10-26-2018 �lry ur
I
GEWA
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INTER-OFFICE MEMORANDUM
TO: City Council
FROM: Tracey T.Barlow,City Manager,77Z
DATE: October 18, 2018
SUBJECT: Sergeant Adam Burris Separation
The purpose of this memorandum is to describe the timeline and occurrences leading up
to the separation of employment of Sergeant Adam Burris.
Sgt. Burris is a 6 year veteran with Edgewater Police Department with 2 years in grade as a
Police Sergeant. On the evening of January 1, 2018 Sgt. Burris and his assigned shift responded
to a domestic violence incident involving a male and female. Shortly after arrival they
encountered a male subject actively shooting at the female as she exited the residence.
Immediately thereafter the officers exchanged gunfire after the male subject would not drop his
gun. The male subject was subsequently fatally shot by another officer on-scene. As procedure
protocol all officers that were involved in this officer involved shooting were placed on
Administrative Leave effective January 2, 2018. The purpose of the Administrative Leave is for
the Florida Department of Law Enforcement (FDLE)to complete a preliminary investigation as
well as have the involved officers evaluated by a Licensed Psychologist. On January 6, 2018 all
involved officers had been cleared to return to normal service (36 hours Paid Administrative
Leave).
April 13, 2018 Sgt. Burris reported to Captain Mahoney that he believed to have a non-physical
injury as a result of the January 1, 2018 shooting incident. Once the non-physical injury was
reported to the Human Resources Department a Workers Compensation claim was immediately
filed. In accordance with Florida Statute at that time Workers Compensation would only
authorize and cover the cost of medical treatment as the condition is considered without physical
injury. Subsequently, on April 13, 2018 Sgt. Burris was provided and signed a letter describing
"It is imperative that you notify the Personnel Department of yaw doctor's appointments and
obtain a Work Status Report form from us to take to your doctor each time you visit them. " It
Once of the City Manaeer
P.O.Box 100.Edgewater,FL 32132-0100
1386)424-2400 Ext. 1201 .Fax(386)424-2421
www.cityofedgeu ter org
further states "You may not return to work until you have personally given this information to
the Human Resources Department." The letter also provides an opportunity for those employees
that work outside of the regular Monday thru Friday schedule to contact the Human Resources
Department by phone to provide their updates. (Document attached)
On April 13, 2018 after Sgt. Bums reported his injury, he was immediately placed on Paid
Administrative Leave and assigned treatment. The Paid Administrative Leave occurred from
April 13, 2018—May 7, 2018(152 hours).
May 7, 2018 SgL Burris was released by his physician to return to regular duties with no
restrictions. Sgt.Burris worked without restrictions until May 22, 2018.
May 25,2018 Sgt Burris was restricted by his physician to administrative duties only, unable to
perform road duties at this time. Sgt. Burris began using his accruals through June 6,2018.
May 29, 2018 Human Resources Director, Julie Christine, met with Sgt Burris and hand
delivered the Family Medical Leave Act paperwork and discussed the light/modified duty
options that were within consideration based on the limitations that his physician has placed on
him. Sgt. Burris expressed interest in any applicable positions available in order to preserve the
depletion of his accrual time. (Nates attached)
May 30, 2018 Sgt. Burris's physician temporarily restricted him from performing his regular
duties stating he currently cannot make critical decisions as required of a law enforcement
officer.
June 5, 2018 the Human Resources Director met with Sgt. Burris and offered him a modified
duty job position in the code enforcement division. SgL Burris accepted the position and began
June 6,2018. (Document attached)
June 7, 2018 Sgt. Burris completed 16.8 hours of work with the code enforcement division and
advised that he could no longer continue as working in the city of Edgewater acerbated his
condition. Sgt. Burris also returned to his physician who restricted him from performing any
work based on the findings of his evaluation.
June 7, 2018 thm October 2, 2018 it is assumed that Sgt. Burris had continued treatment
although follow-up reports were not communicated to the Human Resources.Department. During
this period Sgt. Burris was utilizing his accrual time.
June 8,2018 Police Pension Board Administrator sent Sgt. Burris requested paperwork for the
Application of Permanent Disability.
July 18,2018 Police Pension Board Administrator received paperwork fiom Sgt.Buris's
attorney, Tony Oliver.
August 1,2018 Human Resources Director,Julie Christine mailed SgL Burris the Long Term
Disability Claim Employee's Statement, Authorization to Disclose Personal Information,along
with the Long Term Disability Physician's Statement.
Office of the City Manaeer
P.O.B= 100•Edgewater,M 32132-0100
(386)424-2400 Ext. 1201 •Fax(3861424-2421
w .cnyofedgeuxrter.org
August 7,2018 Human Resources Director,Julie Christine completed the Long Term Disability
Employer's Statement and submitted to the City's Long Term Disability Carrier,Mutual of
Omaha.
August 23, 2018 Sgt. Burris had stopped by the Human Resources Department and spoke with
Brooke Appy asking questions regarding Long Term Disability (LTD) benefits. During such
conversation he had mentioned his desire to separate from "this place, specifically the police
department"because of the stress it was creating on his condition.
September 5, 2018 The Police Pension Board Attorney, Ken Harrison, received the medical
records and an Independent Medical Evaluation(IME)was set-up for October 3, 2018.
October 2, 2018 the Human Resources Director had mailed a certified letter to Sgt. Burris
describing that the twelve (12) weeks of the Family Medical Leave Act (FMLA)was exhausted
as of August 3, 2018 and that the 900 hours afforded to him in accordance with Article
11(Injuries) of the Police Benevolent Association (PBA) Collective Bargaining Agreement
(CBA)will have been exhausted as of October 9,2018.The letter further states that his physician
has reported "that you can no longer perform any duties related to law enforcement and working
in the City of Edgewater is a further harm to your health. " The letter further provided for a
separation of employment date effective October 10, 2018.
October ll, 2018 a Long Term Disability check of$2,855.83 was mailed to Sgt. Burris. The
Long Term Disability qualifying effective date was June 8, 2018. Additional monthly Long
Terre Disability payments are expected to be $2,554.33/month. Amounts may change based on
Sgt.Burris's selection of federal withholdings.
October 25, 2018 is the date that is scheduled for Sgt. Burris's remaining accruals (355 hours at
$22.84)to be cashed-out at a value of$8,108.20, before tax deductions,and will be issued to Sgt.
Burris.
October 31, 2018 is the date that Sgt. Burris city provided healthcare insurance is scheduled to
terminate. (As a supervisor employee Sgt. Burris was provided 100% employee coverage and
75% dependent coverage. He had selected Single Parent Health and Dental coverage. Health
Insurance - city cost $1,215.14/month and employee cost $$140.74/month; Dental - city cost
$50.26/month and employee cost$16.74/month)
In accordance with Ordinance 2017-0-21 Sgt. Burris may qualify for Line-of-Duty Injury Health
Insurance Benefit as outlined in Section 5.04 of the Police Pension Plan amended on June 5,
2017. As provided for in paragraph (a) Eligibility for this benefit shall be determined by the
Police Pension Board Trustees. (Ordinance attached)
From January 1, 2018 thru October 10, 2018 Sgt. Bums received absentee compensation at
$22.17/hr.from the following accounts:
Sick accruals used- 540 hours
Vacation accruals used-259.20 hours
Floating Holiday used-48 hours
Holiday-24 hours
Administrative leave - 188 hours
Office of the Citv Mana¢er
P.O.Bax 100•Edgewater,M 32132-0100
(386)424-2400 Ext. 1201•F.(3861424-2421
wtvw.cityofedgeumte norg
From January 1, 2018 thry October 10, 2018 the following accrual hours were credited to Sgt.
Burris's accrual banks:
Vacation hours- 108 hours
Sick hours-72 hours
October 15, 2018 Councilman Conroy had sent me an email expressing his concerns regarding
the separation status of SgL Burris. He had also referenced that he had sent the Mayor an email
requesting a Special Council Meeting to discuss the topic.
October 16, 2018 at the noticed Whistle Stop walkthrough progress visit with the all of the City
Council, with the exception of Councilman Conroy, I had pooled the interest of the attending
Council members regarding having the requested Special City Council meeting as it was brought
to my attention that Sgt. Burris had previously emailed all of them regarding his complaint. The
majority confirmed interest and 1 later coordinated the date of October 26, 2018 at 10:00 AM in
the City Council Chambers.
October 17, 2017 City staff has been advised by the office of the Police Pension Attorney that
the Independent Medical Evaluation had been completed by the Board appointed physician and
hard copy should have been mailed last week, although they have yet to receive them. They have
also advised that the informal hearing at which the disability application of Sgt. Bums will be
considered has not yet been set but can either take place at the Board's next regularly scheduled
meeting and/or the Board may choose to hold a special meeting once the Independent Medical
Evaluation is received and the disability record compiled.
October 17, 2018 1 telephoned the Police Benevolent Association (PBA) representative, Mike
Scudiero, to ensure he was aware of the scheduled Special Council meeting to discuss the topic
of Sgt. Burris's separation. He confirmed he was aware and had discussed such with Sgt. Bums
the previous date. He had also confirmed that he hadn't previously had conversation with Sgt
Burris regarding this subject since the June time period. I also discussed my interpretation of
Article 11 (Injuries) of the Police Benevolent Association (PBA) Collective Bargaining
Agreement (CBA) which states: "The injured employee will remain on workers' compensation
status, not to exceed six hundred (600) hours (nine hundred (900) hours for those on Platoon
System). If, as a direct result of the continuation of the disability involved, the employee is
unable to return to work at the end of this time period, the employee may petition the DCR
(Designated City Representative, shall mean the City Manager or his appointed representative)
requesting that the employee be carried beyond the established time period." Mr. Scudiero was
in agreement regarding my understanding of the not to exceed 900 hours verbiage without the
extension request of the employee. I had advised that as of this date I had not received any
extension request as afforded in the Collective Bargaining Agreement. I had also advised I didn't
believe I had a good understanding of Sgt. Burris' concemslmquests. I only understood he was
dissatisfied because he did not receive a telephone call regarding separation prior to receiving
written notice. I suggested the 3 of us (Burris, Scudiero and myself)meet in order for me to be
able to provide a reasonable and amicable recommendation to the City Council. He concurred
and later called me back confirming a meeting time for October 18, 2018 at 10:30 AM.
Office of the City Manaeer
P.O.Box 100.Edgeweteq n 32132-0100
(386)424-2400 EM. 1201 .F.)386)424-2421
u,ww catyofedgewater.org
October 18, 2018 I met with Sgt. Burris and Mike Scudiero in my office. I understood Sgt
Burris's concerns to be in which the way the process was handled. His major concern was the
fact he thought he would be permitted to exhaust all of his accruals before being separated.
During such discussion he did acknowledge.the provision within Article 11 of the Collective
Bargaining Agreement was his responsibility but had wished it was specifically pointed out to
him during the process. It was also expressed he should have been given more notice of the
impending separation date with a face-to-face conversation versus receiving a certified letter a
couple of days prior to the separation date. I recognized his concerns and concurred there was
opportunity to do better with future similar occurrences. We discussed a good corrective action
would be to bring the employee in approximately 30-days prior to separation date and walk them
through as to what to expect. This would allow the employee ample time to address any
additional insurance transitions. He also suggested management could improve with more caring
follow-up during the period of absence.
His request was to have his insurance, as he will receive it upon eligibility confirmation by the
Police Pension Board, continued beyond his separation date and until such time the Police
Pension Board either confirms or denies eligibility. He expressed his intent with bringing his
experience to the attention of the city administration and City Council was to help improve the
process going forward. We discussed the opportunity in having the Collective Bargaining Unit as
well as the City Council to consider a Memorandum of Understanding(MOU)that would amend
Article l l (Injuries) of the Collective Bargaining Agreement. The amendment would address the
gap regarding insurance coverage between the time the disabled employee is separated from
employment and the time the Police Pension Board of Trustees evaluates benefit eligibility. It
was discussed to possibly consider a maximum of a 90-day period the employee would continue
insurance coverage, as they would receive it upon eligibility confirmation by the Police Pension
Board.
Upon conclusion of the meeting it was agreed that I would recommend to the City Council that
we continue his insurance coverage, as he will receive it upon eligibility confirmation by the
Police Pension Board, until such time the Police Pension Board Trustees considers his benefit
eligibility. It was also agreed that I would discuss with the City Council their interest in
considering an MOU to address the gap in coverage between employment separation and benefit
eligibility with the Police Pension Board Trustees.
I had provided both Sgt. Burris and Mr. Scudiero a draft copy of this memorandum for their
review. I had agreed to consider any recommendations and/or amendments before the memo is
finalized and distributed. It was also discussed if I was to individually receive authorization from
the majority of City Council members to authorize me to continue his healthcare insurance, as he
will receive it upon eligibility confirmation by the Police Pension Board, would he want for the
City Council to continue the Special meeting if the majority of the Council wishes to cancel. I
also advised him if such occurred I would affirm such decision regarding his healthcare
insurance under my report at the November 12, 2018 regularly scheduled City Council meeting
in order to have it on record. I advised him that I did not want that decision at this meeting but
rather for him and Mr. Scudiero discuss as well as review my memo and report get back with me.
Later this aftemoon Mr. Scudiero reported they were comfortable with contents of the
memorandum.
Office of the Cin Maria¢er
P.O.Box 100•Edgewater,FL 32132-0100
(386)424-2400 B . 1201 •Fax 1386)424-2421
www.cityofedgewater.org
DATE:
TO: INJURED EMPLOYEE
FROM:- HUMAN RESOURCES DEPARTMENT
SUBJECT: SCHEDULED DOCTOR'SAPPOINTMENTS
It is imperative that you notify the Personnel Department of yourdoctor's appointments
andobtaina Work Status Report form from us to take 10 Your doctor each time you visit
them.
You may not return to work until you have personally .given this- informationto the
Human Resources Departmeh^.;.(Per the. WorkersCompensation Statute) For.those of
you who work schedules outside of Monday thru Priday;_please.contact us by phone to
disouss the results of your doctor's appointments. We will then.be.updated as to your
.status and will be able to-answer any questions from your:departments.or the workers
.compensation carrier, if needed,
Physical therapy: If you are scheduled by a physician to undergo:physical therapy, you:
should be given:a schedule We also need a copy of this schedule to coordinate the needs -and answer any questions:fromyour supervisors,etc.
Injured Employee
Date
Pt%nFMn.DIiY.IHlMCM
FAXaYK 424-24 4 ISU
(386)YPD-2dd0 •FAX:x3861 d2A20]4 SU(386) 383-105
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Julie Christine
From: Adam Burris
Sent: Wednesday, May 30, 2018 1008 PM
To: Julie Christine
Cc: Joe Mahoney
Subject: FMLA Questions
Julie,
After reviewing the paperwork you provided me for FMLA you have my start date of FMLA as being 4/13/18.That is the
day I notified my supervisor of the incident.On the 4/13 1 was placed on admin leave by the Chief. On May 7th I was
cleared by my psychologist to go back to work with no restrictions. I continued to work full duty for the next 3 weeks
and on 5/24/18 is when my doctor restricted me to light duty.Since I am on restricted duty per my doctors orders I
believe my FMLA should be starting on 5/24/18 not 4/13/18.
Can you please clarify in writing the start date of my FMLA in accordance to our contract?Is FMLA put on hold for those
3 weeks I was back to work?Does FMLA go by 12 weeks or by hours being out?Thank you.
Adam Burris
Sent from my iPad
[City Websitej<htto://www.edgewaterfl.gov> [Facebook]<h"Ps://www.fambook.com/CityofEdgewate ]Twitter]
<https://twitter.com/citvofedgewater> [Youiube]
<h"ps://www.youtube.com/channel/UCI rOuHACBVuoYf2slPWXkw> INewsletterj
<htto://www.citvofLdgewater.org/how-do-i/receive-ema I-notification [Mobile App]
<http://cportal.opemtionslob.com/mobile/?appmde=edgewaterfl>
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City oGEWAT
ERR
June 5,2018
Adam Burris
HAND DELIVERED
RE: Modified Duty
Dear Mr.Burris:
Please accept this correspondence as notice of our intent to offer you a modified duty job position
beginning on Wednesday,June 6,2018. On that date please reportto Division Chief,Jeff Ladscy at Fire
Station 55, 1605 S.Ridgewood Avenue to begin your temporary modified duty position in the Code
Enforcement Division.It is our intent that your work shift will start at 8:00 a.m.and end at 4:50 p.m.
Monday-Friday,wmking a 42 hour work week.
We are aware of yourjob restrictions of administrative duties only,no road patrol and no life/death
decisions as assigned by Dr.Michael Hoffman. Please be advised the aforementioned light duty job shall
be within those restrictions. If for some reason you believe this position is not within those restrictions
either now or after returning to work please immediately contact Julie Christine,Human Resources
Director at 386424-2400,extension#1701.
If you do not intend to accept this position or if you have any questions,issues or problems with respect
to this temporary modified dutyjob offer,please notify the Human Resources department immediately.
Sincerely,
r, ..
��� ( r�a�Y -e.
Julie Christine
Human Resources Director
Haman Rer..DeparrmeN
104 North Riverside Drive
086)424-2460 Eat.#1701 Fax f386),(24-2474
www.riYofedg—w org
(386)424-2474(fox)
Notice: Under Florida law, a-mail addresses are public records. 17 you do not want your e-mail address
released in response to a public-records request, do not send electronic mail to this entity. Instead,
contact this office by phone or in writing,
From:Joe Mahoney
Sent:Thursday,lune 07, 2018 9:37 PM
To:Julie Christine; Brooke Appy;Tonya Vanek
Cc: Michelle Grenham; Dave Arden
Subject: Fwd: Full Pay
Please see below request.
Sent from my Whone
Begin forwarded message:
From: Adam Burris<aburtis(a�CITYOFEDGEWATER ORG>
Date: June 7,2018 at 9:14:14 PM EDT
To: Joe Mahoney<imahoneyRCITYOFEDGEWATER.ORG>
Subject: Full Pay
Captain Mahoney,
Since I'm back to no work and have to use my sickivacation time, can you make
sure my pay goes back to my normal rate of$22.17 an how. Thank you.
Adam
Get Outlook for iOS
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October 2,2018 ED G E WAT
ri,,,:,�a L'R CERTIFIED MAIL
Adam Burris
Re:Workers Compensation Leave/FMLA
Dear Mr. Burris:
I must inform you that your twelve weeks with the Family Medical Leave Act was exhausted on August 3,2018 and
has been extended beyond the limit.Also, in accordance with Article 1 I of the PBA bargaining agreement your 900
hours of workers' compensation status will have been exhausted on October 9,2018.Your work status provided by
Dr.Michael HOffinan,PHD states that you can no longer perform any duties related to law enforcement and working
in the City ofEdgewater is a further harm to your health.As such,your absence and inability to return to work creates
a hardship on the City of Edgewater's operations and I must provide you this notification that we shall separate your
employment with the City of Edgewater,effective October 10,2018.
On August 1,2018,J submitted your Employer's Long Tenn Disability claim form to Mutual of Omaha,ourdisability
carrier, along with all of the required employer's documentation and information Mumal of Omaha requested.The
employer's portion is completed; however,your claim is still awaiting medical records from your Physician. When
those forms are received, Mutual of Omaha will advise you of your eligibility for benefits or any additional
information that may be required.
Even though you will no longer be eligible for coverage on the City of Edgewater's group health and dental plan after
October 31,2018,you may choose to continue your current family coverage under COBRA.You will be receiving a
separate letter from Cobra Point(City's Cobra Vendor)which will explain your cobra continuation rights and the cost
for purchasing COBRA for both medical and dental coverage.
Additionally,please find enclosed the Conrversion of Group Life Benefits to an Individual Policy(life)forms. Ifyou
wish to continue your life insurance coverage,you have thirty-one(3 1)days from the date of your separation to return
this paperwork along with your premium to Mutual of Omaha.
It is also very important that you contact the Human Resources Department for any outstanding benefns/obligations
You have with the City prior to October 15, 2018.
If you have any questions,or if I can be of any assistance, please do not hesitate to contact me.
Sincerely,
C�Ltttl .
Julie Christine
Human Resources Director
Enclosures
Ra..Resources Depannreaf
104Nnrfh Rivelsi&Drive j
(386)424-2400 F.V.#1701 F"(386)424-2474 t
i
Life Conversion Coverage
LIFE GOES ON WITH GROUP CONVERSION
Your group life insurance has been valuable protection for you and your family. Now that it will be terminated,you may
wish to convert this important coverage to an individual policy. This information has been prepared to help you take
advantage of your right to continue your protection.
ABOUT LIFE CONVERSION COVERAGE
Life Conversion Coverage is individual permanent life insurance issued without evidence of insurability.
Life Conversion Coverage can be obtained when your life insurance under the group policy ends.Your group certificate
Will describe when conversion coverage is available to you,and will show the amount of coverage you can COMM
Conversion coverage will be issued without evidence of good health,provided
(a) you complete the attached application,
(b) you enclose a check or money order for the first premium payment and
(c) these items we forwarded to us within 31 days after your group insurance ends.
Your conversion policy will be effective on the 31st day after your group insurance ends.During this 31-da period,you
remain covered under the continued coverage provision of y l
YO group certificate.
You may apply for an amount that is not more than the amount of your current group insurance coverage(this is your
maximum).You may elect coverage in$1,000 increments UP to your maximum.
Theindividual policy is WhOle Life Express Insurance,which provides a level benefit throughout your lifetime.Premiums
for this coverage are payable while living until the policy anniversary following age 95.
Premium rates are shown in the table that follows.If premium payments are discontinued,you may:
(a) receive any existing cash value or
(b) use the cash value to purchase extended term insurance ora reduced amount of paid-up life insurance.
For additional information or premium rates on conversion coverage,please write or call us at
Atm: Group Policy Services,Group Conversion
United of Omaha Life Insurance Company
Mutual of Omaha Plaza
Omaha,Nebraska 68175
Phone: 1-800-876-8054
TO APPLY FOR LIFE CONVERSION COVERAGE
In order to apply for life Cmwmion coverage,you must do the following:
1) Complete the Life Conversion Application that follows.Use black or blue ink,or a typewriter.Write dearly and do not
erase-any corrections should be crossed out and initialed by you.Answer each question fully-do not use dashes or
ditto marks.
2) Slake sure the section mulled"Information to be Completed by the Personnel Office"is completed by the employer or
administrator of the group policy.
3) Attach your check or money order payable to United of Omaha Life Insurance Company for the first annual or
semiannual premium payment.
4) Send your premium payment and completed application to the above address within 31 days after your group
insurance ends.
Primey Notice:When United of Omaha Life Insurance ComPmry evaluates an application forlif conversion caverage,only the information
on the appNcaa"u oniewed.Thu Ifatio
normn,and other information we may Tater rolled to adminuter ,weragg maysomdim.be
duciosed without your express authorisation.We haven procedure which allows you re review and amend any information we collect about
Wu-other than information relating to a claim,lawsuit or criminal proceeding.ff you would like to know more about our information
p attire's pleuse write us at the address shown above.
MUGC9173_0314
CALCULATING THE PREMIUM
The premium amounts in the table below are per$1,000 of coverage. Calculate your annual and/or semiannual premium
in the calculation worksheet,following the steps and example belmv.
To Calculate annual and swniannual premium:
1) Divide your desired death benefit amount by 1,000.
2) locate your age group and gender on the table below to identify the premium rate per thousand.
3) Multiply#1 by#2 above.
4) Add$36 for the annual policy fee to obtain the annual premium for the coverage.
5) Multiply the annual premium by.52 to obtain the semiannual premium for the coverage.
°-4 $6.80
$6.10
5-9 $7.70
$6.90
10-14 $8.80
$7.80
15-19 $10.00
$9.00
20-24 $17.00
$12.50
25-29 $21.00
3034 $15.00
$25.00 $17.50
35-39 $30.00
40-44 $20.50
$35.00 $2400
45-49 $41.00
50-54 $30.00
$46.00 $33.00
55-59 $58.00
60-64 $40.00
58000 $51,00
6.5-69 $111.00
70-74 $72.
$154.00 $108..0
00
75-79 $196.00
80 84 $149.00
$238.00 $198.00
85 $304.00
$255.00
LIS956.00
A eumea a 50-year-old male with current group life coverage of$201000.)
0 % $46.00 = $920.00 + $36�avwuoVrl,(apthoa d - $956.00
n vcwuyw TaWawuatpremlmn z 52 = $497.12e m lbulremiav,ualprma,m
LulationWorksheet
% + $36% .52
nnual aremu Toblrpaianavd premimn
Conversion Application
tY,aa,0�
This application must be completed and mailed within 31 days after your group insurance ends. Mail the co
Life
Arm: Group Policy Services,Group Conversion,United of OmahaInsurance nversion to:
Company,Mutual of Omaha plaza,
Nebraska 68175.
LIFE INSURANCE SECTION
1 Applicant's Name(First,Middle,Last)
7 Home Phone Number
2 Social Security Number 8 Amount oflnsuranceS
(Show amount in thousands,not greater than the
amount you are entitled to comer[.)
3 Male❑ Female❑ 9 Mode of Premium Payments
Annually ❑Semiannually
4 `28e— 5 Date of Birth
Mo. Day Yr. 10 Amount Paid with Application
6 Residence(Number,Street,City,State,ZIP) $
11 Beneficiary(Give full name and relationship to applicant)
Primary
Contingent
Payment will be shared equally by all primary beneficiaries who survive you.if none,it will be shared equally by all
contingent beneficiaries who survive you. Unless otherwise stated,you have the right to change the beneficiary.
GROUP INFORMATION SECTION
1 Group Policyholder
2 I have been insured under the above Group policyas: ❑An em to Group policy
p pee or member ❑A depp
endent
3 I became insured under the Group Policy:
4 My group insurance terminated: Month Day Year
5 Was termination due to disability? ❑yes ❑No Month Day Year
(If'Yes."we dare and cause of disab0ity.)
LIFE AGREEMENTS SECTION
I am applying to United of Omaha for the life conversion coverage shown above.I agree United win not be under any
obhgation or liability under this application unless:
(1) 1 have the right to convert the insurance shown above.
(2) The application is made within 31 days after my group insurance ends.
Date State signed in
Appl¢ant 5 Signature
Whole Life Express Policy Form 6879L-0202,orstate equivalent.In OK,6918L-0202.In OR,6949L-0202.In TX,6920L-0202.
13540682
INFORMATION TO BE COMPLETED BY THE PERSONNEL OFFICE
Group Policyholder 7 i n
Policy No.
t
Address(Number,Street,City,State,Z[p)
Appli=Cs Name
Certificate No. N
] The Applicant was insured under the above Group policy as:
2 ArlAn employee or member ❑A dependent
For what amount of coverage was the Applicant insured? g o c
3 Whatisthe Appiicavt'sdateofbirth? .p3
Month en 4-)_79,Year
9 When did the Applicant become insured under the Group Policy? i � Month 5 The Applicant's coveragewas; —Day k---Year
Wterminated on 1 D Month 31 Day ',p i g year
❑reducedby $ on
Because of G �,..��y J,.s * Month Day Year
Completed by
Signature(Employer or Administrator)
Title V
Date 1 O Z �!
ARTICLE 11
INJURIES
Duty Related Iniu"
An employee who is temporarily disabled in the line of duty shall be permitted to take
compensated leave in addition to workers' compensation benefits for the period of his disability;
however, in no case shall the total amount paid for both workers' compensation and
compensated leave exceed the amount of wages to which the employee would have been entitled
had the injury not occurred, subject,however,to compliance with all of the following conditions:
A. The disability must have resulted from an injury or an illness directly related to or
sustained in the performance of the employee's work. The City's determination as to whether the
disability is work related shall be governed by the provisions of Chapter 440,Florida Statutes.
B. The DCR, in his discretion, may utilize the services of a physician to determine
whether an employee claiming a disability is physically and/or mentally able to continue
working or to return to work.
C. The injured employee will remain on workers' compensation status, not to exceed
six hundred (600) hours (nine hundred (900) hours for those on Platoon System). If, as a direct
result of the continuation of the disability involved, the employee is unable to return to work at
the end of this time period,the employee may petition the DCR requesting that the employee be
carried beyond the established time period.
D. The City agrees that any employee injured on the job or who suffers ajob related
illness shall be paid for a full day if his treating physician advises that he could not or should not
return to work.
22
PBA Agreement 10/t/2017—9/30/2019-ADOPTED—11/13/17
Non-Duty Related Iniury
In the event the DCF, in consultation with the Police Chief, determines that a non-duty
related disability exists,the following shall apply:
A. If the disability can be corrected, the DCR, in consultation with the Police Chief,
may permit the employee to continue with his normal duties, reassign the employee to other
duties with the Police Department, or temporarily remove the employee from City service.
Should the employee be temporarily removed from City service during the period of time
specified for correction of his disability, the employee may utilize his sick leave, vacation leave
or request a leave of absence without pay for the correction period.
B. If the disability cannot be corrected, the DCR in consultation with the Police
Chief, will attempt to place the employee in another City position, which in DCWs discretion,
the employee can perform satisfactorily. Nothing herein shall require the DCR to create a
position for the employee. If the DCR determines that the employee cannot be placed in another
position, the employee chooses not to accept the position offered, or the DCR in consultation
with the Department Head involved determines that the employee is not satisfactorily performing
in the new position, then the employee shall be afforded an opportunity to resign thereby
retaining any benefits to which he would otherwise be entitled.
23
PBA Agreement 10/1/2017—9/30/2019-ADOPTED— 11/13/17
ORDINANCE NO. 2017-0-21
AN ORDINANCE OF THE CITY COUNCIL OF EDGEWATER.
FLORIDA, AMENDING THE CITY OF EDGEWATER, FLORIDA
POLICE OFFICERS' PENSION PLAN TO PROVIDE FOR A PUBLIC
SAFETY LINE OF DUTY INJURY INSURANCE BENEFIT FOR POLICE
OFFICERS; PROVIDING FOR REPEAL OF LAWS IN CONFLICT;
PROVIDING FOR SEVERABILITY; PROVIDING FOR CODIFICATION;
AND PROVIDING FOR AN EFFECTIVE.DATE..
WHEREAS, Chapter 112 provides for a health insurance benefit for certain public safety
employees who become permanently disabled after suffering a catastrophic injury while in fresh
pursuit;and
WHEREAS, the City of Edgewater wishes to provide a similar health insurance benefit
to police officers who become permanently disabled due to an injury incurred in the line of duty,
but who do not qualify for a benefit under Chapter 112 for a permanent disability that results
from a catastrophic injury suffered while in fresh pursuit; and
WHEREAS,the City Council has received,reviewed, and considered an actuarial impact
statement describing the actual impact of the amendments provided for herein;
NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF THE
CITY OF EDGEWATER FLORIDA,THAT:
Section 1. Section 5.04 is hereby created and shall read as follows:
Section 5.04—Line-of-Duty Iniary Health Insurance Benefit
(a) Eligibility. The City of Edgewater shall continue health insurance coverage for
any Police Officer who has five or more years of credited service under the City
of Edgewater Police Officers' Pension Food, and who, on or after January 1,
1995, suffers an injury in the line of duty that would qualify him or her for a
Service Incurred Disability within the meaning of section 5.03 of this Plan. A
Police Officer who suffers a catastrophic injury while in fresh pursuit within the
meaning of section 112.19(h), Florida Statutes, shall not be entitled to the
I
SwEe-Hseugh passages are deleted.
Underlined passages are added.
#2017-0-21 -CLEAN
benefit described in this section 5.04 but instead shall be entitled to the benefit
described in section 112.19(h), Florida Statutes. This benefit shall apply only to
an injury that occurred while on duty and while the Police Officer is acting
within the scope of employment. The Police Officer shall not be eligible for this
benefit for an injury sustained in connection with any unlawful acts or any
activities not related to a law enforcement assignment. Eligibility for this benefit
shall be determined by the Board of Trustees. Eligibility shall cease if the Board
of Trustees finds that the Police Officer receiving a disability retirement is no
longer disabled. in which event the Board of Trustees shall notify the City.
Eligibility shall cease when a disabled Police Officer reaches age 65. If after
reaching age 65 a disabled Police Officer is not eligible for Social Security
benefits under 42 U.S.C. § 402 or 423, the City shall provide supplemental
insurance or premium reimbursements in a manner equivalent to those benefits
that the Police Officer would have received if he or she were eligible for Social
Security benefits. Any fact or circumstance that would disqualify a Police
Officer from receiving a benefit under section 5.03 of the Plan shall likewise
disqualify the Police Officer from receiving a benefit under this section 5.04.
(b) Amount. The health insurance provided under this section 5.04 shall be equal to
that coverage as provided to the City's current active employees and may only
be amended if such plan is amended for all current employees or as otherwise
amendable in accordance with this section.
(c) Offsets. Health insurance benefits or reimbursements payable from any policy,
plan, settlement,judgment, private or public benefit, worker's compensation, or
any other source shall reduce the benefits payable under this section.
(d) Fraud. It is unlawful for a person to willfully and knowingly make, or cause to
be made, or to assist, conspire with, or urge another to make, or cause to be
made, my false, fraudulent, or misleading oral or written statement to obtain
this health insurance coverage. In addition to any applicable criminal penalty,
upon conviction for a violation as described in this subsection (d), a Police
Officer or other beneficiary who receives or seeks to receive health insurance
benefits under this section shall forfeit the right to receive such health insurance
benefits and shall reimburse the City for all benefits paid due to the fraud or
other prohibited activity. For purposes of this subsection, "conviction" means a
determination of guilt that is the result of a plea or trial, regardless whether
adjudication is withheld.
PART B. If any section, subsection, clause, phrase, sentence or porton of this
Ordinance is for any reason declared by a court of competent jurisdiction to be invalid, such
2
Sadie passages are deleted.
Underlined passages are added.
42017-0-21 -CLEAN
decision shall be deemed a separate, distinct and independent provision and such holding shall
not affect the validity of the remaining portions hereof.
PART C. All sections or parts of sections of the Code of Ordinances, all ordinances
or parts of ordinances, and all resolutions or parts of resolutions, in conflict herewith be and the
same,are hereby repealed to the extent of such conflict.
PART D. 11 is the intention of the City Council that the provisions of this Ordinance
shall be come and be made a part of the Code of Ordinances of Edgewater. Florida, and that the
sections of this ordinance may be renumbered or relettered and the word "Ordinance' may be
changed to"Chapter,""Section,""Article," or such other appropriate word or phrase, the use of
which shall accomplish the intention herein expressed.
PART E. EFFECTIVE DATE.
This Ordinance shall take place upon adoption.
PART F. ADOPTION.
After Motion to approve by Councilman Blazi and Second by Councilwoman Vogt.the
vote on fust reading of this ordinance which was held on May 1,2017 was as follows:
AYE NAY
Mayor Mike Ignasiak x
Councilwoman Christine Power x
Councilwoman Amy Vogt x
Councilman Dan Blazi x
Councilman Gary Conroy X
3
SBJce-Weagb passages are deleted.
Underline d passages are added.
N2017b21 -CLEAN
After Motion to approve by Cna __ and
Second by 6z- - .�ta� the vote on second
reading/public hearing of this ordinance which was held on
u 2017 was as follows:
AVE NAY
Mayor Mike Ignasiak �a
Councilwoman Christine Power
Councilwoman Amy Vogt
Colmcilman Dan Blazi
Councilman Gary Conroy
PASSED AND DULY ADOPTED this S� day of
�x-e� . 2017.
ATTEST: CITY COUNCIL OF THE
CITY OF EDGEWATW FLORIDA
�T 'r By:
Rabin L Matasick Mike Ignasia
City Clerk/Paralegal Mayor
For ,rhe use and reliance Omy by the City of Edgewater, Approved by the City Council of the City of Edgewater.
Florida. Approved as to form and legality by: Florida during me CiV Council mining held on
Aaron R.Wolfe. Esquire this $e day of , 2017 tmder
City Attorney Agendaltem#8�j(_.
Doran.Sims Wolfe.&Clacchmi �l
S
SeiketMoagh passages are deleted.
Underlined passages are added.
#2017-0-21 -CLEAN
@ 1:43—Conroy:"Point of order please Mr.Mayor sir point of order I would like to include the public
today if they would like to have some comments after the council comments if we can get a consensus
of the council to allow that'
@ 1:57—All Council:Okay with that
@2:11-Barlow: Discussed the situation with Sgt. Burris
@
@1:29:22—Conroy:"Add to that motion that we will also work on something we missed it and your
right it's an every revolving ordinance that when an officer gets disabled whoever he has on the
insurance at the time we should carry that too.But that's a conversation for a different time. So my
motion would be just to reinstate Sgt.Burris until the pension board makes a determination on his
disability the full time back pay benefits.
@1:29:45—Barlow: "so the motion is to reinstate Sgt. Burris back on payroll I'm assuming current grade
and as well as his seniority'
@1:30:05—Conroy: "back pay if he has missed anything"
@1:30:10—Barlow:"and we've cashed out the accruals so id assume wed start the accruals over and
now I believe his position has already been filled you don't want me to undo that leave that alone I'm
assuming correct? Lets not harm ... -
@1:30:31—O'Keefe:"You're going to pay him as a Sgt.though."
@1:30:35—Barlow:"Yes that's his current grade yeah yes ma'am so current grade with back pay and
start his accruals and then reinstate him with his insurance coverage as a Sgt. receives 100%employees
and 75%of the dependents he had listed at the time of separation okay and then is there the time
period would extend until he ... -
@1:30:57—O'Keefe:"is approved"
@1:30:59—Barlow:"receives his eligibility disability hearing or until those benefits?"
@1:31:04—O'Keefe: "until those benefits"
@1:31:04—Conroy:"until the benefits kick in"
@1:31:06—Barlow:"okay just want to make sure understood"
@1:31:37—Conroy: "I would like to make a motion that we terminate the employment of our city
manager Tracey Barlow"
@1:31:41—O'Keefe: "SECOND"
@1:31:42—Barlow: "let me walk you through that okay'
@1:31:45—Conroy:"you don't have to talk sir we have a motion and you don't have the right to
interrupt"
@1:31:48—Barlow: "Excuse me Mayor'
@1:31:52—Con my:"you don't have the right this is a council action"
@1:31:52—Mayor. "This is a discussion"
@1:31:53—Conroy: "Not with him with the council motions made there's a second"
@1:31:57—Mayor:"I knew this was coming we have a motion by Councilman Conroy official record to
terminate do we have a reason for termination of the city manager other than you dont like him?
@1:32:11—Conroy: "see this is a personal attack from you do you want me to give you the laundry list"
@1:31:18—Mayor:"yes I want to get it on record"
@1:32:21—Conroy:"His refusal to give me information his verbiage to me is disrespectful for who his
employer is and I've made time and time again I'm on the record what how he helped Steve Cousins on
the payroll for 5 months I can make a list for you next meeting"
Reinstate Sgt Burris on the payroll and the insurance & I would like to add to that motion that
when an officer gets disabled whoever he has on insurance at the time we should care that too
So my motion is to
Reinstate Sgt Burris until the Pension Bond makes a determination on his disability with full
time back pay benefits
CM lets make clear - motion is to reinstate Sgt Burris back on payroll (I am assuming current
grade& as well as his seniority)
Conroy-backpay if he has missed any pay
CM -we have cashed out the accruals so I assume we would start the accruals over
Megan-immediately-today
CM - I believe his position has already been filled - you don't want me to undo that, leave that
alone-I am assuming, correct?
Megan-we are going to pay him as a Sgt though
CM that is current grade with back pay & start his accruals & then reinstate him with his
insurance coverage of as a Sgt received 100% employee/75% dependents he had listed at the
time of separation
CM the time period would extend until he receives his eligibility disability in hearing or until
those benefits
Megan -until those benefits
Conroy-until the benefits kick in
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- 10/25/2018
Special
Sgt.Adam Burris Separation Procedure
October
. • • AM
7Fanmily Medical Leave Act
vered employees to be provided up to 12 weeks of
protected leave to eligible employees for the
asons:
acity due to pregnancy, prenatal medical care or
child birth;
• To care for the employee's child after birth, or placement
for adoption of foster care;
• To care for the employee's spouse, son, daughter or
parent, who has to serious health condition;
• For a serious health condition that makes the employee
unable to perform the employee's job.
1
1t
10/25/2018 ' -
- -
7G..-eral �ployees
Medical Leave Act
2 weeks x 40 hours) = 480 hours
weeks x 42 hours) = 504 hours
• Fire employees (12 weeks x 56 hours) =672 hours
The Human Resources Department completed all documents
associated under the FMLA:
• Calendar Year 2016 -21 FMLA entitlements
• Calendar Year 2017 - 24 FMLA entitlements
• Calendar Year 2018 - 20 FMLA entitlements
• 11 FMLA Separation of Employments in the <36 months
(4-1'Mice arld y-General)
EDG WwTEp
on
7�d�b�,
llective Bargaining Agreement
AIYI'ICL6 I L IarJul�sl
en ho isho u temporarily tlixk- N the line of duty shall be permined to take
n Mahe a additionm work..'cpm tion benno cox shall Neental amountpep f boNworkars'compenaui m and
d Mahe exceed ms amount of wagea to which Ne emVloye W have been entitled
ry na occuwN ellofNefollowingconditions:
. bi bikty must Mahe msWted from an injury m an intro.dir.tly related to or
etau••N m Ihesonormance of the employee'a work. The Cu,a determination as to whether
Ne disability is smoic related shall be governed by the pnviaimw of Chapmr 440,Mrida
Statutes.
• M 7m DCR,in his disam an,may utilise the services of a ph iciaa 1.determine wfierher an
rerirnym wol rk.�a disabihty is physically mai/or mentalty able to continue working or to
• C.The injured ma'"will remain on workers'camPenation sNWa,no[m exceed six
hurMred 900)Noun more hundred 19001 hours(or Ihox on piamon nastem).If,ae a d'nett
reaWt of 9.00)
m the disability involved,the sm,V!,is u able m retmn m work
at the mod of Nie time period,the empplq a may petition Ne OCCR requesting that the
emPbyee be cemed bryond Ne established time period.
• D.The City a�eea that any empbyee mjurcd on Ne' b m who auRen a job rtleled iMeas
shall be paid for a full day d his naming phyvcian advr'aea that he could not or sho m not
return m wmk.
EDL WArpt
2
10/25/201.8
gllective Bargaining Agreement
ARTICLE 11 (INJURIES)
Duty Related Iniury
• C. The injured employee will remain on workers'
compensation status, not to exceed six hundred
(600) hours (nine hundred 19001 hours for those
on Platoon Systeml. If, as a direct result of the
continuation of the disability involved, the employee
is unable to return to work at the end of this time
period, the employee may petition the *DCR
requesting that the employee be carried beyond
the established time period.
*Designated City Representative
Erg .EEa
8 `—
EVENT PROCESS
• Sgt. Adam Bums a 6 year Police Officer (2 as a Sgt.)
• OfTicer Involved Shooting January 1, 2018
• January 2rd-6t° Paid Admin. Leave for Evaluation
• April 13� - Reported to Capt. Mahoney and HR of concerns
• April 13d'- May 7'^ Paid Administrative Leave
• May 7th-Sgt. Bums released to work without restrictions
• May 25•'- Restricted to administrative duties by doctor
ErG *TEN
3
10/25/2018
EVENT PROCESS
• May 29s -HR Director provided FMLA paperwork and
discussed modified duty options
• May 30th -Restricted duty `cannot make critical decisions
as required of a law enforcement officer"
• June 50 -Offered position in code enforcement
• June 60 -7' -Worked in code enforcement
• June 7e -Discontinued working in code enforcement
iuorking in the city of Edgewater acerbated his condition".
Physician restricted him from performing any work.
Eoc w�rtq
EVENT PROCESS
• June 8� - Oct. 9t° -Accrual time used
• Oct. 100'- Separation Date
• Oct. l lr'- Long Term Disability (LTD( check of$2,855.83
was mailed.
• Additional monthly LTD monthly payments will be
$2,554.33/month
• LTD will continue until July 12, 2020 (provided Sgt. Burris
is medically supported)
ea w�r�
4
• 10/25/2018
EVENT PROCESS
• Oct. 251—Accrual check issued for$8,108.20 (before taxes)
for 355 bra. of remaining accrual time at $22.84/hr.
• Oct. 31°t— Sgt. Burris healthcare coverage is scheduled to
terminate (As a supervisor employee Sgt. Burris was provided 100%
employee coverage and 75%dependent coverage. He had selected Single
Parent Health and Dental coverage. Health Insurance-city cost
$1,215.14/month and employee cost$140.74/month;Dental-city cost
$50.26/month and employee cost$16.74/month(
Eoceawr„ �
7EVENT PROCESS
From uary 1, 2018 thru October 10, 2018 Sgt. Burris
bsentee compensation at $22.17/hr. from the
ccounts:
o Sick accruals used - 540 hours
o Vacation accruals used - 259.20 hours
o Floating Holiday used - 48 hours
o Holiday- 24 hours
o Administrative leave - 188 hours
• 7be following accrual hours were credited to Sgt. Burris's
accrual banks during the same time period:
o Vacation hours- 108 hours
D Sick hours- 72 hours
EOG ATFR
5
10/25/2018
7HRD�EPARTMENT CONTACTS
stine-report non-physical injury
tine- discuss modified duty
• May 31st-J. Christine via phone to explain FMLA
• June 5" - J. Christine-offered code enforcement job
• Aug. Pt-J. Christine mailed LTD paperwork to him
• Aug 2V-B. Appy- questioned regarding LTD benefits. J.
Christine was at an HR Conference.
EDGE WPTEA
7HRDEPAIRTMENT CONTACTS
ne mailed certified letter explaining
xhausted and separation will be Oct.
los'
• Oct. l 1s -J. Christine and B. Appy both met with him to
complete separation paperwork
• Oct. 18s -CM met with Sgt. Burris and Mr. Scudiero to
discuss his concerns and desires.
EpG W.EiEP
6
10/25/2018
CONCERNS AND DESIRES
Concerns:
o The way his process was handled;
o length of notice before separation date;
o face-to-face separation;
o more caring from administration during period of absence.
Desires:
o To have his insurance, as he will receive it upon eligibility
confirmation by the Police Pension Board, continued
beyond his separation date and until such time the Police
Pension Board either confirms or denies eligibility.
EDL WATEq
Questions/Di rection?