HomeMy Public PortalAbout107-2018 - HR - Indiana Publice Employer Plan - Worker's Comp & Loss ControlINDUNA PUBLIC EMPLOYERS, PLAN
MMMBERSHIP AGREEMENT
This agreement made and entered into by and between _ Richmond, City of
_ (hereinafter mown as "Member"), a governmental entity or political subdivision of the State of Indiana, and the
Indiana Public Employers' Plan, Inc., an Indiana not -for -profit corporation.
WITNESSETH:
WHEREAS, pursuant to IC 23-17-1 and IC 22 3-6-2(c) and IC 36-1-7-12 to the extent applicable, certain
governmental entities and political subdivisions of the State of Indiana, as described in IC 34-6-2-49, IC 34-6-2-1 I0
and IC 34 13-3, desire to combine in a group self -funded program to be known as the "Indiana Public Employers'
Plan, Inc", an Indiana not -for -profit public benefit corporation, (hereinafter known as "IPEP" or the "Plan") for the
purpose ofsatisSting their respective obligations under IC 22-3-2 through IC 22-3-6, IC 22-3-7 and IC 22-3-9,
hereinafter referred to as the "Acts," and;
WHEREAS, the Member has executed a Membership Application and provided to the Plan a duly executed
resolution of its governing body authorizing its participation in the Plan.
NOW, THEREFORE, in consideration of the payment of an initial contribution of Two hundred eighty
nine thousand six hundred forty six ($289,646.00, Dollars and of the terms and conditions set forth herein, the
Plan and the undersigned Member agree as follows:
I . The Plan shall act for and on behalf of the Member as of 12:01 A.M. on 01-JULY-2018
("effective date") for the defense of and payment of any and all liability imposed by the Acts.for injuries, illness or
death suffered after the effective date by a person covered under the Acts by accident or illness arising out of and in
the course of employment, or covered service, with the Member under the provisions of the Acts as they may from
time to time be amended. A Member which desires to provide coverage for its rostered volunteers under IC 22-3-2-
2.1 must do so by addendum to this agreement.
However, for claims filed under the Indiana Employers' Liability Act (IC 22-3-9), the Plan's payments
shall be limited to:
bodily injury by accident ............... $1,000,000 each employee
bodily injury by disease .......... . .... $1,000,000 each employee
all bodily injury ...................... S 1,000,000 all employees - aggregate limit.
Further, after the effective date, the Plan shall:
1.1 Defend or cause to be defended in the name and on behalf of the Member, any claims arising out
of any alleged injury, death or illness subject to the Acts only; no defense or other services shall be provided for
claims filed under any Act of the Congress of the United States nor for employments excluded under IC 22 3-2-2.
1.2 The obligation of the Plan under the Acts shall not be affected by any default of the Member as to
any claim for injury or disease which occurred or was contracted prior to the date of the member's default. Any
benefits payable under the Acts for injuries which occur or diseases contracted subsequent to the member's default
shalt be at the members expense, including the costs of defending such claims.
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www PERcom Contract No. 107-2018
13 Any and all weekly compensation benefits awarded or agreed upon under the Acts may be paid to
the Member for distribution to its appropriate employee in a timely manner, or directly to the employee at the
direction of the Member.
IA The PIan has authority to settle any claim, for and on behalf of the Member, which payment shall
be conclusive as between the Member and the Plan.
1.5 The Plan shall be subrogated to all rights which the Member may have against any party, in respect
to any claim or payment made, assumed or incurred under this Agreement.
1.6 The Plan through its attorney -in -fact, Public Risk underwriters of Indiana, Inc, shall procure and
continuously maintain excess insurance in an amount and upon terms determined by the Board of Directors of the
Plan and in no event shall any agreement exchanged hereunder render any Member liable as a guarantor of the
liability of other Members except to the extent set forth at Paragraph 3.6, below.
2. The continued participation of any Member in the plan is subject to the Plan's underwriting criteria
and excess carrier approval and any conditions mandated by the excess carrier.
3. The Member pledges, covenants and agrees to be bound by the bylaws as may be from time to time
promulgated by the Board for the administration of the Plan, a copy of which is attached hereto and made a part
hereofas Exhibit "A", and the following:
3.1 upon the occurrence of any event covered by this Agreement, the Member shall give immediate
written notice thereof to the attorney -in -fact, shall complete any and all forms required by the Acts, any
governmental agency or the Board, and shall forward to the attorney -in -fact forthwith every written communication,
or information as to any verbal communication, and every process, pleading and paper of any kind relating to any
and all claims, suits and proceedings related to injury, illness or death of an employee of Member subject to the Ads.
3.2 Tire Member shall not make any admission of liability before or after receipt of notice of injury,
death or illness, nor shall it, except as its own cost, incur any expense, make any payment or settle any claim, nor
shall it interfere in any negotiations for settlement nor in any legal proceedings with respect to any injury or illness
for which the Plan shall be liable under this Agreement without, in each case, the written authority of the attorney -in -
fact or the Plan's counsel.
33 Whenever required by the attorney -in -fact, and at the Plan's expense, the Member shall promptly
aid in securing information and shall famish, on forms prescribed by the Board, the same to the Plan for filing with
the Board, and evidence and the attendance of witnesses, and shall cooperate with the Plan in all matters which the
attorney -in -fact or its counsel may deem necessary in the defense of any claim or suit or in any review or appeal
thereof~
3.4 Contributions from the Members (estimated based upon its application) shall be paid to the Plan by
the effective date of membership in the Plan. An adjustment to the contribution may be made during the succeeding
Plan years after the anniversary date of the Agreement based upon a payroll audit of the of the Member, whether or
not membership is current or has terminated. The Member shall furnish to the attorney-m-fact, whenever requested
to do so, a written declaration of the exact amount of the entire earnings of its employees to whom it may be liable
under the Acts, and shall permit the attorney -in -fad or its agents at all reasonable times during the term of this
Agreement, and within two (2) years of its termination, to examine the Membees books or any other of its records,
so far as they relate to the earnings of the Membees employees. If the total of such earnings differ from the amount
estimated in the application, the contribution shall be adjusted by an additional contribution to the Plan, or by a
mfimd, as the case may be, computed at the rates specified by the attorney4n-fad for and on behalf of the Board for
the applicable membership year
3.5 The attorney -in -fad is authorized as to each Member to appear before the Worker's Compensation
Board of Indiana, by counsel of its choosing, to defend claims by Member's employees under the Ad or to receive
service of process from and appear before a court of competentjurisdiction if the claim is under IC 22 3-9.
[Rev 05/10/121 Page 2
3.6 It is agreed that Member, by entering into this Agreement, covenants and agrees with each Member
to pay an amount in excess of the annual contribution in the event all funds of the Plan be exhausted and there be
outstanding, unpaid liabilities of the Plan which are not subject to reimbursement from the excess carrier, provided,
however, that in no event shall the Member be liable for any amount in excess of its proportional share of the total
contribution attributable to such Member by the Plan during the Plan's fiscal year in which the deficit occurred. The
Member agrees to be liable to the Plan for such assessments for a period of two (2) years following its termination as
a Member.
3.7 The attorney -in -fact shall keep an accounting of all monies paid by each Member, which
accounting shall always be open to inspection by the Member during normal business hours of the attorney -in -fact.
the Plan. 3.8. The attorney -in -fact shall be compensated for services provided as authorized by its contract with
3.9 This Agreement is entered into for a period of twelve months (12) from the effective date. This
Agreement may, upon payment of an adjusted annual contribution, be automatically extended for a further period of
twelve (12) months, provided there are no unpaid contributions for the previous twelve (12) month period.
3.10 This Agreement may be terminated as provided in Article VIII of the Plan's bylaws.
3.11 Each Member agrees to initiate and maintain an individualized safety and loss control program to
give its employees, and other persons subject to the Acts in its service, proper working conditions and agrees to
follow the recommendations of the Plan to promote the general welfare of such persons. Each Member, however,
shall remain solely responsible for all decisions concerning its safety program and practices.
3.12 The Member shall cooperate with the Plan and, upon the Plan's request, attend conferences,
hearings, trials and assist in effecting settlements, securing and giving evidence, obtaining the attendance of
witnesses in matters at law, in equity, or in administrative proceedings. The Member sball not, except at its cost,
which shall not be reimbursed by the Plan, voluntarily make any payment, assume any obligations or incur any
expense other than for such immediate medical and other services at the time of injury as may be required by the
Acts.
3.13 Each Member does hereby appoint the Plan's attorney -in -fact as its attorney -in -fact to act in the
Member's behalf as to any matters effecting membees liability under the Acts or such Membees obligations under
the rules, regulations, orders or awards of the Worker's Compensation Board of Indiana.
3.14 Each Member shall make payment of all contributions as required under this Agreement by the
later of the invoice date or the effective date of its membership.
3.15 The Board, the Plan's attorney-irrfact, and any of their officers, assigns, servants,
employees or attorneys, shall be permitted, at all reasonable times, to inspect the Member's work places, plants,
works, and machinery and within two (2) years following termination of membership to examine Member's books,
vouchers, contracts, documents and records of any and every kind which may be needed to verify any information
provided to the Plan or contributions which are payable or were paid to the Plan.
3.16 No alterations of this Agreement shall be valid unless in writing and executed by the Member and
Plan through its attorney -in -fact.
3.17 This Agreement shall be construed under the laws of the State of Indiana
3.18 It is specifically agreed and understood that participation in the Plan shall not constitute the
purchase of a contract of insurance nor convey an interest in any assets of the Plan except to the extent allowed under
the Bylaws of the Plan or this agreement.
[Rev 05/10/121 Page 3
3.19 The Plan affirms, under the penalties for perjury, it does not ku0wmgly employ an unauthorized alien as
defined in 8 U.S.C.1324(a)(h). The Plan has no employees. All of the services provided to the member are provided through
subcontractors as defined in IC 22-5-1.7-8. Nevertheless the Plan will enroll in the E-Verify program (described in IC 22-5-
1.7-3) and participate therein should it hire employees. Upon entering into any subcontractor contract or the renewal of any
current subcontractors, contract, the Plan will require it to comply with IC 22-5-1.7, will obtain a certificate of compliance as
required by IC 22-5-1.7-15 and maintain on file such certifications for the duration of the contract. The plan will not
knowingly: a) employ or contract with an unauthorized alien, b) contract with a subcontractor which employs an unauthorized
alien, c) retain an employee it subsequently learns is an unauthorized alien, nor d) contract with any subcontractor which it
subsequently learns employs an unauthorized alien.
Ri WITNESS WHEREOF, the Member and the Plan, by and through their duly authorized representatives,
executed this Agreement this ) 14. day of, ✓
1NDIANA PUBLIC EMPLOYERS' PLAN, INC.
By Its Attorney -in -Fact:
By:
Printed name:
Member Name _City of Richmond
Authorized Signature
Printed Name
Title
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