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<p class="MsoNormal"><b><u><span style="font-size:9.0pt;font-family:"Arial","sans-serif";color:#FFC000"><o:p><span style="text-decoration:none"> </span></o:p></span></u></b></p>
<p class="MsoNormal" style="margin-bottom:24.0pt"><span style="font-size:10.0pt;font-family:"Arial","sans-serif""><img width="201" height="58" id="Picture_x0020_1" src="cid:image001.png@01CC478D.D8E292F0" alt="Description: Description: Description: HR Logo1Trans.png"></span><span style="font-size:10.0pt;font-family:"Arial","sans-serif""><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-size:10.0pt;font-family:"Arial","sans-serif"">July 21, 2011<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:.5in;text-indent:-.5in">
<b><span style="font-size:10.0pt;font-family:"Arial","sans-serif"">To</span></b><span style="font-size:10.0pt;font-family:"Arial","sans-serif"">: All Business Officers and Departmental Benefits Assistant/Payroll Personnel<o:p></o:p></span></p>
<p class="MsoNormal" style="text-autospace:none"><b>From: </b>Workplace Health & Wellness – Workers’ Compensation<o:p></o:p></p>
<p class="MsoNormal" style="text-autospace:none"><o:p> </o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:.5in;text-indent:-.5in">
<b><span style="font-size:10.0pt;font-family:"Arial","sans-serif"">Re</span></b><span style="font-size:10.0pt;font-family:"Arial","sans-serif"">: Workers' Compensation Insurance for Out-of-Country Employees<o:p></o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Every year, the Office of the President requires each campus to provide a list of employees who reside and work outside of the United States. These employees are not covered by the University's general Workers' Compensation insurance,
which is only applicable to employees employed within the state. In order to determine if any of your employees require this special foreign insurance coverage, the following criteria would apply:<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<ul style="margin-top:0in" type="disc">
<li class="MsoNormalCxSpMiddle" style="mso-list:l0 level1 lfo1"><span style="font-size:10.0pt;font-family:"Arial","sans-serif"">Permanent employment is outside of the United States<o:p></o:p></span></li><li class="MsoNormalCxSpMiddle" style="color:#1F497D;margin-bottom:12.0pt;mso-add-space:auto;mso-list:l0 level1 lfo1">
<span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:windowtext">Long term employment outside of the United States (longer than a three-month assignment)</span><span style="font-size:10.0pt;font-family:"Arial","sans-serif""><o:p></o:p></span></li></ul>
<p class="MsoNormalCxSpMiddle" style="margin-bottom:10.0pt;mso-add-space:auto;line-height:115%">
<span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif"">If employees are working outside of the United States only on a temporary basis and out of the country for less than three months - they will be covered under the University's
self-insured program.<br>
<br>
If you have any employees who require this special foreign Workers’ Compensation coverage, please provide the following information to Nini Furst in the Workers' Compensation Office<span style="color:#1F497D">
</span>via e-mail at <a href="mailto:nini.furst@ucr.edu"><span style="color:blue">nini.furst@ucr.edu</span></a><span style="color:#1F497D">,</span> by <b><u>Monday, August 1, 2011</u></b><span style="color:blue">:</span><o:p></o:p></span></p>
<p class="MsoNormalCxSpMiddle" style="margin-bottom:10.0pt;mso-add-space:auto;line-height:115%">
<o:p> </o:p></p>
<ul style="margin-top:0in" type="disc">
<li class="MsoNormalCxSpMiddle" style="color:#1F497D;mso-list:l1 level1 lfo2"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:windowtext">Employee Name</span><span style="font-size:10.0pt;font-family:"Arial","sans-serif""><o:p></o:p></span></li><li class="MsoNormalCxSpMiddle" style="color:#1F497D;margin-bottom:10.0pt;mso-add-space:auto;line-height:115%;mso-list:l1 level1 lfo2">
<span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif";color:windowtext">Hiring Department</span><span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif""><o:p></o:p></span></li><li class="MsoNormalCxSpMiddle" style="color:#1F497D;margin-bottom:10.0pt;mso-add-space:auto;line-height:115%;mso-list:l1 level1 lfo2">
<span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif";color:windowtext">Address of Residence (outside the US)</span><span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif""><o:p></o:p></span></li><li class="MsoNormalCxSpMiddle" style="color:#1F497D;margin-bottom:10.0pt;mso-add-space:auto;line-height:115%;mso-list:l1 level1 lfo2">
<span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif";color:windowtext">Work Address (outside the US)</span><span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif""><o:p></o:p></span></li><li class="MsoNormalCxSpMiddle" style="color:#1F497D;margin-bottom:10.0pt;mso-add-space:auto;line-height:115%;mso-list:l1 level1 lfo2">
<span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif";color:windowtext">Payroll Title/Job Description (the job description can be faxed to X 2-2192)</span><span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif""><o:p></o:p></span></li><li class="MsoNormalCxSpMiddle" style="color:#1F497D;margin-bottom:10.0pt;mso-add-space:auto;line-height:115%;mso-list:l1 level1 lfo2">
<span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif";color:windowtext">Description of Operation (choose one: Office, Classroom, Research Lab, Field Station, Dormitory)</span><span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif""><o:p></o:p></span></li><li class="MsoNormalCxSpMiddle" style="color:#1F497D;margin-bottom:10.0pt;mso-add-space:auto;line-height:115%;mso-list:l1 level1 lfo2">
<span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif";color:windowtext">Date of Hire</span><span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif""><o:p></o:p></span></li><li class="MsoNormalCxSpMiddle" style="color:#1F497D;margin-bottom:10.0pt;mso-add-space:auto;line-height:115%;mso-list:l1 level1 lfo2">
<span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif";color:windowtext">End Date (current or projected)</span><span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif""><o:p></o:p></span></li><li class="MsoNormalCxSpMiddle" style="color:#1F497D;margin-bottom:10.0pt;mso-add-space:auto;line-height:115%;mso-list:l1 level1 lfo2">
<span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif";color:windowtext">Annual Salary (payroll for 07/1/2010 to 06/30/2011)</span><span style="font-size:10.0pt;line-height:115%;font-family:"Arial","sans-serif""><o:p></o:p></span></li><li class="MsoNormalCxSpMiddle" style="margin-bottom:12.0pt;mso-add-space:auto;mso-list:l1 level1 lfo2">
<span style="font-size:10.0pt;font-family:"Arial","sans-serif"">Dept. FAU #<o:p></o:p></span></li></ul>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial","sans-serif"">For questions, please call Nini Furst, at extension 2-4207 or email at
<a href="mailto:nini.furst@ucr.edu"><span style="color:blue">nini.furst@ucr.edu</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Thank you,<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">A. Grant Christensen<o:p></o:p></p>
<p class="MsoNormal">Payroll Supervisor<o:p></o:p></p>
<p class="MsoNormal">University of CA Riverside<o:p></o:p></p>
<p class="MsoNormal">(951) 827-1943 Office<o:p></o:p></p>
<p class="MsoNormal">(951) 827-3314 Fax<o:p></o:p></p>
<p class="MsoNormal"><a href="mailto:grant.christensen@ucr.edu">grant.christensen@ucr.edu</a><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
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