CLEA home
Providing superior Long Term Disability Benefits to over 20,000 Law Enforcement Participants since 1985.

Information Update Forms

Have you moved? Changed your email address or phone number? If so, use this form.

Contact Information Update Card



Have any of the following events occurred that would trigger a change for your beneficiary?

  • New marriage

  • Dissolution of marriage

  • Death of chosen beneficiary

  • Creation of a Living Trust

  • Children that have become of age (18)

Change of Beneficiary Card (Please do not designate minors as your beneficiary.)



Please return your completed form to:


Information Update

PO Box 31

Martell, CA 95654


Executive Board


Dave Boffi

Daly City POA

Vice President North

Kevin Mickelson

Sacramento Co. DSA

Vice President South

Darin Ryburn

Burbank POA

Chief Financial Officer

Joe Chirillo

Beverly Hills POA

Executive Secretary

Mario Yagoda

Glendale POA

Chairman of the Board

Jerry Hall

DSA of Santa Clara Co.





California Public Safety Administrators, Inc.

Plan Administrators

CA Insurance Lic. #0544968