveries $0.00Net Incurred 259.01
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 11 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2008-2009
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
t
Total
MedicalTDPD
Voc RehabExpenses
485042,521.7468,529.63 111,051.3712,197.6810,440.23
23,056.63 21,943.9429,860.80 7,464.80
0.00 4,830.000.00 0.00
682.28 817.7214,929.92 7,465.28
45,000.57
0.00
0.0011,197.68
0.000.00
1,000.00
1,820.155,599.08
0.000.00
221.642,799.36
37,325.604,830.00
0.001,500.00
22,395.20
488-05 PoliceCity of Ridgecrest
2010104400Indemnity
üAccount:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
04/03/200906/03/201006/03/2010
Fiscal Year:
Incident Desc: injured his left shoulder while arresting a combative suspect that was resisting arrest.Body Part StrainNature:Shoulder(s) Cause: Struck - Object Handled By Others
$0.00Recoveries $0.00Net Incurred 111,051.37
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-04 Parks and RecreationCity of Ridgecrest
2008078976Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
07/09/2008
02/06/2009
08/12/200808/12/2008
Fiscal Year:
Incident Desc: Dove in off the diving board to retrieve rings and went in too deep too fast hitting the bottom of the poolBody Part FractureNature:Finger(s) Cause: Strike - Stationary Object
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.004,748.07 4,748.070.000.00
4,748.07 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
4,748.07
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008082302Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
10/30/2008
12/28/2010
11/04/200810/31/2008
Fiscal Year:
Incident Desc: While subduing one dog 2 others attackedBody Part PunctureNature:Multiple Body Parts Cause: Struck - Animal/Insect
$0.00Recoveries $0.00Net Incurred 4,748.07
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 12 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2008-2009
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2009091196First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
05/30/2009
08/21/2009
06/29/200906/26/2009
Fiscal Year:
Incident Desc: Upon contact with female suspect and during brief struggle ee was kicked in the eye by suspectBody Part ContusionNature:Eye(s) Cause: Struck Or Injured By
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00192.50 192.500.000.00
192.50 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
192.50
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008081210Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
10/03/2008
12/04/2008
10/07/200810/03/2008
Fiscal Year:
Incident Desc: When trying to make an arrest the suspect charged at the Detective causing his hand to make contactBody Part ContusionNature:Wrist(s) & Hand(s) Cause: Misc - Robbery/Criminal Assault
$0.00Recoveries $0.00Net Incurred 192.50
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 13 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2008-2009
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00355.85 355.850.000.00
355.85 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
355.85
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2008079139First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2008-2009
08/05/2008
09/05/2008
08/15/200808/15/2008
Fiscal Year:
Incident Desc: While opening the can lid cut into the side of left palmBody Part LacerationNature:Hand Cause: Cut - Hand Tool, No Pwr
$0.00Recoveries $0.00Net Incurred 355.85
Fiscal Year Total:
Fiscal Year TotalRecoveries
Net Incurred
25 2,153.365,599.08
0.000.00
236.642,799.36
10,788.44
95,104.5436,633.95 58,470.5940,436.9832,972.18 7,464.8016,830.0012,000.00 4,830.00
0.000.00 0.0018,509.8012,902.08 5,607.72
7,465.28 22,535.7515,070.47193,417.07109,578.68 83,838.39
0.0011,197.68
0.000.00
1,015.000.00
12,212.68
193,417.070.00
MedicalTDPD
Voc RehabExpenses
4850
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00194.26 194.260.000.00
194.26 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
194.26
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-01 AdministrationCity of Ridgecrest
2010105570Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
06/28/2010
11/30/2010
07/08/201007/02/2010
Fiscal Year:
Incident Desc: had a seizureBody Part All Other Specific InjuriesNature:Body Systems & Multi Body Sys Cause: Misc - Other Than Physical Cause
$0.00Recoveries $0.00Net Incurred 194.26
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 14 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-03 Public ServicesCity of Ridgecrest
2009095753First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
10/14/2009
12/31/2009
10/21/200910/19/2009
Fiscal Year:
Incident Desc: Very windy that morning and during her pre-inspection a foreign object flew into her left eyeBody Part Foreign BodyNature:Eye(s) Cause: Misc - Foreign Body In Eye
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.0047.20 47.200.000.00
47.20 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
47.20
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-03 Public ServicesCity of Ridgecrest
2009098445First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
12/02/2009
02/02/2010
12/23/200912/22/2009
Fiscal Year:
Incident Desc: opened her bus door and her left pinky finger got smashed between the door and the poles at the gas pump.Body Part ContusionNature:Finger(s) Cause: Caught In Or Between
$0.00Recoveries $0.00Net Incurred 47.20
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.001,108.18 1,108.180.000.00
686.84 0.000.00 0.000.00 0.000.00 0.00
421.34 0.000.00 0.00
686.84
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.00
421.340.00
488-05 PoliceCity of Ridgecrest
2009094031Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
08/31/2009
04/21/2010
09/11/200909/08/2009
Fiscal Year:
Incident Desc: UnknownBody Part InfectionNature:Abdomen Incl. Groin Cause: Absorption, Ingestion, Inhalation Noc
$0.00Recoveries $0.00Net Incurred 1,108.18
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 15 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485014,835.0326,945.44 41,780.470.0071.91
9,640.52 10,359.4811,902.97 0.003,877.14 4,000.36
0.00 0.001,524.81 475.19
0.00 0.00
20,000.00
0.00
0.000.000.000.000.00
57.770.000.000.00
14.140.00
11,902.977,877.50
0.002,000.00
0.00
488-03 Public ServicesCity of Ridgecrest
2009096783Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
10/29/200911/12/200911/10/2009
Fiscal Year:
Incident Desc: upon loading wheelchair ee was bending over tieing dow wheelchair and felt strain in lower backBody Part StrainNature:Lower Back (muscle) Cause: Injury - Lifting
$0.00Recoveries $0.00Net Incurred 41,780.47
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-01 AdministrationCity of Ridgecrest
2009092477First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
07/16/2009
08/20/2009
07/30/200907/30/2009
Fiscal Year:
Incident Desc: when tearing down walls and moving them ee pinched his left fingers between the wallsBody Part All Other Specific InjuriesNature:Finger(s) Cause: Caught In Or Between
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485015,051.577,098.43 22,150.000.0010.50
7,098.43 14,901.570.00 0.000.00 0.000.00 0.000.00 150.000.00 0.00
22,000.00
0.00
0.000.000.000.000.00
10.500.000.000.000.000.00
0.000.000.00
150.000.00
488-03 Public ServicesCity of Ridgecrest
2009098446Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
12/16/200912/23/200912/22/2009
Fiscal Year:
Incident Desc: sat in an office chair and the back of the chair broke causing him to fall back, catching his right foot under the desk and torquing his upper torso, back and neck.Body Part StrainNature:Multiple Body Parts Cause: Injury - Twisting
$0.00Recoveries $0.00Net Incurred 22,150.00
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 16 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-01 AdministrationCity of Ridgecrest
2010102454First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
03/29/2010
05/13/2010
04/14/201004/13/2010
Fiscal Year:
Incident Desc: when unloading boxes felt something bite himBody Part All Other Specific InjuriesNature:Hand Cause: Struck - Animal/Insect
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00310.53 310.530.000.00
310.53 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
310.53
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-01 AdministrationCity of Ridgecrest
2010103617Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
05/04/2010
07/14/2010
05/12/201005/12/2010
Fiscal Year:
Incident Desc: While unloading truck and box of laundry soap broke and he fell down and braced himself with his right arBody Part ContusionNature:Multiple Upper Extremities Cause: Slip/Fall
$0.00Recoveries $0.00Net Incurred 310.53
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
48500.0065.00 65.0065.0065.00
65.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
65.00
0.00
65.000.000.000.000.00
65.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2011113342Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
03/22/201002/14/201102/14/2011
Fiscal Year:
Incident Desc: While ee jumped over brick wall due to the gate being lock he landed improperBody Part StrainNature:Multiple Lower Extremities Cause: Slip/Fall - Different Level
$0.00Recoveries $0.00Net Incurred 65.00
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 17 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00314.19 314.190.000.00
314.19 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
314.19
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-04 Parks and RecreationCity of Ridgecrest
2009093561Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
08/25/2009
09/30/2009
09/01/200908/26/2009
Fiscal Year:
Incident Desc: While ee was trimming trees branch came down hit loppers knocking from his hand and the swung around and hit him in the right handBody Part ContusionNature:Hand Cause: Strike - Stationary Object
$0.00Recoveries $0.00Net Incurred 314.19
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2009095751First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
09/30/2009
12/31/2009
10/21/200910/19/2009
Fiscal Year:
Incident Desc: while trying to restrain subject officer was bit on the left forearmBody Part PunctureNature:Lower Arm Cause: Struck Or Injured By
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00617.07 617.070.000.00
617.07 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
617.07
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2009097377First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
10/27/2009
02/02/2010
11/30/200911/24/2009
Fiscal Year:
Incident Desc: During training the K-9 police dog pulled bite sleeve off and bitting officerBody Part PunctureNature:Multiple Upper Extremities Cause: Cut/Punct/Scrap
$0.00Recoveries $0.00Net Incurred 617.07
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 18 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.001,693.91 1,693.910.000.00
1,693.91 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
1,693.91
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2010099792Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
12/18/2009
03/29/2011
02/02/201002/02/2010
Fiscal Year:
Incident Desc: was taken down by a K-9 Officer during an aggression training and twisted his left knee.Body Part StrainNature:Knee Cause: Injury - Twisting
$0.00Recoveries $0.00Net Incurred 1,693.91
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00138.36 138.360.000.00
138.36 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
138.36
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-04 Parks and RecreationCity of Ridgecrest
2010099791First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
12/11/2009
03/31/2010
02/02/201002/02/2010
Fiscal Year:
Incident Desc: While ee was cleaniing down walls he turned to get the mop and the handle was lying out of the bucket causing him to trip,slip and fallBody Part SprainNature:Ankle Cause: Injury - Twisting
$0.00Recoveries $0.00Net Incurred 138.36
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.0067.43 67.430.000.00
67.43 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
67.43
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2009093627Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
07/14/2009
09/30/2009
08/28/200908/27/2009
Fiscal Year:
Incident Desc: ee states that over the course of 3 years of riding a dual sport motorcycle it has caused cumulative trama to his mid/lower back and tailbone.Body Part All Other Specific InjuriesNature:Multiple Trunk Cause: Injury Rep. Motion
$0.00Recoveries $0.00Net Incurred 67.43
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 19 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
4850189,583.33117,505.92 307,089.2515,760.074,468.98
70,419.23 139,580.7742,582.57 14,194.18
0.00 27,312.500.00 8,000.00
4,504.12 495.880.00 0.00
210,000.00
0.00
0.0015,760.07
0.000.000.00
2,285.262,183.72
0.000.000.000.00
56,776.7527,312.508,000.005,000.00
0.00
488-04 Parks and RecreationCity of Ridgecrest
2009095947Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
10/06/200910/23/200910/22/2009
Fiscal Year:
Incident Desc: injured his back on 10/06/09 while he was riding the mower over rough terrain and jolted his back. Then on 10/20/09 his leg gave out as he was climbing up the mower trailer.Body Part StrainNature:Lower Back (muscle) Cause: Injury - Using Tool Or Machine
$0.00Recoveries $0.00Net Incurred 307,089.25
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00403.17 403.170.000.00
403.17 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
403.17
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2010103870Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
05/11/2010
12/19/2010
05/19/201005/19/2010
Fiscal Year:
Incident Desc: while trying to remove injured dog from roadway, Officer was bitten on left palm of hand.Body Part LacerationNature:Hand Cause: Struck - Animal/Insect
$0.00Recoveries $0.00Net Incurred 403.17
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.001,136.27 1,136.270.000.00
1,136.27 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
1,136.27
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2009092465Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
07/05/2009
04/29/2010
07/30/200907/30/2009
Fiscal Year:
Incident Desc: Officer step on a 2ft high block wall to look over a 6ft fence when he lost his footing slipping down the wallBody Part All Other Specific InjuriesNature:Multiple Lower Extremities Cause: Slip/Fall - Different Level
$0.00Recoveries $0.00Net Incurred 1,136.27
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 20 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485016,355.922,746.94 19,102.860.0012.28
1,749.44 14,353.420.00 0.000.00 0.00
997.50 1,502.500.00 500.000.00 0.00
16,102.86
0.00
0.000.000.000.000.00
12.280.000.000.000.000.00
0.000.00
2,500.00500.00
0.00
488-04 Parks and RecreationCity of Ridgecrest
2009095752Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
10/06/200910/21/200910/19/2009
Fiscal Year:
Incident Desc: over the past 10 years cumulative, repetative keyboardingBody Part Carpal Tunnel SyndromeNature:Wrist(s) & Hand(s) Cause: Injury Rep. Motion
$0.00Recoveries $0.00Net Incurred 19,102.86
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
4850119,182.44100,420.42 219,602.860.002,363.65
51,700.27 43,299.7330,730.16 1,520.222,526.71 61,700.79
0.00 0.0098.40 11,901.60
15,364.88 760.10
95,000.00
0.00
0.000.000.000.000.00
1,326.830.00
949.570.00
87.250.00
32,250.3864,227.50
0.0012,000.0016,124.98
488-05 PoliceCity of Ridgecrest
2010102453Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
04/05/201004/15/201004/13/2010
Fiscal Year:
Incident Desc: reported a cumulative trauma injury to his neck and bilateral shoulders over 23 years of his employment.Body Part StrainNature:Multiple Body Parts Cause: Injury Rep. Motion
$0.00Recoveries $0.00Net Incurred 219,602.86
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485018,272.691,727.31 20,000.000.001,727.31
0.00 10,000.000.00 0.000.00 0.000.00 0.00
1,727.31 8,272.690.00 0.00
10,000.00
0.00
0.000.000.000.000.00
0.000.000.000.00
1,727.310.00
0.000.000.00
10,000.000.00
488-05 PoliceCity of Ridgecrest
2011112706Indemnity
üAccount:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
04/19/201001/26/201101/26/2011
Fiscal Year:
Incident Desc: over 23 years of service, cumulative tramaBody Part Multiple Physical Injury OnlyNature:Body Systems & Multi Body Sys Cause: Misc - Other Than Physical Cause
$0.00Recoveries $0.00Net Incurred 20,000.00
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 21 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00159.58 159.580.000.00
159.58 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
159.58
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-04 Parks and RecreationCity of Ridgecrest
2009095083Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
09/30/2009
11/17/2009
10/02/200910/01/2009
Fiscal Year:
Incident Desc: while ee was during yard work he felt something bite himBody Part All Other Specific InjuriesNature:Elbow Cause: Struck - Animal/Insect
$0.00Recoveries $0.00Net Incurred 159.58
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2010105036First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
05/20/2010
07/28/2010
06/18/201006/18/2010
Fiscal Year:
Incident Desc: When attemptimg to contain loose dog ee was scratch by citizen with possible MRSABody Part LacerationNature:Multiple Upper Extremities Cause: Cut/Punct/Scrap
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485049,741.3849,196.65 98,938.030.001,620.51
24,395.38 35,604.6220,480.53 0.002,038.79 4,918.71
0.00 4,000.002,281.95 5,218.05
0.00 0.00
60,000.00
0.00
0.000.000.000.000.00
257.330.000.000.00
1,363.180.00
20,480.536,957.504,000.007,500.00
0.00
488-04 Parks and RecreationCity of Ridgecrest
2009096072Indemnity
üAccount:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
10/21/200911/02/200910/26/2009
Fiscal Year:
Incident Desc: While triming and cutting bushes on median his w rist and hand started sw ellng and it began hurting. He w as using toppers, rakes and shovels.Body Part SprainNature:Wrist(s) & Hand(s) Cause: Injury Rep. Motion
$0.00Recoveries $0.00Net Incurred 98,938.03
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 22 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00382.33 382.330.000.00
382.33 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
382.33
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-04 Parks and RecreationCity of Ridgecrest
2010100442Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
02/16/2010
04/29/2010
02/18/201002/18/2010
Fiscal Year:
Incident Desc: EE was switching out acid barrel and wrenched his back while trying to make sure it didn't fall over.Body Part StrainNature:Lumbar & Sacral Verte Cause: Injury - Lifting
$0.00Recoveries $0.00Net Incurred 382.33
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2009092478First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
07/06/2009
08/18/2009
07/30/200907/30/2009
Fiscal Year:
Incident Desc: when ee went to sit down on the chair it slid out from under himBody Part All Other Specific InjuriesNature:Lower Arm Cause: Slip/Fall
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00334.80 334.8010.5010.50
334.80 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
334.80
0.00
10.500.000.000.000.00
10.500.000.000.000.000.00
0.000.000.000.000.00
488-01 AdministrationCity of Ridgecrest
2010103090Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
04/13/2010
09/30/2010
04/29/201004/29/2010
Fiscal Year:
Incident Desc: When employee was handling box he dropped it on his left kneeBody Part ContusionNature:Knee Cause: Injury Rep. Motion
$0.00Recoveries $0.00Net Incurred 334.80
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 23 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00506.21 506.210.000.00
506.21 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
506.21
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2010099595Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
01/20/2010
06/23/2010
01/20/201001/26/2010
Fiscal Year:
Incident Desc: He was running and stepped in pot-holeBody Part ContusionNature:Lower Leg Cause: Slip/Fall - Into Opening
$0.00Recoveries $0.00Net Incurred 506.21
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485035,951.6536,836.15 72,787.800.002,420.50
6,663.97 33,336.039,584.99 0.00
11,687.14 1,947.860.00 0.00
832.24 667.768,067.81 0.00
40,000.00
0.00
0.000.000.000.000.00
1,340.500.00
1,080.000.000.000.00
9,584.9913,635.00
0.001,500.008,067.81
488-05 PoliceCity of Ridgecrest
2010103086Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
04/22/201004/29/201004/29/2010
Fiscal Year:
Incident Desc: Normal Duties of a sworn officer. There are prior claims for back and shoulder arm neckBody Part All Other Cumulative InjuryNature:Multiple Body Parts Cause: Injury Rep. Motion
$0.00Recoveries $0.00Net Incurred 72,787.80
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-03 Public ServicesCity of Ridgecrest
2009092468First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
07/21/2009
08/21/2009
07/30/200907/30/2009
Fiscal Year:
Incident Desc: when removing delineators from the back of the flatbed truck ee twisted his wristBody Part SprainNature:Wrist Cause: Injury - Twisting
$0.00Recoveries $0.00Net Incurred 0.00
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 24 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2009-2010
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00661.49 661.490.000.00
661.49 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
661.49
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-03 Public ServicesCity of Ridgecrest
2009093619Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2009-2010
08/18/2009
11/06/2009
08/31/200908/27/2009
Fiscal Year:
Incident Desc: while ee was picking up cons and placing back into truck he twisted his right wristBody Part SprainNature:Wrist Cause: Injury - Twisting
$0.00Recoveries $0.00Net Incurred 661.49
Fiscal Year Total:
Fiscal Year TotalRecoveries
Net Incurred
32 5,365.972,183.722,029.57
0.003,191.88
0.0012,771.14
480,821.50179,385.88 301,435.62130,995.62115,281.22 15,714.40120,010.0020,129.78 99,880.2214,500.00997.50 13,502.5039,071.3411,390.17 27,681.17
760.10 24,192.7923,432.69809,591.25350,617.24 458,974.01
75.5015,760.07
0.000.000.000.00
15,835.57
809,591.250.00
MedicalTDPD
Voc RehabExpenses
4850
Fiscal Year : 2010-2011
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485050,584.389,088.31 59,672.690.003,735.12
3,999.48 41,000.524,961.26 6,921.43
0.00 2,640.000.00 0.00
127.57 22.430.00 0.00
45,000.00
0.00
0.000.000.000.000.00
2,047.771,559.78
0.000.00
127.570.00
11,882.692,640.00
0.00150.00
0.00
488-02 Administrative ServicesCity of Ridgecrest
2010109227Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
09/27/201010/13/201010/12/2010
Fiscal Year:
Incident Desc: reported left hand up to forearm injury due to repetitive motion over 9 years.Body Part All Other Cumulative InjuryNature:Wrist(s) & Hand(s) Cause: Injury Rep. Motion
$0.00Recoveries $0.00Net Incurred 59,672.69
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 25 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2010-2011
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-01 AdministrationCity of Ridgecrest
2011115887Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
04/21/201104/25/201104/25/2011
Fiscal Year:
Incident Desc: Was walking to Parks and Rec to deliver payrolll checks when I slipped on wet concrete landed of left hand and left kneew, and twisted right ankleBody Part StrainNature:Multiple Body Parts Cause: Slip/Fall
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-01 AdministrationCity of Ridgecrest
2011116015Pending
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
04/25/201105/05/201104/28/2011
Fiscal Year:
Incident Desc: Was walking on sidewalkafter a seal didn t dry or harden. Fell on both knees. Injuring both knees.Body Part StrainNature:Knee Cause: Slip/Fall - Same Level
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00564.89 564.89303.42303.42
444.97 0.0077.38 0.000.00 0.000.00 0.000.00 0.00
42.54 0.00
444.97
0.00
303.420.000.000.000.00
303.420.000.000.000.000.00
77.380.000.000.00
42.54
488-05 PoliceCity of Ridgecrest
2010109196Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
09/05/2010
01/18/2011
10/18/201010/11/2010
Fiscal Year:
Incident Desc: When Officer approached the house he entered the front gate and was attacked by dog.Body Part PunctureNature:Multiple Upper Extremities Cause: Struck - Animal/Insect
$0.00Recoveries $0.00Net Incurred 564.89
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 26 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2010-2011
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
4850148.4110.50 158.91158.9110.50
10.50 148.410.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
158.91
0.00
158.910.000.000.000.00
10.500.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2010109197First Aid
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
07/22/2010
12/22/2010
10/13/201010/11/2010
Fiscal Year:
Incident Desc: When Officer reached into the trunk of his patrol car he struck his middle finger on an unknown object cutting it.Body Part LacerationNature:Elbow Cause: Cut - Object Lift Or Handled
$0.00Recoveries $0.00Net Incurred 158.91
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2010109198Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
09/09/2010
01/06/2011
10/13/201010/11/2010
Fiscal Year:
Incident Desc: Officer was searching a suspects belongings and was pricked by an exposed hypodermic needle in the left thumb.Body Part All Other Specific InjuriesNature:Thumb Cause: Cut/Punct/Scrap
$0.00Recoveries $0.00Net Incurred 0.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
48500.000.00 0.000.000.00
0.00 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
0.00
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2011115114Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
03/04/201104/01/201104/01/2011
Fiscal Year:
Incident Desc: Employee was running to assist officers with in progress hot callBody Part StrainNature:Lower Leg Cause: Injury - Jumping
$0.00Recoveries $0.00Net Incurred 0.00
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 27 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2010-2011
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00199.39 199.390.000.00
199.39 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
199.39
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-05 PoliceCity of Ridgecrest
2010106043Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
07/03/2010
10/22/2010
07/16/201007/16/2010
Fiscal Year:
Incident Desc: while exiting his patrol unit ee felt sharp pain in his lower left backBody Part StrainNature:Lower Back (muscle) Cause: Injury Rep. Motion
$0.00Recoveries $0.00Net Incurred 199.39
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
48502,313.38336.62 2,650.000.0021.00
336.62 2,163.380.00 0.000.00 0.000.00 0.000.00 150.000.00 0.00
2,500.00
0.00
0.000.000.000.000.00
21.000.000.000.000.000.00
0.000.000.00
150.000.00
488-05 PoliceCity of Ridgecrest
2010111207Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
11/18/201012/16/201012/09/2010
Fiscal Year:
Incident Desc: while employee was being served with a pending intternal affairs investigation that was being conducted on him. He felt his blood pressure rise w/rapid heartbeat and chest painsBody Part All Other Specific InjuriesNature:No Phys. Injury/Mental Stress Cause: Misc - Other Than Physical Cause
$0.00Recoveries $0.00Net Incurred 2,650.00
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Closed
Total
MedicalTDPD
Voc RehabExpenses
48500.00383.98 383.980.000.00
383.98 0.000.00 0.000.00 0.000.00 0.000.00 0.000.00 0.00
383.98
0.00
0.000.000.000.000.00
0.000.000.000.000.000.00
0.000.000.000.000.00
488-04 Parks and RecreationCity of Ridgecrest
2010109629Medical
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
10/21/2010
02/28/2011
11/09/201010/22/2010
Fiscal Year:
Incident Desc: while cleaning feeder the filter popped off respirator causing gases to be inhaled by employeeBody Part All Other Specific InjuriesNature:Body Systems & Multi Body Sys Cause: Absorption, Ingestion, Inhalation Noc
$0.00Recoveries $0.00Net Incurred 383.98
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 28 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2010-2011
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485021,153.5715,021.67 36,175.24350.001,799.79
4,155.79 20,844.2110,675.24 0.00
0.00 0.000.00 0.00
190.64 309.360.00 0.00
25,000.00
0.00
0.000.000.000.00
350.00
1,609.150.000.000.00
190.640.00
10,675.240.000.00
500.000.00
488-03 Public ServicesCity of Ridgecrest
2010109966Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
11/01/201011/09/201011/01/2010
Fiscal Year:
Incident Desc: was going down the front stairs when she missed the last step causing her to twist her right ankle/foot.Body Part StrainNature:Ankle Cause: Injury - Twisting
$0.00Recoveries $0.00Net Incurred 36,175.24
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
Page: 29 of 29Run Date: 05/18/2011Run Time: 10:20:30
City of RidgecrestDetail Claim Summary w/ Net Incurred
04/01/2011 - 04/30/2011
Paid Outstanding IncurredReserve Ch.this Period
Paidthis Period
Claims with Incident Dates from 01/01/2008Group by Fiscal Year, Sorted by Claimant Name
Fiscal Year : 2010-2011
Claim Type:Claim Number:Claimant Name:
Claimant Status:Examiner:Litigated:
Open
Total
MedicalTDPD
Voc RehabExpenses
485020,588.763,540.42 24,129.180.00267.79
439.93 19,560.072,067.11 826.97
0.00 0.000.00 0.000.00 150.00
1,033.38 51.72
20,000.00
0.00
0.000.000.000.000.00
267.790.000.000.000.000.00
2,894.080.000.00
150.001,085.10
488-05 PoliceCity of Ridgecrest
2011111861Indemnity
Account:Org. Level 1:Org. Level 2:
Injury Date
Open Date:Closed Date
Adj. Loc. Recd.
Account Claim Number:2010-2011
01/02/201101/07/201101/05/2011
Fiscal Year:
Incident Desc: was arresting a combative suspect requiring him to use physical force which caused him to hyperextend his right knee.Body Part All Other Specific InjuriesNature:Knee Cause: Injury - Twisting
$0.00Recoveries $0.00Net Incurred 24,129.18
Fiscal Year Total:
Fiscal Year TotalRecoveries
Net Incurred
12 4,259.631,559.78
0.000.00
318.210.00
6,137.62
93,687.259,970.66 83,716.5925,529.3917,780.99 7,748.402,640.000.00 2,640.00
0.000.00 0.00950.00318.21 631.79
51.72 1,127.641,075.92123,934.2829,145.78 94,788.50
462.330.000.000.00
350.000.00
812.33
123,934.280.00
MedicalTDPD
Voc RehabExpenses
4850
Grand Total:79 MedicalTDPD
Voc RehabExpenses
4850Grand Total
11,778.969,342.582,029.57
0.003,746.732,799.36
29,697.20
709,522.50249,445.20 460,077.30206,843.55175,915.95 30,927.60148,689.6841,339.46 107,350.2214,500.00997.50 13,502.5059,115.5725,044.89 34,070.68
8,277.10 52,796.7544,519.651,191,468.05537,262.65 654,205.40
537.8326,957.75
0.000.00
1,365.000.00
28,860.58Recoveries
Net Incurred 1,191,468.050.00
Run By: Herb McDuffee on PRODUCTIONCity of Ridgecrest - Confidentiald_claim_summary_loss7_hm
This Page Intentionally Left Blank
City of RidgecrestOrganizational Chart
City Council
City Manager
Police
Captain
Sergeants
Officers
Dispatchers
Animal Control
Public Works
Wastewater
Streets
Engineering
Public Services
Community Development
Planning
City Clerk
Human Resources
Risk Management
Elections
Council Support
Park & Recreation
Parks Maintenance
Facilities
Swimming Pool
Preschool
Recreation
Finance
Payroll
Accounts Payable
Capital
MIS/IT
This Page Intentionally Left Blank
Date: 6/27/2011
Employee Census
Page 1
Position Title Full/Part Time
Annual Salary Group Code
Workers Compensation
Code
EEO Category
CodeACCOUNT CLERK I F $27,217.00 CO 8810 FACCOUNTANT I - ACCT/TRAINING F $53,118.00 CO 8810 BACCOUNTING MANAGER F $92,020.00 MM 8810 AACCOUNTING TECHNICIAN F $44,112.00 CO 8810 CADMINISTRATIVE ANALYST III F $87,869.00 MM 8810 BADMINISTRATIVE ASSISTANT - FI F $66,180.00 CO 8810 FADMINISTRATIVE ASSISTANT - HR F $60,027.00 CO 8810 FADMINISTRATIVE ASST - HR - P/T P $18,479.00 PT 8810 FADMINISTRATIVE SECRETARY-CONF F $42,886.00 CO 8810 F
F $47,259.00 CO 8810 FF $34,410.00 CO 8810 FF $41,843.00 CO 8810 F
ANIMAL CONTROL OFFICER F $29,779.00 PE 7720 DF $28,355.00 PE 7720 D
ANIMAL SHELTER SUPERVISOR F $47,311.00 PE 7720 DCHIEF OF POLICE F $121,800.00 MG 7720 ACHIEF PLANT OPERATOR F $75,949.00 MM 9420 BCITY CLERK F $88,106.00 MG 8810 ACITY COUNCIL MEMBER P $3,250.00 PT 8810 A
P $3,250.00 PT 8810 AP $3,250.00 PT 8810 AP $3,250.00 PT 8810 AP $3,250.00 PT 8810 A
CITY ENGINEER F $89,937.00 MM 9410 BCITY MANAGER F $166,500.00 MG 9410 ACITY PLANNER F $101,773.00 MM 8810 BCODE ENFORCEMENT OFFICER F $44,987.00 RA 9410 DCOMMUNITY DEVELOPMENT TECH F $47,259.00 RA 8810 F
F $37,942.00 RA 8810 FCULTURAL AFFAIRS COORD II F $45,567.00 CO 8810 FCULTURAL AFFAIRS COORD. I F $31,321.00 RA 8810 E
F $28,267.00 RA 8810 EDIR.COMMUNITY/ECONOMIC DEV. F $130,660.00 MG 9410 ADIR.PUBLIC WORKS/CITY ENGINEER F $130,660.00 MG 8810 BDIRECTOR OF FINANCE F $103,148.00 MG 9410 ADIRECTOR OF PARKS & RECREATION F $123,045.00 MG 9410 A
Date: 6/27/2011
Employee Census
Page 2
Position Title Full/Part Time
Annual Salary Group Code
Workers Compensation
Code
EEO Category
CodeDRIVER - TRANSIT F $32,019.00 RA 9422 G
F $25,073.00 RA 9422 GECONOMIC DEVELPMNT PROJECT MGR F $88,106.00 MM 8810 AENGINEERING TECHNICIAN III F $71,651.00 RA 9410 GEXECUTIVE SECRETARY F $72,224.00 CO 8810 FFLEET MECHANIC II F $57,510.00 RA 9422 H
F $46,132.00 RA 9422 HINFORMATION SYSTEMS MANAGER F $92,198.00 MM 9410 EINFORMATION SYSTEMS SPECIALIST F $60,101.00 CO 9420 BINFORMATION SYSTEMS TECHNICIAN F $44,112.00 CO 9420 EKENNEL ATTENDANT F $23,754.00 PE 7720 DMAINTENANCE WORKER I F $34,410.00 RA 9420 H
F $28,325.00 RA 9420 HF $33,602.00 RA 9420 HF $25,698.00 RA 9420 H
MAINTENANCE WORKER II F $38,883.00 RA 9420 HF $39,858.00 RA 9420 HF $37,942.00 RA 9420 HF $40,867.00 RA 9420 HF $40,867.00 RA 9420 HF $38,883.00 RA 9420 HF $34,410.00 RA 9420 HF $34,410.00 RA 9420 HF $36,125.00 RA 9420 HF $36,125.00 RA 9420 H
P.A.C.T. COORDINATOR P/T P $15,975.00 RA 8810 FPARKS MAINTENANCE SUPERVISOR F $53,118.00 MM 9420 HPLANNING COMMISSIONER P $3,250.00 PT 8810 A
P $3,250.00 PT 8810 AP $3,250.00 PT 8810 AP $3,250.00 PT 8810 AP $3,250.00 PT 8810 A
POLICE CAPTAIN F $92,198.00 MM 7720 BPOLICE CLERK I F $25,428.00 RA 8810 FPOLICE CLERK II F $37,029.00 RA 8810 F
F $34,410.00 RA 8810 FF $31,227.00 RA 8810 F
Date: 6/27/2011
Employee Census
Page 3
Position Title Full/Part Time
Annual Salary Group Code
Workers Compensation
Code
EEO Category
CodePOLICE DISPATCHER F $50,030.00 PE 8810 F
F $40,101.00 PE 8810 FF $44,215.00 PE 8810 FF $36,368.00 PE 8810 FF $48,810.00 PE 8810 F
POLICE PATROL OFFICER F $59,288.00 PE 7720 DF $56,431.00 PE 7720 DF $59,288.00 PE 7720 DF $59,288.00 PE 7720 DF $59,288.00 PE 9420 EF $59,288.00 PE 7720 DF $59,288.00 PE 7720 DF $53,712.00 PE 7720 DF $59,288.00 PE 7720 DF $59,288.00 PE 7720 DF $56,431.00 PE 7720 DF $51,154.00 PE 7720 DF $53,712.00 PE 7720 DF $51,154.00 PE 7720 DF $48,719.00 PE 7720 DF $48,719.00 PE 7720 DF $48,719.00 PE 7720 DF $46,399.00 PE 7720 DF $48,719.00 PE 7720 DF $46,399.00 PE 7720 DF $53,712.00 PE 7720 DF $46,399.00 PE 7720 D
POLICE PATROL OFFICER - COPS F $46,399.00 PE 7720 DF $46,399.00 PE 7720 D
POLICE SERGEANT F $72,785.00 PE 7720 CF $69,338.00 PE 7720 CF $72,785.00 PE 7720 DF $62,800.00 PE 7720 CF $72,785.00 PE 7720 CF $72,785.00 PE 7720 C
PROPERTY EVIDENCE CLERK F $26,976.00 PE 7720 DPUBLIC WORKS MAINTENANCE COORD F $49,879.00 MM 9422 G
Date: 6/27/2011
Employee Census
Page 4
Position Title Full/Part Time
Annual Salary Group Code
Workers Compensation
Code
EEO Category
CodeREC LEADER I P $6,000.00 PT 9410 E
P $8,000.00 PT 9410 EP $8,000.00 PT 9410 EP $7,200.00 PT 9410 EP $7,200.00 PT 9410 EP $8,000.00 PT 9410 EP $8,320.00 PT 9410 EP $8,000.00 PT 9410 EP $8,000.00 PT 9410 EP $8,000.00 PT 9410 EP $2,600.00 PT 9410 EP $8,000.00 PT 9410 EP $3,360.00 PT 9410 F
REC LEADER II P $8,400.00 PT 9420 EP $3,780.00 PT 9420 EP $4,816.00 PT 9420 EP $7,938.00 PT 9420 EP $3,704.00 PT 9420 EP $4,763.00 PT 9420 EP $4,763.00 PT 9420 EP $4,763.00 PT 9420 EP $8,736.00 PT 9420 EP $9,173.00 PT 9420 EP $4,234.00 PT 9420 EP $8,000.00 PT 9420 EP $3,704.00 PT 9420 EP $3,704.00 PT 9420 EP $3,704.00 PT 9420 EP $3,704.00 PT 9420 E
REC LEADER III P $10,650.00 PT 9420 BP $10,650.00 PT 9420 BP $9,660.00 PT 9420 BP $9,660.00 PT 9420 BP $4,637.00 PT 9420 BP $9,660.00 PT 9420 B
RESERVES P $10,440.00 PT 7720 DP $0.00 PT 7720 DP $0.00 PT 7720 D
Date: 6/27/2011
Employee Census
Page 5
Position Title Full/Part Time
Annual Salary Group Code
Workers Compensation
Code
EEO Category
CodeRESERVES P $20,881.00 PT 7720 D
P $23,260.00 PT 7720 DP $23,958.00 PT 7720 DP $27,758.00 PT 7720 DP $13,879.00 PT 7720 D
SENIOR BUS DRIVER/DISPATCHER F $37,942.00 CO 8810 FTRANSIT SERVICES COORDINATOR F $72,745.00 MM 9410 GWASTEWATER OPERATOR III F $57,149.00 RA 9420 EWASTEWATER OPERATOR TRAINEE F $25,787.00 RA 9420 G
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Medical Vision
1 Party 2 Party FamilyEmployee Dependant
1
Dependant
2
Dependant
3
Dependent
4
Plan A 9.75$ 9.18$ 8.63$ 8.10$ 7.65$ PERSSelect 216.94$ 433.87$ 564.03$
Monthly $433.87 $867.74 $1,128.06 Plan B 7.68$ 7.23$ 6.80$ 6.40$ 6.03$
PERSCare 393.62$ 787.24$ 1,023.41$ Monthly $787.24 $1,574.48 $2,046.82
PERSChoice 248.08$ 496.15$ 645.00$ Monthly $496.15 $992.30 $1,289.99
PORAC 263.50$ 493.50$ 627.00$ Monthly $527.00 $987.00 $1,254.00 Retirement Health Savings Plan
Dental1 Party 2 Party Family
Ogden Benefits (OBA) 13.84$ 25.14$ 34.75$ Misc:Monthly 27.68$ 50.28$ 69.50$
Long Term Care - PERS
AFLAC Supplemental Policies - See Representative for Rates
Accident InsuranceRecovery Plus InsuranceLife Assurance InsuranceHospital Intensive Care Insurance
City of Ridgecrest Benefit Rates Chart Effective 01/01/11
ICMA - VantageCare
Short-Term Disability Insurance
See UNUM Brochure
Valic
ICMA
FLEX ONE Flexible Spending Accounts
Example: Emp. $9.75 + D1 $9.18 + D2 $8.63 + D3 $8.10 = $35.66 ppp
Life-Group
Cancer Insurance
457 Deferred Comp:
Employee Only w/Major
*Mid-Management/Confidential/Management/Local 1036/PEAR receive the Tiered Cafeteria Plan amount per month to purchase benefits within this Cafeteria Plan (IRS code Section 125).
Monthly Tiered Cafeteria Plan
***Employees enrolled in other City sponsored medical plans qualify for tier 2 with no major medical
Additional Employee Benefits
City Paid PERS Retirement Plan 2.7% @ 55Various Incentive Pays as negotiated by Memorandum of Understanding (UFCW; PEAR; MM; CON, MGT)
**Premium Rates are quoted per pay period
UFCW Local 1036/PEAR/MM/CON/MGT $936.00$738.00$575.00$450.00 (0.00 for PEAR)
Tier 3
Employee + 1 w/Major Tier 4
Employee + 2 + w/Major Tier 1
No MedicalTier 2
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