HomeMy WebLinkAbout7E-Human Resources 7.E k
DOC ID: 2155
CITY OF SAN BERNARDINO—REQUEST FOR COUNCIL ACTION
Request for Proposal
From: Rhonda Haynes M/CC Meeting Date: 12/03/2012
Prepared by: Linda Wynn, (909) 384-5161
Dept: Human Resources Ward(s): All
Subject:
Direct the City Manager to Issue a Request for Proposal for Workers' Compensation Third Party
Administration Services
Financial Impact:
None.
Motion: Direct the City Manager to issue a Request for Proposal for Workers'
Compensation third party administration services forthwith including the approval
of the implementation of the timeline discussed in the attached Request for
Proposal.
Synopsis of Previous Council Action:
None.
Background:
The City's' workers' compensation program is self-insured and self-administered. With the
departure and turnover of staff, the City must be in a position to effectively maintain the
program. In order to meet the statutory requirements and to accommodate the implementation of
the Pendency Plan, it is necessary to issue a Request for Proposal for workers' compensation
third party administration services.
Due to this area of specialty and to ensure the best possible price, bids will be advertised and
solicited via the City's' website and through other well-known Third Party Administrators.
Supporting Documents:
RFP F-13-19 REVISED (DOC)
g �120
Updated: 11/29/2012 by Jason Simpson Packet U�,
Entered Into Rec. at MC
CICDC
by: � -
Andrea Travis-Miller Agenda hem No;
From: James Penman <JFPenman @sbcityattorjy.
kiCpC Secretary
Sent: Monday, December 03, 2012 10:17 AM City of San Bernardino
To: Andrea Travis-Miller
Cr Pat Morris;Jenkins Robert D.;Valdivia,John; Fred Shorett; Kelley Chas;VanJohnson_Ri;
McCammack Wendy;Jolena Grider; Richard D. Luczak; Cindy Underwood;Jason
Simpson;Virginia Marquez;Jim Morris; Rhonda Haynes;Andrea Travis-Miller
Subject: Re:Agenda Item 7E-RFP for Workers' Comp
Andrea,
Thank you for that clarification.
J. Penman
On Dec 3, 2012, at 10:07 AM, "Andrea Travis-Miller"<Travis-Miller An@sbcity.org>wrote:
>Jim,
>Agenda Item 7E relates to the administration of the WC program including intake, processing and reporting of claims
and utilization review and does not address the WC litigation.
>Currently,the City's Risk Management Division has seven positions assigned including one Risk Manager,one clerical
position,one position assigned to liability/risk management, and four adjusters and claims assistants assigned to WC. Of
the four WC positions,one is vacant,one employee is retiring, and two employees have accepted positions with other
agencies. By the end of the month,the four WC positions will be vacant. The City is required to meet statutory WC
caseload standards. To ensure we are able to meet these requirements,we plan to hire temporary employees in the
interim and will request this evening that the Mayor and Common Council authorize staff to issue the request for
proposals. As noted in the pre-pendency plan,this will enable staff to evaluate and compare the costs related to
managing this process with City employees with contracting the administration to a private company and make a
recommendation to the Council related to this function.
> If you have any questions or require further information, please do not hesitate to contact me.
>Andrea
>Andrea M.Travis-Miller
> Interim City Manager
>City of San Bernardino
>300 North "D"Street, 6th Floor
>San Bernardino,California 92418
> Phone: (909)384-5122
>Travis-Miller An @sbcity.org
> Original Message
> From:James Penman Imailto:JFPenman@sbcityattorney.orgl
1
>Sent:Saturday, December 01, 2012 4:31 PM
>To:Andrea Travis-Miller
>Cc: Pat Morris;Jenkins Robert D.; Valdivia,John; Fred Shorett; Kelley Chas;VanJohnson_Ri; McCammack Wendy;
Jolena Grider; Richard D. Luczak; Cindy Underwood
>Subject:Agenda Item 7E-RFP for Workers'Comp
>Andrea,
> I hope Agenda item 7E,on this Monday's agenda, contemplates continuing to use the same local legal law firms to
handle our WC litigation cases. They have done an excellent job for us at very reasonable rates and I do not intend to
cease using them.
> I'm surprised no one has discussed this with us unless no change in the litigation services are contemplated (but
frequently these 3 rd party WC firms have "arrangements"with law firms that have been known to exploit the cities
they work for, according to other CA city attorneys.)
> Those responding to the RFP,which I will have the time to read this weekend for the first time, should know that the
city attorney's office supervises the WC litigation so they understand they won't be bringing their own, out of town law
firms with them.
> If that is already covered in the RFP, or if Jolena Grider has discussed this with you and is confident there will be no
change in legal representation as a result of this agenda item,feel free to disregard this email. (Jolena and I have had no
chance to discuss this item due to the BK and other pressing legal issues last week.) Otherwise,we should discuss this
before Monday's Council meeting. Thank you.
>J. Penman
2
WORKERS' COMPENSATION
THIRD PARTY ADMINISTRATORS
Athens Administrators Gallagher Bassett Services, Incorporated
(Irvine Office) 3350 Shelby Street, Suite 300
PO Box 696 Ontario, CA 91764
Concord, CA 94522 (909) 980-0498
(866)482-3535 Fax: (909) 980-0458
Fax: (949) 648-5816
Intercare Holdings Insurance Services, Inc.
Berkshire Hathaway Homestate Companies PO Box 7111
Workers' Compensation Speciality Division Pasadena, CA 91109-7211
(San Diego Office) (626) 304-1200; (866) 785-6819
PO Box 881716 Fax: (626) 304-1249
San Francisco, CA 94188-1716
(800) 661-6029
Fax: (800) 425-0352 Keenan and Associates
3550 Vine Street, Suite 200
Riverside, CA 92507
Broadspire (951) 715-0190; (800) 654-8347
500 N. State College Blvd., Suite 300 Fax: (951) 788-8013
Orange, CA 92868-6609 www.keenan.com
PO Box 70026
Anaheim, CA 92825-0026
(714) 940-8900 Sedgwick Claims Management Services, Inc.
Fax: (866) 780-4074 (Riverside Office)
www.choosebroadspire.com PO Box 14440
Lexington, KY 40512-4440
Chartis (951) 275-5400; (866) 568-8924
Fax: (951) 275-5499
(Costa Mesa Office)
PO Box 25978
Shawnee Mission, KS 66225-5978 Specialty Risk Services, LLC
(714)436-5100 (Inland Empire)
1420 Iowa Avenue, Suite 200
Riverside, CA 92507
Corvel Corporation PO Box 59907
10750 Fourth Street, Suite 100 Riverside, CA 92517
Rancho Cucamonga, CA 91730 (951) 715-3948; (888) 737-7726
PO Box 669 Fax: (951) 715-2701
Chino, CA 91708
(909) 257-3700
Fax: (909) 257-3785 Tristar Risk Management
www.corvel.corn PO Box 10880
Santa Ana, CA 92711-0880
(714) 543-0700
Crawford & Company Insurance Adjusters Fax: (714) 972-3074
900 E. Washington Street, Suite 350
Colton, C A92324
(909) 825-8730 York Insurance Services Group, Inc.
Fax: (770) 777-6335 (Inland Empire Office)
PO Box 619079
Roseville, CA 95661-9079
(909) 942-4900
Fax: (866) 548-2637
7.E.a
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San Bernar mo
, 2012
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SUBJECT: REQUEST FOR PROPOSALS (RFP) F-13-19 a
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The City of San Bernardino (City) invites proposals from qualified vendors for: d
Workers' Compensation Third Party Administrator
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Parties interested in obtaining a complete copy of this RFP F-13-19 may do so by u_
accessing the City of San Bernardino's website at www.sbcity.org > City Hall >
cc
Finance > Request for Bids, beginning , 2012, or by faxing their N
request to (909) 384-5043, attention Vanessa Sanchez. Please include the following '
information in your request: name and address of firm; name, telephone and
facsimile number of contact person; specify RFP F-13-19. d
Copies of the RFP may also be obtained by calling Vanessa Sanchez at (909) 384-
5330 or in person at City Hall, 300 N. "D" St., 4th Floor, Finance Department, San
Bernardino, CA 92418. N
From the issuance date of this Request for Proposal until a Vendor is selected and w co
the selection is announced, Proposers are not permitted to communicate with any w
City staff or officials regarding this procurement, other than during interviews,
demonstrations, and/or site visits, except at the direction of Vanessa Sanchez,
Accounting Assistant the designated representative of the City of San Bernardino.
Contact with anyone not designated will result in elimination from the bid process a
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Closing Date: Proposals must be submitted at or before 3:00 PM, PST, ,
2013, at the address listed above.
Issuance of this RFP and/or receipt of proposals does not commit the City to award
a contract.
Sincerely,
Jason Simpson
Director of Finance
Packet Pg 121
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RFP F-13-19
Workers'Compensation
Third Party Administrator
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SECTION I. o
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INSTRUCTIONS TO PROPOSER(S)
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RFP F-13-19
Workers'Compensation
Third Party Administrator
City of San Bernardino, Finance Department
RFP F-13-19
Workers' Compensation Third Party Administrator
Bid Documents to Be Returned
❑ Title Page
❑ Cover Letter/ Letter of Introduction °
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❑ Project Approach
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❑ Project Staffing
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❑ Vendor Qualifications and Project Experience c
❑ Statement of Qualifications & References (City Form) �°
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❑ Statement of Past Contract Disqualifications(city Form)
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El Original Proposal Vendor Form y
El Three (3) copies of Proposal Vendor Form
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❑ Original Firm & Fixed Fee Summary Proposal Price Form/Fee Schedule in a
separate SEALED envelope Vendor Form
❑ Authorized Binding Signature(s)
❑
Proof of Insurance w
❑ Addendum Received (City Form) IV Forms
❑ Non-Collusion Affidavit (City Form) IV Forms
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El Listing of Proposed Subcontractor(City Form) IV Forms
❑ 120 Day Minimum Proposal Validity Statement III Additional Requirements, VI General
Specifications#4
❑ Workers' Compensation Insurance Certificate (City Form)
111 Copy of Contractor License or other appropriate Licenses where applicable VI
General Specifications#35
Proposer(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.
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RFP F-13-19
Workers'Compensation
Third Party Administrator
I. GENERAL INSTRUCTIONS TO PROPOSER(S)
A. Pre-Proposal Meeting
Not Applicable
B. Examination of Proposal Documents
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1. By submitting a proposal, the proposer represents that it has thoroughly
examined and become familiar with the items required under this RFP and r
that it is capable of quality performance to achieve the City's objectives.
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2. The City reserves the right to remove from its mailing list for future RFPs, c
for an undetermined period of time, the name of any proposers for failure o
to accept a contract, failure to respond to two (2) consecutive RFPs and/or
unsatisfactory performance. Please note that a "No Proposal" is o
considered a response.
C. Addenda a
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Any City changes to the requirements will be made by written addendum to y
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. z
For automatic electronic notifications, please visit our website and sign-up for
e-Notify.
D. Submission of Proposals
1. Date and Time ce
All proposals are to be submitted to City of San Bernardino, Attention:
Vanessa Sanchez. Proposals received after 3:00 PM PST, ,
2013, will be rejected by the City as non-responsive. L
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2. Address
Proposals shall be addressed as follows:
City of San Bernardino
Finance Department
300 N. "D" Street, 4th Floor
San Bernardino, CA 92418
Proposals may be delivered in person to the Finance Department, 4th
Floor of the above address.
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Packet P,;,g 124
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RFP F-13-19
Workers'Compensation
Third Party Administrator
3. Identification of Proposals
Proposer(s) shall submit a SEALED proposal package consisting of:
a. one (1) signed original of proposer's proposal and
b. three (3) copies also
c. one (1) original Price Form or Fee Schedule in a separate SEALED
envelope, identified as "Fee Schedule RFP F-13-19, WC Third Party
Administrator" a
a
The proposal package shall be addressed as shown above, bearing the
proposer's name and address and clearly marked as follows:
a)
RFP F-13-19 E
Workers' Compensation Third Party Administrator
4. Acceptance of Proposals
a. The City reserves the right to accept or reject any and all proposals, or c
any item or part thereof, or to waive any informalities or irregularities in a
proposals.
a)
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 .2
will be awarded to any proposer(s) responding to this RFP.
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c. The City reserves the right to postpone proposal opening for its own
convenience.
d. Faxed or emailed proposals will not be accepted. o
E. Pre-Contractual Expenses
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Pre-contractual expenses are defined as expenses incurred by the
proposer(s) in:
1. preparing its proposal in response to this RFP; u_
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2. submitting that proposal to the City;
3. negotiating with the City any matter related to this proposal; or o
4. any other expenses incurred by the proposer(s), if any, prior to date
of award of the contract.
The City shall not, in any event, be liable for any pre-contractual expenses
incurred by proposer(s) in the preparation of its proposal. Proposer(s)
shall not include any such expenses as part of its proposal.
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Packet tPg.125
RFP F-13-19
Workers'Compensation
Third Party Administrator
F. 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 proposer(s) should negotiations with the selected proposer(s) be
terminated. The City also reserves the right to apportion the award a
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among two or more proposers.
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A signed Vendor/Consultant Service Agreement (VSA/CSA), along with a N
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 o
commencement of the job.
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G. Acceptance of Order
The successful proposer(s) will be required to accept a Purchase Order in a
accordance with and including as a part thereof the published Request for cc
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. .2
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H. Business License
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The City's Business Ordinance requires that any business doing business to
with the City obtain and maintain a valid City Business Registration
Certificate during the terms of the contract. Proposer(s) agrees to obtain
such certificate prior to undertaking any work under this contract.
I. Local Vendor Preference w
The City gives any formal or informal bid submitted by a local bidder a one
percent (1%) credit for goods and materials, where labor and/or LL
installation is incidental; and a five percent (5%) credit on Contractual
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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.
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For the purposes of this section, "local bidders" shall be bidders for which a
the point of sale of the goods, materials, or services shall be within the City
limits of San Bernardino.
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RFP F-13-19
Workers'Compensation
Third Party Administrator
II. SCOPE OF WORK
A. INTRODUCTION
1. Overview
The City of San Bernardino is soliciting proposals for the Third Party
Administration of its Workers' Compensation Program.
2. City Profile c
The City of San Bernardino encompasses 59.3 square miles, with a
diverse population of 201,800 residents. The City is 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. It is a full service city, including fire, police,
library, community services (encompassing parks and recreation,
engineering, streets, solid waste management, fleet, property c
management, and maintenance), water and wastewater utilities, planning, a
building, economic development and administrative functions. The City LL
employs approximately 1,000 full-time employees plus approximately 300
part-time employees.
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3. 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
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claims exceeding $1,000,000. Workers' compensation program expenses •;
are an internal service and are financed by services charged to the N
various City departments and funds.
The workers' compensation program is under the direction of Human
Resources. The City employs a full-time Risk Manager to supervise the
administration of the program and appropriate staff to ensure fast and
competent cooperation on all cost-containment matters.
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During the past fiscal year, 296 workers' compensation claims were LL
opened. At fiscal-year end, there were 444 open claims: 117 indemnity,
179 Medical-only and 148 Future Medical.
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4. Third Party Administration Services
Of primary importance to the City is a quality Third Party Administrator to
administer the City's' self-insured program while providing cost savings to
the City.
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7'E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
The major responsibilities of the vendor will include, but not be limited to,
all areas noted in "Section II-C. Proposal Specifications" under the
"Services To Be Provided" of this Request for Proposal. Responsibilities
will include any new or related activities mandated by law or legal
precedent and best practices.
5. Schedule For Award Of Contract
RFP Issued , 2012
Pre-Proposal Meeting N/A o
Interviews With Finalist (If needed) TBD y
Finalize Contract TBD
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Award Of Contract TBD
Effective Date Of Contract... , 2013 o
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B. PROPOSAL TERMS AND CONDTIONS
1. 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 .2
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. ce
2. 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 cc
thereby disqualified from quoting prices to other proposers submitting
proposals.
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3. Proposal Withdrawal LL
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A proposer may withdraw its proposal without prejudice prior to the
time specified for the proposal opening by submitting a written request
to the Finance Department, Attention: Vanessa Sanchez, for its
withdrawal. If this occurs the proposal will be returned to the vendor r
unopened. Proposals received after the time specified or at any place
other than the place stated in the Request for Proposals will be
considered.
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RFP F-13-19
Workers'Compensation
Third Party Administrator
4. Proposals 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 a
conform to the specified unit price. F-
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5. Proposal Retention and Award ;
The City reserves the right to retain all proposals. The City also a
reserves the right to determine and waive non-substantial irregularities
in any proposal, to reject any or all proposals, to reject one part of a o
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. o
6. Labor Actions .2
0.
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 n
may accept the next most qualified Proposal from a proposer that is 0
not experiencing a labor action and declare it to be the most qualified
proposer.
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7. 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 within ten w°
(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 M
arranged through subcontracts, all capital and other equipment, labor
and materials to carry out and complete the work hereunder in
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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. 03
8. 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.
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RFP F-13-19
Workers'Compensation
Third Party Administrator
9. Business License
The City's Business Ordinance requires that any business doing
business with the City obtain and maintain a valid City Business
Registration Certificate during the terms of the contract.
10.Firm Fixed 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 F-
must be valid for the entire period indicated in the contract terms c
unless otherwise conditioned by the proposer in the proposal y
exceptions.
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11.Estimated Quantities
The quantities indicated in the Proposal Submission Forms are N
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 required by the City.
12.Non-Exclusive Contract
The City reserves the right to procure the services listed in the
Proposal Submission Forms, as well as any additional services from
other vendors during the contract term. 2
13.Submission of References
Each proposer shall submit a statement of qualifications and Cep
references on the form provided in the proposal package.
14.Statement of Contract Disqualification
Each proposer shall submit a statement regarding any past °w
governmental agency proposal or contract disqualifications on the form
provided in the proposal package.
15.Insurance a)
The proposer shall meet the following provisions (sections "a" through
"g") relating to insurance coverage: a
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a. General Conditions
Without limiting the proposer's indemnification of City, proposer
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:
(1) The City, its Mayor and Common Council, both as a group and
individually, its officers and employees shall be included as
additional insured in all liability insurance policies and
endorsements thereto except for Workers' Compensation and
Professional Errors and Omissions.
Packet P 131 I
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RFP F-13-19
Workers'Compensation
Third Party Administrator
(2) Such insurance shall be primary with respect to any insurance
maintained by the City and shall not call on City's insurance for
contribution.
(3) With respect to the interest of the City, the proposer's insurance
shall not be canceled nor reduced in coverage or limits until
after thirty (30) days' written notice have been sent by Certified
Mail (return receipt requested) to the City of San Bernardino,
Finance Department, 300 N. D Street, San Bernardino, o
California 92418, and shall contain an unequivocal clause so
stating.
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(4) A City-approved endorsement or certified copy of insurance
policy providing coverage shall be submitted to and approved ci
by the City's Risk Manager prior to commencement of any work
or tendency.
b. Workers' Compensation
The proposer shall procure and maintain, during the term of the w
contract, workers' compensation insurance or a valid certificate of a
consent to self-insure for all employees engaged in or at the site of
the project. In case any of the work is sublet, the proposer shall (4
require all subcontractors to similarly provide workers' o
compensation insurance for all the latter's employees unless such
employees are covered by protection afforded by workers'
compensation insurance carried by the proposer.
By submitting a proposal pursuant to these specifications, proposer
hereby certifies that it is aware of the provisions of Section 3700 et
seq., of the Labor Code, which require every employer to be w°
insured against liability for workers' compensation. L0
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c. Aggregated Limits/Blanket Coverage a'
If any of the required insurance coverage contains aggregate limits
or applies to other operations or tenancy of the proposer outside u
these specifications, proposer shall give City prompt, written notice LL
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of any incident, occurrence, claim, settlement, or judgment against
that insurance which may diminish the protection that such
insurance affords the City. Proposer shall further take immediate
steps restoring such aggregate limits or shall provide other
insurance protection for such aggregate limits.
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RFP F-13-19
Workers'Compensation
Third Party Administrator
d. Modification of Coverage
The City reserves the right at any time during the term of any
contract executed with the proposer pursuant to these
specifications (contract) to change the amounts and types of
insurance required hereunder by giving proposer one hundred
twenty (120) days' written notice. If such change should result in a
premium increase in excess of ten percent (10%) to proposer, City
agrees to negotiate additional compensation proportional to the
increased benefit to the City. 1-
e. Failure to Procure or Maintain Insurance '4'11
Proposer's failure to procure or maintain required insurance shall
constitute a material breach of contract under which the 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 L
so paid from proposer, or deduct all monies so paid from payments °
due proposer.
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f. Underlying Insurance
Proposer shall be responsible for requiring indemnification and
insurance from its employees receiving mileage allowance,
consultants, agents, and subproposers, if any, to protect the °
proposer's and the City's interests, and for ensuring that such
persons comply with any applicable insurance statutes. Proposer is
encouraged to seek professional advice in this regard.
g. Evidence of Coverage
Evidence of coverage (as checked below) having as a minimum the
limits shown must be submitted and approved prior to the °w
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.
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RFP F-13-19
Workers'Compensation
Third Party Administrator
Description Limits
Workers' Compensation Statutory
(x) Employers' Liability $500.000
- Waiver of Subrogation
General Liability $1,000,000
(must be written on Occurrence Form)
(x) Premises and Operation
(x) Contractual Liability
(x) Independent Contractors
(x) Products/Completed Operations
(x) Broad Form Property Damage
(x) Personal Injury o
(x) Broad Form Liability Endorsement
Automobile Liability $1,000,000
(must be written on Occurrence Form)
(x) Owned Automobiles
(x) Non-owned/Hired Automobiles
(x) Garage keepers' Legal Liability
O
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(X) Professional Liability(Errors and Omissions) $500,000
(To be in continuous force from date of contract
award until one year after final acceptance of the project.) U,
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C. PROPOSAL SPECIFICATIONS
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1. Services To Be Provided
w
Following is a description of the required services for the Workers'
Compensation Third Party Administrator Services. The following
minimum services will be required of the proposer awarded the L
contract: a
a. Include integrated claims intake, processing and reporting;
b. Comply with all provisions of the California Labor Code related to
workers' compensation;
c. Manage effectively and expeditiously all workers' compensation
claims in such a manner as to minimize the City's costs;
d. Administer claims in such a manner that the City's relationship with
it's employees is not adversely affected;
e. Provide state-of-the-art claims systems, including data
management and reporting;
f. Provide strong medical cost-management capabilities;
14
Packet Pg.134 I
l,E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
g. Provide seamless coordination of all claims and managed care
programs.
2. Proposal Content
The City currently self-administers its own program; proposers will
provide Third Party Administrator services in accordance with best
practices consistent with industry standards.
Written proposals are being requested from vendors capable of
performing the services required. Specific performance criteria will be c
incorporated into the contract.
a,
Proposals should detail the services that will be provided to the City. E
Additional supporting materials may accompany the proposer's o
response. i
d
Y
The City will require the following information in all proposals
submitted:
°
a
a. Background re
Describe how long your firm has administered workers'
compensation claims for self-insured agencies in California. Please
indicate the location of the proposed claim office and if you would °
be willing to assign a dedicated unit to this account.
cr
°
b. Transition Plan
Describe your transition and implementation plan if you were to be
selected. Outline how you will transition claims administration, N
reporting and processing at no or minimal cost to the City and
ensure continuity of service for existing and new claims. The plan w°
description should include discussion regarding the following:
w
et
(1)Any previous experience taking over as a new Third Party
Administrator;
(2) Transition plan timeline;
a.
(3) Plan for transfer of electronic data;
IX
(4) Plan for physical files, open and closed;
(5) Services of required notices upon transition;
(6) Information you require of the City for transition purposes;
(7) The method to be used to communicate the status of the co
transition plan to the City.
15
Packet 135
I 7.E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
c. Claims Management Information System
Describe your Claims Management Information System, including
your ability to modify your system to customize areas to meet the
City's need to maintain loss data suitable to respond to multiple
information requirements. Address your claims diary system and
supervisory oversight. Please include data integrity and security,
online access, OSHA reporting and online notes capabilities.
Provide examples of standard and custom reports provided by your a
Claims Management Information System. Please include plans for o
providing information on individual cases, as well as a description
of the type and number of statistical reports provided. d
Q.
Assemble and submit data as required for the State and City ci
reports, including the annual report to Industrial Relations, Self-
Insurance Program Report, and annual actuarial studies performed
on the Workers' Compensation Program.
For all claims administered by the proposer, the proposer will
perform all activities necessary for the City's compliance with the
reporting requirements of Section 111 of the Medicare, Medicaid,
and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) and
any successor reporting requirements for Workers' Compensation C
(See 42 U.S.C. 1395y(b)(7) & (8).
CD
Reports generated by the proposer will be furnished to the City in
electronic format (PDF files or an equivalent) or spreadsheet
(preferably Excel) for analysis purposes, depending on the criteria
of request.
Provide, at a minimum, the following report to the City electronically LL
co
on a weekly basis:
(1) Disability report outlining the status of all open cases with
employees off on disability or newly returned to work; u
(2)Appearance, hearing, trial, and important date calendar; LL
(3) Claims in "delay" status or newly accepted or denied claims;
(4) Check register, preferably in Excel format;
(5)All open claims by claims type.
Provide, at a minimum, the following reports to the City on a
monthly basis:
(1) Detailed report of all open claims, listed by department, for
dissemination.
16
I Packet Pg.136 I
I 7.E.a k I
RFP F-13-19
Workers'Compensation
Third Party Administrator
(2) Report listing all claims, including name, claim number,
location, codes, work comp class code, description of claim,
injury and mechanism of injury, amounts paid, reserved and
incurred for medical expenses and indemnity.
(3) Lag report listing all claims reported in the last month, listed
by department, and the dates of knowledge and reporting
dates.
(4)Administrative report containing number of claims, medical
only, indemnity and reporting only; number of closed claims;
number of active files assigned to each claims examiner; 2
amount paid for medical, expenses and indemnity for each N
department; indemnity paid in: 4850 benefits, Temporary d
Disability, Permanent Disability, Death Benefits, expenses
paid for UR Nurse Case Management, investigators, and o
attorneys; cases assigned to counsel, investigators, nurse
case managers; amounts recovered in apportionment and
subrogation; number of litigated cases; list of cases settled
during the month, indicating the amount of the settlement
and method of settlement (stipulation, C&R, dismissal);
penalties paid, indicating whether attributable to proposer or re
City.
Provide, at a minimum, the following reports to the City on an C
annual basis:
CT
(1)Annual Self-Insurance Report as required by the State of re
California;
(2) Vendor report, in spreadsheet format, listing amounts paid to N
each vendor;
(3) 1099 report to each vendor;
Lo
(4) Department of Industrial Relations Annual Report of
Inventory.
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Maintain loss data for claims reporting to State. M
Maintain loss data for Cal OSHA 300 annual reporting. U.
IX
Medicare Section 111 Mandatory Reporting.
d. Claims Team
Describe the proposed programs, to include the individual's years
of claims experience, self-insured certifications/licenses/other
certifications, years with your firm, turnover rate. Identify other key
staff that will support the City's programs. Each examiner should
have a claims case load of no more than 150 open indemnity
claims at any one time. In addition, it is preferred that a 2:1 ratio be
maintained between Claims Assistants and Claims Examiner.
Finally, the City prefers the Claims Examiner(s) be assigned to the
17
I Packet Pg.137 J
I7.E.a f I
RFP F-13-19
Workers'Compensation
Third Party Administrator
City's account exclusively. (Claims Examiners must have their Self-
Insured Competency Certificate and must be supervised by a
person who has passed the State of California test for
Administrator, Self-Insurance Plans issued by the Self Insurance
Plans Division of the Department of Workers' Compensation.)
e. Claims Administration
Describe your firm's claims administration policies and practices
that ensure superior customer service to City employees while
maintaining economic and administrative control over claims cost.
03
(1) Identify your firm's criteria for designating a claim as a first
aid, medical only or indemnity case. E
(2) Firm shall provide sufficient Claims Examiners to maintain 0
a case load of no more than 150 open indemnity claims L
per Examiner. Advise if this count includes future medical
designated cases (future medical cases are designated 2:1
ratio).
(3) The City's claims are currently administered using "Best a
Claim Practices." Please describe your firm's claims
administration policies to assure "Best Claim Practices" are
applied.
(4) Firm must have access to the claims index system and 2
index all new claims filed and re-index existing claims as d
needed. Criteria for re-indexing claims should be
discussed in the proposal.
(5) All claim denials and legal actions will require prior
consultation and consideration by the City. Please confirm
that this is acceptable in your proposal.
(6) Describe your firm's policies and practices in establishing w
and maintaining reserves for indemnity, medical care,
expenses and future medical benefits.
(7) Describe your firm's policies and procedures to ensure
timely review and appropriate payment of benefits and
bills.
(8) Describe how your firm plans to provide bills to the City's a.
chosen Bill Review provider within seven (7) days, and
allow for electronic transfer of bill review results and
charges to claims files.
(9) The City maintains an aggressive return-to-work (RTW) 03
program. Describe how your firm will assist and facilitate
RTW activity at the earliest possible opportunity.
(10) Describe your firm's policies and practices to control the
referral and assignment of outside service providers, such
as investigators, nurse case mangers or attorneys.
18
I Packet Pg.138
i
7:E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
(11) Penalties paid by the Third Party Administrator through no
fault of the City shall be reimbursed to the City, with
reimbursement made on a quarterly basis. Overpayment of
benefits that occur due to no fault of City shall be
reimbursed to the City as well. Describe the review system
to mitigate penalties and overpayments and to ensure that
the City does not incur expenses due to no fault of the City.
(12) A written analysis of the case, including settlement options
and recommendations, must be submitted to the City at
least ten (10) working days prior to any settlement offers or o
conferences. Describe the procedure that will be used to
request authority from the City. The proposer will not have
authority to settle the City's cases.
(13) The proposer will be responsible to identify subrogation ci
opportunities and, in consultation with the City, will be
called upon to pursue subrogation. Describe your firm's
practice in identifying subrogation opportunities.
(14) The City aggressively pursues abuse of the workers'
compensation system or suspected fraud. Describe your
firm's practices and procedures to protect the City against
such abuse.
(15) The City's expectation is that every indemnity claim will be
investigated using three point contact and the Index C
Bureau. Please describe your firm's investigation process.
(16) The City's excess insurance carrier, CSAC-EIA, requires
use of its Workers' Compensation Claim Management
standards. The proposal must state the Third Party •;
Administrator's willingness to apply those guidelines to
management of City claims. Please describe any
experience you have had with CSAC-EIA. °
f. Ancillary Services
If your firm provides Managed Care, Bill Review, Nurse Case
Management or UR and would like to include these services in the _M
proposal, please provide a detailed description. The City retains the
right to select these service providers independent of the contract
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for Third Party Administrator services. The City expects the
proposer to fully cooperate with these providers to achieve efficient
and effective results. Please describe your firm's experience
working with managed care services.
If your firm is a managed care service provider, please include the
following in the proposal:
Bill Review Services
Please provide your firm's experience doing business in
California with self-insured organizations. Please include
answers to the following in the response:
19
Packet Pg 39*vI
I 7.E.a 1
RFP F-13-19
Workers'Compensation
Third Party Administrator
(1) Discuss your firm's bill review services and fees
(competitive proposals will include a flat rate for bill
review fees).
(2) Outline features of your firm's systems and availability to
customize the delivery of your services.
(3) Indicate whether your firm's program includes pharmacy
or durable medical equipment review.
(4) Identify reports which will be provided to the City.
(5) Discuss why your firm is superior to others regarding o
service and cost savings. y
(6) Include Third Party Administrator references in California.
o.
Utilization Review
Provide your firm's experience doing business in California with
CD
self-insured organizations. Please include answers to the
following in the response:
(1) Identify utilization standards and guidelines that are used
to review treatment requests.
(2) Outline all review fees to include physician reviews and
any automatic per-file referral fees.
(3) Identify expected turn-around times. o
(4)Advise if your firm's medical director is Board certified y
and how long the director has been with your
cp
organization.
(5) Include what is unique about your firm regarding review
of medical treatment requests and how you can help the N
City reduce utilization review costs. --
0
Nurse Case Management w
co
Please provide your firm's experience providing telephonic and
w
field case management in California, specifically in the San ao ao
Bernardino, area. Please include answers to the following in
your response: u
a
(1)Are your firm's managers RN licensed?
(2) If your firm was chosen to provide services, what office
location would the nurses be working from and how long t
have the nurses that may be assigned to the City's
account been employed with your firm?
(3) Provide a resume for the nurse case manager assigned
to the City's account.
(4) Provide all professional fees for services.
(5) Describe your firm's guidelines and expectations
regarding its nurse case management program.
20
Pace 140 I
� ,ad° .add'
M
7.E.a I
RFP F-13-19
Workers'Compensation
Third Party Administrator
(6) Provide what direct experience the assigned nurse case
manager has in working with medical providers in the
San Bernardino, California, area.
g. Definitions
Define your firm's definitions of an indemnity claim, a medical only
claim, allocated expenses and unallocated expenses.
Proposal submission must be no more than 12 pages (not including
City's forms or contract). c
D. 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 L
best—qualified proposals, it is the City's intent to award the Contract to the °
firm(s) that will provide the best overall service to the City inclusive of fee
considerations. As in all professional service contracts, °
p the City reserves a
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, who will determine the firms selected for further consideration,
based on an evaluation of the proposals using the criteria listed below. .2
The final recommendation will be reviewed by the Finance Director and y
then submitted to the Mayor and Common Council, who will make the final =Fr
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 (also see Section VI, pages 34-37.)
1. Proposer's Experience and Qualification
Experience and knowledge of claims administration of a self-insured
public agency, municipality and/or joint powers authority. The City is
interested in such specialized services through contract as follows:
a. Claims Handling a
(1) Review on behalf of the City all reports of injury as defined by
Labor Code 3208 and 3208.1.
(2) Maintain a diary that supports review of each file every 30
days, but in no event to exceed 45 days. _°
(3) Establish prompt phone contact with each injured employee, a
the employee's supervisor and the medical provider for those
cases involving severe injuries.
(4) Determine the benefits, if any, which should be paid or
rendered under the California Workers' Compensation Laws
upon receipt of each injury report.
21
17.E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
(5) Conclude three-point contact within 24 hours after receipt or
knowledge of a claim.
(6) Return all calls within 24 hours.
(7) Establish and maintain orderly, up-to-date, physical and
electronic claims files, one for each reported claim. Each file
shall be available to the City for inspection with or without prior
notice. .,
(8) Assign an attorney where appropriate, and make a substantial
effort to settle claims without assigning it to legal counsel.
(9) At the Third Party Administrator's expense, maintain claim file
storage for the period of time required by law. a
(10) All claims administration services performed shall comply with
those provisions set forth in the California State Association of
Counties-Excess Insurance Authority (CSAC-EIA) Standards
for Workers' Compensation Claims Administration Services
(http://ww.csac-eia.org/). `o
(11) Administration of all City claims must be performed under the a
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supervision of an examiner/adjuster that has a current State of cu
California certificate to administer workers' compensation N
claims.
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(12) Coordinate with the City to resolve all issues relative to y
vocational rehabilitation, retraining, supplemental job cr
displacement vouchers, return-to-work, Americans with ce
Disability Act, or any other related issue.
(13) Make examiners and supervisor available for participation in
claims review with representatives of City departments, as
requested.
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b. Reserves o)
(1) Maintain an estimate of the total cost of all reasonable,
foreseeable benefits and related expenses on each case.
a
(2) Pay on behalf of the City, from City's funds, those sums that IX
should be reasonably paid under the California Workers'
Compensation Law for each reported claim.
(3) Pay on behalf of the City, from City's funds, all allocated loss c
adjustment expenses.
(4) Fully cooperate with all audit requests by the City or other
associated agencies.
22
ak 4
I 7.E.a I
RFP F-13-19
Workers'Compensation
Third Party Administrator
c. Reports
(1) Prepare the Public/Self—Insurers Annual Report and transmit
to the City for signature two (2) weeks in advance of the
deadline for submission to the State of California.
(2) Prepare the annual report of inventory and transmit to the City
for signature two (2) weeks in advance of the deadline for
submission to the State of California.
(3) Provide online claims access and report producing capabilities
to the City.
(4) The proposer must follow the banking requirements of the g
City, such as establishing, maintaining and reconciling an
interest—bearing checking account with appropriate deposit
and transfer procedures for the payment of claims or make
other payment arrangements which are acceptable to the City. c.)
The proposer will maintain check registers and provide a
monthly check register to the City along with a copy of all
checks and vouchers.
(5) The proposer will accumulate data, prepare and mail 10995
forms for all providers of services who are paid during the a
calendar year, as required by the Internal Revenue Code. re
CD
(6) The proposer will prepare the State of California self-insurer's
annual report in a timely manner and will provide a monthly N
check register/report of claim payments and other claim data
to the City. The proposer will also prepare the annual Cal- y
OSHA 300 log and any other reporting required by the
Division of Workers' Compensation, Self-Insured Plan, and
any other involved entity.
(7) The proposer will prepare statistical information to analyze its
workers' compensation program for cost containment and
actuarial purposes. Other custom/non-standard reports may
co
be required periodically and may require sorting/collation by
any data entry field.
re
(8) Year-end loss runs for open and closed claims to include each
past year in consecutive order for each year as of the most
recent year-end date. The program should have the ability to
a.
capture this information at any time during the year. This loss-
run must include the claim number, date of loss, date
reported, cause of loss, type of loss, description of loss, body
part affected (this item should have the ability to be updated if
other body parts are later added), department and division, co
reserved, paid and total amounts incurred. Temporary
Disability, Permanent Disability, and Labor Code 4850
benefits should be captured in this report.
(9) Provide summaries to include individual claims, number of
visits, visit intervals and dollar amounts.
(10) Expense loss-runs should have the ability to separate legal
expenses, investigative expenses, medical legal expenses,
and other expenses.
23
packet pg. to I
I7.E.a1
RFP F-13-19
Workers'Compensation
Third Party Administrator
(11) Incurred claims run on monthly or quarterly basis showing new
claims filed within a specific time period.
(12) Open claims run showing all claims open as of a specified
date.
(13) Monthly Claims Summary with new claims opened, stipulated,
and closed.
(14) The ability to track return-to-work/modified duty savings. a
(15) The above—stated loss-runs should have the flexibility to
include all or part of the required information. s`
(16) Medicare Section 111 Reporting.
0.
d. Training c
(1) Participate in training of departmental staff with regard to
issues associated with workers' compensation.
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e. Ancillary Services
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The City is concerned that ancillary services necessary to 0.
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effectively administer the case are thorough and fairly priced. CD
Selection of vendor(s) to perform Medical Case Management,
Medical Provider Network (MPN), Utilization Review, Bill Review,
Investigation, or any other frequently used services will be based
CD
on bid criteria set forth in this RFP. If the proposer performs any or a
all of these services, or has affiliated companies that perform these re
services, each ancillary service must be individually priced.
CI;
(1) Checking Account
The City maintains a checking account at a local bank with
which to pay all workers' compensation-related costs. The
account was initiated with funds from the Workers' tx
Compensation Fund and is replenished regularly upon
presentation by the Third Party Administrator of proof of
issuance of checks. The Third Party Administrator will be
required to work with the City's Treasurer Department for bank LL
reconciliation, and provide electronic data to the bank in
support of our positive-pay system.
(2) Medical Case Management
(a) Medical Case Management (MCM) is
needed/advised/useful in the efficient administering of
some claims. The Third Party Administrator shall be
responsible for evaluating cases that would benefit from
referral to either an internal/affiliated MCM entity or non-
affiliated MCM vendor. Any case not considered to be
catastrophic in nature must be discussed with, and
approved by the City prior to making a referral.
24
IPacket J
I 7.E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
(b) MCM should be utilized as a mechanism to ensure
appropriate medical care is rendered while achieving cost
efficiencies in cases with catastrophic injuries or in cases
that are stalled due to treatment issues/disputes.
(c) The MCM provider must have comprehensive protocols in
place to ensure the goals of proper treatment and cost
efficiency.
(3) Medical Provider Network (MPN) p-
The City does not currently participate in a Medical Provider o
Network (MPN) but would contemplate utilizing the proposer's
network if it would provide a cost savings and improve medical
0.
treatment. Describe your network and approximate usage and
establishment of costs. o
U
(4) Utilization Review(UR)
(a) Utilization Review (UR) is required for specific procedures
during the claim process. Currently, ACOEM Guidelines
are the baseline standard to determine appropriate a
treatment protocols.
(b) The Third Party Administrator shall be responsible for
evaluating situations that may require and/or benefit from _N
referral to either an internal/affiliate UR activity or non- .2
affiliated UR vendor. It is expected that experienced
adjusters will make most first-line UR decisions and defer
to formal UR assessment when appropriate medical
expertise is needed or when required by statute.
(c) UR is intended to be a mechanism for ensuring that �'
appropriate treatment is rendered to City employees while
achieving cost efficiencies. w
w
(5) Bill Review
(a) Bill Review is currently performed on all billings related to
the administration of the City's workers' compensation
program. The proposer shall be responsible for providing u
billing information to either an internal/affiliated Bill Review
activity or non-affiliated Bill Review vendor.
(b) Bill Review is primarily a function intended to ensure
payment of medical billings at the State-mandated Official
Medical Fee Schedule (OMFS) rate. Vendor-negotiated
network savings below the OMFS are also a benefit of the
Bill Review process.
(c) It is expected that savings will be realized from a
combination of an appropriate administrative fee for
activities related to the Bill Review process, the payment of
the appropriate OMFS rate for services, and negotiated
network fee savings below the OMFS.
25
P g. 4 5 J
7.E.a I
RFP F-13-19
Workers'Compensation
Third Party Administrator
(6) Investigations
(a) Investigative activities are an integral part of an aggressive
claims management program. Quick decisions must be
made regarding compensability (AOE/COE) issues.
Addressing red flags in cases is also important to prevent
fraudulent claim activity.
(b) This RFP is seeking interested vendors of investigative
services who may be placed on a panel for referral on a a
case-by-case basis. a
(c) The proposer shall discuss all investigative referrals with
the City and will get approval to refer to either an
internal/affiliated investigations activity or non-affiliated a
a.
investigations vendor.
(7) Litigation
Files should reflect a clear understanding of legal issues.
Legal counsel should be used effectively. Cases should be
referred to attorneys listed on the approval panel. No outside
referrals will be made without the City's approval.
y pproval. Attorneys a
should not perform work the Claims Examiners can perform. If
the proposer recommends that a litigated case continue to be
handled by a Claims Examiner without immediate assistance n
of an attorney, prior approval from the City must be obtained. o
Claims staff is expected to be available for conferences and
trials, some depositions and all strategy meetings with 3
defense counsel and the City.
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(8) Subrogation
Subrogation must be identified and pursued. This includes
notice to the employee and the responsible third party, w°
recovering costs for which a third party is liable, and 5
coordinating the filing of actions by City's defense attorney
within the statute of limitations.
(9) Excess Insurance
Third Party Administrator must work with the City's excess LL
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insurance carrier, reporting claims in accordance with policy
requirements. Claims Examiners should be aware of the self-
insured retention (SIR) level; systems should exist that identify s
excess insurance claims. Claims should be promptly reported.
Regular updates should be provided to excess insurance
carrier, and recovery should be properly documented in the
claims files.
26
Packet Pg.146 k
I7.E.a =I
RFP F-13-19
Workers'Compensation
Third Party Administrator
(10) Job Disability
Provide notice to the City, as required by law, about the
employee's inability to return to work at their usual and
customary occupation so that the Interactive Process can
begin promptly.
(11) Medicare Reporting
The proposer shall provide Medicare Agent Services and the
required reporting per Section 111 of the MMSSEA. The
proposer will also provide costs associated with this service. o
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27
Packet g.1
I 7.E.a I
RFP F-13-19
Workers'Compensation
Third Party Administrator
E. STATEMENT OF PROPOSER'S QUALIFICATIONS AND REFERENCES
Third Party Administrator
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 a
specifications under the present business name:
List and describe fully the last three contracts performed by N
y your firm that
demonstrate your ability to complete the work included with the scope of the d
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 o
qualifications.
-112
Reference No.1
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Customer Name:
Contact individual: ,moo`
Address: a
Contract Amount: Phone No: cc
Year:
Description of Work Done: y
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cc
Reference No.2
Customer Name:
Contact individual:
Address: Phone No:
Contract Amount:
Year:
Description of Work Done:
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Reference No.3
a
Customer Name:
Contact individual:
Address: Phone No:
Contract Amount: Year:
Description of Work Done:
Authorized Signature:
Title:
28
I Pack
I7.E.a..,
RFP F-13-19
Workers'Compensation
Third Party Administrator
F. 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 submitting a 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.
a
Do you have any disqualifications, removal, etc., as described in the above o
paragraph to declare? Yes No co
a.
a,
If yes, explain the circumstances.
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California.
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I declare, under penalty of perjury, that the foregoing is true and correct.
Signature(s) of Authorized Proposer Signature of Authorized Proposer
Title Title
29
I Packet P 149 1
7.E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
G. WORKERS' COMPENSATION INSURANCE CERTIFICATE
Sections 1860 and 1861 of the California Labor Code require every proposer 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
require every employer to be insured against liability for workers'
compensation or to undertake self-insurance in accordance with the F-
provisions of that code, and I will comply with such provisions before 0
commencing the performance of the work in this Contract." y
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Workers'Compensation
Third Party Administrator
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BID CONTENT AND FORMS E
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7.E.a.;
RFP F-13-19
Workers'Compensation
Third Party Administrator
SUMMARY PROPOSAL
PRICE FORM
Please provide a Firm Fixed Fee. This form is to be submitted in a separate sealed
envelope (see pages 4 & 5.) The undersigned declares that he or she has carefully
examined the Request for Proposal 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:
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As described in said Request for Proposal, which is made a part of this proposal, c
quoted herein in full.
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Third Party Administration Services
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(b) Pharmacy Bills (per claim) 0
(c) Savings percentages for inpatient/outpatient
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(d) Percentage of PPO savings
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(f) WCAB Appearance (expert witness fees)
(g) Duplicate and Reconsideration charge 0
(h) Hospital Bill Audit
(I) Monthly report fee a
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Utilization Services (Only if Bidding)
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TOTAL COST:
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Packet 52 I
7.E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
SUMMARY PROPOSAL
PRICE FORM (continued)
Are there any other additional or incidental costs that will be required by your firm in
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 c
your firm. C1
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Have you included in your proposal all informational items and forms as requested?
Yes / No (circle one). If you answered "No," please explain: a
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Terms and conditions as set forth in this RFP apply to this proposal.
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Cash discount allowable % days; unless otherwise stated, payment
terms are: Net thirty (30) days.
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In signing this proposal, proposer(s) warrants that all certifications and documents °w
requested herein are attached and properly completed and signed.
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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.
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Verification of Addenda Received
Addenda No: Received on:
Addenda No: Received on:
Addenda No: Received on:
FIRM NAME:
ADDRESS:
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I 7.E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
SUMMARY PROPOSAL
PRICE FORM (continued)
Phone:
Email:
Fax:
Authorized Signature:
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Packet 154
17.E I
RFP F-13-19
Workers'Compensation
Third Party Administrator
ANNUAL PURCHASE ORDER
Effective on or about , 20_ through June 30, 2013, plus three (3), single-
year renewal options, at the City's discretion for City requirements.
Option Year One, if exercised, shall be effective July 1, 2013 through June 30, 2014.
Option Year Two, if exercised, shall be effective July 1, 2014 through June 30, 2015.
Option Year Three, if exercised, shall be effective July 1, 2015 through June 30,
2016.
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Actual option year pricing shall be negotiated with the successful bidder(s) prior to a
exercising any given option year. Option years shall become effective only upon
issuance by the City of a duly authorized Purchase Order. 0
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I 7.E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
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 0
perform that portion himself. to
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DIVISION OF NAME OF FIRM OR LOCATION
WORK OR CONTRACTOR CITY
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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 so seems to best serve the public interest.
36
Packet 15
— I d
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RFP F-13-19
Workers'Compensation
Third Party Administrator
NON-COLLUSION AFFIDAVIT
TO: MAYOR AND COMMON COUNCIL, CITY OF SAN BERNARDINO
In accordance with Title 23, United States Code, Section 112, the undersigned a
hereby states, under penalty of perjury:
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That he/she has not, neither directly nor indirectly, entered into any agreement,
participated in any collusion, or otherwise taken action in restraint of free competitive
proposal in connection with RFP F-13-19.
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Notary Public in and for the County of , State of California.
My commission expires , 20
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Packet Pg.157
7-E-a
RFP F-13-19
Workers'Compensation
Third Party Administrator
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SECTION IV.
GENERAL EVALUATION CRITERIA E
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IV. GENERAL EVALUATION CRITERIA
A. Evaluation Criteria
1. Capabilities of Firm to Effectively Complete the Project
Requirements - 35%
Depth of proposer's understanding of, and ability to manage, City's a
requirements; ability to meet task deadlines; utility of suggested
enhancements or technical innovations. c
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2. Qualifications of Firm/Related Experience -45% CD CD
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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
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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
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commitment.
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3. Reasonableness of Cost and Price - 10%
Reasonableness of the individual firm-fixed prices and
competitiveness of quoted prices with other proposals received; .2
adequacy of the data in support of figures quoted; basis on which
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4. Completeness of Response - 5%
Completeness of response in accordance with RFP instructions;
exceptions to or deviations from the RFP requirements which the
proposer(s) cannot or will not accommodate; other relevant factors °w
not considered elsewhere.
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5. Local Vendor Preference - 5%
As approved in Executive Order 2003-01--proposer(s) which
possess a fixed office or distribution point with at least one owner or
employee located within the City of San Bernardino, and
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possessing all valid and current permits, and licenses required to
transact such business, including, but not limited to a City Business g
Registration Certificate 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 proposer(s).]
Packet Pg I
I 7.E. I
a' ,
RFP F-13-19
Workers'Compensation
Third Party Administrator
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 proposer(s)'s place of
business. Proposer(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
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submit to City Council, for consideration and selection, the offer(s)
judged by staff to be the most competitive. o
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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 proposer(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.
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The City also reserves the right to award its total requirement
among two or more proposers as City staff may deem to be in its
best Interests. In addition, negotiations may or may not be conducted
with proposer(s); therefore, the proposal submitted should contain the
proposer's most favorable terms and conditions, since the selection
and award may be made without discussion with any proposer(s).
D. Tie Proposals _W
If the final evaluation scores (after applying the local preference >
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allowance) result in a tie score, the recommendation for award will be
given to the local vendor.
E. Notification Of Award a
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Proposer(s) who submit a proposal in response to this RFP shall be
notified regarding the firm(s) who was awarded the contract. Such
notification shall be made within a reasonable time after the date the
contract is awarded.
40
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7.E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
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GENERAL SPECIFICATIONS 0
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I 7-E-a* I
RFP F-13-19
Workers'Compensation
Third Party Administrator
IV. GENERAL SPECIFICATIONS
1. Each bid shall be in accordance with Request for Proposal (RFP) Number
F-13-19. All specifications are minimum. Bidders are expected to meet or
exceed these specifications as written. Bidder shall attach to their bid a
complete detailed itemization and explanation for each and every deviation or
variation from the RFP specifications and requirements. Conditional bids, 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 bids and to award a
contract to the bidder whom best meets the City's requirements. This may
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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 d
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.
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3. The City of San Bernardino reserves the right to purchase more or less than
the quantities specified at unit prices bid.
4. Bids shall be firm offers, subject to acceptance or rejection within 120 days of
the opening thereof. .�
5. Regular dealer. No bidder shall be acceptable who is not a reputable
manufacturer or dealer of such items as submitted for bid consideration.
6. 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. w°
"Seconds", factory rejects, and substandard goods are not acceptable.
7. Each bidder shall submit with their bid a copy of the proposed product
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specifications, complete detailed drawings, and other descriptive matter in
sufficient detail to clearly describe the equipment, materials and parts offered. A
8. 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 a
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 bidder must state in their bid the guaranteed delivery date of product E
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.
10. Each bidder shall list in their bid 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 bid.
42
I Packet Pg. 162 ;J
I 7.E.a
RFP F-13-19
Workers'Compensation
Third Party Administrator
11. Successful bidder(s) (Contractor) shall furnish and deliver to the City
complete equipment as bid 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. Bid 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 a
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 bid. Bidders furnishing bids under ttS
these specifications shall supply all items advertised as "standard" equipment
even if such items are not stipulated in the specifications, unless otherwise a
clearly accepted in the bid. o
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15. The items which the bidder 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.
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16. Contractor delivering equipment pursuant to these 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
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own expense.
17. By submitting a bid, each bidder 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. N
18. In case the delivery of the items under this contract is delayed due to strikes, w°
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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 Manager of the City of San Bernardino. The City shall not u
unreasonably refuse such extension.
19. Contract. Each bid shall be submitted and received with the understanding
that acceptance by the City of San Bernardino of bid 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 price bid and in
complete accordance with all provisions of RFP No. F-13-19. In 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.
43
Packet
E. £ .l
RFP F-13-19
Workers'Compensation
Third Party Administrator
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 a
(commencing with Section 1120) of Division 4 of Title I of the Government
Code of the State of California. 2
21. One Document. These specifications, the notice inviting bids, RFP F-13-19,
the Contractor's bid, any written agreement executed by the parties, the a
purchase order and all documents referred to in the complete specifications
and purchase order, and all written modifications of said documents shall be o
construed together as one document. Anything called for in any one of said y
documents shall be deemed to be required equally as if called for in all. Y
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 a cc
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be construed as applying to all sections. CD
22. The City of San Bernardino reserves the right to accept or reject any and all
bids.
23. Prompt payment. Each bidder may stipulate in their bid 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 d
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
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payment discounts will only be used during bid evaluation in the case of
ties.
24. Inquiries. Direct all inquiries to Vanessa Sanchez at 909-384-5330. W
Technical questions may be sent via fax to 909-384-5043. The answers to
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material questions will be provided to all potential bidders. off,
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25. Bid/Price forms. No bid will be acceptable unless prices are submitted on the
pricing forms furnished herein, and all required forms are completed and
included with bid. Deliver all bids, SIGNED and SEALED, to the Purchasing
Division, Finance Department at 300 North "D" Street, 4th Floor, City Hall, San us
Bernardino, California 92418. CLEARLY MARK THE RFP SPECIFICATION
TITLE: WORKERS' COMPENSATION — THIRD PARTY ADMINISTRATOR
and Number F-13-19 ON THE OUTSIDE OF THE ENVELOPE.
26. Time. All bids must be received in the Purchasing Division no later than 3:00
PM, PST, , 2012, where at such time and said place bids will be
publicly opened, examined and declared. Any bid may be withdrawn by
44
I Packet P 6
I7.E.a LLI
RFP F-13-19
Workers'Compensation
Third Party Administrator
bidder prior to the above scheduled time for the opening of bids. Any bid
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 a
equipment bid. a
29. In submitting a bid to a public purchasing body, the bidder offers and agrees o
that if the bid is accepted, it will assign to the purchasing body all rights, title, y
and interest in and to all causes of action it may have under Section 4 of the g
Clayton Act (U.S.C. Sec 15) or under the Cartwright Act (Chapter 2, E
commencing with Section 16700 of Part 2 of Division 7 of the Business and 8
Professions Code), arising from purchases of goods, materials, or services by
the bidder for sale to the purchasing body `
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assignment shall be made and become effective at the time the purchasing
body tenders final payment to the bidder.
30. Contractor shall indemnify, defend and hold City, its officers, employees and w
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agents harmless from any claim, demand, liability, suit, judgment or expense Lct
(including, without limitation, reasonable costs of defense) arising out of or d
related to Contractor's performance of this agreement, except that such duty y
to indemnify, defend and hold harmless shall not apply where injury to person .2
or property is caused by City's willful misconduct or sole negligence. The d
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 d
"attorney's fees"for the purposes of this paragraph. ce
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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 °w
$1,000,000 combined single limit, and statutory worker's compensation N
coverage, and shall file copies of said policies with the City's Risk Manager
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prior to undertaking any work under this Agreement. The policies shall name a)
the City as an additional insured and shall provide for ten (10) day notification A
to the City if said policies are terminated or materially altered. u
32. FAITHFUL PERFORMANCE BOND/BID BOND. The Contractor will be a
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required to furnish a cashier's chcck, certified chcck or faithful performanco
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performance of this contract. Said surety shall be subject to the approval .1
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the City of San Bernardino, bonds shall be in accordance with Ordinance No. a
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in Best's most recent insurance guide of"A" or betteP.
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.
45
I Packet 15I
I, 7.E.al
RFP F-13-19
Workers'Compensation
Third Party Administrator
34. City may, at its discretion, exercise option year renewals for up to three (3)
years, in one-year increments.
35. By submitting a bid, bidder 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 bidder, and are
valid and in full force and effect. Copies or legitimate proof of such licensure
and/or certification shall be included in bidder's response. Bids lacking copies
and/or proof of said licenses and/or certifications may be deemed non-
responsive and may be rejected. a
36. Once the award has been made and prior to the commencement of the job, o
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 a
Certificate during the term of the Agreement. E
37. Vendor (Contractor)/ Consultant services agreement(s) (VSA/CSA). A signed 3
vendor/Consultant service agreement may be required between both parties
prior to commencement of the job.
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I 'Packet Pg.166 I