HomeMy WebLinkAboutExhibitCity of Miami, Florida Contract No. RFP680381
PROFESSIONAL SERVICES AGREEMENT
By and Between
CITY OF MIAMI FLORIDA
And
CONTRACTOR
This Professional Services Agreement ("Agreement") is entered into this _ day of
, 2017 by and between the City of Miami ("City"), a municipal corporation of
the State of Florida, whose address is 444 S.W. 2nd Avenue, 1011 Floor, Miami, Florida 33130 ,
and, Standard Insurance Company a foreign profit corporation, qualified to do business in the
State of Florida whose principal address is 1100 SW 6t" Avenue, Portland, Oregon 97204,
hereinafter referred to as the ("Contractor")
RECITALS:
WHEREAS, the City issued a Request for Proposals No. 680381 on, March 30, 2017 (the
"RFP" attached hereto, incorporated hereby, and made a part of as Exhibit A) for the provision of
Employee Disability Insurance Program, ("Services" as more fully set forth in the scope of work
"Scope" attached hereto as Exhibit B) for City's Risk Management Department and Contractor's
proposal ("Proposal", attached hereto, incorporated hereby, and made part of hereof as Exhibit
C), in response thereto, has been selected as the most qualified proposal for the provision of the
Services.
WHEREAS, the Evaluation/Selection Committee appointed by the City Manager
determined that the Proposal submitted by the Contractor was responsive to the RFP
requirements and recommended that the City Manager negotiate with the Contractor; and
WHEREAS, the City wishes to engage the Services of Contractor, and Contractor wishes
to perform the Services for the City; and
WHEREAS, the City and the Contractor 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, Contractor and the City agree as follows:
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TERMS:
Contract No. RFP680381
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 and Scope of Work are hereby incorporated into
and made a part of this Agreement and attached as Exhibit "B". The Contractor's Response and
Pricing Proposal dated, April 28, 2017, in response to RFP 680381, is hereby incorporated into
and made a part of this Agreement as attached Exhibit °C." The Contractor's Insurance Certificate
is hereby incorporated into and made a part of this Agreement as attached Exhibit °D." The order
of precedence whenever there is conflicting or inconsistent language between documents is as
follows in descending order of priority: (1) Professional Services Agreement ("PSA") (2)
Addenda/Addendum to the RFP; (3) RFP; and (4) Contractor's response and price proposal dated
April 28, 2017, acknowledging scope of services and pricing component of services and, response
to the Request for Proposals.
2. TERM;
The Agreement shall become effective on the date stipulated on the first page, and shall
continue for three (3) years, The City, at its sole discretion, reserves the right to exercise the
option to renew this Agreement for an additional term of three (3) years. The City, acting by and
through its City Manager, shall have the option to renew, extend or terminate the Agreement for
convenience, that is, for any or no cause.
3. SCOPE OF SERVICES;
A. Contractor agrees to provide the Services as specifically described, and under the
special terms and conditions set forth in Exhibits "A" and "B" hereto, which by this reference is
incorporated into and made a part of this Agreement.
B, Contractor represents to the City that: (i) it possesses all qualifications, licenses,
certificates, authorizations, 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 or payment of any monies to the City; (iii) all personnel
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assigned to perf=orm 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
Contractor has been duly authorized to so execute the same and fully bind Contractor as a party
to this Agreement.
C. Contractor shall, at all times, provide fully qualified, competent and physically
capable employees to perform the Services under this Agreement. Contractor shall possess and
maintain any required licenses, permits and certifications to perform the Services under this
Agreement. City may require Contractor to remove any employees 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.
4. COMPENSATION:
A. The amount of compensation payable by the City to the Contractor shall be based
on the negotiated price schedule in Exhibit "C' hereto, which, by this reference, is incorporated
into and made a part of this Agreement. The rates for the initial three (3) year term is guaranteed
as negotiated. The rates for the optional Plan Years 2021, 2022 and 2023 shall be negotiated.
The Contractor shall advise the City of the recommended rates for the three (3) year renewal
period by May V of the year prior to the start of the effected Plan Years (i.e., May 1, 2020),
providing justification for any recommended rate increases above the previous year's rates,
subject to the written concurrence of the City Manager. The City shall not be obliged to accept
the increased rates.
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 Contractor's invoice for Services performed,
which shall be accompanied by sufficient supporting documentation and contain sufficient details,
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 "Local Government Prompt Payment Act",
§218.70. - 218.80, Florida Statutes, and other applicable laws. No advance or future payments
shall be made at any time.
C. Contractor agrees and understands that (i) any and all subcontractors providing
Services related to this Agreement shall be paid through Contractor and not paid directly by the
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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 Contractor.
D. Rates shall remain firm and fixed for the initial three (3) Plan Years (January 1,
2018 — December 31, 2020). Rates will remain at the then current rates for the option or extension
periods; however, prior to expiration of Plan Year 2020 and acceptance and execution of the three
(3) year renewal term, the City may consider an adjustment based on Contractor's
underwriting/actuarial methodology used to determine new rates. Supporting loss ratio claims
experience data shall be provided as requested by the City to facilitate the rates review process.
E. It is the Contractor's responsibility to request the pricing adjustment under this
provision. For the adjustment to commence on the first day of Plan Year 2021, or exercised option
period, the Contractor's requests for the adjustment must be submitted by May 15t of the year
prior to the start of the effected Plan Year (i.e., May 1, 2020 for Plan Year 2021). All requests for
adjustments must be in writing and contain sufficient detail so as to be evaluated by the City
Manager or designee. If no adjustment request is received from the Contractor, this means that
the Contractor has agreed that the optional period may be exercised without pricing adjustment.
Any adjustment received after May 151 will not be considered.
5. OWNERSHIP OF DOCUMENTS:
Contractor understands and agrees that any information, document, report or any other
material whatsoever which is given by the City to Contractor, its employees, or any subcontractor,
or which is otherwise obtained or prepared by Contractor solely and exclusively for the City
pursuant to or under the terms of this Agreement, is and shall at all times remain the property of
the City, except as such records are expressly exempted by applicable insurance, health, and
medical privacy and confidentiality laws and regulations, inc#uding, but not limited to, the
Contractor's proprietary business records created in the course of administering the group
insurance policy(ies). Contractor 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/her sole discretion. Contractor is
permitted to make and to maintain duplicate copies of the files, records, documents, etc. if
Contractor 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 laws be
breached. The City shall maintain and retain ownership of any and all documents which result
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upon the completion of the work and Services under this Agreement as per the terms of this
Section 5.
6. AUDIT AND INSPECTION RIGHTS AND RECORDS RETENTION:
A. Contractor agrees to provide access 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 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 Contractor under this Agreement, audit and inspect, or cause to be audited
and inspected, those books, documents, papers, and records of Contractor which are related to
Contractor's performance under this Agreement. Contractor 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.
Contractor's failure to adhere to, or refusal 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 Contractor's
facilities and perform such tests, as the City deems reasonably necessary, to determine whether
the goods or services required to be provided by Contractor under this Agreement conform to the
terms hereof. Contractor shall permit the City to elect an audit by the City of Miami, or an agreed
upon third party inspector (not a competitor) to perform inspection, Contractor shall make
available to the City all reasonable facilities and assistance to facilitate the performance of tests
or inspections by City representatives of pertinent books and records. All audits, tests and
inspections shall be subject to, and made in accordance with, the provisions of Sections 18-100,
18-101, and 18-102 of the City Code, which apply to this Agreement, as same may be amended
or supplemented, from time to time. The foregoing City Code Sections as well as the entirety of
Chapter 18, "Finance", City of Miami Code, as amended and as applicable, is deemed as being
incorporated by reference herein. Audits will also be subject to applicable privacy and confidential
laws and the Contractor's internal privacy and confidentiality policies and procedures.
7. AWARD OF AGREEMENT:
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 Agreement and that it has not
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offered to pay, paid, or agreed to pay any person any fee, commission, percentage, brokerage
fee, or gift of any kind contingent upon or in connection with, the award of this Agreement.
8. PUBLIC RECORDS:
A. Contractor 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. Contractor'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. Contractor shall additionally comply with Section 119.0701, Florida Statutes, including
without limitation: (1) keep and maintain public records required by the City to perform the service;
(2) upon request from the City's custodian of public records, provide the City with a copy of the
requested records or allow the records to be inspected or copied within a reasonable time at a
cost that does not exceed the cost provided in this chapter or as otherwise provided by law; (3)
ensure that public records that are exempt or confidential and exempt from public records
disclosure requirements are not disclosed except as authorized by law for the duration of the
contract term and following completion of the contract if the contractor does not transfer the
records to the City; (4) upon completion of the contract, transfer, at no cost, to the City all public
records in possession of the contractor or keep and maintain public records required by the City
to perform the service. If the contractor transfers all public records to the City upon completion of
the contract, the Contractor shall destroy any duplicate public records that are exempt or
confidential and exempt from public records disclosure requirements. If the contractor keeps and
maintains public records upon completion of the contract, the contractor shall meet all applicable
requirements for retaining public records. All records stored electronically must be provided to the
City, upon request from the City's custodian of public records, in a format that is compatible with
the information technology systems of the City; and, (6) comply with all State of Florida and federal
privacy laws and regulations that are applicable to Contractor's business. Notwithstanding the
foregoing, Contractor shall be permitted to retain any public records that make up part of its work
product solely as required for archival purposes, as required by law, or to evidence compliance
with the terms of the Agreement, To the extent allowed by the Public Records Act, Chapter 119,
Florida Statute, if applicable, public records shall not include any of the Contractor's proprietary
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business records created in the course of administering the group insurance policies issued to
the City.
C. Should Contractor determine to dispute any public access provision required by
Florida Statutes, then Contractor shall do so at its own expense and at no cost to the City.
Contractor may maintain an exemption for such personal information such as Social Security
Numbers of members or medical information exempted by general law. Should Contractor
determine to dispute any public access provision required by Florida Statutes, then Contractor
shall do so at its own expense and at no cost to the City. IF THE CONTRACTOR HAS
QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA
STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS
AT (305) 416-1830, Via email at PubficRecords miami ov.com, or regular email
at City of Miami Office of the City Attorney, 444 SW 2"d Avenue, 9th FL, Miami, FL
33130.
9. PRIVACY AND CONFIDENTIALITY
Contractor agrees to develop, adopt, and implement standards to safeguard the privacy
and confidentiality of all personal information about eligible employees and members of the
Program. For example, Contractor shall ensure that Contractor does not have completed forms
containing personal information sitting in public view, left in unsecured boxes or files, or left
unattended in any off-site location. Contractor's procedures shall include but not be limited to
safeguarding the identity of members as members of the Program and preventing unauthorized
disclosure of personal information. Contractor agrees to report any unauthorized use or disclosure
of the members' personal information to the City within one (1) business day of any incident of
which it becomes aware. Contractor agrees to comply with all federal and state laws concerning
the privacy and confidentiality of members' information, and agrees to implement any regulations
when they become effective.
In the absence of exigent circumstances, Contractor shall not disclose any member's
personal information to another business associate for pecuniary gain unless the City specifically
authorizes such disclosure in writing. Contractor agrees to mitigate, to the extent practicable, any
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harmful effect that is known to the Contractor of a use or disclosure of members' information by
the Contractor in violation of the requirements of this Agreement or federal or state laws.
Contractor agrees to (1) implement administrative, physical, and technical safeguards that
reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic
personal information of members that Contractor creates, receives, maintains, or transmits; (ii)
report to the City any security incidents of which the Contractor becomes aware, and (iii) ensure
that any agents of the Contractor, including any subcontractors or sub consultants hired solely for
the purpose of performing services to the City under this Agreement, agree to the same
restrictions and conditions that apply to the Contractor with respect to such information.
Contractor agrees not to sell member information. Contractor shall not use member
information unless it is aggregated blinded data, which is not identifiable on a member basis.
Contractor shall not use member identified or non -aggregated information for advertising,
marketing, promotion or any activity intended to influence sales or market share of any product
or service.
Contractor shall have full financial responsibility for any penalties, fines, or other payments
imposed or required as a result of Contractor's non-compliance with, or violation of, federal or
state requirements, and the Contractor shall indemnify the City with respect to any such penalties,
fines, or payments.
Contractor shall assure that all Contractor's staff, including subcontractors or sub
consultants that are hired solely for the purpose of performing services to the City under this
Agreement, are trained in all privacy requirements, as applicable. At the request of the City,
Contractor shall offer credit protection for those times in which a member's personal information
is accidentally or inappropriately disclosed.
10. INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION AND/OR PROTECTED
HEALTH INFORMATION
If applicable, any person or entity that performs or assists the City 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
the privacy, security, and electronic transfer standards, include but are not limited to:
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1. Use of information for performing services required by the Contract or as required by law;
2. Use of appropriate safeguards to prevent non -permitted disclosures;
3. Reporting to the City of any non -permitted use or disclosures;
4. Assurances that any agents and subcontractors agree to the same restrictions and
conditions that apply to the Contractor and reasonable assurances that IIHI/PHI will be
held confidential;
5. Making PHI available to the customer;
6. Making PHI available to the customer for review and amendment; and incorporating any
amendments requested by the customer;
7. Making PHI available to the City for an accounting of disclosures; and
8. Making internal practices, books, and records related to PHI available to the City 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 Contractor 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.
11. COMPLIANCE WITH FEDERAL STATE AND LOCAL LAWS:
Contractor 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 Contractor 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.
Contractor further agrees to include in all of Contractor'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.
12. INDEMNIFICATION:
Contractor shall indemnify, hold harmless, and defend, at its own costs and expense, the
City and its officials and employees for claims (collectively referred to as "Indemnitees") and each
of them from and against all loss, costs, penalties, fines, damages, claims, expenses (including
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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 negligence, recklessness, negligent act or omission, or
intentional wrongful misconduct of Contractor or persons employees or utilized by Contractor in
the performance of this Contract or (ii) omissions or any actions/claims arising out of the a failure
to comply with this Contract, or any applicable laws, codes, rules or regulations. Contractor
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
Contractor, or any of its subcontractors, as provided above, for which the Contractor's liability to
such employee or former employee would otherwise be limited to payments under state Workers'
Compensation or similar laws. Contractor further agrees to indemnify, defend and hold harmless
the Indemnitees from and against (i) any and all Liabilities imposed on account of the violation of
any law, ordinance, order, rule, regulation, condition, or requirement, related directly to
Contractor's negligent performance under this Agreement, compliance with which is left by this
Agreement to Contractor, and (ii) any and all claims and/or suits for services furnished by
Contractor or utilized in the performance of this Agreement or otherwise,
Contractor understands and agrees that any and all liabilities regarding the use of any
subcontractors for Services related to this Agreement shall be borne solely by Contractor
throughout the duration of this Agreement and that this provision shall survive the termination or
expiration of this Agreement, as applicable.
13. DEFAULT:
If Contractor fails to comply with any terms or conditions of this Agreement, or fails to
perform in any material way any of its duties obligations hereunder, and fails to cure such failure
after reasonable notice from the City, which period to cure shall be complied with when stated in
the written notice form the City, then Contractor shall be in default. Contractor understands and
agrees that the termination of this Agreement under this section shall not release Contractor from
any obligations accruing prior to the effective date of termination. Should Contractor be unable or
unwilling to commence to perform the Services within the time provided or contemplated herein,
then, in addition to the foregoing, Contractor may 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
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damages. In no event, however, shall Contractor pay cover costs related to obtaining alternate
or replacement coverage,
14. RESOLUTION OF AGREEMENT DISPUTES:
Contractor understands and agrees that all disputes between Contractor 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 Contractor being entitled to seek judicial relief in
connection 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. Contractor shall not be entitled to seek judicial relief
unless: (i) it has first received City Manager's written decision, approved by the City Commission
if the amount of compensation hereunder exceeds Twenty -Five Thousand Dollars and No/Cents
($25,040), or (fi) 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 (one hundred
and twenty (120) days if City Manager's decision is subject to City Commission approval); or (iii)
City has expressly waived compliance with the procedure set forth in this section by written
instruments, signed by the City Manager, In no event may the amount of compensation under this
Section exceed the total compensation set forth in Section 4 (A) of this Agreement.
15. 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, and without penalty, at any time, by giving written notice to
Contractor at least thirty (30) calendar days prior to the effective date of such termination. In such
event, the City shall pay to Contractor compensation for Services rendered and approved
expenses incurred prior to the effective date of termination. In no event shall the City be liable to
Contractor 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. The
Contractor shall have no recourse or remedy against the City for a termination under this
subsection except for payment of fees due prior to the effective date of termination.
B. The City, by and acting through its City Manager, shall have the right to terminate
this Agreement, in its sole discretion, and without penalty, upon the occurrence of an event of a
material breach hereunder, and failure to cure the same within thirty (30) days after written notice
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of default. In such event, the City shall not be obligated to pay any amounts to Contractor for
Services rendered by Contractor 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 Contractor for any additional compensation and
expenses incurred, other than that provided herein, and in no event shall the City be liable for any
direct, indirect, consequential or incidental damages.
C. Contractor may terminate automatically the Agreement, if premiums are not paid
by the end of the forty-five (45) days grace period. Contractor may terminate with at least 31 days
advance written notice to the City if, on any premium due date, the number of persons insured is
less than the minimum participation of twenty percent (20%).
16. INSURANCE:
A. Contractor 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's Contract number and title (Contract No. RFP680381, Empbyee
Disability Insurance Program), must appear on each certificate of insurance. The Contractor shall
add the City of Miami as an additional insured to its commercial general liability, and auto liability
policies, and as a named certificate holder on all policies. Contractor 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 any cancelled
or non -renewed policy will be replaced with no coverage gap and a current Certificate of Insurance
will be provided. Completed Certificates of Insurance shall be filed with the City prior to the
performance of Services hereunder, provided, however, that Contractor shall at any time; upon
request file duplicate copies of the Certificate of Insurance with the City.
B. Contractor understands and agrees that any and all liabilities regarding the use of
any of Contractor's employees or any of Contractor's subcontractors for Services related to this
Agreement shall be borne solely by Contractor throughout the term of this Agreement and that
this provision shall survive the termination of this Agreement. Contractor further understands and
agrees that insurance for each employee of Contractor and each subcontractor providing Services
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related to this Agreement shall be maintained in good standing and approved by the City Risk
Management Administrator throughout the duration of this Agreement.
C. Contractor 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, Contractor shall be responsible for submitting new or
renewed insurance certificates to the City's Risk Management Administrator as soon as
coverages are bound with the insurers. 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 Contractor in conjunction with the violation of the terms
and conditions of this Agreement.
D. Compliance with the foregoing requirements shall not relieve Contractor of its
liabilities and obligations under this Agreement.
17, NONDISCRIMINATION:
Contractor represents to the City that Contractor does not and will not engage in
discriminatory practices and that there shall be no discrimination in connection with Contractor's
performance under this Agreement on account of race, color, sex, religion, age, handicap, marital
status or national origin. Contractor further covenants that no otherwise qualified individual shall,
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.
18. ASSIGNMENT:
This Agreement shall not be assigned, sold, transferred, pledged, encumbered,
hypothecated, or otherwise conveyed by Contractor, in whole or in part, , without the prior written
consent of the City Manager, which may not be unreasonably withheld or conditioned; the City
shall act in this regard through the City Manager.
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19. NOTICES:
Contract No. RFP680381
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 CONTRACTOR:
Scott B. Wheeler
Senior Employee Benefits Consultant
Standard Insurance Company
Radice Corporate Center
800 Corporate Drive, Suite 210
Ft. Lauderdale, FL 33334
TO THE CITY:
Daniel J. Alfonso
City Manager
444 SW 2"d Avenue, 10th Floor
Miami, FL 33130-1910
Annie Perez, CPPO
Procurement Director
444 SW 2nd Avenue, 6th Floor
Miami, FL 33130-1910
20. 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 sha11 bear its own attorney's fees. Each party to this Agreement waives any defense,
whether asserted by motion or pleading, that the aforementioned courts are an improper or
inconvenient venue; however, this venue provision does not apply to disputes arising between
the Contractor and any individual claimants regarding the group insurance policy or coverage
issues thereunder. Moreover, the parties consent to the personal jurisdiction of the
aforementioned courts and irrevocably waive any objections to said jurisdiction. The parties
irrevocably, voluntarily and knowingly waive any rights to a jury trial.
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Contract No. RFP680381
B. 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.
C. 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.
D. Contractor 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 Contractors.
E. 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
2 above, the City Manager shall have the sole authority to extend, amend, or modify this
Agreement on behalf of the City.
F. Contractor's group insurance policies, which are attached to and made a part of
this Agreement, shall only be amended per the terms of such policies, providing that the City's
Risk Management Director agrees in writing to such change, and their approval will not be
unreasonably withheld. This provision shall not be construed to limit Contractor's ability to
endorse its group policies based on changes in applicable laws.
21. SUCCESSORS AND ASSIGNS
This Agreement shall be binding upon the parties
hereto, their heirs, executors, legal representatives, successors, or assigns.
22. INDEPENDENT CONTRACTORS: Contractor 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 Contractor, nor its employees, nor any subcontractor hired by
Contractor 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
15
Employee Disability Insurance Program Rev. 8/2/17
City of Miami, Florida Contract No, RFP680381
afforded classified or unclassified employees. Contractor further understands that Florida
Workers' Compensation benefits available to employees of the City are not available to
Contractor, its employees, or any subcontractor hired by Contractor to provide any Services
hereunder, and Contractor agrees to provide or to require subcontractor(s) to provide, as
applicable, workers' compensation insurance for any employee or agent of Contractor rendering
Services to the City under this Agreement. Contractor further understands and agrees that
Contractor's or subcontractors' use or entry upon City properties shall not in any way change its
or their status as an independent contractor.
23. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the availability
of funds and continued authorization for program activities and the Agreement is subject to
amendment or termination due to lack of funds, reduction of funds, failure to allocate or
appropriate funds, and/or change in applicable laws or regulations, upon thirty (30) days written
notice. The City shall be liable for premiums through the effective date of termination of any of
Contractor's group insurance policies issued to the City.
24. 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.
16
Employee Disability Insurance Program Rev. 8/2/17
City of Miami, Florida Contract No. RFP680381
25. CITY NOT LIABLE FOR DELAYS: Contractor hereby understands and agrees that
in no event shall the City be liable for, or responsible to Contractor 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.
26. USE OF NAME: Contractor understands and agrees that the City is not engaged in
research for advertising, sales promotion, or other publicity purposes. Contractor 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 Contractor 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.
27. NO CONFLICT OF INTEREST: Pursuant to City of Miami Code Section 2-611, as
amended ("City Code"), regarding conflicts of interest, Contractor hereby certifies to the City that
no individual member of Contractor, no employee, 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. Contractor hereby represents and warrants to the City that throughout the
term of this Agreement, Contractor, its employees, and its subcontractors will abide by this
prohibition of the City Code.
28. NO THIRD -PARTY BENEFICIARY: No persons other than the Contractor and the City
(and their successors and assigns) shall have any rights whatsoever under this Agreement.
29. 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.
30. TRUTH -IN -NEGOTIATION CERTIFICATION, REPRESENTATION AND WARRANTY:
Contractor hereby certifies, represents and warrants to the City that on the date of Contractor's
17
Employee Disability Insurance Program Rev. 8/2/11
City of Miami, Florida Contract No. RFP680331
execution of this Agreement, and so long as this Agreement shall remain in full force and effect,
the wage rates and other factual unit costs supporting the compensation to Contractor under this
Agreement are and will continue to be accurate, complete, and current. Contractor understands,
agrees and acknowledges that the City shall adjust the amount of the compensation and any
additions thereto to exclude any significant sums 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. 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.
31. 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.
32. 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.
18
Employee Disability Insurance Program Rev. $/2/17
City of Miami, Florida
Contract No. RFP680381
IN WITNESS WHEREOF, the part"les hereto have caused this instrument to be
executed by their respective officials thereunto duly authorized, this the day and year above
written.
ATTEST:
Todd B. Hannon, City Clerk
ATTEST: 5uj Y), (,-
"City"
CITY OF MIAMI, a municipal
corporation
By:
Daniel J. Alfonso, City Manager
"Contractor"
STANDARD INSURANCE COMPANY
A foreign profit corporation
OFFICIAL STAMP
a BRENT DUANE WILSON
NOTARY PUBLIC-OREGON
COMMISSION NO.962867 t
`
MY COMMISSION EXPIRES JUNE 05, 2021 By:
Print Name: Brent wi son Print Name: Graeme Queen
Title: Notary Public
(Corporate Sea])
APPROVED AS TO LEGAL FORM
AND CORRECTNESS:
Victoria Mendez
City Attorney
19
Title: 2nd VP Strategic Account Services
(Authorized Corporate Officer)
APPROVED AS TO INSURANCE
REQUIREMENTS:
Ann -Marie Sharpe
Risk Management Director
Employee Disability Insurance Program Rev. 8/2/17
City of Miami, Florida Contract No. RFP680381
CORPORATE RESOLUTION
(This Resolution needs to authorize the signatory to sign)
WHEREAS, ,, a corporation, desires to
enter into an agreement with the City of Miami for the purpose of performing the work described
in the contract to which this resolution is attached; and
WHEREAS, the Board of Directors at a duly held corporate meeting has considered the
matter in accordance with the bylaws of the corporation;
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF DIRECTORS that this
corporation is authorized to enter into the Agreement with the City, and the President and the
Secretary are hereby authorized and directed to execute the Agreement in the name of this
Corporation and to execute any other document and perform any acts in connection therewith as
may be required to accomplish its purpose.
IN WITNESS WHEREOF, this day of , 2016.
("Provider")
0
Print Name:
TITLE:
Print Name:
(State) Corporation
(sign)
(sign)
20
Employee Disability Insurance Program Rev, 8/2/17
City of Miami, Florida
EXHIBIT A
RFP No. 680381
21
Contract No. RFP680381
Fmployee Disability Insurance Program Bev. 8/2/17
ADDENDUM NO. 1
DATE: April 4, 2017
TO: ALL PROSPECTIVE PROPOSERS
SUBJECT: SOLICITATION NO.: RFP 680381
TITLE: Employee Disability Insurance Program
This Addendum becomes a part of the subject solicitation.
The following is an inquiry received and the corresponding response:
1. Is this the formal RFP, and are there missing attachments? If this is complete, is that the only
census, as it is not a complete census and there is no experience. Or are we to use the
information from the previous RFP or is more forthcoming,
Response: Request for Proposals (RFP) 680381 is a new RFP, and is complete as
advertised. The census is also complete; there is no experience, as this is a new program for
participants.
Please note that this is a new RFP so refrain from using information from the previously
rejected RFP, as this solicitation was revised and may contain new and additional information.
All other information remains the same.
APPROVED: —441 6davx
Annie Perez, CPPD, Director of Procurement
LO:lo
c. Lydia Osborne, CPPD, Assistant Director of Procurement
Ann -Marie Sharpe, Director, Risk Management
Rafael Suarez -Rivas, Senior Assistant City Attorney
Date
ADDENDUM NO. 2
DATE: April 13, 2017
TO: ALL PROSPECTIVE PROPOSERS
SUBJECT: SOLICITATION NO.: RFP 680381
TITLE: Employee Disability Insurance Program
This Addendum becomes a part of the subject solicitation.
The following is an inquiry received and the corresponding response:
1. Please provide additional information such as dates of birth and salary, as this information
does not appear on the census that was provided.
Response: Please see attached.
All other information remains the same.
APPROVED: Z a Adman7, 4/13117
Annie Perez, CPPO, Director of Procurement Date
LO:Io
c. Lydia Osborne, CPPD, Assistant Director of Procurement
Ann -Marie Sharpe, Director, Risk Management
Rafael Suarez -Rivas, Senior Assistant City Attorney
RFP No- 607381 Exhibit 1 Employee Disability Insurance Program
Executive Employee Census
PERSON TYPE
GENDER
HR EMPLOYEE GROUP
DATE OF BIRTH
JOB TITLE
RNG
STEP
YRLY
SALARY -BASIS
Employee
F
Executives
25 -May -78
Director, Net Program
24.E
126720
Annual
Employee
M
Police Executives
5 -Jan -80
Net Commander
01.EP
24
124879.24
Annual
Employee
M
Executives
8 -Apr -48
Net Administrator
38.E
71652.04
Annual
Employee
M
Police Executives
26 -Aug -67
Police Major
02.EP
34
151664.44
Annual
Employee
M
Executives
27 -May -68
City Manager
08.Res
203776
Annual
Employee
M
Police Executives
7 -Jul -66
Net Commander
01.EP
34
137876.75
Annual
Employee
M
Fire Executives
Police Executives
11 -der --68
3 -Apr -67
Executive Officer to the Fire Chief
Sergeant -At -Arms
01.EF
OO.EP
10 -Year
34
120461.95
115551.95
Annual
Annual
qeF
Executives
17 -Aug -84
Senior Advisor to the City Manager
23.E
105169.92
Annual
Executives
Executives
16 -Dec -66
19 -Jun -52
Assistant Director, Capital Improvement Prog-Infra
Executive Director, Civilian Investigative Panel
23.E
23.E
98428.1
128000
Annual
Annual
mployee
h1
Police Executives
15 -Sep -61
Exec Asst--Pol Chf, Sr
00.EP
20
97209.84
Annual
Employee
L1
Executives
18 -Dec -75
Treasurer
22.E
126533.46
Annual
Employee
Employee
M
F
Pali[e Executives
Executives
7 -Jan -58
21 -Nov -75
Net Commander
Net Administrator
01.EP
18.F
34
137876.75
Annual
69904.43
Annual
RFP No. 607381 Exhibit 1 Employee Disability Insurance Program
Executive Employee Census
Employee
F
Executives
11 -Oct -64
Director, Grants And Sustainable Initiat
23.E
111000
Annual
Employee
M
Executives
13 -Oct -58
Chief Information Off icer/Director of iT
26.E
129228.8
Annual
Employee
M
Executives
13 -May -64
Asst Dir Of Public Facilities
21.E
105882.4
Annual
Employee
M
Police Executives
15 -Sep -67
Deputy Police Chief
04.EP
36
170554.38
Annual
Employee
M
Police Executives
28 -May -74
Sergeant -At -Arms
OO.EP
26
104684.37
Annual
Employee
F
Executives
25 -May -52
Chief§f AdvisorlG.A.0 to MayorlDireetor, O_I.B.D
28.E
153600
Annual
Employee
F
Executives
20 -Mar -71
Chief of Code Compliance
20.E
94208
Annual
Employee
F
Police Executives
2 -May -72
Net Commander
01.EP
30
132522.83
Annual
Employee
M
Police Executives
9 -Nov -64
Net Commander
01.EP
34
137876.75
Annual
Employee
M
Executives
19 -Mar -69
Chief Fin Officer (CFO)lAssistant City Manager
28.E
170000
Annual
Employee
M
Police Executives
15 -Dec 62
Police Major
02.EP
34
151664.44
Annual
Employee
M
Police Executives
8 -Apr -67
Asst Chief Police
03.EP
34
159247.71
Annual
Employee
M
Executives
24 -Mar -67
Deputy CIO/Asst. Dir. IT
23_E
115000
Annual
Employee
F
Police Executives
1 -Sep -57
Exec.Asst-Pol Chf, Sr
OO.EP
40
124436.81
Annual
Employee:
M
Pglice Executives
3 -Sep -62
Police Major
02.EP
34
151664.44
Annual
Employee
M
Police Executives
12 -Aug -59
Net Commander
01.EP
34
137876.75
Annual
RFP No. 607381 Exhibit 1 Employee Disability Insurance Program
Executive Employee Census
Employee
M
Executives
20 -Jun -71
Assistant Director, Risk Management
20.E
---T85000
Annual
Employee
F
Executives
12 -Nov -63
Net Administrator, Sr
20.E
89705.11
Annual
Employee
M
Fire Executives
25 -Feb -63
Asst Chief Fire
03.EF
21 -Year
184336.44
Annual
Employee
F
Executives
13 -Jun -78
Deputy Director
23.E
95232
Annual
Employee
M
Fire Executives
8 -Apr -77
Asst Chief Fire
03. EF
15 -Year
150096.13
Annual
Employee
M
Executives
24 -Jun -59
Deputy Director
23.E
110907.56
Annual
Employee
F
Executives
9 -Apr -64
Asst. Director, Community Development
20.E
98158.2
Annual
Employee
F
Executives
18 -Sep -78
Assistant City Clerk
20.E
78300
Annual
Employee
M
Executives
27 -Jun -50
Dir General Sero. Admin
25-E
124000
Annual
Employee
Employee
F
M
Police Executives
Executives
9 -Jul -71
19 -Aug -55
Police Major
Senior Assistant To City Manager
02.EP
22.E
142916.8
122797.09
Annual
Annual
Employee
Employee
Employee
M
M
M
Fire Executives
Executives
Police Executives
5 -pct -70
18 -Dec -63
28 -Sep -69
Asst Chief Fire
Dir Finance
Police Major
03.EF
26-E
02.EP
21 -Year
32
184336.44
147632
148690.67
Annual
Annual
Annual
Employee
Employee
M
M
Poiice Executives
Police Executives
13 -Feb -66
19 -Jan -70
Net Commander
Sergeant At-Arras99.OTH
01.EP
34
437876.75
118370.29
Annual
Annual
RFP No. 607381 Exhibit 1 Employee Disability Insurance Program
Executive Employee Census
Employee
Employee
M
M
Fire Executives
Executives
11 -Feb -62
31 -pct -67
Asst Chief Fire, Fire Marshall
Director, Planning
—63 EF
25.E
10 -Year
184336.44
149884.8
Annual
Annual
Employee
M
Fire Executives
22 -Qct -68
Asst Chief Fire
03.EF
21 -Year
165579.44
Annual
Employee
M
Police Executives
9 -Apr -59
Asst Chief Police
03.EP
38
165579.02
Annual
Employee
M
Fire Executives
9 -Jun -62
Asst Chief l=ire
03.EF
184336.44
Annual
Employee
F
Executives
11 -Apr -75
Assl Dir -Planning And Development
21.1
105260
Employee
Employee
M
M
Executives
Executives
14 -Jan -53
23 -Jan -79
Auditor General
Director, Code Compliance
24.E
148480
93678.62
EAnnual
Annual
Employee
Employee
Ivl
F
Executives
Executives
23 -Sep -71
19 -Feb -79
City Clerk
Assistant to the City Manager
04.Res
20,E
128000
Annua[
90200
Annual
Employee
Employee
F
M
Executives
Executives
13 -Aug -82
18-0ct-54
Net Administrator
Senior Director of Building, Planning, & Zoning
18.E
27.E
71652.04
Annual
160000
Annual
Employee
M
Executives
5 -Dec -61
Chief of Operations (CO}/Assistant City Manager
28.E
175000
Annual
Employee
Employee
M
M
Police Executives
F"sre Executives
5 -Dec -69
23 -Apr -59
Police Major
Chief Of Fire
02.1=P
05.EF
32
148690.67
Annual
223329
Annual
Employee
F
Executives
20 -Dec -62
As# Dir Net
22.E
84989.25
Annual
RFP No. 607381 Exhibit 1 Employee Disability Insurance Program
Executive Employee Census
Employee
M
Executives
11 -May -62
Dir., Parks & Rec
24.E
125000
Annual
Employee
F
Executives
27 -Jan -81
Dir Human Resources
26.E
133500
Annual
Employee
M
Police Executives
19 -Oct -66
Net Commander
01.EP
34
137876.75
Annual
Employee
M
Executives
22 -Sep -70
Net Administrator
98.E
71652.04
Annual
Employee
M
Police Executives
23 -May -70
Sergeant -At -Arms
OO.EP
24
102131.09
Annual
Employee
M
Police Executives
3 -Dec -66
Chief Of Police
99.OTH
180000
Annual
Employee
Ni-
Executives
26 -Oct -74
Ast Dir Human Resources
21.E
115000
Annual
Employee
M
Police Executives
26 -May -56
Police Major
02.EP
34
151664.44
Annual
Employee
M
Police Executives
31 -Mar -66
Police Major
02.EP
34
151664.44
Annual
Employee
Employee
M
F
Fire Executives
Executives
12 -Aug -68
17 -Feb -72
Asst Chief Fire
Agenda Coordinator
03 -EF
18.E
21 -Year
165579.44
97268.46
Annual
Annual
Emp}oyee
M
Police Executives
22 -pct -67
Police Major
02.EP
26
140114.62
Annual
Employee
h1
Executives
30 -Sep -57
Dir Community Dev€pt
26.E
122073.41
Annual
Employee
h1i
Executives
5 -Jul -61
Deputy Director
23.E
113540
Annual
Employee
F
Police Executives
3 -Mar -64
Net Commander
01.EP
28
129924.49
Annual
Employee
F
Executives
8 -Oct -66
Executive Secretary-Csb
20.E
112508.81
Annual
RFP No. 607381 Exhibit 1 Employee Disability Insurance Program
Executive Employee Census
EEmployeeTMFire
Executives
27 -May -59
Executive Officer to the Fire Chief
01.EF
16 -Year
126560.3
Annual
Police Executives
23 -Oct -70
Net Commander
01.EP
30
132522.83
Annual
Employee
Police Executives
5 -pec -64
Police Major
02.EP
34
151664.44
Annual
Employee
fi
Police Executives
24 -Nov -60
Asst Chief Police
03.EP
38
165579.02
Annual
Employee
M
Executives
19 -Jan -64
Dir, Solid Waste
25.E
137600
Annual
Employee
Employee
F
F
Executives
Executives
30 -Dec -54
8 -Nov -67
Assistant Director of Procurement
Net Administrator
21.E
19.E
112855.04
78708.52
Annual
Annual
Employee
M
Police Executives
8 -Jun -70
Police Major
02.EP
30
145775,13
Annual
Employee
F
Executives
25 -Jun -76
Ast Dir Of Finance
22.E
106524.47
Annual
Employee
F
Executives
12 -Apr -70
Dir, Purchasing
24.E
126003.2
Annual
Employee
M
Police Executives
29 -Aug -66
Police Major
02.EP
32
148690.67
Annual
Employee
Police Executives
14 -May -73
Net Commander
01.EP
28
129924.49
Annual
Employee
h:i
Fire Executives
10 -May -62
Deputy Fire Chief
04.EF
21 -Year
184336.44
Annual
Employee
1v1
Fire Executives
9 -Mar -78
Asst Chief Fire
03.EF
15 -Year
167099.2
Annual
Employee
Employee
M
M
Executives
Executives
26 -Feb -68
15 Oct
Net Administrator
Deputy Director
18.E
23.E
71552.04
115000
Annual
Annual
RFP leo. 607381 Exhibit 1 Employee Disability Insurance Program
Executive Employee Census
Employee
M
Executives
18 -Mar -78
Net Administrator
-E--
TS.
71652.04
Annual
Employee
Employee
M
F
Fire Executives
Executives
25-Au9-60
9 -Jun -77
Asst Chief Fire
Asst Dir Gsa
03.EF
21 -Year
184336.44
Annual
22.E
84969.25
Annual
Employee
M
Police Executives
3 -Feb -82
Exec Asst--Pol Chf, Sr
00 -EP
20
97209.84
Annuat
Employee
M
Executives
24 -May -47
Executive Mayor11,M
Y r
0
Annual
Employee
M
Executives
23 -May -72
Net Administrator
Eo/Diversity Prg, Admin
Net Administrator
Director, Capital Improvement Program
Net Commander
Director. Office of Management and Budget
Dir Public Facilities
Police Major
Dir Public Works
Deputy Director
Director, Risk Management
18.E
69904.43
Annual
Employee
F
Executives
7 -May -69
22.E
105000
Annual
Employee
F
Executives,
3-Oet-66
19.E
HE
75254.57
135000
Annual
Annual
Employee
M
Executives
8 -Jan -71
Employee
Employee
M
M
Police Executives
Executives
19 -Mar -74
1 -Jan -70
01.EP
26.E
28
129924.49
141488
Annual
Annual
Employee
Employee
M
M
Executives
Police Executives
11 -Oct-66
2 -Dec -61
24.E
139264
Annual
02.EP
27.E
34
151664.44
129228.8
Annual
Annual
Employee
Employee
Employee
M
tv
F
Executives
Executives
Executives
29•Qct 64
16 -Nov -7E
26 -Oct -62
23-E
23.E
129866
112640
Annual
Annual
RFP No. 607381 Exhibit 1 Employee Disability Insurance Program
Executive Employee Census
Employee
M
Executives
13 -Jun -73
Asst. Director, Community Development
20.E
100292.24 Annual
Employee
M
Executives
16 -Aug -67
Homeless Program Administrator
18.E
85287.63
Annual
Employee
M
Executives
31 -Mar -51
Net Administrator
18,E
71652.04
Annual
Employee
M
Fire Executives
3 -Oct -71
Deputy Fire Chief
04 -EF
21 -Year
193560.51
Annual
EmPleYee
M
Executives
20 -Feb -67
Chief of International Affairs and Protocol
23.E
89217.65
Annual
City of IViiiami, Florida
Form B
Price Proposal Schedule
RFP No. 680381
The Proposer's price shall be submitted on this Form -"Price Proposal Schedule", and in the manner stated
herein. Proposer is requested to fill in the applicable blanks on this form.
A. EMPLOYER FUNDED (FULL- PARTICIPATION) DISABILITY INSURANCE PROGRAM
The proposed price for providing all services as stated in Section 3.0, Scope of Services, including the plan
designs identified in Exhibit 2, shall be as stipulated below. The price shall be for a fully -insured program. The
City intends to award all lines of business to one provider. Prices requested below shall be provided on a bi-
weekly basis.
SHORT-TERM DISABILITY (STD)
Plan Design
Bi -weekly Rate Per $100 of Weekly Benefit
$2,000 maximum benefit per week
(14 -day waiting period)
Plan Year 2018
111118'12131118
Pian Year 2019
Plan Year 2020
111120-12131120
111119-12131119
Plan Year 2020
LONG-TERM DISABILITY (LTD)
Plan Design
Bi -weekly Rate Per $100 of
$2,000 maximum benefit per week
(14 -day waiting period)
Covered Monthly Payroll
$10,000 maximum benefit per month
Plan Year 20218
Plan Year 2019
Plan Year 2020
(180 -day waiting period)
111118-12131118
111119-12131119
111120-12131120
$
$
$
B. FULLY EMPLOYEE FUNDED (VOLUNTARY PARTICIPATION) DISABILITY INSURANCE PROGRAM
The proposed price for providing all services as stated in Section 3.0, Scope of Services, including the plan
designs identified in Exhibit 2, shall be as stipulated below. The price shall be for a fully -insured, voluntary
program. The City intends to award al€ lines of business to one provider. Prices requested below shall be
provided on a bi-weekly basis.
SHORT-TERM DISABILITY (STD)
Plan Design
Bi -weekly Rate Per $100 of Weekly Benefit
$2,000 maximum benefit per week
(14 -day waiting period)
Plan Year 2018
111118-12131118
$
Plan Year 2019
Plan Year 2020
111120-12131120
$
111119-12131119
$
LONG-TERM DISABILITY (LTD)
Plan Design
Bi -weekly Rate Per $100 of
Covered Monthly Payroll
$10,000 maximum benefit per month
Plan Year 2018
Plan Year 2019
Plan Year 2020
(180 -day waiting period)
111118-12131118
111119-12131119
111120-12131120
$
$
$
Page 1
EMPLOYEE DISABUTY INSURANCE PROGRAM Rev. 3.15.17
City of Miami, Florida
PREMIER LONG-TERM DISABILITY
RFP No. 680381
Plan Design
Bi -weekly Rate Per $100 of
No
Covered Monthly Payroll
$10,000 maximum benefit per month
Plan Year 2018
Plan Year 2019
Plan Year 2020
(90 -day waiting period)
111118-12/31118
1!1119-12131!19
111120-12131/20
MINIMUM PARTICIPATION REQUIREMENTS (Optional)
Based on Proposer's proposed employee funded rates, indicate guarantee participation periods:
Participation Guarantee Period Number of Plan Years
Greater than 25%
Between 20% and 25%
Between 15% and 20%
Between 10% and 15%
Below 10%
Notes:
1. The rates shall be guaranteed for first two (2) Plan years (through December 31, 2019). It is preferable
that rates not be contingent upon minimum participation requirements, however, Proposer may list the
guarantee periods relating to minimum requirements in the chart above. For Plan Year 2020 and the
optional renewal period, the then current rates will remain, unless the City approves an increase in the
rates, pursuant to Section 4 of the Agreement.
2. Notwithstanding the Proposer's proposed rates, payment to the Successful Proposer shall be based on
the actual enrollment of employees and the actual volume of insurance in the Plans.
3. Proposed rates in Sections A & B will be used to determine the price points for the Price criterion as
indicated.
4. Proposers may confirm optional year guaranteed rate commitment as provided for below in Section C.
C. OPTION TO RENEW YEARS
The City prefers that Proposer guarantee rates for optional 3 -year period (beyond initial term). Proposer should
state whether Proposer will hold rates for the three-year option to renew period by completing the below
information.
Optional Renew Period (January 1, 2020- December 31, 2023)
Yes
No
Will Proposer guarantee its prior year rates for the three-year
option to renew period? If so, please provide rates.
Note: Section C is for informational and negotiation purposes only and will not be utilized for scoring
purposes.
Page 2
EMPLOYEE DISABILITY INSURANCE PROGRAM Rev. 3.15.17
City of Miami
Procurement Department
Miami Riverside Center
444 SW 2nd Avenue, 61h Floor
Miami, Florida 33130
Web Site Address: www miamigov.comlprocurement
Number: 680381,3
Title: Request for Proposals - Employee
Disability Insurance Program
(RESOLICITATION)
Issue Date/Time: 14 -APR -2017
Closing Date/Time: 01 -MAY -2017 @ 15:00:00
Pre-Bid/Pre-Proposal Conference: Voluntary
Pre-Bid/Pre-Proposal Date/Time:
Pre-Bid/Pre-Proposal Location:
Deadline for Request for Clarification
Contracting Officer:
Hard Copy Submittal Location:
Contracting Officer E -Mail Address:
Contracting Officer Facsimile:
Monday, April 10, 2017 @ 10:00:00 AM
MRC Building, 444 SW 2nd Avenue, 6th
Floor, South Conference Room
April 19, 2017 a 5:00:00 PM
Osborne, Lydia
City of Miami - City Clerk
3500 Pan American Drive
Miami FL 33133 US
LOsborne@miamigov.com
305-400-5025
Page i of 47
Certifieation 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 terrrns 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:
PROPOSER NAME:
ADDRESS:
PHONE:
EMAIL:
SIGNED BY:
TITLE:
FAX:
CELL(Optional):
DATE:
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISQUALIFY THIS
RESPONSE
Page 2 of 47
Certifications
Legal Name of Firm:
Entity Type: Partnership, Sole Proprietorship, Corporation, etc.
Year Established:
Office Location: City of Miami, Miami -Dade County, or Other
Business Tax Receipt/Occupational License Number:
Business Tax Receipt/Occupational License Issuing Agency:
Business Tax Receipt/Occupational License Expiration Date:
Will Subcontractor(s) be used? (Yes or No)
Please list and acknowledge all addendum/addenda received. List the addendum/addenda number and
date of receipt (i.e. Addendum No. 1, 7/1107). If no addendum/addenda was/were issued, please insert
N/A.
If Proposer has a Local Office, as defined under Chapter 18/Articlle III, Section 18-73 of the City Code,
has Proposer filled out, notarized, and included with its RFP response the "City of Miami Local Office
Certification" form? YES OR NO? (The City of Miami Local Office Certification form is located in the
Oracle Sourcing system ("iSupplier"), under the Header/Notes and Attachments Section of this
solicitation)
Page 3 of 47
Line: 1
Description: Proposers are not required to enter their proposed Price in this section. Proposers
shall complete Exhibit B, Price Proposal Schedule for proposed Price.
Category: 95300-00
Unit of Measure: Dollar
Unit Price: $ Number of Units: 1 Total: $
Page 4 of 47
68039t,3
Table of Contents
Termsand Conditions......................................................................................................................................................6
1. General Conditions.................................................................................................. ..........................................
.6
1.1. GENERAL TERMS AND CONDITIONS.............................................................................................6
2. Special Conditions...........................................................................................................................................n
2.1. PURPOSE.............................................................................................................................................26
2.2. DEADLINE FOR RECEIPT OF REQUEST FOR ADDITIONAL.
INFO RMATION/CL.ARIFICATION..........................................................................................................26
2.3. DEFINITIONS......................................................................................................................................26
2.4. TERM OF CONTRACT.......................................................................................................................27
2.5. VOLUNTARY PRE -PROPOSAL CONFERENCE............................................................................27
2.6. CONDITIONS FOR RENEWAL.........................................................................................................27
2.7. NON -APPROPRIATION OF FUNDS.................................................................................................27
2.8. MINIMUM QUALIFICATION REQUIREMENTS............................................................................27
2.9. REFERENCES......................................................................................................................................28
2.14. EXECUTION OF AN AGREEMENT...............................................................................................28
2.11. FAILURE TO PERFORM..................................................................................................................28
2.12. INSURANCE REQUIREMENTS......................................................................................................28
2.13. CONTRACT ADMINISTRATOR.....................................................................................................31
2.14. SUBCONTRACTOR(S) OR SUBCONSULTANT(S)......................................................................31
2.15. TERMINATION.................................................................................................................................31
2.16. ADDITIONAL TERMS AND CONDITIONS..................................................................................32
2.17. COMPENSATION PROPOSAL........................................................................................................32
2.18. EVALUATIONISELECTION PROCESS AND CONTRACT AWARD.........................................32
2,19. ADDITIONAL SERVICES................................................................................................................33
2.20. CHANGES/ALTERATIONS.............................................................................................................34
2.21. RECORDS.........................................................................................................................................34
2.22. TRUTH IN NEGOTIATION CERTIFICATE...................................................................................34
3. Specifications..................................................................................................................................................35
3.1. SPECIFICATIONSISCOPE OF WORK..............................................................................................35
4. Submission Requirements................................................................................................................................41
4. I. Submission Requirements.....................................................................................................................41
5. Evaluation Criteria...........................................................................................................................................46
5.1. EVALUATION CRITERIA..................................................................................................................46
Page 5 of 47
680381,3
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 tinder 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'slproposer'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 WILL NOT BE CONSIDERED.
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,
each party shall bear their own attorney's fees through and including 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 Successfitl Bidder/Proposer shall maintain and retain any and all of
Page 6 of 47
680381,3
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 bidders)/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 contractiagreement, 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 suuccessfid bidders)/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 Successfiul 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.
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 maybe 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
Page 7 of 47
680381,3
City's best interests. Such agreement will be fiirnished 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 FOIVVI (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 rale 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 famished after fornlal 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
for, or responsible to, the Bidder/Proposer/Consultant, any sub-contractor/slab-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
Page 8 of 47
680381,3
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 and observe 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 1490, 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 1II.
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.
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
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 RFPs, 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:
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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 IFS (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 financially
interested, directly or indirectly, in the purchase of goads/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.
A. Bidder/Proposer further agrees not to use or attempt to use any knowledge, property or resource which may
be within his/her/its trust, or perform his/her/its deities, to secure a special privilege, benefit, or exemption for
himself/herself/itself, or others. Bidder/Proposer may not disclose or use information not available to members of
the general public and gained by reason of his/her/its position, except for information relating exclusively to
governmental practices, for his/her/its personal gain or benefit or for the personal gain or benefit of any other person
or business entity.
B. Bidder/Proposer hereby acknowledges that he/she/it has not contracted or transacted any business with the
City or any person or agency acting for the City, and has not appeared in representation of any third party before any
board, commission or agency of the City within the past two years. Bidder/Proposer fiirther warrants that he/she/it
is not related, specifically the spouse, son, daughter, parent, brother or sister, to: (i) any member of the commission;
(ii) the mayor; (iii) any city employee; or (iv) any member of any board or agency of the City.
C. A violation of this section may subject the Bidder/Proposer to immediate termination of any professional
services agreement with the City, imposition of the maximum fine and/or any penalties allowed by law.
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Additionally, violations may be considered by and subject to action by the Miami -Dade County Commission on
Ethics.
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.
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. DEBARNIENT AND SUSPENSIONS (See 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 perforin 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
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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.
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
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to comply with these requirements may deem a Response non-responsive.
A. Responsible Bidder shall mean a bidder/proposer who has submitted a bid/prposai and who has the capability,
as determined under the City Procurement Ordinance, in all respects to fully perform the contract requirements, and
the integrity and reliability of which give reasonable assurance of good faith and performance.
1.24. 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. Stich 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
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 goveming 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 successfitl 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:
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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
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 film 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 considered from 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. FIRiVI PRICES - The bidder/proposer warrants that prices, terms, and conditions quoted in its response will
be firm throughout the duration of the contract unless othet-€vise 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
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or supplied over a period of time
1.38. 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, CPC -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 ist.
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 fiumish employee name(s), job tide(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 successfiil bidder/proposer must provide for any and all information to make a wage and
contractual price increase(s) determination.
1.39. 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. In any action or proceeding each party shall bear their own respective
attorney's fees.
1.40, HEADINCS 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.
1.41. 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;
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 internal 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
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practices including specifically, a description of the types of uses and disclosures that would be made with protected
health information.
1.42 INDEMNIFICATION - Contractor shall indemnify, hold/save harmless and defend at its own costs and
expense the City, its officials, officers, agents, directors, and employees, from liabilities, damages, losses, and costs,
including, but not limited to reasonable attorney's fees, to the extent caused by the negligence, recklessness or
intentional wrongful misconduct of Contractor and persons employed or utilized by Contractor in the performance
of this Contract and will indemnify, hold harmless and defend the City, its officials, officers, agents, directors and
employees against, any civil actions, statutory or similar claims, injuries or damages arising or resulting from the
permitted work, even if it is alleged that the City, its officials and/or employees were negligent. These
indemnifications shall survive the term of this Contract. In the event that any action or proceeding is brought
against City by reason of any such claim or demand, Contractor shall, upon written notice from City, resist and
defend such action or proceeding by counsel satisfactory to City. The Contractor expressly understands and agrees
that any insurance protection required by this Contract or otherwise provided by Contractor shall in no way limit the
responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and
instrumentalities as herein provided.
The indemnification provided above shall obligate Contractor to defend at its own expense to and through appellate,
supplemental or bankruptcy proceeding, or to provide for such defense, at City's option, any and all claims of
liability and all suits and actions of every name and description which may be brought against City whether
performed by Contractor, or persons employed or utilized by Contractor.
This indemnity will survive the cancellation or expiration of the Contract. This indemnity will be interpreted under
the laws of the State of Florida, including without limitation and which conforms to the limitations of §725.06
and/or §725.08, Fla. Statues, as amended from time to time as applicable.
Contractor shall require all Sub -Contractor agreements to include a provision that they will indemnify the City.
The Contractor agrees and recognizes that the City shall not be held liable or responsible for any claims which may
result from any actions or omissions of the Contractor in which the City participated either through review or
concurrence of the Contractor's actions. In reviewing, approving or rejecting any submissions by the Contractor or
other acts of the Contractor, the City in no way assumes or shares any responsibility or liability of the Contractor or
Sub -Contractor, under this Agreement.
1.43. FORMATION 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.
1.44. 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 temis 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.
1.45. 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 30 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
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Web Site following recommendation for award.
1.46. 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 lasted 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
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 fitture responses to the City. Information regarding any
insurance requirements shall be directed to the Disk 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 terns that may be
granted to the Bidder/Proposer.
1.47. 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).
1.48. LOCAL PREFERENCE
A. City Code Section 18-85, states, "when a responsive, responsible non -local bidder submits the lowest bid
price, and the bid submitted by one or more responsive, responsible local bidders who maintain a local office, as
defined in Section 18-73, is within fifteen percent (15%) of the price submitted by the non -local bidder, then that
non -local bidder and each of the aforementioned responsive, responsible local bidders shall have the opportunity to
submit a best and final bid equal to or lower than the amount of the low bid previously submitted by the non -local
bidder. Contract award shall be made to the lowest responsive, responsible bidder submitting the lowest best and
final bid. In the case of a tie in the best and final bid between a local bidder and a non -local bidder, contract award
shall be made to the local bidder."
B. City Code Section 18-86, states, "the RFP, RFLI or RFQ, as applicable, may, in the exercise of the reasonable
professional discretion of the City Manager, director of the using agency, and the Chief Procurement Officer,
include a five (5%) percent evaluation criterion in favor of proposers who maintain a local office, as defined in
Section 18-73. In such cases, this five (5%) percent evaluation criterion in favor of proposers who maintain a local
office will be specifically defined in the RFP, RFLI or RFQ, as applicable; otherwise, it will not apply.
1.49. 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 frill liability.
1.50. 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
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as appropriate.
1.51. 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.
1.52. 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.
1.53. 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.
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 oppoitunity
for employment.
1.54. 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 bidder(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 constriction
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.
1.55. OCCUPATIONAL LICENSE - Any person, firm, corporation orjoint 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.I, 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.
1.56. ONE PROPOSAL - Only one (1) Response from an individual, firm, partnership, corporation or joint venture
will be considered in response to this Formai Solicitation.
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1.57. 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.
1.58. 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.
1.59. 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.
1.60. 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.
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 FOI;LMS, UNLESS
OTHERWISE SPECIFIED, AND ANY REQUIRED ATTACHMENTS MUST BE RETURNED TO THE CITY
OR YOUR RESPONSE MAY BE DEEMED NON-RESPONSIVE.
1.61. PRICE ADJUSTMENTS — Any price decrease effectuated during the contract period either by reason of
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market change or on the part of the contractor to other customers shall be passed on to the City of Miami
1.62. 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.
1.63. 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.
1.64. 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 terns 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 cash discount, 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
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.
1.65. 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.
1.66. 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.
1.67. 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 constriction 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.
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1.68. 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 shall additionally comply with the provisions of
Section 119.0701, Florida Statutes, entitled "Contracts; public records". 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.
1.69. QUALITY OF GOODS, MATERIALS, SUPPLIES, PRODUCTS, AND EQUIPMENT - All materials
used in the manufacturing or constriction 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 duality, and of the highest grade of
workmanship, unless as otherwise specified in this Solicitation.
1.70. 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.
1.71. REMEDIES PRIOR TO AWARD (See. 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.
1.72. 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
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 party's right to seekjudicial 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.
1.73. RESOLUTION OF PROTESTED SOLICITATIONS AND AWARDS (Sec. 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
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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.
L 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
H. 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, return receipt requested. A notice of intent to file a protest is considered filed when
received by the Chief Procurement Officer.
W. 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
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 nm 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 shall nun 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 parry to timely file either the notice of intent to file a protest or
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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 party'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.
1.74. SAMPLES - Samples of items, when required, must be submitted within the time specified at no expense to
the City. If not destroyed by testing, bidders)/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.
1.75. 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
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.
1.76. 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.
1.77. 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.
1.78. 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
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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 US 1. US I 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: USI 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.
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.
1.79. 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.
1.80. TERtYIINATION —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
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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.
1.8I. 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.
1.82. 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.
1.83. 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.
1.84.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 114 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 attorney's fees incurred by
the City by reason of any legal action challenging your claim.
1.85. 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.
1.86. 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.
1.87. 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 frilly complies with the City's specifications.
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2. Special Conditions
2.1. PURPOSE
The purpose of this Solicitation is to establish a contract, for the provision of an Employee Disability Insurance
Program, as specified herein, from a source(s), fiflly 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
Procurement Department, Attn: Lydia Osborne, PhD, CPPD, CPPB; fax; (305) 400-5025 or
email: losbomeCmiamigov.com, and a copy filed with the Office of the City Clerk, pursuant to Section 1.20. Cone
of Silence. The solicitation title and number shall be referenced on all correspondence. All questions must be
received no later than April 19, 2017 @ 5:00:00 PM. All responses to questions will be sent to all prospective
bidders/proposers in the form of an addendum. NO QUESTIONS WILL BE RECEIVED VERBALLY OR AFTER
SAID DEADLINE.
2.3. DEFINITIONS
The following words and expressions used in this Solicitation shall be construed as follows, except when it is clear
from the context that another meaning is intended:
1. The word "City" to mean the City of Miami, a municipal corporation of the State of Florida.
2. The words "Fully Insured Plan" to mean a benefits plan where the employer (City) contracts with another
organization to assume financial responsibility for the Members' claims and for all incurred administrative costs.
3. The words "Member" or "Subscriber" to mean all City employees enrolled in the Disability Insurance Program.
4. The words "Plan Design or Plan" to mean designed benefit options to establish a course of coverage.
5. The words "Plan Year" to mean calendar year, January 1 through December 31.
6. The word "Proposer" to mean the person, firm, entity or organization, as stated on the Certification
Statement Form, submitting a response to this Solicitation.
7. The words "Scope of Services" to mean Section 3.0 of this Solicitation, which details the specifications/work to
be performed by the Successful Proposer.
S. The word "Solicitation" to mean this Request for Proposals (RFP) document, and all associated addenda and
attachments.
9. The word "Subcontractor" to mean any person, firm, entity or organization, other than the employees of the
Successful Proposer, who contracts with the Successfid Proposer to fiirnish labor, or labor and materials, in
connection with the Services to the City, whether directly or indirectly, on behalf of the Successful Proposer.
10. The word "Successful Proposer" to mean the Proposer that receives any award of a contract from the City as a
result of this Solicitation, also to be known as "the prime Contractor".
11. The words "Work", "Services", "Program", or "Project" to mean all matters and things that will be required to be
done by the Contractor in accordance with the Scope of Services and the terms and conditions of this Solicitation.
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2.4. 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 terns of the Contract(s) shall be for three (3) years with an option to renew for one (1) additional three (3)
year period.
(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 Proposer. This
prerogative will be exercised only when such continuation is clearly in the best interest of the City.
2.5. VOLUNTARY PRE -,PROPOSAL CONFERENCE
Potential Proposers are encouraged to attend the Voluntary Pre -Proposal Conference, which will occur on Monday,
April 10, 2017 rr 10:00:00 AM, at MRC Building, 444 SW 2nd Avenue, 6th Floor, South Conference Room. 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 perfornied. 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 Voluntary, but highly
recommended.
2.6. 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 hinds
2.7. NON -APPROPRIATION OF FUNDS
In the event no funds or insufficient fiords 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 the Successfitl Proposer(s) 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 project(s) will be awarded to any
firm(s).
2.8. MINIMUM QUALIFICATION REQUIREMENTS
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The City is seeking a single provider to provide all Program services. For a Proposer to be deemed responsive, the
following minimum qualification requirements listed below shall be satisfied. In determining said responsiveness,
such minimum qualification requirements shall be addressed in detail in the proposal submittal. Failure to meet each
of the below minimum qualification requirements and/or failure to provide sufficient detailed documentation
concerning the same, shall result in the Proposal being deemed non-responsive.
Proposer shall:
A. Be licensed by the State of Florida, Office of Insurance Regulations to provide the plan services at the time
of proposal due date, and throughout the term of the contract; any renewals and extensions thereof,
B. If an insurance carrier, hold a minimum "A" insurance rating from A.M. Best or a comparable financial
rating organization (i.e., Moody's, Standard & Poor's or Weiss) and a Financial Classification or "VII" or
higher, at the time of proposal submission,
C. Have a record of performance of no less than five (S) consecutive years, operating under the same name,
and providing group disability insurance programs for commercial or governmental entities, similar in
nature and scope, as described in the specifications herein;
O. Have no record of judgments or pending lawsuits against the City and/or bankruptcy, and not have any
conflicts of interest that have not been waived by the City Commission; and,
E. Have neither Proposer nor any member, officer, or stockholder of Proposer 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.
2.9. REFERENCES
Each proposal MUST be accompanied by a list of three references, which shall include for each project, the name of
the company, dates covering the term of the contract; description of the scope of work; client contact person and
phone number, and statement of whether Proposer was the prime contractor or subcontractor. Where possible, list
those references for those projects performed for government clients or similar size private entities.
2.10. EXECUTION OF AN AGREEMENT
The Successful Proposer(s) evaluated and ranked in accordance with the requirements of this Solicitation, shall be
awarded an opportunity to negotiate a Professional Services Agreement (Agreement) with the City. The City
reserves the right to execute or not execute, as applicable, an Agreement with the Successful Proposer(s) in
substantially the same form as the draft Agreement included as part of this Solicitation. Such Agreement will be
famished by the City, will contain certain terms as are in the City's best interest, and will be subject to approval as to
legal form by the City Attorney.
2.11. FAILURE TO PERFORM
Should it not be possible to reach the Successful Proposer or Successful Proposer's 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 Successful Proposer in default of the contract or make appropriate reductions in the contract
payment.
2.12. INSURANCE REQUIREMENTS
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Successfid Proposer 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 Successful Proposer's performance
under the provisions of the contract, including all acts or omissions to act on the part of SL1cceSSfi[l Proposer,
including any person performing under this Contract for or on Successful Proposer'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 front and against all costs, attorneys'
fees, expenses and liabilities incurred in the defense of any such claim, or the investigation thereof.
The Successful Proposer shall furnish to City of Miami, c/o Procurement 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:
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 listed as an additional insured
Contingent and Contractual Liability -CGL FORM
Premises and Operations Liability- CGL FORM
Primary Insurance Clause
II. Business Automobile Liability
A. Limits of Liability
Bodily Injury and Property Damage Liability
Combined Single Limit
Any Auto
Including Hired, Borrowed or Non -Owned Autos
Any One Accident $ I,000,000
B. Endorsements Required
City of Miami listed as an additional insured
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III. Worker's Compensation
Limits of Liability
Statutory -State Florida
Waiver of Subrogation
Employer's Liability
A. Limits of Liability
$500,000 for bodily injury caused by an accident, each accident
$500,000 for bodily injury caused by disease, each employee
5500,000 for bodily injury caused by disease, policy limit
IV. Professional Liability/Errors and Omissions Coverage
Combined Single Limit
Each Claim $ 2,000,000
General Aggregate Limit $ 2,000,000
Retro date included
V. Umbrella/Excess Liability
A. Limits of Liability
Each Occurrence $1,000,000
Policy Aggregate $1,000,000
City of Miami listed as an additional insured
Excess Form over all applicable liability policies herein contained
The above policies shall provide the City of Miami with written notice of cancellation or material change
from the insurer not less than (30) days 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. All policies and /or certificates of insurance are subject to review and verification by
Risk Management prior to insurance approval.
The insurance coverage required shall include those classifications, as listed in standard liability insurance manuals,
which most nearly reflect the operations of the Successful Proposer.
NOTE: CITY RFP NUMBER AND/OR TITLE OF RFP MUST APPEAR ON EACH CERTIFICATE.
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Compliance with the foregoing requirements shall not relieve the Successfirl Proposer 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 Proposer 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:
(4) Suspend the contract until such time as the new or renewed certificates are received by the City in the manner
prescribed in the Request for Proposal.
(5) The City may, at its sole discretion, terminate this contract for cause and seek re -procurement damages from
the Successful Proposer in conjunction with the General and Special Terms and Conditions of the solicitation.
The Proposer 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 Successfirl Proposer.
2.13. CONTRACT ADMINISTRATOR
Upon award, Successful Proposer shall report and work directly with Director, Risk Management, who shall be
designated as the Contract Administrator for the City.
2.14. 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 ander 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 Successfirl 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 Successfiil 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 Successfiil 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.
2.15. TERMINATION
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A. FOR DEFAULT
If Successfid Proposer 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 Successful Proposer 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 Successful Proposer was not in default or (2) the Successful Proposer'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 interest 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 Successful Proposer 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.
2.16. ADDITIONAL TERMS AND CONDITIONS
No additional terms and conditions included as part of your 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
Conditions and Special Conditions in this solicitation are the only conditions applicable to this solicitation and that
the Proposer's authorized signature affixed to the Proposer's acknowledgment form attests to this. If a Professional
Services Agreement (PSA) or other Agreement is provided by the City and is expressly included as part of this
solicitation, no additional terms or conditions which materially or substantially vary, modify or alter the terms or
conditions of the PSA or Agreement, in the sole opinion and reasonable discretion of the City will be considered.
Any and all such additional terms and conditions shall have no force or effect and are inapplicable to this PSA or
Agreement.
2.17. COMPENSATION PROPOSAL
Each Proposer shall detail any and all fees and costs, on Form B, Price Proposal Schedule, to provide the required
services as listed herein. Proposer shall additionally provide a detailed list of all costs to provide all services as
detailed in Section 3, 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 request 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.
2.18. EVALUATION/SELECTION PROCESS AND CONTRACT AWARD
The procedure for response evaluation, selection and award is as follows:
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(1) Solicitation issued;
(2) Receipt of responses;
(3) Opening and listing of all responses received;
(4)• Procurement staff will review each submission for compliance with the submission requirements of the
solicitation, including verifying that each submission includes all documents required;
(5) An Evaluation Committee ("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 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
Committee and shall be recorded;
(7) The Committee reserves the right to rank the proposals and shall make its recommendation to the City Manager
requesting the authorization to negotiate. No Proposer(s) shall have any rights against the City arising from such
negotiations thereof;
(8) The City Manager reserves the right to reject the Committee's recommendation to negotiate, and instruct the
Committee to re-evaluate and make another recommendation, or reject all proposals. No Proposer(s) shall have any
rights against the City arising from such negotiations thereof;
(9) If the City Manager accepts the Committee's recommendation to negotiate, Procurement will negotiate a final
contract with the Successful Proposer, and submit a recommendation to award a contract (s) to the City Manager;
(10) The City Manager shall then submit his or her award recommendation and negotiated contract(s) to the City
Commission for approval. Written notice shall be provided to all proposers.
(11) If the City Manager accepts the award recommendation, the City Manager's recommendation for award of
contract will be posted on the City of Miami Procurement Department website, in the Supplier Corner, 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
Proposer must contact the Contracting Officer for that solicitation to obtain the suppliers names.
(12) Alter reviewing the City Manager's recommendation, the City Commission may:
1. Approve the City Manager's award recommendation and negotiated contract(s);
2. Reject all proposals,
3. Reject all proposals and instruct the City Manager to reissue a solicitation; or
4. Reject all proposals and instruct the City Manager to enter into competitive negotiations with at least three
individuals or firms possessing the ability to perform such services and obtain information from said individuals or
firms relating to experience, qualifications and the proposed cost or fee for said services, and make a
recommendation to the City Commission.
The decision of the shall be final. Written notice of the award shall be given to the Successfial Proposer.
2.19. ADDITIONAL SERVICES
Services not specifically identified in this Solicitation, may be added to any resultant contract upon successfid
negotiation and mutual consent of the contracting parties.
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2.20. 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.
2.21. 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. 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.
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3. Specifications
3.1. SPECIFICATIONS/SCOPE OF WORK
3.1.1 Background
The City of Miami, hereinafter referred to as the "City," as represented by the City of Miami's Risk Management
Department (Risk), is soliciting proposals from experienced and qualified firms to provide an insured employer
sponsored Executive Employee Group Short -Term Disability (STD), and Long -Term Disability (LTD) Insurance
Program, with the option to allow executive employees to buy -up to a Premier Long -Term Benefit ("Premier LTD"),
and related services. Currently, there are no disability benefits in place for executive employees. There are
approximately 117 lives eligible for participation in this Program (refer to Exhibit 1, Executive Employee Census).
3.1.2 Disability Plan Designs Solicited
1. The Plans shall be fully insured.
2. The effective date of all benefits shall be January 1, 20IS. In the event the City's process for award is
completed in advance of January 1, 2018, the effective date may be earlier.
3. Benefits for short and long terni disability are anticipated to be 100% employer paid. Employees may
voluntarily buy -up to (Premier LTD). Employees interested in buying up to the Premier LTD, will only pay for the
difference in rate between the core and the buy -up. The elimination period for the Premier LTD is ninety (90) days.
4. Employees are eligible for coverage on the first day of the month, following 60 days of employment.
5. Employees must work 60 continuous days of employment.
6. The City would prefer that the Proposer include no minimum participation. However, for the purposes of this
Solicitation, the Proposer shall present guaranteed rates for the following minimum participation in the employee
funded plan, for the initial three years of the contract:
1) If participation is greater than 25%;
2) If participation is between 20% and 25%;
3) If participation is between 15% and 20%p;
4) If participation is between 10% and 15%; and
5) If participation falls below 10%.
7. Variations in actual enrollment in the employer funded plan shall have no effect on the rates.
8. For the LTD and Premier LTD, a pre-existing condition shall mean a sickness or injury for which the insured
received medical treatment, consultation, care or services, including diagnostic measures, or had taken prescribed
dregs or medicines in the three (3) months prior to the effective date of coverage of the insured person. The above
pre-existing condition clause shall not apply once the person has been insured under the Plan for twelve (12)
consecutive months.
9. The City's STD plan does not include a pre-existing condition clause.
10. At the 2017 open enrollment for the Plan Year 2018, all executive employees shall be eligible without evidence
of insurability (guaranteed issue).
11. A single provider shall underwrite both the STD and LTD/Premier plans.
Note: Attached as Exhibit 2, Plan Designs is a snapshot of the plan
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design benefits desired.
Proposals shall be based upon disability plan designs listed in Exhibit 2, titled Disability Plan Designs Solicited,
however, the City may consider and review alternatives. All alternative plans shall clearly designate deviations from
the listed schedule of benefits. The City will evaluate the Proposals to access the capabilities in each of the
following areas:
1, Organization's qualifications, experience and financial stability;
2. Plan design and benefits;
3. Claims administration and customer service;
4. Financial reporting and records; and,
5. Overall plan cost/value.
Refer to Section 5, Evaluation Criteria.
3.1.3 Disability Program Requirements and Services
A. General Program Information
Listed below are some of the highlights for the anticipated Program.
1. Executive employees accrue three (3) or four (4) hours of sick leave per pay period with a maximum accrual of
96 hours per year.
2. There is no cap on the number of sick leave hours that can be accumulated.
3. Executive employees will be enrolled in the STD/LTD Plan, and may choose to voluntarily enroll in the Premier
LTD plan. Enrollment in the Premier LTD plan cannot be combined with the STD and LTD plans, because the
pians are mutually exclusive.
4. The Successful Proposer shall administer the Program in accordance with all applicable state and federal laws, in
addition to monitoring any legislation affecting the delivery of services.
5. The premiums for the Program will be paid on a payroll volume basis by the employer for the STD/LTD
plans. Voluntary participation in the Premier LTD plan shall be employee funded. The City recognizes the
existence of Florida Statutes, Section 624.1275, The Successful Proposer shall administer the Program in accordance
with all applicable state and federal laws.
6. Situs is Florida.
7. The Successful Proposer will provide the City with a 60 -day premium grace period.
B. Call Intake/Customer Service
The Successful Proposer shall:
1. Accept incoming calls from employees and others (i.e., City representatives, family members, physician, or
supervisor).
2. Provide a Call Intake System that has an "automated call distribution" feature with message capability for after
hours. Return calls shall be made within 24 hours.
3. Provide customer service in English, Spanish and Creole, during the City's normal business hours (M -F 8:00 a.m.
to 5:00 p.m., Eastern Time).
t
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C. Clinical Support Services
The clinical and vocational aspects of disability claims require significant detailed medical data in addition to
discussions with attending physicians. Therefore, the Successfiul Proposer shall:
1. Provide clinical review by an appropriate medical professional, including initial claim determination
approval/denial and determination of levels of impairment;
2. Coordinate with healthcare providers to obtain objective clinical information;
3. Contact and discuss with the City's personnel representative, the claimant's job duties and functional
requirements, etc.
4. Provide expert testimony by the appropriate medical professional, when necessary, to support claim decisions;
and,
5. Provide telephone interaction with other appropriate healthcare and vocational vendors, as applicable.
D. Claims Administration and Management
The Successful Proposer shall comply with the Department of Labor's final claims procedure regulations, including
the appropriate timeframe for a) adjusting claims, and b) notice of appeals decisions.
1. Assume full risk on the Plan effective date for all lives effective on or after the Plan effective date;
2. Maintain a file to support payments, denials, Social Security activities, appeals, and vocational assistance;
3. Conduct claimant interviews, if deemed appropriate;
4. Allow an independent claim management audit by a third -party, selected by the City, as requested by the City;
5. Maintain an internal audit program,
6. Process payments and negotiate settlements, as applicable;
7. Provide tax reporting in accordance with the Federal tax code;
8. Provide vocational/occupational and rehabilitation services to claimants, if appropriate;
9. Maintain database for the management of each claimant;
10. Provide implementation assistance to the City including internal training, communication materials, and an
administration manual;
11. Administer a written appeals process for reconsideration of any benefit denial;
12. Resolve all appeals within 30 calendar days of receipt of completed documentation;
13. Maintain all required fomes and authorization guidelines such as employer and employee statements, attending
physician statements, and authorizations to release information statements;
14. Accept Evidence of Insurability directly from employees through the provisions of return envelopes, facsimile
or online submission;
15. Provide appropriate level of personnel to attend Open Enrollment and Employee Workshop meetings;
16. Accept the use of the current City Enrollment Form and/or use the City's on-line enrollment process; and,
17. Assume responsibility for claims incurred prior to contract termination/expiration date.
If, at some date in the future, it becomes necessary to terminate the contract, the Successfid Proposer shall transfer to
the City, or the City's new Program provider, within 30 days of termination, all data and records necessary to
administer the Program, at no cost to the City.
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F. Financial Reporting & Records
The Successful Proposer shall provide to the City, at a minimum, the following reports separately for each of the
plans designs:
1. A quarterly Account Reconciliation Report of cost components within 30 days of the end of each quarter. The
components should include areas such as the number of new submissions, date tracking to assure initial
determination and ongoing medical reviews are occurring at the required times, the number of open files, and the
number of closed files. The latter must denote reasons for case termination.
2. A quarterly Utilization Report for each disability income benefit plan with the following year-to-date, within 30
days of the end of each quarter and plan year reporting periods:
a. Earned premium;
b. Administrative charges;
c. Paid claims;
d. Open reported (pending) claims;
e. Change in "Incurred But Not Reported" (IBNR) reserve;
f. Cost/premium ratio; and,
g. Claims denied.
3. An Annual Savings Report, including comparison of actual, approved and benchmark durations by diagnosis,
within 60 days following the close of the reporting period.
4. A Semi -Annual Summary Report of claims activity by reported diagnosis within 60 days following the close of
the reporting period.
5. Annual reporting of the status of each claim, within the Social Security process, to the City within 45 days
following the close of the reporting period.
F. Fiduciary Protection
In addition to the other insurance requirements stated in the Section 2. 10, titled, Insurance Requirements, the
Successful Proposer shall provide indemnification and liability protection for the clinical and non -clinical
administration components of the Program. The Successful Proposer shall indemnify and hold the City harmless
from any clinical, professional, or administrative decisions made by the Successful Proposer rendering services,
including the administration of the appeals process.
G. Premium Rate Guarantee
All premium rates shall be guaranteed for a minimum of 24 months (the initial two (2) plan years, January 1, 2018
through December 31, 2019), independent of actual enrollment or any other premium rate contingencies. The
Successful Proposer shall provide the rates for Plan Year 2020 (the third year of the initial term) by May 1, 2019.
The renewal rates for the three-year option to renew period, shall be provided by May 1, 2020 by the Successful
Proposer to the City, and are subject to negotiations and acceptance by the City.
H. Guaranteed Issue
For all Plans, the Successful Proposer shall guarantee issue for an employee's first time enrollment in any of the
Plans (including current enrollees and new enrollees, applying within their initial eligibility period). If an employee
chooses to enroll at a subsequent enrollment, the Successfttl Proposer may require medical underwriting. Medical
underwriting shall be performed for subsequent enrollments only.
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I. Actively at Wgrk Provision
For all Plans, employees must be actively at work with the City in order for their coverage to become effective.
However, should the effective date be a non -work day for an employee, insurance will still become effective on that
date, if the employee is otherwise actively -at -work and performed in his/her customary manner all of the regular
duties of his/her employment or occupation on the last preceding scheduled work day, and is not disabled.
If an employee is not actively at work with the City on the date when their coverage would otherwise become
effective, coverage becomes effective on the date of their return to active work with the City.
.I. Pre-existing Conditions Clause
For the LTD and Premier Ptans, a pre-existing condition means a sickness or injury for which the insured received
medical treatment, consultation, care of services including diagnostic measures, or had taken prescribed drugs or
medicines for in the three (3) months prior to the effective date of coverage of the insured person. The above
pre-existing condition clause shall not apply once the person has been insured by the Plan for twelvc'(12)
consecutive months. The City's STD Plan should not include a pre-existing condition clause.
K. Pavment
The City anticipates the STD/LTD plans to be fully funded by the employer and therefore benefit from 100%
executive employee participation. The Premier Plan shall be voluntary and wholly employee funded.
Notwithstanding, the City reserves the right, at its sole discretion, to offer all benefits on a voluntary basis, to be
funded exclusively by employees. Should the City proceed with offering the disability benefits on a voluntary
basis, the City shall providea bi-weekly remittance, for the prior pay period, accompanied by an electronic file of
employee salary deductions to the Successfiil Proposer for the all plans.
The Successful Proposer shall allow retroactive premium adjustments and honor claims that are incurred within 120
days of reporting for eligible employees who are inadvertently and incorrectly excluded from employer remittance
files.
L. Master Contract/Certificates of Coverage
The Successfiil Proposer shall duplicate the requested benefit plan design provisions. The Certificates of Coverage
for all Plans shall be provided to the City no later than May 1, 2018, The Successfiil Proposer shall mail the
approved Certificates of Coverage to members' homes within 60 days of the beginning of the initial plan year and to
subsequent members upon enrollment.
M. Year -End Accounting
The Successful Proposer shall deliver to the City a final year-end report which includes, but is not limited to,
premiums, claims and reserves, if applicable, no later than 90 days after the close of each calendar year. /P>
M. N. Privacy and Confidentiality
Successful Proposer shall:
a) Develop, adopt, and implement standards to safeguard the privacy and confidentiality of all personal information
about eligible employees and members of the Program. Successful Proposer's procedures shall include but not
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limited to safeguarding the identity of members as members of the Program and preventing unauthorized disclosure
of personal information.
b) Report any unauthorized use or disclosure of the members' personal information to the City, within twenty-four
(24) hours of any incident of which it becomes aware.
c) Comply with all federal and state laws concerning the privacy and confidentiality of members' information, and
agrees to implement any regulations when they become effective.
d) Not disclose any member's personal information to another business associate for pecuniary gain, without prior
written authorization from the City.
e) Mitigate, to the extent practicable, any harmfitl effect that is known to the Successfitl Proposer of a use or
disclosure of members' information by the Successful Proposer in violation of the requirements of this Agreement or
federal or state laws.
0 Implement administrative, physical, and technical safeguards that reasonably and appropriately protect the
confidentiality, integrity, and availability of the electronic personal information of members that Successful
Proposer creates, receives, maintains, or transmits.
g) Report to the City any security incident of which the Successfitl Proposer becomes aware, and (iii) ensure that
any agent of the Successful Proposer, including any subcontractor or subconsultant, agrees to the same restrictions
and conditions that apply to the Successful Proposer with respect to such information.
h) Not sell member information. Successfitl Proposer shall not use member information unless it is aggregated
blinded data, which is not identifiable on a member basis. Successful Proposer shall not use member identified or
non -aggregated information for advertising, marketing, promotion or any activity intended to influence sales or
market share of any product or service.
i) Full financial responsibility for any penalties, fines, or other payments imposed or required as a result of
Successful Proposer's non-compliance with, or violation of, federal or state requirements, and the Successfitl
Proposer shall indemnify the City with respect to any such penalties, fines, or payments.
j) Assure that all Successful Proposer's staff, including subcontractor or subconsultant, are trained in all privacy
requirements, as applicable.
k) At the request of the City, offer credit protection for those times in which a member's personal information is
accidentally or inappropriately disclosed.
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4. Submission Requirements
4.1. Submission Requirements
Proposers shall carefully follow the format and instruction 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 and any Sub -Consultants to be utilized for the work contemplated by this
Solicitation. Proposals submitted which do not include the following items may be deemed non-responsive and may
not be considered for contract award.
Proposers shall submit responses in a hardcopy format, consisting of one (1) original and seven (7) copies, and in an
electronic format via a CD-ROM. On-line submittals, via the Oracle System, shall not be accepted. Failure to do so
may deem the Proposal non-responsive. Section 4.1. Submission Requirements supersedes Section 1.78.
Submission and Receipt of Responses of this RFP document.
PROPOSAL FORMAT
The response to this solicitation should be presented in the following format. Failure to do so may deem your
Proposal non-responsive.
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, if applicable
Email addresses; Title of RFP; RFP Number; Federal Employer Identification 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
Provide an Executive Summary describing elements contained within Proposer's Proposal, including such factors as
Organization, Qualifications and Capabilities; Proposed Disability Plan Designs; Customer Service, Reporting
Capabilities, Claims Administration; and Price and Cost Effectiveness.
A. Proposer's Organization, Qualifications, Capabilities & Financial Stability
1) Provide documentation that demonstrates Proposer's ability to satisfy all of the minimum qualification
requirements pursuant to Section 2.7. Proposers who do not meet the minimum qualification requirements or who
fail to provide supporting documentation may be deemed non-responsive.
2) Describe the Proposer's organizational history and structure; years proposing firm has been in business providing
a similar service(s), and indicate whether the City has previously awarded any contracts to the proposing firm.
Proposer should include the name of the organization, business phone/fax/email address, contact person and Federal
Employee Identification Number.
3) Provide a list of all principals, owners, directors and key personnel to be assigned to this project. Identify the
Account Manager for the Program, their office location, their current case load and provide a brief biography of
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such Account Manager
4) Provide a) the number of years in existence of Proposer, both nationally and in the Florida market; b) the current
number of members enrolled in the Proposer's plan, both nationally and in Florida, and c) the primary markets
served. Also, discuss specifically, Proposer's involvement in providing disability benefits, particularly in the South
Florida market.
5) Provide the current number of employees of Proposer; Proposer employees' depth and experience, and number
and job classifications of employees anticipated to be assigned to the City's account, including the overall
qualifications of assigned staff, particularly its experience with disability benefit administration in Florida and with
public entities. Include discussion of employees' diversity and ability of speaking more than one language,
particularly Spanish and Creole.
6) Provide a list of clients of equivalent size to the City which, for whatever reason, discontinued their use of
Proposer's services within the past year and indicate the reasons for same. Include contact name, phone number and
email for discontinued clients.
7) Provide three (3) existing clients, of equivalent size to the City, including contact name, phone number and email
address, size of group and services provided. The City reserves the right to contact any reference as part of the
evaluation process.
8) List Proposer's subcontractors or sub consultants which will work on the City's Program and include a brief
history of their background and experience.
9) Provide any other information which the Proposer deems relevant to its organization and its ability to provide
quality group disability benefit services to the City.
10) Provide Proposer's implementation plan that will be utilized in implementing the City's Program, anticipated to
become effective January I, 2018. This shall include, but not be limited to: a) training offered to City staff, b)
sample of communication materials and administration manual, and c) all anticipated City assigned action items.
11) Identify if Proposer has taken any exception(s) to the terms of this Solicitation. If so, indicate the alternative
being offered and the cost implications of the exception(s).
12) Provide information concerning any prior or pending litigation either civil or criminal, involving a governmental
agency or which may affect the performance of the services to be rendered herein, in which the Proposer, any of its
employees or subcontractors, is or has been, involved within the past three (3) years.
13) Confirm Proposer's organization has complied with all State of Florida, Office of Insurance Regulation filing
requirements for plan/product being offered to the City.
B. Proposed Plan Design and Benefits
1) Provide detailed response as to how well Proposer's Proposed Plan Design mirrors the City's identified plan
benefits, as outlined in Section 3.1.2 and Exhibit 2. Proposer should also provide a brief description of its ability to
provide all the services requested herein.
Page 42 of 47
680381,3
2) If different than the City's identified Plan Design, describe Proposer's exceptions, deviations, etc.
3) Confirm if Proposer will not include minimum participation requirements. For employee funded plan, if
Proposer is proposing minimum participation requirements, refer to guarantee participation listed in Section 3,
Specifications/Scope of Work, subsection 3.1.2, Item 6. Proposer shall enter this information on Form B, Price
Proposal Schedule.
4) Confirm insurance is offered on a "Guaranteed Issue" basis as required by the Scope of Services. Describe the
underwriting requirements?
5) Identify if an eligibility feed is required to manage the Program?
6) Provide as an attachment, a description of Proposer's eligibility file record layout specifications.
7) Provide a sample of the Proposer's STD and LTD disability policies.
8) Describe Proposer's available resources to assist Members in staying at work prior to becoming a disability claim.
9) Provide any other information which the Proposer deems relevant to its organization and its ability to provide
quality managed disability claims administration services to the City.
C. Claims Administration and Customer Service
1) Address Claims Office Operations to include intake adjudication, clinical support, capacity for phone/email
inquiries and any services off -shored.
a. Identify where the claims office that will handle claims for the City is located.
b. Indicate whether the same claims office that handles STD claims, will also handle LTD claims.
c. Provide the hours of operation for the claims office.
d. Describe the training provided to Proposer's Claims Representatives.
e. Describe Proposer's expected team's current case load, each (number of clients).
f. Describe Proposer's database utilized for the management of each claimant.
g. Describe maximum number of open and new claims handled, per Proposer's examiners or clinicians.
h. Identify at what point in the proposed claims process, that Proposer begin to transition a claim from STD to
LTD.
i. Provide as an attachment, Proposer's processed claims process, if no eligibility file is in place.
j. Identify how Proposer's claims representatives will "warm transfer" claimant Members to other vendors (i.e.,
EAP, Disease Management, etc.), if necessary.
2) Describe Proposer's Customer Service Center Operations:
a. Provide the hours of operation for the customer service center.
b. Indicate whether there will be dedicated Customer Service Representatives specifically for City employees. If
so, how many?
c. Indicate how many members each Customer Service Representative will be servicing on average.
d. Describe the training provided to Proposer's Customer Service Representatives.
Page 43 of 47
680381,3
3) Indicate whether Proposer maintains separate toll-free numbers for customer service and claims. Explain how
members' questions regarding the status of their claim are addressed. Will Proposer's customer service center
address inquiry or will Member be directed to contact claims examiner directly?
4) Indicate whether there is an internet site available for Member use. Describe the capabilities.
5) Describe Proposer's telephonic intake of STD/LTD claims.
a. Identify if members are able to provide voice authorization in order to release medical records.
b. Identify whether Proposer utilizes robo-calls in any part of their disability claims processing, If so, please
specify purpose of usage (e.g., reminders of outstanding recommendations, approval notifications, etc.).
6) Indicate whether Proposer offers on-line intake of STD/LTD claims. If so, describe the process.
7) Describe Proposer's written claims appeal process utilized for recommendation of benefit denial.
8) Describe the role(s) that the Proposer's staff types (claim analysts, nurses, physicians, claim supervisors) have in
benefits determination (both acceptance and denial).
9) Identify Proposer's proposed conunitment to implementing the following performance guarantees and the
premium at risk associated with each:
a. Speed of answering calls;
b. Length of time on hold;
c. Responding to after-hours callers;
d. Abandonment rate of calls;
e. Claim himaround time;
f. Percent of claims audited;
g. Claims payment accuracy; and
h. Social Security award success for LTD claimants.
10) Describe Proposer's approach to client services as it relates to resolving complaints from the City and/or
resolution of errors.
11) Describe Proposer's internal audit program.
12)' Provide examples of Proposer's standard notifications, forms, letters and reimbursement agreements.
D. Financial Reporting and Records
1) Provide a list of recent improvements to similar Proposer programs and the respective outcomes. Specifically
describe how Proposer has successfully applied the proposed approach in comparable contracts to make
recommendations to improving benefits, and describe the net effect outcome of these recommendations.
2) Describe Proposer's compliance with HIPAA regulations.
3) Proposer shall provide a statement affirming that Proposer will develop, adopt, and implement standards to
safeguard the privacy and confidentiality of all personal information about eligible employees and members of the
Page 44 of 47
680381,3
Program. Provide description of some of the safeguards that Proposer has implemented for any of the three (3)
existing clients listed above in A(7).
4) Provide samples of required reports (refer to Section 3.1.3, Letter E, Items 1-5) and list any other standard and
non-standard report available, including report function, data elements and distribution frequency, Note: It is the
Proposer's responsibility to redact all confidential information, prior to submitting sample reports.
5) Describe Proposer's capabilities to provide on-line reporting. Identify if Claims Status Reports automatically push
out to the City or does the City need to log onto Proposer's portal to download reports.
6) Describe Proposer's plan at contract expiration/termination to transfer the required information to the City.
7) Describe hove Proposer assures accurate and timely remittance of federal income tax withholdings to the IRS.
Additionally, describe how accurate calculation of federal income tax withholding is assured.
E. Price and Cost Effectiveness
1) Provide detailed rates for STD per S 100 of weekly benefit; and LTD per S1 00 covered monthly payroll, as it were
employer funded or employee paid. Proposer shall also provide rates for employee voluntary buy up to Premier
Plan, per 5100 covered monthly payroll. Please submit proposed pricing utilizing Form B, Price Proposal Schedule.
Notes:
a. All fees shall be guaranteed for a minimum of 24 months (the initial two (2) Plan Yeats (January 1, 2018
through December 31, 2019)),
b. Premium payment to the Successful Proposer shall be based on actual enrollment of employees.
c. Fees shall not be adjusted at any time during City requests and agrees to contractual changes.
d. Rates for the three (3) year option to renew period shall remain firm and fixed unless adjustments are agreed
upon by the City and the Successful Proposer. Any requests for adjustments niust be provided by the Successful
Proposer to the City's Contract Administrator by May Ist of the year prior to the start of the affected Plan Year, A
justification including the Successful Proposer's underwriting/actuarial methodology used to determine the
requested adjustment must be submitted with the request. If no request for adjustment is received by May 1st, the
rates shall remain the same for the option to renew period. Any rate adjustment shall be negotiated and may be based
on any other legislative mandates and industry trend factors.
F. Local Preference
For Proposers seeking local preference consideration in the evaluation process, the following information must be
provided with proposal, pursuant to Section 1.49 of the General Conditions: a) State the Primary Office Location of
the Proposer, b) Provide location from which the Proposer will be based to perform the work.
Page 45 of 47
68038I,3
5. Evaluation Criteria
5.1. EVALUATION CRITERIA
5.2 Evaluation Criteria
Proposals will be reviewed to determine if proposal is responsive to the submission requirements, outlined in this
Solicitation. A responsive proposal is one which follows the requirements of this Solicitation, includes all
documentation, is submitted in the format outlined in this Solicitation, is of timely submission, and has the
appropriate signatures as required. Failure to comply may result in the proposal being deemed non-responsive.
Proposals will be evaluated and ranked by an Evaluation/Selection Committee (Committee) based on criteria and
weight listed below. The Committee will be comprised of appropriate City personnel and members of the
community, as deemed necessary, with the appropriate experience and/or knowledge. The criteria are itemized with
their respective weights for a maximum total of one hundred (100) points per Committee member, with five (5)
additional points added for Local Preference, if applicable.
Technical Criteria and Points
1. Proposer's organization, qualifications, capabilities and financial stability 25 oints
2. Proposed plan designs and Benefits 20points)
3. Customer services and claims administration 20points)
4. Financial reporting and records 20points)
Price Criteria and Points
5. Proposer's proposed price and cost effectiveness J15 oints
Oral Presentations
Upon completion of the technical and price evaluation indicated above, rating and ranking, the Committee may
choose to conduct an oral presentation with the Proposer(s) which the Conunittee deems to warrant further
consideration, based on the highest ranked proposal(s) providing the highest quality of service to the City,
significant breaks in scoring, and or maintaining competition. Upon completion of the oral presentation (s), the
Committee will re-evaluate, re -rate, and re -rank the proposals remaining in consideration, based upon the written
documents combined with the oral presentation.
Price (Evaluation
The price proposal will be evaluated subjectively in combination with the technical proposal, including an
evaluation of how well it matches Proposer's understanding of the City's needs described in the solicitation, the
Proposer's assumptions, and the value of the proposed services. The pricing evaluation is used as part of the
evaluation process to determine the highest ranked Proposer. The City reserves the right to negotiate the final terms,
conditions and pricing of the contract, as may be in the best interest of the City.
Page 46 of 47
680381,3
Local Office
Pursuant to City Code, Section 18-86, the solicitation includes a five percent (5%) evaluation criteria in favor of
proposers who maintain a local office as defined in Section 18.73.
Page 47 of 47
City of Miami, Florida
EXHIBIT B
SCOPE OF WORK
Contract No. RFP680381
Provide the Fully Employer Funded Long Term Disability Insurance Program; the Voluntary
Premier (Buy -up) Long Term Disability Insurance Program; and the Employee Funded Short
Term Disability Insurance Program, per specifications.
22
Employee Disabifity Insurance Program Rev. 8/2/17
City of Miami, Florida
EXHIBIT B
SCOPE OF SERVICES
Contract No. RFP680381
1. Background
The City of Miami, hereinafter referred to as the "City," as represented by the City of Miami's Risk
Management Department (Risk), is contracting with Standard Insurance Company to provide an
insured employer sponsored Executive Employee Group Short -Term Disability (STD), and Long -
Term Disability (LTD) Insurance Program, with the option to allow executive employees to buy -
up to a Premier Long -Term Benefit ("Premier LTD"), and related services. Currently, there are no
disability benefits in place for executive employees. There are approximately 117 lives eligible for
participation in this Program.
2. Disability Pian Designs:
1) The Plans shall be fully insured.
2) The effective date of all benefits shall be as of the date on the first page of the
Professional Services Agreement (PSA), or later as determined by the City.
3) Benefits for LTD are 100% employer paid:
• 180 day benefit waiting period
Benefits to age 65 or normal Social Security retirement age
• 60% benefit to a monthly maximum of $10,000
4) Employees may voluntarily buy -up to (Premier LTD). Employees interested in buying up
to the Premier LTD, will only pay for the difference in rate between the core and the buy -
up. The elimination period for the Premier LTD is ninety (90) days.
5) Benefits for Voluntary STD are 100% employee paid:
• 30 day benefit waiting period
• 150 day maximum benefit period
• 60% benefit to a monthly maximum of $2,000
6) Employees are eligible for coverage on the first day of the month, following 60 days of
employment.
7) Employees must work 60 continuous days of employment.
8) For the term of the contract, minimum participation shall be no less than twenty
percent (20%).
9) Variations in actual enrollment in the employer funded plan shall have no effect on the
rates.
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Employee Disability Insurance Program Rev. 6129/17
City of Miami, Florida
Contract No. RFP680381
10) For the LTD and Premier LTD, a pre-existing condition shall mean a sickness or injury
for which the insured received medical treatment, consultation, care or services,
including diagnostic measures, or had taken prescribed drugs or medicines in the three
(3) months prior to the effective date of coverage of the insured person. The above pre-
existing condition clause shall not apply once the person has been insured under the
Plan for twelve (12) consecutive months.
11) The City's STD plan does not include a pre-existing condition clause.
12) At the 2017 open enrollment for the Plan Year 2018, all executive employees shall be
eligible without evidence of insurability (guaranteed issue).
13) The Contractor shall underwrite both the STD and LTD/Premier plans.
The City relied on the Contractor's proposal to determine the capabilities in each of the following
areas:.
a) Organization's qualifications, experience and financial stability;
b) Plan design and benefits;
c) Claims administration and customer service;
d) Financial reporting and records; and,
e) Overall plan cost/value.
3. Disability Program Requirements and Services
A. General Program Information
Listed below are some of the highlights for the Program.
1) Executive employees accrue three (3) or four (4) hours of sick leave per pay period with
a maximum accrual of 96 hours per year.
2) There is no cap on the number of sick leave hours that can be accumulated.
3) Executive employees may be enrolled in the STD/LTD Plan, and may choose to
voluntarily enroll in the Premier LTD plan. Enrollment in the Premier LTD plan cannot be
combined with the STD and LTD plans, because the plans are mutually exclusive.
4) The Contractor shall administer the Program in accordance with all applicable state and
federal laws, in addition to monitoring any legislation affecting the delivery of services.
5) The premiums for the Program will be paid on a payroll volume basis by the employer
for the LTD plans. Voluntary participation in the STD and Premier LTD plan shall be
employee funded. The City recognizes the existence of Florida Statutes, Section
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Employee Disability Insurance Program Rev. 6129/17
City of Miami, Florida
Contract No. RFP680381
624.1275. The Contractor shall administer the Program in accordance with all applicable
state and federal laws.
6) Situs is Florida.
7) The Contractor shall provide the City with a 60 -day premium grace period.
B. Call Intake/Customer Service
The Contractor shall:
1) Accept incoming calls from employees and others (i.e., City representatives, family
members, physician, or supervisor).
2) Provide a Call Intake System that has an "automated call distribution" feature with
message capability for after hours. Return calls shall be made within 24 hours.
3) Provide customer service in English, Spanish, and Creole, during the City's normal
business hours (M -F 8:00 a.m. to 5:00 p.m., Eastern Time).
C. Clinical Support Services
The clinical and vocational aspects of disability claims require significant detailed medical
data in addition to discussions with attending physicians. Therefore, the Contractor shall:
1) Provide clinical review by an appropriate medical professional, including initial claim
determination approvalldenial and determination of levels of impairment.
2) Coordinate with healthcare providers to obtain objective clinical information.
3) Contact and discuss with the City's personnel representative, the claimant's job duties
and functional requirements, etc.
4) Provide expert testimony by the appropriate medical professional, when necessary, to
support claim decisions.
5) Provide telephone interaction with other appropriate healthcare and vocational vendors,
as applicable.
D. Claims Administration and Management
The Contractor shall comply with the Department of Labor's final claims procedure
regulations, including the appropriate timeframe for a) adjusting claims, and b) notice of
appeals decisions.
1) Assume full risk on the Plan effective date for all lives effective on or after the Plan
effective date.
2) Maintain a file to support payments, denials, Social Security activities, appeals, and
3
Employee Disability Insurance Program Rev. 6129117
City of Miami, Florida
Contract No. RFP680381
vocational assistance.
3) Conduct claimant interviews, if deemed appropriate.
4) Allow an independent claim management audit by a third -party, selected by the City,
as requested by the City.
5) Maintain an internal audit program.
6) Process payments and negotiate settlements, as applicable.
7) Provide tax reporting in accordance with the Federal tax code.
8) Provide vocational/occupational and rehabilitation services to claimants, if appropriate,
9) Maintain database for the management of each claimant.
10) Provide implementation assistance to the City including internal training, communication
materials, and an administration manual.
11) Administer a written appeals process for reconsideration of any benefit denial,
12) Resolve all appeals within thirty (30) calendar days of receipt of completed
documentation.
13) Maintain all required forms and authorization guidelines such as employer and employee
statements, attending physician statements, and authorizations to release information
statements.
14) Accept Evidence of Insurability directly from employees through the provisions of return
envelopes, facsimile or online submission.
15) Provide appropriate level of personnel to attend Open Enrollment and Employee
Workshop meetings.
16) Accept the use of the current City Enrollment Form and/or use the City's on-line
enrollment process.
17) Assume responsibility for claims incurred prior to contract terminationlexpiration date.
If, at some date in the future, it becomes necessary to terminate the contract, the Contractor shall
transfer to the City, or the City's new Program provider, within thirty (30) days of termination, all
data and records necessary to administer the Program, at no cost to the City.
E. Financial Reporting & Records
The Contractor shall provide to the City, at a minimum, the following reports separately for
each of the plans designs:
1) A quarterly Account Reconciliation Report of cost components within thirty (30) days of
the end of each quarter. The components should include areas such as the number of
4
Employee Disability Insurance Program Rev. 6129117
City of Miami, Florida
Contract No. RFP680381
new submissions, date tracking to assure initial determination and ongoing medical
reviews are occurring at the required times, the number of open files, and the number
of closed files. The latter must denote reasons for case termination.
2) A quarterly Utilization Report for each disability income benefit plan with the following
year-to-date, within thirty (30) days of the end of each quarter and plan year reporting
periods;
a. Earned premium;
b. Administrative charges;
c. Paid claims;
d. Open reported (pending) claims;
e. Change in "Incurred But Not Reported" (IBNR) reserve;
f. Cost/premium ratio; and,
g. Claims denied.
3) An Annual Savings Report, including comparison of actual, approved and benchmark
durations by diagnosis, within sixty (60) days following the close of the reporting period.
4) A Semi -Annual Summary Report of claims activity by reported diagnosis within sixty (60)
days following the close of the reporting period.
5) Annual reporting of the status of each claim, within the Social Security process, to the
City within forty-five (45) days following the close of the reporting period.
F. FiduciaU Protection
In addition to the other insurance requirements, the Contractor shall provide indemnification
and liability protection for the clinical and non -clinical administration components of the
Program. The Contractor shall indemnify and hold the City harmless from any clinical,
professional, or administrative decisions made by the Contractor rendering services,
including the administration of the appeals process.
G. Premium Rafe Guarantee
All premium rates shall be guaranteed for a minimum of thirty-six 36 months (the initial
three (3) plan years, January 1, 2018 through December 31, 2020), independent of actual
enrollment or any other premium rate contingencies. The Contractor shall provide the
renewal rates for the three-year option to renew period by May 1, 2020, to the City, and are
such renewal rates are subject to negotiations and acceptance by the City.
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Employee Disability Insurance Program Rev. 6129/17
City of Miami, Florida
H. Guaranteed Issue
Contract No. RFP680381
For all Plans, the Contractor shall guarantee issue for an employee's first time enrollment in
any of the Plans (including current enrollees and new enrollees, applying within their initial
eligibility period). If an employee chooses to enroll at a subsequent enrollment, the
Contractor may require medical underwriting. Medical underwriting shall be performed for
subsequent enrollments only.
1. Actively -at Work Provision
For all Plans, employees must be actively at work with the City in order for their coverage to
become effective. However, should the effective date be a non -work day for an employee,
insurance will still become effective on that date, if the employee is otherwise actively -at -
work and performed in his/her customary manner all of the regular duties of his/her
employment or occupation on the last preceding scheduled work day, and is not disabled.
If an employee is not actively at work with the City on the date when their coverage would
otherwise become effective, coverage becomes effective on the date of their return to active
work with the City.
J. Pre-existing Conditions Clause
For the LTD and Premier Plans, a pre-existing condition means a sickness or injury for which
the insured received medical treatment, consultation, care of services including diagnostic
measures, or had taken prescribed drugs or medicines for in the three (3) months prior to
the effective date of coverage of the insured person. The above pre-existing condition
clause shall not apply once the person has been insured by the Plan for twelve (12)
consecutive months. The City's STD Pian should not include a pre-existing condition
clause.
K. Payment
The LTD plan will be fully funded by the employer and therefore benefit from 100%
executive employee participation. The STD and Premier Plan shall be voluntary and wholly
employee funded.
Notwithstanding, the City reserves the right, at its sole discretion, to offer all benefits on a
voluntary basis, to be funded exclusively by employees. Should the City proceed with
6
Employee Disability Insurance Program Rev. 6129117
City of Miami, Florida
Contract No. RFP680381
offering the disability benefits on a voluntary basis, the City shall provide a bi-weekly
remittance, for the prior pay period, accompanied by an electronic file of employee salary
deductions to the Contractor for the all plans.
The Contractor shall allow retroactive premium adjustments and honor claims that are
incurred within 120 days of reporting for eligible employees who are inadvertently and
incorrectly excluded from employer remittance files.
L. Master Contract/Certificates of Coverage
The Contractor shall duplicate the requested benefit plan design provisions. The Certificates
of Coverage for all Plans shall be provided to the City no later than October 1, 2017. The
Contractor shall mail the approved Certificates of Coverage to members' homes within sixty
(60) days of the beginning of the initial plan year and to subsequent members upon
enrollment.
M. Year -End Accounting
The Contractor shall deliver to the City a final year-end report which includes, but is not
limited to, premiums, claims and reserves, if applicable, no later than ninety (90) days after
the close of each calendar year.
N. Privacy and Confidentiality
Contractor shall:
1) Develop, adopt, and implement standards to safeguard the privacy and confidentiality
of all personal information about eligible employees and members of the Program.
Contractor's procedures shall include, but not limited to safeguarding the identity of
members as members of the Program and preventing unauthorized disclosure of
personal information.
2) Report any unauthorized use or disclosure of the members' personal information to the
City, within twenty-four (24) hours of any incident of which it becomes aware.
3) Comply with all federal and state laws concerning the privacy and confidentiality of
members' information, and agrees to implement any regulations when they become
effective.
4) Not disclose any member's personal information to another business associate for
7
Employee Disability Insurance Program Rev. 6/29/17
City of Miami, Florida Contract No. RFP680381
pecuniary gain, without prior written authorization from the City.
5) Mitigate, to the extent practicable, any harmful effect that is known to the Contractor of
a use or disclosure of members' information by the Contractor in violation of the
requirements of this Agreement or federal or state laws.
6) Implement administrative, physical, and technical safeguards that reasonably and
appropriately protect the confidentiality, integrity, and availability of the electronic
personal information of members that Contractor creates, receives, maintains, or
transmits.
7) Report to the City any security incident of which the Contractor becomes aware, and
ensure that any agent of the Contractor, including any subcontractor or sub consultant,
agrees to the same restrictions and conditions that apply to the Contractor with respect
to such information.
8) Not sell member information. Contractor shall not use member information unless it is
aggregated blinded data, which is not identifiable on a member basis. Contractor shall
not use member identified or non -aggregated information for advertising, marketing,
promotion or any activity intended to influence sales or market share of any product or
service.
9) Full financial responsibility for any penalties, fines, or other payments imposed or
required as a result of Contractor's non-compliance with, or violation of, federal or state
requirements, and the Contractor shall indemnify the City with respect to any such
penalties, fines, or payments.
10) Assure that all Contractor's staff, including subcontractor or sub consultant, are trained
in all privacy requirements, as applicable.
11) At the request of the City, offer credit protection for those times in which a member's
personal information is accidentally or inappropriately disclosed.
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Employee disability Insurance Program Rev. 6129/17
City of Miami, Florida
Contract No. RFP680381
EXHIBIT C
PROPOSAL AND NEGOTIATED PRICE SCHEDULE
23
Fmployee Disability Insurance Program Rev. 8/2/17
EXHIBIT C
PRICE SHEET
City Of Miami Executive's Long Term Disability and Short Term Disability
3 Year Rate Guarantee Included
EMPLOYER FUNDED LONG TERM DISABILITY PLAN
1.80 day benefit waiting period, benefits to age 65 or normal Social
Security retirement age. 60% benefit to a monthly maximumof
$10,000
Monthly Billed rate: .341% of covered payroll
Monthly premium based upon salaries quoted: $4,556
VOLUNTARY SHORT TERM DISABILITY PLAN
30 day benefit waiting period, 150 day maximum benefit period.
60% benefit to a maximum weekly benefit amount of $2,000
Monthly Bi -weekly
0-29
0.383
0.177
30-34
0.432
0.199
35-39
0.328
0.151
40-44
0.302
0.139
45-49
0.363
0.168
50-54
0.423
0.195
55-59
0.58
0.268
60-64
0.71
0.328
65-69
0.71
0.328
70-74
0.71
0.328
75-99
0.71
0.328
Certification Statement
Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and retain
a cop), for your files. Prices should include all costs, including transportation to destination. TheCity
resen-es the right to acceptor reject all or any part of this submission. Prices should be firm for a minimum
of I80 days following the time set for closing of the submissions.
The proposal is valid for 90 days.
In the event of errors in extension of totals, the unit prices shall govern in determining the quoted
prices.
%Ve (1) certify that we have read your solicitation, completed the necessary documents, and propose to
furnish and deliver, F.0,13. DESTINAT10N, 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
IS -107 or Ordinance No. 12271.
All exceptions to this submission have been documented in the section below (refer to paragraph and
section).
EXCEPTIONS:
4Ve (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:
PROPOSER NAME: Standard Insurance Company (The Standard)
ADDRESS: 920 SUV 611 Avenue, Portland, OR 97204
Pf30NE: 971-321-2529
EMAIL: Graeme.Queen(Wstandard.com
SIGNED BY:
2"e Vice President
TITLE: Strategic Account Services
FAX: NIA
CELL(Optional):
DATE: 4!26117
F.ATLCRE TO CONIPLETE. SIGN. AND RETLRN THIS FOR\1 SFTALL DISQUALIFY THIS
RESPONSE.
Certifications
Legal Name of Firm:
Standard Insurance Company
Entity Type: Partnership, Sole Proprietorship, Corporation, etc.
Corporation
Year Established:
1906
Office Location: City of Miami, Miami -Dade County, or Other
Our home office is in Portland, Oregon. Our Miami field office is in Ft. Lauderdale, Florida.
Business Tax Reccipt/Occupational License Number:
739510
Business Tax Receipt/Occupational License Issuing Aeency:
City of Fort Lauderdale Business Tax Division
Business Tax ReceiptlOccupational License Expiration Date:
9130?2017
Will Subcontractors) be used? (Yes or No
Yes.
Please list and ackno-wled,e all addendumiaddenda received. List the addendum?addenda number and
date of receipt (i.e. Addendum No. 1, 7/1/07). if no addendum/addenda was'w ere issued, please insert
N/A.
Addendum No. 3. 41141172. No. 2. 411117 (Census)
If Proposer has a Local Office, as defined under Chapter 18.'Articlle III, Section 16-73 of the City Code,
has Proposer filled out, notarized, and included with its RFP response the "City of Miami Local Office
Certification" form? YES OR NO? (The City of Miami Local Office Certification form is located in the
Oracle Sourcing system ("iSupplier"), under the Header/Notes and Attachments Section of this
solicitation)
We do not have a Local Office as defined here.
Proposal Prepared on:
July 14, 2017
Proposed Effective Date:
January 1, 2018
Standard Insurance Company
Long Term Disability Insurance
Short Term Disability Insurance
LThe&t7andardl
Proposed Effective Date Prepared for:
January 01, 2018 City of Miami
Uk
Protect your employees' income and your company's bottom line. This insurance comes with innovative resources designed to help you build
a more productive workplace. Our Workplace Possibilities(SM) program, included at no extra cost, helps employees stay on the job and return
to work sooner. While not all claims can be shortened, the program has proven to reduce disability duration by an average of 24 days per
claimant (as of Mar. 31, 2014, based on internal company data). That's just one example of how we add real value as your partner.
Covered Members
A regular Executive employee of the Employer working 30 or more hours per week.
Benefit Schedule
Insured Predisability a
Earnings j
Maximum Monthly Benefit
Minimum Monthly Benefit
Benefit Waiting Period
Maximum Benefit Period '.
Guarantee Issue Amount
Employer Contribution
Minimum Participation
Taxability of Benefits
Own Occupation Period
Partial/Residual Disability
Preexisting Condition Period 4
Mental & Nervous Limitation —
Substance Abuse Limitation '4
Other Limited Conditions
Musculoskeletal/Connective
Tissue Limitation
Return to Work Incentive
Employee Assistance
Program
12 months
12 months
12 months
Included: 3 face-to-face
Opportunity ID: 006AOOOOOOXVp6SIAT Standard Insurance Company 1
Proposed Effective Date Prepared for:
January 01, 2018 City of Miami
I&,
Additional Plan Design Details
-
- The Standard pays the employer's matching FICA and Medicare taxes and prepares W -2s for members receiving LTD benefits.
- The plan includes the Workplace Possibilities(SM) program, an innovative approach to addressing and reducing the causes of absence and
disability - with innovative tools and resources designed to help keep your employees productive and on the job.
- This coverage includes a $25,000 Reasonable Accommodation Expense Benefit, which reimburses employers for workplace modifications
that enable employees to return to or remain at work. The Reasonable Accommodation Expense Benefit is separate from the LTD claim
payment.
- A Rehabilitation Plan Benefit is included, which increases the LTD benefit amount by 10% of predisability earnings, not to exceed the
maximum benefit, when member is participating in an approved rehabilitation plan. This benefit will also assist in paying for approved
expenses incurred by a disabled membera part of an approved rehabilitation plan.
- Survivors Benefit pays a lump sum equal to 3 times the non-integrated LTD benefit.
- The limitations included in the policy are combined lifetime limitations.
Opportunity ID: 006AOOOOOOXVp6SIAT Standard Insurance Company
Proposed Effective Date Prepared for:
January 01, 2018 City of Miami la.
Members
Volume
Rate: Percent of earnings
Monthly Premium
Rate Guarantee
Ass
Sick leave payable to the memberwill be used as deductible income.
- Workers' compensation benefits will be considered deductible income.
- Primary and dependents Social Security benefits will be used as deductible income.
- Rates assume the group participates in Social Security.
- Rates include electronic documents. Printed certificates are available for an additional cost.
- Rates assume billing is centralized in one location.
Conditions
- Rate assumes that coverage is not currently in force.
- Confirmation that you participate in Social Security is required.
- STD benefit payments end once the disabled member begins to receive LTD benefits.
More Information
For additional information on the available features and benefits of Long Term Disability Insurance from The Standard:
Click here for California: httpJ/www.standard.com/ca-group-long-term-disability
Click here for all otherstates: http://www.standard.com/group-long-term-disability
Opportunity ID: 006A000000XVp6SIAT Standard Insurance Company 3
Proposed Effective Date Prepared for:
January 01, 2018 City of Miami
I&,
When it comes to handling Short Term Disability claims, our team of experts is standing by. Our claims examiners have been with us for an
average of 5 years, and our nurse case managers boast an average of 27 years of experience in thaIr field (internal company data as of Mar,
31, 2013). With this kind of expertise, we can typically render our initial claim decision in just 3-5 days, because the last thing a claimant needs
is a delay.
Covered Members
A regular Executive employee of the Employer working 30 or more hours per week.
Benefit Schedule
60%
Insured Predisability Earnings
$3,333
Maximum Weekly Benefit
$2,000
Minimum Weekly Benefit
X$15
Benefit Waiting Period
Accident
30 Days
Benefit Waiting Period
Sickness
30 Days
Maximum Benefit Period
150 Days
Guarantee Issue
Full Benefit ^i
Employer Contribution
0%
Minimum Participation
Greater of 20% or 10 lives
Taxability of Benefits
Non -Taxable
Partial/Residual Disability
Included
Temporary Recovery
90 Days
Y
Maternity
...... ....... dam
Covered the same as any other illness t
Additional Plan Design Details
- This is a non -occupational plan providing coverage for disabilities occurring off the job.
- The Standard prepares W -2s for members receiving benefits.
- Evidence of Insurability is required for members who enroll more than 31 days afterthey are first eligible for coverage.
- STD benefits are no longer payable once an insured member begins receiving LTD benefits.
Opportunity ID: 006A000000XVp6SIAT Standard Insurance Company 4
Proposed Effective Date Prepared for:
January 01, 2018 City of Miami
TheStandard
Members To Be Determined
Volume To Be Determined
................ - _.,__... - _ ....... ..... -_.._ ,,...... - .....e ._... -
Rate: Per $10 of Benefit - Lives Age Rate Volume
Premium
TBD 0-29 .383 TBD
TBD
30-34 .423
35-39 .328
40-44 .302
45-49 .363
50-54 .423
55-59 .580
60-64 .71p
65-69 .710
70-74 .710
75-99 .710 i
Monthly Premium
1
TBD
M__
Guarantee _
_Rate
3 yearS_...
Assumptions
- Sick leave will not be used as deductible income unless the STD benefit plus the sick leave exceeds
100% of indexed predisability
earnings. Only the excess above 100% will be used as deductible income.
- Final rates are subject to change if actual enrollment varies from the assumed enrollment of 20%
i
• Rates include electronic documents. Printed certificates are available for an additional cost.
Conditions �
• We require evidence of insurability for:
— Members who enroll more than 31 days after they are first eligible for coverage.
- Rate assumes coverage not currently in force..
More Information
Foradditional information on the available features and benefits of Short Term Disability Insurance from The Standard:
Click here for California: http://www.standard.com/ca-short-term-disability
Click here for all other states: http://www.standard-com/group-short-term-disability
Opportunity ID: 006A000000XVp6SIAT Standard Insurance Company 5
Proposed Effective Data Prepared for:
January 01, 2018 City of Miami
Producer Compensation Disclosure
We recognize the valuable role of insurance advisors, consultants and brokers ("producers") in helping their clients design an employee benefits
program, and we support reasonable and fair compensation for these services. Producers may be eligible to receive compensation from The
Standard.
The commission quoted in this proposal are noted below. Additionally, fees for administrative, marketing or consulting services may apply.
If applicable, fees are noted below.
Normal commission scale (www.standard.com/compensation/eb/) included for LTD and STD.
Unless participation is declined by the producer or client, contingent compensation is additional compensation that may also be paid and is
dependent on the satisfaction of one or more minimum requirements, such as a specified amount of now premium volume or persistency in
connection with the producer's block of business. For information about our customary producer rewards program visit
vvww.standard.com/compensation/eb/. Some producers may have a contingent compensation arrangement that differs from our customary
program. Please consult with your producer for additional details.
About This Employee Benefits Proposal
We appreciate the opportunity to provide you with this benefit and cost summary proposal from The Standard. This document outlines certain
important features of the group insurance coverages available. This is not a contract or an offer to contract for such coverages.. Detailed
information about other important features of the coverage proposed is available on request. Just ask your broker/consultant or your
representative at The Standard.
A completed application must be submitted before a group can be considered for coverage. Insurance will be effective after the application is
accepted by The Standard. If approved, we will issue a contract containing our customary language. It will not duplicate policy language from
another carrier. The group contract will contain provisions and defined terms not described in this Employee Benefits Proposal. The group
contract will control if there are discrepancies between it and this proposal.
This benefit and cost summary proposal expires on October 11, 2017, uniess replaced or withdrawn by The Standard.
The proposed premium rate and plan design for each coverage are based on the underwriting data received by The Standard. Final premium
rates and plan provisions will be determined by The Standard on the basis of: applicable state laws, policyholder contributions, confirmation of
occupations, the actual composition of the group of personswho will become insured and our current underwriting rules and practices.
Financial Strength Ratings
For information about our Financial strengths ratings visit www.standard.com/about
Opportunity ID: 006A000000XVp6SIAT Standard Insurance Company
Group Long Term
Disability Insurance
Safeguarding Your Employees' Income
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Your Proposed Group Insurance Pian
The Standard# appreciates the opportunity ID proWde you with
a proposal for Group Long Terris Dlsa4i insurance. This
rld the Employee Benefits P ogether outline the
bas : eatures of your proposed LTD in6ii l ce pian. They are
not contract.
Establishing group LTD insurance coverage with The Standard
requires your completed, signed application for group insurance
and our acceptance of it When we approve your` application, we will
issue you a group policy containing our customary language. tt will
not duplicate the language of any existing policies you may have.
Your group policy with The Standard will contain prov►sions and
defined terms not described in this booklt*"jnryour Employee'
proposal, If ar r crepancies a li etween the group
P Errtployee� Iis booklet, your'
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Will expire on the date shown in your Empkiyee
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business. Having this li; a used expert` terns our
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MOW The proposed policy woLdd pmwWe group disability income insurance only. It does nut
f vAde basic hospital, baste medical armajar medical insurance as defined by the Hew Yark
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Group Long Term
Disab�Hty fnsuranee
A Vital Part Of Your
Employee Benefits Package
Long Term Disability insurance from The Standard provides
a monthly benefit to eligible employees who are partially
or totally disabled due to a covered physical disease,
injury, pregnancy or mental disorder. It is key to smart
financial planning for both employers and employees.
Employees most likely purchase home, automobile and
life insurance to safeguard themselves against the threat
of loss. Yet they may not understand the importance
of insuring a portion of their incomes against the threat
of disability. The risk of disability is greater than most
people might think. Recent statistics have shown:
• A disabling injury occurs nearly every second of each
day -- on and off the job. That's more than 70,000
every day, more than 25 million every year.
National Safety Council, Injury Facts 2011
• Three in 10 workers entering the workforce today will
become disabled before retiring.
Social Security Administration Fact Sheet 2011
LTD insurance from The Standard provides benefits to
replace a portion of lost income for eligible employees
who meet the definition of disability under the group
policy. This helps disabled employees recuperate with
fewer financial worries.
Financial Support For Employees,
A Recruitment Tool For Employers
Savings, sick leave, workers' compensation, Social
Security, friends and family are some of the sources
used to replace income lost due to disability. However,
the financial impact of a long term disability often
exceeds these limited resources. The Standard's LTD
insurance supplements other sources of income and
provides incentives and assistance to facilitate a return
to work whenever possible.
LTD coverage also helps employers by enhancing their
benefits package — one of the best ways to attract and
retain high-caliber employees. The Standard offers
LTD insurance with flexible plan designs and claims
management expertise, all at competitive group rates.
Grog -p Long Terre Disability Insurance
Plan Design Information
LTD Benefit Schedule
LTD benefits replace a specified percentage of a
disabled employee's predisability earnings, as defined
in the group policy. The percentage can range from
30 to 70 percent, subject to minimum and maximum
LTD benefit amounts. As part of an income -replacement
program, LTD benefits will be reduced by other amounts,
called deductible income, which the employee receives
or is eligible to receive.
Coverage up to a certain level, the guarantee issue
amount, is available without submitting evidence
of insurability. Evidence may be required for higher
amounts. For detailed information about this plan's
design, please refer to the Employee Benefits Proposal.
D,efinEUo�n Of Fred€sa ilfty Earnings
Most definitions of predisability earnings include:
• Salary
• Shift differential pay
• Commissions averaged over the preceding 12 -month
period or over the period of employment if less than
12 months
• Employee contributions made through a salary reduction
agreement with the employer to an Internal Revenue
Code (IRC) Section 401(k), 403(b), 408(k), 408(p) or 457
deferred compensation arrangement, or an executive
non-qualified deferred compensation arrangement
• Amounts contributed to fringe benefits according
to salary reduction agreements under IRC Section
125 plans
The definition of predisability earnings generally
excludes bonuses, overtime or any other extra
compensation. However, these items may be
included if approved by The Standard. If so, they
will be shown in the Employee Benefits Proposal. An
employer's contributions on the employee's behalf to
any deferred compensation arrangement or pension
plan are also generally excluded from the definition
of predisability earnings.
Coverage up to a certain level, the guarantee
issue amount, is available without submitting
evidence of insurability. Evidence may be required
for higher amounts.
When LTD Benefits Begin
When LTD benefits are payable, they begin at the end
of the benefit waiting period. Benefits are not payable
during the benefit waiting period.
For disabilities subject to the Preexisting Condition
Limitation' described on pages 8 and 9, the benefit
waiting period is the longer of (a) and (b):
(a) the 12 -month period beginning on the date the
employee becomes insured under the group
policy; and
(b) from 30 - 180 days of continuous disability (the
most common selection is 90 days of continuous
disability). Periods (a) and (b) run concurrently.
7 Preexisting condition is considered a Limitation in New York, in ail states it is
considered an Exclusion.
For disabilities not subject to the Preexisting Condition
Limitation oe Exclusion, the benefit waiting period is
from 30 -180 days of continuous disability. The most
common selection is 90 days of continuous disability;
however, the period can range from 30 days to one year
depending on the specific needs of the employer.
For more information about benefit waiting period
options, piease refer to the Employee Benefits Proposal.
When LTD Eenef Its End
LTD benefits end automatically on the date the employee:
• Ceases to be disabled or dies
• Fails to provide proof of continuing disability
• Becomes eligible for benefits under another LTD
plan during a period of temporary recovery
• Reaches the end of the maximum benefit period
for which LTD benefits are payable for any one
period of continuous disability, whether from one
or more causes
LTD benefits are not payable after the end of the maximum
benefit period, even if the employee remains disabled.
For employees who become disabled after age 60,
The Standard offers three age -graded reduction
schedules that provide benefits beyond age 65. If the
proposed pan design has a shorter maximum benefit
period, such as two or five years, the maximum benefit
period is adjusted accordingly for older employees.
4 The Standard
Definitions Of Disability
The definition of disability determines whether benefits
are payable and the extent to which disabilities are
covered. The Standard's definitions of disability offer
flexibility in designing a benefit program to meet each
organization's specific needs.
Some employees will meet the applicable definition
and also retain the ability to perform some of their
work duties full-time or part-time, or be able to work in
another occupation. The Standard's disability definitions
provide coverage for individuals who work while
disabled, as defined by the group policy,
Material Duties And
Indexed Predisability Earrings
The Standard offers own occupation and any
occupation definitions of disability. Most plans include
both definitions, but they can be separated, and the
time periods when they apply may vary in order to meet
the needs of the organization and its employees. Our
basic plan includes a 24 -month own occupation period
followed by an any occupation period.
Both own occupation and any occupation definitions
refer to material duties and indexed predisability
earnings. Material duties are the essential tasks,
functions, operations, skills, abilities, knowledge, training
and experience generally required by employers from
those engaged in a particular occupation that cannot
be reasonably modified or omitted. However, in no event
would a requirement to work an average of more than
40 hours per week be considered a material duty.
Indexed predisability earnings are based upon
predisability earnings and the U.S. Consumer Price
Index, and are calculated strictly for purposes of
determining disability, indexed predisability earnings may
apply in determining whether an employee meets the
own occupation or any occupation definition of disability.
Own Occupation disability
During the benefit waiting period and the first 24 months
of the own occupation period thereafter, employees
are disabled if, as a result of physical disease, injury,
pregnancy or mental disorder they:
• Are unable to perform with reasonable continuity
the material duties of their own occupation, and
Group Long Term Disability Insurance
• Suffer a loss of at least 20 percent in their
indexed predisability earnings when working
in their own occupation.
Own occupation means any employment, business,
trade, profession, calling or vocation that involves
material duties of the same general character as the
occupation the employee is regularly performing for
the employer when the disability begins. However,
own occupation is not limited to how the employee
specifically performs the job for the employer. Rather,
The Standard may view how the occupation is
generally performed in the national economy. If the
own occupation involves the rendering of professional
services and requires a professional or occupational
license in order to work, the definition of own occupation
is as broad as the scope of the license.
While this definition applies, employees who are
disabled from their own occupation may work in another
occupation and continue to qualify for LTD benefits as
song as their work earnings do not meet or exceed 80
percent of their indexed predisability earnings. Work
earnings will be used to reduce the LTD benefits as
noted under "Return To Work Incentive" on page 6.
Any Occupation Disability
During the any occupation period, after the 24 months of
the own occupation period, employees are disabled if, as
a result of physical disease, injury, pregnancy or mental
disorder, they are unable to perform with reasonable
continuity the material duties of any occupation.
Any occupation means any occupation or employment
that the employee is able to perform, whether due to
education, training or experience, which is available at
one or more locations in the national economy, and in
which the employee could be expected to earn at least
60 percent of indexed predisability earnings within 12
months following his or her return to work, regardless
of whether the employee is working in his or her own or
any other occupation.
While this definition applies, disabled employees may
work and continue to qualify for LTD benefits as long
as they meet the any occupation definition of disability.
Work earnings will reduce the LTD benefits as noted
under "Return To Work Incentive."
Optional Definitions Of Disability
The Standard understands the specialized training and
financial investment required for many professional
careers. We offer definitions of disability specifically
designed for professionals, key management employees
and certain employer groups.
Own Occupation To Age 66
The Standard offers a definition of disability that
requires employees to be disabled from only their own
occupations. This definition applies during the benefit
waiting period and throughout the maximum benefit
period. Employees who are disabled from their own
occupations may work in another occupation. However,
they will no longer meet the definition of disability when
their work earnings meet or exceed 80 percent of
indexed predisability earnings.
Own Specialty Protection
For physicians and attorneys, The Standard offers
two-year, five-year, and to end of maximum benefit
period own specialty protection. For physicians, own
occupation is defined as the medical specialty the
physician is board-certified to practice. For attorneys,
own occupation is defined as the one or two legal
subject -matter areas or types of legal practice in which
the attorney has specialized, provided the attorney
has been in practice for at least five years .2
Certain percentages of the gross professional fee
income must have been earned in those specialty
areas or types of practice during the 24 months just
before disability began. These percentages are at least
60 percent for physicians and 85 percent for attorneys.
During the remainder of the maximum benefit period,
the employee must meet the usual own occupation
definition of disability. Those who meet this definition
of disability may work in another occupation. However,
they will no longer be considered as disabled when
their work earnings exceed 100 percent of indexed
predisability earnings.
Triaf attomey or trial practice will not be considered one of the specialty legal
subject matter areas or types of legal practice unless the attorney personally
appears and actively participates In legal proceedings on behalf of clients at least
four hours per day on an average of at least 50 days per year during the 24
months just before disability begins. Time the attorney spends preparing to
actively participate in legal proceedings can be Included when calculating up to
one-half of the hours -per -day and days -per -year requirement Legal proceedings
include civil or criminal triats, administrative rule-making or contested -case
hearings, workers' compensation hearings, arbitration and mediation hearings,
and the taking or defending of depositions.
Returning To Work
Our claims management services have been carefully
designed to promote and optimize the return of disabled
employees to a productive life whenever possible.
Our benefits analysts work with vocational experts,
nurses and physicians to provide early screening,
assess disability durations and identify return -to -work
opportunities. As a result, disabled employees may
return to work earlier than anticipated, which may
reduce the likelihood of permanent disability. This helps
employers regain valuable employees and contain
disability claims costs.
Return To Work Incentive
Providing incentives for disabled employees to return to
work at their full potential is critical for any successful
rehabilitation plan. The Standard's Return to Work
Incentive is one of the most comprehensive in the
employee benefits industry. It is automatically included
in every LTD policy to provide valuable financial support
to eligible employees in their efforts to return to work.
During the 12 (or optional 24) months immediately after a
disabled employee first returns to work, the LTD benefit
is reduced by only the amount of work earnings that,
when added to the employee's maximum LTD benefit,
exceeds 100 percent of indexed predisability earnings.
Following 12 (or optional 24) months, The Standard will
deduct one-half of work earnings while the employee
remains disabled. This typically means that employees
who return to work will receive more total income than
those who do not. Work earnings will include amounts
they could earn if they worked to their full potential in
work that is reasonably available.
Reasonable Accommodation Expense Benefit
To help employers return employees with disabilities
to active work whenever possible, The Standard
automatically includes a Reasonable Accommodation
Expense Benefit in its LTD policies. This reimburses
an employer up to $25,000 for worksite modifications
made on behalf of a disabled employee, when the
modifications enable the employee to return to
work. Reimbursable modifications are subject to
The Standard's prior approval.
6 The Standard
Rehabilitation Plan Provision
To help employees with disabilities prepare to return
to active work, The Standard automatically includes a
Rehabilitation Plan Provision in all LTD policies. Subject
to The Standard's prior approval, employees may
participate in a rehabilitation plan at any time, and in
doing so, may receive an additional 10 percent of their
predisability earnings, not to exceed the maximum LTD
benefit as a result of this increase. Some or all of the
expenses incurred by employees that are intended to
support a return to work, include;
• Training and education
• Family (child and elder) care
• Job -search and other job-related expenses
Temporary Recovery
The Standard automatically includes a Temporary
Recovery provision in every LTD policy to further
encourage employees to return to work. Our flexible policy
language enables us to work with employees to make
permanent recoveries out of temporary ones. Employees
who recover from a disability for a period of time, but
later suffer a relapse and become disabled again from
the same cause or causes, may not have to serve a new
benefit waiting period if the period of recovery does not
exceed 90 days during the benefit waiting period or 180
days during the maximum benefit period.
in either case, the recovery period does not count
toward the benefit waiting period, the maximum benefit
period or the own occupation period. LTD benefits are
not payable during the recovery period. Predisability
earnings used to determine the LTD benefits will not
change. No LTD benefits will be payable after benefits
become payable under any other disability plan under
which the employee became insured during the
recovery period. Otherwise, the group policy is applied
as if the disability were uninterrupted.
Return To Work Pesponsibility
In addition to providing financial incentives to return to
work, The Standard's LTD policy also establishes clear
expectations for those who are able to return to work.
Disabled employees who are capable of part-time work
Group Long Term Disability Insurance
have a responsibility to take advantage of available work
opportunities. They must accept part-time work in their
own occupation during the own occupation period and
in any occupation during the any occupation period,
if they are able to earn at least 20 percent of indexed
predisability earnings. LTD benefits will not be payable
for any period when partially disabled employees fail to
meet this return to work responsibility.
Workplace Possibilitiess"
To help employers proactively manage absence
and disability, this innovative program aims to keep
employees at work by addressing and reducing the
causes of absence and disability. For employers
with 1,000 or more employees, we offer to place a
Workplace Possibilities Consultant onsite, as part of
their group disability insurance through The Standard.
The Consultant — a certified case manager who may be
a nurse or vocational rehabilitation specialist — works to
keep employees on the job and get them back to work
quicker. The goal is a more productive workplace with
measurable reductions in absence and disability -related
costs. And it takes a big burden off the HR team.
Cost Containment Features
Disabilities Subject To Limited Pay Periods
Payment of LTD benefits is limited to 24 (or optional 12)
months during the employee's lifetime for disabilities
caused or contributed to by any one or more of the
following, or medical or surgical treatment of one or
more of the following:
• Any mental, emotional or psychological disorder
regardless of cause (such as depression, anxiety,
stress, bipolar affective disorder, organic brain
syndrome, schizophrenia); at the end of the limited
pay period, benefits may continue if the employee is
continuously confined in a hospital solely because of
a mental disorder, however; hospital does not include
a rest home, nursing home, convalescent home, home
for the aged or a facility primarily affording custodial,
educational or rehabilitative care
• The use of alcohol or any drug (including
hallucinogens), alcoholism or drug addiction
Other limited conditions include chronic fatigue
conditions (such as chronic fatigue syndrome and
post viral syndrome), any allergy or sensitivity to
chemicals or the environment (such as sick building
syndrome and multiple chemical sensitivity syndrome),
chronic pain conditions (such as fibromyalgia, reflex
sympathetic dystrophy and myofascial pain), carpal
tunnel or repetitive motion syndrome, temporomandibular
or craniomandibular joint disorder3
As an additional cost-containment option, employers
may elect to limit payment of LTD benefits for disabilities
caused or contributed to by musculoskeletal or
connective tissue disorders, such as arthritis, diseases
or disorders of the cervical, thoracic or lumbosacral
back and its surrounding soft tissue, and strains or
sprains of joints or muscles. This expanded limitation
would not apply to rheumatoid or psoriatic arthritis,
herniated disks with neurological abnormalities that are
documented by electromyogram and computerized
tomography or magnetic resonance imaging, scoliosis,
traumatic spinal cord injuries, diseases or inflammations
of the spinal cord, overlapping vertebrae (grade 11 or
higher), osteoporosis, discitis or Paget's disease.
3 This limitation does not apply to neoplastic diseases, neurologic diseases, endocrine
diseases, hematologic diseases, asthma, allergy -induced reactive lung disease,
tumors, malignancies, vascular malformations, demyelinating diseases or lupus.
Standard Insurance Company
Limitations
No LTD benefits will be paid for any period when the disabled
employee is:
• Not under the ongoing care of a physician in an appropriate
specialty as determined by The Standard
• Not participating in good faith in a plan of medical treatment,
vocational training or education approved by The Standard, unless
the disability prevents the employee from participating
• Able to work part time, but elects not to (.e., the employee fails to
meet his return to work responsibility)
• Confined for any reason in a penal or correctional institution
In addition, payment of LTD benefits is limited to 12 months for any
period when the employee resides outside the United States or Canada.
Exclusions From Coverage
Disabilities are not covered when caused or contributed to by:
• War or any act of war
• An intentionally self-inflicted injury, whether the insured employee
is sane or insane'
• Loss of professional or occupational license or certification
• Committing or attempting to commit an assault or felony
• Active participation in a violent disorder or riot
• A preexisting condition or treatment of a preexisting condition,
unless, on the date disability begins, the employee has been
continuously insured under the group policy for the entire 12
months for groups with 20 or more lives and 24 months for groups
with fewer than 20 lives and has been actively at work for at least
one full day after the end of that exclusion period
Diagnosed or misdiagnosed, a preexisting condition is a mental or
physical condition:
• That was discovered or suspected as a result of any routine or
other medical examination at any time during the preexisting
condition period, or
• For which the employee has (or a reasonably prudent person would
have) consulted a physician or other licensed medical professional,
received medical treatment, services or advice, undergone
diagnostic procedures (including self-administered procedures), or
taken prescribed drugs or medications at any time during the
preexisting condition period.
The preexisting condition period is the three- or six-month period just
before the employee's insurance becomes effective, as specified in
the Employee Benefits Proposal. The Standard grants credit for time
served toward satisfying the preexisting condition exclusion period for
eligible employees insured under the employer's prior group LTD plan
that was replaced by The Standard,
4 For Colorado and Missouri residents, "insane" is not applicable.
The Standard
The Standard Life Insurance Company of New York
Limitations
No LTD benefits will be paid for any period when the disabled
employee is:
• Not under the ongoing care of a physician in an appropriate
specialty as determined by The Standard
• Not participating in good faith in a plan of medical treatment,
vocational training or education approved by The Standard, unless
the disability prevents the employee from participating
• Able to work part time, but elects not to (i.e., the employee fails to
meet his return to work responsibility)
Payment of the LTD benefit will be limited if disability is caused or
contributed to by a preexisting condition or the medical or surgical
treatment of a preexisting condition unless, on the date the employee
becomes disabled they:
• Have been continuously insured under the group policy for a period
of 12 months, and
• Have been actively at work for at least one full day at the and of
that 12 months
A preexisting condition is a mental or physical condition (whether
diagnosed or misdiagnosed) that occurs at any time during the
preexisting condition period specified in the Employee Benefits
Proposal and,
• For which the employee has (or a reasonably prudent person
would have): consulted a physician or other licensed medical
professional; received medical treatment, services or advice;
undergone diagnostic procedures, including self-administered
procedures; or taken prescribed drugs or medications, or
• Which was discovered or suspected as a result of any routine or
other medical examination.
In addition, payment of LTD benefits is limited to 12 months for any
period when the employee resides outside the United States or Canada.
Exclusions From Coverage
Disabilities are not covered when caused or contributed to by,
• War or any act of war
• An intentionally self-inflicted injury, while sane
• Loss of professional or occupational license or certification
• Committing or attempting to commit an assault or felony
• Active participation in a violent disorder or riot
Croup Long Term Disability Insurance
Deductible Income
The Standard's LTD insurance helps replace part
of the income lost as a result of disability. Often
employees are eligible for other sources of income,
such as workers' compensation or Social Security, To
prevent overinsurance, LTD benefits are reduced by an
employee's deductible income, which generally includes
the following, although these may vary depending on if
the employer is a public or private entity:
• Work earnings, as described under "Return To
Work Incentive"
• Sick pay, annual or personal leave pay, severance
pay or other salary continuation, including donated
amounts (but not vacation pay), which, when added
to the maximum LTD benefit, exceed 100 percent of
indexed predisability earnings
• Benefits from the Federal Social Security Act, the
Canada Pension Plan, the Quebec Pension Plan,
the Railroad Retirement Act or similar plans or acts
providing benefits that the employee or the employee's
dependents receive or are eligible to receives
• Benefits the employee receives or is eligible to receive
from workers' compensation, state disability income
benefits law, the Jones Act; Maritime Doctrine of
Maintenance, Wages or Cure; Longshore and Harbor
Workers' Act; or any similar acts or law
• Any earnings or compensation included in predisability
earnings which an employee receives or is eligible to
receive while LTD benefits are payable
• Any amount an employee receives or is eligible to
receive under any unemployment compensation law
or similar act or law
• Any amount an employee receives or is eligible to
receive from or on behalf of a third party
• Any disability or retirement benefits an employee
receives from a private employer's retirement plan
• Any disability or retirement benefits an employee
receives or is eligible to receive from a public
employer's retirement plan and any lump sum refund,
withdrawal or distribution of contributions and
5 Employers may choose a plan design that offsets LTD benefits by part
or none of the dependent's benefits.
earnings received'
• Any amount received by compromise, settlement or
other method, as a result of a claim for any of the
above, disputed or undisputed
Exceptions To Deductible Income
The following are generally not considered deductible
income, although exceptions may vary depending on
if the employer is a public or private entity:
« Any amounts attributable to the employee's contributions
to the employer's retirement plan or which the
employee could have received upon termination of
employment without being disabled or retired
• Benefits from a profit-sharing plan, thrift or savings
plan, deferred -compensation plan, 401(k), 408(k) or
457 plan, IRA, tax-sheltered annuity under IRC
Section 403(b), stock ownership plan or Keogh
(HR -10) plan
• Any lump -sum refund, withdrawal or distribution of the
employee's contributions and earnings received from
the employer's retirement plan because the employee
is not vested under the plan
• Social Security early-retirement benefits not received
by the insured employee
• Group credit, mortgage disability insurance benefits
and accelerated death benefits paid under a life
insurance policy
• Any cost -of -living increases in deductible income,
other than work earnings
• Reimbursement for hospital, medical or
surgical expenses
• Reasonable attorney fees incurred in connection
with a claim for deductible income
Additional LTD Plan
Provisions And Services
Employee Assistance Program'
6 If the employee receives a lump sum refund, withdrawal or distribution of
contributions and earnings, LTD benefits are determined using a Iifetime monthly
annuity amount with no survivor income. Employee and employer contributions
are considered as distributed simultaneously throughout the employee's lifetime,
regardless of how funds are distributed from the retirement plan.
An Employee Assistance Program (EAP) can help
increase productivity by assisting employees with their
attempts to balance work and personal life. An EAP
can address concerns such as health, marital, family,
financial, alcohol, drug, legal, emotional and other
personal issues that may adversely affect employee job
performance. EAP and Worklife services are included
with The Standard's Long Term Disability policies and
are offered as optional enhancements with our group
Life insurance.
A specialist will provide consultation by phone as well
as arrange for up to three face-to-face assessments and
short-term counseling from a network provider when
necessary. The services also include Critical Incident Stress
Debriefings in which a counselor will provide on-site, group
counseling for employees if a traumatic event occurs
in the workplace. The services also include referrals to
community resources and educational materials.
Coverage For New Disabilities
If a period of disability is extended by a new cause while
LTD benefits are payable, benefits will continue while
the employee remains disabled, but not beyond the end
of the original maximum benefit period. In addition, all
policy limitations and exclusions apply to the new cause
of disability.
Survivors Benefit
If an employee who has been continuously disabled for
at least 180 days dies while LTD benefits are payable,
The Standard will pay a Survivors Benefit. The benefit is
a lump sum equal to three times the employee's monthly
LTD benefit without reduction by deductible income.
The Survivors Benefit is intended to meet a portion of a
family's financial needs in the event of the employee's
death. The benefit is paid to the surviving spouse"
or unmarried chi€dren under age 25. As an option, it
may also be paid to the deceased employee's estate,
However, The Standard will first use the Survivors Benefit
to reduce any overpayment on the employee's claim.
Direct Deposit
The Standard offers direct deposit (also known as
Electronic Funds Transfer or EFT), a convenient and
secure benefit payment option. With direct deposit,
7 Provided for employers with 10-2,499 employees. Employers with more
than 2,500 employees can customize their coverage by adding this feature to
their LTD policy. EAP services are provided through an arrangement with Horizon
Behavioral Services, LLC, which is not affiliated with The Standard. EAP is not an
Insurance product,
8 Spouse may include a clvll union partner. EligiblPty not available In all states.
Contact your sales representative for details.
10 The Standard
employees' LTD benefit payments will be automatically
deposited into their designated checking or savings
account on their payment due date, even if that date
falls on a weekend or a holiday.
Social Security Assistance
The Standard offers eligible disabled employees
assistance with Social Security benefits starting with the
initial application. Each of our claims management teams
includes a specialist who helps administer our Social
Security assistance program and acts as a liaison to our
nationwide network of contracted specialists.
Payment 016 F 7 axes
The Standard automatically pays the employer's portion
of FICA (Social Security and Medicare) taxes for all LTD
claims. Also, The Standard prepares and mails W-2
forms and reports yearly totals to the IRS and Social
Security Administration for all LTD claims. This service
saves the employer time and helps to expedite tax
preparation for the employee.
Automatic V!a; imus Benefit Increase
The Automatic Maximum Benefit increase feature
provides for the maximum LTD benefit of the plan to
automatically increase by 5 percent annually for five
years. This is a convenient way to assure the LTD plan
design keeps pace with salary increases without
having to amend the group policy each year. There
is no cost to add this feature to your coverage, but
it must be requested — it's not automatically included
in coverage plans.
Options Available At Additional Cost
Benefits For The Severely Disabled
The Standard offers three enhancements to group
LTD coverage to address the needs of severely
disabled employees:
• Assisted Living Benefit, which may increase the
income replacement level up to 80 or 100 percent
of insured predisability earnings (up to a $5,000
maximum benefit)
• Housing Assistance Benefit, which provides an
additional 25 percent of predisability earnings
to pay for rent or mortgage (up to a $5,000
maximum benefit)
• Lifetime Security Benefit, which extends the
maximum benefit period to the severely disabled
employee's lifetime
Employers may choose one of the above or include
the Lifetime Security Benefit in conjunction with either
of the two other options. When one of these options
is included, an employee to whom LTD benefits are
payable may receive the additional benefits if, as a
result of physical disease or injury, the employee:
• Is unable to safely and completely perform two or
more activities of daily livings without assistance
due to loss of functional capacity, or
• Requires substantial supervision for health or safety
due to severe cognitive impairment.
The disabling condition must be expected to last 90
days or more and be certified by a physician in the
appropriate specialty as determined by The Standard.
Other provisions and benefits may not be available and
certain limitations and exclusions will apply.
8 The six activities of dally living are bathing, continence, dressing, eating,
Colleting and transferring.
Group Long Terre Disability Insurance 1t
Annuity Contribution Benefit
The Annuity Contribution Benefit is an optional
Group Long Term Disability insurance feature
designed to bridge the savings gap created when
disabled employees may no longer have the financial
means or opportunity to fund a retirement plan.
After a claimant has been disabled for 36 months,
The Standard will set up and fund an individual annuity
in the claimant's name. Each month, a designated
percentage of the disabled employee's predisability
earnings, not to exceed $5,000, will be deposited into
the annuity.
Family Care Expenses Adjustment
As another return to work incentive, employers may
add the Family Care Expenses Adjustment provision
as an option to their group policy. If selected, the
provision applies during the 12 (or optional 24) months
immediately after a disabled employee first returns
to work. While this applies, work earnings used to
calculate LTD benefits may be reduced by a portion of
the employee's family -care expenses, up to a monthly
maximum of $250 per family member or $500 per family
Certain restrictions apply.
�z
Dependent Education Benefit
The Dependent Education Benefit provides a monthly
benefit for disabled employees who have children or a
spouse1° who are registered and in full-time attendance
at an accredited educational institution beyond high
school. Disabled employees can receive $150 for each
eligible student, with a maximum of $600 per month
for all eligible students. Spouses must be attending an
institution for the purpose of obtaining employment or
increasing earnings. Other restrictions may apply.
Conversion Provision
The Conversion of Insurance provision allows qualified
employees to buy LTD conversion insurance after their
insurance under the group policy ends. To qualify, an
employee must meet the eligibility requirements for
conversion as outlined in the group policy. Employees
may maintain the same benefit level, up to a $4,000
monthly benefit, without submitting evidence of
insurability. A benefit of up to $5,000 a month may
be available with approved evidence of insurability.
Conversion is available with most plan designs, although
exclusions, limitations and reductions may apply.
Cost Of Living Adjustment (COLA) Benefit
The COLA benefit helps protect an employee's LTD
benefits from inflation. The Standard offers COLA
benefit options calculated according to the current
Consumer Price Index. if on April 1 an employee has
been disabled for the required number of calendar
years (one or five), the LTD benefit will be adjusted
with the COLA increase.
Age -graded Maximum Benefit Periods
The Standard offers a variety of maximum benefit
period schedules for employers to provide LTD benefits
to employees who work beyond age 65. Typically,
the maximum benefit period is determined by the
employee's age when the disability begins. The typical
age -graded benefit reduction schedule includes a
maximum benefit period to age 65 for employees
who become disabled before age 62, with the benefit
duration age -graded for employees who become
disabled on or after age 62. With the Social Security
normal retirement age (SSNRA) maximum benefit period
option, the maximum benefit period corresponds to the
employee's SSNRA under the federal Social Security
Act. Additional options for maximum benefit periods
beyond age 70 are also available.
10 Spouse may include a civil union partner. Child may include a child of a civil
union partner, Eligibility not available in all states. Contact your sales
representative for details.
12 The Standard
Commonly Asked Questions
V1ho Is Eigg.ibEe For Coverage?
Coverage is available to all of an employer's active
employees who:
• Are citizens or residents of the United States
or Canada'
• Are actively at work at least 30 hours each week
• Meet the required eligibility waiting period as shown in
the Employee Benefits Proposal
Temporary and seasonal employees, full-time members
of the armed forces of any country, leased employees
and independent contractors are not eligible for
coverage. There is no age limit on eligibility for coverage
under The Standard's group insurance plans.
What Is The Effective [date Of This Plan?
Subject to the active work requirement, coverage is
effective as follows:
• Coverage requiring evidence of insurability is not
effective until evidence is approved
11 For The Standard Life Insurance Company of New York policies only: Area
regular employee of the employer working in the United States.
• For noncontributory plans, coverage is effective on the
date the employee becomes eligible
• For contributory plans, employees must apply in writing
for coverage. Coverage is effective on the later of:
- The date the employee becomes eligible
- The date the employee applies if the employee submits
an application within 31 days of becoming eligible
- The date required evidence of insurability is
approved, if the employee applies more than
31 days after becoming eligible
Vlhat is The Active WorkRequirement?
Employees who are performing the material duties of
their own occupation at the employer's usual place of
business meet the active work requirement. Employees
who are not capable of active work due to physical
disease, injury, pregnancy or mental disorder on the day
before insurance would otherwise become effective will
not become insured until the day after completing one
full day of active work as an eligible employee.
Group Lona Terra Disability Insurance
13
What Leve? Of E-mpfoyee
Participation is Required?
For noncontributory plans, 100 percent of the eligible
employees must participate. If a plan is contributory
(partially or fully funded by employees), a minimum
number of eligible employees must participate, as
specified in the Employee Benefits Proposal.
When Does Coverage End?
LTD insurance ends automatically on the earliest of
the following:
• The date the last period ends for which a premium
contribution is received
• The date the group policy terminates
• The date employment terminates
• The date the employee fails to meet the definition
Of a member (however, LTD insurance may be
continued under certain conditions, such as during
an approved leave of absence scheduled to last no
more than 30 days)
When Does The Group Palfoy Terminate?
An employer may terminate a group policy by providing
The Standard with written notice. The group policy will
automatically terminate if premium is not received by
the end of the grace period shown in the Employee
Benefits Proposal. The Standard may terminate the
group policy if the number of employees insured is less
than the minimum participation requirement as shown
in the Employee Benefits Proposal. The Standard may
also terminate the group policy if we determine that the
policyholder has failed to promptly furnish any necessary
information requested by us or has failed to perform any
other obligations relating to the group policy.
Performance Guarantee
The Standard is committed to providing world-class
customer service. We guarantee we will meet the
policyholder's overall service expectations or we will
refund 5 percent of the quarterly expenses charged
to the policyholder's account (for administration and
paying claims) for any quarter in which we do not meet
this guarantee 12
12 The minimum group size for Performance Guarantee for LTD coverage is 1,000
covered employees. No more than one refund per quarter will be paid. Claim
decisions are made based on the terms of the plan. The ultimate claim decision,
whether to approve or deny, is not covered by this Performance Guarantee. This
guarantee is in effect for the initial rate guarantee period shown in the group policy.
Thereafter, The standard reserves the right to modify the terms or terminate this
guarantee at any time at its sole discretion,
14
The Standard
Standard Insurance Company's first group policy, written
in 1951 and still in force today, stands as a testament to
our commitment to building long-term relationships. The
Standard Life Insurance Company of New York founded
in White Plains, New York in 2000 is the sister company
of Standard Insurance Company founded in Portland,
Oregon in 1906, a nationally recognized provider of group
Disability, Life, Dental and Vision insurance.
To learn more about group LTD insurance from The Standard,
contact your insurance advisor, call the Employee Benefits
Sales and Service Office for your area at 800.633.8575 or
visit us at www.standard.com.
The Standard is a marketing name for StanGorp Financial Group,
Inc. and subsidiaries. Insurance products are offered by Standard
Insurance Company of Portland, Ore. in all states except New
York, where insurance products are offered by The Standard Life
Insurance Company of New York of White Plains, N.Y. Product
features and availability vary by state and company, and are solely
the responsibility of each subsidiary. Each company is solely
responsible for its own financial condition. Standard Insurance
Company is licensed to solicit insurance business in all states
except New York. The Standard Life Insurance Company of
New York is licensed to solicit insurance business in only the
state of New York.
Group LTD Insurance underwritten by Standard Insurance Company is provided
under policy form numbers: GP190-LTD/S399, GP190-LTD/TRUST/S399, GP399-LTD/
TRUST, GPi90-LTD/ASSOC/S399, GP491-LTD/TRUST/S399, GP899-LTD, GP209-LTD,
OP608-LTD
Group LTD Insurance underwritten by The Standard Life Insurance Company of New York
Company Is provided under policy form number, GPNY0500-LTO
Group Long Term Disability Insurance
16544 (4/13) SI/S NY PR/ER
Proposal Prepared on:
April 28, 2017
Proposed Effective Date:
January 1, 2018
Standard Insurance Company
Long Term Disability Insurance
Short Term D sability Insurance
Proposed Effective Date Prepared for:
January 01, 2018 City of Miami
I& -
Protect
your employees' income and your company's bottom line. This insurance comes with innovative resources designed to help you build
a more productive workplace. Our Workplace Possibilities(SM) program, included at no extra cost, helps employees stay on the job and return
to work sooner. While not all claims can be shortened, the program has proven to reduce disability duration by an average of 24 days per ?
claimant (as of Mar. 31, 2014, based on internal company data), That's just one example of how we add real value as your partner.
Covered Members
A regular Executive employee of the Employer working 30 or more hours per week.
Opportunity ID: 006A000000XVp6SIAT Standard Insurance Company
Base
9 uy-up :
3
Benefit Schedule
60% =
60%
60%
60%
Insured Predisability
$16,667
$16,667
$16,667
$16,667
Earnings
Maximum Monthly Benefit
$10,000 $10,000
-----------
-- -----
$10,000
$1U00
Minimum
Minimum Monthly Benefit -
$100 or 10%
$100 or 10%
$100 or 10%
$900 or 10%
Benefit Waiting Period
180 Days
180 Days
180 Days
90 Days
—�
Maximum Benefit Period
To SSNRA
To SSNRA k
To SSNRA
To SSNRA
Guarantee Issue Amount _
Full Benefit
Full Benefit =
Full Benefit
Full Benefit
Employer Contribution °=
100%
0% ---
100%
0%
Minimum Participation
100%
Greater of 25% or 10 lives
100%
Greater of 25% or 10 lives
'taxability of Benefits _
Taxable
Non -Taxable =
Taxable
Non -Taxable
Own Occupation Period
24 Months
24 Months
24 Months
24 Months
Partial/Residual Disability
Included
-_--_------ -
Included t
Included
Included
Preexisting Condition Period
---'--
3112
-3112 � _--
3112—_---�--
3112 ----_---
.Mental & Nervous Limitation
24 months
T � 24 months
�— 24 months
24 months
�
-
Substance Abuse Limitation j
24 months
24 months
24 months
24 months
F
Other Limited Conditions
24 months
k
24 months =
24 months
24 months
Return to Work Incentive
12 months
12 months
_ 12 months
12 months
Employee Assistance `s
Program
Included: 3 face-to-face
Included: 3 face-to-face
Included: 3 face-to-face
Included: 3 face-to-face
Opportunity ID: 006A000000XVp6SIAT Standard Insurance Company
Proposed Effective Gabe Prepared for:
January 01, 2018 City of Miami
Additional Plan Design Details = 4 - fi
- The Standard pays the employer's matching FICA and Medicare taxes and prepares W -2s for members receiving LTD benefits,
LThe-S7tan7clarld
- The plan includes the Workplace Possibilities(SM) program, an innovative approach to addressing and reducing the causes of absence and
disability - with innovative tools and resources designed to help keep your employees productive and on the job.
- This coverage includes a $25,000 Reasonable Accommodation Expense Benefit, which reimburses employers for workplace modifications
that enable employees to return to or remain at work. The Reasonable Accommodation Expense Benefit is separate from the LTD claim
payment.
- A Rehabilitation Plan Benefit is included, which increases the LTD benefit amount by 10% of predisability earnings, not to exceed the
maximum benefit, when member is participating in an approved rehabilitation plan. This benefit will also assist in paying for approved
expenses incurred by a disabled membera part of an approved rehabilitation plan.
- Survivors Benefit pays a lump sum equal to 3 times the non-integrated LTD benefit,
- The limitations included in the policy are combined lifetime limitations.
Opportunity ID: 006AOOOOOOXVp6SIAT Standard Insurance Company
Proposed Effective Date Prepared for:
January 01, 2018 City of Miami
C0SI _
Members
Volume
Rate: Percent of earnings
Monthly Premium
Rate Guarantee
Members
Volume
Rate: Percent of earnings
i
Monthly Premium
(tate Guarantee
Lives
TBD
122
$1,337,932
.409
$5,472
2 years
Age
0-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-99
LTheSt.7ardkaard'
Base
Buy -up -
122
31
$1,337,932 --f---
$334,483
.413
.244
-- $5,526 —�-_-_
$816
2 years
2 years
To Be Determined
To Be Determined
Rate Volume
107 j TBD
.203
.364
.545
.826
1.171
1.295
1.141
1.119
2.261 I
2.909
Premium
TBD
TBD
3 years
Plan 4
- LTD rates forthe Buy -up Plan applyto the total monthly predisability earnings (including the monthly predisability earnings covered underthe
Base Plan).
- The premium and volume figures shown above for the Base Plan reflect the volume, rate and the employer's portion of the total premium for
both plans.
- The policy will describe the Base and Buy -up LTD plans as separate and distinct plans, identified as Plan 1 and Plan 2 within the contract.
Members will be insured under either the Base or Buy -up Plan, but not both. The total cost for the Buy -up Plan will be the sum of the base
and buy -up premiums for each memberas determined by the rates shown above.
Opportunity ID: 006A000O00XVp6SIAT Standard Insurance Company 3
Proposed Effective Date Prepared for:
January 01, 2018 City of Miami
LTheTheStandard
��
A,ssumptlons (continued)
Rates assume billing is centralized in one location.
Plan 2
- Final rates are subject to change if actual enrollment varies from the assumed enrollment of 25%
-
i
Rate assumes that coverage is not currently in force.
- Confirmation that you ,participate in Social Security is required.
- STD benefit payments end once the disabled member begins to receive LTD benefits.
Plan 2
- We require evidence of insurability for:
— Members who enroll more than 31 days afterthey are first eligible for coverage.
— Members eligible under the current plan but not enrolled.
- Final rates will be based on actual enrollment.
Plan 4
We require evidence of insurability for:
— Members who enroll more than 31 days afterthey are first eligible for coverage.
— Members eligible under the current plan but not enrolled.
More Information
For additional information on the available features and benefits of Long Term Disability Insurance from The Standard:
Click here for California: http://www.standard.com/ca-group-long-term-disability
Click here for all other states: http://www.standard.corn/group-long-term-disability
Opportunity ID: 006A000000XVp6SIAT Standard Insurance Company 4
Sample Disability Income Report
Standard Insurance Company produces Disability Income Reports to help employers prepare year-
end W-2 Wage and Tax Statements and identify eligible employees who will receive a W-2 from The
Standard, The reports show yearly totals for benefit payments and tax withholding for each employee
who received group Short Term Disability or Long Term Disability benefits during the previous
calendar year.
Ccs 2010 StanCorp Financial Group, Inc.
Standard InStll'a ICe
Company produces
Disability Income
Reports to help
employers prepare
year-end VV -2 Wage
and Tax Statements
and identify eliclible
employees :^1hr) v"Jll
receive a VV -2 fron}
The Standard, The
reports yearly
totals for benefit
payrn_nts and tax
%vithholding for each
2niployee ,,%,ho received
grr3up Short Term
Disabi%( or Lol)i
Term Disability benefits
during tho prl=_`,'i1Dus
calendar Year.
The portion of your
employee's benefit Mal Is
considertA taxable. Please
nolifyTlle' Standard If this
Information Is Incorrect.
F-7nter Social 5ecurfty
Taxes 41'idJhckl In Box 4
on your 04'.2 form for t111s
employee.
Enler Aletlirare Taxes
Willi seld in Bax G on
your W -c" Farm far this
employee.
O
;4•
U4
ft
Your federal tax
i l"1 ---,Standard'
ldentUlcatlun
^s���l.•>I
number, vAilch
VAR appear on
your emploYPIA
1A`2 statement.
Please nc'tify
41 99x9^9 TAY. MCT Tts0!
The Standard If
P1DDL TAX LDt OPOropjtl
this Infonnatbn
I,< C-MrANY
is Incorrect.
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your VV -2.
ror more Informatlon about The Standard's financial reports, contact your
Insurance advisor or the Employee Benefks Sales and Service Orrice for
your area at 87!7.633.8575.
Ccs 2010 StanCorp Financial Group, Inc.
Standard InStll'a ICe
Company produces
Disability Income
Reports to help
employers prepare
year-end VV -2 Wage
and Tax Statements
and identify eliclible
employees :^1hr) v"Jll
receive a VV -2 fron}
The Standard, The
reports yearly
totals for benefit
payrn_nts and tax
%vithholding for each
2niployee ,,%,ho received
grr3up Short Term
Disabi%( or Lol)i
Term Disability benefits
during tho prl=_`,'i1Dus
calendar Year.
The portion of your
employee's benefit Mal Is
considertA taxable. Please
nolifyTlle' Standard If this
Information Is Incorrect.
F-7nter Social 5ecurfty
Taxes 41'idJhckl In Box 4
on your 04'.2 form for t111s
employee.
Enler Aletlirare Taxes
Willi seld in Bax G on
your W -c" Farm far this
employee.
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Sample Group Benefits Activity Report
Standard Insurance Company produces the Group Benefits Activity Report at the end of each month
when there is some type of claim activity. This report provides a summary of disability benefit
payments made during the month, Social Security and Medicare taxes withheld and any other
deductions withheld during the month. This information can be reported in aggregate, by employer
location or by affiliate.
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l7educCmis
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Sample FICA Tax Activity Report
Standard Insurance Company produces a daily FICA Tax Activity report when an employee's Short
Term Disability or Long Term Disability claim has any type of Social Security or Medicare tax
activity—either withholding or adjustment. The report details the amount of Social Security and
Medicare taxes withheld. Information can be reported by employer location or affiliate with different
taxpayer identification numbers, if requested.
I r -Standard'
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0 2010 StanCorp Financial Group, Inc.
CITY OF MIAMI
Account Service and Claims Management Teams
Account Management Philosophy
Standard Insurance Company understands that as an employer, you have distinct employee benefits needs.
These are best served by dedicated, experienced resources you can trust to provide innovative solutions,
n
superior service and a firm commitment to your satisfaction.
0
The following list includes the designated resources that would work with City of Miami and its employees to get
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0 r_
CD
the most out of your group insurance plan. While each member has distinct responsibilities and expertise, the
as well as outstanding customer service.
common theme is that our business is founded on building long lasting relationships with our customers through
Will provide assistance to City of Miami on daily account management issues.
superior customer service.
>
Direct phone numbers and emails for every resource listed below will be provided if we are the selected carrier.
Account Service - Home Office
Portland, OR Toll-free: 800.642.9888 Fax: 979.329.5072
Josh Gar[ington Provides a consistent underwriting approach, analyzes claims trends and
Associate Underwriter projects future plan costs. When the City of Miami policy renews, the Underwriter
will work to suggest ways to enhance the plan, control costs or offer other plan
changes.
Account Service - Sales and Service Office
Ft. Lauderdale, FL Tel: 954.771.6828 Toll-free: 800.530.2299 Fax: 954.779.7086
0 2010 StanCorp Financial Group, Inc.
Scott Wheeler
Works to find a solution for City of Miami's employee benefits needs, and is
Employee Benefits
committed to working with underwriting and claims professionals and others to
Consultant
make sure that we meet our goal to provide quality products at an affordable cost,
as well as outstanding customer service.
Isabel Palacios
Will provide assistance to City of Miami on daily account management issues.
Account Specialist
The Account Manager works closely with the entire Home Office team.
Claim Management -
Home Office
Altavista, VA and Portland,
OR Tall -free: 800.368.1135 Fax: 971.321.6400
4 -
Cary Geist
Manages the STD benefit analysts and support staff that will administer claims
Manager - STD Benefits
for City of Miami employees. The Manager's role is to help assure that the
accounts assigned to the team receive the care and level of service that they
expect and deserve. The Manager checks the quality of the team's work,
monitors workflow and workloads, and adjusts as appropriate.
Relene Shrader
Manages the LTD benefit analysts and support staff that will administer claims
Manager - LTD Benefits
for City of Miami employees. The Manager's role is to help assure that the
accounts assigned to the team receive the care and level of service that they
expect and deserve. The Manager checks the quality of the team's work,
monitors workflow and workloads, and adjusts as appropriate.
0 2010 StanCorp Financial Group, Inc.
Biographies
Josh Garlington, Associate Underwriter, Portland, Oregon
Josh began working for The Standard in 2014 as a policy admin in the CTA department and moved into the
Underwriting department as a Rating Analyst. I've been an Assoc. UW since 2016 working primarily on the SE
team.
Cary Geist, Manager - Disability Benefits, Portland, OR
Cary is a Manager in Disability Benefits (STD), a position he has held since 2016. He is responsible for
supervising the Benefits Team, communicating with our field offices and other teams. Cary joined The Standard
in 2002 as a STD Benefits Examiner and then moved to the LTD department in 2006 where he was a Disability
Benefits Analyst and a Senior Disability Benefits Analyst (2012-2016), In addition to his claims experience, Cary
earned his Bachelor's of Science in Political Science from Oregon State University.
Relene Shrader, FMLI, Manager, Disability Benefits - LTD, Altavista, VA
Relene is a Manager, Disability Benefits (LTD) in our Altavista, Virginia location with nearly 20 years of
experience in the insurance industry. She is responsible for managing a team of Analysts, ensuring that claims
decisions are made accurately and on a timely basis, handling escalations and provides coaching and mentoring
to her team members. Prior to joining The Standard she worked as a Team Leader and in IT and Operations
positions at Genworth Financial, Inc. Relene is a member of the Life Office Management Association (LOMA)
and in 2002 earned her Fellow, Life Management Institute (FMLI) professional designation.
0 2010 StanCorp Financia] Group,Dic.
( $
Scott Wheeler, Employee Benefits Consultant �- Tampa Employee Benefit Sales and
Service Office.
o
n �
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Scottjoined The Standard in June, 2016 and is responsible for new sales and retention of clients in the South
90 r+
Florida market. Prior to joining The Standard, Scott worked with several group carriers in bath a sales and
management capacity and was most recently working as an Employee Benefits Producer at a National
�.
Brokerage firm. Scott earned his Bachelor's degree at the USF College of Business (Finance).
Isabel Palacios, Account Specialist - Miami Employee Benefits Sales and Service
r?
Office
Isabel joined The Standard in the Spring of 2012 and is an Account Specialist in our Miami Office. She is
responsible for servicing groups anywhere between two and 500 lives. Isabel has experience in the Employee
Benefits field from both the broker and carrier sides of the business.. Prior to joining The Standard she was
employed by one of our Broker Strategic Partners. Although some of her years in the industry were spent in
Sales, the majority of her career has been on the Servicing of Clients. This includes 8 years with several well-
known consulting firms, 6 years with a Non -Occupational TPA firm, and 14 years with one of our disability
competitors.
Isabel has a Bachelor of Arts degree in International Studies with an emphasis in Economics from The Ohio
State University and holds a Health, Life and Variable Annuity license in multiple states.
Cary Geist, Manager - Disability Benefits, Portland, OR
Cary is a Manager in Disability Benefits (STD), a position he has held since 2016. He is responsible for
supervising the Benefits Team, communicating with our field offices and other teams. Cary joined The Standard
in 2002 as a STD Benefits Examiner and then moved to the LTD department in 2006 where he was a Disability
Benefits Analyst and a Senior Disability Benefits Analyst (2012-2016), In addition to his claims experience, Cary
earned his Bachelor's of Science in Political Science from Oregon State University.
Relene Shrader, FMLI, Manager, Disability Benefits - LTD, Altavista, VA
Relene is a Manager, Disability Benefits (LTD) in our Altavista, Virginia location with nearly 20 years of
experience in the insurance industry. She is responsible for managing a team of Analysts, ensuring that claims
decisions are made accurately and on a timely basis, handling escalations and provides coaching and mentoring
to her team members. Prior to joining The Standard she worked as a Team Leader and in IT and Operations
positions at Genworth Financial, Inc. Relene is a member of the Life Office Management Association (LOMA)
and in 2002 earned her Fellow, Life Management Institute (FMLI) professional designation.
0 2010 StanCorp Financia] Group,Dic.
I&
meStandard°
The Standard's Information Security Program
Overview: The Standard's Information Security Program has a documented and approved Information
Security Policy and an associated set of standards based on the internationally recognized code of practice for
information security management as defined in ISO 27002:2013. The Program has achieved ISO 27001
certification.
The policy and standards represent the expressed intent of The Standard's senior management with regard to the
protection and security of customer, policyholder, and employee information as well as The Standard's approach
to meeting legal and regulatory requirements. The policy and standards specifically address privacy and security
as well as data classification, operational management, data processing and access management.
Information Security Team: The Standard has an established Information Security team dedicated to information
security risk identification, assessment, education and advisory services to the organization. This team coordinates
handling security and privacy incidents response across the organization.
Security Governance: The Standard also has an Information Security and Privacy Oversight group (IPOG) that
includes representation from all parts of the business. Part of its charter is to provide governance and direction
to the Information Security Program.
User Access Control: The Standard has established access management procedures that require management
approval of access and provides for the segregation and separation of duties, The Standard uses industry -
standard tools and best practices to validate the identity of information system users, including the use of two -
factor authentication for remote access to systems. These controls include:
a. Unique User identifiers (User IDs) to ensure accountability
b. Controls to lock account access after several consecutive failed login attempts,
c. Controls on the number of invalid login requests before locking out a User.
d. Controls to ensure generated initial passwords must be reset on first use.
e. Controls to force a User password to expire after a period of use.
f. Controls to terminate a User session alter a period of inactivity.
g. Password length, complexity and history controls to limit password reuse.
h. Verification question before resetting password.
Upon termination of employment, user access is revoked following established procedures
Network Protection: The Standard restricts and controls access between The Standard's network and other
networks, including the Internet, using firewalls and other commercially available control mechanisms.
Viruses / Anti -Virus Protection: The Standard uses and maintains appropriate anti-virus measures to
protect networks, systems, and end-user devices (e.g, desktops, laptops, mobile devices).
Security Logs and Intrusion Detection: The Standard records all relevant system activity (including for
firewalls, routers, network switches, and operating systems). The Standard proactively monitors for unauthorized
access attempts to its systems and services using industry -standard tools and practices. Third party security event
and incident monitoring protects our organization from a broad range of threats by systematically collecting,
correlating and analyzing data from security devices and critical IT assets in real time.
Data Ownership: The Standard owns all data stored, transmitted and processed on its information systems,
including on systems provided by third parties and will not use or disclose the data for any purpose except as
permitted to provide contractual service to customers and support internal business operations. Information Security
Standard Insurance Company
1100 SW Sixth Avenue
Portland OR 97204
tel 888.937.4783
ensures the protection of the information assets by understanding the information security risks and designing
appropriate controls.
Data Residence: To the best of its ability, The Standard will not transmit or stare its data on systems, devices, or in
printed form outside the boundaries of the United States and its territories.
Data Encryption: The Standard uses data encryption methods and practices that meet current industry standards
and best practices. The Standard encrypts electronic data when transmitted or otherwise transferred over data
networks between The Standard and external parties. When in non -electronic farm, the data is protected using
reasonable standards of care that may include, but is not limited to, the use of tamper evident packages and tracking
of shipment for printed material.
The Standard encrypts electronic data at rest, including mobile devices (e.g. laptops, tablets, PDAs, smart phones) as
well as removable media (e.g. Backup media, USB thumb drives, CD/DVD, portable hard drives).
Data Retention: The Standard retains customer data as needed to meet business, legal, and regulatory requirements
that may exceed the term of contracts with the customer. An example of this is an active claim against an insurance
policy that needs continued administration after the termination of the policy.
Data Destruction / Media Sanitization: Prior to the disposal of media that stores data, The Standard implements
media sanitization practices, including the sanitization of server disks and the shredding of paper documents. Such
practices are as identified by NIST SP 800-88 "Guidelines for Media Sanitization" or (pursuant to the guidelines in
DoD 5220-M) the Defense Security Service (DSS) "Clearing and Sanitization Matrix (C&SM)".
Vendor Management: The Standard requires the assessment of the information security, business continuity and
disaster recovery practices of contractors, subcontractors, or other third -party providers involved in providing and/or
supporting services for and by The Standard. Third parties that will store, process or transport data must meet
information and business continuity / disaster recovery requirements through contracts and service agreements.
These terms include requirements to protect data and meet service level agreements, recovery time objectives and
recovery point objectives as specified in the contractual documents.
Information Security Incident Management: The Standard has developed and maintains security incident
management policies and procedures, including detailed security incident escalation procedures.
The Standard will notify affected individuals in the event The Standard becomes aware of an actual or reasonably
suspected unauthorized disclosure of the individual's data that creates a reasonable risk of harm to the individual.
This notification will occur as part of the incident response process following The Standard taking any necessary
actions needed to contain and mitigate the continuation of the event.
Vulnerability Management: Applications developed by and used in the providing of services by The Standard
are tested for security vulnerabilities prior to deployment and identified vulnerabilities are appropriately
r mediated or otherwise mitigated. The Standard provides for the regular security testing of application and
system changes and regularly scans systems for vulnerabilities using a third -party service with findings
appropriately remediated or otherwise mitigated.
In addition, to gain an independent view of its security posture, The Standard also engages third -party resources for
security assessments at least annually.
Change Management: The Standard maintains a change management program that ensures all system, application,
and service changes have been appropriately reviewed, tested, and approved by management prior to deployment
into production environment.
Physical Security: The Standard physically secures its production data centers and restricts access to only
authorized personnel that have a need to access the security areas. The Standard also employs video recording of its
data center and maintains these recordings for a reasonable period of time.
Standard Insurance Company
1100 SW Sixth Avenue
Portfand OR 97204
tel 888.937.4783
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 184 days following the time set for closing of the submissions.
The proposal is valid for 90 days.
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
I8-107 or Ordinance No. 12271.
All exceptions to this submission have been documented in the section below (refer to paragraph and
section),
EXCEPTIONS:
We (1) 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 (1) 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:
PROPOSERNAME: Standard Insurance Company (The Standard)
ADDRESS: 920 SW 6t' Avenue, Portland, OR 97204
PHONE. _ 874-321-2529 FAX: NIA
EMAIL: Graeme.Queen standard.com CELL(Optional):
SIGNED BY: (�
2"d Vice President
TITLE: Strategic Account Services DATE: 4126/17
FAILURE TO COMPLETE, SIGN AND RETURN THIS F01 M SHALL DISQUALIFY THIS
RESPONSE.
Page 2 of 47
C= OF
FORT LAUDERDALE BUSINESS TAX YEAR 2016-2017
BUSINEss TAX DIVISION
100 N. ANDREWS AVENUE, 1 ST FLOOR, FORT LAUDERDALE, FLORIDA 33301
(954) 82 8 -5195
Business TD: 1300584 Business Name. STANDARD INSURANCE COMPANY
Business Address: 800 CORPORATE DR 4 210
Tax Category: OFFICE USE ONLY Tax*: 739510 Dee:
STANDARD INSURANCE
J GREG NESS CEO
1100 SW SIXTH AVE
PORTLAND, OR 97006
***DETACH AND POST THIS RECEIPT INA CONSPICUOUS PLACE***
............. -........... ..........,................ ....... ....., x ........................... ...... ............................... ............ .............. x. ....... ........... ............,...................................................
Business TD: 1300584
Tax Number: 739510
Business Name: STANDARD INSURANCE COMPANY
Business Address: 800 CORPORATE DR # 210
Business Owner: NESS, J GREG CEO
■ This Receipt is issued for the period commencing October 1st and ending September 30th of
the years shown above.
■ If you have moved out of the city, please provide a written statement.
■ A transfer of business location within the city limits is subject to zoning approval. Please
complete a Business Tax Transfer Application and bring it to our office to obtain the necessary
approval.
■ A Transfer fee applies of 10% of the annual business tax fee. The fee shall not be less than
$3.00, nor greater than $25.00.
■ If you have sold your business, please provide us with a copy of the Bill of Sale.
Please be advised that this issuance of a Business Tax Receipt establishes that the business
you intend to conduct is a use permitted by the City Zoning Cade for the location at which
you intend to operate. The issuance of a Business Tax Receipt in no way certifies that the
property located at this address is in compliance with other provisions of the City Carie of
Ordinances.
BUSINESS TAX DIVISION
100 N. ANDREWS AVENUE, IST FLOOR, FORT LAUDERDALE, FLORIDA 33301
TEL (954)828-5195 FAX (954)828-5881
Rev. 5/20/2016 WWW.FORTLAUDERDALE,GOV
Ac" 10P CERTIFICATE OF LIABILITY INSURANCE 4iDAT DATE
7 p>tY,
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
Woodruff -Sawyer Oregon, Inc.
1001 SW 5th Avenue, Suite 1000
Portland OR 97204
CONTACT
NAME: Jessica Carpenter
PHONE 503-416 7758 F°x 503-243-1815
-1. c No
E-MAIL . car enter wsandco.com
e 1 P @
INSURERS AFFORDING COVERAGE NAIC #
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE r OCCUR
INSURER A: Federal Insurance Company 20281
INSURED STANFIN-01
INSURER B:Sentry Insurance, A Mutual Company 24988
Standard Insurance Company
1100 SW Sixth Avenue, P11 C
Portland, OR 97204
INSURERC:Atlantic Specialty Insurance Cam an 127154
INSURER D:
MED EXP (Any one person) $10,000
INSURER IE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1511868799 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.
!LTR
TYPE OF INSURANCE
1NSD
WVD
I POLICY NUMBER
MMIDD EFF
I MMIODY EXP
LIMITS
C
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE r OCCUR
7120077550009
71112C16
71112017
EACH OCCURRENCE $1,000,000
PREMI ETORENTED
PREMISES Ea occurrence $1,000,000
MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $2,000,000
POLICY PRO LOG
PRODUCTS - COMP/OP AGG I s2,000,000
Is
OTHER:
C
AUTOMOBILE
LIAH14ITY
7120077550009
7/1/2016
711/2017BIND
C $
SINGLE LIMIT
Co,EaccidEent 1,000,000
BODILY INJURY (Per person) $
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY iPer accident)
HIRED AUTOS X NON-DWNE❑
AUTOS
PRDPERTYDAMAGE $
per accident
$
C
X
UMBRELLA LIAB
X
OCCUR
7120077550009
71112016
7/112017
EACH OCCURRENCE $1,000,000
AGGREGATE $1,000,000
EXCESS LIAR
CLAIMS MADE
DEC, RETENTIONS
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
9016875
7/112016
711/2017
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $1,000,000
ANY PROPRIETORIPARTNERfEXECUTIVE ❑
OFFICERlMEMBER EXCLUDED?(Mandatory
E.L. DISEASE -EA EMPLOYE $1,000,000
In NH)
INIA
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT $1,000,000
A
Professional Liability82086841
7/112016
7!112017
Aggregate $2,000,000
Each Claim $1,000,000
DESCRIPTION OF OPERATIONS f LOCATIONS! VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached If more space is required)
Operations of the Named Insured subject to the terms, conditions and exclusions of the policy issued fay the Insurance Company.
RE: Evidence of Coverage (RFP)
City of Miami is included as additional insured per attached forms VCA201 and VCG205 as required by written contract. Waiver of
subrogation applies perform WC000313.
%,=M t it'll.A I C r1UE-U17- N t.,ANUr-LLA I IVN
City of Miami Procurement Department
Miami Riverside Center
444 SW 2nd Ave, 6th Floor
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
1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2094/01) The ACORD name and logo are registered marks of ACORD
CERTIFICATE OF REGISTRATION
Information Security Management System
ISO 27001: 2013
This is to certify that the Information Security Management System of:
Standard Insurance
1100 SW 6th Ave.
Portland, Oregon 97204
conforms with the requirements of ISO 27001: 2013 for the scope of service listed below:
StanCorp Financial Group and its affiliates (the Company and/or The Standard) has established an Information Security
Management System (ISMS) in accordance with the requirements of ISO standard ISO/IEC 27001:2013 that preserves the
Confidentiality, Integrity, and Availability (CIA) of the Standard's information technology infrastructure and operations. The
ISMS framework serves as StanCorp Financial Group's mechanism to appropriately identify, select, maintain and improve
information security controls that are critical to its clients and businesses.
The ISMS scope includes the following services:
• Logical access to critical network servers &
databases
• Secure storage, transmission and replication of
sensitive information
• Client support services
• Application development
• Internal IT
Certificate Number: SEC1588
Issue Date: 10/21/2016
Issued by:
JA r I
v
Partner, A-LIGN
4
ANM
A C C R E D I T E D
MANAGEMENT SYSTEMS
CERTIFICATION BODY
• 1T Compliance
• Human Resources
• Legal
• Physical and environmental access controls
• Incident management— "security incidents"
Statement of Applicability: as of 06/7/2016 v1
Expiration Date: 10/21/2019
This certificate was issued electronically and is bound by the terms and conditions set forth in the agreement.
Further clarification regarding the scope of this certificate and applicability to the ISO 27001: 2013 standard
may be obtained at www.a-lign.com.
A-LIGN Headquarters: 400 N. Ashley Dr. Suite 1325 Tampa, Florida 33602 Tel: 888-702-5446
STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282
(503) 321-7000
GROUP SHORT TERM DISABILITY INSURANCE POLICY
Policyholder:
Policy Number:
Effective Date:
Sample K2000 Non--occ Private Group
720100-B
January 1, 2013
The consideration for this Group Policy is the application of the Policyholder and the payment by the
Policyholder of premiums as provided herein.
Subject to the Policyholder Provisions and the Incontestability Provisions, this Group Policy (a) is
issued for the Initial Rate Guarantee Period shown in the Coverage Features, and (b) may be renewed
for successive renewal periods by the payment of the premium set by us on each renewal date. The
length of each renewal period will be set by us, but will not be less than 12 months.
For purposes of effective dates and ending dates under this Group Policy, all days begin and end at
12:00 midnight Standard Time at the Policyholder's address.
All provisions on this and the following pages are part of this Group Policy. ''You" and "your" mean the
Member. "We", "us", and "our" mean Standard Insurance Company. Other defined terms appear with
their initial letters capitalized. Section headings, and references to them, appear in boldface type.
STANDARD INSURANCE COMPANY
is
THIS POLICY IS NOT AVAILABLE IN CALIFORNIA, FLORIDA, MARYLAND, NEW YORK, OR
VERMONT
This is a sample policy. Product availability, plan provisions and features may vary by state.
The proposed premium rate and plan design is based on the underwriting data received by us.
Final premium rates and pian provisions will be determined on the basis of: applicable state
laws, Policyholder contributions, confirmation of occupations, the actual composition of the
group of persons who will become insured, and our current underwriting rules and practices.
GF399-STD
Table of Contents
COVERAGE FEATURES .......... .................................. .................................................. I
GENERAL POLICY INFORMATION ............ . . ........................... . ...............................
I
SCHEDULE OF INSURANCE..................................................................................
I
PREMIUM CONTRIBUTIONS..................................................................................2
PREMIUM AND RENEWALS...................................................................................
2
INSURINGCLAUSE.....................................................................................................
3
BECOMING INSURED...................................................................
WHEN YOUR INSURANCE BECOMES EFFECTIVE......................................................
3
ACTIVE WORK PROVISIONS ...........................
WHEN YOUR INSURANCE ENDS.................................................................................
4
REINSTATEMENT OF INSURANCE...............................................................................5
DEFINITION OF DISABILITY........................................................................................
5
RETURN TO WORK PROVISIONS ............................................ ...................
6
REASONABLE ACCOMMODATION EXPENSE BENEFIT ...............................................
7
TEMPORARY RECOVERY............................................................................................
7
WHEN STD BENEFITS END ........................................................ . ...............................
8
PREDISABILITY EARNINGS.........................................................................................
8
DEDUCTIBLE INCOME...............................................................................................
9
EXCEPTIONS TO DEDUCTIBLE INCOME..................................................................
10
RULES FOR DEDUCTIBLE INCOME..........................................................................
11
SUBROGATION.........................................................................................................
11
BENEFITS AFTER INSURANCE ENDS OR IS CHANGED ............................................
12
EFFECT OF NEW DISABILITY...................................................................................
12
DISABILITIES EXCLUDED FROM COVERAGE...........................................................
12
LIMITATIONS.....................................................................
.......................................
12
CLAIMS....................................................................................... ........
.....................
13
ALLOCATION OF AUTHORITY ............................................. ...
...................................
15
TIME LIMITS ON LEGAL ACTIONS............................................................................
16
INCONTESTABILITY PROVISIONS.............................................................................
16
CLERICAL ERROR, AGENCY AND MISSTATEMENT...................................................
16
TERMINATION OR AMENDMENT OF THE GROUP POLICY ........................................
17
DEFINITIONS............................................................................................................
17
POLICYHOLDER PROVISIONS...................................................................................
18
Index of Defined Terms
Maximum STD Benefit, 1
Active Work, Actively At Work, 4 Member, 1, 3
Allowable Periods, 7 Mental Disorder, i8
Minimum Participation Number, 2
Benefit Waiting Period, 2, 17 Minimum Participation Percentage, 2
Minimum STD Benefit, 1
Class Definition, 1
Contributory, 17
Deductible Income, 9
Eligibility Waiting Period, 1
Employer, 17
Employer(s), 1
Enrollment Period, 2
Evidence Of Insurability, 4
Group Policy, 17
Group Policy Effective Date, 1
Group Policy Number, 1
Hospital, 17
Initial Rate Guarantee Period, 2
Injury, 17
L.L.C. Owner -Employee, 17
Maximum Benefit Period, 2, 18
Noncontributory, 18
P.C. Partner, 18
Physical Disease, 18
Physician, 18
Policyholder, 1
Predisability Earnings, 8
Pregnancy, 18
Premium Due Dates, 2
Prior Plan, 18
Proof Of Loss, 13
Reasonable Accommodation Expense
Benefit, 7
STD Benefit, 1, 18
Temporary Recovery, 7
War, 12
Work Earnings, 6
INSURING CLAUSE
If you become Disabled while insured under the Group Policy, we will pay STD Benefits according to
the terms of the Group Policy after we receive Proof Of Loss satisfactory to us.
ST.IC.OT.1
BECOMING INSURED
To become insured you must be a Member, complete your Eligibility Waiting Period, and meet the
requirements in Active Work Provisions and When Your Insurance Becomes Effective.
You are a Member if you are:
I. A regular employee of the Employer;
2. Actively At Work at least 30 hours each week (for purposes of the Member definition, Actively
At Work will include regularly scheduled days off, holidays, or vacation days, so long as you are
capable of Active Work on those days); and
3. A citizen or resident of the United States or Canada.
You are not a Member if you are a temporary or seasonal employee, a full-time member of the
armed forces of any country, a leased employee, or an independent contractor.
Eligibility Waiting Period means the period you must be a Member before you become eligible for
insurance. Your Eligibility Waiting Period is shown in the Coverage Features.
(VARMMRDEF) ST.BI.oT,l
WHEN YOUR INSURANCE BECOMES EFFECTIVE
A. When Insurance Becomes Effective
Subject to the Active Work Provisions, your insurance becomes effective as follows;
1. Insurance Subject To Evidence Of Insurability
Insurance subject to Evidence Of Insurability becomes effective on the date we approve your
Evidence Of Insurability.
2. Insurance Not Subject To Evidence Of Insurability
The Coverage Features states whether insurance is Contributory or Noncontributory.
a. Noncontributory Insurance
Noncontributory insurance not subject to Evidence Of Insurability becomes effective on the
date you become eligible.
b. Contributory Insurance
You must apply in writing for Contributory insurance and agree to pay premiums.
Contributory insurance not subject to Evidence Of Insurability becomes effective on:
i. The date you become eligible if you apply on or before that date; or
ii. The date you apply if you apply after the date you become eligible.
Note: If you do not apply during the Enrollment Period, then until you have been
insured under the Group Policy for 12 consecutive months, you will have a longer
Benefit Waiting Period for Disabilities caused by Physical Disease, Pregnancy or Mental
Disorder. The Enrollment Period and applicable Benefit Waiting Periods are shown in
Coverage Features.
Printed 03/22/2013 - 3 - 720106-B
B. Takeover Provisions
1. If you were insured under the Prior Plan on the day before the effective date of your Employer's
coverage under the Group Policy, your Eligibility Waiting_ Period is waived on the effective date
of your Employer's coverage under the Group Policy.
2. You must submit satisfactory Evidence Of Insurability to become insured if you were eligible
for insurance under the Prior Placa for more than 31 days but were not insured.
C. Evidence Of Insurability Requirement
Evidence Of Insurability satisfactory to us is required:
a. For Members eligible for more than 31 days but not insured under the Prior Plan.
b. For reinstatements if required.
Providing Evidence Of Insurability means you must:
1. Complete and sign our medical history statement;
2. Sign our form authorizing us to obtain information about your health;
3. Undergo a physical examination, if required by us, which may include blood testing; and
4. Provide any additional information about your insurability that we may reasonably require.
(VAR BOI_WITH 80 DAY PD) ST.EF.OT.3
ACTIVE WORK PROVISIONS
A. Active Work Requirement
You must be capable of Active Work on the day before the scheduled effective date of your
insurance or your insurance will not become effective as scheduled. If you are incapable of Active
Work because of Physical Disease, Injury, Pregnancy or Mental Disorder on the day before the
scheduled effective date of your insurance, your insurance will not become effective until the day
after you complete one full day of Active Work as an eligible Member.
Active Work and Actively At Work mean performing with reasonable continuity the Material Duties
of your Own Occupation at your Employer's usual place of business.
B. Changes In Insurance
This Active Work requirement also applies to any increase in your insurance.
ST.Aw.oT.1
WHEN YOUR INSURANCE ENDS
Your insurance ends automatically on the earliest of:
1. The date the last period ends for which a premium contribution was made for your insurance.
2, The date the Group Policy terminates.
3. The date your employment terminates.
4. The date you cease to be a Member. However, your insurance will be continued during the
following periods when you are absent from Active Work, unless it ends under any of the above.
a. During the first 90 days of a temporary or indefinite administrative or involuntary leave of
absence or sick leave, provided your Employer is paying you at least the same Predisability
Earnings paid to you immediately before you ceased to be a Member. A period when you are
Printed 03/22/2013 - 4 - 720106-B
absent from Active Work as part of a severance or other employment termination agreement is
not a leave of absence, even if you are receiving the same Predisability Earnings.
b. During a leave of absence if continuation of your insurance under the Group Policy is required
by a state -mandated family or medical leave act or law.
c. During any other temporary leave of absence approved by your Employer in advance and in
writing and scheduled to last 30 days or less. A period of Disability is not a leave of absence.
d. During the Benefit Waiting Period and while STD Benefits are payable.
ST.EN.OT.1
REINSTATEMENT OF INSURANCE
If your insurance ends, you may become insured again as a new Member. However, the following will
apply:
1. If you cease to be a Member because of a Disability that is not covered solely because of the
exclusion for work related Disabilities, your insurance will end. However, if you become a Member
again immediately after workers' compensation temporary benefits end, the Eligibility Waiting
Period will be waived.
2. If your insurance ends because you cease to be a Member for any reason other than item 1 above,
and if you become a Member again within 90 days, the Eligibility Waiting Period will be waived.
3. If your insurance ends because you fail to make a required premium contribution, you must
provide Evidence Of Insurability to become insured again.
4. If your insurance ends because you are on a federal or state -mandated family or medical leave of
absence, and you become a Member again immediately following the period allowed, your
insurance will be reinstated pursuant to the federal or state -mandated family or medical leave act
or law.
5. In no event will insurance be retroactive.
(NONOCC) sT.i2E.OTA
DEFINITION OF DISABILITY
You are Disabled if you meet the following Own Occupation definition of Disability
You are required to be Disabled only from your Own Occupation. You are Disabled from your Own
Occupation if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder:
1. You are unable to perform with reasonable continuity the Material Duties of your Own
Occupation; and
2. You suffer a loss of at least 20% in your Predisability Earnings when working in your Own
Occupation,
Note: You are not Disabled merely because your right to perform your Own Occupation is restricted,
including a restriction or loss of license.
You may work in another occupation while you meet the Own Occupation definition of Disability.
However, you will no longer be Disabled when your Work Earnings from another occupation exceed
80% of your Predisability Earnings.
Your Work Earnings may be Deductible Income. See Return To Work Provisions and Deductible
Income.
Own Occupation means any employment, business, trade, profession, calling or vocation that involves
Material Duties of the same general character as the occupation you are regularly performing for your
Printed 03/22/2013 - 5 - 720106-B
Employer when Disability begins. In determining your Own Occupation, we are not limited to looking
at the way you perform your job for your Employer, but we may also look at the way the occupation is
generally performed in the national economy. If your Own Occupation involves the rendering of
professional services and you are required to have a professional or occupational license in order to
work, your Own Occupation is as broad as the scope of your license.
Material Duties weans the essential tasks, functions and operations, and the skills, abilities,
knowledge, training and experience, generally required by employers from those engaged in a
particular occupation, that cannot be reasonably modified or omitted. In no event will we consider
working an average of more than 40 hours per week to be a Material Duty.
(WTFH 40_WITH PARTL) 5T.DD.OT.1
RETURN TO WORK PROVISIONS
A. Return To Work Responsibility
No S'I'D Benefits will be paid for any period of Disability when you are able to work in your Own
Occupation and able to earn at least 20% of your Predisability Earnings, but you elect not to work.
B. Return To Work Incentive
You may serve your Benefit Waiting Period while working if you meet the Own Occupation
definition of Disability.
You are eligible for the Return To Work Incentive on the first day you work after the Benefit
Waiting Period if STD Benefits are payable on that date.
Your Work Earnings will be Deductible Income as determined in 1., 2. and 3.
1. Determine the amount of your STD Benefit as if there were no Deductible Income, and add
your Work Earnings to that amount.
2. Determine 100% of your Predisability Earnings.
3. If 1. is greater than 2., the difference will be Deductible Income.
C. Work Earnings Definition
Work Earnings means your gross weekly earnings from work you perforin while Disabled, plus the
earnings you could receive if you worked as much as you are able to, considering your Disability,
in work that is reasonably available in your Own Occupation. Work Earnings includes sick pay,
vacation pay, annual or personal leave pay or other salary continuation earned or accrued while
working.
Earnings from work you perform will be included in Work Earnings when you have the right to
receive them. If you are paid in a lump sum or on a basis other than weekly, we will prorate your
Work Earnings over the period of time to which they apply. If no period of time is stated, we will
use a reasonable one.
In determining your Work Earnings we:
1. Will use the financial accounting method you use for income tax purposes, if you use that
method on a consistent basis.
2. Will not be limited to the taxable income you report to the Internal Revenue Service
3. May ignore expenses under section 179 of the IRC as a deduction from your gross earnings.
4.. May ignore depreciation as a deduction from your gross earnings.
5. May adjust the financial information you give us in order to clearly reflect your Work Earnings.
Printed 03/22/2013 - 6 - 720106-B
If we determine that your earnings vary substantially from week to week, we may determine your
Work Earnings by averaging your earnings over the most recent four-week period. You will no
longer be Disabled when your average Work Earnings over the last four weeks exceed 80% of your
Predisability Earnings.
STAMOTA
REASONABLE ACCOMMODATION EXPENSE BENEFIT
If you return to work in any occupation for any employer, not including self-employment, as a result of
a reasonable accommodation made by such employer, we will pay that employer a Reasonable
Accommodation Expense Benefit in an amount agreed to by us, but not to exceed the expenses
incurred.
The Reasonable Accommodation Expense Benefit is payable only if the reasonable accommodation is
approved by us in writing prior to its implementation.
ST.RA.OT.1
TEMPORARY RECOVERY
You may temporarily recover from. your Disability during the Maximum Benefit Period, and then
become Disabled again from the same cause or causes, without having to serve a new Benefit Waiting
Period. Temporary Recovery means you cease to be Disabled for no longer than the applicable
allowable period. See Definition Of Disability.
A. Allowable Period
The allowable period of recovery during the Magnum Benefit Period is: a total of 90 days of
recovery.
B. Effect Of Temporary Recovery
If your Temporary Recovery does not exceed the Allowable Period, the following will apply.
1. The Predisability Earnings used to determine your STD Benefit will not change.
2. The period of Temporary Recovery will not count toward your Maximum Benefit Period.
3. No STD Benefits will be payable for the period of Temporary Recovery.
4. No STD Benefits will be payable after benefits become payable to you under any other disability
insurance plan under which you become insured during your period of recovery.
5. Except as stated above, the provisions of the Group Policy will be applied as if there had been
no interruption of your Disability.
ST.TR.OT. 2
Printed 03/22/2013 - 7 - 720106-B
WHEN STD BENEFITS END
Your STD Benefits end automatically on the earliest of.
1. The date you are no longer Disabled.
2. The date your Maximum Benefit Period ends.
3. The date you die.
4. The date long term disability benefits become payable to you under a group long term disability
policy, even if that occurs before the end of the Maximum Benefit Period.
5. The date benefits become payable to you under any other disability insurance plan under which
you become insured through employment during a period of Temporary Recovery.
6. The date you fail to provide proof of continued Disability and entitlement to STD Benefits.
(REV LTD IZK ST.BE.DT.3
PREDISABILITY EARNINGS
Your Predisability Earnings will be based on your earrings in effect on your last full day of Active
Work. However, if you are a Partner, L.L.C. Owner -Employee, Sole Proprietor or S -Corporation
Shareholder, your Predisability Earnings will be based on your Employer's prior tax year or the
Policyholder's prior tax year if you are a P.C. Partner. Any subsequent change in your earnings will
not affect your Predisability Earnings.
A. Partners, P.C. Partners, L.L.C. Owner-Ernployces, Sole Proprietors and S -Corporation Shareholders
If you are a Partner, L.L.C. Owner -Employee, Sole Proprietor or S -Corporation Shareholder,
Predisability Earnings means your average weekly compensation from your Employer during the
Employer's prior tax year. If you are a P.C. Partner, Predisability Earnings means the average
weekly compensation received by your professional corporation from the Policyholder during the
Policyholder's prior tax year. Your average weekly compensation is determined by adding the
following amounts as reported on the applicable Schedule K-1, Schedule C, Form W-2 or
S -Corporation federal income tax return, and dividing by 52 (or by the number of weeks you were a
Partner, P.C. Partner, L.L.C. Owner -Employee, Sole Proprietor or S -Corporation Shareholder if less
than 52) :
1. Your ordinary income (loss) from trade or business activity(ies).
2. Your guaranteed payments, if you are a Partner.
3. Your net profit (loss) from business.
4. Your compensation (as an officer), salary, or wages, if you are an S -Corporation Shareholder.
If you were not a Partner, P.C. Partner, L.L.C. Owner -Employee, Sole Proprietor or S -Corporation
Shareholder during the entire prior tax year, your Predisability Earnings will be your average
weekly compensation for your period as a Partner, P.C. Partner, L.L.C. Owner -Employee, Sole
Proprietor or S -Corporation Shareholder.
B. All Other Members
Predisability Earnings means your weekly rate of earnings from your Employer, including:
1. Commissions averaged over the prior 52 weeks or over the period of your employment if less
than 52 weeks.
2. Shift differential pay.
Predisability Earnings does not include:
Printed 03/22/2013 - 8 - 720106-B
1. Bonuses.
2. Overtime pay.
3. Any other extra compensation.
If you are paid on an annual contract basis, your weekly rate of earnings is one fifty-second
(1/52nd) of your annual contract salary.
If you are paid hourly, your weekly rate of earnings is based on your hourly pay rate multiplied by
the number of hours you are regularly scheduled to work per week, but not more than 40 hours.
If you do not have regular work hours, your weekly rate of earnings is based on the average
number of hours you worked per week during the preceding 52 calendar weeks (or during your
period of employment if less than 52 weeks), but not more than 40 hours.
C. All Members
Predisability Earnings includes:
1. Contributions you make through a salary reduction agreement with your Employer to:
a. An Internal Revenue Code (IRC) Section 401(k), 403(b), 408(k), 408(p), or 457 deferred
compensation arrangement, or
b. An executive nonqualified deferred compensation arrangement.
2. Amounts contributed to your fringe benefits according to a salary reduction agreement under
an IRC Section, 125 plan.
Predisability Earnings does not include:
1. Your Employer's contributions on your behalf to any deferred compensation arrangement or
pension plan, or
2. Stock options or stock bonuses.
X1_REG wm-i COM -NO STOCK) ST.P11.0T.1
DEDUCTIBLE INCOME
Subject to Exceptions To Deductible Income, Deductible Income means:
Printed 03/22/2013 - 9 - 720105-B
1. Your Work Earnings, as described in the Return To Work Provisions.
2. Any amount you receive or are eligible to receive because of your disability under a state disability
income benefit law or similar law.
3. Any amount you receive or are eligible to receive because of your disability under another group
insurance coverage.
4, Any disability or retirement benefits you receive under your Employer's retirement plan.
5. Any earnings or compensation included in Predisability Earnings which you receive or are eligible
to receive while STD Benefits are payable.
6. Any amount you receive or are eligible to receive under any unemployment compensation law or
similar act or law.
7. Any amount you receive or are eligible to receive from or on behalf of a third party because of your
disability, whether by judgment, settlement or other method. If you notify us before filing suit or
settling your claim against such third party, the amount used as Deductible Income will be
reduced by a pro rata share of your costs of recovery, including reasonable attorney fees.
8. Any amount you receive by compromise, settlement, or other method as a result of a claim for any
of the above, whether disputed or undisputed.
(PRW-NONOCC WITH RTW NO OTHR OFFST_WITH 3RD) ST.DI.OT.I
EXCEPTIONS TO DEDUCTIBLE INCOME
Deductible Income does not include:
1. Any cost of living increase in any Deductible Income other than Work Earnings, if the increase
becomes effective while you are Disabled and while you are eligible for the Deductible Income.
2. Reimbursement for hospital, medical, or surgical expense.
3. Reasonable attorneys fees incurred in connection with a claim for Deductible Income.
4. Benefits from any individual disability insurance policy.
5. Group credit or mortgage disability insurance benefits.
6. Accelerated death benefits paid under a life insurance policy.
7. Benefits from the following:
a. Profit sharing plan.
b. Thrift or savings plan.
e. Deferred compensation plan.
d. flan under IRC Section 401(k), 408(k), 408(p), or 457.
e. Individual Retirement Account (IRA).
f. Tax Sheltered Annuity (TSA) under IRC Section 403(b).
g. Stock ownership plan.
h. Keogh (HR -10) plan.
S. The following amounts under your Employer's retirement plan:
a. A lump sum distribution of your entire interest in the plan.
b. Any amount which is attributable to your contributions to the pian.
Printed 03%22/2013 - 10- 720106-B
c. Any amount you could have received upon termination of employment without being disabled
or retired.
RULES FOR DEDUCTIBLE INCOME
A. Weekly Equivalents
(FRiV_NO OTHR OFFST) ST.ED.OT.1
Each week we will determine your STD Benefit using the Deductible Income for the same weekly
period, even if you actually receive the Deductible Income in another week.
If you are paid Deductible Income in a lump sum or by a method other than weekly, we will
determine your STD Benefit using a prorated amount. We will use the period of time to which the
Deductible Income applies. If no period of time is stated, we will use a reasonable one.
B. Your Duty To Pursue Deductible Income
You must pursue Deductible Income for which you may be eligible. We may ask for written
documentation of your pursuit of Deductible Income. You must provide it within 60 days after we
mail you our request. Otherwise, we may reduce your STD Benefits by the amount we estimate you
would be eligible to receive upon proper pursuit of the Deductible Income.
C. Pending Deductible Income
We will not deduct pending Deductible Income until it becomes payable. You must notify us of the
amount of the Deductible Income when it is approved. You must repay us for the resulting
overpayment of your claim.
D. Overpayment Of Claim
We will notify you of the amount of any overpayment of your claim under any group disability
insurance policy issued by us. You must immediately repay us. You will not receive any STD
Benefits until we have been repaid in full. In the meantime, any STD Benefits paid, including the
Minimum STD Benefit, will be applied to reduce the amount of the overpayment. We may charge
you interest at the Iegal rate for any overpayment which is not repaid within 30 days after we first
mail you notice of the amount of the overpayment.
ST.RU.0T.1
SUBROGATION
If STD Benefits are paid or payable to you under the Group Policy as the result of any act or omission
of a third party, we will be subrogated to all rights of recovery you may have in respect to such act or
omission. You must execute and deliver to us such instruments and papers as may be required and
do whatever else is needed to secure such rights. You must avoid doing anything that would prejudice
our rights of subrogation.
If you notify us before filing suit or settling your claim against such third party, the amount to which
we are subrogated will be reduced by a pro rata share of your costs of recovery, including reasonable
attorney fees. If suit or action is filed, we may record a notice of payments of STD Benefits, and such
notice shall constitute a lien on any judgment recovered.
If you or your legal representative fail to bring suit or action promptly against such third party, we
may institute such suit or action in our name or in your name. We are entitled to retain from any
judgment recovered the amount of STD Benefits paid or to be paid to you or on your behalf, together
with our costs of recovery, including attorney fees. The remainder of such recovery, if any, shall be
paid to you or as the court may direct.
ST,SG.OT.1
Printed 03/22/2013 - 11 - 720106-B
BENEFITS AFTER INSURANCE ENDS OR IS CHANGED
During each period of continuous Disability, we will pay STD Benefits according to the terms of the
Group Policy in effect on the date you become Disabled. Your right to receive STD Benefits will not be
affected by:
1. Any amendment to the Group Policy that is effective after you become Disabled; or
2. Termination of the Group Policy after you become Disabled.
ST.B& DT.1
EFFECT OF NEW DISABILITY
If a period of Disability is extended by a new cause while STD Benefits are payable, STD Benefits will
continue while you remain Disabled. However, 1 and 2 below will apply.
1. STD Benefits will not continue beyond the end of the original Maximum Benefit Period.
2. All provisions of the Group Policy, including the Disabilities Excluded From Coverage and
Limitations sections, will apply to the new cause of Disability.
DISABILITIES EXCLUDED FROM COVERAGE
A. War
&TAD.OTJ
You are not covered for a Disability caused or contributed to by War or any act of War. War means
declared or undeclared war, whether civil or international, and any substantial armed conflict
between organized forces of a military nature.
B. Intentionally Self -Inflicted Injury
You are not covered for a Disability caused or contributed to by an intentionally self-inflicted
Injury, while sane or insane.
C. Work Related
You are not covered for a Disability arising out of or in the course of any employment for wage or
profit.
D. Violent Or Criminal Conduct
You are not covered for a Disability caused or Contributed to by your committing or attempting to
commit an assault or felony, or actively participating in a violent disorder or riot. Actively
participating does not include being at the scene of a violent disorder or riot while performing your
official duties.
E. Loss Of License Or Certification
You are not covered for a Disability caused or contributed to by the loss of your professional
license, occupational license or certification.
LIMITATIONS
A. Care Of A Physician
(NONOcc) sT.XD.OT.l
You must be under the ongoing care of a Physician in the appropriate specialty as determined by
us during the Benefit Waiting Period. No STD Benefits will be paid for any period of Disability
Printed 03/22/2013 - 12- 720106-B
when you are not under the ongoing care of a Physician in the appropriate specialty as determined
by us.
B. Occupational Benefits
No STD Benefits will be paid for any period when you are eligible to receive benefits for your
Disability under a workers' compensation law or similar law. If your claim for these benefits is
accepted, compromised or settled (whether disputed or undisputed), you must repay us for the full
amount of any payments we make to you while your claim for occupational benefits is pending.
C. Paid Sick Leave Or Other Salary Continuation
No STD Benefits will be paid for any period when you are receiving paid sick leave pay, annual or
personal leave pay, or other salary continuation, including donated amounts, (but not vacation
pay) from your Employer.
D. Imprisonment
No STD Benefits will be paid for any period of Disability when you are confined for any reason in a
penal or correctional institution.
E. Return To Work Responsibility
No STD Benefits will be paid for any period of Disability when you are able to work in your Own
Occupation and able to earn at least 20% of your Predisability Earnings, but you elect not to work.
F. Rehabilitation Program
No STD Benefits will be paid for any period of Disability when you are not participating in good
faith in a plan, program or course of medical treatment or vocational training or education
approved by us unless your Disability prevents you from participating.
CLAIMS
A. Filing A Claire
(NONOCC-RTW RSP-MAND REHB) ST.LM.OT.I
Claims should be filed on our forms. If you do not receive our forms within 15 days after you ask
for them, you may submit your claim in a letter to us. The letter should include the date Disability
began, and the cause and nature of the Disability.
B. Time Limits On Filing Proof Of Loss
You must give us Proof Of Loss within 90 days after the end of the Benefit Waiting Period. If you
cannot do so, you must give it to us as soon as reasonably possible, but not later than one year
after that 90 -day period, If Proof Of Loss is filed outside these time limits, your claim will be
denied. These limits will not apply while you lack legal capacity.
C. Proof Of Loss
Proof Of Loss means written proof that you are Disabled and entitled to STD Benefits. Proof Of
Loss must be provided at your expense.
For claims of Disability due to conditions other than Mental Disorders, we may require proof of
physical impairment that results from anatomical or physiological abnormalities which are
demonstrable by medically acceptable clinical and laboratory diagnostic techniques.
D. Documentation
Completed claims statements, a signed authorization for us to obtain information, and any other
items we may reasonably require in support of a claim must be submitted at your expense. If the
required documentation is not provided within 45 days after we mail our request, your claim may
be denied.
Printed 03/22/2013 - 13- 720100-B
E. Investigation Of Claim
We may investigate your claim, at any time.
At our expense, we may have you examined at reasonable intervals by specialists of our choice.
We may deny or suspend STD Benefits if you fail to attend an examination or cooperate with the
examiner.
F. Time Of Payment
We will pay STD Benefits within 60 days after you satisfy Proof Of Loss.
STD Benefits will be paid to you at the end of each week you qualify for them. STD Benefits
remaining unpaid at your death will be paid to your estate.
G. Notice Of Decision On Claire
We will evaluate your claim promptly after you file it. Within 45 days after we receive your claim
we will send you: (a) a written decision on your claim; or (b) a notice that we are extending the
period to decide your claim for 30 days. Before the end of this extension period we will send you:
(a) a written decision on your claim; or (b) a notice that we are extending the period to decide your
claim for an additional 30 days. If an extension is due to your failure to provide information
necessary to decide the claim, the extended time period for deciding your claim will not begin until
you provide the information or otherwise respond.
If we extend the period to decide your claim, we will notify you of the following: (a) the reasons for
the extension; (b) when we expect to decide your claim.; (c) an explanation of the standards on
which entitlement to benefits is based; (d) the unresolved issues preventing a decision; and (e) any
additional information we need to resolve those issues.
If we request additional information, you will have 45 days to provide the information. If you do
not provide the requested information within. 45 days, we may decide your claim based on the
information we have received.
If we deny any part of your claim, you will receive a written notice of denial containing:
a. The reasons for our decision.
b. Reference to the parts of the Group Policy on which our decision is based.
c. Reference to any internal rule or guideline relied upon in making our decision.
d. A description of any additional information needed to support your claim.
e. Information concerning your right to a review of our decision.
f. Information concerning your right to bring a civil action for benefits under section 502(x) of
ERISA if your claim is denied on review.
H. Review Procedure
If all or part of a claim is denied, you may request a review. You must request a review in writing
within 180 days after receiving notice of the denial.
You may send us written comments or other items to support your claim. You may review and
receive copies of any non -privileged information that is relevant to your request for review. There
will be no charge for such copies. You may request the names of medical or vocational experts
who provided advice to us about your claim.
The person conducting the review will be someone other than the person who denied the claim and
will not be subordinate to that person. The person conducting the review will not give deference to
the initial denial decision. If the denial was based on a medical judgment, the person conducting
the review will consult with a qualified health care professional. This health care professional will
be someone other than the person who made the original medical judgment and will not be
Printed 03/22/2013 -14- 720106-B
subordinate to that person. Our review will include any written comments or other items you
submit to support your claim.
We will review your claim promptly after we receive your request. Within 45 days after we receive
your request for review we will send you: (a) a written decision on review; or (b) a notice that we are
extending the review period for 45 days. If the extension is due to your failure to provide
information necessary to decide the claim on review, the extended time period for review of your
claim will not begin until you provide the information or otherwise respond.
If we extend the review period, we will notify you of the following: (a) the reasons for the extension;
(b) when we expect to decide your claim on review; and (c) any additional information we need to
decide your claim.
If we request additional information, you will have 45 days to provide the information. If you do
not provide the requested information within 45 days, we may conclude our review of your claim
based on the information we have received,
If we deny any part of your claim on review, you will receive a written notice of denial containing:
a. The reasons for our decision.
b. Reference to the parts of the Group Policy on which our decision is based.
c. Reference to any internal rule or guideline relied upon in malting our decision.
d. Information concerning your right to receive, free of charge, copies of non -privileged documents
and records relevant to your claim.
e. Information concerning your right to bring a civil action for benefits under section 502(a) of
ERISA.
The Group Policy does not provide voluntary alternative dispute resolution options. However, you
may contact your local U.S. Department of Labor Office and your State insurance regulatory
agency for assistance.
L Assignment
The rights and benefits under the Group Policy are not assignable.
(REV PRIV WRDG) ST.CL.OT,2
ALLOCATION OF AUTHORITY
Except for those functions which the Group Policy specifically reserves to the Policyholder or
Employer, we have full and exclusive authority to control and manage the Group Policy, to administer
claims, and to interpret the Group Policy and resolve all questions arising in its administration,
interpretation, and application of the Group Policy.
Our authority includes, but is not limited to:
1. The right to resolve all matters when a review has been requested;
2. The right to establish and enforce rules and procedures for the administration of the Group Policy
and any claim under it;
3. The right to determine:
a. Eligibility for insurance;
b. Entitlement to benefits;
c. The amount of benefits payable;
d. The sufficiency and the amount of information we may reasonably require to determine a., b.,
or c., above.
Printed 03/22/2013 - 15- 720106-B
Subject to the review procedures of the Group Policy, any decision we make in the exercise of our
authority is conclusive and binding.
ST.AL.OT.1
TIME LIMITS ON LEGAL ACTIONS
No action at law or in equity may be brought until 60 days after you have given us Proof Of Loss. No
such action may be brought more than three years after the earlier of:
1. The date we receive Proof Of Loss; and
2. The time within which Proof Of loss is required to be given.
ST.TL.oT. I
INCONTESTABILITY PROVISIONS
A. Incontestability Of Insurance
Any statement you make to obtain or to increase insurance is a representation and not a warranty.
No misrepresentation will be used to reduce or deny a claim or contest the validity of insurance
unless:
1. The insurance would not have been approved if we had known the truth; and
2. We have given you or any person claiming benefits a copy of the signed written instrument
which contains your misrepresentation.
After insurance has been in effect for two years, during the lifetime of the insured, we will not use
a misrepresentation to reduce or deny the claim., unless it was a fraudulent misrepresentation.
B. Incontestability Of The Group Policy
Any statement made by the Policyholder or Employer to obtain the Group Policy is a representation
and not a warranty.
No misrepresentation by the Policyholder or your Employer will be used to deny a claim or to deny
the validity of the Group Policy unless:
1. The Group Policy would not have been issued if we had known the truth; and
2. We have given the Policyholder or Employer a copy of a written instnunent signed by the
Policyholder or Employer which contains the misrepresentation.
The validity of the Group Policy will not be contested after it has been in force for two years, except
for nonpayment of premiums or fraudulent misrepresentations.
ST.1N.oT.1
CLERICAL ERROR, AGENCY AND MISSTATEMENT
A. Clerical Error
Clerical error by the Policyholder, your Employer, or their respective employees or representatives
will not:
1. Cause a person to become insured.
2. Invalidate insurance under the Group Policy otherwise validly in force.
3. Continue insurance under the Group Policy otherwise validly terminated.
Printed 03/22/2013 - 16- 720106-B
B. Agency
The Policyholder and your Employer act on their own behalf as your agent, and not as our agent.
The Policyholder and your Employer have no authority to alter, expand or extend our liability or to
waive, modify or compromise any defense or right we may have under the Group Policy,
C. Misstatement Of Age
If a person's age has been misstated, we will make an equitable adjustment of premiums, benefits,
or both. The adjustment will be based on:
1. The amount of insurance based on the correct age; and
2. The difference between the amount paid and the amount which would have been paid if the age
had been correctly stated.
ST. CE.OT.1
TERMINATION OR AMENDMENT OF THE GROUP POLICY
The Group Policy may be terminated by us or the Policyholder according to its terms. It will terminate-
automatically
erminateautomatically for nonpayment of premium. The Policyholder may terminate the Group Policy in whole,
and may terminate insurance for any class or group of Members, at any time by giving us written
notice.
Benefits under the Group Policy are limited to its terms, including any valid amendment. No change
or amendment will be valid unless it is approved in writing by one of our executive officers and given to
the Policyholder for attachment to the Group Policy. If the terms of the certificate differ from the
Group Policy, the terms stated in the Group Policy will govern. The Policyholder, your Employer, and
their respective employees or representatives have no right or authority to change or amend the Group
Policy or to waive any of its terms or provisions without our signed written approval.
We may change the Group Policy in whole or in part when any change or clarification in law or
governmental regulation affects our obligations under the Group Policy, or with the Policyholder's
consent.
Any such change or amendment of the Group Policy may apply to current or future Members or to any
separate classes or groups of Members.
ST.TA.OT.1
DEFINITIONS
Benefit Waiting Period means the period you must be continuously Disabled before STD Benefits
become payable. No STD Benefits are payable for the Benefit Waiting Period, See Coverage Features.
Contributory means insurance is elective and Members pay all or part of the premium for insurance.
Employer means an employer (including approved affiliates and subsidiaries) for which coverage under
the Group Policy is approved in writing by us.
Group Policy means the group STD insurance policy issued by us to the Policyholder and identified by
the Group Policy Number.
Hospital means a legally operated hospital providing full-time medical care and treatment under the
direction of a full-time staff of licensed physicians. Rest homes, nursing homes, convalescent homes,
homes for the aged, and facilities primarily affording custodial, educational, or rehabilitative care are
not Hospitals.
Injury means an injury to the body.
L.L.C. Owner -Employee means an individual who owns an equity interest in an Employer and is
actively employed in the conduct of the Employer's business.
Printed 03/22/2013 - 17- 720100-B
Maximum Benefit Period means the longest period for which STD Benefits are payable for any one
period of continuous Disability, whether from one or more causes. It begins at the end of the Benefit
Waiting Period. No STD Benefits are payable after the end of the Maximum Benefit Period, even if you
are still Disabled. See Coverage Features.
Mental Disorder means any mental, emotional, behavioral, psychological, personality, cognitive, mood
or stress-related abnormality, disorder, disturbance, dysfunction or syndrome, regardless of cause
(including any biological or biochemical disorder or imbalance of the brain) or the presence of physical
symptoms. Mental Disorder includes, but is not limited to, bipolar affective disorder, organic brain
syndrome, schizophrenia, psychotic illness, manic depressive illness, depression and depressive
disorders, anxiety and anxiety disorders.
Noncontributory means (a) insurance is nonelective and the Policyholder or Employer pay the entire
premium for insurance; or (b) the Policyholder or Employer require all eligible Members to have
insurance and to pay all or part of the premium for insurance.
P.C. Partner means the sole active employee and majority shareholder of a professional corporation in
partnership with the Policyholder.
Physical Disease means a physical disease entity or process that produces structural or functional
changes in your body as diagnosed by a Physician.
Physician means a licensed M.D. or D.O., acting within the scope of the license. Physician does not
include you or your spouse, or the brother, sister, parent, or child of either you or your spouse.
Pregnancy means your pregnancy, childbirth, or related medical conditions, including complications of
pregnancy.
Prior Plan means your Employer's group short term disability insurance pian in effect on the day
before the effective date of your Employer's coverage under the Group Policy and which is replaced by
the Group Policy.
STD Benefit means the weekly benefit payable to you under the terms of the Group Policy
POLICYHOLDER PROVISIONS
A. Premiums
ST.DF.OT.1
The premium due on each Premium Due Date is the sum of the premiums for all persons then
insured. Premium Rates are shown in the Coverage Features.
B. Contributions From Members
The Policyholder determines the amount, if any, of each Member's contribution toward the cost of
insurance under the Group Policy.
C. Changes In Premium Rates
We may change Premium Rates whenever:
1. A change or clarification in law or governmental regulation affects the amount payable under
the Group Policy, Any such change in Premium Rates will reflect only the change in our
obligations.
2. Factors material to underwriting the risk we assumed under the Group Policy with respect to
an Employer, including, but not limited to, number of persons insured, age, Predisability
Earnings, gender, and occupational classification, change by 25% or more.
3. The premium contribution arrangement for Members is changed or varies from that stated in
the Group Policy when issued or last renewed.
Printed 03/22/2013 - 18- 720106-B
4. We and the Policyholder or the Employer mutually agree to change Premium Rates.
Except as provided above, Premium Rates will not be change
Period shown in the Coverage Features. Thereafter, except
Premium Rates upon 31 days advance written notice to the
Premium Rates may be made effective on any Premium Due
made more than once in any contract year. Contract years
computed from the end of the Initial Rate Guarantee Period.
D. Payment Of Premiums
d during the Initial Rate Guarantee
as provided above, we may change
Policyholder. Any such change in
Date, but no such change will be
are successive 12 month periods
All premiums are due on the Premium Due Dates shown in the Coverage Features.
Each premium is payable on or before its Premium Due Date directly to us at our home office. The
payment of each premium by the Policyholder as it becomes due will maintain the Group Policy in
force until the next Premium Due Date.
E. Grace Period And Termination For Nonpayment
If a premium, is not paid on or before its Premium Due Date, it may be paid during the following
Grace Period of 31 days. The Group Policy or an Employer's coverage under the Group Policy will
remain in force during the Grace Period.
If the premium is not paid during the Grace Period, the Group Policy will terminate automatically
at the end of the Grace Period.
The Policyholder is liable for premium for insurance under the Group Policy during the Grace
Period. We may charge interest at the legal rate for any premium which is not paid during the
Grace Period, beginning with the first day after the Grace Period.
F. Termination For Other Reasons
The Policyholder may terminate the Group Policy by giving us written notice. The effective date of
termination will be the later of:
1. The date stated in the notice; and
2. The date we receive the notice.
We may terminate the Group Policy as follows;
1. On any Premium Due Date if the number of persons insured is less than the Minimum
Participation shown in the Coverage Features.
2. On any Premium Due Date if we determine that the Policyholder has failed to promptly furnish
any necessary information requested by us, or has failed to perform any other obligations
relating to the Group Policy.
The minimum advance notice of termination by us is 31 days.
G. Premium Adjustments
Premium adjustments involving a return of unearned premiums to the Policyholder will be limited
to the 12 months just before the date we receive a request for premium adjustment.
H. Certificates
We will issue certificates to the Policyholder showing the coverage under the Group Policy. The
Policyholder will distribute a certificate to each insured Member. If the terms of the certificate
differ from the Group Policy, the terms stated in the Group Policy will govern.
Printed 03/22/2013 - 19- 72010E -B
I. Records And Reports
The Policyholder or Employer will furnish on our forms all information reasonably necessary to
administer the Group Policy. We have the right at all reasonable times to inspect the payroll and
other records of the Policyholder or Employer which relate to insurance under the Group Policy.
J. Agency And Release
Individuals selected by the Policyholder or by any Employer to secure coverage under the Group
Policy or to perform their administrative function under it, represent and act on behalf of the
person selecting them, and do not represent or act on behalf of Standard. The Policyholder,
Employer and such individuals have no authority to alter, expand or extend our liability or to
waive, modify or compromise any defense or right we may have under the Group Policy. The
Policyholder and each Employer hereby release, hold harmless and indemnify Standard from any
liability arising from or related to any negligence, error, omission, misrepresentation or dishonesty
of any of there or their representatives, agents or employees.
K. Notice Of Suit
The Policyholder and Employer shall promptly give us written notice of any lawsuit or other legal
proceedings arising under the Group Policy.
L. Entire Contract, Changes
The Group Policy and the application of the Policyholder constitute the entire contract between the
parties. A copy of the Policyholder's application is attached to the Group Policy when issued.
The Group Policy may be changed in whole or in part. No change in the Group Policy will be valid
unless it is approved in writing by one of our executive officers and given to the Policyholder for
attachment to the Group Policy. No agent has authority to change the Group Policy, or to waive
any of its provisions.
M. Effect On Workers' Compensation, State Disability Insurance
The coverage provided under the Group Policy is not a substitute for coverage under a workers'
compensation or state disability income benefit law and does not relieve the Employer of any
obligation, to provide such coverage.
ST YM OT.1
AK/STDP2000
Printed 03/22/2013 -20- 720106-B
( JOIN% M1,9M
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Protect Your Employees From Loss Of Income
Standard Insurance Company
Short Term Disability Insurance
Group Short Term
Disability Insurance
An Attractive Option For Your
Employee Benefits Package
Short Term Disability insurance from The Standard
is designed to provide coverage for disabilities
resulting from physical disease, injury, pregnancy
or mental disorder. STD insurance offers an attractive
option for employers who want to supplement a sick
leave or statutory disability benefits program. The
proposed STD benefit amount and maximum benefit
period are shown in the Employee Benefits Proposal.
STD Product information
Definition Of Disability
Insured employees are disabled if, as a result of physical
disease, injury, pregnancy or mental disorder, they
are unable to perform with reasonable continuity the
material duties of their own occupation and suffer a loss
of at least 20 percent in their predisability earnings when
working in their own occupation.
Own occupation means the job the employee is regularly
performing for their employer when disability begins.*
Material duties means the usual duties the employee
performs in their regular job** with the employer that
cannot be reasonably modified or omitted. In no event
will we consider working more than 8 hours per day
or an average of more than 40 hours per week to be a
material duty.
Employees who are disabled from their own occupation
may work in another occupation and continue to qualify
for STD benefits as long as their work earnings do not
exceed 80 percent of their predisability earnings. Work
earnings will be used to reduce the STD benefit as noted
under "Return To Work Incentive."
*In Oregon, Own Occupation means the usual job an employee is ordinarily
performing for their employer when disability begins.
** In Oregon, usual job is substituted for regular job.
Coverage For New Disabilities
If a period of disability is extended by a new cause while
STD benefits are payable, benefits will continue while
the employee remains disabled but not beyond the end
of the original maximum benefit period. In addition, all
policy limitations and exclusions apply to the new cause
of disability.
Plan Options
The Standard offers STD pians that provide both non-
occupational and 24-hour coverage. Non -occupational
plans provide coverage for disabilities occurring off the
job as a complement to workers' compensation
coverage. 24-hour STD plans provide coverage for
disabilities occurring on or off the job.
Minimum STD Benefit
For STD plans that are integrated with deductible
income, the minimum STD benefit is $15 per week. The
Employee Benefits Proposal will indicate whether this
applies to this proposed plan.
Group Short Term Disability Insurance
Returning To 'Mork
Our claims management services have been carefully
designed to promote and optimize the return of disabled
employees to a productive life whenever possible.
When a disability occurs, our focus is on returning the
employee to work through our claims management
process, the services we provide and the policy
provisions we offer.
Reasonable Accommodation
Expense Benefit
To help employers return employees with disabilities
to active work whenever they are able, The Standard
automatically includes a Reasonable Accommodation
Expense Benefit in its STD policies. This benefit
reimburses an employer for worksite modifications
made on behalf of a disabled employee, which result
in a return to work for the employee. The reimbursable
modifications are subject to The Standard's
prior approval.
Return To Work Incentive
Providing incentives for disabled employees to return to
work at their full potential is critical for any successful
rehabilitation plan. Automatically included in our STD
policies, The Standard's Return To Work Incentive
provision is designed to provide valuable financial
support to disabled employees in their efforts to
return to work.
The Standard's STD benefit is reduced by only the
amount of work earnings which, when added to the
employee's maximum STD benefit, exceeds 100
percent of predisability earnings. This typically means
that employees who return to work receive more total
income than those who do not. Work earnings will
include amounts they could earn if they worked to their
full potential in work that is reasonably available.
Return To Work Responsibility
In addition to providing positive financial incentives
to return to work, The Standard's STD policy also
establishes a clear expectation for those who are able
to return to work. Disabled employees who are capable
of part-time work have a responsibility to take advantage
of available work opportunities. They are expected to
accept part-time work in their own occupation if they are
able to earn at least 20 percent of predisability earnings.
No STD benefits are payable for any period when
partially disabled employees fail to meet
this responsibility.
Temporary Recovery
The Standard automatically includes a Temporary
Recovery provision in every STD policy to further
encourage employees to return to work. Our policy
language is among the most flexible in the industry and
enables us to work with employees to make permanent
recoveries out of temporary ones.
Employees who recover from a disability for a period of
time during the maximum benefit period but later suffer
a relapse and become disabled again from the same
cause or causes, may not have to serve a new benefit
waiting period, depending on the length of the period of
temporary recovery.
A new benefit waiting period is not required if the
periods of recovery during the maximum benefit period
do not exceed a total of 90 days. In addition:
• Benefits are not payable for the recovery period
• The recovery period does not count toward the
maximum benefit period
• Predisability earnings used to determine the
STD benefit will not change
• No STD benefits will be payable after benefits become
payable to the employee under any other disability
plan for which the employee became insured during
the period of temporary recovery
Other than the above, the group policy is applied as if
the disability were uninterrupted.
Additional Cost Options
Daily Hospital Benefit
With the Daily Hospital Benefit, the eligible insured
employee will receive STD benefits for each day of
hospitalization during the benefit waiting period.
First-day Hospital Benefit
If an insured employee is hospital -confined for at least
four hours during the benefit waiting period, the benefit
waiting period will be satisfied. Hospital -confined means
the employee is admitted to a hospital as an in-patient,
for which they are charged room and board. They must
be under the ongoing care of a physician while they are
hospital -confined. STD benefits will become payable on
the date of hospitalization. The maximum benefit period
will also begin on that date.
4 Standard Insurance Company
Exclusions From Coverage
The Standard's STD policies do not cover disabilities
caused or contributed to by:
• War or any act of war
• An intentionally self-inflicted injury, while sane
or insane"
• A disability arising out of, or in the course of, any
employment for wage or profit (applies to
non -occupational plans only)
• Committing or attempting to commit an assault
or felony, or active participation in a violent disorder
or riot
• Loss of a professional or occupational license
or certification
Limitations
No STD benefit will be paid for any period when the
disabled employee is:
• Not under the ongoing care of a physician in an
appropriate specialty as determined by The Standard
• Eligible to receive benefits under any workers'
compensation or similar law (applies to
non -occupational plans only)
• Able to work part-time, but elects not to work
(i.e., fails to meet the return to work responsibility)
• Confined for any reason in a penal or
correctional institution
• Not participating in good faith in a plan of medical
treatment or vocational training or education approved
by The Standard, unless the disability prevents the
employee from participating
• Receiving sick leave pay or other salary continuation
from the employer, unless a sick leave integration
option is chosen
Preexisting Condition Limitation
The preexisting condition limitation typically applies to
STD benefit amounts of $2,500 per week or more. If on
the date disability begins, the employee has not been
continuously insured under the group policy for the
12- (or optional 24-) month limitation period and has not
been actively at work for at least one full day after that
limitation period, the weekly STD benefit will be limited
to not more than $2,500 if the disability results from a
preexisting condition.
"For Colorado and Missouri residents, "insane" is not applicable,
A preexisting condition is a mental or physical condition
whether or not diagnosed or misdiagnosed:
• Which was discovered or suspected as a result of
any routine or other medical examination at any time
during the preexisting condition period
For which the employee has (or a reasonably prudent
person would have) consulted a physician or other
licensed medical professional, received medical
treatment, services or advice, undergone diagnostic
procedures, including self administered procedures,
or taken prescribed drugs or medications at anytime
during the preexisting condition period
The preexisting condition period is the three- or six-
month period just before the employee's insurance
becomes effective, as specified in the Employee
Benefits Proposal.
We grant credit for time served toward satisfying
the preexisting condition limitation period for eligible
employees insured under the employer's prior group
STD plan that was replaced by The Standard's
coverage.
Group Short Term Disability Insurance
Deductible Income
The Standard's STD insurance helps replace a portion of
income lost as a result of a disability. Often employees
are eligible for other sources of income. To prevent
overinsurance, the STD benefit is reduced by deductible
income, which generally includes the following, although
it may vary depending on whether the employer is a
public or private entity:
• Work earnings, as described under "Return To
Work Incentive"
• Benefits the employee receives or is eligible to receive
from workers' compensation; state disability income
benefit law; the Jones Act; Maritime Doctrine of
Maintenance, Wages, and Cure; Longshore and
Harbor Worker's Act or any similar acts or laws
(applies to 24-hour coverage only)
• Benefits from other insurance (including group
insurance for non-professionals) the employee
receives or is eligible to receive
• Any disability or retirement benefits received from the
employer's retirement plan
• Any earnings or compensation included in
predisability earnings which the employee receives or
is eligible to receive while STD benefits are payable
Commonly Asked Questions
Who Is Eligible For Coverage?
Coverage is available to all of an employer's active
employees who:
• Are citizens or residents of the United States
or Canada
• Are actively at work at least 30 hours each week
• Meet the required eligibility waiting period as shown
in the Employee Benefits Proposal
Temporary and seasonal employees, full-time members
of the armed forces of any country, leased employees
and independent contractors are not eligible for
coverage. There is no age limit on eligibility for coverage
under The Standard's group insurance plans.
When Is Coverage Effective?
Subject to the active work requirement, coverage is
effective as follows:
• Coverage requiring evidence of insurability is not
effective until evidence is approved
• For noncontributory plans, coverage is effective
on the date the employee becomes eligible
• Any amount the employee receives or is eligible to
For contributory plans, employees must apply in
receive under any unemployment compensation law
writing for coverage. Coverage is effective on
or similar act or law
the later of:
• Any amount the employee receives or is eligible to
- The date the employee becomes eligible
receive from, or on behalf of, a third party
- The date the employee applies if the employee
• Any amount received by compromise, settlement or
submits an application within 31 days of
other method, as a result of a claim for any of the
becoming eligible
above, whether disputed or undisputed
- The date that required evidence of insurability is
Exceptions To Deductible Income
approved, if the employee applies more than
31 days after becoming eligible
The following are generally not considered deductible
income, although exceptions vary depending on
whether the employer is a private or public entity:
• Group credit, mortgage disability insurance benefits
and accelerated death benefits paid under a life
insurance policy
• Any cost -of -living increase in deductible income,
other than work earnings
• Reimbursement for hospital, medical or
surgical expenses
• Reasonable attorney fees incurred in connection with
a claim for deductible income
What Is The Active Work Requirement?
Employees who are performing the material duties of
their own occupation at the employer's usual place of
business meet the active work requirement. Employees
who are not capable of active work due to physical
disease, injury, pregnancy or mental disorder on the day
before insurance would otherwise become effective will
not become insured until the day after completing one
full day of active work as an eligible employee.
6 Standard Insurance Company
What Level Of Employee
Participation Is Required?
For noncontributory plans, 100 percent of the eligible
employees must participate. If a plan is contributory
(partially or fully funded by employees), a minimum
number of eligible employees must participate, as
specified in the Employee Benefits STD Proposal,
When Does The Coverage End?
STD insurance ends automatically on the
earliest of the following:
• The date the last period ends for which a
premium contribution is received
• The date the group policy terminates
• The date employment terminates
• The date the employee fails to meet the definition of a
member (however, STD insurance may be continued
under certain conditions, such as during an approved
leave of absence scheduled to last no more than
30 days)
When Does The Croup Policy Terminate?
An employer may terminate a group policy by providing
The Standard with written notice. The group policy will
automatically terminate if premium is not received by
the end of the grace period shown in the Employee
Benefits Proposal. The Standard may terminate the
group policy if the number of employees insured is
less than the minimum participation requirement shown
in the Employee Benefits Proposal, The Standard
may also terminate the group policy if we determine
that the policyholder has failed to promptly furnish
any necessary information requested by us or has
failed to perform any other obligations relating to the
group policy.
Founded in Portland, Oregon in 1906, The Standard is a
nationally recognized provider of group Disability, Life,
Dental and Vision insurance and Individual Disability
insurance. We provide insurance to nearly 26,500
groups covering more than 8.4 million employees
nationwide.' Our first group policy, written in 1951
and still in force today, stands as a testament to our
commitment to building long-term relationships.
We always strive to do what's right — for our
policyholders and their employees. This dedication has
resulted in a national reputation for quality products,
superior service and industry expertise.
To (earn more about group STD insurance from
The Standard, contact your insurance advisor or the
Employee Benefits Sales and Service Office for your
area at 800.633.8575 or visit us at www.standard.com
As of September 30, 2011, based on internal data developed
by Standard Insurance Company.
Standard Insurance Company
1100 SW Sixth Avenue
Portland OR 97204
www.standard.com
GP399-STD, GP399-STD/TRUST, GP19()-STD/S399,
GP309-STD, GP209-STD, GP399-STD/ASSOC, GP899-STD
Group STD Proposal Booklet
SI 8844 (4115) PR/ER
STANDARD INSURANCE COMPANY
A Stock Life Insurance Company
900 SW Fifth Avenue
Portland, Oregon 97204-1282
(503) 321-7000
GROUP LONG TERM DISABILITY INSURANCE POLICY
Policyholder:
Policy Number:
Effective Date:
Sample K2000 Public Group
720100-B
January 1, 2013
The consideration for this Group Policy is the application of the Policyholder and the
payment by the Policyholder of premiums as provided herein.
Subject to the Policyholder Provisions and the Incontestability Provisions, this
Group Policy (a) is issued for the Initial Rate Guarantee Period shown in the Coverage
Features, and (b) may be renewed for successive renewal periods by the payment of the
prernium set by us on each renewal date. The length of each renewal period will be set
by us, but will not be less than 12 months.
For purposes of effective dates and ending dates under this Group Policy, all days begin
and end at 12:00 midnight Standard Time at the Policyholder's address,
All provisions on this and the following pages are part of this Group Policy. "You" and
"your" mean the Member, "We", "us", and "our" mean Standard Insurance Company.
Other defined terms appear with their initial letters capitalized. Section headings, and
references to them, appear in boldface type.
STANDARD INSURANCE COMPANY
THIS POLICY IS NOT AVAILABLE IN CALIFORNIA, MARYLAND, OR NEW YORK
This is a sample policy. Product availability, plan provisions and features may
vary by state. The proposed premium rate and plan design is based on the
underwriting data received by us. Final premium rates and plan provisions will be
determined on the basis of: applicable state laws, Policyholder contributions,
confirmation of occupations, the actual composition of the group of persons who
will become insured, and our current underwriting rules and practices..
GP190-=/S399
Table of Contents
COVERAGEFEATURES.............................................................................................. 1
GENERAL POLICY INFORMATION.........................................................................
1
SCHEDULE OF INSURANCE..................................................................................
1
PREMIUM CONTRIBUTIONS..................................................................................2
PREMIUM AND RENEWALS...................................................................................
2
INSURINGCLAUSE.....................................................................................................3
BECOMINGINSURED.................................................................................................3
WHEN YOUR INSURANCE BECOMES EFFECTIVE......................................................
3
ACTIVE WORK PROVISIONS.......................................................................................4
CONTINUITY OF COVERAGE......................................................................................4
WHEN YOUR INSURANCE ENDS.................................................................................
5
WAIVEROF PREMIUM................................................................................................
5
REINSTATEMENT OF INSURANCE..............................................................................6
DEFINITION OF DISABILITY........................................................................................
6
RETURN TO WORK PROVISIONS................................................................................
7
REASONABLE ACCOMMODATION EXPENSE BENEFIT...............................................8
REHABILITATION PLAN PROVISION............................................................................
9
TEMPORARY RECOVERY............................................................................................
9
WHEN LTD BENEFITS END...................................................................................... 10
PREDISABILITY EARNINGS ......... ..............................................................................
10
DEDUCTIBLEINCOME.............................................................................................
I I
EXCEPTIONS TO DEDUCTIBLE INCOME.................................................................
12
RULES FOR DEDUCTIBLE INCOME ....................................................... . ..................
13
SUBROGATION.........................................................................................................
13
SURVIVORS BENEFIT...............................................................................................
14
BENEFITS AFTER INSURANCE ENDS OR IS CHANGED ............................................
14
EFFECT OF NEW DISABILITY...................................................................................
14
DISABILITIES EXCLUDED FROM COVERAGE...........................................................
14
DISABILITIES SUBJECT TO LIMITED PAY PERIODS .................................................
15
LIMITATIONS............................................................................................................
16
CLAIMS....................................................................................................................
17
ALLOCATION OF AUTHORITY...................................................................................
19
TIME LIMITS ON LEGAL ACTIONS............................................................................
19
INCONTESTABILITY PROVISIONS.............................................................................
19
CLERICAL ERROR, AGENCY, AND MISSTATEMENT..................................................
20
TERMINATION OR AMENDMENT OF THE GROUP POLICY ........................................
20
DEFINITIONS..................................................................... . ............................ , .........
21
POLICYHOLDER PROVISIONS...................................................................................
22
Index of Defined Terms
Active Work, Actively At Work, 4
Allowable Periods, 9
Any Occupation, 7
Any Occupation Period, 1
Benefit Waiting Period, 2, 21
Class Definition, 1
Contributory, 21
CPI -W, 21
Deductible Income, 11
Disabled, 6
Eligibility Waiting Period, I
Employer, 21
Employer(s), 1
Evidence Of Insurability, 4
Grace Period, 22
Group Policy, 21
Group Policy Effective Date, 1
Group Policy Number, 1
Hospital, 16
Indexed Predisability Earnings, 21
Initial Rate Guarantee Period, 2
Injury, 21
L.L.C, Owner -Employee, 21
LTD Benefit, 21
Material Duties, 7
Maximum Benefit Period, 2, 21
Maximum LTD Benefit, 2
Member, 1, 3
Mental Disorder, 15
Minimum LTD Benefit, 2
Minimum Participation Number, 2
Minimum Participation Percentage, 2
Noncontributory, 21
Other Limited Conditions, 16
Own Occupation, 7
Own Occupation Period, 1
P.C. Partner, 21
Physical Disease, 21
Physician, 21
Policyholder, 1
Predisability Earnings, 10
Preexisting Condition, 15
Pregnancy, 22
Premium Due Dates, 2
Premium Rates, 2
Prior Plan, 22
Reasonable Accommodation Expense
Benefit, 8
Rehabilitation Plan, 9
Substance Abuse, 16
Survivors Benefit, 14
Temporary Recovery, 9
War, 14
Work Earnings, S
COVERAGE FEATURES
This section contains many of the features of your long term disability (LTD) insurance. Other
provisions, including exclusions, limitations, and Deductible Income, appear in other sections. Please
refer to the text of each section for full details. The Table of Contents and the Index of Defined Terms
help locate sections and definitions.
GENERAL POLICY INFORMATION
Group Policy Number: 720100-B
Policyholder: Sample K2000 Public Group
Employer(s): Sample K2000 Public Group
Group Policy Effective Date: January1, 2013
Policy Issued in: Alaska
Member means:
1. A regular employee of the Employer;
2. Actively At Work at least 30 hours each week (for purposes of the Member definition, Actively
At Work will include regularly scheduled days off, holidays, or vacation days, so long as the
person is capable of Active Work on those days); and
3. A citizen or resident of the United States or Canada.
Member does not include a temporary or seasonal employee, a full-time member of the armed
forces of any country, a Ieased employee, or an independent contractor.
Class Definition: None
SCHEDULE OF INSURANCE
Eligibility Waiting Period: You are eligible on one of the following dates:
If you are a Member on the Group Policy Effective Date,
you are eligible on that date.
If you become a Member after the Group Policy Effective
Date, you are eligible on the first day of the calendar
month coinciding with or next following 90 consecutive
days as a Member.
Eligibility Waiting Period means the period you must be a Member before you become eligible for
insurance.
Own Occupation Period: The first 24 months for which LTD Benefits are paid..
Any Occupation Period: From the end of the Own Occupation Period to the end of
the Maximum Benefit Period.
LTD Benefit:
60% of the first $16,667 of your Predisability Earnings,
reduced by Deductible Income.
Printed 04/01/2013 - 1 - 720100-B
Maximum: $10,000 before reduction by Deductible Income.
Minimum: $100
Benefit Waiting Period: 90 days.
Maximum Benefit Period: Determined by your age when Disability begins, as follows:
Age Maximum Benefit Period
61 or younger ....................................... To age 65, or 3 years 6 months, if longer.
62 ........................................................ 3 years 6 months
63 ........................................................ 3 years
64 ........................................................ 2 years 6 months
65 ........................................................ 2 years
66 ................. ....................................... 1 year 9 months
67 ........................................................ 1 year 6 months
68 ........................................................ I year 3 months
69 or older ............................................ 1 year
PREMIUM CONTRIBUTIONS
Insurance is: Noncontributory
Premium Rates:
LTD Insurance:
Premium Due Dates:
Initial Rate Guarantee Period:
Minimum Participation Number:
Minimum Participation Percentage:
PREMIUM AND RENEWALS
0.880% of the first $16,667 of each insured Member's
insured Predisability Earnings.
January 1, 2013 and the first day of each calendar month
thereafter,
January 1, 2013 to January 1, 2015
10 insured Members
100% of eligible Members
Printed 04/01/2013 - 2 - 720100-B
INSURING CLAUSE
If you become Disabled while insured under the Group Policy, we will pay = Benefits according to
the terms of the Group Policy after we receive Proof Of Loss satisfactory to us.
LT.IC.0T.1
BECOMING INSURED
To become insured you must be a Member, complete your Eligibility Waiting Period, and meet the
requirements in Active Work Provisions and When Your Insurance Becomes Effective.
You are a Member if you are;
1. A regular employee of the Employer;
2. Actively At Work at least 30 hours each week (for purposes of the Member definition, Actively
At Work will include regularly scheduled days off, holidays, or vacation days, so long as you are
capable of Active Work on those days); and
3. A citizen or resident of the United States or Canada.
You are not a Member if you are a temporary or seasonal employee, a full-time member of the
armed forces of any country, a leased employee, or an independent contractor.
Eligibility Waiting Period means the period you must be a Member before you become eligible for
insurance. Your Eligibility Waiting Period is shown in the Coverage Features.
(VAR MBR DER) LT.BLOTA
WHEN YOUR INSURANCE BECOMES EFFECTIVE
A. When Insurance Becomes Effective
Subject to the Active Work Provisions, your insurance becomes effective as follows:
1. Insurance Subject To Evidence Of Insurability
Insurance subject to Evidence Of Insurability becomes effective on the date we approve your
Evidence Of Insurability.
2. Insurance Not Subject To Evidence of Insurability
The Coverage Features states whether insurance is Contributory or Noncontributory.
a. Noncontributory Insurance
Noncontributory insurance not subject to Evidence Of Insurability becomes effective on the
date you become eligible.
b. Contributory Insurance
You must apply in writing for Contributory insurance and agree to pay premiums.
Contributory insurance not subject to Evidence Of Insurability becomes effective on.-
i.
n;i. The date you become eligible if you apply on or before that date; or
ii. The date you apply if you apply within 31 days after you become eligible.
Late application: Evidence Of Insurability is required if you apply more than 31 days after
you become eligible.
Printed 04/01/2013 - 3 - 720100-B
B. Takeover Provisions
1. If you were insured under the Prior Plan on the day before the effective date of your Employer's
coverage under the Group Policy, your Eligibility Waiting Period is waived on the effective date
of your Employer's coverage under the Group Policy.
2. You must submit satisfactory Evidence Of Insurability to become insured if you were eligible
for insurance under the Prior Plan for more than 31 days but were not insured.
C. Evidence Of Insurability Requirement
Evidence Of Insurability satisfactory to us is required:
a. For late application for Contributory insurance.
b. For Members eligible but not insured under the Prior Plan.
c. For reinstatements if required.
Providing Evidence Of Insurability paeans you must:
1. Complete and sign our medical history statement;
2. Sign our form authorizing us to obtain information about your health,
3. Undergo a physical examination, if required by us, which may include blood testing; and
4. Provide any additional information about your insurability that we may reasonably require.
{VAR E% LT.EF.OT.1
ACTIVE WORK PROVISIONS
A. Active Work Requirement
You must be capable of Active Work on the day before the scheduled effective date of your
insurance or your insurance will not become effective as scheduled. If you are incapable of Active
Work because of Physical Disease, Injury, Pregnancy or Mental Disorder on the day before the
scheduled effective date of your insurance, your insurance will not become effective until the day
after you complete one full day of Active Work as an eligible Member.
Active Work and Actively At Work mean performing with reasonable continuity the Material Duties
of your Own Occupation at your Employer's usual place of business.
B. Changes In Insurance
This Active Work requirement also applies to any increase in your insurance.
LT.AW.QT.1
CONTINUITY OF COVERAGE
If your Disability is subject to the Preexisting Condition Exclusion, LTD Benefits will be payable if:
1. You were insured under the Prior Plan on the day before the effective date of your Employer's
coverage under the Group Policy;
2. You became insured under the Group Policy when your insurance under the Prior Plan ceased;
3. You were continuously insured under the Group Policy from the effective date of your insurance
under the Group Policy through the date you became Disabled from the Preexisting Condition; and
4. Benefits would have been payable under the terms of the Prior Plan if it had remained in force,
taking into account the preexisting condition exclusion, if any, of the Prior Plan,
Printed 04/01/2013 - 4 - 720100-B
For such a Disability, the amount of your LTD Benefit will be the lesser of:
a. The monthly benefit that would have been payable under the terms of the Prior Pian if it had
remained in force; or
b. The LTD Benefit payable under the terms of the Group Policy, but without application of the
Preexisting Condition Exclusion.
Your LTD Benefits for such a Disability will end on the earlier of the following dates:
a. The date benefits would have ended under the terms of the Prior Plan if it had remained in
force; or
b. The date LTD Benefits end under the terms of the Group Policy.
(PX) LT.CC.OT.1
WHEN YOUR INSURANCE ENDS
Your insurance ends automatically on the earliest of:
1. The date the last period ends for which a premium contribution was made for your insurance.
2. The date the Group Policy terminates.
3. The date your employment terminates.
4. The date you cease to be a Member. However, your insurance will be continued during the
following periods when you are absent from Active Work, unless it ends under any of the above.
a. During the first 90 days of a temporary or indefinite administrative or involuntary leave of
absence or sick leave, provided your Employer is paying you at least the same Predisability
Earnings paid to you immediately before you ceased to be a Member. A period when you are
absent from Active Work as part of a severance or other employment termination agreement is
not a leave of absence, even if you are receiving the same Predisability Earnings.
b. During a leave of absence if continuation of your insurance under the Group Policy is required
by a state -mandated family or medical leave act or law.
c. During any other temporary leave of absence approved by your Employer in advance and in
writing and scheduled to last 30 days or less. A period of Disability is not a leave of absence.
d. During the Benefit Waiting Period.
WAIVER OF PREMIUM
We will waive payment of premium for your insurance while LTD Benefits are payable.
LT.ELY.OT.1
LT. WP. OT.1
Printed 04/01/2013 - 5 - 720100-B
REINSTATEMENT OF INSURANCE
If your insurance ends, you may become insured again as a new Member. However, the following will
apply:
1. If you cease to be a Member because of a covered Disability following the Benefit Waiting Period,
your insurance will end; however, if you become a Member again immediately after LTD Benefits
end, the Eligibility Waiting Period will be waived and, with respect to the condition(s) for which LTD
Benefits were payable, the Preexisting Condition Exclusion will be applied as if your insurance had
remained in effect during that period of Disability.
2. If your insurance ends because you cease to be a Member for any reason other than a covered
Disability, and if you become a Member again within 90 days, the Eligibility Waiting Period will be
waived.
3. If your insurance ends because you fail to make a required premium contribution, you must
provide Evidence Of Insurability to become insured again.
4. If your insurance ends because you are on a federal or state -mandated family or medical leave of
absence, and you become a Member again immediately following the period allowed, your
insurance will be reinstated pursuant to the federal or state -mandated family or medical leave act
or law.
5. The Preexisting Conditions Exclusion will be applied as if insurance had remained in effect in the
following instances:
a. If you become insured again within 90 days.
b. If required by federal or state -mandated family or medical leave act or law and you become
insured again immediately following the period allowed under the family or medical leave act or
law.
6. In no event will insurance be retroactive.
LT.RE.oT.2
DEFINITION OF DISABILITY
You are Disabled if you meet the following definitions during the periods they apply:
A. Own Occupation Definition Of Disability.
B. Any Occupation Defmition Of Disability.
A. Own Occupation Definition Of Disability
During the Benefit Waiting Period and the Own Occupation. Period you are required to be Disabled
only from your Own Occupation.
You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury, Pregnancy
or Mental Disorder:
1. You are unable to perform with reasonable continuity the Material Duties of your Own
Occupation; and
2. You suffer a loss of at least 20% in your Indexed Predisability Earnings when working in your
Own Occupation.
Note: You are not Disabled merely because your right to perform your Own Occupation is
restricted, including a restriction or loss of license.
During the Own Occupation Period you may work in another occupation while you meet the Own
Occupation Definition Of Disability. However, you will no longer be Disabled when your Work
Printed 04/01/2013 - 6 - 720100-B
Earnings from another occupation meet or exceed 80% of your Indexed Predisability Earnings.
Your Work Earnings may be Deductible Income. See Return To Work Provisions and Deductible
Income.
Own Occupation means any employment, business, trade, profession, calling or vocation that
involves Material Duties of the same general character as the occupation you are regularly
performing for your Employer when Disability begins. In determining your Own Occupation, we
are not limited to looking at the way you perform your job for your Employer, but we may also look
at the way the occupation is generally performed in the national economy. If your Own Occupation
involves the rendering of professional services and you are required to have a professional or
occupational license in order to work, your Own Occupation is as broad as the scope of your
license.
Material Duties means the essential tasks, functions and operations, and the skills, abilities,
knowledge, training and experience, generally required by employers from those engaged in a
particular occupation that cannot be reasonably modified or omitted. In no event will we consider
working an average of more than 40 hours per week to be a Material Duty.
B. Any Occupation Definition Of Disability
During the Any Occupation Period you are required to be Disabled from all occupations.
You are Disabled from all occupations if, as a result of Physical Disease, Injury, Pregnancy or
Mental Disorder, you are unable to perform with reasonable continuity the Material Duties of Any
Occupation.
Any Occupation means any occupation or employment which you are able to perform, whether due
to education, training, or experience, which is available at one or more locations in the national
economy and in which you can be expected to earn at least 60% of your Indexed Predisability
Earnings within twelve months following your return to work, regardless of whether you are
working in that or any other occupation.
Material Duties means the essential tasks, functions and operations, and the skills, abilities,
knowledge, training and experience, generally required by employers from those engaged in a
particular occupation that cannot be reasonably modified or omitted. In no event will we consider
working an average of more than 40 hours per week to be a Material Duty.
Your Own Occupation Period and Any Occupation Period are shown in the Coverage Features.
(oWNOCC_ANY_WITH 40) LT.DD.oT.1
RETURN TO WORK PROVISIONS
A. Return To Work Responsibility
During the Own Occupation Period no LTD Benefits will be paid for any period when you are able
to work in your Own Occupation and able to earn at least 20% of your Indexed Predisability
Earnings, but you elect not to work.
During the Any Occupation Period no LTD Benefits will be paid for any period when you are able to
work in Any Occupation and able to earn at least 20% of your Indexed Predisability Earnings, but
you elect not to work.
B. Return To Work Incentive
You may serve your Benefit Waiting Period while working if you meet the Own Occupation
Definition Of Disability.
Printed 04/01/2013 - 7 -- 720100-B
You are eligible for the Return To Work Incentive on the first day you work after the Benefit
Waiting Period if LTD Benefits are payable on that date. The Return To Work Incentive changes 12
months after that date, as follows:
1. During the first 12 months, your Work Earnings will be Deductible Income as determined in a.,
b. and c:.
a. Determine the amount of your LTD Benefit as if there were no Deductible Income, and add
your Work Earnings to that amount.
b. Determine 100% of your Indexed Predisability Earnings.
c. If a. is greater than b., the difference will be Deductible Income.
2. After those first 12 months, 50% of your Work Earnings will be Deductible Income.
C. Work Earnings Definition
Work Earnings means your gross monthly earnings from work you perform while Disabled, plus
the earnings you could receive if you worked as much as you are able to, considering your
Disability, in work that is reasonably available:
a. In your Own Occupation during the Own Occupation Period; and
b. In Any Occupation during the Any Occupation Period.
Work Earnings includes earnings from your Employer, any other employer, or self-employment,
and any sick pay, vacation pay, annual or personal leave pay or other salary continuation earned
or accrued while working.
Earnings from, work you perform will be included in Work Earnings when you have the right to
receive them. If you are paid in a Iump sum or on a basis other than monthly, we will prorate your
Work Earnings over the period of tiTnc to which they apply. If no period of time is stated, we will
use a reasonable one.
In determining your Work Earnings we:
1. Will use the financial accounting method you use for income tax purposes, if you use that
method on a consistent basis.
2. Will not be limited to the taxable income you report to the Internal Revenue Service.
3. May ignore expenses under section 179 of the IRC as a deduction from your gross earnings.
4. May ignore depreciation as a deduction from your gross earnings.
5. May adjust the financial information you give us in order to clearly reflect your Work Earnings.
If we determine that your earnings vary substantially from month to month, we may determine
your Work Earnings by averaging your earnings over the most recent three-month period. During
the Own Occupation Period you will no longer be Disabled when your average Work Earnings over
the last three months exceed 80% of your Indexed Predisability Earnings. During the Any
Occupation Period you will no longer be Disabled when your average Work Earnings over the last
three months exceed 60% of your Indexed Predisability Earnings.
LT.Rw.oT. i
REASONABLE ACCOMMODATION EXPENSE BENEFIT
If you return to work in any occupation for any employer, not including self-employment, as a result of
a reasonable accommodation made by such employer, we will pay that employer a Reasonable
Accommodation Expense Benefit of up to $25,000, but not to exceed the expenses incurred.
Printed 04/01/2013 - 8 - 720100-B
The Reasonable Accommodation Expense Benefit is payable only if the reasonable accommodation is
approved by us in writing prior to its implementation.
LT.RA.OT.1
REHABILITATION PLAN PROVISION
While you are Disabled you may qualify to participate in a Rehabilitation Plan- Rehabilitation Plan
means a written plan, program or course of vocational training or education that is intended to
prepare you to return to work.
To participate in a Rehabilitation Plan you must apply on our forms or in a letter to us. The terms,
conditions and objectives of the plan mast be accepted by you and approved by us in advance. We
have the sole discretion to approve your Rehabilitation Plan.
While you are participating in an approved Rehabilitation Plan, your LTD Benefit will be increased by
10% of your Predisability Earnings. Your LTD Benefit may not exceed the Maximum LTD Benefit
shown in the Coverage Features as a result of this increase.
An approved Rehabilitation Plan may include our payment of some or all of the expenses you incur in
connection with the plan, including:
a. Training and education expenses.
b. Family care expenses.
c. Job-related expenses.
d, Job search expenses.
(WITH REHAB INC BFT) LT,RH.0T,1
TEMPORARY RECOVERY
You may temporarily recover from your Disability and then become Disabled again from the same
cause or causes without having to serve a new Benefit Waiting Period. Temporary Recovery means you
cease to be Disabled for no longer than the applicable Allowable Period. See Definition Of Disability.
A. Allowable Periods
1, During the Benefit Waiting Period: a total of 90 days of recovery.
2. During the Maximum Benefit Period: 180 days for each period of recovery.
B. Effect Of Temporary Recovery
If your Temporary Recovery does not exceed the Allowable Periods, the following will apply.
1. The Predisability Earnings used to determine your LTD Benefit will not change.
2. The period of Temporary Recovery will not count toward your Benefit Waiting Period, your
Maximum Benefit Period or your Own Occupation Period.
3. No LTD Benefits will be payable for the period of Temporary Recovery.
4. No LTD Benefits will be payable after benefits become payable to you under any other disability
insurance plan under which you become insured during your period of Temporary Recovery.
5. Except as stated above, the provisions of the Group Policy will be applied as if there had been
no interruption of your Disability.
(NEW TR PERIOD) LT.TR.OT,1
Printed 04/01/2013 - 9 - 720100-B
WHEN LTD BENEFITS END
Your LTD Benefits end automatically on the earliest of:
1. The date you are no longer Disabled.
2, The date your Maximum Benefit Period ends.
3. The date you die.
4. The date benefits become payable under any other LTD plan under which you become insured
through employment during a period of Temporary Recovery.
5. The date you fail to provide proof of continued Disability and entitlement to LTD Benefits.
LT.BE.OT.1
PREDISABILITY EARNINGS
Your Predisability Earnings will be based on your earnings in effect on your last full day of Active
Work. Any subsequent change in your earnings after that last full day of Active Work will not affect
your Predisability Earnings.
Predisability Earnings means your monthly rate of earnings from your Employer, including:
1. Contributions you make through a salary reduction agreement with your Employer to:
a. An Internal Revenue Code (IRC) Section 401(k), 403(b), 408(k), 408(p), or 457 deferred
compensation arrangement; or
b. An executive nonqualified deferred compensation arrangement.
2. Commissions averaged over the preceding 12 months or over the period of your employment if
less than 12 months.
3. Shift differential pay.
.4. Amounts contributed to your fringe benefits according to a salary reduction agreement under
an IRC Section 125 plan.
Predisability Earnings does not include:
1. Bonuses.
2. Overtime pay.
3. Stock options or stock bonuses.
4. Your Employer's contributions on your behalf to any deferred compensation arrangement or
pension plan.
5. Any other extra compensation.
If you are paid on an annual contract basis, your monthly rate of earnings is one -twelfth (1/12th) of
your annual contract salary.
If you are paid hourly, your monthly rate of earnings is based on your hourly pay rate multiplied by
the number of hours you are regularly scheduled to work per month, but not more than 173 hours. If
you do not have regular work hours, your monthly rate of earnings is based on the average number of
hours you worked per month during the preceding 12 calendar months (or during your period of
employment if less than 12 months), but not more than 173 hours.
(REG WITH COM NO STOCK) LT.PD.OT.1
Printed 04/01/2013 - 10- 720100-B
DEDUCTIBLE INCOME
Subject to Exceptions To Deductible Income, Deductible Income means:
1. Sick pay, annual or personal leave pay, severance pay, or other salary continuation, including
donated amounts, (but not vacation pay) paid to you by your Employer, if it exceeds the amount
found in a. , b., and c.
a. Determine the amount of your LTD Benefit as if there were no Deductible Income, and add
your sick pay or other salary continuation to that amount.
b. Determine 100% of your Indexed Predisability Earnings.
c. If a. is greater than b., the difference will be Deductible Income.
2. Your Work Earnings, as described in the Return To Work Provisions.
3. Any amount you receive or are eligible to receive because of your disability, including amounts for
partial or total disability, whether permanent, temporary, or vocational, under any of the following:
a. A workers' compensation law;
b. The Jones Act;
e. Maritime Doctrine of Maintenance, Wages, or Cure;
d. Longshoremen's and Harbor Worker's Act; or
c. Any similar act or law.
4. Any amount you, your spouse, or your child under age 18 receive or are eligible to receive because
of your disability or retirement under:
a. The Federal Social Security Act;
b. The Canada Pension Plan,
c. The Quebec Pension Plan;
d. The Railroad Retirement Act; or
e. Any similar plan or act.
Full offset: Both the primary benefit (the benefit awarded to you) and dependents benefit are
Deductible Income.
Benefits your spouse or a child receives or are eligible to receive because of your disability are
Deductible Income regardless of marital status, custody, or place of residence. The term "child"
has the meaning given in the applicable plan or act.
Printed 04/01/2013 - 11 - 720100-B
5. Any amount you receive or are eligible to receive because of your disability under any state
disability income benefit law or sin lar law.
6. Any amount you receive or are eligible to receive because of your disability under another group
insurance coverage.
7. Any disability or retirement benefits you receive or are eligible to receive under your Employer's
retirement plan, including a public employee retirement system, a state teacher retirement system,
and a plan arranged and maintained by a union or employee association for the benefit of its
members. You and your Employer's contributions will be considered as distributed
simultaneously throughout your lifetime, regardless of how funds are distributed from the
retirement plan.
If any of these plans has two or more payment options, the option which comes closest to providing
you a monthly income for life with no survivors benefit will be Deductible Income, even if you
choose a different option.
8. Any earnings or compensation included in Predisability Earnings which you receive or are eligible
to receive while LTD Benefits are payable.
9. Any amount you receive or are eligible to receive under any unemployment compensation law or
similar act or law.
10. Any amount you receive or are eligible to receive from or on behalf of a third party because of your
disability, whether by judgment, settlement or other method. If you notify us before filing suit or
settling your claim against such third party, the amount used as Deductible Income will be
reduced by a pro rata share of your costs of recovery, including reasonable attorney fees.
11. Any amount you receive by compromise, settlement, or other method as a result of a claim for any
of the above, whether disputed or undisputed.
(NO OTHR OFFST_PUB WITH 3RD) LT.DI.OT.1
EXCEPTIONS TO DEDUCTIBLE INCOME
Deductible Income does not include:
1. Any cost of living increase in any Deductible Income other than "Work Earnings, if the increase
becomes effective while you are Disabled and while you are eligible for the Deductible Income.
2. Reimbursement for hospital, medical, or surgical expense.
3. Reasonable attorneys fees incurred in connection with a claim for Deductible Income.
4. Benefits from any individual disability insurance policy.
5. Early retirement benefits under the Fcdcral Social Security Act which are not actually received.
6. Group credit or mortgage disability insurance benefits.
7. Accelerated death benefits paid under a life insurance policy.
8. Benefits from the following:
a. Profit sharing plan.
b. Thrift or savings plan.
c. Deferred compensation plan.
d. Plan under IRC Section 401(k), 408(k), 408(p), or 457.
e. Individual Retirement Account (IRA).
f. Tax Sheltered Annuity (TSA) under IRC Section 403(b).
Printed 04/01/2013 -12- 720100-B
g. Stock ownership plan.
h. Keogh (HR -10) plan.
RULES FOR DEDUCTIBLE INCOME
A. Monthly Equivalents
(PUB -NO OTHR OFFST) LT.ED.OT.1
Each month we will determine your LTD Benefit using the Deductible Income for the same monthly
period, even if you actually receive the Deductible Income in another month.
If you are paid Deductible Income in a lump sum or by a method other than monthly, we will
determine your LTD Benefit using a prorated amount. We will use the period of time to which the
Deductible Income applies. If no period of time is stated, we will use a reasonable one.
B. Your Duty To Pursue Deductible Income
You must pursue Deductible Income for which you may be eligible. We may ask for written
documentation of your pursuit of Deductible Income. You must provide it within 60 days after we
mail you our request. Otherwise, we may reduce your LTD Benefits by the amount we estimate you
would be eligible to receive upon proper pursuit of the Deductible Income.
C. Pending Deductible Income
We will not deduct pending Deductible Income until it becomes payable. You must notify us of the
amount of the Deductible Income when it is approved. You must repay us for the resulting
overpayment of your claim.
D. Overpayment Of Claim
We will notify you of the amount of any overpayment of your claim under any group disability
insurance policy issued by us. You must immediately repay us. You will not receive any LTD
Benefits until we have been repaid in full. In the meantime, any LTD Benefits paid, including the
Minimum LTD Benefit, will be applied to reduce the amount of the overpayment. We may charge
you interest at the legal rate for any overpayment which is not repaid within 30 days after we first
mail you notice of the amount of the overpayment.
LT.RYJ.OT.l
SUBROGATION
If LTD Benefits are paid or payable to you under the Group Policy as the result of any act or omission
of a third party, we will be subrogated to all rights of recovery you may have in respect to such act or
omission. You must execute and deliver to us such instruments and papers as may be required and
do whatever else is needed to secure such rights. You must avoid doing anything that would prejudice
our rights of subrogation.
If you notify us before filing suit or settling your claim against such third party, the amount to which
we are subrogated will be reduced by a pro rata share of your costs of recovery, including reasonable
attorney fees. If suit or action is filed, we may record a notice of payments of LTD Benefits, and such
notice shall constitute a lien on any judgment recovered.
If you or your legal representative fail to bring suit or action promptly against such third party, we
may institute such suit or action in our name or in your name. We are entitled to retain from any
judgment recovered the amount of LTD Benefits paid or to be paid to you or on your behalf, together
with our costs of recovery, including attorney fees. The remainder of such recovery, if any, shall be
paid to you or as the court may direct.
LT.SG.OT.1
Printed 04/01/2013 - 13 - 720100-B
SURVIVORS BENEFIT
If you die while LTD Benefits are payable, and on the date you die you have been continuously
Disabled for at least 180 days, we will pay a Survivors Benefit according to I through 4 below.
1. The Survivors Benefit is a lump sum equal to 3 times your LTD Benefit without reduction by
Deductible Income.
2. The Survivors Benefit will first be applied to reduce any overpayment of your claim.
3. The Survivors Benefit will be paid at our option to any one or more of the following:
a. Your surviving spouse;
b. Your surviving unmarried children, including adopted children, under age 25;
c. Your surviving spouse's unmarried children, including adopted children, under age 25; or
d. Any person providing the care and support of any person listed in a., b., or c. above.
4. No Survivors Benefit will be paid if you are not survived by any person listed in a., b., or c. above.
(MULTPL) LT.SB.OT.1
BENEFITS AFTER INSURANCE ENDS OR IS CHANGED
During each period of continuous Disability, we will pay LTD Benefits according to the terms of the
Group Policy in effect on the date you become Disabled. Your right to receive LTD Benefits will not be
aff' ctcd by:
1. Any amendment to the Group Policy that is effective after you become Disabled.
2. Termination of the Group Policy after you become Disabled.
LT.BA.OT.1
EFFECT OF NEW DISABILITY
If a period of Disability is extended by a new cause while LTD Benefits are payable, LTD Benefits will
continue while you remain Disabled. However, 1 and 2 apply.
1. LTD Benefits will not continue beyond the end of the original Maximum Benefit Period.
2. The Disabilities Excluded From Coverage, Disabilities Subject To Limited Pay Periods, and
Limitations sections will apply to the new cause of Disability.
DISABILITIES EXCLUDED FROM COVERAGE
A. War
LT.ND.OT.1
You are not covered for a Disability caused or contributed to by War or any act of War. War means
declared or undeclared war, whether civil or international, and any substantial armed conflict
between organized forces of a military nature.
B. Intentionally Self -Inflicted Injury
You are not covered for a Disability caused or contributed to by an intentionally self-inflicted
Injury, while sane or insane.
Printed 04/01/2013 - 14 - 720100-B
C. Preexisting Condition
1. Definition
Preexisting Condition means a mental or physical condition whether or not diagnosed or
misdiagnosed:
a. For which you have done or for which a reasonably prudent person would have done any of
the following:
i. Consulted a physician or other licensed medical professional;
ii. Received medical treatment, services or advice;
W. Undergone diagnostic procedures, including self-administered procedures;
iv. Taken prescribed drugs or medications;
b. Which, as a result of any medical examination, including routine examination, was
discovered or suspected;
at any time during the 90 -day period just before your insurance becomes effective.
2. Exclusion
You are not covered for a Disability caused or contributed to by a Preexisting Condition or
medical or surgical treatment of a Preexisting Condition unless, on the date you become
Disabled, you:
a. Have been continuously insured under the Group Policy for 12 months; and
b. Have been Actively At Work for at least one full day after the end of that 12 months.
D. Loss Of License Or Certification
You are not covered for a Disability caused or contributed to by the loss of your professional
license, occupational license or certification.
E. Violent Or Criminal Conduct
You are not covered for a Disability caused or contributed to by your committing or attempting to
commit an assault or felony, or actively participating in a violent disorder or riot. Actively
participating does not include being at the scene of a violent disorder or riot while performing your
official duties.
(WITH PRUDNT) LT.XD.OT.1
DISABILITIES SUBJECT TO LIMITED PAI' PERIODS
A. Mental Disorders, Substance Abuse and Other Limited Conditions
Payment of LTD Benefits is limited to 24 months during your entire lifetime for a Disability caused
or contributed to by any one or more of the following, or medical or surgical treatment of one or
more of the following:
1. Mental Disorders;
2. Substance Abuse; or
3, Other Limited Conditions.
However, if you are confined in a Hospital solely because of a Mental Disorder at the end of the 24
months, this limitation will not apply while you are continuously confined.
Mental Disorder means any mental, emotional, behavioral, psychological, personality, cognitive,
mood or stress-related abnormality, disorder, disturbance, dysfunction or syndrome, regardless of
Printed 04/01/2013 - 15- 720100-B
cause (including any biological or biochemical disorder or imbalance of the brain) or the presence
of physical symptoms. Mental Disorder includes, but is not limited to, bipolar affective disorder,
organic brain syndrome, schizophrenia, psychotic illness, manic depressive illness, depression and
depressive disorders, anxiety and anxiety disorders.
Substance Abuse means use of alcohol, alcoholism, use of any drug, including hallucinogens, or
drug addiction,
Other Limited Conditions means chronic fatigue conditions (such as chronic fatigue syndrome,
chronic fatigue immunodeficiency syndrome, post viral syndrome, limbic encephalopathy, Epstein-
Barr virus infection, herpes virus type 6 infection, or myalgic encephalomyelitis), any allergy or
sensitivity to chemicals or the environment (such as environmental allergies, sick building
syndrome, multiple chemical sensitivity syndrome or chronic toxic encephalopathy), chronic pain
conditions (such as fibromyalgia, reflex sympathetic dystrophy or myofascial pain) , carpal tunnel
or repetitive motion syndrome, temporomandibular joint disorder, or craniomandibular joint
disorder.
However, Other Limited Conditions does not include neoplastic diseases, neurologic diseases,
endocrine diseases, hematologic diseases, asthma, allergy -induced reactive lung disease, tumors,
malignancies, or vascular malformations, demyelinating diseases, or lupus.
Hospital means a legally operated hospital providing full-time medical care and treatment under
the direction of a full-time staff of licensed physicians. Rest homes, nursing homes, convalescent
homes, homes for the aged, and facilities primarily affording custodial, educational, or
rehabilitative care are not Hospitals.
B. Rules For Disabilities Subject To Limited Pay Periods
1. If you are Disabled as a result of a Mental Disorder or any Physical Disease or Injury for which
payment of LTD Benefits is subject to a limited pay period, and at the same time are Disabled
as a result of a Physical Disease, Injury, or Pregnancy that is not subject to such limitation,
LTD Benefits will be payable first for conditions that are subject to the limitation.
2. No LTD Benefits will be payable after the end of the limited pay period, unless on that date you
continue to be Disabled as a result of a Physical Disease, Injury, or Pregnancy for which
payment of LTD Benefits is not limited.
LIMITATIONS
A. Care Of A Physician
LT.LP.OT.1
You must be under the ongoing care of a Physician in the appropriate specialty as determined by
us during the Benefit Waiting Period. No LTD Benefits will be paid for any period of Disability
when you are not under the ongoing care of a Physician in the appropriate specialty as determined
by us.
B, Return To Work Responsibility
During the Own Occupation, Period no LTD Benefits will be paid for any period of Disability when
you are able to work in your Own Occupation and able to earn at least 20% of your Indexed
Predisability Earnings, but you elect not to worn.
During the Any Occupation Period, no LTD Benefits will be paid for any period of Disability when
you are able to work in Any Occupation and able to earn at least 20% of your Indexed Predisability
Earnings, but elect not to work.
Printed 04/01/2013 - 16- 720100-B
C. Rehabilitation Program
No LTD Benefits will be paid for any period of Disability when you are not participating in good
faith in a plan, program or course of medical treatment or vocational training or education
approved by us unless your Disability prevents you from participating.
D. Foreign Residency
Payment of LTD Benefits is limited to 12 months for each period of continuous Disability while you
reside outside of the United States or Canada.
E. Imprisonment
No LTD Benefits will be paid for any period of Disability when you are confined for any reason in a
penal or correctional institution.
CLAIMS
A. Filing A Claim
LT.LM.oT.I
Claims should be filed on our forms. If we do not provide our forms within 15 days after they are
requested, you may submit your claim in a letter to us. The letter should include the date
disability began, and the cause and nature of the disability.
B. Time Limits On Filing Proof Of Loss
You must give us Proof Of Loss within 90 days after the end of the Benefit Waiting Period. If you
cannot do so, you must give it to us as soon as reasonably possible, but not later than one year
after that 90 -day period. If Proof Of Loss is filed outside these time limits, your claim will be
denied. These limits will not apply while you lack legal capacity.
C. Proof Of Loss
Proof Of Loss means written proof that you are Disabled and entitled to LTD Benefits. Proof Of
Loss must be provided at your expense.
For claims of Disability due to conditions other than Mental Disorders, we may require proof of
physical impairment that results from anatomical or physiological abnormalities which are
demonstrable by medically acceptable clinical and laboratory diagnostic techniques.
D. Documentation
Completed claims statements, a signed authorization for us to obtain information., and any other
items we may reasonably require in support of a claim must be submitted at your expense. If the
required documentation is not provided within 45 days after we mail our request, your claim may
be denied.
E. Investigation Of Claim
We may investigate your claim at any time.
At our expense, we may have you examined at reasonable intervals by specialists of our choice.
We may deny or suspend LTD Benefits if you fail to attend an examination or cooperate with the
examiner.
F. Time Of Payment
We will pay LTD Benefits within 60 days after you satisfy Proof Of Loss.
LTD Benefits will be paid to you at the end of each month you qualify for them. LTD Benefits
remaining unpaid at your death will be paid to the person(s) receiving the Survivors Benefit. If no
Survivors Benefit is paid, the unpaid LTD Benefits will be paid to your estate.
Printed 04/01/2013 -17- 720100-B
G. Notice Of Decision On Claim
We will evaluate your claim promptly after you file it, Within 45 days after we receive your claim
we will send you: (a) a written decision on your claim; or (b) a notice that we are extending the
period to decide your claim for 30 days. Before the end of this extension period we will send you:
(a) a written decision on your claim; or (b) a notice that we are extending the period to decide your
claim for an additional 30 days. If an extension is due to your failure to provide information
necessary to decide the claim, the extended time period for deciding your claim will not begin until
you provide the information or otherwise respond.
If we extend the period to decide your claim, we will notify you of the following: (a) the reasons for
the extension; (b) when we expect to decide your claim; (c) an explanation of the standards on
which entitlement to benefits is based; (d) the unresolved issues preventing a decision; and (e) any
additional information we need to resolve those issues.
If we request additional information, you will have 45 days to provide the information. If you do
not provide the requested information within 45 days, we may decide your claim based on the
information we have received.
If we deny any part of your claim, you will receive a written notice of denial containing:
a. The reasons for our decision.
b. Reference to the parts of the Group Policy on which our decision is based.
c. A description of any additional information needed to support your claim.
d. Information concerning your right to a review of our decision.
H. Review Procedure
If all or part of a claim is denied, you may request a review. You must request a review in writing
within 180 days after receiving notice of the denial.
You may send us written comments or other items to support your claim. You may review and
receive copies of any non -privileged information that is relevant to your request for review. There
will be no charge for such copies. You may request the names of medical or vocational experts
who provided advice to us about your claim.
The person conducting the review will be someone other than the person who denied the claim and
will not be subordinate to that person. The person conducting the review will not give deference to
the initial denial decision. If the denial was based on a medical judgment, the person conducting
the review will consult with a qualified health care professional. This health care professional will
be someone other than the person who made the original medical judgment and will not be
subordinate to that person. Our review will include any written comments or other items you
submit to support your claim.
We will review your claim promptly after we receive your request. Within 45 days after we receive
your request for review we will send you: (a) a written decision on review; or (b) a notice that we are
extending the review period for 45 days. If the extension is due to your failure to provide
information necessary to decide the claim on review, the extended time period for review of your
claim will not begin until you provide the information or otherwise respond.
If we extend the review period, we will notify you of the following: (a) the reasons for the extension;
(b) when we expect to decide your claim on review; and (c) any additional information we need to
decide your claim.
If we request additional information, you will have 45 days to provide the information. If you do
not provide the requested information within 45 days, we may conclude our review of your claim
based on the information we have received.
If we deny any park of your claim on review, you will receive a written notice of denial containing:
Printed 04/01/2013 - 18 - 720100-B
a. The reasons for our decision.
b. Reference to the parts of the Group Policy on which our decision is based.
c. Information concerning your right to receive, free of charge, copies of non -privileged documents
and records relevant to your claim.
I. As signment
The rights and benefits under the Group Policy are not assignable.
(REV PUH WRD,G) LT. M OT.2
ALLOCATION OF AUTHORITY
Except for those functions which the Group Policy specifically reserves to the Policyholder or
Employer, we have full and exclusive authority to control and manage the Group Policy, to administer
claims, and to interpret the Group Policy and resolve all questions arising in the administration,
interpretation, and application of the Group Policy.
Our authority includes, but is not limited to:
1. The right to resolve all matters when a review has been requested;
2. The right to establish and enforce rules and procedures for the administration of the Group
Policy and any claim under it;
3. The right to determine:
a. Eligibility for insurance;
b. Entitlement to benefits;
c. The amount of benefits payable; and
d. The sufficiency and the amount of information we may reasonably require to determine a.,
b„ or c., above.
Subject to the review procedures of the Group Policy, any decision we make in the exercise of our
authority is conclusive and binding.
LT AI..OT.1
TIME LIMITS ON LEGAL ACTIONS
No action at law or in equity may be brought until 60 days after you have given us Proof Of Loss. No
such action may be brought more than three years after the earlier of:
1. The date we receive Proof Of Loss; and
2. The time within which Proof Of loss is required to be given.
LT.TL.OT.1
INCONTESTABILITY PROVISIONS
A. Incontestability Of Insurance
Any statement made to obtain insurance or to increase insurance is a representation and not a
warranty.
No misrepresentation will be used to reduce or deny a claim or contest the validity of insurance
unless:
1. The insurance would not have been approved if we had known the truth; and
Printed 04/01/2013 - 19- 720100-B
2. We have given you or any other person claiming benefits a copy of the signed written
instrument which contains the misrepresentation.
After insurance has been in effect for two years during the lifetime of the insured, we will not use a
misrepresentation to reduce or deny the claire, unless it was a fraudulent misrepresentation.
B. Incontestability Of The Group Policy
Any statement made by the Policyholder or Employer to obtain the Group Policy is a representation
and not a warranty.
No misrepresentation by the Policyholder or your Employer will be used to deny a claim or to deny
the validity of the Group Policy unless:
1. The Group Policy would not have been issued if we had known the truth; and
2. We have given the Policyholder or Employer a copy of a written instrument signed by the
Policyholder or Employer which contains the misrepresentation.
The validity of the Group Policy will not be contested after it has been in force for two years, except
for nonpayment of premiums or fraudulent misrepresentations.
CLERICAL ERROR, AGENCY, AND MISSTATEMENT
A. Clerical Error
MIN, 07.1
Clerical error by the Policyholder, your Employer, or their respective employees or representatives
will not:
1. Cause a person to become insured.
2. Invalidate insurance under the Group Policy otherwise validly in force.
3. Continue insurance under the Group Policy otherwise validly terminated.
B. Agency
The Policyholder and your Employer act on their own behalf as your agent, and not as our agent.
The Policyholder and your Employer have no authority to alter, expand or extend our liability or to
waive, modify or compromise any defense or right we may have under the Group Policy.
C. Misstatement Of Age
If a person's age has been misstated, we will make an equitable adjustment of premiums, benefits,
or both. The adjustment will be based on:
1. The amount of insurance based on the correct age; and
2. The difference between the premiums paid and the premiums which would have been paid if
the age had been correctly stated.
M CL. oT.1
TERMINATION OR AMENDMENT OF THE GROUP POLICY
The Group Policy may be terminated by us or the Policyholder according to its terms. It will terminate
automatically for nonpayment of premium. The Policyholder may terminate the Group Policy in whole,
and may terminate insurance for any class or group of Members, at any time by giving us written
notice.
Benefits under the Group Policy are limited to its terms, including any valid amendment. No change
or amendment will be valid unless it is approved in writing by one of our executive officers and given to
Printed 04/01/2013 -20- 720100-B
the Policyholder for attachment to the Group Policy. If the terms of the certificate differ from the
Group Policy, the terms stated in the Group Policy will govern. The Policyholder, your Employer, and
their respective employees or representatives have no right or authority to change or amend the Group
Policy or to waive any of its terms or provisions without our signed written approval.
We may change the Group Policy in whole or in part when any change or clarification in law or
governmental regulation affects our obligations under the Group Policy, or with the Policyholder's
consent.
Any such change or amendment of the Group Policy may apply to current or future Members or to any
separate classes or groups of Members.
LT.TA.OT. I
DEFINITIONS
Benefit Waiting Period means the period you must be continuously Disabled before LTD Benefits
become payable. No LTD Benefits are payable for the Benefit Waiting Period. See Coverage Features,
Contributory means insurance is elective and Members pay all or part of the premium for insurance.
CPI -W means the Consumer Price Index for Urban Wage Earners and Clerical Workers published by
the United States Department of Labor. If the CPI -W is discontinued or changed, we may use a
comparable index. Where required, we will obtain prior state approval of the new index.
Employer means an employer (including approved affiliates and subsidiaries) for which coverage under
the Group Policy is approved in writing by us.
Group Policy means the group LTD insurance policy issued by us to the Policyholder and identified by
the Group Policy Number.
Indexed Predisability Earnings means your Predisability Earnings adjusted by the rate of increase in
the CPI -W. During your first year of Disability, your Indexed Predisability Earnings are the same as
your Predisability Earnings. Thereafter, your Indexed Predisability Earnings are determined on each
anniversary of your Disability by increasing the previous year's Indexed Predisability Earnings by the
rate of increase in the CPI -W for the prior calendar year. The maximum adjustment in any year is
10%. Your Indexed Predisability Earnings will not decrease, even if the CPI -W decreases.
Injury means an injury to the body.
L.L.C. Owner -Employee means an individual who owns an equity interest in an Employer and is
actively employed in the conduct of the Employer's business.
LTD Benefit means the monthly benefit payable to you under the terms of the Group Policy.
Maximum Benefit Period means the longest period for which LTD Benefits are payable for any one
period of continuous Disability, whether from one or more causes. It begins at the end of the Benefit
Waiting Period. No LTD Benefits are payable after the end of the Maximum Benefit Period, even if you
are still Disabled. See Coverage Features.
Noncontributory means (a) insurance is nonelective and the Policyholder or Employer pay the entire
premium for insurance; or (b) the Policyholder or Employer require all eligible Members to have
insurance and to pay all or part of the premium for insurance.
P.C. Partner means the sole active employee and majority shareholder of a professional corporation in
partnership with the Policyholder.
Physical Disease means a physical disease entity or process that produces structural or functional
changes in the body as diagnosed by a Physician.
Physician mans a licensed M.D. or D.O., acting within the scope of the license. Physician does not
include you or your spouse, or the brother, sister, parent, or child of either you or your spouse.
Printed 04/01/2013 -21- 720100-B
Pregnancy means your pregnancy, childbirth, or related medical conditions, including complications of
pregnancy.
Prior Plan means your EmpIoyer's group long term disability insurance plan in effect on the day before
the effective date of your Employer's participation under the Group Policy and which is replaced by
coverage under the Group Policy.
POLICYHOLDER PROVISIONS
A. Premiums
LT, DF. oT.1
The premium due on each Premium Due Date is the sum of the premiums for all persons then
insured. Premium Rates are shown in Coverage Features.
B. Contributions From Members
The Policyholder determines the amount, if any, of each Member's contribution toward the cost of
insurance.
C. Changes In Premium Rates
We may change Premium Rates whenever:
1. A change or clarification in law or governmental regulation affects the amount payable under
the Group Policy. Any such change in Premium Rates will reflect only the change in our
obligations.
2. Factors material to underwriting the risk we assumed under the Group Policy with respect to
an Employer, including, but not limited to, number of persons insured, age, Predisability
Earnings, gender, and occupational classification, changes by 25% or more.
3. The premium contribution arrangement for Members is changed or varies from that stated in
the Group Policy when issued or last renewed.
4. We and the Policyholder or the Employer mutually agree to change Premium Rates.
Except as provided above, Premium Rates will not be changed during the Initial Rate Guarantee
Period shown in Coverage Features. Thereafter, except as provided above, we may change
Premium Rates upon 31 days advance written notice to the Policyholder. Any such change in
Premium, Rates may be made effective on any Premium Due Date, but no such change will be
made more than once in any contract year. Contract years are successive 12 month periods
computed from the end of the Initial Rate Guarantee Period.
D. Payment Of Premiums
All premiums are due on the Premium Due Dates shown in Coverage Features.
Each premium is payable on or before its Premium Due Date directly to us at our home office. The
payment of each premium by the Policyholder as it becomes due will maintain the Group Policy in
force until the next Premium Due Date.
E. Grace Period And Termination For Nonpayment
If a premium is not paid on or before its Premium Due Date, it may be paid during the following
Grace Period of 31 days. The Group Policy or an Employer's coverage under the Group Policy will
remain in force during the Grace Period.
If the premium is not paid during the Grace Period, the Group Policy will terminate automatically
at the end of the Grace Period.
Printed 04/01/2013 -22- 720100-B
The Policyholder is liable for premium for coverage during the Grace Period. We may charge
interest at the legal rate for any premium which is not paid during the Grace Period, beginning
with the first day after the Grace Period.
F. Termination For Other Reasons
The Policyholder may terminate the Group Policy by giving us written notice. The effective date of
termination will be the later of
1. The date stated in the notice; and
2. The date we receive the notice.
We may terminate the Group Policy as follows;
1. On any Premium Due Date if the number of persons insured is less than the Minimum
Participation shown in Coverage Features.
2. On any Premium Due Date if we determine that the Policyholder has failed to promptly furnish
any necessary information requested by us, or has failed to perform any other obligations
relating to the Group Policy.
The minimum advance notice of termination by us is 31 days.
G. Premium Adjustments
Premium adjustments involving a return of unearned premiums to the Policyholder will be limited
to the 12 months ,just before the date we receive a request for premium adjustment.
H. Certificates
We will issue certificates to the Policyholder showing the coverage under the Group Policy. The
Policyholder will distribute a certificate to each insured Member. If the terms of the certificate
differ from the Group Policy, the terms stated in the Group Policy will govern.
I. Records And Reports
The Policyholder will furnish on our forms all information reasonably necessary to administer the
Group Policy. We have the right at all reasonable times to inspect the payroll and other records of
the Policyholder which relate to insurance under the Group Policy.
J. Agency And Release
Individuals selected by the Policyholder or by any Employer to secure coverage under the Group
Policy or to perform their administrative function under it, represent and act on behalf of the
person selecting them, and do not represent or act on behalf of Standard, The Policyholder,
Employer and such individuals have no authority to alter, expand or extend our liability or to
waive, modify or compromise any defense or right we may have under the Group Policy. The
Policyholder and each Employer hereby release, hold harmless and indemnify Standard from any
liability arising from or related to any negligence, error, omission, misrepresentation or dishonesty
of any of them or their representatives, agents or employees.
K. Notice Of Suit
The Policyholder or Employer shall promptly give us written notice of any lawsuit or other legal
proceedings arising under the Group Policy.
L. Entire Contract, Changes
The Group Policy and the applications of the Policyholder constitute the entire contract between
the parties. A copy of the Policyholder's application is attached to the Group Policy when issued.
The Group Policy may be changed in whole or in part, No change in the Group Policy will be valid
unless it is approved in writing by one of our executive officers and given to the Policyholder for
Printed 04/01/2013 -23- 720100-B
attachment to the Group Policy. No agent has authority to change the Group Policy, or to waive
any of their provisions.
M. Effect On Workers' Compensation, State Disability Insurance
The coverage provided under the Group Policy is not a substitute for coverage under a workers'
compensation or state disability income benefit law and does not relieve the Employer of any
obligation to provide such coverage.
{ND DM LT.PH.DT.1
AK/LTDP2000
Printed 04/01/2013 -24- 720100-B
City of Miami, Florida
Form B
Price Proposal Schedule
RFP No. 680381.
The Proposer's price shall be submitted on this Form -"Price Proposal Schedule", and in the manner stated
herein. Proposer is requested to fill in the applicable blanks on this form.
A. EMPLOYER FUNDED (FULL- PARTICIPATION) DISABILITY INSURANCE PROGRAM
The proposed price for providing all services as stated in Section 3.0, Scope of Services, including the plan designs identified in Exhibit
2, shall be as stipulated below. The price shall be for a fully -insured program. The City intends to award all lines of business to one
provider. Prices requested below shall be provided on a bi- weekly basis.
SHORT-TERM DISABILITY {STD] see attached page for detail (carrier bill will be monthly)
Plan Design
Bi -weekly Rate Per $100 of Weekly Benefit
$2,000 maximum benefit per week
(14 -day waiting period)
Pign Year 2018
111118-12131118
$ .137 Bi Weekly
Plan Year 2019
Plan Year 2020
111120-12131120
$NA
111119-12131119
$.137 Bi -Weekly
LONG-TERM DISABILITY (LTD), see attached page for detail (carrier bill will be monthly)
Plan Design
Bi -weekly Rate Per $100 of
$2,000 maximum benefit per week
Covered Monthly Payroll
$10,000 maximum benefit per month
Plan Year 20218
Plan Year 2019
Plan Year 2020
(180 -day waiting period)
111118-12131118
111119-12131119
111120-12131120
$ See attached page
$ .189 Bi -Weekly
$ .189 Bi -Weekly
$ NA
B. FULLY EMPLOYEE FUNDED (VOLUNTARY PARTICIPATION) DISABILITY INSURANCE PROGRAM
The proposed price for providing all services as stated in Section 3.0, Scope of Services, including the plan
designs identified in Exhibit 2, shall be as stipulated below. The price shall be for a fully -insured, vollintar
program. The City intends to award all lines of business to one provider. Prices requested below shall be
provided on a bi-weekly basis.
SHORT-TERM DISABILITY STD Age Banded Rates, see attached 12age f r detail
Plan Design
Bi -weekly Rate Per $100 of Weekly Benefit
$2,000 maximum benefit per week
Plan Year 2018
Plan Year 2019
Plgn Y2ar 2020
(14 -day waiting period)
111118-12131118
111119-12131119
111120-12131120
119-12131119
111120-12131120
$ See attached page
See att. page
$ NA
LONG-TERM DISABILITY (LTD) Arse Banded Ratg5, see next gage for detail
Plan Design
Bi -weekly Rate Per $100 of
Covered Monthly Payroll
$10,000 maximum benefit per month
Plan Year 2018
Plan Year 2019
Plan Year 2020
(180 -day waiting period)
111118-12131118
119-12131119
111120-12131120
$ See attached page
See attached page
$
Page 1
EMPLOYEE DISABILITY INSURANCE PROGRAM Rev. 3.15.17
City of Aliami, Florida
RFP No. 680381
PREMIER LONG-TERM DISABILITY See attached Rate Page for detail
Plan Design
Bi -weekly Rate Per $100 of
No
Covered Monthly Payroll
$10,000 maximum benefit per month
Plan Year 2018
Plan Year 2019
Plan Year 2020
(90 -day waiting period)
111/18-12131118
111119-12121/19„,
111120-12131120
$ .283
$ .283
$NA
MINIMUM PARTICIPATION REQUIREMENTS (01tional]
Based on Proposer's proposed employee funded rates, indicate guarantee participation periods:
Participation Guarantee Period (Number of Plan Years)
Greater than 25% 25 % required 2 rears
Between 20% and 25%
Between 15% and 20%
Between 10% and 15%
Below 10%
N off:
1. The rates shall be guaranteed for first two (2) Plan years (through December 31, 2019). It is preferable
that rates not be contingent upon minimum participation requirements, however, Proposer may list the
guarantee periods relating to minimum requirements in the chart above. For Plan Year 2020 and the
optional renewal period, the then current rates will remain, unless the City approves an increase in the
rates, pursuant to Section 4 of the Agreement.
2. Notwithstanding the Proposer's proposed rates, payment to the Successful Proposer shall be based on
the actual enrollment of employees and the actual volume of insurance in the Plans.
3. Proposed rates in Sections A & B will be used to determine the price points for the Price criterion as
indicated.
4. Proposers may confirm optional year guaranteed rate commitment as provided for below in Section C.
C. OPTION TO RENEW YEARS
The City prefers that Proposer guarantee rates for optional 3 -year period (beyond initial term). Proposer should
state whether Proposer will hold rates for the three-year option to renew period by completing the below
information.
Optional Renew Period (January 1, 2020- December 31, 2023)
Yes
No
Will Proposer guarantee its prior year rates for the three-year
option to renew period? If so, please provide rates.
Subject to
Underwriting Re`°tew
Note: Section C is for informational and negotiation purposes only and will not be utilized for scoring
purposes.
Page 2
EMPLOYEE DISABILfTY INSURANCE PROGRAM Rev. 3.15.17
City of Miami Alternative Form B Price Proposal Schedule
A) Employer Funded STD
14-14-180 Day Duration
Bi -weekly Rate 0.137
Monthly Billed rate
Rates Guaranteed to 12/31/2019
B) Employee Funded STD with
180 Day Benefit Period. 25%
minimum participation
Required. Age banded Rates
I A) Employer Funded LTD with
180 Day Waiting Period ' I
Bi -weekly Rate 0.189
Monthly Billed rate 0.409
Rates Guaranteed to 12/31/2019
B) Employee Funded LTD with
180 Day Waiting Period. 25%
minimum participation
Required. Age banded Rates.
gilled
Bi -weekly
monthly STD
Age
STD Rates
rates
0-29
0.218
0.472
30-34
0.241
0.523
35-39
0.188
0.408
40-44
0.175
0.380
45-49
0.210
0.456
50-54
0.244
0.530
55-59
0.336
0.728
60-64
0.411
0.891
65-69
0.411
0.891
70-74
0.411
0.891
75-99
0.411
0.891
Rates Guaranteed to 12/31/2019
I A) Employer Funded LTD with
180 Day Waiting Period ' I
Bi -weekly Rate 0.189
Monthly Billed rate 0.409
Rates Guaranteed to 12/31/2019
B) Employee Funded LTD with
180 Day Waiting Period. 25%
minimum participation
Required. Age banded Rates.
B) Employee Funded Dual Option LTD plan: Base 180 Day
Benefit Waiting Period With Option To Buy Up to a 90 Day
K Benefit waiting Period. 25% participation required I
i
E
180 Day Base Voluntary LTD Plan Additional Rate for 90 Day Buy -up LTD
Bi -weekly Rate 0.191 Bi -weekly Rate 0.092
Monthly Billed rate 0.413 Monthly Billed rate 0.200
Rates Guaranteed to 12/31/2019 Rates Guaranteed to 12/31/2019
B) Employee Funded STD Tied To Dual Option
LTD Plan.
Class 1: Employees in the 180 day LTD plan.
Class 2: Employees buying up to 90 day LTD plan
Rate is the same for both classes
Bi -weekly Rate 0.128
Monthly Billed rate 0.276
Rates Guaranteed to 12/31/2019
Bified
Bi -weekly
monthly LTD
Age
LTD Rates
rates
0-29
0.050
0.107
30-34
0.093
0.203
35-39
0.168
0.364
40-44
0.252
0.545
45-49
0.381
0.826
50-54
0.540
1.171
55-59
0.598
1.295
60-64
0.564
1,141
65-69
0.517
1.119
70-74
1.043
2.261
75-99
1.343
2,909
Rates Guaranteed to 12/31/2019
B) Employee Funded Dual Option LTD plan: Base 180 Day
Benefit Waiting Period With Option To Buy Up to a 90 Day
K Benefit waiting Period. 25% participation required I
i
E
180 Day Base Voluntary LTD Plan Additional Rate for 90 Day Buy -up LTD
Bi -weekly Rate 0.191 Bi -weekly Rate 0.092
Monthly Billed rate 0.413 Monthly Billed rate 0.200
Rates Guaranteed to 12/31/2019 Rates Guaranteed to 12/31/2019
B) Employee Funded STD Tied To Dual Option
LTD Plan.
Class 1: Employees in the 180 day LTD plan.
Class 2: Employees buying up to 90 day LTD plan
Rate is the same for both classes
Bi -weekly Rate 0.128
Monthly Billed rate 0.276
Rates Guaranteed to 12/31/2019
City of Miami, Florida
EXHIBIT D
INSURANCE REQUIREMENTS
24
Contract No. RFP680381
Empfoyee Disability Insurance Program Rev. 8/2/17
City of Miami
INSURANCE REQUIREMENTS
Contract No. RFP 680381
Contractor 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
Contractor's performance under the provisions of the contract, including all acts or omissions to
act on the part of Contractor, including any person performing under this Contract for or on
Contractor'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 Contractor shall furnish to City of Miami, c/o Procurement 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:
Commercial General Liability
A. Limits of Liability
Bodily Injury and Property Damage Liability
Each Occurrence $1,000,000
IV
II
A.
General Aggregate Limit $ 2,000,000
Personal and Adv. Injury $ 1,000,000
Products/Completed Operations $ 1,000,000
Endorsements Required
City of Miami listed as an additional
insured Contingent and Contractual
Liability -CGL FORM Premises and
Operations Liability- CGL FORM Primary
Insurance Clause
Business Automobile Liability
Limits of Liability
Bodily Injury and Property Damage
Liability Combined Single Limit
Any Auto
Including Hired, Borrowed or Non -Owned Autos Any One Accident
B. Endorsements Required
City of Miami listed as an additional insured
$ 1,000,000
City of Miami
Worker's
Compensation
Limits of Liability
Statutory -State
Florida Waiver of
Subrogation
Employer's Liability
Contract No. RFP 680381
A. Limits of Liability
$500,000 for bodily injury caused by an accident, each accident
$500,000 for bodily injury caused by disease, each employee
$500,000 for bodily injury caused by disease, policy limit
IV. Professional Liability/Errors and Omissions Coverage
Combined Single Limit
Each Claim $ 2,000,000
General Aggregate $ 2,000,000
Limit Retro date
Umbrella/Excess Liability
A. Limits of Liability
Each Occurrence $1,000,000
Policy Aqqreqate $1,000,000
City of Miami listed as an additional insured
Excess Form over all applicable liability policies herein contained
The above policies shall provide the City of Miami with written notice of cancellation
or material change from the insurer not less than (30) days 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, Oidwick, New Jersey, or its equivalent. All policies and for
certificates of insurance are subject to review and verification by Risk Management prior
to insurance approval.
City of Miami
Contract No. RFP 680381
The insurance coverage required shall include those classifications, as listed in standard liability
insurance manuals, which most nearly reflect the operations of the Contractor.
NOTE: CITY RFP NUMBER AND/OR TITLE OF RFP MUST APPEAR ON EACH CERTIFICATE.
Compliance with the foregoing requirements shall not relieve the Contractor 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 Proposer
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:
(4) Suspend the contract until such time as the new or renewed certificates are received by the
City in the manner prescribed in the Request for Proposal.
(5) The City may, at its sole discretion, terminate this contract for cause and seek re -
procurement damages from the Contractor in conjunction with the General and Special Terms
and Conditions of the solicitation.
The Proposer 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 Contractor.
City of Miami, Florida Contract No. RFP680381
EXHIBIT E
CORPORATE RESOLUTIONS
AND EVIDENCE OF QUALIFICATION TO DO BUSINESS IN FLORIDA
(To be provided upon document execution)
25
Employee Disability Insurance Program Rev. 8/2/17
Detail by Entity Name
Flonda Department of State
Department of Slate ! Division of Corporations ! Search Records 1 DntaN By Documenl Number 1
Detail by Entity Name
Foreign Profit Corporation
STANDARD INSURANCE
COMPANY
Filing Information
Document Number
P13468
FEIIEIN Number
93-0242990
Date Filed
03/04/1987
State
OR
Status
ACTIVE
Principal Address
1100 S.W. 6TH AVENUE
PORTLAND, OR 97204
Changed: 04/30!2013
Mailing Address
1100 S.W. 6TH AVENUE
PORTLAND, OR 97204
Changed: 04/30/2013
Registered Agent Name & Address
FLORIDA CHIEF FINANCIAL OFFICER AS R/A
200 E. GAiNES ST
TALLAHASSEE, FL 32399-0000
Name Changed: 03/25/2014
Address Changed: 03/25/2014
Officer/Director Detail
Name & Address
Titfe Chairman, President and Chief Executive Officer
Ness, J. Greg
1100 S.W. 6TH AVENUE
PORTLAND, OR 97204
Title Senior Vice President and Chief Financial Officer
Chadee, Floyd F.
Pagel of 3
DIVISION Or CORPGPATIONS
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Detail by Entity Name
1100 S.W. 6TH AVENUE
PORTLAND, OR 97204
Title Vice President Individual Disability Insurance and Corporate Marketing & Communications
Durham, Katherine M.
1100 S.W. 6TH AVENUE
PORTLAND, OR 97204
Title Vice President Chief Investment Officer
Hibbs , Scott A.
1100 S.W. 6TH AVENUE
PORTLAND, OR 97204
Title Vice President Employee Benefits
McMillan, Daniel J.
1100 S.W. 67H AVENUE
PORTLAND, OR 97204
Title Senior Vice President Information Technoiogy
O'Brien, David M.
1100 S.W. 6TH AVENUE
PORTLAND, OR 97204
Title Vice President Human Resources
Hooper, John A.
1100 S.W. 6TH AVENUE
PORTLAND, OR 97204
Title Vice President Chief Legal Officer & Corporate Secretary
Franklin, Holley Y.
1100 S.W. 6TH AVENUE
PORTLAND, OR 97204
Annual Reports
Report Year
Filed Date
2015
01/14/2015
2016
04/11/2016
2017
03/21/2017
Document Images
03121/2017 — ANNUAL REPORT
041111201(3--ANNIIAI RFPnPT
03125i2014 — ANNUAL REPORT
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04;1912001 -ANNUAL REPORTL
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01;0612011-AhJNUAL REPORT
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01,,'2112010 - ANNUAL REPORT
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