HomeMy WebLinkAboutR-03-0876J-03-662
07/23/03
RESOLUTION NO. 03— 8`6
A RESOLUTION OF THE MIAMI CITY COMMISSION,
WITH ATTACHMENT(S), AUTHORIZING THE CITY
MANAGER TO EXECUTE A PROFESSIONAL SERVICES
AGREEMENT ("AGREEMENT"), IN SUBSTANTIALLY
THE ATTACHED FORM, WITH GALLAGHER BASSETT
SERVICES, INC., THE TOP-RANKED FIRM SELECTED
AS A RESULT OF THE COMPETITIVE SELECTION
PROCESS TO PROVIDE WORKERS COMPENSATION
CLAIMS ADMINISTRATION SERVICES
(PART I SERVICES) AND GENERAL, AUTOMOBILE
AND PROFESSIONAL LIABILITY CLAIMS
ADMINISTRATION SERVICES (PART II SERVICES),
FOR THE DEPARTMENT OF RISK MANAGEMENT, FOR
AN INITIAL THREE-YEAR PERIOD, WITH THE
OPTION TO EXTEND FOR FIVE ADDITIONAL
ONE-YEAR PERIODS, WITHOUT FURTHER APPROVAL
OF THE CITY COMMISSION, IN AN AMOUNT NOT TO
EXCEED THE NEGOTIATED AMOUNT SET FORTH IN
"EXHIBIT 2," ATTACHED AND INCORPORATED, WITH
INCREASES IN THE AMOUNT OF COMPENSATION
PAYABLE DURING THE EACH OF THE OPTIONAL YEAR
PERIODS NOT TO EXCEED THE CONSUMER PRICE
INDEX OVER THE IMMEDIATELY PRECEDING YEAR;
ALLOCATING FUNDS FROM ACCOUNT CODE
NO. 515001.624401.6.270.
WHEREAS, the City of Miami ("City") issued Request for
Proposal No. 02-03-010 •seeking qualified and experienced firms
for the provisions of the following services for the Department
of Risk Management:
C:'ITY COMMISSION
MEETING OF
J U L. 2 4 2003
Resolution No.
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Part I Services: Workers Compensation Claims
Administration and Part II Services: General, Automobile
and Professional Liability Claims Administration (Police
Tort and Public Officials Liability); and
WHEREAS, the Evaluation Committee evaluated the proposals
received and ranked Gallagher Bassett Services, Inc. as the
top-ranked firm, and recommended that the City Manager negotiate
a Professional Services Agreement ("Agreement"), in
substantially the attached form, for an initial three-year
period, with the option to extend for five additional one-year
periods, without further approval of the City Commission,
provided that any increase in the amount of compensation payable
during each of the additional one-year periods does not exceed
Consumer Price Index over the immediately preceding year; and
WHEREAS, the City Manager concurred with the recommendation
of the Evaluation Committee; and
WHEREAS, Resolution No. 03-364, adopted April 10, 2003,
authorized the City Manager to negotiate an Agreement with
Gallagher Bassett Inc., the top-ranked firm, and present the
negotiated Agreement to the City Commission for review and
consideration; and
WHEREAS, funds for said services will be allocated from
Account Code No. 515001.624401.6.270;
NOW, THEREFORE, BE IT RESOLVED BY THE COMMISSION OF THE
CITY OF MIAMI, FLORIDA:
Page 2 of 4 03— 876
Section 1. The recitals and findings contained in the
Preamble to this Resolution are adopted by reference and
incorporated as if fully set forth in this Section.
Section 2. The City Manager is authorizedll to execute a
Professional Services Agreement ("Agreement"), in substantially
the attached form, with Gallagher Bassett Inc., the top-ranked
firm selected as a result of the competitive selection process
to provide Workers Compensation Claims Administration Services
(Part I Services) and General, Automobile and Professional
Liability Claims Administration Services (Part II Services) for
the Department of Risk Management, for an initial three-year
period, with the option to extend for five additional one-year
periods, without further approval of the City Commission, in an
amount not to exceed the negotiated amount set forth in
"Exhibit 2," attached and incorporated, with increases in the
amount of compensation payable during each of the optional year
periods not to exceed the Consumer Price Index over the
immediately preceding year, with funds allocated from Account
Code No. 515001.624401.6.270.
1� The herein authorization is further subject to compliance with
all requirements that may be imposed by the City Attorney,
including but not limited to those prescribed by applicable
provisions of the City Charter and Code.
Page 3 of 4 03— 876
Section 3. This Resolution shall become effective
immediately upon its adoption and signature of the Mayoral
PASSED AND ADOPTED this
ATTEST:
,. RI CILLA A. THOMP ON
CITY CLERK
24th day of July , 2003.
APPROV S TO M AND CORRECTNESS:)
EJANDRO VILARELLO
CITY ATTORNEY
W7407:tr:AS:BSS
zi If the Mayor does not sign this Resolution, it shall become
effective at the end of ten calendar days from the date it was
passed and adopted. If the Mayor vetoes this Resolution, it
shall become effective immediately upon override of the veto by
the City Commission.
Page 4 of 4 03— 876
PROFESSIONAL SERVICES AGREEMENT
This Agreement is entered into this — day of , 2003 by and between the
City of Miami, a municipal corporation of the State of Florida ("City") and Gallagher Bassett
Services, Inc., an Illinois corporation ("Provider")
RECITAL
A. The City has issued a Request for Proposal ("RFP") for the provision of Workers'
Compensation, General Automobile & Professional Liability Claims Administration Services
("Services") and Provider's proposal ("Proposal"), in response thereto, has been selected as the
most qualified proposal for the provision of the Services. The RFP and the Proposal, as modified
by Provider's presentation before the Evaluation Committee on , 2003, are
sometimes referred to herein, collectively, as the Solicitation Documents, and are by this
reference incorporated into and made a part of this Agreement.
B. The Commission of the City of Miami, by Resolution No. 03-364, adopted on
April 10, 2003, approved the selection of Provider and authorized the City Manager to negotiate
an agreement for an initial term of three (3) years with the options to extend the Agreement for
five (5) additional terms one (1) year period; and
C. The Commission of the City of Miami, by Resolution No. , adopted on
2003, authorized the City Manager to execute this Agreement under the terms
and conditions set forth herein.
NOW, THEREFORE, in consideration of the mutual covenants and promises herein
contained, Provider and the City agree as follows:
TERMS
1. RECITALS: The recitals are true and correct and are hereby incorporated into and
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made a part of this Agreement.
2. TERM: The initial term of this Agreement shall be three (3) years, commencing on
the date hereof, and may be extended by the City, for a maximum period of five (5) additional
years, in accordance with Section 3 below. In the event the City requires Provider to continue to
handle claim files that remain open as of the termination date of the Agreement, until their
conclusion, then the provisions of this Agreement shall continue to apply to Provider's
performance of Services for such claims until they are closed.
3. OPTION TO EXTEND: The City shall have five (5) options to extend the Term,
each for a period of one (1) year, subject to availability and appropriation of funds and the parties
reaching an agreement on the amount or schedule of compensation payable during the extended
term. If Provider requests an increase in compensation during a proposed extended term, it must
submit its proposed change to City at least one (1) year prior to the expiration of the initial term.
In such event, the amount of compensation shall be renegotiated by the parties, in good faith, but
shall not exceed the lowest of CPI over the immediately preceding year, or prevailing rates
charged by the Provider, to its preferred clients, as of that date. The City may exercise the
options, in its sole discretion and without City Commission approval, by written notice to the
Provider given at least sixty (60) days prior to the expiration of the then current term.
4. SCOPE OF SERVICE:
A. Provider agrees to provide the Services as specifically described, and under the
terms and conditions set forth in Attachment "A" hereto, which by this reference is incorporated
into and made a part of this Agreement. The City reserves the right not to turn over to Provider,
and to retain management, handling and control of, all or a portion of the claims that are the
subject of this Agreement. The City also reserves the right to perform, or caused to be
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performed by other parties, some or all of the services that are subject to Allocated Expenses, as
the term is defined in Section II.I I.C. of Attachment "A".
B. Provider represents and warrants to the City that: (i) it possesses all qualifications,
licenses and expertise required under the Solicitation Documents for the performance of the
Services; (ii) it is not delinquent in the payment of any sums due the City, including payment of
permit fees, occupational licenses, etc., nor in the performance of any obligations to the City;
(iii) all personnel assigned to perform the Services are and shall be, at all times during the term
hereof, fully qualified, licensed and trained to perform the tasks assigned to each; and (iv) the
Services will be performed in the manner described in Attachment "A".
5. COMPENSATION:
A. In consideration for the Services, the City agrees to pay to Provider compensation
based on the rates and schedules described in Attachment `B" hereto, which by this reference is
incorporated into this Agreement.
B. Unless otherwise specifically provided in Attachment `B", payment shall be made
within forty-five (45) days after receipt of Provider' s invoice, which shall be accompanied by
sufficient supporting documentationand contain sufficient detail, to allow a proper audit of
expenditures, should City require one to be performed.
6. DESIGNATED PERSONNEL: Provider acknowledges that in selecting Provider as
the most qualified firm for the provisions of the Services the City has relied on Provider's
representations regarding its staffing model and its commitment to dedicate personnel
exclusively to the City for the provisions of Services. Provider agrees to assign exclusively to
the City, the personnel specified in Attachment "C", which is incorporated by reference and
made a part to this Agreement, to perform the Services (the "DESIGNATED PERSONNEL").
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7. OWNERSHIP OF DOCUMENTS:
A. Provider understands and agrees that any information, document, report, file or
any other material whatsoever which is given by the City to Provider or which is otherwise
obtained or prepared by Provider pursuant to or under the terms of this Agreement is and shall
at all times remain the property of the City. Provider agrees not to use any such information,
document, report, file or material for any purpose whatsoever, except as authorized in this
Agreement, without the written consent of City, which may be withheld or conditioned by the
City in its sole discretion. Claim files that are closed shall be returned to the City in accordance
with the provisions of Attachment "A".
B. At all times during the Term, and for a period of five (5) years after its
termination, Provider shall provide City access to all files and records maintained on City's
behalf. Provider further agrees to deliver to the City or to such address as requested by the City,
all files, or such files as the City may request, in hard copies or such electronic format as may be
required by the City, not later than ten (10) days after receipt of City's written request.
C. Not later than ten (10) days after the termination of the term, Provider shall
deliver to the City, in addition to all other documents, information and data described in
Attachment "A", all original claim files, computer tapes or other computer media containing all
of the data required for claims adjudication and loss statistics. Such data shall be made available
in a format generally importable into a commonly recognized database for claims adjudication
and loss statistics.
8. AUDIT AND INSPECTION RIGHTS:
A. The City may, at reasonable times, and for a period of up to five (5) years)
following the date of final payment by the City to Provider under this Agreement, audit, or cause
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to be audited, those books and records of Provider which are related to Provider's performance
under this Agreement. Provider agrees to maintain all such books and records at its principal
place of business for a period of five (5) years after final payment is made under this Agreement.
B. The City may, at reasonable times during the term hereof, inspect Provider's
facilities and perform such tests, as the City deems reasonably necessary, to determine whether
the goods or Services required to be provided by Provider under this Agreement conform to the
terms hereof and/or the terms of the Solicitation Documents, if applicable. Provider shall make
available to the City all reasonable facilities and assistance to facilitate the performance of tests
or inspections by City representatives. All tests and inspections shall be subject to, and made in
accordance with, the provisions of Section 18-100 of the Code of the City of Miami, Florida, as
same may be amended or supplemented, from time to time.
9. AWARD OF AGREEMENT: Provider represents and warrants to the City that it
has not employed or retained any person or company employed by the City to solicit or secure
this Agreement and that it has not offered to pay, paid, or agreed to pay any person any fee,
commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection
with, the award of this Agreement.
10. PUBLIC RECORDS: Provider understands that the public shall have access, at
all reasonable times, to all documents and information pertaining to City contracts, subject to the
provisions of Chapter 119, Florida Statutes, and agrees to allow access by the City and the public
to all documents subject to disclosure under applicable law. Provider's failure or refusal to
comply with the provisions of this section shall result in the immediate cancellation of this
Agreement by the City.
11. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: Provider
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understands that agreements between private entities and local governments are subject to certain
laws and regulations, including laws pertaining to public records, conflict of interest, record
keeping, etc. City and Provider agree to comply with and observe all applicable laws, codes and
ordinances as they may be amended from time to time. Additionally, at all times during the
Term Provider shall comply with and observe, all applicable Federal, State and Local laws,
statues, rules and regulations applicable to the Services, including specifically, but without
limitation, the provisions of the Health Insurance Portability and Accountability Act of 1996
("HIPAA") and the Privacy Standards contained therein. Provider shall enter into a Business
Associate Agreement with the City of Miami for HIPAA compliance.
12. INDEMNIFICATION: Provider shall indemnify, defend and hold harmless the
City and its officials, employees and agents (collectively referred to as "Indemnities") and each
of them from and against all loss, costs, penalties, fines, damages, claims, expenses (including
attorney's fees) or liabilities (collectively referred to as "Liabilities") arising out of, resulting
from, or in connection with (i) the performance or non-performance of the Services
contemplated by this Agreement which is or is alleged to be directly or indirectly caused, in
whole or in part, by any act, omission, default or negligence (whether active or passive) of
Provider or its employees, agents or subcontractors (collectively referred to as "Provider"),
regardless of whether it is, or is alleged to be, caused in whole or part (whether joint, concurrent
or contributing) by any act, omission, default or negligence (whether active or passive) of the
Indemnities, or any of them or (ii) the failure of the Provider to comply with any of the
paragraphs herein or the failure of the Provider to observe, comply with or conform to statutes,
ordinances, or other regulations or requirements of any governmental authority, federal or state,
in connection with the performance of this Agreement. Provider expressly agrees to indemnify
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and hold harmless the Indemnities, or any of them, from and against all liabilities which may be
asserted by an employee or former employee of Provider, or any of its subcontractors, as
provided above, for which the Provider's liability to such employee or former employee would
otherwise be limited to payments under state Workers' Compensation or similar laws.
13. DEFAULT: If Provider fails to comply with any term or condition of this Agreement,
or fails to perform any of its obligations hereunder, then Provider shall be in default. Upon the
occurrence of a default hereunder the City, in addition to all remedies .available to it by law, may
immediately, upon written notice to Provider, terminate this Agreement whereupon all payments,
advances, or other compensation paid by the City to Provider while Provider was in default shall
be immediately returned to the City. Provider understands and agrees that termination of this
Agreement under this section shall not release Provider from any obligation accruing prior to the
effective date of termination. Should Provider be unable or unwilling to commence to perform
the Services within the time provided or contemplated herein, then, in addition to the foregoing,
Provider shall be liable to the City for all expenses incurred by the City in preparation and
negotiation of this Agreement, as well as all costs and expenses incurred by the City in the re -
procurement of the Services, including consequential and incidental damages.
14. RESOLUTION OF CONTRACT DISPUTES: Provider understands and agrees that
all disputes between Provider and the City based upon an alleged violation of the terms of this
Agreement by the City shall be submitted to the City Manager for his/her resolution, prior to
Provider being entitled to seek judicial relief in connection therewith. In the event that the
amount of compensation hereunder exceeds $50,000.00, the City Manager's decision shall be
approved or disapproved by the City Commission. Provider shall not be entitled to seek judicial
relief unless: (i) it has first received City Manager' s written decision, approved by the City
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Commission if the amount of compensation hereunder exceeds $50,000.00, or (ii) a period of
sixty (60) days has expired, after submitting to the City Manager a detailed statement of the
dispute, accompanied by all supporting documentation (ninety (90) days if City Manager' s
decision is subject to City Commission approval); or (iii) City has waived compliance with the
procedure set forth in this section by written instruments, signed by the City Manager.
15. CITY'S TERMINATION RIGHTS:
A. The City shall have the right to terminate this Agreement, in its sole discretion, at
any time, by giving written notice to Provider at least sixty (60) days prior to the effective date of
such termination. In such event, the City shall pay to Provider compensation for Services
rendered prior to the effective date of termination. In no event shall the City be liable to
Provider for any additional compensation, other than that provided herein, or for any
consequential or incidental damages.
B. The City shall have the right to terminate this Agreement, without notice to
Provider, upon the occurrence of an event of default hereunder. In such event, the City shall not
be obligated to pay any amounts to Provider and Provider shall reimburse to the City all amounts
received while Provider was in default under this Agreement.
C. If on the date of termination of this Agreement the compensation earned by the
Provider for Services rendered up to that date is less than the amounts paid by the City under
Attachment "B", the Provider shall immediately, but in no event later than ten (10) days after the
termination of the Agreement, return the amount of the overpayment to the City.
D. Not later than ten (10) days after the termination of this Agreement, Provider
shall, at no cost to the City, deliver to the City such tapes, discs or other medial containing all
data pertaining to the Services for transference to the Department, or to a successive
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administrator, in the data or media format required by the City to ensure the successful
conversion of the computer systems software and data to the systems of a successive
administrator.
E. Not later than five (5) business days after termination of this Agreement, the City
shall notify the Provider, in writing, if the City requires Provider to continue to handle open files,
until their conclusion, in accordance with the provisions of Attachment "A".
16. INSURANCE: Provider shall, at all times during the term hereof, maintain such
insurance coverage as stated in Attachment "D", which is incorporated by reference and made a
part of this Agreement. All such insurance, including renewals, shall be subject to the approval
of the City for adequacy of protection and evidence of such coverage shall be furnished to the
City on Certificates of Insurance indicating such insurance to be in force and effect and
providing that it will not be canceled during the performance of the Services under this contract
without thirty (30) calendar days prior written notice to the City. Completed Certificates of
Insurance shall be filed with the City prior to the performance of Services hereunder, provided,
however, that Provider shall at any time upon request file duplicate copies of the policies of such
insurance with the City.
If, in the judgment of the City, prevailing conditions warrant the provision by Provider of
additional liability insurance coverage or coverage which is different in kind, the City reserves
the right to require the provision by Provider of an amount of coverage different from the
amounts or kind previously required and shall afford written notice of such change in
requirements thirty (30) days prior to the date on which the requirements shall take effect.
Should the Provider fail or refuse to satisfy the requirement of changed coverage within thirty
(30) days following the City's written notice, this Contract shall be considered terminated on the
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date that the required change in policy coverage would otherwise take effect.
17. NONDISCRIMINATION: Provider represents and warrants to the City that Provider
does not and will not engage in discriminatory practices and that there shall be no discrimination
in connection with Provider' s performance under this Agreement on account of race, color, sex,
religion, age, disability, marital status, national origin or sexual preference. Provider further
covenants that no otherwise qualified individual shall, solely by reason of his/her race, color, sex,
religion, age, disability, marital status, national origin, or sexual preference be excluded from
participation in, be denied Services, or be subject to discrimination under any provision of this
Agreement.
18. MINORITY AND WOMEN BUSINESS AFFAIRS AND PROCUREMENT
PROGRAM: The City has established a Minority and Women Business Affairs and
Procurement Program (the "M/WBE Program") designed to increase the volume of City
procurement and contracts with Blacks, Hispanic and Women -owned business. The M/WBE
Program is found in Ordinance No. 10062, a copy of which has been delivered to, and receipt of
which is hereby acknowledged by, Provider. Provider understands and agrees that the City shall
have the right to terminate and cancel this Agreement, without notice or penalty to the City, and
to eliminate Provider from consideration and participation in future City contracts if Provider, in
the preparation and/or submission of the Proposal, submitted false or misleading information as
to its status as Black, Hispanic and/or Women owned business and/or the quality and/or type of
minority or women owned business participation.
19. ASSIGNMENT: This Agreement shall not be assigned by Provider, in whole or in
part, without the prior written consent of the City's, which may be withheld or conditioned, in
the City's sole discretion.
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20. NOTICES: All notices or other communications required under this Agreement shall
be in writing and shall be given by hand -delivery or by registered or certified U.S. Mail, return
receipt requested, addressed to the other party at the address indicated herein or to such other
address as a party may designate by notice given as herein provided. Notice shall be deemed
given on the day on which personally delivered; or, if by mail, on the fifth day after being posted
or the date of actual receipt, whichever is earlier.
If to Provider:
Robert Mason, CFO Gallagher
Bassett Services, Inc. The Gallagher
Centre Two Pierce Place Itasca,
Illinois 60143
With copies to: Vilma Palma -
Blackmon, VP Gallagher Bassett
Services, Inc. 3350 S.W. 148th
Avenue, Suite 200 Miramar, Florida
33027
If to City:
Joe Arriola, City Manager City of Miami
3500 Pan American Drive Miami, Florida
33133
With conies to: Alejandro Vilarello,
City Attorney City of Miami 444 S.W. 2"1
Avenue, Suite 945 Miami, Florida 33130
Diane Ericson, Director of Risk Management
City of Miami 444 S.W. 2"a Avenue, Ninth
Floor Miami, Florida 33130
21. MISCELLANEOUS PROVISIONS:
A. This Agreement shall be construed and enforced according to the laws of the State
of Florida.
B. Title and paragraph headings are for convenient reference and are not a part of
this Agreement.
C. No waiver or breach of any provision of this Agreement shall constitute a waiver
of any subsequent breach of the same or any other provision hereof, and no waiver shall be
effective unless made in writing.
D. Should any provision, paragraph, sentence, word or phrase contained in this
Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise
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unenforceable under the laws of the State of Florida or the City of Miami, such provision,
paragraph, sentence, word or phrase shall be deemed modified to the extent necessary in order to
conform with such laws, or if not modifiable, then same shall be deemed severable, and in either
event, the remaining terms and provisions of this Agreement shall remain unmodified and in full
force and effect or limitation of its use.
22. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties
hereto, their heirs, executors, legal representatives, successors, or assigns.
23. INDEPENDENT CONTRACTOR: Provider has been procured and is being
engaged to provide Services to the City as an independent contractor, and not as an agent or
employee of the City. Accordingly, Provider shall not attain, nor be entitled to, any rights or
benefits under the Civil Service or Pension Ordinances of the City, nor any rights generally
afforded classified or unclassified employees. Provider further understands that Florida
Workers' Compensation benefits available to employees of the City are not available to Provider,
and agrees to provide workers' compensation insurance for any employee or agent of Provider
rendering Services to the City under this Agreement.
24. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the
availability of funds and continued authorization for program activities and the Agreement is
subject to amendment or termination due to lack of funds, reduction of funds and/or change in
regulations, upon thirty (30) days notice.
25. REAFFIRMATION OF REPRESENTATIONS: Provider hereby reaffirms all of the
representations contained in the Solicitation Documents.
26. ENTIRE AGREEMENT: This instrument and its attachments constitute the sole and
only agreement of the parties relating to the subject matter hereof and correctly set forth the
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rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises,
negotiations, or representations not expressly set forth in this Agreement are of no force or
effect.
IN WITNESS WHEREOF, the parties hereto have caused this instrument to be
executed by their respective officials thereunto duly authorized, this the day and year above
wntten.
"Provider"
ATTEST: Gallagher Bassett Services, Inc.,
an Illinois corporation
By:
Print Name: Print Name:
Title: Corporate Secretary Title: President
«Cit,»
CITY OF MIAMI, a municipal
ATTEST: corporation
By:
Priscilla A. Thompson, City Clerk Joe Arriola, City Manager
APPROVED AS TO FORM AND
CORRECTNESS:
Alejandro Vilarello
City Attorney
APPROVED AS TO INSURANCE
REQUIREMENTS:
Diane Ericson
Risk Management Administrator
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ATTACHMENT A
SCOPE OF SERVICES
GENERAL PROVISIONS:
The services which are the subject matter of this Agreement (the "Services") consist of Workers
Compensation Claims Administration ("Part I Services"), and General, Automobile &
Professional Liability Claims Administration ("Part II Services"), which are as of the date hereof
being provided by the City. Unless otherwise specifically stated, the General Provisions shall
apply to both Part I Services and Part II Services. In the event of conflict or inconsistency
between the General Provisions and provisions specifically included under Part I Services or Part
II Services, the specific provisions shall control.
The City reserves the right not to turn over to Provider, and to retain the management, handling
and control of, all or some of the claims which are the subject of this Agreement. Further, the
City reserves the right to perform, or caused to be performed by other parties, some or all of the
services that are subject to Allocated Expenses, as the term is defined in Section II.1.C. of this
Attachment "A".
1. THE SERVICES — PROPOSAL:
The Services are described in the Proposal, as modified by Provider's presentation before the
Evaluation Committee on February 24, 2003, and as further modified hereunder. In the event of
a conflict in the description of the Services as described in the Proposal, the presentation and
hereunder, the description or interpretation of the Services that is most favorable to the City shall
control.
2. SAFETY PROGRAM/LOSS CONTROL SERVICES:
The Provider and the City agree to take the necessary steps to improve the City's Safety
Program. The Provider shall assist the Department of Risk Management (the "Department") in
improving the Safety Program, to the City' s satisfaction, and fully implementing it for the City
and all labor groups, recognizing that a strong safety program is a primary tool for mitigating
losses.
When requested by the City to do so, the Provider shall consult with the City, its employees,
agents and others, concerning workplaces, operations, work procedures, and equipment owned or
operated by the City, and make recommendations to the City regarding same, for the purpose of
establishing loss control systems to mitigate and/or control losses, damage, and claims; provided,
however, it is understood and agreed that neither the rights of the Provider to make inspections,
nor its recommendations or reports as to loss control, shall constitute an undertaking on behalf of
or for the benefit of the City, or its employees or others, to determine, warrant, or guarantee that
such work places, operations, procedures, or equipment are free and safe from defects and/or
hazards.
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3. REPORTING REQUIREMENTS AND STATUS REPORTS
A. The Provider shall immediately, but not later than (a) 1 hour following receipt of
a fatality claim, and (b) 24 hours following the occurrence of a "Reporting
Event", advise the Risk Management Administrator or designee (the
"Administrator") by telephone or electronic mail, followed by written document,
of its occurrence. A "Reporting Event" is herein defined as a claim that meets
any one of the following conditions: (i) a claim with a reserve set at or above
$50,000;(ii) a claim involving a "Serious Injury", which is defined to 1 include, in
addition to the Serious Injury Categories defined in the Proposal, back problems
involving surgery, serious burns or disfigurement, paraplegia, quadriplegia,
amputation, partial loss of sight or hearing, partial brain damage, environmental
exposures/conditions or other permanent injury ; (iii) any non -workers
compensation claim involving the City's Police Department; (iv) any category of
injury or disability included in the Control Loss Program, or (iv) any claim in
which there is a notice or likelihood.of litigation.
B. All files will be created and assigned the proper facility and location code, and
entered into Provider' s computer system within twenty-four (24) hours upon
receipt of first report of incident or claim.
C. The Provider shall provide to the City such information or interim report as the
City may from time to time request on specific files.
D. The Provider shall submit to the Administrator monthly experience/statistical
reports, which shall include, but not be limited to, a summary of experience by
department stating cause of accident, frequency and cost. Open and closed claims
shall include specific information on the accident date, claimant' s name, cause of
accident, injury type, amount paid and reserved, and state if the claim is open or
has been finalized. These reports must be delivered by the I Oth of each month and
must provide summary information by department, by participant, and by total
program. The City shall have full access to all data, records, reports and
information maintained by the Provider under this Agreement, through the various
media and methods described in the Proposal, at no cost to the City.
E. Provider's "Dedicated Personnel", as defined in Section 6 of the Agreement and
described in Attachment "C" thereto shall be available to attend meetings, as
required by the City, at the City's office, or such other place as may be required
by the City, if requested by the City, at no additional cost to the City.
F. The Provider, at no additional cost to the City, shall meet with the Administrator
and other personnel as may be designated by the Administrator to discuss selected
files subject to auditing in accordance with the provisions of the Performance
Agreement, attached to the Agreement as Attachment "E". The files to be
audited must be accompanied, at a minimum, by status reports, printed claim file
notes, and payment registers.
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G. No later than ninety (90) days prior to the expiration of the initial, and if
applicable, any extended term of this Agreement, the Provider shall submit a
written report to City detailing all activities conducted by the Provider for the City
during the corresponding term. The report shall include a discussion of any
known problems and recommendations for solutions to those problems and a
listing of objectives to be accomplished. If the Agreement is not renewed, or
there are no extensions available, Provider shall provide City with a summary of
outstanding items, and Provider shall submit all original claim files and any
additional documentation necessary for the City to transfer the City's claims
administration programs to another third party administrator.
4. SETTLEMENT AUTHORITY:
A. Provider shall have no authority to retain legal counsel on behalf of the City,
unless expressly approved by the City Attorney. Provider acknowledges that all
cases involving the City of Miami are handled by the City's Law Department (the
"City Attorney").
B. The Provider shall have the authority to settle, on behalf of the City, workers'
compensation claims up to $10,OOO,per claim, and all other claims, up to $3,000,
per claim.. Claims involving amounts greater than the authorized amount shall
not be settled without the written authorization of the City Attorney. The request
for authorization must be presented in writing, including the adjuster' s evaluation
and recommendation in a format required by the City. After authorization is
granted, the Provider will settle the claim and obtain the appropriate release(s).
The City' s release of Provider, as provided in the Proposal, shall be subject to the
approval of the City Attorney.
C. All settlements obtained by the Provider shall include a release of potential future
"bad faith actions".
5. LITIGATION MANAGEMENT:
A. Provider shall provide a copy of the complete claim file upon the City Attorney's
notification to the Provider that litigation has commenced.
B. Prior to the initiation of litigation, Provider shall contact the Administrator if, in
its good judgment, it determines that there is the need for legal counsel concerning
a claim.
C. Within three (3) working days of Provider being provided with notice by the City
Attorney of the initiation of litigation concerning a claim, the Provider shall send a
letter to the City Attorney outlining the claim status, work remaining to be done
by the Provider and the time frame in which the work shall be completed. All
information shall be updated, as needed, to assist the City Attorney in the handling
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of the claim.
D. After commencement of litigation concerning a claim, Provider shall perform all
investigative and claims related services necessary, in the sole judgment of the
City Attorney, to assist the City Attorney in the defense of a claim in litigation.
E. Within 30 days after notice to the Provider of the initiation of litigation concerning
a claim, the Provider shall provide to the City Attorney its written opinion as to
compensability, value and settlement/defense strategy.
F. The Provider agrees to abide by the any Litigation Management Guidelines that
may be promulgated by the City Attorney, as amended from time to time.
G. Provider shall provide a designated representative at any mediation pursuant to
the rules of procedure for workers compensation adjudication or whenever
requested by the City Attorney. Provider shall provide such periodic up -dates on
ongoing litigation as may be requested by the Administrator or City Attorney.
H. Provider shall coordinate with representatives of any excess liability insurance
carrier, as required by the Administrator.
6. RESERVES:
The Provider shall establish a realistic reserve for each claim within 3 business days after receipt
of notification of a claim. The amount of the reserve will take into consideration probable
payments related to the loss, including liability, damages, statutory cap, Allocated Expenses, and
any other factor necessary to determine the estimated amount the City will be required to pay on
that claim.
Provider shall notify the Administrator, in writing, of any information that may affect the value
of a claim and will require an adjustment to the Reserve, by increasing it or decreasing it, by an
amount in excess of $5,000. Such notice shall include a detailed explanation of the anticipated
need for such adjustment.
7. OTHER GENERAL REQUIREMENTS:
The Provider shall:
A. Provide on a monthly basis, two (2) copies of loss runs to the Department sorted
separately by line of coverage (Workers' Compensation General Liability,
Automobile Liability, Police Tort and Public Officials Liability), loss year, and
department/location. Loss runs shall list each claim separately. Specific summary
reports must also be provided. This requirement may be satisfied by utilizing the
Provider's on-line system. The following reports, at a minimum, are required:
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1. Claims list - lists all claims alphabetically;
2. Check register;
3. Cumulative report by line of coverage by year;
4. Annual summary reports;
5. Location report;
6. Large loss or severity report;
7. Safety report;
8. Excess insurance report;
9. Litigation report;
10. Legal payments report;
11. SAF 200 (OSHA log)
B. Provide the Department with a directory of Dedicated Personnel including
addresses, direct phone numbers, email addresses and fax numbers, said directory
to be updated as needed.
C. The Provider shall maintain at all times during the Term an 800 or toll-free
telephone line for calls from within Miami -Dade and Broward Counties.
D. The Provider shall give the Department at bast 30 days advance notice of any
change in the Dedicated Personnel. The City reserves the right to request a
change or reassignment of any of the Dedicated Personnel, in its reasonable
discretion.
E. Provide to the Administrator all amendments to Provider's claims reporting and
service procedures manual.
F. Provider shall provide to the City all amendments and updates to its policies and
procedures manual, and agrees to make such modifications to the manual, as it
pertains to the Services, as may be reasonably requested by the City.
G. Obtain the Department's written approval prior to issuing a Denial of Claim letter.
H. Provider acknowledges and agrees that all files created or maintained pursuant to
this Agreement are the property of the City. Every two (2) years, during the Term,
Provider shall deliver to the City all files that have been closed during the
corresponding period, categorized by year, and in alphabetical order, and labeled
as required by the City, together with an inventory of each container. Pending
delivery to the City the files shall be maintained and stored by Provider, at no cost
to the City.
I. Make written recommendations to Department regarding any procedure or
condition that should be examined to prevent future claims, which are revealed
during the Provider's investigation of a claim.
J. Provider understands and agrees, that at the request of the City, it may be required
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to continue to handle claim files that remain open as of the termination date of the
Agreement, until their conclusion. In such event, the amount of compensation
shall be renegotiated by the parties, in good faith, but shall not exceed prevailing
rates charged by the Provider, to its preferred clients, as of the date of such
termination.
8. COMMUNICATION:
A. Provider shall maintain open, general lines of communication with the
Department on an ongoing basis and shall respond to requests of the Department
or the City Attorney, on a timely basis and in a cooperative manner.
B. At no additional cost to the City, Provider shall be available to attend meetings
required by the Department in order to: (i) educate its own and the Department' s
personnel on relevant laws/filings and claim handling procedures that affect any
claim, (ii) discuss specific cases of concern, (iii) resolve any problems involving
the claims administration program, and (iv) address such other matters as may be
reasonably required by the Department relative to the performance of services
under this Agreement.
C. Provider shall immediately provide the Department with information on any
Workers' Compensation legislative changes.
D. Provider shall return phone calls from the City or injured employee the same
working day. Other requests from the City will be responded to in a timely
manner. Failure to comply with the provisions of this Section shall release the
City from payment of the per -claimant fee described in Attachment B with respect
to such claim, as more specifically described in the Performance Agreement.
9. STAFFING, QUALITY CONTROL AND SUPERVISION:
The Provider shall render high-quality claims management and adjusting services throughout the
Term. The Dedicated Personnel shall have, at a minimum, the following levels of experience and
licensing:
Supervisor or supervising adjuster 4 years
Adjusters 3 years
Medical -only processor(s) 1 year
Provider shall assign personnel with the ability to provide full service to English, Spanish, and
Haitian -Creole speaking individuals when needed.
A list of the Dedicated Personnel is attached to the Agreement as Attachment "C", and shall be
updated, as needed.
The City reserves the right to request a change or reassignment of any of the Dedicated
03- 876
Personnel, in its reasonable discretion.
Claims personnel must be employees of the Provider. The use of independent adjusters,
subcontractors, or temporary adjusters will not be acceptable without prior approval of the
Administrator. Adjuster trainees are not acceptable for handling of the City's claims.
The Provider shall ensure that all Dedicated Personnel are familiar with the City's labor contracts
and any changes thereto, and are kept abreast of all applicable laws, including, specifically, the
Workers' Compensation Statutes, DWC rules, and applicable laws.
10. BANKING/LOSS FUND MANAGEMENT:
The Proposal describes three (3) Banking Options. The City selects the Automated Payment and
Control System (APCS), with the Self Insured Money Management System (SIMMS) option, as
more particularly described in the Proposal. The City and the Provider agree to establish the
agreed upon imprest balance and the funding frequency within thirty (30) days after the date of
the Agreement.
11. "BAD FAITH" LAWSUITS:
The City shall be notified of all "bad faith" lawsuits filed against the Provider, which include
breach of good faith and fair dealing. Any "bad faith" lawsuits filed against the City shall be
handled by the City Attorney. If the allegation is that the Provider committed or acted in "bad
faith," the defense of the lawsuit and attorneys' fees and expenses shall be the Provider' s
responsibility, but the City Attorney shall have the right to monitor the progress of the lawsuit to
its conclusion. Once a "bad faith" lawsuit has been filed, a separate file pertaining only to the
issues on "bad faith" shall be established.
12. IRS FILING REOUIREMENTS OF PROVIDER:
Provider will furnish required tax information for the Internal Revenue Service including 1099s
with a magnetic tape of the 1099s submitted to the IRS. In the event the City requires the
Provider to continue to handle claims after the termination of the Agreement, as provided in
Section 7.G. above, then, at the City' s option, the Provider will file with the IRS all required
information and/or documents, or will deliver such information and/or documents to the City, in
the format required by the City, at no additional cost to the City.
13. OTHER REPORTS AND REOUIRED FILINGS:
Provider shall be required to provide the following services:
A. Prepare, maintain, and file all records and reports as may be required by legal
authorities (Local, State or Federal).
B. Prepare, maintain, and file statistical data, records, or reports as required by excess
insurers, City actuaries, and the State.
C. Prepare, maintain, and file statistical information required by worker's
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compensation rating bureaus, including all data required for the promulgation of
the City's experience modification and state assessment.
D. Prepare and file any other reports as required by the City and the State relating to
claims experience, payments, etc. (such as DWC-51, etc.)
E. Review for accuracy and approve the appropriateness of state assessments/audits,
prior to the due date of the assessment.
F. Prepare and submit to the Administrator, for its review and approval, all reports
and/or data required to satisfy Florida' s self-insurance requirements. Required
self-insurance reports shall be completed and delivered to the Administrator on a
timely basis but in no event later than 30 days prior to their due date, so that the
City will have sufficient time to review and execute the documents before the due
date.
G. Prepare and submit to the Administrator, for its review, the Unit Statistical Report
(LES form SI -17) at least 30 days prior to its due date.
14. COMPUTER INFORMATION:
Provider shall ensure compatibility of its systems with the current system and software used by
the City as the same may be upgraded or replaced. Provider further ensures, at its cost, that its
systems will remain a viable solution for on-line claims administration in the event the City
upgrades or replaces any aspect of its systems throughout the Term. Provider shall be responsible
for data integrity, which will include, without limitation, inputting all cause codes, facility codes,
location codes, loss descriptions, and other claims information. The Provider warrants the
integrity of the combined data once the data conversion is completed.
Provider shall ensure successful integration/migration of all computer systems, software, and
data utilized for the performance of all Services throughout the term of the Agreement. Provider
shall further ensure the successful conversion of the computer systems software and data to the
systems of a successive administrator, upon termination of the term of the Agreement, at no
additional cost to the City.
Provider shall ensure that all system notes are printed out and placed in the claim files upon
termination of this Agreement.
Provider shall ensure that all claims, payment data and historical data are not purged from the
existing system nor merged into the new system.
Workers compensation claims that do not involve indemnity payment or medical treatment shall
be recorded in the database as reporting purpose only (RPO), first aid or no pay cases and should
be identified in the system that same way.
15. PENALTIES OR OTHER ASSESSMENTS:
Provider agrees to pay on behalf of the City any and all penalties, late fees or other amounts that
may be assessed against the City, or that the City may be required to pay, as a result of Provider'
s failure to comply with its obligations under the Agreement. The Provider further agrees to
03- 876
reimburse the City for payments made in error.
16. PERFORMANCE AGREEMENT:
Provider shall comply with the Performance Agreement attached to the Agreement as
Attachment "E" to the Agreement.
II
PART I SERVICES
WORKERS COMPENSATION CLAIMS ADMINISTRATION
Part I Services include, but are not limited to, all specified adjusting services for all claims made
against the City for Workers' Compensation, as well as all other required services, such as
administration, computerized claim/loss statistical information and loss fund reconciliation.
Specific services to be provided are outlined in the Solicitation Documents. Provider
acknowledges and agrees that the City reserves the right to add additional services as may be
deemed necessary, in its sole but reasonable discretion.
The Provider shall assume all of the Department' s regular
activities in the processing and handling of Workers' Compensation claims. The Provider shall
recommend risk control measures and safety programs to protect the City' s interest. The staff of
the Provider shall work closely and in cooperation with the City Attorney, the Finance
Department and other major departments in the City.
The Provider represents and warrants to the City that it is, and at all times during the term hereof
shall be, familiar, and comply with all existing and future labor contracts involving the City, as
they may be amended from time to time, and with all local, state and federal laws, rules and
regulations pertaining to the subject matter of this Agreement, including, but are not limited to,
any and all laws regarding discrimination, the Florida Rules of Workers' Compensation, F.S.
440; Rules for Self -Insurers under the Workers' Compensation Act, Title 4 of the Department of
Insurance; and the Rules of the Division of Workers' Compensation, Title 38, Department of
Labor and Employment Security, as the same may be amended from time to time.
The Provider represents that the claims personnel dedicated to the City for the provision of
Services shall be available on a 7 day, 24 hour basis for investigating claims.
1. INVESTIGATION:
The Provider shall ensure that the following procedures are followed and observed:
A. Weekly benefits may be terminated only upon written or verbal notification by the
treating physician or the City when employee returns to work. If return to work
information is obtained verbally, the claims adjustor must follow up in writing
with a request for written verification. If treating physician releases the employee
to modified work, the Provider must promptly determine if modified work is
available and offered to the employee before benefits are terminated.
o3- 876
B. Where needed, rehabilitation and/or retraining will be recommended. The
recommendation will be discussed with the Department to determine the
availability of a permanent modified job. If City does not have a job available,
rehabilitation will be initiated with concurrence by the Department as soon as
practicable and the progress will be closely monitored and controlled. The
Department shall be provided with a copy of all rehabilitation plans.
C. Allocated Expenses will be used only where necessary, on a limited investigation
basis, and only after approved by the Department. The file will include the reason
for the outside assignment and the approving source at Department. The Provide
will exercise discretion and control exercised on the outside person retained.
Allocated Expenses are the expenses allocated to a particular claim file, which are
not covered by Provider's compensation, and are limited to the expenses described
in the Proposal as "Allocated Expenses", excluding photographs, video/audio
tapes, supplies, postage, and other services or equipment which are normally
utilized in the provision of investigative services.
2. REPORTING REOUIREMENTS AND STATUS REPORTS:
A. The Provider shall provide to the Administrator a listing every 30 days indicating
all employees that are losing time or working in a light-duty or restricted capacity
B. Provider shall complete a Loss Notice Form at Level $,
3. ADDITIONAL PROVIDER DUTIES:
In addition to all other responsibilities set forth in the Agreement, and at no additional
cost to the City, the Provider shall:
A. Attend Workers' compensation hearings, depositions, mediations and Pension
Board hearings involving work-related injuries as requested by the City and
provide responses to discovery as required by the City Attorney.
B. Provide notification of pre -litigation discovery and litigation being filed against
the City for any reason, to the City Attorney and to the Administrator within
twenty-four (24) hours.
M.
PART II SERVICES
GENERAL, AUTOMOBILE, & PROFESSIONAL LIABILITY CLAIMS
ADMINISTRATION
1. FILE DOCUMENTATION:
Provider agrees as follows:
o)3— 876
A. Updated case analysis summaries will be completed and placed in any claim file
involving bodily injury at least every ninety (90) days after the opening of the file.
The summary will include any and all information that relates to the direction and
value of the case, as well as further work to be done and a target date for
completion.
B. The Control Loss Criteria outlined under the Control Loss Program section of the
Liability Products Standard in the Proposal shall include Reporting Events, as
defined in Section I. 3. A. hereof.
2. INVESTIGATION:
Provider agrees as follows:
A. Conduct a thorough and complete investigation of the incident, according to the
requirements of the City which shall include, but is not be limited to, the
following:
1. Provider shall use best efforts to have photographs of accident scenes taken
before the automobil--s have been removed from the scene.
2. Photographs or diagrams are required for all claims.
3. For automobile claims, obtain, the police and/or fire rescue report and
rescue field copy, and such other documents or information as may assist
in the investigation including, but not limited to, id photos from the Miami
Police Department, driver' s license history and disposition of traffic
citation.
4. For premises liability claims, obtain, at a minimum, if applicable, fire
rescue report and field copy, police report, public works statement on
jurisdiction and maintenance history of the accident location.
5. For police
liability claims, where applicable, obtain at a minimum the
following:
a.
Internal affairs file relating to the claim and Internal Affairs
profile of involved officers
b.
Control of persons report
C.
K9 Bite report
d.
OC Usage report
e.
Tazer report
f.
Arrest affidavit
g.
Incident report/persons report
h.
State Attorney's file
i.
Criminal Court file
j.
Jail Booking record and jail photo
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3.
k. Bonding Video
1. Fire/rescue report and field copy
M. Disposition of any hearing panel such as DDRB or
Accident Review Board
n. Discharge of firearms report
o. Claimant's prior arrest history
P. Communications take
q. Homicide file and supplementary report
r. 1D Unk photos
S. P sheet
t. Officer worksheet
6. For fire/rescue claims, obtain the fire/rescue report and field copy, and
applicable portions of medical protocols.
7. For labor claims: where applicable, obtain at a minimum, the following_
a. Employees personnel files
b. Employment history with City
C. Job announcements and advertisements for job
classification
d. Civil service hearing records
e. Labor relations reports and findings
f. Court transcripts
g. Internal security records at Miami Police Department
h. Payroll summaries
i. EEOC records
j. Department's employee personnel records.
k. Timesheet records
1. Employment shift records at Miami Police Department
M. RFP/Bid package and responses
n. Employment applications
o. Register and Certification lists
P. 110 requests/responses
q. Justice Department approvals
B. As soon as possible, Provider shall obtain authorization from the injured party to
obtain the pertinent information from the treating medical facility to establish the
extent of injury, length of disability, and causal relationship of the injury to the
alleged incident.
ADDITIONAL PROVIDER DUTIES:
Provider shall attend all mediations and trials as requested by the City Attorney, at no
additional cost to the City. With respect to claims with impending trial dates, the Provider
will take an active and aggressive role in settlement or preparation for trial.
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ATTACHMENT "B" - COMPENSATION
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City of Miami
RUN IN CLAIMS
COSTS AND TERMS
# of Per Claimant
Service Claimants Fee Total
Run -In Claims
Medical Only - one time fee
222
$55
$12,210
Indemnity - per claim / per year
990
$395
$391,050
Auto Liability - per claim / per year
253
$395
$99,935
General Liabili - per claim / per year
256
$395
$101,120
Professional Liability
296
$395
$116,920
Run -In Claims: Totall
2,017
$721,235
TotalStorage File Rate
Closed Files 0 $1 $0
Storage: Total 0 $0
Grand Total: 2,020 $748,235
"Data Tapes section applies to the conversion process only from the City's existing system vendor.
No fees will be charged for any data tapes requested by the City outside of this initial conversion.
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of considering a quote
for claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a
business need to know the information. it must be destroyed or returned to Gallagher Bassett Services, Inc. after its intended use.
si3— 876
TotalData
$15,000
Tapes*
Claim
Source
1
Rate
$15,000
Transactions / Detail Payments
1
$6,000
$6,000
Notes
1
$6,000
$6,000
Data Tapes: Total
3
$27,000
TotalStorage File Rate
Closed Files 0 $1 $0
Storage: Total 0 $0
Grand Total: 2,020 $748,235
"Data Tapes section applies to the conversion process only from the City's existing system vendor.
No fees will be charged for any data tapes requested by the City outside of this initial conversion.
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of considering a quote
for claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a
business need to know the information. it must be destroyed or returned to Gallagher Bassett Services, Inc. after its intended use.
si3— 876
r�iwra\
The City of Miami
LIFE OF PARTNERSHIP
COSTS AND TERMS
Effective Date:
Date:
This material is the proprietary. confidential property of Gallagher Bassett Services, Inc. tt has been provided to you for the sole purpose of considering a quo(* for
claims administration services. tt is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the information. It must be destroyed or returned to Gallagher Bassett Services. Inc. after its intended use.
03- 876
of Per
Claimant
Deposit#
Service
Workers Compensation
Claimants
Fee
of Partnmhip
Medical Only
720
$129
$92,880
Indemnity
180
$850
$153,000
Total Workers Compensatior
900
$245,880
Liability
General BI
120
$695
$83,400
General PD
80
$335
$26,800
Auto BI
210
$695
$145,9-50
Auto PD
140
$335
$46,900
Professional Liability
160
$825
$132,000
.0
$0
$0
Total Liabilit
710
$435,050
Ancillary Services
Administration
Include
Data Management
Include
Account Management
$15,00
Index Bureau Reporting
Includec
Claim Reporting (telephonic, web or a -Fax)
Include
risxfacs.corn - 10 Full Users & 5 Inquiry Use
Includec
Electronic Incident
0
$45
$0
Total:
0
$15,000
Additional Services (charges are per user)
risxfacs.cotn - Additional Users -Full
0
$2,195
$0
risxfacs.cotn - Additional Users -Inquiry
0
$1,095
$0
Total:
0
" Grand Total:
1,610
$695,930
Date:
This material is the proprietary. confidential property of Gallagher Bassett Services, Inc. tt has been provided to you for the sole purpose of considering a quo(* for
claims administration services. tt is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the information. It must be destroyed or returned to Gallagher Bassett Services. Inc. after its intended use.
03- 876
LIFE OF PARTNERSHIP
COSTS AND TERMS
(1) Claim Deposits will be reviewed semi-annually and audited at the 18th, 24th, 36th and 48th month.
(2) Claims will be handled for the life of the partnership with no additional per claim fees.
Note: There will be additional charges for ongoing Data Management (RISX-FACS®), dsxfacs.com users,
Administration and Banking fees for as long as GB handles claims.
(3) Data Management includes the following:
• New Claim Setup
• Historical Claims
• Monthly Report by Email or the Website
• Carrier Report Package by Email or Website
(4) Account Administration includes the following:
• Designated Account Manager
• Topical Captioned Reports @ $50,000
• Index Bureau Reporting
• Settlement Authority @ various levels as set for in Attachment A, Settlement Authority
• Banking Administration (SIMMS) - Provided Loss Fund is Properly Funded
• One Audit Per Year not including performance reviews
• Meetings on an as needed basis
• Reserve Alerts @ $10,000 and subsequent $5,000 changes
(5) Claim Reporting
• ClaimLine - Telephonic 800# reporting
• Web Reporting - First reports via the web
• e -Fax - Fax reporting (wc only)
(6) risxfacs.com : Standard internet browseraccess to Gallagher Bassett claim database
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of conskdermg a
quote for claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client
that have a business need to know the information. It must be destroyed of returned to Gallagher Bassett Services, Inc. after its Intended use.
03 876
STANDARD CLAIMS MANAGEMENT SERVICES
Claim Charoes:
The claim charge is applicable per claimant per line of coverage.
Example: A client during working hours is involved in an automobile accident with another vehicle with two occupants.
Both occupants were injured, both cars were damaged and our client was injured.
The claims handling charges (example only) will be:
Claimant #1 - Auto Liability Bodily Injury
$695
Claimant #2 - Auto Liability Bodily Injury
695
Claimant Owner - Auto Liability Property Damage
335
Client — Workers' Compensation
850
Client — Auto Physical Damage
335
$2,910
The total GB fee for this one occurrence is $2,910 to adjust the accident. Specific claim charges by claimant by
line of coverage is normal practice in our industry.
Allocated Expenses: Shall be your responsibility and shall include, but not be limited to:
• Legal Fees
• Professional Photographs*
• Extraordinary costs for witness statements
• Medical records
• Experts' rehabilitation costs
• Fees for service of process
• Architects, contractors
• Engineer
• Police, fire, coroner, weather, or other such
• Property damage appraisals
• Sub rosa investigation
• Official documents and transcripts
• Pre- and post judgment interest paid
• Subrogation at 15% of gross recovery
• Managed Care, when applicable
Medical Examinations
Extraordinary Travel made at client's request
' Court reports
Accident reconstruction
• Chemist
Collection cost payable to third parties on
subrogation
• Any other similar cost, fee or expense
negotiation, settlement or defense of a claim
or loss which must have the explicit prior
approval of the client
Outside Investigation
*Photos taken by adjustors are not to be charged as allocated expenses
03- 876
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. Il has been provided to you for the sole purpose of considering a quote for
claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the information. It must be destroyed or retumed to Gallagher Bassett Services, Inc. after its intended use.
AA
STANDARD CLAIMS MANAGEMENT SERVICES
Workers Compensation - Medical Only Claims
Evaluate and adjudicate work-related claims involving medical treatment only. Claims will be adjudicated according to
statutory state requirements and corporate guidelines as amended in this Agreement. The guidelines anticipate:
Investigation sufficient to determine claim type and compensability
Lost days do not exceed statutory waiting period.
No payments for indemnity per statute and vocational rehab
No subrogation required
No loss notices, captioned reports, client meetings or settlement authority is required
Payment on claims do not exceed $2500
Services provided beyond the guidelines stated above will be considered indemnity cases and will be on a contract
basis only.
Workers Compensation - Indemnity Claims
Investigate, evaluate and adjudicate work-related claima involving disability and/or payment of medical and other
expenses. Claims will be adjudicated according to statutory state requirements and corporate guidelines as amended
in this Agreement.
Incident - Electronic and Manual
Review first report and mark as "Incident'. If an adjuster is required to perform any additional work other than reviewing
the first report, the incident will be converted to a claim.
Liability Claims
Investigate, evaluate and adjudicate all third -party claims for which you may be legally obligated. Third -party claims will
be managed and administered in accordance with our product guidelines as amended in this Agreement.
Property Claims
Investigate, evaluate and adjudicate all first -party claims which you report involving damage or loss of real or personal
property. First -party claims will be managed and administered in accordance with our product guidelines as amended
in this Agreement.
03- 876
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of considering a quote for
claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the information. It must be destroyed or returned to Gallagher Bassett Services, Inc. after its intended use.
ATTACHMENT C —
DESIGNATED PERSONNEL
Provider shall assign the following personnel to provide Services specified in this Agreement:
1. ACCOUNT MANAGER: The Account Manager is fully qualified and responsible for
the performance of Provider' s responsibilities under the Agreement. The Account
Manager's responsibilities include, but are not limited to:
Act as Provider's representative on any claim issue or problems;
ii. Act as a liaison between the City, managed care provider, medical network and
any other parties as deemed necessary by the City.
iii. Participate with and assist the Department in the performance reviews, as required
under the Performance Agreement attached to the Agreement as Exhibit and
review of other claims as requested by the Department under the Agreement.
The Account Manager assigned to the City is
Z. CLAIMS REPRESENTATIVE: (describe duties of claim' s representative and
give required information about the Claim Representatives dedicated to the City).
NAME
TITLE
Upon approval by the City, Provider may assign or change such other personnel as Provider
deems necessary to provide the Services to the City. In such event, Provider shall replace the
personnel listed above, with qualified and experienced personnel.
03- 876
ATTACHMENT D —
PROVIDERS' INSURANCE REQUIREMENTS
Provider agrees to maintain in full force and effect the following policies of insurance
during the term of this Agreement:
TYPE
Workers Compensation
Employers Liability
Commercial General Liability
Business Auto Liability
Umbrella Liability
Errors & Omissions
LIMITS OF LIABILITY
Statutory
$1,000,000
Each Acc., Bodily Injury
$1,000,000
Each Employee, Disease
$1,000,000
Policy Limit, Disease
$1,000,000 Each Occurrence
$2,000,000 General Aggregate
$1,000,000 Each Accident
$10,000,000 Each Occurrence
$10,000,000 Aggregate
$10,000,000 Each Occurrence
$10,000,000 Aggregate
Provider shall submit a certificate or certificates evidencing the coverages in a form
satisfactory to City. Said certificates(s) shall provide for thirty (30) days notice to City
prior to cancellation, non -renewal or material change of any insurance required by this
Agreement.
Receipt of deficient certificates by City, or by any of City's representatives, does not
constitute a waiver of Provider's obligation to fulfill the insurance requirements herein.
The Successful Proposer(s) shall be responsible for assuring that the insurance certificates
required in conjunction with this Section remain in force for the duration of the contractual
period; including any and all option terms that may be granted to the Provider.
If insurance certificates are scheduled to expire during the contractual period, the Provider shall
be responsible for submitting new or renewed insurance certificates to the City at a minimum of
ten (10) calendar days in advance of such expiration.
In the event that expired certificates are not replaced with new or renewed certificates which
cover the contractual period, the City shall:
t 3- 876
A) Suspend the Contract until such time as the new or renewed certificates are received by
the City.
B) The City may, at its sole discretion, terminate the Contract for cause and seek re -
procurement damages from the Provider in conjunction with the violation of the terms
and conditions of the Contract.
03- 87
ATTACHMENT E —
PERFORMANCE AGREEMENT
Gallagher Bassett Services, Inc. ("Provider") has been retained to provide claims
administration services to the City of Miami ("City") in accordance with the provisions of
the Professional Services Agreement dated , 2003. The service
contract is effective on , 2003, and is for an initial period of three (3)
years, with five (5) one (1) year renewal options at the discretion of the City.
The Provider and the City agree that Performance Reviews will be conducted after the
first six months of operations, affecting all claims received during said 6 month period,
and every six month period thereafter (each, a "Performance Period"). Each
Performance Review will involve 100 randomly selected files, excluding workers'
compensation "medical only" files. The make-up of the files selected for each review
will be approximately 50 from workers' compensation, 15 auto liability, 15 general
liability, and 20 police professional or public officials' liability, with at least 50% open
files in each category.
Claims for review will be randomly selected. Provider will provide the City with a listing
of all claims incurred during each Performance Period, sorted by type of claim. The City
will select random claims, such as every tenth claim, from each category until the
appropriate number of claims has been selected.
The City will perform two Performance Reviews for each annual period of the
Agreement. The initial review will be after the Provider has been providing claims
administration services for six (6) months. Each Performance Review will occur
approximately 1-2 months after the conclusion of the Performance Period. The
following chart outlines this schedule.
Failure to perform at or above expected levels will result in a financial penalty of 5% of
the amount that would be charged by the Provider for the newly incurred claims
reported during the Performance Period. Any financial penalties will be credited against
future amounts invoiced by Provider to the City.
The review will measure seven (7) objective performance standards which are easily
identified and measured. Each claim will generate a maximum of 10 points. All
timeliness standards of performance are stated in business, not calendar, days. In all
instances where a standard is not applicable to a particular claim file, the file will be
awarded the appropriate point(s) for that standard.
After each review is performed, Provider will meet with the City of Miami Risk
Management Administrator or designee to discuss initial evaluation results. Thereafter,
a final tally of the review results will be prepared. The outcome of all reviews will be
presented to the Self -Insurance and Insurance Trust Committee for approval. The first
03- 876
review will be for information purposes only and no penalties will be imposed.
A minimum of 80% average compliance (i.e. average of 8 of the possible 10 points for
each claim reviewed) with claims administration expectations is expected in the first
annual period of the contract. The minimum average compliance expectation is raised
to 90% on the second annual period, and 95% for annual periods thereafter. Failure to
meet these average compliance expectations will result in the penalty noted above.
03- 876
Performance
Performance Period
Expected Time of
% Average
Penalty
Review
Review
Compliance for
(Claims incurred during
(months after
No Penalty to
Performance Period are
initiation of
Apply
subject to review)
contract
1
Months 1 — 6 of Contract
7 — 8 months
80%
NA
2
Months 7 —12 of Contract
13 — 14 months
80%
5%
3
Months 13 — 18 of
19 = 20 months
90%
5%
Contract
4
Months 19 — 24 of
25 — 26 months
90%
5%
Contract
5
Months 25 — 30 of
31 — 32 months
95%
5%
Contract
6
Months 31 — 36 of
37 — 38 months
95%
5%
Contract
#)3- 876
PERFORMANCE STANDARDS
1) Claim Receipt and Recording (1 point per claim for compliance)
Provider will document workers' compensation new claim information received from
the managed care vendor, and this information will be available electronically within
two (2) hours of receipt from the managed care vendor.
Provider will document claims intake information on all liability claims, and this
information will be available electronically within two (2) hours of claim being
reported.
(For both workers' compensation and liability claims, if first claim data is provided to
Provider after 3:00 p.m., appropriate documentation by 10:00 a.m. the next business
day will be considered compliance.)
2) Two/Three Point Contact by Claims Adjuster Within 24 Hours of Claim
Receipt
(2 points per claim for compliance — 1 point for claimant contact
attempt, 1 point for supervisor contact attempt)
A minimum of "three attempts" by the claims adjuster to contact the appropriate
claimant(s) and/or supervisor will be considered a "contact," if followed up with
appropriate correspondence within the measurement period.
3) Document Subrogation Recovery Potential (1 point per claim for
compliance)
Adjusters will document subrogation, contribution, and/or coordination of benefits
recovery potential in the claim file within fourteen (14) days of claim receipt.
4) Compensability Determination/Direction Within Fourteen (14) Days of
Claim Receipt (1 point per claim for compliance)
For workers' compensation claims, within fourteen (14) days of receipt of the claim,
the claims adjuster will document compensability analysis findings.
For liability claims, within two (2) days of receipt of the claim, the claims adjuster will
document appropriate specific direction for the investigation and handling of the
case.
5) Establishment of Reserves (2 points per claim for compliance — 1 point
for appropriate reserve reviews and 1 point for appropriate City
approval of reserve changes.)
03- 876
Within 72 hours of receipt of the claim, initial reserves for the file set;
thereafter, reserves will be reviewed on an on-going basis, as follows:
30 days from 72 hour review
30 days from 30 day review
60 days from last 60 day review
Every 6 months thereafter
Increase or Decrease of reserves by $10,000 or more requires City of Miami Risk
Management Administrator or designee approval. File should document approvals,
if appropriate.
6) Rapid Response to Litigation Complaints (1 point for compliance — if
"not applicable," 1 point assigned.)
Claims adjusters will "address" litigation within two (2) days of litigation receipt. This
will mean referral to the City Attorney's office for assignment within two (2) days.
7) Timely Preparation of Status Reports to the Risk Management
Administrator or Designee (2 points total for compliance, 1 point for
each required status report. If only one report required at time of
review, 2 points assigned.)
Required status reports were presented to the Risk Management Administrator or
designee. Required status reports are outlined in Attachment A, Scope of Services,
Reporting Requirements and Status Reports.
CE AGREEMENT
03- 876
2-1-71-1111-1
l J�
City of Miami
RUN IN CLAIMS
COSTS AND TERMS
# of Per Claimant
Service Claimants Fee Total
Run -In Claims
Medical Only - one time fee
222
$55
$12,210
Indemnity - per claim / per year
990
$395
$391,050
Auto Liability - per claim / per year
253
$395
$99,935
General Liability - per claim / per year
256
1 $395
$101,120
Professional Liability
'296
$395
$116,920
Run -In Claims: Total
2,017
1 $721,235
Storage File Rate Total
Clos
..-
Closed Files 0 $1 $0
Storage: Total 0 $0
Grand Total: 2,020 $748,235
• Data Tapes section applies to the conversion process only from the City's existing system vendor.
No fees will be charged for any data tapes requested by the City outside of this initial conversion.
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of considering a quote
for claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a
business need to know the information. It must be destroyed or returned to Gallagher Bassett Services, Inc. after its intended use.
03- 876
Data Tapes'
Claim
1
$15,000
$15,000
Transactions / Detail Payments
1
$6,000
$6,000
Notes
1
$6,000
$6,000
Data Tapes: Total
3
$27,000
Storage File Rate Total
Clos
..-
Closed Files 0 $1 $0
Storage: Total 0 $0
Grand Total: 2,020 $748,235
• Data Tapes section applies to the conversion process only from the City's existing system vendor.
No fees will be charged for any data tapes requested by the City outside of this initial conversion.
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of considering a quote
for claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a
business need to know the information. It must be destroyed or returned to Gallagher Bassett Services, Inc. after its intended use.
03- 876
den �taV
.�19i
The City of Miami
LIFE OF PARTNERSHIP
COSTS AND TERMS
Effective Date:
Date:
This material is the proprietary, confidential property of Gallagher Bassett Services. Inc. ✓< has been provided to you for the sole purpose of considering a quote for
claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the information. It must be destroyed or retumed to Gallagher Bassett Services, Inc. after its intended use.
03- 876
of
Per Claimant
Deposit#
Service
Claimants
Fee
Partnership
Workers Compensation
of
Medical Only
720
$129
$92,880
Indemnity
180
$850
$153,000
Total Workers Compensation
900
$245,880
Liability
General BI
120
$695
$83,400
General PD
80
$335
$26,800
Auto BI
210
$695
$145,950
Auto PD
140
$335
$46,990
Professional Liability
160
$825
$132,000
0
$0
$0
Total Liabilit
710
$435,050
Ancillary Services
Administration
Include
Data Management
Include
Account Management
$15,00
Index Bureau Reporting
Include
Claim Reporting (telephonic, web or a -Fax)
Include
risxfacs.com - 10 Full Users & 5 Inquiry User.,
Include
Electronic Incident
0
$45
$0
Total:
0
$15,000
Additional Services (charges are per user)
risxfacs.com - Additional Users -Full
0
$2,195
$0
risxfacs.com - Additional Users -Inquiry
0
$1,095
$0
Total:
0
Grand Total:
1,610
$695,930
Date:
This material is the proprietary, confidential property of Gallagher Bassett Services. Inc. ✓< has been provided to you for the sole purpose of considering a quote for
claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the information. It must be destroyed or retumed to Gallagher Bassett Services, Inc. after its intended use.
03- 876
i�ira\
P� d1/
LIFE OF PARTNERSHIP
COSTS AND TERMS
(1) Claim Deposits will be reviewed semi-annually and audited at the 18th, 24th, 36th and 48th month.
(2) Claims will be handled for the life of the partnership with no additional per claim fees.
Note: There will be additional charges for ongoing Data Management (R1SX-FACS@), risxfacs.com users,
Administration and Banking fees for as long as GB handles claims.
(3) Data Management includes the following:
• New Claim Setup
• Historical Claims
• Monthly Report by Email or the Website
• Carrier Report Package by Email or Website
(4) Account Administration includes the following:
• Designated Account Manager
• Topical Captioned Reports @ $50,000
• Index Bureau Reporting
• Settlement Authority @ various levels as set for in Attachment A, Settlement Authority
• Banking Administration (SIMMS) - Provided Loss Fund is Properly Funded
0 One Audit Per Year not including performance reviews
• Meetings on an as needed basis
• Reserve Alerts @ $10,000 and subsequent $5,000 changes
(5) Claim Reporting
• ClaimLine - Telephonic 800# reporting
• Web Reporting - First reports via the web
• e -Fax - Fax reporting (wc only)
(6) risxfacs.com : Standard internet browseraccess to Gallagher Bassett claim database
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of considering a
quote for claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client
that have a business need to know the information. It must be destroyed or returned to Gallagher Bassett Services, Inc. after its intended use.
03— V 16
STANDARD CLAIMS MANAGEMENT SERVICES
Claim Charges:
The claim charge is applicable per claimant per line of coverage.
Example: A client during working hours is involved in an automobile accident with another vehicle with two occupants.
Both occupants were injured, both cars were damaged and our client was injured.
The claims handling charges (example only) will be:
Claimant #1 - Auto Liability Bodily Injury $695
Claimant #2 - Auto Liability Bodily Injury 695
Claimant Owner - Auto Liability Property Damage 335
Client — Workers' Compensation 850
Client — Auto Physical Damage 335
$2,910
The total GB fee for this one occurrence is $2,910 to adjust the accident. Specific claim charges by claimant by
line of coverage is normal practice in our industry.
Allocated Expenses: Shall be your responsibility and shall include, but not be limited to:
• Legal Fees
Professional Photographs*
• Extraordinary costs for witness statements
Medical records
Experts' rehabilitation costs
Fees for service of process
' Architects, contractors
• Engineer
• Police, fire, coroner, weather, or other such
Property damage appraisals
Sub rosa investigation
• Official documents and transcripts
• Pre- and post judgment interest paid
Subrogation at 15% of gross recovery
• Managed Care, when applicable
• Medical Examinations
• Extraordinary Travel made at client's request
• Court reports
• Accident reconstruction
Chemist
• Collection cost payable to third parties on
subrogation
• Any other similar cost, fee or expense
negotiation, settlement or defense of a claim
or loss which must have the explicit prior
approval of the client
• Outside Investigation
*Photos taken by adjustors are not to be charged as allocated expenses
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of considering a quote for
claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the information. It must be destroyed or returned to Gallagher Bassett Services, Inc. after its intended use. 03—
3_ 876
STANDARD CLAIMS MANAGEMENT SERVICES
Workers Compensation - Medical Only Claims
Evaluate and adjudicate work-related claims involving medical treatment only. Claims will be adjudicated according to
statutory state requirements and corporate guidelines as amended in this Agreement. The guidelines anticipate:
Investigation sufficient to determine claim type and compe_ usability
Lost days do not exceed statutory waiting period.
No payments for indemnity per statute and vocational rehab
No subrogation required
No loss notices, captioned reports, client meetings or settlement authority is required
Payment on claims do not exceed $2500
Services provided beyond the guidelines stated above will be considered indemnity cases and will be on a contract
basis only.
Workers Compensation - Indemnity Claims
Investigate, evaluate and adjudicate work-related claims involving disability and/or payment of medical and other
expenses. Claims will be adjudicated according to statutory state requirements and corporate guidelines as amended
in this Agreement.
Incident - Electronic and Manual
Review first report and mark as "Incident". If an adjuster is required to perform any additional work other than reviewing
the first report, the incident will be converted to a claim.
Liability Claims
Investigate, evaluate and adjudicate all third -party claims for which you may be legally obligated. Third -party claims will
be managed and administered in accordance with our product guidelines as amended in this Agreement.
X.
Property Claims
Investigate, evaluate and adjudicate all first -party claims which you report involving damage or loss of real or personal
property. First -party claims will be managed and administered in accordance with our product guidelines as amended
in this Agreement.
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of considering a quote for
claims administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the information. It must be destroyed or returned to Gallagher Bassett Services, Inc. after its intended use.
03- 87c
CITY OF MIAMI, FLORIDA 35
INTER -OFFICE MEMORANDUM
TO : Honorable M d DATE : JUL 17 M FILE
Members o e Ci ommis o
SUBJECT : A resolution authorizing the
City Manager to execute a
?hi
Professional Services
FROM : REFERENCES : Agreement with Gallagher
ola Bassett, Inc.
f Administrator/City Manager ENCLOSURES:
RECOMMENDATION
It is respectfully recommended that the City Commission adopt the attached resolution,
pursuant to Resolution No. 03-364, authorizing the City Manager to execute a
professional services agreement, in substantially the attached form, attached as Exhibit 1
hereto, with Gallagher Bassett, Inc., the top ranked firm, for an initial term of three years
with the City having the opti@n to extend the term for five (5) additional one (1) year
periods, without further approval of the City Commission, provided that the increase in
the amount of compensation payable during each of the additional one (1) year periods
does not , exceed CPI. Funds will be allocated from Account Code No.
515001.624401.6.270 in an amount not to exceed the negotiated amount set forth in
Exhibit 2 hereto.
BACKGROUND
The City of Miami issued RFP No. 02-03-010 seeking qualified and experienced firms to
provide Workers Compensation Claims Administration (Part I Services) and General,
Automobile and Professional Liability Claims Administration (Part II Services). The
City Commission accepted the recommendation of the City Manager approving the
findings o f t he E valuation C ommittee and a uthorized t he C ity M anager t o n egotiate a
professional services agreement with Gallagher Bassett, Inc., the top-ranked firm. The
Department of Risk Management has negotiated this agreement and the City Manager
will present the negotiated agreement to the City Commission for review and
consideration.
JA/I�AVE db
03- 876
Budgetary Impact Analysis
Department Risk Management Division
Commission Meeting Date: July 24, 2003
Title and brief description of legislation or attached ordinance/resolution:
Gallagher -Bassett. Company will handle all claims administration
1. Is this item related to revenue? NO ❑ YJb (If yes, skip to item #4)
2. Are there sufficient funds in Line Item?
CIP Project 4: (If applicable)
Yes: Index Code: 515001 Minor: 270
No: Complete the following information:
i
3. Source of funds: Amount budgeted in the line item:
Balance in line item:
Amount needed in line item:
Sufficient funds will he transferred frnm the fnllnvrina hna ;t, -me -
Amount:,,, attarhad fee schedule
$ 338,490.00
$ ini,95n_nn
$ see attached
ACTION ACCOUNT NUMBER
TOTAL
Project No./Index/Minor Object
From
$
From
$
To
$
To
Is
4. Comments: _^ i 1 i
fil 70 COMI�At2 M ���dl{ � ..eta
API"*"*
li�lf � 1r►sm�snsll�
Department DjLMpr/Desi
APPROVALS
Verlfi1 t0 frt
napuft-aL[d"WC; Ito, dgeting &
�€fer�a ».�»..........r
VO 10pDate: 1 110 03
Date
Verified by CIP: (If applicable).
Director/Designee
Date:
�J3— 6
The City of Miami
LIFE OF PARTNERSHIP
COSTS AND TERMS
Effective Date:
Service
Workers Compensation
of Per
Claimants
Claimant
Fee
Deposit#
of Partnership
Medical Only
720
$129
$92,880
Indemnity
180
$850
$153,000
Total Workers Compensation
900
$245,880
Liability
-
General BI
120
$695
$83,400
General PD
80
$335
$26,800
Auto BI
210
$695
$145,950
Auto PD
140
$335
$46,900
Professional Liability
160
$825
$132,000
0
$0
$0
Total Liability,710
$435,050
Ancillary Services
Administration
Include
Data Management
L
Include
Account Management
$15,00
Index Bureau Reporting
Includec
Claim Reporting (telephonic)
$25,000
fisxfacs.com -10 Full Users & 5 Inquiry
Use
Include
Electronic Incident
0
$45
$0
Total:
0
$40,000
Additional Services (charges are per
user
dWacs.com - Additional Users -Full
0
$2,195
$0
fi'sxfacs.com - Additional Users -inquiry
0
$1,095
$0
Total:
0
$0
Grand Total:
1,6101
$720,930
Date:
This material la the proprietary, oorNtd9nW Property of Cabapher Bassett SWV c hK lthas been provided to you for the sole propose of const *ft a quote for
daimf adm ration services. kis not to be dtrpleaW arshared in any fam wkh anyone dher than the ftmbkuals of such pmspec&9 diem that have a business
need 10know the Wwrallon. M must be des&oyed orr hoW to Gafther Bassett Service; bro. atter its Intended use.
03- 876
tG i�1\
y/
City of Miami
RUN IN CLAIMS
COSTS AND TERMS
Data
Run -In Claims "
Medical Only - one time fee
222
$55
$12,210
Indemnity - per claim / per year
990
$395
$391,050
Auto Liability - per claim / per year
253
$395
$99,935
General Liability - per claim / per year
256
$395
$101,120
Professional Liability -per claim/per year
296
$395
$116,920
Run -In Claims: Total
2,017
$721,235
Data
Claim
1
$15,000
$15,000
Transactions / Detail Payments
1
$6,000
$6,000
Notes
1
$6,000
$6,000
Data Tapes: Total
3
$27,000
Data Tapes section applies to the conversion process only from the City's existing system vendor.
No fees will be charged for any data tapes requested by the City outside of this initial conversion.
This mate W is the WWdet&W aordld-" properly ofGapagherBe&"# Serviees, Ina it has been provided to you for the sole propose of considering a quote
for etelms a&*9s&v5w aervtoes. !tis not to be du ftefed or shared in any form wtth anyone other than the 6ailvid cats of such praspecVve awit Viet have a
business creed to blow the kubmw0m. It must be destroyed or retumed to Gabghw Smelt Servtoes. V= after tts bKended use.
dig
tz A�i
LIFE OF PARTNERSHIP
COSTS AND TERMS
(1) Claim Deposits will be reviewed semi-annually and audited at the 18th, 24th, 36th and 48th month.
(2) Claims will be handled for the life of the partnership with no additional per claim fees.
Note: There will be additional charges for ongoing Data Management (R1SX-FACSO), dsxfacs.com users,
Administration and Banking fees for as long as GB handles claims.
(3) Data Management includes the following:
• New Claim Setup
• Historical Claims
• Monthly Report by Email or the Website
0 Carrier Report Package by Email or Website including data tapes
(4) Account Administration includes the following: _
• Designated Account Manager
• Topical Captioned Reports @ $50,000
• Index Bureau Reporting
• Settlement Authority @ various levels as set for in Attachment A, Settlement Authority
Banking Administration (SIMMS) - Provided Loss Fund is Properly Funded
• One Audit Per Year not including p"rmance reviews
• Meetings on an as needed basis z
• Reserve Alerts @ $10,000 and subsequent $5,000 changes
(5) Claim Reporting
• ClaimLine - Telephonic 800# reporting
(6) risxfacs.com : Product description included in Provider's proposal with all reporting levels and Selexfacs and
i -Link shall be available to the City for full users
This material is the proprietary, cmWengal properly of GaNagtw Bassett Services, Inc. It has been provided to you for the sole purpose of considering a
quote for claims administ vffw services. It is rwt to be dup wted or shared In any fam with anyone other than the k0widuals of such prospective e0ent
Mat have a busaress creed to know the Hdormation... It must be destroyed or returned to Gallagher Bassett Services, Inc. atter its »tended use.
03- 876
STANDARD CLAIMS MANAGEMENT SERVICES
Claim Charces:
The claim charge is applicable per claimant per line of coverage.
Example: A client during working hours is involved in an automobile accident with another vehicle with two occupants.
Both occupants were injured, both cars were damaged and our client was injured.
The claims handling charges (example only) will be:
Claimant #1 - Auto Liability Bodily Injury
$695
Claimant #2 - Auto Liability Bodily Injury
695
Claimant Owner - Auto Liability Property Damage
335
Client — Workers' Compensation
850
Client — Auto Physical Damage
335
$2,910
The total GB fee for this one occurrence is $2,910 to adjust the accident. Specific claim charges by claimant by
line of coverage is normal practice in our industry.
Allocated Expenses: Shall be your respopsibility and shall include, but not be limited to:
• Legal Fees
• Professional Photographs*
• Extraordinary costs for witness statements
• Medical records
• Experts' rehabilitation costs
• Fees for service of process
• Architects, contractors
• Engineer
• Police, fire, coroner, weather, or other such
• Property damage appraisals
• Sub rosa investigation
• Official documents and transcripts
• Pre- and post judgment interest paid
• Subrogation at 15% of gross recovery
• Managed Care, when applicable
• Medical Examinations
• Extraordinary Travel made at client's request
• Court reports
• Accident reconstruction
• Chemist
• Collection cost payable to third parties on
subrogation
• Any other similar cost, fee or expense
negotiation, settlement or defense of a claim
or loss which must have the explicit prior
approval of the client
• Outside Investigation
*Photos taken by adjustors are not to be charged as allocated expenses
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. If has been provided to you for the sole purpose of considering a quote for
claans administration services. It is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the information. It must be destroyed or returned to Gallagher Bassett Services. Inc. after its intended use.
iGi11
L 107.AP
STANDARD CLAIMS MANAGEMENT SERVICES
Workers Compensation - Medical Only Claims
Evaluate and adjudicate work-related claims involving medical treatment only. Claims will be adjudicated according to
statutory state requirements and corporate guidelines as amended in this Agreement. The guidelines anticipate:
Investigation sufficient to determine claim type and compensability
Lost days do not exceed statutory waiting period.
No payments for indemnity per statute and vocational rehab
No subrogation required
No loss notices, captioned reports, client meetings or settlement authority is required
Payment on claims do not exceed $2500
Services provided beyond the guidelines stated above will be considered indemnity cases and will be on a contract
basis only. -
Workers Compensation - Indemnity Claims
Investigate, evaluate and adjudicate work-related claims involving disability and/or payment of medical and other
expenses. Claims will be adjudicated according to statutory state requirements and corporate guidelines as amended
in this Agreement.
Incident - Electronic and Manual
Review first report and mark as "Incident". If an adjuster is required to perform any additional work other than reviewing
the first report, the incident will be converted to a claim.
Liability Claims
Investigate, evaluate and adjudicate all third -party claims for which you may be legally obligated. Third -party claims will
be managed and administered in accordance with our product guidelines as amended in this Agreement.
Property Claims
Investigate, evaluate and adjudicate all first -party claims which you report involving damage or loss of real or personal
property. First -party claims will be managed and administered in accordance with our product guidelines as amended
in this Agreement.
This material is the proprietary, confidential properly of Gallagher Bassett Services, Inc. It has been provided to you for Bre sale purpose of considering a quote for
daims admirdstrabon servke& it is not to be duplicated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the informerion. It must be destroyed or returned to Gattagher Bassett Services Inc. atter its intended use.
03- 876
MAY -13-2003 12:40 r TY CLERKS OFFICE 305 858 1610 P.02
J-03-227
3/13/03
RESOLUTION NO. 0 3` 364
A RESOLUTION OF THE MIAMI CITY COMMISSION
APPROVING THE FINDINGS OF THE EVALUATION
COMMITTEE PURSUANT TO REQUEST FOR PROPOSAL
NO. 02-03-010, FOR WORKERS COMPENSATION
CLAIMS ADMINISTRATION (PART I SERVICES);
GENERAL, AUTOMOBILE AND PROFESSIONAL
LIABILITY HANDLING CLAIMS ADMINISTRATION
(PART II SERVICES), AND/OR MANAGED CARE
SERVICES (PART III SERVICES); AUTHORIZING THE
CITY MANAGER TO NEGOTIATE A PROFESSIONAL
SERVICES AGREEMENT ("AGREEMENT"),' WITH
GALLAGHER BASSETT SERVICES, INC., THE
TOP-RANKED FIRM, FOR THE PROVISION OF PART I
AND PART II SERVICES, AND SHOULD NEGOTIATIONS
FAIL WITH THIR TOP-RANKED FIRM, TO NEGOTIATE
WITH CRAWFORD=AND COMPANY, THE SECOND -RANKED
FIRM, UNTIL A CONTRACT IS NEGOTIATED; FURTHER
AUTHORIZING THE CITY MANAGER TO NEGOTIATE AN
AGREEMENT WITH PREFERRED GOVERNMENTAL CLAIMS
SOLUTIONS (PGCS), THE TOP-RANKED FIRM, FOR
THE PROVISION OF PART III SERVICES, FOR A
THREE-YEAR PERIOD, -WITH THE OPTION TO EXTEND
FOR FIVE ADDITIONAL ONE-YEAR PERIODS, AND
SHOULD NEGOTIATIONS FAIL, THE EVALUATION
COMMITTEE SHALL RECONVENE TO RECONSIDER ITS
RECOMMENDATION FOR AWARD; DIRECTING THE CITY
MANAGER TO PRESENT THE NEGOTIATED
AGREEMENT(S) TO THE CITY COMMISSION FOR
CONSIDERATION.
WHEREAS, the City of Miami ("City") issued Request for
Proposal No. 02-03-010 seeking qualified and experienced firms
for the provision of the following services for the Department of
Risk Management:
03- 87
CITY CO3DUSSWU
NrE£TING OF
App' 1 2003
Reaolutica Na
MAY -13-2003 12:40 CI" CLERKS OFFICE 305 858 1610 P.03
Part I Services: Workers Compensation Claims
Administration
Part II Services: General, Automobile and
Professional Liability Claims
Administration (Police Tort and
Public Officials Liability)
Part III Services: Managed Care Services;
and
WHEREAS, Risk Management requires the services of a
qualified and experienced third -party claims administrator and
workers compensation managed care provider to provide
alternatives to its Risk Management Division to more efficiently
,s
and effectively utilize its resources to reduce the overall
number and/or severity of workers compensation and liability
claims as well as develop, implement, and monitor certain service
quality indicators in an effort to improve the overall quality
and efficiency of services provided to the citizens, vendors and
employees of the City; and
WHEREAS, Parts I
and
II Services
require a
Third -party
Claims Administrator
("TPA")
to assume
the daily
activities,
currently performed by staff in the Risk Management Division, to
process and handle the City's claims for Workers' Compensation,
and Liability - general, auto, and professional liability (police
tort and public officials liability), including all specified
adjusting services and other required services such as
03- 876
Page 2 of 6
MAY -13-2003 12:41 TY CLERKS OFFICE 305 858 1610 P.04
administration, computerized claim/loss statistical information,
and loss fund reconciliation; and
WHEREAS, the TPA will also provide 24-hour call center
service, recommend risk control measures to protect the City's
interests, implement an enhanced comprehensive Safety program,
and implement an enhanced comprehensive Light Duty Program for
the entire City and all labor groups; and
WHEREAS, Part III Services provide that the Managed Care
vendor provide all of the services related to the City's workers
Compensation Managed Care Claims, which is essentially a change
of vendors, as the City is currently utilizing Occupational
Health Systems, Inc. for the provision of these services; and
WHEREAS, the Evaluation. Committee recommended Gallagher
Bassett Services, Inc., as the top-ranked firm, for the provision
of both Parts I and II Services; and
WHEREAS, the Evaluation Committee further recommended that
should negotiations fail with Gallagher Bassett Services, Inc.,
that the City negotiate with Crawford and Company, the
second -ranked firm, until a contract is negotiated to present to
the City Commission for final approval; and
03- 876
Page 3 of 6
HAY -13-2003 12:41 C"'Y CLERKS OFFICE 305 858 1610 P.05
WHEREAS,
the
Evaluation
Committee
recommended Preferred
Governmental
Claim
Solutions
("PGCS"), as
the top-ranked firm,
for the provision of Part III Services; and
WHEREAS, the Evaluation Committee further recommended that
should negotiations fail with PGCS, the Evaluation Committee
shall reconvene to reconsider its recommendation for award; and
WHEREAS, the City Manager concurred with the recommendations
of the Evaluation Committee;
NOW, THEREFORE, BENT RESOLVED BY THE COMMISSION OF THE CITY
OF MIAMI, FLORIDA:
Section 1. The recitals and findings contained in the
Preamble to this Resolution are adopted by reference and
incorporated as if fully set forth in this Section.
Section 2. The recommendation of the City Manager to
approve the findings of the Evaluation Committee pursuant to
Request for Proposal No. 02-03-010, that the firms most qualified
to provide Worker's Compensation Claims Administration (Part I
Services) and General Automobile and Professional Liability
Handling Claims Administration (Part II Services), in rank order
are. (1) Gallagher Bassett Services, Inc., the top-ranked firm
and (2) Crawford and Company, the second -ranked firm, and the
03- 8'7 6
Page 4 of 6
MAY -13-2003
12=41 r*TY CLERKS OFFICE
305 958 1610
P.06
firm
most qualified to provide Managed Care
Services (Part
III
Services) is Preferred Governmental Claims Solutions ("PGCS"),
are approved.
Section 3. The City Manager is authorized' -'l to negotiate
a Professional Services Agreement ("Agreement"), with Gallagher
Bassett Services, Inc,, the top-ranked firm, for Parts I and II
Services, for a three-year period, with the option to extend for
five additional one-year periods.
Section 4. The -City Manager is further authorizedll to
negotiate an Agreement with Crawford and Company, the
second -ranked firm, should negotiations fail with Gallagher
Bassett Services, Inc.
Section S. The City Manager is authorizedll to negotiate
an Agreement, in a form acceptable to the City Attorney, with
Preferred Governmental Claims Solutions ("PGCS") the top-ranked
firm, for the provision of Part III services, for a three-year
period, with the option to extend for five additional one-year
periods.
�i The herein authorization is further subject to compliance with
all requirements that may be imposed by the City Attorney,
including but not limited to those prescribed by applicable
provisions of the City charter and Code.
03- 87C
Page 5 of 6 """'�
MAY -13-2003 12:41 CT" ' CLERKS OFFICE 305 858 1610 P.07
Section 6. The Evaluation Committee shall reconvene to
reconsider its recommendation for award should negotiations fail
with PGCS.
Section 7. The City Manager is directed to present the
negotiated Agreements to the City Commission for consideration.
Section B. This Resolution shall become effective
immediately upon its adoption and signature of the Mayoral
PASSED AND ADOPTED this 10th day of
ATTEST:
f J
PRISCILLA A. THOMPSON /
CITY CLERK
APPROVED"A TO F CORRECTNESS -.t
iV
''CITY ATTORNEY
033:tr:AS:BSS
it
, 2003.
If the Mayor does not sign this Resolution, it shall become
effective at the end of ten calendar days from the date it was
passed and adopted. If the Mayor vetoes this Resolution, it shall
become effective immediately upon
City Commission. override of the veto by the
03'. 876
Page 6 of 6
7/23/03
Mayor and Commissioners;
SUBMITTED INTO THE
PUBLIC RECORD FOR
ITEM 35 ON- Fav -o3
I have been appearing before the City Commission for 16 years now. At no
time have I ever given erroneous numbers in any presentation on backup that
I have given; and I have certainly never lied to any Commissioner or Mayor
on any presentation I have given. All the numbers I have used in any
presentation have been directly from the City records. I also knew that if I
had ever lied I could of faced punishment up to and including dismissal like
every other Civil Servant I represent; there are strict rules in every
department and Civil Service rules about truthfulness. But more so than that
I knew my credibility was at stake every time I appeared before the City
Commission. If I had ever lied, I would have had to give up my job as Union
President, because no Mayor or Commissioner would have ever believed my
numbers again. The Union has hired an economist, Mr. Larry Jessup, to
present information regarding the data provided by the City.
I told you in two previous appearances before the Commission on Risk
Management that hiring a private company would cost the Tax pavers of
Miami more money. No less than seven times in the two Commission
03- 876
meetings regarding Risk Management discussions have you had an Assistant
to the City Manager mislead you. Assistant Manager, Mr. Monzon,
sat in the managers chair and told you that you would save more than
half a million dollars by doing this change. During those two meetings
Assistant City Manager, Ms. Haskins, has also stood by Mr. Myers and
assistant City Manager Mr. Monzon, shaking her head, yes the city would
save more than half a million dollars by privatizing Risk Management.
When asked by Commissioner Winton, on record, if this was a net savings,
Mr. Myers responded, yes it is. I ask all of you how can you trust any
numbers that these individuals give you now. You now have in place an
Auditing General that responds directly to the Commission, and before you
make any decisions you should use those tools that you have in place to
protect yourselves and check all of the City's numbers and assertions
contained in the Gallagher Bassett contract.
Since Commissioner Sanchez got involved a few years ago, the City has
hired at least fifteen new employees including executives in Risk
Management.
If you notice in the City's contract, they are requiring for Gallagher Bassett
supervisors in charge of our program for four years experience as a
supervisor and they cannot use trainees for the City's work. I have incl ded
Submitted Into the public
item_--
�ju-so;or�
��g
City Glcrk
03- 876
our job requirements for claims adjuster I through claims supervisor. If you
look at claims adjuster I, II, III, all are required to have State of Florida
licenses. Claim Adjuster I must have 6 months experience. Claim Adjuster II
must have 2 years experience. Claims Adjuster III must have 5 years
experience. Claims Supervisor must have a bachelor's degree in Risk
Management and Insurance or Health Administration or a close related field
and posses 3 years experience plus a State of Florida license. As you can
see we are down grading our qualifications. All of the employees that the
City has hired have more experience and qualifications that is required by
the Gallagher Bassett contract.
There is no doubt that if the City was willing to commit half the resources
the City Manager is willing to give Gallagher Bassett, you would have a
great Risk Management Department. In the last three weeks, you have had
two employees resign. One has gone to work for Gallagher Bassett and the
other has gone to work for Dade County. There is no question that we have
skilled and competent employees working in the Risk Management
Department. Furthermore, if the City Manager wanted to privatize the Risk
Management Department, why did he hire a new Director? This makes no
sense to me. It also does not make any sense to manipulate the information
03- 876
you, the Commission, need to make your decisions. It is especially offensive
when the administration does not tell the truth in order to have its way.
At the last Commission meeting when Commissioner Sanchez stated that he
asked the management to pick 4 employees and do surveillance on them, he
stated that two out of the 4 were working else where while on disability. At
that time you also asked Risk Management how many employees have been
investigated since then? They did not have that number available for you. I
would appreciate if you would have the City put on record, how many
employees have been investigated? I think you will find that we don't have
50 % of those on disability who shouldn't be on disability. If there are any
then they should be taken off of disability benefits.
At this time I would like to turn over my presentation to Mr. Larry Jessup.
3 5 -7 3
03- 876
DEPT FIRST NAME
MIDDLE
NAME
LAST NAME
UNION
YEARS
SERVICE
MONTHS
SERVICE
6200 DULCE
M
BORGES
6
28
3
6200 SYLVIA
L
OGUNTOYINBO
1
24
4
6200 DORIS
I
RAMIREZ
1
23
4
6200 MARIO
BARRERA
1
22
2
6200 ANTIONETTE
R
DAVIS
1
21
1
6200 BONNIE
L
WILLEY
6
18
0
6200 TERRY
M
QUEVEDO
1
15
9
6200 DENISE
R
MORALES
4
15
8
6200 ANA
M
CRUZ
1
14
0
6200 MARIA
L
HERNANDEZ
1
9
6
6200 HAROLD
R
STEINBERG
8
4
7
6200 MIRIAM
BALASINO
1
3
11
6200 ANGELLA
A
BREADWOOD
6
3
7
6200 PAULA
C.
CHANDLER
1
3
3
6200 JEFFREY
L
COLLIER
1
2
11
6200 JOANN
T
DOUGLAS
1
2
11
6200 FRANCISCO
GOMEZ JR
1
2
11
6200 PATRICE
E
NOVAL
4
2
9
6200 NILDA
J
PRENDES
1
2
9
6200 COURTLAND
BULLARD
1
2
7
6200 SADIE
S
BROWN
1
2
5
6200 ANTOINE
P
LAURENT
1
1
6
6200 ENERGILIA.
A.
LOPEZ
1
0
9
6200 MARY
A.
HUNTER
8
0
8
6200 DIANE
J
IERICSON
21
0
5
03-- 876
JULY 17, 2003
CITY OF MIAMI
REPORT 180-300
PAYROLL
/ PERSONNEL
SYSTEM
DEPT/DIV
006200
AFSCME
REQUEST 7/17/2003
----------EMPLOYEE
NAME----------
EMPLE GROUP
ANNUAL SALRY
JOB CODE
JOB CDE ABBR
ABBREV
MIRIAM
BALASINO
O1
32,740.66
001060
CLAIMSREPR
RISK
MGMT.
MARIO
BARRERA
O1
55,965.52
001810
CLMS ADJ I
RISK
MGMT.
SADIE
S
BROWN
O1
24,316.86
001010
CLERK I
RISK
MGMT.
COURTLAND
BULLARD
O1
41,852.93
001820
COL/SUB SP
RISK
MGMT.
PAULA
C
CHANDLER
O1
22,038.85
001021
TYP CLK II
RISK
MGMT.
JEFFREY
L
COLLIER
O1
43,918.99
001812
CLMS ADJ 2
RISK
MGMT.
ANA
M
CRUZ
O1
43,918.99
001808
CLMACCTSPC
RISK
MGMT.
ANTIONETTE
R
DAVIS
O1
60,258.02
001812
CLMS ADJ 2
RISK
MGMT.
JOANN
T
DOUGLAS
O1
46,064.51
001812
CLMS ADJ 2
RISK
MGMT.
FRANCISCO
GOMEZ JR
O1
48,316.11
001812
CLMS ADJ 2
RISK
MGMT.
MARIA
L
HERNANDEZ
O1
46,064.51
001812
CLMS ADJ 2
RISK
MGMT.
ANTOINE
P
LAURENT
O1
19,019.31
001011
CLERK II
RISK
MGMT.
ENERGILIA
A
LOPEZ
O1
34,356.61
001810
CLMS ADJ I
RISK
MGMT.
SYLVIA
L
OGUNTOYINBO
O1
55,965.52
001345
FISC ASST
RISK
MGMT.
NILDA
J
PRENDES
O1
32,740.66
001154
GRPINSAIDE
RISK
MGMT.
TERRY
M
QUEVEDO
O1
58,654.96
001812
CLMS ADJ 2
RISK
MGMT.
DORIS
I
RAMIREZ
O1
43,968.29
001022
TY CLK III
RISK
MGMT.
DENISE
R
MORALES
04
50,806.50
001156
GRPINSASST
RISK
MGMT.
PATRICE
E
NOVAL
04
68,077.15
001330
SAFTY COOR
RISK
MGMT.
• DULCE
M
BORGES
06
71,441.34
008083
ADM AST II
RISK
MGMT.
ANGELLA
A
BREADWOOD
06
71,441.34
008051
CLAIMS SUP
RISK
MGMT.
BONNIE
L
WILLEY
06
53,322.67
008083
ADM AST II
RISK
MGMT.
PAGE 203
ez
JULY 17, 2003
CITY OF MIAMI
REPORT 180-300
PAYROLL / PERSONNEL
SYSTEM
DEPT/DIV
006200
AFSCME REQUEST 7/17/2003
E GROUP ANNUAL SALRY
JOB CODE
----------EMPLOYEE
NAMfi----------MPLE
MARY
A HUNTER
08 47,840.00
009254
..HAROLD
R STEINBERG
08 47,840.00
009254
DIANE
J ERICSON
21 115,000.08
008052
TOTAL COUNT:
25 DEPT TOTALS:
JOB CDR ABBR ABBREV
ADJSTR T
ADJSTR T
RISKMGTADM
RISK MGMT.
RISK MGMT.
RISK MGMT.
PAGE 204
MJC/mjc
4/29/02
Original/Revised
I" POSTING
v . r
I,�,t of
S, 0-, t F,!Ued Into the public
on
-Nl-b3
C4 (,-Iafk18l0
CLAIMS ADJUSTOR I
Starting Salary: $33,162 yearly
Closing Date: When a sufficient number of
qualified persons have applied.
Maximum Salary: $42,392 yearly
Method of Qualification: Applicants will be
assessed on the basis of their training and
experience as shown on the application form.
REQUIREMENTS: High School Diploma or G.E.D., plus current State of Florida 520, 524, 620 or
624 license with a minimum of six (6) months experience in one of the
following areas: tort claims or workers' compensation claims. Possession of a
valid Florida Driver License is also required.
DOCUMENTS: Copies of valid Florida Driver License and current State of Florida Class
520, 524, 620 or 624 license must be submitted at time of application.
Driving records will be reviewed prior to eligibility determination. It is
essential that applicants describe their experience in a detailed manner, or
they will be disqualified.
TOXICOLOGY: PROSPECTIVE EMPLOYEES SHALL SUBMIT TO A TOXICOLOGY
SCREEN AT THEIR OWN EXPENSE. THE COST IS $20.50. IF THE
RESULTS ARE NEGATIVE, THE CITY WILL REIMBURSE THE
CANDIDATE FOR THE COST OF THE SCREEN. IF THE RESULTS ARE
POSITIVE, THE CANDIDATE WILL ASSUME THE COST INCLUDING
THAT OF ANY TEST CONFIRMATION.
DUTIES: This is general investigative work involving torts and workers' compensation.
Position incumbent participates in the investigation of claims and counter-
claims filed by and against the City of Miami, interviews witnesses, takes
statements and affidavits, photographs scenes of accidents, and assembles
evidence for court presentations. Takes initial workers' compensation injury
reports and analyzes compensability of claims. Ensures that injured City
employees receive medical care, treatment and disability payments. Handles
workers' compensation litigation claims, when necessary. Works closely with
supervisor and workers' compensation attorneys. Helps to maintain
investigative files of claims for and against the City.
OPEN/NON-COMPETITIVE
APPLY: DEPARTMENT OF HUMAN RESOURCES, EMPLOYMENT OFFICE 4,14 Sly+/ ?nd / voi� .:e .1129. Miam, FI 33130. JOB LINE: (305) 416-2050
WEBSITE: www.ci.miami.fl.us.
NOTE: SUBMIT A NEW APPLICATION EACH TIME YOU APFLY FOR A CITY NUB. PROOF OF EDUCATION (diplorna. degree, certification, if required) MUST
BE SUBMITTED AT TIME OF APPLICATION. COLLEGE TRANSCRIPT ARE REQUIRFD UNi.ESS ACADEMIC MAJOR IS INDICATED ON THE FACE OF
THE CREDENTIAL. FOREIGN DEGREES, CERTIFICATES OR CIPLOIVA,'; F)I OUR; TF;AfwtiCF`dPT EVAH1PTIOI',IS BY COLL.EGEL:, Uf11VEIlSIrIL-3, OR
APPROVED TRANSCRIPT EVALUATION SERVICES WHICH PROVIDE SUCH SERVh:,E` T(%! -',El ERMINF RECIPROCITY TO AMERICAN TRAINING.
PRIOR TO MAKING POSITION OFFERS, THE HIRING DEPARTMENT MAY INTERVIEW ALL ELIGIBLE APPLICANTS OR A REPRESENTATIVE_ NUMBER IN
ORDER TO ENSURE THE APPOINTMENTS ARE BASED ON MERIT AND IN COMPLIANCE WITH THE CITY'S AFFIRMATIVE ACTION PLAN, CIVIL SERVICE
RULES, APPLICABLE LABOR AGREEMENTS, ADMINISTRATIVE POLICIES, AND/OR ANY APPLICABLE COURT RULINGS. PRIOR TO EMPLOYMENT
WITH THE CITY OF MIAMI, SUCCESSFUL COMPLETION OF A DRUG SCREEN, MEDICAL EXAMINATION, AND BACKGROUND INVESTIGATION WILL BE
REQUIRED. APPOINTMENT (INCLUDING PROMOTIONS OR TRANSFERS) TO CERTAIN POSITIONS WILL REQUIRE A DRUG SCREEN, MEDICAL
EXAMINATION AND/OR A BACKGROUND INVESTIGATION.
VETERAN'S PREFERENCE IS AWARDED IN ACCORDANCE WITH FLORIDA STATE STATUTE 295.07. IF VETERAN'S PREFERENCE IS BEING CLAIMED,
IT MUST BE INDICATED ON THE APPLICATION FORM AND PROPER DOCUMENTATION MUST BE SUBMITTED WITH APPLICATION. AN ORIGINAL
DD -214 (IF APPLICABLE) MUST BE SHOWN. CITY EMPLOYEES AND RESIDENTS MAY RECEIVE PREFERENCE DURING THE HIRING PROCESS.
THE CITY OF MIAMI IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE ON THE BASIS OF HANDICAP.
03- XVR
MJC/mjc
11/05/01
Orig.
Vt Posting
lltt1a of .,ffliami
'Into the pub -lir,
Pn3c- dla A. 1812
P •,
RESTRICTED TO CITY OF MIAMI EMPLOYEES
CLAIMS ADJUSTOR II
Starting Salary: $35,061 annually
Closing Date: Friday, November 16, 2001
Maximum Salary: $44,628 annually
Method of Selection: Applicants will be
assessed on the basis of training and
experience as shown on the application
form.
REQUIREMENTS: Graduation from High School or GED, PLUS current State of Florida Class 520,
524, 620 or 624 license with a minimum of two (2) years experience as an
adjustor investigating varied types of insurance claims in the related area of
assignment: tort claims, workers' compensation claims, or claims in a related
field. Additionally, a valid Florida Non -Commercial driver's license is required.
DOCUMENTATION: All applicants must submit proof of education, current 520, 524, 620 or 624
license and a Florida Driver's license with application. Additionally,
applicant must detail required experience on the application form or risk
disqualification.
NOTE: Driver's license record will be checked prior to appointment.
SELECTION: Selection process may include a formal interview and/or performance test,
background investigation, toxicology screen and/or post -offer medical
examination. Appointment to this position may require the submission of official,
sealed college transcripts.
DUTIES: This is specialized investigative work, where the work products are used in the
preparation and presentation of court cases. Position incumbent investigates
claims and counter -claims filed by and against the City of Miami, interviews
witnesses, takes statements and affidavits, photographs scenes of accidents,
and assembles evidence for court presentation. Investigates claims for
damages to private property or personal injuries alleged to be caused by
negligence of City employees or damages caused to City property by others.
Investigates Workers' Compensation claims; maintains Workers' Compensation
claims files; analyzes the compensability of Workers' Compensation claims;
performs periodic reviews of medical reports and work status of claimants.
Performs other related work as required.
RESTRICTED/NON-COMPETITIVE
0_3_- ___8_76
APPLY: DEPARTMENT OF HUMAN RESOURCES, EMPLOYMENT OFFICE, 444 SW 2nd Avenue, #129, Miami, FI 33130. JOB LINE: (305) 416-2050.
WEBSITE: www.ci.miami.fl.us.
NOTE: SUBMIT A NEW APPLICATION EACH TIME YOU APPLY FOR A CITY JOB. PROOF OF EDUCATION (diploma, degree, certification, if required) MUST
BE SUBMITTED AT TIME OF APPLICATION. COLLEGE TRANSCRIPTS ARE REQUIRED UNLESS ACADEMIC MAJOR IS INDICATED ON THE FACE OF
THE CREDENTIAL. FOREIGN DEGREES, CERTIFICATES OR DIPLOMAS REQUIRE TRANSCRIPT EVALUATIONS BY COLLEGES, UNIVERSITIES, OR
APPROVED TRANSCRIPT EVALUATIQN SERVICES WHICH PROVIDE SUCH SERVICES TO DETERMINE RECIPROCITY TO AMERICAN TRAINING.
PRIOR TO MAKING POSITION OFFERS, THE HIRING DEPARTMENT MAY INTERVIEW ALL ELIGIBLE APPLICANTS OR A REPRESENTATIVE NUMBER IN
ORDER TO ENSURE THE APPOINTMENTS ARE BASED ON MERIT AND IN COMPLIANCE WITH THE CITY'S AFFIRMATIVE ACTION PLAN, CIVIL SERVICE
RULES, APPLICABLE LABOR AGREEMENTS, ADMINISTRATIVE POLICIES, AND/OR ANY APPLICABLE COURT RULINGS. PRIOR TO EMPLOYMENT
WITH THE CITY OF MIAMI, SUCCESSFUL COMPLETION OF A DRUG SCREEN, MEDICAL EXAMINATION, AND BACKGROUND INVESTIGATION WILL BE
REQUIRED. APPOINTMENT (INCLUDING PROMOTIONS OR TRANSFERS) TO CERTAIN POSITIONS WILL REQUIRE A DRUG SCREEN, MEDICAL
EXAMINATION AND/OR A BACKGROUND INVESTIGATION.
VETERAN'S PREFERENCE IS AWARDED IN ACCORDANCE WITH FLORIDA STATE STATUTE 295.07. IF VETERAN'S PREFERENCE IS BEING CLAIMED,
IT MUST BE INDICATED ON THE APPLICATION FORM AND PROPER DOCUMENTATION MUST BE SUBMITTED WITH APPLICATION. AN PRIGINAL
DD -214 (IF APPLICABLE) MUST BE SHOWN. CITY EMPLOYEES AND RESIDENTS MAY RECEIVE PREFERENCE DURING THE HIRING PROCESS.
THE CITY OF MIAMI IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE ON THE BASIS OF HANDICAP.
MJC/bgv
9/30/88
ORIG.
G
�itu of Atamt `..
SubT pu
with
orY`ipson 1816
City Clerk
The advertisement for this position is pursuant to the administrative function of maintaining a list of
eligibles. Positions can be filled upon approval by the City Manager.
RESTRICTED TO CITY OF MIAMi EMPLOYEES IN THE LAW DEPARTMENT
CLAIMS ADJUSTOR 111
Starting Salary: $22,797 yearly Maximum Salary: Depends on date of appointment and
bargaining unit.
Closing Date: Oct. 7, 1988
Method of Selection: Applicants will be assessea
on the basis of their training and experience as
shown on the application form.
REQUIREMENTS: Possession of a valid State of Florida class 520 or 620 license and a minimum of five (5)
years experience performing specialized investigations in the areas of Police Tort, Civil
Rights and General Liability Claims.
NOTE ii: A COPY OF STATE OF FLORIDA CLASS 520 OR 620 LICENSE MUST BE SUBMITTED BY CLOSING DATE IN ORDER
TO QUALIFY.
NOTE: /2: PURSUANT TO THE CITY COMMISSION'S RULING ALL APPLICANTS WHO ARE INTERVIEWED AND OFFERED
EMPLOYMENT SHALL AT THEIR OWN EXPENSE PAY FOR THE TOXICOLOGY SCREENING PRIOR TO BEING
PROCESSED ANY FURTHER THROUGH THE MEDICAL EXAMINATION WHICH IS A PREREQUISITE FOR EMPLOYMENT.
THE COST OF SCREENING IS $15.00. IF THE RESULTS OF THE SCREENING COMES OUT NEGATIVELY THE
CITY WILL GLADLY REIMBURSE APPLICANTS FOR THE COST OF THE TEST. IF THE TEST RESULTS REFLECT
THE INGESTION OF ILLEGAL SUBSTANCES, THE APPLICANT MUST ASSUME THE TOTAL COST - INCLUDING THAT
FOR ANY TEST CONFIRMATION.
DUTIES: This is advanced specialized investigative work. Position incumbent investigates complex
Police Tort, Civil Rights and General Liability Claims; interviews city employees, claimants
and witnesses; takes statements and affidavits; photographs scenes of accidents; assembles
evidence for court presentations.
Prepares reports of findings and negotiates settlements with claimants within specified
monetary limits.
Recommends litigation when settlement cannot be negotiated; prepares correspondence to claim-
ants regarding recommendations on admissibility of claim.
Performs related work as required.
RESTRICTED/NON-COMPETITIVE
APPLY: EMPLOYMENT OFFICE, iDEPARTMENT OF PERSONNEL MANAGEMENT, 1147 N.W. 11TH STREET, MIAMI, FL 33136/
JOB LINE 579-3356
NOTE: SUBMIT A NEW APPLICATION EACH TIME YOU APPLY FOR A CITY JOB. f
IF YOU ARE A VETERAN, WHETHER DISABLED OR NON -DISABLED, OF ANY BRANCH OF THE UNITED STATES ARMED FORCES,
OR THE SPOUSE OR WIDOW (ER) OF SUCH VETERAN, YOU MAY (OR MAY NOT) BE ELIGIBLE FOR VETERAN'S PREFERENCE
UNDER FLORIDA STATUTES CHAPTER 295 AND SECTION 1.01(15). IF VETERAN'S PREFERENCE IS BEING CLAIMED, IT MUST BE
INDICATED ON THE APPLICATION FORM AND A DD -214 MUST BE SUBMITTED WITH APPLICATION.
FOREIGN DEGREES REQUIRE TRANSCRIPT EVALUATIONS BY COLLEGES OR UNIVERSITIES WHICH PROVIDE SUCH SERVICES !
TO DETERMINE RECIPROCITY TO AMERICAN DEGREES.
THE CITY OF MIAMI IS AN EOUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE ON THE BASIS OF HANDICAP.
MJC/neg
10/28/97
ORIG.
18t POSTING
t# T �f
, ubliC
with
_35-pson
City abst
RESTRICTED TO CITY OF MIAMI EMPLOYEES
ASSISTANT CLAIMS SUPERVISOR
Starting Salary: $29,488 yearly
Closing Date: Friday, November 14, 1997
REQUIREMENTS:
NOTE:
TOXICOLOGY:
Maximum Salary: Based on date of appointment and
bargaining unit.
Method of Selection: Applicants will be assessed on
the basis of their training and experience as shown on
the application form.
Valid Florida Non -Commercial Driver's license (Class D or E). Possession of a current
State of Florida 520 or 620 license and permanent civil service status as a Claims
Adjustor III with one (1) year of continuous service in said classification beyond the
date of permanent appointment. Supervisory experience is preferred.
Valid Florida Non -Commercial Driver's license (Class D or E). Possession of a current
State of Florida 520 or 620 license and permanent civil service status as a Claims
Adjustor II with four (4) years of continuous service in said classification beyond the
date of permanent appointment. Supervisory experience is preferred.
COPIES OF CURRENT STATE OF FLORIDA 520 OR 620 LICENSE AND FLORIDA NOW
COMMERCIAL DRIVER'S LICENSE CLASS D OR E MUST BE SUBMITTED NO LATER
THAN THE CLOSING DATE IN ORDER TO QUALIFY.
PROMOTIONAL PROCESS MAY REQUIRE A PHYSICAL EXAMINATION WHICH WILL.
INCLUDE A DRUG SCREEN.
DUTIES: This is advanced technical and supervisory work assisting with the management of
liability, worker's compensation and property loss claims. Position incumbent assists in
supervising activities involved with initial contact, investigation and adjudication of all
claims.
Assists in developing and implementing claims handling procedures. Assists in
assigning and supervising the work of claims adjustors and support staff.'`
Prepares comprehensive reports to include statistical data. Establishes reserves on all
pending claims. Performs related work as required.
PROMOTIONALINON-COMPETITIVE
APPLY: EMPLOYMENT OFFICE, DEPARTMENT OF HUMAN RESOURCES, 444 S.W. 2nd Avenue,lst Floor, MIAMI, FL 33130
JOB LINE 416-2050 0
NOTE: SUBMIT ANEW APPLICATION EACH TIME YOU APPLY FOR A CITY ,JOB.
03- 876
IF YOU ARE A VETERAN, WHETHER DISABLED OR NON -DISABLED. OF ANY BRANCH OF THE UNITED STATES ARMED FORCES, OR
THE SPOUSE OR WIDOW (ER) OF SUCH VETERAN, YOU MAY (OR MAY NOT) BE ELIGIBLE FOR VETERAN'S PREFERENCE UNDER
FLORIDA STATUTES CHAPTER 295 AND SECTION 1.01 (15). IF VETERAN'S PREFERENCE IS BEING CLAIMED, IT MUST BE INDICATED
ON THE APPLICATION FORM AND A DD -214 MUST BE SUBMITTED WITH APPLICATION. AN ORIGINAL DD -214 MUST BE SHOWN.
FOREIGN DEGREES REQUIRE TRANSCRIPT EVALUATIONS BY COLLEGES, UNIVERSITIES, OR APPROVED TRANSCRIPT EVALUATION
SERVICES WHICH PROVIDE SUCH SERVICES TO DETERMINE RECIPROCITY TO AMERICAN DEGREES. q
THE CITY OF MIAMI IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE ON THE BASIS OF HANDICAP)
RO/ro
6/14/99
.*/Rev.
3' Posting
situ �f
Liblic
fo
35 7.,,npson
tidy Clerk
1824
CLAIMS SUPERVISOR
Salary Range: $33,818 - $49,974 yearly
(In -hire rate may be negotiable depending on training and experience)
Closing Date: When a sufficient number of qualified
persons have applied.
Maximum Salary: Based on date of appointment
and bargaining unit.
Method of Selection: Applicants will be assessed
on the basis of their training and experience as shown on
the application form.
REQUIREMENTS: Bachelor's degree in Risk Management and Insurance, Business Administration, Health
Administration or a closely related field plus three (3) years of experience investigating,
reviewing or settling worker's compensation claims with an insurance carrier, adjusting firm
or self-insurance program OR an equivalent combination of training and experience beyond
an Associate's degree. Possession of current State of Florida 220, 520, 524, 620 or 624
license is required. At least one year of the aforementioned experience must have
been in a supervisory capacity.
DOCUMENTATION: Copy of current State of Florida 220, 520, 524, 620 or 624 license must be submitted with
application in order to qualify. In addition, proof of education must be submitted with
application in order to qualify. If degree does not reflect academic major on its face, a
transcript must be submitted.
SELECTION: Prior to making position offers, the hiring department may interview all eligible applicants or a representative
number in order to ensure the appointments are based on merit and in compliance with the City's Affirmative
Action Plan, Civil Service Rules, applicable labor agreements, Administrative Policies, and/or any applicable
court rulings. Prior to employment with the City of Miami, successful completion of a medical examination,
which includes a drug screen, and a background investigation will be required. Appointment (including
promotions or transfers) to certain positions or departments may require a drug screen, medical examination
and/or a background investigation.
TOXICOLOGY: Prospective employees shall submit to a toxicology screen at their own expense. The cost is
$13.50. If the results are negative, the city will reimburse the prospective employee for the
cost of the screen. If the results are positive, the prospective employee will assume the cost
including that of any test confirmation.
PREFERENCE: City employees may be given preference in the selection process.
DUTIES: This is advanced technical and supervisory work in the management of worker's
compensation claims.
Supervises activities involved with initial contact, investigation and adjudication of all
worker's compensation claims; develops and establishes worker's compensation claims
handling procedures; develops and implements quality control measures; assigns and
supervises the work of worker's compensation claims investigative staff; establishes
reserves on all pending Worker's compensation claims; coordinates all subrogation activities.
Performs related duties as required.
OPEN/NON-COMPETITIVE
APPLY: EMPLOYMENT OFFICE, DEPARTMENT OF HUMAN RESOURCES, 444 S.W. 2nd Avenue, 1st Floor, MIAMI, FL 33130
JOB LINE 416-2050 0
NOTE: SUBMIT A NEW APPLICATION EACH TIME YOU APPLY FOR A CITY JOB.
03— 876
IF YOU ARE A VETERAN, WHETHER DISABLED OR NON -DISABLED, OF ANY BRANCH OF THE UNITED STATES ARMED FORCES, OR
THE SPOUSE OR WIDOW (ER) OF SUCH VETERAN, YOU MAY (OR MAY NOT) BE ELIGIBLE FOR VETERAN'S PREFERENCE UNDER
FLORIDA STATUTES CHAPTER 295 AND SECTION 1.01 (15). IF VETERAN'S PREFERENCE IS BEING CLAIMED, IT MUST BE INDICATED
ON THE APPLICATION FORM AND A DD -214 MUST BE SUBMITTED WITH APPLICATION. AN ORIGINAL DD -214 MUST BE SHOWN.
FOREIGN DEGREES REQUIRE TRANSCRIPT EVALUATIONS BY COLLEGES, UNIVERSITIES, OR APPROVED TRANSCRIPT EVALUATION
SERVICES WHICH PROVIDE SUCH SERVICES TO DETERMINE RECIPROCITY TO AMERICAN DEGREES. 1
THE CITY OF MIAMI IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE ON THE BASIS OF HANDICAP',
J. Provider understands and agrees, that at the request of the City, it may be required
to continue to handle claim files that remain open as of the termination date of the
Agreement, until their conclusion. In such event, the amount of compensation
shall be renegotiated by the parties, in good faith, but shall not exceed prevailing
rates charged by the Provider, to its preferred clients, as of the date of such
termination.
K. The Control Loss Criteria outlined under the Control Loss Program section of the
Workers' Compensation and Liability Product Standards in the Proposal shall
include Reporting Events, as defined in Section I.3. A. hereof.
L. Provider will notify, by e-mail, the City's managed care vendor of any changes in
claims status (i.e., settlements, file closings and reopenings, controverted claims,
presumption claims, litigated claims or attorney representation of claimant).
8. COMMUNICATION:
A. Provider shall maintain open, general lines of communication with the
Department on an ongoing basis and shall respond to requests of the Department
or the City Attorney, on a timely basis and in a cooperative manner.
B. At no additional cost to the City, Provider shall be available to attend meetings
required by the Department in order to: (i) educate its own and the Department' s
personnel on relevant laws/filings and claim handling procedures that affect any
claim, (ii) discuss specific cases of concern, (iii) resolve any problems involving
the claims administration program, and (iv) address such other matters as may be
reasonably required by the Department relative to the performance of services
under this Agreement.
C. Provider shall immediately provide the Department with information on any
Workers' Compensation legislative changes.
D. Provider shall return phone calls from the City or injured employee the same
working day. Other requests from the City will be responded to in a timely
manner. Failure to comply with the provisions of this Section shall release the
City from payment of the per -claimant fee described in Attachment B with respect
to such claim, as more specifically described in the Performance Agreement.
9. STAFFING. QUALITY CONTROL AND SUPERVISION:
The Provider shall render high-quality claims management and adjusting services throughout the
Term. The Designated Personnel shall have, at a minimum, the following levels of experience
and licensing:
Supervisor or supervising adjuster 4 years
1 R pthe
p*pR�1bI$1C
35 A4
City Clerk
Adjusters 3 years
Medical -only processor(s) 1 year
Provider shall assign personnel with the ability to provide full service to English, Spanish, and
Haitian -Creole speaking individuals when needed.
A list of the Designated Personnel is attached to the Agreement as Attachment "C", and shall be
updated, as needed.
The City reserves the right to request a change or reassignment of any of the Designated
Personnel, in its reasonable discretion.
Claims personnel must be employees of the Provider. The use of independent adjusters,
subcontractors, or temporary adjusters will not be acceptable without prior approval of the
Administrator. Adjuster trainees are not acceptable for handling of the City's claims.
The Provider shall ensure that all Designated Personnel are familiar with the City's labor
contracts and any changes thereto, and are kept abreast of all applicable laws, including,
specifically, the Workers' Compensation Statutes, DWC rules, and applicable laws.
10. BANE ING/LOSS FUND MANAGEMENT:
The Proposal describes three (3) Banking Options. The City selects the Automated Payment and
Control System (APCS), with the Self Insured Money Management System (SWIMS) option, as
more particularly described in the Proposal. The City and the Provider agree to establish the
agreed upon imprest balance and the funding frequency within thirty (30) days after the date of
the Agreement. At a minimum, Provider will report the following activity to the City on the
imprest account:
A. Monthly activity report reflecting checks written;
B. Statement of actual clearing activity through the imprest account;
C. Monthly reconciliation report.
11. "BAD FAITH" LAWSUITS:
The City shall be notified of all "bad faith" lawsuits filed against the Provider, which include
breach of good faith and fair dealing. Any "bad faith" lawsuits filed against the City shall be
handled by the City Attorney. If the allegation is that the Provider committed or acted in "bad
faith," the defense of the lawsuit and attorneys' fees and expenses shall be the Provider' s
responsibility, but the City Attorney shall have the right to monitor the progress of the lawsuit to
its conclusion. Once a "bad faith" lawsuit has been filed, a separate file pertaining only to the
issues on "bad faith" shall be established.
12. IRS FILING REQUIREMENTS OF PROVIDER:
Provider will furnish required tax information for the Internal Revenue Service including 1099s
`� � x c) the public
F J \
ANDARD CLAIMS MANAGEMENT SER. .,ES
Claim Charges:
The claim charge is applicable per claimant per line of coverage.
Example: A client during working hours is involved in an automobile accident with another vehicle with two occupants.
Both occupants were injured, both cars were damaged and our client was injured.
The claims handling charges (example only) will be:
Claimant #1 - Auto Liability Bodily Injury
$695
Claimant #2 - Auto Liability Bodily Injury
695
Claimant Owner - Auto Liability Property Damage
335
Client — Workers' Compensation
850
Client — Auto Physical Damage
335
$2,910
The total GB fee for this one occurrence is $2,910 to adjust the accident. Specific claim charges by claimant by
line of coverage is normal practice in our industry.
Allocated Expenses: Shall be your responsibility and shall include, but not be limited to:
' Legal Fees
• Professional Photographs*
Extraordinary costs for witness statements
Medical records
' Experts' rehabilitation costs
• Fees for service of process
Architects, contractors
• Engineer
• Police, fire, coroner, weather, or other such
• Property damage appraisals
Sub rosa investigation
• Official documents and transcripts
• Pre- and post -judgment interest paid
Subrogation at 15% of gross recovery
• Managed Care, when applicable
• Medical Examinations
• Extraordinary Travel made at client's request
' Court reports
Accident reconstruction
Chemist
• Collection cost payable to third parties on
subrogation
• Any other similar cost, fee or expense
negotiation, settlement or defense of a c,aim
or loss which must have the explicit prior
approval of the client
• Outside Investigation
*Photos taken by adjustors are not to be charged as allocated expenses
o the public
I �s` �s.n
This material is the proprietary, confidential property of Gallagher Bassett Services, Inc. It has been provided to you for the sole purpose of considering a quote for
claims administration services. It is not to be dUpllcated or shared in any form with anyone other than the individuals of such prospective client that have a business
need to know the information. It must be destroyed or returned to Gallagher Bassett Services, Inc. after its intended use.
New Claims
Workers Compensation
Liability
Total
Additonal Fees
Total New Claims Pro osal
Run In Claims
Workers Compensation
Liability
Total
Additonal Fees
Total Run In Claims Pro osal
Total Proposal
Mie ,i General Employees, AFSCME Local ..,07
Department 62 - Risk Management
Gallagher Basset Proposals
Dedicated Unit vs. Life of Partnership
Claims and Cost
Dedicated Unit
Staff
Est. Claims
Cost
12
7
900
710
1,370,000
920,800
19
1,610
2,290,800
21,000
12,311,800]
Staff
Est. Claims
Cost
?
?
1212
805
403,260
317,975
?
2,017
721,235
27,000
748,235
3,060,035
Life of Partnership
Staff
Est. Claims
Cost
?
?
900
710
245,880
435,050
?
1,610
680,930
40,000
720,930
Staff
Est. Claims
Cost
?
?
1212
805
403,260
317,975
?
2,017
721,235
Additional Charges for Life of Partnership proposal not included above:
1. Data Management (RISX-FACX) - amount is not specified
2. riixfacs,com users -
$2,195 per user for more than 10 full users and $1,095 per user for more than 5 inquiry users
3. Electornic Incident - $45 (per incident ?)
4. Administration and Banking fees.
Note: The FY 04 Budget workpapers for Department 62 - Risk Management shows the estimated cc
Life of Partnership contract as $1,545,000 or $78,835 more than the amount shown above.
n?Wed into the public
•.:ton with
r �A
: rk
Prepared by Lawrence E. Jessup, Jr., Economic Consultant
27,000
748,235
1,469,1-675
Miami General Employees, AFSCME Local 1907
Department 62 - Risk Management
Cost Comparison Estimates
Gallagher Basset Claim Handling Charges Example
Claimant #1
Claimant #2
Claimant Owner
Client
Client
. Coverage
Amount
Auto Liability Bodily Injury
$695
Auto Liability Bodily Injury
$695
Auto Liability Property Damage
$335
Workers' Compensation
$850
Auto Physical Damage
$335
Total
$2,910
Average Cost per Hour
$291
City's Maximum Hourly Rate for Claim Handling
Claims Adjustor 21 Hourly Rate 1 $35.41
Total Cost at Maximum Hourly Rate $354.10
Hours require to expend $2,910 82.18
City's Minimum Hourly Rate for Claim Handling
Claims Adjustor 11 Hourly Rate 1 $21.89
Total Cost at Minimum Hourly Rate $218.90
Hours require to expend $2,910 132.94
Estimated
Handling
Hours
2
2
2
3
1
10
After consultation with personnel in the Risk Management Department, the
maximum number of hours required to handle each category of the claim was
estimated to be 10 hours. Based on the total Gallagher Bassett charge of
$2,910, the cost per hour is $291.
This is compared to the Maximum and Minimum hourly rate of existing City
Claims Adjustors.
Based on the Maximum hourly rate the total cost would be $354.10,
and this adjustor would have to spend 82.18 hours in order to expend $2,910.
Based on the Maximum hourly rate the total cost would be $218.90,
and this adjustor would have to spend 132.94 hours in order to expend $2,910.
Obviously, it is more cost effective for the City's Claims Adjustor's to handle
the claim.
(1) Includes base pay plus City's contribution for Family Health Insurance,
S.S., Workers' Comp & Life Insurance)
Y is PUN&
Prepared by Lawrence E. Jessup, Jr., Economic Consultantnr ,,>....
Miami General Employees, AFSCME Local
Department 62 - Risk Management
Cost Comparison Estimates - Exhibit 1
Property and Casualty Cost Center
Current & Reorganized Personnel based on FY 04 Bu(
Claims Adjustor III
Current Personnel
0
P/E 7/17/03
6
Number of
Salary, Allowances
Title
Personnel
& S.S.
Risk Mgmt Admin
1
135,398
Admin Asst II
2
149,362
Claims Sup
1
82,097
Claims Su v Asst
0
0
Management Positions
41
366,857
Claims Adjustor III
0
0
Claims Adjustor II
6
367,312
Claims Adjustor 1
2
103,524
Temporary Adjustor
2
95,680
Collect/Sub Spec.
1
51,466
Claims Accnt Spec.
1
51,260
Claims Rep
1
37,366
Claims Handling Positions
131
706,608
Safety Coord
1
73,868
Account Clerk
0
0
Typist Clerk III
1
48,928
Clerk II
1
21,962
Clerk I
11
28,048
Support Positions
41
172,806
Total 1 211 1,246,271
Prepared by Lawrence E. Jessup, Jr., Economic Consultant
1907
Salary Data
Reorganized Personnel
Eliminate 9 Positions
Number of
Salary, Allowances
Personnel
& S.S.
1
135,398
2
149,362
1
82,097
01
0
4
366,857
0
0
3
198,986
1
65,291
0
0
0
0
1
51,260
01
0
51_
315,537
1
73,868
0
0
1
48,928
0
0
1
28,048
31
150,844
121 833,238
Miami _. aneral Employees, AFSCME LOL-, 1907
Department 62 - Risk Management
Cost Comparison Estimates - Exhibit 2
Property and Casualty Cost Center
Summary of Additional City Cost
GB Life of Partnership & Run In Claims Cost
City Cost (Exhibit 1)
Eliminate current Claims M nt Sys
Combined GB & City Cost
Current City Cost
Increased City Cost
Maintain
All Personnel
1,469,165
1,246,271
-130,000
2,585,436
Eliminate
9 Positions
1,469,165
833,238
-130,000
2,172,403
1,246,271 1,246,271
1,339,1 926,132
Note: The FY 04 Budget workpapers for Department 62 - Risk Management shows
the estimated cost of the Life of Partnership contract as $1,545,000 or $78,835 more
than the amount shown above.
public
Prepared by Lawrence E. Jessup, Jr., Economic Consultant