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City of Miami Legislation Resolution: R-10-0556 City Hall 3500 Pan American Drive Miami, FL 33133 www.miamigov.com File Number: 10-01234 Final Action Date: 12/16/2010 A RESOLUTION OF THE MIAMI CITY COMMISSION ACCEPTING THE RECOMMENDATION OF THE CITY MANAGER APPROVING THE FINDINGS OF THE EVALUATION COMMITTEE, PURSUANT TO REQUEST FOR PROPOSALS ("RFP") NO. 207193, FOR CLAIMS ADMINISTRATION AND MANAGED CARE SERVICES; AUTHORIZING THE CITY MANAGER, TO NEGOTIATE AND EXECUTE A PROFESSIONAL SERVICES AGREEMENT ("PSA"), IN SUBSTANTIALLY THE ATTACHED FORM, WITH GALLAGHER BASSETT SERVICES, INC., FOR THE PROVISION OF CLAIMS ADMINISTRATION SERVICES AND MANAGED CARE SERVICES PART I: WORKERS' COMPENSATION CLAIMS ADMINISTRATION, PART II: GENERAL, AUTOMOBILE, AND PROFESSIONAL LIABILITY CLAIMS ADMINISTRATION, AND PART III: MANAGED CARE SERVICES, FOR THE DEPARTMENT OF RISK MANAGEMENT, SUBJECT TO SUCCESSFUL NEGOTIATIONS BETWEEN THE PARTIES, FORA PERIOD OF ONE (1) YEAR, WITH OPTIONS TO RENEW FOR FIVE (5) ADDITIONAL ONE-YEAR PERIODS; WITH THE NEGOTIATED PSA BEING BROUGHT BEFORE THE CITY COMMISSION FOR ITS REVIEW AND APPROVAL PRIOR TO EXECUTION BY THE CITY MANAGER; ALLOCATING FUNDS FROM THE VARIOUS SOURCES OF FUNDS OF THE USER DEPARTMENT, SUBJECT TO THE AVAILABILITY OF FUNDS AND BUDGETARY APPROVAL. WHEREAS, on April 13, 2010, Request for Proposals ("RFP") No. 207193 for Claims Administration Services and Managed Care Services was issued and eight (8) proposals were received, two (2) were deemed non -responsive for Part I, II, and III and two (2) were deemed non -responsive for Part HI only; and WHEREAS, Section 3.1. of the RFP, indicates that the City of Miami ("City") reserves the right to award Part I, and/or Part II, and/or Part III services to a Successful Proposer; and WHEREAS, the Evaluation Committee, appointed by the City Manager, recommended that the City enter into negotiations with Gallagher Bassett Services, Inc. for Part I, Part II, and Part III, and should contract negotiations fail with Gallagher Bassett Services, Inc. for all three parts, the City should then enter into negotiations with Gallagher Bassett Services, Inc. for Parts I and II and with Amerisys for Part III, and should negotiations fail with Gallagher Bassett Services, Inc. and Amerisys, the City should then enter into negotiations with PGCS for Part I, with York Risk Services Group, Inc., for Part II, and with Amerisys for Part III Services; and WHEREAS, the City Manager concurred with the findings of the Evaluation Committee; NOW, THEREFORE, BE IT 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 City of Miami Page 1 of 2 File Id: 10-01234 (Version: 4) Printed On: 8/18/2014 File Number:' 10-01234 Enactment Number: R-10-0556 reference and incorporated as if fully set forth in this Section. Section 2. The recommendation of the of the City Manager approving the findings of the Evaluation Committee pursuant to RFP No. 207193, to accept the proposal of Gallagher Bassett Services, Inc. for the provision of Claims Administration Services and Managed Care Services (Part I: Workers Compensation Claims Administration, Part II: General, Automobile and Professional Liability Claims Administration, and Part III: Managed Care Services), is accepted, subject to successful negotiations between the parties. Section 3. The City Manager is authorized {1} to negotiate and execute a Professional Services Agreement ("PSA"), in substantially the attached form, with Gallagher Bassett Services, Inc. for Part I, Part II, and Part III, Claims Administration and Managed Care Services fora period of one (1) year, with options to renew for five (5) additional one-year periods, with funds allocated from the various sources of funds of the user departments. Section 4. This Resolution shall become effective immediately upon its adoption and signature of the Mayor. {2} Footnotes: {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 City Charter and Code provisions. {2} 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 . City of Miatni Page 2 of 2 File Id: 10-01234 (Version: 4) Printed On: 8/18/2014 PROFESSIONAL SERVICES AGREEMENT By and Between The City of Miami, Florida and Gallagher Bassett Services, Inc. This Professional Services Agreement ("Agreement") is entered into this 15th day of February, 2011 by and between the City of Miami, a municipal corporation of the State of Florida, whose address is 444 S.W. 2nd Avenue, 10tl' Floor, Miami, Florida 33130 ("City"), and Gallagher Bassett Services, Inc., a Delaware Corporation qualified to do business in Florida whose principal address is Two Pierce Place, Itasca, Illinois 60143 ("Provider"). RECITALS: WHEREAS, the City issued Request for Proposals No. 207193 on April 13, 2010, (the "RFP", attached hereto, and as modified, incorporated hereby, and made a part hereof as Exhibit A) for the provision of Claims Administration Services and Managed Care Services, Part I: Workers Compensation Clain -is Administration, Part II: General, Automobile and Professional Liability Claims Administration, and Part III: Managed Care Services, ("Services" as more fully set forth in the scope of work "SOW" attached hereto as Exhibit B) for the Risk Management Department and Provider's proposal ("Proposal", attached hereto, incorporated hereby, and made a part hereof as Exhibit C), in response thereto, has been selected as the most qualified proposal for the provision of the Services. WHEREAS, the Evaluation Committee appointed by the City Manager determined that the Proposal submitted by the Provider was responsive to the RFP requirements and recom>.nencled that the City.Manager negotiate with the Provider; and WHEREAS, the City wishes to engage the Services of Provider, and Provider wishes to perform the Services for the City; and Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 1 WHEREAS, the City and the Provider desire to enter into 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 AND INCORPORATIONS; DEFINITIONS: A. The recitals are true and correct and are hereby incorporated into and made a part of this Agreement. The City's RFP is hereby incorporated into and made a part of this Agreement and attached hereto as Exhibit "A". The Services are hereby incorporated into and made a part of this Agreement as attached Exhibit `B". The Provider's Response dated, May 17, 2010, is hereby incorporated into and made a part of this Agreement as attached Exhibit "C". The Provider's Insurance Certificate is hereby incorporated into and made a part of this Agreement as Exhibit "D". The order of precedence whenever there is conflicting or inconsistent language between documents is as follows: (1) Professional Services Agreement; (2) Exhibit B - Scope of Work; (3) Addenda/Addendum to the Request for Proposals; (4) Exhibit A - Request for Proposals; and (5) Gallagher Bassett Services, Inc., response to the Request for Proposals. 2. TERM: The initial term of this Agreement shall commence on the Effective Date and shall continue in effect for an initial term of one (1) year. 2a. OPTION TO EXTEND: The City shall have_ five (5). opt on(s) _ to extend the term, hereof for a period of one (1) year each, subject to availability and appropriation of finds, and subject to the approval of City Commission. The City shall exercise its right to extend the term Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 2 hereof by giving Provider at least thirty (30) days written notice prior to the expiration of the previous term. 3. SCOPE OF SERVICES: A. Provider agrees to provide the Services as specifically described, and under the special teams and conditions set forth in Exhibit "A" hereto, and any Addenda/Addendum to the Request for Proposal, and any other memorandum of understanding mutually acknowledged and agreed upon by the City and Gallagher Bassett Services, Inc. which by this reference is incorporated into and made a part of this Agreement. B. Provider represents to the City that: (i) it possesses all qualifications, licenses and expertise required for the performance of the Services, including but not limited to full qualification to do business in Florida; (ii) it is not delinquent in the payment of any sums due the City, including payment of permits, 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 and trained to perform the tasks assigned to each; (iv) the Services will be performed in the manner described in Exhibit "A"; and (v) each person executing this Agreement on behalf of Provider has been duly authorized to so execute the same and fully bind Provider as a party to this Agreement. C. Provider shall at all times provide fully qualified, competent and physically capable employees to perform the Services under this Agreement. City may require Provider to remove any employee the City deems careless, .incompetent insubordinate, or _otherwise objectionable and whose continued services under this Agreement is not in the best interest of the City. Each of the Provider's employees shall have and wear proper identification. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 3 D. When claims enter into litigation, the Provider shall act at the direction of the City Attorney or designee, and the Provider acknowledges that the City Attorney shall designate the attorney(s) that provide the defense for claims against the City. E. Prior to claims entering into litigation: (a) the Provider has the authority to settle claims on behalf of the City up to $3,000 per claim for property damage and $3,000 for bodily injury; and (b) the Provider will present in writing all settlements above $3,000, whether relating to property damage, personal injury, or any other liability of the City, to City Attorney for approval, with a copy to Risk Management. In matters involving City employees as claimants, the employee shall not be contacted regarding settlement until approval of proposed settlement is obtained from the City Attorney. In other matters, the employee shall not be contacted regarding settlement. F. Upon entry of a claim into litigation, Provider shall seek the direction and approval of the City Attorney to hire experts. Experts include, but are not limited to, accident reconstruction engineers and experts, medical and rehabilitation experts, and private investigative and surveillance experts. G. Provider shall refer any recommendations pertaining to the handling of a claim in litigation to the City Attorney. H. Provider shall assist the City Attorney or its designee with any additional investigations as determined necessary by the City Attorney. Provider acknowledges that the City Attorney shall be responsible for designating and assigning an attorney for the legal defense of all litigated claims. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 4 I. Upon a claim entering litigation, Provider will continue to monitor the file in litigation, but the City Attorney shall direct all activities of defense counsel. J. Provider shall provide a monthly report of all litigated claims in a format specified and approved by the City Attorney or its designee. K. Provider shall provide a quarterly report in a form suitable to the City on all settlements. L. Provider shall perform monthly claims review on Workers' Compensation related claims with Risk Management. The monthly claims review shall include the Administrator's/Provider's assigned adjuster, Risk Management and the City Attorney or its designee. 4. COMPENSATION: A. The amount of compensation payable by the City to the Provider shall be based on the rates and schedules described in Exhibit "E" hereto, which by this reference is incorporated into and made a part of this Agreement. B. Payment shall be made in arrears based upon work performed to the satisfaction of the City within forty-five (45) days after receipt of Provider's invoice for Services performed, which shall be accompanied by sufficient supporting documentation and contain sufficient detail, to allow a proper audit of expenditures, should the City require one to be performed. Invoices shall be sufficiently detailed so as to comply with the "Florida Prompt Payment Act", §218.70. 218.79, Florida Statutes, and other applicable laws. No advance payments shall be made at any time. C. Provider agrees and understands that (i) any and all subcontractors providing Services related to this Agreement shall be paid through Provider and not paid directly by_the City, and (ii) any and all liabilities regarding payment to or use of subcontractors for any of the Services related to this Agreement shall be borne solely by Provider. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 5 D. Provider acknowledges and agrees that provided there is a reduction of staffing requirements due to decreased claims adjustment activities on a semi-annual basis and upon mutual agreement that Provider will reduce its pricing for services by an amount corresponding to the reduction of expenses associated with any related staffing reduction. 5. DESIGNATED PERSONNEL: A. 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 designated personnel exclusively to the City for the provision 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"). 6. OWNERSHIP OF DOCUMENTS: Provider understands and agrees that any information, document, report or any other material whatsoever which is given by the City to Provider, its employees, or any subcontractor, 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 or material for any other purpose whatsoever without the written consent of the City Manager, which may be withheld or conditioned by the City Manager in his sole discretion. Provider is permitted to make and to maintain duplicate copies of the files, records, documents, etc. if Provider determines copies of such records are necessary subsequent to the termination of this Agreement; however, in no way shall_ the confidentiality as permitted ,by applicable law be breached. The City shall maintain and retain ownership of any and all documents which result upon the completion of the work and Services under this Agreement. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 6 7. AUDIT AND INSPECTION RIGHTS AND RECORDS RETENTION: A. Provider agrees to provide access to the City or to any of its duly authorized representatives, to any books, documents, papers, and records of Provider which are directly pertinent to this Agreement, for the purpose of audit, examination, excerpts, and transcripts. The City may, at reasonable times, and for a period of up to three (3) years following the date of final payment by the City to Provider under this Agreement, audit and inspect, or cause to be audited and inspected, those books, documents, papers, and records of Provider which are related to Provider's performance under this Agreement. Provider agrees to maintain any and all such books, documents, papers, and records at its principal place of business for a period of three (3) years after final payment is made under this Agreement and all other pending matters are closed. Provider's failure to adhere to, or refuse to comply with, this condition shall result in the immediate cancellation of this Agreement by the City. B. The City may, at reasonable times during the term hereof, inspect the 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 RFP, 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 and 18-101 of the Code of the City of Miami, Florida as same may be amended or supplemented, from time to time. _8. 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, Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 7 commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with, the award of this Agreement. 9. PUBLIC RECORDS: A. Provider understands that the public shall have access, at all reasonable times, to all documents and information pertaining to City Agreements, 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 laws. 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. B. Should Provider determine to dispute any public access provision required by Florida Statutes, then Provider shall do so at its own expense and at no cost to the City. 10. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: Provider understands that agreements with 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 such applicable federal, state and local laws, rules, regulations, codes and ordinances, as they may be amended from time to time. Provider further agrees to include in all of Provider's agreements with subcontractors for any Services related to this Agreement this provision requiring subcontractors to comply with and observe all applicable federal, state, and local laws rules, regulations, codes and ordinances, as they may be amended from time to time. 11. INDEMNIFICATION: Provider shall indemnify, defend and hold harmless the. City and its officials, officers, and employees (collectively referred to as "Indemnitees") and each of them from and against all loss, costs, penalties, fmes, damages, claims, expenses Professional Services Agreement for Claims Administration Services and Managed Care Services (RP? 207193) 8 (including attorney's fees) or liabilities (collectively referred to as "Liabilities") by reason of any injury to or death of any person or damage to or destruction or loss of any property arising out of, resulting from, or in connection with (i) the negligent performance or non-performance of the Services contemplated by this Agreement (whether active or passive) of Provider or its employees or subcontractors (collectively referred to as "Provider") regardless of whether it is, or alleged to be, caused in whole or in part (whether joint, concurrent or contributing), by any act, omission, default or negligence (whether active or passive) of the Indemnitiees, or any of them (ii) the failure of the Provider to comply with any of the paragraphs herein, or (iii) the failure of the Provider to observe, comply with or conform to statutes, ordinances, or other regulations or requirements of any governmental authority, local, federal or state, in connection with the performance of this Agreement. Provider further expressly agrees to indemnify, defend and hold harmless the Indemnitees, 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. Provider further agrees to indemnify, defend and hold harmless the Indemnitees from and against any and all claims, and/or suits for labor and materials furnished to Provider or utilized in the performance of this Agreement or otherwise. In the event that any third party asserts claims .against the Provider and/or the Indemnitees for which Provider is defending the Indemnitees hereunder, Provider shall have the Professional Services Agreement for Claims Administration Services and Managed Care Services (RRPP 207193) 9 right to select its legal counsel for such defense, subject to the approval of the City Attorney, which approval shall not be unreasonably withheld. Provider understands and agrees that any and all liabilities regarding the use of any subcontractor for Services related to this Agreement shall be borne solely by Provider throughout the duration of this Agreement and that this provision shall survive the termination of this Agreement. 12. DEFAULT: If Provider fails to comply materially with any teuu or condition of this Agreement, or fails to pet -foul in any material way any of its obligations hereunder, and fails to cure such failure after reasonable notice from the City, then Provider shall be in default. 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. 13. RESOLUTION OF AGREEMENT 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 inconnection therewith. In the event that the amount of compensation hereunder.. exceeds . Twenty -Five . Thousand Dollars and No/Cents ($25,000), 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 Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 10 City Manager's written decision, approved by the City Commission if the amount of compensation hereunder exceeds Twenty -Five Thousand Dollars and No/Cents ($25,000), 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 or a period of 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. 14. TERMINATION;OBLIGATIONS UPON TERMINATION: A. The City, acting by and through its City Manager, 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) calendar days prior to the effective date of such termination. In such event, the City shall pay to Provider compensation for Services rendered and approved expenses incurred prior to the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. B. The City Manager shall have the right to terminate this Agreement, without notice or liability to Provider, upon the occurrence of an event of a material default hereunder. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses. incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. Professional Services Agreement for Claims Administration Services and Managed Care Services (PPP 207193) 11 C. This Agreement may be terminated, in whole or in part, at any time by mutual written consent of the parties hereto. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. D. This Agreement may be terminated, in whole or in part, by either party if there has been a material default or breach on the part of the other party in any of its representations, warranties, covenants, or obligations contained in this Agreement and such default or breach is not cured within ninety (90) days following written notice from the non -breaching party. In such event, the City shall not be obligated to pay any amounts to Provider for Services rendered by Provider after the date of termination, but the parties shall remain responsible for any payments that have become due and owing as of the effective date of termination. In no event shall the City be liable to Provider for any additional compensation and expenses incurred, other than that provided herein, and in no event shall the City be liable for any consequential or incidental damages. 15. INSURANCE: A. Provider shall, at all times during the term hereof, maintain such insurance coverage(s) as may be required by the City. The insurance coverage(s) required as of the Effective Date of this_ Agreement. are. attached hereto as Exhibit "D" and incorporated herein by this reference. The City RFP number and title of the RFP must appear on each certificate of insurance. The Provider shall add the City of Miami as an additional named insured to its Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 12 commercial general liability policies. Provider shall correct any insurance certificates as requested by the City's Risk Management Administrator. All such insurance, including renewals, shall be subject to the approval of the City for adequacy of protection and evidence of such coverage(s) and shall be furnished to the City Risk Management Administrator on Certificates of Insurance indicating such insurance to be in force and effect and providing that it will not be canceled, modified, or changed during the performance of the Services under this Agreement without endeavoring to provide thirty (30) calendar days prior written notice to the City Risk Management Administrator. Completed Certificates of Insurance shall be filed with the City prior to the performance of Services. B. If, in the reasonable judgment of the City, prevailing conditions in the insurance marketplace warrant the provision by Provider of additional One Million Dollars ($1,000,000) of professional liability insurance coverage, the City reserves the right to require the provision by Provider of up to such additional amount of professional liability coverage, 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 additional coverage within thirty (30) days following the City's written notice, this Agreement shall be considered terminated on the date the required change in policy coverage would otherwise take effect. C. Provider understands and agrees that any and all liabilities regarding the use of any of Provider's employees or any of Provider's subcontractors for Services related to this Agreement shall be borne solely by Provider throughout the term.of this .Agreement and that this provision shall survive the termination of this Agreement. Provider further understands and agrees that insurance for each employee of Provider and each subcontractor providing Services Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 13 related to this Agreement shall be maintained in good standing and approved by the City Risk Management Administrator throughout the duration of this Agreement. D. Provider shall be responsible for assuring that the insurance certificates required under this Agreement remain in full force and effect for the duration of this Agreement, including any extensions hereof. If insurance certificates are scheduled to expire during the term of this Agreement and any extension hereof, Provider shall be responsible for submitting new or renewed insurance certificates to the City's Risk Management Administrator 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 term of this Agreement and any extension thereof: (i) the City shall suspend this Agreement until such time as the new or renewed certificate(s) are received in acceptable form by the City's Risk Management Administrator; or (ii) the City may, at its sole discretion, terminate the Agreement for cause and seek re -procurement damages from Provider in conjunction with the violation of the terms and conditions of this Agreement. E. Compliance with the foregoing requirements shall not relieve Provider of its liabilities and obligations under this Agreement. 16. NONDISCRIMINATION: Provider represents 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, handicap, marital status or national origin. Provider further covenants that no otherwise qualified individual shall, Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 14 solely by reason of his/her race, color, sex, religion, age, handicap, marital status or national origin, be excluded from participation in, be denied services, or be subject to discrimination under any provision of this Agreement. 17. ASSIGNMENT: This Agreement shall not be assigned by Provider, in whole or in part, and Provider shall not assign any part of its operations, without the prior written consent of the City, which may be withheld or conditioned, in the City's sole discretion through the City Manager, Provider may not change or replace sub -contractors performing work under the Scope of Services identified in Exhibit "B" without the prior written consent from the City Manager. 18. 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. TO PROVIDER: TO THE CITY: Iffy t trap, 7R Forrest Norris, CFO Carlos -A Mg-aya Gallagher Bassett Services, Inc. City Manager Two Pierce Place 444 SW 2nd Avenue, 10th Floor Itasca, IL 60143 Miami, Florida 33130 Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 15 19. MISCELLANEOUS PROVISIONS: A. This Agreement shall be construed and enforced according to the laws of the State of Florida. Venue in any proceedings between the parties shall be in Miami -Dade County, Florida. Each party shall bear its own attorney's fees. Each party waives any defense, whether asserted by motion or pleading, that the aforementioned courts are an improper or inconvenient venue. Moreover, the parties consent to the personal jurisdiction of the aforementioned courts and irrevocably waive any objections to said jurisdiction. The parties irrevocably waive any rights to a jury trial. 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 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 the 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. E. Provider shall comply with all applicable laws, rules and regulations in the performance of this Agreement, including but not limited to licensure, and certifications required by law for professional service providers. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 16 F. This Agreement constitutes the sole and entire agreement between the parties hereto. No modification or amendment hereto shall be valid unless in writing and executed by properly authorized representatives of the parties hereto. Except as otherwise set forth in Section 3 above, the City Manager shall have the sole authority to extend, to amend or to modify this Agreement on behalf of the City. 20. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties hereto, their heirs, executors, legal representatives, successors, or assigns. 21. INDEPENDENT CONTRACTORS: 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, neither Provider, nor its employees, nor any subcontractor hired by Provider to provide any Services under this Agreement shall 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, its employees, or any subcontractor hired by Provider to provide any Services hereunder, and Provider agrees to provide or to require subcontractor(s) to provide, as applicable, workers' compensation insurance for any employee or agent of Provider rendering Services to the City under this Agreement. Provider further understands and agrees that Provider's or subcontractors' use or entry upon City properties shall not in any way change its or their status as an independent contractor. 22. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the availability of funds and continued authorization for program activities and the Agreement is Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 17 subject to amendment or termination due to lack of funds, reduction of funds and/or change in regulations, upon thirty (30) days written notice. 23. FORCE MAJEURE: A "Force Majeure Event" shall mean an act of God, act of governmental body or military authority, fire, explosion, power failure, flood, storm, hurricane, sink hole, other natural disasters, epidemic, riot or civil disturbance, war or terrorism, sabotage, insurrection, blockade, or embargo. In the event that either party is delayed in the performance of any act or obligation pursuant to or required by the Agreement by reason of a Force Majeure Event, the time for required completion of such act or obligation shall be extended by the number of days equal to the total number of days, if any, that such party is actually delayed by such Force Majeure Event. The party seeking delay in performance shall give notice to the other party specifying the anticipated duration of the delay, and if such delay shall extend beyond the duration specified in such notice, additional notice shall be repeated no less than monthly so long as such delay due to a Force Majeure Event continues. Any party seeking delay in performance due to a Force Majeure Event shall use its best efforts to rectify any condition causing such delay and shall cooperate with the other party to overcome any delay that has resulted. 24. CITY NOT LIABLE FOR DELAYS: Provider hereby understands and agrees that in no event shall the City be liable for, or responsible to Provider or any subcontractor, or to any other person, firm, or entity for or on account of, any stoppages or delay(s) in work herein provided for, or any damages whatsoever related thereto, because of any injunction or other legal or equitable proceedings or on account of any delay(s) for any cause over which. the City has no control. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 18 25. USE OF NAME: Provider understands and agrees that the City is not engaged in research for advertising, sales promotion, or other publicity purposes. Provider is allowed, within the limited scope of normal and customary marketing and promotion of its work, to use the general results of this project and the name of the City. The Provider agrees to protect any confidential information provided by the City and will not release information of a specific nature without prior written consent of the City Manager or the City Commission. 26. NO CONFLICT OF INTEREST: Pursuant to City of Miami Code Section 2- 611, as amended ("City Code"), regarding conflicts of interest, Provider hereby certifies to City that it has no actual knowledge of individual members of Provider, no employees providing services under this contract, and no subcontractor under this Agreement nor any immediate family member of any of the same is also a member of any board, commission, or agency of the City. Provider hereby represents and warrants to the City that throughout the term of this Agreement, Provider, its employees and its subcontractors will abide by this prohibition of the City Code. 27. NO THIRD -PARTY BENEFICIARY: No persons other than the Provider and the City (and their successors and assigns) shall have any rights whatsoever under this Agreement. 28. SURVIVAL: All obligations (including but not limited to indemnity and obligations to defend and hold harmless) and rights of any party arising during or attributable to the period prior to expiration or earlier termination of this Agreement shall survive such expiration or earlier termination. 29. TRUTH -IN -NEGOTIATION CERTIFICATION, REPRESENTATION... AND. WARRANTY: Provider hereby certifies, represents and warrants to City that on the date of Provider's execution of this Agreement and so long as this Agreement shall remain in full force Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 19 and effect, the wage rates and other factual unit costs supporting the compensation to Provider under this Agreement are and will continue to be accurate, complete, and current. Provider understands, agrees and acknowledges that the City shall meet with Provider as provided in Section 4.D and adjust the amount of the compensation as mutually agreed and any additions thereto to exclude any significant sums on a go -forward basis by which the City determines the contract price of compensation hereunder was increased due to inaccurate, incomplete, or non- current wage rates and other factual unit costs as discussed and mutually -agreed upon. All such contract adjustments shall be made within one (1) year of the end of this Agreement, whether naturally expiring or earlier terminated pursuant to the provisions hereof. 30. COUNTERPARTS: This Agreement may be executed in three or more counterparts, each of which shall constitute an original but all of which, when taken together, shall constitute one and the same agreement. 31. 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 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 written. "City" CITY OF MIAMI, a municipal ATTEST: corporation Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 20 By: Priscilla A. Thompson, City CYerk PlAtc94/ ATTEST: Print Name: Lao f (fe,r Title: Acco6a-Ff 0o,+.0( (Corporate Seal) APPROVED AS TO FORM AND CORRECTNESS: Julie O. B City Attorney Tony E. Crapp, Jr., City Manager. "Provider" Gallagher Bassett Services, Inc. Bv: /Print Name: Title: Scott Hudson (President & CEO: Authori edaporate Officer) APPROVED AS/O INSURANCE REQUIREMENTS: Gary S. Reshefsky 'sk Management Director Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 21 EXHIBIT A Request for Proposal No. 207193 and All Addenda thereto Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 22 City of Miami Request for Proposals (RFP) Purchasing Department Miami Riverside Center 444 SW 2nd Avenue, 61h Floor Miami, Florida 33130 Web Site Address: http://ci.miami.fl.us/procurement RFP Number: Title: Issue Date/Time: RFP Closing Date/Time: Pre -Bid Conference: Pre -Bid Date/Time: Pre -Bid Location: Deadline for Request for Clarification: Buyer: Hard Copy Submittal Location: Buyer E-Mail Address: Buyer Facsimile: 207193,2 Request for Proposals for Claims Administration Services & Managed Care Services 13-APR-2010 17-MAY-2010 @ 12:00:00 Mandatory Monday, April 19, 2010 at 10:00 .a.m. 444 SW 2nd Avenue, loth Floor Large Conference Room, Miami, Florida Tuesday, April 20, 2010 at 3:00 PM Eastern Standard Time Suarez, Maritza City of Miami - City Clerk 3500 Pan American Drive Miami FL 33133 US msuarez@miamigov.com (305)400-5025 Page 1 of 66 Certification Statement Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and retain a copy for your files. Prices should include all costs, including transportation to destination. The City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a minimum of 180 days following the time set for closing of the submissions. In the event of errors in extension of totals, the unit prices shall govern in determining the quoted prices. We (I) certify that we have read your solicitation, completed the necessary documents, and propose to furnish and deliver, F.O.B. DESTINATION, the items or services specified herein. The undersigned hereby certifies that neither the contractual party nor any of its principal owners or personnel have been convicted of any of the violations, or debarred or suspended as set in section 18-107 or Ordinance No. 12271. All exceptions to this submission have been documented in the section below (refer to paragraph and section). EXCEPTIONS: We (I) certify that any and all information contained in this submission is true; and we (I) further certify that this submission is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a submission for the same materials, supplies, equipment, or service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms and conditions of this solicitation and certify that I am authorized to sign this submission for the submitter. Please print the following and sign your name: SUPPLIER NAME. ADDRESS PHONE: FAX: EMAIL: BEEPER. SIGNED BY. TITLE: DATE. FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISQUALIFY THIS BID. Page 2 of 66 Certifications Legal Name of Firm: Entity Type: Partnership, Sole Proprietorship, Corporation, etc. Year Established: Business Address: City, State, and Zip Code: Telephone Number: Fax Number: E-mail Address: Office Location: City of Miami, Miami -Dade County, or Other Occupational License Number: Occupational License Issuing Agency: Occupational License Expiration Date: Respondent certifies that (s) he has read and understood the provisions of City of Miami Ordinance No. 10032 (Section 18-105 of the City Code) pertaining to the implementation of a "First Source Hiring Agreement.": (Yes or No) Page 3 of 66 Do you expect to create new positions in your company in the event your company was awarded a Contract by the City? (Yes or No) In the event your answer to question above is yes, how many new positions would you create to perform this work? Please list the title, rate of pay, summary of duties, number of positions, and expected length or duration of all new positions which might be created as a result of this award of a Contract. Will Subcontractor(s) be used? (Yes or No) Page 4 of 66 Line: 1 Description: Total Annual Fee to Provide Part I Services - Workers Compensation Claims Administration, as per the Scope of Work Proposer shall clearly indicate in proposal if providing a response for Part I, Part H, and/or Part III Services. Category: 95327-00 Unit of Measure: Year Unit Price: $ Number of Units: 3 Total: $ Line: 2 Description: Total Annual Fee to Provide Part II Services - General, Automobile, and Professional Liability Claims Administration, as per the Scope of Work Category: 95327-00 Unit of Measure: Year Unit Price: $ Line: 3 Number of Units: 3 Total: $ Description: Total Annual Fee to Provide Part III Services - Statutory Managed Care Services, as per the Scope of Work Category: 95327-00 Unit of Measure: Year Unit Price: $ Number of Units: 3 Total: $ Line: 4 Description: Total Annual Fee to Provide Part III Services - Non -Statutory Managed Care Services, as per the Scope of Work Category: 95327-00 Unit of Measure: Year Unit Price: $ Number of Units: 3 Total: $ Page 5 of 66 Line: 5 Description: Per Claim Fee to Provide Part I Services - Workers Compensation Claims Administration. (Estimated quantities provided are on an annual basis) Line: 5.1 Description: Existing Claims for lost time Category: 95327-00 Unit of Measure: Each Unit Price: $ Number of Units: 1,039 Total: $ Line: 5.2 Description: Existing Claims for medical only Category: 95327-00 Unit of Measure: Each Unit Price: $ Number of Units: 29 Total: $ Line: 5.3 Description: Prospective Claims for lost time Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 5.4 Number of Units: 406 Total: $ Description: Prospective Claims for medical only Category: 95327-00 Unit of Measure: Each Page 6 of 66 Unit Price: $ Line: 6 Number of Units: 396 Total: $ Description: Per Claim Fee to Provide Part II Services - General, Automobile, and Professional Liability Administration. (Estimated quantities provided are on an annual basis) Line: 6.1 Description: Existing Claims for General Liability Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 6.2 Number of Units: 199 Total: $ Description: Existing Claims for Automobile Liability Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 6.3 Number of Units: 309 Total: $ Description: Existing Claims for Professional Liability Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 6.4 Number of Units: 93 Total: $ Description: Prospective Claims for General Liability Page 7 of 66 Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 6.5 Number of Units: 254 Total: $ Description: Prospective Claims for Automobile Liability Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 6.6 Number of Units: 358 Total: $ Description: Prospective Claims for Professional Liability Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 7 Number of Units: 27 Total: $ Description: Per Claim Fee to Provide Part III Services - Statutory Managed Care. (Estimated quantities provided are on an annual basis) Line: 7.1 Description: Existing Claims for lost time Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 7.2 Number of Units: 78 Total: $ Page 8 of 66 Description: Existing Claims for medical only Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 7.3 Number of Units: 615 Total: $ Description: Prospective Claims for lost time Category: 95327-00 Unit of Measure: Each Unit Price: $ Number of Units: 406 Total: $ Line: 7.4 Description: Prospective Claims for medical only Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 8 Number of Units: 396 Total: $ Description: Per Claim Fee to Provide Part III Services - Non -Statutory Managed Care. (Estimated quantities provided are on an annual basis) Line: 8.1 Description: Existing Claims for lost time Category: 95327-00 Unit of Measure: Each Unit Price: $ Number of Units: 78 Total: $ Page 9 of 66 Description: Existing Claims for medical only Category: 95327-00 Unit of Measure: Each Unit Price: $ Line: 8.3 Number of Units: 615 Total: $ Description: Prospective Claims for lost time Category: 95327-00 Unit of Measure: Each Unit Price: $ Number of Units: 406 Total: $ Line: 8.4 Description: Prospective Claims for medical only Category: 95327-00 Unit of Measure: Each Unit Price: $ Number of Units: 396 Total: $ Page 10 of 66 Request for Proposals (RFP) 207193,2 Table of Contents Terms and Conditions 12 1. General Conditions 12 1.1. GENERAL TERMS AND CONDITIONS 12 2. Special Conditions 32 2.1. PURPOSE 32 2.2. DEADLINE FOR RECEIPT OF REQUEST FOR ADDITIONAL INFORMATION/CLARIFICATION 32 32 32 32 2.6. MINIMUM QUALIFICATION REQUIREMENTS 32 2.7. CONTRACT EXECUTION 33 2.8. MANDATORY PRE -PROPOSAL CONFERENCE 33 2.9. FAILURE TO PERFORM 33 2.10. INSURANCE REQUIREMENTS 34 2.11. CONTRACT ADMINISTRATOR 35 2.12. SUBCONTRACTOR(S) OR SUBCONSULTANT(S) 36 2.13. TERMINATION 36 2.14. ADDITIONAL TERMS AND CONDITIONS 36 2.15. PRIMARY CLIENT (FIRST PRIORITY) 37 2.16. UNAUTHORIZED WORK 37 2.17. CHANGES/ALTERATIONS 37 2.18. COMPENSATION PROPOSAL 37 2.19. EVALUATION/SELECTION PROCESS AND CONTRACT AWARD 37 2.20. ADDITIONAL SERVICES 38 2.21. RECORDS 38 2.22. ATTACHMENTS 38 2.23. TRUTH IN NEGOTIATION CERTIFICATE 39 3. Specifications 40 3.1. SPECIFICATIONS/SCOPE OF WORK 40 4. Submission Requirements 58 4.1. SUBMISSION REQUIREMENTS 58 5. Evaluation Criteria 66 5.1. EVALUATION CRITERIA 66 2.3. TERM OF CONTRACT 2.4. CONDITIONS FOR RENEWAL 2.5. NON -APPROPRIATION OF FUNDS Page 11 of 66 Request for Proposals (RFP) 207193,2 Terms and Conditions 1. General Conditions 1.1. GENERAL TERMS AND CONDITIONS Intent: The General Terms and Conditions described herein apply to the acquisition of goods/equipment/services with an estimated aggregate cost of $25,000.00 or more. Definition: A formal solicitation is defined as issuance of an Invitation for Bids, Request for Proposals, Request for Qualifications, or Request for Letters of Interest pursuant to the City of Miami Procurement Code and/or Florida Law, as amended. Formal Solicitation and Solicitation shall be defined in the same manner herein. 1.1. ACCEPTANCE OF GOODS OR EQUIPMENT - Any good(s) or equipment delivered under this formal solicitation, if applicable, shall remain the property of the seller until a physical inspection and actual usage of the good is made, and thereafter is accepted as satisfactory to the City. It must comply with the terms herein and be fully in accordance with specifications and of the highest quality. In the event the goods/equipment supplied to the City are found to be defective or does not conform to specifications, the City reserves the right to cancel the order upon written notice to the Contractor and return the product to the Contractor at the Contractor's expense. 1.2. ACCEPTANCE OF OFFER - The signed or electronic submission of your solicitation response shall be considered an offer on the part of the bidder/proposer; such offer shall be deemed accepted upon issuance by the City of a purchase order. 1.3. ACCEPTANCE/REJECTION — The City reserves the right to accept or reject any or all responses or parts of after opening/closing date and request re -issuance on the goods/services described in the formal solicitation. In the event of such rejection, the Director of Purchasing shall notify all affected bidders/proposers and make available a written explanation for the rejection. The City also reserves the right to reject the response of any bidder/proposer who has previously failed to properly perform under the terms and conditions of a contract, to deliver on time contracts of a similar nature, and who is not in a position to perform the requirements defined in this formal solicitation. The City further reserves the right to waive any irregularities or minor informalities or technicalities in any or all responses and may, at its discretion, re -issue this formal solicitation. 1.4. ADDENDA — It is the bidder's/proposer's responsibility to ensure receipt of all Addenda. Addenda are available at the City's website at: http://www.ci.miami.fl.us/procurement 1.5. ALTERNATE RESPONSES MAY BE CONSIDERED - The City may consider one (1) alternate response from the same Bidder/Proposer for the same formal solicitation; provided, that the alternate response offers a different product that meets or exceeds the formal solicitation requirements. In order for the City to consider an alternate response, the Bidder/Proposer shall complete a separate Price Sheet form and shall mark "Alternate Response". Alternate response shall be placed in the same response. This provision only applies to formal solicitations for the procurement of goods, services, items, equipment, materials, and/or supplies. 1.6. ASSIGNMENT - Contractor agrees not to subcontract, assign, transfer, convey, sublet, or otherwise dispose of the resulting Contract, or any or all of its right, title or interest herein, without City of Miami's prior written consent. 1.7. ATTORNEY'S FEES - In connection with any litigation, mediation and arbitration arising out of this Contract, the prevailing party shall be entitled to recover its costs and reasonable attorney's fees through and including Page 12 of 66 Request for Proposals (RFP) 207193,2 appellate litigation and any post judgment proceedings. 1.8. AUDIT RIGHTS AND RECORDS RETENTION - The Successful Bidder/Proposer agrees to provide access at all reasonable times to the City, or to any of its duly authorized representatives, to any books, documents, papers, and records of Contractor which are directly pertinent to this formal solicitation, for the purpose of audit, examination, excerpts, and transcriptions. The Successful Bidder/Proposer shall maintain and retain any and all of the books, documents, papers and records pertinent to the Contract for three (3) years after the City makes final payment and all other pending matters are closed. Contractor's failure to or refusal to comply with this condition shall result in the immediate cancellation of this contract by the City. 1.9. AVAILABILITY OF CONTRACT STATE-WIDE - Any Governmental, not -for -profit or quasi -governmental entity in the State of Florida, may avail itself of this contract and purchase any and all goods/services, specified herein from the successful bidder(s)/proposer(s) at the contract price(s) established herein, when permissible by federal, state, and local laws, rules, and regulations. Each Governmental, not -for -profit or quasi -governmental entity which uses this formal solicitation and resulting bid contract or agreement will establish its own contract/agreement, place its own orders, issue its own purchase orders, be invoiced there from and make its own payments, determine shipping terms and issue its own exemption certificates as required by the successful bidder(s)/proposer(s). 1.10. AWARD OF CONTRACT: A. The Formal Solicitation, Bidder's/Proposer's response, any addenda issued, and the purchase order shall constitute the entire contract, unless modified in accordance with any ensuing contract/agreement, amendment or addenda. B. The award of a contract where there are Tie Bids will be decided by the Director of Purchasing or designee in the instance that Tie Bids can't be determined by applying Florida Statute 287.087, Preference to Businesses with Drug -Free Workplace Programs. C. The award of this contract may be preconditioned on the subsequent submission of other documents as specified in the Special Conditions or Technical Specifications. Bidder/Proposer shall be in default of its contractual obligation if such documents are not submitted in a timely manner and in the form required by the City. Where Bidder/Proposer is in default of these contractual requirements, the City, through action taken by the Purchasing Department, will void its acceptance of the Bidder's/Proposer's Response and may accept the Response from the next lowest responsive, responsible Bidder or Proposal most advantageous to the City or re -solicit the City's requirements. The City, at its sole discretion, may seek monetary restitution from Bidder/Proposer and its bid/proposal bond or guaranty, if applicable, as a result of damages or increased costs sustained as a result of the Bidder's/Proposer's default. D. The term of the contract shall be specified in one of three documents which shall be issued to the successful Bidder/Proposer. These documents may either be a purchase order, notice of award and/or contract award sheet. E. The City reserves the right to automatically extend this contract for up to one hundred twenty (120) calendar days beyond the stated contract term in order to provide City departments with continual service and supplies while a new contract is being solicited, evaluated, and/or awarded. If the right is exercised, the City shall notify the Bidder/Proposer, in writing, of its intent to extend the contract at the same price, terms and conditions for a specific number of days. Additional extensions over the first one hundred twenty (120) day extension may occur, if, the City and the Successful Bidder/Proposer are in mutual agreement of such extensions. F. Where the contract involves a single shipment of goods to the City, the contract term shall conclude upon completion of the expressed or implied warranty periods. Page 13 of 66 Request for Proposals (RFP) 207193,2 G. The City reserves the right to award the contract on a split -order, lump sum or individual -item basis, or such combination as shall best serve the interests of the City unless otherwise specified. H. A Contract/Agreement may be awarded to the Bidder/Proposer by the City Commission based upon the minimum qualification requirements reflected herein. As a result of a RFP, RFQ, or RFLI, the City reserves the right to execute or not execute, as applicable, an Agreement with the Proposer, whichever is determined to be in the City's best interests. Such agreement will be furnished by the City, will contain certain terms as are in the City's best interests, and will be subject to approval as to legal form by the City Attorney. 1.11. BID BOND/ BID SECURITY - A cashier's or certified check, or a Bid Bond signed by a recognized surety company that is licensed to do business in the State of Florida, payable to the City of Miami, for the amount bid is required from all bidders/proposers, if so indicated under the Special Conditions. This check or bond guarantees that a bidder/proposer will accept the order or contract/agreement, as bid/proposed, if it is awarded to bidder/proposer. Bidder/Proposer shall forfeit bid deposit to the City should City award contract/agreement to Bidder/Proposer and Bidder/Proposer fails to accept the award. The City reserves the right to reject any and all surety tendered to the City. Bid deposits are returned to unsuccessful bidders/proposers within ten (10) days after the award and successful bidder's/proposer's acceptance of award. If sixty (60) days have passed after the date of the formal solicitation closing date, and no contract has been awarded, all bid deposits will be returned on demand. 1.12. RESPONSE FORM (HARDCOPY FORMAT) - All forms should be completed, signed and submitted accordingly. 1.13. BID SECURITY FORFEITED LIQUIDATED DAMAGES - Failure to execute an Agreement and/or file an acceptable Performance Bond, when required, as provided herein, shall be just cause for the annulment of the award and the forfeiture of the Bid Security to the City, which forfeiture shall be considered, not as a penalty, but in mitigation of damages sustained. Award may then be made to the next lowest responsive, responsible Bidder or Proposal most advantageous to the City or all responses may be rejected. 1.14. BRAND NAMES - If and wherever in the specifications brand names, makes, models, names of any manufacturers, trade names, or bidder/proposer catalog numbers are specified, it is for the purpose of establishing the type, function, minimum standard of design, efficiency, grade or quality of goods only. When the City does not wish to rule out other competitors' brands or makes, the phrase "OR EQUAL" is added. When bidding/proposing an approved equal, Bidders/Proposers will submit, with their response, complete sets of necessary data (factory information sheets, specifications, brochures, etc.) in order for the City to evaluate and determine the equality of the item(s) bid/proposed. The City shall be the sole judge of equality and its decision shall be final. Unless otherwise specified, evidence in the form of samples may be requested if the proposed brand is other than specified by the City. Such samples are to be furnished after formal solicitation opening/closing only upon request of the City. If samples should be requested, such samples must be received by the City no later than seven (7) calendar days after a formal request is made. 1.15. CANCELLATION - The City reserves the right to cancel all formal solicitations before its opening/closing. In the event of bid/proposal cancellation, the Director of Purchasing shall notify all prospective bidders/proposers and make available a written explanation for the cancellation. 1.16. CAPITAL EXPENDITURES - Contractor understands that any capital expenditures that the firm makes, or prepares to make, in order to deliver/perform the goods/services required by the City, is a business risk which the contractor must assume. The City will not be obligated to reimburse amortized or unamortized capital expenditures, or to maintain the approved status of any contractor. If contractor has been unable to recoup its capital expenditures during the time it is rendering such goods/services, it shall not have any claim upon the City. 1.17. CITY NOT LIABLE FOR DELAYS - It is further expressly agreed that in no event shall the City be liable Page 14 of 66 Request for Proposals (RFP) 207193,2 for, or responsible to, the Bidder/Proposer/Consultant, any sub-contractor/sub-consultant, or to any other person for, or on account of, any stoppages or delay in the work herein provided for by injunction or other legal or equitable proceedings or on account of any delay for any cause over which the City has no control. 1.18. COLLUSION —Bidder/Proposer, by submitting a response, certifies that its response is made without previous understanding, agreement or connection either with any person, firm or corporation submitting a response for the same items/services or with the City of Miami's Purchasing Department or initiating department. The Bidder/Proposer certifies that its response is fair, without control, collusion, fraud or other illegal action. Bidder/Proposer certifies that it is in compliance with the Conflict of Interest and Code of Ethics Laws. The City will investigate all potential situations where collusion may have occurred and the City reserves the right to reject any and all bids/responses where collusion may have occurred. 1.19. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS - Contractor understands that contracts between private entities and local governments are subject to certain laws and regulations, including laws pertaining to public records, conflict of interest, records keeping, etc. City and Contractor agree to comply with andobserve all applicable laws, codes and ordinances as that may in any way affect the goods or equipment offered, including but not limited to: A. Executive Order 11246, which prohibits discrimination against any employee, applicant, or client because of race, creed, color, national origin, sex, or age with regard to, but not limited to, the following: employment practices, rate of pay or other compensation methods, and training selection. B. Occupational, Safety and Health Act (OSHA), as applicable to this Formal Solicitation. C. The State of Florida Statutes, Section 287.133(3)(A) on Public Entity Crimes. D. Environment Protection Agency (EPA), as applicable to this Formal Solicitation. E. Uniform Commercial Code (Florida Statutes, Chapter 672). F. Americans with Disabilities Act of 1990, as amended. G. National Institute of Occupational Safety Hazards (NIOSH), as applicable to this Formal Solicitation. H. National Forest Products Association (NFPA), as applicable to this Formal Solicitation. I. City Procurement Ordinance City Code Section 18, Article III. J. Conflict of Interest, City Code Section 2-611;61. K. Cone of Silence, City Code Section 18-74. L. The Florida Statutes Sections 218.73 and 218.74 on Prompt Payment. M. First Source Hiring Agreement, City Ordinance No. 10032, as applicable to this Formal Solicitation. Implemented to foster the creation of new and permanent jobs for City of Miami residents; requires as a condition precedent to the execution of service contracts including professional services. Lack of knowledge by the bidder/proposer will in no way be a cause for relief from responsibility. Non-compliance with all local, state, and federal directives, orders, and laws may be considered grounds for termination of contract(s). Copies of the City Ordinances may be obtained from the City Clerk's Office. 1.20. CONE OF SILENCE - Pursuant to Section 18-74 of the City of Miami Code, a "Cone of Silence" is imposed upon each RFP, RFQ, RFLI, or IFB after advertisement and terminates at the time the City Manager issues a written Page 15 of 66 Request for Proposals (RFP) 207193,2 recommendation to the Miami City Commission. The Cone of Silence shall be applicable only to Contracts for the provision of goods and services and public works or improvements for amounts greater than $200,000. The Cone of Silence prohibits any communication regarding REPs, RFQs, RFLI or IFBs (bids) between, among others: Potential vendors, service providers, bidders, lobbyists or consultants and the City's professional staff including, but not limited to, the City Manager and the City Manager's staff; the Mayor, City Commissioners, or their respective staffs and any member of the respective selection/evaluation committee. The provision does not apply to, among other communications: oral communications with the City purchasing staff, provided the communication is limited strictly to matters of process or procedure already contained in the formal solicitation document; the provisions of the Cone of Silence do not apply to oral communications at duly noticed site visits/inspections, pre -proposal or pre -bid conferences, oral presentations before selection/evaluation committees, contract negotiations during any duly noticed public meeting, or public presentations made to the Miami City Commission during a duly noticed public meeting; or communications in writing or by email at any time with any City employee, official or member of the City Commission unless specifically prohibited by the applicable RFP, RFQ, RFLI or IFB (bid) documents (See Section 2.2. of the Special Conditions); or communications in connection with the collection of industry comments or the performance of market research regarding a particular RFP, RFQ, RFLI OR IFB by City Purchasing staff. Proposers or bidders must file a copy of any written communications with the Office of the City Clerk, which shall be made available to any person upon request. The City shall respond in writing and file a copy with the Office of the City Clerk, which shall be made available to any person upon request. Written communications may be in the form of e-mail, with a copy to the Office of the City Clerk. In addition to any other penalties provided by law, violation of the Cone of Silence by any proposer or bidder shall render any award voidable. A violation by a particular Bidder, Proposer, Offeror, Respondent, lobbyist or consultant shall subject same to potential penalties pursuant to the City Code. Any person having personal knowledge of a violation of these provisions shall report such violation to the State Attorney and/or may file a complaint with the Ethics Commission. Proposers or bidders should reference Section 18-74 of the City of Miami Code for further clarification. This language is only a summary of the key provisions of the Cone of Silence. Please review City of Miami Code Section 18-74 for a complete and thorough description of the Cone of Silence. You may contact the City Clerk at 305-250-5360, to obtain a copy of same. 1.21. CONFIDENTIALITY - As a political subdivision, the City of Miami is subject to the Florida Sunshine Act and Public Records Law. If this Contract/Agreement contains a confidentiality provision, it shall have no application when disclosure is required by Florida law or upon court order. 1.22. CONFLICT OF INTEREST — Bidders/Proposers, by responding to this Formal Solicitation, certify that to the best of their knowledge or belief, no elected/appointed official or employee of the City of Miami is fmancially interested, directly or indirectly, in the purchase of goods/services specified in this Formal Solicitation. Any such interests on the part of the Bidder/Proposer or its employees must be disclosed in writing to the City. Further, you must disclose the name of any City employee who owns, directly or indirectly, an interest of five percent (5%) or more of the total assets of capital stock in your firm. 1.23. COPYRIGHT OR PATENT RIGHTS —Bidders/Proposers warrant that there has been no violation of copyright or patent rights in manufacturing, producing, or selling the goods shipped or ordered and/or services provided as a result of this formal solicitation, and bidders/proposers agree to hold the City harmless from any and all liability, loss, or expense occasioned by any such violation. Page 16 of 66 Request for Proposals (RFP) 207193,2 1.24. COST INCURRED BY BIDDER/PROPOSER - All expenses involved with the preparation and submission of Responses to the City, or any work performed in connection therewith shall be borne by the Bidder(s)/Proposer(s). 1.25. DEBARMENT AND SUSPENSIONS (Sec 18-107) (a) Authority and requirement to debar and suspend. After reasonable notice to an actual or prospective Contractual Party, and after reasonable opportunity for such party to be heard, the City Manager, after consultation with the Chief Procurement Officer and the city attorney, shall have the authority to debar a Contractual Party, for the causes listed below, from consideration for award of city Contracts. The debarment shall be for a period of not fewer than three years. The City Manager shall also have the authority to suspend a Contractual Party from consideration for award of city Contracts if there is probable cause for debarment, pending the debarment determination. The authority to debar and suspend contractors shall be exercised in accordance with regulations which shall be issued by the Chief Procurement Officer after approval by the City Manager, the city attorney, and the City Commission. (b) Causes for debarment or suspension. Causes for debarment or suspension include the following: (1) Conviction for commission of a criminal offense incident to obtaining or attempting to obtain a public or private Contract or subcontract, or incident to the performance of such Contract or subcontract. (2) Conviction under state or federal statutes of embezzlement, theft, forgery, bribery, falsification or destruction of records, receiving stolen property, or any other offense indicating a lack of business integrity or business honesty. (3) Conviction under state or federal antitrust statutes arising out of the submission of Bids or Proposals. (4) Violation of Contract provisions, which is regarded by the Chief Procurement Officer to be indicative of nonresponsibility. Such violation may include failure without good cause to perform in accordance with the terms and conditions of a Contract or to perform within the time limits provided in a Contract, provided that failure to perform caused by acts beyond the control of a party shall not be considered a basis for debarment or suspension. (5) Debarment or suspension of the Contractual Party by any federal, state or other governmental entity. (6) False certification pursuant to paragraph (c) below. (7) Found in violation of a zoning ordinance or any other city ordinance or regulation and for which the violation remains noncompliant. (8) Found in violation of a zoning ordinance or any other city ordinance or regulation and for which a civil penalty or fine is due and owing to the city. (9) Any other cause judged by the City Manager to be so serious and compelling as to affect the responsibility of the Contractual Party performing city Contracts. (c) Certification. All Contracts for goods and services, sales, and leases by the city shall contain a certification that neither the Contractual Party nor any of its principal owners or personnel have been convicted of any of the violations set forth above or debarred or suspended as set forth in paragraph (b)(5). (d) Debarment and suspension decisions. Subject to the provisions of paragraph (a), the City Manager shall render a written decision stating the reasons for the debarment or suspension. A copy of the decision shall be provided promptly to the Contractual Party, along with a notice of said party's right to seek judicial relief. Page 17 of 66 Request for Proposals (REP) 207193,2 1.26. DEBARRED/SUSPENDED VENDORS —An entity or affiliate who has been placed on the State of Florida debarred or suspended vendor list may not submit a response on a contract to provide goods or services to a public entity, may not submit a response on a contract with a public entity for the construction or repair of a public building or public work, may not submit response on leases of real property to a public entity, may not award or perform work as a contractor, supplier, subcontractor, or consultant under contract with any public entity, and may not transact business with any public entity. 1.27. DEFAULT/FAILURE TO PERFORM - The City shall be the sole judge of nonperformance, which shall include any failure on the part of the successful Bidder/Proposer to accept the award, to furnish required documents, and/or to fulfill any portion of this contract within the time stipulated. Upon default by the successful Bidder/Proposer to meet any terms of this agreement, the City will notify the Bidder/Proposer of the default and will provide the contractor three (3) days (weekends and holidays excluded) to remedy the default. Failure on the contractor's part to correct the default within the required three (3) days shall result in the Contract being terminated and upon the City notifying in writing the contractor of its intentions and the effective date of the termination. The following shall constitute default: A. Failure to perform the work or deliver the goods/services required under the Contract and/or within the time required or failing to use the subcontractors, entities and personnel as identified and set forth, and to the degree specified in the Contract. B. Failure to begin the work under this Contract within the time specified. C. Failure to perform the work with sufficient workers and equipment or with sufficient materials to ensure timely completion. D. Neglecting or refusing to remove materials or perform new work where prior work has been rejected as nonconforming with the terms of the Contract. E. Becoming insolvent, being declared bankrupt, or committing any act of bankruptcy or insolvency, or making an assignment for the benefit of creditors, if the insolvency, bankruptcy, or assignment renders the successful Bidder/Proposer incapable of performing the work in accordance with and as required by the Contract. F. Failure to comply with any of the terms of the Contract in any material respect. All costs and charges incurred by the City as a result of a default or a default incurred beyond the time limits stated, together with the cost of completing the work, shall be deducted from any monies due or which may become due on this Contract. 1.28. DETERMINATION OF RESPONSIVENESS - Each Response will be reviewed to determine if it is responsive to the submission requirements outlined in the Formal Solicitation. A "responsive" response is one which follows the requirements of the formal solicitation, includes all documentation, is submitted in the format outlined in the formal solicitation, is of timely submission, and has appropriate signatures as required on each document. Failure to comply with these requirements may deem a Response non -responsive. 1.29. DISCOUNTS OFFERED DURING TERM OF CONTRACT - Discount Prices offered in the response shall be fixed after the award by the Commission, unless otherwise specified in the Special Terms and Conditions. Price discounts off the original prices quoted in the response will be accepted from successful Bidder(s)/Proposer(s) during the term of the contract. Such discounts shall remain in effect for a minimum of 120 days from approval by the City Commission Any discounts offered by a manufacturer to Bidder/Proposer will be passed on to the City. 1.30. DISCREPANCIES, ERRORS, AND OMISSIONS - Any discrepancies, errors, or ambiguities in the Formal Solicitation or addenda (if any) should be reported in writing to the City's Purchasing Department. Should it be Page 18 of 66 Request for Proposals (RFP) 207193,2 found necessary, a written addendum will be incorporated in the Formal Solicitation and will become part of the purchase agreement (contract documents). The City will not be responsible for any oral instructions, clarifications, or other communications. A. Order of Precedence — Any inconsistency in this formal solicitation shall be resolved by giving precedence to the following documents, the first of such list being the governing documents. 1) Addenda (as applicable) 2) Specifications 3) Special Conditions 4) General Terms and Conditions 1.31. EMERGENCY / DISASTER PERFORMANCE - In the event of a hurricane or other emergency or disaster situation, the successful vendor shall provide the City with the commodities/services defined within the scope of this formal solicitation at the price contained within vendor's response. Further, successful vendor shall deliver/perform for the city on a priority basis during such times of emergency. 1.32. ENTIRE BID CONTRACT OR AGREEMENT - The Bid Contract or Agreement consists of this City of Miami Formal Solicitation and specifically this General Conditions Section, Contractor's Response and any written agreement entered into by the City of Miami and Contractor in cases involving RFPs, RFQs, and RFLIs, and represents the entire understanding and agreement between the parties with respect to the subject matter hereof and supersedes all other negotiations, understanding and representations, if any, made by and between the parties. To the extent that the agreement conflicts with, modifies, alters or changes any of the terms and conditions contained in the Formal Solicitation and/or Response, the Formal Solicitation and then the Response shall control. This Contract may be modified only by a written agreement signed by the City of Miami and Contractor. 1.33. ESTIMATED QUANTITIES —Estimated quantities or estimated dollars are provided for your guidance only. No guarantee is expressed or implied as to quantities that will be purchased during the contract period. The City is not obligated to place an order for any given amount subsequent to the award of this contract. Said estimates may be used by the City for purposes of determining the low bidder or most advantageous proposer meeting specifications. The City reserves the right to acquire additional quantities at the prices bid/proposed or at lower prices in this Formal Solicitation. 1.34. EVALUATION OF RESPONSES A.Rejection of Responses The City may reject a Response for any of the following reasons: 1) Bidder/Proposer fails to acknowledge receipt of addenda; 2) Bidder/Proposer mistates or conceals any material fact in the Response ; 3) Response does not conform to the requirements of the Formal Solicitation; 4) Response requires a conditional award that conflicts with the method of award; 5) Response does not include required samples, certificates, licenses as required; and, 6) Response was not executed by the Bidder's/Proposer(s) authorized agent. The foregoing is not an all inclusive list of reasons for which a Response may be rejected. The City may reject and re -advertise for all or any part of the Formal Solicitation whenever it is deemed in the best interest of the City. B. Elimination From Consideration Page 19 of 66 Request for Proposals (RFP) 207193,2 1) A contract shall not be awarded to any person or firm which is in arrears to the City upon any debt or contract, or which is a defaulter as surety or otherwise upon any obligation to the City. 2) A contract may not be awarded to any person or firm which has failed to perform under the terms and conditions of any previous contract with the City or deliver on time contracts of a similar nature. 3) A contract may not be awarded to any person or firm which has been debarred by the City in accordance with the City's Debarment and Suspension Ordinance. C. Determination of Responsibility 1) Responses will only be consideredfrom entities who are regularly engaged in the business of providing the goods/equipment/services required by the Formal Solicitation. Bidder/Proposer must be able to demonstrate a satisfactory record of performance and integrity; and, have sufficient financial, material, equipment, facility, personnel resources, and expertise to meet all contractual requirements. The terms "equipment and organization" as used herein shall be construed to mean a fully equipped and well established entity in line with the best industry practices in the industry as determined by the City. 2) The City may consider any evidence available regarding the financial, technical and other qualifications and abilities of a Bidder/Proposer, including past performance (experience) with the City or any other governmental entity in making the award. 3) The City may require the Bidder(s)/Proposer(s) to show proof that they have been designated as an authorized representative of a manufacturer or supplier which is the actual source of supply, if required by the Formal Solicitation. 1.35. EXCEPTIONS TO GENERAL AND/OR SPECIAL CONDITIONS OR SPECIFICATIONS - Exceptions to the specifications shall be listed on the Response and shall reference the section. Any exceptions to the General or Special Conditions shall be cause for the bid (IFB) to be considered non -responsive. It also may be cause for a RFP, RFQ, or RFLI to be considered non -responsive; and, if exceptions are taken to the terms and conditions of the resulting agreement it may lead to terminating negotiations. 1.36. F.O.B. DESTINATION - Unless otherwise specified in the Formal Solicitation, all prices quoted/proposed by the bidder/proposer must be F.O.B. DESTINATION, inside delivery, with all delivery costs and charges included in the bid/proposal price, unless otherwise specified in this Formal Solicitation. Failure to do so may be cause for rejection of bid/proposal. 1.37. FIRM PRICES - The bidder/proposer warrants that prices, terms, and conditions quoted in its response will be firm throughout the duration of the contract unless otherwise specified in the Formal Solicitation. Such prices will remain firm for the period of performance or resulting purchase orders or contracts, which are to be performed or supplied over a period of time. 1.38. FIRST -SOURCE HIRING AGREEMENT (Sec.18-105) (a) The Commission approves implementation of the first -source hiring agreement policy and requires as a condition precedent to the execution of service contracts for facilities, services, and/or receipt of grants and loans, for projects of a nature that create new jobs, the successful negotiation of first -source hiring agreements between the organization or individual receiving said contract and the authorized representative unless such an agreement is found infeasible by the city manager and such fording approved by the City Commission at a public hearing. (b) For the purpose of this section, the following terms, phrases, words and their derivations shall have the following meanings: Authorized representative means the Private Industry Council of South Florida/South Florida Employment and Page 20 of 66 Request for Proposals (RFP) 207193,2 Training Consortium, or its successor as local recipient of federal and state training and employment funds. Facilities means all publicly financed projects, including but without limitation, unified development projects, municipal public works, and municipal improvements to the extent they are financed through public money services or the use of publicly owned property. Grants and loans means, without limitation, urban development action grants (UDAG), economic development agency constmction loans, loans from Miami Capital Development, Incorporated, and all federal and state grants administered by the city. Service contracts means contracts for the procurement of services by the city which include professional services. Services includes, without limitation, public works improvements, facilities, professional services, commodities, supplies, materials and equipment. (c) The authorized representative shall negotiate each first -source hiring agreement. (d) The primary beneficiaries of the first -source hiring agreement shall be participants of the city training and employment programs, and other residents of the city. 1.39. FLORIDA MINIMUM WAGE - The Constitution of the State of Florida, Article X, Section 24, states that employers shall pay employee wages no less than the minimum wage for all hours worked in Florida. Accordingly, it is the contractor's and its' subcontractor(s) responsibility to understand and comply with this Florida constitutional minimum wage requirement and pay its employees the current established hourly minimum wage rate, which is subject to change or adjusted by the rate of inflation using the consumer price index for urban wage earners and clerical workers, CPI-W, or a successor index as calculated by the United States Department of Labor. Each adjusted minimum wage rate calculated shall be determined and published by the Agency Workforce Innovation on September 30th of each year and take effect on the following January 1st. At the time of responding, it is bidder/proposer and his/her subcontractor(s), if applicable, full responsibility to determine whether any of its employees may be impacted by this Florida Law at any given point in time during the term of the contract. If impacted, bidder/proposer must furnish employee name(s), job title(s), job description(s), and current pay rate(s). Failure to submit this information at the time of submitting a response constitute successful bidder's/proposer's acknowledgement and understanding that the Florida Minimum Wage Law will not impact its prices throughout the term of contract and waiver of any contractual price increase request(s). The City reserves the right to request and successful bidder/proposer must provide for any and all information to make a wage and contractual price increase(s) determination. 1.40. GOVERNING LAW AND VENUE - The validity and effect of this Contract shall be governed by the laws of the State of Florida. The parties agree that any action, mediation or arbitration arising out of this Contract shall take place in Miami -Dade County, Florida. 1.41. HEADINGS AND TERMS - The headings to the various paragraphs of this Contract have been inserted for convenient reference only and shall not in any manner be construed as modifying, amending or affecting in any way the expressed terms and provisions hereof. 1.42. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA) - Any person or entity that performs or assists the City of Miami with a function or activity involving the use or disclosure of "individually identifiable health information (IIHI) and/or Protected Health Information (PHI) shall comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the City of Miami Privacy Standards. HIPAA mandates for privacy, security and electronic transfer standards, which include but are not limited to: A. Use of information only for performing services required by the contract or as required by law; Page 21 of 66 Request for Proposals (RFP) 207193,2 B. Use of appropriate safeguards to prevent non -permitted disclosures; C. Reporting to the City of Miami of any non -permitted use or disclosure; D. Assurances that any agents and subcontractors agree to the same restrictions and conditions that apply to the Bidder/Proposer and reasonable assurances that IIHI/PHI will be held confidential; E. Making Protected Health Information (PHI) available to the customer; F. Making PHI available to the customer for review and amendment; and incorporating any amendments requested by the customer; G. Making PHI available to the City of Miami for an accounting of disclosures; and H. Making intemal practices, books and records related to PHI available to the City of Miami for compliance audits. PHI shall maintain its protected status regardless of the form and method of transmission (paper records, and/or electronic transfer of data). The Bidder/ Proposer must give its customers written notice of its privacy information practices including specifically, a description of the types of uses and disclosures that would be made with protected health information. 1.43. INDEMNIFICATION - The Contractor shall indemnify and save harmless forever the City, and all the City's agents, officers and employees from and against all charges or claims resulting from any bodily injury, loss of life, or damage to property from any act, omission or neglect, by itself or its employees; the Contractor shall become defendant in every suit brought for any of such causes of action against the City or the City's officials, agents and employees; the Contractor shall further indemnify City as to all costs, attorney's fees, expenses and liabilities incurred in the defense of any such claims and any resulting investigation. 1.44. INFORMATION AND DESCRIPTIVE LITERATURE —Bidders/Proposer must furnish all information requested in the spaces provided in the Formal Solicitation. Further, as may be specified elsewhere, each Bidder/Proposer must submit for evaluation, cuts, sketches, descriptive literature, technical specifications, and Material Safety Data Sheets (MSDS)as required, covering the products offered. Reference to literature submitted with a previous response or on file with the Buyer will not satisfy this provision. 1.45. INSPECTIONS - The City may, at reasonable times during the term hereof, inspect Contractor's facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods and/or services required to be provided by the Contractor under this Contract conform to the terms and conditions of the Formal Solicitation. Contractor 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 the City of Miami Ordinance No. 12271 (Section 18-79), as same may be amended or supplemented from time to time. 1.46. INSPECTION OF RESPONSE - Responses received by the City pursuant to a Formal Solicitation will not be made available until such time as the City provides notice of a decision or intended decision or within 10 days after bid closing, whichever is earlier. Bid/Proposal results will be tabulated and may be furnished upon request via fax or e-mail to the Sr. Procurement Specialist issuing the Solicitation. Tabulations also are available on the City's Web Site following recommendation for award. 1.47. INSURANCE - Within ten (10) days after receipt of Notice of Award, the successful Contractor, shall furnish Evidence of Insurance to the Purchasing Department, if applicable. Submitted evidence of coverage shall demonstrate strict compliance to all requirements listed on the Special Conditions entitled "Insurance Requirements". The City shall be listed as an "Additional Insured." Issuance of a Purchase Order is contingent upon the receipt of proper insurance documents. If the insurance certificate is received within the specified time frame but not in the manner prescribed in this Solicitation the Page 22 of 66 Request for Proposals (RFP) 207193,2 Contractor shall be verbally notified of such deficiency and shall have an additional five (5) calendar days to submit a corrected certificate to the City. If the Contractor fails to submit the required insurance documents in the manner prescribed in this Solicitation within fifteen (15) calendar days after receipt Notice of Award, the contractor shall be in default of the contractual terms and conditions and shall not be awarded the contract. Under such circumstances, the Bidder/Proposer may be prohibited from submitting future responses to the City. Information regarding any insurance requirements shall be directed to the Risk Administrator, Department of Risk Management, at 444 SW 2nd Avenue, 9th Floor, Miami, Florida 33130, 305-416-1604. The Bidder/Proposer shall be responsible for assuring that the insurance certificates required in conjunction with this Section remain in effect for the duration of the contractual period; including any and all option terms that may be granted to the Bidder/Proposer. 1.48. INVOICES - Invoices shall contain purchase order number and details of goods and/or services delivered (i.e. quantity, unit price, extended price, etc); and in compliance with Chapter 218 of the Florida Statutes (Prompt Payment Act). 1.49. LOCAL PREFERENCE - City Code Section 18-85, states that the City Commission may offer to a responsible and responsive bidder/proposer, who maintains a Local Office, the opportunity of accepting a bid at the low bid amount, if the original bid amount submitted by the local vendor is not more than ten percent (10%) in excess of the lowest other responsible and responsive bidder/proposer. 1.50. MANUFACTURER'S CERTIFICATION - The City reserves the right to request from bidders/proposers a separate Manufacturer's Certification of all statements made in the bid/proposal. Failure to provide such certification may result in the rejection of bid/proposal or termination of contract/agreement, for which the bidder/proposer must bear full liability. 1.51. MODIFICATIONS OR CHANGES IN PURCHASE ORDERS AND CONTRACTS - No contract or understanding to modify this Formal Solicitation and resultant purchase orders or contracts, if applicable, shall be binding upon the City unless made in writing by the Director of Purchasing of the City of Miami, Florida through the issuance of a change order, addendum, amendment, or supplement to the contract, purchase order or award sheet as appropriate. 1.52. NO PARTNERSHIP OR JOINT VENTURE - Nothing contained in this Contract will be deemed or construed to create a partnership or joint venture between the City of Miami and Contractor, or to create any other similar relationship between the parties. 1.53. NONCONFORMANCE TO CONTRACT CONDITIONS - Items may be tested for compliance with specifications under the direction of the Florida Department of Agriculture and Consumer Services or by other appropriate testing Laboratories as determined by the City. The data derived from any test for compliance with specifications is public record and open to examination thereto in accordance with Chapter 119, Florida Statutes. Items delivered not conforming to specifications may be rejected and returned at Bidder's/Proposer's expense. These non -conforming items not delivered as per delivery date in the response and/or Purchase Order may result in bidder/proposer being found in default in which event any and all re -procurement costs may be charged against the defaulted contractor. Any violation of these stipulations may also result in the supplier's name being removed from the City of Miami's Supplier's list. 1.54. NONDISCRIMINATION —Bidder/Proposer agrees that it shall not discriminate as to race, sex, color, age, religion, national origin, marital status, or disability in connection with its performance under this formal solicitation. Furthermore, Bidder/Proposer agrees that no otherwise qualified individual shall solely by reason of his/her race, sex, color, age, religion, national origin, marital status or disability be excluded from the participation in, be denied benefits of, or be subjected to, discrimination under any program or activity. Page 23 of 66 Request for Proposals (RFP) 207193,2 In connection with the conduct of its business, including performance of services and employment of personnel, Bidder/Proposer shall not discriminate against any person on the basis of race, color, religion, disability, age, sex, marital status or national origin. All persons having appropriate qualifications shall be afforded equal opportunity for employment. 1.55. NON-EXCLUSIVE CONTRACT/ PIGGYBACK PROVISION - At such times as may serve its best interest, the City of Miami reserves the right to advertise for, receive, and award additional contracts for these herein goods and/or services, and to make use of other competitively bid (governmental) contracts, agreements, or other similar sources for the purchase of these goods and/or services as may be available. It is hereby agreed and understood that this formal solicitation does not constitute the exclusive rights of the successful bi.dder(s)/proposer(s) to receive all orders that may be generated by the City in conjunction with this Formal Solicitation. In addition, any and all commodities, equipment, and services required by the City in conjunction with construction projects are solicited under a distinctly different solicitation process and shall not be purchased under the terms, conditions and awards rendered under this solicitation, unless such purchases are determined to be in the best interest of the City. 1.56. OCCUPATIONAL LICENSE - Any person, firm, corporation or joint venture, with a business location in the City of Miami and is submitting a Response under this Formal Solicitation shall meet the City's Occupational License Tax requirements in accordance with Chapter 31.1, Article I of the City of Miami Charter. Others with a location outside the City of Miami shall meet their local Occupational License Tax requirements. A copy of the license must be submitted with the response; however, the City may at its sole option and in its best interest allow the Bidder/Proposer to supply the license to the City during the evaluation period, but prior to award. 1.57. ONE PROPOSAL - Only one (1) Response from an individual, firm, partnership, corporation or joint venture will be considered in response to this Formal Solicitation. When submitting an alternate response, please refer to the herein condition for "Alternate Responses May Be Considered". 1.58. OWNERSHIP OF DOCUMENTS - It is understood by and between the parties that any documents, records, files, or any other matter whatsoever which is given by the City to the successful Bidder/Proposer pursuant to this formal solicitation shall at all times remain the property of the City and shall not be used by the Bidder/Proposer for any other purposes whatsoever without the written consent of the City. 1.59. PARTIAL INVALIDITY - If any provision of this Contract or the application thereof to any person or circumstance shall to any extent be held invalid, then the remainder of this Contract or the application of such provision to persons or circumstances other than those as to which it is held invalid shall not be affected thereby, and each provision of this Contract shall be valid and enforced to the fullest extent permitted by law. 1.60. PERFORMANCE/PAYMENT BOND —A Contractor may be required to furnish a Performance/Payment Bond as part of the requirements of this Contract, in an amount equal to one hundred percent (100%) of the contract price. 1.61. PREPARATION OF RESPONSES (HARDCOPY FORMAT) —Bidders/Proposers are expected to examine the specifications, required delivery, drawings, and all special and general conditions. All bid/proposed amounts, if required, shall be either typewritten or entered into the space provided with ink. Failure to do so will be at the Bidder's/Proposer's risk. A. Each Bidder/Proposer shall furnish the information required in the Formal Solicitation. The Bidder/Proposer shall sign the Response and print in ink or type the name of the Bidder/Proposer, address, and telephone number on the face page and on each continuation sheet thereof on which he/she makes an entry, as required. Page 24 of 66 Request for Proposals (RFP) 207193,2 B. If so required, the unit price for each unit offered shall be shown, and such price shall include packaging, handling and shipping, and F.O.B. Miami delivery inside City premises unless otherwise specified. Bidder/Proposer shall include in the response all taxes, insurance, social security, workmen's compensation, and any other benefits normally paid by the Bidder/Proposer to its employees. If applicable, a unit price shall be entered in the "Unit Price" column for each item. Based upon estimated quantity, an extended price shall be entered in the "Extended Price" column for each item offered. In case of a discrepancy between the unit price and extended price, the unit price will be presumed correct. C. The Bidder/Proposer must state a definite time, if required, in calendar days for delivery of goods and/or services. D. The Bidder/Proposer should retain a copy of all response documents for future reference. E. All responses, as described, must be fully completed and typed or printed in ink and must be signed in ink with the firm's name and by an officer or employee having authority to bind the company or firm by his/her signature. Bids/Proposals having any erasures or corrections must be initialed in ink by person signing the response or the response may be rejected. F. Responses are to remain valid for at least 180 days. Upon award of a contract, the content of the Successful Bidder's/Proposer's response may be included as part of the contract, at the City's discretion. G. The City of Miami's Response Forms shall be used when Bidder/Proposer is submitting its response in hardcopy format. Use of any other forms will result in the rejection of the response. IF SUBMITTING HARDCOPY FORMAT, THE ORIGINAL AND THREE (3) COPIES OF THESE SETS OF FORMS, UNLESS OTHERWISE SPECIFIED, AND ANY REQUIRED ATTACHMENTS MUST BE RETURNED TO THE CITY OR YOUR RESPONSE MAY BE DEEMED NON -RESPONSIVE. 1.62. PRICE ADJUSTMENTS — Any price decrease effectuated during the contract period either by reason of market change or on the part of the contractor to other customers shall be passed on to the City of Miami. 1.63. PRODUCT SUBSTITUTES - In the event a particular awarded and approved manufacturer's product becomes unavailable during the term of the Contract, the Contractor awarded that item may arrange with the City's authorized representative(s) to supply a substitute product at the awarded price or lower, provided that a sample is approved in advance of delivery and that the new product meets or exceeds all quality requirements. 1.64. CONFLICT OF INTEREST, AND UNETHICAL BUSINESS PRACTICE PROHIBITIONS - Contractor 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 Contract 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 Contract. 1.65. PROMPT PAYMENT —Bidders/Proposers may offer a cash discount for prompt payment; however, discounts shall not be considered in determining the lowest net cost for response evaluation purposes. Bidders/Proposers are required to provide their prompt payment terms in the space provided on the Formal Solicitation. If no prompt payment discount is being offered, the Bidder/Proposer must enter zero (0) for the percentage discount to indicate no discount. If the Bidder/Proposer fails to enter a percentage, it is understood and agreed that the terms shall be 2% 20 days, effective after receipt of invoice or final acceptance by the City, whichever is later. When the City is entitled to a cashdiscount, the period of computation will commence on the date of delivery, or receipt of a correctly completed invoice, whichever is later. If an adjustment in payment is necessary due to damage, the cash discount period shall commence on the date final approval for payment is authorized. If a discount Page 25 of 66 Request for Proposals (RFP) 207193,2 is part of the contract, but the invoice does not reflect the existence of a cash discount, the City is entitled to a cash discount with the period commencing on the date it is determined by the City that a cash discount applies. Price discounts off the original prices quoted on the Price Sheet will be accepted from successful bidders/proposers during the term of the contract. 1.66. PROPERTY - Property owned by the City of Miami is the responsibility of the City of Miami. Such property furnished to a Contractor for repair, modification, study, etc., shall remain the property of the City of Miami. Damages to such property occurring while in the possession of the Contractor shall be the responsibility of the Contractor. Damages occurring to such property while in route to the City of Miami shall be the responsibility of the Contractor. In the event that such property is destroyed or declared a total loss, the Contractor shall be responsible for replacement value of the property at the current market value, less depreciation of the property, if any. 1.67. PROVISIONS BINDING - Except as otherwise expressly provided in the resulting Contract, all covenants, conditions and provisions of the resulting Contract shall be binding upon and shall inure to the benefit of the parties hereto and their respective heirs, legal representatives, successors and assigns. 1.68. PUBLIC ENTITY CRIMES - A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a response on a contract to provide any goods or services to a public entity, may not submit a response on a contract with a public entity for the construction or repair of a public building or public work, may not submit responses on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list. 1.69. PUBLIC RECORDS - Contractor 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 City of Miami Code, Section 18, Article III, and agrees to allow access by the City and the public to all documents subject to disclosure under applicable law. Contractor's failure or refusal to comply with the provision of this section shall result in the immediate cancellation of this Contract by the City. 1.70. QUALITY OF GOODS, MATERIALS, SUPPLIES, PRODUCTS, AND EQUIPMENT - All materials used in the manufacturing or construction of supplies, materials, or equipment covered by this solicitation shall be new. The items bid/proposed must be of the latest make or model, of the best quality, and of the highest grade of workmanship; unless as otherwise specified in this Solicitation. 1.71. QUALITY OF WORK/SERVICES - The work/services performed must be of the highest quality and workmanship. Materials furnished to complete the service shall be new and of the highest quality except as otherwise specified in this Solicitation. 1.72. REMEDIES PRIOR TO AWARD (Sec. 18-106) - If prior to Contract award it is determined that a formal solicitation or proposed award is in violation of law, then the solicitation or proposed award shall be cancelled by the City Commission, the City Manager or the Chief Procurement Officer, as may be applicable, or revised to comply with the law. 1.73. RESOLUTION OF CONTRACT DISPUTES (Sec. 18-105) (a) Authority to resolve Contract disputes. The City Manager, after obtaining the approval of the city attorney, shall have the authority to resolve controversies between the Contractual Party and the city which arise under, or by virtue of, a Contract between them; provided that, in cases involving an amount greater than $25,000, the City Commission must approve the City Manager's decision. Such authority extends, without limitation, to controversies Page 26 of 66 Request for Proposals (RFP) 207193,2 based upon breach of Contract, mistake, misrepresentation or lack of complete performance, and shall be invoked by a Contractual Party by submission of a protest to the City Manager. (b) Contract dispute decisions. If a dispute is not resolved by mutual consent, the City Manager shall promptly render a written report stating the reasons for the action taken by the City Commission or the City Manager which shall be final and conclusive. A copy of the decision shall be immediately provided to the protesting party, along with a notice of such parry's right to seek judicial relief, provided that the protesting party shall not be entitled to such judicial relief without first having followed the procedure set forth in this section. 1.74. RESOLUTION OF PROTESTED SOLICITATIONS AND AWARDS (See. 18-104) (a) Right to protest. The following procedures shall be used for resolution of protested solicitations and awards except for purchases of goods, supplies, equipment, and services, the estimated cost of which does not exceed $25,000. Protests thereon shall be governed by the Administrative Policies and Procedures of Purchasing. 1.Protest of Solicitation. I. Any prospective proposer who perceives itself aggrieved in connection with the solicitation of a Contract may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within three days after the Request for Proposals, Request for Qualifications or Request for Letters of Interest is published in a newspaper of general circulation. A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer; or H. Any prospective bidder who intends to contest the Solicitation Specifications or a solicitation may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within three days after the solicitation is published in a newspaper of general circulation. A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer. 2. Protest of Award. i. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within two days after receipt by the proposer of the notice of the City Manager's recommendation for award of Contract, which will be posted on the City of Miami Purchasing Department website, in the Supplier Comer, Current Solicitations and Notice of Recommendation of Award Section. The notice of the City Manager's recommendation can be found by selecting the details of the solicitation and is listed as Recommendation of Award Posting Date and Recommendation of Award To fields. If "various" is indicated in the Recommendation of Award To field, the Bidder/Proposer must contact the buyer for that solicitation to obtain the suppliers name. It shall be the responsibility of the Bidder/Proposer to check this section of the website daily after responses are submitted to receive the notice; or ii. Any actual Responsive and Responsible Bidder whose Bid is lower than that of the recommended bidder may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within two days after receipt by the bidder of the notice of the city's determination of non responsiveness or non responsibility. The receipt by bidder of such notice shall be confirmed by the city by facsimile or electronic mail or U.S. mail, retum receipt requested. A notice of intent to file a protest is considered filed when received by the Chief Procurement Officer. iii. A written protest based on any of the foregoing must be submitted to the Chief Procurement Officer within five (5) days after the date the notice of protest was filed. A written protest is considered filed when received by the Chief Procurement Officer. The written protest may not challenge the relative weight of the evaluation criteria or the formula for assigning Page 27 of 66 Request for Proposals (RFP) 207193,2 points in making an award determination. The written protest shall state with particularity the specific facts and law upon which the protest of the solicitation or the award is based, and shall include all pertinent documents and evidence and shall be accompanied by the required Filing Fee as provided in subsection (f). This shall form the basis for review of the written protest and no facts, grounds, documentation or evidence not contained in the protester's submission to the Chief Procurement Officer at the time of filing the protest shall be permitted in the consideration of the written protest. No time will be added to the above limits for service by mail. In computing any period of time prescribed or allowed by this section, the day of the act, event or default from which the designated period of time begins to run shall not be included. The last day of the period so computed shall be included unless it is a Saturday, Sunday or legal holiday in which event the period shallrun until the end of the next day which is neither a Saturday, Sunday or legal holiday. Intermediate Saturdays, Sundays and legal holidays shall be excluded in the computation of the time for filing. (b) Authority to resolve protests. The Chief Procurement Officer shall have the authority, subject to the approval of the City Manager and the city attorney, to settle and resolve any written protest. The Chief Procurement Officer shall obtain the requisite approvals and communicate said decision to the protesting party and shall submit said decision to the City Commission within 30 days after he/she receives the protest. In cases involving more than $25,000, the decision of the Chief Procurement Officer shall be submitted for approval or disapproval thereof to the City Commission after a favorable recommendation by the city attorney and the City Manager. (c) Compliance with filing requirements. Failure of a party to timely file either the notice of intent to file a protest or the written protest, together with the required Filing Fee as provided in subsection (f), with the Chief Procurement Officer within the time provided in subsection (a), above, shall constitute a forfeiture of such parry's right to file a protest pursuant to this section. The protesting party shall not be entitled to seek judicial relief without first having followed the procedure set forth in this section (d) Stay of Procurements during protests. Upon receipt of a written protest filed pursuant to the requirements of this section, the city shall not proceed further with the solicitation or with the award of the Contract until the protest is resolved by the Chief Procurement Officer or the City Commission as provided in subsection (b) above, unless the City Manager makes a written determination that the solicitation process or the Contract award must be continued without delay in order to avoid an immediate and serious danger to the public health, safety or welfare. (e) Costs. All costs accruing from a protest shall be assumed by the protestor. (f) Filing Fee. The written protest must be accompanied by a filing fee in the form of a money order or cashier's check payable to the city in an amount equal to one percent of the amount of the Bid or proposed Contract, or $5000.00, whichever is less, which filing fee shall guarantee the payment of all costs which may be adjudged against the protestor in any administrative or court proceeding. If a protest is upheld by the Chief Procurement Officer and/or the City Commission, as applicable, the filing fee shall be refunded to the protestor less any costs assessed under subsection (e) above. If the protest is denied, the filing fee shall be forfeited to the city in lieu of payment of costs for the administrative proceedings as prescribed by subsection (e) above. 1.75. SAMPLES - Samples of items, when required, must be submitted within the time specified at no expense to the City. If not destroyed by testing, bidder(s)/proposer(s) will be notified to remove samples, at their expense, within 30 days after notification. Failure to remove the samples will result in the samples becoming the property of the City. 1.76. SELLING, TRANSFERRING OR ASSIGNING RESPONSIBILITIES - Contractor shall not sell, assign, transfer or subcontract at any time during the term of the Contract, or any part of its operations, or assign any portion Page 28 of 66 Request for Proposals (RFP) 207193,2 of the performance required by this contract, except under and by virtue of written permission granted by the City through the proper officials, which may be withheld or conditioned, in the City's sole discretion. 1.77. SERVICE AND WARRANTY —When specified, the bidder/proposer shall define all warranty, service and replacements that will be provided. Bidders/Proposer must explain on the Response to what extent warranty and service facilities are available. A copy of the manufacturer's warranty, if applicable, should be submitted with your response. 1.78. SILENCE OF SPECIFICATIONS - The apparent silence of these specifications and any supplemental specification as to any detail or the omission from it of detailed description concerning any point shall be regarded as meaning that only the best commercial practices are to prevail and that only materials of first quality and correct type, size and design are to be used. All workmanship and services is to be first quality. All interpretations of these specifications shall be made upon the basis of this statement. If your firm has a current contract with the State of Florida, Department of General Services, to supply the items on this solicitation, the bidder/proposer shall quote not more than the contract price; failure to comply with this request will result in disqualification of bid/proposal. 1.79. SUBMISSION AND RECEIPT OF RESPONSES - Responses shall be submitted electronically via the Oracle System or responses may be submitted in hardcopy format to the City Clerk, City Hall, 3500 Pan American Drive, Miami, Florida 33133-5504, at or before, the specified closing date and time as designated in the IFB, RFP, RFQ, or RFLI. NO EXCEPTIONS. Bidders/Proposers are welcome to attend the solicitation closing; however, no award will be made at that time. A. Hardcopy responses shall be enclosed in a sealed envelope, box package. The face of the envelope, box or package must show the hour and date specified for receipt of responses, the solicitation number and title, and the name and return address of the Bidder/Proposer. Hardcopy responses not submitted on the requisite Response Forms may be rejected. Hardcopy responses received at any other location than the specified shall be deemed non -responsive. Directions to City Hall: FROM THE NORTH: I-95 SOUTH UNTIL IT TURNS INTO US1. US1 SOUTH TO 27TH AVE., TURN LEFT, PROCEED SOUTH TO SO. BAYSHORE DR. (3RD TRAFFIC LIGHT), TURN LEFT, 1 BLOCK TURN RIGHT ON PAN AMERICAN DR. CITY HALL IS AT THE END OF PAN AMERICAN DR. PARKING IS ON RIGHT. FROM THE SOUTH: US1 NORTH TO 27TH AVENUE, TURN RIGHT, PROCEED SOUTH TO SO. BAYSHORE DR. (3RD TRAFFIC LIGHT), TURN LEFT, 1 BLOCK TURN RIGHT ON PAN AMERICAN DR. CITY HALL IS AT THE END OF PAN AMERICAN DR. PARKING IS ON RIGHT. B. Facsimile responses will not be considered. C. Failure to follow these procedures is cause for rejection of bid/proposal. D. The responsibility for obtaining and submitting a response on or before the close date is solely and strictly the responsibility of Bidder/Proposer. The City of Miami is not responsible for delays caused by the United States mail delivery or caused by any other occurrence. Responses received after the solicitation closing date and time will be returned unopened, and will not be considered for award. E. Late responses will be rejected. F. All responses are subject to the conditions specified herein. Those which do not comply with these conditions are subject to rejection. Page 29 of 66 Request for Proposals (RFP) 207193,2 G. Modification of responses already submitted will be considered only if received at the City before the time and date set for closing of solicitation responses. All modifications must be submitted via the Oracle System or in writing. Once a solicitation closes (closed date and/or time expires), the City will not consider any subsequent submission which alters the responses. H. If hardcopy responses are submitted at the same time for different solicitations, each response must be placed in a separate envelope, box, or package and each envelope, box or package must contain the information previously stated in 1.82.A. 1.80. TAXES - The City of Miami is exempt from any taxes imposed by the State and/or Federal Government. Exemption certificates will be provided upon request. Notwithstanding, Bidders/Proposers should be aware of the fact that all materials and supplies which are purchased by the Bidder/Proposer for the completion of the contract is subject to the Florida State Sales Tax in accordance with Section 212.08, Florida Statutes, as amended and all amendments thereto and shall be paid solely by the Bidder/Proposer. 1.81. TERMINATION —The City Manager on behalf of the City of Miami reserves the right to terminate this contract by written notice to the contractor effective the date specified in the notice should any of the following apply: A. The contractor is determined by the City to be in breach of any of the terms and conditions of the contract. B. The City has determined that such termination will be in the best interest of the City to terminate the contract for its own convenience; C. Funds are not available to cover the cost of the goods and/or services. The City's obligation is contingent upon the availability of appropriate funds. 1.82. TERMS OF PAYMENT - Payment will be made by the City after the goods and/or services awarded to a Bidder/Proposer have been received, inspected, and found to comply with award specifications, free of damage or defect, and properly invoiced. No advance payments of any kind will be made by the City of Miami. Payment shall be made after delivery, within 45 days of receipt of an invoice and authorized inspection and acceptance of the goods/services and pursuant to Section 218.74, Florida Statutes and other applicable law. 1.83. TIMELY DELIVERY - Time will be of the essence for any orders placed as a result of this solicitation. The City reserves the right to cancel such orders, or any part thereof, without obligation, if delivery is not made within the time(s) specified on their Response. Deliveries are to be made during regular City business hours unless otherwise specified in the Special Conditions. 1.84. TITLE - Title to the goods or equipment shall not pass to the City until after the City has accepted the goods/equipment or used the goods, whichever comes first. 1.85.TRADE SECRETS EXECUTION TO PUBLIC RECORDS DISCLOSURE- All Responses submitted to the City are subject to public disclosure pursuant to Chapter 119, Florida Statutes. An exception may be made for "trade secrets." If the Response contains information that constitutes a "trade secret", all material that qualifies for exemption from Chapter 119 must be submitted in a separate envelope, clearly identified as "TRADE SECRETS EXCEPTION," with your firm's name and the Solicitation number and title marked on the outside. Please be aware that the designation of an item as a trade secret by you may be challenged in court by any person. By your designation of material in your Response as a "trade secret" you agree to indemnify and hold harmless the City for any award to a plaintiff for damages, costs or attorney's fees and for costs and attomey's fees incurred by Page 30 of 66 Request for Proposals (RFP) 207193,2 the City by reason of any legal action challenging your claim. 1.86. UNAUTHORIZED WORK OR DELIVERY OF GOODS- Neither the qualified Bidder(s)/Proposer(s) nor any of his/her employees shall perform any work or deliver any goods unless a change order or purchase order is issued and received by the Contractor. The qualified Bidder(s)/Proposer(s) shall not be paid for any work performed or goods delivered outside the scope of the contract or any work performed by an employee not otherwise previously authorized. 1.87. USE OF NAME - The City is not engaged in research for advertising, sales promotion, or other publicity purposes. No advertising, sales promotion or other publicity materials containing information obtained from this Solicitation are to be mentioned, or imply the name of the City, without prior express written permission of the City Manager or the City Commission. 1.88. VARIATIONS OF SPECIFICATIONS - For purposes of solicitation evaluation, bidders/proposers must indicate any variances from the solicitation specifications and/or conditions, no matter how slight. If variations are not stated on their Response, it will be assumed that the product fully complies with the City's specifications. Page 31 of 66 Request for Proposals (RFP) 207193,2 2. Special Conditions 2.1. PURPOSE The purpose of this Solicitation is to establish a contract, for Claims Administration Services for Workers Compensation, Liability, and Managed Care Services and, as specified herein, from a source(s) of supply that will give prompt and efficient service fully compliant with the terms, conditions and stipulations of the solicitation. 2.2. DEADLINE FOR RECEIPT OF REQUEST FOR ADDITIONAL INFORMATION/CLARIFICATION Any questions or clarifications concerning this solicitation shall be submitted by email or facsimile to the Purchasing Department, Attn: Maritza Suarez, CPPB; fax: (305) 400-5025 or email: msuarez@ci.miami,fl.us. The solicitation title and number shall be referenced on all correspondence. All questions must be received no later than Tuesday, April 20, 2010 at 3:00 PM Eastern Standard Time. All responses to questions will be sent to all prospective bidders/proposers in the form on an addendum. NO QUESTIONS WILL BE RECEIVED VERBALLY OR AFTER SAID DEADLINE. 2.3. TERM OF CONTRACT The proposer(s) qualified to provide the service(s) requested herein (the "Successful Proposer(s)") shall be required to execute a contract ("Contract") with the City, which shall include, but not be limited to, the following terms: (1) The term of the Contract(s) shall be for three (3) years with an option to renew for five (5) additional one (1) year periods. (2) The City shall have the option to extend or terminate the Contract. Continuation of the contract beyond the initial period is a City prerogative; not a right of the bidder/proposer. This prerogative will be exercised only when such continuation is clearly in the best interest of the City. 2.4. CONDITIONS FOR RENEWAL Each renewal of this contract is subject to the following: (1) Continued satisfactory performance compliance with the specifications, terms and conditions established herein. (2) Availability of funds 2.5. NON -APPROPRIATION OF FUNDS In the event no funds or insufficient funds are appropriated and budgeted or are otherwise unavailable in any fiscal period for payments due under this contract, then the City, upon written notice to Contractor or his assignee of such occurrence, shall have the unqualified right to terminate the contract without any penalty or expense to the City. No guarantee, warranty or representation is made that any particular or any project(s) will be awarded to any firm(s), 2.6. MINIMUM QUALIFICATION REQUIREMENTS Page 32 of 66 Request for Proposals (RFP) 207193,2 Proposer Qualifications Proposers shall satisfy each of the following requirements cited below. Failure to do so will result in the Proposal being deemed non -responsive. For the provision of Part I, Claims Administration Services. Part II. General, Automobile, and Professional Liability Claims Administration and Part III, Managed Care Services: A. Proposer shall have been in existence and providing the services as described in this RFP for a minimum of five (5) years; and have sufficient financial support, equipment and organization to insure that it can satisfactorily execute the services if awarded a Contract under the terms and conditions herein stated. B. Shall have the ability to effectively interface with the computerized tracking system of the City and its proposed on-line claims management system, or if Proposer plans to provide its own system, must provide system and interface with City's system and data. C. Neither Proposer nor any member, officer, or stockholder of Proposer (s) shall be in arrears or in default of any debt or contract involving the City, (as a party to a contract, or otherwise); nor have failed to perform faithfully on any previous contract with the City. 2.7. CONTRACT EXECUTION The selected Proposer(s) evaluated and ranked in accordance with the requirements of this Solicitation, shall be awarded an opportunity to negotiate a contract ("Contract") with the City. The City reserves the right to execute or not execute, as applicable a Contract with the selected Proposer(s) that is determined to be most advantageous and in the City's best interest. Such Contract will be furnished by the City, will contain certain terms as are in the City's best interests, and will be subject to approval as to legal form by the City Attorney. 2.8. MANDATORY PRE -PROPOSAL CONFERENCE Potential Proposers are required to attend the Mandatory Pre -Proposal Conference, which will occur on Monday, April 19, 2010 at 10:00 a.m., at 444 SW 2nd Avenue, 10th Floor Large Conference Room, Miami, Florida. A discussion of the requirements of the solicitation will occur at that time. Each potential Proposer is required, prior to submitting a Proposal, to acquaint itself thoroughly with any and all conditions and/or requirements that may in any manner affect the work to be performed. No allowances will be made because of lack of knowledge of these conditions. The purpose of the pre -proposal conference is to allow potential Proposers an opportunity to present questions to staff and obtain clarification of the requirements of the solicitation documents. Because the City considers the conference to be critical to understanding the solicitation requirements, attendance is Mandatory. Proposers who arrive more than one-half (1/2) hour late to the conference shall not be deemed as having met this mandatory requirement. FAILURE TO ATTEND SHALL DEEM ANY PROPOSAL FROM UNATTENDING PROPOSER AS NON -RESPONSIVE. 2.9. FAILURE TO PERFORM Should it not be possible to reach the contractor or supervisor and/or should remedial action not be taken within 48 hours of any failure to perform according to specifications, the City reserves the right to declare Contractor in Page 33 of 66 Request for Proposals (RFP) 207193,2 default of the contract or make appropriate reductions in the contract payment. 2.10. INSURANCE REQUIREMENTS INDEMNIFICATION Bidder shall pay on behalf of, indemnify and save City and its officials harmless, from and against any and all claims, liabilities, losses, and causes of action, which may arise out of bidder's performance under the provisions of the contract, including all acts or omissions to act on the part of bidder, including any person performing under this Contract for or on bidder's behalf, provided that any such claims, liabilities, losses and causes of such action are not attributable to the negligence or misconduct of the City and, from and against any orders, judgments or decrees which may be entered and which may result from this Contract, unless attributable to the negligence or misconduct of the City, and from and against all costs, attorneys' fees, expenses and liabilities incurred in the defense of any such claim, or the investigation thereof. The bidder shall furnish to City of Miami, c/o Purchasing Department, 444 SW 2nd Avenue, 6th Floor, Miami, Florida 33130, Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets the requirements as outlined below: (1) Worker's Compensation A. Limits of Liability - Statutory - State of Florida - Waiver of Subrogation (2) Commercial General Liability A. Limits of Liability Bodily Injury and Property Damage Liability - Each Occurrence: $1,000,000 General Aggregate Limit: $2,000,000 Personal and Adv. Injury: $1,000,000 Products and Completed Operations: $1,000,000. B. Endorsements Required: City of Miami included as an Additional insured. Employees included as insured. Contractual Liability. Premises and Operations Liability Contingent Liability (3) BusinessAutomobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Combined Single Limit. Any Auto, including Hired, Borrowed or or Non -Owned Autos. Any One Accident: $1,000,000 B. Endorsements Required: City of Miami included as an Additional Insured (4) Employer's Liability A. Limits of Liability $100,000 for bodily injury caused by an accident, each accident $100,000 for bodily injury caused by disease, each employee Page 34 of 66 (5) Request for Proposals (RFP) 207193,2 $500.000 for bodily injury caused by disease, policy limit Excess Liability A. Limits of Liability Each Occurrence: $1,000,000.00 Aggregate: $1,000,000.00 (6) Errors and Omissions/Professional Liability A. Limits of Liability Each Claim: $5,000,000.00 Aggregate: $5,000,000.00 Crime Coverage (If applicable) A. Limits of Liability: $1,000,000.00 City of Miami included as a loss payee BINDERS ARE UNACCEPTABLE. The insurance coverage required shall include those classifications, as listed in standard liability insurance manuals, which most nearly reflect the operations of the bidder. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: The Company must be rated no less than "A" as to management, and no less than "Class V" as to financial strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and/or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. Certificates will indicate no modification or change in insurance shall be made without thirty (30) days written advance notice to the certificate holder. NOTE: CITY BID NUMBER AND/OR TITLE OF BID MUST APPEAR ON EACH CERTIFICATE. Compliance with the foregoing requirements shall not relieve the bidder of his liability and obligation under this section or under any other section of this Agreement. --If insurance certificates are scheduled to expire during the contractual period, the Bidder 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: (8) Suspend the contract until such time as the new or renewed certificates are received by the City in the manner prescribed in the Invitation To Bid. (9) The City may, at its sole discretion, terminate this contract for cause and seek re -procurement damages from the Bidder in conjunction with the General and Special Terms and Conditions of the Bid. The Bidder 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 Bidder. (7) 2.11. CONTRACT ADMINISTRATOR Page 35 of 66 Request for Proposals (RFP) 207193,2 Upon award, contractor shall report and work directly with Ms. Angella Breadwood, who shall be designated as the Contract Administrator. 2.12. SUBCONTRACTOR(S) OR SUBCONSULTANT(S) A Sub -Consultant, herein known as Sub-Contractor(s) is an individual or firm contracted by the Proposer or Proposer's firm to assist in the performance of services required under this Solicitation. A Sub -Contractor shall be paid through Proposer or Proposer's firm and not paid directly by the City. Sub -Contractors are allowed by the City in the performance of the services delineated within this Solicitation. Proposer must clearly reflect in its Proposal the major Sub -Contractors to be utilized in the performance of required services. The City retains the right to accept or reject any Sub -Contractors proposed in the response of Successful Proposer or prior to contract execution. Any and all liabilities regarding the use of a Sub -Contractor shall be borne solely by the Successful Proposer and insurance for each Sub -Contractors must be maintained in good standing and approved by the City throughout the duration of the Contract. Neither Successful Proposer nor any of its Sub -Contractors are considered to be employees or agents of the City. Failure to list all Sub -Contractors and provide the required information may disqualify any proposed Sub -Contractors from performing work under this Solicitation. Proposers shall include in their Responses the requested Sub -Contractor information and include all relevant information required of the Proposer. In addition, within five (5) working days after the identification of the award to the Successful Proposer, the Successful Proposer shall provide a list confirming the Sub -Contractors that the Successful Proposer intends to utilize in the Contract, if applicable. The list shall include, at a minimum, the name, location of the place of business for each Sub -Contractor, the services Sub -Contractor will provide relative to any contract that may result from this Solicitation, any applicable licenses, references, ownership, and other information required of Proposer. 2.13. TERMINATION A. FOR DEFAULT If Contractor defaults in its performance under this Contract and does not cure the default within 30 days after written notice of default, the City Manager may terminate this Contract, in whole or in part, upon written notice without penalty to the City of Miami. In such event the Contractor shall be liable for damages including the excess cost of procuring similar supplies or services: provided that if, (1) it is determined for any reason that the Contractor was not in default or (2) the Contractor's failure to perform is without his or his subcontractor's control, fault or negligence, the termination will be deemed to be a termination for the convenience of the City of Miami. B. FOR CONVENIENCE The City Manager may terminate this Contract, in whole or in part, upon 30 days prior written notice when it is in the best interests of the City of Miami. If this Contract is for supplies, products, equipment, or software, and so terminated for the convenience by the City of Miami the Contractor will be compensated in accordance with an agreed upon adjustment of cost. To the extent that this Contract is for services and so terminated, the City of Miami shall be liable only for payment in accordance with the payment provisions of the Contract for those services rendered prior to termination. 2.14. ADDITIONAL TERMS AND CONDITIONS Page 36 of 66 Request for Proposals (RFP) 207193,2 No additional terms and conditions included with the solicitation response shall be evaluated or considered, and any and all such additional terms and conditions shall have no force or effect and are inapplicable to this solicitation. If submitted either purposely, through intent or design, or inadvertently, appearing separately in transmittal letters, specifications, literature, price lists or warranties, it is understood and agreed that the General and Special Conditions in this solicitation are the only conditions applicable to this solicitation and that the bidder's/proposer's authorized signature affixed to the bidder's/proposer's acknowledgment form attests to this. 2.15. PRIMARY CLIENT (FIRST PRIORITY) The successful bidder(s)/proposer(s) agree upon award of this contract that the City of Miami shall be its primary client and shall be serviced first during a schedule conflict arising between this contract and any other contract successful bidder(s)/proposer(s) may have with any other cities and/or counties to perform similar services as a result of any catastrophic events such as tornadoes, hurricanes, severe storms or any other public emergency impacting various areas during or approximately the same time. 2.16. UNAUTHORIZED WORK The Successful Proposer(s) shall not begin work until a Purchase Order is received. 2.17. CHANGES/ALTERATIONS Proposer may change or withdraw a Proposal at any time prior to Proposal submission deadline; however, no oral modifications will be allowed. Written modifications shall not be allowed following the proposal deadline. 2.18. COMPENSATION PROPOSAL Each Proposer shall detail any and all fees and costs to provide the required services as listed herein, and in accordance with the Submission Requirement for each of the Part(s) proposer is submitting a proposal for. Proposer shall additionally provide a detailed list of all costs to provide all services as detailed in Section III Scope of Services, as proposed. The City reserves the right to add or delete any service, at any time. Should the City determine to add an additional service for which pricing was not previously secured, the City shall seek the Successful Proposer to provide reasonable cost(s) for same. Should the City determine the pricing unreasonable, the City reserves the right to negotiate cost(s) or seek another vendor for the provision of said service(s). Failure to submit compensation proposal as required shall disqualify Proposer from consideration. 2.19. EVALUATION/SELECTION PROCESS AND CONTRACT AWARD The procedure for response evaluation, selection and award is as follows: (1) Solicitation issued. (2) Receipt of responses (3) Opening and listing of all responses received (4) Purchasing staff will review each submission for compliance with the submission requirements of the Page 37 of 66 Request for Proposals (RFP) 207193,2 Solicitation, including verifying that each submission includes all documents required. (5) An Evaluation Committee, appointed by the City Manager, comprised of appropriate City Staff and members of the community, as deemed necessary, with the appropriate technical expertise and/or knowledge, shall meet to evaluate each response in accordance with the requirements of this Solicitation and based upon the evaluation criteria as specified herein. (6) The Evaluation Committee reserves the right, in its sole discretion, to request Proposers to make oral presentations before the Committee as part of the evaluation process. The presentation may be scheduled at the convenience of the Evaluation Committee and shall be recorded. (7) The Evaluation Committee reserves the right to rank the Proposals and shall submit its recommendation to the City Manager for acceptance. If the City Manager accepts the Committee's recommendation, the City Manager's recommendation for award of contract will be posted on the City of Miami Purchasing Department website, in the Supplier Comer, Current Solicitations and Notice of Recommendation of Award Section. The notice of the City Manager's recommendation can be found by selecting the details of the solicitation and is listed as Recommendation of Award Posting Date and Recommendation of Award To fields. If "various" is indicated in the Recommendation of Award To field, the Bidder/Proposer must contact the buyer for that solicitation to obtain the suppliers name. The City Manager shall make his recommendation to the City Commission requesting the authorization to negotiate and/or execute an agreement with the recommended Proposer(s). No Proposer(s) shall have any rights against the City arising from such negotiations or termination thereof. (8) The City Manager reserves the right to reject the Committee's recommendation, and instruct the Committee to re-evaluate and make another recommendation, reject all proposals, or recommend that the City Commission reject all proposals. (9) The City Commission shall consider the City Manager's and Evaluation Committees' recommendation(s) and, if appropriate and required, approve the City Manager's recommendation(s). The City Commission may also reject any or all response. (10) If the City Commission approves the recommendations, the City will enter into negotiations with the selected Proposer(s) for a contract for the required services. Such negotiations may result in contracts, as deemed appropriate by the City Manager. (11) The City Commission shall review and approve the negotiated Contract with the selected Proposer(s). 2.20. ADDITIONAL SERVICES Services not specifically identified in this request may be added to any resultant contract upon successful negotiation and mutual consent of the contracting parties. 2.21. RECORDS During the contract period, and for a least five (5) subsequent years thereafter, Successful Proposer shall provide City access to all files and records maintained on the City's behalf. 2.22. ATTACHMENTS A. Managed Care Contract with AmeriSys B. Third Party Claim Administration Contract with Gallagher Bassett Page 38 of 66 Request for Proposals (RFP) 207193,2 C. Labor Agreements with 1 FOP 2. TAFF 3. AFSCME 4. CIGU D. Background Information on Workers Compensation Claims Please be advised that due to the voluminous nature of Attachments A, B, and C, the aforementioned Attachments will be distributed at the Mandatory Pre -Proposal Conference. Attachment D is included with this RFP. 2.23. TRUTH IN NEGOTIATION CERTIFICATE Execution of the resulting agreement by the Successful Proposer shall act as the execution of truth -in -negotiation certificate stating that wage rates and other factual unit costs supporting the compensation of the resulting Agreement are accurate, complete, and current at the time of contracting. The original contract price and any additions thereto shall be adjusted to exclude any significant sums by which City determines the contract price was increased due to inaccurate, incomplete, or non -current wage rates and other factual unit costs. All such contract adjustments shall be made within one (1) year following the end of the Agreement. Page 39 of 66 Request for Proposals (RFP) 207193,2 3. Specifications 3.1. SPECIFICATIONS/SCOPE OF WORK 3.1 BACKGROUND It is the City's intention to establish, on behalf of the Department of Risk Management, a term Contract for the provision of various services described below. The services required under this RFP will be divided into three (3) Parts: Part I Services: Workers Compensation Claims Administration Services Part II Services: General, Automobile and Professional Liability Claims Administration Services Bart III Services: Managed Care Services While the City is seeking a Proposer to provide comprehensive services to meet all of its needs indicated above, Proposer may propose to provide either Part I, Part II, and/or Part III services. The City reserves the right to award Part I, Part II, and/or Part III services to a Successful Proposer(s), whichever is in the best interests of the City. The Contract for the provision of Part I, Part II, and/or Part III services is to be for an initial period of three (3) years, with five (5) one (1) year renewal options. Proposals not including an all inclusive guaranteed annual fee for three years for all specified services, except for Managed Care, will not be considered. The City's current Third Party Claims Administrator is Gallagher Bassett Services, Inc. and Managed Care Administrator is AmeriSys. They have been under contract to provide services since October, 2003. The Department of Risk Management provides optimum service to employees and the public through a variety of interrelated health, safety and liability/loss control programs. The provision of these crucial prevention -oriented programs greatly enhances the working environment and serves as an incentive for employee recruitment, retention and satisfaction, while protecting the City's assets, employees and citizens. Its objectives include goals to eliminate, where possible, the threat of accident and other forms of liability, and where it is possible to eliminate the risk, to at the very least, reduce the possibility of an accident or risk occurring. Currently, the City has approximately 4,486 employees, including approximately 1,190 sworn law enforcement officers and 635 sworn fire personnel, temporary and part-time employees. There are four (4) Labor Unions in the City: Fraternal Order of Police (FOP), American Federation of State County and Municipal Employees (AFSCME), International Association of Fire Fighters (IAFF), and American Federation of State, County and Municipal Employees 79 (AFSCME). Labor unions represent eighty-five (85%) of the City's workforce. Any assessment of Risk Management must consider each of the existing labor contracts for the above as it affects employees related to workers compensation and group health benefits. See attachment C. The City has created and maintains a Self -Insurance program. The Self Insurance Program provides protection to the City for all property and casualty loss exposures, workers' compensation claims and provides group health benefits to active and retired employees. In addition, Risk Management cares for the City's injured workers. Attention is focused in the areas of safety awareness, prevention, treatment of injured workers, rehabilitation, job placement, education, and communications with the employees and the departments. Guidelines for the treatment and care of injured employees are based on Florida Statutes 440 which govern the State's Workers' Compensation Law. However, as a result of bargaining agreements, additional benefits are granted depending on the bargaining unit. The Proposer must become familiar with the existing labor contracts. These contracts will be provided to prospective proposers at the Mandatory Pre -Proposal Conference, due to their bulk. The City's current claims administrator utilizes Risx Facs claim processing system where all data is maintained, Page 40 of 66 Request for Proposals (RFP) 207193,2 updated and payments are issued. The adjudication of Worker's Compensation medical bills and payments to the City's providers are performed through this system. Any computer system/software proposed must successfully integrate with all other computerized systems used by the current claims administrator, Finance and other applicable departments throughout the term of the Contract. Currently, Gallagher Bassett through Citibank provides the City with bank reconciliation reports to interface with the City's financial system on a monthly basis. The Successful Proposer(s) shall be responsible for the conversion of any data necessary should its proposed system not be compatible with the City's. Any procedures, equipment, software, or any other costs necessary to replace the existing Risx Facs system and/or connect with the current claims administrator's hardware and software shall be the sole responsibility of the Successful Proposer(s). Workers' Compensation medical bills, indemnity payments and all settlement payments are processed through this system. On a monthly basis, Gallagher Bassett Services provides the City with bank reconciliations for reconciliation with the City's financial information. Self Insurance Program The City is 100% self -insured for Workers' Compensation and maintains a formal Self -Insurance Program ("Program"). The City utilizes the Program to provide protection to the City for all property and casualty loss exposures and Workers' compensation claims and to provide group health benefits to its active and retired employees. Proposers should refer to Attachment D for a history of Workers' Compensation claims of the City for the past three (3) years. There is an excess Workers' Compensation policy in effect since 2/5/01-9/30/09 for injuries which occurred during that period. Although the Program utilizes a single insurance fund, the scope of Part I of the RFP addresses the area of Workers' Compensation only. Managed Care Program Per the provision of Part III services, the City had originally entered into a Managed Care Agreement with AmeriSys. AmeriSys now provides managed care to the City. This contract will expire October 2011, and it does not have any further extensions. Under the current extension, the City has the right to procure managed care services prior to the expiration of final extension. Refer to Attachment A . Reporting requirements with AmeriSys include the provision of monthly reported claims report; monthly open claims report; daily DWC1; and weekly status reports. Safety Program The City recognizes the importance of a strong Safety Program as a primary tool for mitigating losses. The City runs a City-wide Safety Program under the Department of Risk Management. The Safety Manager who develops and implements safety objectives heads the Division of Safety. The development of safe working conditions and practices are the principal objectives, along with the reduction in work -related accidents and injuries. Regular safety inspections are performed to reduce and eliminate hazards and ensure employees are using proper equipment and procedures. Claims investigation and accident analysis are conducted to locate areas of frequent accidents and patterns. An appropriate educational program has been established to increase employee awareness of safety and loss prevention. Additionally, driver training courses are provided to reduce frequency and severity of auto related injuries. It is the expectation of the Successful Proposer to work closely with the Safety Manager to enhance the Safety Program for the entire City and all labor groups. Light Duty Program The City has accommodated Light -Duty Programs for injured employees for many years. It is the expectation of the Successful Proposer to assist in exploring enhancement and development of a comprehensive Light Duty Program for the entire City and all labor groups. 3.2 SCOPE OF WORK Page 41 of 66 Request for Proposals (RFP) 207193,2 PART I - WORKERS COMPENSATION CLAIMS ADMINISTRATION The City is seeking Proposals for third party Claims Administration Services by a Successful Proposer ("Claims Administrator") for the City's Workers' Compensation Self -Insurance Program. The Claims Administrator will provide 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. this RFP. However, the City reserves the right to add additional services as may be deemed necessary. The Claims Administrator must be prepared to assume the daily activities in the processing and handling of Workers' Compensation claims. The Claims Administrator shall recommend risk control measures and safety programs to protect the City's interest. The staff of the Claims Administrator will be required to work closely with the City Attorney's Office, the Finance Department and other major departments in the City. The City is seeking Proposals for third party claims administration services for its self-insurance program. The City carries excess workers' compensation coverage (with SIR of $350,000 - $500,000 per claim for years 2001-2009). The Claims Administrator must be familiar with and have working knowledge of 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. The Claims Administrator shall provide Claims personnel, who shall be available on a 7 day, 24 hour basis for investigating claims, and must have and maintain an 800 or other toll -free telephone for emergency service. The s adjuster or staff of adjusters. s claims Claims Administrator ave limited settlement authority,cand all larger settlements,e space or facility(s) for testablished by the City, must bet adjusters wapproved by the City. The Successful Proposer must agree to be responsible to manage Workers' Compensation claims to be opened within the year(s) following contract execution, along with the current inventory of open files. The City is seeking a Successful Proposer that will provide claims administration on a "life of relationship basis." At this time, Risk Management oversees Workers' Compensation claims administered by the current claims administrator. The number of personnel utilized by the claims administrator for current claims vs. future claims includes 6 adjusters, and 2 claims representatives. The City must be able to access Proposer's system, and Proposer must include any costs of its system in its Proposal. A. The Claims Administrator shall be responsible for performing, as a minimum, the following services: 1. Establish reporting procedures which are compatible with the needs and organizational structure of the City as determined by Risk Management. Notice of injury reports will be submitted to the administrator paperless format i.e. Internet or E-mail. Establish claims acknowledgment procedures to the City's satisfaction. 2. Provide necessary forms and instructions for use. Such forms are to include appropriate first reports of injury with mailing address of claim administrator pre-printed thereon. 3. Designate the number of adjusters necessary to appropriately handle the City's claims. 4. Receive and examine on behalf of the City all reports of employee injury claims 5. Establish and maintain complete files on each claim. Page 42 of 66 Request for Proposals (RFP) 207193,2 6. Accept or deny all reported claims for employee's injuries on behalf of the City in accordance with the applicable Workers' Compensation Law. The decision to controvert a claim must first be discussed with and approved by Risk Management. 7. Conduct the required investigations deemed necessary as it relates to Workers' Compensation, including scene investigations and personal claimant contact on all lost time or light duty cases. Contact with claimants must be attempted within 24 hours of the Administrator's receipt of the claim. Field investigations and claimant contact must be performed by employees of the Administrator. Independent adjusters cannot be used to provide this service. 9. Perform job site visits to become familiar with exposures unique to the City. 10. Provide a list every 30 days indicating all employees that are losing time or working in a light -duty or restricted capacity. 11. Submit a full summary report to Risk Management every 90 days on all claims of the following types: a) any claim in which an employee is not working full -duty b) total incurred value exceeding $25,000 c) potentially controverted cases d) cardiovascular claims e) claims in which settlement (washout) is recommended 12. Prepare and maintain files necessary for legal defense of claims and/or other litigation (such as actions for subrogation) or other proceedings. 13. Pay in a timely fashion all claims and expenses from the loss fund account established by the City, which will be maintained by the Administrator. Fees and civil penalties for late payments are to be paid by the Administrator unless caused due to late reporting by the City. 14. Pursue all possibilities of subrogation and recovery from the Special Disability Fund. 15. While the City will designate the attorney(s) that provide the defense of claims, the Administrator shall provide the defense attomey(s) a complete copy of the file in question and monitor and actively participate in the activities of the defense attorney(s). 16. Attend Workers' Compensation hearings, mediations and Pension Board hearings involving work -related injuries as requested by the City. 17. Make written recommendations to Risk Management regarding any procedure or condition that should be examined to prevent future claims, which are revealed during the Administrator's investigation of a claim. 18. Contact Risk Management by telephone on all claims where the compensability or the relatedness of the medical expenses on the claim is in question. 19. Contact employees who experience loss time at least every two weeks, for the duration of temporary total disability payments. When an employee is represented, the attorney shall be contacted when appropriate, If attorney contact is appropriate, that contact should be on a 60-day basis. 20. Report all lost time and/or questionable cases to the Index Bureau. All lost time shall be re -indexed every six (6) months. 21. Establish initial reserves within ten (10) days of receipt of the First Report. All files must be reserved adequately to extend through the expected life of the claim. Although all the necessary facts may not be available at Page 43 of 66 Request for Proposals (RFP) 207193,2 the onset of a claim, reserves should be adjusted when medical information or investigation indicates the existing reserve is inadequate or overstated. The following factors shall be considered when establishing a reserve: a) the injury; b) the investigation; c) medical treatment and costs; d) projected temporary total disability benefits to be paid; e) projected permanent partial disability and impairment benefits, f) and potential use of outside experts (i.e., rehabilitation service providers, attorneys, etc.) The Administrator shall review the adequacy of reserves at least every three months, and documentation in the file shall reflect this review. 22. Present in writing all settlements to Risk Management and City Attorney for approval, regardless of the amount. The injured employee will not be contacted regarding settlement until approval of proposed settlement is obtained from Risk Management and and/or City Attorney. 23. Follow all DWC rules when compensation, medical or other benefits are being controverted. The case must be discussed with Risk Management before the claim is denied. 24. Obtain medical reports as necessary to determine the status of the employee's injury and to verify disability; coordinate with the City's Managed Care provider. 25. Report all claims involving a fatality to Risk Management immediately. Payments on such files shall be made in accordance with the Florida Workers' Compensation Law and/or governing contractual agreements. Periodic activity checks shall be performed to ensure that dependents who receive survivor's benefits are still eligible to receive them, and notify Risk Management regarding those activity checks. 26. Prepare and file with the appropriate State agency all applications required for the City's qualification as a self -insurer. 27. Prepare, maintain and file all records and reports as may be required by legal authorities (State, local and Federal.) Attach copies of reports. 28. Prepare, maintain and file statistical or other records and reports as required by the Division of Workers' Compensation. 29. Prepare, maintain and file statistical information required by Workers' Compensation Rating Bureaus, including all required data necessary for the promulgation of experience modifications. 30. Review for accuracy and approve the appropriateness of state assessments, prior to the due date of the assessment. 31. Establish an Imprest bank account to make claim, indemnity, expense and legal payments on checks drawn from this account. It is understood that all funds in this account are City funds and shall be returned upon the City's request or the termination of the Contract. Regarding this account, the Administrator shall: a) Reconcile on a monthly basis the account and provide all bank statements to the City monthly, along with a request for a deposit from the City to maintain the balance needed in the account, as determined by the City. b) Ensure that any interest earned on the account is to go to reducing the subsequent monthly deposit by the City. c) Submit a monthly statement including the following: d) balance at inception Page 44 of 66 Request for Proposals (RFP) 207193,2 e) total disbursements by date and claimant f) balance at closing g) amount of deposit required h) list of all checks along with all statements supplied to the City i) Bank account transactions and other information can additionally, or in lieu of, be provided by the Successful Proposer to the City on-line or via other means for "real-time" access by the City. 32. Ensure that all adjusters handling City of Miami cases are kept abreast of the Workers' Compensation Statutes, DWC rules, and applicable laws. 33. Ensure that the minimum standards of performance of its personnel conform to the Florida statutes and administrative rules or future changes therein, if any. 34. Ensure all DWC filings, including compromise settlement agreement payments, are made in a correct and timely manner. 35. Provide notification of suit being filed against the City for any reason, to the City Attorney's Office and to Risk Management within twenty-four (24) hours. 36. Aggressively pursue recoveries to the satisfaction of the City, including recoveries based on subrogation and special disability trust fund. The Administrator will pursue, track and provide quarterly reports on all second injury fund. 37. Shall be responsible for data integrity. This includes properly inputting all cause codes, location codes, loss descriptions, and other claims information. If a data conversion is involved, the Administrator must attest to the integrity of the combined data. 38. Obtain the approval of Risk Management to hire experts in connection with claims against the City. Experts include, but are not limited to, rehabilitation vendors and private investigators. 39. Provide the means for the City to perform claims status inquiries. 40. Provide training for supervisory personnel of the City for those individuals responsible for workers' compensation activities. 41. Comply with all applicable laws and regulations regarding the administration of Worker's Compensation benefits. 42. Provide and integrate successfully an on-line claims management system that interfaces with all other existing systems to be utilized in the performance of the scope reflected within this RFP. 43. Work closely with the Safety Manger to enhance Safety Program to reduce claims on an annual basis. 44. Assist in exploring the development of a Light Duty Program for City employees. 45. Shall provide to the City a performance guarantee, to be negotiated with the City in the provision of Part I services as cited herein, to improve its effectiveness and efficiency while maximizing City resources. B. HEARINGS / TRIALS The Claims Administrator shall ensure that the following requirements for hearing conferences/trials are followed: 1. Pre -hearing or pre-trial reports shall be submitted by the Claims Administrator to the City Attorney at least two weeks prior to the hearing conference/trial or whenever requested by the City Attorney. Periodic up -dates on Page 45 of 66 Request for Proposals (RFP) 207193,2 ongoing litigation will be scheduled by the City Attorney as needed. 2. The reports must contain all information pertinent to the file including transcribed statements and depositions. 3. The Claims Administrator shall obtain settlement authority from the City prior to any hearing conference/trial. 4. Any recommendations made by the Claims Administrator pertaining to the file should be carried out or referred to the City Attorney. C. REPORTING REQUIREMENTS 1. Claims Administrator shall make an immediate report to the Risk Management Director or the designee on: a) fatalities; and b) catastrophic occurrences with potential exposure of $50,000 or more 2. Submit "full captioned reports" within 30 days of setting reserve at or above $25,000. The content of the "full captioned reports" shall include, but not be limited to, the following: coverage items, the employee's background, (e.g., age, resident), dependents, employee's job description, occurrence, injury, medical management, wage and compensation rates, dates and periods of disability, rehabilitation, other employee benefits, litigation, index/state filings, subrogation, remarks and/or recommended actions, and future strategy. 3. Submit "full -captioned report" on all files in litigation. Provide copies of all pleadings along with the report. 4. Ensure that follow-up reports are received within 90 days of the "full -captioned report." 5. Submit 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 loth of each month and must provide summary information by department, by participant, and by total program. 6. Shall become familiar with existing labor contracts and report all activities pursuant to those contracts to the Risk Management Director or the designee as requested, at least on a monthly basis. 7. Shall provide the necessary reports and/or data to satisfy Florida's self-insurance requirements. Required forms shall be completed by the Administrator and sent to the City for review and appropriate signatures. Required self-insurance reports shall be provided on a timely basis so that the City will have sufficient time to review and execute the documents before the due date. D. "BAD FAITH" PROCEDURES The following procedures shall be followed to avoid potential actions for breach of good faith and fair dealings: 1. Termination of Weekly Benefits: 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 examiner must follow up in writing with a request for written verification. If treating physician releases the employee to modified work, the Administrator must promptly determine if modified work is available and offered to the employee before benefits are terminated. 2. Controverting Claims: the supervisors or examiner shall contact the City prior to formally denying a claim. This will not be necessary when controverting the reasonableness and necessity of medical bills. 3. Judgments/Settlements: judgments/settlements should release potential future "bad faith" actions. 4. Penalties and Fines: penalties and fines assessed by the DWC shall be paid by the Administrator if such fines Page 46 of 66 Request for Proposals (RFP) 207193,2 and penalties result from negligent performances of its duties. PART II SERVICES - GENERAL, AUTOMOBILE, & PROFESSIONAL LIABILITY CLAIMS ADMINISTRATION A. Upon receipt of all liability claims, the Successful Proposer ("Claims Administrator"), on behalf of the City, shall perform, at a minimum, the following services: 1. Review all first notices of claim reports received from the City (which will consist of loss reports, claim letters, suits or for claims that are phoned, mailed, or faxed in by the City), prior to an assignment to an adjuster approved by the City. 2. The Claims Administrator will designate the necessary number of outside field adjusters to handle all City claims and also designate an alternate in their absence. The designation of these persons is subject to the approval of the City. 3. Conduct a thorough and complete investigation of the accident, according to the requirements of the City. 4. Investigations are to include, but not be limited to, the following: a) Contact the claimant or the claimant's attorney within 24 hours of the time the accident report is received by the Successful Proposer. (In the case of underrepresented claimants, personal contact is required the same day the claim is received). All claim files must contain adjuster's logs documenting all contact and activity. b) Obtain recorded statements from the claimant, witnesses, and the City personnel. Personal contact of all underrepresented claimants by outside adjusters is required. c) Complete a timely scene investigation consisting of photos and diagrams. This is required within 2 days of receipt of any serious AL or GL claim assignment. d) Obtain the police and/or fire rescue report. e) Obtain and review all medical reports and bills submitted by the claimant or their attorney. f) Obtain and review all estimates and appraisals for property damage claims. g) Establish appropriate reserves on all claims, and revise the reserves as needed. h) Submit a report to the City within 30 days of receipt of the claim, summarizing: i. Date/time/location of loss ii. Claimant information iii. Description of accident iv. Injuries or damages v. Witnesses' version vi. Liability analysis vii. Evaluation of claim (i.e. amount of recommended settlement, denial, reserves, attorney demand). If a settlement recommendation cannot be made at this initial report (due to lack of information), indicate same and reason. However, remainder of investigation should be completed. i) Submit a status report every 90 days thereafter to the City until the claim is resolved. The City prefers the above reporting requirement to be accomplished via the online claims management system for "real-time" viewing. 5. The Claims Administrator has the authority to settle cases on behalf of the City up to $10,000 per claim for property damage and $3,000 for bodily injury. Page 47 of 66 Request for Proposals (RFP) 207193,2 6. For any settlement in excess of the above, the Claims Administrator must receive authorization from the City. The request for this authorization must be presented in writing, including the adjuster's evaluation and recommendation and ob ini aformatappropriate pro riaterelease. The Cby the City. laims Adminisfter trator will adion is vert se settlements, the claims srequied by settleator will Floridaclaim and obtain pp p FoStatute, Chapter 69. Additionally, the Claims Administrator will provide a quarterly report to the City on all settlements above and below $10,000. 7. The City will assign an attorney for the legal defense of any claim that goes into b suit. the The claims oits attorney. will assist the City's attorneys with any additional investigations as necessary Y City TheyClaims Administrator will y continue0 daysto monitor the and directing the attorn y's activities. in litigation Claims Administrcontrol the activities oator defense counsel provide a by requiring status reportsevery monthly report of all litigated claims in the format specified by the City. 8. Upon notification from the City, forward a copy of the file in suit to the City's selected attorney with a transcription of all statements. 9.i The Claimsig Administratordates, the Manager of the Claims Administrator will take an actall mediations and trials as requested by ive e and agge City. ressive ive role i claims with impending trial , settlement or preparation for trial. 10. The Claims Administrator, after approval of the City, can assign the necessary auto appraiser for property damage claims. These expenses will be paid as an allocated expense by the Claims Administrator from the City's loss fund. 11. Any other claim expense must be approved by the City prior to being incurred. However, expenses for normal claim activities, such as photographs, tapes, supplies, postage, etc. are the responsibility of the Claims Administrator. 12. The Claims Administrator will meet monthly (or more frequently if required by the City) with the City Manager and/or authorized representative to review all large exposure (over $25,000) incurred cases and report on their status. 13. All claim files are at all times the property of the City. The City has the right to inspect any and all files whenever we deem necessary. If the contract is terminated, the City will receive all original claim files. 14. The Claims Administrator will make recommendations to the City as to actions that can be taken to prevent future claims. These loss prevention recommendations can be included in the status reports. 15. All work must be performed by the employees of the Successful Proposer. The use of any contracted or independent adjuster is prohibited, unless prior approval is granted by the City. 16. The Claims Administrator will reimburse the City for payments made in error that are non -recoverable from third parties by the Claims Administrator. 17. The Claims Administrator shall provide to the Cityitseeffectie veness sarantd efficiency,to be n otiatedwith the maximizing ityty in the provision of Part II services as cited herein, to improve resources. The City desires prompt, personal contact of all claimants. Evaluations of each claim are to be made as soon as the necessary information is received. The investigation and evaluation of all claims should be completed prior to suit being filed, since F.S. 768.28 (sovereign immunity statute) requires the claimant provide six months notice of intention to file suit. Atnformation below for this time, are fo 611 he pendingaims for years forGeneral ility. Liability,r to the 1Automobile Liability,the and Police e Toer ofrt/Public and other pertinent data for past ( Official Liability. Page 48 of 66 GENERAL LIABILITY Year # of Claims 10/1/2006 -9/30/2007 275 10/1/2007 - 9/30/2008 246 10/1/2008 - 9/30/2009 283 AUTOMOBILE LIABILITY Year # of Claims 10/1/2006 — 9/30/2007 335 10/1/2007 — 9/30/2008 376 10/1/2008 — 9/30/2009 348 POLICE TORT Year # of Claims 10/1/2006 — 9/30/2007 33 10/1/2007 — 9/30/2008 37 10/1/2008 — 9/30/2009 11 PUBLIC OFFICIAL LIABILITY Year # of Claims 10/1/2006 — 9/30/2007 11 10/1/2007 — 9/30/2008 2 Paid $227,852.38 118,041.62 25,103.50 Paid Reserves $412,597.88 1,050,288.00 211,341.75 Request for Proposals (RFP) 207193,2 Total Incurred 640,450.26 1,168,270.48 236,445.25 Reserves Total Incurred $466,457.62 $122,443.53 465,657.70 351,833.57 197,597.88 359,553.05 Paid Reserves $110,630.58 $970,757.14 11,194.88 122,795.67 2,071.43 46,158.13 588,901.15 817,491.27 557,150.93 Total Incurred $1,081,387.72 133,990.55 48,229.56 Paid Reserves Total Incurred $267,794.86 $319,548.53 788.42 0.00 587,298.39 788.42 10/1/2008 — 9/30/2009 0 The Administrator must have up-to-date policy and procedure manuals on hand in the work place. These manuals should describe and discuss the day to day procedures for adjusting files. The manuals should be kept in accordance with statutory requirements. The Claims Administrator shall provide adequate toll -free telephone access to the claims office. The Claims Administrator shall provide Claims personnel, who shall be available on a 7 day, 24 hour basis for investigating claims, and must have and maintain an 800 or toll -free number for emergency service. The Claims Administrator must provide its own office space or facility(s) for its adjuster or staff of adjusters. The Successful Proposer must agree to be responsible to manage liability claims to be opened within the year(s) following contract execution, along with the current inventory of open files. The City is seeking a Successful Proposer that will provide claims administration on a "life of relationship basis." PART III SERVICES MANAGED CARE SERVICES Of the approximate 4,486 full-time employees, the following generally represents the location of their Residences: Miami -Dade County 3,869 Broward County 573 Collier County 7 Palm Beach County 31 Page 49 of 66 Request for Proposals (RFP) 207193,2 St. Lucie County 6 Unknown 3 * zip codes do not appear in 4 counties listed The number of new claims is approximately 550 per year. The ratio of medical only to loss time is 50% Medical only, and 50% loss time. Expenditures for the past two years are represented below: Medicals paid: $4,626,969.35 Indemnity paid: 1,172,184.22 Expenses paid: 70,067.31 A. The following represents the minimum required services to be provided to the City as required in this RFP. The Successful Proposer: 1. Shall provide 24 hour toll free telephone number service for reporting worker injuries. 2. Shall complete Statutory first report of injury (DWC1), injured worker information/grievances and medical provider services. 3. Shall channel injured workers to in -network and/or out -of -network providers approved by the City. 4. Shall manage the lost time element of claims. 5. Shall coordinate ancillary medical/disability management services. 6. Shall provide Preferred Provider Organization (PPO) networks access. 7. Shall conduct Medical Utilization Review, Professional Peer Review, and provider appeal process. 8. Shall conduct Medical provider bill review and provider compliance. 9. Shall manage Out -of -network providers. 10. Shall provide telephonic medical case management, vocational assessments, job site evaluations, and other vocational services. 11. Shall provide mandatory reports, all State mandated reports, required tax information for the Internal Revenue Service, including 1099 to the IRS, special administrative reports such as the OSHA 200 and others as determined by the City. 12. Shall effectively interface with the City's on-line claims management system or the TPA as part of this RFP. 13. Shall prepare and submit the managed care application to the State of Florida with the assistance of the City. 14. Successful Proposer will pay the providers' medical bills and interface with the Claims Administrator's current and future system to ensure cost and effective processing of claims. 15. Shall provide to the City a performance guarantee, to be negotiated with the City in the provision of Part III services as cited herein, to improve its effectiveness and efficiency while maximizing City resources. As discussed previously, the City's current Claims Administrator utilizes on-line claims processing system where all data is maintained, updated, and payments are issued. The adjudication of Workers' Compensation medical bills and payments to the City's providers are performed through this system. On a monthly basis, the Claims Administrator provides the City with a bank reconciliation report to interface with the City's financial system. The Successful Proposer shall be responsible for the provision of an on-line claim processing system and the conversion of any data necessary for successfulintegration with any and all other systems, including following the termination of the Contract. Any procedures, equipment, and/or costs necessary to connect with the current Claims Administrator's hardware and software shall be the sole responsibility of the Successful Proposer. Page 50 of 66 Request for Proposals (RFP) 207193,2 The Claims Administrator shall provide Claims personnel, who shall be available on a 7 day, 24 hour basis for investigating claims, and must have and maintain an 800 or toll -free number for emergency service. The Claims Administrator must provide its own office space or facility(s) for its adjuster or staff of adjusters. The Successful Proposer must agree to be responsible for managed care claims to be opened within the year(s) following contract execution, along with the current inventory of open files. The City is seeking a Successful Proposer that will provide claims administration on a "life of relationship" basis. 3.3 STAFFING, QUALITY CONTROL AND SUPERVISION A. Workers' Compensation and Liability The Claims Administrator shall render high -quality claims management and adjusting services throughout the entire Contract term. The personnel of the Claims Administrator should have, as a minimum, the following levels of experience and licensing. Supervisor or supervising adjuster 5-7 years Adjusters 3 years Medical -only processor(s) 1 year A copy of each adjuster's and supervisor's Florida adjusting license must be made available prior to the assignment of any claims. Files must reflect evidence of supervisory direction and involvement at every level. All files must be kept current. File review should be performed on 30, 60, 90 or 120 day cycles as appropriate. Periodic review by the handling adjuster and all supervisors should be reflected in the file. Supervisors should receive all First Reports of Injury and outline investigative needs for the adjusters to follow through. Supervisors should assign the most difficult files to the most qualified adjuster. Successful Proposer shall perform monthly claims review with Risk Management to include the adjusters, Risk Management and City Attorney. It is the City's claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control the City's self -insured loss payments is to ensure the claims administrator hires and retains the appropriately qualified professionals to handle the City's claims. Additionally, the adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services. The City therefore requires that the Successful Proposer agree to staffing, qualifications, and caseload criteria established by the City. The City reserves the right to the final prior approval of the hiring and/or assignment of the claims manager, supervisors, and adjusters that are to handle the City's claims. The Claims Administrator agrees to add staff as necessary to maintain these maximum pending caseload levels. The proposer in its response must explain how its office or unit will be staffed, and the level of supervision that will be provided. Claims personnel must be employees of the Claims Administrator. The use of independent adjusters, subcontractors, or temporary adjusters will not be acceptable without prior approval of the City. Adjuster trainees are not acceptable for handling of the City's claims. The proposer must submit with its proposal the resumes of all claims professionals specifically to be assigned to this account. All claims professionals must possess a current Florida adjuster's license. In addition to those services previously discussed, the Claims Administrator will additionally perform the following Page 51 of 66 Request for Proposals (RFP) 207193,2 related services: 1) State required filings. 2) Loss fund management 3) Computer generated loss runs and other management reports, preferably on-line 4) Provide an annual SAS 70 audit report. The Claims Administrator shall have the ability to provide full service to English, Spanish, and Haitian -Creole speaking individuals when needed. The Claims Administrator shall make available to the City an individual with management authority to meet with Risk Management Director or the designee upon reasonable notice. This individual shall have the authority to make "agreed to changes." The Claims Administrator will meet Risk Management or the designee on a quarterly or as -needed basis to discuss claims of interest. Sufficient advance notice will be given to allow adequate preparation and data collection. The Claims Administrator's personnel, including the adjuster or supervisor, must be available to attend Mediation conferences as necessary. B. Managed Care Services The Provider shall render high -quality claims management services throughout the entire Contract term. The personnel of the Provider should have, as a minimum, the following levels of experience and licensing. Supervisor 5-10 years Nurse Case Manager 5-7 years Account Representative: The Account Representative is fully qualified and responsible for the performance of Provider's responsibilities under the Agreement. The Account Representative's responsibilities include, but are not limited to: Act as Provider's representative on any claims issue or problems. Act as a liaison between the City, medical network, City's designated Claims Administrator and any other parties as deemed necessary by the City. Participate with and assist the Risk Management in the performance reviews, as required under the Performance Agreement and review other claims as requested by the Risk Management under the Agreement. Files must reflect evidence of supervisory direction and involvement at every level. All files must be kept current. File review should be performed on 30, 60, 90, 120 day cycles as appropriate. Periodic review by the handling Nurse Case Manager and Supervisors should be reflected in the file. Supervisors should receive all First Report of Injury and outline investigative needs for the Nurse Case Manager to follow through. Supervisors should assign the most difficulty files to the most qualified Nurse Case Manager. Successful Proposer shall perform monthly claims review with Risk Management to include the adjusters, Risk Management and City Attorney. It is the City's claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control the City's self -insured loss payments is to ensure the claims administrator hires and retains the appropriately qualified professionals to handle the City's claims. Additionally, the adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services. The City therefore requires that the Successful Proposer agree to staffing, qualifications, and caseload criteria established by the City. The City reserves the right to the final prior approval of the hiring and/or assignment of the Nurse Case Manager, Page 52 of 66 Request for Proposals (RFP) 207193,2 supervisors to handle the City's claims. The Provider agrees to add staff as necessary to maintain these maximum pending caseload levels. The proposer in its response must explain how its office or unit will be staffed, and the level of supervision that will be provided. Claims personnel must be employees of the Provider. The use of Nurse Case Manager, subcontractors, or temporary Nurse Case Manager will not be acceptable without prior approval of the City. The proposer must submit with its proposal the resumes of all claims professionals specifically to be assigned to this account. All claims professionals must possess a current Florida adjuster's license. The Provider shall have the ability to provide full service to English, Spanish, and Haitian -Creole speaking individuals when needed. The Provider shall make available to the City an individual with management authority to meet with Risk Management Director or the designee upon reasonable notice. This individual shall have the authority to make "agreed to changes." The Provider will meet Risk Management or the designee on a quarterly or as -needed basis to discuss claims of interest. Sufficient advance notice will be given to allow adequate preparation and data collection. The Provider's personnel, including the Case Manager or supervisor, must be available to attend Mediation conferences as necessary. 3.4 "BAD FAITH" LAWSUITS The City shall be notified of all "bad faith" lawsuits which include breach of good faith and fair dealing. Any "bad faith" lawsuits filed against the City or the Contract Administrator shall be handled by the City of Miami's Law Department or its designee. If the allegation is that the Contract Administrator committed or acted in "bad faith", the lawsuit and attorneys' fees and expenses shall be the Contract Administrator's responsibility, but the City's Law Department will monitor the progress of the lawsuit to its conclusion. If a claim is in litigation and there is also a "bad faith" claim alleged, it may be necessary to retain separate attorneys. Once a "bad faith" lawsuit has been filed, a separate file pertaining only to the issues on "bad faith" shall be established. 3.5 LOSS CONTROL SERVICES When requested by the City to do so, the Contract Administrator 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 Contract Administrator 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. 3.6 IRS FILING REQUIREMENTS OF CLAIMS ADMINISTRATOR Contract Administrator will furnish required tax information for the Internal Revenue Service including 1099s with a copy of the 1099s submitted to the IRS. Contract Administrator will prepare, maintain and file all records and reports as may be required by legal authorities (State, local and Federal). Contract Administrator will prepare, maintain and file statistical information required by the Division of Workers' Compensation and Rating Bureaus, including all data necessary for the promulgation of experience modification, and as required by any other legal entity(s). 3.7 STATE REQUIRED FILINGS At a minimum, the Claims Administrator shall be required to provide the following services: Page 53 of 66 Request for Proposals (RFP) 207193,2 A. Prepare and file, on behalf of the City, with the appropriate state agency, all applications required for the City's continued qualification as a self -insurer. B. Prepare, maintain, and file all records and reports as may be required by legal State or Federal. C. Prepare, maintain, and file statistical data, records, or reports as required by excess insurers, City actuaries, and the State. D. Prepare, maintain, and file statistical information required by worker's compensation rating bureaus, including all data required for the promulgation of the City's experience modification and state assessment. E. 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.) 3.8 LOSS FUND MANAGEMENT A. The Imprest Account will be maintained at the City's commercial banking institution. The account will be classified as part of the analysis group of the City's accounts. The City will pay all service fees that are normal and customary in this account. All interest earned or service credits generated will accrue to the benefit of the City. B. The Claims Administrator is required to follow Florida law concerning public deposits. Specifically, the Claims Administrator needs to follow F.S. 237.211(6) and F.S. 280 Security of Public Deposits. Failure to comply with these laws is sufficient cause for the City to terminate the contractual agreement with the Claims Administrator. C. All claims, expense and legal payment will be made by the Claims Administrator on checks drawn on an account set up by the Claims Administrator and funded monthly by the City. It is understood that all funds in this account are City funds, and are to be returned to the City upon request or at termination of the contract. D. The Claims Administrator is responsible for the monthly reconciliation of this account and will provide bank statements to the City monthly, along with a request for a deposit from the City to maintain the monthly balance in the loss fund, as determined by the City. E. The monthly reconciliation statement submitted by the Claims Administrator to the City shall, at minimum, include the following: 1) Balance at inception of statement period 2) Total disbursements which cleared, by date and claimant/payee 3) Balance at close of statement period 4) Amount of deposit required. F. A list of all checks is to be submitted on a monthly basis. 3.9 COMPUTER LOSS INFORMATION All charges related to these services are to be included in the annual claims administration fee. Any costs associated with programming changes that are necessary to create a report required by the City are the responsibility of the claims administrator. In its proposal, Proposer should indicate any fees to be charged for the creation of any special reports requested by the City, as necessary. All reports currently provided to the City are required from the successful Claims Administrator. Successful Proposer(s) must ensure conductivity with the current system and software used by Risk Management and the Depai talent of Finance, and all other involved departments. It must continue to ensure, at its cost, that its system remains a viable solution for on-line claims administration should the City upgrade or replace any aspect of its Risk and/or financial system throughout the term of the Contract. All claims data is the property of the City and any data and media will be provided to the City upon request and/or upon termination of the contract. All computer notes will be printed out and placed in the files prior to file transfer Page 54 of 66 Request for Proposals (RFP) 207193,2 to a successive Claims Administrator. The successful Claims Administrator, at its expense, will ensure all claims and payment data is included in their loss runs by a date as determined by the City. Historical data from the current claims administrator's database cannot be purged. Claims data for all open and closed claims must be transferred. Loss runs are to be provided on a monthly basis (two copies), sorted separately by line of coverage (WC, GL, AL), policy year, and department/location. Loss runs should list each claim separately. Specific summary reports also must be provided. This requirement may be satisfied by utilizing the Successful Proposer's on-line system. The following reports, at a minimum, are required: 1) Claims list — lists all claims alphabetically 2) Check register 3) Cumulative report byline 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) Workers compensation claims involving no payment or no medical treatment are reported by the City for inclusion in the database as reporting purpose only (RPO) or first aid or no pay cases and should be identified in the system that same way. The Claims Administrator must provide the City the access via internet to the system for file review, e-mail, or other purposes at no additional cost to the City. An 800 or other toll -free number is necessary for on-line connections and faxes if the call is outside Miami -Dade County. 3.10 PROPOSED FEES Proposer shall submit, separately, its proposed fees for the provision of Part I services, Part II services, Part III services, or a combination thereof. For Part I, Workers Compensation Claims Administration Services; Part II General, Automobile, and Professional Liability Claims Administration: and Part III Managed Care Services: Proposer shall submit a guaranteed, all-inclusive annual fee as previously detailed. This fee is to represent all claims, administrative, and loss data fees. For Part III Services, Managed Care Services, the City is interested in a program which will generate savings over the current expenditures in the workers compensation area. The proposed fee structure should address the mechanism for achieving a minimum of 15% net savings with an escalating incentive bonus for savings that exceed the minimum and a penalty for a shortfall in the desire net savings. Proposed rates are to be guaranteed annual fees for the first three (3) years, as opposed to per claim time and expense or any other fee proposal. Proposals not containing an all inclusive guaranteed annual fee for three (3) years for all specified services will not be considered. Clearly indicate any charge not included in the proposed annual fee. Page 55 of 66 Request for Proposals (RFP) 207193,2 Other than the filing of applications for self-insurance, the Successful Proposer, at the option of the City, shall be required to provide services on all claims occurring during the contract period and until six months after the termination of the contract (including renewals, extensions, or replacements thereof), all legally required reports for the contract period rendered, and all required reports to the Rating Bureaus or other appropriate agencies made. The Successful Proposer's fee shall include the full consideration for such continuing obligations, and except as noted herein, no additional consideration shall be due for such obligations which extend beyond the contract period. However, as part of its Proposal, and in order to determine pricing structure, Proposer shall also submit a separate quote(s) for existing claims, and a separate quote(s) for prospective claims; pricing on a "per claim" basis for both existing claims and prospective claims, and a breakdown of the cost between lost time vs. medical. In addition, provide a per claim cost vs. flat dollar cost. Include any other charges not included in pricing. Proposer shall provide prices in U.S dollars for the required services. It is important that Proposer outline features of the Proposal, such as value-added product(s) and/or service(s) that would not normally be addressed in a pricing evaluation as they are of a non -monetary nature. As such, Proposer should include any relevant services or products that will be provided to the City which are not priced in its Proposal, but which will enhance the acquisition process. As the Administrator may assume responsibility for the accurate and professional management of all open claims previously administered by the City, Proposers shall review these claim files to determine the additional cost, if any, to assume responsibility for these files. Financial data will be accurately merged in the risk management information system so that loss -history information for prior periods will be accurately included in the City's loss reports and for remote claims status inquiry. Proposer shall be responsible for indicating in its Proposal the cost, if any, of assuming these prior claims and data conversion and whether it is a one-time charge or an annual charge. The current Claims Administrator utilizes an on-line claim processing system where all data is maintained, updated and payments are issued. The Successful Proposer(s) must provide a similar mechanism as Risx Facs Systems to provide the City with a bank reconciliation report to interface with the City's financial information. The Successful Proposer(s) will include in its costs for the provision of an enhanced system and for the conversion of any data necessary. A Proposal must contain rates based on the "life of relationship basis," namely for those prospective claims, and the City's inventory of open files. Proposer shall be responsible for all claims regardless of day(s) or year(s) open, as the City will only pay a one- time charge at the time the files are opened. Provide separate quotes for the assumption of prior claims and for prospective claims commencing on the commencement date of the Contract. The pursuit of subrogation and recovery from the Special Disability Fund is to be included in the Administrator's annual fee. The City will pay all legal defense fees, legal expenses, surveillance and any other claim related expenses that are incurred in the proper handling of all claims that are not specifically outlined in this RFP.All such expenses must have prior approval from Risk Management or the designee and of the City Attorney. Normal operating expenses such as photos, copying, faxing, office supplies, postage, travel, etc. are to be included in the annual fee and shall not be charged back to the City. Some modifications of existing procedures, forms and contracts may be necessary to satisfy the City's intent. It is understood that modifications may require a substantially greater fee than services without the modifications, the amount of additional fee for the modifications must be disclosed in advance so the City may exercise its option to purchase the modifications. It is preferred by the City that all desired modifications be provided with little or no additional fee. Proposers shall provide all costs related to the provision of all services per Part, as specified in this RFP. In addition, Proposers shall provide in detail any other costs not foreseen, contemplated or considered by the City at Page 56 of 66 Request for Proposals (RFP) 207193,2 this time but which is regularly provided by Proposer. Additional fee structures will be considered, in addition to the required fee structures, with preference given to those which will generate significant savings to the City. Proposed fees for the renewable option years, if applicable, must be submitted by the Successful Proposer(s) to the City for consideration four (4) months in advance of each end of the Contract year. The City reserves the right to accept, reject, and negotiate with Successful Proposer(s) any and all fees proposed for each option year(s). Page 57 of 66 Request for Proposals (RFP) 207193,2 4. Submission Requirements 4.1. SUBMISSION REQUIREMENTS The following documentation shall be included as a minimum in the Proposal and submitted to the City. Instructions to Proposers: Proposers should carefully follow the format and instructions outlined below, observing format requirements where indicated. Proposals should contain the information itemized below and in the order indicated. This information should be provided for the Proposer for the work contemplated by this RFP. Proposals submitted which do not include the following items may be deemed non -responsive and may not be considered for contract award. ALL RESPONSES WILL BE SUBMITTED IN HARD COPY FORMAT ONLY TO INCLUDE ONE ORIGINAL AND FIVE (5) COPIES. NO ON-LINE SUBMITTALS WILL BE ACCEPTED. The response to this solicitation should be presented in the following format. Failure to do so may deem your Proposal non -responsive. Should Proposer submit a Proposal to provide Part I Workers Compensation Claims Administration Services: Part II General, Automobile, and Professional Liability Claims Administration: and/or Part III Managed Care Services, Proposers must clearly indicate for which Part it is submitting its Proposal and must provide all of the following for each Part proposed. 1. Cover Page The Cover Page should include the Proposer's name; Contact Person for the RFP; Firm's Liaison for the Contract; Primary Office Location; Local Business Address, if applicable; Business Phone and Fax Numbers; Title of RFP; RFP Number; Federal Employer Identification Number or Social Security Number. 2. Table of Contents The table of contents should outline, in sequential order, the major sections of the proposal as listed below, including all other relevant documents requested for submission. All pages of the proposal, including the enclosures, should be clearly and consecutively numbered and correspond to the table of contents. 3. Executive Summary: A signed and dated summary of not more than two (2) pages containing the Proposer's Qualifications and Experience, Ability to Perform Required Services, and Overall Approach and Methodology to Scope of Work as contained in the submittal. Proposer must indicate for which Part(s) it is submitting a proposal. Include the name of the organization, business phone and contact person. Provide a summary of the work to be performed by Proposer. The following information and documents are required to be provided with Proposer's response to this RFP. Failure to do so may deem your Proposal non -responsive. Part I: Workers Compensation Claims Administration Services 4. Proposer's Qualifications and Experience a) Describe the Proposer's organizational history and structure; years Proposer and/or firm have been in business providing a similar service(s), and indicate whether the City has previously awarded any contracts to the Proposer/firm. b) Provide a list of all principals, owners or directors. c) Provide a complete list of all current Florida clients for which Proposer administers claims in a Workers' compensation self-insurance or retention program. Include name, address, type of entity, type of work done, phone number(s) and contact persons within each organization. Specifically identify clients for whom a similar service has Page 58 of 66 Request for Proposals (RFP) 207193,2 been provided, particularly to governmental entities similar in size to the City, Trust, or other similar type as the City. Indicate whether Proposer assisted in disability, safety program, light duty / return -to -work program, etc. d) Provide a list of clients that have, for whatever reason, discontinued to use your services within the past two (2) years, and indicate the reasons for the same. The City reserves the right to contact any reference as part of the evaluation process. e) Provide detailed background on the Project Manager and Claims Administrator to be assigned the City's account throughout the duration of the Contract term, and whether Proposer agrees to City's terms for approval of future Project Manager(s) / Claims Administrator should proposed representative leave Proposer's firm during the Contract term. Provide copies of current applicable licenses for work to be performed in the State of Florida. f) Provide two (2) Letters of Reference on letterhead from similar size governmental entities as the City and for whom similar services have been performed. This information is subject to verification as part of the evaluation process. g) Provide letters of reference from law firms which currently handle your litigation. Provide contact person and phone number for each. 5. Proposer's Ability to Perform Required Services a) Describe the size of Proposer. Provide a complete list of all claims office locations and territory serviced with Proposer's current personnel, indicating the number of personnel of Proposer and its ability to provide required services to the City. b) Describe where your main office is located and the location where the primary work will be performed. Indicate location where the Project Manager / Claims Administrator will be located. c) Discuss how its office or unit will be staffed, and the level of supervision that will be provided. Discuss case assignments, including pending case load for each designated Adjuster and current number of monthly new assignments to each Adjuster. d) Discuss whether the award of this contract necessitates an increase in your staff size to meet the City's staffing and caseload requirements, and whether staff will be in place by the start of the contract. e) Provide a complete list of all licensed claim's personnel that will handle City's claims. Include a resume of each Claims Administrator and / or Supervisor or Supervising Adjuster, Adjusters, Medical -only processors, or other individuals including clerical and or support staff detailing education, experience in the area of workers' compensation claims, and type of license(s). Include copies of all licenses held by each individual, as all claims professionals must possess a current Florida adjuster's license. f) Explain the percentage of time your Adjusters are out of the office doing field work. If all are telephone Adjusters, indicate as such. Explain whether you utilize independent contracted Adjusters, and under what circumstances. Provide the name, address, phone, and contact person for independents you utilize. g) Provide Copy of the most recently audited (or unaudited if audited not available) Financial Statement of Proposer. 6. Overall Approach to Scope of Work a) Discuss in detail Proposer's overall approach to the work to be performed. b) Describe procedures and systems to be utilized. Include projected case loads per employee of Proposer assigned to City account. c) Provide a detailed timetable identifying significant milestones for the smooth transition of the operations. Proposer shall identify the necessary support that shall be required from City staff during that transition. d) Provide a description of the standard loss reports, as well as provide a sample and descriptions of any Page 59 of 66 Request for Proposals (RFP) 207193,2 additional reports to be utilized. e) Explain whether you currently file state and excess insurance forms on behalf of your clients and attach copies of the forms used. f) Describe Proposer's methodology for evaluating and determining savings as expected within this RFP. Include in detail the mechanisms Proposer would use to track whether proposed savings goal has been met, and methods to meet those goals. Indicate if willing to accept the incentive or penalty as indicated should savings not result. g) Detail any procedures, equipment, and/or costs necessary to connect with the City's hardware and software, particularly related to conductivity with Risk and Finance, at the time of this RFP and should the City's system be modified or replaced during the Contract term. Should there be associated costs; indicate those costs, the reasons for the same, and who will pay those costs. Costs, if any, shall be detailed in the Fee Proposal Section. h) Explain any options which the Proposer's system has that will permit the City to generate reports from, and to make direct inquiries into the Administrator's data base by on-line access. Proposer must clearly identify in its Proposal the costs of providing any special conversion systems, license and software costs for accessing the system, and the party(s) responsible for the payment of those costs, if any. (Costs shall be fully detailed in Fee Proposal Section). i) If proposed, describe in detail Proposer's computerized on-line claims management system and software to be utilized during the performance of the scope of work reflected herein. Detail functionality, transition from current system, and if a cost is proposed, indicate in Proposer's Fee Proposal. j) Provide sample reports describing information such as type of accident, accident site, department, date and time, cause of accident, injury, and part of body. Proposer shall describe in detail any safety/loss control reports that are provided by the system, and shall submit a listing of the variety of claims reports available, and provide sample copies of formats that may be requested by the City. k) Provide the methodology and list of allocated or anticipated expenses to employ outside professionals such as surveillance, rehabilitation, experts, attorneys and others to assist in the investigation and adjustment of claims, 7. Fee Proposal a) Proposer shall submit a guaranteed, all-inclusive annual fee as previously detailed. This fee is to represent all claims, administrative, and loss data fees. Proposed rates are to be guaranteed annual fees for the first three (3) years, as opposed to per claim time and expense or any other fee proposal. Proposals not containing an all inclusive guaranteed annual fee for three (3) years for all specified services, will not be considered. The pursuit of subrogation and recovery from the Special Disability Fund is to be included in the Administrator's annual fee. Clearly indicate any charge not included in the proposed annual fee. b) As part of its Proposal, and in order to determine pricing structure of an ensuring Contract, Proposer shall also submit a separate quote(s) for existing claims, and a separate quote(s) for prospective claims; pricing on a "per claim" basis for both existing claims and prospective claims, and a breakdown of the cost between lost time vs. medical. In addition, provide a per claim cost vs. flat dollar cost. Include any other charges not included in pricing. c) Proposal must contain rates based on the "life of relationship basis," namely for those prospective claims, and the City's inventory of open files. Proposer shall be responsible for all claims regardless of day(s) or year(s) open, as the City will only pay a one time charge at the time the files are opened. Provide separate quotes for the assumption of prior claims and for prospective claims commencing on the commencement date of the Contract. d) Proposer shall provide prices in U.S dollars for the required services. It is important that Proposer outline features of the Proposal, such as value-added product(s) and/or service(s) that would not normally be addressed in a pricing evaluation as they are of a non -monetary nature. As such, Proposer should include any relevant services or products that will be provided to the City which are not priced in its Proposal, but which will enhance the Page 60 of 66 Request for Proposals (RFP) 207193,2 acquisition process. e) Proposer shall be responsible for indicating in its Proposal the cost, if any, of assuming these prior claims and data conversion and whether it is a one-time charge or an annual charge. As the current TPA utilizes an on-line claim processing system where all data is maintained, updated and payments are issued, the Successful Proposer(s) must provide a similar mechanism as Risx-Facs to provide the City with a bank reconciliation tape and a tape to interface with the City's financial information. The Successful Proposer(s) will include in its costs for the provision of an enhanced system and for the conversion of any data necessary. f) Proposed performance guarantee, to be negotiated with the City. g) Provide any and all additional costs, itemby item, as identified by Proposer in any other area not previously discussed anddetail what those additional costs, if applicable, would entail. Include which entity (Proposer or City) that will be responsible for payment of those costs. 8. Local Preference, if applicable a) State the Primary Office Location of the Proposer. b) Provide location from which the Proposer will be based to perform the work. Part H: General, Automobile, and Professional Liability Claims Administration 4. Proposer's Qualifications and Experience a) Describe the Proposer's organizational history and structure; years Proposer and/or firm have been in business providing a similar service(s), and indicate whether the City has previously awardedany contracts to the Proposer/furl. b) Provide a list of all principals, owners or directors. c) Provide a complete list of all current Florida clients for which Proposer administers general and automobile liability claims. Include name, address, type of entity, type of work done, phone number(s) and contact persons within each organization. Specifically identify clients for whom a similar service has been provided, particularly to governmental entities similar in size to the City, Trust, or other similar type as the City. d) Discuss in detail Proposer's qualifications and experience to provide general liability and automobile liability claims administration. Include the Proposer's thorough knowledge of all State Statutes and other applicable laws governing this RFP to show a complete understanding of the work to be performed. e) Provide a list of clients that have, for whatever reason, discontinued to use your services within the past two (2) years, and indicate the reasons for the same. The City reserves the right to contact any reference as part of the evaluation process. f) Provide detailed background on the Project Manager and Claims Administrator to be assigned the City's account throughout the duration of the Contract term, and whether Proposer agrees to City's terms for approval of future Project Manager(s) / Claims Administrator should proposed representative leave Proposer's firm during the Contract term. Provide copies of current applicable licenses for work to be performed in the State of Florida. g) Provide two (2) Letters of Reference on letterhead from similar size governmental entities as the City and for whom similar services have been performed. This information is subject to verification as part of the evaluation process. h) Provide letters of reference from law firms which currently handle your litigation. Provide contact person and phone number for each. 5. Proposer's Ability to Perform Required Services a) Provide a general description of the firm, including its size, approximate number of personnel, and the areas Page 61 of 66 Request for Proposals (RFP) 207193,2 of coverage. Provide a complete list of all claims office locations and territory serviced with Proposer's current personnel, indicating the number of personnel of Proposer and its ability to provide required services to the City. b) Describe where your main office is located and the location where the primary work will be performed. Indicate location where the Project Manager / Claims Administrator will be located. c) Discuss how its office or unit will be staffed, and the level of supervision that will be provided. Discussed case assignments, including pending case load for each designated Adjuster and current number of monthly new assignments to each Adjuster. d) Discuss whether the award of this contract necessitates an increase in your staff size to meet the City's staffing and caseload requirements, and whether staff will be in place by the start of the contract. e) Provide a complete list of all licensed claim's personnel that will handle City's claims. Include a resume of each Claims Administrator and / or Supervisor or Supervising Adjuster, Adjusters, or other individuals including clerical and or support staff detailing education, experience in the area of liability claims, and type of license(s). Provide copies of all licenses held by each individual, as all claims professionals must possess a current Florida adjuster's license. 6. Overall Approach to Scope of Work a) Discuss in detail Proposer's overall approach to the work to be performed. b) Describe procedures and systems to be utilized. Include projected case loads per employee or Proposer assigned to City account. c) Provide a detailed timetable identifying significant milestones for the smooth transition of the operations. Proposer shall identify the necessary support that shall be required from City staff during that transition. d) Provide a description of the standard reports, as well as provide a sample and descriptions of any additional reports tube utilized. e) Explain whether you currently file state and excess insurance forms on behalf of your clients and attach copies of the forms used. f) If proposed, describe in detail Proposer's computerized on-line claims management system and software to be utilized during the performance of the scope of work reflected herein. Detail functionality, transition from current system, and if a cost is proposed, indicate in Proposer's Fee Proposal. g) Explain any options which the Proposer's system has that will permit the City to generate reports from, and to make direct inquiries into the Administrator's data base by on-line access. Proposer must clearly identify in its Proposal the costs of providing any special conversion systems, license and software costs for accessing the system, and the party(s) responsible for the payment of those costs, if any. (Costs shall be fully detailed in Fee Proposal Section). h) Provide sample reports describing information such as type of accident, accident site, department, date and time, cause of accident, injury, and part of body. Proposer shall describe in detail any safety/loss control reports that are provided by the system, and shall submit a listing of the variety of claims reports available, and provide sample copies of formats that may be requested by the City. i) Provide the methodology and list of allocated or anticipated expenses to employ outside professionals such as surveillance, experts and attorneys to assist in the investigation and adjustment of claims. 7. Fee Proposal a) Proposer shall submit a guaranteed, all-inclusive annual fee as previously detailed. This fee is to represent all claims, administrative, and loss data fees. Proposed rates are to be guaranteed annual fees for the first three (3) years, as opposed to per claim time and expense or any other fee proposal. Proposals not containing an all inclusive Page 62 of 66 Request for Proposals (RFP) 207193,2 guaranteed annual fee for three (3) years for all specified services, will not be considered. Clearly indicate any charge not included in the proposed annual fee. b) As part of its Proposal, and in order to determine pricing structure of an ensuring Contract, Proposer shall also submit a separate quote(s) for existing claims, and a separate quote(s) for prospective claims; pricing on a "per claim" basis for both existing claims and prospective claims, and a breakdown of the cost between lost time vs, medical. In addition, provide a per claim cost vs. flat dollar cost. Include any other charges not included in pricing. c) Proposal must contain rates based on the "life of relationship basis," namely for those prospective claims, and the City's inventory of open files. Proposer shall be responsible for all claims regardless of day(s) or year(s) open, as the City will only pay a one time charge at the time the files are opened. Provide separate quotes for the assumption of prior claims and for prospective claims commencing on the commencement date of the Contract. d) Proposer shall provide prices in U.S dollars for the required services. It is important that Proposer outline features of the Proposal, such as value-added product(s) and/or service(s) that would not normally be addressed in a pricing evaluation as they are of a non -monetary nature. As such, Proposer should include any relevant services or products what will be provided to the City which are not priced in its Proposal, but which will enhance the acquisition process. e) Proposer shall be responsible for indicating in its Proposal the cost, if any, of assuming these prior claims and data conversion and whether it is a one-time charge or an annual charge. As current TPA utilizes an on-line claim processing system where all data is maintained, updated and payments are issued. The Successful Proposer(s) must provide a similar mechanism as Risx-Facs to provide the City with a bank reconciliation tape and a tape to interface with the City's financial information. The Successful Proposer(s) will include in its costs for the provision of an enhanced system and for the conversion of any data necessary. f) Proposed performance guarantee, to be negotiated with the City. g) Provide any and all additional costs, item by item, as identified by Proposer in any other area not previously discussed and detail what those additional costs, if applicable, would entail. Include which entity (Proposer or City) that will be responsible for payment of those costs. 8. Local Preference, if applicable a) State the Primary Office Location of the Proposer. b) Provide location from which the Proposer will be based to perform the work. Part III: Managed Care Services 4. Proposer's Qualifications and Experience a) Describe the Proposer's organizational history and structure; years Proposer and/or firm have been in business providing a similar service(s), and indicate whether the City has previously awarded any contracts to the Proposer/firm. b) Provide a list of all principals, owners or directors. c) Provide a complete list of all current Florida clients for which Proposer administers managed care services. Include name, address, type of entity, type of work done, phone number(s) and contact persons within each organization. Specifically identify clients for whom a similarservice has been provided, particularly to governmental entities similar in size to the City, Trust, or other similar type as the City. d) Discuss in detail Proposer's qualifications and experience to provide managed care services. Include the Proposer's thorough knowledge of all State Statutes and other applicable laws governing this RFP to show a complete understanding of the work to be performed. e) Provide a list of clients that have, for whatever reason, discontinued to use your services within the past two (2) years, and indicate the reasons for the same. The City reserves the right to contact any reference as part of the Page 63 of 66 Request for Proposals (RFP) 207193,2 evaluation process. f) Provide detailed background on the Account Representative/Project Manager and Claims Administrator to be assigned the City's account throughout the duration of the Contract term, and whether Proposer agrees to City's terms for approval of future Project Manager(s) / Claims Administrator should proposed representative leave Proposer's firm during the Contract term. Provide copies of current applicable licenses for work to be performed in the State of Florida. g) Provide two (2) Letters of Reference on letterhead from similar size governmental entities as the City and for whom similar services have been performed. This information is subject to verification as part of the evaluation process. 5. Proposer's Ability to Perform Required Services a) Describe the size of Proposer. Provide a complete list of all claims office locations and territory serviced with Proposer's current personnel, indicating the number of personnel of Proposer and its ability to provide required services to the City. b) Describe where your main office is located the location where the primary work will be performed. Indicate location where the Project Manager/Claims Administrator will be located. c) Discuss how its office or unit will be staffed, and the level of supervision that will be provided. Discuss case assignments, including pending case load for each designated nurse case manager and current number of monthly new assignments to each nurse case manager. d) Discuss whether the award of this contract necessitates an increase in your staff size to meet the City's staffing and caseload requirements, and whether staff will be in place by the start of the contract. e) Provide a complete list of all licensed claim's personnel that will handle the City's managed care services. Include a resume of each Supervisor or Supervising nurse case manager, case manager, Medical -only processors, or other individuals including clerical and or support staff detailing education, experience in the area of managed care, and type of license(s). Include copies of all licenses held by each individual. f) Provide a general description of the firm, including its size, approximate number of personnel, and the areas of coverage. Include how Proposer will ensure managed care services by City employees residing in Miami -Dade, Broward, Palm Beach, and Monroe Counties, among other locales. g) Provide copy of the most recent recently audited (or unaudited if audited not available) Financial Statement of Proposer. 6. Overall Approach to Scope of Work a) Discuss in detail Proposer's overall approach to the work to be performed. b) Describe procedures and systems to be utilized. Include projected case loads per employee of Proposer assigned to the City's account. c) Discuss in detail exactly how all services reflected in the Scope of Work will be accomplished. All items (#1-#15) should be individually addressed. Include a complete approach Proposer will take to meet all responsibilities expected of Proposer by the City. Include any and all information regarding affiliated physicians, other medical personnel, locations to provide said services, and other related information regarding the provision of such services for the City. d) Provide detailed timetable identifying significant milestones for the smooth transition of operations. Proposer shall identify the necessary support that shall be required from City staff during that transition. e) Provide a description of the standard loss reports, as well as provide a sample and descriptions of any additional reports to be utilized. Page 64 of 66 Request for Proposals (RFP) 207193,2 f) Detail any procedures, equipment, and/or costs necessary to connect with the City's hardware software. Should there be associated costs, indicate those costs, the reasons for the same, and who will pay those costs. Costs, if any, shall be detailed in the Fee Proposal Section. g) If proposed, described in detail Proposer's computerized on-line claims management system and software to be utilized during the performance of the scope of work reflected herein. Detail functionality, transition from current system, and if a cost is proposed, indicate the Proposer's Fee Proposal. h) Explain any options which the Proposer's system has that will permit the City to generate reports from, and to make direct inquires intn the Administrator's data base on on-line access. i) Provide sample reports describing information such as type of accident, accident site, depai tnient, date and time, cause of accident, injury, and part of body. Proposer shall describe in detail any safety/loss control reports that are provided by the system, and shall submit a listing of the variety of claims reports available, and provide sample copies of formats that may be requested by the City. j) Provide the methodology and list of allocated or anticipated expenses to employ outside professionals such as surveillance, rehabilitation, experts, attorneys, etc. to assist. 7. Fee Proposal a) As the City is interested in a program which will generate savings over the current expenditures in the workers' compensation area, the proposed fee structure should address the mechanism for achieving a minimum of 15% net savings with an escalating incentive bonus for savings that exceed the minimum and a penalty for a shortfall in the desire net savings. b) Proposed rates are to be guaranteed annual fees for the first three (3) years, as opposed to per claim time and expense or any other fee proposal. Proposals not containing an all inclusive guaranteed annual fee for three (3) years for all specified services, will not be considered. Clearly indicate any charge not included in the proposed annual fee. c) Proposer shall also submit a separate quote(s) for existing claims, and a separate quote(s) for prospective claims; pricing on a "per claim" basis for both existing claims and prospective claims, and a breakdown of the cost between lost time vs. medical. In addition, provide a per claim cost vs. flat dollar cost. Include any other charges not included in pricing. 8. Local Preference, if applicable a) State the Primary Office Location of the Proposer. b) Provide location from which the Proposer will be based to perform the work. 9. Trade Secrets Execution to Public Records Disclosure All Proposals submitted to the City are subject to public disclosure pursuant to Chapter 119, Florida Statutes. An exception may be made for "trade secrets." If the Proposal contains information that constitutes a "trade secret", all material that qualifies for exemption from Chapter 119 must be submitted in a separate envelope, clearly identified as "TRADE SECRETS EXCEPTION," with your firm's name and the RFP number marked on the outside. Please be aware that the designation of an item as a trade secret by you may be challenged in court by any person. By your designation of material in your Proposal as a "trade secret" you agree to indemnify and hold harmless the City for any award to a plaintiff for damages, costs or attorney's fees and for costs and attomey's fees incurred by the City by reason of any legal action challenging your claim. Page 65 of 66 Request for Proposals (RFP) 207193,2 5. Evaluation Criteria 5.1. EVALUATION CRITERIA Proposals shall be evaluated based upon the following criteria and weight: CRITERIA PERCENTAGE Proposer's Qualifications and Experience 20 Proposer's Ability to Perform Required Services 20 Methodology and Overall Approach. to Scope of Services 25 Fee Proposal 25 Local Preference, if applicable 10 Total: 100 Page 66 of 66 EXHIBIT B SCOPE OF WORK PART I - WORKERS COMPENSATION CLAIMS ADMINISTRATION The City is seeking Proposals for third party Claims Administration Services by a Successful Proposer ("Claims Administrator") for the City's Workers' Compensation Self -Insurance Program. The Claims Administrator will provide 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 fiend reconciliation. Specific services to be provided are outlined in this RFP. However, the City reserves the right to add additional services as may be deemed necessary. The Claims Administrator must be prepared to assume the daily activities in the processing and handling of Workers' Compensation claims. The Claims Administrator shall recommend risk control measures and safety programs to protect the City's interest. The staff of the Claims Administrator will be required to work closely with the City Attorney's Office, the Finance Department and other major departments in the City. The City is seeking Proposals for third party claims administration services for its self-insurance program. The City carries excess workers' compensation coverage (with SIR of $350,000 - $500,000 per claim for years 2001-2009, and $750,000 per claim beginning 10/26/10). The Claims Administrator must be familiar with and have working knowledge of 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. The Claims Administrator shall provide Claims personnel, who shall be available on a 7 day, 24 hour basis for investigating claims, and must have and maintain an 800 or other toll -free telephone for emergency service. The Claims Administrator must provide its own office space or facility(s) for its adjuster or staff of adjusters. Its claims adjusters will have limited settlement authority, and all larger settlements, established by the City, must be approved by the City. The Successful Proposer must agree to be responsible to manage Workers' Compensation claims to be opened within the year(s) following contract execution, along with the current inventory of open files. The City is seeking a Successful Proposer that will provide claims administration on a "life of relationship basis." At this time, Risk Management oversees Workers' Compensation claims administered by the current claims administrator. The number of personnel utilized by the claims administrator for current claims vs. future claims includes 6 adjusters, and 2 claims representatives. The City must be able to access Proposer's system, and Proposer must include any costs of its system in its Proposal. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 23 A. The Claims Administrator shall be responsible for performing, as a minimum, the following services: 1. Establish reporting procedures which are compatible with the needs and organizational structure of the City as determined by Risk Management. Notice of injury reports will be submitted to the administrator paperless format i.e. Internet or E-mail. Establish claims acknowledgment procedures to the City's satisfaction. 2. Provide necessary forms and instructions for use. Such forms are to include appropriate first reports of injury with mailing address of claim administrator pre-printed thereon. 3. Designate the number of adjusters necessary to appropriately handle the City's claims. 4. Receive and examine on behalf of the City all reports of employee injury claims. 5. Establish and maintain complete files on each claim. 6. Accept or deny all reported claims for employee's injuries on behalf of the City in accordance with the applicable Workers' Compensation Law. The decision to controvert a claim must first be discussed with and approved by Risk Management. 7. Conduct the required investigations deemed necessary as it relates to Workers' Compensation, including scene investigations and personal claimant contact on all lost time or light duty cases. Contact with claimants must be attempted within 24 hours of the Administrator's receipt of the claim. Field investigations and claimant contact must be performed by employees of the Administrator. Independent adjusters cannot be used to provide this service. 9. Perform job site visits to become familiar with exposures unique to the City. 10. Provide a list every 30 days indicating all employees that are losing time or working in a light -duty or restricted capacity. 11. Submit a full summary report to Risk Management every 90 days on all claims of the following types: a) any claim in which an employee is not working full -duty b) total incurred value exceeding $25,000 c) potentially controverted cases d) cardiovascular claims e) claims in which settlement (washout) is recommended Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 24 12. Prepare and maintain files necessary for legal defense of claims and/or other litigation (such as actions for subrogation) or other proceedings. 13. Pay in a timely fashion all claims and expenses from the loss fund account established by the City, which will be maintained by the Administrator. Fees and civil penalties for late payments are to be paid by the Administrator unless caused due to late reporting by the City. 14. Pursue all possibilities of subrogation and recovery from the Special Disability Fund. 15. While the City will designate the attorneys) that provide the defense of claims, the Administrator shall provide the defense attorney(s) a complete copy of the file in question and monitor and actively participate in the activities of the defense attomey(s). 16. Attend Workers' Compensation hearings, mediations and Pension Board hearings involving work -related injuries as requested by the City. 17. Make written recommendations to Risk Management regarding any procedure or condition that should be examined to prevent future claims, which are revealed during the Administrator's investigation of a claim. 18. Contact Risk Management by telephone on all claims where the compensability or the relatedness of the medical expenses on the claim is in question. 19. Contact employees who experience loss time at least every two weeks, for the duration of temporary total disability payments. When an employee is represented, the attorney shall be contacted when appropriate. If attorney contact is appropriate, that contact should be on a 60-day basis. 20. Report all lost time and/or questionable cases to the Index Bureau. All lost time shall be re - indexed every six (6) months. 21. Establish initial reserves within ten (10) days of receipt of the First Report. All files must be reserved adequately to extend through the expected life of the claim. Although all the necessary facts may not be available at the onset of a claim, reserves should be adjusted when medical information or investigation indicates the existing reserve is inadequate or overstated. The following factors shall be considered when establishing a reserve: a) the injury; b) the investigation; c) medical treatment and costs; d) projected temporary total disability benefits to be paid; e) projected permanent partial disability and impairment benefits, Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 25 f) and potential use of outside experts (i.e., rehabilitation service providers, attorneys, etc.) The Administrator shall review the adequacy of reserves at least every three months, and documentation in the file shall reflect this review. 22. Present in writing all settlements to Risk Management and City Attorney for approval, regardless of the amount. The injured employee will not be contacted regarding settlement until approval of proposed settlement is obtained from Risk Management and and/or City Attorney. 23. Follow all DWC rules when compensation, medical or other benefits are being controverted. The case must be discussed with Risk Management before the claim is denied. 24. Obtain medical reports as necessary to determine the status of the employee's injury and to verify disability; coordinate with the City's Managed Care provider. 25. Report all claims involving a fatality to Risk Management immediately. Payments on such files shall be made in accordance with the Florida Workers' Compensation Law and/or governing contractual agreements. Periodic activity checks shall be performed to ensure that dependents who receive survivor's benefits are still eligible to receive them, and notify Risk Management regarding those activity checks. 26. Prepare and file with the appropriate State agency all applications required for the City's qualification as a self -insurer. 27. Prepare, maintain and file all records and reports as may be required by legal authorities (State, local and Federal.) Attach copies of reports. 28. Prepare, maintain and file statistical or other records and reports as required by the Division. of Workers' Compensation. 29. Prepare, maintain and file statistical info illation required by Workers' Compensation Rating Bureaus, including all required data necessary for the promulgation of experience modifications. 30. Review for accuracy and approve the appropriateness of state assessments, prior to the due date of the assessment. 31. Establish an Imprest bank account to make claim, indemnity, expense and legal payments on checks drawn from this account. It is understood that all funds in this account are City funds and shall be returned upon the City's request or the termination of the Contract. Regarding this account, the Administrator shall: a) Reconcile on a monthly basis the account and provide all bank statements to the City monthly, along with a request for a deposit from the City to maintain the balance needed in the account, as determined by the City. Professional Services Agreement for Claims Administration Services and Managed Care Services (RPP 207193) 26 b) Ensure that any interest earned on the account is to go to reducing the subsequent monthly deposit by the City. c) Submit a monthly statement including the following: d) balance at inception e) total disbursements by date and claimant f) balance at closing g) amount of deposit required h) list of all checks along with all statements supplied to the City i) Bank account transactions and other information can additionally, or in lieu of, be provided by the Successful Proposer to the City on-line or via other means for "real-time" access by the City. 32. Ensure that all adjusters handling City of Miami cases are kept abreast of the Workers' Compensation Statutes, DWC rules, and applicable laws. 33. Ensure that the minimum standards of performance of its personnel conform to the Florida statutes and administrative rules or future changes therein, if any. 34. Ensure all DWC filings, including compromise settlement agreement payments, are made in a correct and timely manner. 35. Provide notification of suit being filed against the City for any reason, to the City Attorney's Office and to Risk Management within twenty-four (24) hours. 36. Aggressively pursue recoveries to the satisfaction of the City, including recoveries based on subrogation and special disability trust fund. The Administrator will pursue, track and provide quarterly reports on all second injury fund. 37. Shall be responsible for data integrity. This includes properly inputting all cause codes, location codes, loss descriptions, and other claims information. If a data conversion is involved, the Administrator must attest to the integrity of the combined data. 3 8.Obtain the approval of Risk Management to hire experts in connection with claims against the City. Experts include, but are not limited to, rehabilitation vendors and private investigators. 39. Provide the means for the City to perform claims status inquiries. 40. Provide training for supervisory personnel of the City for those individuals responsible for workers' compensation activities. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 27 41. Comply with all applicable laws and regulations regarding the administration of Worker's Compensation benefits. 42. Provide and integrate successfully an on-line claims management system that interfaces with all other existing systems to be utilized in the performance of the scope reflected within this RFP. 43. Work closely with the Safety Manger to enhance Safety Program to reduce claims on an annual basis. 44. Assist in exploring the development of a Light Duty Program for City employees. 45. Shall provide to the City a performance guarantee, to be negotiated with the City in the provision of Part I services as cited herein, to improve its effectiveness and efficiency while maximizing City resources. B. HEARINGS / TRIALS The Claims Administrator shall ensure that the following requirements for hearing conferences/trials are followed: 1. Pre -hearing or pre-trial reports shall be submitted by the Claims Administrator to the City Attorney at least two weeks prior to the hearing conference/trial or whenever requested by the City Attorney. Periodic up -dates on ongoing litigation will be scheduled by the City Attorney as needed. 2. The reports must contain all information pertinent to the file including transcribed statements and depositions. 3. The Claims Administrator shall obtain settlement authority from the City prior to any hearing conference/trial. 4. Any recommendations made by the Claims Administrator pertaining to the file should be carried out or referred to the City Attorney. C. REPORTING REQUIREMENTS 1. Claims Administrator shall make an immediate report to the Risk Management Director or the designee on: a) fatalities; and b) catastrophic occurrences with potential exposure of $50,000 or more 2. Submit "full captioned reports" within 30 days of setting reserve at or above $25,000. The content of the "full captioned reports" shall include, but not be limited to, the following: Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 28 coverage items, the employee's background, (e.g., age, resident), dependents, employee's job description, occurrence, injury, medical management, wage and compensation rates, dates and periods of disability, rehabilitation, other employee benefits, litigation, index/state filings, subrogation, remarks and/or recommended actions, and future strategy. 3. Submit "full -captioned report" on all files in litigation. Provide copies of all pleadings along with the report. 4. Ensure that follow-up reports are received within 90 days of the "full -captioned report." 5. Submit 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 l Oth of each month and must provide summary information by department, by participant, and by total program. 6. Shall become familiar with existing labor contracts and report all activities pursuant to those contracts to the Risk Management Director or the designee as requested, at least on a monthly basis. 7. Shall provide the necessary reports and/or data to satisfy Florida's self-insurance requirements. Required forms shall be completed by the Administrator and sent to the City for review and appropriate signatures. Required self-insurance reports shall be provided on a timely basis so that the City will have sufficient time to review and execute the documents before the due date. D. "BAD FAITH" PROCEDURES The following procedures shall be followed to avoid potential actions for breach of good faith and fair dealings: 1. Termination of Weekly Benefits: 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 examiner must follow up in writing with a request for written verification. If treating physician releases the employee to modified work, the Administrator must promptly determine if modified work is available and offered to the employee before benefits are terminated. 2. Controverting Claims: the supervisors or examiner shall contact the City prior to formally denying a claim. This will not be necessary when controverting the reasonableness and necessity of medical bills. 3. Judgments/Settlements: judgments/settlements should release potential future "bad faith" actions. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 29 4. Penalties and Fines: penalties and fines assessed by the DWC shall be paid by the Administrator if such fines and penalties result from negligent performances of its duties. PART II SERVICES - GENERAL, AUTOMOBILE, & PROFESSIONAL LIABILITY CLAIMS ADMINISTRATION A. Upon receipt of all liability claims, the Successful Proposer ("Claims Administrator"), on behalf of the City, shall perform, at a minimum, the following services: 1. Review all first notices of claim reports received from the City (which will consist of loss reports, claim letters, suits or for claims that are phoned, mailed, or faxed in by the City), prior to an assignment to an adjuster approved by the City. 2. The Claims Administrator will designate the necessary number of outside field adjusters to handle all City claims and also designate an alternate in their absence. The designation of these persons is subject to the approval of the City. 3. Conduct a thorough and complete investigation of the accident, according to the requirements of the City. 4. Investigations are to include, but not be limited to, the following: a) Contact the claimant or the claimant's attorney within 24 hours of the time the accident report is received by the Successful Proposer. (In the case of underrepresented claimants, personal contact is required the same day the claim is received). All claim files must contain adjuster's logs documenting all contact and activity. b) Obtain recorded statements from the claimant, witnesses, and the City personnel. Personal contact of all underrepresented claimants by outside adjusters is required. c) Complete a timely scene investigation consisting of photos and diagrams. This is required within 2 days of receipt of any serious AL or GL claim assignment. d) Obtain the police and/or fire rescue report. e) Obtain and review all medical reports and bills submitted by the claimant or their attorney. f) Obtain and review all estimates and appraisals for property damage claims. g) Establish appropriate reserves on all claims, and revise the reserves as needed. h) Submit a report to the City within 30 days of receipt of the claim, summarizing: i. Date/time/location of loss ii. Claimant. information Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 30 iii. Description of accident iv. Injuries or damages v. Witnesses' version vi. Liability analysis vii. Evaluation of claim (Le. amount of recommended settlement, denial, reserves, attorney demand). If a settlement recommendation cannot be made at this initial report (due to lack of information), indicate same and reason. However, remainder of investigation should be completed. i) Submit a status report every 90 days thereafter to the City until the claim is resolved. The City prefers the above reporting requirement to be accomplished via the on-line claims management system for "real-time" viewing. 5. The Claims Administrator has the authority to settle cases on behalf of the City up to $3,000 per claim for property damage and $3,000 for bodily injury. 6. For any settlement in excess of the above, the Claims Administrator must receive authorization from the City. The request for this 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 claims administrator will settle the claim and obtain the appropriate release. The Claims Administrator will advertise settlements as required by Florida Statute, Chapter 69. Additionally, the Claims Administrator will provide a quarterly report to the City on all settlements above and below $10,000. 7. The City will assign an attorney for the legal defense of any claim that goes into suit. The claims administrator will assist the City's attorneys with any additional investigations as deemed necessary by the City or its attorney. The Claims Administrator will continue to monitor the file in litigation and control the activities of defense counsel by requiring status reports every 90 days and directing the attorney's activities. Claims Administrator will provide a monthly report of all litigated claims in the format specified by the City. 8. Upon notification from the City, forward a copy of the file in suit to the City's selected attorney with a transcription of all statements. 9. The Claims Administrator will attend all mediations and trials as requested by the City. With respect to claims with impending trial dates, the Manager of the Claims Administrator will take an active and aggressive role in settlement or preparation for trial. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 31 • 10. The Claims Administrator, after approval of the City, can assign the necessary auto appraiser for property damage claims. These expenses will be paid as an allocated expense by the Claims Administrator from the City's loss fluid. 11. Any other claim expense must be approved by the City prior to being incurred. However, expenses for normal claim activities, such as photographs, tapes, supplies, postage, etc. are the responsibility of the Claims Administrator. 12. The Claims Administrator will meet monthly (or more frequently if required by the City) with the City Manager and/or authorized representative to review all large exposure (over $25,000) incurred cases and report on their status. 13. All claim files are at all times the property of the City. The City has the right to inspect any and all files whenever we deem necessary. If the contract is terminated, the City will receive all original claim files. 14. The Claims Administrator will make recommendations to the City as to actions that can be taken to prevent future claims. These loss prevention recommendations can be included in the status reports. 15. All work must be performed by the employees of the Successful Proposer. The use of any contracted or independent adjuster is prohibited, unless prior approval is granted by the City. 16. The Claims Administrator will reimburse the City for payments made in error that are non- recoverable from third parties by the Claims Administrator. 17. The Claims Administrator shall provide to the City a performance guarantee, to be negotiated with the City in the provision of Part II services as cited herein, to improve its effectiveness and efficiency while maximizing City resources. The City desires prompt, personal contact of all claimants. Evaluations of each claim are to be made as soon as the necessary information is received. The investigation and evaluation of all claims should be completed prior to suit being filed, since F.S. 768.28 (sovereign immunity statute) requires the claimant provide six months notice of intention to file suit. The Administrator must have up-to-date policy and procedure manuals on hand in the work place. These manuals should describe and discuss the day to day procedures for adjusting files. The manuals should be kept in accordance with statutory requirements. The Claims Administrator shall provide adequate toll -free telephone access to the claims office. The Claims Administrator shall provide Claims personnel, who shall be available on a 7 day, 24 hour basis for investigating claims, and must have and maintain an 800 or toll -free number for emergency service. The Claims Administrator must provide its own office space or facility(s) for its adjuster or staff of adjusters. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 32 The Successful Proposer must agree to be responsible to manage liability claims to be opened within the year(s) following contract execution, along with the current inventory of open files, The City is seeking a Successful Proposer that will provide claims administration on a "life of relationship basis." Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 33 EXHIBIT C DESIGNATED PERSONNEL STAFFING, QUALITY CONTROL AND SUPERVISION A. Workers' Compensation and Liability The Claims Administrator shall render high -quality claims management and adjusting services throughout the entire Contract term. The personnel of the Claims Administrator should have, as a minimum, the following levels of experience and licensing. Supervisor or supervising adjuster 5-7 years Adjusters 3 years Medical -only processor(s) 1 year A copy of each adjuster's and supervisor's Florida adjusting license must be made available prior to the assignment of any claims. Files must reflect evidence of supervisory direction and involvement at every level. All files must be kept current. File review should be performed on 30, 60, 90 or 120 day cycles as appropriate. Periodic review by the handling adjuster and all supervisors should be reflected in the file. Supervisors should receive all First Reports of Injury and outline investigative needs for the adjusters to follow through. Supervisors should assign the most difficult files to the most qualified adjuster. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 34 EXHIBIT D INSURANCE REQUIREMENTS PROFESSIONAL SERVICES AGREEMENT THIRD PARTY ADMINISTRATION SERVICES I. Commercial General Liability A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence $1,000,000 General Aggregate Limit $ 2,000,000 Personal and Adv. Injury $ 1,000,000 Products/Completed Operations $ 1,000,000 B. Endorsements Required City of Miami included as an Additional Insured II. Business Automobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Combined Single Limit Owned/Scheduled Autos Including Hired, Borrowed or Non -Owned Autos Any One Accident $ 1,000,000 B. Endorsements Required III. Worker's Compensation Limits of Liability Statutory -State of Florida Waiver of Subrogation IV. Employer's Liability A. Limits of Liability $1,000,000 for bodily injury caused by an accident, each accident $1,000,000 for bodily injury caused by disease, each employee $1,000,000 for bodily injury caused by disease, policy limit Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 35 V. Umbrella Liability (Excess Follow Form) Limits of Liability Each Occurrence $10,000,000 Policy Aggregate $10,000,000 VI. Professional Liability/Errors and Omissions Coverage Each Claim General Aggregate Limit $10,000,000 $10,000,000 The above policies shall endeavor to provide the City of Miami with written notice of cancellation or material change from the insurer not less than (30) clays prior to any such cancellation or material change. Companies authorized to do business in the State of Florida, with the following qualifications, shall issue all insurance policies required above: The company must be rated no less than "A-" as to management, and no less than "Class V" as to Financial Strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. AlI policies and /or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 36 ACO R CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/13/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 300 South Riverside Plaza Suite 1900 Chicago IL 60606 INSURED Gallagher Bassett Services 2901 S.W. 149th Avenue, Suite 200 P.O. Box 279800 Miramar FL 33027 NAME: Direct All Inquiries to Email PHONE (NC No Ext1• E-MAIL FAX (A/C, No): INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :ARCH INS CO (A XV) INSURER B : 11150 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1957575423 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF {MM/DDlYYI'Y� POLICY EXP (MMlDDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL. LIABILITY Y 41GPP4938406 10/1/2013 10/1/2014 ("2014 EACH OCCURRENCE $1,000,000 PRMMGE TO RENTED PREMISES (Ea occurrence) $100,000 CLAIMS -MADE X J OCCUR MED EXP (Any one person) $10,000 X Gen Agg per loc PERSONAL & ADV INJURY $1,000,000 X to $10 MIL polio GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE POLICY LIMIT AP.S J_ECf X PER: LOC PRODUCTS - COMP/OP AGG $3,000,000 $ A AUTOMOBILE LIABILITY Y 41CAB4038306 10/1/2013 "�t�` 'refer. $2,000,000 $ A X _ X ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED 41CAB4939006 (M ( r1 I� 10/1/2013 rma V 1/201 (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE .tt''•; 1'• If " EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N 1 N/A 41 WCI4938106 (AOS) 41 WC14938106 (W) 0/1/2013 10/1/2013 10/1/20 4 10/1/20 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Miami is shown as an Additional Insured solely with respect to General Liability and Auto Liability coverages as evidenced herein as required by written contract with respect to work performed by the Named Insured. CERTIFICATE HOLDER CANCELLATION City of Miami 444 SW 2 Ave. Miami FL 33130 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD `�(C�R�� CERTIFICATE OF LIABILITY INSURANCE `... -� DfDD/YYYY) 08/28 08/28/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-312-704-0100 Arthur J. Gallagher Risk Management Services, Inc. 300 South Riverside Plaza Suite 1900 Chicago, IL 60606 Direct all inquires to email CONTACT PHONE FAX (_A/C. No, Ext): (A/C, No): E-MAIL ADDRESS: Chi_Certificates@ajg.com _ jg•com INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: LEXINGTON INS CO 1gt37 -INSURED Arthur J. Gallagher & Co., et al., including Gallagher Bassett Services, Inc., et al. The Gallagher Centre Two Pierce Place Itasca, IL 60143 INSURER B: XL SPECIALTY INS CO 37885 INSURER C: INSURERD: INSURERS: INSURER F : COVERAGES CERTIFICATE NUMBER: 35397653 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD^ POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS -- GENERAL LIABILITY GENERAL LIABILITY / J EACH OCCURRENCE $ DAMAGE S (RENTED 7COMMERCIAL PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONADV INJURY &COMP/OP $ G GENERAL AGGREGATE $ PRODUCTSAL - AGG $ GEN'L AGGREGATE POLICY LIMIT APPLIES PRO- j�� JECT I PER: LOC $ AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED SCHEDULED �`'� \___ 11 �tik \`{� a a I; I. V ' VeP 1r (Ea accident) BODILY INJU�fj..(P erson) $ BOBJLrV INJURY (Per accident) $ �RROPERTY DAMAGE (Per accident) $ UMBRELLA LIAR EXCESS LIAB O OCCUR CLAIMS -MADE dr u - EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N NIA - ( - WC STATU- 1 TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A B Errors & Omissions (Claims Made) 013345681 ELU13116713 09/01/11 09/01/14 Each Wrongful Act 20,000,000 Aggregate 20,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Miami 444 SW 2nd Avenue, 6th Floor Miami, FL 33130 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) jkee£echi 35397653 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EXHIBIT E COMPENSATION (See Attached Document) COM LOP Cost Plus - Quoted December 13 2010 (4).xls Professional Services Agreement for Claims Administration Services and Managed Care Services (RFP 207193) 37 Workers Compensation Medical Only Indemnity CITY OF MIAMI (#000757) Cost Plus - Life of Partnership Option COSTS AND TERMS Effective Date: QUOTED DECMBER 03, 2010 NEW CLAIMS & OPEN INVENTORY CLAIMS COMBINED ervice Life of Partnership ►nnuai Cost Plus stimated Year:1 Life of Partnership; Life of. Partnership; Annual Cost Plus i Annual Cost Pius Estimated I�Year 21 Estimated Year 3 Ind -Tier II -Florida, New York, Ohio and Texas Ind -Tier III -California, Hawaii, Alaska Liability All Fees included in salries below All Fees included in salries below All Fees included in salries below All Fees included in salries below All Fees included in salries below General Bodily Injury General Property Damage Auto Bodily Injury Auto Property Damage Auto Physical Damage Professional Liability Property All Fees included in salries below All Fees included in salries below All Fees included in salries below All Fees included in salries below All Fees included in salries below All Fees included in salries below All Fees included in salries below' All Fees included in salries below Year One Estimated Actual Salaries at Actual Salaries at Salaries at Commencent Commencement Commencement of Total Salary Expense of Contract: $745,000 of 2nd Year 3rd Year Total Estimated Service Fee (2.35 multiplier) Annual Fee for Licensing of SysFacs (up to six users) $1,750,000 TBD TBD $100,000 $104,000 $108,160 Grand Total $1,850,000 TBD * True Salaries to be Calculated at Beginning at Service Period * Client and GB to Agree on Staffing Prior to Beginning of Serivce Period * GB will perform normal salary administration pursuant to GB Procedures * Assumes City of Miami takes all claims prior to October 8, 2003 date of loss. *Assumes City of Miami takes enough open liability files and newly arising liability files to allow GB to remove one existing staff member. TBD CITY OF MIAMI (#000757) Cost Plus - Life of Partnership Option COSTS AND TERMS Effective Date: QUOTED DECMBER 03, 2010 ,TERMS & CONDITIONS -LIFE OF PARTNERSHIP (1) Claims 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. If you should decide to non - renew or stop using GB in a specific state, the existing open files can be handled in one of three ways. ► Gallagher Bassett would continue to handle the open files at our prevailing rates fee per year per open file. ► Gallagher Bassett would continue to handle the open files on a Time and Expense basis. ► Gallagher Bassett would return the files to the client (contingent upon Carrier approval) at the clients expense. Note: There will be additional charges for ongoing Data Management (RISX-FRCS®), risxfacs.com users, Administration, Banking fees and monthly reports for as long as GB handles claims. Data Management includes the following: ► New Claim Setup ► Historical Claims I. Monthly Report by Email or the Website ► Carrier Report Package by Email or Website (4) Account Administration includes the following: ► Designated Account Manager ► Detailed Status Reports @$50,000 ► Settlement Authority @$25,000 ► Banking Administration (SIMMS) - Provided Loss Fund is Properly Funded ► Two Claim Reviews a Year or One Audit ► Reserve Alerts © $10,000 and subsequent $5,000 changes ► Acknowledgement Letter (5) Claim Reporting ► ClairnLine - Telephonic 800# reporting ► Web Reporting - First reports via the web ► e-Fax - Fax reporting (wc only) (6) risxfacs.com: Standard Internet browser access to Gallagher Bassett claim database Billing and Payment Terms: Fees will be billed on an agreed upon interval (monthly, quarterly) during the calendar year. Fees are payable upon receipt of the invoice. Gallagher Bassett reserves the right to charge 1% per month, or the maximum legal rate, on balances unpaid after 30 days. Pricing is based on using GB Managed Care for Bill Review, PPO and UR. Any Property Loss involving Ten (10) or more buildings as a result of a single event (i.e. hurricane, tornado, flood, earthquake, etc.), will be billed on a Time & Expense basis, and paid as an allocated claim expense against the claim file, including outside adjusting expenses. (10) Material Change - GB reserves the right to modify its fees if: ► It is determined that the historical data upon which GB's fees and service charges developed were based upon erroneous, obsolete or insufficient information, or that a change in CLIENT's business will materially change the nature and/or volume of its business or claims as contemplated at the inception of the Agreement. ► During the term of the Agreement, legislative and/or regulatory requirements materially impact or change the scope of GB's services or responsibilities. (11) Applicable taxes will be added to the service fee where required (3) (8) (9) 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. Gallagher Bassett Services, Inc. will not pay a fee, commission, or rebate to any party for the privilege of presenting our proposal or in order to secure the awarding of any program to Gallagher Bassett Services. 1 HTC/LOP COMBINED -deposit C&T 9-09.xls CITY OF MIAMI (#000757) Cost Plus - Life of Partnership Option COSTS AND TERMS Effective Date: QUOTED DECMBER 03, 2010 GENERAL TERMS & CONDITIONS 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 n/a Claimant #2 - Auto Liability Bodily Injury n/a Claimant Owner - Auto Liability Property Damage n/a Client — Workers' Compensation n/a Client — Auto Physical Damage n/a $0 The total GB fee for this one occurrence is $3,410 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 ► Medical Examinations ► Professional Photographs ► Travel made at client's request ► Costs for witness statements ► Court reports ► Medical records ► Accident reconstruction ► Experts' rehabilitation costs ► Chemist ► Fees for service of process ► Collection cost payable to third parties on Is. Architects, contractors subrogation ► Engineer ► Any other similar cost, fee or expense ► Police, fire, coroner, weather, or other such reports reasonably chargeable to the investigation, ► Property damage appraisals negotiation, settlement or defense of a claim ► Sub rosa investigation or loss which must have the explicit prior ► Official documents and transcripts approval of the client ► Pre- and post -judgment interest paid ► Outside Investigation ► Index Bureau Reporting ► Managed Care ► Second Injury Fund Recovery Managed Care: Managed Care services may include, but are not limited to: ► Preferred provider organization networks ► Utilization review services ► Automated state fee scheduling ► Medical case management and vocational rehabilitation network ► Light duty/return-to-work programs ► Prospective injury management services ► Hospital bill audit services 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. Gallagher Bassett Services, Inc. will not pay a fee, commission, or rebate to any party far the privilege of presenting our proposal or in order to secure the awarding of any program to Gallagher Bassett Services, 1 HTCILOP COMBINED -deposit C&T 9-09.xls #REF! DEFINITIONS 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. The guidelines anticipate: ► Claimant is not considered Medicare Eligible by CMS. ► No payments for indemnity and vocational rehabilitations. ► Claim is not contested or in suit. ► No investigations. ► No loss notices, captioned reports, client meetings or settlement authority is required. ► Payments on claims do not exceed $2,500 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. Incident - Electronic and Manual An Incident is a loss reported electronically through ClaimLine and/or the Web, or set up manually at the branch. GB will review the Incident and make a courtesy call [if necessary] to determine if it is a claim or Incident. GB will have full discretion in the determination and handling of these Incidents and/or their conversion into claim status. 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. 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. 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. Gallagher Bassett Services, Inc. will not pay a fee, commission, or rebate to any party for the privilege of presenting our proposal or in order to secure the awarding of any program to Gallagher Bassett Services. 1 HTC/LOP COMBINED -deposit C&T 9-09.xls CITY OF MIAMI (#000757) Cost Plus - Life of Partnership Option COSTS AND TERMS Effective Date: QUOTED DECMBER 03, 2010 GB MANAGED CARE SERVICES (AS AGREED BY COM ON 10/14/10) COTS AND TERMS Bill Review (FS/UCR) ) Charges. $9.50 per bill Enhanced Bill Review Savings No charge PPO Hospital and Outpatient Care Networks (OCN) 30% of savings after bill review reductions Specialty Networks (MedRisk) 30% of savings after bill review reductions Provider Out of Network Program 35% of savings after bill review reductions Clinical Validation 30% of savings after bill review reductions Telephonic Case Management $75 Medical Triage Hospital Certification Program $120 for hospital inpatient precertification Utilization Review Program $105 for outpatient precertification $105 for outpatient continued review Physician Review/Peer Review $270 per review Task Based Field Case Management • Task 1: One Visit Task • Task 2: Two Visit Task • Task 3: Labor Market Survey • Task 4: Vocational Assessment • Task 5: Home Visit $530 per assignment $705 per assignment $635 per assignment $590 per assignment $660 ($730 in CA) per assignment Medical Case Management and Vocational Rehabilitation - Hourly $92 per hour plus expenses $103 per hour - AK, CA, HI, NY Priority Care - 365 $90 per call PPO Retail Pharmaceutical Network Cost of prescriptions - No charge for Bill Review or PPO Wholesale Prescriptions and Medical Equipment Program Cost of prescriptions and medical equipment - Not charge for Bill Review or PPO Dental Review Program (Nadent) Charged on a per review basis OSHA Reporting $4,500 per year (includes set-up, OSHA access & unlimited OSHA logs and summaries) Taxes All applicable taxes will be added to the service fees where required 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. if another preferred managed care vendor other than Gallagher Bassett Managed Care Services, Inc. is utilized. an administrative fee may apply in exchange for bona fide administrative services. The administrative services may include, but not be limited to overhead costs for the oversight and management of Managed Care vendors which includes the development and oversight of quality standards, development and maintenance of EDi interfaces and reports, monitoring of Managed Care vendor performance, and ensuring proper mandatory state compliance and reporting. Gallagher Bassett Services, Inc. will not pay a fee, commission, or rebate to any party for the privilege of presenting our proposal or in order to secure the awarding of any program to Gallagher Bassett Services. 1 NTC/LOP COMBINED-deposlt C&T 9-09.xls