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Home My WebLink AboutRES 2019-18 - BoardForm:A-2(1-2016)IPage5RESOLUTIONNO.:2019-18DATED:06/05/2019ARESOLUTIONAUTHORIZINGAPPLICATIONTOTHEDIRECTOROFINDUSTRIALRELATIONS,STATEOFCALIFORNIAFORACERTIFICATEOFCONSENTTOSELF-INSUREWORKERS’COMPENSATIONLIABILITIESAtameetingoftheTruckeeDonnerPublicUtilityDistrict(EnterNameoftheBoard)oftheTruckeeDonnerPublicUtilityDistrict(EnterNameofPublicAgency,District,Etc.(aSpecialDistrictorganizedandexistingunderthe(EnterTypeofAgency,i.e.,County,City,SchoolDistrict,etc.)lawsoftheStateofCalifornia,heldonthe5tdayofJune2019,thefollowingresolutionwasadopted:RESOLVED,thattheabovenamedpublicagencyisauthorizedandempoweredtomakeapplicationtotheDirectorofIndustrialRelations,StateofCalifornia,foraCertificateofConsenttoSelf-Insureworkers’compensationliabilitiesandrepresentativesofAgencyareauthorizedtoexecuteanyandalldocumentsrequiredforsuchapplication.INWITNESSWHEREOF:IHAVESIGNEDANDAFFIXEDTHEAGENCYSEAL.xDATE:06/05/2019SIGNED:BoardSecretaryorChairBobEllisPrintedNamePresidentTitle.....AffixSealHereTruckeeDonnerPublicUtilityDistrictAgencyName