HomeMy WebLinkAbout106.020 - FC-17, Employee's Claim for Workers' Compensation Benefits
Fresno City Fire Department
100 Administrative Manual
SECTION 106.020 (FC-17, EMPLOYEE’S CLAIM FOR WORKERS’
COMPENSATION BENEFITS)
PURPOSE
This policy ensures proper documentation of all injuries sustained during the course
of employment with the City of Fresno Fire Department.
APPLICATION
The Employee's Claim for Workers' Compensation Benefits form is for members
seeking medical treatment or hospitalization due to on-the-job injury or illness from
industrial causes.
OPERATIONAL POLICY
The Employee's Claim for Workers' Compensation Benefits form shall be completed
whenever a member seeks medical treatment or hospitalization and submitted to the
Safety and Wellness Officer as soon as possible after an injury has occurred or no
later than the end of the day or shift in which the injury occurred.
OPERATIONAL GUIDELINE
It is the responsibility of the company officer or the immediate supervisor to provide
this claim form to the member seeking medical treatment or hospitalization within one
day of the injury.
It is the responsibility of the member to complete the top section of the form (titled
EMPLOYEE) and return it to the company officer or supervisor immediately.
It is the responsibility of the company officeror direct supervisor to provide the member
with a copy of the form with the EMPLOYEE section completed and signed. The
company officer or direct supervisor should complete the bottom section of the form
(titled EMPLOYER) and ensure the form is submitted to the Safety and Wellness
Officer at Headquarters prior to the end of the shift in which the injury occurred.
Effective Date: June 2008 Paul Garnier, Captain Current Revision Date: 09/13/2022 Section 106.020
Next Revision (2) Date: 09/13/2027 Page 1 of 7
PROCESS
Company officers should use the Department’s Record Management System (RMS)
for workers' compensation related entries. A completed Workers’ Compensation
Benefits form (FC -17) will be automatically generated and emailed to the injured
worker upon the supervisor’s completion of the FC -06 in the RMS when indication that
medical treatment at a health care facility for on-the-job injury or illness is needed.
The Supervisor's Report of Injury (FC -6), Medical Service Order (MSO)/Occupational
Health Provider’s List (FC -11), and the Employee’s Claim for Workers’ Compensation
Benefits form (FC -17) must all be submitted to the Safety and Wellness Officer at
headquarters prior to the end of the shift in which the injury occurred.
Note: Forms shall be submitted through the RMS prior to the end of
the shift in which the injury occurred. In the event this option is
not available, forms may be accessed through the File Center /
Forms, in Vector Solutions. The completed forms may be
scanned and sent electronically, or hand delivered to the Safety
and Wellness Office at Headquarters.
Brief instructions are contained on the form.
The member is to complete the top section of the form labeled EMPLOYEE as follows:
1. Enter first name, middle name or initial, and last name. Enter the
date the form is completed.
2. Enter present home address.
3. Enter city, state, and zip code.
4. Enter date and time of injury.
5. Enter location where injury occurred (i.e., 1234 Main Street or Fire
Station No. 11 and the address) and describe exact location on the
premises.
6. Enter information regarding the injury and the part of the body
affected.
7. Enter member's Social Security Number.
8. Member’s signature.
Effective Date: June 2008 Paul Garnier, Captain
Current Revision Date: 09/13/2022 Section 106.020
Next Revision (2) Date: 09/13/2027 Page 2 of 7
Note: Member shall be given a copy of the form with the EMPLOYEE
section completed.
The company officer or supervisor is to complete the bottom section of the form
labeled EMPLOYER as follows:
1. Enter Fresno Fire Department.
2. Enter 911 H Street, Fresno, CA 93721.
3. Enter date employer first knew of injury or illness.
4. Enter date the claim form was provided to the member.
5. Enter date employer received the completed claim form from
member.
6. Enter Tristar, P. O. Box 9783, Fresno, CA 93794-9783.
7. Leave insurance policy number blank.
8. Company officer or supervisor signature.
9. Enter appropriate title (i.e., fire captain, fire battalion chief, fire
equipment supervisor, fire prevention engineer).
10. Enter supervisor's telephone number. (Note: Company officers
enter 621-4177.)
Administration’s Responsibilities
The Workers’ Compensation claim shall be:
1. Entered into the Tristar’s SIMS reporting portal.
2. Scan and email to COFsafety@fresno.gov copies of:
a. Form 5020 (Tristar generated form from the SIMS portal)
b. FC-17 DWC -1 (State form)
c. FC-06 Supervisor’s Report of Injury
Effective Date: June 2008 Paul Garnier, Captain
Current Revision Date: 09/13/2022 Section 106.020
Next Revision (2) Date: 09/13/2027 Page 3 of 7
3. Route completed/signed copies of FC -17, FC -06, and FC-11 to the
member.
All originals are maintained by the Safety and Wellness Officer.
INFORMATION
During the 1989 session, the State Legislature substantially reformed workers'
compensation procedures. These changes involved new and additional formsand an
increased importance on the processing of reports and maintenance of records.
Effective January 1, 1990, the City was required by California law to provide an
Employee's Claim for Workers' Compensation Benefits form within one working day
of knowledge of an industrial injury, illness, or exposure to a member who seeks
medical treatment or hospitalization.
DEFINITIONS
This section intentionally left blank.
CROSS-REFERENCES
Administrative Manual
Section 106.015, Supervisor’s Report of Injury (FC -06)
Section 106.018, Medical Service Order (MSO/Occupational Health
Provider’s List (FC -11)
Section 106.141, Medical Status Report Form (FD -79 A-D)
Section 110.001, Guidelines and Responsibilities Section 110.002,
Appropriate Level of Care for On-the-Job Injuries (OJI)
Section 110.003, On-the-Job Injury (OJI) Reporting
Section 110.004, Modified (Light) D uty Assignments
Section 110.005, Physical Minimum Qualifications
Effective Date: June 2008 Paul Garnier, Captain
Current Revision Date: 09/13/2022 Section 106.020
Next Revision (2) Date: 09/13/2027 Page 4 of 7
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Section 106.020
Page 5 of 7
Compensation Claim Form (DWC 1) & Notice of Potential Eligibility
Formitlario de Recfomo de Compe nmci<>n de Trab({jadores (DWC 1) y Nottf1caci<5n de Posible Elegibilidad
ff you arc i11_jmcd or !Jcco,nc ill , c ilhcr physically or 111c111ally, lJc<:ause o r
your job, including injuries resulting from a workplace crime, you ma y he
ent itl ed lo workers' compc11sa1io11 benefits. Attached is the form fo r filin g
a workers' compensat ion cla im wit h yo ur employer. Yo u s hould r ca cl all
of' the information below. Keep th is sheet and all othe r papers for your
records. You may be eligible for some nr a ll o r the bcncfils li sted
depending on th e nature of' yo ur claim. I f' required you wil l be nol ii'icd by
the c la ims admi11 istrn1o r, who is responsibl e. for handlin g yom c laim,
about your elig ibil ity for benefits.
To file a c la im, complete !he "Em ployee " section or the form, keep one
copy and give th e rest to your Clll llloy cr. Your c111 1lloy er will 1l1 e.n
complete the "Employer" scc1 io11 , give you a dated copy, keep one copy
and send on e 10 th e claims administrator. Be11eJ'i1s can '1 start uni ii th e
claims adminis trator knows of l'h c injury, so co1npletc {l1e rorrn as soon -as
poss ible.
Medical Care: Your clHims admini strator will pay all reason a bl e and
necessary 111 cd ic,1I cai·c for your work injury or illness. llfrdic:11 bene fit s
ma y include treatment by a doctor, hospita l serv ice s , physical therapy, lab
tests, x-rnys, and medicines. Your c laim s administra to r will pay the costs
direct ly so you should 11cvc.r sec a bill. There is a li mit on some medical
se rvices.
The Primary Treating Phwician (!'Tl') is th e doctor wi th th e overal l
responsibility f'or 1rca1111c111 or you r inju ry or ill ness. Genera ll y your
employer selects the PTP you will sec for til e firs t .10 days, however. in
spec ified condi1io11s, you may be treated by yo ur predes ig na te d doctor or
medical group. Jr a docto r says you sti II need lrca1111en1 after .10 days, yo u
may be abl e. to switch lo the doctor or your choice. Different rules apply ii'
you r c mploy e t· is using a Health Care Orga11i1ation (HCO) or a Medica l
Provider Network (MPN). A MPN is a selec ted nctwork of health ca re
prov id ers to provide lrcatmcnt to wo rk ers injured 011 th e job. You should
receiv e in fo rmati on from you r e mployer if ym 1 are covered by an HCO or
a MPN. Contact yom emplo yer for more informat ion. If yo ur employer
has not put up a posl er describin g yo ur rights to workers· compcnsa1 io11,
you may choose you r own doctor immed ia te ly.
W ithin 011c working day aft er you file a c laim l'o rrn , you r emp loyer sha ll
authori1c the provision of all lrea tm c nl , cons istcm with th e appli cable
treat in g guide lin es, fo r the all eged injury ,111d slwll co ntinue lo be liable
for u p to $10,000 in 1rcatmc11t unt il th e claim is accepted or reje cted.
Disclosure ot' Medical Records: After yo u make a claim for workers'
compensa ti on benefi ts, yo w· rncdicnl records will not have the same level
of pri vacy that you usuall y expect. If you don't agree lo voluntar il y
re lease med ical reco rd s~ a workers' compe nsat ion judge may decide what
records will be relea sed. If yo u request pri vacy, the judge ma y "sea l"
(keep pr iva te) ce rtain medical records.
Payment: for 'l'cmponll'y Disability (Lost Wagc.!i)_: 11· you can't work
while you arc recovering from a job inju ry o r illness~ for most injuries you
will receive te mporary disability paymen ts f'ot a lim ited per io d of lime.
T hese paymcnls may clrnngc or stop \vh c n your doc tor says yo u arc able
to return to work. T hese benefits a rc ta,-l'rcc. Temporary dis.1bilit y
payments arc two-third s of you r ave rage week ly pay, w ith in min imums
and maximums sci by slate law. l'aymcnls arc nol made fo r ihc firs! three
days you arc off the job unless yo u arc hospitali1.cd overnight (ll' ca nn ot
wo rk for more th an 14 days.
Rct.ul'n to Work : To help yo u to ret urn to work as soon as possible , you
should act ive ly cornmunicalc with yom treat in g doctor, claims
admini stra tor , an d emp loye r aho ul the kind s or wo rk you can do while
recove ring. They may coordinale cfforls to l'Clurn you to modified duty or
other work that is medically approprialc. This mod if'icd or othe r duty may
Rev . 6/10
Si Ud. se lcsiona o se cnf-Cnnai ya sea ffs icamente o 111c11talrnc11te , deb ldo a
su trab.ajo 1 i ncl uycndo lcs ioncs quc rcsultcn de un cri mcn e n t-1 lu gar de
trabajo, cs posiblc quc Ud. tc nga dcrccho a bcncl'icios de compcnsaci6n de
trabajad orcs. Sc. adjunta el fonnu!ario para prcscntar un i-cclamo de
compcnsaci6n de lrabajadorcs con su cmplcadnr. lid. dcbc le er toda In
infonnacion a conlinuacion . Guardc csla hoja y todos Ins dcmas
documentos para st 1s archivos. Es posib lc qrt e ust cd ,-c t1na los ,-cqu is it os
para todos los bcneficios, o par·1c de cslos, quc sc e mtmeran , dcpcndicndo
de. la 1ndolc de su rcclarno. S i sc rcquic,·e , cl ad111ini strador de rc clamos ,
quien cs responsah lc poi-cl nicmej() de su rccl arn o, le nolificiml sob re su
clcgibilidad pa,-a bcncricios.
Para prcsentar un rcclamo, Ilen e la sccci()n dcl rormu lar io dcsignada pa ra t~I
"Ernplcado ," guarde una cop ia, y dc lc e-1 rcsto a su ctnp lcado r. En1onccs,
su cmplcador completara la sccci(m des ignm la para c l ''Emplcador," le. dan1
a Ud. una copia fcc hada, guardal'a una copia, y cnvianl una al
admi11is1rador de rcclamos. Los bcnefic ios no pu cdcn comc nzar h,1 s1a , q uc
el admin istrado r de rcclamos sc cnlcrc de la lcsit)11 , asf quc comp lete cl
formula ri o lo antes pos ib lc.
AtcndO n M(~dita: Su adm in istrador de reclamos pagar:l tnd11 la alcnci{)n
mCd ica razo na blc y nccc sar ia , para su lesi(ln o cn fcrmcdnd rc lac ion ada crn1
cl lrabajo . Es posiblc quc Ins bcneficio s med icos inc lu ya n cl 1rata111ien10
por pane de un medico, los sc rvicios de hospita l, la tcrapia ffs ica, los
analisis de laboralorio y las mcdicinas. Su ad111 inistra dor de re.clamos
pa gan'i d i rcclamcntc !os cost.os , de mancrn quc ustc d nunca vcn:l un cob ro.
Hay un lfmile para cierlos scrvicios mCdicos.
EI Medico l'rimario quc le Ati cnclc-l'ri111ar y Treating Phvsicia11 1'11' cs
cl medico con la respo nsab il idad total para 1ra 1ar su lesio n o c nf'cnnedml.
(iencralrnentc, su c1i1p lcado r sc lccc iona a l P'JP quc Lid . vcnl dur.ante los
prirn cros 10 dfas. Sin cmba ,-go, en condi ci oncs cspccfficas, cs posible quc
ustcd pucda ser tratado por su medico o grupo med ico prcvi am cnte
de-sign ado. Si cl doclor dice quc ustcd alln ncccsitn lralamicnlo dcspuCs de
30 d fas, cs posibl c quc Ud. pucda cmnbia r al medico de su prekrenc ia. Hay
rcglas diffcrcntc s quc se aplican cuando su ernplcador usa una
Orga11i1.ac ion de Cuidado Medico (HCO) o una Red de Provccdo rcs
Medicos (MPN). Una MPN cs una red de provccdorcs de asistcncia mcdiea
sclcccionados para dar tratamic nto a los l rabajadorcs lesionados en cl
trabajo. listed dcbe ,ecibit in fonnac ion de su cmpleador si su tratam ic 111 0
cs cubicrlo ll0r utrn HCO o una MPN. Hable con su c111plcador para m,\s
in fonnac.i6 n. S i su c mp!cador no ha colocado un ca rt el dcscribicndo sus
dercchos para la compcnsaci6n de traba_jadorcs 1 Ud. pucde selccc io11a r a ::;u
propio medi co in111 cdia1amcnlc.
Dcntro de un d1a desp ucs de quc Ud. Prcscntc un fonnulario de rc cla mo , su
cmplcador au torizanl todo trata1nicnto 1nCdi cn de acucrdo con Ins pau1as de
lrnlam icn to ap li cablcs a la prcsunta lesion y scr:, rcspo nsablc po r $10,000
en lratam icnlO hasta qt 1c cl rcdamo se a accptado o rcclrnzado.
Divulgaci6n de Expcdicnlcs Medicos : Dcspues de quc Ud. prcsc111 c u11
rcclamo para bcncricios de compcnsaci6n de traba_jadoi-~~s, sus ~xpcd icn t0s
mCdicos rn) tcndrcln cl misrno nivcl de privacidad quc uslcd normalmcntc
espcrn. Si Ud . 110 csta de acucrdo en divu lgar volu11ti iri a111entc In s
cxpcdicntcs medicos, rm jucz de co111pe11saci611 de 1rahajadorcs
posib lcrncnlc dc c ida quc expcdicnlcs sc rcvclarfo. Si Ud. solicita
privaci dad , cs posiblc q uc cl _ju c1. "scllc" (manlcnga privados ) cicrtos
cx pcdic.ntcs rn cclicos.
.!J!go JJ<ff lncapacidad Temporal (S uc ldos Pcrd idos l_: Si Ud. no puedc
trabi·1_jar , mi~-ntras sc c.st,l recupernndo de un.a lesi<l n o enfor rn cdad
rcla c ionada co n cl trabajo, Ud. rec ibin1 pagos por incapa ci dad tempora l
para la mayorfa de las lesions por trn per iod li 111i1ado. Es posibk quc cstos
pagos camhic.n o parc11, cuando su mC.dico c.lign quc Ud. esHi en trn ldi cion~~s
de regresa r a trnbu_ja r. Estos bcncficios son librcs <k~ im puc.stos . Los pagos
Section 106.020
Page 6 of 7
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,,... ... , ... ,11 l•~••t ..... .,. 111-~ ,, i:r ,.,,111i11, I " -,,n. LM.I 11\;I )'
,,11.11lily lnr ,, , 11 Jr;,1 i'·n1hl~ , ,1111~ :,-PJ)· 1,1 I for 11!1iail1111{•
,11,di', ,lull ,11ILLIIH'J1J,,;lll II' )'' ,11 q1•1l 1 r . I 11ini,t, ,1111-,.,II
I )' 1hc "'"' "l' 1 .. 11.., ll!ll>;lll111111 ,.... I I . .,..,1 <ltl V• .I
r,:,,·,·11111!'. ,,r ' n,,.wni .J '-ii' )'
• )L'; h t!'.!'11.-ITI : It Iii,; mj11ry 1 •I I lli>e-<, , 1--.:, lk r,, J",1)'111<"111• m.1~
111.a,k, 10"' 1i, nr h,,1..._1',11d m,"fnb!.' -11t,,,,... •1,: finn11~i1II; 1k:11'·11Kkn1
1111 iii.; ck ·"",'cl "',1r\,, ·r
Ir I. lllio.'Lml {11r ,-,:,pr -~m11l1> r,1: 1,n p 1111• ,i, fir..: y,1 1 lilt I,, .,. , " ;uh
u1,1ur:r u in,,._....., ll•r lili11 1, a d.1im, ,,.. 1 -.1ir)'illll ·11 rmoLh..-r l>Cf!l•111.
\\'Ill kcr.,' i:,111,p."lll,IJH>n r11:.r ( Lttbor ( •'Ilk' 1:12' ). If (ll'O'l'Cll, j'UII ma:,,
tL'1.,l•t;, I, ,1 ,.-,.i;~•, )"l> •u1N,1W liil:111 II < ·,h I l..-1 •Ii'· 1111'1 L'ui.l. :111d
L'1<j'.lcll,..,, lljl Do limil• '<\:( I>)' """ ~a c.
'l'lllu h,w" 1h,,, l'l'hl 1,, ,!i · l\J • • ·1111< --i~-... rr~:ti1 1 )'•11.1rd~im If )Oil
h.wc " ,1i,.,,_r1...:-rn~'l'll, s'Oll ·1~1 )'l-d; ims ml ,nini3lralor fil'II io • , r JOU
L~III I\.Wh • II Ir Y(II I 111/14 .:iVIII{! 1>1:111:(rt 'j ~I 11 '/ bl." :,Ilk h• tc"I
St.1 1,: l)E,a,bil II)' 111,111:11,1,; • (SOI) b..'l!':lil~. ( II I ii;' 1:111 plo I 1~111
I.le ·k 1m11;nll\.'J'al1m.:11t (!>iUOHR0-;1-137
Yoo cal'I inl!i...m rl\' • i11 rl!fm lioo rn:,111 11 inf111m.1lioo 11,d .:,~sl:11il0<.'
,ill'h,. ,,( it..: Si t.: llivi oo of W,1rkl: ·' <.'n1 :t1,1lioo LI)\ ('). or .)1'1111
~:11'1 I,,;,., rnwn'l,'<I mfnn 111'111 i ntl 11 11, of Im;: I offifi'> h>• <.'3.llill•' (II )
'ill'l•?<ID I . Y,111 111,1)' '11~ ~!J I<> 11111' l)\ l-w~ '"il~. I ""' d C , ~-
Olll .... l1 um ul! \,\ illj iH! aueu,ry. MOSI .ll ~a.Jf'nC)FN orr~, Of'k: fl\."-:
u,,1-..,.,,li I i,;111. If )'"U ,t.:,id~ lo hm: .an ,lllomey, h1 llf bcr fr-.: ,;, ill he wlml
Olll .. r ~111 • of J'fl'l!r l>l:nct"tl I 'H (I 11, .. o,; or \\ ,1rt.c1--· CL111lp1.'Jt1,..lit11'1
.,u,11111c-y,.,. t:.11 11 1 I • S1. I<' 11; r ,,f { lifom · ;ii C'I I :'i) :'.Hlt-2 120 or go 11\i!i,
~h ,i1" 111 ""'-' ,-fl' li(nmh1 I'< I lf,1,-111:i:
r,,.11 .,,.._,,,:iL'JL!:1d ,. '"!'""' "'11 '-'" 4'.'flii,>,i d,.' >II p.! ' I ,,it,.
.-. .. , ·nl'II ,,1 ,,,1 111 11, 111; , )' m .. i~ 1111:t~ ,:<tabk.,.11_~ " p,_1r '-""
l.11~ 1".t~:•1" 111,. "h.1\4 .,•111 dur .. n1I .. '4 ,.: pntnt.:n l• ..... 1ilin-.i _•1• ,1i:.
:1 ,n.: ''" ,.., u,1. '" l••"'I'' '""",.''' 1111,1 11,-..: • ,, "'' IIC l•'\IH mt,·
.,..,. LI.: I .t di:JlL
1 al ·1 ndt.1'<1: l~u:i :l')11d arl 1 ,.., '' :ir n I, h,1j.1r l,1 ,ll•I~ 11• ibk,
·b..: u,11,.1111.:,,r,..· 1. • 111a "-'I'll :;1t1;J.-:1 ,;JIii cl 11-..'diM •]Iii' I· t11i-11d.,. d
:1<hu i,1,-11 ti,., ti: ,..,,_.1.,.,.," )' ,,J ""'I' '.1Ll,1r, ·01 1 J)<'\1,, ii I d 1.i
L1i1I l;IJU lfl>t IJd. , .... ,d 1 .. ,ccr 111i 11 1111 ~ • 1'1.-.;ur "nl I·--I".,.. ,Ni.· lf1 • .:11 ..
L"Ot'l1Llu• ·1, t")i.frh,·11,~ l"-:lral ft; 1 n; ... 1 I ■ • LIii rr";l~• · 11 tnt.w lifo.J..t JI, 11.!1 ■I i.11Jt.,
L1,1h,1jn. 4,.: ,.:., a-1,,,,1 , ... lo L1,,,.tlc cl Jl(lllln ck, ~. 11 ~i,o hh' 1,. h,1j,.,
,,,.,,rr~a,lu II Lllll• 11:11 .. Jll p,1dri.1 r -tllf1'11J I 11 ,.-.111 .. , O:\!s,1 ,k, •
,lq,c ,d .,.,,r., .,,._. L, i, ,I •k ,k ,u Ir,,,,.-, 11 c11r~'f1 ,'\lad
1'1l1141 111 t lm.•;ql:t.l.'t<la1l l'5'1•y,rn111•uJr: Si ••I 11,ll'l••i ,J11
c,1(i:11n,,IJ<I , L-:nlt.1 c'J'l 1t11;, '"""I 11,;id aJ p..-r,11anl"llh". l.,.
,i: Ii• 1\a 1t,:Ll>. ;a,1,._ .. 11,alc,,. I :i 1,11 iLI; d llcp.:ml ; ,le 111 ('I
L'C l,Ld. "' LiCLIIXIC>L•II ) la 1.-~-a • • I ,~ ..... ·,.,
l!<-11,-:!kfa S.11ll,•111,•11 lj1 ri m
11 I< '-I I l,; ••II II
liiM..:-L.t~ l ld
' ck 1,;:sll{'<t SLi
k.,i.,mi 1k-,,p11',,, tkl I fl, 1 . •
11np1d:.i, ic • >.11 ,,1 t111 'J' i~ ck-.puL-.. u..-, ~
111<c.1px11lttd 1c,ripm,,I 1cn11i ~ -o .. 'l' ~I! 1111 , IJ!.'
1ncKhnc,1du o all!.' 11,1111<>, ,,._ r,u,11 • c1 I • ifo r;
I\' ,t,., IUl > I · llil•lr.111,,~..,1,1,,, (1'11:Jllk,Ju ~ jKI I\: \i)
,; 11 r,;:1111l'lii,111LJ Y'" F!1 •.i, nr ,1, hn'l>1l1dn,I Si lkl. r,.-;111 • It"-,ilio,.., cl
,1d,ni11bi,.111lllf Jc , • l,ul'lu, l""'N• I.("' ~• I. ~ 1111 m~:,;imo ,:,;.1nbk:ci.Jo
l'°I 1:i~ lcy~-,.. .,,,,11111t..,~ l,,, · k•ro 11 pol'!ll:11 ajc ck ilk.'-•I citlid p1.·n1 1-..:1,1·.
~1t,111!,i'ld1H I"' l\h1t"rl,:: S, l;i I~ ,n n 0:11~ mlClbd .:lrlt<3 b 1crlc, ~
,.,, 1,,1.;i qu~ lus p.1 •p•,.,, IQJl..111 o kl« r-~n r I~" • f ~ p."(lo> ,, • •I It 11iv.:11 ("fl
cl l,a "'' y quc dc1'JC11ili.1,11 cw:111lm1 u11'1'nl<' dcl u-Jhaj.Jdof difunto.
i\ ltni;nl 'Ill!::. u \'nlilk,ula.-I,: ~p,.!ii''II.' o "riil:t, f)(ll' .._,flir na k"41",11 o
cl'lrn,.,L,-,1.JM I eil d 1r: h j<>, p;,r l'"l,..°""''l'llllr u11 reel.moo por 1c . ifk rend
<.,L>!l <.k "''""f'l-'""'~11i11 d • 1111bu.Ju,;k ,Jc olr )'l'rhil11J1. Uil ( 'ud1i-•' Lall<ll :.11
._ c·i,,,i IJ:!., I I:>.: ,,,:r pr a l ruin, , ,,..i 1>11>N1.: ~il,,i r 10, tKJf r,rr,r ck
_,;~l,l<>s, t'L'J'll:""l.-11\rt dd 1,nh,ijl,, 111111 nto de bcrrcfk io · )' g. ,Los a ... [I
lin1i1~.< nla ki;11J .. I'""~• --pdn,
l.l<l. ,..,,lie ,icrorh.i n n 0011 clo.."C, i,,,.._,. qt-.: nf,-.::len "''
,cd:11111,1. Si I l, 11 1111 tit-...: ~111:1,kt, Jlfi11'dn cn.-,,111lc111,~ c,lfl ,-
a,i,nmi.-.rinw ln1 ,i., !nm.-"' r-• , r i l'tl ll'ICde rewl\ ·oo. ·, u,i,:d lllll
c,1 n:.:,b, ·,wlu 1..,, •(11;1W ~ I 1h • quc Jd 11uc.1n uhl.::o~ be,• •ft.,,., .kl
Si:~11m i!.'11:ilal .I • l1i{arm:id~,I (Sllll U me ~! lkp.1n..a111<.'flll' Esi:i.1 I dd
l'.k.">Jlrmlt<1,kl 1-:,npl ,u pmn, I (SOOl '1 0-326}.
Utl pucdc ub1.:1111,i m lu 11 n 1 i.'N! .t1! ,,, de III of..:111 d.:: i11i"01m.1cio11 y
.,., s:1da, iJc I,, l>1va.i,\11 I i<1 t I de Coo11icn c 1t'!11 de Tnl!.tj;1dc1t,•
('l);,,.,i,,,, ,,f Jt',rl,oa ' (,,..,fJ 'il\rJ/t"'' J)W(J o 11ucck ""'"UC u
i11f,,.n1,;...-, 111 ic•J ;nla ,, ,i "'"11"' 111 lisl, Lie ofi i11 ~ lo.: lo ll;1m:a11do al
( 00) 7.¼--7.f I u,1 , mbo<'n pU!:a.'k: 1NJl~r c'l(}ll I payit111 Wd1 ,k I;
OW<"c11 "'"'" 111 · ·a CJ::!'.·
l ),i. ,,,.,,.11(, •·ua•ull , r •\; 1J f ill fljhpcliit. rn )'<It J ilc ll"-fl •!},nit.•
orrtt,;11 ur!aal COlhlllL, lllli<, Si Ui,l cJ..,.;ilk oor,lrninr ;i Lill .111 ... ~. lo
lwNI r, i,-... riin 1,..,1111,lni. de ;ilgu -Ji ,le i bi::,..efo: 1'11t.o tllik1"K:1
INJll'lb,,·~ d;;; alio~'-""'" ,I, t;Ul l'llJl'<'IF<.lO:ioo Jc. IF.1hoj11o1lufl..'"<, ll:111lC ., I:.
A3iiicia.not1 b.1:.1 1,\I <Ii, Aho\:,;•~ de Cnliforni:a u:, llr,r) I [•I I.SI .sJ11.
2 I 2t1., c ,nsnllc "''"' I r,1 .fi Web I 1•11 l11q:.rr1a l l,t,or-,:..
Section 106.020
Page 7 of 7