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HomeMy WebLinkAboutRFP - P910 CLAIMS ADMINISTRATOR SERVICESCITY OF FORT COLLINS REQUEST FOR PROPOSAL CLAIMS ADMINISTRATOR SERVICES PROPOSAL NO. P-910 PROPOSAL DATE: November 7, 2003 - 3:00 p.m. (our clock) TABLE OF CONTENTS REQUEST FOR PROPOSAL PAGE 1 PURPOSE AND BACKGROUND PAGE 2 SELECTION CRITERIA AND METHOD PAGE 2-3 SPECIFICATIONS PAGE 3 ANCILLARY SERVICES PAGE 3 CONTINUANCE OF SERVICE CONTRACT PAGE 3 SECTION I - PROPOSAL REQUIREMENTS PAGE 4 SECTION II CLAIMS IMPLEMENTATION AND TERMINATION PAGE 5-8 SECTION III CLAIMS MANAGEMENT STANDARDS & PROCEDURES PAGE 9-11 SECTION III - CLAIMS PHILOSOPHY PAGE 12 SECTION IV - SPECIAL PROVISIONS PAGE 13 SECTION V - APPENDIX DATA PAGE 14 Exhibit I 3 pages Exhibit II 1 page Exhibit III 5 pages Exhibit IV 1 page Exhibit V 1 page Exhibit VI 5 pages SECTION VI - PROFESSIONAL SERVICES AGREEMENT PAGE 1-5 Exhibit B Insurance Requirements 1 page 1 REQUEST FOR PROPOSAL CITY OF FORT COLLINS CLAIMS ADMINISTRATOR SERVICES PROPOSAL NO. P-910 The City of Fort Collins is requesting proposals from firms for Claims Administrator Services. Written proposals, four (4) will be received at the City of Fort Collins' Purchasing Division, 215 North Mason St., 2nd floor, Fort Collins, Colorado 80524. Proposals will be received before 3:00 p.m. (our clock), November 7, 2003. Proposal No. P-910. If delivered, they are to be sent to 215 North Mason Street, 2 nd Floor, Fort Collins, Colorado 80524. If mailed, the address is P.O. Box 580, Fort Collins, 80522-0580. Questions concerning the scope of the project should be directed to the Project Manager, Stewart Ellenberg, ARM-P, Risk Manager (970) 221-6774. Questions regarding proposals submittal or process should be directed to James B. O’Neill II, CPPO, Director of Purchasing and Risk Management (970) 221-6775. A copy of the Proposal may be obtained as follows: 1. Call the Purchasing Fax-line, 970-416-2033 and follow the verbal instruction to request document #30910. 2. Download the Proposal/Bid from the Purchasing Webpage, www.fcgov.com/purchasing. 3. Come by Purchasing at 215 North Mason St., 2 nd floor, Fort Collins, and request a copy of the Bid. Sales prohibited/conflict of interest: No officer, employee, or their dependent or person residing in and sharing the expenses of their household, shall have a financial interest in the sale to the City of any real or personal property, equipment, material, supplies, or services. This rule also applies to subcontracts with the City. This shall not apply to members of any authority, board, committee or commission of the City, other than the members of the City Council. Soliciting or accepting any gift, gratuity favor, entertainment, kick-back or any items of monetary value from any person who has or is seeking to do business with the City of Fort Collins is prohibited. Any vendor knowing of this type of activity is encouraged to report in confidence to the Director of Purchasing and Risk Management, Director of Finance, City Attorney or City Manager so the matter can be dealt with. The City of Fort Collins reserves the right to reject any and all proposals and to waive any irregularities or informalities. 2 No proposal shall be accepted from, or any purchase order awarded, to any person, firm or corporation that is in default on any obligation to the City. Non-Collusion: Your authorized signature on this proposal assures that such proposal is genuine and is not a collusive or sham proposal. Vendors: The City of Fort Collins Purchasing Division has implemented an on-line vendor registration system. This system allows vendors to register, view and update their business information and commodities. In the future, vendors will also be able to receive Requests for Proposals (RFP’s) through the on-line system. All vendors doing business with the City of Fort Collins are requested to register. The vendor registration system is accessible through the City of Fort Collins Purchasing Department internet webpage at www.fcgov.com/purchasing. The vendor registration form is located by clicking https://secure2.fcgov.com/bso/login.jsp Note the printable instruction pages link. If you have any difficulty completing the registration process, please call the Purchasing Division at (970)221-6775 for assistance. Sincerely, James B. O'Neill II, CPPO Director of Purchasing & Risk Management 3 REQUEST FOR PROPOSAL The City of Fort Collins invites your firm to submit a proposal for Third Party Claims Administrator to provide self insured workers' compensation and liability claims services. 1. PURPOSE AND BACKGROUND The City's purpose is to select a qualified claims administrator handling both workers' compensation and liability. The City's insurance program is out to bid. When the evaluation is complete, the Claims Administrator will be awarded. The Claims Administrator may administer both workers' compensation and liability, or depending on excess markets, may administer one or the other. The City's liability and worker’s compensation claims have been administered by Cannon Cochran Management Services, Inc. since 01-01-99. Due to the need to maintain a close working relationship, and timely responses in the event of an incident requiring immediate assistance, the Claim Administrator will be required to have a servicing office in Fort Collins. 2. SELECTION CRITERIA AND METHOD A Review Team will rank the proposals based on the City of Fort Collins' procedures for the review of professional firms. The three highest ranked firms may then be invited to discuss their proposals and qualifications with the review team. Based on these interviews, a final ranking of the consultants will be made and contract negotiations will be initiated with the highest ranked firm. On-site tours may be requested. THE FOLLOWING POINT SYSTEM WILL BE USED: POINTS QUALIFICATION STANDARD 1 - 5 Adequacy of current Meeting and under- Proposal in light of standing needs; The Proposal administrative Requirements procedures 1 - 15 Qualifications to References, perform services management and staff assigned 1 - 15 Computer support Data base and reports availability reports initiated 1 - 5 Availability Ability to be at an Incident scene within one hour 4 1 - 10 Reasonable cost for Services provided proposed service __________ Total Points (50 points possible) 3. SPECIFICATIONS Proposals are to be submitted in strict compliance with these specifications. These specifications are to be considered as providing desirable claims administration services. Any limitations or deviations from these specifications must be designated in the proposal; otherwise, companies proposing will be strictly held to the specifications. This Request for Proposals and your response will become an integral part of a final contract should your firm be selected. A failure to deliver services and fees quoted in your proposal may result in a mid- term cancellation of the Service Contract and a replacement of the Third Party Administration firm. The information contained in the specifications is believed to be correct, but is not warranted. The responsibility for determining the full extent of the exposure and the verification of all information shall rest solely upon the Third Party Administrator. The City of Fort Collins or its representatives will not be responsible for any errors or omissions, nor for the failure on the part of the Third Party Administrator to determine the full extent of the exposures. 4. ANCILLARY SERVICES All Proposals must fully describe the nature of any ancillary services which your firm may offer. If independent firms are to be used, the name and address of the firms are to be shown. 5. CONTINUANCE OF SERVICE CONTRACT FOR A FIVE YEAR PERIOD It is the intent of the City to continue the service contract for a minimum period of five years without competitive quotations. However, the City reserves the right to cancel or non-renew the contract at its discretion. 5 SECTION I PROPOSAL REQUIREMENTS Please address the following questions, in the order they are asked, in your proposal. 1. QUALIFICATIONS A. Give a brief description of your firm including: 1. Names of principal owners, partners or officers. 2. Length of time the firm has been in business. 3. Number of offices and locations. 4. Offices that would service this account. 5. The availability of a toll-free number for the use of claimants and the City. B. Indicate the proposed number of personnel (including supervisory and management) who would be assigned to administer the City's program and give details regarding: 1. Position of each 2. Experience and education 3. Experience with public entities 4. Length of time with your firm 5. Computer skills C. Would technical personnel assigned to the City also be assigned to other accounts? If so, how many? D. Would an Account Executive be assigned to the City as the primary contact on items not directly related to specific claims? E. Describe training programs offered to claim personnel and incentives for employees to further their training and education. F. In the past two years, what percentage of employee turnover has your firm experienced for the office that will be handling the City’s claims? G. What is the anticipated case load of open files that would be managed by examiners assigned to the City? H. Provide names, addresses, telephone numbers and length of service with at least three Colorado references for whom you have provided worker's compensation and liability claims services (preferably public agencies). I. Describe any additional special programs or areas of emphasis that you think would be beneficial in helping us to understand your level of expertise. 6 2. CLAIMS IMPLEMENTATION, PROCESSING AND TERMINATION A. Provide procedure and timetable for initial set-up and implementation of City's account into your system. B. Provide the set-up, process and timetable for a new claim to be placed in the system. C. Advise how frequently your diary system allows claims supervisory personnel to review open claims. D. Describe your procedures for making initial and follow-up contact with injured employees or claimants. E. Describe your company philosophy and procedures for the establishment of case reserves. What are the procedures for revising reserves? F. Describe cost containment procedures utilized by your firm. G. Under the current arrangement, the City provides an account and checks for the processing of claim payments by the claim administrator. Indicate if this system would work for your firm. H. Advise in what instances an independent adjustor would be required and which independent claims service you would use. I. Attach copies of all standard forms used in your administration process. J. Submit samples of any cards, letters, pamphlets, et cetera, that would be provided to injured employees and claimants. K. Do you have a formal program for managing lawsuits and litigation expense? If so, please describe. L. Provide the City with various options regarding the handling of open claims in the event of termination or regular expiration of the claims administrator contract. M. Include any other information that you feel would contribute a positive and successful program if your firm were selected. Describe in detail the claims administrator's various investigative techniques and general claim handling philosophies, addressing the following: 1. Method of explaining claimant's right. 2. Circumstances when in-person investigations would be used rather than by telephone. 3. Philosophy and method of contesting and denying claims payments. 7 N. Provide a description of the quality controls currently in place. The description should include the approach to and frequency of internal claims audits of claims offices. 3. DATA PROCESSING AND REPORTING SERVICES A. To demonstrate your data processing and report system, provide an online demonstration of twenty five worker’s compensation claims. Five claims shall be re-opened from the year 2000, ten claims shall be medical only, and ten shall be indemnity claims. Be as detailed as possible, showing all charges, fee schedule, PPO & prescription discounts, and the bottom line cost to the city for each claim. All claims shall contain, but not be limited to, the following information. 1. Workers' Compensation a. Claim Number b. Department Code c. Employee Name d. Injury Date, Day of Week and Time of Day e. Brief Verbal Description of Injury/Accident f. Nature of Injury g. Body Part h. Nature of Incident i. Object Causing Injury j. Medical, Indemnity and Expense Paid to Date k. Subrogation l. Rehabilitation m. Reserved n. Litigation o. Status 2. Liability a. Line of Coverage b. Department Code c. Claim Number d. Accident Date, Date of Week and Time of Day e. Claimant's Name f. Brief Verbal Description of Accident g. Nature of Accident h. Object causing Accident I. Payment and Expense Paid to Date j. Reserve k. Indication if in Suite l. Status (Open/Closed) B. Indicate whether the following reports could be provided online: 1. Accident analysis report giving a breakdown by cause, body part, injury, day, time et cetera. 2. Vendor report to identify service providers and attorney involvement. 3. Cumulative check register giving a summary of all medical, indemnity and 8 other payments to date. 4. Reports showing IBNR factors and trending, claims pay-out profiles and claims development analysis. 5. Sorting capabilities of Program. C. Can your organization customize reports for our needs? Is there an extra charge for this service? D. Can your organization interface with the J. D. Edwards One World Workforce Management System? E. Does your organization have the capability to captures all correspondence, medical records, letters, etc., electronically and store them in the claimants file? F. Is it possible for the City to access your data base? If so, please describe your system, the necessary mechanics, and what information would be available to access. G. Advise how frequently your system is updated. H. Please submit samples of each standard report generated by your system and explain any additional ad hoc reporting capability you could put at our disposal. 4. AVAILABILITY A. Approximately how far is the servicing office from downtown Fort Collins? Will you be able to have an operational office in Fort Collins at contract inception? B. Can your firm respond immediately to investigate an incident that has just occurred? Indicate how long it would take a claim representative to physically be on site of an incident after telephone notification. C. Are your claim representatives "on call" 24 hours per day? Are pagers, cell phones or similar devices provided to the representatives? D. How many representatives could reasonably be expected to handle claims for the City? 5. PRICING AND FEES If different pricing and fees are used for workers' compensation and liability, please quote separately. A. Quote your per claim fee in one or more of these ways: 1. Cost per claim (regardless of type). 2. Cost per claim by type. 3. Minimum cost/maximum costs. 9 4. Lifetime handling of claims. If a flat fee is submitted, please include the total number of claims included in the fee and the annual maximum cost. Other pricing methods will also be considered. Indicate if a different fee could be charged to track "record only" claims. The City currently pays a guaranteed one-time fee for a specified number of claims per year for life time handling of those claims. The third party administrator handles these claims until all are closed. An additional fee per claim is paid if the number of claims handled by the T.P.A. exceeds the number of claim specified in the contract. Simple claims that require no investigation (a check or denial letter is issued) are handled at a cost of $50 per claim. B. Specify whether or not your fee includes your firm performing all of the necessary state filing. C. Indicate whether the per claim cost includes recovery of subrogation losses. D. Indicate the types of allocated claims expenses which are not included in your per case claims costs. E. State what services or type of claims that are not included in your standard fees. F. Occupational Health Services at Poudre Valley Health Systems is the City’s designated health care provide. Are they part of your organizations PPO network and if so what discount do you receive? What other Northern Colorado health care providers are part of your PPO network? G. Exhibit III is a list of the top 30 drugs prescriptions in 2003. If your organization has a prescription discount program, what would be the unit cost, to the city, for each of these drugs? Explain your prescription drug program process. H. Since the term of the contract will be five years, renewable annually, give an indication of expected increase in rates and basis for increases. 10 SECTION II CLAIMS MANAGEMENT STANDARDS & PROCEDURES Following are standards and services the City wishes to maintain. Review these points and indicate any area that could be a problem in your firm. I. CLAIMS ADMINISTRATION A. Create files and reserve within two (2) working days from receipt of the initial report. B. Establish diaries so each claim is reviewed at least every thirty (30) days or more frequently where needed. Document confirmation of review. C. Examine and analyze all claims to determine compensability/validity of workers’ compensation and liability claims. D. Pay bills promptly per City instructions. E. Audit medical bills and repair bills for casual relationship and reasonableness of charges. F. Report all indemnity claims to the Index Bureau upon file creation, and retain a copy with the file. G. Review medical-only claims for possible closure no less frequently than every thirty (30) days. H. Provide copies of all written correspondence from the administrator to doctors, claimants, attorneys, rehabilitation counselors, investigators and state agencies. I. Clearly document all file activity, including telephone conversations or personal meetings, and diary reviews to reflect the date, individuals involved, content of discussion and plan of action. J. Establish specific direction on the investigation and handling of all indemnity cases within three (3) working days from receipt of the initial report, and clearly evidenced in the file. K. Notify appropriate excess insurer(s) of all claims or losses meeting the reporting requirements of the insurer and provide such insurer with all required information and updates. Send update reports to excess carriers no less frequently than semi-annually. L. Provide a written analysis of all proposed settlements by stipulation or compromise for consideration and authorization, in losses valued in excess of $50,000. 11 M. Establish claim reserves and provide a continual review and update of reserves to reflect changes. It is expected that reserves will be reviewed at least twice a year with city staff. N. Maintain a file for each claim submitted with the file available for review by the City at any reasonable time. O. Consult and cooperate with the City and its employees as may be necessary to achieve a successful claims management program. This includes regular meetings between City staff and the Third Party Administrator being held every 7- 14 days, to discuss claim settlements/denials. 2. CLAIMS INVESTIGATION AND MANAGEMENT: A. Conduct the necessary investigation of each claim using competent and qualified personnel, including such investigation as is necessary to determine he City's liability. The City reserves the right to require additional investigation. With the approval of the City, engage the services of persons of firms outside its organization for special work in connection with investigations. B. Contact or attempt to contact all employees and claimants within three (3) days of receipt of claim. Upon initial contact, document the description of injury/accident. Document attempts to contact employee or claimant. C. Contact the department and designated employee for City's statement before determining liability. D. Contact the City within three (3) days to confirm whether compensability/liability is acknowledged or should have been questioned. E. Monitor treatment program for injured employees to assure that treatment is related to the compensable injury or illness. F. Maintain a close liaison with treating physicians to assure that employees receive proper care and to avoid over treatment situations. G. Determine eligibility for and authorize payment of Temporary Disability compensation in accordance with medical advice and rehabilitation efforts. H. Maintain telephone or personal contact with temporarily disabled employees no less frequently than monthly, to maintain rapport and to monitor medical progress and return to work status. I. Schedule independent medical examinations with qualified physicians in cases where treatment, length of disability or extent of permanent disability assigned is in question. J. Investigate whether subrogation can be rule out or pursued in all cases which may involve third party negligence. 12 K. Refer litigated cases to attorneys utilizing an agreed listing or legal firms. Assist in the preparation of litigated cases and participate as needed in hearings and settlement actions. L. Attend bi-weekly meetings with City's designated physician. 3. CLAIMS ANALYSIS AND REPORT A. Provide the City with continuing information on the progress of individual claims and the effectiveness of cost control programs relating to all claims. A closing report is required for every claim indicating the amount paid to settle the claim. B. Submit statistical summaries and narrative reports as requested to assist in the evaluation of the City's program. C. Assist the City in the analysis of claims in an effort to prevent future occurrences of a similar nature. D. Maintain a claim file for each reported claim which shall be available to the City at all times for inspection. Such file shall contain all data pertinent to the claim to support its disposition and shall remain the exclusive property of the City. E. Assist the City in preparation of required self insurance reports, reports required by the city’s insurance carriers, and information for the NCCI to calculate the workers’ compensation modifier. F. Prepare an annual report related to workers’ compensation claims to assist City payroll staff with W-2 adjustments of employees who received TPD payments. 4. SPECIAL SERVICES A. Provide information and guidance to city employees regarding workers' compensation benefits and respond to inquiries regarding specific injuries and permanent disability ratings. B. When appropriate, develop rehabilitation programs for injured employees for approval by the City, the employee and appropriate agencies ensuring that rehabilitation, retraining or reassignment is provided to employees with physical or performance limitations resulting from industrial injuries. C. Review existing City claims management programs and procedures and recommend changes as needed. 13 SECTION III CLAIMS PHILOSOPHY The City of Fort Collins' claims management philosophy is as follows: 1. To be certain claimants are given a high standard of care and concern to avoid poor public opinion. 2. To be certain employees are advised of their benefits under Workers' Compensation in a timely fashion. 3. To give prompt attention to all claims matters in an attempt to discourage unnecessary litigation. 4. To encourage early recovery from injury and early return to productive work. 5. To encourage employees' return to work for modified duty. 6. To identify fraudulent claims and aggressively defend those claims. 7. To identify cause of loss and correct, if necessary, to prevent future loss. 8. To keep communication open between the TPA, Risk Management staff, employees, claimants, and medical providers. 14 SECTION IV SPECIAL PROVISIONS 1. CLAIM ASSIGNMENT The City of Fort Collins does not send all claims to a third party claims administrator. The City Attorneys Office and the Risk Management division reserves the right to determine which claims will be handled in-house and those that will be assigned to the third party administrator. 2. CANCELLATION BY ADMINISTRATOR Because of the time required to replace this contract on a favorable basis, each firm must include in their proposal a written agreement not to change the rates and terms of the contract, nor cancel the contract during the first annual term, except in the case of non-payment of fees. Each firm must also agree not to change the rates and terms of the contract at renewal or refuse to renew the contract without ninety (90) days advance written notice. 3. CLAIMS RUN-OFF PROVISIONS Ensure that your company's claims run-off requirements, including fees for present as well as future claims, are included as a contract provision in your specimen contract. 4. TITLE RIGHTS Ensure that the City shall have full, complete and absolute title to all studies, files, documents, correspondence, tapes, movies, recordings, reports, analyses and other materials prepared or acquired regardless of the state of completion. Further ensure that the City may make full and complete use of said materials as it desires, and within its own discretion without liability of any kind whatsoever to the Administrator other than payment of consideration as provided. 5. INSURANCE Required insurance limits are listed in Exhibit B, Section VI. 15 SECTION V APPENDIX DATA EXHIBIT I Citizen Claims Procedure EXHIBIT II Five Year Claim History EXHIBIT III Top 30 Drugs 16 Exhibit I CITIZEN CLAIMS PROCEDURE The following is a summary of the claims handling process that is used: 1. Risk Management receives notice of an incident involving property damage or bodily injury. This notice may come from a number of sources including the citizen involved, the City department involved, or a police report. An Incident Report is completed by an employee of the department involved. This report contains basic information about the incident that helps determine if the City is legally liable for the incident. 2. A citizen who expressed the desire to file a claim against the City is informed that claim forms can be mailed to them or can be obtained at the Risk Management office. Claims may also be initiated by the filing of a Notice of Claim (usually from the claimant’s attorney or insurance company) which is in compliance with Section 24-10-109 C.R.S (If a Notice of Claim does not comply with that section, the City Attorney’s office will notify Risk Management of that fact so that it can be raised as a defense at a later date, if necessary.) 3. Upon receipt of a claim, a copy is sent by Risk Management to the department involved. In addition, two or three letters are generated by Risk Management. The first is a letter to our third-party claims administrator (in 2000 this is Occupational Healthcare Management Services) informing them of the claim. Included with this letter are the claim form or Notice of Claim and all supporting documentation provided by the claimant. The second letter is sent to the claimant stating that the City is in receipt of their claim and has forwarded the information to our claims administrator. It also gives the address and telephone number for our claims administrator, encouraging the claimants to contact the claims administrator directly if they have questions or problems regarding their claim. The third letter is to the City’s insurance carrier who may provide coverage for the claim, if any, notifying it of the claim. If the insurance carrier is involved, Risk Management will ensure that it is kept apprised of the status of the claim, contacted for settlement authority and is otherwise involved to the extent desired by the insurance company. 4. After receiving the claim, the claims administrator assigns an adjuster to the case who then begins an investigation of the incident. The adjuster contacts City employees involved, witnesses, and the claimant. 5. Periodic meetings are held with the City Attorney’s Office, Risk Management, and the claims administrator to discuss each claim and to make recommendations concerning whether and to what extent the claim should be paid. As a general rule, a citizen’s claim will be paid if: a. The claim is filed within the required 180 days of the accident or occurrence; (and) 17 b. The City is legally liable for the damages alleged; (and) c. Governmental immunity for the type of claim presented does not exist. Compromise settlements may occur in some cases if there is a question regarding one or more of the above criteria. Occasionally, departments may choose to pay part or all of a claim as a good will gesture, regardless of whether the City’s liability is clear. Such payments are made out of the department’s budget, rather than the Loss Fund. Such payments are discouraged because of the risk of setting a precedent, which the City cannot afford to follow. When made, such payments should only be made through Risk Management after the signing of a release by the claimant. 6. The size of the claim determines who can authorize claim payments: a. If the claim is less that $50,000, the Director of Purchasing and Risk Management, the third party administrator and the City Attorney’s Office will determine if payment should be made. The City Manager will be notified by a semi-annual report of all claims settled for $10,000 or more. b. Settlement amounts above $50,000 but less than $100,000 (excluding claim processing related costs such as investigative fees and defense costs and fees) will only be paid after approval from the City Manager. c. City Council will be informed of the status of statutory claims and pending litigation in the semiannual Litigation Update Report prepared by the City Attorney’s office. Although the Director of Purchasing and Risk Management has authority to pay claims up to the limits set out in the Self-Insurance Ordinance ($150,000 to any one person for claims arising out of a single incident or occurrence or $600,000 to all persons for claims arising out of a single incident or occurrence, in accordance with the State of Colorado Governmental Immunity Act), staff will confer with City Council in executive session on any settlement amounts of $100,000 and over. 7. The claims administrator issues a payment or a denial letter to the claimant. Payments are only issued after the claimant signs a release for all damages arising out of the claim. This concludes the claims handling process. 8. The claims administrator provides the City with a monthly-computerized loss report. This report contains information about the number of claims handled, the departments involved and the cost of claims. 9. If a lawsuit is filed, the City Attorney decides whether the City’s interests will be represented by staff attorneys or by outside counsel and whether any conflict of interest exists between the City and any individually named defendants. The litigation of most claims is handled by outside counsel rather than the City Attorney’s staff, but the decision is made by the City Attorney’s office on a case- by-case basis. In the event that outside counsel is hired, the City Attorney’s office will choose the counsel. The City Attorney will notify the Director of Purchasing and Risk Management of the firms selected. The claims administrator will continue to monitor the case only to the extent necessary to keep the monthly-computerized 18 loss report current. Risk Management will coordinate with the City Attorney’s office to ensure that any insurance company involved on behalf of the City receives appropriate reports concerning the status of the litigation. If the litigation results in an award to a claimant, the City Attorney (and outside counsel if appropriate) will make estimates and recommendations to City staff and, when appropriate City Council, as to the costs and merits of an appeal. Adopted: __________________________ ____________________________________ John Fischbach, City Manager ____________________________________ James B. O’Neill II, CPPO SA 10/01 19 Exhibit II Five Year Claim History 1. Workers’ Compensation Year # Claims # Med Only # Indemnity # Open Incurred Cost 1999 221 190 31 1 $415,754 2000 214 214 21 2 $270,797 2001 217 217 21 1 $320,822 2002 218 218 44 6 $576,017 2003 130 111 19 27 $350,151 2. Auto Liability Year # Claims # Open Incurred Cost 1999 67 0 $ 39,589 2000 43 3 $ 87,800 2001 72 0 $ 79,873 2002 77 2 $123,557 2003 115 28 $213,019 3. General Liability Year # Claims # Open Incurred Cost 1999 200 0 $176,670 2000 244 1 $274,682 2001 177 3 $244,536 2002 181 11 $222,417 2003 75 22 $163,933 Of the auto liability and general liability claims listed, the City of Fort Collins handles approximately 150 of these claims in-house per year. The TPA has to either issue a check for payment or a denial letter on these files. All claims data as of 10/13/03. SA 10/01 20 Exhibit III Top 30 Drugs Rank Drug Generic 1 Hydrocodone Y 2 Oxycodone Y 3 Vioxx N 4 Celebrex N 5 Propoxy Y 6 Ibuprofen Y 7 Cyclobenzaprine Y 8 Neurontin N 9 Bextra N 10 Naproxen Y 11 Skelaxin N 12 Oxycontin N 13 Ultracet Tablet N 14 Tramadol Hcl Y 15 Cephalexin Y 16 Carisoprodol Y 17 Ambien N 18 Percocet O 19 Tizanidine Hcl Y 20 Amitriptyline Hcl Y 21 Acetaminophen Y 22 Diazepam Y 23 Prednisone Y 24 Lidoderm N 25 Duragesic N 26 Zoloft N 27 Methocarbamol Y 28 Mobic N 29 Flexeril N 30 Alprazolam Y SA 10/01 21 SERVICES AGREEMENT THIS AGREEMENT made and entered into the day and year set forth below by and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the "City" and ____________________________, hereinafter referred to as "Service Provider". WITNESSETH: In consideration of the mutual covenants and obligations herein expressed, it is agreed by and between the parties hereto as follows: 1. Scope of Services. The Service Provider agrees to provide services in accordance with the scope of services attached hereto as Exhibit "A", consisting of ____ (____) page[s], and incorporated herein by this reference. 2. The Work Schedule. [Optional] The services to be performed pursuant to this Agreement shall be performed in accordance with the Work Schedule attached hereto as Exhibit "B", consisting of ____ (____) page[s], and incorporated herein by this reference. 3. Time of Commencement and Completion of Services. The services to be performed pursuant to this Agreement shall be initiated within ______________ (____) days following execution of this Agreement. Services shall be completed no later than _______________. Time is of the essence. Any extensions of the time limit set forth above must be agreed upon in a writing signed by the parties. 4. Contract Period. [Option 1] This Agreement shall commence upon the date of execution shown on the signature page of this Agreement and shall continue in full force and effect for one (1) year, unless sooner terminated as herein provided. In addition, at the option of the City, the Agreement may be extended for an additional period of one (1) year at the rates provided with written notice to the Professional mailed no later than ninety (90) days prior to contract end. SA 10/01 22 4. Contract Period. [Option 2] This Agreement shall commence ________, 200_, and shall continue in full force and effect until ________, 200_, unless sooner terminated as herein provided. In addition, at the option of the City, the Agreement may be extended for additional one year periods not to exceed ___ (_) additional one year periods. Pricing changes shall be negotiated by and agreed to by both parties and may not exceed the Denver - Boulder CPI-U as published by the Colorado State Planning and Budget Office. Written notice of renewal shall be provided to the Service Provider and mailed no later than ninety (90) days prior to contract end. 5. Delay. If either party is prevented in whole or in part from performing its obligations by unforeseeable causes beyond its reasonable control and without its fault or negligence, then the party so prevented shall be excused from whatever performance is prevented by such cause. To the extent that the performance is actually prevented, the Service Provider must provide written notice to the City of such condition within fifteen (15) days from the onset of such condition. [Early Termination clause here as an option. 6. Early Termination by City/Notice. Notwithstanding the time periods contained herein, the City may terminate this Agreement at any time without cause by providing written notice of termination to the Service Provider. Such notice shall be delivered at least fifteen (15) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties. All notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the following addresses: City: Service Provider: __________________________ ______________________________ __________________________ ______________________________ __________________________ ______________________________ SA 10/01 23 In the event of early termination by the City, the Service Provider shall be paid for services rendered to the date of termination, subject only to the satisfactory performance of the Service Provider's obligations under this Agreement. Such payment shall be the Service Provider's sole right and remedy for such termination. 7. Contract Sum. The City shall pay the Service provider for the performance of this Contract, subject to additions and deletions provided herein, the sum of Dollars ($_________) [Option Cost Breakdown is attached Exhibit "C"] 8. City Representative. The City will designate, prior to commencement of the work, its representative who shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the services provided under this agreement. All requests concerning this agreement shall be directed to the City Representative. 9. Independent Service provider. The services to be performed by Service Provider are those of an independent service provider and not of an employee of the City of Fort Collins. The City shall not be responsible for withholding any portion of Service Provider's compensation hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or for any other purpose. 10. Personal Services. It is understood that the City enters into the Agreement based on the special abilities of the Service Provider and that this Agreement shall be considered as an agreement for personal services. Accordingly, the Service Provider shall neither assign any responsibilities nor delegate any duties arising under the Agreement without the prior written consent of the City. 11. Acceptance Not Waiver. The City's approval or acceptance of, or payment for any of the services shall not be construed to operate as a waiver of any rights or benefits provided to the City under this Agreement or cause of action arising out of performance of this Agreement. SA 10/01 24 12. Warranty. (a) Service Provider warrants that all work performed hereunder shall be performed with the highest degree of competence and care in accordance with accepted standards for work of a similar nature. (b) Unless otherwise provided in the Agreement, all materials and equipment incorporated into any work shall be new and, where not specified, of the most suitable grade of their respective kinds for their intended use, and all workmanship shall be acceptable to City. (c) Service Provider warrants all equipment, materials, labor and other work, provided under this Agreement, except City-furnished materials, equipment and labor, against defects and nonconformances in design, materials and workmanship/workwomanship for a period beginning with the start of the work and ending twelve (12) months from and after final acceptance under the Agreement, regardless whether the same were furnished or performed by Service Provider or by any of its subcontractors of any tier. Upon receipt of written notice from City of any such defect or nonconformances, the affected item or part thereof shall be redesigned, repaired or replaced by Service Provider in a manner and at a time acceptable to City. 13. Default. Each and every term and condition hereof shall be deemed to be a material element of this Agreement. In the event either party should fail or refuse to perform according to the terms of this agreement, such party may be declared in default thereof. 14. Remedies. In the event a party has been declared in default, such defaulting party shall be allowed a period of ten (10) days within which to cure said default. In the event the default remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek damages; (b) treat the Agreement as continuing and require specific performance; or (c) avail himself of any other remedy at law or equity. If the non-defaulting party commences legal or equitable actions against the defaulting party, the defaulting party shall be liable to the non-defaulting party for the non-defaulting party's reasonable attorney fees and costs incurred because of the default. 15. Binding Effect. This writing, together with the exhibits hereto, constitutes the entire agreement between the parties and shall be binding upon said parties, their officers, SA 10/01 25 employees, agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal representatives, successors and assigns of said parties. 16. Indemnity/Insurance. a. The Service Provider agrees to indemnify and save harmless the City, its officers, agents and employees against and from any and all actions, suits, claims, demands or liability of any character whatsoever brought or asserted for injuries to or death of any person or persons, or damages to property arising out of, result from or occurring in connection with the performance of any service hereunder. b. The Service Provider shall take all necessary precautions in performing the work hereunder to prevent injury to persons and property. c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider shall provide and maintain insurance coverage naming the City as an additional insured under this Agreement of the type and with the limits specified within Exhibit ___, consisting of ______ (___) pages[s], attached hereto and incorporated herein by this reference. The Service Provider before commencing services hereunder, shall deliver to the City's Director of Purchasing and Risk Management, P. O. Box 580 Fort Collins, Colorado 80522 one copy of a certificate evidencing the insurance coverage required from an insurance company acceptable to the City. 17. Entire Agreement. This Agreement, along with all Exhibits and other documents incorporated herein, shall constitute the entire Agreement of the parties. Covenants or representations not contained in this Agreement shall not be binding on the parties. 18. Law/Severability. The laws of the State of Colorado shall govern the construction interpretation, execution and enforcement of this Agreement. In the event any provision of this Agreement shall be held invalid or unenforceable by any court of competent jurisdiction, such holding shall not invalidate or render unenforceable any other provision of this Agreement. SA 10/01 26 19. Special Provisions. [Optional] Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit ___, consisting of _____ (____) page[s], attached hereto and incorporated herein by this reference. CITY OF FORT COLLINS, COLORADO a municipal corporation By: _________________________________ John F. Fischbach City Manager By:_______________________________ James B. O'Neill II, CPPO, FNIGP Director of Purchasing and Risk Management Date:_____________________________ ATTEST: _________________________________ City Clerk APPROVED AS TO FORM: ________________________________ Assistant City Attorney [Insert Corporation's name] or [Insert Partnership name] or [Insert individual's name] Doing business as ____[insert name of business] By:_______________________________ __________________________________ PRINT NAME __________________________________ CORPORATE PRESIDENT OR VICE PRESIDENT Date:_____________________________ ATTEST: (Corporate Seal) _____________________________ CORPORATE SECRETARY 7/98 1 EXHIBIT B INSURANCE REQUIREMENTS 1. The Service Provider will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Service Provider shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies, and containing substantially the following statement: "The insurance evidenced by this Certificate will not be cancelled or materially altered, except after ten (10) days written notice has been received by the City of Fort Collins." In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Service Provider under this Agreement. The City, its officers, agents and employees shall be named as additional insureds on the Service Provider's general liability and automobile liability insurance policies for any claims arising out of work performed under this Agreement. 2. Insurance coverages shall be as follows: A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain during the life of this Agreement for all of the Service Provider's employees engaged in work performed under this agreement: 1. Workers' Compensation insurance with statutory limits as required by Colorado law. 2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee. B. Commercial General & Vehicle Liability. The Service Provider shall maintain during the life of this Agreement such commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for each coverage, Commercial General and Vehicle, shall not be less than $500,000 combined single limits for bodily injury and property damage. In the event any work is performed by a subcontractor, the Service Provider shall be responsible for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. CITY OF FORT COLLINS ADDENDUM No. 1 SPECIFICATIONS AND CONTRACT DOCUMENTS Description of Bid: P910 Claims Administrator Services OPENING DATE: 3:00 p.m. (Our Clock) November 7, 2003 To all prospective bidders under the specifications and contract documents described above, the following changes are hereby made. ADD: Cooperative Language Other governmental agencies outside the City and within the Fort Collins area may be extended the opportunity to negotiate a contract with the selected firm to provide Third Party Administrator services for workers compensation, with the agreement of the selected firm and the City. The City is not an agent of, partner to or representative of these outside agencies and is not obligated or liable for any action or debts that may arise out of such independently negotiated contracts. RECEIPT OF THIS ADDENDUM MUST BE ACKNOWLEDGED BY A WRITTEN STATEMENT ENCLOSED WITH THE BID/QUOTE STATING THAT THIS ADDENDUM HAS BEEN RECEIVED.