l~RDER Nfl. 1989(=,
APPRQVAL OF A RESOI-.UTION TO TAC WORKER''
CnMPEN:AT3t}N TO t'i~VF.R EI.F..(CTEC~ (7FFIGTAI._S
l1NDFR Wt~RKERS' COMPENSATION
Oc: this the 18t!-: day of October 19'3v~, upon nic.~t::ion made= by
{~ommission~~r Morgan, sec~~n~j~~d by t'ommissic,n~~r Holel~::~mp, the
Cc::: t. unanimously approved by a vote of 4 to 0 t~ .~ic:~; 3
re:aoluti.or, to TAC Worl•:ers' Compt-~nsation makii:g it official
that: °~+?('.tt'(j Of~:Lt'1a1_ are ccoVert=d ~~/ WOI'1:t~1': curnpen~~ation.
TEXAS ASSOCIATIOI`I OF CO~II`ITIES
G`pTlp\
O N ~\
y
P.O. Box 2131, Austin. Texas 78768 a o
C
~, 2~
Sam D. Seale, Executive Director \1 S
September 28, 1990
MEMORANDUM
TO: Workers' Compensation Coordinators
FROM: Terry Wyatt, Comptroller '~1 ~~
~ 1204 San Antonio (512) 478753
SUBJECT: 1991 Estimated Payroll Request -- Due 10/31/90
Enclosed are the necessary forms for you to provide TAC the 1991 estimated payroll which is
due Oct. 31, 1990. The forms have been revised to request information that is necessary for
calculating your 1991 estimated workers' compensation premium and for expediting future
claims processing. Please read and complete the forms entirely to ensure that we have accurate
information on file for your entity.
Compare your 1991 estimated payroll to the 1990 payroll figures provided on the worksheet. If
any class code differs by more than ten percent, please provide an explanation for the difference.
Remember that the contribution, or premium, you pay during 1991 will be based on estimated
payroll. At the end of 1991 you will be asked to provide actual payroll figures for that yeaz, as
of Dec. 31, 1991. Any subsequent adjustment to your 1991 premium will be due to the
difference between your estimated and actual payroll figures.
The following, tentative schedule should help you plan for reporting, payment, commissioners'
court approvals, etc.:
Oct. 31, 1990 1991 estimated payroll worksheets due at TAC
Jan. 1, 1991	First quarter, 1991 contribution due
Feb. 15, 1991	1990 actual payroll worksheets due at TAC
Apr. 1, 1991	Second quarter, 1991 contribution due
May 1, 1991	Contribution adjustments based on 1990 actual payroll are due
Jul. 1, 1991	Third quarter, 1991 contribution due
Oct. 1, 1991	Fourth quarter, 1991 contribution due
We have enclosed a guide to reporting and classifying payrolls for your convenience. If you
have questions, please call myself; Jim Jean, Director of Workers' Compensation; or Sandra
Bragg, Billing Dept.

Thank you for your attention to this matter, we appreciate the opportunity to serve you.
IT IS IMPORTANT THAT YOU COMPLETE THIS ENTIRE FORM!
Kerr County -- 1330
This worksheet was prepared by: Name:
Phone:
Date:
Federal Tax ID #:
The following information is necessary to update our records in order to provide quicker claims
processing.
ELECTED OFFICIALS
Coverage of elected officials is optional, but if you want to include ~tny elected official, you must
include all elected officials, and there must be a resolution on file at TAC requesting the coverage. Do
the payroll figures include elected officials? YES NO -
VOLUNTEERS
Coverage of volunteers is optional, but if you want to include any volunteer in a particular class code,
you mclst cover all volunteers that will fall into that code. For example, if you choose to cover reserve
deputies, you must also cover volunteer ambulance drivers because they are both in code 7720V.
Volunteer coverage also requires a resolution be on file at TAC. For volunteers, please list separately
and include a letter "V" as designation (i.e., 7720V) on your payroll worksheet. If the payroll figures
include any volunteers, please list the types of volunteers below:
JURORS AND ELECTION PERSONNEL ,
Coverage of jurors and/or election personnel is optional,
Do the payroll figures include jurors? YES NO
Do the payroll figures include election personnel? YES
but a court resolution must be on file at TAC.
NO
POLITICAL SUBDIVISIONS '
Please list the names of any political subdivisions that are reported in your payroll. For instance, list
the names of hospitals, nursing homes, drainage districts, appraisal districts, MHMRs, Meals on
Wheels, 911 districts, etc. This will expedite claims processtng when an employee of one of those
subdivisions files a claim.

I'AC: WC-2 Rcv. 9/l5/90
• PLEASE FURNISH ONE ORIGINAL AND SEVEN COPIES OF THIS REQUEST AND DOCUMENTS
TO BE REVIEWED BY THE COURT.
MADE BY:
llorothy I-Iilburn
OFF ICE: County `I'rcasurcr
TIME PREFERRED: n/a
MEETING DATE: ~~~%' " ''~ '~'
SUBJECT: (PLEASE BE SPECIFIC): '1'nC Workers' Compensation Pund _
Options to be considered: coverage for jurors, election personnel, elected officials
and submitting resolutions.
ESTIMATED LENGTH OF PRESENTATION:
IF PERSONNEL MATTER -NAME OF EMPLOYEE:
NAME OF PERSON ADDRESSING THE COURT:
Time for submitt-ng this request for Court to assure that the matter Is posted In
accordance with Article 6252- 17 Is as follows:
. Meetings held on second Monday: 12:00 P. M. previous Wednesday
• Meetings held on Thursdays: 5:00 P. M. previous Thursday.
If preferable, Agenda Requests may be made on office stationery with the above
Information attached.
THIS REQUEST RECEIVED BY:
THIS REQUEST RECEIVED ON
.~ /~

All Agenda Requests will be screened by the County Judge's Office to determine 1f
adequate information has been prepared for the Court's formal consideration and action at
time of Court meetings. Your cooperation w111 be appreciated and contribute towards
your request being addressed at the earliest opportunity.
ORD~ Np, 19896
Z~Z~~ T(} TAC
APFI~VAL ~F A~~TIOI3 `~ ~~
way o~ ~~1~ ~
Qc~~T 18, 1990
Vol. Sr P9. 20