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<br />6.3C <br />Page 13 <br /> <br />ATTACHMENT 3 <br /> <br />CALIFORNIA EMPLOYER'S RETIREE BENEFIT TRUST PROGRAM ("CERBT") <br /> <br />AGREEMENT AND ELECTION <br />OF <br /> <br />(NAME OF EMPLOYER) <br /> <br />TO PREFUND OTHER POST EMPLOYMENT <br />BENEFITS THROUGH CalPERS <br /> <br />WHEREAS (1) Government Code Section 22940 establishes in the State Treasury the <br />Annuitants' Health Care Coverage Fund for the prefunding of health care coverage for <br />annuitants (Prefunding Plan); and <br /> <br />WHEREAS (2) The California Public Employees' Retirement System (CaIPERS) Board <br />of Administration (Board) has sole and exclusive control and power over the <br />administration and investment of the Prefunding Plan (sometimes also referred to as <br />CERBT), the purposes of which include, but are not limited to (i) receiving contributions <br />from participating employers and establishing separate Employer Prefunding Accounts <br />in the Prefunding Plan for the performance of an essential governmental function (ii) <br />investing contributed amounts and income thereon, if any, in order to receive yield on <br />the funds and (iii) disbursing contributed amounts and income thereon, if any, to pay for <br />costs of administration of the Prefunding Plan and to pay for health care costs or other <br />post employment benefits in accordance with the terms of participating employers' <br />plans; and <br /> <br />WHEREAS (3) <br /> <br />(NAME OF EMPLOYER) <br /> <br />(Employer) desires to participate in the Prefunding Plan upon the terms and conditions <br />set by the Board and as set forth herein; and <br /> <br />WHEREAS (4) Employer may participate in the Prefunding Plan upon (i) approval by <br />the Board and (ii) filing a duly adopted and executed Agreement and Election to Prefund <br />Other Post Employment Benefits (Agreement) as provided in the terms and conditions <br />of the Agreement; and <br /> <br />WHEREAS (5) The Prefunding Plan is a trust fund that is intended to perform an <br />essential governmental function within the meaning of Section 115 of the Internal <br />Revenue Code as an agent multiple-employer plan as defined in Governmental <br />Accounting Standards Board (GASB) Statement No. 43 consisting of an aggregation of <br />single-employer plans, with pooled administrative and investment functions; <br /> <br />Rev 12/01/2009 <br />