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Home My Public Portal AboutCA-ICA, INC COMPENSATION THIRD PARTY ADMINISTRTORr 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 AGREEMENT NO. 05 This Agreement is made and entered into this 1st day of August, 2005 by and between City of Carson a municipal corporation, hereinafter referred to as "City", and CA -ICA, INC. a California corporation, hereinafter referred to as "Administrator, " with it's principal place of business located at 3547 Voyager Street, Suite 104, Torrance, California 90503. WHEREAS, City is self-insured in the area of its liability under the Workers' Compensation Laws of the State of California; and WHEREAS, City anticipates issuing or participating in a request for proposals ("the RFP process") for workers' compensation claims administration prior to the end of calendar year 2005; and WHEREAS, Administrator represents itself as being capable and qualified to provide such services in a manner commensurate with the highest professional standards and in accordance with all applicable legal standards; NOW, THERFORE, IN CONSIDERATION OF THESE PREMISES, THE PARTIES HERETO AGREE AS FOLLOWS: ARTICLE 1 -SCOPE OF SERVICE A. Administrator agrees to perform all services required to be performed as specified and in the manner provided for in City's Request for Proposal (Exhibit "A"). In the event of any conflict between this Agreement and the terms and conditions of Exhibit "A," the terms and conditions of this Agreement shall prevail. B. Claims Administration: 1. Administrator shall perform all services required to resolve claims arising from City's self-insured workers' compensation program and to act as representative for City in all matters relating to City's obligations under the Workers' Compensation laws of the State of California. Such services shall include, but are not limited to, the following: claims administration services program administration services; medical management services; litigation 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 management services; and management information services more particularly set forth herein after and pursuant to City satisfaction and in accordance with state law and industry standards. (a) When appropriate, refer litigated cases to attorneys utilizing the City defense panel, assist in the preparation of litigation cases and negotiations of settlements and subrogation actions. (b) Notifications of City's excess workers' compensation carrier of all claims which meet the reporting requirements of the carrier. Maintain liaison between the carrier and City on matters affecting th adjusting of such claims. (c) Maintain close contact with treating physicians to assure that: (1) employees receive proper medical treatment. (2) avoid over treatment situations. (3) are provided transitional duty when appropriate, and (4) are returned to full employment at the earliest possible date. (d) Administrator shall contact by telephone all indemnity claimants within 24 hours of report of the claim to Administrator. (e) Administrator shall appraise City of major developments arising in the investigation, adjustments and settlement of significant claims. City agrees that the terms "major developments" and "significant claims" as used in this Article are solely defined within Administrator's discretion. 2. Program Administration: (a) Assist City in the development of rules, procedures and practices involving employee injuries. (b) Attend City Council meetings if requested. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (c) Provide a claim review meeting with the City monthly. Provide a written claim summary of all cases to be discussed at least one week prior to the meeting. (d) Coordinate all temporary disability payments in coordination with the City's salary continuance and benefit plans. (e) Provide City with necessary or required Workers' Compensation forms and provide necessary advice and guidance as to the proper utilization of these forms. As necessary, provide training to City staff on the use of these forms. (f) At least once per year and as requested, provide staff training on the Workers' Compensation system and related topics. (g) Keep City informed of new legislation, regulations, and other information pertinent to Workers' Compensation. (h) City or any agent thereof shall have reasonable rights during normal business hours and upon reasonable notice to inspect or audit the records pertaining to any claim for which services are provided under the Agreemeni provided that City shall reimburse Administrator for the cost of making such records available for any audit undertaken by City more frequently than once each year during the term hereof. Any such inspection or audit shall be conducted in a manner so as to not unnecessarily interfere with the business of Administrator. 11 3. Management Information Systems. (a) Provide City with monthly reports itemizing monthly expenditures, reserve status, claim inventory status, claim costs, and potential subrogation recovery in a format approved by City. (b) Prepare and provide to the City no later than February 1St of each year the Annual OSHA Log Summary, including notification to post during the month of February. 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (c) Prepare and provide to City no later than September 15t of each year the Self -Insurer's Annual Report. (d) Upon request of the City, provide on-line access to the Administrator system, including training in its use at no additional charge. The cost of the computer and the telephone time to be borne by the City. (e) Provide 1099 forms to all appropriate vendors no later than January 31St of each year as required by the Internal Revenue Service. (f) Administrator shall provide computer back-up off site updated weekly. C. Administrator and City agree to operate and administer vouchers to be used for payment or benefits to employees in accordance with the procedures mutually agreed upon and subject to the Workers' Compensation Laws of the State of California. D. Administrator agrees to assign the work involved only to persons who are specially trained, experienced and competent in the administration of public sector workers' compensation claims. In conjunction therewith, City shall have the right, reasonably exercised, to direct Administrator not to use persons who, in the opinion of the City, are not specially trained, experienced and competent to render the required services. ARTICLE 2 -COMPENSATION City agrees to pay and Administrator agrees to accept as compensation for its services, the sum of $35,400, annually, for services rendered for all new claims, as well as services on all existing claims continued from or assumed for prior years. City agrees to pay ICA fees for services in accordance with the fee schedule set forth as Schedule 2A (Exhibit "B") upon the assignment of a claim for adjustment and to promptly make all payments for Claims. Administrator shall invoice City monthly in advance. City shall process and pay said invoices as soon as practicable after receipt, in the ordinary course of City business. A 1 2 3 4 51 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ARTICLE 3 -TERM The term of this Agreement shall commerce on August 1, 2005 and shall end on June 30, 2008 provided that: 1. Either party may terminate this Agreement at any time upon giving ninety days' written notice to the other party. Upon such termination, Administrator shall be entitled to a pro rata fee based upon work actually accomplished as of the effective date of such termination, and a final accounting will be made of the fees of Administrator and of any funds belonging to City in the possession of the Administrator, and any balance due either party will be promptly paid. Upon termination, pending claim files and lawsuits shall revert to the control of and become the responsibility of the City. ARTICLE 4 -INSURANCE Administrator shall procure and maintain for the duration of this Agreement, insurance as required below against claims for bodily injuries, property damage or loss that may arise from or in connection with the performance or non-performance of this Agreement by Administrator or any of its officers, agents, employees or subcontractors. City, its governing body, the individuals thereof, and all officers, agents, employees, representatives and volunteers shall be named as additional insureds on the general liability policies. A "third party clause' covering the interest of City should be endorsed onto the crime policy. The coverages shall contain no special limitations on the scope of protection afforded by City, its governing body, the individuals thereof, and all officers, agents, employees, representatives, and volunteers. The Administrator shall furnish City with certificates of insurance and with original endorsements effecting coverage required by this Agreement. The certificates and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf and shall specifically reference this Agreement. All certificates and endorsements are to be received and approved by City before work commences. City reserved the right to require complete, certified copies of all required insurance policies at any time. In any insurance i written on claims made forms, such insurance shall be endorsed to provide extended 5 1 reporting period of not less than five years following termination of this Agreement. All 2 insurance shall be placed with insurers admitted in the State of California and having a 3 Best's rating of no less than A:VII. 4 All certificates of insurance and policies shall state clearly that the City shall be notified 5 by registered mail at least thirty (30) days prior to cancellation of the policy for any reason. 6 Administrator shall maintain these policies and shall cause all parties supplying 7 services, labor or materials to maintain the following insurance in amounts not less than s those specified in this section. 9 A. Public Liability and Property Damage Insurance. Administrator shall maintain 10 commercial general liability insurance in an amount not less than one million dollars 11 ($1,000,000.00) combined single limit for bodily injury and property damage per 12 1 occurrence and one million dollars ($1,000,000.00) combined single limit aggregate which 13 shall be primary over any other insurance carried by the City, including City's self-insured. 14 retention. Certificates of insurance issued to Administrator shall name the City as an 15 additional insured. 16 B. Errors and Omissions Insurance. Administrator shall maintain Errors and 17 Omissions Insurance in an amount not less than one million dollars ($1,000,000.00). 18 C. Workers' Compensation Insurance. Administrator shall maintain Workers' 19 Compensation insurance in compliance with the laws of the State of California. 20 ARTICLE 5 -HOLD HARMLESS/ INDEMNIFICATION 21 A. Administrator agrees to defend, indemnify, save and hold harmless City, its 22 governing body, the individuals thereof, and all officers, agents, employees, 23 representatives, and volunteers from all loss, costs, and expense (including, but not by way 24 of limitation, attorneys fees and court costs) resulting from any penalty or penalties 25 assessed by an authorized body pursuant to statues, rules or regulations governing 26 workers' compensation claims or arising out of any liability or claim for injury, damage or 27 loss sustained or claimed to have been sustained arising out of , or incidental to activities 2s 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 in connection with the furtherance or performance of any provision of this Agreement. The terms of this Article shall survive termination. B. Administrator further agrees to waive all rights of subrogation against City. The provisions of this Article do not apply to loss, cost, and expense (including, but not by way of limitation, attorneys fees and court cost) resulting from any penalty or penalties assessed by any authorized body pursuant to laws, rules, or regulations governing workers' compensation or claims caused solely by the negligence of City or to the extent that Administrator's act or failure to act was at the specific direction of the city. C. City shall indemnify, hold harmless and defend Administrator, its agents, employees, officers and directors against any and all loss, damage, fines, liability, costs anc expenses (including, but not limited to, attorney fees, court costs and reasonable investigative and delivery costs) and other such sums which Administrator, its agents, servants, employees, officers and/or directors may reasonably pay or become obligated to pay on account of acts or negligence of City, its agents or employees, officers or directors. Administrator agrees to notify City promptly in writing in the event of such a claim, demand, assertion or liability or action is brought to Third Party Administrator's attention. D. City shall not be liable to Administrator for personal injury of Administrator's employees or property damage sustained by Administrator in the performance of the services specified in this Agreement. E. Penalties and assessments arising from the failure of City to provide timely notice of claims or other such employer obligations as provided under the California Workers' Compensation Reform Act of 1989, as amended shall be and remain the sole responsibility of City and City hereby agrees to indemnify, defend, and hold harmless Administrator for all claims arising from the imposition of such penalties and assessments resulting from such actions by City. Administrative penalties arising solely from the failure of Administrator to comply in the timely and proper manner with its duties as the Administrator of City's workers' compensation claims shall be and remain the sole responsibility of Administrator and Administrator hereby agrees to indemnify, defend and 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 hold harmless City from all claims arising from the imposition of such administrative penalties. F. The parties acknowledge that the California Workers' Compensation Reform Act of 1989 as amended, requires first payment of temporary disability indemnity within fourteen (14) days of City's knowledge of injury and generally imposed the automatic penalty of ten (10%) percent of the amount delayed for indemnity payments which shall be payable directly to the injured employee without application. Furthermore, the parties aggress that unless Administrator is provided with a notice of the claim within seven (7) days of City's knowledge of the injury, the above -referenced automatic penalty of ten (10%) percent shall be and remain the sole responsibility of City. ARTICLE 6 -FINDINGS CONFIDENTIAL All of the reports, findings and conclusions prepared or assembled by Administrator under this Agreement are confidential and Administrator agrees that they shall not be made available to any individual or organization without prior written approval of City. All reports and findings shall become the property of City, however, no conclusions, opinions or studies provided by Administrator shall be made available to any other party except in connection with the original purpose of the assignment, without prior written approval of the City. ARTICLE 7 -NOTICES Notices pursuant to this Agreement shall be given by United States Postal Service, postage prepaid, addressed to the parties as follows: 1. City City of Carson City Hall c/o Administrative Services General Manager 1701 East Carson Street Carson, CA 90745 2. Administrator 4 5 6 7 s 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Marilyn E. Murata, President CA -ICA, INC. 3547 Voyager Street, Suite 104 Torrance, CA 90503 Notices shall be deemed given as of the time and date of mailing, if the party mailing the notice has complied with the provisions of this Article. ARTICLE 8 -NON ASSIGNABILTY Administrator shall not assign any interest in this Agreement and shall not transfer any interest in the same whether by assignment or novation without prior written approval of City. ARTICLE 9 -EQUAL EMPLOYMENT Administrator agrees that during the performance of this Agreement, it will not discriminate against any employee or applicant for employment because of race, creed, color, sex, age, sexual orientation, disability or handicap, religion or national origin. ARTICLE 10 -GENERAL CONDITIONS A. This Agreement shall be interpreted in accordance with the laws of the State of California. B. This Agreement may be modified or amended only by a written amendment signed by both parties. No waiver of one or more provisions of this Agreement shall constitute a waiver of any other provision. C. In the event Administrator fails to perform in accordance with the indemnif;ra+; and insurance requirements clauses of this Agreement, or otherwise breaches an y other provision of this Agreement, the City shall be entitled to recover all legal fees, costs, and other expenses incident to securing performance or incurred as a consequence of nonperformance. D. While performing the specified services, Third Party Administrator is an independent contractor and not an officer, agent or employee of the City. ARTICLE 11 -ATTORNEY'S FEES 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 If any action at law or in equity, including an action for declaratory relief, is brought to enforce or interpret the provision of this Agreement, the prevailing party shall be entitled to a reasonable attorney's fee, which may be set by the court in the same action or in a separate action brought for that purpose, in addition to any other relief to which it may be entitled. ARTICLE 12 -FORCE MAJEURE Neither party shall be responsible for the delays or failures in performance resulting from acts beyond the control of such parties. Such acts shall include, but not limited to, acts of God, strikes, lockouts, riots, acts of war, epidemics, governmental regulations superimposed after the fact, fire, communication lines failure, earthquakes, or other disasters. ARTICLE 13 -APPROPRIATION OF FUNDS Payments to be made to Administrator by City for services performed within the current fiscal year are within the currant fiscal budget and within an available, unexhausted and unencumbered appropriation of City. In the event City does not appropriate sufficient funds for payment of Administrator's services beyond the current fiscal year, this agreement shall cover payment for Administrator's services only up to the conclusion of the last fiscal year in which City appropriates sufficient funds and shall automatically terminate at the conclusion of such fiscal year. ARTICLE 14 -ENTIRE AGREEMENT This Agreement constitutes the entire agreement between the parties and shall supersede any other notes, records, memoranda or oral understanding in existence at the time of execution, as well as all prior and contemporaneous negotiations. In the event of any conflict between terms, conditions and provisions of this Agreement and any prior agreement, document or instrument, the terms, conditions and provisions of this Agreement shall prevail. The parties agree, that in the event this Agreement is subject to judicial or quasi-judicial interpretation, any such interpretation shall be without regard to the identity of the party drafting this Agreement. 10 1 2 3 4 5 6 7 8 9 10 11 12. 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 In witness whereof the parties hereto have executed this Agreement on the date and year first above written. CA {ISA, Inc. s . CITY OF c Mayor ATTEST: APPROVED AS TO FORM: Ci Attorney 11 i' Marilyn JZ. MurAta, President/CEO CITY OF CARSON WORKER'S COMPENSATION CLAIM ADMINISTRATION SERVICES REQUEST FOR PROPOSALS For the period July 1, 2005 — June 30, 2008 Prepared by: { .zq Ed Holton Sr. Risk Management Analyst FEBRUARY 2005 Exhibit "A" REQUEST FOR PROPOSAL FOR WORKERS' COMPENSATION CLAIMS ADMINISTRATOR A. INTRODUCTION/BACKGROUND The City of Carson (,'City") is soliciting request for proposals ("RPF") from qualified third party claim administrators ("TPA") for administration of the City's self-insured worker compensation program. The City's Human Resources Division is responsible for management of the City's worker compensation program, including contract administration of the TPA contract. The City's Human Resources Division coordinates all aspects of the workers' compensation program with the TPA. This includes: reporting of injuries; employee contact; providing lost time and salary information; training for managers, supervisors and employees; early return to work program; claimant service evaluation and maintenance of the City's worker compensation claim files. The City is self-insured for workers' compensation benefits under Certificate Number 7237 and has been self-insured since July 1, 1981. The City maintains a self-insured retention level of $1 M and excess insurance coverage up to the State statutory limits. The City's total salaries (excluding benefits) for the 2003-2004 fiscal year was approximately $25,036,607. Provided as Exhibit 1, is the City's current loss run summary as of December 31, 2004. This loss run reflects 102 open claims of which 61 are indemnity. Provided as Exhibit 2, is the City's Public Self -Insurer's Annual Report for fiscal year end June 30, 2004. FISCAL YEAR YEAR END CLAIMS TOTAL 1999-2000 101 2000-2001 114 2001-2002 111 2002-2003 141 2003-2004 96 B. SCOPE OF WORK i The City seeks a third party claim administrator who will be able to meet the following service objectives: Claim administration and adjustment of all existing claims, open and closed, and all new claims during the contract term. Conversion and/or establishment of loss run data and transference of claim files from the . previous third party claim administrator. Proposer will indicate in the proposal if there is any fee for conversion of data or transfer of claim files from the previous third party claim administrator. Claims administrator shall have a minimum of five (5) years experience administering claims as a claims administrator and hold a Self -Insurance Certificate or become certified within one year of inception of the contract. The City shall be notified when the claims administrator's .caseload exceeds 150 open indemnity files at any one time. Non -City claim files are to be included in the 150 total. Claims Management Services: ■ Make initial contact with the employee and establish a claims file within 24 hours of receipt of the Employers' First Report of Injury for the City. Claim files will be available for review by the City at anytime during the third party claim administrator's regular business hours. Contact City employees to explain Department of Workers' Compensation (DWC) benefit notices and other required letters and forms. In addition, the claims administrator will provide guidance and information regarding workers' compensation benefits to City employees. ■ Respond to City staff inquiries within twenty hours (24) hours and critical issues on the same day. ■ Monitor treatment programs for injured employees to ensure that they receive proper care and to avoid over treatment situations. ■ Establish claim reserves and provide a continual review and update of reserves to reflect changes during the life of the claim. ■ Administer workers' compensation benefits in accordance with the Labor Code. ■ All penalties incurred because of failure of the TPA to comply with statutory laws and/or administrative regulations shall be the sole responsibility of the third party claim administrator. ■ Maintain accurate and timely loss runs in a format and system acceptable to the City. K ■ In accordance with the Labor Code, reduce medical bills, other than medical legal expenses, based on the Relative Value Schedule (RVS) and recommended rates set by the Administrative Director, Division of Workers' Compensation. ■ The City will select defense and subrogation counsel with input from the third party claim administrator. ■ The third party claim administrator is responsible for proceeding against responsible persons, agencies, and/or agents in subrogation actions to recover losses suffered by the City due to employee injuries. ■ The City reserves the right to approve, disapprove or select any and all service providers including medical case managers, rehabilitation counselors, primary medical treatment in-patient and out patient facilities, physicians, specialists, chiropractors, legal services, etc. ■ Investigate and recommend special, outside investigations for questionable claims with the coordination and assistance of Human Resources. ■ Provide advance notice and explanation to the Human Resources Division of any claim for workers' compensation benefits that is contested and maybe denied by the third party claims administrator. ■ The City and/or excess insurer reserve the right to conduct an annual independent Claims Audit paid for by the City and/or excess insurer. Closing of Claims: ■ Maintain closed files in accordance with Labor Code provisions. ■ All claims files remain the property of the City and will not be disposed of without the City's prior authorization. ■ Close files that meet closing criteria in a timely manner. Additional Services: ■ Attend Workers' Compensation Appeals Board hearings, status conferences and trials along with depositions, conferences with legal defense counsel, and meetings with City staff as required. ■ Provide all forms, posters, and pamphlets as required by the Labor Code and the Administrative Director that are necessary for the processing of claim and benefit information at your own expense. ■ Prepare the Public Entities Self -Insured Annual Report. 3 ■ Report all claims meeting the City excess insurance carrier's reporting ; criteria as established by the excess insurance carrier. ■ Work with the City's Safety Committee as necessary. ■ Demonstrate knowledge of a Early Return to Work Program Medical Cost Control: ■ Provide details of medical service cost savings resulting from your Preferred Provider Network. ■ Provide details of medical facility cost savings from your Preferred Provider Network. ■ Provide details of cost savings from your third party claims administrator operation or contracted bill review activities. Litigation: ■ Discuss medical control on litigated claims with the City before allowing defense counsel to select a physician. ■ Closely monitor litigation efforts and communicate regularly with the City. The City must authorize all depositions, investigations and subrosa activities. ■ The City must approve settlement authority on all claims. ■ Prior to any settlement conference, hearing or trial, the claims administrator and defense counsel will provide a written analysis of the case, including options and recommendations for settlement. All permanent disability ratings must include the rating formula and dollar amount. ■ Establish controls and procedures to manage and contain claim defense costs. Financial/Accounting: ■ A copy of all vouchers created by the claims administrator to pay benefits shall be provided to the City with supporting documentation. ■ Provide a monthly voucher register of all transactions made for the period. Data Processing/Loss Reporting: ■ Provide a computer generated loss run analysis/summary report for each month covering activity on all new claims reported, open and closed claims for the period. 2 ■ This report will be customized to meet City needs and will provide ,as a minimum, the following information by claim year: a) Monthly listing of open claims by department. b) Monthly listing of open claims alphabetically by claimant: c) Summaries of all open and closed claims by department and the City as a whole. d) Special reports on demand, at no additional charge, such as injury analysis by age, site, occupation, cause, body part, years of service, etc. Records, File and Transcripts: ■ All records, files, transcripts, computer tapes, including loss run data files and other materials related to the management and administration of the City's worker compensation claims are the property of the City and must be relinquished in good order and condition upon termination of the contract with the third party claims administrator. ■ The City will not pay additional costs or fees for the transfer of such property to the City or its agent. Insurance Requirements: ■ General Liability: $1M combined single limit per occurrence for bodily injury, personal injury and property damage. City shall be named as an additional insured. ■ Workers' Compensation and Employer's Liability: Workers' Compensation limits as required by the Labor Code of the State of California and Employers Liability of $1M per occurrence. The Contractor's insurer shall agree to waive all rights of subrogation against the City, its officers, officials, employees and volunteers for losses arising from work performed by the Contractor for the City. ■ Errors and Omissions Liability: $1M combined single limit per occurrence. ■ Professional Liability: $1M combined single limit per occurrence. ■ Proposal will include the name of the third party claim administrator's insurance carrier, the policy coverage and limits, exclusions and expiration dates. Insurance coverage: Each insurance policy required shall be endorsed to state that coverage shall not be canceled, except after thirty (30) days' prior written notice by certified mail, return receipt requested, has been given to the City. All certificates and endorsements are required to be received and approved by the City before work commences. The City reserves the right to require complete, certified copies of all 5 required insurance policies, including endorsements effecting coverage required by these specifications at any time. C. FORM OF PROPOSAL The following`, information states the terms and conditions' that will govern the submission, content, and evaluation of the proposals submitted to the City in response to this RFP. 1. Acceptance of Terms and Conditions Submission of a proposal pursuant to this RFP shall constitute acknowledgment and acceptance of all the terms and conditions hereinafter set forth in this RFP otherwise expressly stated in proposal 2. Right of Reiection by the City Notwithstanding any other provisions of this RFP, the City reserves the right to reject all proposals and to waive any informality in a proposal when to do so would be to the advantage of the City or its taxpayers. 3. Financial Responsibility The City shall have no financial responsibility for any costs incurred by the Proposer in responding to this RFP. 4. Award of Contract The Proposer to whom the contract for any or all of the desired services is awarded shall be required to enter into a written contract with the City of Carson in a form approved by the City Attorney. This RFP and the proposal, or any part thereof, may be incorporated into and made a part of the final contract. However, the City reserves the right to further negotiate the terms and conditions of the contract with the selected Proposer. 5. Conference During the Evaluation Period After the deadline to submit proposals and continuing until a contract has been awarded, all City personnel involved in the administration of the City's Workers' Compensation Program will have been specifically directed against holding any meetings, conferences or technical discussions with any bidder except as needed for the evaluation of the RFP or as needed in the regular course of business. Failure to comply with this requirement will automatically terminate further consideration of that firm or individual's proposal. 6. Adherence to RFP Format R Responses to this RFP must be made in accordance with the format set forth in the RFP... Failure to adhere to this format may be cause for rejection of the proposal as being non-responsive. 7. Preparation of Proposal Each proposal will be prepared simply and economically, avoiding the use of elaborate promotional materials beyond those sufficient to provide a complete, accurate and reliable presentation. 8. Number of Copies Required The Proposer must submit six (6) copies of the proposal, including one clearly marked "ORIGINAL." If discrepancies are found between copies, the "ORIGINAL" copy will provide the basis for resolving such discrepancies. If one copy of the proposal is not clearly marked "ORIGINAL" and there is a discrepancy, the City will reject the proposal. 9. Deadline and Address for Submission Due Date — The Proposer shall submit three (6) copies of the proposal in a sealed envelope plainly marked in the upper left-hand corner with the name and address of the Proposer and the words "Request for Proposal for Workers' Compensation Claims Administrator." All proposals are due no later than 6:OOp.m., March 31, 2005, and should be directed to: . Ed Holton. Sr. Risk Management Analyst City of Carson 701 E. Carson Street Carson, CA 90745 10. Proposal Conditions or Limitations Proposals which impose conditions or limitations to those set forth in this RFP may be considered not responsive and be rejected. 11. Proposal Interpretations and Addenda Any changes to or interpretation of the RFP will be sent by the City to each firm or individual to whom an RFP has been sent and any such changes or interpretations shall become a part of said RFP and may be incorporated into any contact awarded pursuant thereto. 12. Execution of Proposals If the Proposer is a partnership, the proposal must be signed in the name of the partnership by a General Partner thereof. If the Proposer is a corporation, the proposal must be signed on behalf of the corporation by two authorized officers (a Chairperson of the Board, President or Vice -President and a Secretary, 7 Treasurer or Chief Financial Officer) or an officer authorized by the Board of Directors to execute such documents on behalf of the corporation. All Signatures above must be original and in ink. 13. Packaging of Proposal The proposal shall be enclosed in a sealed package(s), marked "Request for Proposal for a Workers' Compenation Claims Administrator," with the name and address of the Proposer in the upper left corner. 14. Terms of Withdrawal All proposals shall be firm offers and may not be withdrawn for a period of one hundred twenty (120) days following the deadline date for submission of proposals noted therein. 15. Modification of Proposal Any Proposer may modify his proposal by written request any time prior to the scheduled closing date and time for receipt of proposal, provided such written request is received by the City prior to said closing time and further provided that the City receives a full, written confirmation of the written request, such confirmation having been mailed prior to said closing time. 16. Disposition of Proposals All proposals submitted in response to this RFP shall become the property of the City of Carson and a matter of public record. Proposers must identify all copyrighted material, trade secrets and other proprietary information and the specific page or pages that the Proposers claim are exempt from the California Public Records Act (California Government Code Section 6250, et seq.). In the event a Proposer claims such an exemption, the Proposer is required to state in the proposal that: "The proposer will indemnify the City and hold it harmless from any claim or liability and defend any action brought against the City for its refusal to disclose copyrighted material, trade secrets, or other proprietary information to any person making a request therefore." Failure to include such 'a statement shall constitute a waiver of the proposer's right to exemption from disclosure. 9 D. INSTRUCTIONS FOR THE WRITTEN PROPOSAL 1. Proposals shall be presented on 8 %" by 11" recycled paper made on both sides of each sheet of paper with no specific page number requirement, other than being .clear and concise. 2. Describe the claim administration' firm completing this proposal, including background and years of experience in workers' compensation claims management and administration. 3. The Proposer shall spell out the cost of the contract, including any possible "add-on" charges that may not be included in the fixed price contract fee. For example, bill review fees. 4. Provide a list of ten of your current and previous clients, including all clients serviced in the last three years. Provide the company name, telephone number, address, contact person and number of years servicing the account. 5. Provide your firm's managerial and technical (claim administrator) turnover percentage for the past three years. 6. Submit samples of any cards, letters, pamphlets, etc. that would be provided to City employees. 7. Describe your company's mechanism(s) for keeping current with changes in workers' compensation laws, statutes and regulations. 8. Describe your company's philosophy and procedures for the establishment of case reserves. 9. Provide a sample of the monthly loss reports you provide to clients. 10. Describe the firm's philosophy regarding- denied and contested claims. What investigative techniques are in place to defend against these types of claims? 11. Provide procedures, timetable, and costs, if any, for the initial set-up and integration of the City's claim into your system. 12. Provide the location and address where the City's claim files will be located and managed. 13. Proposer must quote an annual fee for the three-year contract. 14. Please describe the workers' compensation experience of the staff that will process the City's workers compensation claims. N 15.The third party claim administrators whose proposals are selected as finalists for considerationmay be asked to appear, at their own expense, before an evaluation panel to discuss their proposal. 16. Please describe any services not previously covered which you believe may be of particular value to the City, such as bill review, provider and facility networks, on-line access to claims files, litigation management, etc. Also, indicate if additional costs are associated with any of these services. 17. Please describe your philosophy and experience with Early Return to Work Programs. 18. The proposal must indicate that the Proposer agrees to be bound by the proposal and shall enter a contract to provide services in a form approved by the City. 19. The proposal must be valid for 120 calendar days from the final submission date of the bids. 20. Please provide the biographies of the claims assistant, claims examiner, and claims supervisor who would be assigned to the City's account. 21. Submit a cover letter that contains the name, title, address and telephone number of the individual(s) with authority to bind the proposal during the period in which the City is evaluating the proposal. 22.A principal of the firm shall sign the cover letter or other person fully authorized to act on behalf of the firm. 23. Provide evidence that the Proposer has a valid Certificate to Administer Self -Insured Employer claims as set forth in the Labor Code. 24. Samples of loss runs and other computer-generated reports must accompany the proposal. E. SELECTION CRITERIA The proposal evaluation team (PET) will be responsible for evaluation and ranking the proposals. The selection criteria to be used to select the successful bidder will include, but is not limited to, the following: ■ Established record of consistent professional service and reputation within the industry. ■ Ability to meet the requirements in the Scope of Work section. ■ High quality references from public entities, particularly cities. 10 ■ Staffing, experience levels and commitment to training. ■ Cost effectiveness of medical and legal cost containment programs. Overall cost -benefit advantages. Proposal Evaluation Criteria and Scoring: Each Proposer will receive a rating of one (1) to five (5) points for each item listed below; with five (5) being the highest score: ■ Cost/Price proposal ■ Personnel qualifications and commitment to training ■ References ■ Ability to perform the contract requirements as outlined in the Scope of Work ■ Claim management approach ■ Early Return to Work approach ■ Medical and legal cost control approach F. SELECTION AND CONTRACT NEGOTIATION The Proposers, whose written proposals are determined to be within the competitive range by the PET, may be asked to enter contract negotiations. Upon evaluation of the proposals and outcome of the negotiations, PET will make a recommendation for the contract award to the City Council. The City may: ■ Reject any or all proposals or make no award. ■ Issue subsequent request for proposals. ■ Cancel the request for proposal. ■ Appoint alternate member(s) of the PET. ■ Approve or disapprove the use of particular vendors. ■ Establish a short list of Proposers eligible for interviews after review of the written proposals by the PET and consideration of its recommendations. 11 ■ Modify any requirement contained in the RFP and request revised submittals from Proposers determined to be within the competitive range. ■ Negotiate with any, all, or none of the Proposers. ■ Solicit best and final offers from all, some, or none of the Proposers. ■ Award a contract to one or more Proposers. ■ Accept the written proposal as an offer, without negotiation and issue a notice to proceed. ■ Waive any informality on any proposal The RFP does not commit the City to negotiate a contract, nor does it obligate the City to pay for any costs incurred in preparation and submission of proposals or in anticipation of a contract. The City reserves the right to issue a contract with any of the firms responding to this RFP based solely upon its judgment of the qualifications and capabilities of that firm. No information related to the results of the RFP process will be released until after the recommendation by the PET. Firm's Responsibility: The Firm selected will appoint and make known to the City the personnel who will be responsible for all coordination and communication between the City and the successful third party claim administrator. Within ten (10) days of the City mailing the Notification of Award of Contract and the Contract Form, the Proposer shall provide the City with all the required insurance certificates. The City reserves the right to investigate the qualifications of all firms under consideration and to confirm any part of the information furnished by the Proposer. Moreover, the City may require evidence of managerial, financial or technical capabilities that are considered necessary for the successful performance of the contract. Non -Discrimination — In the performance of this Contract, Contractor shall not discriminate in recruiting, hiring, promotion, demotion, or termination practices on the basis of race, religious creed, color, national origin, ancestry, sex, age, physical or mental disability. 12 Estimated Timetable: Issuance of the Request for Proposal (RFP) Deadline for Submission of Proposals Review of Proposals and TPA Interviews Date of the Contract Award Contract Start -Up date February 16, 2005 March 31, 2005 March 31 May 31, 2005 June 1, 2005 July 1, 2005 Questions concerning this Request for Proposal should be directed to Ed Holton, Senior Risk Management Analyst, at (310) 952-1700, extension 1160 between the hours of 7:00 a.m. and 6:00 p.m., Monday through Thursday. 13 CITY OF CARSON AFFIDAVIT OF NON -COLLUSION The undersigned, as Proposer, declares that this proposal is made without collusion with any other person, firm or corporation and that the only person or parties interested as principals are named herein. Having carefully examined the Request for Proposal for Workers' Compensation Claim Administrator, the Terms and Conditions, we do hereby propose and agree in event of acceptance hereof, to enter into the required agreement with the City of Carson. Dated this day of 2005, certify (or declare) under penalty of perjury That the foregoing is true and correct. NAME OF COMPANY SIGNATURE IIILE 14 Exhibit 1 December 31, 2004 Loss Run -� 0 o E F O b o p N In O n o p o b O OWa a a� o p o kn n r f'1 q O m • O- O I!1 o O O [i O "'� O .1 O m O O O O 00 O O O O q O Ln O m W O O O q n b O O O m 0 0 O t7 O b O v O b O N O v O p 4 hZ4 W a ". ; .p. nen ry.r, voi vvi a uoiv p or N ol0o lOa 0mo., Dn Ob p' 0 = q m .r O q O b NI v n G O n v 0 er cn 0 Ibv n Ifl q 1n N q b 11 N m v O m h U N N p N .. N a a N n .r N O O F F 0 0 0 0 O p O b 0 In O 1n O O O o W W S S> O O O O O N r1 n O m O b O O O O 0 0 0 0 O b O p O "� O q O q as P. 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T N .1 .-1 o m O% N .-e H O o O� N tV H G Q z m \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ O V .-1 O W 7 H v1 v N O N O N N m N O O eT n %D O .-I O n o r N M N o to O N N n v H N O n N N H r N O O W Q h \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ 4 ul m 01 N H L N O O n n 1n r N m .r m n .-1 .-e N 1 I O O O .� V L O, ay e O y - O H m T H b � al E a z 14-1 z d d O X N Z U 4 4 Z C4 9 x E F 'J .�7 E a O U W a O w yw 4 w d w m w ai z E m H N F H U C. a F .UC F w m C o a a O U w T Q d iD b z= y O a O p a Z H W H H R d d m 4 w .'a7 .�-1 O 7 E m to 4 G\G > Z O .ai N H w .7 .7 .w7 W ct; m 3 H Q H z w Z w twit O H O w a w H x7 3 H O Q t�TOC 4 r1 a s d a a a O W y G H W H H H E. O O 4 b s ix a s m O Z H O 4 z N H O N W o N (1 U H 7 7 0 O C at w H z r7 H z K d m o m E. 4 OGG 1 .7 Z q H 1 N a a d to v v v W W 4 h h E (9 �e w 1 .7 a 5 1 a s d 1 .7 S n Z E. ai m H 1 .: cess 3 S N 1 F S T 1 U U ♦ in �o d W U H H 4 j D .W7 1 > a a 1 > F (4 I taA to 1 Exhibit 2 Public Self -Insurer's Annual Report Fiscal Year 2003 - 2004 NOTE: Claims Administrator Complete thisMeforA"reports except item B Errtploymenfl ftes, which !s completed by Selfinsumdemployer. Page 2 Fiscal Ycar Ending June 30, 2004 IT. CONSOLIDATED LIABILITIES Certificate Numbcr. ®- 7 2 7 3-2 1- 0 5 2 Name of Master Certificate Holder: City of Carson Type of Rcport: ❑R Original Report (Due October 1 each year) ❑ Intcrim/Amcndcd Report for the Period of: A. CASES AND BENEFITS fin n-nr-et iml-1 I m 006®�_� 5. Number of MEDICAL -ONLY cases reported in FY 2003-2 004 :................... . 6. Number of INDEMNITY cases reported In FY 2003-2004: ......................... 7. TOTAL of 5 and 6 (also enter in 2c above):. .......................... . S. TOTAL number of open indemnity cases (all years): ........................ 9. Number of Fatality eases reported in FY 2003-2004: ........................ 10. (a) Number of FY 2003-2004 claims for which the employer or administrator was notified ofrepresentation by an attorney or legal representative In FY2003-2004:... (b) Number of non -FY 2003-2004 claims for which the employer or administrator was notified of representation by an attorney or legal representative In FY 2003-2004:.. . B. TOTAL EMPLOYMENT AND WAGES PAID IN FISCAL YEAR 2003-2004 FOR THIS SELF INSURER: (a) NUMBER OF EMPLOYEES 1017 (Number orindividual employees listed on Form DE -6 for year ending June 30, 2004) (b) TOTAL 1VACES AND SALARIES PAID S 25, 036, 607.39 (As reported on EDD Form Ub: 6 Linc M for all four(qunrlers) 33 26 59 73 0 0 2 Fiscal Year incurred Liability Paid to Date Future Liability Numba $ Indemnity S Medical S Indemnity S Medical S Indemnity S Medical 1, u cae� open otN7anool b FAY 199 13 686,746 663,143 564,926 545,500 121,820 117,643 L open k Cloud CtlH: .. FY 1999110 Told a 61 252,330 304,129 236,461 281,149 15, 869 22, 980 FY 1"9-00 Casnapca 3 16,983 82,000 1,114 59,020 b. FY 200401 Tutalca¢e Micd 88 134,947 - 228,975 82,154 171, 264 57,711 FY 2000.0152,793 Cato opia 12 102,815 134,705 50,022 _77,439 L FY 2001 •I002 Toulwes 60 182,432 267,535 116,873 232,370 65, 559 35,165 FUM1.2002 C.W. 5 148,422 113,.973 82,863 78,808 d. FY2002.2003 Toulwes rtcd 68 426,017 649,823 219,529 466,421 206,488 183,402 FY2002.2003 Cara qxn 24 414,456 594,464 207,960 411,062 e. FY 2003.2061 ToW am 59 211,595 287,684 56,948 89,63 154,647 191),04'; FY 2001.2001 1'aara q+rn 39 2.11,510 273,239 56, U71 75,194 • SUBTOTAL 3. ESTIMATED FUTURE LIABILITY (Indemnity plus Medical) TOTAL 4. Total Benefits paid durintt FY 2003-2004 (Include all case emendituresL• ....... _ _ _ S Ind -nit S Mcdical 617,176 614,946 1,232,122 S Indcmni S Medical 261,298 661,626 5. Number of MEDICAL -ONLY cases reported in FY 2003-2 004 :................... . 6. Number of INDEMNITY cases reported In FY 2003-2004: ......................... 7. TOTAL of 5 and 6 (also enter in 2c above):. .......................... . S. TOTAL number of open indemnity cases (all years): ........................ 9. Number of Fatality eases reported in FY 2003-2004: ........................ 10. (a) Number of FY 2003-2004 claims for which the employer or administrator was notified ofrepresentation by an attorney or legal representative In FY2003-2004:... (b) Number of non -FY 2003-2004 claims for which the employer or administrator was notified of representation by an attorney or legal representative In FY 2003-2004:.. . B. TOTAL EMPLOYMENT AND WAGES PAID IN FISCAL YEAR 2003-2004 FOR THIS SELF INSURER: (a) NUMBER OF EMPLOYEES 1017 (Number orindividual employees listed on Form DE -6 for year ending June 30, 2004) (b) TOTAL 1VACES AND SALARIES PAID S 25, 036, 607.39 (As reported on EDD Form Ub: 6 Linc M for all four(qunrlers) 33 26 59 73 0 0 2 Fiscal Year 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 SCHEDULE 2A Effective: SERVICE FEES Yearly Fee Schedule: $35,400 for the bundled services for bill review, utilization review and legal/ lien services is the following fee schedule: MJM Bill Review fees: Bill Review Hospital & ASC PPO No Fee for Duplicates Utilization Review: $1.00 a line 4 line minimum 12% of Savings 18% of Savings $70 per hour for Registered Nurses for Utilization Review $150 flat rate for delayed/ denied reports from Medical Director Legal and Liens filed with the WCAB $75.00 per hour for Lien Manager $85.00 per hour for Attorney $75.00 per hour for expert witness fees for bill review Quarterly Status Reports Additional Status Reports VOS access for view only Monthly Loss Run Reports Semi -Annual Meeting with Client Telephone conference calls Copy Service fees for files No Charge $100 per claim/ per report No Charge No Charge No Charge Actual Cost Actual Cost Exhibit "B" 12 City of Carson Selection of Workers' Compensation Third Party Administrator RATING SHEET Third Party Administrator: Date: CRITERIA MAX SCORE COMMENTS SCORE Cost/Price 5 Personnel Qualifications 5 and Commitment to Training • Claim staff experience • Knowledge of WC laws References: 5 • Public Entity clients • Cost savings • Feedback to clients • Claims management Scope of Work Ability 5 • Overall TPA program and quality of proposal Claims Management 5 Approach • Case management • Employee contact • Feedback to City • Case reserve philosophy • Management claim oversight • Claim diary philosophy • Ability to assign claims staff on an ongoing basis Early Return to Work 5 Approach Medical and Legal Cost 5 Control Approach • Litigation cost control • Settlement analysis and discussion • Medical cost control and bill review service Total: 35 Rater: Date: 51k 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 AGREEMENT NO. 05 - This Agreement is made and entered into this _1st day of August, 2005 by and between City of Carson a municipal corporation, hereinafter referred to as "City", and C, ICA, INC. a California corporation, hereinafter referred to as "Administrator, " with it's principal place of business located at 3547 Voyager Street, Suite 104, Torrance, California 90503. WHEREAS, City is self-insured in the area of its liability under the Workers' Compensation Laws of the State of California; and WHERAS, City anticipates issuing or participating in a request for proposals ("the RFP process") for workers' compensation claims administration prior to the end of calendar year 2005; and WHERAS, Administrator represents itself as being capable and qualified to provide such services in a manner commensurate with the highest professional standards and in accordance with all applicable legal standards; C:) NOW, THERFORE, IN CONSIDERATION OF THESE PREMISES, THErPA" HERETO AGREE AS FOLLOWS: CD �` -- ARTICLE 1 -SCOPE OF SERVICE A. Administrator agrees to perform all services required to be perform' -'ed as specied and in the manner provided for in City's Request for Proposal (Exhibit -A-). In the event of any conflict between this Agreement and the terms and conditions of Exhibit "A," the terms and conditions of this Agreement shall prevail. B. Claims Administration: 1. Administrator shall perform al services required to resolve claims arising from City's self-insured workers' compensation program and to act as representative for City in all matters relating to City's obligations under the Workers' Compensation laws of the State of California. Such services shall include, but are not limited to, the following: claims administration service,, program administration services; medical management services; litigatior/ 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 management services; and management information services more particularly set forth herein after and pursuant to City satisfaction and in accordance with state law and industry standards. (a) When appropriate, refer litigated cases to attorneys utilizing the City defense panel, assist in the preparation of litigation cases and negotiations of settlements and subrogation actions. (b) Notifications of City's excess workers' compensation carrier of all claims which meet the reporting requirements of the carrier. Maintain liaison between the carrier and City on matters affecting adjusting of such claims. (c) Maintain close contact with treating physicians to assure that: (1) employees receive proper medical treatment. (2) avoid over treatment situations. (3) are provided transitional duty when appropriate, and (4) are returned to full employment at the earliest possible date. (d) Administrator shall contact by telephone all indemnity claimants within 24 hours of report of the claim to Administrator. (e) Administrator shall appraise City of major developments arising in the investigation, adjustments and settlement of significant claims. City agrees that the terms "major developments' and "significant claims" as used in this Article are solely defined within Administrator's discretion. 2. Program Administration: (a) Assist City in the development of rules, procedures and practices involving employee injuries. (b) Attend City Council meetings if requested. 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (c) Provide a claim review meeting with the City monthly. Provide a written claim summary of all cases to be discussed at least one week prior to the meeting. (d) Coordinate all temporary disability payments in coordination with the City's salary continuance and benefit plans. (e) Provide City with necessary or required Workers' Compensation forms and provide necessary advice and guidance as to the proper utilization of these forms. As necessary, provide training to City staff on the use of these forms. (f) At least once per year and as requested, provide staff training the Workers' Compensation system and related topics. (g) Keep City informed of new legislation, regulations, and other information pertinent to Workers' Compensation. (h) City or any agent thereof shall have reasonable rights during normal business hours and upon reasonable notice to inspect or audit the records pertaining to any claim for which services are provided under the Agreemeni provided that City shall reimburse Administrator for the cost of making such records available for any audit undertaken by City more frequently than once each year during the term hereof. Any such inspection or audit shall be conducted in a manner so as to not unnecessarily interfere with the business of Administrator. 3. Management Information Systems. (a) Provide City with monthly reports itemizing monthly expenditures, reserve status, claim inventory status, claim costs, and potential subrogation recovery in a format approved by City. (b) Prepare and provide to the City no later than February 1St of each year the Annual OSHA Log Summary, including notification to post during the month of February. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (c) Prepare and provide to City no later than September 1St of each year the Self -Insurer's Annual Report. (d) Upon request of the City, provide on-line access to the Administrator system, including training in its use at no additional charge. The cost of the computer and the telephone time to be borne by the City. (e) Provide 1099 forms to all appropriate vendors no later than January 31St of each year as required by the Internal Revenue Service. (f) Administrator shall provide computer back-up off site updated weekly. C. Administrator and City agree to operate and administer vouchers to be used for th payment or benefits to employees in accordance with the procedures mutually agreed upon and subject to the Workers' Compensation Laws of the State of California. D. Administrator agrees to assign the work involved only to persons who are specially trained, experienced and competent in the administration of public sector workers' compensation claims. In conjunction therewith, City shall have the right, reasonably exercised, to direct Administrator not to use persons who, in the opinion of the City, are not specially trained, experienced and competent to render the required services. ARTICLE 2 -COMPENSATION City agrees to pay and Administrator agrees to accept as compensation for its services, the sum of $35,400, annually, for services rendered for all new claims, as well as services on all existing claims continued from or assumed for prior years. City agrees to pay ICA fees for services in accordance with the fee schedule set forth as Schedule 2A (Exhibit "B") upon the assignment of a claim for adjustment and to promptly make all payments for Claims. Administrator shall invoice City monthly in advance. City shall process and pay said invoices as soon as practicable after receipt, in the ordinary course of City business. 4 �� 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ARTICLE 3 -TERM The term of this Agreement shall commerce on August 1, 2005 and shall end on June 30, 2008 provided that: 1. City may terminate this Agreement at anytime upon ninety days' written notice to the Administrator. Upon such termination, Administrator shall be entitle to a pro rata fee based upon work actually accomplished as of the effective date of such termination, and a final accounting will be made of the fees of Administrator and of any funds belonging to City in the possession of the Administrator, and any balance due either party will be promptly paid. Upon termination, pending claim files and lawsuits shall revert to the control of and become the responsibility of the City. ARTICLE 4 -INSURANCE Administrator shall procure and maintain for the duration of this Agreement, insurance as required below against claims for bodily injuries, property damage or loss that may arise from or in connection with the performance or non-performance of this Agreement by Administrator or any of its officers, agents, employees or subcontractors. City, its governing body, the individuals thereof, and all officers, agents, employees, representatives and volunteers shall be named as additional insureds on the general liability policies. A "third party clause" covering the interest of City should be endorsed onto the crime policy. The coverages shall contain no special limitations on the scope of protection afforded by City, its governing body, the individuals thereof, and all officers, agents, employees, representatives, and volunteers. The Administrator shall furnish City with certificates of insurance and with original endorsements effecting coverage required by this Agreement. The certificates and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf and shall specifically reference this Agreement. All certificates and endorsements are to be received and approved by City before work commences. City reserved the right to require complete, certified copies of all required insurance policies at any time. In any insurance is written on claims made forms, such insurance shall be endorsed to provide extended 10 11 12 13 14 15 16 17 18 19' 20 21 22 23 24 25 26 27 28 reporting period of not less than five years following termination of this Agreement. All insurance shall be placed with insurers admitted in the State of California and having a Best's rating of no less than A:VII. All certificates. of insurance and policies shall state clearly that the City shall be notified by registered mail at least thirty (30) days prior to cancellation of the policy for any reason Administrator shall maintain these policies and shall cause all parties supplying services, labor or materials to maintain the following insurance in amounts not less than those specified in this section. A. Public Liability and Property Damage Insurance. Administrator shall maintain commercial general liability insurance in an amount not less than one million dollars ($1,000,000.00) combined single limit for bodily injury and property damage per occurrence and one million dollars ($1,000,000.00) combined single limit aggregate which shall be primary over any other insurance carried by the City, including City's self-insured retention. Certificates of insurance issued to Administrator shall name the City as an additional insured. B. Errors and Omissions Insurance. Administrator shall maintain Errors and Omissions Insurance in an amount not less than one million dollars ($1,000,000.00). C. Workers' Compensation Insurance. Administrator shall maintain Workers' Compensation insurance in compliance with the laws of the State of California. ARTICLE 5 -HOLD HARMLESS/INDEMNIFICATION A. Administrator agrees to defend, indemnify, save and hold harmless City, its governing body, the individuals thereof, and all officers, agents, employees, representatives, and volunteers from all loss, costs, and expense (including, but not by wa of limitation, attorneys fees and court costs) resulting from any penalty or penalties assessed by an authorized body pursuant to statues, rules or regulations governing workers' compensation claims or arising out of any liability or claim for injury, damage or loss sustained or claimed to have been sustained arising out of , or incidental to activiAes 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 in connection with the furtherance or performance of any provision of this Agreement. The terms of this Article shall survive termination. B. Administrator further agrees to waive all rights of subrogation against City. The provisions of this Article do not apply to loss, cost, and expense (including, but not by way of limitation, attorneys fees and court cost) resulting from any penalty or penalties assessed by any authorized body pursuant to laws, rules, or regulations governing workers' compensation or claims caused solely by the negligence of City or to the extent that Administrator's act or failure to act or failure to act was at the specific direction of the city. C. City shall indemnify, hold harmless and defend Administrator, its agents, employees, officers and directors against any and all loss, damage, fines, liability, costs ani expenses (including, but not limited to, attorney fees, court costs and reasonable investigative and delivery costs) and other such sums which Administrator, its agents, servants, employees, officers and/or directors may reasonably pay or become obligated to pay on account of acts or negligence of City, its agents or employees, officers or directors. Administrator agrees to notify City promptly in writing in the event of such a claim, demand, assertion or liability or action is brought to Third Party Administrator's attention. D. City shall not be liable to Administrator for personal injury of Administrator's employees or property damage sustained by Administrator in the performance of the services specified in this Agreement. E. Penalties and assessments arising from the failure of City to provide timely notice of claims or other such employer obligations as provided under the California Workers' Compensation Reform Act of 1989, as amended shall be and remain the sole responsibility of City and City hereby agrees to indemnify, defend, and hold harmless Administrator for all claims arising from the imposition of such penalties and assessments resulting from such actions by City. Administrative penalties arising solely from the failure of Administrator to comply in the timely and proper manner with its duties as the Administrator of City's workers' compensation claims shall be and remain the sole 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 responsibility of Administrator and Administrator hereby agrees to indemnify, defend hold harmless City from all claims arising from the imposition of such administrative 11 penalties. F. The parties acknowledge that the California Workers' Compensation Reform Act o 1989 as amended, requires first payment of temporary disability indemnity within fourteen (14) days of City's knowledge of injury and generally imposed the automatic penalty of ten (10%) percent of the amount delayed for indemnity payments which shall payable directly to the injured employee without application. Furthermore, the parties aggress that unless Administrator is provided with a notice of the claim within seven (7) days of City's knowledge of the injury, the above -referenced automatic penalty of ten (10%) percent shall be and remain the sole responsibility of City. ARTICLE 6 -FINDINGS CONFIDENTIAL All of the reports, findings and conclusions prepared or assembled by Administrator under this Agreement are confidential and Administrator agrees that they shall not be made available to any individual or organization without prior written approval of City. All reports and findings shall become the property of City, however, no conclusions, opinions or studies provided by Administrator shall be made available to any other party except in connection with the original purpose of the assignment, without prior written approval of the City. ARTICLE 7 -NOTICES Notices pursuant to this Agreement shall be given by United States Postal Service, postage prepaid, addressed to the parties as follows: 1. City City of Carson City Hall c/o Administrative Services General Manager 1701 East Carson Street Carson, CA 90745 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2. Administrator Marilyn E. Murata, President CA -ICA, INC. 3547 Voyager Street, Suite 104 Torrance, CA 90503 Notices shall be deemed given as of the time and date of mailing, if the party mailing the notice has complied with the provisions of this Article. ARTICLE 8 -NON ASSIGNABILTY Administrator shall not assign any interest in this Agreement and shall not transfer any interest in the same whether by assignment or novation without prior written approval of City. ARTICLE 9 -EQUAL EMPLOYMENT Administrator agrees that during the performance of this Agreement, it will not discriminate against any employee or applicant for employment because of race, creed, color, sex, age, sexual orientation, disability or handicap, religion or national origin. ARTICLE 10 -GENERAL CONDITIONS A. This Agreement shall be interpreted in accordance with the laws of the State of California. B. This Agreement may be modified or amended only by a written amendment signed by both parties. No waiver of one or more provisions of this Agreement shall constitute a waiver of any other provision. C. In the event Administrator fails to perform in accordance with the indernnificatio and insurance requirements clauses of this Agreement, or otherwise breaches an y other provision of this Agreement, the City shall be entitled to recover all legal fees, costs, and other expenses incident to securing performance or incurred as a consequence of nonperformance. D. While performing the specified services, Third Party Administrator is an A independent contractor and not an officer, agent or employee of the City. 6 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ARTICLE 11 -ATTORNEY'S FEES In any action at law or in equity, including an action for declaratory relief, is brough to enforce or interpret the provision of this Agreement, the City shall be entitled to a reasonable attorney's fee if it prevails, which may be set by the court in the same action or in a separate action brought for that purpose, in addition to any other relief to which it may be entitled. ARTICLE 12 -FORCE MAJEURE Neither party shall be responsible for the delays or failures in performance resulting from acts beyond the control of such parties. Such acts shall include, but not limited to, acts of God, strikes, lockouts, riots, acts of war, epidemics, governmental regulations superimposed after the fact, fire, communication lines failure, earthquakes, or other disasters. ARTICLE 13-APPROPIATION OF FUNDS Payments to be made to Administrator by City for services performed within the current fiscal year are within the currant fiscal budget and within an available, unexhausted and unencumbered appropriation of City. In the event City does not appropriate sufficient funds for payment of Administrator's services beyond the current fiscal year, this agreement shall cover payment for Administrator's services only up to the conclusion of the last fiscal year in which City appropriates sufficient funds and shall automatically terminate at the conclusion of such fiscal year. ARTICLE 14 -ENTIRE AGREEMENT This Agreement constitutes the entire agreement between the parties and shall supersede any other notes, records, memoranda or oral understanding in existence at the time of execution, as well as all prior and contemporaneous negotiations. In the event of any conflict between terms, conditions and provisions of this Agreement and any prior agreement, document or instrument, the terms, conditions and provisions of this Agreement shall prevail. The parties agree, that in the event this Agreement is subject to 10 1 2 3 4' 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 judicial or quasi-judicial interpretation, any such interpretation shall be without regard to the identity of the party drafting this Agreement. In witness whereof the parties hereto have executed this Agreement on the date and year first above written. CITY OF I ATTEST: Mayor City Clerk II APPROVED AS TO FORM: City Attorney IISCHEDULE 2A Effective: III 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 SERVICE FEES Yearly Fee Schedule: $35,400 for the bundled services for`billlreview, 0,1 utilization review and legal/ lien services is tyle fdlf"owing fee schedule: MJM Bill Review fees: Bill Review $1.00 a line 4 line minimum Hospital & ASC 12% of Savings PPO 18% of Savings No Fee for Duplicates Utilization Review: $70 per hour for Registered Nurses for Utilization Review $150 flat rate for delayed/ denied reports from Medical Director Legal and Liens filed with the WCAB $75.00 per hour for paralegal $85.00 per hour for Attorney $75.00 per hour for expert witness fees for bill review Quarterly Status Reports No Charge Additional Status Reports �I VOS access for view only 11 Monthly Loss Run Reports 0 Semi -Annual Meeting with Client 11 Telephone conference calls Copy Service fees for files $100 per claim/per report No Charge No Charge No Charge Actual Cost Actual Cost