ࡱ> Z\Y_ K@bjbj -B>\>\n"""8Z4D"7tL   rYL(6666666$f9<7"""7  7&&&"F  6&"6&&a4Q6 `S~d"^}5"67075<"<DQ6<Q6R&T77% 7""""<> : DECEASED EMPLOYEE  GUIDELINES FOR SURVIVOR(S) The following information is provided to assist the employee s survivor(s). If you have any questions contact the person listed below: Contact PersonTelephone FORMTEXT      (  FORMTEXT     )  FORMTEXT      DepartmentDepartment Address FORMTEXT       FORMTEXT       1. Obtain Certified Copies of the Death Certificate If the death occurred in San Bernardino County, a certified copy of the death certificate may be obtained from the Auditor-Controller/Treasurer/Tax Collector, 222 W. Hospitality Lane, 1st floor, San Bernardino, CA 92415-0022, (909) 387-8314. Certified copies may be required for each separate agency. Should the death occur in another county or state, a certified copy of the death certificate should be obtained from the appropriate authority. c. If cause of death stated is pending, some of the agencies below may not accept the death certificate. Contact the individual organizations listed below to determine their requirements. 2. Notify the Appropriate Private Life Insurance Carriers If the deceased had private life insurance, contact the appropriate life insurance company or companies. Check with Employee Benefits & Services Division-Human Resources, 157 W. Fifth Street, 1st floor, San Bernardino, CA 92415-0440, (909) 387-5787, regarding life insurance, either as a benefit or optional (purchased through the county). A certified copy of the death certificate will be required. Current Life Insurance contact: _ FORMTEXT      ___________________ Ph. # _ FORMTEXT      ___________ Contact the appropriate organizations below regarding life insurance which the deceased may have carried with them: Teamsters Local 1932 (previously SBPEA), 433 North Sierra Way, San Bernardino, CA 92410, (909) 889-8377 Safety Employees Benefit Association (SEBA), 555 North E Street, San Bernardino, CA 92401, (909) 885-6074 San Bernardino County Public Attorney Association (SBCPAA), P.O. Box 5834, San Bernardino, CA 92412, (909) 891-3329 California Nurses Association (CNA), 425 W. Broadway, Suite 111, Glendale, CA 91204, (818) 240-1900 American Federation of State, County, and Municipal Employees, 514 Shatto Pl., Los Angeles, CA 90020, (213) 487-9887 (for carpenters, electricians, and other trade or craft unions). Any professional, trade, or craft organization of which the deceased may have been a member. Any religious or social organization to which the deceased may have belonged. If death was caused by a work related injury, contact Workers Compensation, Risk Management, 222 W. Hospitality Lane, 3rd floor, San Bernardino, CA 92415-0016, (909) 386-8655. This is especially important with the Safety occupational groups (Sheriff, D.A. Investigator, etc.). 3. Contact Each of the Following County Departments Auditor-Controller/Treasurer/Tax Collector Office, Central Payroll, 268 W. Hospitality Lane, 4th floor, San Bernardino, CA 92415-0032, (909) 382-3154, to make arrangements for obtaining and cashing any paychecks (warrants) due the deceased, and payment of any monies due for overtime, sick leave, vacation time, and/or any other leave time. Check with this office even though the deceased may have been on leave without pay. A certified copy of the death certificate will be required. Current Central Payroll Contact: _ FORMTEXT      ____________________ Ph. # _ FORMTEXT      _________ San Bernardino County Employees Retirement Association (SBCERA), 348 W. Hospitality Lane 3rd floor, San Bernardino, CA 92415-0014 (909) 885-7980, to make arrangements for any death benefits that may be due. A certified copy of the death certificate will be required. Veterans Affairs Office, 175 W. Fifth Street, 2nd floor, San Bernardino, CA 92415-0470, (909) 387-5516, should be contacted to check on possible veterans benefits. Employee Benefits & Services Division-Human Resources, 157 W. Fifth Street, 1st floor, San Bernardino, CA 92415-0440. Check with Employee Benefits & Services Division, (909) 387-5787, regarding the continuation of County sponsored health benefits or Deferred Compensation (401k & 457b). Employee Benefits & Services will have the necessary forms required for payment to the Beneficiary. Current Group Health contact: _ FORMTEXT      ______^p r     " $ b d x z | ڷԪڷԠzmڷ`jhuvGCJUj>huvGCJUjhUXCJUmHnHujhUXh,B CJU hUXCJjhUXCJUj huvGCJUjhuvGCJUmHnHujhuvGCJU huvGCJjhuvGCJUhuvG5CJ\ huvGCJhuvGhuvG5CJ \%^`p r " zp $If^nkd$$Ifl0<")< 064 lal $$If^a$$a$$a$ " $ : ` $$If^a$pkd$$IflP0<")< 064 lal` b $$If^a$nkd$$Ifl0")&064 lal " $   / 1 K M T R S MN *,fh|žոի՟x՟!jhuvG>*CJUmHnHujhuvG>*CJU huvG>*CJjhuvG>*CJU huvGCJ huvG@H* huvG@ huvG@H* huvG@ h=>* huvG>*huvG huvGCJ huvGCJjhuvGCJUmHnHujhuvGCJU* " $ R S M}}pg$^a$ $^`a$$a$$ & Fa$$a$pkd&$$Ifl}0")&064 lal MN23~$  ^a$ $ & F  a$$ ^a$$ ^a$$ & F a$$^a$$a$$ & Fa$$^a$|~23~567\^234;<FTU^egoy{ллллллл˩ˤЙhKhK@ H* huvG@ hK@ hR>* hZ&Y>* hcS>* huvGH*^J huvG^J huvGCJ hi huvGCJ huvG>*huvG!jhuvG>*CJUmHnHujhuvG>*CJUj<huvG>*CJU6~67348:@A$*^*a$$ & Fa$$a$$^a$$  ^a$ $ & F  a$   ^ 8:JZ~@Av۬ۍjhuvG>*CJU huvG@ huvGH* huvG>*j$huvG>*CJU!jhuvG>*CJUmHnHujhuvG>*CJU huvG>*CJjhuvG>*CJU huvGCJhRhuvGhK6______________ Ph. # _ FORMTEXT      ______ ___ Current Deferred Compensation contact: _ FORMTEXT      ______________ Ph. # _ FORMTEXT      _________ Contact Each of the Following Social Security Office, (800) 772-1213, nearest your home to determine whether there are any Social Security benefits. Bank/Savings & Loans and other financial institutions, for release of bank accounts, savings accounts, loans, safety deposit boxes, and/or death benefits.     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