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HomeMy WebLinkAbout17-Human Resources CITY OF SAN BERNARDINO — REQUEST FOR COUNCIL ACTION ORIGINAL From: Linn Livingston Subject: RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF Dept: Human Resources THE CITY OF SAN BERNARDINO AUTHORIZING AGREEMENT WITH Date: May 23, 2011 CORVEL TO PROVIDE UTILIZATION REVIEW SERVICES FOR CITY'S WORKERS' COMPENSATION PROGRAM. M/CC Meeting Date: June 6, 2011 Synopsis of Previous Council Action: On February 19, 2008, Mayor and Common Council authorized the execution of an agreement with CorVel to provide Utilization Review services for the City's Workers' Compensation Program. Recommended Motion: Adopt Resolution. Signa Contact person: Linn Livingston Phone: 384-5161 Supporting data attached: Yes Ward: FUNDING REQUIREMENTS: Amount: $95,000 Source: (Acct. No.)_ 678-110-5163-0000-0057 ($92,000) 678-110-5949-0000-0057 ($3,000 _ (Acct. Description) Professional/Contractual Svcs Finance: Council Notes: 220 moll - /a Agenda Item No. ! :z C(.0-ap adl/ a CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION Staff Report Subiect• Resolution of the Mayor and Common Council of the City of San Bernardino authorizing the execution of an agreement with CorVel to provide utilization review services for the City's self-insured workers' compensation program. Background: On February 19, 2008, Mayor and Common Council authorized a contract with CorVel to provide utilization review (UR) services to the City for a term of one year with options for two, one-year extensions. On February 24, 2011, the City opened the bid process for its UR services. On March 16, 2011, ten sealed bids were received and reviewed by the City (see attached Addendum #1 and #2 to RFP F-11-16). After careful review of the proposals and subsequent presentations by the vendors, the bid review committee determined that CorVel still provides the best services for the current needs of the City. CorVel is a managed healthcare organization that specializes in cost-containment and evidence-based medical compliance by using advanced communication and information technology to improve healthcare management. State Law requires every employer who is a self-insured administrator handling workers' compensation claims to establish a mandatory Utilization Review Program. A UR Program manages costs associated with workers' compensation claims, evaluates patient care by using evidence-based guidelines, ensures the delivery of appropriate and reasonable care, and channels cases into the Preferred Provider Organization (PPO) network. Further, a UR system communicates with bill review and claims administrators regarding approved, modified, negotiated, or denied services; audits hospital bills for appropriateness of medical services; negotiates rates not included in the Official Medical Fee Schedule (OMFS); and will emphasize early return-to-work goals. Utilization Review is one of the many cost-containment measures used by the City's Workers' Compensation Division to control costs associated with claims handling. The Cirf currently contracts with other cost-containment providers who°monitor and manage ancillary costs associated with the workers' compensation program. Examples of this include bill review, occupational clinics, pharmacy programs, durable medical equipment programs, and medical case managers. The costs associated with the UR Program are not expected to exceed $95,000. The City's FY 2011-12 proposed budget includes funds for workers' compensation cost-containment programs. The Human Resources Department is proposing a one-year agreement with CorVel, with options for two, one- year extensions, and is requesting that the Mayor and Common Council adopt this Resolution and authorize a Purchase Order in an amount not to exceed $95,000. Financial Impact: Funds for this service in the amount of$95,000 are included in the Workers' Compensation Claims account in the proposed budget for FY 2011-12 (Account No. 678-110-5163-0000-0057). Recommendation: Adopt Resolution. Attachments: Addendum#1 to RFP F-11-16 Addendum#2 to RFP F-11-16 Addendum 1 ~ Z WC Utilization Review • San flernard'iflo SM March 10, 2011 ADDENDUM #1 TO Request for Proposal (RFP) F-11-16 Workers Compensation Utilization Review i Notice is hereby given that the following changes, additions, deletions, or clarifications are incorporated as an Addendum to the Request for Proposal (RFP) F-11-16. 1. Page 14 of the RFP packet (under the heading "proposal content") states that the proposal may not exceed 12 pages. Can you clarify if this includes items such as staff resumes, sample reports (not including City forms or contract), charts, workflows, attachments, etc.? These items by themselves would probably total about 12 pages. ANSWER: The resumes of staff are not considered as part of the proposal pages; however the charts, workflow and staff reports are. 2. The UR volume per year. ANSWER: The number of UR request averages about 120 3. The amount paid in UR last year. ANSWER: We have a contact not to exceed $95K 4. Who is handling the UR now? ANSWER: Corvel 5. Approximately how many URs are requested annual? ANSWER: Same as question number 2 6. Could we put a nurse onsite where the claims are administered? ANSWER: No. 7. How many Peer Reviews have been completed for the last two years by the City's current provider? ANSWER: Approximately seven. 8. If any, how many UR's have been late due to the City's UR service provider? ANSWER: None. 1 Addendum 1 WC Utilization Review 9. Does the City expect to continue to refer out approximately the same number of UR's going forward? If not, why? ANSWER: No, because UR has been in effect for a while, and the statue provides the number of visits required for i.e. chiro, PT acupuncture, we will likely reduce our referrals. 10.What total dollar figure has the City paid to its Peer Review service provider for Peer Review in the last two years? ANSWER: We have a contract with the vendor and it is not to exceed the contracted amount, which includes Peer review and all other ancillary services. 11.Is there currently an interface with the City's UR and Bill Review companies that electronically ensures that unauthorized, delayed, or denied treatment does not get paid by the bill review company? ANSWER: No, there is no interface and we are not looking to interface at this time. Our bill review is notified of all denials based on our work flow procedures. 12.If not, this becomes a critical examiner's duty correct? ANSWER: I am not sure what you mean by this question, it is the job of the manager to ensure that there is a process to prevent payments of denied claims. If there is no process then I believe there is a problem with the workflow that should be corrected. 13.What kinds of cases are referred out for UR? ANSWER: It varies however most surgical cases are referred. 14.What kinds of cases do the examiners approve? ANSWER: It varies, however most cases that fall within the scope of the Labor Code i.e. Chiro, PT, acupuncture, and most diagnostic requests. 15.Has Corvel been the City's UR provider for the last two years? If not, what company is the UR provider? ANSWER: Yes. Sincerely, Deborah R. Morrow, C.P.M., MPA Purchasing Division 2 • San Bernar ino SM February 24, 2011 SUBJECT: REQUEST FOR PROPOSALS (RFP) F-11-16 The City of San Bernardino (City) invites Proposals from qualified vendors for: Worker's Comp Utilization Review Parties interested in obtaining a complete copy of this RFP F-11-16 may do so by accessing the City of San Bernardino Web Page at www.sbcity.org City Services > Request for Bids > City Finance, beginning February 24, 2011, or by faxing their request to (909) 384-5043, attention Deborah R. Morrow. Please include the following information in your request: name and address of firm; name, telephone and facsimile number of contact person; specify RFP F-11-16. Copies of the RFP may also be obtained by calling Deborah Morrow at (909) 384-5086, Vanessa at (909) 384-5330, or in person at City Hall, 300 N. "D" St., 4th floor Finance Department, San Bernardino, CA 92418. Closing Date: Proposals must be submitted at or before 3:00 PM, PST, March 16, 2011, at the address listed above. Issuance of this RFP and/or receipt of Proposals does not commit the City to award a contract. Sincerely, Deborah R. Morrow, C.P.M. Purchasing Manager i i r RFP F-11-16 WC Utilization Review SECTION I. INSTRUCTIONS TO OFFEROR(S) 2 3 RFP F-11-16 WC Utilization Review City of San Bernardino, Finance Department Purchasing Division RFP F-11-16 Worker's Comp Utilization Review Bid Documents to Be Returned ❑ Company Background/Overview ❑ Description of Proposed Program ❑ Workflow and Methodologies ❑ Samples of Reports ❑ Staff Backgrounds/Resume's ❑ Qualifications and References ❑ Statement of Proposer(s) Past Contract Disqualifications (City Form) ❑ One (1) signed original of Proposal ❑ Two (2) copies of Proposal in a SEALED (envelope separate from Pricing) t ❑ Summary Proposal Submission Form (SEALED envelope separate from proposal) (City Form) ❑ Authorized Binding Signature(s) ❑ Verifications of Addenda Received (City Form) IV Forms ❑ Non-Collusion Affidavit (City Form) IV Forms ❑ Listing of Proposed Subcontractor (City Form) IV Forms ❑ 90 Day Minimum Proposal Validity Statement III Additional Requirements,VI General Specifications#4 ❑ Worker's Compensation Insurance Certificate ❑ Copy of Contractor License or other appropriate Licenses where applicable VI General Specifications#35 i Offeror(s) are requested to submit this checklist completed with all bid documents. This list may not be inclusive of all documents needed to submit your RFP. Please refer to entire packet for additional documents. 3 RFP F-11-16 WC Utilization Review i I. GENERAL INSTRUCTIONS TO OFFEROR(S) A. Pre-Proposal Conference N/A B. Examination of Proposal Documents 1. By submitting a proposal, the Offeror(s) represents that it has thoroughly examined and become familiar with the items required under this RFP and that it is capable of quality performance to achieve the City's objectives. 2. The City reserves the right to remove from its mailing list for future RFPs, for an undetermined period of time, the name of any Offeror(s) for failure to accept a contract, failure to respond to two (2) consecutive RFPs and/or unsatisfactory performance. Please note that a "No Proposal" is considered a response. C. Addenda Any City changes to the requirements will be made by written addendum to this RFP. Any written addenda issued pertaining to this RFP shall be incorporated into the terms and conditions of any resulting Purchase Order. The City will not be bound to any modifications to or deviations from the requirements set forth in this RFP as the result of oral instruction. For automatic electronic notifications, please visit our website and sign-up for SB Connect. D. Clarifications 1. Examination of Documents Should an Offeror(s) require clarifications of this RFP, the Offeror(s) shall notify the City in writing in accordance with Section D.2 below. Should it be found that the point in question is not clearly and fully set forth, the City will issue a written addendum clarifying the matter which will be sent to all persons who have requested the RFP. 2. Submitting Requests a. All questions, clarifications or comments shall be put in writing and must be received by the City no later than 5:00 PM, March 2, 2011 and be addressed as follows: City of San Bernardino 300 North "D" Street 4 3 z { T ' RFP F-11-16 WC Utilization Review 4th floor, Attn: Deborah R. Morrow San Bernardino, CA 92418 b. The exterior envelope or email Subject line of all requests for clarifications, questions and comments must be clearly labeled, "Not an Offer." The City is not responsible for failure to respond to a request that has not been labeled as such. The City will also accept questions sent by facsimile machines or email, however, all faxed or emailed questions must be received by the City no later than 5:00 PM, PST, March 2, 2011. Send facsimile transmissions to (909) 384-5043, attention Deborah R. Morrow, and emails to morrow—de@sbcity.org. C. Inquiries received after 5:00 PM March 2, 2011 will not be accepted. 3. City Responses Responses from the City will be communicated in writing to all recipients of this RFP, by a posting to our website, www.sbciiy.org by the close of business March 10, 2011. For automatic electronic notifications, please visit our Homepage and register for SB Connect. If you are not registered for SB Connect, you may view or download the Addendum at www.sbcity.org > City Services > Request for Bids > City Finance — Purchasing. E. Submission of Proposals 1. Date and Time All Proposals are to be submitted to City of San Bernardino, Attention: Deborah Morrow. Proposals received after 3:00 PM PST, March 16, 2011, will be rejected by the City as non-responsive. 2. Address Proposals shall be addressed as follows: City of San Bernardino Finance Department Purchasing Division 300 N. "D" Street, 4th floor San Bernardino, CA 92418. Proposals may be delivered in person to the Purchasing Division, 4th floor of the above address. 5 I ' RFP F-11-16 WC Utilization Review 3. Identification of Proposals Offeror(s) shall submit a SEALED proposal package consisting of: a) one (1) signed original of Offeror Proposal and b) two (2) copies c) one (1) original "Summary Proposal Submission Form" (Fee Schedule) in a separate SEALED envelope, identified as "Fee Schedule RFP F-11-16, Worker's Comp Utilization Review" The proposal package shall be addressed as shown above, bearing the Offeror(s) name and address and clearly marked as follows: RFP F-11-16 Worker's Comp Utilization Review 4. Acceptance of Proposals a. The City reserves the right to accept or reject any and all Proposals, or any item or part thereof, or to waive any informalities or irregularities in proposals. b. The City reserves the right to withdraw this RFP at any time without prior notice and the City makes no representations that any contract will be awarded to any Offeror(s) responding to this RFP. C. The City reserves the right to postpone proposal opening for its own convenience. d. Faxed or emailed proposals will not be accepted. F. Pre-Contractual Expenses Pre-contractual expenses are defined as expenses incurred by the Offeror(s) in: 1. preparing its proposal in response to this RFP; 2. submitting that proposal to City; 3. negotiating with City any matter related to this proposal; or 4. any other expenses incurred by the Offeror(s) prior to date of award, if any, of the Agreement. 6 RFP F-11-16 WC Utilization Review The City shall not, in any event, be liable for any pre-contractual expenses incurred by Offeror(s) in the preparation of its proposal. Offeror(s) shall not include any such expenses as part of its proposal. G. Contract Award Issuance of this RFP and receipt of Proposals does not commit the City to award a Purchase Order. The City reserves the right to postpone proposal opening for its own convenience, to accept or reject any or all Proposals received in response to this RFP, and to negotiate with other than the selected Offeror(s) should negotiations with the selected Offeror(s) be terminated. The City also reserves the right to apportion the award among two or more OFFERORM. A signed Vendor (Contractor) / Consultant Service Agreement (VSA/CSA), along with a pre-performance meeting, outlining additional terms and conditions relating to performance, warranty, materials, goods, services, or other items as deemed necessary by the City, may be required prior to the commencement of the job. H. Acceptance of Order The successful Offeror(s) will be required to accept a Purchase Order in accordance with and including as a part thereof the published Request for Proposals, and the RFP documents including all requirements, conditions and specifications contained therein, with no exceptions other than those specifically listed in the written purchase order. I. Business License The City's Business Ordinance requires that a Business doing business with the City, obtain and maintain a valid City Business Registration Certificate during the terms of the Agreement. Bidder agrees to obtain such Certificate prior to undertaking any work under this Agreement. J. Local Vendor Preference The City of San Bernardino gives any formal or informal bid submitted by a local bidder a one percent (1%) credit for goods and materials, where labor and/or installation is incidental; and a five percent (5%) credit on Contractual services, for comparison purposes with other bidders, as authorized in the San Bernardino Municipal Code Section 3.04.125, and Executive Order 2003-1, respectively. For the purposes of this section, "local bidders" shall be bidders for which the point of sale of the goods, materials, or services shall be within the City limits of San Bernardino. 7 } RFP F-11-16 WC Utilization Review SECTION II. SCOPE OF WORK 8 RFP F-11-16 WC Utilization Review I. INTRODUCTION OVERVIEW The City of San Bernardino is soliciting proposals for the administration the City's' Workers' Compensation Utilization Review (UR). CITY PROFILE The City of San Bernardino encompasses 59.3 square miles, with a diverse population of 201,800 residents. Located about 60 miles east of Los Angeles, 120 miles northeast of metropolitan San Diego, and 55 miles northwest of Palm Springs. The city was incorporated in 1854 as a general law city and is governed under the Mayor/Council/City Manager form of government. We are a full service city, including fire, police, library, community services (encompassing parks and recreation, engineering, streets, solid waste management, fleet, property management, and maintenance), water and wastewater utilities, planning, building, economic development and administrative functions. The City has an annual budget of 189 million and employs 1500 full-time employees plus 300 part- time employees. WORKERS' COMPENSATION PROFILE The City self-administers the workers' compensation program and is self-insured for claims up to $1,000,000. Excess insurance is maintained for claims exceeding $1,000,000. The Workers' Compensation Division is an internal service and is financed by service charged to the various City Department and funds. The Workers' Compensation Division is part of the Human Resources Department. The City employs a full-time Workers' Compensation Manager to supervise the administration of the program, and appropriate staff assistance so that a vendor can be assured of fast and competent cooperation on all cost containment matters. During the past year, 324 workers' compensation claims were opened and 131 claims closed. The amount paid for all open claims during the past year was approximately $2,766,133.00. There are currently 565 open indemnity and Medical only claims. COST CONTAINMENT SERVICES Of primary importance to the City's Workers' Compensation Division is a quality utilization review program that improves the administration of workers' compensation claims for injured workers while providing cost savings to the City. The major responsibilities of the vendor will include, but not be limited to, all areas noted in Section III Proposal Specifications under the "SERVICES TO BE PROVIDED' of this Request for Proposals. Responsibilities will include any new or related activities mandated by the law or legal precedent and general utilization review services and practices. 9 RFP F-11-16 WC Utilization Review SCHEDULE FOR AWARD OF CONTRACT • RFP ISSUED................................................................. February 24,2011 • PRE-PROPOSAL MEETING.....................................................N/A • INTERVIEWS WITH FINALIST ( IF NEEDED).........................TBD • FINALIZE CONTRACT.............................................................TBD • AWARD OF CONTRACT .........................................................TBD • EFFECTIVED DATE OF CONTRACT......................................TBD II. PROPOSAL TERMS AND CONDTIONS Requirement to Meet All Proposal Provisions - Each proposal shall meet all of the specifications and proposal terms and conditions. By virtue of the proposal submission, the proposer acknowledges agreement with and acceptance of all provisions of the specifications except as expressly qualified in the proposal. Non-substantial deviations may be considered provided that the proposer submits a full description and explanation of and justification for the proposed deviations. The City of San Bernardino in its sole discretion will determine whether any proposed deviation is non-substantial. Submission of One Proposal Only - No individual or business entity of any kind shall be allowed to make or file or to be interested in more than one proposal, except an alternative proposal when specifically requested. However, an individual who has quoted prices on materials to a proposer submitting a Proposal is not thereby disqualified from quoting prices to other proposer submitting proposals. Proposal Withdrawal - A proposer may withdraw its Proposal without prejudice prior to the time specified for the proposal opening by submitting a written request to the Purchasing Manager for its withdrawal. If this occurs the Proposal will be returned to the vendor unopened. Proposal received after the time specified or at any place other than the place stated in the Request for Proposals will be considered. Proposal Quotes and Unit Prices Extensions -The extensions of unit prices for the quantities indicated and the lump sum prices quoted by the proposer must be entered in figures in the space provided on the Proposal Submission Form(s) or other format used. The Proposal Submission "Form(s) must be totally completed. If the unit price and the total amount stated by any proposer for any item are not in agreement, the unit price alone will be considered as representing the proposer(s) intention and the total will be corrected to conform to the specified unit price. Proposal Retention and Award - The City reserves the right to retain all proposals. The City also reserves the right to determine and waive non-substantial irregularities in any proposal, to reject any or all proposal, to reject one part of a proposal and accept the other, except to the extent that the proposals are qualified by specific limitations, and to award the contract as the interests of the City may require. 10 RFP F-11-16 WC Utilization Review Labor Actions - In the event that the successful proposer is experiencing a labor action at the time of award of the Contract, the City reserves the right to declare said proposer is no longer the most qualified proposer and may accept the next most qualified Proposal from a proposer that is not experiencing a labor action and declare it to be the most qualified proposer. Contract Requirement - The proposer to whom award is made shall execute a written contract with the City within ten (10) calendar days after notice of the award has been sent by mail to the address given in the proposal or written (10) calendar days after receipt by proposer of oral communication of the intent to award, whichever occurs first. The Contract shall be made in the form adopted by the City and incorporated in these specifications. The proposer warrants that proposer possesses, or has arranged through subcontracts, all capital and other equipment, labor and materials to carry out and complete the work hereunder in compliance with all Federal, State, County, City and Special District Laws, Ordinances, and Regulations which are applicable; and further, proposer shall comply with all Federal, State, County, City and Special District laws, Ordinances, and Regulations which are applicable. Failure to Accept Contract - If upon notification of intent to award the Proposal by the City, the proposer fails to enter into the Contract within the specified time period; the pending award will be annulled. Any security will be forfeited in accordance with these Proposal Terms and Conditions if a bond or security is required. An Award may be made to the next most qualified proposer who shall fulfill every term and condition of the Contract. Firm Pricing - The City will use the proposed services on an as-needed basis during the entire term of the Contract. The proposed pricing for these services must be valid for the entire period indicated in the contract terms unless otherwise conditioned by the proposer in the proposal exceptions. Estimated Quantities - The Quantities indicated in the Proposal Submission Forms are estimated based on past experience. Actual quantities for each services procured during the period of this contract may vary up or down from these estimated amounts as require by the City. Non-Exclusive Contract - The City reserves the right to procure the services listed in the Proposal Submission Form, as well as any additional services from other vendors during the contract term. Submission of References - Each proposer shall submit a statement of qualifications and references on the form provided in the proposal package. Statement of Contract Disqualification - Each proposer shall submit a statement regarding any past governmental agency proposal or contract disqualification on the form provided in the proposal package. Insurance - The Contractor shall meet the following provisions (Sections 1 through 7) relating to insurance coverage. 11 RFP F-11-16 WC Utilization Review 1. General Conditions —Without limiting the Contractor's indemnification of City, Contractor shall provide and maintain at its own expense the insurance listed under Section 7 (Evidence of Coverage) covering its operation, subject to the following conditions: a) The City, it's Mayor and Common Council, Both as a Group, and Individually; Its Officers and Employees shall be included as additional insurers in all liability insurance policies and endorsements thereto expect for Workers' Compensation and Professional Errors and Omissions. b) Such insurance shall be primary with respect to any insurance maintained by City and shall not call on City's insurance for contribution. C) With respect to the interest of the City, the Contractor's insurance shall not be canceled nor reduced in coverage or limits until after thirty (30) days written notice shall have been sent by certified mail (return receipt requested) to the City of San Bernardino, Human Resource Department 300 N. D Street, San Bernardino, California 92418 and shall contain an unequivocal clause so stating. d) A City-approved endorsement or certified copy of insurance policy providing coverage shall be submitted to and approved by the City's Risk Manager prior to commencement of any work or tendency. 2. Workers' Compensation —The Contractor shall procure and maintain, during the life of the contract, workers' compensation insurance or a valid certificate of consent to self- insure for its entire employee engaged on or at the site of the project. In case any of the work is sublet, the Contractor shall require all subcontractors to similarly provide workers' compensation insurance for all the latter's employees unless such employees are covered by protection afforded by workers' compensation insurance carried by the Contractor. By Submitting a Proposal pursuant to these specifications, Contractor hereby certifies that it is aware of the provisions of Section 3700 et seq., of the Labor Code, which require every employer to be insured against liability for Workers' Compensation. 3. Aggregated Limits/Blanket Coverage - If any of the required insurance coverage's contain aggregate limits or apply to other operations or tenancy of the Contractor outside these specifications, Contractor shall give City prompt, written notice of any incident, occurrence, claim, settlement, or judgment against that insurance which may diminish the protection that such insurance affords the City. Contractor shall further take immediate steps restoring such aggregate limits or shall provide other insurance protection for such aggregate limits. 4. Modification of Coverage - The City reserves the right at any time during the term of any contract executed with the Contractor pursuant to these specifications (Contract) to change the amounts and types of insurance required hereunder by giving Contractor ninety (90) days written notice. If such change should result in a premium increase in excess of ten (10)% percent to Contractor, City agrees to negotiate additional compensation proportional to the increase benefit to the City. 5. Failure to Procure or Maintain Insurance- Contractor's failure to procure or maintain required insurance program shall constitute a material breach of contract under which the 12 RFP F-11-16 WC Utilization Review City may immediately terminate the Contract or, at its discretion, procure or renew such insurance to protect the City's interests and pay any and all premiums in connection therewith, and recover all monies so paid from Contractor, or deduct all monies so paid from payments due Contractor. 6. Underlying Insurance- Contractor shall be responsible for requiring indemnification and insurance from its employees receiving mileage allowance, consultants, agents, and subcontractors, if any, to protect the Contractor's and the City's interests, and for ensuring that such persons comply with any applicable insurance statutes. Contractor is encouraged to seek professional advice in this regard. 7. Evidence of Coverage's Evidence- of coverage's (as checked below) having as a minimum the limits shown must be submitted and approved prior to the commencement of work or any tenancy. Amounts shown are Combined Single Limits (CSL). Split limits may be substituted if the total per occurrence equals or exceeds the CSL amount. Description Limits Workers' Compensation Statutory (x) Employers' Liability $500,000 - Waiver of Subrogation -General Liability (must be written on an Occurrence Form) $1,000,000 (x) Premises and Operation (x) Contractual Liability (x) Independent Contractors (x) Products/Completed Operations (x) Broad Form Property Damage (x) Personal Injury (x) Broad Form Liability Endorsement -Automobile Liability (must be written on an Occurrence Form)$1,000,000 (x) Owned Automobiles (x) Non-owned/Hired Automobiles (x) Garage keepers' Legal Liability - (X) Professional Liability (Errors and Omissions) $5,00,000 (To be in continuous force from date of contract award until one year after final acceptance of the project. 13 RFP F-11-16 WC Utilization Review III. PROPOSAL SPECIFICATIONS SERVICES TO BE PROVIDED Following is a description of the required services for the Workers' Compensation Utilization Review (UR): Per the requirements of S13228, administer Utilization Review for the City as follows: • Review treatment for medical necessity, appropriateness, and duration of care in the following treatment categories, applying American College of Occupational and Environmental Medicine (ACOEM) guidelines and other approved evidence-based guidelines: • Chiropractic; • Physical Therapy and other physical treatment modalities; • MRI and other major diagnostic test • Hospitalization; • Outpatient Surgery/Outpatient Procedures. • Provided service requests within the applicable time standards and provided medical advice as warranted. • In accordance with labor Code 4610 all prospective and concurrent decisions must be reviewed and a decision made within 5 working days from receipt of information but not to exceed 14 days from the date of the treatment recommendation by the physician. PROPOSAL CONTENT Proposals for services shall include the following information: • An overview of your company's experience in providing UR services for cities and other clients. • Minimum of three professional references. • List of physicians/nurses who will be performing UR services, along with resumes. • Experience and training of UR staff, including nurses who would will conduct initial reviews. • Your company's average-turn around time for UR requests. • Fee options and how fees are calculated. • Samples of reports documenting claims review and action taken. • Describe workflow and the method information is gathered and exchanged between City's medical providers and your company in performing UR services. • Any distinguishing or unique qualifications that your company possesses or any other information that more fully documents your ability to provide UR services. • Proposal submission must be no more than 12 pages (not including City forms or contract.) 14 RFP F-11-16 WC Utilization Review IV. PROPOSAL EVALUATION & SELECTION CRITERIA This section describes the guidelines used for analyzing and evaluating the various proposals. In an effort to reach a decision concerning the best —qualified proposals, it is the City's intent to award this contract to the firm or firms that will provide the best overall service to the City inclusive of fee considerations. As in all professional service contracts, the City reserves the right to accept other than the lowest price offer and reject all proposals that are not responsive to this request. Proposals will be evaluated by city staff, which will determine the firms selected for further consideration, based on an evaluation of the proposals using the criteria listed below. The final recommendation will be reviewed by the Human Resources Director and then submitted to Mayor and City Council who will make the final approval for the award of the contract. This list serves as a general guide, and may not be all-inclusive. The City reserves the right to evaluate all factors it deems appropriate, whether or not such factors have been included in this section., • Proposer(s) Experience and Qualification -Experience and understanding of the concepts and requirements of cost containment, per SB 228, SB899 and other applicable State law and sound industry practice. Experience in administering the Utilization Review process, including establishment of a network of physician experienced in the Utilization Review process. • Computer Reporting Ability to work effectively with City staff and to provide efficient and responsive service. - Number of staff that would be assigned the City's account. Customer services training provided to above staff. Responsiveness to RFP and Completeness of Proposal Overall quality of proposal, including responses to all RFP requirements and thorough explanation of all services to be provided. • Cost of Services Proposed Fees structure; overall cost to the City for the proposed services. (see page 25. SECTION IV GENERAL EVALUATION CRITERIA for additional criteria requirements.) i 15 RFP F-11-16 WC Utilization Review V. STATEMENT OF PROPOSER'S QUALIFICATIONS AND REFERENCES UTILIZATION REVIEW The proposer is required to state the proposer(s) financial ability and a general description of similar work performed. Number of years engaged in providing the work included within the scope of the specifications under the present business name: List and describe fully the last three contracts performed by your firm, which demonstrate your ability to complete the work included with the scope of the specifications. Attach additional pages if required. The City reserves the right to contact each of the references listed for additional information regarding your firm's qualifications. Reference No.1 Customer Name: Contact individual: Address: Phone No: Contract Amount: Year: Description of Work Done: Reference No.2 Customer Name: Contact individual: Address: Phone No: Contract Amount: Year: Description f Work Done: Reference No.3 Customer Name: Contact individual: Address: Phone No: Contract Amount: Year: Description of Work Done: Signature Title: 16 RFP F-11-16 WC Utilization Review VI. STATEMENT OF PROPOSER'S PAST CONTRACT DISQUALIFICATIONS Pursuant to Section 10162 of Public Contract Code, the proposer shall state whether such proposer, any officer of employee of such proposer who has proprietary interest in such proposer has ever been disqualified, removed, or otherwise prevented from proposal on, or completing a Federal, State, or local government project because of a violation of law or a safety regulation; and if so, explain the circumstances. 1. Do you have any disqualifications, removal, etc., as described in the above paragraph to declare? Yes No 2. If yes, explain the circumstances. Executed on at , California. I declare, under penalty of perjury, that the foregoing is true and correct. Signature(s) of Authorized Proposer Signature of Authorized Proposer Title Title 17 RFP F-11-16 WC Utilization Review VII. WORKERS' COMPENSATION INSURANCE CERTIFICATE Sections 1860 and 1861 of the California Labor Code require every contractor to whom a public works contract is awarded to sign and file with the awarding body the following statement: "I am aware of the Provisions of Section 3700 of the labor Code which, requires every employer to be insured against I liability for Workers' Compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such Provisions before commencing the performance of the work of this Contract. " By: Date: Title: By: Date: Title: 18 ' RFP F-I 1-16 WC Utilization Review SECTION III. BID CONTENT AND FORMS 19 RFP F-11-16 WC Utilization Review VIII.SUMMARY PROPOSAL SUBMISSION FORM (FEE SCHEDULE) The undersigned declares that he or she has carefully examined the Request for Proposals and is thoroughly familiar with the contents thereof, is authorized to represent the proposing firm, and proposes to provide to the City of San Bernardino: As described in said Request for Payment, which is made a part of this proposal, quoted herein in full • Utilization Review (a) Nurse (per hour or flat rate per claim) (b) Physician (per hour or flat rate per claim) (c) Other Associated Costs (per hour or flat per claim) Explain: TOTAL COST: Per hour Flat Rate Per Claim THE ONLY EXCEPTIONS FROM THE SPECIFICATION ARE AS FOLLOWS: i s s li Are there any other additional or incidental costs that will be required by your firm in 1 order to meet the requirements of the Proposal Specifications? Yes / No (circle one). If you answered "Yes", please provide detail of said additional costs: Please indicate any elements of the Proposal Specifications that cannot be met by your firm. Have you included in your proposal all informational items and forms as requested? Yes / No . (circle one). If you answered "No", please explain: This offer shall remain firm for 90 days from RFP close date. -20 RFP F-11-16 WC Utilization Review VIII.SUMMARY PROPOSAL SUBMISSION FORM (FEE SCHEDULE) continued Terms and conditions as set forth in this RFP apply to this proposal. i Cash discount allowable % days; unless otherwise stated, payment terms are: Net thirty (30) days. In signing this proposal, Offeror(s) warrants that all certifications and documents requested herein are attached and properly completed and signed. From time to time, the City may issue one or more addenda to this RFP. Below, please indicate all Addenda to this RFP received by your firm, and the date said Addenda was/were received. Verification of Addenda Received Addenda No: Received on: Addenda No: Received on: Addenda No: Received on: FIRM NAME: ADDRESS: Phone: Email: Fax: Authorized Signature: Print Name: Title: IF SUBMITTING A "NO PROPOSAL", PLEASE STATE REASON (S) BELOW: ' RFP F-11-16 WC Utilization Review SUBCONTRACTOR'S LIST As required by California State Law, the General Contractor bidding will hereinafter state the subcontractor who will be the subcontractor on the job for each particular trade or subdivision of the work in an amount in excess of one-half of one percent of the General Contractor's total bid and will state the firm name and principal location of the mill, shop, or office of each. If a General Contractor fails to specify a subcontractor, or if he specifies more than one subcontractor for the same portion of work to be performed under the contract in excess of one-half of one percent, he agrees that he is fully qualified to perform that portion himself and that he shall perform that portion himself. DIVISION OF NAME OF FIRM OR LOCATION WORK OR CONTRACTOR CITY TRADE Print Name Signature of Bidder Company Name: Address: REJECTION OF BIDS The undersigned agrees that the City of San Bernardino reserves the right to reject any or all bids, and reserves the right to waive informalities in a bid or bids not affected by law, if to do seems to best serve the public interest. 22 RFP F-11-16 WC Utilization Review NON - COLLUSION AFFIDAVIT I f TO: THE COMMON COUNCIL, CITY OF SAN BERNARDINO In accordance with Title 23, United States Code, Section 112, the undersigned hereby states, under penalty of perjury: That he/she has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken action in restraint of free competitive proposal in connection with RFP F-11-16. Business Name Business Address Signature of Offeror(s) X Place of Residence Subscribed and sworn before me this day of , 20_. Notary Public in and for the County of , State of California. My commission expires , 20 : 23 RFP F-11-16 WC Utilization Review SECTION IV. GENERAL EVALUATION CRITERIA 24 i IV. GENERAL EVALUATION CRITERIA A. EVALUATION CRITERIA 1. Capabilities of Firm to Effectively Complete the Project Requirements - 35% Depth of Offeror(s)'s understanding of, and ability to manage, City's requirements; ability to meet task deadlines; utility of suggested enhancements or technical innovations. 2. Qualifications of Firm/Related Experience -45% Experience in providing services similar to those requested herein; experience working with public agencies; strength and stability of the firm; strength, stability, experience and technical competence of subcontractors; assessment by client references; qualifications of project staff; key personnel's level of involvement in performing related work; logic of project organization; adequacy of labor commitment. 3. Reasonableness of Cost and Price - 10% Reasonableness of the individual firm-fixed prices and competitiveness of quoted prices with other proposals received; adequacy of the data in support of figures quoted; basis on which prices are quoted. 4. Completeness of Response - 5% :q Completeness of response in accordance with RFP instructions; exceptions to or deviations from the RFP requirements which the Offeror(s) cannot or will not accommodate; other relevant factors not considered elsewhere. 5. Local Vendor Preference - 5% As approved in Executive Order 2003-01--Offeror(s)'s which posses a fixed office or distribution point with at least one owner or employee located within the City of San Bernardino, and possessing all valid and current permits, and licenses required to transact such business, including, but not limited to a City Business Registration Certificate fi shall receive a five percent (5%) preference. [Unless contrary to Federal, State or Local Law (such as contracts for the construction of public works projects), or unless contrary to the requirements mandated by the funding source for such contractual services (such as the Federal Government or other source which requires award to the lowest responsible Offeror(s.) RFP F-11-16 WC Utilization Review B. EVALUATION PROCEDURE All proposals received as specified will be evaluated by City staff in accordance with the above criteria. Additional sub-criteria beyond those listed may be considered by the evaluators in applying the major criteria to the proposals. During the evaluation period, the City may require an on- site visit and/or tour of the Offeror(s)'s place of business. OFFEROR(S) should be aware; however, that award may be made without vendor visits, interviews, or further discussions. C. AWARD Depending on the dollar amounts of the offers received, City staff will either select the vendor best meeting the above-specified criteria or submit to City Council, for consideration and selection, the offer(s) judged by staff to be the most competitive. The City reserves the right to withdraw this RFP at any time without prior notice and, furthermore, makes no representations that any contract(s) will be awarded to any OFFEROR(S) responding to this RFP. The City expressly reserves the right to postpone proposal opening for its own convenience, to waive any informality or irregularity in the proposals received, and to reject any and all proposals responding to this RFP without indicating any reasons for such rejection. The City also reserves the right to award its total requirement among two or more OFFEROR(S) as City staff may deem to be in its best Interests. In addition, negotiations may or may not be conducted with OFFEROR(S); therefore, the proposal submitted should contain the OFFEROR(S) most favorable terms and conditions, since the selection and award may be made without discussion with any Offeror(s). D. TIE PROPOSALS If the final evaluation scores (after applying the local preference allowance) result in a tie score, then the recommendation for award will be given to the local vendor. E. NOTIFICATION OF AWARD OFFEROR(S) who submit a proposal in response to this RFP shall be notified regarding the firm(s) who was awarded the agreement. Such notification shall be made within a reasonable time after the date the agreement is awarded. 26 RFP F-11-16 WC Utilization Review SECTION V. GENERAL SPECIFICATIONS 27 ..... ...... . .. ........ RFP F-11-16 WC Utilization Review V. GENERAL SPECIFICATIONS 1. Each proposal shall be in accordance with Request for Proposal (RFP) Number RFP F-11-16. All specifications are minimum. Offeror(s) are expected to meet or exceed these specifications as written. Offeror(s) shall attach to their proposal a complete detailed itemization and explanation for each and every deviation or variation from the RFP specifications and requirements. Conditional Proposals, or those that take exception to the RFP specifications and requirements, may be considered non-responsive and may be rejected. 2. The City reserves the right to accept or reject any and all Proposals and to award a contract to the Offeror(s) whom best meets the City's requirements. This may include waiver of minor irregularities or discrepancies, or nonconformity to specifications in appropriate circumstances. Purchase shall be on a best buy basis after due consideration of all relevant factors, including but not limited to, workmanship, accessibility of parts and service, known evidence of manufacturer's responsibility and record, durability and known operational record of product and suitability as well as conformity to City needs and requirements. In all cases the best interest of the City shall prevail in all contract awards. 3. The City of San Bernardino reserves the right to purchase more or less than the quantities specified at unit prices proposal. a. Proposals shall be firm offers, subject to acceptance or rejection within 90 days minimum of the opening thereof. s. Regular dealer. No Offeror(s) shall be acceptable who is not a reputable manufacturer or dealer of such items as submitted for proposal consideration. s. All materials, workmanship and finish entering into the construction of the equipment must be of the best of these respective kinds and must conform to the character of the equipment and the service for which it is intended to be used and shall be produced by use of the current manufacturing processes. "Seconds", factory rejects, and substandard goods are not acceptable. 7. Each Offeror(s) shall submit with their proposal a copy of the proposed product specifications, complete detailed drawings, and other descriptive matter in sufficient detail to clearly describe the equipment, materials and parts offered. s. Manufacturer and/or Contractor shall defend any and all suits and assume all liability for any and all claims made against the City of San Bernardino, or any of its officials or agents for the use of any patented process, device or article forming a part of equipment or any item furnished under the contract. 9. Each Offeror(s) must state in their proposal the guaranteed delivery date of product and/or services in number of calendar days from the date of contract execution by the City of San Bernardino, time is of the essence relative to this contract. Contractor shall prosecute the work continuously and diligently and shall deliver the items at the earliest possible date following the award of the contract. 28 RFP F-11-16 WC Utilization Review 10. Each Offeror(s) shall list in their proposal all factory, manufacturer's and/or dealer's warranty and/or guarantee coverage and shall submit such written documents evidencing the same attached to the proposal. 11. Successful Offeror(s) (Contractor) shall furnish and deliver to the City complete equipment as proposed and awarded, ready for installation and fully equipped as detailed in these specifications. 12. Price shall be quoted F.O.B. San Bernardino (all transportation charges shall be fully prepaid), and shall include all discounts. Proposal shall include California sales tax, where applicable, (effective April 1, 2009) computed at the rate of 9%, this will normally be shown as a separate line item on the price form. 13. City shall make payment within thirty (30) days after the complete delivery and acceptance of the specified items by the City of San Bernardino and receipt of the Contractor's priced invoice. 14. All "standard equipment" is included in any proposal. OFFEROR(S) furnishing Proposals under these specifications shall supply all items advertised as "standard" equipment even if such items are not stipulated in the specifications, unless otherwise clearly excepted in the proposal. 15. The items which the Offeror(s) proposes to furnish the City must comply in all respects with the appropriate safety regulations of all regulatory commissions of the Federal Government and the State of California, whether such safety features and/or items have been specifically outlined in these specifications or not. 16. Contractor delivering equipment pursuant to this RFP specifications shall guarantee that equipment meets specifications as set forth herein. If it is found that equipment delivered does not meet requirements of these specifications the Contractor shall be required to correct the same at their own expense. 17. By submitting a proposal, each Offeror(s) agrees that in the event complete delivery is not made within the time or times set forth pursuant to this specification, damage will be sustained by the City, and that it is, and will be impractical and extremely difficult to, ascertain the actual damage which the City will sustain in the event of and by reason of such delay. 18. In case the delivery of the items under this contract is delayed due to strikes, injunctions, government controls, or by reason of any cause or circumstance beyond the control of the Contractor, the time for delivery may be extended (in the City's sole discretion) by a number of days to be determined in each instance by mutual written agreement between the Contractor and the Purchasing Division of the City of San Bernardino. The City shall not unreasonably refuse such extension. 1s. Contract. Each proposal shall be submitted and received with the understanding that acceptance by the City of San Bernardino of proposal in response to this solicitation shall constitute a contract between the Contractor and the City. This shall bind the Contractor to furnish and deliver at the prices proposed and in complete accordance with all provisions of RFP F-11-16. In 29 ' RFP F-11-16 WC Utilization Review most cases the basis of award will be the City's standard purchase order that may or may not incorporate this solicitation by reference. 20. Prohibited interest. No member, officer, or employee of the City or of any agency of the City during his tenure or for one year thereafter shall have any interest, direct or indirect in this contract or the proceeds thereof. Furthermore, the parties hereto covenant and agree that to their knowledge no board member, officer or employee of the City has any interest, whether contractual, non-contractual, financial or otherwise, in this transaction, or in the business of the contracting party other than the City, and that if any such interest comes to the knowledge of either party at any time, a full and complete disclosure of all such information will be made in writing to the other party or parties, even if such interest would not be considered a conflict of interest under Article 4(commencing with Section 1090) or Article 4.6 (commencing with Section 1120) of Division 4 of Title I of the Government Code of the State of California. 21, One Document. These specifications, the Request for Proposal, RFP F-11- 16, the Contractor's proposal, any written agreement executed by the parties, the purchase order and all documents referred to in the complete specifications and purchase order, and all written modifications of said documents shall be construed together as one document. Anything called for in any one of said documents shall be deemed to be required equally as if called for in all. Anything necessary to complete the work properly shall be performed by the contractor, whether specifically set out in the contract or not. All sections of the specifications shall be read as constituting a whole and not as an aggregation of individual parts, and whatever is specified in one section shall be construed as applying to all sections. 22. The City of San Bernardino reserves the right to accept or reject any and all Proposals. 23. Prompt payment. Each Offeror(s) may stipulate in their proposal a percentage prompt payment discount to be taken by the City in the event the City makes payment to the Contractor within ten (10) working days of receipt of material and approval of invoice. For the purpose of this provision, payment is deemed to be made on the date of mailing of the City check. NOTE: prompt payment discounts will only be used during proposal evaluation in the case of ties. 24. Inquiries. Technical questions may be-sent via fax to 909-384-5043, or email: morrow_de @sbcity.org. The answers to material questions will be provided in writing by Addendum(s) to all potential Offeror(s) by a posting to the City's website. 25. Proposal/Fee Schedules. No proposal will be acceptable unless fees/prices are submitted on the pricing forms furnished by the contractor hereiR, and all required forms are completed and included with proposal. Deliver all Proposals, SIGNED and SEALED, to the Purchasing Division, Finance Department at 300 North "D" Street, 4th Floor, City Hall, San Bernardino, California 92418. CLEARLY MARK THE RFP SPECIFICATION TITLE: 30 y RFP F-11-16 WC Utilization Review Worker's Comp Utilization Review and RFP F-11-16 ON THE OUTSIDE OF THE ENVELOPE. leg 26. Time. All Proposals must be received in the Purchasing Division no later than 3:00 PM, PST, MARCH 2011, where at such time and said place Proposals will be publicly opened, examined and declared. Any proposal may be withdrawn by Offeror(s) prior to the above scheduled time for the opening of Proposals. Any proposal received after that time and date specified shall NOT be considered. 27. The City of San Bernardino reserves the right at its own discretion to award separate contracts for each category, or to award multiple contracts, or to award one contract for furnishing and delivering of all equipment and/or services in all categories. 28. Equipment. In the purchase of equipment, Contractor shall be required to furnish one (1) OPERATORS MANUAL and one (1) PARTS MANUAL for all equipment proposal. 29. In submitting a proposal to a public purchasing body, the Offeror(s) offers and agrees that if the proposal is accepted, it will assign to the purchasing body all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton Act (U.S.C. Sec 15) or under the Cartwright Act (Chapter 2, commencing with Section 16700 of Part 2 of Division 7 of the Business and Professions Code), arising from purchases of goods, materials, or services by the Offeror(s) for sale to the purchasing body pursuant to the proposal. Such assignment shall be made and become effective at the time the purchasing body tenders final payment to the Offeror(s). 30. Contractor shall indemnify, defend and hold City, its officers, employees and agents harmless from any claim, demand, liability, suit, judgment or expense (including, without limitation, reasonable costs of defense) arising out of or related to Contractor's performance of this agreement, except that such duty to indemnify, defend and hold harmless shall not apply where injury to person or property is caused by City's willful misconduct or sole negligence. The costs, salary and expenses of the City Attorney and members of his office in enforcing this Agreement on behalf of the City shall be considered as "attorney's fees" for the purposes of this paragraph. 31. While not restricting or limiting the foregoing, during the term of this Agreement, Contractor shall maintain in effect policies of comprehensive public, general, and automobile liability insurance, in the amount of $1,000,000 combined single limit, and statutory worker's compensation coverage, and shall file copies of said policies with the City's Risk Division prior to undertaking any work under this Agreement. The policies shall name the City as an additional insured and shall provide for ten- (10) day notification to the City if said policies are terminated or materially altered. 32. c c OF faithful perf -C11 in f 1 31 RFP F-11-16 WC Utilization Review shall have a rating in Best's most recent insurance guide of"A" or better. 33. Written contract documents, duly authorized and signed by the appropriate authority, constitute the complete and entire agreement(s) that may result from the RFP. 34. City may, at its discretion, exercise option year renewals for up to three (3) years, in one-year increments. 35. By submitting a proposal, Offeror(s) warrants that any and all licenses and/or certifications required by law, statute, code or ordinance in performing under the scope and specifications of this RFP are currently held by Offeror(s), and are valid and in full force and effect. Copies or legitimate proof of such licensure and/or certification shall be included in Offeror(s)'s response. Proposals lacking copies and/or proof of said licenses and/or certifications may be deemed non-responsive and may be rejected. 36. Once the award has been made and prior to the commencement of the job, the City's Municipal Code (M.C. 5.04.005) requires that a Business doing business with the City, obtain and maintain a valid City Business Registration Certificate during the term of the Agreement. 37. Vendor (Contractor)/ Consultant services agreement(s) (VSA/CSA). A signed vendor/Consultant service agreement may be required between both parties prior to commencement of the job. 32 II I r 7 t` Addendum 2 WC Utilization Review CITY OF Safl Berflar IN SM March 8, 2011 ADDENDUM #2 TO Request for Proposal (RFP) F-11-16 Workers Compensation Utilization Review Notice is hereby given that the following changes, additions, deletions, or clarifications are incorporated as an Addendum to the Request for Proposal (RFP) F-11-16. Correction: Page 31, Item 26, should read: March 16, 2011 The correct due date of proposals is March 16, 2011 Sincerely, Deborah R. Morrow, C.P.M., MPA Purchasing Division 1 ti BID DATA SHEET Department: Human Resources RFP / R-FQ# F-11-16 Description: Workers' Comp Utilization Review Bid Issue (advertisement) Date: 02/24/11 Bid Due Date: 03/16/11 Methods of Public Advertisement: The SB County Sun SB Area Chamber of Commerce (SBACC) City of SB Website & SB Connect "Notice Inviting Bids / Proposals" sent by Purchasing: Fax Email US Postal Servn(3e GeFtified Magi Local Vendors (within SB City Limits): 00 Non-Local Vendors: 09 Total Vendors 09 Number of Bids / Proposals Received: Local Vendors (within SB City Limits): 00 Non-Local Vendors: 10 Total Bid Packages Received: 10 # of Vendors who declined to bid (No Bid): 00 Prepared by: D. Morrow Date: 03/22/11 t DEPARTMENT AWARD CHECKLIST BID# Description Requisition # ❑ Vendor Debarment Verification (Grants only) (1) ❑ Local Vendor Verification - within SB City limits �1) ❑ Local Vendor Preference (LVP) given? (1)(Companies Within our city limits;for comparison purposes only:1%credit for goods or materials,or 5%for services*must be reflected on bid/quote sheet) ❑ City of San Bernardino Business License Verification(2) ❑ W-9 Form (2) ❑ Faithful Performance/Bid Bond Required? �1) Yes ❑ No ❑ ❑ Contractor's License (where applicable)(1) ❑ $1,000,000 Insurance Policy (1)Comprehensive,public,general&auto liability ❑ Worker's Compensation Insurance (1) ❑ Vendor/ Consultant Agreement Required? (2) Yes ❑ No ❑ 1) Must be obtained prior to Council award 2) Must be obtained prior to issuance of a purchase order,commencement of service,or receipt of goods, supplies,materials, and payment of invoices. This checklist may not be reflective of all documents necessary for submittal. All insurance certificates must be approved by Risk Management 03/09/10 drm i SIB CHAMBER OF COMMERCE REHAB WEST INC (RWI) TOTAL HEALTH CARE MGMT ATTN ALEX MELLOR 546 W. 6T" ST. ATTN KATHY THOMAS P. 0. BOX 301010 SAN BERNARDINO, CA 92410 17310 REHILL AVE. STE#300 ESCONDIDO CA 92030 SBA(n>VFRI70N NET IRVINE ::,:;26'14 FAX (7b1) 1-9b-7564 KATHY @THMNET.COM 949) 757-0076 DEFINITI HEALTHCARE MGMT CID MANAGEMENT ATTN: ALBERTO RIVERA MONITOR INTEGRATED HEALTH ATTN JAMES SCHLUETER 26429 RANCHO PARKWAY SOUTH#145 CARE—ATTN MIGNON MARLOW 2415 SAN RAMON VALLEY BL#4414 LAKE FOREST CA 92630 2920 H STREET, STE# 140 SAN RAMON CA 94583 ALBERTO.RIVERA @DEFINITLNET BAKERSFIELD CA 93301 FAX (925) 886-8710 & (925)886-4853 MIGNON @MONITORINTEGRATEDHC.NET TRISTAR MANAGED CARE INTERMED COST CONTAINMENT COMP PARTNERS ATTN JENNIFER HARPENAU ATTN MICHAEL RAMSER ATTN: STEVE HUNTINGTON ATTN LYNN MATTHEWS DAVID THOMPSON 18881 VON KARMAN AVE STE 900 203 N GOLDEN CIRCLE STE 310 3010 LAVA RIDGE COURT STE 200 IRVINE CA 92612 SANTA ANA CA 92705 ROSEVILLE CA 95661 (949)253-3115 JENNIFER.HARPENAU @TRISTARGROUP.NET FAX (916) 781-5758 & (916)781-5505 LYNN.MATTHEWS@TRI STARGROUP.NET CORVEL ATTN LEANN FARLANDER 600 CITY PARKWAY WEST#700 ORANGE CA 949) 233-5303 LEAN N_FARLANDER @CORVEL.COM RFP F-11-16 WORKERS COMP ✓ UTILIZATION REVIEW (Risk Mgmt) DUE 03/16/11 1 Resolution No 2 D 'y RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORI G E 3 EXECUTION OF AN AGREEMENT WITH CORVEL TO PROVIDE UTILIZATION 4 REVIEW SERVICES FOR THE CITY'S WORKERS' COMPENSATION PROGRAM. 5 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: 6 SECTION 1: The City Manager of the City of San Bernardino is hereby authorized and 7 directed to execute on behalf of said City an Agreement with CorVel to provide Utilization 8 Review services for a period of one (1) year with two (2) one (1) year extensions, a copy of 9 which is attached hereto, marked Exhibit "A" and incorporated herein by reference as fully as 10 though set forth at length. I 11 SECTION 2: The Purchasing Manager is hereby authorized to issue a Purchase Order to 12 CorVel for Utilization Review services for the Workers' Compensation Division for a total 13 amount not to exceed$95,000. 14 15 SECTION 3: The authorization to execute the above mentioned agreement is rescinded 16 if the parties to the agreement fail to sign it within sixty (60) days of the passage of this 17 resolution. 18 19 20 21 22 23 24 b ti 25 1 RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE EXECUTION OF AN AGREEMENT WITH CORVEL TO PROVIDE UTILIZATION 2 REVIEW SERVICES FOR THE CITY'S WORKERS' COMPENSATION PROGRAM. 3 I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and 4 the Common Council of the City of San Bernardino at a meeting thereof, 5 held on day of , 2011,by the following vote,to wit: 6 7 COUNCILMEMBERS: AYES NAYES ABSTAIN ABSENT 8 MARQUEZ 9 VACANT 10 BRINKER SHORETT 11 KELLEY 12 JOHNSON 13 MCCAMMACK 14 15 Rachel G. Clark, City Clerk 16 17 The foregoing resolution is hereby approved this day of 18 , 2011. 19 Patrick J. Morris, Mayor 20 City of San Bernardino 21 Approved as to form: 22 JAMES F. PENMAN, 23 City Attorney 24 B 25 r C�Cr-✓ ems:Reso.CorVe1.2011 EXHIBIT"A" 1 VENDOR SERVICE AGREEMENT 2 This Vendor Service Agreement is entered into this 1st day of July 2011, by and between 3 CorVel("VENDOR") and the City of San Bernardino ("CITY"). 4 WITNESSETH: 5 WHEREAS, the Mayor and Common Council has determined that it is advantageous an 6 in the best interest of the CITY to acquire Utilization Review Services; and 7 WHEREAS, the CITY did solicit and accept proposals and bids from a number o 8 vendors for Utilization Review Services; 9 10 NOW, THEREFORE,the parties hereto agree as follows: 11 1. SCOPE OF SERVICES. 12 For the remuneration stipulated, San Bernardino hereby engages the services o 13 VENDOR to'provide those products and services as set forth in Exhibit "A", attache 14 hereto and incorporated herein by this reference. If a conflict arises between this Vendo 15 Services Agreement (hereinafter "Agreement") and Exhibit "A," the terms of the 16 Agreement shall govern. 17 2. COMPENSATION AND EXPENSES. 18 a. For the services delineated above, the CITY, upon presentation of an invoice 19 shall pay the VENDOR the amount of monthly invoices for services rendered 20 during the previous month. Invoices shall include task description, the number o 21 hours spent on each task, and applicable hourly rate. Cost not to exceed $95,00 !I 22 23 annually. 24 b. No other expenditures made by VENDOR shall be reimbursed by CITY. j 25 iii J Ii :1 i! '3 � 1 1 3. TERM. 2 The term of this Agreement shall be for a period of one(1) year with two (2) one(1) year 3 extensions. 4 This Agreement may be terminated at any time by thirty (30) days written notice 5 by either party. The terms of this Agreement shall remain in force unless mutually 6 amended. The duration of this Agreement may be extended with the written consent o 7 both parties. 8 4. INDEMNITY. 9 10 Vendor agrees to and shall indemnify and hold the City, its elected officials, employees 11 agents or representatives, free and harmless from all claims, actions, damages an 12 liabilities of any kind and nature arising from bodily injury, including death, or property 13 damage, based or asserted upon any actual or alleged act or omission of Vendor, it 14 employees, agents, or subcontractors, relating to or in any way connected with the 15 accomplishment of the work or performance of services under this Agreement, unless the 16 bodily injury or property damage was actually caused by the sole negligence of the City, 1' its elected officials, employees, agents or representatives. As part of the foregoing 18 indemnity, Vendor agrees to protect and defend at its own expense, including attorney' 19 fees, the City, its elected officials, employees, agents or representatives from any and all 20 legal actions based upon such actual or alleged. acts or omissions. Vendor hereby waive 21 22 any and all rights to any types of express or implied indemnity against the City, it 23 elected officials, employees, agents or representatives, with respect to third party claim 24 against the Vendor relating to or in any way connected with the accomplishment of the 25 work or performance of services under this Agreement. 2 1 5. INSURANCE. AVON 2 While not restricting or limiting the foregoing, during the term of this Agreement 3 VENDOR shall maintain in effect policies of comprehensive public, general an 4 automobile liability insurance, in the amount of$1,000,000.00 combined single limit, an 5 statutory Workers' Compensation coverage in accordance with the laws of the State o 6 California. VENDOR shall maintain professional malpractice insurance for professional 7 negligence, including errors, omissions, or other professional acts in the amount o 8 $100,000.00. VENDOR shall file Certificate(s) of Insurance with the CITY's Ris 9 to Manager prior to undertaking any work under this Agreement. CITY shall be set forth a 11 an additional named insured in each Certificate of Insurance provided hereunder. The 12 Certificate(s) of Insurance furnished to the CITY shall require the insurer to notify CIT 13 of any change or termination in the policy. 14 6. NON-DISCRIMINATION. 15 In the performance of this Agreement and in the hiring and recruitment of employees 16 VENDOR shall not engage in, nor permit its officers, employees or agents to engage in 17 discrimination in employment of persons because of their race, religion, color, nation 18 origin, ancestry, age, mental or physical disability, medical condition, marital status 19 sexual gender or sexual orientation, or any other status protected by law, except ass 20 permitted pursuant to Section 12940 of the California Government Code. 21 7. CONFIDENTIALITY. 22 23 VENDOR understands and agrees that CITY, as a public entity, and can maintairi 24 VENDOR's confidentiality only to the extent that doing so does not conflict with its 25 3 I duties under the California Public Records Act, the Ralph M. Brown Act or any othe 2 requirement of law,regulation,rule, or court or other government decision. 3 8. INDEPENDENT CONTRACTOR. 4 VENDOR shall perform work tasks provided by this Agreement, but for all intents an 5 purposes VENDOR shall be an independent contractor and not an agent or employee o 6 the CITY. VENDOR shall secure, at its expense, and be responsible for any and all 7 payment of Income Tax, Social Security, State Disability Insurance Compensation 8 9 Unemployment Compensation, and other payroll deductions for VENDOR and it 10 officers, agents, and employees, and all business licenses, if any are required, i 11 connection with the services to be performed hereunder. 12 9. BUSINESS REGISTRATION CERTIFICATE AND OTHER REQUIREMENTS. 13 VENDOR warrants that it possesses or shall obtain, and maintain a business registration 14 certificate pursuant to Chapter 5 of the Municipal Code, and any other licenses, permits 15 qualifications, insurance and approval of whatever nature that are legally required o 16 !I VENDOR to practice its business or profession. 17 10. NOTICES. 18 Any notice to be given pursuant to this Agreement shall be deposited with the Unite 19 States Postal Service,postage prepaid and addressed as follows: 20 TO THE CITY: 21 Linn Livingston,Human Resources Director 22 300 North "D" Street,2nd Floor San Bernardino, CA 92418 23 Telephone: (909) 384-5161 24 25 4 I TO THE VENDOR: 2 Sharon O'Connor Leann Farlander Director of Legal Services Account Executive 3 CorVel Corporation CorVel Corporation 4 2010 Main Street, Suite 600 600 City Parkway West, Suite 700 Irvine, CA 92614 Orange, CA 92868 5 11. ATTORNEYS'FEES. 6 In the event that litigation is brought by any party in connection with this Agreement,the 7 prevailing party shall be entitled to recover from the opposing party all costs an 8 expenses, including reasonable attorneys' fees, incurred by the prevailing party in th 9 10 exercise of any of its rights or remedies hereunder or the enforcement of any of the terms, 11 conditions or provisions hereof. The costs, salary and expenses of the City Attorney an 12 members of his office in enforcing this Agreement on behalf of the CITY shall be 13 considered as "attorneys'fees" for the purposes of this paragraph. 14 12. ASSIGNMENT. 15 VENDOR shall not voluntarily or by operation of law assign, transfer, sublet o 16 encumber all or any part of the VENDOR's interest in this Agreement without CITY' 17 prior written consent. Any attempted assignment, transfer, subletting or encumbrance 18 shall be void and shall constitute a breach of this Agreement and cause for the 19 termination of this Agreement. Regardless of CITY's consent, no subletting or 20 assignment shall release VENDOR of VENDOR's obligation to perform all other 21 22 obligations to be performed by VENDOR hereunder for the term of this Agreement. 23 13. VENUE. 24 The parties hereto agree that all actions or proceedings arising in connection with this 25 F 5 1 Agreement shall be tried and litigated either in the State courts located in the County o 2 San Bernardino, State of California or the U.S. District Court for the Central District o 3 California, Riverside Division. The aforementioned choice of venue is intended by the 4 parties to be the mandatory and not permissive in nature. 5 14. ' GOVERNING LAW. 6 This Agreement shall be governed by the laws of the State of California. 7 15. SUCCESSORS AND ASSIGNS. 8 9 This Agreement shall be binding on and inure to the benefit of the parties to thi 10 Agreement and their respective heirs, representatives, successors, and assigns. 11 16. HEADINGS. 12 The subject headings of the sections of this Agreement are included for the purposes o 13 convenience only and shall not affect the construction or the interpretation of any of it 14 provisions. 15 17 SEVERABILITY. 16 If any provision of this Agreement is determined by a court of competent jurisdiction t 17 be invalid or unenforceable for any reason, such determination shall not affect the 18 validity or enforceability of the remaining terms and provisions hereof or of the offending 19 provision in any other circumstance, and the remaining provisions of this Agreemen 20 shall remain in full force and effect. 21 22 18. ENTIRE AGREEMENT; MODIFICATION. 23 This Agreement constitutes the entire agreement and the understanding between the 24 parties, and supersedes any prior agreements and understandings relating to the subject 25 6 1 manner of this Agreement. This Agreement may be modified or amended only by 2 written instrument executed by all parties to this Agreement. 3 IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the da 4 and date first above shown. 5 ATTEST: CITY OF SAN BERNARDINO 6 7 8 Rachel Clark, City Clerk Charles McNeely,City Manager 9 10 CORVEL CORPORATION 11 12 13 By: 14 Approved as to form: 15 16 JAMES F. PENMAN s 17 City Attorney 18 By: 19 20 21 22 23 24 25 7 1 VENDOR SERVICE AGREEMENT 2 This Vendor Service Agreement is entered into this 1st day of July 2011, by and betwee 3 CorVel ("VENDOR") and the City of San Bernardino ("CITY"). 4 WITNESSETH: 5 WHEREAS, the Mayor and Common Council has determined that it is advantageous an 6 in the best interest of the CITY to acquire Utilization Review Services; and 7 WHEREAS, the CITY did solicit and accept proposals and bids from a number o 8 9 vendors for Utilization Review Services; 10 NOW,THEREFORE, the parties hereto agree as follows: 11 1. SCOPE OF SERVICES. 12 For the remuneration stipulated, San Bernardino hereby engages the services o 13 VENDOR to provide those products and services as set forth in Exhibit "A", attache 14 hereto and incorporated herein by this reference. If a conflict arises between this Vendo 15 Services Agreement (hereinafter "Agreement") and Exhibit "A," the terms of the 16 Agreement shall govern. 17 2. COMPENSATION AND EXPENSES. 18 a. For the services delineated above, the CITY, upon presentation of an invoice 19 shall pay the VENDOR the amount of monthly invoices for services rendered 20 21 during the previous month. Invoices shall include task description, the number o 22 hours spent on each task, and applicable hourly rate. Cost not to exceed $95,00 23 annually. 24 b. No other expenditures made by VENDOR shall be reimbursed by CITY. 25 1 1 13. TERM. 2 The term of this Agreement shall be for a period of one(1) year with two (2) one(1) yeai 3 extensions. 4 This Agreement may be terminated at any time by thirty (30) days written notice 5 by either party. The terms of this Agreement shall remain in force unless mutuall 6 amended. The duration of this Agreement may be extended with the written consent o 7 both parties. 8 4. INDEMNITY. 9 10 Vendor agrees to and shall indemnify and hold the City, its elected officials, employees 11 agents or representatives, free and harmless from all claims, actions, damages an 12 liabilities of any kind and nature arising from bodily injury, including death, or prope 13 damage, based or asserted upon any actual or alleged act or omission of Vendor, it 14 employees, a ents or subcontractors relating to or in an way connected with the g g Y Y 15 accomplishment of the work or performance of services under this Agreement, unless the 16 bodily injury or property damage was actually caused by the sole negligence of the City 17 its elected officials, employees, agents or representatives. As part of the foregoing 18 indemnity, Vendor agrees to protect and defend at its own expense, including attorney' 19 fees, the City, its elected officials, employees, agents or representatives from any and al 20 legal actions based upon such actual or alleged acts or omissions. Vendor hereby waive 21 22 any and all rights to any types of express or implied indemnity against the City, it 23 elected officials, employees, agents or representatives, with respect to third party claim 24 against the Vendor relating to or in any way connected with the accomplishment of the 25 work or performance of services under this Agreement. 2 1 115. INSURANCE. 2 While not restricting or limiting the foregoing, during the term of this Agreement, 3 VENDOR shall maintain in effect policies of comprehensive public, general an 4 automobile liability insurance, in the amount of$1,000,000.00 combined single limit, an 5 statutory Workers' Compensation coverage in accordance with the laws of the State o 6 California. VENDOR shall maintain professional malpractice insurance for professions 7 negligence, including errors, omissions, or other professional acts, in the amount of s r 9 $100,000.00. VENDOR shall file Certificate(s) of Insurance with the CITY's Risk 10 Manager prior to undertaking any work under this Agreement. CITY shall be set forth as 11 an additional named insured in each Certificate of Insurance provided hereunder. The 12 Certificate(s) of Insurance furnished to the CITY shall require the insurer to notify CIT 13 of any change or termination in the policy. 14 6. NON-DISCRIMINATION. 15 In the performance of this Agreement and in the hiring and recruitment of employees 16 VENDOR shall not engage in, nor permit its officers, employees or agents to engage in 17 discrimination in employment of persons because of their race, religion, color, nations 18 origin, ancestry, age, mental or physical disability, medical condition, marital status 19 sexual gender or sexual orientation, or any other status protected by law, except a 20 permitted pursuant to Section 12940 of the California Government Code. 21 7. CONFIDENTIALITY. 22 23 VENDOR understands and agrees that CITY, as a public entity, and can maintai 24 VENDOR's confidentiality only to the extent that doing so does not conflict with its 25 3 1 duties under the California Public Records Act, the Ralph M. Brown Act or any other 2 requirement of law,regulation, rule,or court or other government decision. 3 8. INDEPENDENT CONTRACTOR. 4 VENDOR shall perform work tasks provided by this Agreement, but for all intents an 5 purposes VENDOR shall be an independent contractor and not an agent or employee o 6 the CITY. VENDOR shall secure, at its expense, and be responsible for any and all 7 payment of Income Tax, Social Security, State Disability Insurance Compensation 8 9 Unemployment Compensation, and other payroll deductions for VENDOR and it 10 officers, agents, and employees, and all business licenses, if any are required, in 11 connection with the services to be performed hereunder. 12 9. BUSINESS REGISTRATION CERTIFICATE AND OTHER REQUIREMENTS. 13 VENDOR warrants that it possesses or shall obtain, and maintain a business registration 14 certificate pursuant to Chapter 5 of the Municipal Code, and any other licenses, permits 15 qualifications, insurance and approval of whatever nature that are legally required o 16 I f VENDOR to practice its business or profession. 17 10. NOTICES. 18 Any notice to be given pursuant to this Agreement shall be deposited with the Unite 19 States Postal Service,postage prepaid and addressed as follows: 20 TO THE CITY: 21 Linn Livingston,Human Resources Director 22 300 North "D" Street,2nd Floor San Bernardino, CA 92418 23 Telephone: (909) 384-5161 24 25 4 1 TO THE VENDOR: 2 Sharon O'Connor Leann Farlander Director of Legal Services Account Executive 3 CorVel Corporation CorVel Corporation 4 2010 Main Street, Suite 600 600 City Parkway West, Suite 700 Irvine, CA 92614 Orange, CA 92868 5 11. ATTORNEYS'FEES. 6 In the event that litigation is brought by any party in connection with this Agreement, the 7 prevailing party shall be entitled to recover from the opposing party all costs an 8 9 expenses, including reasonable attorneys' fees, incurred by the prevailing party in the 10 exercise of any of its rights or remedies hereunder or the enforcement of any of the terms, 11 conditions or provisions hereof. The costs, salary and expenses of the City Attorney an 12 members of his office in enforcing this Agreement on behalf of the CITY shall be 13 considered as "attorneys' fees" for the purposes of this paragraph. 14 12. ASSIGNMENT. 15 VENDOR shall not voluntarily or by operation of law assign, transfer, sublet o 16 encumber all or any part of the VENDOR's interest in this Agreement without CITY'ss 17 prior written consent. Any attempted assignment, transfer, subletting or encumbrance 18 shall be void and shall constitute a breach of this Agreement and cause for the 19 termination of this Agreement. Regardless of CITY's consent, no subletting of 20 assignment shall release VENDOR of VENDOR's obligation to perform all othe 21 22 obligations to be performed by VENDOR hereunder for the term of this Agreement. 23 13. VENUE. 24 The parties hereto agree that all actions or proceedings arising in connection with this 25 5 i Agreement shall be tried and litigated either in the State courts located in the County o 2 San Bernardino, State of California or the U.S. District Court for the Central District o 3 California, Riverside Division. The aforementioned choice of venue is intended by the 4 parties to be the mandatory and not permissive in nature. 5 14. ' GOVERNING LAW. 6 This Agreement shall be governed by the laws of the State of California. 7 15. SUCCESSORS AND ASSIGNS. 8 This Agreement shall be binding on and inure to the benefit of the parties to this 9 to Agreement and their respective heirs, representatives, successors, and assigns. 11 16. HEADINGS. 12 The subject headings of the sections of this Agreement are included for the purposes o 13 convenience only and shall not affect the construction or the interpretation of any of it 14 p rovisions. 15 17 SEVERABILITY. 16 If any provision of this Agreement is determined by a court of competent jurisdiction t 17 be invalid or unenforceable for any reason, such determination shall not affect the 18 validity or enforceability of the remaining terms and provisions hereof or of the offending 19 provision in any other circumstance, and the remaining provisions of this Agreemen 20 shall remain in full force and effect. 21 22 18. ENTIRE AGREEMENT; MODIFICATION. 23 This Agreement constitutes the entire agreement and the understanding between the 24 parties, and supersedes any prior agreements and understandings relating to the subject 25 6 I manner of this Agreement. This Agreement may be modified or amended only by 2 written instrument executed by all parties to this Agreement. 3 IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the da 4 and date first above shown. 5 ATTEST: CITY OF SAN BERNARDINO 6 7 8 Rachel Clark, City Clerk Charles McNeely, City Manager 9 10 CORVEL CORPORATION 11 12 13 By: 14 Approved as to form: 15 16 JAMES F. PENMAN 17 City Attorney ` 18 By: CC-,(- 19 20 21 22 23 24 25 7 CORVE L. Response to Request for Proposal for City of San Bernardino -. Workers' Comp Utilization Review RFP F-11-16 j � March 16, 2011 � Tab Ile o f Contents Table of Contents Confidentiality Statement...............................................................................................3 CoverLetter...................................................................................................................4 ProposalContent ...........................................................................................................5 Attachments.................................................................................................................12 ' � ` ' ' | CorVaCorporation Page Qty of San Bernardino VVorknm'Cump Utilization Review -._.__ .. Confidentiality Statement Note: Prior to reviewing our RFP response, please read the following carefully. CORVEL HEALTHCARE CORPORATION CONFIDENTIAL TREATMENT REQUESTED Pursuant to the City of San Bernardino's Request for Proposal ("RFP"), RFP No. F-11- 16, CorVel Healthcare Corporation, a wholly-owned subsidiary of CorVel Corporation ("CorVel"), hereby provides its statement regarding Requests for Confidentiality of Proposal pursuant to the California Public Records Act (Government Code § 6250). CorVel hereby states that certain confidential information shall be attached under this RFP which shall fall under the section of the California Code of Regulations, Title 10, § 250.10(a)(1) whereby it defines and provides a exemption for Confidential Information being provided under this RFP bid proposal as "Information which is of a proprietary business nature and is in fact confidential, including but not limited to trade secrets" and § 250.10(a)(2) which is defined as "Information which is of a confidential business nature and which is in fact confidential, the release of which would be damaging or prejudicial to the business concerned". These exempt trade secret documents that CorVel shall provide as part of the RFP shall be marked to read "CONFIDENTIAL INFORMATION" and must be treated as such as defined under the California Code of Regulations and not be disclosed publicly under this RFP. CorVel hereby represents that pursuant to the California Code of Regulations, Title 10, § 250.10(b)(1-7) it is fully in compliance with its obligations for approval of its request for the Confidential Information being protected as stipulated in the above referenced code. CorVel Corporation Page 3 City of San Bernardino Workers'Comp Utilization Review 'Cover Letter March 16, 2011 City of San Bernardino 300 N. "D" Street, 4t" Floor Finance Department San Bernardino, CA 92418 Attn: Deborah Morrow, Purchasing Manager Dear Ms. Morrow, Thank you for considering CorVel Corporation as a strategic partner to continue to help the City of San Bernardino (the City) reduce the cost of its workers' compensation program with our industry-leading Utilization Review solutions. CorVel applies technology, intelligence and a human touch to the challenge of treating work-related injuries proactively and cost-effectively. With more than two decades of experience, CorVel understands the cost drivers associated with treating work-related injuries. Our innovative approach is distinguished I by: • Utilization Review —Assure that inpatient admissions and outpatient procedures are provided in the most appropriate setting and time to reduce costs and maximize savings. • CorVel's is committed to quality service delivered by experienced staff supported by industry leading technology. • Local, Superior Account Management — CorVel offers quality services measured by objectives and performance driven standards. We are committed to high standards of excellence with customer service available 7 days a week, 24 hours a day. The program described in our proposal has been based on the objectives and services contained in your RFP. We look forward to continue working collaboratively with your team so we can help the City to continue achieving the same outstanding results. Thank you again for your consideration. Sincerely, r _ Richard J Schweppe '—Leann Farlander Director Account Executive CorVel Corporation Page 4 City of San Bernardino Workers'Comp Utilization Review I Proposal Content • An overview of your company's experience in providing UR services for cities and other clients. CorVel's utilization review program provides prospective, concurrent and retrospective review of all treatments. CorVel's experienced staff of Utilization Review Case Managers, board certified Medical Directors and peer review physicians utilize medical treatment protocols and expert systems technology to determine the medical appropriateness of care as well as frequency, duration and setting. The goal of our utilization review program is to avoid unnecessary treatments and their associated costs and to ensure high quality, timely, cost effective medical care for injured workers. Key utilization review features include: • Medical treatment plan review • Patient referral to select CorVel PPO providers • Pre-certification of an admission and approval of a specific length of stay • Coordination of discharge planning, DME and other services • Timeliness of service: compliance with California legislation • Confirmation letter to the provider, claimant and claims administrator �. of any certification or denial As the City's current UR provider, CorVel understand the City's treatment protocols and processes. On a daily bases CorVel works with the City's claims staff to ensure that the City's injured workers are receiving the proper level of care while concurrently ensuring that RTW timelines are compressed. The City's claims examiners utilize our web-enabled application platform, Care"" to submit UR requests and view nurse notes in real time. The City's examiners have an excellent working relationship with CorVel's nurses. This positive relationship impacts the injured workers' overall satisfaction which in turns affects the programs outcomes. CorVel has been providing utilization review services since 1991. • Minimum of three professional references San Diego and Imperial County Schools Risk Management Diane Crosier, Executive Director, Risk Management Phone: (858) 292-3747 CorVel Corporation Page 5 City of San Bernardino Workers'Comp Utilization Review Proposall Content Private Adjusting Services, Rancho Cucamonga Denise Ashley, Vice President Phone: (909) 481-4111 Foster Farms Niel Piethe, Claims Manager (209) 398-6708 • List of physicians/nurses who will be performing UR services, along with resumes. Joanna Palladino, Utilization Review Case Manager and Ann Deon, Utilization Review Case Manager will continue to assist the City with their UR needs. CorVel utilizes more than 100 California licensed, board-certified physician specialists who currently practice and have knowledge of California's Workers' Compensation. All of CorVel's physician specialists are board certified in their specialty. These physicians are educated in California's UR Labor Code, including all medical guidelines pertaining to California's UR protocols. Please see Attachment A: Resumes • Experience and training of UR staff, including nurses who will conduct initial reviews Case Managers responsible for handling utilization reviews are graduates of an accredited school of nursing and hold a current license in their state of operation. CorVel's UR Case Managers have a strong clinical background in orthopedics, neurology or rehabilitation. We also require our staff to have a strong cost containment background, such as utilization review or healthcare management. We require three or more years of recent clinical experience, preferably in rehabilitation, and/or at least one year experience in workers' compensation or STD/LTD case management. Negotiation and extensive clear and tactful communication skills (writing, reading, telephone calls, note taking, letter writing, memoranda) are also required. As with all CorVel staff, we encourage continuing education and the company policy participates and reimburses for those expenses. Each local/regional/national office is encouraged to host monthly meetings, offer continuing education programs and solicit guest speaker continuing education programs. CorVel Corporation Page 6 City of San Bernardino Workers'Comp Utilization Review Proposal Content • Your company's average turn around time for UR requests. CorVel's average turn around time for UR services is 2.5 days. Our internal standards for turn around time are as follows: • Prospective UR requests are completed within 4 business days, in most instances they are completed within 72 hours. • Retrospective UR requests have an aver turn around time of 4 days. • Concurrent hospital UR requests are completed within 72 hours, in most instances they are completed within 24 hours. • Appeal reviews are completed within 5 days. • Denial letters are sent within 24 hours to the requesting physician, facility, claims administrator and claimant. The claims professional, provider, applicant attorney and claimant receive copies of CorVel's recommendations for certification or non-certification within 24 hours of a determination being made. CorVel is able to transmit our UR results through email, fax, electronic copy, eRoster or Caremc Browser. UR determination letters are entered directly into the claims system and can also be emailed or faxed upon request. In the case of a non-certification determination, the claims payor is also notified via phone, fax or email at the time of determination. • Fee options and how fees are calculated Please see the attached Summary Proposal Submission Form (Fee Schedule) for fee options and how fees are calculated. • Samples of reports documenting claims review and action taken Please see Attachment B: Sample Report • Describe workflow and the method information is gathered and exchanged between City's medical providers and your company in performing UR services. Please see Attachment C for CorVel's utilization review process flow chart with the accompanying description that follows: CorVel's utilization review program is designed to assure that inpatient admissions and outpatient procedures are provided in the most appropriate setting and at the most appropriate time. CorVel Corporation Page 7 City of San Bernardino Workers'Comp Utilization Review Proposal Content CorVel's utilization review program includes three components: • Pre-Certification • Concurrent Review • Discharge Planning Pre-Certification CorVel's pre-certification process is a review service that helps reduce unnecessary inpatient stays and outpatient surgeries. Utilizing the nationally recognized Institute for Healthcare Quality's Quality First guidelines and other medically recognized criteria a CorVel's utilization review Case Manager verifies the medical necessity of Inpatient Admissions, Outpatient Surgeries and high cost diagnostic procedures. Appropriate lengths of stay for inpatient admissions are also certified utilizing the Quality First guidelines. Concurrent Review The CorVel continued stay review service concurrently evaluates the medical necessity and appropriateness of the patient's hospitalization. This ongoing review assures that the patient's care is progressing and that a continued hospital stay is warranted. Discharge Planninq Early Discharge may be appropriate for cases, which lend themselves to alternate treatment settings or at home care. CorVel's Discharge Planning service develops alternative treatment plans, that can be delivered without sacrificing the quality of care, in a more cost effective setting. Process • Notification of an impending, non emergency, or active, emergency, hospital admission may be made to the CorVel pre-cert department by the employer, employee, claims Ad'uster, physician or hospital by telephone (an 800 number) or by Care c. • Initial demographic information is input into our pre-certification software system by the utilization review Case Manager or an Intake Coordinator. • The utilization review Case Manager contacts the physician office for clinical information to make a determination of medical necessity. • Clinical information is compared to established criteria for determination of medical necessity of in-patient surgery/treatment vs. outpatient or denial. In California, request is reviewed in accordance with the state mandated American College of CorVel Corporation Page 8 City of San Bernardino Workers'Comp Utilization Review Proposal Contomt Occupational and Environmental Medicine Practice Guidelines (ACOEM). • Pre-cert decision is made within 5 days of receipt of information. • Length of stay is certified. • Verbal notification of the certification and length of stay is given by telephone to the physician and facility. • Confirmation letters automatically generated by the software system are mailed to all pertinent parties within 24 hours of certification. • Case is diaried automatically for expected discharge date. • Telephone contact is made on expected discharge date to determine if discharge has occurred as scheduled. • Upon discharge, case is closed, completion date is entered into the system and a claim data report is printed to initiate the billing process. CorVel utilization review Case Managers are trained to utilize internal policies and procedures that address the following: • Confidentiality • First level review • Peer review • Appeals process • Performance standards • Quality assurance Physician advisors are utilized for all cases that fail to meet standards of practice guidelines. Denials CorVel physician reviewers may deny requests for authorization that do not meet standards of care guidelines or due to lack of medical information to support the treatment being requested. Denials are communicated to the health care provider telephonically and in the form of a Denial Letter, faxed or mailed. The explanation shall include, but not be limited to: • The name of the medical reviewer. • The telephone number of the reviewer, and hours of availability. • The medical criteria upon which the denial is based. CorVel Corporation Page 9 City of San Bernardino Workers'Comp Utilization Review Proposal Content • The process whereby the objection may be appealed, including the time period for appeal and the telephone and fax number for initiating the appeal. The utilization review, bill review and case management processes are linked through Care"" to provide a comprehensive program. When the utilization review Case Managers pre-certifies treatment, modalities frequency, duration, and care setting, the information is transmitted into bill review to await receipt of the bill, Only those services that have been certified are accepted and processed for payment. Exchanging Information If a decision has been reached to pursue a complete review of a claim against medical records, CorVel will obtain all medical records including diagnosis, treatment, as well as CorVel's history with the facility to complete our review. CorVel will work with customer to establish full claim suspension until info has been received. In addition, CorVel may need request for authorization from the City. CorVel's proprietary healthcare management website Caremc connects payors, employers, healthcare management professionals, and providers in real time. With Caremc customers can access timely and comprehensive case information at their convenience, communicate with other healthcare professionals instant, and collaborate on claims without any delay or all the paperwork. Carem tools address: claim status reporting, case manager updates, FNOL and treatment calendar. By integrating all of the managed care services involved in an episode of care, Caremc extends value from the automated processing of incident reporting to the other components of claims management. • Request services online, in real time. • Manage files throughout the life of the claim. • Receive and relay case notes from case managers in the field. • Integrate information from multiple claims management sources into one database. • Any distinguishing or unique qualifications that your company possesses or any other information that more fully documents your ability to provide UR services. As the City's current Utilization Review partner, CorVel understands your program needs and expectations. CorVel will continue to provide the City with excellent customer service and superior savings. We value our CorVel Corporation Page 10 City of San Bernardino Workers'Comp Utilization Review Proposal partnership with the City and hope to continue our relationship. The utilization of our technology coupled with our expertise and compress timeframes result in greater savings and faster return to work. CorVel offers the most comprehensive solution for your case management needs. F CorVel Corporation Page 11 City of San Bernardino Workers'Comp utilization Review Attachments Attachments r Attachment List I i Attachment List Attachment A: Resumes Attachment B: Sample Report Attachment C: Utilization Review Workflow Attachment D: City Forms Attachment E: Proof of Insurance Attachment F: Expectations 0 0 CorVel Corporation Page 12 City of San Bernardino Workers' Compensation Utilization Review Attai;h ms Gea t?tS Attachment A: Resumes 0 fir IL CorVel Corporation City of San Bernardino Workers'Comp Utilization Review JOANNE PALLADINO,RN,MSN,CNS UTILIZATION REVIEW CASE MANAGER J OAN N E_PALLAD I NO@COR V EL.COM PROFESSS(ONAL HISTORY • 2004 to present: CorVel Corporation,Utilization Review Case Manager • 2001 to 2004:Field Medical Case Manager • 1992 to 1998:Interim Healthcare,Director,Health Care Services • 1984 to 1992: Interim Healthcare,Director of Nursing • 1978 to 1983: Parkview Community Hospital,Patient Care Coordinator EDUCATION • Associate of Science,Nursing.Northern Arizona University(1965) • Bachelor of Science,Nursing.California State University San Bernardino(1992) • Master of Science,Nursing.California State University San Bernardino(2003) CREDENTIALS 1 IALS AND AFFILIATIONS • Certified Public Health Nurse • Clinical Nurse Specialist 4 I Confidential CORVEL ANN DEON,RN-BC,CCM UTILIZATION REVIEW CASE MANAGER ANN DEONC&CORVEL.COM PROFESSIONAL HISTORY • 2009 to present: CorVel Corporation,Utilization Review Case Manager • 2008 to 2009: Forensics Psychiatric and Civil Contract • 2005 to 2008: Behavioral Health/Psychiatric Nursing • 2004 to 2007:Disability Case Management Specialty • 2001 to 2004: Medical Case Manager • 1996 to 2001: Staff RN-Pre-op,PACU,Emergency Department • Associates Degree,Nursing(1996) /y CREDEN i SALS AND f-FiLI ATIONS • Board Certified Psychiatric Mental Health RN(2004) • Certified Case Manager 0 Multi-State Licensed RN Confidential Attachments I Attachment B: Sample Report I t i I i i CorVel Corporation City of San Bernardino Workers'Comp Utilization Review all C� q G; U') 00 cr) CL LL CD Cl) C14 04 64 69 6-J, 6a 0 0 0 0 0 CD (D U') C. Lo to D LO U) U) Lo 0) Vy m 0) LL (3) CD 0) 0) 6% 613, 6% C) CD C, cli C) in C) c 6% Ct 64). Lq 69 m 04 CV U) E a) 'a 8 !E 0 (D a) 0 L) '0 C) CD C%l C11 6 4 co C*ll Cl) E C2 t:: z 1-7 r- 2�! Q 0 cli C11 cli CV cli cli C14 cli CD C) Q a. Q z z C14 C-14 04 cq .2 C CD C*4 CV of E U) .0 m M.S a) 0 Q L) 0 a) 0 .0 cf) 6 0 W CL 12 M 0 Co 2 .G e a X 0 uj Ol OR -ZI20 2 a) a)— a)An E 'a� - -- :E > UJ cr r_ ") L , . . x C,4-6 < U) Cl ou-a U- -j LU t: (D (D _ID 0- 0. CO) Q. < 0- CL CL (L 0- 0- CL 6 (6 rl� C4 (6 CQ LO co U-) Lo Cl) Cl) 0) 04 0) fl- W) cli co co co — (D 0) CD cli w Lo CD V) V) m Cl) Cl) CD C) 'r It (L CCIJ t- N cp C14 m w C*4 Cli Lo CD CD �: 0 C) E mw C6 Cb 6 6 6 C. 6 CD E 9 CD 90) 70 T c, 0 CD :3 C14 CD 00 C%j co C'j v- Co Cl) z - CD CIJ CD C-4 0 CM C-4 C-1 C� C� N 0 0 C11 CD 0 CA 0 04 0 Cl) C,0 CD 0 C,0 00 0 C) S 00 C, .9) C� C, CD Z! Z! co cli cli C*4 CY C-4 m 0 CL co U. CM co 04 0 a 0 C 0 0 c 0 c 0 c 0 r_ 0 c r- 0 w 0 m c m a m C r_ m c m c ctl - cn w 2 — _-2 16 ;a 16 168 "6 0 rm 0 ca 0 to 0 0 0 M E E E E E E E CD E 'D co co 0 co ED co co @ Attachments Attachment C: Utilization Review Workflow COrVei Corporation City of San Bernardino Workers'Comp Utilization Review �p Utilization Review Program Level I and 11 Referral Received by CorVel If medicals are not received from provider after 3 days or 2 phone calls,non-cert letter will be issued for'lack of information'. Certification Level II Unable to Certify - � � -Notification to Adjuster Certification letters to provider, -Referral to Clinical Peer Physician facility,attorney,adjusters Ty Clinical Peer Physician Cert vs t .No -Cert determination a Clinical Peer Report to UR Nurse as I f , r c . .. Non-Certification -Receive Clinical Peer Report -Notification to Adjuster -Non-Certification letters with j appeals process x •i°� Confidential Utilization Program Review-Appeals Level III Appeals Request from Provider or Injured Worker Clinical Peer Physician Review and make determination to approve or deny appeal Report to UR Nurse fRl 3�u.. UR Nurse k -Contact Adjuster -Prepare and send appeal-upheld or appeal-denied to Provider or m Injured worker i I i i Confidential A ttac n-jents Attachment D: City Forms Ar CorVel Corporation City of San Bernardino Workers'Comp Utilization Review RFP F-11-16 WC Utilization Review City of San Bernardino, Finance Department Purchasing Division RFP F-11-16 Worker's Comp Utilization Review Bid Documents to Be Returned ❑ Company Background/Overview ❑ Description of Proposed Program ❑ Workflow and Methodologies ❑ Samples of Reports ❑ Staff Backgrounds/R6sume's ❑ Qualifications and References ❑ Statement of Proposer(s) Past Contract Disqualifications (City Form) ❑ One(1) signed original of Proposal ❑ Two (2) copies of Proposal in a SEALED (envelope separate from Pricing) ❑ Summary Proposal Submission Form (SEALED envelope separate from proposal) (City Form) [_j Authorized Binding Signature(s) ❑ Verifications of Addenda Received (City Form) IV Forms ❑ Non-Collusion Affidavit(City Form) IV Forms ❑ Listing of Proposed Subcontractor(City Form) IV Forms ❑ 90 Day Minimum Proposal Validity Statement III Additional Requirements,VI General Specifications#4 ❑ Worker's Compensation Insurance Certificate ❑ Copy of Contractor License or other appropriate Licenses where applicable \11 General Specifications#35 Offeror(s) are requested to submit this checklist completed with all bid documents. This list may not be inclusive of all documents needed to submit your RFP. Please refer to entire packet for additional documents. 3 RFP F-11-16 WC Utilization Review V. STATEMENT OF PROPOSER'S QUALIFICATIONS AND REFERENCES UTLIZATION REVIEW The proposer is required to state the proposer(s) financial ability and a general description of similar work performed. Number of years engaged in providing the work included within the scope of the specifications under the present business name: 32 List and describe fully the last three contracts performed by your firm, which demonstrate your ability to complete the work included with the scope of the specifications. Attach additional pages if required. The City reserves the right to contact each of the references listed for additional information regarding your firm's qualifications. Reference No.1 Customer Name: Private Adjusting Services Contact individual. Denise Ashley,Vice President Address: 9570 Central Ave.Rancho Cucamonga,CA Phone No: (909)466-9595 Contract Amount: Confidential Year: 2008 Description of Work Done: CorVel provided Bill Review,Case Management and utilization Review services for Private Adjusting Services. Reference No.2 Customer Name: County of Los Angeles Contact individual: Alex Rossi,CEO Risk Management Address: 3333 Wilshire Blvd.Suite 820,Los Angeles,CA Phone No: (213)639-6072 Contract Amount: Confidential Year: 1998 Description f Work Done: CorVel provided Bill Review Case Management and utilization Review services for the County of Los Angeles. e Reference No.3 Customer Name: City of Redding Contact individual: Gail Crowley Manager _ Address: 777 Cypress Ave.Redding,CA Phone No: (530)225-4348 Contract Amount: confidential Year: 2006 Description of Work Done: CorVel provided Bill Review,Case Management and utilization Review services for the City of Redding. Signature Richard J.SctWeppe Title: Director 16 i RFP F-11-16 WCL1tilizafin,RrwriP.v VI. STATEMENT OF PROPOSER'S PAST CONTRACT DISQUALIFICATIONS Pursuant to Section 10162 of Public Contract Code, the proposer shall state whether such proposer, any officer of employee of such proposer who has proprietary interest in such proposer has ever been disqualified, removed, or otherwise prevented from proposal on, or completing a Federal, State, or local government project because of a violation of law or a safety regulation; and if so, explain the circumstances. 1. Do you have any disqualifications, removal, etc., as described in the above paragraph to declare? Yes No 2. If yes, explain the circumstances. Not Applicable f Executed on March 14. 2011 at Irvine , California. I decl ,,eff under pen of perjury, that the foregoing "s true and correct. L(� 7 "�u'T i � rd J.Schwa e Signature( f Author" d Proposer Signature of Authorized Proposer Director Title Title 17 RFF F-11-16 WC Utilization Review VII.WORKERS' COMPENSATION INSURANCE CERTIFICATE Sections 1860 and 1861 of the California Labor Code require every contractor to whom a public works contract is awarded to sign and file with the awarding body the following statement: "1 am aware of the Provisions of Section 3700 of the labor Code which, requires every employer to be insured against I liability for Workers' Compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such Provisions before commencing the performance of the work of this Contract. " By. AIIPAW�v ichard J.Schweppe V VV Date: 3/14/2011 Title: Director By: Date:, 4t4ht Title: 4CkZA* �c i I i i 18 i I RFP F-11-16 WC Utilization Review SUBCONTRACTOR'S LIST As required by California State Law, the General Contractor bidding will hereinafter state the subcontractor who will be the subcontractor on the job for each particular trade or subdivision of the work in an amount in excess of one-half of one percent of the General Contractor's total bid and will state the firm name and principal location of the mill, shop, or office of each. If a General Contractor fails to specify a subcontractor, or if he specifies more than one subcontractor for the same portion of work to be performed under the contract in excess of one-half of one percent, he agrees that he is fully qualified to perform that portion himself and that he shall perform that portion himself. DIVISION OF NAME OF FIRM OR LOCATION WORK OR CONTRACTOR CITY TRADE None None None_ Richard J. Schweppe, Director Signature of Bidder Print Name Company Name: Coffel Healthcare Corporation Address: 2010 Main Street.Suite 600,Irvine,CA 92614 REJECTION OF BIDS The undersigned agrees that the City of San Bernardino reserves the right to reject any or all bids, and reserves the right to waive informalities in a bid or bids not affected by law, if to do seems to best serve the public interest. RFP F-11-16 QWC Utilization Review NON -COLLUSION AFFIDAVIT TO: THE COMMON COUNCIL, CITY OF SAN BERNARDINO In accordance with Title 23, United States Code, Section 112, the undersigned hereby states, under penalty of perjury: That he/she has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken action in restraint of free competitive proposal in connection with RFP F-11-16. Business Name Corvel Healthcare Corporation Business Address 2010 Main Street, Su'e 690,Irvine,CA 9 614 Signature of Offeror(s)X dt-�4jv 'R ichar . Schwepp irector rvt r< Place of Residence Subscribed and sworn before me this c a"T , 20_• Notary Public in and for the County of , State of California. My commission expires , 20 State of Callfoinio,County of Orarge K. FARAIAt1D Subscribed and swom to Iorattinngbefleme M 1115 Co►rM. 190ap9tt I W day of D25,201 i,by 6''1"I'l N proved to-iii—on the basis of so aC ur cow Eu.ocr.r�•2ou to be the person(s) w)t o red baton IN. 23 AttaChn-tents Attachment E: Proof of Insurance ,I CorVel Corporation City of San Bernardino Workers'Comp Utilization Review 7 DATE(MMIDD/YYYY) A,C"R" CERTIFICATE OF LIABILITY INSURANCE 01/00011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS �FRTIFWATF DOES NOT AFFIRMATIVELY OR NFGATIVF.,l Y AMEND, EXTEND OR Al TI FIR THE COVERAGE AFFORDED BY THE POLICIES 3ELOW. 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). CONTACT PRODUCER NAME: MARSH USA INC. PHONE FAX 500 WEST MONROE STREET eve No Ext: (A/C.No CHICAGO,IL 60661 E-MAIL ADDRESS: Attn:Fax:212-948-0770 or Chicago.CertRequest @marsh.com PRODUCER M D 401944-DNU-WPROF-10-11 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Travelers Property Casualty Company Of America 25674 CorVel Healthcare Corporation St.Paul Fire 8 Marine Ins Co 24767 Attn:Jeanette Mungcal INSURER B 2010 Main Street,Suite 600 INSURER C:Employers Fire Insurance Company 20648 Irvine,CA 92614 INSURER D: INSURER E: INSURER F: (COVERAGES CERTIFICATE NUMBER: CHI-003577n5-00 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. '"SR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER IMMIDDIYYYYI (MMIDDIYYYYI A GENERAL LIABILITY TJ-GLSA-280K509-5-10 0413012010 0413012011 EACH OCCURRENCE $ 1,000,000 X PRMA'I R NTu ante $ 1,000,000 COMMERCIAL GENERAL LIABILITY CLAIMS-MADE F_X1 OCCUR MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 �GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO: X LOC $JECT •� AUTOMOBILE LIABILITY TJ-CAP-280K510-2-10`'. 04130/2010 0413012011 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO - BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ Xk X SCHEDULED AUTOS _ PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ PHYSICAL DAMAGE DED COMP$5001COLL$500 $ g X UMBRELLA LJAB X occuR 01<01202397 04130/2010 0413012011 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE, AGGREGATE $ _ 1,000,000 DEDUCTIBLE - $ X RETENTION $10,000 $ q WORKERS COMPENSATION, TC2J-UB-280K507-1-10(AOS) 04/30/2010 04/30/2011 X WC sTATU- orH- T AND EMPLOYERS'LIABILITY YIN A ANY PROPRIETOR/PARTNERIEXECUI N/A TRJ-UB-280K5083-10 04130/2010 0413012011 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER.EXCLUDED7 'AK,AZ,MA,NE,NH,NJ,OK,OR' 1,000,000 (Mandatory in NH) ( - ) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C MANAGED HEALTHCARE PROF LIAB_ MCP-0514-10 10131/2010 10131/2011 PER CLAIM 5,000,000 $250,000 SIR 'RETRO DATE:0410-1987' AGGREGATE 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if mom space is required) Eddence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CerVel Healthcare Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2010 Main Street,Suite 600 ACCORDANCE WITH THE POLICY PROVISIONS. CA 92614 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. LKatey E.Jones V,p_Ka W✓_ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Confidential Attachiients Attachment F: Exceptions CorVel Corporation City of San Bernardino Workers'Comp Utilization Review Exceptions City of San Bernardino Request for Proposal ("RFP") RFP No. F-11-16 If awarded the contract, CorVel reserves the right to negotiate the following sections: • Page 12, Section 3, Aggregated Limits/Blanket Coverage • Page 12, Section 4, Modification of Coverage • Page 13, Section 7, Automobile Liability • Page 31, Section 30 • Page 31, Section 31 0 i f 2011 CorVel Corporation.All rights reserved. Confidential City of San Bernardino Request for Proposal F-11-16 Workers' Compensation Utilization Review CorVel's Contractual Exceptions Section II(1)(d). General Conditions: Insurance CorVel ("Contractor") can provide insurance certificate and any endorsements, but cannot provide any form of the insurance policy. Terms CorVel ("Contractor") would like included in contract: REPRESENTATIONS,WARRANTIES AND COVENANTS OF THE CITY A. Authorily. The City represents and warrants that (i) it has all necessary corporate power and authority to enter into this Agreement and to perform its obligations hereunder, and the execution and delivery of this Agreement and the consummation of the transactions contemplated hereby have been duly authorized by all necessary corporate actions on its part, (ii) this Agreement constitutes a legal, valid and binding obligation of The City, enforceable against it in accordance with its terms, and (iii) the execution, delivery and performance of this Agreement will not constitute a violation of any judgment, order or decree or a breach of a material agreement that would materially impair or prevent The City from complying with its obligations under this Agreement. B. Authorizations. The City represents and warrants that (i) it has obtained or shall obtain such authorizations or approvals as are required for Contractor to perform the services described in this Agreement, including but not limited to receiving and disclosing patient-specific data as contemplated hereunder, (ii) it shall maintain the compliance of its workers' compensation program under all applicable laws, (iii) it has obtained and shall maintain during the Term any regulatory approval needed in order for Contractor to perform its obligations hereunder, and (iv) it shall promptly notify Contractor if any such approval is terminated, suspended or otherwise materially limited. C. Non-Solicitation. The City agrees that during the Term of this Agreement and for a period of one (1) year after any expiration or termination thereof, The City shall not, directly or indirectly, recruit or solicit for employment, employ or in any manner engage the services of or otherwise interfere with the employment relationship of any Contractor employee who was in any way involved in providing services to The City pursuant to the Agreement without the prior written consent of Contractor. In the event The City breaches this covenant of non-solicitation and non- employment, Contractor shall be entitled to recover the amount of one (1)times annual salary per employee from The City as liquidated damages. The parties acknowledge that Contractor's actual damages in the event of such a breach by The City would be extremely difficult or impracticable to determine and acknowledge that this liquidated damages amount has been agreed upon as a reasonable estimate of Contractor's damages and as Contractor's exclusive remedy against The City in the event of a breach of this Section 3D by The City. The parties further agree that in any action brought on account of any alleged breach of this covenant, the prevailing party shall be entitled to recover its reasonable attorney's fees and costs. REPRESENTATIONS,WARRANTIES AND COVENANTS OF CONTRACTOR A. Authority. Contractor represents and warrants that(i) it has all necessary corporate power and authority to enter into this Agreement and to perform its obligations hereunder, and the execution and delivery of this Agreement and the consummation of the transactions contemplated hereby have been duly authorized by all necessary corporate actions on its part, (ii) this Agreement constitutes a legal, valid and binding obligation of Contractor, enforceable against it in accordance with its terms, and (iii) the execution, delivery and performance of this Agreement will not constitute a violation of any judgment, order or decree or a breach of a material agreement that would materially impair or prevent Contractor from complying with its obligations under this Agreement. B. Performance. Contractor represents and warrants that (i) it has the necessary knowledge, skills and experience to provide and perform the Managed Care Services in accordance with the Agreement, and (ii) it will perform the Managed Care Services in a diligent, professional and workmanlike manner using an appropriate number of properly trained and qualified individuals and in accordance with applicable industry standards. DISCLAIMERS A. Coverage and Compensability. CONTRACTOR IS NEITHER A HEALTH CARE PROVIDER NOR A CLAIMS ADMINISTRATOR AND CONTRACTOR DOES NOT MAKE FINAL DETERMINATIONS REGARDING THE COVERAGE OR COMPENSABILITY OF HEALTH CARE SERVICES RENDERED BY HEALTH CARE PROVIDERS TO INJURED PERSONS. THE SERVICES PROVIDED BY CONTRACTOR UNDER THIS AGREEMENT ARE ADVISORY ONLY AND ARE PROVIDED SOLELY TO FACILITATE THE CITY'S BUSINESS OPERATIONS. THE CITY AND THE CITY'S EMPLOYEES AND/OR AGENTS HAVE THE OPTION TO ACCEPT OR REJECT ANY ADVICE OFFERED BY CONTRACTOR HEREUNDER. CONTRACTOR DOES NOT MAKE DETERMINATIONS RELATING TO THE CITY'S BUSINESS, INCLUDING, BUT NOT LIMITED TO, THOSE REGARDING THE COVERAGE OR COMPENSABILITY OF HEALTH CARE SERVICES. THE CITY SHALL RETAIN FULL RESPONSIBILITY FOR ALL FINAL DETERMINATIONS REGARDING THE PAYMENT OF POLICY BENEFITS. B. Healthcare Authori ty. CONTRACTOR AND ITS AGENTS HAVE NO AUTHORITY TO CONTROL OR DIRECT THE HEALTH CARE SERVICES PROPOSED FOR OR PROVIDED TO INJURED PERSONS. THIS AUTHORITY SHALL LIE ONLY WITH THE INJURED PERSON AND HIS/HER TREATING PHYSICIAN IN ANY CASE, AND THOSE INDIVIDUALS MAY ACCEPT, REJECT OR MODIFY ANY ADVISORY DETERMINATIONS MADE BY CONTRACTOR OR ITS AGENTS, EXCEPT INSOFAR AS STATE WORKERS' COMPENSATION LAWS MAY REQUIRE THEM TO FOLLOW THE DETERMINATIONS OF THE CITY, THE CITY'S AGENTS, A WORKERS' COMPENSATION JUDGE OR REVIEW PANEL, OR ANOTHER THIRD PARTY. C. No Interference with Practice of Medicine. Neither Contractor nor The City shall attempt to directly or indirectly, to control, direct or interfere with the practice of medicine by any health care provider. CONFIDENTIALITY A. Definition of Confidential Information. "Confidential Information" shall mean any non- public data, information and other materials regarding the products, services or business of a party (and/or, if either party is bound to protect the confidentiality of any third party's information, of a third party)provided to either party by the other party where such information is marked or otherwise communicated as being "proprietary" or"confidential"or the like, or where such information should, by its nature, be reasonably considered to be confidential and/or proprietary. Without limiting the foregoing, the parties agree that (i) the CareMC Application, Documentation, Contractor Content(as defined in the in the CareMC License Agreement) and all software, source code, source documentation, inventions, know-how, and ideas, updates and any documentation and information relating thereto constitutes Confidential Information of Contractor, (ii) the The City Data (as defined in the CareMC License Agreement) constitute Confidential Information of The City, and (iii) this Agreement, the Exhibits and Schedules attached hereto, and the terms and conditions set forth herein and therein are Confidential Information of both parties. B. Disclosure and Use of Confidential Information. The Confidential Information disclosed by either party ("Disclosing Party") to the other("Receiving_Party") constitutes the confidential and proprietary information of the Disclosing Party and the Receiving Party agrees to treat such Confidential Information in the same manner as it treats its own similar proprietary information, but in no case will the degree of care be less than reasonable care. The Receiving Party shall use the Confidential Information of the Disclosing Party only in performing under this Agreement and shall retain the Confidential Information in confidence and not disclose it to any third party (except as authorized under this Agreement) without the Disclosing Party's express written consent. The Receiving Party shall disclose the Disclosing Party's Confidential Information only to those employees and contractors of the Receiving Party who have a need to know such information for the purposes of this Agreement, and such employees and contractors must be bound by this Agreement or have entered into agreements with the Receiving Party containing confidentiality provisions covering the Confidential Information with terms and conditions at least as restrictive as those set forth herein. C. Exceptions. Notwithstanding the foregoing, the parties' confidentiality obligations hereunder shall not apply to information which: (i) is already known to the Receiving Party prior to disclosure by the Disclosing Party, (ii)becomes publicly available without fault of the Receiving Party, (iii)is rightfully obtained by the Receiving Party from a third party without restriction as to disclosure, (iv) is approved for release by written authorization of the Disclosing Party, (v) is developed independently by the Receiving Party without use of or access to the Disclosing Party's Confidential Information, or(vi) is required to be disclosed by law,rule,regulation, court of competent jurisdiction or governmental order, provided, however, that the Receiving Party shall advise the Disclosing Party of the Confidential Information required to be disclosed promptly upon learning thereof in order to afford the Disclosing Party a reasonable opportunity to contest, limit or assist the Receiving Party in crafting the disclosure, and then such disclosure shall be made only to the extent necessary to satisfy such requirements. D. Use of Data. Nothing shall prohibit Contractor from using aggregate, non-identifying, statistical data generated through its customers', including The City, use of the CareMC Application and Online Services for marketing purposes,provided that Contractor shall not use or disclose any such data or information in a manner that would reveal the identity of, or other confidential information concerning, The City. Such aggregate, non-identifying statistical data could include, without limitation, statistics regarding usage of the CareMC Application and Online Services, the number of case referrals generated through the CareMC Application and Online Services and the efficiencies gained by Contractor customers through their use of the CareMC Application and Online Services. CITY OF SAN BERNARDINO — REQUEST FOR COUNCIL ACTION Staff Report Subiect• Resolution implementing a Memorandum of Understanding between the City of San Bernardino and employees in the General Unit bargaining group represented by the International Union of Operating Engineers (IUOE). Background: The contract with the General Unit employees expired on December 31, 2010. The City Team and The International Union of Operating Engineers (IUOE) met for several months and reached a tentative agreement on a successor Memorandum of Understanding (MOU). The membership ratified the agreement on June 2, 2011. The following is a summary of the agreement: • Effective June 1, 2011 through June 30, 2012, employees will be reduced to a 36-hour work week resulting in four (4) hours of no pay per week. The reduced work week will not alter existing MOU articles on leave accruals and reportable PERS monthly salaries. The reduced work week will equate to approximately a ten percent(10%) pay reduction. Effective June 1, 2011 all General Unit employees will forego step/merit increases through June 30, 2012. • The City will implement a Two-Tier Retirement Plain(2% @ 55) for new employees hired after September 1, 2011. • New employees hired after June 1, 2011 will pay 7% of the employee contribution amount of the members' contribution towards PERS retirement. • July 1"Holiday carryover hours will increase from 18 to 40. • Employees who work a reduced 36-hour work week shall be paid overtime compensation in compliance with FLSA for hours worked over 36 hours in the designated work week. • The City and IUOE agree to a reopener to discuss health care cost in January 2012. • The City will provide an annual $50 reimbursement for employees in the enterprise fund towards the purchase of work footwear consistent with City policy. Employees shall wear such footwear at all times while on duty. • Various language clean-up. • Term: January 1, 2011 through June 30, 2012. Financial Impact: The above provisions will result in approximately$168,700 in savings for FY 2010-11 and $2,395,800 in savings for FY 2011-12. Recommendation: Adopt Resolution. Attachment: Resolution implementing Memorandum of Understanding between the City of San Bernardino and employees in the General bargaining unit represented by IUOE.