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AP 12-03-09
S. wfr " SOUTH TAHOE PUBLIC UTILITY DISTRICT REGULAR BOARD MEETING AGENDA Thursday, December 3, 2009 2:00 P.M. District Board Room 1275 Meadow Crest Drive, South Lake Tahoe, California Richard Solbri , General Manager Paul Sciuto, Assistant General Manager Mary Lou Mosbacher, President BOARD MEMBERS Dale Rise, Vice President James R. Jones, Director Eric W. Schafer, Director Ernie Claudio, Director 1. CALL TO ORDER REGULAR MEETING — PLEDGE OF ALLEGIANCE 2. COMMENTS FROM THE AUDIENCE (Short non - agenda items that are within the subject matter jurisdiction of the District. Five - minute limit. No action will be taken.) 3. CORRECTIONS TO THE AGENDA OR CONSENT CALENDAR 4. ADOPTION OF CONSENT CALENDAR (Any item can be discussed and considered separately upon request) 5. CONSENT ITEMS BROUGHT FORWARD FOR SEPARATE DISCUSSION / ACTION 6. PRESENTATION a. Report on the 2009 Fiscal Year Financial Statement Audit (Larry Mace, Partner, Grant Thornton) 7. ITEMS FOR BOARD ACTION REQUESTED BOARD ACTION a. Self- Insured Health Plan Renewal Pg. 9 (Nancy Hussmann) (1) Approve Renewal of Stop Loss Carrier with QBE Insurance Group; (2) Approve Specific Stop Loss Deductible Level of $75,000; and (3) Approve Renewal of Third Party Administrators with CDS Group Health and Universal Health Network REGULAR BOARD MEETING AGENDA — DECEMBER 3, 2009 PAGE — 2 b. Plan Document for Self- Insured Health Plan Approve Revisions to Plan Pg. 13 (Nancy Hussmann) Document C. Self- Insured Health Plan Renewal — Funding Approve 2010 Funding Level and Pg. log Level and COBRA Rates COBRA Rates at the Same Level as (Nancy Hussmann) the 2009 Funding Level and COBRA Rates d. Snowshoe Thompson Ditch No. 1 / Millich Continue Emergency Action Pg. 113 Ditch Washout (Paul Sciuto) e. 2:30 P.M. PUBLIC HEARING Pg. 115 South Tahoe Public Utility District Recycled Hold a Public Hearing to Certify the Water Facilities Master Plan Recycled Facilities Master Plan (Jim Hoggatt) Environmental Impact Report f. Payment of Claims Pg. 139 Approve Payment (Payment of claims will be distributed prior to, and at the Board meeting) 8. BOARD MEMBER STANDING COMMITTEE REPORTS (Discussions may take place; however, no action will be taken) a. Water & Wastewater Operations Committee (Jones / Rise) b. Finance Committee (Schafer / Claudio) C. Executive Committee (Mosbacher / Rise) d. Planning Committee (Mosbacher / Schafer) 9. BOARD MEMBER AD HOC COMMITTEE REPORTS a. Union & Management MOU Ad Hoc Committee 10. EL DORADO COUNTY WATER AGENCY PURVEYOR REPRESENTATIVES REPORT 11. BOARD MEMBER REPORTS (Discussions may take place; however, no action will be taken) 12. GENERAL MANAGER REPORTS (Discussions may take place; however, no action will be taken) a. Luther Pass Pump Station Power Generation Facility 13. STAFF / ATTORNEY REPORTS (Discussions may take place; however, no action will be taken) a. Meeting with City Staff, Redevelopment Project #2 (Paul Hughes) b. Holiday Events (Kathy Sharp) 14. NOTICE OF PAST AND FUTURE MEETINGS / EVENTS Past Meetines / Events 11/24/09 — Union & Management MOU Ad Hoc Committee Meeting 11/30/09 — Water and Wastewater Operations Committee Meeting 11/30/09 — El Dorado County Water Agency Special Board Meeting 11/30/09 — 12/4/09 ACWA Conference in San Diego 12/01/09 — CASA Federal Legislative Committee Annual Planning Meeting 12/02/09 — Recycled Water Facilities Master Plan EIR Public Meeting in Alpine County 12/03/09 — Finance Committee Meeting REGULAR BOARD MEETING AGENDA - DECEMBER 3, 2009 PAGE - 3 Future Meetings / Events 12/09/09 — 8:00 a.m. — ECC (Employee Communications Committee) Meeting at District (Director Rise is Board representative) 12/09/09 —10:00 a.m. — El Dorado County Water Agency Meeting in Shingle Springs 12/14/09 — 3:30 p.m. — Water and Wastewater Operations Committee Meeting at District 12/15/09 — 9:00 a.m. — Alpine County Supervisors Regular Meeting in Markleeville 12/17/09 — 2:00 p.m. — STPUD Regular Board Meeting at District Office 12/24/09 — Union Holiday (District Closed) 12/25/09 — Christmas Holiday (District Closed) 15. CLOSED SESSION (Closed Sessions are not open to the public) a. Pursuant to Government Code Section 54956.9(a) /Conference with Legal Counsel — Pg. 141 Existing Litigation re: Meyers Landfill Site: United States of America vs. El Dorado County and City of South Lake Tahoe and Third Party Defendants, Civil Action No. S -01 -1520 LKK GGH, United States District Court for the Eastern District of CA b. Pursuant to Government Code Section 54956.9(a) /Conference with Legal Counsel- Pg. 143 Existing Litigation: Tahoe Asphalt, Inc. and Tahoe Asphalt Materials Company, LLC, vs. STPUD, Case No. SC20090104, El Dorado Superior Court 16. ACTION / REPORT ON ITEMS DISCUSSED DURING CLOSED SESSION 17. ADJOURNMENT (To the next regular meeting, December 17, 2009, 2:00 p.m.) The South Tahoe Public Utility District Board of Directors regularly meets the first and third Thursday of each month. A complete agenda packet, including all backup information is available for review at the meeting and at the District office during the hours of 8:00 a.m. — 5:00 p.m., Monday through Friday. A recording of the meeting is retained for 30 days after minutes of the meeting have been approved. Items on this agenda are numbered for identification purposes only and will not necessarily be considered in the order in which they appear on the agenda. Designated times are for particular items only. Public Hearings will not be called to order prior to the time specified, but may occur slightly later than the specified time. Public participation is encouraged. Public comments on items appearing on the agenda will be taken at the same time the agenda items are heard; comments should be brief and directed to the specifics of the item being considered. Comments on items not on the agenda can be heard during "Comments from the Audience;" however, action cannot be taken on items not on the agenda. Please provide the Clerk of the Board with a copy of all written material presented at the meeting. Backup to any agenda item(s) not included with the Board packet will be made available when finalized at the District office, at the Board meeting, and upon request to the Clerk of the Board. The meeting location is accessible to people with disabilities. Every reasonable effort will be made to accommodate participation of the disabled in all of the District's public meetings. If particular accommodations for the disabled are needed (i.e., disability- related aids, or other services), please contact the Clerk of the Board at 530.544.6474, extension 6203, at least 24 hours in advance of the meeting. •1950•W CONSENT CALENDAR DECEMBER 3, 2009 ITEMS REQUESTED ACTION a. Employee Assistance Program Pg. 1 (Nancy Hussmann) Authorize Execution of a Contract with CSAC Excess Insurance Authority to Provide Employee Assistance Program Services to District Employees and their Families, in the Amount of $3,341 b. Regular Board Meeting Minutes: Pg. 5 November 19, 2009 (Kathy Sharp) Approve Minutes South Tahoe Public Utility District • 1274 Meadow Crest Drive • South Lake Tahoe, CA 96150 Phone 530.544.6474 ■ Facsimile 530.541.0614 • www.stpud.us Genera! Manager Richard H. solbrie ut Tah Er"ie Directors Claudio J anes K. Jones PuHic Utility Piotrict Mary Lou Woba` 4275 Maadow Crwt DHve * South Lake Tahoe • CA 96150 Fhone 530 544 -C�74 a Fax 5S0 541 -0614 BOARD AGENDA ITEM 4a TO: Board of Directors FROM: Nancy Hussmann, Human Resources Director MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: Employee Assistance Program REQUESTED BOARD ACTION: Authorize execution of a contract with CSAC Excess Insurance Authority to provide Employee Assistance Program services to District employees and their families, in the amount of $3,341. DISCUSSION: The District has provided Employee Assistance Program (EAP) services through the Tahoe Employee Assistance Program for many years. Paul Gessford is the current EAP Coordinator, who has informed the District that he will no longer be providing the DOT, Certified Substance Abuse Professional services as part of his program services. The DOT Certified Substance Abuse Professional services are an essential component due to the many commercial drivers that are required to undergo random drug testing and evaluation by a Certified Substance Abuse Professional for a positive test result. Alliant Insurance (the insurance company for the District's other insurance programs through CSRMA) has a pooled program through the California State Association of Counties (CSAC), Excess Insurance Authority (EIA). They contract with Managed Health Network (MHN) to provide EAP services. MHN contracts with a network of providers throughout the state of California and Nevada for mental health and substance abuse services, including Certified Substance Abuse Professionals for DOT services. MHN also provides other employee services such as legal referral services, financial consultations, and education and schooling referrals, in addition to ten hours of training per year. The District's current plan provides for three sessions per incident per family member for a cost of $1.25 per employee per month. CSAC -EIA MHN offers the same provisions plus the additional services mentioned above for a cost of $2.40 per employee per month. The $1.25 charge currently paid has not changed in over ten years, and for the services provided $2.40 per employee per month is considered reasonable, and in fact $2.50 per employee per month was budgeted in anticipation of changing EAP providers. Staff therefore recommends changing to CSAC -EIA MHN for their Employee Assistance Program services. -1- Nancy Hussmann December 3, 2009 Page 2 SCHEDULE: December 4, 2009 — sign contract with CSAC -EIA; conduct training 12/10 and 12/15 for employees. COSTS: $3,341 per year ACCOUNT NO: 50/50 -22 -4405 BUDGETED AMOUNT REMAINING: $2,610. Remaining amount to be included in the 2010/11 budget. ATTACHMENTS: CSAC -EAI MHN EAP Comparison CONCURRENCE WITH REQUESTED ACTION: GENERAL MANAGER: YES NO CHIEF FINANCIAL OFFICER: YES NO -2- CATEGORY: General CSAC -EIA MHN Rates EAP Price (PEPM) PEPY Rate Guarantee Number of Sessions Frequency Employee Services Substance Abuse Professional Work Life Legal Dependent Care Financial Education Referrals Concierge Employer Services Brown Bag Seminars & Management Training Management Consultations CISD - Critical incident Stress Debriefing Re orts Newsletter and Collateral Materials Internet Service 3 Sessions $2.40 $28.80 Through July 1, 2012 3 Sessions per incident per family member No limit in frequency or time of telephone Consultation Sessions Telephonic Counseling & Referral for Counseling Sessions Included Work/Life Services Legal Referral Service - Up to 30 minutes /session & 25% rate reduction off hourly fee Child & Elder Care Referral Service Financial Consultations to include Pre - retirement and tax consultations Education and Schooling Referrals Concierge Services 10 hours per year /EIA member Unlimited 20 hours er incident/EIA member Quarterly Utilization Re orts Yes; No Charge MHN.com 15 Sessions $2.98 $35.76 Through July 1, 2012 5 Sessions per incident per family member No limit in frequency or time of telephone Consultation Sessions Telephonic Counseling & Referral for Counseling Sessions Included Work/Life Services Legal Referral Service - Up to 30 minutes /session & 25% rate reduction off hourly fee Child & Elder Care Referral Service Financial Consultations to include Pre - retirement and tax consultations Education and Schooling Referrals Concierge Services 10 hours per year /EIA member Unlimited 20 hours Der incident/EIA member #MHN. Utilization Reports s; No Charge 4014 —3— so TA 0-- _Qni1T14 TAwnr Pi im ir I IT11 ITV nlQTDlf%T Mary LOU IvIosbacher, President DUAKU Mr_M5r_Kb Dale Rise, Vice Presiden A James R. Jones, Director Eric W. Schafer, Director .-,Ernie Claudio, ......Director t REGULAR MEETING OF THE BQMD OF DIRECTO0110- SOUTH TAHOE PUBLIC AWITY DISTRICT NOVEMBER 19, 2009 M INU T ES The Board of Directors of the South %Public Utility District met in a regular session, November 19, 2009, 2:00 P.m., Distr NW, 1275 Meadow Crest Drive, South Lake Tahoe, California. BOARD OF DIRECTORS: Vice President Rise, Claudio, Jones, Schaf4r. President Mosbacher wasiabserit• A STAFF: Solbrig, Sharp, Sciuto, Hughes, Curtis, Hoggati..")kown, Cocking, Attorney Hetvma Chris _y, JohnAdamski, Cameron Falls Bob ey and Carme? postp ";he decision t I e p rmits'� after the eco alls urpd the Board to �.time I! hft on sewer gy recovers. Passed to appewo,,the Co t Calendar as submitted: a. Pump Run Servid*704�k - Awarded bid to the lowest responsive,'.t*sponsible bidder, San Fran- cisco Ford, Lincoln, Mercury, in the amount of $20,290.63; b. Engineering Student Interns - Approved contract with Substitute Personnel for one engineering student intern, in an amount not to exceed $12,500; WLL CALL COMMENTS FROM AUDIENCE CONSENT CALENDAR -5- REGULAR BOARD MEETING MINUTES - NOVEMBER 19, 2009 PAGE - 2 c. 2010 Water Meter Installation Project: Phase 2 - CONSENT CALENDAR Authorized Task Order No. 3 (PO No. P22162) (continued) to c2me Engineering for plan development, in the amount of $14,000; d. Final and Secondary Effluent Pump Station - (1) Approved the Project Closeout Agreement and Release of Claims for Pacific Mechanical Corpor- ation; and (2) Authorized staff to file a Notice of Completion with the El Dorado County Clerk; e. Headworks Replacement - Authorized staff to advertise for bids for Phase I of the headworks project; 1 r , f. 2009 Sonora Waterline Replacement Project - Approved a < $44,477.67 > deductive Cha Order No. 4 to Campbell Construction Co., g. Interim Customer Service Manager Position - Approved an increase to Purchase Order No. 22 to Blue Ribbon Personnel Services, Its the amount of $15,000; h. Association of California Water Agents 2011; j Annual Membership Dues - Approved „ ymentt ACWA in the amount . X50; i. Approved Regular rd Meets Minutes: November 5, 2 AM ACTION Whiteroq„ etrtt n, Si rosion Contror, and SNOWSHOE THOMPSON DITCH staff 'the pro , re the damages NO. 1 / MILLICH DITCH WASHOUT cau"r erosion. A ican Lion of the costs (EMERGENCY ACTION OF 11 /5/09) will Ctovered by the prj+i9 t wa . ' Y that is still in place frot”" the work perforAlWd in tft tpring. Moved Sch'elfer / Second Jo M / Mosbacher Absent / Passed to conttnue emerges* action. Moved Claudio / SecoM"$chafer / Mosbacher Absent / PAYMENT OF CLAIMS Passed to approve payment in the amount of $1,347,980.90. Water and Wastewater Operations Committee: The BOARD MEMBER STANDING committee met November 16. Minutes of the meeting COMMITTEE REPORTS are available upon request. Finance Committee: The committee met November 19 to discuss self- insured medical plan issues. -6- REGULAR BOARD MEETING MINUTES - NOVEMBER 19, 2009 PAGE - 3 Director Claudio reported on the results of the pressurized smoke test conducted at the Blue Angel restaurant. Director Schafer reported representatives from ENS Resources were here and discussed preparations for an upcoming legislative trip to Washington D. C. Chief Financial Officer: Paul Hughes reported the Customer Service Manager position has been filled. Tim Bledsoe is expected to begin work December 7. District Information Officer: Dennis Cocking expressed disappointment that the new LTRA (Lake Tahoe Restoration Act) did not include funding for water infrastructure for fire fighting. It does, however, include the language for reimbursement for utility relocations for erosion control projects. BOARD MEMBER REPORTS STAFF, RTS Assistant General Manager /Engineer: Paul Sciuto reported 11 contractors attended the re -bid meeting for Phase 2 of the metering project. ;. -bid opening is scheduled for December 11. 2:50 - 2:55 P.M. MEETING BREAK AND s "ADJOUNMENT TO CLOSED ON ACTION, F IWOORT ON IMS DIS SED DURING CLOSED SESSION No reportable Board a qJkM. Pursuant to Government Code Section 54956.9(a) /Conference with Legal Counsel - Existing Litigation re: Meyers Landfill Site: United States of America vs. El Dorado County and City of South Lake Tahoe and Third Party Defendants, Civil Action No. S -01 -1520 LKK GGH, U.S. District Court for the Eastern District of Ca. No reportable BA WAR Ac ' Pursuant to Government Code Section 54956.9(a) /Conference with Legal Counsel - Existing Litigation: Tahoe Asphalt, Inc., and Tahoe Asphalt Materials Company, LLC, vs. STPUD, Case No. SC20090104, El Dorado Superior Court REGULAR BOARD MEETING MINUTES - NOVEMBER 19, 2009 PAGE - 4 3:00 P.M. ADJOURNMENT Mary Lou Mos • , 3 rd President South Tahoe c Uti district ATTEST: Kathy Sharp, Clerk of the South Tahoe Public Utility Dhavict xd .8. T� u a .8. 1275 Meadow Cmt Drive + 5outh Lake Tahoe + CA 96150 Phone 530 544 -6474 • Fax 530 541 -0614 BOARD AGENDA ITEM 7a TO: Board of Directors FROM: Nancy Hussmann, Human Resources Director MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: Self- Insured Health Plan Renewal REQUESTED BOARD ACTION: (1) Approve renewal of stop loss carrier with QBE Insurance Group; (2) Approve Specific stop loss deductible level of $75,000; and (3) Approve renewal of Third Party Administrators with CDS Group Health and Universal Health Network. DISCUSSION: 1. In 2009, the District generally experienced relatively low claims experience, except for one large claim. BB &H Benefit Designs Inc., (BB &H) received an initial renewal proposal for stop loss coverage from our current carrier, Gerber, but was unhappy with the results of their negotiations with Gerber. They therefore marketed the stop loss insurance and found a competitive renewal with QBE. A Comparison of Stop Loss Proposals is attached for reference. Staff met with the Finance Committee and recommends that the District renew its stop loss insurance and change to QBE as the stop loss carrier. 2. The Specific stop loss deductible level is another way to save on fixed plan costs, although it does increase the Annual Maximum Claims Liability. After analysis and explanation from BB &H, the District would have to have five individuals exceed the $75,000 stop loss level before it would lose money on the change to $75,000. With the concurrence of the Finance Committee, staff recommends increasing the Specific stop loss deductible from $65,000 to $75,000. 3. CDS Group Health (CDS) and Universal Health Network (UHN) provide Third Party Administration and Preferred Provider Network services to the District's Self - Insured Health Plan. In August, 2009, CDS took over the Utilization Management component previously done by UHN, and the $2.15 charge per employee per month is being shifted from UHN to CDS. Additionally, CDS is proposing a $0.60 per employee per month increase in its medical claims administration fee (currently $15.00 per employee per month). -9- Generit Manager Richard H. 5oibrig �7iYGCt"" 15h out Ernie C["Io �M/ �✓ Jamey R. Jonas F o "U H!c Uti l ity P ►�,, GJ- G.1. ..ii... 1275 Meadow Cmt Drive + 5outh Lake Tahoe + CA 96150 Phone 530 544 -6474 • Fax 530 541 -0614 BOARD AGENDA ITEM 7a TO: Board of Directors FROM: Nancy Hussmann, Human Resources Director MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: Self- Insured Health Plan Renewal REQUESTED BOARD ACTION: (1) Approve renewal of stop loss carrier with QBE Insurance Group; (2) Approve Specific stop loss deductible level of $75,000; and (3) Approve renewal of Third Party Administrators with CDS Group Health and Universal Health Network. DISCUSSION: 1. In 2009, the District generally experienced relatively low claims experience, except for one large claim. BB &H Benefit Designs Inc., (BB &H) received an initial renewal proposal for stop loss coverage from our current carrier, Gerber, but was unhappy with the results of their negotiations with Gerber. They therefore marketed the stop loss insurance and found a competitive renewal with QBE. A Comparison of Stop Loss Proposals is attached for reference. Staff met with the Finance Committee and recommends that the District renew its stop loss insurance and change to QBE as the stop loss carrier. 2. The Specific stop loss deductible level is another way to save on fixed plan costs, although it does increase the Annual Maximum Claims Liability. After analysis and explanation from BB &H, the District would have to have five individuals exceed the $75,000 stop loss level before it would lose money on the change to $75,000. With the concurrence of the Finance Committee, staff recommends increasing the Specific stop loss deductible from $65,000 to $75,000. 3. CDS Group Health (CDS) and Universal Health Network (UHN) provide Third Party Administration and Preferred Provider Network services to the District's Self - Insured Health Plan. In August, 2009, CDS took over the Utilization Management component previously done by UHN, and the $2.15 charge per employee per month is being shifted from UHN to CDS. Additionally, CDS is proposing a $0.60 per employee per month increase in its medical claims administration fee (currently $15.00 per employee per month). -9- Nancy Hussmann December 3, 2009 Page 2 This rate has been in effect since joining the CDS in January, 2008. Staff, with the concurrence of the Finance Committee recommends accepting this small increase in administration fees, particularly given the improvement in audit results from 2008 to 2009. SCHEDULE: December 4, 2009 — Notify all applicable parties COSTS: $331,170.72 Annual Stop Loss Fixed Costs; $21,715.20 Medical Claims Administration ACCOUNT NO: BUDGETED AMOUNT REMAINING: Costs are absorbed through the 2010 health plan funding level. ATTACHMENTS: Comparison of Stop Loss Proposals CONCURRENCE WITH REQUESTED ACTION: CATEGORY: General GENERAL MANAGER: YES NO CHIEF FINANCIAL OFFICER: YES NO -10- South Tahoe Public Utility District Comparison of Stop Loss Proposals Exhibit 5 Level Covers $65,000 $65,000 $75,000 $65,000 $75,000 Contract Basis Medical & RX Medical & RX Medical & RX Medical & RX Medical & RX Lifetime Maxlmim 15/12 $1,935.000 15/12 $1.935.000 15/12 $1.926.000 15/12 $1.935,000 15/12 $1.926.000 Laser Included 1 . �. c Premiums: c . Single Family 21 $79.31 $119.87 $105.96 $125.62 $107.01 Monthly Cost 100 $194.98 $21,163.51 $295.84 $32,101.27 $261.25 $28,350.16 $277.62 $30,400.02 $240.98 $26,345.21 Annual Cost $253,962.12 $385,215.24 $340,201.92 $364,800.24 $316,142.52 S Incl case 1% Increase $131,253.12 :i :i Aggregate stop Loss Attached At Covers 125% 125% 125% 125% 125% Contract Basis Medical & RX Medical & RX Medical & RX Medical & RX Medical & RX Minimum Attachment 15112 95% 15/12 95% 15/12 95% 15/12 95% 15/12 Aggregate Maximum $1,000,000 $1,000,000 $1,000,000 $1,000,000 95% $1,000,000 Monthly Acxomodation Not included Not included Not included Not included Not included Premiums: Single 121 $10.88 $10.03 $10.09 $10.35 $10.35 Monthly Cost $1,316.48 $1,213.63 $1,220.89 $1,252.35 $1,252.35 Annual Cost $15,797.76 $14,563.56 $14,650.68 $15,028.20 $15,028.20 0: Combined Fixed Costs Monthly Cost: $22,479.99 $33,314.90 $29,571.05 $31,652.37 $27,597.56 Annual Cost: $269,759.88 $399,778.80 $354,852.60 $379,828.44 $331,170.72 Claims Liability Levels Maximum Liability Single Family 21 $935.34 $837.45 $851.69 $728.26 $738.65 Monthly Max Liability 100 $2,324.32 $252,074.14 $2,081.07 $225,693.45 $2,116.45 $229,530.49 $1,809.72 $196,265.46 $1,835.54 $199,065.65 Annual Maximum Liability $3,024,889.68 $2,708,321.40 $2, 754, 365.88 $2,355,185.52 $2,388,787.80 Increase 'Y,, . �. c Increase c . Maximum Total Costs Annual Fixed Costs $269,759.88 $399,778.80 $354,852.60 $379,828.44 $331,170.72 Annual Claims Liability Total Annual Uabllity $3,024,889.68 $3,294,649.58 $2,708,321.40 $3,108,100.20 $2,754,365.88 $3,109,218.48 $2,355,185.52 $2,735,013.96 $2,388,787.80 $2,719,958.52 'Please note, Gerber costs are not finalized until review of claims through 11/30/2009 are reviewed by the underwriter and individuals with claims in excess of $25,000 are reviewed for prognosis. QBE quote is final. 1 s�n�nt etaf�n� -11- � rw General Manager (i ;hard H, 5A63 { y ` Erni Claudio James R. Jones PuHlo Utility Ph5triot `����'"'��`"w IM Meadow Cruet Drive + South Lake Tahoe + CA 96150 Phone 530 544 -6474 • Fax BW 541 -0644 BOARD AGENDA ITEM 7b TO: Board of Directors FROM: Nancy Hussmann, Human Resources Director MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: Plan Document for Self Insured Health Plan REQUESTED BOARD ACTION: Approve revisions to Plan Document. DISCUSSION: Effective January 1, 2010, there are two federal mandates pertaining to health insurance coverage: (1) Mental Health Parity Act and (2) Michelle's Law. The Mental Health Parity Act requires that if a Plan offers coverage for Mental Health and /or Substance Abuse treatment, that coverage should be the same as any other illness or injury, with no limitations imposed as far as maximum benefits payable. The District's plan covers mental health and substance abuse treatment, therefore all previous limitations have been removed (pages 23, 24, 31, 32, and 37). Michelle's law states that if a dependent child is attending post - secondary school and is required to take a leave of absence due to a serious iflness or injury, coverage shall be continued for one year, or until reaching the maximum age of 25. Language was added to page 18 of the Plan Document to comply with this federal mandate. Additionally, the District changed the provisions for Occupational and Physical Therapy, allowing for coverage to be combined to a total Calendar Year Maximum of $3,000, when recommended by the attending physician. This is due to the fact that the $1,500 annual maximum has not changed since 1997 and several Plan Exception Requests authorizing $3,000 combined OT /PT benefits have been granted to address the rising cost of physical therapy. These changes are reflected on pages 34 and 35 of the Plan Document. Clarification was also made to the Child Wellness Guidelines on page 26, due to concerns raised by participants and physicians about unnecessary tests being required of young children. The new language eliminates the requirement for x -rays and clarifies the type of hearing, vision, lab and urinalysis tests that can be performed. One other change was the addition of Foot Surgery on page 37, which authorizes Ossatron procedures for Plantar Fasciitis and bone spurs, due to Plan Exceptions that have been granted for this more cost effective treatment of those diagnoses. —13— Nancy Hussmann December 3, 2009 Page 2 The District met and conferred with the Union and Management Representatives regarding these changes and has reached agreement on the changes noted above. SCHEDULE: December 4, 2009 — Begin distribution to plan participants and plan training for plan participants regarding changes. COSTS: ACCOUNT NO: BUDGETED AMOUNT REMAINING: Any financial impact will be absorbed into the 2010 funding level. ATTACHMENTS: Plan Document for Employees' Benefit Plan CONCURRENCE WITH REQUESTED ACTION: CATEGORY: General GENERAL MANAGER: YES 4N,4 NO CHIEF FINANCIAL OFFICER: YES NO -14- Plan Document and Summary Plan Description For South Tahoe Public Utility District Employees' Benefit Plan Implemented January 1, 1997 Updated January 1, 1998 Updated May 12, 2000 Updated January 1, 2004 Updated January 1, 2007 Updated January 1, 2008 Updated January 1, 2010 -15- Introduction This document is a description of the South Tahoe Public Utility District Employees' Benefit Plan (the Plan). The Plan described is designed to protect Plan Participants against catastrophic health expenses, as well as for more routine medical, dental, and prescription needs. This Plan is intended to provide the Employee and eligible dependents health insurance coverage for preventive care, routine services and minor injuries and illnesses, in addition to providing coverage for catastrophic illness or injury. This Plan can ease financial burdens by providing reimbursement for the great majority of covered expenses. This document summarizes the Plan rights and benefits for covered Employees and their Dependents and is divided into the following parts: -16- Table of Contents Section page # Special Notices Newborns & Mothers Health Protection Act and Women's Health & Cancer Rights Act .............................................. ............................... l COBRA Notification Procedures Provides an overview of the COBRA Notification Requirements ..... ..............................1 Defined Terms Defines those Plan terms that have a specific meaning ...................... ..............................4 Eligibility, Funding, Effective Date, and Termination Explains eligibility for coverage under the Plan, funding of the Plan, and when the coverage takes effect and terminates ........................... .............................11 Schedule of Benefits Provides an outline of the Plan reimbursement formulas, as well as payment limits on certain services .................................... .............................19 Wellness Program Guidelines ......................................................... .............................25 Notes for Schedule of Benefits, Benefit Descriptions & Benefit Limits Explains when the benefit applies, the types of charges covered, and the limits applicable for certain conditions or treatment methods ...........................29 Prescription Drug Benefit Provides an outline of the Plan reimbursement formulas as well as payment limits regarding prescription drugs ..................................... .............................38 Dental Benefits Provides an outline of the Plan reimbursement formulas as well as payment limits on certain dental services .......................................... .............................42 Medical Management Services Explains the methods used to curb unnecessary and excessive charges This part should be read carefully since each Participant is required to take action to assure that the maximum payment levels under the Plan arepaid........... .................................................................................. .............................48 Case Management Services Explains voluntary program where catastrophic conditions are monitored and care coordinated to provide the most appropriate level of care .. .............................52 -17- Table of Contents — Continued Section Page # Plan Exclusions Shows what charges are not covered ................................................. .............................53 Claim Provisions Explains the rules for filing claims .................................................... .............................57 Claim Denials Explains the provisions when a claim is denied in whole or in part .. .............................60 Appeal Procedures Explains the process for appealing a denied claim ............................ .............................60 Coordination of Benefits Shows the Plan payment order when a person is covered under more than one nlan ............................................................................. .............................63 Subrogation and Reimbursement Provisions Explains the Pan's rights to recover payment of charges when a Covered Person has a claim against another person because of injuries sustained ............ .............................67 COBRA Continuation Options Explains when a person's coverage under the Plan ceases, and the continuation options which are available .............................. .............................72 USERRA Continuation Coverage Explains continuation coverage for a covered Employee and covered Dependents who lose coverage due to service in the Uniformed Services .....................77 Plan Amendment Regarding HIPAA Privacy Compliance Explains the provisions of the Health Insurance Portability and Accountability Act of 1996 ......................................................... .............................79 Responsibilities for Plan Administration Outlines the duties and responsibilities of the Plan Administrator .... .............................83 General Plan Information Provides general plan information as required by federal law .......... .............................85 Attachments Attachment 1 Authorization for Release of Claim Information 87 Attachment 2 Claim Appeal Release of Medical Information Form 88 Attachment 3 Release of Medical Information Authorization for Request for Plan Exception 89 -18- Special Notices The Newborns and Mothers Health Protection Act Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean delivery. However, Federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). The Women's Health and Cancer Rights Act Under Federal law, the health benefits of most plans must include coverage for the following post - mastectomy services and supplies when provided in a manner determined in consultation between the attending physician and the patient: Reconstruction of the breast on which a mastectomy has been performed, 2. Surgery and reconstruction of the other breast to produce symmetrical appearance, 3. Breast prostheses, and 4. Physical complications of all stages of mastectomy, including lymphedemas. Plan participants must be notified, upon enrollment and annually thereafter, of the availability of benefits required due to the Women's Health and Cancer Rights Act (WHCRA). COBRA Notification Procedures Notice Responsibilities It is a Plan participant's responsibility to provide the following Notices relating to COBRA Continuation Coverage: Notice of Divorce or Separation — Notice of the occurrence of a Qualifying Event that is a divorce or legal separation of a covered Employee from his or her spouse. Notice of Child's Loss of Dependent Status — Notice of a Qualifying Event that is a child's loss of Dependent status under the Plan (e.g., a Dependent child reaching the maximum age limit). Page 1 of 89 -19- Notice of a Second Qualifying Event — Notice of the occurrence of a second Qualifying Event after a Qualified Beneficiary has become entitled to COBRA coverage with a maximum duration of 18 (or 29) months. Notice Regarding Disability — Notice that: 1. A Qualified Beneficiary entitled to receive COBRA Continuation Coverage with a maximum duration of 18 months has been determined by the Social Security Administration (SSA) to be disabled at any time during the first 60 days of continuation coverage, or 2. A Qualified Beneficiary as described in "1." Has subsequently been determined by the SSA to no longer be disabled. Notification Procedures Notification must be made in accordance with the following procedures. Any individual who is either the covered Employee, a Qualified Beneficiary with respect to the Qualifying Event, or any representative acting on behalf of the covered Employee or Qualified Beneficiary may provide the Notice. Notice by one individual shall satisfy any responsibility to provide Notice on behalf of all related Qualified Beneficiaries with respect to the Qualifying Event. Form or Means of Notification — Notification of the Qualifying Event must be provided to the District's Human Resources Department. Content — Notification must include any official documentation showing evidence that a Qualifying Event has occurred, such as a copy of a divorce decree, a child's birth certificate, a copy of the Social Security Administration's disability determination, etc. Delivery of Notification — Notification must be received by the District's Human Resources Department. Time Requirements for Notification — Should an event occur (as described in Notice Responsibilities above), the Employee, other Qualified Beneficiary, or a representative acting on behalf of any such person must provide Notice to the designated recipient within a certain time frame. In the case of divorce, legal separation or a child losing dependent status, Notice must be delivered within 60 days from the later of: 1. The date of the Qualifying Event, 2. The date health plan coverage is lost due to the event, or 3. The date the Qualified Beneficiary is notified of the obligation to provide Notice through the Summary Plan Description or the Plan Sponsor's General COBRA Notice. If Notice is not received within the 60 -day period, COBRA Continuation Coverage will not be available, except in the case of a loss of coverage due to foreign competition Page 2 of 89 -20- where a second COBRA election period may be available — see "Effect of the Trade Act" in the COBRA Continuation Coverage section of this Plan Document. If an Employee or Qualified Beneficiary is determined to be disabled under the Social Security Act, Notice must be delivered within 60 days from the later o£ 1. The date of the determination, 2. The date of the Qualifying Event, 3. The date coverage is lost as a result of the Qualifying Event, or 4. The date the covered Employee or Qualified Beneficiary is advised of the Notice obligation through the Plan Document or the Plan Sponsor's General COBRA Notice. Also, Notice must be provided within the 18 -month COBRA coverage period. Page 3 of 89 -21- Defined Terms The following terms have special meanings and when used in this Plan will be capitalized. Active Employee is an Employee who performs all of the duties of his or her job with the Employer on a full -time basis. Ambulatory Surgical Center is a licensed facility that is used mainly for performing outpatient surgery, has a staff of Physicians, has continuous Physicians and nursing care by registered nurses (R.N.$) and does not provide for overnight stays. Baseline shall mean the initial Test Results to which the results in future years will be compared in order to detect abnormalities. Birthing Center means any freestanding health facility, place, professional office or institution which is not a Hospital or in a Hospital, where births occur in a home -like atmosphere. This facility must be licensed and operated in accordance with the laws pertaining to Birthing Centers in the jurisdiction where the facility is located. The Birthing Center must provide facilities for obstetrical delivery and short-term recovery after delivery in compliance with the Mothers and Newborns Protection Act; provide care under the full -time supervision of a Physician and either a registered nurse (R.N.) or a licensed nurse - midwife; and have a written agreement with a Hospital in the same locality for immediate acceptance of patients who develop complications or require pre- or post - delivery confinement. Calendar Year means January I through December 31 sc of the same year. COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended. Claims Administrator /Contract Administrator — A company that performs all functions reasonably related to the administration of one or more benefits of the Plan (e.g., processing of claims for payment in accordance with the terms and conditions of the Benefit Document and an administration agreement between the Contract Administrator and the Plan Sponsor. Cosmetic Surgery means medically unnecessary surgical procedures, usually, but not limited to, plastic surgery directed toward preserving beauty or correcting scars, burns or disfigurements. Covered Person is an Employee, Dependent, or Active Board Member who is covered under this Plan. Page 4 of 89 —22— Custodial Care is care (including room and board needed to provide that care) that is given principally for personal hygiene or for assistance in daily activities and can, according to generally accepted medical standards, be performed by persons who have no medical training. Examples of Custodial Care are help in walking and getting out of bed; assistance in bathing, dressing, feeding; or supervision over medication which could normally be self - administered. Dentist is a person who is properly trained and licensed to practice dentistry and who is practicing within the scope of such license. Durable Medical Equipment means equipment which (a) can withstand repeated use; (b) is primarily and customarily used to serve a medical purpose; (c) generally is not useful to a person in the absence of an Illness or Injury and (d) is appropriate for use in the home. Employee means a person who is an Active, regular Employee of the Employer, regularly scheduled to work for the Employer in an Employee/Employer relationship. Experimental and /or Investigational means services, supplies, care and treatment which do not constitute accepted medical practice properly within the range of appropriate medical practice under the standards of the case and by the standards of a reasonably substantial, qualified, responsible, relevant segment of the medical community or government oversight agencies at the time services were rendered. The Plan Administrator, or his/her designee, must make an independent evaluation of the experimental /non - experimental standings of specific technologies. The Plan Administrator, or his/her designee shall be guided by reasonable interpretation of Plan provisions. The decisions shall be made in good faith and rendered following a detailed factual background investigation of the claim and the proposed treatment. The Plan Administrator, or his/her designee will be guided by the following principles: 1. If the drug or device cannot be lawfully marketed without approval of the U.S. Food and Drug Administration and approval for marketing has not been given at the time the drug or device is furnished; or 2. If the drug, device, medical treatment or procedure, or the patient informed consent document utilized with the drug, device, treatment or procedure, was reviewed and approved by the treating facility's Institutional Review Board or other body serving a similar function, or if the federal law requires such review or approval; or 3. If Reliable Evidence shows that the drug, device, medical treatment or procedure is the subject of on -going phase I or phase II clinical trials, is the research, experimental, study or investigational arm of on -going phase III clinical trials, or is otherwise under study to determine its maximum tolerated dose, its toxicity, its Page 5 of 89 -23- safety, its efficacy or its efficacy as compared with a standard means of treatment or diagnosis; or 4. If Reliable Evidence shows that the prevailing opinion among experts regarding the drug, device, medical treatment or procedure is that further studies or clinical trials are necessary to determine its maximum tolerated dose, its toxicity, its safety, its efficacy or its efficacy as compared with a standard means of treatment or diagnosis. Reliable Evidence shall mean only published reports and articles in the authoritative medical and scientific literature; the written protocol or protocols used by the treating facility or the protocol(s) of another facility studying substantially the same drug, device, medical treatment or procedure; or the written informed consent used by the treating facility or by another facility studying substantially the same drug, device, medical treatment or procedure. Family Unit is the covered Employee and the family members who are covered as Dependents under the Plan. Generic Drug means a Prescription Drug which has the equivalency of the brand name drug with the same use and metabolic disintegration. This Plan will consider as a Generic Drug any Food and Drug Administration- approved generic pharmaceutical dispensed according to the professional standards of a licensed pharmacist and clearly designated by the pharmacist as being generic. Home Health Care Agency is an organization that meets all of these tests: its main function is to provide Home Health Care Services and Supplies; it is federally certified as a Home Health Care Agency; and it is licensed by the state in which it is located, if licensing is required. Home Health Care Services and Supplies include: part-time or intermittent nursing care by or under the supervision of a registered nurse (R.N.); part -time or intermittent home health aide services provided through a Home Health Care Agency (this does not include general housekeeping services); physical, occupational and speech therapy; medical supplies; and laboratory services by or on behalf of the Hospital. Hospice Agency is an organization where its main function is to provide Hospice Care Services and Supplies and it is licensed by the state in which it is located, if licensing is required. Hospice Care Plan is a plan of terminal patient care that is established and conducted by a Hospice Agency and supervised by a Physician. Hospice Care Services and Supplies are those provided through a Hospice Agency and under a Hospice Care Plan and include inpatient care in a Hospice Unit or other licensed facility, home care, and family counseling during the bereavement period. Page 6 of 84 -24- Hospice Unit is a facility or separate Hospital Unit, that provides treatment under a Hospice Care Plan and admits at least two unrelated persons who are expected to die within six months. Hospital is an institution which is engaged primarily in providing medical care and treatment of sick and injured persons on an inpatient basis at the patient's expense and which fully meets these tests: it is accredited as a Hospital by the Joint Commission on Accreditation of Healthcare Organizations; it is approved by Medicare as a Hospital; it maintains diagnostic and therapeutic facilities on the premises for surgical and medical diagnosis and treatment of sick and injured persons by or under the supervision of a staff of Physicians; it continuously provides on the premises 24- hour -a -day nursing services by or under the supervision of registered nurses (R.N.$); and it is operated continuously with organized facilities for operative surgery on the premises. The definition of "Hospital" shall be expanded to include the following: • A facility operating legally as a psychiatric Hospital or residential treatment facility for mental health and licensed as such by the state in which the facility operates. A facility operating primarily for the treatment of Substance Abuse if it meets these tests: maintains permanent and full -time facilities for bed care and full -time confinement of at least 15 residential patients; has a Physician in regular attendance; continuously provides 24 -hour a day nursing service by a registered nurse (R.N.); has a full -time psychiatrist or psychologist on the staff; and is primarily engaged in providing diagnostic and therapeutic services and facilities for treatment of Substance Abuse. Illness is, for all persons: Sickness, disease, or Pregnancy. Injury means an accidental physical injury to the body caused by unexpected external means. Intensive Care Unit is defined as a separate, clearly designated service area which is maintained within a Hospital solely for the care and treatment of patients who are critically ill. This also includes what is referred to as a "coronary care unit" or an "acute care unit ". It has: facilities for special nursing care not available in regular rooms and wards of the Hospital; special life saving equipment which is immediately available at all times; at least two beds for the accommodation of the critically ill; and at least one registered nurse (R.N.) in continuous and constant attendance 24 hours a day. Lifetime is a word that appears in this Plan in reference to benefit maximums and limitations. Lifetime is understood to mean while covered under this Plan. Under no circumstances does Lifetime mean during the lifetime of the Covered Person. Page 7 of 89 -25- Medical Care Facility means a Hospital, or a facility that treats one or more specific ailments or any type of Skilled Nursing Facility. Medical Emergency means a sudden onset of a condition with acute symptoms requiring immediate medical care and includes such conditions as heart attacks, cardiovascular accidents, poisonings, loss of consciousness or respiration, convulsions or other such acute medical conditions. Medically Necessary care and treatment is recommended or approved by a Physician; is consistent with the patient's condition or accepted standards of good medical practice; is medically proven to be effective treatment of the condition; is not performed mainly for the convenience of the patient or provider of medical services; is not conducted for research purposes; and is the most appropriate level of services which can be safely provided to the patient. All of these criteria must be met; merely because a Physician recommends or approves certain care does not mean that it is Medically Necessary. Medicare is the Health Insurance for the Aged and Disabled program under Title XVIII of the Social Security Act, as amended. Mental Disorder means any disease or condition that is classified as a mental Disorder in the current edition of International Classification of Diseases published by the U.S. Department of Health and Human Services or is listed in the current edition of Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Morbid Obesity is a diagnosed condition in which the body weight exceeds the medically recommended weight by either 100 pounds or is twice the medically recommended weight in the most recent Metropolitan Life Insurance Co. tables for a person of the same height, age, and mobility as the Covered Person. No -Fault Auto Insurance is the basic reparations provision of a law providing for payments without determining fault in connection with automobile accidents. Outpatient Care is treatment including services, supplies and medicines provided and used at a Hospital under the direction of a Physician to a person not admitted as a registered bed patient; or services rendered in a Physician's office, laboratory or X -ray facility, an Ambulatory Surgical Center, or the patient's home. Pharmacy means a licensed establishment where covered Prescription Drugs are filled and dispensed by a pharmacist licensed under the laws of the state where he or she practices. Physician means a Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), Doctor of Dental Surgery (D.D.S.), Doctor of Podiatry (D.P.M.), Doctor of Chiropractic (D.C.), Page 8 of 89 -26- Audiologist, Certified Nurse Anesthetist, Licensed Professional Counselor, Licensed Professional Physical Therapist, Midwife, Occupational Therapist, Optometrist (O.D.), Physiotherapist, Psychiatrist, Psychologist (Ph.D.), Speech Language Pathologist and any other practitioner of the healing arts who is licensed and regulated by a state or federal agency and is acting within the scope of his or her license. Plan or Plan Program means South Tahoe Public Utility District Employees' Benefit Plan, which is a benefits plan for certain employees of South Tahoe Public Utility District, and is described in this document. Plan Participant is any Employee or Dependent who is covered under this Plan. Plan Year is the 12 -month period beginning on the effective date of the Plan. Pregnancy is childbirth and conditions associated with Pregnancy, including complications. Preferred Provider Organization (PPO) means the currently designated networks of discounting providers for which the Plan provides financial incentive to plan participants. Selection of PPO providers by participants results in the highest plan benefits. The Plan may enter into other discounting arrangements with non -PPO designated providers. When a participant uses one of these providers, benefits will be paid at the non -PPO percentage, however the non -PPO co- insurance will be payable on a smaller (e.g., negotiated) amount. Prescription Drug means any of the following: a drug or medicine which, under federal law, is required to bear the legend: "Caution: federal law prohibits dispensing without prescription "; injectable insulin, Imitrex, Glucagon, prescribed Bee Sting Kits for allergic Covered Persons, or other approved injectables as defined in the Prescription Drug section; hypodermic needles or syringes, but only when dispensed upon a written prescription of a licensed Physician. Such Drug must be Medically Necessary in the treatment of a Sickness or Injury. Sickness is, for all persons: Illness, disease or Pregnancy. Skilled Nursing Facility is a facility that fully meets all of these tests: 1. It is licensed to provide professional nursing services on an inpatient basis to persons convalescing from Injury or Sickness. The service must be rendered by a registered nurse (R.N.) or by a licensed practical nurse (L.P.N.) under the direction of a registered nurse (R.N.). Services to help restore patients to self -care in essential daily living activities must be provided. 2. Its services are provided for compensation and under the full -time supervision of a Physician. Page 9 of 89 -27- 3. It provides 24 -hour per day nursing services by licensed nurses, under the direction of a full -time registered nurse. 4. It maintains a complete medical record on each patient. S. It has an effective utilization review plan. 6. It is not, other than incidentally, a place for rest, the aged, drug addicts, alcoholics, mental retardates, Custodial or educational care or care of Mental Disorders. 7. It is approved and Iicensed by Medicare. This term also applies to charges incurred in a facility referring to itself as an extended care facility, convalescent nursing home or any other similar nomenclature. Spinal Manipulation/Chiropractic Care means skeletal adjustments, manipulation or other treatment in connection with the detection and correction by manual or mechanical means of structural imbalance or subluxation in the human body. Such treatment is done by a Physician to remove nerve interference resulting from, or related to, distortion, misalignment or subluxation of, or in, the vertebral column. Massage therapy is not included as a covered benefit. Substance Abuse is the condition caused by regular excessive compulsive drinking of alcohol and/or physical habitual dependence on drugs that results in a chronic disorder affecting physical health and/or personal or social functioning. This does not include dependence on tobacco and ordinary caffeine - containing drinks. Temporomandibular Joint (TMJ) syndrome is the treatment of jaw joint disorders including conditions of structures linking the jaw bone and skull and the complex muscles, nerves and other tissues related to the temporomandibular joint. Usual, Customary and Reasonable Charge (UCR) is a charge which is not higher than the usual charge made by the provider of the care or supply and does not exceed the usual charge made by most providers of like service in the same area. This test will consider the nature and severity of the condition being treated. It will also consider medical complications or unusual circumstances that require more time, skill or experience. For services, supplies or fees where publications of Usual, Customary, and Reasonable Charges are not available, the Claims Administrator shall survey local or nearest geographic providers of the same service to determine the allowable Usual, Customary, and Reasonable Charges utilizing applicable local resources. Page 10 of 89 -28- ElieiWRY, Fundine, Effective Date & Termination Provisions Eligribili Eligible Classes of Employees The following Classes of Employees are considered eligible classes of Employees: 1. All Active Full -Time Employees of the Employer. An Employee is considered to be Full -Time if he or she normally works at least 20 hours per week and is on the regular payroll of the Employer for that work. 2. Active members of the Board of Directors. 3. Those persons formerly covered under the Board/Management insurance plan prior to I/ 1 /96, who are not otherwise classified in #1 or #2 above. 4. Any other persons who become eligible in accordance with the Memorandum of Understanding in effect at the time they would otherwise be considered ineligible. Eligibility Requirements for Employee Coverage A person is eligible for Employee coverage on the first day of the Calendar month following date of hire. Eligible Classes of Dependents Dependent is any one of the following persons: A covered Employee's Spouse and unmarried children from birth to the limiting age of 19 years. However, a Dependent child will continue to be covered after age 19, provided the child is a full -time student at an accredited school, primarily dependent upon the covered Employee for support and maintenance, is unmarried and under the limiting age of 25. When the child reaches either limiting age, coverage will end on the last day of the child's birthday month. The term "Spouse" shall mean the person recognized as the covered Employee's husband or wife under the laws of the state where the covered Employee lives. The Plan Administrator may require documentation proving a legal marital relationship. The term "children" shall include natural children, adopted children or Step- children who reside in the Employee's household, including those with court order that mandates dependent coverage. However, if a dependent is enrolled in a mandatory full -time (40 hour /week) unpaid internship as a mandatory Page 11 of 89 -29- requirements of their degree program, and such unpaid internship results in enrollment in less than 12 units, such dependent shall continue to be eligible for coverage for that semester. Satisfactory documentation of same will be required to be provided to the Plan Administrator, and shall include verification from the accredited school. The phrase "primarily dependent upon" shall mean dependent upon the covered Employee for support and maintenance as defined by the Internal Revenue Code and the covered Employee must declare the child as an income tax deduction or have a court order mandating that employee provide dependent coverage. The Plan Administrator may require documentation proving dependency, including birth certificates, tax records or initiation of legal proceeding severing parental rights, 2. A covered Dependent child who is incapable of self - sustaining employment by reason of mental retardation or physical handicap, primarily dependent upon the covered Employee for support and maintenance, unmarried, and covered under the Plan when reaching the limiting age. The Plan Administrator may require, at reasonable intervals during the two years following the Dependent's reaching the limiting age, subsequent proof of the child's disability and dependency. After such two -year period, the Plan Administrator may require subsequent proof not more than once each year. The Plan Administrator reserves the right to have such Dependent examined by a Physician of the Plan Administrator's choice, at the Plan's expense, to determine the existence of such incapacity. These persons are excluded as Dependents: 1. Other individuals living in the covered Employee's home, but who are not eligible as defined; 2. The legally separated or divorced former Spouse of the Employee; 3. Any person who is on active duty in any military service of any country. If a person covered under this Plan changes status from Employee to Dependent or Dependent to Employee, and the person is covered continuously under this Plan before, during, and after the change in status, credit will be given for all amounts applied to maximums. If both husband and wife are Employees, their children will be covered as Dependents of both. Page 12 of 89 -30- Eligibility Requirements for Dependent Coverage A family member of an Employee will become eligible for Dependent coverage on the first day that the family member satisfies the requirements for Dependent coverage. At any time, the Plan may require proof that a Spouse or a child qualifies or continues to qualify as a Dependent as defined by this Plan. Funding Cost of the Plan South Tahoe Public Utility District pays the entire cost of Employee and Dependent coverage under this Plan. Enrollment Enrollment Requirements An eligible Employee or eligible Board Member must enroll for coverage by filling out and signing an enrollment application. The covered Employee or Board Member is required to enroll for Dependent coverage also, including coverage for newborn children. Enrollment Requirements for Newborn Children A newborn child of a Plan Participant is covered under the parent's coverage for routine nursery care covered under this Plan. For coverage of Sickness or Injury, including Medically Necessary care and treatment of congenital defects, birth abnormalities or complications resulting from prematurity, the newborn child must be enrolled as a Dependent under this Plan within 31 days of the child's birth in order for non - routine coverage to take effect from birth. If the child is not enrolled within 31 days of birth, the enrollment will be considered a Late Enrollment. Timely and Late Enrollments An enrollment is either "timely" or "late ": 1. Timely Enrollment — The enrollment will be "timely" if the completed form is received by the Plan Administrator no later than 31 days after the person becomes eligible for the coverage. 2. Late Enrollment — Late enrollment is accepted at the next Annual Enrollment Period. Page 13 of 89 -31- Effective Date Effective Date of Employee Coverage An Employee or Board Member will be covered under this Plan as of the first day of the calendar month following the date that the Employee or Board Member satisfies all of the following: Eligibility Requirement 2. The Enrollment Requirements of the Plan Effective Date of Dependent Coverage A Dependent will be covered under this Plan on the first date that the Dependent satisfies all of the following: 1. Eligibility Requirement 2. Enrollment Requirements of the Plan Coverage for a subsequent Dependent is effective, upon enrollment, as follows: For a spouse, the date of marriage; 2. For a newborn child, the date of birth; 3. For an adopted child, the date of adoption or placement for adoption; 4. For any other child, the date the child becomes a Dependent. Enrollment Periods The Initial Eligibility Period is the 31 -day period which begins on the date the Employee or Board Member is first eligible under this Plan. The District must offer enrollment during that time and advise the employee of the deadline. Employees and/or Dependents who are not enrolled during the Initial Eligibility Period, or a Special Enrollment Period, through the Employee's election or omission, must wait until the next Annual Enrollment Period to enroll for coverage. The Annual Enrollment Period is designated by the Employer as December of each year. It is held before the start of each Plan Year. During this period, all eligible Employees and Dependents can enroll for coverage. Page 14 of 89 -32- Special Enrollment Periods are available to certain persons who have lost other coverage and to certain dependents. A Special Enrollment Period is available to a covered Employee's spouse or minor child if a court orders that coverage must be provided under this Plan and the request for enrollment is made within 30 days after the issuance of the order. A Special Enrollment Period is available to a person who meets each of the following conditions: 2. The Employee or Dependent was covered under a group health plan or had health insurance coverage or was covered under no- share -of -cost Medi -Cal coverage at the time coverage under this Plan was previously offered to the Employee or Dependent. 3. The Employee stated in writing, at the time coverage was previously offered, that the other coverage was the reason for declining enrollment under this Plan. The Employer must have requested the statement and provided the Employee with notice of this requirement (and its consequences) at that time. If the Employer cannot produce the signed waiver form at the time the person wants to enroll, the provision does not apply. 4. The Employee's or Dependent's prior coverage was one of the following: A. COBRA continuation which was exhausted. B. Non -COBRA coverage which was terminated either as a result of loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment) or employer contributions towards such coverage where terminated. C. The Employee requests enrollment under this Plan not later than 31 days after the date of the end of COBRA continuation, termination of coverage, or termination of Employer contribution. A Special Enrollment Period is available to Subsequent Dependents. The Dependent Special Enrollment Period is the 31 -day period which begins with the date the person becomes a dependent. If a Subsequent Dependent is enrolled, the Employee must enroll at the same time if not already covered. In addition, any of the Employee's other Dependents may be enrolled at the same time, if not already covered, subject to the same enrollment requirements. "Subsequent Dependent" includes a spouse or child of an eligible Employee whose coverage is ordered by the court. The request for enrollment must be made within 30 days after issuance of the order. Page 15 of 89 -33- Qualified Medical Child Support Orders In the event a court order provides that coverage under the Plan or some portion thereof, must be provided for your minor child, the following rules will apply: 1. You must submit the order in a timely manner to the Plan Administrator. The Plan Administrator will notify you and your child that the order has been received and what procedures will be used to determine if the order is a qualified medical child support order within the meaning of Section 609 of ERISA. The Plan Administrator will decide whether the order is qualified and notify the Participant and the Participant's child of that decision. 2. If the Plan Administrator determines that the order is qualified, the Plan Administrator shall permit an alternate recipient (as defined in ERISA Section 609(a)(2)(C)) to designate a representative for recipient of copies of notices that are sent to the alternate recipient with respect to the medical child support order. 3. If the Plan Administrator determines that the circumstances surrounding the court order constitutes and/or satisfies the change in family status requirements under the Plan, then you will be permitted to change your election of benefits under the Plan Programs. Termination of Coverage When Employee Coverage Terminates Employee or Board Member's coverage will terminate on the earliest of these dates (except in certain circumstances, a covered Employee may be eligible for COBRA continuation coverage. For a complete explanation of when COBRA continuation coverage is available, what conditions apply, and how to select it, see the section entitled COBRA Continuation Option): 1. The date the Plan is terminated. 2. The last day of the calendar month in which the covered Employee ceases to be in one of the Eligible Classes. This includes death or termination of employment of the covered Employee. (See the COBRA Continuation Option) Continuation During Periods of Employer - Certified Disability, Leave of Absence or Layoff A person may remain eligible for a limited time if active, full -time work ceases due to disability, leave of absence or layoff. Limited eligibility shall be determined by the negotiated Memorandum of Understanding between the applicable employee group and the District. Page 16 of 89 -34- While continued, coverage will be that which was in force on the last day worked as an Active Employee. However, if benefits reduce for others in the class, they will also reduce for the continued person. Continuation During Family and Medical Leave Regardless of the established leave policies mentioned above, this Plan shall at all times comply with the Family and Medical Leave Act of 1993 as promulgated in regulations issued by the Department of Labor. During any leave taken under the Family and Medical Leave Act, the Employer will maintain coverage under this Plan on the same conditions as coverage would have been provided if the covered Employee had been continuously employed during the entire leave period. If Plan coverage terminates during the FMLA leave, coverage will be reinstated for the Employee and his or her eligible Dependents if the Employee returns to work in accordance with the terms of the FMLA leave. Coverage will be reinstated only if the person(s) had coverage under this Plan when the FMLA leave started, and will be reinstated to the same extent that it was in force when that coverage terminated. Rehiring a Terminated Employee A terminated Employee who is rehired will be treated as a new hire and will be required to satisfy all Eligibility and Enrollment requirements, with the exception of an Employee returning to work directly from COBRA coverage. An Employee returning to work directly from COBRA coverage does not have to satisfy the employment waiting period. Employees on Military Leave Employees going into or returning from military service will have Plan rights mandated by the Uniformed Services Employment and Re- employment Rights Act. These rights include up to 18 months of extended health care coverage upon payment of the entire cost of coverage plus a reasonable administration fee and immediate coverage with no pre- existing conditions exclusions applied in the Plan upon return from service. These rights apply only to Employees and their Dependents covered under the Plan before leaving for military service. Plan exclusions and waiting periods may be imposed for any Sickness or Injury determined by the Secretary of Veterans Affairs to have been incurred in, or aggravated during, military service. When Dependent Coverage Terminates A Dependent's coverage will terminate on the earliest of these dates (except in certain circumstances, a covered Dependent may be eligible for COBRA continuation coverage. Page 17 of 89 -35- For a complete explanation of when COBRA continuation coverage is available, what conditions apply, and hpw to select it, see the section entitled COBRA Continuation Option): 1. The date the Plan is terminated. 2. The date that the Employee's or Board Member's coverage under the Plan terminates for any reason including death (See the COBRA Continuation Option). 3. The date De indent coverage is terminated under the Plan. 4. On the last clay 'df the month that follows the first date that he or she ceases to be a Dependent as defined by the Plan (See eligibility for dependents). In compliance withMichelle Is Law, coverage will be continued for Dependent Children who are Post secondary school students who are required to take a leave of absence from scho, &*J to a serious illness or injury. Such leave and serious illness or injury, must, & 44!. 'nted by the school and treating physician. Under this provision, cdvet = not be terminated before the earlier of one year after the leave of absence begins;, or the date of which the child's coverage would otherwise terminate (as indicated in items 1 -3 above). Added due to federal mandate. 1 ! Page 18 of 89 -36- Schedule of Benefits Verification of Eligibility Call (800) 455 -4236 or (775) 352 -6900 to verify eligibility for Plan benefits before the charge is incurred Medical Benefits Note: The following non - emergency services must be pre - certified or reimbursement from the Plan will be reduced: • Hospitalizations; • MRI (on second or subsequent tests per year, • Skilled Nursing Facility stays; • Home Health Care; • Durable Medical Equipment exceeding $3,000; • Outpatient Surgical Procedures performed in an ambulatory surgical center, hospital, or free - standing surgical center; and • Prosthetics. Please see the Medical Management section in this booklet for details. Participating Provider Organization (PPO) This Plan has entered into an agreement with certain Hospitals, Physicians and other health care providers, which are called Participating Providers. Because these Participating Providers have agreed to charge reduced fees to persons covered under the Plan, the Plan can afford to reimburse a higher percentage of their fees. Therefore, when a Covered Person uses a Participating Provider, that Covered Person will receive a higher payment from the Plan than when a Non - Participating Provider is used. It is the Covered Person's choice as to which Provider to use. The District will reimburse the following providers, who currently are not participants in the self - insured plan preferred provider organization, as if they were participants in the self - insured plan preferred provider organization: Jose Aguirre, MD Meddirect Catherine Aisner, PhD Alison Monroe, MD — Alpine Family Practice Maggie Che MD Tony Naccarratto, DC Tony Cruz Viola Nungary, MFCC Thomas Dickey, MFCC Larry Pappas, MD Timothy Doyle, MD Jeanne Plumb, MD Page 19 of 89 -37- Lee Van Epps, MD Reno Ortho Appliance William Everts, MD Renown — for Designated Trauma Center Robert Flie ler, MD Carol Scott, MD Ron Gemberlin , MD Winston Serrano, MD Colleen Carr Hurwitz, MA D. Thekekkara, MD Renown Ned Jaleel, MD UCD Medical Center M. Mack, Chiropractor UCD Medical Grou Additional information about this option, as well as a list of Participating Providers will be given to covered Employees and updated as needed. Members who use a non - network Physician will need to file their own claim and make sure treatment is approved by the applicable Cost Management Services. Members who use a non - network provider for large claims may receive a negotiated discount to reduce claims costs. The Participant is not responsible for any negotiated discount obtained, however charges will be paid at the non -PPO benefit level. Allowable Covered Expenses All medical benefits are subject to allowable covered expense guidelines. Network providers have agreed to negotiated rates. Members are not responsible for expenses over the negotiated rates for covered services. Members are responsible for any applicable co -pays, deductibles, and coinsurance. For non - network providers, the allowable covered expense is determined by usual and customary charge guidelines. The usual and customary charge for each service or supply received will be the lesser of the fee usually charged by a provider and the fee usually charged by other providers in the same geographical area (Tahoe, Reno, Sacramento) for these services and supplies. When Participants utilize the services of a PPO network facility, such as hospital, emergency room, and/or diagnostic medical imaging facility, for which there are no network physicians, benefits will be paid at the higher PPO benefit level. Additionally, in the event an employee is required to utilize a non - network facility due to medical necessity, when there is no availability at a comparable network facility, benefits will be paid at the higher PPO benefit level. Page 20 of 89 -38- Deductibles /Co- Payments Payable by Plan Participants Deductibles and Co- Payments Deductibles and co- payments are dollar amounts that the Covered Person must pay before the Plan pays. A deductible is an amount of money that is paid once a Calendar Year per Covered Person. Typically, there is one deductible amount per Plan and it must be paid before any money is paid by the Plan for any covered service. This is an amount of covered charges for which no benefits will be paid. Before benefits can be paid in a Calendar Year, a Covered Person must meet the deductible shown below. Each January I", a new deductible amount is required. Deductibles do not accrue toward the 100% maximum out -of- pocket payment. A co- payment is a smaller amount of money that is paid each time a particular service is used. Typically, there may be co- payments on some services and other services will not have any co- payments. Co- payments do not accrue toward the 100% maximum out -of- pocket payment. Deductible Three -Month Carryover Covered expenses incurred in, and applied toward the deductible in October, November and December will be applied toward the deductible in the next Calendar Year. Family Unit Limit When the dollar amount shown in this Schedule of Benefits has been incurred by members of a Family Unit toward their Calendar Year deductibles, the deductibles of all members of that Family Unit will be considered satisfied for that year. Deductible for a Common Accident This provision applies when two or more Covered Persons in a Family Unit are injured in the same accident. These persons need not meet separate deductibles for treatment of injuries incurred in this accident; instead, only one deductible for the Calendar Year in which the accident occurred will be required for them as a unit. Incentives for Wellness Program Plan participants are encouraged to participate in the recommended Wellness Program outlined in this Plan Document with the goal of prevention and/or early detection of potential illnesses. Different Deductibles, Co -Pays, and Out of Pocket Maximums shall apply to Plan Participants who follow the Wellness Program guidelines than to those who do not follow the Wellness Program guidelines, as follows: Page 21 of 89 -39- Note: If the employee and all eligible dependents comprising the Family Unit, fail to participate in the recommended annual wellness testing program, the Family Unit's annual co -pays, deductibles, and out of pocket maximum will be increased for the subsequent year. The Calendar Year Deductible is waived for Second Surgical Opinions. Maximum Out -of- Pocket Payments, per Calendar Year The Plan will pay the percentage of covered charges designated in the Schedule of Benefits until the above amounts of out -of- pocket payments are reached, at which time the Plan will pay 100% of the remainder of covered charges for the rest of the Calendar Year, unless stated otherwise. The charges for the following do not apply to the 100% benefit limit and are never paid at 100% • Deductible(s) • Outpatient mental treatment charges • Outpatient substance abuse treatment charges • Cost containment penalties • Co- payments Medical Benefits Medical Benefits apply when covered charges are incurred by a Covered Person for care of an Injury or Sickness and while the person is covered for these benefits under the Plan. Benefit Payment Each Calendar Year, benefits will be paid for the covered charges of a Covered Person. Payment will be made at the rate shown under Percentage Payable in the Schedule of Benefits. No benefits will be paid in excess of the Maximum Benefit Amount or the "Benefit Limits" of the Plan. Page 22 of 89 -40- Deductible Co-Pay Out of Pocket Maximum Wellness Program PPO: $1000 Single Guidelines $100 Single $2000 Family Followed $200 Family $10 per office visit Non -PPO: $1500 Single $3000 Famil Wellness Program PPO: $2000 Single Guidelines Not $250 Single $4000 Family Followed $500 Single + 1 $20 per office visit Non -PPO: $750 Family $3000 Single (See Note below) $6000 Famil Note: If the employee and all eligible dependents comprising the Family Unit, fail to participate in the recommended annual wellness testing program, the Family Unit's annual co -pays, deductibles, and out of pocket maximum will be increased for the subsequent year. The Calendar Year Deductible is waived for Second Surgical Opinions. Maximum Out -of- Pocket Payments, per Calendar Year The Plan will pay the percentage of covered charges designated in the Schedule of Benefits until the above amounts of out -of- pocket payments are reached, at which time the Plan will pay 100% of the remainder of covered charges for the rest of the Calendar Year, unless stated otherwise. The charges for the following do not apply to the 100% benefit limit and are never paid at 100% • Deductible(s) • Outpatient mental treatment charges • Outpatient substance abuse treatment charges • Cost containment penalties • Co- payments Medical Benefits Medical Benefits apply when covered charges are incurred by a Covered Person for care of an Injury or Sickness and while the person is covered for these benefits under the Plan. Benefit Payment Each Calendar Year, benefits will be paid for the covered charges of a Covered Person. Payment will be made at the rate shown under Percentage Payable in the Schedule of Benefits. No benefits will be paid in excess of the Maximum Benefit Amount or the "Benefit Limits" of the Plan. Page 22 of 89 -40- Maximum Benefit Amounts The Maximum Benefit Amount is shown in the Schedule of Benefits. It is the total amount of benefits that will be paid under the Plan for all covered charges incurred by a Covered Person ; i•F • Lifetime, while covered ........................... ............................... $2,000,000 There are other maximums on individual benefits. These follow under; Benefit Limits. Schedule of Benefits Page 23 of 89 -41- % ; .. Co -Pay= Co -Pay or Benefit Payable % Payable - :, or Co -Xns Co -Ins Benefit Type Limits PPO Non -PPO'' , ! PPO NonPPO Acupuncture 52 visits 90% 70% : ` ,1'0 ° l0 . . , 30% combined with ; chiropractic Ambulance Per trip 90% 90% IO %' 10% max , Chiropractic 52 visits 90% 70% 1 4 W # o 30/0 combined Correct ' with t acupuncture Durable Medical 90% 70% 10% 30% Equipment' Emergency Room 90% 70% $50110% 30% Home Health Care 100 visits 90% 70% �. l`0 o 30% p er year Hospice Care $15,000 per 90% 70% 10% 30% lifetime Hospital Care /Services 90% 70% 10 %• 30% Immunizations 100% 70% $10 30% Injury to or Care of 90% 70% 10% 30% Mouth, Teeth & Gums 10 Mastectom 90% 70% 10% 30% Mental Health - 30 daysAw 90% 70% 10% 30% Inpatient Deleted per federal mandate Mental Health -Out, t 100% 70% $ i`0 30% Organ Transplant 100% 70% $10 30% Page 23 of 89 -41- Page 24 of 89 -42- % Co -Pay Co -Pay or Benefit Payable % Payable or Co -Ins Co -Ins Benefit.T "_ Limits PPO Non -PPO PPO NonPPO Other Med caj Serwic�s,; ; 90% 70% 10% 30% & Suppl s Out of Area liew a►t `; '' ' 80% 80% 20% 20% , Emergencies Outpatient Care & 90% 70% 10% 30% Services 25 Physical Thera ' , $1,500/ 90% 70% 10% 30% Physician 90% 70% 10% 30% Care /Ser , iCes17 R ' Physician's Office ; , 100% 70% $10 30% Visit Pregnancy - Employee; 90% 70% 10% 30% Spouse or Covered Child Prostheticsrthotics /O 90% 70% 10% 30% Wellness Program Care 100% 80% -0- 20% (See Wellness Ptogr= ,' ;i Guidelines Child Wellness ro 100% 80% -0- 20% Care (See Wellness Program Guidelines ) Wellness Program 100% 80% -0- 20% Testing (See Wellness Program Guidelines)" Second Surgical , 100% 100% -0- -0- Opinion 22 Skilled Nursing 100 days 90% 70% 10% 30% FacilitY Substance Abuse $20,000 90% 70% 10% 30% Treatment- Inpatient 24 1}fetie Deleted per federal mandate Substance Abuse 1 l 100% 70% fie -$73 $10 30% Treatment- Outpe Abeve Deleted due to . Deleted per federal federal mandate mandate Urgent Care Center 1 100% 70% I slo 30% Page 24 of 89 -42- Covered Charges Covered charges are the Usual and Reasonable Charges that are incurred for the following items of service and supply. These charges are subject to the "Benefit Limits" of this Plan. A charge is incurred on the date that the service or supply is performed or furnished. Wellness Program Guidelines Plan Participants are encouraged to be proactive in seeking out medical testing and wellness information for the prevention and early diagnosis of potential illnesses. It is the Plan Participant's responsibility to meet the Wellness Program Guidelines in order to qualify for the lower co -pays, deductibles, and out of pocket maximums. The Wellness Program's two -tier structure will become effective January 1, 2008. There is no change to current benefit levels prior to that date. Well care and wellness testing will be paid at 100% for PPO providers and at 80% for non -PPO providers, and will not be subject to the annual deductible. If a participant's physician recommends a more frequent exam and/or testing than the frequency described herein, due to medical history or physical exam, such extra exams and/or testing will not be paid at 100 %, but will be paid at the applicable PPO or Non -PPO benefit level for regular medical care. If a participant's physician states that due to health history and/or exam, a particular test or exam is not needed as frequently as is indicated herein, the participant must have the physician put such recommendation in writing and submit it to the Plan's Claims Administrator no later than the last day of the Calendar Year, so that there is no reduction in benefits for the following year. Benefit levels for new employees hired between January I" and June 30 and their dependents, or new Adult Dependents, will be at the lower deductibles, co -pays, and out - of pocket maximums until January 1 St of the following year. During this time, the employee and/or their dependents must meet the Wellness Program Guidelines. Benefit levels for new employees hired between July 1 St and December 31 and their dependents or new Adult Dependents, will be at the lower deductibles, co -pays, and out -of- pocket maximum until January 1 St following their one -year anniversary. During this time period, the employee and/or their dependents must meet the Wellness Program Guidelines. Any new employees and/or their dependents failing to meet the deadlines as stated above, will then be subject to the higher deductibles, co -pays, and out -of pocket maximums for the subsequent calendar year. The annual/bi- annual physical exams that are currently required for employees possessing a commercial license and/or who wear respirators, will be replaced by the full physical exams that are part of the Wellness Program Guidelines. The table below summarizes the Wellness Program Guidelines that are to be followed in order to qualify for the lower deductible, co -pay and out of pocket maximums: Page 25 of 89 -43- Wellness Proeram Guidelines Child Wellness es Children through 18 years of age shall receive a minimum of one annual physical exam, and young children way. receive more than one well -child exam, up to the Frequency Limits listed below. Benefit is payable at 100% with no deductible or co -pay for PPO Providers and 80.%'payable for non -PPO providers. Coverageed charges include the following routuo ; } es, as recommended by the physician: 1. Physic including whispered voice test Z Osion risk u&sessment via questions to parents/child and/or eye chart 3. Routine, preventive, non - diagnostic laboratory blood tests 4-- _ mys Routine, preventive, non - diagnostic urinalysis 6. Immunizations (See Immunization Requirements, below) i. The above is as cta j rwA' an so that unnecessary tests are not routinely ordered by the physi cidns; " Well Child Care Freauencv Limits Age ` Frequency Limit 1 S y ear of fife Seven visits 2no year of life . Three visits 3 throu `1$ ; ' life One visit per Calendar Year Child Immunization Requirements (Per 2006 CDC Recommendations Immunization I' Dose 2 Id Dose 3 Dose 4 Dose/Booster Diptheria, 2 months 4 months 6 months Between 15 and 18 months. Can Tetanus, Pertussis be given as early as 12 months (DTP/DTaP) as long as 6 months have passed . ' since third dose. Fourth dose should be given at the latest between 4 -6 years. Tetanus and If If If 11 -18 years: One booster dose if Diptheria (Td) previously previously previously the child has completed the completed completed completed DTP/DTaP series and has not yet received a booster for any reason. Hepatitis A t ' . - I hgonths 23 months N/a (Hep A) Given at least 6 ' months apart Page 26 of 89 ;� -44- Immunization 1 St Dose 2 Id Dose 3 Dose 4 th Dose/Booster Hepatitis B Birth 1 -2 months 6 -18 2 -18 years: Three dose series (Hep B) months given to all children under 18 Annually who didn't get the vaccine as weight, neck, pelvic, rectal, testicles & groin, X infants H. influenzae type 2 months 4 months 6 months b (Hib) or between rectal exam, hemoccult (stool occult blood), blood 12 -15 p ressure months Measles/Mumps, Between One month N/a Second dose is typically given Rubella (MMR) 12 -15 after first between 4 -6 years, and should be months dose given by 11 -12 years at the lastest. Pneumococcus 2 months 4 months 6 months 12 -15 months (PCV7) X X Chickenpox 12 -24 N/a N/a Can be given up to age 13 in a (Varicella, Var) months Thyroid-Stimulating Hormone (TSH ) Every 3 years child who has not contracted X X chickenpox Rotavirus (RV) 2 -3 months 4 -10 weeks 6 -8 months All three doses should be given X after the no later than 8 months. first dose Polio (IPV) 2 months 4 months Between 6- Between 4 -6 years Injectable Polio 18 months Vaccine Menin ococcal Age 13 -15 Age 18 Femailes — HPV Ages 9 -26 Immunization series Adult Wellness Program Guidelines Exam Test or Procedure Frequency 18 -25 26 -39 40 -49 50-64 65+ Comprehensive Physical Exam, including such items as abdomen, breasts, heart, height, Annually weight, neck, pelvic, rectal, testicles & groin, X X X X X vision/color, hearing (forced whisper), prostate rectal exam, hemoccult (stool occult blood), blood p ressure Fasting Complete Blood Count (CBC), Every 5 years X X Complete Metabolic Panel (CMP) & Every 2 years X Chemical Urinalysis Annually X X Fasting Lipid Profile Every 3 Years X X Thyroid-Stimulating Hormone (TSH ) Every 3 years X X TB Skin Every 5 years X X X X X Page 27 of 89 -45- Exam, Test or Procedure Frequency 18 -25 26 -39 40 -49 50 -64 65+ Resting EKG Baseline Age 30 Resting EKG Every 4 years X Stress EKG Every 3 years X X Colonoscopy Every 10 X X ears Bone Mineral Density Assessment (Central or Perpheral; CT not cov'd as Wellnesss) Every 3 yrs X X Women post menopausal Men At least One X Exam Test or Procedure Frequency 18 -25 26 -39 40 -49 50 -64 65+ Women Onl Pap/Pelvic Annually X To 30 Every 2 years 31 + X X Mammogram Baseline 35 -39 Every 2 years X Annually X X HPV immunization series Ages 19 -26 X To 26 Men Onl PSA Blood Test Annually X X Adult Immunization Guidelines an accordance with 2006 CDC Recommendations) Immunization Frequency or Booster Tetanus Td or Tdap if indicated Every 10 years at 30, 40, 50, 60, etc Influenza (flu) Annually if over 50 Pneumovax (pneumonia shot) Once over age 65 Page 28 of 89 -46- Notes for Schedule of Benefits Benefit Descriptions & Benefit Limits L Acupuncture: PPO is payable at 90% and Non -PPO is payable at 70 %, up to a maximum of 52 visits per Calendar Year, combined with Chiropractic services. 2. Ambulance: Covered Charges are for local Medically Necessary professional land or air ambulance service. A charge for this item will be a Covered Charge only if the service is to the nearest Hospital or Skilled Nursing Facility where necessary treatment can be provided, or the transfer from a non -PPO hospital to a PPO hospital, if approved by Universal Health Network. The Per Trip Maximum for Ambulance Services is paid at 90 %. 3. Chiropractic: PPO is payable at 90% and non -PPO is payable at 70% up to a maximum of 52 visits per Calendar Year, combined with Acupuncture services. Spinal manipulation/Chiropractic services will be paid as shown in the Schedule of Benefits, but does not include massage therapy. 4. Durable Medical Equipment: Covered charges include rental of durable medical or surgical equipment if deemed Medically Necessary up to the amount of purchase price. These items may be bought rather than rented, but only if agreed to in advance by the Plan Administrator. 5. Emergency Room: For Non - Emergency visits to the Emergency Room, a $50 co -pay will be charged in addition to the regular Calendar Year deductible before benefits are paid at either 90% (PPO) or 70% (Non -PPO). For Emergency visits, or if the Covered Person is admitted directly from the emergency room to the Hospital because of a Medical Emergency, this $50 co- payment will be waived and the Plan will apply only the Calendar Year deductible before paying benefits at either 90% or 70 %. Medical Emergency means a sudden onset of a condition with acute symptoms requiring immediate medical care and includes, but is not limited to, such conditions as heart attacks, cardiovascular accidents, poisonings, loss of consciousness or respiration, convulsions or other such acute medical conditions. 6. Home Health Care Services and Supplies: Home Health Care benefits payable are limited to a Calendar Year maximum of 100 visits. Charges for home health care services and supplies are covered only for care and treatment of an Injury or Sickness when Hospital or Skilled Nursing Facility confinement would otherwise be required. The diagnosis, care and treatment must be certified by the attending Physician and be contained in a Home Health Care Plan. Benefit payment for nursing, home health aide and therapy services is subject to the Home Health Care limit shown in the Schedule of Benefits. Page 29 of 89 -47- A home health care visit will be considered a periodic visit by either a nurse or therapist, as the case may be, or four hours of home health aide services. 7. Hospice Care Services and Supplies: The Benefit payment Limit for Hospice Care is limited to $15,000 per Lifetime. Charges for hospice care services and supplies are covered only when the attending Physician has diagnosed the Covered Person's condition as being terminal, determined that the person is not expected to live more than six months, and placed the person under a Hospice Care Plan. 8. Hospital Care and Services: The Daily Limit for Hospital Room and Board is the semi - private room rate. The Daily Limit for the Intensive Care Unit is the Hospital's ICU charge. The Daily Limit for Skilled Nursing Facility is the facility's Usual and Reasonable Charge, with a maximum number of 100 days payable per Calendar Year. Covered charges include the medical services and supplies furnished by a Hospital or Ambulatory Surgical Center or a Birthing center. Covered charges for room and board will be payable as shown in the Schedule of Benefits. After 23 observation hours, a confinement will be considered an inpatient confinement. Room charges made by a Hospital having only private rooms will be paid at 80% of the average private room rate. The 20% coinsurance paid by the Employee will count toward the out -of- pocket maximum. 9. Immunizations: Immunizations received by a PPO are paid at 100 %. Immunizations received from a Non -PPO are payable at 70 %. 10. Injury to or Care of Mouth, Teeth and Gums: Charges for injury to or care of the mouth, teeth, gums and alveolar processes will be covered charges under Medical Benefits only if that care is for the following oral surgical procedures: A. Excision of tumors and cysts of the jaws, cheeks, lips, tongue, roof and floor of the mouth. B. Emergency repair due to Injury to sound natural teeth. This repair must be made within 12 months from the date of an accident and the accident must have occurred while the person was covered under the Plan. C. Surgery needed to correct accidental injuries to the jaws, cheeks, lips, tongue floor and roof of the mouth when the Injuries occurred while covered under the Plan. D. Excision of benign bony growths of the jaw and hard palate. Page 30 of 89 -48- E. External incision and drainage of cellulitis. F. Incision of sensory sinuses, salivary glands or ducts., G. Removal of impacted teeth. No charge will be covered under Medical Benefits for dental and oral surgical procedures involving orthodontic care of the teeth, periodontal disease and preparing the mouth for the fitting of or continued use of dentures. 11. Women's Health and Cancer Rights Act. Under the Woinen's. Health and Cancer Rights Act, a group health plan participant or benof ciaiy who is receiving benefits in connection with a mastectomy, and who elects'brdast reconstruction in connection with the mastectomy is entitled to coverage for the following: A. Reconstruction of the breast on which the mastectomy has been performed; B. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and C. Prostheses and treatment of physical complications at all stages of mastectomy, including lymphedemas. Coverage for these benefits or services will be provided in a manner determined in consultation with the participant's attending physician., Additionally, coverage for the mastectomy- related benefits or services required ui'ider`the Women's Health Law will be subject to the same deductibles and coinsurance or co- payment provisions that apply with respect to other medical or surgical benefits provided under the group medical plan. Your rights to benefits in this Plan are subject to amendment, modification, or termination in accordance with the Plan Eligibility and Participation Section of this Plan, and the applicable provisions. Any amendment, modification or termination of a Program will also be an amendment, modification or termination of this Plan. 12. Mental Health Inpatient and Outpatient: Covered charges for care and treatment of Mental Disorders will be limited as follows: A. All tFeatment is subjeet to the benefit payment fnw*V41�5 pheA% in the Sehedule of Benefits Treatment is covered the sa* a4 any other illness or injury and is subject to the same co pay and/or, co- insurance. Changed due to federal mandate Page 31 of 89 -49- C. Psychiatrists (.M.D.), psychologists (Ph.D) or counselors (MFCC, LCSW) may bill the Plan directly. Other licensed mental health practitioners must bill the Plan through these professionals. �= Deleted due to federal manadate D. Outpatient mental health co- payment is applied per office visit. Non PPO Deleted due to federal mandate. Outpatient charges for Mental Disorders will not (deleted due to federal mandate) be counted in accumulating covered changes toward the 100% payment percentage of other charges. nor will 13 . Occupational Therapy: Benefit payable is limited to $1,500 per Calendar Year. Covered charges include occupational therapy performed by a licensed occupational therapist. Therapy must be ordered by a Physician, result from an Injury or Sickness that occurred while covered under the Plan and improve a body function. Covered expenses do not include recreational programs, maintenance therapy or supplies used in occupational therapy. The Occupational Therapy benefit may be extended to a maximum of $3,000, when combined with the annual Physical Therapy benefit, upon the recommendation of the attending physician. The combined Occupational Therapy and Physical Therapy benefits cannot exceed $3,000 per calendar year. 14. Organ Transplant — Covered Transplant Procedures: Organ and tissue transplants are covered except those which are classified as "Experimental and/or Investigational". Percentage payable in a network facility is 100 %. Percentage Payable in a Non - Network Facility is 70% with an Unlimited Maximum Out -Of- Pocket. Charges for the, reasonable travel expenses of the Covered Person's immediate family to the designated transplant facility will be covered when pre - authorized, up to a maximum of $10,000 per transplant. Organ Transplant Coverage Limits Charges otherwise covered under the Plan that are incurred for the care and treatment due to an organ or tissue transplant are subject to these limits: A. Charges made by a Hospital or a Physician's fee for organ transplants are treated as covered charges when incurred as a recipient only, except as provided'below. Page 32 of 89 -50- B. Covered charges will be paid at 100% for transplants done at a designated transplant facility. Covered charges for transplants performed at a non - network facility will be paid at 70% and such non - network charges are subject to an unlimited maximum out -of- pocket limit. C. Charges made by a Hospital or a physician's fee for a donor will be paid at 100% if the organ transplant is performed at a designated transplant facility and such charges are pre - authorized. When the donor has medical coverage, his or her plan will pay first. The benefits under this Plan will be reduced by those payable under the donor's plan. Donor charges include those for: ♦ Evaluating the organ; ♦ Removing the organ from the donor; and ♦ Transportation of the organ from within the United States and Canada to the place where the transplant is to take place. D. The Plan covers a Covered Person's charges as a donor, only when the recipient is either an immediate family member of the Covered Person, or is also a Covered Person. Immediate family is defined as mother, father, natural or adopted child, grandparent, grandchild, brother or sister. Such donor charges will be paid at 100% if the organ transplant is done at a designated transplant facility and such charges are pre - authorized by Hometown Health Providers. 15. Other Medical Services and Supplies: These services and supplies not otherwise included in the items above are covered as follows: A. Anesthetic; oxygen; blood and blood derivatives that are not donated or replaced; intravenous injections and solutions. Administration of these items is included. B. Cardiac rehabilitation as deemed Medically Necessary provided services are rendered (a) under the supervision of a Physician; (b) in connection with a myocardial infarction, coronary occlusion or coronary bypass surgery; (c) initiated within 12 weeks after other treatment for the medical condition ends; and (d) in a Medical Care Facility as defined by this Plan. C. Radiation or Chemotherapy and treatment with radioactive substances. The materials and services of technicians are included. D. Initial contact lenses or glasses required following cataract surgery. E. Laboratory Studies Page 33 of 89 -51- F. Prescription Drugs (as defined). G. Private Duty Nursing Care. The private duty nursing care by a licensed nurse (R.N., L.P.N., or L.V.N.). Covered charges for this service will be included to this extent: ♦ Inpatient Nursing Care. Charges are covered only when care is Medically Necessary or not Custodial in nature and the Hospital's Intensive Care Unit is filled or the Hospital has no Intensive Care Unit. ♦ Outpatient Nursing Care. The only charges covered for Outpatient nursing care are those shown below, under Home Health Care Services and Supplies. Outpatient private duty nursing care on a shift -basis is not covered. H. Speech Therapy by a licensed speech therapist. Therapy must be ordered by a Physician and follow either: (i) surgery for correction of a congenital condition of the oral cavity, throat or nasal complex (other than a frenectomy) of a person born while covered under the Plan; (ii) an Injury; or (iii) a Sickness that is other than a learning or Mental Disorder. Sterilization procedures. J. Surgical dressings, splints, casts and other devices used in the reduction of fractures and dislocations. K. Diagnostic x -rays. 16. Physical Therapy: Covered charges are for physical therapy by a licensed physical therapist. The therapy must be in accordance with a Physician's exact orders as to type, frequency and duration and to improve a body function. If recommended and prescribed by a Physician due to Medical Necessity as a result of serious illness, physical therapy performed by a certified exercise trainer may be payable upon written request to the Plan Administrator. Physical Therapy benefits payable are limited to $1,500 per Calendar Year. The Physical Therapy benefits may be extended to a maximum of $3,000, when combined with the annual Occupational Therapy benefit, upon the recommendation of the attending physician. The combined Occupational Therapy and Physical Therapy benefits cannot exceed $3,000 per Calendar Year. A, Page 34 of 89 -52- ' WWWATA . Few W My I 17. Physician Care. The professional services of a Physician for surgical or medical services. Covered charges for Physician Care and Services includes services received in office; other than office visit charge, Inpatient Services/Treatment, Outpatient Services/Treatment and Surgical Services/Procedures. 18. Physician's Office Visit: Cc -pay applies to Physician's Office Visit only. All other services provided in physician's office are payable at 90% after satisfying deductible, unless specified elsewhere in the Plan. The Plan covers only one office visit charge per visit to the physician's office. 19. Pregnancy Benefits: For Normal Delivery — 48 hour inpatient hospital stay is approved. For Caesarean Section: 96 -hour inpatient hospital stay is approved. A shorter length of stay may be approved if the decision is made by participant and attending physician. The Usual and Reasonable Charges for the care and treatment of Pregnancy are covered the same as any other Sickness for covered Employee, covered Spouse or Dependent child. Group health plans and health insurance issuers offering group insurance coverage generally may not, under Federal law (the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA)) restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a normal vaginal delivery, or less than 96 hours following a caesarean section, or require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of the above periods. 20. Prosthetics /Orthotics: Benefits are payable for covered charges for the initial purchase, fitting, repair and replacement of fitted prosthetic devices which replace body parts or for the initial purchase, fitting, repair and replacement of orthotic appliances such as braces, splints or other appliances which are required for support for an injured or deformed part of the body as a result of a disabling congenital condition or an Injury or Sickness that occurred while covered under the Plan. Page 35 of 89 -53- 21. Charges for Child Wellness Program Care. Routine well newborn nursery care is room, board and other normal care for which a Hospital makes a charge. The Usual and Reasonable Charge made by the Hospital for routine nursery care provided as shown below after the newborn child's birth will be considered as covered charges under the Plan. This coverage is only provided if a parent is a Covered Person who was covered under the Plan at the termination of the Pregnancy and the newborn child is an eligible Dependent and is neither injured nor ill. Charges for Wellness Program Care. The benefit is limited to the Usual and Reasonable Charges made by a Physician for the first pediatric visit to the newborn child after birth while Hospital confined. 22. Second Surgical Opinion: Deductible is waived and benefit is payable at 100% for second surgical opinion. 23. Skilled Nursing Facility Care. The room and board and nursing care furnished by a Skilled Nursing Facility will be payable if and when: a. The patient is confined as a bed patient in the facility; b. The attending Physician certifies that the confinement is needed for further care of the condition that caused the Hospital confinement; and c. The attending Physician completes a treatment plan which includes a diagnosis, the proposed course of treatment and the projected date of discharge from the Skilled Nursing Facility. d. Covered charges for a Covered Person's care in these facilities is limited to the covered daily charge limit shown in the Schedule of Benefits and for other charges incurred for necessary medical care on a day for which Room and Board benefits are payable. Covered services are limited to the first 100 days of confinement each Calendar Year. 24. Substance Abuse Inpatient and Outpatient: Covered charges for care and treatment of Substance Abuse will be limited as follows: a. All treatment is subject to the benefit payment maximums shown in the Schedule of Benefits. Page 36 of 89 -54- b. Physician's visits are limited to one treatment per day. c. Psychiatrists (M.D.), psychologists (Ph.D) or couaselors (MFCC, LCSW) may bill the Plan directly. Other licensed mental health practitioners must bill the Plan through these professionals. and Outpatient Substmee Abuse tfeatment eembin6d is . Deleted due to federal mandate e. Outpatient Substance Abuse Treatment is paid at 100% after $10 co -pay for PPO, , Na-DD49, Deleted due to federal manadate. Non -PPO outpatient Substance Abuse Treatment is paid at 70% (Deleted due to federal mandate). Outpatient charges for Substance Abuse will Piet (Changed due to federal mandate) be counted in accumulating covered charges toward the 100% payment percentage of other charges. 100- payfiWat. 25. Foot Surgery — The Ossatron procedure for Plantar Fasciitis and bone spurs is an authorized treatment under the Plan. Added due to Plan Exception authorized 26. Smoking Cessation. Costs for medically supervised classes and/or cessation supplies to a maximum of three programs per participant lifetime. Proof of mandatory attendance shall be provided to the Claims Administrator. Page 37 of 89 -55- Prescription Druz Benefi t In an effort to reduce the costs of the prescription drug plan, effective January 1, 2007, the following changes will be implemented to the Prescription Drug Plan, so that Plan Participants can have control over how much they spend on prescription medications, thereby assisting the Plan in controlling costs as well. Pharmacy Drug Charge Participating pharmacies have contracted with the Plan to charge Covered Persons reduced fees for covered Prescription Drugs. Catalyst RX is the administrator of the pharmacy drug plan effective January 1, 2008. Co- Payment The co- payment is applied to each covered pharmacy drug charge and is shown in the Prescription Drug Plan Schedule of Benefits. The co- payment amount is not a covered charge under the Medical Plan. Any one prescription is limited to the greater of a 30 -day supply or a 100 -unit dose. If a drug is purchased from a non - participating pharmacy, or a participating pharmacy when the Covered Person's ID card is not used, the amount payable in excess of the co- payment will be the ingredient cost and dispensing fee. Mail Order Drug Benefit Option The mail order drug benefit option is available for maintenance medications (those that are taken for long periods of time, such as drugs sometimes prescribed for heart disease, high blood pressure, asthma, etc). Because of volume buying, the mail order pharmacy, is able to offer Covered Persons significant savings on their prescriptions. Co- Payment The co- payment is applied to each covered mail order prescription charge and is shown in the Prescription Drug Plan Schedule of Benefits. It is not a covered charge under the Medical Plan. Any one prescription is limited to the greater of a 90 -day supply or a 300 -unit dose. Page 38 of 89 -56- Prescription Drug Benefit Schedule of Renefits Notes: a. Retail Pharmacy is for short-term use; 100 -unit dose or 30 day supply or if prescription is unavailable by mail service b. Maintenance Medication is a 90 day supply or a 300 unit dose, is taken longer than 60 days for a long term or chronic condition, and is purchased through the mail order service. A maintenance medication does not require frequent dosage adjustments, and is prescribed to treat a long -term condition such as birth control or chronic condition such as arthritis, diabetes and/or high blood pressure. Ask your physician if you will be taking a prescribed medication longer than 60 days. If you purchase a maintenance medication at a retail pharmacy after the second (2 fill, you will be charged the applicable Retail Pharmacy Maintenance Service co- payment described above for the usual 30 day, 100 unit dose retail prescription. Covered Prescription Drugs 1. All drugs prescribed by a Physician that require a prescription either by federal or state law, except injectables. The following injectables will be covered: Insulin, Imitrex, Glucagon, Copaxin for multiple sclerosis, Enbrel for the treatment of psoriasis and/or rheumatoid arthritis, Injectable DHE for migraines, injectable Depo- Testosterone and prescribed Bee Sting Kits for allergic Covered Persons. Page 39 of 89 -57- Brand Name when no generic available, or when noted "Dispense as Written" for Purchase Generic Brand Name Brand Name Location Generic Available Retail Pharmacy See Note (1) $5.00 $45.00 $5.00 Mail Service for Maintenance Medication (See $10.00 $75.00 $10.00 Note (2 Retail Pharmacy for Maintenance $20.00 $75.00 $20.00 Medication Notes: a. Retail Pharmacy is for short-term use; 100 -unit dose or 30 day supply or if prescription is unavailable by mail service b. Maintenance Medication is a 90 day supply or a 300 unit dose, is taken longer than 60 days for a long term or chronic condition, and is purchased through the mail order service. A maintenance medication does not require frequent dosage adjustments, and is prescribed to treat a long -term condition such as birth control or chronic condition such as arthritis, diabetes and/or high blood pressure. Ask your physician if you will be taking a prescribed medication longer than 60 days. If you purchase a maintenance medication at a retail pharmacy after the second (2 fill, you will be charged the applicable Retail Pharmacy Maintenance Service co- payment described above for the usual 30 day, 100 unit dose retail prescription. Covered Prescription Drugs 1. All drugs prescribed by a Physician that require a prescription either by federal or state law, except injectables. The following injectables will be covered: Insulin, Imitrex, Glucagon, Copaxin for multiple sclerosis, Enbrel for the treatment of psoriasis and/or rheumatoid arthritis, Injectable DHE for migraines, injectable Depo- Testosterone and prescribed Bee Sting Kits for allergic Covered Persons. Page 39 of 89 -57- 2. All compounded prescriptions containing at least one prescription ingredient in a therapeutic quantity. 3. Insulin when prescribed by a Physician. 4. Retin -A; when Medically Necessary for persons over the age of 19. 5. Gleevec for treatment of Chronic Myeloid Leukemia (CML). 6. Ritalin for treatment of Narcolepsy. 7. Strattera, when Medically Necessary for persons over the age of 19, for the diagnosis of Attention Deficit Disorder. I 8. Meridia is a covered medication when taken to counteract the side effects of anti psychotic medications. Added due to Plan Exception authorized Limits to this Benefit This benefit applies only when a Covered Person incurs a covered Prescription Drug charge. The covered drug charge for any one prescription will be limited to: 1. Refills only up to the number of times specified by a Physician. 2. Refills up to one year from the date of order by a Physician. Expenses Not Covered This benefit will not cover a charge for any of the following: 1. A charge excluded under Medical Plan Exclusions. 2. A drug or medicine that can legally be bought without a written prescription. This does not apply to injectable insulin. 3. Devices of any type, even though such devices may require a prescription. These inolude (but are not limited to) therapeutic devices, artificial appliances, braces, support garments, or any similar device. 4. Immunization agents or biological sera. 5. A drug or medicine labeled: "Caution — limited by federal law to investigational use ". Page 40 of 89 -58- 6. Experimental drugs and medicines, even though a charge is made to the Covered Person. 7. Any charge for the administration of a covered Prescription Drug. 8. Any drug or medicine that is consumed or administered at the place where it is dispensed. 9. A drug or medicine that is to be taken by the Covered Person, in whole or in part, while Hospital confined. This includes being confined in any institution that has a facility for the dispensing of drugs and medicines on its premises. 10. A charge for Prescription Drugs which may be properly received without charge under local, state, or federal programs. 11. A charge for hypodermic syringes and/or needles, injectables or any prescription directing administration by injection (other than insulin, Imitrex, Glucagon, Copaxin, or prescribed Bee Sting Kits for allergic Covered Persons). 12. A charge for Prescription Drugs for smoking cessation (i.e., nicotine gum), except for a medically supervised program including prescription for Chantix, up to three programs per participant lifetime. 13. A charge for infertility medication. 14. A charge for smoking deterrent patches. 15. A charge for Crinone will not be covered, unless prescribed for the purpose of assisting in the continuation of an existing pregnancy. New FDA approved drugs are evaluated by our pharmacy benefit management company. Oversight and final approval are given by the pharmacy benefit manager and the Plan Administrator. Some drugs may have dispensing limits which are primarily based on FDA recommendations. Page 41 of 89 -59- Dental Benefits Calendar Year Deductible for Class B (Basic) and Class C (Major) Services Per person ..... ............................... Per Family Unit ........................... Dental Percentage Payable $25.00 $50.00 Class A Services — Preventive ............................ ...........................100% (No Deductible) Class B Services — Basic .................................... ............................... 80% after deductible Class C Services — Major ................................... ............................... 80% after deductible Participants and their families are encouraged to obtain their routine dental exams and cleanings twice per year, with the goal of reducing the number of Basic and Major dental services needed and utilizing the Plan in a cost effective manner. The District's self - insured plan therefore implements this Preventive Dental Program to provide incentives to employees to obtain preventive dental care. Preventive Dental Program 2007 Dental Benefits Preventive Dental Program Preventive Dental Program Payable Guidelines Followed Guidelines Not Followed Preventative (Exam & Preventive - 3 or 4 Oral Minimum of 3 oral exams Cleaning) Exams & Cleanings every 6- and cleanings not received Paid at 100 %, with No 8 months during the previous during the previous two year Deductible two -year period. period. 100% with no deductible Each exam/cleaning paid at 100% with no deductible Basic Dental Services (as Basic Dental Services as Basic Dental Service as defined below) defined below defined below continued to Paid at 80% Continued to be paid at 80% be paid at 80% Major Dental Services as If follow above preventive, If preventive not followed defined below —Paid at Major dental services will be Major services will be paid at 80% paid at 80 %. Participants 50 %. with full dentures need only obtain one oral exam prior to January 2008 and then one oral exam per year thereafter, to qualify for the 80% benefit for Major services. Page 42 of 89 -60- Exams and cleanings will be an on -going requirement in order to maintain the 80% rate for Major dental work. New hires only: No benefits are payable for Class C (Major) Services in the first 12 months of the Covered Person's coverage under the Plan Maximum Benefit Amount Per Person per Calendar Year .......................... ............................... .........................$2,000 This benefit applies when covered dental charges are incurred by a person while covered under this Plan. Deductible Deductible Amount: This is an amount of dental charges for which no benefits will be paid. Before benefits can be paid in a Calendar Year, a Covered Person must meet the deductible shown in the Schedule of Benefits. Family Unit Limit: When the dollar amount shown in the Schedule of Benefits has been incurred by members of a Family Unit toward their Calendar Year deductibles, the deductibles of all members of that Family Unit will be considered satisfied for that year. Benefit Payment Each Calendar Year benefits will be paid to a Covered Person for the dental charges in excess of the deductible. Payment will be made at the rate shown under Dental Percentage Payable in the Schedule of Benefits. No benefits will be paid in excess of the Maximum Benefit Amount. Dental Charges Dental charges are the Usual, Customary and Reasonable Charges made by a Dentist or other Physician for necessary care, appliances or other dental material listed as a covered dental service. A dental charge is incurred on the date the service or supply for which it is made is performed or furnished. However, there are times when one overall charge is made for all or part of a course of treatment. In this case, the Claims Administrator will apportion that overall charge to each of the separate visits or treatments. The pro rata charge will be considered to be incurred as each visit or treatment is completed. Page 43 of 89 -61- Covered Dental Services Class A Services: ................................. Preventive and Diagnostic Dental Procedures The limits on Class A Services are for routine services. If dental need is present, this Plan will consider for reimbursement services performed more frequently than the limits shown. 1. Routine oral exams. This includes the cleaning and scaling of teeth. Limit of two exams per Covered Person each Calendar Year. 2. One bitewing x -ray series every Calendar Year. 3. One full mouth x -ray every five Calendar Years. 4. One fluoride treatment for covered Dependent children under age 19 each Calendar Year. 5. Dental sealants for covered Dependent children under age 19. 6. Space maintainers for covered Dependent children under age 19 to replace primary teeth. 7. Emergency palliative treatment for pain. ClassB Services: ..................................................................... Basic Dental Procedures 1. Dental x -rays not included in Class A. 2. Oral surgery. Oral surgery is limited to removal of teeth, preparation of the mouth for dentures and removal of tooth - generated cysts of less than ' / inch. 3. Periodontics (gum treatments) 4. Endodontics (root canals). 5. Extractions. This service includes local anesthesia and routine post- operative care. 6. Recementing bridges, crowns, or inlays. 7. Fillings, other than gold. Page 44 of 89 -62- 8. General anesthetics, upon demonstration of Medical Necessity. 9. Antibiotic drugs. Class Services ...................................... ............................... Major Dental Procedures 1. Gold restorations, including inlays, onlays and foil fillings. The cost of gold restorations in excess of the cost for amalgam, synthetic porcelain or plastic materials will be included only when the teeth must be restored with gold. 2. Installation of crowns. 3. Installing precision attachments for removable dentures. 4. Installing partial, full or removable dentures to replace one or more natural teeth that were extracted while the person was covered for this benefit. This service also includes all adjustments made during a six -month period following the installation. 5. Addition of clasp or rest to existing partial removable dentures. 6. Initial installation of fixed bridgework to replace one or more natural teeth which were extracted while the person was covered for these benefits. Initial installation of fixed bridgework will be covered for one or more natural teeth if the adult permanent teeth are missing due to congenital birth defect. 7. Repair of crowns, bridgework, and removable dentures. 8. Rebasing or relining of removable dentures. 9. Replacing an existing removable partial or full denture or fixed bridgework; adding teeth to an existing removable partial denture; or adding teeth to existing bridgework to replace newly extracted natural teeth. However, this item will apply only if one of these tests is met: A. The replacement or addition of teeth is required because of one or more natural teeth being extracted after the person is covered under these benefits. B. The existing denture or bridgework was installed at least five years prior to its replacement and cannot currently be made serviceable. Replacement dentures will be allowed earlier than 5 years if deemed medically necessary due to dental oral health being compromised and the existing dentures cannot be made serviceable. Page 45 of 89 -63- C. The existing denture is of an immediate temporary nature. Further, replacement by permanent dentures is required and must take place within 12 months from the date the temporary denture was installed. 10. Night guards are covered for night grinding only. They are not covered for orthodontics. Voluntary Predetermination of Benefits Before starting a dental treatment for which the charge is expected to be $300 or more, a predetermination of benefits form should be submitted. A regular dental claim form is used for the predetermination of benefits. The covered Employee fills out the Employee section of the form and then gives the form to the Dentist. The Dentist must itemize all recommended services and costs and attach all supporting x -rays to the form. The Dentist should send the form to the Claims Administrator at this address: CDS Group Health P.O. Box 50190 Sparks, NV 89435 -0190 (800) 455 -4236 The Claims Administrator will notify the Dentist of the benefits payable under the Plan. The Covered Person and the Dentist can then decide on the course of treatment, knowing in advance an estimate of how much the Plan will pay. Alternate Treatment Many dental conditions can be treated in more than one way. This Plan has an "alternate treatment" clause which governs the amount of benefits the Plan will pay for treatments covered under the Plan. If a patient chooses a more expensive treatment than is needed to correct a dental problem according to accepted standards of dental practice, the benefit payment will be based on the cost of the treatment which provides professionally satisfactory results at the most cost - effective level. For example, if a regular amalgam filling is sufficient to restore a tooth to health, and the patient and the Dentist decide to use a gold filling on any tooth, or a composite filling on posterior teeth, the Plan will base its reimbursement on the Usual, Customary and Reasonable Charge for an amalgam filling. The patient will pay the difference in cost. Page 46 of 89 -64- Exclusions A charge for the following is not covered: 1. Services that are excluded under Medical Plan Exclusions. 2. Services that, to any extent, are payable under any medical expense benefits of the Plan. 3. Services which are not included in the list of covered dental services. 4. Crowns for teeth that are restorable by other means or for the purpose of Periodontal Splinting. 5. Crowns, fillings or appliances that are used to connect (splint) teeth, or change or alter the way the teeth meet, including altering the vertical dimension, restoring the bite (occlusion) or are Cosmetic. 6. Implants, including any appliances and/or crowns which are actually implants and the surgical insertion or removal of implants and any expense specifically related to examination for or preparation for implants. 7. Replacement of lost or stolen appliances. 8. Orthodontic treatment and orthognatic surgery 9. Personalization of dentures. 10. Oral hygiene, plaque control programs or dietary instructions. Page 47 of 89 -65- Medical Management Services Medical Management Services Phone Number: -(800) 776 6931 CDS Group Health Medical Management P.O. Box 50190 Sparks, IW 89435 -0190 800 - 455 -4236 or 775 -352 -6939 Fax: 775-352-6992 Changed to reflect new provider The patient or family member must call this number to receive certification of certain Medical Management services. This call must be made at least 48 hours in advance of services being rendered or within 24 hours after an emergency. Any reduced reimbursement due to failure to follow medical management procedures will not accrue toward the 100% maximum out -of- pocket payment. Utilization Review Utilization review is a program designed to help ensure that all Covered Persons receive necessary and appropriate health care while avoiding unnecessary expenses. It is the Employee's or Covered Person's responsibility to make certain that the compliance procedures of this program are completed. To minimize the risk of reduced benefits, the Covered Person should contact Medical Management Services to make certain that the hospital or attending physician has initiated the necessary procedures. Also, any prior authorization is not a guarantee of coverage. The Utilization Review Program is designed to determine whether or not a proposed course of treatment is Medically Necessary and appropriate. Benefits under the plan will depend upon the person's eligibility for coverage and the Plan's limitations and exclusions. The Program Consists of: 1. Pre - certification of the Medical Necessity for the following non - emergency services before medical services are provided: Hospitalizations MRI (only on 2 and any subsequent MRI in the calendar year Home Health Care Outpatient surgical procedures performed in an ambulatory surgical center, hospital, or free- standing surgical center Page 48 of 89 -66- Durable Medical Equipment exceedin $3,000 Skilled Nursing Facility stays Prosthetics 2. Retrospective Review of the Medical Necessity of the listed services provided on an emergency basis; 3. Concurrent Review, based on the admitting diagnosis, of the listed services requested by the attending Physician; and 4. Certification of Services and planning for discharge from a Medical Care Facility or cessation of medical treatment. The purpose of the program is to determine: 1. The medical necessity of the care 2. The appropriate location for the care to be provided 3. If admitted to the hospital, the appropriate length of stay. If a particular course of treatment or medical service is not certified, it means that the Plan will not consider that course of treatment as appropriate for the maximum reimbursement under the Plan. In order to maximize Plan reimbursement, please read the following provisions carefully. Here's How the Program Works: Pre - Certification Before a Covered Person enters a Medical Care Facility on a non - emergency basis or receives other listed medical services, Medical Management Services will, in conjunction with the attending Physician, certify the care as appropriate for Plan reimbursement. A non - emergency stay in a Medical Care Facility is one that can be scheduled in advance. The Utilization Review Program is set in motion by a telephone call from the Covered Person. Contact Medical Management Services at: Universal H N t knor a m • P ro f ess i ona l s Pref erre d (800) 776 -6959 CDS Medical Management 800 -455 -4236 ext. 6939 or 775 -352 -6939 Fx: 775- -352 -6992 Changed to reflect new contact information Page 49 of 89 -67- at least 48 hours before the services are scheduled to be rendered, with the following information: 1. The name of the patient and relationship to the Covered Employee 2. The name, Social Security Number and address of the Covered Employee 3. The name of the Employer 4. The name and telephone number of the attending Physician 5. The name of the Medical Care Facility, proposed date of admission, and proposed length of stay 6. The diagnosis and/or type of surgery 7. The proposed rendering of listed medical services. If there is an emergency admission to the Medical Care Facility, the patient, patient's family member, Medical Care Facility or attending Physician must contact Universal Health Network within 24 hours of the first business day after the admission. If a Physician does not get pre - treatment authorization, or if a Covered Person does not follow these pre - certification procedures, benefit payment will be reduced by 50 %. This reduction of benefits cannot be applied toward the deductible or out -of- pocket maximum. It is the Covered Person's responsibility to ensure that these procedures are followed. IF THE COVERED PERSON DOES NOT RECEIVE AUTHORIZATION AS EXPLAINED IN THIS SECTION, THE BENEFIT PAYMENT WILL BE REDUCED BY 50% Concurrent Review; Discharge Planning Concurrent review of a course of treatment and discharge planning from a Medical Care Facility are parts of the utilization review program. Medical Management Services will monitor the Covered Person's Medical Care Facility stay or use of other medical services and coordinate with the attending Physician, Medical Care Facilities and Covered Person either the scheduled release or an extension of the Medical Care Facility stay or extension or cessation of the use of other medical services. If the attending Physician feels that it is Medically Necessary for a Covered Person to receive additional services or to stay in the Medical Care Facility for a greater length of time than has been pre - certified, the attending Physician must request the additional services or days. Second and /or Third Opinion Program Certain surgical procedures are performed either inappropriately or unnecessarily. In some cases, surgery is only one of several treatment options. In other cases, surgery will not help the condition. In order to prevent unnecessary or potentially harmful surgical Page 50 of 89 -68- treatments, the second and/or third opinion program fulfills the dual purpose of protecting the health of the Plan's Covered Persons and protecting the financial integrity of the Plan. Benefits will be provided for a second (and third, if necessary) opinion consultation to determine the Medical Necessity of an elective surgical procedure. An elective surgical procedure is one that can be scheduled in advance; that is, it is not an emergency or of a life - threatening nature. Benefits will be payable as described in the Schedule of Benefits. The patient may choose any board - certified specialist who is not an associate of the attending Physician and who is affiliated in the appropriate specialty. Please refer to the "Claims Procedures" section of this booklet for information on submitting and appealing a Medical Management decision. Page 51 of 89 -69- Case Manazement The Case Management (CM) Program helps Members with serious Illnesses manage their health care. The `goal of the CM program is to develop alternative treatment plans that will help the Member obtain the type of care needed outside of a Hospital setting. Members who choose to participate in the program are assigned a case manager to help coordinate care. Case Management is a process performed by Universal Health Network Registered Nurses and Social Workers who coordinate services for members, both in the inpatient setting as well as services in the ambulatory setting. Many of these services require prior authorization to confirm benefit coverage and medical necessity. After an admission to a facility, Universal Health Network Case Managers monitor the member's progress, with the attending physician, to assure the appropriate level of care is maintained and services utilized are delivered in a quality, cost - effective manner using national standards (Interqual criteria, Milliman & Robertson) and Universal Health Network custom community guidelines. These Case Managers work with the attending physician and community resources to develop a plan of treatment per the benefit level of the plan. Note: Case Management is a voluntary service. There are no reductions of benefits or penalties if the patient and family choose note to participate. Each treatment plan is individually tailored to a specific patient and should not be seen as appropriate or recommended for any other patient, even one with the same diagnosis. Page 52 of 89 -70- Plan Exclusions Note: All exclusions related to Prescription Drugs are shown in the Prescription Drug Plan. All exclusions related to Dental are shown in the Dental Plan. For all Medical Benefits shown in the Schedule of Benefits, a charge for the following is not covered: Abortion. Services, supplies, care or treatment in connection with an abortion unless the life of the mother is endangered by the continued Pregnancy or the Pregnancy is the result of rape or incest. Complications of non - covered treatments. Care, services or treatment required as a result of complications from a treatment not covered under the Plan, except when Medically Necessary due to complications arising out of previous surgery, up to $1,000 per Calendar Year and $2,000 while covered under the Plan. Cosmetic Services. Care and treatment provided for cosmetic reasons. This exclusion will not apply if the care and treatment is for repair or damage from an accident that occurred while the person was covered under the Plan. Reconstructive breast surgery following a Medically Necessary mastectomy is covered. Custodial Care. Services or supplies provided mainly as a rest cure, maintenance or Custodial Care. Educational or Vocational Testing. Services for educational or vocational testing or training. Excess Charges. The part of an expense for care and treatment of an Injury or Sickness that is in excess of the Usual, Customary and Reasonable Charge. Exercise Programs. Exercise programs for treatment of any condition, except for Physician prescribed and supervised programs, including cardiac rehabilitation, occupational or physical therapy covered by this Plan. Experimental or not Medically Necessary. Care and treatment that is either Experimental /Investigational or not Medically Necessary. Eye Care. Radial keratotomy or other eye surgery to correct near - sightedness. Also, routine eye examinations, including refractions, lenses for the eyes and exams for their fitting. This exclusion does not apply to aphakic patients and soft lenses or sclera shells intended for use as corneal bandages. Page 53 of 89 -71- Foot Care. Treatment of weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions (except orthotics up to $200 per Calendar Year, and open cutting operations), and treatment of corns, calluses or toenails (unless needed in treatment of a metabolic or peripheral - vascular disease). The Ossotron procedure for the treatment of Plantar FascUds and bone spurs is an approved surgical treatment procedure. Added due to Plan Exception authorized Government Coverage. Care, treatment or supplies furnished by a program or agency funded by any government. This does not apply to Medicaid or when otherwise prohibited by law. Hair Loss. Care and treatment for hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed by a Physician. Hearing Aids and Exams. Charges for services or supplies in connection with hearing aids or exams for their fitting. Hospital Employees. Professional services billed by a Physician or nurse who is an employee of a Hospital or Skilled Nursing Facility and paid by the Hospital or facility for the service. Illegal Acts. Charges for services received as a result of Injury or Sickness caused by or contributed to by taking part in the commission of a felony. Infertility. Diagnosis, care and treatment for infertility, artificial insemination or in vitro fertilization. Massage Therapy. Charges for any condition, except when prescribed by a Physician following trigger point injection treatment due to inflammation of the myofascia of the muscle. Such prescription shall designate type, frequency and duration of Medicallly Necessary massage therapy. No Charge. Care and treatment for which there would not have been a charge if no coverage had been in force. Non- Emergency Hospital Admissions. Care and treatment billed by a Hospital for non- Medical Emergency admissions on a Friday or a Saturday. This does not apply if surgery is performed within 24 hours of admission. No Obligation to Pay. Charges incurred for which the Plan has no legal obligation to pay. No Physician Recommendation. Care, treatment, services or supplies not recommended and approved by a Physician; or treatment, services or supplies when the Covered Person is not under the regular care of a Physician. Regular care means ongoing medical supervision or treatment which is appropriate care for the Injury or Sickness. Page 54 of 89 -72- Not Specified as Covered. Services, treatments and supplies which are not specified as covered under this Plan. Obesity. Care and treatment of obesity, weight loss or dietary control whether or not it is, in any case, a part of the treatment plan for another Sickness. Medically Necessary charges for Morbid Obesity will be covered. Occupational. Care and treatment of an Injury or Sickness due to or aggravated by employment with any employer or self - employment. Personal Comfort Items. Personal comfort items or other equipment, such as, but not limited to, air conditioners, air - purification units, humidifiers, electric heating units, orthopedic mattresses, blood pressure instruments, scales, elastic bandages or stockings, nonprescription drugs and medicines, and first -aid supplies and non - hospital adjustable beds. Relative Giving Services. Professional services performed by a person who ordinarily resides in the Covered Person's home or is related to the Covered Person as a Spouse, parent, child, brother or sister, whether the relationship is by blood or exists in law. Replacement Braces. Replacement of braces of the leg, arm, back, neck, or artificial arms or legs, unless there is sufficient change in the Covered Person's physical condition to make the original device no longer functional. Routine Care. Charges for routine or periodic examinations, screening examinations, evaluation procedures, preventive medical care, or treatment or services not directly related to the diagnosis or treatment of a specific Injury, Sickness or pregnancy- related condition which is known or reasonably suspected, unless such care is specifically covered in the Schedule of Benefits. Self - Inflicted. Any loss due to intentionally self - inflicted Injury, while sane or insane. Services Before Coverage. Care, treatment or supplies for which a charge was incurred before a person was Covered under this Plan. Sex Changes. Care, services or treatment for non - congenital transsexualism, gender dysphoria or sexual reassignment or change. This exclusion includes medications, implants, hormone therapy, surgery, medical or psychiatric treatment. Sleep Disorders. Care and treatment for sleep disorders unless deemed Medically Necessary. Smoking Cessation. Care and treatment for smoking cessation programs, including smoking deterrent patches that is in excess of three times per participant lifetime and is not medically supervised. Page 5 3 of 89 Surgical Sterilization Reversal. Care and treatment for eversal of surgical sterilization. Temporomandibular Joint Syndrome. All diagnostic and treatment services related to the treatment of jaw joint problems including temporomandibular joint (TMJ) syndrome. War. Any loss that is due to a declared or undeclared act of war. Page 56 of 89 -74- Claims Procedures (How to Submit a Claim) It is the intent of the Plan Administrator that the following claims procedures comply with the United States Department of Labor ( "DOL ") regulation 29 CFR § 2560.503 -1. Where any provision is in conflict with the DOL's claims procedure regulations, or any other applicable law, such law shall control. Administrative Processes and Safe uards The Plan requires that claims determinations be made in accordance with governing documents of the Plan and that they be applied consistently with respect to similarly situated Claimants. The claims procedures will not be administered in a way that unduly inhibits or hampers the initiation or processing of claims or claims appeals. Authorized Representative May Act for Claimant Any of the following actions which can be done by the Claimant can also be done by an authorized representative acting on the Claimant's behalf. The Claimant may be required to provide reasonable proof of such authorization. For an urgent claim, a health care professional, with knowledge of a Claimant's medical condition, will be permitted to act as the authorized representative of the Claimant. "Health care professional" means a physician or other health care professional licensed, accredited, or certified to perform specified health services consistent with state law. Benefit Determinations Upon the Claims Administrator's receipt of a written claim for benefits and pursuant to the procedures described herein, the Claims Administrator will review the claim submission, proof of claim, and all associated and/or applicable information provided by the Claimant and gathered independently by the Claims Administrator in light of the Plan Document through which benefits of the Plan are paid. Further, the Claims Administrator will assure that all benefit determinations are applied consistently to similarly- situated Plan participants by maintaining appropriate claim and benefit records which shall be reviewed periodically and on a case -by -case basis to determine past practices in similar claim situations. Should the Claims Administrator at any time during its review period determine that additional information is required from the Employee or Claimant, the Claims Administrator will request such necessary information from the Employee. The Claims Administrator will make every effort to make its benefit determination in as reasonable a time frame as possible. Page 57 of 89 -75- Submitting a Claim A claim is a request fora benefit determination which is made, in accordance with the Plan's procedures, by a Claimant or his authorized representative. A claim must be received by the person or organizational unit customarily responsible for handling benefit matters on behalf of the Plan so that the claim review and benefit determination process can begin. A claim must name the Plan, a specific Claimant, a specific health condition or symptom or diagnostic code, and a specific treatment, service or supply (or procedure /revenue codes) for which a benefit or benefit determination is requested, the date of service, the amount of charges, the address (location) where services are received, and provider name, address, phone number and tax identification number. For purposes of the Plan, the Plan Administrator, at its discretion, may contract with other entities to handle claims communications and benefit determinations for the Plan. Such other entities may include a third party claims administrator, a managed care organization, or a pharmacy benefit manager. Contact information for such entities is provided below. There are two types of claims: (1) Pre - Service Claims, and (2) Post - Service Claims: 1. A Pre - Service Claim is a written or oral request for Inpatient Hospital benefits where the terms of the Plan condition benefits, in whole or in part, on prior approval of the proposed care (e.g., a utilization review requirement). See the Medical Management Program/Utilization Review section for that information. . A Pre - Service Claim should be submitted to: P.O. Box Rene, NAL 89520 300-7 CDS Group Health P.O. Box 50190 Sparks, NV 89435-0190 Important: A Pre - Service Claim is only for the purposes of assessing the Medical Necessity and appropriateness of care and delivery setting. A determination on a Pre - Service Claim is not a guarantee of benefits from the Plan. Plan benefit payments are subject to review upon submission of a claim to the Plan after medical services have been received, and are subject to all related Plan provisions, including exclusions and limitations. Note: Requests for benefit determination and requests for Plan approval where prior approval is desired but not required should be directed to CDS Group Health, the Claims Administrator as identified in the "Post- Service Claim" information below, or call (775) 352 -6900. Page 58 of 89 -76- 2. A Post Service Claim is a written request for benefit determination after a service has been rendered and expense has been incurred. Proof of loss for a Post Service Claim must be submitted to the claims office within twelve (12) months after the date a service is rendered. Failure to furnish such proof within the time required will not invalidate nor reduce any claim if it can be shown that it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible. It is the Claimant's responsibility for timely submission of all claims. A Post Service Claim should be submitted to: CDS Group Health P.O. Box 50190 Sparks, NV 89435 -0190 Note: Proof of loss for a claim has not been "furnished" unless and until the Claims Administrator has received all information they reasonably deem necessary to allow processing of the claim. This includes responding to reasonable requests for completion of forms, providing additional information about the claim, or providing of documents in support of the claim. If satisfactory proof of loss is not furnished within the 12 -month period after charges are incurred, benefits will not be available. Note: In accordance with federal law, the Centers for Medicare and Medicaid Services (CMS) have three (3) years to submit claims when CMS has paid as the primary plan and the Plan should have been primary. Assienments to Providers All Eligible Expenses reimbursable under the Plan will be paid to the covered Employee except that: 1. Assignments of benefits to Hospitals, Physicians, or other providers of service will be honored, 2. The Plan may pay benefits directly to providers of service unless the Covered Person requests otherwise, in writing, within the time limits for filing proof of loss, and 3. The Plan may make benefit payments for a child covered by a Qualified Medical Child Support Order (a QMCSO) directly to the custodial parent or legal guardian of such child. Note: Benefit payments on behalf of a Covered Person who is also covered by a state's Medicaid program will be subject to the state's right to reimbursement for benefits it has paid on behalf of the Covered Person, as created by an assignment of rights made by the Covered Person or his beneficiary as may be required by the state Medicaid plan. Furthermore, the Plan will honor any subrogation rights that a state may have gained Page 59 of 89 -77- from a Medicaid - eligible beneficiary due to the state's having paid Medicaid benefits that were payable under the Plan. Claims Denials The Claims Administrator shall provide adequate notice in writing to any Claimant whose claims for benefits under this Plan have been denied, written in a manner intended to be understood by the Claimant, including: 1. The specific reason(s) for the denial;; 2. Specific reference to the Plan provision(s) on which the denial is based; 3. A description of any additional information needed for further review of the claim; and; 4. An explanation of the Plan's review procedure. Further, the Claims Administrator shall afford a reasonable opportunity to any Claimant whose claim for benefits has been denied for a full and fair review of the decision denying the claim by the person designated by the Plan Administrator for that purpose. Appeal Procedures If a claim has been denied in whole or in part by the Claims Administrator, the Claimant may appeal the determination of that claim under the lowest review level indicated below. If the denial is upheld, Claimant may appeal to the next highest level of review, until the entire appeals process has been exhausted. Level I: REVIEW OF THE CLAIM BY THE CLAIMS ADMINISTRATOR: The Claimant may submit an appeal letter referencing the claim to the Claims Administrator. The Claimant shall have this opportunity to present additional information and/or documentation supporting this appeal. The Claims Administrator will review the claim for appropriateness based on the Plan Document, and if needed for medical interpretation or clarification, request a Physician review. Appeal letter and additional information and/or documentation must be submitted within sixty (60) days of the claim denial to: CDS Medical Management P.O. Box 50190 Sparks, NV 89435 -0190 The Claims Administrator will render a decision within sixty (60) days of receipt of the appeal letter and will notify the Claimant in writing of the findings. Page 60 of 89 -7s- Level II: PLAN ADMINISTRATOR REVIEW: If after completing Level 1, the Claimant is dissatisfied with the Claim Administrator decision, the Claimant may submit a written appeal to the Plan Administrator for review and/or Request for Plan Exception. The appeal shall contain all information and/or documentation the Claimant would like reviewed by the Plan Administrator and shall include a signed Authorization for Release of Medical Information for Claim Appeal/Request for Plan Exception form. The written appeal must be submitted within sixty (60) days of the Level I decision to: South Tahoe Public Utility District General Manager/Plan Administrator The Claimant will be notified in writing of the Plan Administrator's decision within sixty (60) days of the date the decision was made. Pre- Certification/Prior Authorization Appeals If the pre - certification of a service or procedure has not been approved by Universal Health Network, and the service or procedure has not yet been rendered, a Claimant may appeal the determination under the lowest review level indicated below. If the determination is upheld, Claimant may appeal to the next highest level of review until the entire appeals process is exhausted. If the service or procedure has been rendered, Claimant will need to follow the "Claims Appeals" procedures outlined above. Level I: REVIEW OF THE CLAIM BY THE UTILIZATION REVIEW FIRM: The Claimant may submit an appeal letter referencing the determination to Universal Health Network. The Claimant shall have this opportunity to present additional information and/or documentation supporting this appeal. The Medical Director will review the information to determine medical necessity. Appeal letter and additional information and/or documentation must be submitted within thirty (30) days of the original determination to: U n i versa l H ea lth 1 /NPP n var`�'c-r-�is rzrc - ur ��lnrn�rvrrvz�T Reno, NV 89520 3007 CDS Medical Management P.O. Box 50190 Sparks, NV 89435 -0190 The Medical Director will render a decision within thirty (30) days of the date the appeal letter was received and will notify the Claimant in writing of his/her findings. Level II: PLAN ADMINISTRATOR REVIEW: If after completing Level I, the Claimant is dissatisfied with the Medical Director decision, the Claimant may submit a written appeal and Request for Plan Exception to the Page 61 of 89 -79- Plan Administrator for his/her review. The appeal shall contain all information and /or documentation the Claimant would like reviewed by the Plan Administrator, including a signed Release of Information for Request for Plan Exception form. The written appeal must be submitted within thirty (30) days of the Level I decision to: South Tahoe Public Utility District ATTN: General Manager/Plan Administrator 1275 Meadow Crest Drive South Lake Tahoe, CA 96150 The Claimant will be notified in writing of the Plan Administrator's decision within thirty (30) days of the date the decision was made. Page 62 of 89 -80- Coordination of Benefits Coordination of the benefit plans Coordination of benefits sets out rules for the order of payment of covered Charges when two or more plans — including Medicare — are paying. When a Covered Person is covered by this Plan and another plan, or the Covered Person's Spouse is covered by this Plan and by another plan, or the couple's Covered children are covered under two or more plans, the plans will coordinate benefits when a claim is received. The plan that pays first according to the rules will pay as if there were no other plan involved. The secondary and subsequent plans will pay the balance of the claim after the primary plan has paid. Deductible(s) and co- pay(s) shall not be taken when this plan is the secondary plan. Benefit Plan This provision will coordinate the medical and dental benefits of a benefit plan. The term benefit plan means this Plan or any one of the following plans: 1. Group or group -type plans, including franchise or blanket benefit plans. 2. Blue Cross and Blue Shield group plans. 3. Group practice and other group prepayment plans. 4. Federal government plans or programs. This includes Medicare. 5. Other plans required or provided by law. This does not include Medicaid or any benefit plan like it that, by its terms, does not allow coordination. 6. No Fault Auto Insurance, by whatever name it is called, when not prohibited by law. Allowable Charge For a charge to be allowable it must be a Usual, Customary, and Reasonable Charge and at least part of it must be covered under this Plan. In the case of HMO (Health Maintenance Organization) plans: This Plan will not consider any charges in excess of what an HMO provider has agreed to accept as payment in full. Also, when an HMO pays its benefits first, this Plan will not consider as Page 63 of 89 -si- an allowable charge, any charge that would have been covered by the HMO had the Covered Person used the services of an HMO provider. In the case of service type plans where services are provided as benefits, the reasonable cash value of each service will be the allowable charge. Automobile Limitations When medical payments are available under vehicle insurance, the Plan shall pay excess benefits only, without reimbursement for vehicle plan deductibles. This Plan shall always be considered the secondary carrier regardless of the individual's election under PIP (Personal Injury Protection) coverage with the auto carrier. Benefit Plan Payment Order When two or more plans provide benefits for the same allowable charge, benefit payment will follow these rules. 1. Plans that do not have a coordination provision, or one like it, will pay first. Plans with such a provision will be considered after those without one. 2. Plans with a coordination provision will pay their benefits by these rules up to the allowable charge. A. The benefits of the plan which covers the person as an employee, member, or subscriber (that is, other than as a dependent) are determined before those of the plan which covers the person as a dependent; except that: if the person is also a Medicare beneficiary, and as a result of the rule established by Title XVIII of the Social Security Act and implementing regulations, Medicare is: Secondary to the plan covering the person as a dependent, and 2. Primary to the plan covering the person as other than a dependent (e.g., a retired employee), Then the benefits of the plan covering the person as a dependent are determined before those of the plan covering that person as other than a dependent. B. If both husband and wife are Employees, benefits covering the person as an Employee are determined before benefits covering the person as a Dependent. After determining benefits for the person as an Employee, Internal Coordination of Benefits will apply, and benefits will be determined for the person as a Dependent. Page 64 of 89 -82- Benefits for children covered as Dependents of both Employee Spouses will be determined in accordance with the Dependent rules below and coordinated internally. C. The benefits of a benefit plan which covers a person as an Employee who is neither laid off nor retired are determined before those of a benefit plan which covers that person as a laid -off or Retired Employee. The benefits of a benefit plan which covers a person as a Dependent of an Employee who is neither laid off nor retired are determined before those of a benefit plan which covers a person as a Dependent of a laid -off or Retired Employee. If the other benefit plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this rule does not apply. D. The benefits of a benefit plan which covers a person as an Employee who is neither laid off nor retired or a Dependent of an Employee who is neither laid off nor retired are determined before those of a plan which covers the person as a COBRA beneficiary. E. When a child is covered as a Dependent and the parents are not separated or divorced, these rules will apply: The benefits of the benefit plan of the parent whose birthday falls earlier in a year are determined before those of the benefit plan of the parent whose birthday falls later in that year. 2. If both parents have the same birthday, the benefits of the benefit plan which has covered the patient for the longer time are determined before those of the benefit plan which covers the other parent. F. When a child's parents are divorced or legally separated, these rules will apply: 1. This rule applies when the parent with custody of the child has not remarried. The benefit plan of the parent with custody will be considered before the benefit plan of the parent without custody. 2. This rule applies when the parent with custody of the child has remarried. The benefit plan of the parent with custody will be considered first. The benefit plan of the stepparent that covers the child as a Dependent will be considered next. The benefit plan of the parent without custody will be considered last. 3. This rule will be in place of items (1) and (2) above when it applies. A court decree may state which parent is financially Page -65-of 89 responsible for medical and dental benefits of the child. In this case, the benefit plan of that parent will be considered before other plans that cover the child as a Dependent. 4. If the specific terms of the court decree state that the parents shall share joint custody, without stating that one of the parents is responsible for the health care expenses of the child, the plans covering the child shall following the order of benefit determination rules outlined above when a child is covered as a Dependent and the parents are not separated or divorced. G. If there is still a conflict after these rules have been applied, the benefit plan which has covered the patient for the longer time will be considered first. 3. Medicare will pay primary, secondary, or last, to the extent stated in federal law. When Medicare is to be the primary payer, this Plan will base its payment upon benefits that would have been paid by Medicare under Parts A and B, regardless of whether or not the person was enrolled under both of these parts. Claims Determination Period Benefits will be coordinated on a Calendar Year basis. This is called the claims determination period. Right to Receive or Release Necessary Information To make this provision work, this Plan may give or obtain needed information from another insurer or any other organization or person. This information may be given or obtained without the consent of or notice to any other person. A Covered Person will give this Plan the information it asks for about other plans and their payment of allowable charges. Facility of Payment This Plan may repay other plans for benefits paid that the Plan Administrator determines it should have paid. That repayment will count as a valid payment under this Plan. Right of Recovery This Plan may pay benefits that should be paid by another benefit plan. In this case, the Plan may recover the amount paid from the other benefit plan or the Covered Person. That repayment will count as a valid payment under the other benefit plan. Pag_eA6 of 89 Further, this Plan may pay benefits that are later found to be greater than the allowable charge. In this case, the Plan may recover the amount of the overpayment from the source to which it was paid. SubroLyation and Reimbursement Provisions Right of Subrogation and Refund When this provision applies: The Covered Person may incur medical or dental charges due to injuries, sickness, disease or disability which may be caused, in whole or in part, by or resulting from the acts or omissions of a third party, or from the acts or omissions of Plan Participant where any insurance coverage, no- fault, uninsured motorist, underinsured motorist, medical payment provision or other insurance policies or funds ( "Coverage ") exist. In such circumstances, the Covered Person may have a claim against that third party, or insurer, for payment of the medical or dental charges and the Plan will conditionally advance payment or extend credit of medical benefits as a courtesy in such situations. Payment Conditions 1. Plan Participant, his or her attorney, and/or legal guardian of a minor or incapacitated individual(s) agrees, by accepting benefits under this Plan for those incurred medical or dental expenses, to maintain in trust and without dissipation one hundred percent (100 %) of the amount paid for benefits by the Plan, or the full extent of payment received, less reasonable attorney's fees, when recovered from any one or combination of first and third party sources. 2. By accepting benefits under the Plan, the Plan Participant recognizes this property right or equitable interest of the Plan in any cause of action the Plan Participant may have or the proceeds thereof and allows the Plan to pursue any claim which the Covered Person has against any third party, or insurer, whether or not the Covered Person chooses to pursue that claim. 3. The Plan may make a claim directly against the third party or insurer. In the event a Plan Participant settles, recovers, or is reimbursed by any third party or Coverage, the Plan has the first priority right of recovery and a first lien on any amount recovered by the Covered Person whether or not designated as payment for medical expenses, and shall be paid before any other claims for the Plan Participant as the result of the illness or injury. This lien shall remain in effect until the Plan is repaid in full. Said right and/or lien may be filed with any person or organization responsible, or potentially responsible, to the Plan Participant for indemnification, the Plan Participant's attorney, or the Court. Page 67 of 89 -85- 4. If the Plan Participant fails to reimburse the Plan for all benefits paid or to be paid, less reasonable attorney' fees, as a result of said injury or condition, out of recovery or reimbursement received, the Plan Participant will be liable for any and all expenses (whether fees or costs) associated with the Plan's attempt to recover such money from the Plan Participant. 5. The Plan requires written consent for any fees or costs associated with a Plan Participant pursuing a claim against any Coverage. The Plan Participant agrees to hold the Plan harmless against any unreasonable claims made against the Plan by the attorneys retained by the Plan Participant, however these rights of subrogation and reimbursement shall apply without regard to whether any separate written acknowledgement of these rights is issued by the Plan and signed by the Plan Participant. 6. This provision shall not limit any other remedies of the Plan provided by law. These rights of subrogation and reimbursement shall apply without regard to the location of the event that led to or caused the applicable sickness, injury, disease, or disability. The Covered Person: 1. As a condition to participating in and receiving benefits under the Plan, automatically agrees to assign to the Plan any and all claims, causes of action or rights that they have or that may arise against any person, corporation and/or other entity, third party or insurer when this provision applies and to any Coverage for which the Covered Person claims an entitlement to benefits under this Plan, regardless of how classified or characterized. 2. To promptly reimburse the Plan for any benefits paid on his or her behalf out of the recovery made from the third party or insurer, when such recovery through settlement, judgment, award or other payment is received; 3. To cooperate with the Plan or its agents in defining, verifying and protecting its rights of subrogation and reimbursement and to do nothing to prejudice the Plan's rights of subrogation and reimbursement. 4. To provide the Plan with pertinent information regarding the injury or sickness, including various forms of documentation, accident reports, settlement reports and any other requested additional information; 5. To take such action, furnish such information and assistance, and execute such documents as the Plan may require to facilitate enforcement of its subrogation and reimbursement rights. Page 68 of 89 -86- Amount Subject to Subrogation or Refund 1. The Covered Person agrees to recognize the Plan's right to subrogation and reimbursement. These rights provide the Plan with a priority over M funds to recover 100% of the benefits paid by a third party to a Covered Person relative to the Injury or Sickness, with reasonable deduction for non - medical or dental charges, attorney fees, or other costs and expenses, without regard to whether the Plan Participant is fully compensated by his/her net recovery from all sources. This obligation exists whether or not the judgment or settlement specifically designates the recovery or a portion of it as including medical, disability, or other expenses, and exists regardless of how classified or characterized. If the Plan Participant's net recovery is less than the benefits paid, then the Plan is entitled to be paid all of the net recovery achieved, less reasonable attorney's fees. 2. Notwithstanding its priority to funds, the Plan's subrogation and refund rights, as well as the rights assigned to it, are limited to the extent to which the Plan has made, or will make, payments for medical or dental charges as well as any costs and fees associated with the enforcement of its rights under the Plan. Assignment of Rights 1. As a condition to the Plan making payments for any medical or dental charges, the Covered Person must assign to the Plan his or her rights to any recovery arising out of or related to any act or omission that caused or contributed to the Injury or Sickness for which such benefits are to be paid. The scope of this assignment is consistent with the amount subject to subrogation or refund set forth above. 2. If the Covered Person decides to pursue a third party or any Coverage available to them as a result of the said injury or condition, when a right of recovery exists, the Covered Person agrees to include the Plan's subrogation claim in that action and will execute and deliver all required instruments and papers as well as doing whatever else is needed to secure the Plan's right of subrogation as a condition to having the Plan make payments. In addition, the Covered Person will do nothing to prejudice the right of the Plan to subrogate. If the Covered Person fails to include the Plan's subrogation claim in that action, the Plan will be legally presumed to be included in such action or recovery. 3. In the event the Plan Participant fails to make a claim against or pursue damages against: A. The responsible party, its insurer, or any other source on behalf of that ply; B. Any first part insurance through medical payment coverage or personal injury protection; Page O of 89 C. The Plan Participant's uninsured or underinsured motorist coverage; D. Any policy or contract of insurance from any insurance company or guarantor of a third party; E. Workers' Compensation or other liability insurance company; or F. Any other source, including but not limited to crime victim restitution funds, any medical, disability or other benefit payments, and no -fault or school insurance coverages, Then the Plan Participant authorizes the Plan to pursue, sue, compromise or settle any such claims in their name, to execute any and all documents necessary to pursue said claims in their name, and agrees to fully cooperate with the Plan in the prosecution of any such claims, and assigns all rights to the Plan or its assignee to pursue a claim and the recovery of all expenses from any sources listed above. 4. If at the time of injury, sickness, disease or disability there is available, or potentially available based on information known or provided to the Plan or to the Plan Participant, any other Coverage, including but not limited to judgment at law or settlements, the benefits under this Plan shall apply only as excess insurance over such other sources of indemnifications. The Plan's benefits shall be excess to the parties listed above. 5. The Plan may, in its own name, or in the name of the Plan Participant or their personal representative, commence a proceeding or pursue a claim against such other third person for the recovery of all damages in the full extent of the value of any such benefits or services furnished or payment advanced or credit extended by the Plan. 6. In the event the Plan Participant is a minor as that term is defined by applicable law, the minor's parents or court- appointed guardian, as the case may be, shall take and cooperate in any and all action requested by the Plan to seek and obtain any requisite court approval in order to bind the minor and his or her estate insofar as the subrogation and reimbursement provisions are concerned. If the minor's parents or court- appointed guardian fail or refuse to take such action, any court costs or legal fees incurred by the Plan associated with obtaining such approval, shall be paid by the minor's parents or court - appointed guardian. Language Interpretation and Severability 1. The Plan Administrator retains sole, full and final discretionary authority to construe and interpret the language of this provision, to determine all questions of fact and law arising under this provision, and to administer the Plan's subrogation/reimbursement rights. 2. In the event that any section of this provision is considered invalid or illegal for any reason, said invalidity or illegality shall not affect the remaining sections of this provision and Plan. The section shall be fully severable. The Plan shall be Page of 89 construed and enforced as if such invalid or illegal sections had never been inserted in the Plan. Defined Terms 1. Recovery means monies paid to the Covered Person by way of judgment, settlement, or otherwise to compensate for all losses caused by the Injuries or Sickness whether or not said losses reflect medical or dental charges covered by the Plan. 2. Subrogation means the Plan's right to pursue the Covered Person's claims for medical or dental charges against the other person. 3. Refund means repayment to the Plan for medical or dental benefits that it has paid toward care and treatment of the Injury or Sickness. Page 34 of 89 COBRA Continuation Options To provide options for individuals who lose health coverage from an employer- sponsored insurance plan, the Federal Government enacted the Consolidated Omnibus Budget Reconciliation Act of 1985 (Public Law 99 -272, Title X), commonly known as COBRA. The following will explain your rights under the law and what should be done if you (or a covered dependent) experience a COBRA "qualifying event ". A qualifying event is an event that occurs whereby an employee or covered dependent would no longer be eligible to continue under a group health plan. We request that you and your covered dependents take the time to read this important notification. COBRA Law With a few exceptions, employers with twenty or more employees that provide health benefits are required to offer employees (and/or their covered dependents) the right to a temporary extension of group insurance (called "continuation coverage ") upon experiencing a qualifying event. An individual experiencing a qualifying event is referred to as a "qualified beneficiary" and receives many of the rights granted to similarly situated active employees as it relates to group insurance plans. It is the employee's responsibility to notify the Plan Administrator immediately upon experiencing a qualifying event, so that the Plan Administrator may effectuate the required notification within the required time frames. See definition of Qualifying Events, below. Continuation coverage is different from converting to individual coverage after termination of employment. The major advantages of COBRA are that participants will receive the same group plan benefits as a similarly situated active employee and will be charged the company's group rate (plus a maximum of two percent as an administrative fee). These COBRA rates may (or may not) be less than the premiums charged under a conversion policy so it is recommended that you contact the insurer directly to receive a quote. With many conversion policies, benefits are reduced and premiums are based upon the age and sex of the converting members. Another difference is that COBRA allows for covered dependents to independently continue their health coverage and retain COBRA rights throughout their continuation time frame. Employer and Qualified Beneficiary's Responsibilities When you or your covered dependent experience a qualifying event, you will be sent a notification explaining your rights to elect COBRA continuation coverage. The Plan Administrator shall provide this notification through its third party COBRA administrator, within fourteen days from the date of the qualifying event (or as soon as administratively possible). You or -your dependent have the responsibility to notify the third party COBRA administrator of your desire to continue coverage within sixty (60) days from the later of the date of notification or loss of coverage. Upon acceptance you or your dependent will be notified of any enrollment forms that must be completed. Keep in mind, qualified beneficiaries who elect continuation coverage Page 72 of 89 are responsible for premiums back to the date termination from the plan would have occurred. If you or a covered dependent experience a qualifying event and do not receive a qualifying event notification in a timely fashion, you are requested to contact the Plan Administrator immediately. Even if you elect not to continue coverage, it is vital you have the information necessary to make an informed decision. The Employer will know when certain qualifying events (i.e., reduced work hours, employment termination and death of an employee) occur. You and your covered dependents will be responsible for notifying the Plan Administrator or his/her designee of a divorce, legal separation, Medicare entitlement or when a dependent loses his/her "dependent status ". You or your dependent(s) have sixty (60) days to notify the Plan Administrator or his designee of these qualifying events If the Plan Administrator or his designee is not notified within this time frame, COBRA continuation cannot be offered. In order to take advantage of the disability extension described below, you must also notify us within sixty days of a determination by Social Security that you or a dependent are "disabled ". COBRA Qualifying Events Listed below are qualifying events for which you and/or your covered dependents are able to continue coverage under COBRA. As shown, the maximum continuation coverage time frame depends upon the qualifying event experienced. To be considered a qualified beneficiary, you or your dependent must have been enrolled on the group plan on the day prior to the qualifying event. One exception to this rule is when a child is born to (or placed for adoption with) an employee during the COBRA continuation period. These children will receive all the rights of a qualified beneficiary throughout the COBRA continuation period. Qualifying Events that Yield a Qualifying Events that Yield a Maximum of 18 Months Coverage Maximum of 36 Months Coverage Ex erienced b the Em to ee (Experienced b a Covered Dependent Termination of employment (for reason Death of the employee other than "gross misconduct ") Reduction of employee's work hours Divorce or legal separation Employee is entitled to Medicare but dependents are not Dependent child who no longer meets the lan's definition of a "dependent" Page 79 i o f 89 Disability Extension If the qualifying event is an employee's termination or reduction in work hours and you or a covered dependent are determined to be "disabled" by Social Security (under Title XI or Title XVI) either before that qualifying event or within sixty days of such event, you and your covered dependents are eligible for an additional eleven months of coverage (yielding a total of 29 months). For this extension to apply, evidence of disability under the Social Security Act must be provided to the Plan Administrator within the initial eighteen month continuation coverage time frame and within sixty days from the date of Social Security's determination. Multiple Qualifying Events If you experience a qualifying event that entitles you and your covered dependents to less than thirty-six months of continuation coverage (including the disability extension described above) and during your period of continuation coverage your covered dependents experience a second (or "multiple ") qualifying event, the period of continuation coverage for your covered dependents may be extended under COBRA from eighteen months (or twenty -nine months if disabled) to thirty -six months. The maximum continuation period is thirty-six months regardless of how many qualifying events your covered dependents experience. It is your responsibility, or the responsibility of your covered dependents to notify the Plan Administrator within sixty days of the multiple qualifying event. Employees who experience a reduction in work hours followed by a termination of employment shall only be eligible for eighteen months of continuation coverage under COBRA. Family and Medical Leave Act Under the Family and Medical Leave Act of 1993 (FMLA), eligible employees have the right to take up to twelve weeks of unpaid leave to care for themselves or a specified relative. If you elect to take this leave and later notify the company that you will not be returning, you have the ability to continue your coverage for eighteen months from the date benefits are terminated on account of your failure to return to work. Please refer to the District's Family Care and Medical Leave Policy for complete details regarding benefits status during this type of leave. Re- Enrollment after a FMLA Leave If any or all of an Employee's coverages end while the Employee is on a FMLA leave, the Employee can re- enroll for coverage when he or she returns to work from the FMLA leave. The Employee and any Dependents will be considered timely enrollees if the Employee re- enrolls within thirty one (3 1) days from the date he or she returns to work. Any waiting period will be applied as if there had been no break in coverage. Page 74 of 89 -92- COBRA Termination Although COBRA continuation coverage has a maximum time frame, you may voluntarily terminate coverage at any time by notifying the Plan Administrator in advance. In addition, COBRA states that continuation coverage will end for one or more of the following reasons: 1. The District terminates all of its health plans for similarly situated active employees. 2. COBRA premiums are not paid in a timely manner. 3. You and/or your Covered Dependents become covered under another group plan after electing continuation coverage and that plan does not exclude a pre - existing medical condition affecting you or your dependents. 4. You become entitled to Medicare (meaning enrolled in Parts A and/or B) after you have elected continuation coverage under COBRA. However, your dependent's continuation coverage may be extended to thirty -six months upon notifying the Plan Administrator of your Medicare entitlement. 5. You or a Covered Dependent are enrolled in a plan that requires you to live in the plan's "Service Area" or visit contracted providers and you move out of that service area. However, if another plan is available to similarly situated active employees who move from the service area, coverage under that plan will be offered to you. 6. You file fraudulent claims or engage in other activities for which a similarly situated active employee would be terminated "for cause ". 7. A "disabled" participant is determined by Social Security to be no longer disabled during the eleven month extension. In that case, the entire family unit will be terminated from COBRA. Premium Costs The cost of continuation coverage will be determined at the time of the qualifying event. Your cost will be the amount determined by the District for similarly situated active employees under the Plan, plus a 2% administration fee. An employee who is deemed to be disabled and who elects the disability extension may be charged a 50% administration fee during the eleven month extension. (If the disabled employee does not elect the disability extension or terminates coverage before the extension would ordinarily end, his/her covered dependent's administration fee will be reduced to 2 %). If the District's "premium" funding increases or decreases, the COBRA participant's premiums will be adjusted accordingly. Premium rates for the plan are set for twelve month periods based upon the Plan Year. Page g §_of 89 If you elect to continue coverage under COBRA, you will be granted an initial forty-five day grace period to make your payment. Your first payment must include the premiums for coverage retroactively to the date you or your covered dependents would have lost coverage if you hadn't elected to continue coverage. Subsequent premium payments will have a thirty -day grace period. If premiums are not received within the allotted grace period, COBRA coverage will be terminated back to the date for which premiums were applied. Coverage under COBRA Since COBRA is a continuation of benefits, your benefits will remain the same as prior to the qualifying event. If the District elects to change plans and/or benefits, you will be eligible to enroll in the changed plan and will therefore receive the same benefits as similarly situated active employees. If your Plan has deductibles and co- insurance maximums, these amounts will be based upon expenses incurred prior to the qualifying event by only those family members electing to continue under the plan. COBRA participants who move from the plan's service area may lose coverage under the group health plan (as would a similarly situated active employee). If the District offers a plan that would provide coverage in the new area, the COBRA participant will be offered the right to enroll in that plan. Open Enrollment COBRA participants are offered the same rights as similarly situated active employees during open enrollment. They may change plans and add/delete eligible dependents. Although part of the family unit, dependents (other than newborn children and adopted children of the employee) added during open enrollment will not have the same COBRA rights as the initial qualified beneficiaries. The District's open enrollment may vary from year to year, so feel free to contact the Plan Administrator for further information on open enrollment. Trade Act of 2002 On August 6, 2002, the Trade Act of 2002 was signed into law expanding the benefits available to workers displaced by import competition or shifts of production to other countries. The Trade Act of 1974 initially offered benefits (known as "trade adjustment assistance ") which expired September 30, 2001. The Trade Act of 2002 extended this period to September 30, 2007 and offers qualified workers a tax credit of up to 65% of COBRA health insurance premiums for both them and their family. To be eligible for the tax credit, you must be currently receiving trade adjustment assistance or considered an "eligible PBGC pension recipient ", paying premiums for qualified health insurance, not receiving other coverage and not in prison. The law also creates a second "election period" for individuals not electing COBRA coverage upon Page 9 7 4 6 of 89 ; their loss of employment if they are within the six months immedi i iaely.after{their group health plan coverage ended. For further information on the Trade 'acct of 2002, please visit the website at www.cobralaw.com/trade -act Health Insurance Portability and Accountability Act of 1996 �HIRAA) The scope of HIPAA is to eliminate barriers for individuals (mmit;pple,wifh pre- existing medical conditions that would have difficulty obtaining. 6ai�ate, 6&erage) who lose coverage and want to find a replacement plan. The la plan's, "pre - existing condition limitation time frame" to twelve months for nl�ly enrolling individuals and provides credit for prior medical coverage, including COBRA continuation coverage. When you terminate from a group medical plan, you will receive a Certificate of Coverage that illustrates your prior coverage. This certificate should be shown to a new employer to receive one month credit for every rap nth of prior coverage. If there is a break in coverage greater than sixty -three (63) days; t��:!idw employer does not have to provide any prior coverage credit. (Individuals receit��i , 'trade adjustment assistance and who enroll in COBRA during the "second electidiiOp�Irtp�d' shall receive creditable coverage even with a break in coverage larger than sixtly.three days.) In addition, if you elect COBRA and keep your coverage for the maximum continuation period available to you, you may be eligible for coverage under ari.itldividual plan (through an insurer of your choice) on a guaranteed issue basis witbout any prp existing condition limitations. Questions Regarding COBRA COBRA is complex, placing certain requirements on both the employer and the qualified beneficiary. It is designed to provide temporary health insurance with a defined termination date. If you have any questions regarding this notification of your COBRA rights, please feel free to contact Conexis at (866) 263 -7277. Continuation of Coverage Under USERRA If your Service ends due to a qualified military leave of absence you may be eligible to continue coverage under this provision, subject to payment of contributions. The Uniformed Services Employment and Reemployment Rights 'pt f 1994 . ( USERRA) established requirements that Employers must meet'# ,i'gin.-1✓t ployees who are involved in the Uniformed Services. In addition to the .6ghts'tutd+er COBRA continuation of coverage, you are entitled under USERRA to continue the coverage yu had under the group for Medical, Prescription Drug and Dental. "Service in the Uniformed Services" means the performance of active duty in the Uniformed Services under competent authority which includes training, full -time National Guard duty and the time necessary for a person to be abseht from employment Page. gg -of 89 for an examination to determine the fitness of the person to perform any of the assigned duties. When a covered Employee takes a leave for Service in the Uniformed Services, USERRA coverage for the covered Employee and covered Dependents for whom coverage is elected, begins the day after the Employee and covered Dependents lose coverage under the Plan and it continues for a maximum period of up to 24 months. If you are entitled to COBRA continuation coverage, both COBRA and USERAA coverage are concurrent. This means both COBRA coverage and USERRA coverage will begin upon commencement of the employee's leave. The administrative policies and procedures described for COBRA continuation coverage will also apply to USERAA coverage. In some instances, COBRA coverage may continue longer. Additional information on COBRA continuation coverage is described in this Plan Document. If coverage under USERRA is elected, the covered Employee and covered Dependents will be required to pay up to 102% of the applicable group rate. However, if your Uniformed Service leave of absence is less than 31 days, you are not required to pay more than the amount that you pay as an active Employee for that coverage. Page 9 8 of 89 Plan Amendment Regarding HIPAA Privacy Compliance For the South Tahoe Public Utility District Employees' Benefit Plan Introduction The South Tahoe Public Utility District (Plan Sponsor) sponsors the South Tahoe Public Utility District Employees' Benefit Plan (the Plan). Members of the District's workforce may have access to the individually identifiable health information of Plan participants for administrative functions of the Plan. When this health information is provided from the Plan to the Plan Sponsor, it is Protected Health Information (PHI). The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations restrict the Plan Sponsor's ability to use and disclose PHI. The following HIPAA definition of PHI applies to this Plan Amendment: Protection Health Information: Protected health information means information that is created or received by the Plan and relates to the past, present, or future physical or mental health or condition of a participant; the provision of health care to a participant; or the past, present, or future payment for the provision of health care to a participant; and that identifies the participant or for which there is a reasonable basis to believe the information can be used to identify the participant. Protected health information includes information of persons living or deceased. The Plan Sponsor shall have access to PHI from the Plan only as permitted under this Plan Amendment or as otherwise required or permitted by HIPAA. Provision of Protected Health Information to Plan Sponsor Permitted Disclosure of Enrollment/Dis- Enrollment Information The Plan (or a health insurance issuer or HMO with respect to the Plan) may disclose to the Plan Sponsor information on whether the individual is participating in the Plan, or is enrolled in or has dis- enrolled from a health insurance issuer or HMO offered by the Plan. Permitted Uses and Disclosure of Summary Health Information The Plan (or a health insurance issuer or HMO with respect to the Plan) may disclose Summary Health Information (defined below) to the Plan Sponsor, provided the Plan Sponsor requests the Summary Health Information for the purpose of Page of 89 Obtaining premium bids from health plans for providing health insurance coverage under the plan; or 2. modifying, amending, or terminating the Plan. Summary Health Information: Summary health information means information that (a) summarizes the claims history, claims expenses or type of claims experienced by individuals for whom a plan sponsor had provided health benefits under a Health Plan; and (b) from which the information described at 42 CFR § 164.514(b)(2)(I) has been deleted, except that the geographic information described in 42 CFR § 164.514(b)(2)(i)(B) need only be aggregated to the level of a five -digit zip code. Permitted and Required Uses and Disclosure of Protected Health Information for Plan Administration Purposes Unless otherwise permitted by law, and subject to the conditions of disclosure described under "Conditions of Disclosure for Plan Administration Purposes ", and obtaining written certification pursuant to "Certification of Plan Sponsor ", the Plan (or a health insurance issuer of HMO on behalf of the Plan) may disclose PHI to the Plan Sponsor, provided the Plan Sponsor uses or discloses such PHI only for Plan administration purposes. Plan Administration Purposes: Plan administrative purposes means administration functions performed by the Plan Sponsor on behalf of the Plan, such as quality assurance, claims processing, utilization trends, auditing, and monitoring. Plan administration functions do not include functions performed by the Plan Sponsor in connection with any other benefit or benefit plan of the plan of the Plan Sponsor, and they do not include any employment related functions. Notwithstanding the provisions of this Plan to the contrary, in no event shall the Plan Sponsor be permitted to use or disclose PHI in a manner that is inconsistent with 45 CFR § 164.504(f). Conditions of Disclosure for Plan Administration Purposes Plan Sponsor agrees that with respect to any PHI (other an enrollment/dis- enrollment information and Summary Health Information, which are not subject to these restrictions) disclosed to it by the Plan (or a health insurance issuer or HMO on behalf of the Plan) Plan Sponsor shall: Pag_e of 89 1. Not use or further disclose the PHI other than as permitted or required by the Plan or as required by law. 2. Ensure that any agent, including a subcontractor, to whom it provides PHI received from the Plan agrees to the same restrictions and conditions that apply to the Plan Sponsor with respect to PHI. 3. Not use or disclose the PHI for employment - related actions and decisions or in connection with any other benefit or employee benefit plan of the Plan Sponsor. 4. Report to the Plan any use or disclosure of the information that is inconsistent with the uses or disclosures provided for, of which it becomes aware. 5. Make available PHI to comply with HIPAA's right to access in accordance with 45 CFR § 164.524. 6. Make available PHI for amendment and incorporate any amendments to PHI in accordance with 45 CFR § 164.526. 7. Make available the information required to provide an accounting of disclosures in accordance with 45 CFR § 164.528. 8. Make its internal practices, books, and records relating to the use and disclosure of PHI received from the Plan available to the Secretary of Health and Human Services for purposes of determining compliance by the Plan with HIPAA's privacy requirements. 9. If feasible, return or destroy all PHI received from the Plan that the Plan Sponsor still maintains in any form and retain no copies of such information when no longer needed for the purposes for which disclosure was made, except that, if such return or destruction is not feasible, limit further uses and disclosure to those purposes that make the return or destruction of the information infeasible. 10. Ensure that the adequate separation between Plan and Plan Sponsor (i.e., the "firewall "), required in 45 CFR § 504(f)(2)(iii), is satisfied. Adequate Separation Between Plan and Plan Sponsor The Plan Sponsor shall allow the General Manager (as Plan Administrator), Human Resources Director (as Plan Coordinator) and Chief Financial Officer and/or Accounting Manager (to conduct internal audit of the Plan's expenses and payment of claims), access to the PHI. No other persons shall have access to and use PHI to the extent necessary to perform the Plan administration functions that the Plan Sponsor performs for the Plan. In the event that any of these specified employees do not comply with the provisions of this Section, that employee shall be subject to disciplinary action by the Plan Sponsor for Page,§4 -of 89 non - compliance, pursuant to the Plan Sponsor's employee discipline and termination procedures. Certification of Plan Sponsor The Plan (or a health insurance issuer or HMO with respect to the Plan) shall disclose PHI to the Plan Sponsor only upon the receipt of a certification by the Plan Sponsor that the Plan has been amended to incorporate the provisions of 45 CFR § 164.504(f)(2)(ii), and that the Plan Sponsor agrees to the conditions of disclosure set forth in the preceding paragraphs of this Section. Page $i of 89 Responsibilities for Plan Administration Plan Administrator South Tahoe Public Utility District Employees' Benefit Plan is the benefit plan for Employees of South Tahoe Public Utility District. The Plan Administrator, also called the Plan Sponsor is an individual appointed by the South Tahoe Public Utility District to be Plan Administrator and serve at the convenience of the Employer. If the Plan Administrator resigns, dies or is otherwise removed from the position, South Tahoe Public Utility District shall appoint a new Plan Administrator as soon as reasonably possible. The Plan Administrator shall administer this Plan in accordance with its terms and establish its policies, interpretations, practices, and procedures. It is the express intent of this Plan that the Plan Administrator shall have maximum legal discretionary authority to construe and interpret the terms and provisions of the Plan, to make determinations regarding issues which relate to eligibility for benefits, to decide disputes which may arise relative to a Plan Participant's rights, and to decide questions of Plan interpretation and those of fact relating to the Plan. The decisions of the Plan Administrator will be final on all interested parties. Duties of the Plan Administrator 1. To administer the Plan in accordance with its terms. 2. To interpret the Plan, including the right to remedy possible ambiguities, inconsistencies or omissions. I To decide disputes which may arise relative to a Plan Participant's rights. 4. To prescribe procedures for filing a claim for benefits and to review claim denials. 5. To keep and maintain the Plan documents and all other records pertaining to the Plan. 6. To appoint a Claims Administrator to pay claims. 7. To delegate to any person or entity such powers, duties and responsibilities as it deems appropriate. Plan Administrator Compensation The Plan Administrator serves without compensation; however, all expenses for Plan administration, including compensation for hired services, will be paid by the Plan. Page 83 of 89 -ioi- Claims Administrator is not a Fiduciary A Claims Administrator is not a fiduciary under the Plan by virtue of paying claims in accordance with the Plan's rules as established by the Plan Administrator. Funding the Plan and Payment of Benefits The cost of the Plan is funded as follows: 1. For Employee and Dependent Coverage: A. Funding is derived solely from the funds of the Employer. 2. Benefits are paid directly from the Plan through the Claims Administrator. Plan is not an Employment Contract The Plan is not to be construed as a contract for or of employment. Clerical Error Any clerical error by the Plan Administrator or an agent of the Plan Administrator in keeping pertinent records or a delay in making any changes will not invalidate coverage otherwise validly in force or continue coverage validly terminated. An equitable adjustment of contributions will be made when the error or delay is discovered. If, due to a clerical error, an overpayment occurs in a Plan reimbursement amount, the Plan retains a contractual right to the overpayment. The person or institution receiving the overpayment will be required to return the incorrect amount of money. In the case of a Plan Participant, if it is requested, the amount of overpayment will be deducted from future benefits payable. Self - Funded Benefits Medical, Prescription Drug, Dental and Vision Benefits The Plan Administrator has complete authority to control and manage the Plan. The Plan Administrator has full discretion to determine eligibility, to interpret the Plan, and to determine whether a claim should be paid or denied, according to the provisions of the Plan as set forth in this booklet. The Employer is fully responsible for the self - funded benefits. The Claims Administrator processes claims and provides other services to the Employer related to the self - funded benefits. The Claims Administrator does not insure or guarantee the self - funded benefits. Page 84 of 89 -102- General Plan Information The Plan will provide benefits, in accordance with the applicable requirements of federal laws, such as COBRA, HIPAA (the Health Insurance Portability and Accountability Act of 1996), the NMHPA (The Newborns' and Mothers' Health Protection Act of 1996), and the WHCRA (The Women's Health and Cancer Rights Act of 1998). The Plan will also provide benefits as required by any qualified medical child support order, as defined in ERISA § 609(a), and provide benefits to dependent children placed with participants or beneficiaries for adoption under the same terms and conditions as apply in the case of dependent children who are natural children or participants of beneficiaries, in accordance with ERISA §609(c). Your right to benefits under this Plan will be determined under each Program in which you participate. Your rights to benefits in this Plan or any Program are subject to amendment, modification or termination in accordance with the Plan Eligibility and Participant Section of this Plan, and the applicable provisions of each Program. Any amendment, modification or termination of a Program will also be an amendment, modification or termination of this Plan. Amendment or Termination of this Plan The Employer fully intends to maintain this Plan indefinitely. However, it reserves the right to terminate, suspend, discontinue or amend the Plan at any time upon advance notice to all Participants, subject to the terms of the applicable MOU. Changes in the Plan may occur in any or all parts of the Plan including benefit coverage, deductibles, maximums, co- payments, exclusions, limitations, definitions, eligibility and the like. If the Plan is terminated, the rights of Covered Persons are limited to covered charges incurred before termination. Funding All benefits paid under the Plan are paid in cash from the general assets of the District. No Employees have any right, title, or interest whatever in or to any investment reserves, accounts, or funds that the District may purchase, establish, or accumulate to aid in providing Benefits under the Plan. Nothing contained in the Plan, and no action taken under its provisions, creates a trust or fiduciary relationship of any kind between the District and an Employee or any other person. Neither an Employee nor a beneficiary of an Employee acquires any interest greater than that of an unsecured creditor. Type of Plan The Plan provides medical, dental, and prescription drug benefits. Pagg � of 89 Type of Administration The Plan is a self - funded welfare plan and the administration is provided through a third party Claims Administrator Plan Name Plan Number South Tahoe Public Utility District Employees' Benefit Plan 901 Plan Effective Date Plan Year January 1, 1997 January 1 through December 31 S` The Plan has been amended several times since its original effective date. See the title page for all amendment dates. Employer Information South Tahoe Public Utility District 1275 Meadow Crest Drive South Lake Tahoe, CA 96150 (530) 544 -6474 Claims Administrator CDS Group Health 1625 East Prater Way, Building C, Suite 101 P.O. Box 50190 Reno, NV 89435 -0190 (800) 4554236 Plan Coordinators Nancy Hussmann; Paul Hughes South Tahoe Public Utility District 1275 Meadow Crest Drive South Lake Tahoe, CA 96150 (530) 543 -6222 or 543 -6211 Plan Administrator General Manager South Tahoe Public Utility District 1275 Meadow Crest Drive South Lake Tahoe, CA 96150 (530) 543 -6201 Trustee(s) Board of Directors South Tahoe Public Utility District 1275 Meadow Crest Drive South Lake Tahoe, CA 96150 Agent of Legal Process General Manager/Plan Administrator South Tahoe Public Utility District 1275 Meadow Crest Drive South Lake Tahoe, CA 96150 (530) 5343 -6201 The Plan Trustees reserve the right to change Claims Administrator and/or Plan Administrator at their discretion. The Plan and its attachments constitute the written Plan Document required by ERISA § 402. Pag i b� of 89 Attachment 1 Authorization for Release of Claim Information Claim Assistance 1, , hereby authorize the staff of CDS Group Health, claims administrator for the South Tahoe Public Utility District, to release to Nancy Hussmann, Plan Coordinator, information regarding This release of information is for the purpose of allowing the Plan Coordinator to assist me with claim processing questions and to assist in resolving any billing and/or claim discrepancies. Specifically, I authorize the staff of CDS Group Health, to provide Nancy Hussmann, Plan Coordinator, with billing and/or claim processing information, which may include diagnosis and/or medical information, that will assist in determining the appropriate action needed regarding the above claim(s). This authorization will expire 60 days after the date of my signature on this Authorization, after which date CDS Group Health is no longer authorized to discuss my current medical claims information with the Plan Coordinator, unless a new Authorization is signed by me. I understand that the District shall not use any information contained in or obtained as a result of this Medical Information Release against me in any District personnel action (promotion, demotion, layoff, or disciplinary determination). I further understand that a copy of this signed authorization will be provided to me upon my request. Signature: Print Name: Original: Plan Coordinator Cc: Employee Claims Administrator Date: PagellAof 89 Attachment 2 Authorization for Release Of Claim Information For Claim Anneal I, , hereby authorize the staff of CDS Group Health, Claims Administrator for the South Tahoe Public Utility District, to release information regarding to the Human Resources Director (Plan Coordinator) and/or General Manager (Plan Administrator). This release of information is for the purpose of allowing the Plan Administrator and/or Coordinator to assist me with appealing the denial of the above claim. Specifically, I authorize the Claims Administrator to provide the General Manager (Plan Administrator) and/or Human Resources Director (Plan Coordinator) with billing and/or claim processing information, which may include diagnosis and/or medical information, that will assist in determining the appropriate action needed regarding the above claim(s). This authorization will expire 60 days after the date of my signature on this Authorization, after which date Claims Administrator is no longer authorized to discuss my current medical condition with the Plan Administrator and/or Coordinator, unless a new Authorization is signed by me. I understand that the District shall not use any information contained in or obtained as a result of this Medical Information Release against me in any District personnel action (promotion, demotion, layoff, or disciplinary determination). I further understand that a copy of this signed authorization will be provided to me upon my request. Signature: Print Name: Original: Plan Administrator Cc: Plan Coordinator Employee Claims Administrator Date: Page of 89 Attachment 3 Authorization for Release of Medical Information To Claims Administrator and Plan Administrator Request for Plan Exception I, , hereby authorize the staff of CDS Group Health and/or Medical Provider, to release to the Human Resources Director and/or General Manager (Plan Coordinator and Plan Administrator) for the South Tahoe Public Utility District, information regarding This release of information is for the purpose of allowing the Plan Administrator to make an informed decision regarding my Request for Plan Exception. I understand that the Claims Administrator will consult with the Plan Administrator and that any information released pursuant to this Authorization may be shared with the Plan Administrator for purposes of decision regarding the requested plan exception. Specifically, I authorize Provider to inform the Claims Administrator of any medical information bearing upon my Request for Plan Exception, including when relevant, my current diagnosis, recommended course of action, and medical information relevant to the recommended course of action, including any documents, test results, x -rays, etc. I further specifically authorize the Claims Administrator to share this information with the Plan Administrator. I further authorize Provider, Claims Administrator and/or Plan Administrator to release this information to any third party qualified to review such claims which may be consulted by Claims Administrator and/or Plan Administrator for purposes of obtaining a recommendation or opinion regarding my Request for Plan Exception. This authorization will expire 60 days after the date of my signature on this Authorization, after which date Provider is no longer authorized to discuss my current medical condition with the Claims Administrator. I understand that the District shall not use any information contained in or obtained as a result of this Medical Information Release against me in any personnel (promotion or demotion or layoff determination) or District disciplinary action. I further understand that a copy of this signed authorization will be provided to me upon my request. Signature: Date: Original: Claims Administrator Cc: Plan Coordinator, Plan Administrator, Employee Pagej %jDf 89 Genera Manager plcF ^f. 50ibrig 5outh Tahoe Ernie Claudio James K. Jones PuMic Utility Diotn'ot Mar Lou G,er vela Rlae 1275 Meadow Crest ©rive s South Lake Tahoe * CA 96150 Phone 530 544 -6474 « Fox 534 541 -0614 BOARD AGENDA ITEM 7c TO: Board of Directors FROM: Nancy Hussmann, Human Resources Director MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: Self- Insured Health Plan Renewal — Funding Level & COBRA Rates REQUESTED BOARD ACTION: Approve 2010 funding level and COBRA rates at the same level as the 2009 funding level and COBRA rates. DISCUSSION: BB &H Benefit Designs, Inc. (BB &H) performs an analysis to determine the appropriate funding level to fund claims and fixed costs for the self - insured health plan. Claims to date are annualized and then increased by an average trend factor to estimate the 2010 claims. Total estimated claims, fees, and stop loss premiums are added together and divided by the number of projected 2010 employees to arrive at the recommended funding level. Due to the Plan's good claim experience in 2009, the projected claims for 2010 is lower than the projections for estimated claims in the analysis for the funding level for 2009. Last year, BB &H recommended a funding level of $1,877.63 and the District approved a funding level of $1,800.00 per employee per month based on this recommendation. For 2010, with a $75,000 specific stop loss level, BB &H recommended a funding level of $1,559.20 per employee per month. However, with the concurrence of the Finance Committee, staff recommends remaining at the $1,800.00 per employee per month funding level, in order to rebuild the Plan's reserves. Currently the Plan reserves include $300,000 in contingency funds and an estimated $100,000 in true Plan reserves. By maintaining the current funding level, the reserves can be built up to a more acceptable level. COBRA Rate recommendations for 2010 did not change substantially from the 2009 COBRA Rate recommendation. Therefore, staff recommends, with the concurrence of the Finance Committee, that COBRA rates for 2010 remain the same as 2009, as follows: $80.00 Single Dental; $225.00 Family Dental; $900.00 Single Medical; $2,200.00 Family Medical. These rates are calculated on 85% of the stop loss attachment factor proposed by the stop loss carrier plus the fixed costs. Dental rates are determined by trending actual claims at 5.9% and then adding the administration fees. -109- Nancy Hussmann December 3, 2009 Page 2 SCHEDULE: December 4, 2009 — Notify applicable parties COSTS: Annual total: $2,505,000 ACCOUNT NO: BUDGETED AMOUNT REMAINING: Funded on a calendar year basis - $1,252,500 remaining in 2009/10 budget, remaining amount to be included in the 2010/11 budget. ATTACHMENTS: Funding Analysis $75k Specific CONCURRENCE WITH REQUESTED ACTION: CATEGORY: General GENERAL MANAGER: YES �- 9 NO CHIEF FINANCIAL OFFICER: YES NO ::)dc # of covered employees # of covered dependent Medical Claims Paid Total Est. Paid Claims Dental Claims Paid Plan Year 2010 Administration Fees Paid (Dental /Medical) 1 COBRA Fees^ 1-, PPO /UR Fee I— Specific Stop Loss Premium Paid Aggregate Stop Loss Premium Paid Total FEES & CLAIMS TOTAL COST /EE /MO (FUNDING LEVEL) Self Insured Liability TOTAL COST /EE /MO WITH UNINSURED LIABILITY South Tahoe Public Utility District Plan Year 2010 Funding Analysis Exhibit 6 ($75k spec) * 2010 data is projected based upon data through 10/31/09 ^ COBRA is included in administrative fee paid to CDS. ** 2010 includes repricing and ppo access fees ^' Used 10.3% increase in medical claims and 6.2% dental trend. 2010 funding level assumes QBE providing stop Toss at $75,000 specific level. 1,454 1,192 1,298,639.56 1,718,879.32 177,546.86 28,651.68 5,017.68 442,787.11 15,053.04 1,967,695.93 1,352.93 206.27 1,559.20 1275 Meadow Crest Dr W * South Lake Tahoe • CA 96150 Phone 530 544 -6474 f Fax 530 541 -0614 BOARD AGENDA ITEM 7d TO: Board of Directors FROM: Paul A. Sciuto, Assistant General Manager MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: Snowshoe Thompson Ditch No. 1 / Millich Ditch Washout Repairs REQUESTED BOARD ACTION: Continue Emergency Action DISCUSSION: The Board declared this an emergency on November 5, 2009. Repairs to the erosion damage are still underway. Public Contract Code Section 22050(c) requires the Board to review the emergency action at every scheduled board meeting thereafter until the action is terminated, to determine, by a four -fifths vote, that there is a need to continue the action. An update will be given at the Board meeting. SCHEDULE: Repairs expected to be completed by December 17, 2009 COSTS: $50,000 (estimated) for Millich Ditch and Snowshoe Thompson No. 1 Ditch ACCOUNT NO: 1029 - 7075 /SNOBLO; 1029 - 7076 /MILBLO BUDGETED AMOUNT REMAINING: Unbudgeted ATTACHMENTS: CONCURRENCE WITH REQUESTED ACTION: wer N: CATEGORY: S GENERAL MANAGER: YES , p NO CHIEF FINANCIAL OFFICER: YES NO —113— Genera? Manager Kichara -1 '30 t-ha ii r5 15 Tahoc Ernie Claud C James R. Jones Fu Util ity D iotrict ��� M pale Dale Rises " c- G..L..L'�.. 1275 Meadow Crest Dr W * South Lake Tahoe • CA 96150 Phone 530 544 -6474 f Fax 530 541 -0614 BOARD AGENDA ITEM 7d TO: Board of Directors FROM: Paul A. Sciuto, Assistant General Manager MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: Snowshoe Thompson Ditch No. 1 / Millich Ditch Washout Repairs REQUESTED BOARD ACTION: Continue Emergency Action DISCUSSION: The Board declared this an emergency on November 5, 2009. Repairs to the erosion damage are still underway. Public Contract Code Section 22050(c) requires the Board to review the emergency action at every scheduled board meeting thereafter until the action is terminated, to determine, by a four -fifths vote, that there is a need to continue the action. An update will be given at the Board meeting. SCHEDULE: Repairs expected to be completed by December 17, 2009 COSTS: $50,000 (estimated) for Millich Ditch and Snowshoe Thompson No. 1 Ditch ACCOUNT NO: 1029 - 7075 /SNOBLO; 1029 - 7076 /MILBLO BUDGETED AMOUNT REMAINING: Unbudgeted ATTACHMENTS: CONCURRENCE WITH REQUESTED ACTION: wer N: CATEGORY: S GENERAL MANAGER: YES , p NO CHIEF FINANCIAL OFFICER: YES NO —113— 1275 Meadow Crest Price a South Lake Tahoe + CA 96150 Mona 5W 544 -6474 • Fax 5W 341 -0614 BOARD AGENDA ITEM 7e TO: Board of Directors FROM: Jim Hoggatt, Engineering Department Manager MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: South Tahoe Public Utility District Recycled Water Facilities Master Plan 2:30 P.M. PUBLIC HEARING REQUESTED BOARD ACTION: Hold a Public Hearing to certify the Recycled Water Facilities Master Plan Environmental Impact Report, adopt the Recycled Water Facilities Master Plan, and approval of Master Plan Projects 1, 2, 11, and 12 which include Project Component 11 - Construction of Irrigation Fields with Pumping Back to HPR, Project Component 18 — Optimize Application Rate on Existing Irrigated Lands, and Project Component 19 — Pursue the Permitting of More Land in Alpine County. DISCUSSION: At 2:30 p.m. open public hearing to discuss and certify the South Tahoe Public Utility District Recycled Water Facilities Master Plan Draft Environmental Impact Report, Master Plan, and Master Plan Projects 1, 2, 11, and 12. The District and Hauge Brueck Associates have prepared the Final EIR in response to comments received on the Draft EIR, including responses to comments and edits to the Draft EIR. SCHEDULE: COSTS: N/A ACCOUNT NO: N/A BUDGETED AMOUNT REMAINING: N/A ATTACHMENTS: Notice; Introduction and Summary; Due to its length the complete document "Recycled Water Facilities Master Plan — Environmental Impact Report Final - November 2009" can be viewed at the Board Clerk's Office upon request. GENERAL MANAGER: YES R NO CHIEF FINANCIAL OFFICER: YES NO -115- (:�rnerai Manager £.ic.hard H. u 15oth Tahoe Ernie Claudio James R. Janes � � FuHio Utility Plotrilot Pa1C R36C MW 1275 Meadow Crest Price a South Lake Tahoe + CA 96150 Mona 5W 544 -6474 • Fax 5W 341 -0614 BOARD AGENDA ITEM 7e TO: Board of Directors FROM: Jim Hoggatt, Engineering Department Manager MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: South Tahoe Public Utility District Recycled Water Facilities Master Plan 2:30 P.M. PUBLIC HEARING REQUESTED BOARD ACTION: Hold a Public Hearing to certify the Recycled Water Facilities Master Plan Environmental Impact Report, adopt the Recycled Water Facilities Master Plan, and approval of Master Plan Projects 1, 2, 11, and 12 which include Project Component 11 - Construction of Irrigation Fields with Pumping Back to HPR, Project Component 18 — Optimize Application Rate on Existing Irrigated Lands, and Project Component 19 — Pursue the Permitting of More Land in Alpine County. DISCUSSION: At 2:30 p.m. open public hearing to discuss and certify the South Tahoe Public Utility District Recycled Water Facilities Master Plan Draft Environmental Impact Report, Master Plan, and Master Plan Projects 1, 2, 11, and 12. The District and Hauge Brueck Associates have prepared the Final EIR in response to comments received on the Draft EIR, including responses to comments and edits to the Draft EIR. SCHEDULE: COSTS: N/A ACCOUNT NO: N/A BUDGETED AMOUNT REMAINING: N/A ATTACHMENTS: Notice; Introduction and Summary; Due to its length the complete document "Recycled Water Facilities Master Plan — Environmental Impact Report Final - November 2009" can be viewed at the Board Clerk's Office upon request. GENERAL MANAGER: YES R NO CHIEF FINANCIAL OFFICER: YES NO -115- APPENDIX A CEQA FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS OF THE SOUTH TAHOE PUBLIC UTILITY DISTRICT FOR THE RECYCLED WATER FACILITIES MASTER PLAN EIR Adopted December 3, 2009 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 1 INTRODUCTION AND BACKGROUND These Findings and Statement of Overriding Considerations have been prepared in accordance with the California Environmental Quality Act ( "CEQA ") and the CEQA Guidelines (California Code Regulation, Title 14, Section 15000 et seq.). The South Tahoe Public Utility District is the lead agency for the environmental review of the Project and has the principal responsibility for its approval. The Project covered by these findings and relevant CEQA documents is the Recycled Water Facilities Master Plan and Master Plan Projects 1, 2, 11, and 12 (Project). 1.1 THE PROJECT AND ALTERNATIVES The Project and three alternatives have been evaluated in the Environmental Impact Report (EIR). A description of the Project is provided in Chapter 2 of the EIR. A description and analysis of the alternatives are provided in Chapter 19. No Project Alternative (Alternative 1) Alternative 1 consists of the existing District Recycled Water and freshwater facilities in Alpine County, CA as of April 19, 2007 (see Figure 2 -3). These facilities include: ditches and pipelines to convey freshwater to ICR, ditches and pipelines to convey recycled water for storage to HPR and the Diamond Ditch system to convey recycled water to current ranch users. Sections 3 and 4 of the Master Plan provide a description of these facilities. Table 2 -3 provides a summary of the existing facilities and operations in Alpine County. Project (Alternative 2) The Project is the implementation of the Recycled Water Facilities Master Plan. The Master Plan includes 20 projects that implement one or more of the 28 components. A list of the Master Plan projects and the individual Project Components that comprise each project are included in Table 2 -2 of the EIR. Chapter 13 of the Master Plan (Stantec 2008) details the Master Plan implementation and summarizes the process the District follow to decide which projects to implement as based on future triggers. Master Plan Recommended Projects (Alternative 3) The Master Plan recommends nine Project Components for implementation based on the need to address infrastructure and management inadequacies and compliance with State of California waste discharge requirements (WDR) during temporary discharge situations. The following is a list of components that comprise Alternative 3: 3 — Capacity and conveyance improvements in the Diamond Ditch system 4 — Provide pressurized recycled water to the Fredericksburg system 2 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 6 — Provide pressurized recycled water to the Ranchettes 11 — Construct irrigation fields with pumping back to Harvey Place Reservoir 18 — Optimize application rate on existing irrigated lands 19 — Pursue permitting of more land in Alpine County 22 — Parallel recycled water pipeline along existing Diamond Ditch 29 — Irrigate the District Pasture 30 — Irrigate the Jungle with Recycled Water Alternative 3 is considered the minimum action alternative, as this alternative includes the least number of Project Components that can be implemented to meet the District's objectives. This alternative does not allow for future implementation of the Project Components that could become necessary due to changing land use patterns, economic conditions or regulations. Master Plan Trigger Projects (Alternative 4) Alternative 4 is composed of Project Components that can be implemented in the future to allow the District greater flexibility to respond to changing conditions. As the Master Plan is a 20 -year document, there may be unforeseen changes that the District may face in response to: future land uses on the existing irrigated ranches; changes in requirements for discharge of recycled water; changes in total volume of recycled water to be managed; and economic shifts. These triggers could have an impact on the District's ability to dispose of recycled water. Alternative 4 allows the District flexibility in choosing and implementing select Project Components. Alternative 4 allows for the analysis of a reduced project scenario that meets the District's objectives. The following is a list of components that comprise Alternative 4: 1 — Provide recycled water to new non - irrigated, permitted land 2 — Make recycled water available to irrigators in Nevada 3 — Capacity and conveyance improvements in the Diamond Ditch system 4 — Provide pressurized recycled water to the Fredericksburg system 6 — Provide pressurized recycled water to the Ranchettes 7 — Non -flood irrigation application system 11 — Construct irrigation fields with pumping back to Harvey Place Reservoir 14 — Pipe recycled water systems to minimize setbacks and human contact 16 — Subsurface recycled water irrigation in public contact of buffer areas 17 — Increase Snowshoe Thompson No. 1 conveyance capacity 18 — Optimize application rate on existing irrigated lands 19 — Pursue permitting of more land in Alpine County 22 — Parallel recycled water pipeline along existing Diamond Ditch 23 — Route Mud Lake winter flows through Indian Creek Reservoir 24 — Transfer additional water rights to storage in Indian Creek Reservoir 29 — Irrigate the District Pasture 30 — Irrigate the Jungle with Recycled Water 31 — Divert Stormwater Flow away from Harvey Place Reservoir and to Indian Creek Reservoir 3 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 1.2 CEQA REQUIREMENTS Pursuant to CEQA, discretionary decisions by public agencies regarding public projects are subject to environmental review. The purpose of an environmental impact report is to identify the significant effects of the project on the environment, to identify alternatives to the project, and to indicate the manner in which those significant effects can be mitigated or avoided (Section 21002.1(a)). Whenever it is feasible, each public agency is required to mitigate or avoid the significant environmental impacts of projects it approves. The EIR was prepared by the South Tahoe Public Utility District as the lead agency for the Recycled Water Facilities Master Plan site pursuant to CEQA and the CEQA Guidelines (California Administrative Code Section 1500 et seq.). Environmental effects of the project that must be addressed include the significant adverse effects of the project, growth- inducing effects of the project, and significant cumulative effects of past, present, and reasonably anticipated future projects. The Final Environmental Impact Report (Final EIR) for the Recycled Water Facilities Master Plan Draft EIR was published on June 29, 2007. The District Board has certified that the final EIR has been completed in compliance with CEQA; that the final EIR was presented to the District Board, the decision - making body, that the District Board reviewed and considered the information contained in the Final EIR, the written comments and oral comments, and that the District Board determined that the final EIR reflects the lead agency's independent judgment and analysis. The District has eliminated or substantially lessened all significant effects on the environment where feasible as shown in the findings provided in this document. The District Board has determined that remaining significant effects on the environment found to be unavoidable under Section 15091 are acceptable due to overriding concerns presented in this document. The District Board finds that the EIR has been prepared in accordance with CEQA, and that the EIR meets the requirements of a Master Plan EIR. The EIR will be used to evaluate subsequent projects under the Recycled Water Facilities Master Plan. Additional environmental review under CEQA may be required and will be based on the subsequent project's consistency with the Recycled Water Facilities Master Plan and the analysis in the EIR, as required under CEQA. In accordance with CEQA Guidelines Sections 15168 and 15162, the EIR should be used as the primary environmental document to evaluate subsequent planning and permitting actions associated with the Recycled Water Facilities Master Plan. In addition, the District Board finds that the EIR may be used as the basis for future projects' compliance with CEQA, pursuant to CEQA 4 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS Guidelines sections 15182 and 15183. Pursuant to CEQA Guidelines section 15183(f), the District Board finds that the development policies and standards set forth in the Recycled Water Facilities Master Plan EIR substantially mitigate, as to future projects, impacts identified in the EIR, except those determined to be significant and unavoidable. Other agencies have discretionary authority to approve part or all of the Project and will rely on the District to produce an EIR adequate for their needs. These agencies must use the EIR as the basis for their permit approvals. The District must confer with other interested public agencies that do not have approval authority over the Project, but which have specific expertise with regard to the Project or have responsibility for resources affected by the Project. The following agencies may be Responsible Agencies under CEQA, which may need to issue approvals for the Project that will rely upon the EIR. • U.S. Army Corps of Engineers (Trustee Agency) - Fill in wetlands or waters of the U.S. require a Section 404 permit under the Clean Water Act would be required from the U.S. Army Corps of Engineers (Corps). • U.S. Fish and Wildlife Service (Trustee Agency) - The Project site may contain federally listed species which may also be present within the Project area. • California Department of Fish and Game (Trustee Agency) — Projects may require a Lake and Streambed Alternation Agreement. RECORD OF PROCEEDINGS Various documents and other materials constitute the record of proceedings upon which the District bases its findings and decisions contained herein. The record of proceedings is located at 1275 Meadow Crest Drive, South Lake Tahoe, CA. The custodian for the record of proceedings is the South Tahoe Public Utility District. This information is provided in compliance with Public Resources Code section 21081.6(a)(2) and 14 California Code Regs, § 15091(e). For purposes of CEQA and these findings, the record before the District includes, without limitation, the following: A. The Initial Study; B. The DEIR and appendices to the DEIR; C. The FEIR and appendices to the FEIR; D. Notices required by CEQA, staff reports and presentation materials related to the Project; 5 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS E. Studies conducted for the Project and contained in, or referenced by, staff reports, the DEIR, or the FEIR; F. Public reports and documents related to the Project prepared for the District Board and other agencies; G. Documentary and oral evidence received and reviewed at public hearings and workshops and all transcripts and minutes of those hearings related to the Project and the FEIR, if any, which were forwarded to the District Board. H. Additional items not included above if they are required by law. 1.4 GENERAL FINDINGS TERMINOLOGY OF FINDINGS Section 15091 of the CEQA Guidelines requires that, for each significant environmental effect identified in an EIR for a proposed project, the approving agency must issue a written finding reaching one or more of three allowable conclusions. The first is that "[ c]hanges or alterations have been required in, or incorporated into, the project which avoid or substantially lessen the significant environmental effect as identified in the FEIR." The second potential finding is that "[s]uch changes or alterations are within the responsibility and jurisdiction of another public adopted by such other agency or can and should be adopted by such other agency." The third permissible conclusion is that "[s]pecific economic, social, or other considerations make infeasible the mitigation measures or project alternatives identified in the final EIR." For purposes of these findings, the term "mitigation measures" shall constitute the "changes or alterations" discussed above. The term "avoid or substantially lessen" will refer to the effectiveness of one or more of the mitigation measures or alternatives to reduce an otherwise significant environmental effect to a less than significant level. Although section 15091, read literally, does not require findings to address environmental effects that an EIR identifies as merely "potentially significant," these findings will nevertheless fully account for all such effects identified in the EIR for the proposed Project. When an impact remains significant or potentially significant with mitigation, the findings will generally find that the impact is still "significant." In the process of adopting mitigation, the District will be making decisions on whether each mitigation measure proposed in the EIR is feasible or infeasible. Pursuant to the CEQA Guidelines, "feasible means capable of being accomplished in a successful manner within a reasonable period of time, taking into account economic, environmental, legal, social and technological factors." When the District finds a measure is not feasible, it will provide evidence for its decision. on STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS CERTIFICATION OF FEIR In adopting these findings, in accordance with CEQA, the District has considered the environmental effects as shown in the FEIR prior to approving the Project. These findings represent the independent judgment and analysis of the South Tahoe Public Utility District. CHANGES TO THE DEIR In the course of responding to comments received during the public review and comment period on the DEIR, certain portions of the DEIR have been modified and some new information has been added. The changes made to the DEIR do not result in: 1. A significant new environmental impact that would result from the Project or an adopted Mitigation Measure; 2. A substantial increase in the severity of an environmental impact that is not reduced to a level less than significant by adopted Mitigation Measures; 3. A feasible project alternative or Mitigation Measure not adopted that is considerably different from others analyzed in the DEIR that would clearly lessen the significant environmental impacts of the Project; or 4. Information that indicates that the public was deprived of a meaningful opportunity to review and comment on the DEIR. The South Tahoe Public Utility District finds that the amplifications and clarifications made to the DEIR do not collectively or individually constitute significant new information within the meaning of Public Resources Code section 21092.1 and CEQA Guidelines section 15088.5. EVIDENTIARY BASIS FOR FINDINGS These findings are based upon substantial evidence in the entire record before the District Board as described in Section 4. The references to the DEIR and to the FEIR set forth in the findings are for ease of reference and are not intended to provide an exhaustive list of the evidence relied upon for these findings. 7 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS FINDINGS REGARDING MITIGATION MEASURES Except as otherwise noted, the Mitigation Measures herein referenced are those identified in the FEIR. Except as otherwise stated in these findings, in accordance with CEQA Guidelines Sections 15091, 15092, and 15093, the District finds that the environmental effects of the Project: • Will not be significant; or • Will be mitigated to a less than significant level by the Mitigation Measures adopted by the District Board; or • Can and should be mitigated to a less than significant level by the Mitigation Measures within the jurisdiction of another public agency; or • Will remain significant after mitigation, but specific economic, legal, social technological, or other considerations outweigh the unavoidable adverse environmental effects. The District finds that the Mitigation Measures incorporated into and imposed upon the Project are feasible and fully capable of implementation. FINDINGS REGARDING MONITORING /REPORTING OF CEQA MITIGATION MEASURES As required in Section 21081.6 of the California Public Resources Code the District adopts a monitoring and reporting program regarding changes in the Project or Mitigation Measures imposed to mitigate or avoid significant effects on the environment. The Mitigation Monitoring and Reporting Plan is Appendix D of the FEIR and is adopted because it effectively fulfills the CEQA mitigation monitoring requirement. 1.5 PUBLIC AND AGENCY INVOLVEMENT The District held a public scoping meeting to solicit comments about issues that should be addressed in the Recycled Water Facilities Master Plan EIR. In preparation for the public scoping meeting, the District mailed a notice to interested persons and agencies. A Notice of Preparation (NOP) prepared for this EIR started circulation on April 20, 2007 and ended on May 21, 2007. Two scoping meetings were held: the first on May 16, 2007 at Turtle Rock Park in Alpine County and the second on May 17, 2007 at the South Tahoe Public Utility District Board Room in South Lake Tahoe. N . STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS A revised NOP was prepared and circulated on January 5, 2009 and ended on February 6, 2009. The revised NOP included the addition of four components to the project description and the addition of two new alternatives; Alternative 3 and Alternative 4. The Draft EIR circulation started on July 23, and ended on September 7, 2009. A Notice of Completion (NOC) was submitted to the California State Clearinghouse on July 23. Two public meetings were held to take comments on the Draft EIR: September 2, 2009 at Turtle Rock Park in Markleeville, CA and September 3, 2009 at the South Tahoe Public Utility District Board of Directors Meeting in South Lake Tahoe, CA. The Draft EIR and Final EIR was available for review at these locations: • Internet http://www.stpud.us/ • STPUD Office 1275 Meadow Crest Drive South Lake Tahoe, CA 96150 • El Dorado County Library 1000 Rufus Allen Blvd. South Lake Tahoe, CA 96150 • Markleeville Library 270 Laramie Street P.O. Box 187 Markleeville, CA, 96120 The Final EIR was circulated for review to the individuals and agencies who commented on the Draft EIR for 10 days. The Final EIR was available for review at the above locations. The review period of the Final EIR closed on November 30, 2009. Written comments were to be delivered to: Jimmie Hoggatt South Tahoe Public Utility District 1275 Medow Crest Drive South Lake Tahoe, CA 96150 The District Staff considered the adequacy of the Environmental Impact Report and submitted their recommendation to the District Board. The District Board considered the adequacy of the EIR prior to considering approval of the project 0 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 2. CEQA FINDINGS CEQA requires that when a project EIR identifies one or more significant environmental effects of the project the lead agency must make written findings for each of those significant effects, accompanied by a brief explanation of the rationale for each finding. The Recycled Water Facilities Master Plan Final EIR identified significant environmental effects. Each significant effect is listed below with the required written finding and a brief explanation of the rationale for each finding. 2.1 SIGNIFICANT AND UNAVOIDABLE IMPACTS The following environmental impacts have been identified as significant and unavoidable. Implementation measures are included in the Recycled Water Facilities Master Plan which reduce environmental impacts, however the following impacts cannot be reduced to a less than significant level. Geology, Soils and Seismicity Impact GEO -2. Implementation of the Project would be subject to ground rupture due to location near a surface trace of an active fault. No mitigation is possible. Finding: No mitigation is possible above and beyond designing and engineering facilities to withstand ground rupture within or in the vicinity of the project area (Standard Practice 17 Pipeline Design Features in Active Fault Zones). The situation remains that the faults that run through the project area are considered active and pose the potential to cause ground rupture. Explanation: These measures reduce the damage that may be caused to pipelines that cross fault zones. Pipelines will be sited outside of fault zones whenever possible. During final design, engineers will implement standard engineering design features to reduce the effects of a potential pipeline break, but can not assure the prevention of a pipe rupture in the event of a seismic event. This impact remains significant. Geology, Soils and Seismicity Impact GW -1. Implementation of the Project would result in the degradation of groundwater quality in the Carson, Wade and Diamond Valleys. 11111 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS Mitigation: SP -33 — Surface and Groundwater Protection Plan, GW -IA Remove Cattle Grazing from Portions of the Diamond Valley Ranch Irrigated with Recycled Water Finding: To date, groundwater monitoring results have not measured degradation of groundwater quality in these portions of the project area, and a number of Project Components will improve upon existing recycled water infrastructure, reducing transmissive losses and unmanaged surface water and groundwater interactions. Regardless of the potential benefits expected to result from construction and operation of Components 1, 2, 3, 4, 5, 6, 14, 21, 22 and 30, site - specific hydraulic loading limits have not been determined for these portions of the project area and optimized application rates have not been calculated. Until site - specific NMPs are developed which outline the appropriate application rates for water balance with hydraulic loading rates, the potential impact to groundwater quality remains significant. Explanation: Components 1, 2, 3, 4, 5, 6, 14, 21, 22 and 30 will be located in portions of the project area that have not been studied as part of the Diamond Valley Ranch NMP. NMPs, as outlined in SP -33, Surface and Ground Water Protection Plan, will be completed for these portions of the project area. To adequately convey, apply and manage average daily flows projected for 2028, these portions of the project area must be able to assimilate approximately 1.0 MGD of recycled waters exported from the District's WWTP. This is the difference between the 5.8 MGD projected for daily flows in 2028 and the 4.8 MGD total flow (71.89 in/yr or 5.99 acre - feet /acre) that can be applied effectively on the 904 irrigable acres in Diamond Valley Ranch with no calculated risk to groundwater quality. This application rate exceeds the current 2008 discharge from the District's WWTP, but does not adequately address projected discharge through 2028. Improving the Diamond Ditch System (Component 3) will result in increasing the capacity of the system to transport higher volumes of recycled water. By stabilizing these segments of the system, erosion and flooding will be alleviated. Unlined portions of the system will be lined or piped. These system upgrades will decrease losses to groundwater due to flooding and leaks. The construction of conveyance infrastructure such as new underground lines to the Fredricksburg area, Wade Valley and the Ranchettes (Components 4, 5, and 6) and for piping recycled water to minimize setbacks and human contact (Component 14) will involve trenching across alluvial fans that may contain groundwater resources. Component 1 will provide recycled water to new non - irrigated, permitted land and Component 2 involves pursuing the permitting of land in Nevada by NDEP for receipt of recycled water from HPR, which will involve the construction of new underground lines and may also involve trenching activities. Trenching construction activities will require a NPDES permit, which includes surface water protection measures but not defined ground water protection measures. The recycled water will be delivered to users under pressure which will allow the 11 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS irrigators to use sprinkler irrigation instead of the less efficient flood irrigation. A more structured application rate and volume will avoid potential impacts to groundwater by allowing for more controlled applications of recycled water that are matched to the hydraulic loading levels of the site. Tailwater control systems will be constructed under Component 21 that will improve surface water quality and indirectly groundwater quality. Component 30 will spray irrigate the portion of the project area referred to as the "jungle" with recycled waters. This portion of the project area is located on the alluvium of the West Fork of the Carson River floodplain. Misapplication of recycled waters in the jungle could impact shallow groundwater sources. Component 22 parallels a recycled water pipeline along the existing Diamond Ditch. By piping the recycled water, the District will have greater control over the quality of water delivered to any site. The recycled water will be delivered to users under pressure, which will allow the irrigators to use sprinkler irrigation instead of less efficient flood irrigation. A more structured application rate will avoid potential impacts to groundwater by allowing for more controlled applications of recycled water that do not not impact the root zones of crops. Surface Water Impacts SWA Implementation of Component 30 of the project would result in numeric and narrative -based criteria to be exceeded at West Fork Carson River in California. Mitigation: SW -3 — Develop Project Specific Nutrient Management Plan for the Jungle. Finding: The delineation and confirmation of the presence or absence of State waters is necessary for this portion of the project area. A NMP and associated tailwater controls have not been developed for the 140 acres referred to as the Jungle. Given that site - specific management of nutrients has not been determined and the close proximity of Project Component to the West Fork of the Carson River, the potential impact of Component 30 remains significant after mitigation. Explanation: As no nutrient management plan has been generated for Component 30 (Irrigate the Jungle with Recycled Water) the impacts to surface and groundwater quality remain potentially significant until site - specific hydraulic loading levels and corresponding recycled water application rates are determined for the area. Historical and Archaeological Resources and Paleontology Impact ARCH -1 — Implementation of the Project Components 29, 30, 31, 32 have the potential to disturb known potentially eligible National or California 12 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS Register properties, including archaeological, historical, architectural, and Native American/traditional heritage resources. Mitigation: ARCH -1 — Identification , Evaluation and Avoidance of Cultural Resources. Finding: Implementation measures have been incorporated into the project which substantially lessen the significant environmental effect identified in the final EIR. However the area of Project Components 29, 30, 31 and 32 have not been surveyed, the potential exists that eligible national or California Register properties may be present and therefore the impact is considered significant. Explanation: The impacts to prehistoric and historic archaeological sites for portions of the project area not yet surveyed remain significant until surveys are completed as outlined in mitigation measure ARCH -1. Impact ARCH -2 — Implementation of the Project Components 29, 30, 31, 32 have the potential to disturb unknown archaeological resources or human remains. Mitigation: ARCH -1 — Identification , Evaluation and Avoidance of Cultural Resources; and ARCH -2 — Protect Undiscovered Cultural Resource Sites. Finding: There is the possibility that surface or subsurface cultural resources not identified during the review of records at the CCIC and the NSM will be encountered during construction or operation/maintenance of pipelines, irrigation systems, irrigation fields, infiltration basins and impoundments, or that there are unexpected effects on known cultural resources and therefore the impact is considered significant. Explanation: The impacts to unknown archaeological sites for portions of the project area not yet surveyed remain significant until surveys are completed as outlined in mitigation measures ARCH -1 and ARCH -2. 13 Impact Pre - Mitigation Significance Mitigation Measure Significance After Mitigation Biological Resources BIO -1. Will the Project Components cause loss of individuals or occupied habitat of endangered, threatened, or rare fish, wildlife or plant species directly or indirectly? Significant BIO -1 — Conduct Biological Resource Assessments; SP -25 Sensitive Resource Program Less than significant BIO -2. Will the Project Components cause loss of individuals of CNPS List 2, 3, or 4 plant species? Significant SP -26 — Sensitive Plant Protection Program Less than significant BIO -3. Will the Project Components cause loss of active raptor nests, migratory bird nests or wildlife Significant SP -30 — Pre - construction Surveys for Migratory Birds, Nesting Raptors and Wildlife Nurseries Less than significant Table 1 Summary of Significant Impacts and Mitigation Measures Impact Pre- Mitigation Significance Mitigation Measure Significance After Mitigation Surface Water SW -4. Will the Project Components cause TMDLs to be exceeded at Indian Creek Reservoir (ICR)? Significant (Component 31) SW -4. Develop Erosion Control Methods for ICR Less than significant SW -5. Will the Project Components cause narrative -based criteria to be exceeded in Indian Creek below Harvey Place Reservoir? Significant (Component 31 and 32) SW -4. Develop Erosion Control Methods for ICR SW -5. Implement Component 15 prior to Component 32 Less than significant 2.2 SIGNIFICANT IMPACTS STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS The following impacts have been identified as being significant. Standard Practices and Mitigation Measures have been incorporated into the Recycled Water Facilities Master Plan that avoid or substantially lessen the environmental impacts to be less than significant. 14 nursery sites? BIO -4. Will the Project Components substantially block or disrupt major fish or wildlife migration or travel corridors? Significant BIO -4A — Fish Passage Structures and Deer Migration Corridors; BIO- 4B — Schedule Construction to Avoid Breeding and Migrating Wildlfie Less than significant BIO -5. Will the Project Components have a substantial adverse effect on any riparian habitat or other sensitive natural community identified in local or regional plans, policies, regulations or by the California Department of Fish and Game or US Fish and Wildlife Service? Significant SP -31. Pre - construction Marking and Fencing of Sensitive Native Plant Communities; SP -32. Pre - construction Marking and Fencing of Wetlands and Riparian Habitat; BIO- 5A. Map Sensitive Native Plant Communities and Prepare Habitat Restoration Plan; BIO -5B. Monitor Habitat Restoration and Revegetation Sites Less than significant BIO -7. Will the Project Components have an effect on federally protected wetlands as defined by Section 404 of the Clean Water Act or waters of the U.S. through direct removal, filling, hydrological interruption, or other means? Significant SP -23. Delineate Wetlands, Waters of the United States, and Riparian Habitat; SP -24. Prepare Wetland And Riparian Mitigation And Monitoring Plan; SP -27. Avoid Impacts to Wetland and Riparian Areas; SP -32. Pre - construction Marking and Fencing of Wetlands and Riparian Habitat; BIO -7. Monitor Wetland And Riparian Mitigation Sites Less than significant STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 15 Table 2 Summary of Impacts Found to be Less than Significant or Have No Impact Impact Significance Potential Land Use LU -1. Will the Project Components be inconsistent with the land use plan map of an adopted General Plan or Master Plan? No impact LU -2. Will the Project Components be inconsistent with zoning? No impact LU -3. Will the Project Components increase potential for conflict as a result of incompatible land uses? No impact LU -4. Will the Project Components result in the loss of locally known and /or important mineral resources? No impact Agriculture AGR -1. Will the Project convert Prime Farmland, Unique Farmland, or Farmland of Statewide Importance (Farmland), as shown on maps prepared pursuant to the Farmland Mapping and Monitoring Program of the California Resources Agency, to non - agricultural use? No impact AGR -2. Will the Project conflict with existing zoning for agricultural use or a Williamson Act contracts? No impact AGR -3. Will the Project involve other changes in the existing environment which, due to their locate or nature, could result in conversion of Farmland, to non - agricultural use? No impact Geology Soils and Seismicity GEO -1. Will the Project Components be damaged by unstable slope conditions? Less than significant GEO -3. Will the Project Components be located in areas with soils and groundwater conditions that are susceptible to liquefaction during an earthquake? Less than significant GEO -4. Will earthquake- induced strong ground shaking damage the Project Components? Less than significant STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 2.3 IMPACTS NOT FOUND TO BE SIGNIFICANT The EIR identified the following impacts, which are considered to have a less than significant impact on the environment. 16 GEO -5. Will construction of the Project Components cause off -site water - related erosion? Less than significant GEO -6. Will the Project Components be exposed to damage due to expansive soils? Less than significant GEO -7. Will the Project Components be exposed to damage due to construction on corrosive soils ?. Less than significant Groundwater GW -2. Will the Project Components cause groundwater mounding or increase groundwater levels that cause surface water discharge in a non - stream environment? Less than significant GW -3. Will the Project Components lower groundwater levels at existing wells? Less than significant Surface Water SW -1. Will the Project Components cause numeric criteria to be exceeded at West Fork Carson River at Woodfords? No Impact SW -2. Will the Project Components cause numeric criteria to be exceeded at West Fork Carson River at Stateline? Less than significant SW -3. Will the Project Components cause numeric and narrative -based criteria to be exceeded at West Fork Carson River in California? Less than significant (with the exception of Component 30) SW -4. Will the Project Components cause TMDLs to be exceeded at Indian Creek Reservoir (ICR)? Less than significant (with the exception of Component 31 SW -5. Will the Project Components cause narrative -based criteria to be exceeded in Indian Creek below Harvey Place Reservoir? Less than Significant (with the exception of Components 32 and 32) Hydrology HYDRO -1. Will the Project Components cause flooding? Less than significant HYDRO -2. Will the Project Components cause alter stream bank erosion? Less than significant HYDRO -3. Will the Project Components cause flooding due to rupture of ditches, pipelines, and impoundments? Less than significant HYDRO -4. Will the Project Components reduce quantities of surface water available to users? No impact HYDRO -5. Will the Project Components interfere with the maintenance of water rights? No impact HYDRO -6. Will the Project Components expose people or structures to inundation by seiche, tsunami or mudflow? No impact Public Health and Safety Impact Significance Potential STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 17 PHS -1. Will the Project Components create a public health risk due to their use of recycled water? Less than significant PHS -2. Will the Project Components expose workers or the public to hazards from a known hazardous waste site? No impact PHS -3. Will the Project Components increase potential exposure of the public to hazardous materials due to a chemical release? Less than significant PHS -4. Will the Project Components expose the public to safety hazards associated with operation of heavy machinery, vehicles, or equipment; or creation of accessible excavations (trenches, pits, or borings); or creation of an accessible open body of water? Less than significant PHS -5. Will the Project Components increase the potential exposure of the public to disease vectors (i.e., mosquitoes)? No impact PHS -6. Will the Project Components expose people or structures to fire hazards? Less than significant Biological Resources BIO -6. Will the Project Components conflict with any local, regional, or state policies or ordinances protecting biological resources, habitat conservation plans or other approved plan? No impact Traffic and Circulation TRAFFIC -1. Will Project Component traffic cause congestion along study area roadways? Less than significant TRAFFIC -2. Will lane closures due to Project Component construction cause traffic delays, restricted access, increased traffic hazards, and rerouting of traffic, including emergency vehicles? Less than significant TRAFFIC -3. Will Project Component traffic increase traffic hazards to motor vehicles, bicyclists, or pedestrians? No Impact TRAFFIC -4. Will Project Component construction traffic damage public or private roadbeds? Less than significant TRAFFIC -5. Will there be inadequate parking for Project Component activities? No Impact Air Quality AQ -1. Will construction of the Project Components generate emissions, which exceed allowable limits? Less than significant AQ -2. Will the Project Components operational emissions cumulatively exceed allowable limits? Less than significant AQ -3. Will the Project Components cause potential impacts from objectionable odors or expose sensitive receptors to substantial pollutant concentrations? Less than significant STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 18 AQ -4. Will the Project Components result in substantial greenhouse gas emissions and /or substantially contribute to global warming? Less than significant Noise NOISE -1. Will construction of the Project Components expose the public to high noise levels? Less than significant NOISE -2. Will operation and maintenance of the Project Components expose the public to high noise levels? Less than significant NOISE -3. Will construction of the Project Components cause temporary or periodic increases in ambient noise levels from construction traffic? Less than significant Historical and Archaeological Resources and Paleontology ARCH -3. Will the Project Components disturb unknown important paleontologic resources? No impact Visual Resources and Open Space VISUAL -1. Will the Project Components affect viewsheds from any designated scenic route, scenic corridor or residential or recreation areas due to changes involving grading, vegetation removal, road construction or other construction activities? Less than significant VISUAL -2. Will structures constructed as part of the Project Components be inconsistent with the protection of views of open areas, ridges, and peaks from any designated scenic route, scenic corridor, open space, residential or recreation area? No impact VISUAL -3. Will the Project Components create a new light source? No impact VISUAL -4. Will the Project Components result in the conversion of open space land, including agricultural open space, to non -open space uses? No impact Public Services and Utilities PU -1. Will the Project Components increase demand for police, fire, park and recreation facilities, water, sewage treatment and disposal or solid waste removal to such a degree that accepted service standards are not maintained? No impact PU -2. Will the Project Components construction disrupt police, fire, schools, parks and recreation facilities to such a degree that accepted service standards are not maintained? No impact PU -3. Will the Project Components increase public use of services other than recreation, to a degree that accepted service standards are not maintained? No impact Population and Housing STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 19 HOUSING -1. Will the Project Components result in a net loss, through conversion or demolition, of homes occupied by low- or moderate - income households? No impact HOUSING -2. Will the Project Components result in a net loss, through conversion or demolition, of multifamily rental housing? No impact HOUSING -3. Will the Project Components increase the demand for housing, thereby causing indirect environmental impacts? No impact STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 20 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 3. MITIGATION MONITORING PROGRAM A Mitigation Monitoring Program (MMP) has been prepared for the Project, and is being approved by the District Board by the Resolution adopting these findings. (See Public Resources Code, Section 21081.6, subdivision (a)(1); CEQA Guidelines, Section 15097.) The MMP is contained in Appendix D of the Environmental Impact Report. The District will use the MMP to track compliance with Project mitigation measures. The MMP will remain available for public review at the District office during the compliance period. 21 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 4. PR OJECT ALTERNATIVES CEQA Guidelines section 15126.6 requires a discussion of a reasonable range of alternatives to the Project or to the location of the Project. An EIR need not consider an alternative whose implementation is remote or speculative. An EIR is required to describe and comparatively evaluate a range of reasonable alternatives to a project, or location of the project, that would feasibly attain most of the basic objectives of the project but would avoid or substantially lessen any of the significant effects of the project. As discussed in the EIR, most significant impacts from implementation of the Reccyled Water Facilities Master Plan could be reduced to a less -than significant level with implementation of mitigation measures and standard practices outlined in the final EIR, except for impacts to project components due to exposure to ground faults, groundwater degradation, surface water quality degradation and impacts to undiscovered archaeological resources. Accordingly, two alternative, in addition to the required No Project alternative, were considered and evaluated in the resource chapters and in Chapter 19 of the EIR. All three alternatives are described below. No Project Alternative (Alternative 1) Alternative 1 consists of the existing District Recycled Water and freshwater facilities in Alpine County, CA as of April 19, 2007 (see Figure 2 -3). These facilities include: ditches and pipelines to convey freshwater to ICR, ditches and pipelines to convey recycled water for storage to HPR and the Diamond Ditch system to convey recycled water to current ranch users. Operation of the existing facilities will continue as they are currently being implemented. No new construction of pipelines or changes in irrigation practices would be implemented. Master Plan Recommended Projects (Alternative 3) The Master Plan recommends nine Project Components for implementation based on the need to address infrastructure and management inadequacies and compliance with State of California waste discharge requirements (WDR) during temporary discharge situations. Alternative 3 is considered the minimum action alternative, as this alternative includes the least number of Project Components that can be implemented to meet the District's objectives. This alternative does not allow for future implementation of the Project Components that could become necessary due to changing land use patterns, economic conditions or regulations. Master Plan Trigger Projects (Alternative 4) Alternative 4 is composed of Project Components that can be implemented in the future to allow the District greater flexibility to respond to changing conditions. As the Master Plan is a 20 -year document, there may be unforeseen changes that the District may face in response to: future land uses on the existing irrigated ranches; changes in requirements for discharge of recycled water; changes in total volume of recycled water to be managed; and economic shifts. These triggers could have an impact on the District's 22 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS ability to dispose of recycled water. Alternative 4 allows the District flexibility in choosing and implementing select Project Components. Alternative 4 allows for the analysis of a reduced project scenario that meets the District's objectives. ENVIRONMENTALLY SUPERIOR ALTERNATIVE Alternative 3 Master Plan Recommended Projects is the Environmentally Superior Alternative. Typically Alternative 1, No Project, would be considered environmentally superior because no action is required. The analysis in Chapters 4 through 18 demonstrate Alternative 1 has four significant and unavoidable impacts. The Master Plan has been prepared to mitigate the impacts of the No Project alternative. Alternative 3 meets the purpose, need, and objectives of the District and has a reduced footprint of activities by implementing nine components in comparison to Alternative 2, which implements 28 components, and Alternative 4, which implements 18 components. 23 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS 5. STATEMENT OF OVERRIDING CONSIDERATIONS In determining whether to approve the Project, CEQA requires a public agency to balance the benefits of a project against its significant unavoidable environmental impacts. (Cal. Code Regs., tit. 14, 15093). In accordance with Public Resources Code section 21081(b) and CEQA Guidelines section 15093, the District has, in determining whether or not to approve the proposed Project, balanced the economic, technological, and other benefits of the Project against its unavoidable environmental effects, and has found that the benefits of the Project outweigh the significant adverse environmental effects that are not mitigated to less than significant levels, for the reasons set forth below. This statement of overriding considerations is based on the Recycled Water Facilities Master Plan Environmental Impact Report, oral and written testimony, and other evidence received at the public hearings held on the project and the EIR. The District finds that each of the following benefits is an overriding consideration, independent of the other benefits, that warrants approval of the Project notwithstanding the Project's significant unavoidable impacts. Implementation of the mitigation measures discussed in the draft EIR and final EIR will avoid or substantially lessen all but the following five of the Project specific significant impacts: (1) GEO -2 (2) GW -1; (3) SW -3; (4) ARCH -1, and; (5) ARCH -2. The District recognizes that the Project will cause the five significant Project - specific impacts. The District has carefully balanced the benefits of the proposed Project against the unavoidable adverse impacts identified in the draft EIR, final EIR and the District's Findings of Fact. Notwithstanding the disclosure of impacts identified as significant and which have not been eliminated or mitigated to a level of insignificance, the District, acting pursuant to Section 15093 of the CEQA Guidelines, hereby determines that the benefits of the Project outweigh the significant unmitigated adverse impacts. Based upon the above recitals and the entire record, including the Recycled Water Facilities Master Plan Environmental Impact Report, oral and written testimony, and other evidence received at the public hearings held on the project and the EIR, the District finds that there is evidence that supports a finding that the Project will result in substantial benefits, including environmental, economic, technological, or other benefits, that outweigh and render acceptable the significant effects on the environment that cannot be mitigated to a level less than significant prior to additional surveys to protect archaeological resources and nutrient management plans generated for specific areas to protect ground water and surface water resources. Benefits of the project also outweigh the impact of potential disturbance to facilities from surface faults as the project will improve water quality and efficiency of the recycled water and fresh water systems that currently exist within the project area. Substantial evidence is included in the record of these proceedings and in documents relating to the Project demonstrating the environmental benefits which would result from 24 STPUD RECYCLED WATER FACILITIES MASTER PLAN FINDINGS OF FACT AND STATEMENT OF OVERRIDING CONSIDERATIONS the implementation of the Project. Proper application of recycled water to District and contract irrigator lands would result from implementation of the project in addition to increased efficiency and safety of use of recycled and freshwater systems. Four of the five significant and unavoidable impacts will likely be mitigated to a level of less than significant upon completion of Nutrient Management Plans and additional cultural surveys. The one remaining impact to the project components is from ground rupture due to active faults in the area. This impact can not be fully mitigated as there is no alternative location for the Recycled Water Facilities Master Plan projects. Any one of these reasons is sufficient in and of itself to support the approval of the project notwithstanding the significant unmitigated impacts. PASSED, APPROVED AND ADOPTED this day of 2009. South Tahoe Public Utility District Board of Directors , President South Tahoe Public Utility District Board of Directors ATTEST: APPROVED AS TO FORM Kathy Sharp Clerk to the Board South Tahoe Public Utility District 25 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 RESOLUTION NO. 2877 -09 A RESOLUTION BY THE BOARD OF DIRECTORS OF THE SOUTH TAHOE PUBLIC UTILITY DISTRICT TO CERTIFY THE FINAL ENVIRONMENTAL IMPACT REPORT FOR THE RECYLED WATER FACILITIES MASTER PLAN AND ADOPTING FINDINGS PER CEQA, A STATEMENT OF OVER - RIDING CONSIDERATION, A MITIGATION MONITORING AND REPORTING PROGRAM, ADOPTING THE RECYCLED WATER FACILITIES MASTER PLAN AND APPROVING MASTER PLAN PROJECTS 1, 2, 11, AND 1 111 l,;�L_ WHEREAS, the South Tahoe Public Utility District (District) is considering the adoption of the Recycled Water Facilities Master Plan and approval of Master Plan Projects 1, 2, 11, and 12, collectively hereinafter referred to as the "Project;" and WHEREAS, the District is the lead agency under the California Environmental Quality Act (CEQA) (Public Resources Code § 21000 et seq.) and the State CEQA Guidelines (Cal. Code Regs., tit. 14, § 15000 et seq.),; and WHEREAS, the District has determined the Project is a "project" as defined under the California Environmental Quality Act and State CEQA Guidelines, and is not categorically or statutorily exempt; and WHEREAS, the District, in accordance with CEQA, to State CEQA Guidelines sections 15082(a), 15103, and 15375; issued a Notice of Preparation stating that an EIR for the Project would be prepared and inviting comments from Federal Agencies, State responsible and trustee agencies, other public agencies, interested organizations, and the general public, and filed the Notice of Preparation with the State Clearinghouse and the Clerk of Alpine County; and WHEREAS, upon completion of the Draft Environmental Impact Report ( "Draft EIR "), the District issued a Notice of Completion, along with copies of the Draft EIR, to the State Clearinghouse to begin the review period for interested State and Federal agencies and filed the Notice of Completion with the State Clearinghouse and the Clerk of Alpine County; and 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 WHEREAS, the District provided a 47 -day public review period, affording the public and Federal, State, and local agencies the opportunity to review the Draft EIR and published a legal notice in the Tahoe Daily Tribune providing notice of the availability of the Draft EIR; and WHEREAS, all potential significant adverse environmental impacts were sufficiently analyzed in the Draft EIR; and WHEREAS, the draft environmental impact report was circulated to the public from July 23, 2009, through September 7, 2009, to receive written comments in accordance with CEQA; and WHEREAS, public hearings were held at Turtle Rock Park in Alpine County and before the District Board on September 2, 2009, and September 3, 2009, respectively to take oral testimony on the draft environmental impact report; and WHEREAS, the District received written comments on the Draft EIR, evaluated and responded in writing to those comments, and prepared a Final Environmental Impact Report pursuant to Sections 15088 and 15089(a) of the CEQA Guidelines; and WHEREAS, the District prepared the Final EIR and, pursuant to Public Resources Code section 21092.5, the District provided copies of the Final EIR to all commenting agencies; and WHEREAS, as contained herein, the District has endeavored in good faith to set forth the basis for its decision on the Project; and WHEREAS, all the requirements of CEQA and the State CEQA Guidelines have been satisfied by the District in the Final EIR, which is sufficiently detailed so that all of the potentially significant environmental effects of the Project have been adequately evaluated; and N 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 WHEREAS, the Final EIR prepared in connection with the Project sufficiently analyzes both the feasible mitigation measures necessary to avoid or substantially lessen the Project's potential environmental impacts and a range of feasible alternative capable of eliminating or reducing these effects in accordance with CEQA, the State CEQA Guidelines and the Authority's Local CEQA Guidelines; and WHEREAS, all of the findings and conclusions made by the District pursuant to this Resolution are based upon the oral and written evidence presented to it as a whole and not based solely on the information provided in this Resolution; and WHEREAS, environmental impacts identified in the Final EIR that the Authority finds are less than significant and do not require mitigation are described in Section II hereof; and WHEREAS, environmental impacts identified in the Final EIR as potentially significant but which the Authority finds can be mitigated to a level of less than significant through the imposition of feasible mitigation measures identified in the Final EIR and set forth herein are described in Section III hereof; and WHEREAS, environmental impacts identified in the Final EIR as potentially significant but which the Authority finds cannot be fully mitigated to a level of less than significant, despite the imposition of all feasible mitigation measures identified in the Final EIR and set forth herein are described in Section IV hereof; and WHEREAS, alternatives to the Project that might eliminate or reduce significant environmental impacts are described in Section VIII hereof; and WHEREAS, prior to taking action, the District has heard, been presented with, reviewed and considered all of the information and data in the administrative record, including the Initial Study, the Final EIR, and all oral and written evidence presented to it during all meetings and hearings; and w 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 WHEREAS, the Final EIR reflects the independent judgment of the District's Board and is deemed adequate for purposes of making decisions on the merits of the Project and on the Master Plan Projects 1, 2, 11, and 12; and WHEREAS, no comments made in the public hearings conducted by the District or any additional information submitted to the District have produced substantial new information requiring recirculation or additional environmental review under State CEQA Guidelines section 15088.5; and WHEREAS, all other legal prerequisites to the adoption of this Resolution have occurred; NOW, THEREFORE, BE IT RESOLVED BY THE DISTRICT BOARD AS FOLLOWS: I. FINDINGS At a regular session assembled on December 3, 2009, the Board determined that, based on all of the evidence presented, including but not limited to the Initial Study, the Final EIR, written and oral testimony given at meeting and hearings, and submission of testimony from the public, organizations and regulatory agencies, the following environmental impacts associated with the Project are: (1) less than significant and do not require mitigation; or (2) potentially significant and each of these impacts will be avoided or reduced to a level of insignificance through the identified mitigation measures and /or implementation of an environmentally superior alternative to the Project; or (3) significant and cannot be fully mitigated to a level of less than significant but will be substantially lessened to the extent feasible by the identified mitigation measures. 111. RESOLUTION REGARDING ENVIRONMENTAL IMPACTS NOT REQUIRING MITIGATION The Board hereby finds that the following potential environmental impacts of the Project, (See Appendix A, Section 2.2, Table 1, pages 14 through 20 listing no impacts), are less than significant with the implementation of the Project and therefore do not require the imposition of mitigation measures: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 RESOLUTION REGARDING ENVIRONMENTAL IMPACTS MITIGATED TO A LEVEL OF LESS THAN SIGNIFICANT The Board hereby finds that mitigation measures have been identified in the Final EIR that will avoid or substantially lessen the following potentially significant environmental impacts to a less than significant level. The potentially significant impacts and the mitigation measures will reduce them to a less than significant level are as follows: See Appendix A, Section 2.2, Table 1, pages 14 through 20 impacts identified as less than significant. IV. RESOLUTION REGARDING ENVIRONMENTAL IMPACTS NOT FULLY MITIGATED TO A LEVEL OF LESS THAN SIGNIFICANT The Board hereby finds that the following impacts cannot be fully mitigated to a less than significant level and that no feasible mitigation measures are available and a Statement of Overriding Considerations is therefore included herein: See Appendix A, Section 2. 1, pages 10 through 13 listing significant unavoidable impacts. V. RESOLUTION REGARDING CUMULATIVE IMPACTS The range of projects to be included in the cumulative analysis encompasses "past, present, and reasonably anticipated future projects producing related or cumulative impacts, including those outside of the control of the agency." (State CEQA Guidelines, § 15130.) A cumulative effect is deemed significant if the Project's incremental contribution to a cumulative impact is "considerable." (ibid.) A cumulative impact is not considered significant if the impact can be mitigated to below the level of significance, by providing improvements and /or contributing funds through fee - payment programs. The Final EIR examines "reasonable options for mitigating or avoiding any significant cumulative effects of a Project" (State CEQA Guidelines, § 15130). A description of potential cumulatively considerable impacts is presented in each environmental impact category. Overall, the Project would have cumulatively considerable impacts related to groundwater quality for the No Project Alternative (see Final EIR Section 7.7) /// /// 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 VI. RESOLUTION REGARDING SIGNIFICANT IRREVERSIBLE ENVIRONMENTAL CHANGES Section 15126.2(c) of CEQA provides guidance as to what sorts of changes might be considered irreversible. Such changes include use of nonrenewable resources, commitment of future generations to similar uses, and environmental accidents that could occur as a result of the project. The Project will involve construction activities that commit non - renewable resources including fuels, construction materials and land. Once constructed, Project facilities will continue to use energy. Construction of new facilities will irretrievably commit lands to use for public facilities. (See Final EIR Section 20.3 pages 20 -3 through 20 -4) VII. RESOLUTION REGARDING GROWTH- INDUCING IMPACTS The Project (Alternative 2) and action alternatives (Alternatives 3 and 4) will not result in the removal of obstacles to growth. The Recycled Water Facilities Master Plan is the District's implementation program for expanding the reuse and /or application of recycled water to 5.8 million gallons per day (mgd). The Project does not require expansion of the District's treatment plant, which has a capacity of 7.7 mgd. The impacts of the plant's capacity and the District's plan for accepting new sewer connections have been evaluated in prior environmental documents. The Environmental Impact Report/Environmental Impact Statement (EIR/EIS) for the District Future Sewer Connections Plan concludes that growth- inducing impacts of that project were less than significant. The District Recycled Water Facilities Master Plan will not allow additional growth beyond that projected in the EIR/EIS for the District Future Sewer Connections Plan. Future development ultimately will be determined through the Tahoe Regional Planning Agency (TRPA) planning process. (See Final EIR Section 1.7.1 pages 1 -9 through 1 -10) VIII. RESOLUTION REGARDING ALTERNATIVES The District's Board hereby declares that it has considered and rejected as either infeasible, or environmentally inferior, the alternatives identified in the Draft EIR and described below. CEQA requires that an EIR evaluate a reasonable range of alternatives to a project, or to the location of the Project, which: (1) offer substantial 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 environmental advantages over the Project proposal, and (2) may be feasibly accomplished in a successful manner within a reasonable period of time considering the economic, environmental, social and technological factors involved. An EIR must only evaluate reasonable alternatives to a project which could feasibly attain most of the Project objectives, and evaluate the comparative merits of the alternatives. In all cases the consideration of alternatives is to be judged against a rule of reason. The lead agency is not required to choose the environmentally superior alternative identified in the EIR if the alternative does not provide substantial advantages over the Project and: (1) through the imposition of mitigation measures the environmental effects of a project can be reduced to an acceptable level, or (2) there are social economic, technological or other considerations which make the alternative infeasible. (See Final EIR Chapter 19) 11 A. SUMMARY OF PROJECT ACTIONS AND OBJECTIVES The District requires a reliable recycled water reuse and emergency storage system that accommodates the flows generated by the residents and visitors within the Lake Tahoe Basin of El Dorado County, CA and recycled by the District wastewater treatment facility located in South Lake Tahoe, CA. The District utilized the following objectives for selection of the Master Plan components and projects: • Establish a plan for recycled water and freshwater management for operation through the year 2028; • Assure regulatory compliance for the District's recycled water and freshwater operations; • Protect and enhance the environment in Alpine County; • Continue cooperation with Alpine County stakeholders; and • Preserve agricultural practices in Alpine County. IX. RESOLUTION ADOPTING A STATEMENT OF OVERRIDING CONSIDERATIONS The Board hereby declares that, pursuant to State CEQA Guidelines Section 15093, the Board has balanced the benefits of the Project against any unavoidable environmental impacts in determining whether to certify the Final EIR and approve the Project. If the 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 benefits of the Project outweigh the unavoidable adverse environmental impacts to aesthetics, those impacts may be considered "acceptable." The Board hereby declares that the Final EIR has identified and discussed significant effects which may occur in the areas of Geology, Soils and Seismicity, Groundwater, Surface Water and Historical and Archaeological Resources and Paleontology as a result of the Project. With the implementation of the policies and mitigation measures discussed in the Final EIR, these effects will be significant and unavoidable. The Board hereby declares that it has made a reasonable and good faith effort to eliminate or substantially mitigate the potential impacts resulting from the Project. The Board hereby declares that to the extent any mitigation measures recommended in the EIR could not be incorporated, such mitigation measures are infeasible because they would impose restrictions on the Project that would prohibit the realization of specific economic, social and other benefits that this Board finds outweigh the unmitigated impacts. The Board further finds that except for the Project, all other alternatives set forth in the EIR are infeasible because they would prohibit the realization of Project objectives and /or specific economic, social and other benefits that this Board finds outweigh any environmental benefits of the alternatives. The Board hereby declares that, having reduced the adverse significant environmental effects of the Project to the extent feasible by adopting the proposed policies and mitigation measures, having considered the entire administrative record on the Project, and having weighed the benefits of the Project against its unavoidable adverse impacts after mitigation, the Board has determined that the following social, economic and environmental benefits of the Project outweigh the potential unavoidable adverse impacts and render those potential adverse environmental impacts acceptable based upon the following overriding considerations: 1. The Project will secure infrastructure improvements and protect property for the future of the community. 2. The Project would enhance the tax base and thus support public services, employment and future development. 3. The Project will promote diversification and preservation of existing and future water resources to better serve the community. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 4. The Project will allow for the improvement of the existing water distribution infrastructure with advanced technology to greater conserve the environment and water resources. 5. The Project will allow for the greater conservation of natural resources. The Board hereby declares that the foregoing benefits provided to the public through approval and implementation of the Project outweigh the identified significant adverse environmental impacts of the Project to Geology, Soils and Seismicity, Groundwater, Surface Water and Historical and Archaeological Resources and Paleontology which cannot be mitigated. The Board finds that each of the Project benefits outweighs the unavoidable adverse environmental effects identified in the Final EIR and therefore finds those impacts to be acceptable. X. RESOLUTION CERTIFYING THE EIR The Board finds that (1) the Final EIR is an accurate and objective statement that has been completed in compliance with CEQA and the State CEQA Guidelines; (2) the Final EIR was presented to the Board and the Board reviewed and considered the information contained in the Final EIR prior to approving the Project and Master Plan Projects 1, 2, 11, and 12; and (3) the Final EIR reflects the District's independent judgment and analysis. The Board declares that no new significant impacts as defined by State CEQA Guidelines Section 15088.5 have been received by the District after circulation of the Final EIR, which would require recirculation. The Board certified the Final EIR based on the following findings and conclusions: A. Findings. The following significant environmental impacts have been identified in the Final EIR and will require mitigation as set forth in Section IV of this Resolution: [GEO -2, GW -1, SW -3, ARCH -1 and ARCH -2]. B. Conclusions. 1. All significant environmental impacts from the implementation of the Project have been identified in the Final EIR and, with implementation of the mitigation measures identified, will be mitigated to a less than significant level, except for Geology, Soils and Seismicity, Groundwater, Surface Water and Historical and Archaeological Resources and Paleontology. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 2. Other reasonable alternatives to the Project that could feasibly achieve most of the basic objectives of the Project have been considered and rejected in favor of the Project. 3. Environmental, economic, social and other considerations and benefits derived from the development of the Project override and make infeasible any alternatives to the Project or further mitigation measures beyond those incorporated into the Project. XI. RESOLUTION ADOPTING A MITIGATION MONITORING PROGRAM Pursuant to Public Resources Code Section 21081.6, the Board hereby adopts the Mitigation Monitoring Program attached to this Resolution as Appendix A (see Section 3). In the event of any inconsistencies between the mitigation measures as set forth herein and the Mitigation Monitoring Program, the Mitigation Monitoring Program shall control. XII. RESOLUTION APPROVING THE PROJECT Based on the entire record before the Board, including the above findings and all written and oral evidence presented to the Board, the Board hereby adopts the STPUD Recycled Water Facilities Master Plan and approves Master Plan Projects 1, 2, 11, and 12 with all the mitigation measures and the Mitigation Monitoring Program as set forth in this Resolution. XIII. RESOLUTION REGARDING THE CUSTODIAN OF RECORD The documents and materials constitute the record of proceedings on which this Findings have been based are located at the South Tahoe Public Utility District office located at 1275 Meadow Crest Drive, South Lake Tahoe, CA 96150. This information is provided in compliance with Public Resources Code Section 20181.6. I XIV. RESOLUTION REGARDING STAFF DIRECTION A Notice of Determination shall be filed with the County of Alpine within five (5) working V days of final Project approval. p� 3 C"�+�� HI I P /� 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 NOW, THEREFORE, BE IT RESOLVED that the District Board certifies: 1. The Final Environmental Impact Report for Recycled Water Facilities Master Plan has been completed in compliance with the California Environmental Quality Act Statutes and Guidelines; and 2. The Final EIR was presented to the District Board and the District Board reviewed and considered the information contained in the Final EIR prior to its decision to adopt the Recycled Water Facilities Master Plan and approve Master Plan Projects 1, 2, 11, and 12; and 3. The Final EIR reflects the independent judgment and analysis of the District Board based upon its review of the entirety of the administrative record, which provides substantial evidence to support the adoption of this resolution. WE, THE UNDERSGINED, do hereby certify that the above and foregoing resolution was duly and regularly adopted and passed by the Board of Directors of the South Tahoe Public Utility District at a regular meeting duly held on the 3 rd day of December, 2009, by the following vote: AYES: NOES: ABSENT: Mary Lou Mosbacher, Board President South Tahoe Public Utility District ATTEST: Kathy Sharp, Clerk of the Board NOTICE OF AVAILABILITY SOUTH TAHOE PUBLIC UTILITY DISTRICT RECYCLED WATER FACILITIES MASTER PLAN FINAL ENVIRONMENTAL IMPACT REPORT This notice is to inform you that a 10 -day review period for the Recycled Water Facilities Master Plan Final EIR will commence on November 20, 2009 and concludes on November 30, 2009. Comments may be submitted no later than November 30, 2009 in writing and mailed, or emailed to: Mail: South Tahoe Public Utility District Email: dvreir@stpud.dst.ca.us 1275 Meadow Crest Drive South Lake Tahoe, CA 96150 ATTN: Recycled Water Facilities Master Plan EIR The South Tahoe Public Utility District Recycled Water Facilities Master Plan includes a combination of actions to dispose of treated effluent and associated actions to convey and apply reclaimed water to District lands and manage fresh water resources. The plan updates the 1989 Master Plan and includes new and revised information on increases in system demands and disposal opportunities and constraints. Copies of the Final EIR are available for public review during normal business hours at the South Tahoe Public Utility District Office (1275 Meadow Crest Drive, South Lake, CA), the Markleeville Library and Archives (270 Laramie Street, Markleeville, CA) and the El Dorado County Library (345 Fair Lane, Placerville, CA). A PDF of the Final EIR is available to download on the District's website at: http:// www.stpud.us /. TWo public meetings are scheduled on the Project: December 2, 2009: 1:00 p.m. to 3:00 p.m. at Turtle Rock Park, 99 Water Street, Markleeville, CA. December 3, 2009: South Tahoe Public Utility District Board Meeting, 2:30 p.m. to 3:00 p.m. at the District Office, 1275 Meadow Crest Drive, South Lake Tahoe, CA. The South Tahoe Public Utility District is scheduled to make a decision on the EIR, Master Plan, and Projects at their December 3, 2009 Board Meeting. For additional information, please contact Jim Hoggatt, Project Manager, at (530) 543 -6206 or email jhoggatt@stpud.dst.ca.us. —117— ENVIRONMENTAL IMPACT REPORT S o u t h T a h o e P u b l i c U t i l t y D i s t r i c t Recycled W a t e r F a c i l i t i e s Ma s t e r P l a n 1 Introduction and Summary Pursuant to the California Environmental Quality Act (CEQA), discretionary decisions by public agencies regarding public projects are subject to environmental review. The purpose of an environmental impact report (EIR) is to identify the significant environmental effects of a project, to identify alternatives to the project, and to indicate the manner in which those significant effects can be mitigated or avoided ( §21002.1(a)). When feasible, the public agency is required to mitigate or avoid a projects significant environmental impacts. The South Tahoe Public Utility District (District) proposes to adopt the Recycled Water Facilities Master Plan (Project) and approve four Master Plan projects for implementation. The Project identifies facilities, improvements, and operations necessary to provide for the reliable reuse and disposal of recycled water generated by the District's wastewater treatment operations located in South Lake Tahoe, CA. This EIR has been prepared by the District as the lead agency for the Project in compliance with CEQA and the CEQA Guidelines (California Administrative Code § 1500 et seq.). Environmental effects of the Project that are addressed include the significant adverse effects of the project, growth- inducing effects and significant cumulative effects of past, present, and reasonably anticipated future projects. W ,. - ."T November 2009 Introduction and Summary Page 1 -t -119- ENVIRONMENTAL IMPACT REPORT S o u t h T a h o e P u b l i c U t i I i t y D i s t r i c t R e c y c l e d W a t e r F a c i I: t, e s M a s t e r P l a n Site specific soil conditions and groundwater monitoring results in the vicinity of PWiect Component I1 is provided in the Farr Report and Memorandum. �•• =1! ► •11• all I ti VGMT •111'1 .1• Appendix 0 - Comments Received on Draft EIR Ap•:1• Response • Comments Received on Draft EIR A ppend i x Q L • 111 Appendix ► - Corresponden P r o ject • Alternatives The Project, two Project alternatives, and the No Project alternative are evaluated in this EIR. A description of the Project and the alternatives, including detailed descriptions of the four Master Plan projects to be implemented, are provided in Chapter 2. Analysis of the alternatives is provided in Chapter 19. 1.1.1 Overview of Project Location and District Operations The District's existing fresh water and recycled water facilities are located in northeastern Alpine County on the eastern slope of the Sierra Nevada. Although operations are within Alpine County, CA, the closest urban areas are the towns of Minden and Gardnerville located 20 miles north of Alpine County in Douglas County, NV. The District's service area is 25 miles away in El Dorado County, CA. The Project vicinity is illustrated in Figure 1 -1. The existing recycled water system begins at the District's wastewater treatment plant (WWTP) in South Lake Tahoe where recycled water is pumped out of the Lake Tahoe Basin along State Route (SR) 89 over Luther Pass to SR 88 in Hope Valley, and then along the West Fork of the Carson River to Harvey Place Reservoir (HPR) southeast of Woodfords, CA. Existing operations are detailed in Chapter 2, section 2.8, No Project (Alternative 1). The project area encompasses portions of Alpine County, CA and Douglas County, NV. As shown in Figure 2 -1 in Chapter 2, the Project area is comprised of lands of the West Fork of the Carson River watershed and the Indian Creek watershed. The project area extends from south of Woodfords in Alpine County to a portion north of the Carson Valley in Douglas County. 1.1.2 Project Background The District is the wastewater service provider for the South Lake Tahoe, CA area. Wastewater generated within the District service area is treated at its wastewater treatment facilities in South Lake Tahoe and exported to Alpine County, CA where the recycled water has been used to irrigate ranch lands since the 1960's. The District manages the use of the recycled water and a freshwater systems in support of Indian Creek Reservoir (ICR) and HPR located in Alpine County. The Recycled Water Facilities Master Plan has been prepared to assure the continued reliable operation of the recycled water and freshwater systems. November 2009 Introduction and Summary Page 1-2 -120- ENVIRONMENTAL IMPACT REPORT South Tahoe Public Utility District Recycled Water Facilities Master Plan Figure 1 -1 Project Vicinity (8.5X11) November 2009 Introduction and Summary Page 1-3 -121- ENVIRONMENTAL IMPACT REPORT S o u t h T a h o e P u b l i c U t i l i t y D i s t r i c t R e c y c l e d Water F a c i i. t i e s M a s t e r P l a n This page intentionally left blank. November 2000 Introduction and Summary Papa 1 -4 -122- ,l a p Diamond Valley Ranch NMP /; ro F.hrus 2009 Sub e.k. e. EON South Tahoe PUD 0, ay cMK s.aF T.h.. PUo a _ la�poo � Z Vicinity Map tom''''• oosipn.a ey cMK P.o.r 9.tlk T.hw PUD = chocked ay' M. ENVIRONMENTAL IMPACT REPORT S o u t h T a h o e P u b I i c U t i l i t y D i s t r i c I R e c y c l e d W a t e r F a c i I i 1 i e s M a s t e r P l a n The District embarked on the Recycled Water Facilities Master Plan in 2000. A Draft EIR was circulated and hearings held on the Master Plan and Draft EIR. The project was suspended pending the purchase of the Heise Ranch. In 2007, after completion of the purchase of the Heise Ranch, the District restarted the master plan update and environmental review process. To ensure that a reasonable range of alternatives are considered as required by CEQA, the District identified 28 facility and operational components designed to meet the District's need to manage their recycled water and freshwater systems. These 28 Master Plan components were refined through the planning and environmental review process. The Master Plan assembles sets of components into Master Plan projects to identify the group of components necessary to implement each project. Individual components may be in one or more of the Master Plan projects. The EIR analyzes each of the 28 components individually and cumulatively. The Master Plan projects impacts are disclosed from the individual and cumulative impacts of the components included in each project. During the development of the Master Plan, six components were determined to not be included in the Master Plan. The six components have been retained for future consideration in an appendix to the Master Plan because these may be needed in the future in response to changes in land ownership, law, or the economy. 1.1.3 Project Objectives The District requires a reliable recycled water reuse and emergency storage system that accommodates the flows generated by the residents and visitors within the Lake Tahoe Basin of El Dorado County, CA and recycled by the District wastewater treatment facility located in South Lake Tahoe, CA. The District utilized the following objectives for selection of the Master Plan components and projects: 1. Establish a plan for recycled water and freshwater management for operation through the year 2028; 2. Assure regulatory compliance for the District's recycled water and freshwater operations; 3. Protect and enhance the environment in Alpine County; 4. Continue cooperation with Alpine County stakeholders; and 5. Preserve agricultural practices in Alpine County. 1.1.4 No Project Alternative (Alternative 1) Alternative 1 consists of the existing District Recycled Water and freshwater facilities in Alpine County, CA as of April 19, 2007 (see Figure 2 -3). These facilities include: ditches and pipelines to convey freshwater to ICR, ditches and pipelines to convey recycled water for storage to HPR and the Diamond Ditch system to convey recycled water to current ranch users. Sections 3 and 4 of the Master Plan provide a description of these facilities. Table 2 -3 provides a summary of the existing facilities and operations in Alpine County. 1.1.5 Project (Alternative 2) The Project is the implementation of the Recycled Water Facilities Master Plan. The Master Plan includes 20 projects that implement one or more of the 28 components. A list of the Master Plan projects and the individual Project Components that comprise each project are included in Table 2 -2. November 2009 Introduction and Summary Pape 1 -5 -125- ENVIRONMENTAL IMPACT REPORT S o u t h T a h o e P u b l i c U t i l i t y D i s t r i c t R e c y c l e d W a t e r F a c i l i t i e s Master P l a n Chapter 13 of the Master Plan (Stantec 2008) details the Master Plan implementation and summarizes the process the District follow to decide which projects to implement as based on future triggers. Because implementation of every component may not be necessary to meet the District's objectives based on future conditions, components are analyzed individually in this EIR to allow for the best combination to be selected by the District in response to future freshwater and recycled water triggers and contingencies. 1.1.6 Master Plan Recommended Projects (Alternative 3) The Master Plan recommends nine Project Components for implementation based on the need to address infrastructure and management inadequacies and compliance with State of California waste discharge requirements (WDR) during temporary discharge situations. The following is a list of components that comprise Alternative 3: e 3 - Capacity and conveyance improvements in the Diamond Ditch system a 4 - Provide pressurized recycled water to the Fredericksburg system 6 - Provide pressurized recycled water to the Ranchettes 11- Construct irrigation fields with pumping back to Harvey Place Reservoir 18 - Optimize application rate on existing irrigated lands 19 - Pursue permitting of more land in Alpine County 22 - Parallel recycled water pipeline along existing Diamond Ditch e 29 - Irrigate the District Pasture e 30 - Irrigate the Jungle with Recycled Water Alternative 3 is considered the minimum action alternative, as this alternative includes the least number of Project Components that can be implemented to meet the District's objectives. This alternative does not allow for future implementation of the Project Components that could become necessary due to changing land use patterns, economic conditions or regulations. 1.1.7 Master Plan Trigger Projects (Alternative 4) Alternative 4 is composed of Project Components that can be implemented in the future to allow the District greater flexibility to respond to changing conditions. As the Master Plan is a 20 -year document, there may be unforeseen changes that the District may face in response to: future land uses on the existing irrigated ranches; changes in requirements for discharge of recycled water; changes in total volume of recycled water to be managed; and economic shifts. These triggers could have an impact on the District's ability to dispose of recycled water. Alternative 4 allows the District flexibility in choosing and implementing select Project Components. Alternative 4 allows for the analysis of a reduced project scenario that meets the District's objectives. The following is a list of components that comprise Alternative 4: a 1- Provide recycled water to new non - irrigated, permitted land a 2 - Make recycled water available to irrigators in Nevada November 2009 Introduction and Summary Pape 1 -6 -126- ENVIRONMENTAL IMPACT REPORT S o u t h T a n o e P u b l i c U t i l i t y D i s t r i c t R e c y c l e d W a t e r F a c i l i t i e s Master P l a n • 3 — Capacity and conveyance improvements in the Diamond Ditch system • 4 — Provide pressurized recycled water to the Fredericksburg system 6 — Provide pressurized recycled water to the Ranchettes 7 — Non -flood irrigation application system 11— Construct irrigation fields with pumping back to Harvey Place Reservoir 14 — Pipe recycled water systems to minimize setbacks and human contact 16 — Subsurface recycled water irrigation in public contact of buffer areas 17 — Increase Snowshoe Thompson No. 1 conveyance capacity 18 — Optimize application rate on existing irrigated lands 19 — Pursue permitting of more land in Alpine County 22 — Parallel recycled water pipeline along existing Diamond Ditch 23 — Route Mud Lake winter flows through Indian Creek Reservoir 24 — Transfer additional water rights to storage in Indian Creek Reservoir 29 — Irrigate the District Pasture e 30 — Irrigate the Jungle with Recycled Water e 31— Divert Stormwater Flow away from Harvey Place Reservoir and to Indian Creek Reservoir 1.2 Environmental Review — CEQA This EIR is both a Program EIR and a Project EIR based on the level of detail provided for each Project Component. The Project Components evaluated at a project level in the EIR are: 11— Construct irrigation fields with pumping back to Harvey Place Reservoir 18 — Optimize application rate on existing irrigated lands 19 — Pursue permitting of more land in Alpine County The remaining 25 Project Components are evaluated at a program level in the EIR. A Program EIR under the provisions of CEQA Guidelines § 15168 evaluates the impacts of a series of actions that can be characterized as one large project and are related either: (1) Geographically; (2) As logical parts in a chain of contemplated actions; November 2008 Introduction and Summary Pape 1 -7 -127- ENVIRONMENTAL IMPACT REPORT South Tahoe Public Utility District Recycled Water Facilities Master P l a n (3) Are connected with issuances of rules, regulations, plans or other general criteria to govern the conduct of a continuing program; or (4) As individual activities carried out under the same authorizing statutory or regulatory authority and having generally similar environmental effects which can be mitigated in similar ways. For Project Components evaluated at a program level in this EIR, additional environmental review may be required to address details of each component not evaluated in this EIR. As Project Components are designed for implementation, the District will conduct the appropriate level of environmental review prior to component implementation. A Project EK as defined by CEQA Guidelines §15161, is an EIR that examines the environmental impacts of a specific development project. The Project EIR evaluates the detailed project including planning, construction, and operation. 1.3 Environmental Review — NEPA The National Environmental Policy Act (NEPA) applies to projects that are carried out, financed, or approved in whole or in part by federal agencies. The Project does not involve a federal action, and therefore NEPA environmental analysis is not required. If implementation of the Master Plan requires a federal action, such as issuance of a Section 404 permit by the Corps of Engineers under the Clean Water Act, the District will initiate environmental review through a designated NEPA lead agency. 1.4 Public and Agency Involvement The environmental review process complies with the CEQA requirements for public notice and review of environmental documentation for the Project, thus assuring that interested parries have the opportunity to review and comment on the implementation of the Master Plan components. A Notice of Preparation (NOP) prepared for this EIR started circulation on April 20, 2007 and ended on May 21, 2007. Two scoping meetings were held: the first on May 16, 2007 at Turtle Rock Park in Alpine County and the second on May 17, 2007 at the South Tahoe Public Utility District Board Room in South Lake Tahoe. A revised NOP was prepared and circulated on January 5, 2009 and ended on February 6, 2009. The revised NOP included the addition of four components to the project description and the addition of two new alternatives; Alternative 3 and Alternative 4. The Draft EIR circulation started on July, and ended on September 7, 2009, A Notice of Completion ( OC) was submitted to the California State Clearinghouse on July 23. Two public meetings were held to take comments on the Draft EIR: SelYtember 2. 2009 at Turtle Rock Park in Marl leeville, CA and Scpt mb r 3. 2009 at the South Tahoe Public UtiliV District Board of Directors Meeting in South Lake Tahoe, CA. The Final EIR will be circulated stating November 20. 2009 for review by the individuals and agencies who commented on the Draft EIR for 10 days ending November 30, 2009. The Final EIR will be available for review at these locations: The South Tahoe Public Utility District 1275 Meadow Crest Drive. South Lake Tahoe, CA 96150; the South Lake Tahoe Library, 1000 Rufus Allen Blvd. South Lake Tahoe. CA 96150, and the A112i o to . . iL bran+ 270 Laramie St. Marldeeville. CA 96120, November 2009 Introduction and Summary Page 1 -8 -128- ENVIRONMENTAL IMPACT REPORT Recirculati 1.5 EIR • Secti 15 088 . 5 of 1 Q: Guidelines govems recirculati of Sri EI R prior to certificati Recirculation is re!quired when "significant new information" is included in the Final EIR. such as information showing that: new e1 ! t e nvir orunental impact would result from t he prQject or 111 a new 1 1 •1 f1 sure Mpgsed to be i mplemen ted, su bstantial ! 1 the severity o f " 1 • 1 11 • atal im • 1 result unless Mitigation measures are adopted to reduce the impact to a level of insignificance. • A feasible project altemative or mitigation measure considerably different from others previously anal r'1 .•. ! clearly lessen the sigWfic e nvironmental i mpacts of I" pL Qject. b t h e / • e cfs pmpon d ecline d to adop T he minor !f' and cl arifications to t he IC analysis 11 not signific the F or .1' analysis presented 1 t Dc:i EIR nor 1• the resu i new Vf •..1 t impacts or . .s.r i n crease i n less i m p acts. - } - . 1 these minor 1 ?1' mere " make r r c.l modification in the Pr.Q and EIR. as is pennitted 4 State CEQA Guidelines section 15088.5. Acc o r dingl y, t he se minor IEI'' and t he EIF analysis for t he PWiect 1• not 1"1 the public o meaningful opportunity t• comment =n ! i su bstantial adverse ' t • 1_ N ' f .: i • 1 the FPIIQ o feasible WiLy to mitigate or avoid such an effect (including a feasible rPlr.Qject "r1• that FI- Q j ect ' s proponents have d t imple ment, " CE/ A Guidelines. 1: 8.5(a) F urther. the n 11 r:.f not JI =.! new 1 •ri! i1! withi the meaning of Q: In Illl" 46 si gn ifi cant new 1 • r17: i • ! consists • disclosure of 1 - r : t .l1 disclosure o n., • •► Ir !1".. •! 1 r:► +. i" "1 In .f •.!"n / 1 !: r'1 }, .• 1 .1 " 1 • ! 11 1 1! / : 1 41 . 1 1 / • 9 I . 111111 M " - 11 - 11111 / 1 11 1 ( 1 N 1 : 1 11 • i..1 +.:.11"1.: W /:. }.1:,1 }1 11 •I% 1111101 M-RV.111-111M. MW :. • 1 _1 • i " . f . . } " 11 1 • r :.! ' f • . i " 11 ! 1 :. r • 1. !1 1. - WIN _ W11 21 M.- .! - It - i I\. %.+ • .} - - . .•_! 1 , + " 1 1 / 1 t .! / It 4 +;.r' t!• • .r �• %l . ! 11 1 111111 1" 1• •1 :.f i • 1 - 1 - } . 1 1 • 1 : 1 • rll : 1 } 1 ,,r 1 }. - / - i 1 1 • 1 % ! 1 11! e • ! 1 ._,r • 1. .1 ;. 1 1 ' 1 :.! 11 • - f • 1 f! ". 1 _11 1 : 1 1 !i .1 - ' • 1• • + .! " ' r : :.! • .1 " M 2 }- _. f!' E.r_ • :•11/ M=s 11<.," f JI :.1 It• 11. 1 .1' M .•'1 I :.l 1: 1'x11 i "1 1 x 4 y a l v eff , - }- F-1 1 1 -139t 03. IM&M-11 [view 6,10 1' 1 I rq a •} I/ 1 • 1 IC % i" 1 1 I• 1 `• 1" ; 1� • .1 � C l 1► 1 .1- 1 "Ir r" 1 1 1 1!'•_1 1'i •IIIti..l i, • •1l 11'1 /•1 1 .:.f • "1 •!!!'!.• i :l • i ' 1 • • 1 - " 't "1 81 11 RIN I) • is f 1 " i t7w, 1 : r . 1 • - / 1 1 1 1 " ! November 2009 Introduction and Summary Pape 1 -9 -129- ENVIRONMENTAL IMPACT REPORT S o u t h T a h o e P u b l i c U t i l i t y D i s t r i c t R e c y c l e d W a t e r F a c i l i t i e s Master P l a n details on the analysis lr a yprovided in the EIR. Accordingly_ the information presented in these errata merely "clarifies" or "amplifies" the analysis provided in the Draft EIR_. and recirculation is not required. Additionally, the errata includes the i mposition of further mitigation measures. These mitigation measures were proceed by commenters, �nd pursuant to CEOA, the District imposed those measures to mitigate for pgtentially _S`lgnificant impacts wherever feasible or iu=sed the measures to further reduce already insi gnificant impacts These mitigation measures however, are not required to reduce si fgm icant impacts to a less than significant level, nor are thgy imposed due to discovery of new significant impacts. Moreover, and because these mitigation measures address ways to implement the proposed Project but do not propose the construction of new facilities, none of these new mitigation measures will result in env tential y significant impacts of their own. Accordingly, neither the errata, nor the clarifications to the Draft EIR, nor the supplemental analysis provided in Chapters 1, 7, 11_13, 15 and pendices I -a, I -b, I-c M, N. O. P. O. and R nor the addition of further mitigation measures results in any changes to the EIR "that deprived] the public of meaningful opportunity to comment upon a substantial adverse environmental effect of the [E]rQject or a feasible way to mitigate or avoid such an effect (including a feasible MrQjecl alternative) that the Project's proponents have declined to implement." (State CEQA Guidelines, § 15088.5.(a).) Thus. there is substantial evidence aMorting _the District's determination that neither the errata nor the new mitigation measures require recirculation of the EIR under CEOA. (Stat CE QA Guidelines. § 1 05 88.5.) 1.6 Uses of the EIR The District, as lead agency, must consider the information in this EIR to make its decision on the Project. The District may approve, approve with conditions, or deny the Project. The EIRs conclusions do not control the District's decision. The lead agency may approve a project despite significant adverse impacts if it issues two sets of findings. The first set of findings must state how the lead agency has responded to the significant effects identified in the EIR. The second set of findings must include a "statement of overriding considerations" which states the specific reasons the agency has approved the project despite significant environmental effects. After the District has certified the EIR and issued the appropriate findings, the District may make a decision on the Project. The District will use the EIR for approval of projects and operations pursuant to the Master Plan. Other agencies have discretionary authority to approve part or all of the Project and will rely on the District to produce an EIR adequate for their needs. These agencies must use the EIR as the basis for their permit approvals. The District must confer with other interested public agencies that do not have approval authority over the Project, but which have expertise with regard to the Project or have responsibility for resources affected by the Project. The following agencies may be Responsible Agencies under CEQA and may need to issue approvals for the Project: • South Tahoe Public Utility District - The District Board must approve the Recycled Water Master Plan and must approve the four Master Plan projects (Master Plan Projects 1, 2, 11 and 12) for implementation. The District will use the EIR in the review of future approvals of projects identified in the Master Plan. • U.S. Army Corps of Engineers - Fill in wetlands or waters of the U.S. requires a Section 404 permit under the Clean Water Act. • U.S. Fish and Wildlife Service - Impacts to Threatened or Endangered species will require Section 7 consultation with U.S. Fish and Wildlife Service. November 2009 Introduction and Summary Pape 1- 10 -130- ENVIRONMENTAL IMPACT REPORT S o u t h T a h o e P u b l i c U t i l i t y D i s t r i c t R e c y c l e d Water Facilities Master P l a n • Lahontan Regional Water Quality Control Board ( Lahontan) - Lahontan will issue new Water Quality Certifications for the projects (Section 401) and update the Waste Discharge Requirements (NO.R6T 2004 -0010) including monitoring and reporting requirements. All construction projects that disturb greater than one acre of land must apply for a National Pollutant Discharge Elimination System (NPDES) Permit Order No. 99- 08 -DWQ, which requires the preparation of a Storm Water Pollution Prevention Plan (SWPPP). 1.7 Areas of Controversy and Issues to be Resolved The CEQA Guidelines (Section 15123(b)(2)) require the EIR to identify areas of controversy or expressed concern known to the Lead Agency, including issues raised by agencies and the public. Issues of concern raised by regional and local agencies and the public in written comments received on the January 8, 2009 NOP and through comments made at the scoping meetings include: • Direct and indirect impacts to waters of the state as defined by the California Water Code (CWC) section 13050(e) and delineated on the Diamond Valley Ranch; • Impacts to wetlands as defined in the Water Quality Control Plan Report for the North Lahontan Basin (Basin Plan) standards and requirements (pp 4.9 -8 through 4.9 -14); • Determination of the presence or absence of state waters in the portion of the project area referred to as the Jungle absent of ongoing influence of human water manipulations; • Impacts to channel morphology and riparian habitat caused by diversion of storm water away from storage in HPR and into Indian Creek; • Impacts from erosion and soil loss; and • Impacts to surface water and groundwater interactions from misapplication or over use of recycled water, including water quality, recharge, flooding and beneficial uses. 1.8 Summary of CEQA Required Sections 1.8.1 Growth - inducing Impacts The Project (Alternative 2) and action alternatives (Alternatives 3 and 4) will not result in the removal of obstacles to growth. The Recycled Water Facilities Master Plan is the District's implementation program for expanding the reuse and/or application of recycled water to 5.8 million gallons per day (mgd). The Project does not require expansion of the District's treatment plant, which has a capacity of 7.7 mgd. The impacts of the plant's capacity and the District's plan for accepting new sewer connections have been evaluated in prior environmental documents. The Environmental Impact Report/Environmental Impact Statement (EIR/EIS) for the District Future Sewer Connections Plan concludes that growth- inducing impacts of that project were less than significant. The District Recycled Water Facilities Master Plan will not allow additional growth beyond that projected in the EHVEIS for the District Future Sewer Connections Plan. Future development ultimately will be determined through the Tahoe Regional Planning Agency (TRPA) planning process. 1.8.2 Significant and Unavoidable Adverse Impacts Section 2100(b)(2)(A) of CEQA requires that an EIR identify any significant environmental effects that cannot be avoided if the project were implemented. Significant unavoidable impacts are summarized in Chapter I and discussed in detail in Chapters 4 through 18 and summarized in Chapter 19. Significant unavoidable impacts are those impacts that remain significant after implementation of proposed November 2009 Introduction and Summary Page 1- 11 -131- ENVIRONMENTAL IMPACT REPORT S o u t h T a h o e P u b l i c U t i I i t y D i s t r i c t R e c y c l e d W a t e r F a c i l i t i e s M a s t e r P l a n mitigation measures. Although the Project Components have the potential to result in a number of significant environmental impacts, most of these can be avoided through the adoption of appropriate mitigation measures that reduce those effects to a less than significant level. Summary of Significant Impacts and Mitigation Measures Impact Leve of Sl ilinificance Mitigation Measure EO 2. Will the Project Components be subject to 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, No additional mitigation is ound rupture due to location near a surface trace ol 13, 14, 15, 16, 17, 20, 21, 22, 29, possible. in active fault? 30,31,320 W -1. Will the Project Components degrade 1, 2, 3, 4, 5, 6, 44-14, 21, 22, 30 W-33. Surface and oundwater quality in the Carson, Wade and • ndwater Protection Plan iamond Valleys? IA. Dewmitie a egkfie for. le Diaffieft Hey Reneh Remove Cattle mziag from Portions of the gated with Recy-cle W -1B. DeteFmine A GIN-Mum 1313 ion feF W-3. Will the Project Components cause numeric 30 • W-3. Develop Project - nd narrative -based criteria to be exceeded at West pacific Nutrient ork Carson River in California? anagement Plan for the ungle I0-1. Will the Project Components cause loss of 1, 2, 3, 4, 5, 6, 7, 9, 10, 12, 13, I0-1. Conduct Biological ndividuals or occupied habitat of endangered, 14, 15, 16, 17, 19, 21, 22, 23, 24, esource Assessments atened, or rare fish, wildlife or plant species 29,30,31,32D • irectly or indirectly? P -25. Sensitive Resource rogram IO -2. Will the Project Components cause loss of 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, P -26. Sensitive Plant ndividuals of CNPS List 2, 3, or 4 plant species? 13, 14, 15, 16, 17, 19, 21, 22, 23, rotection Program 4, 29, 30, 31, 32 Q • IO -3. Will the Project Components cause loss of 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, P -30. Pre - construction ctive raptor nests, migratory bird nests or wildlife 13, 14, 15, 16, 17, 19, 21, 22, 23, urveys for Migratory Birds. ursery sites? 24,29,30,31,32(P • esting Raptors and Wildlife urseries November 2009 Introduction and Summary Papa 1- 12 -132- ENVIRONMENTAL IMPACT REPORT South T a h o e P u b l i c U t i l i t y D i s t r i c t R e c y c l e d W a t e r F a c i l i t i e s Master P l a n mripmal Summary of Significant Impacts and Mitigation Measures Impact Level of Significance Mitigation Measure I0-7. Will the Project Components have an effect 1, 2, 3, 4, 5, 6, 7, 9, 10, 11 (HPR P -23. Delineate Wetlands, n federally protected wetlands as defined by Bypass Pipeline, A, B, C), 12, Waters of the United States, ection 404 of the Clean Water Act or waters of the 13, 14, 15, 16, 17, 19, 20, 21, 22, and Riparian Habitat .S. through direct removal, filling, hydrological 23,24,29,30,31,320 nterruption, or other means? P -24. Prepare Wetland And iparian Mitigation And onitoring Plan P -27. Avoid Impacts to Wetland and Riparian Areas P -32. Pre - construction Marking and Fencing of Wetlands and Riparian Habitat I0-7. Monitor Wetland nd Riparian Mitigation tes RCH -1. Will the Project Components disturb 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, RCH -1. Identification, ilaltuml own, potentially- eligible National or California 13, 14, 15, 16, 17, 18, 19, 20, 21, valuation, and Avoidance of egister properties, including archaeological, 2 O Resources istorical, architectural, and Native American/ ditional heritage resources? 29,30,31,32 • RCH -2. Will the Project Components disturb 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, RCH -1. Identification, own archaeological resources? 13, 14, 15, 16, 17, 18, 19, 20, 21, valuation, and Avoidance of 2 O ultural Resources RCH -2. Protect 9, 30, 31, 32 • ndiscovered Cultural esource Sites Source: Hauge Brueck Assoc. 2009 Notes: Level of Significance 1.8.3 Environmentally Superior Alternative Alternative 3 Master Plan Recommended Projects is the Environmentally Superior Alternative. Typically Alternative 1, No Project, would be considered environmentally superior because no action is required. The analysis in Chapters 4 through 18 demonstrate Alternative 1 has four significant and unavoidable impacts. The Master Plan has been prepared to mitigate the impacts of the No Project alternative. Alternative 3 meets the purpose, need, and objectives of the District and has a reduced footprint of activities by implementing nine components in comparison to Alternative 2 which implements 28 components and Alternative 4 which implements 18 components. November 2009 Introduction and Summary Page 1- 13 -133- of applicable o impact ignificant impact before and after mitigation ignificant impact; less than significant after mitigation s than significant impact; no mitigation proposed 1.8.3 Environmentally Superior Alternative Alternative 3 Master Plan Recommended Projects is the Environmentally Superior Alternative. Typically Alternative 1, No Project, would be considered environmentally superior because no action is required. The analysis in Chapters 4 through 18 demonstrate Alternative 1 has four significant and unavoidable impacts. The Master Plan has been prepared to mitigate the impacts of the No Project alternative. Alternative 3 meets the purpose, need, and objectives of the District and has a reduced footprint of activities by implementing nine components in comparison to Alternative 2 which implements 28 components and Alternative 4 which implements 18 components. November 2009 Introduction and Summary Page 1- 13 -133- ENVIRONMENTAL IMPACT REPORT South Tahoe Public Utility Distract Recycled Water Facil; ties Master Plan 1.9 Impact and Mitigation Summary Mitigation Required for Projects and Components Component Project Number(s) Mitigation Required Number N and Name (s) 1 8 - West Forts 10 -1. Conduct Biological Resource Assessments Pipeline I0-5A. Map Sensitive Native Plant Communities and Prepare Habita - On -Farm Pipeline estoration Plan 10 -5B. Monitor Habitat Restoration and Revegetation Sites I0-7. Monitor Wetland and Riparian Mitigation Sites RCH -1. Identification, Evaluation and Avoidance of Cultural Resources RCH -2. Protect Undiscovered Cultural Resource Sites 13 - make Recycled IO -1. Conduct Biological Resource Assessments Water Available to 1 104A. Fish Passage Structures and Deer Migration Corridors Irrigators in Nevada ICIAB. Schedule Construction to Avoid Breeding and Migrating Wildlife 110-7. Monitor Wetland and Riparian Mitigation Sites RCH -1. Identification, Evaluation and Avoidance of Cultural Resources A RCH-2. Protect Undiscovered Cultural Resource Sites - Diamond Ditch I0-1. Conduct Biological Resource Assessments onveyance 13104A. Fish Passage Structures and Deer Migration Corridors mprovements 13104B. Schedule Construction to Avoid Breeding and Migrating Wildlife - Waterfall Pipeline 10 -5A. Map Sensitive Native Plant Communities and Prepare Habita orebay and Pipeline Restoration Plan I0-5B. Monitor Habitat Restoration and Revegetation Sites I0-7. Monitor Wetland and Riparian Mitigation Sites ARCH- 1. Identification, Evaluation and Avoidance of Cultural Resources CH -2. Protect Undiscovered Cultural Resource Sites - Waterfall Pipeline I0-1. Conduct Biological Resource Assessments orebay and Pipeline IO-4A. Fish Passage Structures and Deer Migration Corridors - West Fork I0-4B. Schedule Construction to Avoid Breeding and Migrating Wildlife ipeline 10 -SA. Map Sensitive Native Plant Communities and Prepare Habita sto ration Plan J O -5B. Monitor Habitat Restoration and Revegetation Sites 0 -7. Monitor Wetland and Riparian Mitigation Sites RCH -1. Identification, Evaluation and Avoidance of Cultural Resources RCH -2. Protect Undiscovered Cultural Resource Sites 10 - Wade Valley I0-1. Conduct Biological Resource Assessments Pipeline BIOAA. Fish Passage Structures and Deer Migration Corridors IOAB. Schedule Construction to Avoid Breeding and Migrating Wildlife I0-5A. Map Sensitive Native Plant Communities and Prepare Habita Restoration Plan I0-5B. Monitor Habitat Restoration and Revegetation Sites I0-7. Monitor Wetland and Riparian Mitigation Sites ARCH-1. Identification, Evaluation and Avoidance of Cultural Resources A RCH-2. Protect Undiscovered Cultural Resource Sites - Waterfall Pipeline 10 -1. Conduct Biological Resource Assessments orebay and Pipeline IOAA. Fish Passage Structures and Deer Migration Corridors - On -Farm Pipeline ICIAB. Schedule Construction to Avoid Breeding and Migrating Wildlife I0-5A. Map Sensitive Native Plant Communities and Prepare Habita estoration Plan IRCH-2. I0-5B. Monitor Habitat Restoration and Revegetation Sites fO -7. Monitor Wetland and Riparian Mitigation Sites RCH -1. Identification, Evaluation and Avoidance of Cultural Resources Protect Undiscovered Cultural Resource Sites November 2009 Introduction and Summary Pape 1 -14 -134- ENVIRONMENTAL IMPACT REPORT South Tahoe Public Utility District Recycled Water Facilities Master Plan Mitigation Required for Projects and Components Component Project Number(s) Number Mitigation Required and Name (s) - District Pasture 1310- 1. Conduct Biological Resource Assessments Subsurface Irrigation 10 -7. Monitor Wetland and Riparian Mitigation Sites ilot Project RCH-1. Identification, Evaluation and Avoidance of Cultural Resources - West Fork RCH-2. Protect Undiscovered Cultural Resource Sites ipeline - On -Farm Pipeline 6 - Injection Well 10 -1. Conduct Biological Resource Assessments rogram Monitor Wetland and Riparian Mitigation Sites -1. Identification, Evaluation and Avoidance of Cultural Resources 2. P -rotect Undiscovered Cultural Resource Sites L4ARCH. Raflel} Remove Cattle Grazine from Portions of the Diamond Val rigated with Recycled Water 310- 1. Conduct Biological Resource Assessments I0-5A. Map Sensitive Native Plant Communities and Prepare Habita estoration Plan I0-513. Monitor Habitat Restoration and Revegetation Sites 10 -7. Monitor Wetland and Riparian Mitigation Sites RCH -1. Identification, Evaluation and Avoidance of Cultural Resources RCH -2. Protect U ndiscovered Cultural Resourc Sites 10 1 - Recycled Water W IA. Gfazing Regime &F the Disainet; rrigation Fields on e13 Remove Cattle Grazing from Portions of the Diamond Val ey Le iamond Valley nch 10 -1. Conduct Biological Resource Assessments I0-7. Monitor Wetland and Riparian Mitigation Sites RCH -1. Identification, Evaluation and Avoidance of Cultural Resources RCH -2. Protect Undiscovered Cultural Resource Sites 11 I - Recycled Water W lA. rrigation Fields on Vall iamond Valley ch W 1B. - Harvey Place xceed a Maximum Duration of Tempoma Containment (100 DAys) eservoir Bypass 10 -1. Conduct Biological Resource Assessments ystem Pipelines and 3104A. Fish Passage Structures and Deer Migration Corridors itches 3104B. Schedule Construction to Avoid Breeding and Migrating Wildlife - Diamond Valley 10 -5A. Map Sensitive Native Plant Communities and Prepare Habita anch Irrigation Restoration Plan ields Pump Back 10 -5131. Monitor Habitat Restoration and Revegetation Sites ystem 10 -7. Monitor Wetland and Riparian Mitigation Sites ARCH- 1. Identification, Evaluation and Avoidance of Cultural Resources A RCH-2. Protect Undiscovered Cultural Resource Sites 12 1 - Recycled Water 10 -1. Conduct Biological Resource Assessments rrigation Fields on 10 -7. Monitor Wetland and Riparian Mitigation Sites iamond Valley RCH -1. Identification, Evaluation and Avoidance of Cultural Resources ch RCH -2. Protect Undiscovered Cultural Resource Sites 13 1 - Recycled Water W 1 A. rrigation Fields on falley - Ra;aeh Remove Cattle Grazing from Portions Diamon iamond Valley Ranch Irrigaied with Recycled Wate nch 1310- 1. Conduct Biological Resource Assessments I0-7. Monitor Wetland and Riparian Mitigation Sites ARCH- 1. Identification, Evaluation and Avoidance of Cultural Resources RCH -2. Protect Undiscovered Cultural Resource Sites November 2009 Introduction and Summary Pape 1 -15 -135- ENVIRONMENTAL IMPACT REPORT S o u t h T a h o e P u b l i c U t i l i t y D i s t r i c t R e c y c l e d W a t e r F a c i l i t i e s Master P l a n Mitigation Required for Projects and Components Component Project Number(s) Mitigation Required N Number and Name (s) 14 7 - District Pasture W 1 A. S ubsurface Irrigation Valley - Ranelr Remove Cattle Grazing from Portions of the Diamond Valley ilot Project - West Fork BIO-1. Conduct Biological Resource Assessments ipeline B104A. Fish Passage Structures and Deer Migration Corridors - On -Farm Pipeline B104B. Schedule Construction to Avoid Breeding and Migrating Wildlife 10 - Wade Valley BIO-5A. Map Sensitive Native Plant Communities and Prepare Habita ipeline estoration Plan I0-5B. Monitor Habitat Restoration and Revegetation Sites 10 -7. Monitor Wetland and Riparian Mitigation Sites RCH -1. Identification, Evaluation and Avoidance of Cultural Resources RCH -2. Protect Undiscovered Cultural Resource Sites 15 W -lA. Vall Rene Re ove 6aliie GraziW from Portions of the Diamond Valle IO -1. Conduct Biological Resource Assessments IO -7. Monitor Wetland and Riparian Mitigation Sites A RCH-1. Identification, Evaluation and Avoidance of Cultural Resources A RCH-2. Protect Undiscovered Cultural Resource Sites 16 7 - District Pasture IO -7. Monitor Wetland and Riparian Mitigation Sites S ubsurface Irrigation W IA. P ilot Project Valley Rwe Remove Cattle Graziug from Portions of the Diamond Valley Irrigated Recycled Water ch with 1. Conduct Biological Resource Assessments 5A. Map Sensitive Native Plant Communities and Prepare Habita oration Plan 5B. Monitor Habitat Restoration and Revegetation Sites 7. Monitor Wetland and Riparian Mitigation Sites H -1. Identification, Evaluation and Avoidance of Cultural Resources H -2. Protect Undiscovered Cultural Resource Sites 17 14 - Snowshoe 1. Conduct Biological Resource Assessments [esto Th ompson No. 1 4A. Fish Passage Structures and Deer Migration Corridors C onveyance Capacity 48. Schedule Construction to Avoid Breeding and Migrating Wildlife I mprovements 5A. Map Sensitive Native Plant Communities and Prepare Habita ration Plan 5B. Monitor Habitat Restor ation and Revegetation Sites 7. Monitor Wetland and Riparian Mitigation Sites H -1. Identification, Evaluation and Avoidance of Cultural Resources H -2. Protect Undiscovered Cultural Resource Sites 18 11 - Prepare Nutrient ARCH- 1. Identification, Evaluation and Avoidance of Cultural Resources M analzement Plan ARCH-2. Protect Undiscovered Cultural Resource Sites 19 12- Permitting for W 1 A. R ecycled Water Use Valley - Raeelt Remove Cattle Grazing from Portions of the Dia;��nd'�a in Diamond Valley IR,,nch Irrigated with ycled Water -1. Conduct Biological Resource Assessments -7. Monitor Wetland and Riparian Mitigation Sites CH -1. Identification, Evaluation and Avoidance of Cultural Resources CH -2. Protect Undiscovered Cultural Resource Sites [RCH-2. 0 13 -Make Recycled -7. Monitor Wetland and Riparian Mitigation Sites ater Available to CH -1. Identification, Evaluation and Avoidance of Cultural Resources rri ators in Nevada Protect Undiscovered Cultural Resource Sites November 2009 Introduction and Summery Pepe 1 •t 8 -136- ENVIRONMENTAL IMPACT REPORT S o u t h T a h o e P u b l i c U t l l : t y D i s t r i c t R e c y c l e d Water Facilities Master P l a n November 2009 Introduction and Summary Pape 1- 17 -137- Mitigation Required for Projects and Components Component Project Number(s) Number and Name (s) Mitigation Required 1 B10- 1. Conduct Biological Resource Assessments I0-7. Monitor Wetland and Riparian Mitigation Sites RCH -1. Identification, Evaluation and Avoidance of Cultural Resources RCH -2. Protect Und iscovered Cultural Resource Sites 2 - Waterfall Pipeline I0-1. Conduct Biological Resource Assessments 4A. Fish Passage Structures and Deer Migration Corridors 10 -Wade Valley 104B. Schedule Construction to Avoid Breeding and Migrating Wildlife ipeline IO -5A. Map Sensitive Native Plant Communities and Prepare Habita 1RCH estoration Plan 10 -5B. Monitor Habitat Restoration and Revegetation Sites 0 -7. Monitor Wetland and Riparian Mitigation Sites RCH -1. Identification, Evaluation and Avoidance of Cultural Resources -2. Protect Undiscovered Cultural Resource Sites 3 14 - Snowshoe I0-1. Conduct Biological Resource Assessments hompson No. 1 10 -7. Monitor Wetland and Riparian Mitigation Sites onveyance Capacity Improvements 15 - Upper Dressler Ditch Conveyance improvements 16 - Indian Creek Treatment Wetlands 19 - use Mud Lake Winter Flows for Indian Creek eservoir Flushin 4 14 - Snowshoe 10- 1. Conduct Biological Resource Assessments ompson No. 1 I0-7. Monitor Wetland and Riparian Mitigation Sites onveyance Capacity m provements 1 5 - Upper Dressler itch Conveyance mprovements 16 - Indian Creek I eatment Wetlands 0 - Storage of Water or Downstream sers 5 1- Develop Future Project Component - not analyzed in this EIR ecycled Water olesale Pro 6 2 - Biosolids Future Project Component - not analyzed in this EIR ompostin 7 3 - Become a Water Future Project Component - not analyzed in this EIR . ghts Buyer/Broker o Maintain the Value f Rec cled Water 8 P4 - Power Future Project Component - not analyzed in this EIR eneration November 2009 Introduction and Summary Pape 1- 17 -137- ENVIRONMENTAL IMPACT REPORT South Tahoe Public Utility District Recycled Water Facilities Master P l a n Mitigation Required for Projects and Components Component Project Number(s) Number and Name (s) Mitigation Required 9 - Diamond Valley W IA. Freshwater/Recycled Valley Rme Remove Cattle Gmzing from Portions of the Diamond Valley Water Irrigation ch Irrigated with Recycled Water System 10- 1. Conduct Biological Resource Assessments I0-7. Monitor Wetland and Riparian Mitigation Sites RCH -1. Identification, Evaluation and Avoidance of Cultural Resources RCH -2. Protect Undiscovered Cultural Resource Sites 0 4 — Diamond Valley 10 -1. Conduct Biological Resource Assessments Freshwater/Recycled I0-7. Monitor Wetland and Riparian Mitigation Sites Water Irrigation RCH -1. Identification, Evaluation and Avoidance of Cultural Resources Sy stem RCH -2. Protect Undiscovered Cultural Resource Sites 1 17 — Diversion Ditch W4. Develop Erosion Control Methods for ICR or Stormwater Flow W 5. Implement Component 15 Prior to Component 32 Away from Harvey 10- 1. Conduct Biological Resource Assessment Place Reservoir and I0-7. Monitor Wetland and Riparian Mitigation Sites to Indian Creek RCH -1. Identification, Evaluation and Avoidance of Cultural Resources R eservoir RCH -2. Protect Undiscovered Cultural Resource Sites 2 18 — Indian Creek W -5. Implement Component 15 Prior to Component 32 Reservoir Spillway IO -1. Conduct Biological Resource Assessments Channel I0-7. Monitor Wetland and Riparian Mitigation Sites ARCH-1. Identification, Evaluation and Avoidance of Cultural Resources A RCH-2. Protect Undiscovered Cultural Resource Sites 3 5 — Extend the C- Future Project Component - not analyzed in this EIR ine to the State Line 4 6 — Injection Well i ro Future Project Component - not analyzed in this EIR November 2009 Introduction and Summary Pape 1- is -138- Ocnrrol Managcr Kitha'd H 501bria Dwectom 15outh Tahoe, Ernie Claudia James K. Jones PuHic Utility Diotrict Mary M" 1275 Meadow Crust DrIm + South Lake Tahoe • CA 96150 Phone 530 544 -6474 • Fox 530 541 -0614 BOARD AGENDA ITEM 7f TO: Board of Directors FROM: Accounts Payable MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: Payment of Claims REQUESTED BOARD ACTION: Approve payment. DISCUSSION: The Payment of Claims was not available when this agenda was published. It will be distributed prior to, and at the Board meeting. SCHEDULE: COSTS: ACCOUNT NO: BUDGETED AMOUNT REMAINING: ATTACHMENTS: To be distributed prior to, and at the Board meeting. CONCURRENCE WITH REQUESTED ACTION: CATEGORY: General GENERAL MANAGER: YES 1 kW NO CHIEF FINANCIAL OFFICER: YES O —139— PAYMENT OF CLAIMS FOR APPROVAL December 3, 2009 Payroll 12/2/09 Total Payroll BNY Western Trust Company CDS- health care payments ADP Brownstein /Hyatt/Farber /Schreck legal services Bank of America Union Bank Total Vendor EFT Accounts Payable Checks -Sewer Fund Accounts Payable Checks -Water Fund Accounts Payable Checks -Self- funded Insurance Accounts Payable Checks - Grants Fund Total Accounts Payable Grand Total Payroll EFTs & Checks EFT AFLAC Medical & Dependent Care EFT CA Employment Taxes & W/H EFT Federal Employment Taxes & W/H EFT CalPERS Contributions EFT Great West Deferred Comp CHK Stationary Engineers Union Dues EFT United Way Contributions EFT Employee Direct Deposits CHK Employee Garnishments CHK Employee Paychecks Total 12/2/09 192.31 24,072.28 122,356.79 71,778.69 17,588.32 2,419.37 156.00 282,706.02 1,636.95 6,970.46 529,877.19 529, 877.19 529,877.19 270,418.75 114,106.39 0.00 22, 583.74 156, 572.80 0.00 279,824.38 225,385.01 24,889.21 2,520.00 532,618.60 1,626..177.47 Vendor Name 3T EQUIPMENT CO User: THERESA Department / Proi Name UNDERGROUND REP PAYMENT OF CLAIMS Description Acct# / Proi Code SMART COVERS 1001 - 8001 Check Total: Amount Check Num Tvce 8,258.18 8,258.18 AP - 00074355 MW A - CHEMICAL INC GEN & ADMIN SHOP SUPPLY INV 1000 - 0421 8.16 A -1 CHEMICAL INC GEN & ADMIN JANIT /SUPPLY INV 1000 - 0422 1,566.33 Check Total: 1,574.49 AP 00074356 MW ACWA BOARD OF DIR DUES /MEMB /CERT 2019 - 6250 17,850.00 Check Total: 17,850.00 AP - 00074358 MW ACWA HEALTH BENEFITS AUTHORITY GEN & ADMIN VISION INS 1000 - 2530 2,565.32 Check Total: 2,565.32 AP - 00074357 MW AFLAC GEN & ADMIN SUPP INS W/H 1000 - 2532 850.40 AFLAC GEN & ADMIN AFLAC FEE DED 1000 - 2538 115.00 Check Total: 965.40 AP 00074359 MW AHERN RENTALS ENGINEERING - IROQUOIS BSTR ST BSTR STN IROQ 2029 - 8967 - IQBSTR 27.68 Check Total: 27.68 AP - 00074360 MW ALLGOR, JAY UNDERGROUND REP DUES /MEMB /CERT 1001 - 6250 62.11 Check Total: 62.11 AP 00074361 MW ALPEN SIERRA COFFEE GEN & ADMIN OFC SUPPLY ISSUE 1000 - 6081 129.88 Check Total: 129.88 AP - 00074362 MW ALPINE COUNTY DIAMOND VLY RNCH LAND TAXES 1028 - 6651 30,373.61 Check Total: 30,373.61 AP - 00074363 MW ALPINE EYECARE LLC HEAVY MAINT SAFETY /EQUIP /PHY 1004 - 6075 284.00 ALPINE EYECARE LLC INFORMATION SYS SAFETY /EQUIP /PHY 1037 - 6075 117.00 ALPINE EYECARE LLC INFORMATION SYS SAFETY /EQUIP /PHY 2037 - 6075 117.00 Check Total: 518.00 AP - 00074364 MW ALPINE UPHOLSTERY EQUIPMENT REP AUTOMOTIVE 1005 - 6011 800.00 Check Total: 800.00 AP 00074365 MW AMERIPRIDE UNIFORM SERVICES GEN & ADMIN UNIFORM PAYABLE 1000 - 2518 961.23 Check Total: 961.23 AP 00074366 MW ASPEN PUBLISHERS INC. FINANCE SUBSCRIPTIONS 1039 - 4830 175.50 ASPEN PUBLISHERS INC. FINANCE SUBSCRIPTIONS 2039 - 4830 175.50 Page: 1 Current Date: 12/02/2009 Report: OH_PMT_CLAIMS_BK Current Time: 09:48:15 Check Total: 351.00 AP - 00074367 MW Vendor Name AT &T /CALNET 2 AT &T /CALNET 2 AT &T /CALNET 2 AT &T /CALNET 2 AT &T /CALNET 2 AT &T /CALNET 2 AT &T /CALNET 2 ATLAS COPCO COMPRESSORS INC BANK OF NEW YORK MELLON, THE BAY TOOL & SUPPLY INC Department / Proi Name GEN & ADMIN PUMPS OPERATIONS CUSTOMER SERVICE GEN & ADMIN PUMPS CUSTOMER SERVICE PUMPS FINANCE GEN & ADMIN BB &H BENEFIT DESIGNS BB &H BENEFIT DESIGNS BENTLY AGROWDYNAMICS OPERATIONS HUMAN RESOURCES HUMAN RESOURCES BING MATERIALS UNDERGROUND REP BLUE RIBBON TEMP PERSONNEL CUSTOMER SERVICE BLUE RIBBON TEMP PERSONNEL CUSTOMER SERVICE BROWN & CALDWELL CONSULTANTS BROWN & CALDWELL CONSULTANTS BSK ANALYTICAL LABS C2ME ENGINEERING User: THERESA Report: OH_PMT_CLA IMS_BK ENGINEERING - ANGORA TNK REPL ENGINEERING - ECHO TANK REPL LABORATORY PAYMENT OF CLAIMS Page: 2 Description TELEPHONE TELEPHONE TELEPHONE TELEPHONE TELEPHONE TELEPHONE TELEPHONE PUMP STATIONS FISCAL AGENT FEE SMALL TOOLS INV CONTRACT SERVICE CONTRACT SERVICE SLUDGE DISPOSAL PIPE /CVRS /MHLS CONTRACT SERVICE CONTRACT SERVICE TANK, ANGORA TANK, ECHO MONITORING CUSTOMER SERVICE - WT MTR MXU INST MTR RTFT MXU'S Acct# / Proi Code 1000 - 6310 1002 - 6310 1006 - 6310 1038 - 6310 2000 - 6310 2002 - 6310 2038 - 6310 1002 - 6051 2039 - 6730 1000 - 0423 1022 - 4405 2022 - 4405 1006 - 6652 2001-6052 1038 - 4405 2038 - 4405 2007 - 6110 Check Total: Check Total: Check Total: Check Total: Check Total: Check Total: Check Total: Check Total: 2029 - 7064 - ANGOTK 2029 - 8809 - ECHOTK Check Total: Check Total: 2038 - 8074 - MTRMXU Check Total: Current Date: 12/02/2009 Current Time: 09:48:15 Amount 23.38 81.97 30.34 7.15 23.38 35.87 7.14 209.23 AP -00074368 MW 409.24 409.24 AP -00074369 MW 2,210.10 2,210.10 AP -00074370 MW 243.77 243.77 AP -00074371 MW 624.50 624.50 1,249.00 AP- 00074372 MW 889.00 889.00 AP -00074373 MW 9,976.29 9,976.29 AP -00074374 MW 3,402.00 3,402.00 6,804.00 AP -00074375 MW 2,387.97 5,664.56 8,052.53 AP -00074376 MW 4,250.00 4,250.00 AP- 00074377 MW 7,752.90 Check Num Tvoe 7,752.90 AP -00074378 MW Vendor Name CALIF BOARD OF EQUALIZATION CALIF BOARD OF EQUALIZATION CALIF WATER RESOURCES CTRL BD CALIF WATER RESOURCES CTRL BD CALIFORNIA SURVEY CALIFORNIA SURVEY CALIFORNIA SURVEY CALIFORNIA SURVEY CAPITOL WEBWORKS LLC CAPITOL WEBWORKS LLC CAROLLO ENGINEERS CAROLLO ENGINEERS CAROLLO ENGINEERS CASHMAN EQUIPMENT CDS GROUP HEALTH CDW - G CORP CDW - G CORP CDW - G CORP CDW - G CORP CDW - G CORP CDW - G CORP CITY OF SOUTH LAKE TAHOE User: THERESA Report: OH_PMT_CLAIMS_BK Department / Proi Name FINANCE FINANCE ENGINEERING ENGINEERING ENGINEERING ENGINEERING ENGINEERING ENGINEERING DIO DIO ENGINEERING - HEADWORKS ENGINEERING - TWIN PEAKS BS ENGINEERING - ARSENIC FACILITY EQUIPMENT REPAIR SELF FUNDED INS PUMPS INFORMATION SYS FINANCE PUMPS INFORMATION SYS FINANCE UNDERGROUND REP PAYMENT OF CLAIMS Page: 3 Description SUPPLIES SUPPLIES OPERATING PERMIT OPERATING PERMIT GPS ANTENNA GPS LASER RANGEF GPS UNIT GPS UNIT CONTRACT SERVICE CONTRACT SERVICE HDWKS IMP PROJ BSTR, TWN PEAKS ARSNC TRTMNT AUTOMOTIVE ADMIN FEE OFFICE SUPPLIES DIST.COMP SPPLIS OFFICE SUPPLIES OFFICE SUPPLIES DIST.COMP SPPLIS OFFICE SUPPLIES OPERATING PERMIT Acct# / Proi Code 1039 - 6520 2039 - 6520 2029 - 6650 2029 - 6650 2029 - 7584 2029 - 7585 2029 - 8936 2029 - 8965 1027 - 4405 2027 - 4405 Check Total: 1029 - 8033 - HDWORK 2029 - 7070 - TPBSTR 2029 - 8864 - ARSNIC Check Total: 2005 - 6011 3000 - 6741 1002 - 4820 1037 - 4840 1039 - 4820 2002 - 4820 2037 - 4840 2039 - 4820 2001 - 6650 Check Total: Check Total: Check Total: Check Total: Check Total: Check Total: Check Total: Current Date: 12/02/2009 Current Time: 09:48:15 Amount Check Num 9.00 9.00 18.00 AP -00074379 MW 851.66 851.66 AP- 00074353 MW 851.66 851.66 AP- 00074380 MW 2,661.11 2,142.38 6,698.35 3.81 11,505.65 AP- 00074381 MW 35.00 35.00 70.00 AP- 00074382 MW 56,049.25 27,164.00 2,565.05 85 778.30 AP -00074383 MW 934.50 934.50 AP -00074384 MW 2,292.00 TYRe 2,292.00 AP -00074385 MW 210.44 210.46 210.44 210.44 210.44 210.44 1,262.66 AP -00074386 MW 900.00 PAYMENT OF CLAIMS Vendor Name Department / Proi Name Description Acct# / Proi Code Amount Check Num LT& Check Total: 900.00 AP -00074387 MW CONSTRUCTION MATERIALS ENG INC ENGINEERING - ANGORA TNK REPL TANK, ANGORA 2029 - 7064 - ANGOTK 956.50 Check Total: 956.50 AP- 00074388 MW CWEA ENGINEERING DUES /MEMB /CERT 1029 - 6250 79.00 Check Total: 79.00 AP- 00074389 MW D'ORAZIO, FRED HUMAN RESOURCES CONTRACT SERVICE 1022 - 4405 373.53 D'ORAZIO, FRED HUMAN RESOURCES CONTRACT SERVICE 2022 - 4405 373.52 Check Total: 747.05 AP -00074390 MW DEHNEN, SUSAN ENGINEERING - WT METERING PRJ WTR METERING /NEW 2029 - 7078 - METERS 216.05 Check Total: 216.05 AP-00074391 MW DELL MARKETING L P INFORMATION SYS SRVR, ACTV FACT 1037 - 8042 5,684.90 Check Total: 5,684.90 AP- 00074392 MW DICK'S FULLER - HEAVY MAINT BIOSOL EQUP /BLDG 1004 - 6653 19.15 Check Total: - 19.15 AP- 00074393 MW EIDAM, EILEEN FINANCE TRAVEUMEETINGS 1039 - 6200 33.00 Check Total: 33.00 AP- 00074394 MW ENS RESOURCES INC DIO CONTRACT SERVICE 1027 - 4405 3,177.84 ENS RESOURCES INC DIO CONTRACT SERVICE 2027 - 4405 3,177.84 Check Total: 6,355.68 AP- 00074395 MW ENTRIX INC ENGINEERING - SUT WELL REDRILL SUT WELL REDRILL 2029 - 8463 - RWSUTR 889.20 Check Total: 889.20 AP- 00074396 MW FEDEX GEN & ADMIN POSTAGE EXPENSES 1000 - 4810 6.59 FEDEX GEN & ADMIN POSTAGE EXPENSES 2000 - 4810 6.59 Check Total: 13.18 AP -00074397 MW FERGUSON ENTERPRISES INC. PUMPS PUMP STATIONS 1002 - 6051 55.94 FERGUSON ENTERPRISES INC. PUMPS SMALL TOOLS 1002 - 6073 26.57 FERGUSON ENTERPRISES INC. ELECTRICAL SHOP BUILDINGS 1003 - 6041 13.12 FERGUSON ENTERPRISES INC. PUMPS WELLS 2002 - 6050 9.61 FERGUSON ENTERPRISES INC. PUMPS SMALL TOOLS 2002 - 6073 26.57 Check Total: 131.81 AP- 00074398 MW GBC SCIENTIFIC EQUIP INC LABORATORY SERVICE CONTRACT 1007 - 6030 1,698.63 User: THERESA Page: 4 Current Date: 12/02/2009 Report: OH_PMT_CLAIMS_BK Current Time: 09:48:15 Vendor Name GBC SCIENTIFIC EQUIP INC User: THERESA PAYMENT OF CLAIMS Department / Proi Name Description LABORATORY SERVICE CONTRACT Acct# / Proi Code Amount Check Num Type 2007 - 6030 1,698.62 Check Total: 3,397.25 AP- 00074399 MW GERBER LIFE INSURANCE COMPANY SELF FUNDED INS EXCESS INSURANCE 3000 - 6744 21,925.21 Check Total: 21,925.21 AP- 00074400 MW GFOA FINANCE ADVISORY 1039 - 4440 217.50 GFOA FINANCE ADVISORY 2039 - 4440 217.50 Check Total: 435.00 AP- 00074401 MW GFOA FINANCE DUES/MEMB /CERT 1039 - 6250 65.00 GFOA FINANCE DUES/MEMB /CERT 2039 - 6250 65.00 Check Total: 130.00 AP- 00074402 MW GFS CHEMICAL LABORATORY LAB SUPPLIES 1007 - 4760 186.56 GFS CHEMICAL LABORATORY LAB SUPPLIES 2007 - 4760 137.10 Check Total: 323.66 AP- 00074403 MW GRAINGER GEN & ADMIN SHOP SUPPLY INV 1000 - 0421 264.91 GRAINGER ELECTRICAL SHOP BUILDINGS 1003 - 6041 1,304.46 GRAINGER EQUIPMENT REP AUTOMOTIVE 1005 - 6011 277.71 GRAINGER OPERATIONS BUILDINGS 1006 - 6041 235.68 GRAINGER OPERATIONS GROUNDS & MNTC 1006 - 6042 229.53 GRAINGER HEAVY MAINTENANC BUILDINGS 2004 - 6041 520.71 GRAINGER EQUIPMENT REPAIR AUTOMOTIVE 2005 - 6011 277.73 Check Total: 3,110.73 AP- 00074404 MW GROVE MADSEN INDUSTRIES INC PUMPS PUMP STATIONS 1002 - 6051 748.18 GROVE MADSEN INDUSTRIES INC ELECTRICAL SHOP PUMP STATIONS 1003 - 6051 2,934.98 Check Total: 3,683.16 AP- 00074405 MW HARTFORD, THE GEN & ADMIN LIFE INS 1000 - 2512 2,021.55 HARTFORD, THE GEN & ADMIN LTD, UNION 1000 - 2539 2,562.10 Check Total: 4,583.65 AP- 00074406 MW HIGH SIERRA BUSINESS SYSTEMS HUMAN RESOURCES SERVICE CONTRACT 1022 - 6030 16.82 HIGH SIERRA BUSINESS SYSTEMS CUSTOMER SERVICE SERVICE CONTRACT 1038 - 6030 57.32 HIGH SIERRA BUSINESS SYSTEMS HUMAN RESOURCES SERVICE CONTRACT 2022 - 6030 16.82 HIGH SIERRA BUSINESS SYSTEMS CUSTOMER SERVICE SERVICE CONTRACT 2038 - 6030 57.32 Page: 5 Current Date: 12/02/2009 Report: OH_PMT_CLAIMS_BK Current Time: 09:48:15 PAYMENT OF CLAIMS Vendor Name Department / Proi Name Description Acct# / Proi Code Amount Check Num Type Check Total: 148.28 AP- 00074407 MW HOME DEPOT CREDIT DIAMOND VLY RNCH GROUNDS & MNTC 1028 - 6042 390.69 Check Total: 390.69 AP- 00074408 MW INSITE LAND SURVEYS ENGINEERING - ANGORA TNK REPL TANK, ANGORA 2029 - 7064 - ANGOTK 1,400.00 Check Total: 1,400.00 AP- 00074409 MW INTERSTATE SAFETY & SUPPLY GEN & ADMIN SHOP SUPPLY INV 1000 - 0421 888.42 Check Total: 888.42 AP -00074410 MW J &L PRO KLEEN INC FINANCE JANITORIAL SERV 1039 - 6074 3,207.00 J &L PRO KLEEN INC FINANCE JANITORIAL SERV 2039 - 6074 3,207.00 Check Total: 6,414.00 AP -00074411 MW JONES, ROBERT CUSTOMER SERVICE - WTR CONS PROG WTR CONS EXPENSE 2038 - 6660 - WCPROG 3,438.00 Check Total: 3,438.00 AP -00074412 MW KAMAN INDUSTRIAL TECHNOLOGIES PUMPS PUMP STATIONS 2002 - 6051 867.52 Check Total: 867.52 AP- 00074413 MW KEN'S TIRE CENTER EQUIPMENT REP AUTOMOTIVE 1005 - 6011 1,324.41 Check Total: 1,324.41 AP -00074414 MW KIWANIS CLUB OF LAKE TAHOE DIO - PR EXP- EXTERNAL PUB RELATIONS 1027 - 6620 - PREEXT 187.50 KIWANIS CLUB OF LAKE TAHOE DIO - PR EXP- EXTERNAL PUB RELATIONS 2027 - 6620 - PREEXT 187.50 Check Total: 375.00 AP -00074415 MW LAKE TAHOE EYE CARE OPERATIONS SAFETY /EQUIP /PHY 1006 - 6075 85.00 Check Total: 85.00 AP- 00074416 MW LAKE TAHOE GLASS HEAVY MAINT MOBILE EQUIP 1004 - 6012 295.75 LAKE TAHOE GLASS HEAVY MAINT BUILDINGS 1004 - 6041 104.40 Check Total: 400.15 AP -00074417 MW LANG ENGINEERING EQUIP CO PUMPS PUMP STATIONS 1002 - 6051 823.59 Check Total: 823.59 AP -00074418 MW LEGALINK, INC. HUMAN RESOURCES PERSONNEL LEGAL 1022 - 4445 195.25 LEGALINK, INC. HUMAN RESOURCES PERSONNEL LEGAL 2022 - 4445 195.25 Check Total: 390.50 AP- 00074419 MW LOOMIS FINANCE CONTRACT SERVICE 1039 - 4405 296.59 LOOMIS FINANCE CONTRACT SERVICE 2039 - 4405 296.59 User: THERESA Page: 6 Current Date: 12/02/2009 Report: OH_PMT_CLAIMS_BK Current Time: 09:48:15 PAYMENT OF CLAIMS Vendor Name Department / Proi Name Description Acct# / Proi Code Amount Check Num Type Check Total: 593.18 AP -00074420 MW LYNCH, KELLY GEN & ADMIN UB SUSPENSE 1000 - 2002 12,783.84 LYNCH, KELLY GEN & ADMIN UB SUSPENSE 2000 - 2002 2,923.32 LYNCH, KELLY GEN & ADMIN METER SALE 2000 - 3545 286.00 Check Total: 15,993.16 AP -00074421 MW MARTIN, CHARLES CUSTOMER SERVICE - WTR CONS PROG WTR CONS EXPENSE 2038 - 6660 - WCPROG 3,150.00 Check Total: 3,150.00 AP- 00074422 MW MC MASTER CARR SUPPLY CO PUMPS PUMP STATIONS 1002 - 6051 625.09 MC MASTER CARR SUPPLY CO PUMPS REP PMP#1 BIJOU 1002 - 8006 127.51 Check Total: 752.60 AP -00074423 MW MOTION INDUSTRIES INC PUMPS REP PMP#1 BIJOU 1002 - 8006 594.70 Check Total: 594.70 AP- 00074424 MW MWH LABORATORIES ENGINEERING - ARSENIC FACILITY ARSNC TRTMNT 2029 - 8864 - ARSNIC 300.00 Check Total: 300.00 AP -00074425 MW MY OFFICE PRODUCTS ENGINEERING OFFICE SUPPLIES 1029 - 4820 190.91 MY OFFICE PRODUCTS FINANCE OFFICE SUPPLIES 1039 - 4820 22.56 MY OFFICE PRODUCTS ENGINEERING OFFICE SUPPLIES 2029 - 4820 190.91 MY OFFICE PRODUCTS FINANCE OFFICE SUPPLIES 2039 - 4820 22.54 Check Total: 426.92 AP -00074426 MW NASSCO INC UNDERGROUND REP DUES /MEMB /CERT 1001 - 6250 250.00 Check Total: 250.00 AP -00074427 MW NEWARK IN ONE ELECTRICAL SHOP PUMP STATIONS 2003 - 6051 120.67 Check Total: 120.67 AP -00074428 MW NORTHWEST HYD. CONSULT INC ENGINEERING - CTC GRNT -BMPs BMP PROJECTS 1029 - 8737 - CTCBMP 1,070.42 NORTHWEST HYD. CONSULT INC ENGINEERING - CTC GRNT -BMPs BMP PROJECTS 2029 - 8745 - CTCBMP 1,070.42 Check Total: 2,140.84 AP -00074429 MW O I CORP LABORATORY LAB SUPPLIES 1007 - 4760 68.29 O I CORP LABORATORY LAB SUPPLIES 2007 - 4760 53.29 Check Total: 121.58 AP- 00074430 MW OFFICE MAX ADMINISTRATION OFFICE SUPPLIES 1021 - 4820 10.80 OFFICE MAX FINANCE OFFICE SUPPLIES 1039 - 4820 168.34 User: THERESA Page: 7 Current Date: 12/02/2009 Report: OH_PMT_CLAIMS_BK Current Time: 09:48:15 PAYMENT OF CLAIMS Vendor Name Department / Proi Name Description Acct# / Proi Code Amount Check Num Tyne OFFICE MAX ADMINISTRATION OFFICE SUPPLIES 2021 - 4820 10.78 OFFICE MAX FINANCE OFFICE SUPPLIES 2039 - 4820 168.36 Check Total: 358.28 AP -00074431 MW ONTRAC LABORATORY POSTAGE EXPENSES 1007 - 4810 8.00 ONTRAC LABORATORY - ARHD3 TRTMT EXP POSTAGE EXPENSES 2007 - 4810 - AH3EXP 3.75 ONTRAC LABORATORY - BKRFLD TRTMT EXP POSTAGE EXPENSES 2007 - 4810 - BKRFLD 3.75 Check Total: 15.50 AP -00074432 MW PRAXAIR 174 HEAVY MAINT SECONDARY EQUIP 1004 - 6022 23.91 PRAXAIR 174 HEAVY MAINT SHOP SUPPLIES 1004 - 6071 23.48 PRAXAIR 174 EQUIPMENT REP SHOP SUPPLIES 1005 - 6071 24.78 PRAXAIR 174 EQUIPMENT REPAIR SHOP SUPPLIES 2005 - 6071 24.77 Check Total: 96,94 AP -00074433 MW RADIO SHACK UNDERGROUND REP PIPE /CVRS/MHLS 1001 - 6052 - 102.32 RADIO SHACK ENGINEERING SUPPLIES 1029 - 6520 97.87 RADIO SHACK INFORMATION SYS DIST.COMP SPPLIS 1037 - 4840 10.32 RADIO SHACK ENGINEERING SUPPLIES 2029 - 6520 97.87 RADIO SHACK INFORMATION SYS DIST.COMP SPPLIS 2037 - 4840 10.31 Check Total: 114.05 AP -00074434 MW RAIN FOR RENT WOODLAND PUMPS WELLS 2002 - 6050 715.00 Check Total: 715.00 AP- 00074435 MW RED WING SHOE STORE DIAMOND VLY RNCH SAFETY/EQUIP /PHY 1028 - 6075 249.58 Check Total: 249.58 AP -00074436 MW REDWOOD PRINTING ENGINEERING - WT METERING PRJ WTR METERING /NEW 2029 - 7078 - METERS 1,497.44 Check Total: 1,497.44 AP -00074437 MW REED ELECTRIC & FIELD SERVICE PUMPS PUMP STATIONS 1002 - 6051 4,495.34 REED ELECTRIC & FIELD SERVICE PUMPS REP PMP#1 BIJOU 1002 - 8006 1,694.89 Check Total: 6,190.23 AP- 00074438 MW RENNER EQUIPMENT CO EQUIPMENT REP AUTOMOTIVE 1005 - 6011 1,065.44 Check Total: 1,065.44 AP -00074439 MW RENO GAZETTE- JOURNAL ENGINEERING - WT METERING PRJ WTR METERING /NEW 2029 - 7078 - METERS 115.33 Check Total: 115.33 AP -00074440 MW User: THERESA Page: 8 Current Date: 12/02/2009 Report: OH_PMT_CLAIMS_BK Current Time: 09:48:15 Vendor Name RESOURCE DEVELOPMENT INC RESOURCE DEVELOPMENT INC RESOURCE DEVELOPMENT INC RICH'S SMALL ENGINE SERVICE SAUNDERS, WALTER SCOTT FRIEDEL OFFICE MACHINES SCOTT FRIEDEL OFFICE MACHINES SCOTT FRIEDEL OFFICE MACHINES SCOTT FRIEDEL OFFICE MACHINES SHEPPARD MULLIN SHEPPARD MULLIN SIANO, CHRIS SIERRA CHEMICAL CO SIERRA CHEMICAL CO SIERRA CHEMICAL CO SIERRA NEVADA APPLIANCE REPAIR SIERRA NEVADA MEDIA GROUP SIERRA NEVADA MEDIA GROUP SIERRA PACIFIC POWER SIERRA PACIFIC POWER SIERRA PACIFIC POWER Department / Proi Name GEN & ADMIN - TWIN PEAKS BS GEN & ADMIN - TWIN PEAKS BS ENGINEERING - TWIN PEAKS BS DIAMOND VLY RNCH GEN & ADMIN - T &M UB CASH BRD ENGINEERING CUSTOMER SERVICE ENGINEERING CUSTOMER SERVICE HUMAN RESOURCES HUMAN RESOURCES OPERATIONS OPERATIONS OPERATIONS PUMPS HEAVY MAINTENANC DIO - PR EXP- EXTERNAL DIO - PR EXP- EXTERNAL GEN & ADMIN GEN & ADMIN GEN & ADMIN PAYMENT OF CLAIMS User: THERESA Page: 9 Report: OH_PMT_CLAIMS_BK Description Acct# / Proi Code Amount Check Num Type SUSPENSE 2000 - 2504 - TPBSTR - 43,428.16 CONST RETAINAGE 2000 - 2605 - TPBSTR - 11,316.50 BSTR, TWN PEAKS 2029 - 7070 - TPBSTR 113,165.00 Check Total: GROUNDS & MNTC 1028 - 6042 MISC INCOME OFC EQUIP/REPAIR 1029 - 6027 OFC EQUIP /REPAIR 1038 - 6027 OFC EQUIP/REPAIR 2029 - 6027 OFC EQUIP /REPAIR 2038 - 6027 PERSONNEL LEGAL 1022 - 4445 PERSONNEL LEGAL 2022 - 4445 TRAVEUMEETINGS 1006 - 6200 HYPOCHLORITE 1006 - 4755 BIOSOL EQUP /BLDG 1006 - 6653 HYPOCHLORITE 2002 - 4755 BUILDINGS 2004 - 6041 PUB RELATIONS PUB RELATIONS ELECTRICITY 1000 - 6330 ST LIGHTING EXP 1000 - 6740 ELECTRICITY 2000 - 6330 Check Total: 2000 - 3540 - TMCBUB Check Total: Check Total: Check Total: Check Total: Check Total: Check Total: 1027 - 6620 - PREEXT 2027 - 6620 - PREEXT Check Total: Check Total: Current Date: 12/02/2009 Current Time: 09:48:15 58,420.34 AP- 00074441 MW 118.02 118.02 AP- 00074442 MW 1,126.47 1,126.47 AP -00074443 MW 32.91 22.50 32.91 22.50 110.82 AP- 00074444 MW 2,442.38 2,442.37 4,884.75 AP- 00074445 MW 120.52 120.52 AP- 00074446 MW 3,803.93 700.27 2,215.86 6,720.06 AP -00074447 MW 257.00 257.00 AP- 00074448 MW 868.55 868.55 1,737.10 AP -00074449 MW 56,970.92 7.93 21,984.93 78,963.78 AP -00074450 MW Vendor Name SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIERRA SPRINGS SIGNS OF TAHOE SOUTHWEST GAS SOUTHWEST GAS SPRINGBROOK SOFTWARE INC SPRINGBROOK SOFTWARE INC SUBSTITUTE PERSONNEL & SUBSTITUTE PERSONNEL & SUBSTITUTE PERSONNEL & SUBSTITUTE PERSONNEL & SUBSTITUTE PERSONNEL & SUNGARD PUBLIC SECTOR SUNGARD PUBLIC SECTOR SUSAN LINDSTROM ARCHAEOLOGIC User: THERESA Report: OH_PMT_CLAIMS_BK Department / Prof Name UNDERGROUND REP PUMPS ELECTRICAL SHOP HEAVY MAINT EQUIPMENT REP OPERATIONS DIAMOND VLY RNCH CUSTOMER SERVICE UNDERGROUND REP PUMPS ELECTRICAL SHOP EQUIPMENT REPAIR CUSTOMER SERVICE ENGINEERING - ARSENIC FACILITY GEN & ADMIN GEN & ADMIN INFORMATION SYS INFORMATION SYS DIAMOND VLY RNCH ENGINEERING CUSTOMER SERVICE ENGINEERING CUSTOMER SERVICE INFORMATION SYS INFORMATION SYS PAYMENT OF CLAIMS Description SUPPLIES SUPPLIES SUPPLIES SUPPLIES SUPPLIES SUPPLIES SUPPLIES SUPPLIES SUPPLIES SUPPLIES SUPPLIES SUPPLIES SUPPLIES ARSNC TRTMNT NATURAL GAS NATURAL GAS CONTRACT SERVICE CONTRACT SERVICE CONTRACT SERVICE CONTRACT SERVICE CONTRACT SERVICE CONTRACT SERVICE CONTRACT SERVICE SERVICE CONTRACT SERVICE CONTRACT ENGINEERING - IROQUOIS BSTR ST BSTR STN IROQ Acct# / Proi Code 1001 - 6520 1002 - 6520 1003 - 6520 1004 - 6520 1005 - 6520 1006 - 6520 1028 - 6520 1038 - 6520 2001 - 6520 2002 - 6520 2003 - 6520 2005 - 6520 2038 - 6520 2029 - 8864 - ARSNIC Check Total: 1000 - 6350 2000 - 6350 1037 - 4405 2037 - 4405 1028 - 4405 1029 - 4405 1038 - 4405 2029 - 4405 2038 - 4405 1037 - 6030 2037 - 6030 2029 - 8967 - IQBSTR Check Total: Check Total: Check Total: Check Total: Check Total: Page: 10 Current Date: 12/02/2009 Current Time: 09:48:15 539.40 95.37 79.08 Amount Check Num Type 29.73 1.98 9.91 29.73 9.91 29.73 9.91 9.91 29.73 7.93 9.91 9.91 9.91 198.20 AP- 00074451 MW 539.40 AP -00074452 MW 174.45 AP -00074453 MW 500.00 500.00 1,000.00 AP -00074454 MW 643.72 111.84 1,112.64 111.84 2,154.39 4,134.43 AP- 00074455 MW 348.28 348.27 696.55 AP -00074456 MW 1,730.00 Vendor Name SUTER WALLAUCH CORBETT &ASSOC DIO SUTER WALLAUCH CORBETT &ASSOC 010 SWAIN, CAROL SWAIN, CAROL TAHOE BLUEPRINT TAHOE DAILY TRIBUNE TAHOE DAILY TRIBUNE TAHOE MOUNTAIN NEWS TAHOE MOUNTAIN NEWS TAHOE PRINTING TAHOE PRINTING TAHOE SAND & GRAVEL THOMAS HAEN CO INC THOMAS HAEN CO INC TRANSCAT TRPA U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE User: THERESA Report: OH_PMT_CLAIMS_BK Department / Proi Name INFORMATION SYS INFORMATION SYS ENGINEERING - ARSENIC FACILITY ADMINISTRATION ADMINISTRATION DIO - PR EXP- EXTERNAL DIO - PR EXP - EXTERNAL GEN & ADMIN GEN & ADMIN UNDERGROUND REP UNDERGROUND REP UNDERGROUND REP PUMPS EQUIPMENT REP PAYMENT OF CLAIMS Description Acct# / Proi Code CONTRACT SERVICE 1027 - 4405 CONTRACT SERVICE 2027 - 4405 TRAVEUMEETINGS 1037 - 6200 TRAVEUMEETINGS 2037 - 6200 ARSNC TRTMNT SUBSCRIPTIONS 1021 - 4830 SUBSCRIPTIONS 2021 - 4830 PUB RELATIONS PUB RELATIONS SUPPLIES 1000 - 6520 SUPPLIES 2000 - 6520 PIPE /CVRS/MHLS 2001 - 6052 UNDERGROUND REP - SEWER LN,D ST D ST SWR MAIN EX UNDERGROUND REP - WTR MN,D ST WTLN,IN HS UPSIZ ELECTRICAL SHOP SMALL TOOLS 1003 - 6073 ENGINEERING - REPL GEN, LPPS REPL GEN LPPS PIPE /CVRS /MHLS 1001 - 6052 TRAVEUMEETINGS 1001 - 6200 OFFICE SUPPLIES 1002 - 4820 SHOP SUPPLIES 1005 - 6071 Page: 11 Check Total: Check Total: Check Total: 2029 - 8864 - ARSNIC Check Total: Check Total: 1027 - 6620 - PREEXT 2027 - 6620 - PREEXT Check Total: Check Total: Check Total: 1001 - 7586 - HAENSL 2001 - 8905 - HAENWL Check Total: Check Total: 1029 - 8933 - RGLPPS Check Total: Current Date: 12/02/2009 Current Time: 09:48:15 Amount Check Num Tvce 1,730.00 AP - 00074457 MW 1,225.00 1,225.00 2,450.00 100.75 100.75 201.50 92.44 92.44 62.04 62.03 124.07 AP- 00074461 MW 163.00 162.00 325.00 AP - 00074462 MW 321.86 321.86 AP -00074458 MW 643.72 AP- 00074463 990.50 990.50 AP 00074464 11,930.00 17,580.00 29 510.00 733.47 733.47 2,420.00 40.56 37.35 5.75 62.50 AP- 00074459 MW AP -00074460 MW AP -00074465 AP -00074466 2,420.00 AP -00074354 MW MW MW MW MW Vendor Name U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE Department / Proi Name OPERATIONS LABORATORY BOARD OF DIR ADMINISTRATION HUMAN RESOURCES 010 - PR EXP- EXTERNAL DIAMOND VLY RNCH DIAMOND VLY RNCH ENGINEERING ENGINEERING ENGINEERING INFORMATION SYS INFORMATION SYS CUSTOMER SERVICE CUSTOMER SERVICE FINANCE - PAYROLL SYS /ADP FINANCE UNDERGROUND REP HEAVY MAINTENANC EQUIPMENT REPAIR EQUIPMENT REPAIR LABORATORY BOARD OF DIR ADMINISTRATION HUMAN RESOURCES DIO - PR EXP - EXTERNAL ENGINEERING ENGINEERING ENGINEERING ENGINEERING - WT METERING PRJ INFORMATION SYS INFORMATION SYS PAYMENT OF CLAIMS • Description TRAVEUMEETINGS LAB SUPPLIES OFFICE SUPPLIES TRAVEUMEETINGS PERSONNEL EXPENS TRAVEL/MEETINGS GROUNDS & MNTC TELEPHONE OFFICE SUPPLIES TRAVEUMEETINGS SUPPLIES DIST.COMP SPPLIS TRAVEUMEETINGS OFFICE SUPPLIES TRAVEUMEETINGS OFFICE SUPPLIES TRAVEUMEETINGS TRAVEL/MEETINGS BUILDINGS AUTOMOTIVE SHOP SUPPLIES LAB SUPPLIES OFFICE SUPPLIES TRAVEUMEETINGS PERSONNEL EXPENS TRAVEUMEETINGS OFFICE SUPPLIES TRAVEUMEETINGS SUPPLIES WTR METERING/NEW DIST.COMP SPPLIS TRAVEUMEETINGS Acct# / Proi Code 1006 - 6200 1007 - 4760 1019 - 4820 1021 - 6200 1022 - 6670 1027 - 6200 - PREEXT 1028 - 6042 1028 - 6310 1029 - 4820 1029 - 6200 1029 - 6520 1037 - 4840 1037 - 6200 1038 - 4820 1038 - 6200 1039 - 4820 PAYADP 1039 - 6200 2001 - 6200 2004 - 6041 2005 - 6011 2005 - 6071 2007 - 4760 2019 - 4820 2021 - 6200 2022 - 6670 2027 - 6200 - PREEXT 2029 - 4820 2029 - 6200 2029 - 6520 2029 - 7078 - METERS 2037 - 4840 2037 - 6200 User: THERESA Page: 12 Current Date: 12/02/2009 Report: OH_PMT_CLAIMS_BK Current Time: 09:48:15 Amount Check Num Type 1,413.29 6.96 21.25 14.47 18.83 38.09 953.50 59.99 30.25 842.41 56.44 32.62 693.51 124.62 723.61 85.26 300.90 74.91 134.05 1,029.83 62.50 39.53 21.25 84.08 18.83 38.08 118.96 839.76 56.44 43.48 32.61 693.51 Vendor Name U S BANK CORPORATE U S BANK CORPORATE - U S BANK CORPORATE U S BANK CORPORATE U S BANK CORPORATE UNITED RENTALS INC UNIVERSAL HEALTH NETWORK USA BLUE BOOK USA BLUE BOOK USA BLUE BOOK USA BLUE BOOK VELOCITY DYNAMICS INC VERIZON CALIFORNIA WECO INDUSTRIES INC WESTERN BOTANICAL SERVICES WESTERN BOTANICAL SERVICES WESTERN ENERGETIX INC WESTERN ENERGETIX INC WESTERN ENVIRONMENTAL WESTERN NEVADA SUPPLY WESTERN NEVADA SUPPLY Department / Proi Name Description CUSTOMER SERVICE OFFICE SUPPLIES CUSTOMER SERVICE TRAVEL/MEETINGS CUSTOMER SERVICE - WTR CONS PROG WTR CONS EXPENSE FINANCE - PAYROLL SYS /ADP OFFICE SUPPLIES FINANCE TRAVELJMEETINGS EQUIPMENT REPAIR SELF FUNDED INS PUMPS ELECTRICAL SHOP OPERATIONS OPERATIONS OPERATIONS DIAMOND VLY RNCH UNDERGROUND REP ENGINEERING - ANGORA TNK REPL EXPORT PIPELINE - B LINE REVEG GEN & ADMIN GEN & ADMIN LABORATORY PUMPS DIAMOND VLY RNCH PAYMENT OF CLAIMS PPO FEE User: THERESA Page: 13 Report: OH_PMT_CLAIMS_BK AUTOMOTIVE REP PMP#1 BIJOU PUMP STATIONS LAB SUPPLIES GROUNDS & MNTC BIOSOL EQUP/BLDG TELEPHONE INFILTRTN /INFLOW TANK, ANGORA BLINE REVEG GASOLINE INV DIESEL INVENTORY MONITORING SHOP SUPPLIES FENCING DVR Acct# / Proi Code 2038 - 4820 2038 - 6200 2038 - 6660 - WCPROG 2039 - 4820 - PAYADP 2039 - 6200 2005 - 6011 3000 - 6742 1002 - 8006 1003 - 6051 1006 - 4760 1006 - 6042 1006 - 6653 1028 - 6310 1001 - 6055 1000 - 0415 1000 - 0416 1007 - 6110 1002 - 6071 1028 - 8030 Check Total: Check Total: Check Total: Check Total: Check Total: Check Total: Check Total: 2029 - 7064 - ANGOTK 9098 - 8736 - BLNVEG Check Total: Check Total: Check Total: Current Date: 12/02/2009 Current Time: 09:48:15 Amount Check Num Dm 124.62 766.60 314.22 85.26 300.89 10,441.57 AP - 00074468 MW 391.37 391.37 AP - 00074469 MW 672.00 672.00 AP 00074470 MW 151.00 1,064.49 931.88 431.34 2,578.71 AP - 00074471 MW 503.34 503.34 AP - 00074472 MW 181.83 181.83 AP 00074473 MW 1,055.03 1,055.03 AP - 00074474 MW 1,602.00 2,520.00 4.122.00 AP 00074475 MW 4,815.78 7,837.09 12,652.87 AP 00074476 MW 120.00 120.00 AP - 00074477 MW 7.09 1,127.26 Vendor Name WESTERN NEVADA SUPPLY WESTERN NEVADA SUPPLY WESTERN NEVADA SUPPLY PAYMENT OF CLAIMS Department / Proi Name Description UNDERGROUND REP PIPE /CVRS /MHLS PUMPS SHOP SUPPLIES CUSTOMER SERVICE - WT MTR MXU INST MTR RTFT MXU'S WINZLER & KELLY CONSULT ENGRS ENGINEERING - EFFLUENT EVAL WOOD RODGERS INC XUAN- PHUONG, TRAN GEN & ADMIN User: THERESA Report: OH_PMT_CLAIMS_BK REP EXP PUMPS DIAMOND VLY RNCH - DVR NUTRIENT MGM NUTR MGMT PLAN UB SUSPENSE Acct# / Proi Code Amount Check Num Type 2001 - 6052 6.53 2002 - 6071 7.09 2038 - 8074 - MTRMXU 1,439.85 Check Total: 2,587.82 AP -00074478 MW 1029 - 8676 - EFFLEV 12,634.56 Check Total: 12,634.56 AP -00074479 MW 1028 - 8993 - DVRNUT 3,685.20 Check Total: 3,685.20 AP -00074480 MW 1000 - 2002 4,364.04 Check Total: 4,364.04 AP -00074481 MW 569,881.50 Grand Total: Total 569,881.50 Less: Raver Necks 37,262.90 Grand Total 532,618.60 Page: 14 Current Date: 12/02/2009 Current Time: 09:48:15 Check South Tahce P.U.D. TLS, NAT 24, 2009, AP00073717 V44858 11/24/09 VOID, TYPED & REVE SED P CHEEK RQMSTER 2:09 FM L E -- -leg: CE, JL- - -lcc: CNSTIE---- jCbb: 446928 #J968 - -- pgn: EE200 <1.19> Payee ID. Payee Name Late Check A ncu t Type Subs Ref lb Note GRAND TOTALS: Tbta1 Void Nhure Written Total Void Hand Written 'Ibtal Machine Written Tbtal Hand Written Total Reversals Zbtal Cancelled GRAND TOTAL 0 09/17/09 7,752.90 RV 'IR Reversed 0.00 0.00 0.00 0.00 7,752.90 0.00 7,752.90 timber of Checks Processed: Muter of Checks Processed: Muter of Checks Processed: Niuber of Checks Processed: Muter of Checks Processed: Muter of Checks Processed: rpt id: C - - 0 0 0 0 1 0 South Tahoe P.U.D. 11/24/ 09 VOID, WED & SED oJP CIm �•� 'ILE, 1�T 24, 2009, 11:40 PM - - -req: CNSITE - GL, JL�- - -lcC: - - -j : 446873 #J9 - - -- - CheC�[ pgn: x(200 <1.19> zpt id: -- ID. � 1 Date Check Firma t Type Subs Ref 'Ib Nye AP00074274 V42262 HAW ENMEERM GRAND TOTALS: 'Ibta1 Void Machine Written 'Ibta1 Void Hand Written 'Ibtal Machin a Written Ibta1 Haarl Written Tbta1 Reversals 'Ibtal Cancelled GRAND TOTAL 11/19/09 29,510.00 RV 'IR Reversed 0.00 0.00 0.00 �°° ( ∎ 0.00 1 29,510.00 0.00 29,510.00 I&i±er of Checks Proaessed: Nnber of Checks accessed: Nutter of Checks Processed: Miter of Checks Processed• Nutieer of Chedks Processed: /Inter of Checks Pte 0 0 0 0 1 0 12.75 Meadow Crest Drive # South Lake Tahoe • CA 96150 Phone 530 544 -5474 & Fax 5W 541 -0614 BOARD AGENDA ITEM 15a TO: Board of Directors FROM: Richard H. Solbrig, General Manager MEETING DATE: December 3, 2009 ITEM — PROJECT: Conference with Legal Counsel — Existing Litigation REQUESTED BOARD ACTION: Direct staff. DISCUSSION: Pursuant to Section 54956.9(a) of the California Government Code, Closed Session may be held for conference with legal counsel regarding existing litigation: Meyers Landfill Site - United States of America vs. El Dorado County and City of South Lake Tahoe and Third Party Defendants, Civil Action No. S -01 -1520 LKK GGH, United States District Court for the Eastern District of California. SCHEDULE: COSTS: ACCOUNT NO: BUDGETED AMOUNT REMAINING: ATTACHMENTS: CONCURRENCE WITH REQUESTED ACTION: CATEGORY: Sewer GENERAL MANAGER: YES by NO CHIEF FINANCIAL OFFICER: YES NO -141- Ge -nerai Manager Kichard H. 5o!7rig 15ou T ie Clau Ern Jlo Ern Claudio Jame K. Jones Die trict � Lou MaSb�tGt�er U t V V 1/ Dale Rise 12.75 Meadow Crest Drive # South Lake Tahoe • CA 96150 Phone 530 544 -5474 & Fax 5W 541 -0614 BOARD AGENDA ITEM 15a TO: Board of Directors FROM: Richard H. Solbrig, General Manager MEETING DATE: December 3, 2009 ITEM — PROJECT: Conference with Legal Counsel — Existing Litigation REQUESTED BOARD ACTION: Direct staff. DISCUSSION: Pursuant to Section 54956.9(a) of the California Government Code, Closed Session may be held for conference with legal counsel regarding existing litigation: Meyers Landfill Site - United States of America vs. El Dorado County and City of South Lake Tahoe and Third Party Defendants, Civil Action No. S -01 -1520 LKK GGH, United States District Court for the Eastern District of California. SCHEDULE: COSTS: ACCOUNT NO: BUDGETED AMOUNT REMAINING: ATTACHMENTS: CONCURRENCE WITH REQUESTED ACTION: CATEGORY: Sewer GENERAL MANAGER: YES by NO CHIEF FINANCIAL OFFICER: YES NO -141- tM Meadow Creet Drfe * South Lake Tahoe + CA 96150 Phone 530 544 -6474 • Fax 530 541 -0614 BOARD AGENDA ITEM 15b TO: Board of Directors FROM: Richard Solbrig, General Manager MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: Conference with Legal Counsel — Existing Litigation REQUESTED BOARD ACTION: Direct staff. DISCUSSION: Pursuant to Section 54956.9(a) of the California Government code, Closed Session may be held for conference with legal counsel regarding existing litigation: Tahoe Asphalt, Inc., and Tahoe Asphalt Materials Company, LLC, vs. South Tahoe Public Utility District, Civil Action No. SC20090104, Superior Court, County of El Dorado, State of California. SCHEDULE: COSTS: ACCOUNT NO: BUDGETED AMOUNT REMAINING: ATTACHMENTS: CONCURRENCE WITH REQUESTED ACTION: CATEGORY: Water �9 GENERAL MANAGER: YES NO CHIEF FINANCIAL OFFICER: YES NO —143— Cirneral Manager t?irGGtnft 15h out T ahoe. Ernie Claudia James R. Janes Ut!ity [) ` , ' Fu b11C 15tf lot Data RFse C .a-. 4L-L -9 ce.. tM Meadow Creet Drfe * South Lake Tahoe + CA 96150 Phone 530 544 -6474 • Fax 530 541 -0614 BOARD AGENDA ITEM 15b TO: Board of Directors FROM: Richard Solbrig, General Manager MEETING DATE: December 3, 2009 ITEM — PROJECT NAME: Conference with Legal Counsel — Existing Litigation REQUESTED BOARD ACTION: Direct staff. DISCUSSION: Pursuant to Section 54956.9(a) of the California Government code, Closed Session may be held for conference with legal counsel regarding existing litigation: Tahoe Asphalt, Inc., and Tahoe Asphalt Materials Company, LLC, vs. South Tahoe Public Utility District, Civil Action No. SC20090104, Superior Court, County of El Dorado, State of California. SCHEDULE: COSTS: ACCOUNT NO: BUDGETED AMOUNT REMAINING: ATTACHMENTS: CONCURRENCE WITH REQUESTED ACTION: CATEGORY: Water �9 GENERAL MANAGER: YES NO CHIEF FINANCIAL OFFICER: YES NO —143— 12/3/2009 12/3/2009 le recycled Watei'tAew non - irrigated, permitted recycled water availabic to irrigators in Nevada ity and conveyance improvements in the Diamond system ie pressurized recycled water to the Fredericksburg pressurized recycled water through Wade Valley pressurized recycled water to the Ranchettes A irrigation application system recycled water quality eater recharge using infiltration basins ict zero - discharge basins ict irrigation fields with pumping back to IIPR iomass crops for pulp production using recycled d sod and smil'Production yded water systems to minimize setbacks and contact ion wetland creation using freshwater 'ace recycled water irrigation in public contact of , 17 Tn`cre�se Sno'ivshoe 7'horn}isdn Nn. i:ar� � + »'� capa 18 dptimrze application rate on dittingjXrtgaEedi6vidse 19 Ptutue permitting of more land 1h Alpine^ titttlty x `' 20 ltnprote operation of tlie,Oiamond Ditch ay meth District and user nee' 'as , y, 21— Develop tailwater control system 22 — Parallel recycled water pipeline along I arriy Ditch. la's, F3 23r Route',Mud late winter flows tfirdttgh?CCIC 24 — TraYisfer additional water rights,to store'g n IClt 29 — Irrigate the District Pasture ":;i' 3o —Irrigate the.rtingle with Reevel@d.Water ";',i„ 1 t40, 31— Divert Stormwater flow aWay from HP>Z hAd t ICR 32 -� ICR Spilhvay Channel 7 V lA`' 4tc ""`fin. 12/3/2009 12/3/2009 12/3/2009 I 12/3/2009 i l on r-'Qeitification of q pt the, Recy","P., Approve Maste" Adopt CEQA Fi Adopt Mitigatic I-U ''Dater Facllits ' Master Plan ects I; 2' 12 and 13 rsigs a.01.0vetriding Considerations to-nitoring.Prog-ram A ci - , L Y--) -� a- WASTEWATER COLLECTION SYSTEM MASTER PLAN EXECUTIVE SUMMARY This Executive Summary summarizes the findings and recommendations of the Wastewater Collection System Master Plan (Master Plan) for South Tahoe Public Utility District (STPUD or District). The Master Plan was developed using the Asset Management Concepts of Risk and Level of Service and is based on assessments of the hydraulics and physical condition of the collection system. The Master Plan includes recommended improvements to provide adequate hydraulic capacity and improve the collection system's condition and reliability. Supporting information for this Executive Summary can be found in the Master Plan Introduction and the following Technical Memoranda that were prepared for the Master Plan: • TM 1 — Level of Service • TM 2 — Risk Assessment • TM 3 — Pump Station Condition Assessment • TM 4 — Design Flow Analysis • TM 5 — Model Program Selection • TM 6 — Model Development and Calibration • TM 7 — Pipeline Condition Assessment • TM 8 — Hydraulic Evaluation • TM 9 — Design Criteria • TM 10 — Capital Improvement Plan Background The District collects and treats wastewater from businesses and residents within the District's service area, which encompasses approximately 42 square miles and includes the City of South Lake Tahoe and unincorporated area of El Dorado County within the Tahoe Basin. The collection system includes 42 pumping station facilities, approximately 314 miles of gravity sewers that range in size from 4 inches to 24 inches in diameter, and approximately 22 miles of force mains that range in size from 2 '/z inches to 18 inches in diameter. Study area flows are conveyed to the District's Wastewater Treatment Plant (XX W`TP). The District's WWTP, last expanded in 1989, has a capacity 7.7 million gallons per day (mgd). Effluent is exported 26 miles to Harvey Place Reservoir in Alpine County. The W\X'TP treats an average annual flow of 4 mgd. Peak average daily flows of approximately 5 mgd occur during summer holiday weekends. The 2005 New Year's Eve storm saw continuous rainfall measuring 4.71 inches, which caused an instantaneous peak flow of 18.5 mgd at the WW`TP. ES-1 Vs Executive Summary Wastewater Collection System Master Plan Sanitary Sewer Overflows California State Water Resources Control Board (SWRCB) Order No. 2006 -003 provides statewide general Waste Discharge Requirements (WDR) for all publicly owned sanitary sewer collection systems in California with more than one mile of sewer pipe. Agencies meeting these criteria must develop a Sewer System Management Plan (SSMP). SSMPs are created to help sewer agencies develop and implement a plan to effectively manage wastewater collection systems. The SSMP will establish goals and present objectives to minimize the number and impact of sanitary sewer overflows (SSO), provide sewer capacity to accommodate design storm flows, and maintain the condition of the collection system such that the District can continue to provide reliable service. Reported SSO averages for a sample of agencies located throughout the United States range from two to six dry weather SSOs per 100 miles of sewer per year. This information comes from published data by the Water Environment Research Foundation (WERF), American Society of Civil Engineers (ASCE), and the Environmental Protection Agency (EPA) Region 9. Reported SSOs for the District for 2005 to 2008 ranged from 2.9 to 3.8 per 100 miles, which falls within the middle of the range of national averages. Primary causes for the District's SSOs included grease (30 percent), rags (20 percent), roots (14 percent), debris (7 percent), vandalism (5 percent), pipe damage (2 percent) and unknown /not reported (23 percent). Each recorded SSO during this period occurred during dry weather. Seventy percent of the SSOs occurred in 6- inch - diameter pipe. Seventy-nine percent of the SSOs occurred in asbestos cement pipe (ACP). Sixty-seven percent of the SSOs occurred in areas that were cleaned as recent as 2005 or 2006. Asset Management This collection system master plan helps the District implement asset management practices and develop an asset - management -driven capital improvement program. Asset management is a process that provides a defined level of collection system performance at the lowest life -cycle cost. The Master Plan addresses four aspects of asset management: Level of Service. Defining level of service is key to good asset management. Levels of service relate to an agency's main mission —they identify the things most important to customers or the environment. They are key indicators of how an agency will meet its critical institutional goals. Levels of service were developed in five categories: • Collection system service • Community health, safety, and environment • Employee safety • Regulatory requirements • Customer service. This master plan focuses primarily on the first three levels of service, Risk Assessment. In this Master Plan, a risk assessment helped identify the District's most critical assets and projects. The assessment considered independently an asset's likelihood of failure and ES-2 Executive Summary Wastewater Collection System Master Plan consequence of failure in meeting the designated levels of service. An asset's consequences of failure would result in a SSO, injured employee, or injured member of the public. The consequences of SSOs were further evaluated according to the size and location of the SSO. The asset's likelihood of failure was determined during the hydraulic and condition assessment tasks. The hydraulic assessment evaluated growth in the collection system and the increase of flows from new connections and the effects of wet weather flows. These factors helped determine a failure probability caused by a lack of hydraulic capacity. Failure probabilities were based on structural condition, operational information, maintenance data, and the reliability assessment. The reliability assessment considered such topics as the obsolescence of equipment that may make obtaining spare parts difficult. Business Case Evaluations (BCE). Business case evaluations incorporate risk, along with social and environmental costs and benefits, when evaluating project alternatives. The BCE process can be applied equally to improvement and replacement projects. The BCE supports a thorough alternatives evaluation and helps ensure that the District's money is put to the best use to meet specified levels of service. Capital Improvement Program (CIP) Prioritization. Using risk assessment, District staff and the consultant team prioritized projects within the CIP. The resulting CIP is well- documented and founded on asset management principles that allow it to stand up to scrutiny. The CIP is focused on the most critical situations that would lead to a SSO or injury. This approach enables the District to maintain a higher level of service by most efficiently using its limited resources. Pipeline and Pump Station Condition Assessment The condition assessment was based on field inspections at 22 pump station facilities completed in 2007 and review of existing pipeline closed - circuit television (CCTV) inspection information collected by the District over the past five to six years. Since 2003, the District conducted CCTV inspection of approximately 44 miles of sewer, which represents 14 percent of the collection system. Approximately 8 percent of the inspected pipe segments had a defect that required a repair. The District repairs these defects as part of its ongoing pipeline rehabilitation program. Pipeline Condition Assessment. The District's pipes and manholes are generally well maintained, though there is room for improvement in specific areas. The District experiences a moderate number of dry weather SSOs, roughly falling within the range of averages seen by other agencies around the country. Most of these SSOs occur in 6- inch - diameter pipes, which are often difficult to maintain because they are prone to blockage due to their small diameter. In contrast to the District, most sewer agencies do not clean their systems every three years; however, the District's cleaning schedule is necessary to maintain the 6- inch - diameter pipes that experience root intrusion and structural problems at a higher rate than larger pipes in other parts of the system. This cleaning program has allowed the District to maintain low levels of dry weather SSOs. Despite approaching 50 years of age, the District's pipeline infrastructure remains in relatively good condition. The District's ongoing CCTV inspection program identifies pipeline defects that are repaired quickly. The District is improving its inspection frequency and procedures for pipes and ES-3 Executive Summary Wa Collection System Master Plan manholes, and is on track to inspect the system approximately once every 12 years. The District recently implemented the National Association of Sewer Service Companies (NASSCO) standardized system for rating pipe and manhole defects. CCTV inspections are currently not prioritized. One area for further improvement is the District's force main maintenance and inspection program. Air relief valves (ARV) on a number of force mains are not being maintained, which puts the District at risk for a force main failure due to corrosion or an ARV spill. Priority 1 recommended improvement projects focus on areas of high maintenance and poor condition. Approximately 13,000 LF of Priority 1 pipe should be considered for rehabilitation. Additional rehabilitation needs will be identified through the District's ongoing CCTV inspection program and be addressed by an annual program. Approximately 17,000 LF of Priority 2 sewers should be considered for rehabilitation. The Priority 2 list includes pipes with moderate defects and maintenance levels. The District identified one additional Priority 1 project —the Highway 89 /Fifth Street redundant sewer crossing. This sewer has a high consequence of failure and District staff has identified that it should have a high priority. Other recommendations from the condition assessment that are not capital projects are listed below: Maintenance Recommendations • Prioritize CCTV inspections and develop a plan to evaluate results. • Inspect stream crossings two times per year and meadow sewers every 18 to 24 months. • Maintain ARVs on all force mains to help ensure that they operate properly and protect the pipeline from damage. • Monitor manholes where there is a force main discharge on an annual basis to evaluate for corrosion damage. Policy Recommendations • Minimum pipe diameter should be eight inches. When existing 6 -inch pipes are scheduled for rehabilitation or replacement, replace them with 8 -inch pipe to reduce maintenance. • Private building laterals should be tested and renovated on a standard basis as an approach to reduce infiltration and inflow (I /I). Many communities require lateral testing when a property is sold. Pump Station Condition Assessment. The District has made a significant effort to prevent overflows in the system, and no pump related overflows have occurred in the last five years. The District's pump stations are well maintained; staff is highly knowledgeable and skilled in maintaining and improving the wide variety of pump stations. The District has several types of pump stations, many of which are 40+ years old. The equipment in these pump stations varies. The District is geographically isolated relative to manufacturers' service facilities. This means the District must have spare parts on hand, and the in -house expertise to make repairs themselves in a timely manner, especially during inclement weather. ES-4 Executive Summary Wastewater Collection System Master Plan The District has retained its staff for many years, which means staff has significant experience and internal knowledge of the pump stations. Replacing employees who retire or leave may be difficult because of their high skill level and knowledge of facilities. Safety is a concern at some of the District's pump stations because confined space entry procedures are required for entry into the dry wells. The pumping and vacuum system at Fallen Leaf Lake (FLL) is also a concern. This system requires significant operation and maintenance attention from the District because of its design. The District has spent many hours fine - tuning this system because a failure in the FLL system would have significant consequences. A Business Case Evaluation performed on the FLL system identified cost - effective improvements to select portions of the system that will reduce the District's overall risk. The pump station condition assessment identified two Priority 1 improvement projects for implementation within the next 10 years. These include the vacuum valve improvements at FFL and the system wide SCADA improvements. There are 13 Priority 2 pump station projects identified in the 10- to 20 -year time frame. These projects fall into two categories: employee safety improvements and maintenance improvements. Several other recommendations not identified for the CIP that will be implemented by District Staff are listed below: Safety Recommendations • Provide wet well fall protection. • Install combustible gas detectors installed in wet wells. • Install bollards to protect the Beecher Pump Station electrical panels from vehicular traffic. • Install a new electrical cabinet at the Beecher Pump Station. • Provide Ground Fault Circuit Interrupt protection at the electrical outlets at pump stations • Evaluate electrical equipment layouts to ensure compliance with "Working Space" requirements. Structural Recommendations • Remove metal items in the wet wells (including ladders). Other Recommendations • Install standby pumps at Flanders and Taggart pump stations. • Install redundant sump pumps in dry wells. Another recommendation included developing a standardized submersible pump station design. These pump stations have less equipment to operate and maintain than wet well /dry well pump stations and are easier for new employees to learn to operate and maintain. Hydraulic Assessment The hydraulic assessment was based on hydraulic modeling of 231 miles of trunk sewers /force mains and 10 pump stations under current and future flow conditions. The District's Geographic Information System (GIS) data provided the base for the hydraulic model. Flow projections are ES-5 1 ro a. i;. Executive Summary Wastewater Collection System Master Plan based on flow monitoring performed by the District and by a subcontractor during this project. Land use information for developing future flow projections came from the City of South Lake Tahoe, El Dorado County, the Tahoe Regional Planning Authority and the United States Forest Service. Because the District's service area is almost built out only minor increases in average daily flow are anticipated. Peak wet weather flows were based on a 25 -year, 24 -hour design storm. Table ES -1 summarizes flow projections for the District's service area. Summer Avg Summer Peak Peak Hourly Winter Daily Flow Hourly Flow Design Storm Flow Scenario (mgd) (mgd) (mgd) Current 4.84 8.56 16.75 Future 5.62 8.65 16.98 The hydraulic assessment found two areas within the trunk sewer network and one pump station with inadequate hydraulic capacity to convey future wet weather flows without excessive surcharging or SSOs. This finding led to three hydraulic capacity enhancement projects for the Capital Improvement Plan. These projects include the Al Tahoe and Bijou relief sewer projects. These sewers will be under capacity for the future design flow event. The Tahoe Keys pump station capacity upgrade is also needed. This pump station is currently undersized for the existing and future design flow conditions. Capital Improvement Plan Capital improvement projects will mitigate hydraulic and structural deficiencies, reduce maintenance and improve overall system safety, reliability and operation. Information from the hydraulic and condition assessments and the risk assessment were used to prioritize the capital projects into three categories. Individual projects were discussed in the previous sections. The comprehensive Capital Improvement Plan (CIP) is listed in Table ES -2 and shown on Figures ES -1. Priority 1. Projects with the greatest risk for collection system SSO or employee injury. Priority 2. Projects that are not needed until development occurs and projects that will reduce maintenance and improve system safety, reliability and redundancy. Priority 3. Other projects that are not anticipated to occur in the next 20 years. ES-6 ?.: : •. - Pipeline Wildwood Sewer Interceptor - - 1,653,000 850,500 580,000 1,073,000 850,500 1,653,000 - Pipeline Force Main Bypass - AI Tahoe 630,000 126,000 756,000 1,021,000 756,000 756,000 - Pipeline Force Main Bypass - Tahoe Keys 880,000 176,000 1,056,000 1,056,000 259,000 1,056,000 - Pipeline Cleaning of Sewer Trunk Lines - - 554,000 554,000 901,000 554,000 1 Pipeline HWY 89- 5th St Relief Sewer 170,100 34,000 204,100 622,600 204,100 204,100 1 Pipeline High Maintenance and Poor Condition Sewer Replacement (Pnodty 1) 749,970 150,030 900,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 557,200 900,000 2 Pipeline High Maintenance and Poor Condition Sewer Replacement (Pnorily 2) 1,666,600 333,400 2,000,000 1,966,200 1,966,200 Johnson 2,000,000 2,000,000 2 Pipeline Al Tahoe Re8ef Sewer (Open 1,171,100 234,200 $1,405,300 1,638,500 1,638,500 Pioneer Village 98,300 19,700 1,405,300 1,405,300 2 Pipeline Bijou Relief Sewer 1,334,500 257,000 1,601,400 118,000 118,000 Pope Beach #1 163,900 32,800 196,700 1,601,400 1,601,400 1 Pump Station SCADA Upgrades 2,835,000 567,000 3,402,000 850,500 850,500 850,500 850,500 3,402,000 1 Pump Station Tahoe Keys Pump Station Capacity Upgrade 851,000 170,000 1,021,000 1,021,000 1,021,000 1 Pump Station Fallen Leaf Lake System Improvements (Upgrade WS #3, Replace WS #8) 216,000 43,000 259,000 259,000 259,000 2 Pump Station Al Tahoe Pump Station Maintenance Improvements 751,000 150,000 901,000 901,000 901,000 2 Pump Station Pump Station Safety Improvements Baldwin Beach 518,800 103,800 622,600 622,600 622,600 Bellevue 464,300 92,900 557,200 557,200 557,200 Bijou 1,638,500 327,700 1,966,200 1,966,200 1,966,200 Johnson 1,365,400 273,100 1,638,500 1,638,500 1,638,500 Pioneer Village 98,300 19,700 118,000 118,000 118,000 Pope Beach #1 163,900 32,800 196,700 196,700 196,700 Pope Beach #2 131,100 26,200 157,300 157,300 157,300 San Montz 532,600 106,500 639,100 639,100 639,100 Taylor Creek 901,300 180,300 1,081,600 1,081,600 1,081,600 Trout Creek 819,300 163,900 983,200 983,200 983,200 Venice 163,900 32,800 196,700 196,700 196,700 FLL Main Station 245,800 49,200 295,000 295,000 295,000 Technical Memorandum No. 10 kY Naha( tp T. ins Pro acts mp etanon Pro Other Capital Expenditures Ptobact Nam Candasetlan Costth Dssipq Pahanidradan, Ssrsaw n) C4hd Coat h) Capital Improvement Plan 1 2 Master Plan Update Flaw Monitoring and Hydraulic Model Update TOTAL 10,29!,470 3,949,530 350,000 200,000 24,714,900 200,000 0 504,100 1,121,000 1,912,000 1,209,500 1,530,500 2,023,500 1,504,500 100,000 100,000 350,000 14,709,800 1 Propel costs are current to the Tahoe Basin Summer 2009 ENR CC1 of 9103 They indude a contingency of 35 percent and are AACE Class 5 Order of magnitude 2 These costs should be adjusted to the construction midpoint at the tune of project planning 3 The atawance for Design, Adnunistrason and Construction Semces is 20 percent ES-7 350,000 200,000 24,714,900 Pxw s3\PxLu\sig\dv4 andIS 179CZM000MVd IOOfOJd ON Z AI!JOPd iofevy d13 UleW f4lABJE) AMH 1 ON V SG%fotl z A)POPd V � AjPO!Jd V SuIBW G d13 uol)elS dwnd GN3031 lee U! eloos 006'4 0 0917'Z 006't S AN SPOOM 4U8WGAojdwj lelldeo L-S3 ejn6i_A NVId 2OiSVN i:mjisia,kinun onend 30H` i Hinos m <0 t. fl v A-A WASTEWATER COLLECTION SYSTEM MASTER PLAN INTRODUCTION South Tahoe Public Utility District (STPUD or District) owns and maintains a wastewater collection system that serves approximately 17,000 sewer customers in the City of South Lake Tahoe and unincorporated area of El Dorado County within the Tahoe Basin. The collection system conveys wastewater from the District's service area to the District Wastewater Treatment Plant (WWTP). The District last prepared a wastewater collection system master plan in 1986. In January 2007, the District retained Brown and Caldwell (BC) to prepare a new Master Plan. The Master Plan provides a comprehensive plan for improving the collection system over the next 20 to 30 years. The study includes a hydraulic evaluation and condition assessment and develops a detailed capital improvement plan using the concepts of Asset Management. The Master Plan will facilitate the District's development of its Sewer System Management Plan (SSMP) as required by the State Water Resources Control Board (SWRCB). This section summarizes the process undertaken to develop this Master Plan and provides background information on the study area, collection system and regulatory drivers. 1.1 Scope of Work The Master Plan scope of work includes the tasks outlined below. Completed work tasks were documented in technical memoranda and submitted to the District for review. These technical memoranda are included as chapters of this Master Plan report. Data Collection and Assessment of Wastewater System. Review available information on the collection system and confirm the sub -basin discharge points. Design Criteria and Level of Service. Develop the Master Plan basis of Asset Management and recommend updates to the District's Design Criteria. Flow Monitoring and Analysis. Perform dry and wet weather flow monitoring, project current and future wastewater flows, and determine the design storm criteria for infiltration and inflow (I /I) projections. Condition Assessments. Perform focused condition and reliability assessments on select pipes and pump stations using Asset Management principles; develop alternatives to address condition deficiencies. Hydraulic Model Development. Develop a hydraulic model of the collection system to identify current and future hydraulic deficiencies and allow the District to make hydraulic evaluations in the future. System Performance Evaluation and Capacity Assurance Plan. Identify hydraulic deficiencies in the collection system and develop improvement alternatives. Introduction Wastewater C Sys Master Plan Long Range Capital Improvement Plan Development. Develop capital projects to address conditional and hydraulic deficiencies; prioritize the projects in a CIP using Asset Management principles. Master Plan Report. Document the Master Plan in a readily useable report. 1.2 Study Area The Master Plan study area encompasses the District's 42- square mile service area and includes the City of South Lake Tahoe and an unincorporated area of El Dorado County within the Tahoe Basin. The service area is bordered by Hwy 89 North past Cascade Lake, Hwy 89 South to Luther Pass, Hwy 50 East to Nevada state line, and Hwy 50 West before Echo Lake. The service area, illustrated in Figure 1, also includes state parks and USFS land. 1.3 Existing Collection System The collection system owned and maintained by the District includes 42 pumping station facilities (including pumping stations, vacuum valves and the Stanford Generating Station), approximately 314 miles of gravity sewers that range in size from 4 inches to 24 inches in diameter, and approximately 22 miles of force mains that range in size from 2 '/z inches to 18 inches in diameter. Flows from the study area are conveyed to the District's wastewater treatment plant (WWTP). 1.4 Wastewater Treatment The District's WWTP was last expanded in 1989 and has a capacity 7.7 mgd. Effluent is exported 26 miles from Harvey Place Reservoir in Alpine County. The WWTP treats an annual average flow of 4 mgd. Peak average daily flows of approximately 5 mgd occur during summer holiday weekends. The 2005 New Year's Eve storm saw continuous rainfall measuring 4.71 inches and caused an instantaneous peak flow of 18.5 mgd at the WWTP. 1.5 Previous Planning Reports and Information In 1986, James M. Montgomery Consulting Engineers, Inc., completed the District's previous evaluation of the wastewater collection system. Additional reports and planning documents have been prepared for the collection system and are as follows: • El Dorado County Parcel GIS, September 2008 • City of South Lake Tahoe 1999 General Plan (Including the 2008 General Plan Housing Element Public Review Draft) • El Dorado County 2004 General Plan • Tahoe Regional Planning Agency Community Plan Statement Maps and the Community Plans for Stateline /Ski Run, Bijou /Al Tahoe, and South Y Industrial. • STPUD Future Connections Facilities Plan, 1995 (Referenced within the 2008 General Plan Housing Element) • STPUD Emergency Power and /or Storage Facilities Plan, Carollo Engineers, 1991 ..,., ... .. "i ,. ".ah. %0 1 . Introduction Wastewater Collection System Master Plan • STPUD Emergency Power and /or Storage Facilities Plan Amendment 1, Carollo Engineers, 1994 These reports were used, in conjunction with other existing data, to evaluate and develop recommendations for the District's collection system. 1.6 Regulatory This section summarizes current regulatory requirements and rules. It is intended to provide general discussion of the subject matter covered. To the extent it addresses laws, regulations or court decisions of any jurisdiction, it is not intended as a precise, detailed or thorough summary of the pertinent legal authorities. Regulatory Environment. The United States Environmental Protection Agency (USEPA) began drafting Capacity, Management, Operations and Maintenance (CMOM) regulations in the mid -1990s to require owners and operators of publicly owned wastewater collection systems to eliminate SSOs. SSOs occur when wastewater escapes the collection system as a result of blockages or capacity restrictions in the system. The State of California, through its State Water Resources Control Board, has moved forward. The State issued Sewer System Management Plan (SSMP) requirements to achieve the SSO reduction goals of CMOM. Both state and federal regulators have recently taken enforcement actions against collection system agencies in California because of SSOs. CMOM/SSMP Goals and Components. CMOM and SSMP were developed to help sewer agencies develop and implement a plan to effectively manage a wastewater collection system. This plan will establish goals and present objectives to minimize the number and impact of SSOs, provide sewer capacity to accommodate design storm flows, and maintain and improve the condition of the collection system so the District can continue to provide reliable service. SSMP. California State Water Resources Control Board (SWRCB) Order No. 2006 -003 provides statewide general Waste Discharge Requirements (WDR) for all publicly owned sanitary sewer collection systems in California with more than one mile of sewer pipe. Agencies meeting these criteria must develop a Sewer System Management Plan (SSMP) that includes at least 11 mandatory elements, which are identified in Table 1. The agency's SSMP must be approved by the collection system's governing body. The WDR also requires uniform reporting of all sanitary sewer overflows (SSOs) to a statewide electronic database maintained by the SWRCB. All elements of the SSMP must be in place by specified dates prior to August 1, 2009, for sewer agencies serving populations between 10,000 and 100,000. 3 Introduction Wa stewater Collection System Master Plan Components Components Table 1. SSMP Major Goals 1. Goals Properly manage, operate and maintain all parts of the sanitary sewer system. 2. Organization Cie ady identify the parties responsible for the plan; management, administration and maintenance; and the chain of communication for SSO reporting. Demonstrate through ordinances, agreements or other legally binding procedures that the agency has the legal authority to: prevent illicit discharges into the sewer system; require that 3. Legal Authority sewers and connections be properly designed and constructed; ensure access for maintenance, inspection and repairs; limit the discharge of fats, oils and grease (FOG); and enforce violation of sewer ordinances. a) Maintain an up -to -date map; b) Regular preventive maintenance activities; 4. 0 &M Program c) Develop a prioritized rehabilitation and replacement plan; d) Provide training; e) Provide equipment and replacement part inventories. 5. Design and Performance Provisions a) Design and construction standards and specifications; b) Procedures and standards for inspecting and testing new sewers. a) Proper notification procedures; b) Overflow response program; 6. Overflow Emergency Response Plan c) Overflow notification procedures; d) Emergency Response Plan procedures; e) Traffic and crowd control procedures; f) Program to ensure reasonable steps are taken to contain SSO. a) Public education and outreach plan; b) FOG disposal plan; c) Legal authority to prevent discharges; 7. Fog Control Program d) Grease removal device requirements; e) Authority to inspect grease producing facilities; f) Identification of areas prone to FOG blockages; g) Development and Implementation of FOG source control measures. a) Evaluation of areas experiencing SSO discharge; 8. System Evaluation and Capacity b) Develop design criteria; Assurance Plan c) Develop a CIP to address identified hydraulic deficiencies; d) Develop a schedule of completion dates. a) Maintain information to establish and prioritize SSMP activities; b) Monitor the implementation and effectiveness of each element; 9. Monitoring, Measurement and Program c) Assess the success of the preventive maintenance program; Modifications d) Update program elements as necessary; e) Identify and illustrate SSO trends. 10. SSMP Audits Conduct a program audit at least every two years to evaluate the effectiveness of the SSMP. 11. Communication Program Communicate on a regular basis with the public on the development, implementation and performance of the SSMP. BOOZ'LZ6nV pxweeivApnls \p— \sl'J \dv4 andiS 69£Z£N000Z£l\'d 0 eajV ApniS ueld Jaiseyy � ain6id N` ]d 2J31SVVY ioi2jiSld Alums( onand 30HVi H1f10S a t' and MS uosp,e4oia d—o ,ofayy z{uoyy U.S . none .:._ AMH ee�on,y,addn ! .. 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