HomeMy WebLinkAboutCertificate of Concent to Self-InsureSTATE OF CALIFORNIA GAVIN NEWSOM, Governor
DEPARTMENT OF INDUSTRIAL RELATIONS
mr ygP toR, T,y. s'\ OFFICE OF SELF INSURANCE PLANS a ,
1750 H0WE AVE, SUITE 215
SACRAMENTO, CA 95825
PHONE (916) 464-7000
Our File: 7207
September 12, 2025
Laura Miyakawa
Human Resources Analyst II
City of Cupertino
10300 Torre Ave
Cupertino, CA 95014
Re: Certificate of Consent to Self -Insure No. 7177 -City of Cupertino
Dear Laura:
Enclosed for your files is an Order Amending Effective Date of Certificate of Consent to Self -Insure
correcting the original effective date for the City of Cupertino from January 1, 1979 to October 1,
1976. A new corrected Re -Instated Certificate for City of Cupertino will be issued reflecting the
change.
Should you have any questions regarding this matter, please contact this office.
Sincerely,
DIANA REED
Staff Services Analyst
Encls: Order Amending Effective Date of Re -Instated Certificate of Consent to Self -
Insure
Amended Certificate
STATE OF CALIFORNIA GAVIN NEWSOM, Governor
DEPARTMENT OF INDUSTRIAL RELATIONS
yEPi�oRi Tie
OFFICE OF SELF INSURANCE PLANS
1750 HOWE AVE, SUITE 215 = �o
SACRAMENTO, CA 95825
PHONE (916) 464-7000 q 6onNP
Our File: 7207
September 12, 2025
Laura Miyakawa
Human Resources Analyst II
City of Cupertino
10300 Torre Ave
Cupertino, CA 95014
Re: Certificate of Consent to Self -Insure No. 7177 -City of Cupertino
Dear Laura:
Enclosed for your files is an Order Amending Effective Date of Certificate of Consent to Self -Insure
correcting the original effective date for the City of Lompoc from January 1, 1979 to October 1,
1976. A new corrected Re -Instated Certificate for City of Cupertino will be issued reflecting the
change.
Should you have any questions regarding this matter, please contact this office.
Sincerely,.
DIANA REED
Staff Services Analyst
Ends: Order Amending Effective Date of Re -Instated Certificate of Consent to Self -
Insure
Amended Certificate
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STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATIONS
Office of the Director
Certificate No. 7207
In the Matter of )
City of Cupertino )
Employer, )
ORDER AMENDING EFFECTIVE
DATE OF CERTIFICATE OF
CONSENT TO SELF -INSURE
WHEREAS, the Director of the Department of Industrial Relations issued Certificate of
Consent to Self -Insure No. P-0282 to City of Cupertino, effective January 1, 1979, pursuant to Sections
3700 through 3705 of the California Labor Code; and
WHEREAS, to comply with newly adopted regulations governing self-insurance, the Director
of Industrial Relations issued on March 1, 1993 new certificates of consent to self -insure bearing new
certificate numbers to each and every public self -insurer, superseding the certificate of consent to self -
insure originally issued to each public self -insurer; and
WHEREAS, Certificate of Consent to Self -Insure issued to Certificate No. P-0282 was
amended and transferred from its original to its superseding Certificate No. 7207; and
WHEREAS, when the superseding certificates of consent to self -insure were issued on or
about March 1, 1993, the effective dates were incorrectly identified as March 1, 1993, and the effective
date of Certificate No. 7207 was amended to read January 1, 1979; and
WHEREAS, when Certificate of Consent to Self -insure, No. 7207 was issued to City of
Cupertino, after reviewing the original application and resolution, the effective date was incorrectly
identified as January 1, 1979, and should have been effective October 1, 1976; and
NOW, THEREFORE, IT IS ORDERED that Certificate of Consent to Self -Insure No. 7207,
issued to City of Cupertino, is amended to read: effective October 1, 1976.
Sacramento, California
Dated: September 12, 2025
LYN AO BOOZ, Chief
Office of Self Insurance Plans
/dr
STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATIONS
JENNIFER OSBORN, Director
Department of Industrial Relations