HomeMy WebLinkAbout1985-07-23; City Council; 8259; Employee benefits insurance2
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DEPT. CM
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CI; OF CARLSBAD - AGEND,. BILL
TITLE DEPT. HD. %
EMPLOYEE BENEFITS INSURANCE
CITY MGR.-
RECOMMENDED ACTION:
Approve concept of preferred provider organization for
implementation as part of the medical plan, retain existing benefit levels under the life, medical, dental, vision and
long term disability plans, and direct staff to negotiate renewal of insurance program with Crown Life.
ITEM EXPLANATION:
The city's insured medical, dental, vision and life insurance program is provided by Crown Life Insurance Co. The policy is up for renewal on August 1, 1985.
The following actions are recommended:
Implement Preferred Provider Organization (PPO)
The San Diego PPO is offered by Crown as part of the medical plan and as a cost containment feature. Rates and charges are negotiated with hospitals and doctors
and the resulting savings in claim costs allows a
reduction in premiums. The proposed decrease to
implement PPO is 16%. Representatives of two
employee groups have given conceptual approval.
Direct Staff to Negotiate Renewal with Crown Life
Crown is proposing a decrease in the medical premium
of 5.8% effective August 1, 1985. The decrease is
based on favorable claims experience of the city
during the current policy year and is applicable
to current medical plan design. This decrease will
occur not withstanding the implementation of a PPO.
If the Council approves the above recommendations, staff
will negotiate amendments to the contract with Crown to
implement the changes and return the final documents for
for Council approval. Included will be premium rates,
financial accounting, reserve and liability levels, and
benefit vs non-benefit costs.
AGENDA BILL NO. BdS 7 7/16/85
Page 2
FISCAL IMPACT:
The total premium for Crown medical, dental, vision and life insurance is estimated at $690,858 for the
1984-85 policy year. If the existing program is renewed with Crown, the medical portion of the premium is expected to decrease 5.83%. If the PPO alternative is also implemented, the medical premium will decrease by an additional 16%.
The proposed reduction in premiums will only affect the medical portion of the premiums. The reduction in overall premium costs cannot be precisely calculated until the rates are quoted by the insurance company.
EXHIBITS :
1. Memo from Assistant City Manager, dated 6/25/85
2. Memo from CFA, Inc. President, dated 6/27/85
3. Memo from CCEA Staff Representative, dated 6/27/85
4. Memo from CPO President, dated 6/27/85
5. Report from Wyatt Co., dated 7/9/85
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June 25, 1985
TO : CITY MANAGER
FROM: Assistant City Manager - Mannen
EMPLOYEE BENEFITS PROGRAM
The city provides an insured medical, dental, vision and life insurance programs through Crown Life Insurance Co. The city also provides medical coverage through Kaiser, a health maintenance organization (HMO). The policy year for the Crown programs runs from August 1 to July 31 each year.
Renewal
The Crown policy is up for renewal on August 1, 1985. The
policy is experience rated and premiums are therefore based
on claims and inflationary costs.
Based on the current claims trend, Crown is proposing a reduction in premiums of approximately 5.83% for the next policy year.
The exact premiums for the various categories of coverage (employee, employee plus one dependent, and employee plus two or more dependents) has not yet been precisely calculated but will reflect the above reduction.
The contract with Crown provides for a retrospective premium adjustment. After the final results for the policy year are known, a final accounting is done. If actual claims are higher
than expected the city may have to pay additional premiums.
Last year the city was required to pay an additional $61,321.
This year actual claims are anticipated to be significantly
below expected claims and the city should receive a refund of premiums. It is recommended that any refund received be put into a retrospective premium reserve to help fund any future
retrospective premium payments.
3
CITY MANAGER
June 25, 1985
Page 2
PPO Alternative
The city's employee benefits consultant, Mike Baker of the
Wyatt Co., has been working with Crown Life to develop a cost
containment alternative as part of the insured medical plan.
Crown Life offers a preferred provider organization (PPO)
program in conjunction with the San Diego Foundation for
Medical Care.
The PPO concept works as follows: The insurance company (through the San Diego Foundation for Medical Care) negotiates
fixed rates and charges with doctors and hospitals, 25 hospitals
and 80% of the doctors in San Diego County participate.
Employees and dependents who use PPO doctors and hospitals
would receive reimbursement from the insurance company for
90% of the covered charges (based on previously negotiated
rates) from PPO doctors and hospitals. The hospital deductible
would be waived.
Employees and dependents who do not use PPO doctors and hospitals
would only receive reimbursement from the insurance company for
90% of the covered charge that a PPO doctor or hospital would
charge. If the bill from the doctor or hospital was more than
the bill a PPO doctor of hospital would charge, the employee
would have to pay the difference. An employee would also be
subjected to a $250 hospital deductible if a non-PPO hospital
was used.
A PPO program is based on the concept of providing financial
incentives for an employee to use a "preferred provider" who
would provide medical and hospital services at a predetermined
negotiated price. The price stability and predictability
allows the insurance company to offer coverage at a reduced
premimum. The estimated reduction in premium for Carlsbad is
16% through the use of the Crown PPO.
The city has discussed the PPO alternative with the presidents
of employee groups. Two employee group representatives have given
tentative conceptual approval to the PPO alternative and they express support for the remaining benefits program.
Selection of Insurance Carrier
Crown Life has been the city medical insurance carrier since 1974. In 1979 dental and vision coverage was added to the
insurance program. In 1982 the city changed from pooled concept
to an experience rated concept of insurance and negotiated a
retrospective premium payment system.
* CITY MANAGER
June 25, 1985
Page 3
The city staff and insurance consultant have reviewed the merits
of seeking bids from other carriers on the employee insurance
program.
The premiums for the program are in line with other agencies.
Actually the city's premiums are based upon our own claims plus administration and risk/insurance costs. The claims will be the
same regardless of the carrier therefore non-benefit costs are the
only variable. If non-benefit costs are competitive then there is
no further need to bid the program.
by the company are reasonable and consistent with practices in the
industry. Claims have been paid in a timely and satisfactory
manner.
The non-benefit expenses charged
Although the city has experienced a serious problem with the
company when Crown inadvertently extend common-law dependent
coverage to city employees, the problem has been satisfactorily
resolved and the company has otherwise been generally responsible
to the city's needs.
The only current significant area of concern with the company's
service involves claims utilization and management information. The company has not been able to provide the type of information needed to evaluate the benefit design and utilization in order to better control costs. The company has been working to develop
a computer based claims and reporting system but has not yet been
able to deliver the type of information felt necessary to be able
to tightly control the program.
However, the expense costs that the company is proposing are too
high for the quality of the management information we are getting
and will be negotiated downward if the city renews with Crown.
Based on discussion with the city's insurance consultant and
review by the staff it is not felt that significant savings would be realized by going out to bid on the city's insurance program ar this time. In addition to the staff time involved, the city
would have to pay a consultant or broker, in the form of fees or
commissions, to prepre bid specifications, market the program,
and analyze proposals.
If the Council wishes to go out to bid, the insurance carrier
could be changed at the beginning of any month. It would take
approximately three months to complete the process. In light
of the fact that the city did go out to bid more companies may
be interested in what would appear to be a good risk.
FRANR MANNEN
Assistant City Manager
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EXHIBIT #2
June 27, 1985
TO : Personnel Director
FROM: CFA, Inc. President, MARC REVERE
The Carlsbad Firefighters Association, Inc. has partici-
pated in discussions concerning employee insurance
programs with the city, other employee associations, and
Crown Life Insurance representatives. CFA, Tnc.
endorses the proposed Crown Life group benefit plan,
including the Preferred Provider Organization.
MARC WVERE \
EXHIBIT #3
June 27, 1985
TO : Personnel Director
FROM: CCEA Staff Representative, KELLY IRVING
The Carlsbad City Employees' Association has participated
in discussions concerning employee insurance programs
with the city, other employee associations, and Crown
Life Insurance representatives. CCEA endorses the proposed
Crown Life group benefit plan, including the Preferred
Provider Organization.
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EXHIBIT #4
June 27, 1985
TO : Personnel Director
FROM: CPOA President, DON METCALF
The Carlsbad Police Officers' Association has participated
in discussions of employee insurance programs with the
city, other employee associations, and Crown Life Insurance
representatives.
DON METCALF I
EXHIBIT #5
EMPLOYEE BENEFITS
COMPENSATION PROGRAMS
EMPLOYEE COMMUNICATIONS
ADMINISTRATIVE SYSTEMS
RISK MANAGEMENT
INTERNATIONAL SERVICES
THE COMPANY
ACTUARIES AND CONSULTANTS
SUITE 300
9339 GENESEE AVENUE
SAN DIEGO, CALIFORNIA 92121
(619) 458-3900
OFFICES IN PRINCIPAL CITIES
AROUND THE WORLD
July 9, 1985
Mr. Frank Mannen
Assi stant City Manager
City of Carlsbad
1200 Elm Avenue
Carlsbad, CA 92008
Dear Mr. Mannen:
The purpose of this letter is to set forth our findings and
recommendations concerning:
o the pending August 1, 1985 group benefits program renewal
o financial accounting for the August 1, 1984 to July 31, 1985
plan year.
I. Background Information
For the past 12 or more years, the City has utilized the Crown
Life Insurance Company as its insurance carrier for group benefits.
The plans currently include: life, supplemental life, dependent life,
medical , dental , and vi si on care benefits.
In 1981 we performed an analysis of plan design, funding concepts,
cost sharing, and communications issues relative to the City's group
benef i t s program.
Our Findings
A. Plan Design
The benefits pl an was total ly redesigned to pl ace emphasi s upon outpatient as well as wellness type benefits. The City's program is very competitive by industry and govern- ment agency plan standards.
B. Funding Concepts
We found the past practice of 100 percent pooling to be cost
ineffective and totally in the carrier's favor. A compari-
son of pooling versus experience rating indicated that the
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plan was approximately $85,000 too costly due to pooling the arrangement during the prior three plan years.
As a result, we negotiated an experience-rated, retention
charge, net cost funding arrangement for the improved
program. Under the new arrangement, the City is eligible to
participate in dividends or surplus premiums. In other
words, if paid premiums, less incurred claims and less
retention (carrier expense and profit margin) results in a
surplus, the City is refunded this surplus as a dividend.
Under the prior “pooled” concept, this was not true.
C. Plan Financial Results
Attached is a comparison of plan financial results for the
period 1978 through 1984. In addition, the first 10 months
of 1984-85 were annualized to provide projected results for
the current year ending July 31, 1985 (See Exhibit A).
o The period 1978-81 was under the pooled experience
concept; therefore, the carrier kept the difference
between paid premium and incurred claims.
- For the 3-year period, paid premiums were $589,652,
incurred claims were $434,382, and the amount
retained, retention, by the carrier for expense and
profit totaled $155,270 or 26.3 percent of premium.
- We found these expenses high by industry standard and
used this finding to support the need for implementing
a dividend el i gi ble , experience-rated, net cost type
contract .
- The carrier was also over reserved by industry
standards and actual claim runoff figures.
o In the 1982-83 plan year, the financial results were:
- $407,553 in paid premiums - $331,529 in incurred claims - $75,827 of retention charges - $197 dividend paid to City
Comment: Retention was slightly higher than normal due to the plan redesign and first year start up costs.
o The 1983-84 plan results were impacted by several large,
catastrophic type claims as well as an overall increase
in medical care, inflation, and utilization. The plan
had the following results:
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- $571,855 in paid premiums - $662,309 in incurred claims - $87,725 of retention charges - $138,179 deficit
Comment: Due to the aggregate stop loss, retrospective
premium arrangement in effect with Crown Life, the City
paid Crown $61,321 in additional premiums and Crown wrote
off the deficit.
o The financial results of the first 10 months of the
1984-85 plan year are very favorable. We have trended
and annualized these results to arrive at an expected
12-month plan year result. Assuming claims continue as
trended, the 1984-85 plan year results will be:
- $564,116 of paid premium (no retrospective premium
- $414,308 of incurred claims - $79,294 of retention charges -
requi red)
$70,514 is the estimated dividend for the year
Comment: You can see that the carriers retention, as a percent of premium, is decreasing each year to a more
competitive level. There are two ways of evaluating
retention:
- What the carrier charged as a percent of premium.
- What they actually collected after writing off the
deficit .
Both are competitive by industry standards for the size
of the group, the claims levels, and the cash flow
results for the time periods illustrated.
111. The August 1, 1985 Plan Renewal (currently being negotiated)
A. Plan Design & Funding Concepts (Current Concepts, No
Changes 1
Based upon the favorable financial results of the plan,
Crown Life has agreed to renew for next year (12-month
period of 8/1/85 to 7/31/86) at a six percent decrease in
plan medical rates.
B. Comment
We find the rates to be less important than the nonbenefit,
retention costs provided, of course, that they are within a
THE (%$& COMPANY
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reasonable expected range. Also, claims will be the same
regardless of the payor assuming they are paid according to
the exact same plan design specifications. They only
variables are plan reserves and retention/pool ing charges. Premium simply becomes an estimate of the monies needed for
the period to pay claims and nonbenefit expenses.
We feel confident we can lower the guaranteed retention
charges for the coming year to a level of about 10.5 percent
to 11.5 percent of premiums through negotiations with Crown
Life.
C. Recommendation #1
If we are successful in these negotiations and the City
makes no plan desian chanaes. we recommend retainina Crown
Life and r'enewing fir 1985"at -a six percent to eight bercent
decrease in medical premiums for the current level of plan
benefits .
D. Proposed Changes to Plan Design
During the past four months staff, the insurance committee,
and our firm have evaluated plan design issues. There was
no interest in changing the life, dental , vision, or
disability income benefits. There was interest in either
adding a1 ternative health maintenance (Kaiser type plans) or
in adopting Preferred Provider and Hospital ReviewKOst
Containment features in the Crown Life indemnity medical
plan.
Staff , the Committee, and consultants evaluated these
alternatives as well as plan design features to assure their
effectiveness.
Comment: The medical plan design changes recommended and
agreed to by the employee insurance committee and their cost
impact to the medical plan are summarized in Exhibit B.
In summary the plan design changes involve:
o Adding outpatient surgery and diagnostic x-ray and lab
benefits to encourage use of the lessor expensive
outpatient services and avoidance of unnecessary, more
costly hospital stays.
o Adding a "hospital review program" which approves nonemergency, prehospital admittance, performs concurrent
hospital review, and does post-hospital stay audits, if
necessary.
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- The City has had a hospital review plan for two years
but no one used it because it lacked incentives and
contained no penalties.
- The San Diego Foundation for Medical Care, SDFFMC,
will continue to perform this function.
- The cost is included in the Crown Life retention charges.
o Adding the SDFFMC Preferred Provider feature to the medical pl an.
- Under this arrangement, employees using Preferred Provider hospitals (currently 24 member hospitals in
San Diego County) and physicians (over 2,200 doctor
members or 80 percent of total) will receive a 90 per- cent reimbursement of their expenses. Those who do
not use PPO members will receive a 70 percent payment
level.
o Adding a separate $250 per hospital admission deductible requi rement to curtai 1 unnecessary hospital stay/ surgeries.
o Employees who observe the rules of the Hospital Review Program wi 11 have the $250 hospital deduct i bl e wai ved and
their expenses paid at the 90 percent level. Those who
do not will receive a 70 percent reimbursement of their
charges.
o The net fiscal impact upon plan rates will be
approximately a 16 percent decrease.
- This is in addition to the proposed six percent
decrease if the City makes no changes and leaves plan
design as it is now.
The three City bargaining units assisted with the
development of the plan desi gn/cost containment features.
They have endorsed the adoption of the design changes. The
recommended cost containment saves the City money and it
decreases employees out-of-pocket contributions. These
changes are very effective towards controlling costs and are prevalent in industry and government agency medical plans.
Staff and consultants thank the Committee for their input,
support, and assi stance.
in E qd! COMPANY 13
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Recommendation #2
We recommend the City authorize staff and consultants to take
the following actions:
o Continue to negotiate lower insurance rates, reserve levels,
and retention charges with Crown Life to the lowest possible
level.
o Adopt the PPO and Hospital Review Medical plan changes
effective 8/1/85.
o Renew the improved program with Crown Life effective August 1,
1985 through July 31, 1986, contingent upon a complete,
accurate, and reasonable fi nanci a1 accounting which includes
payment of any dividends owed to the City. Crown will also be
required to reduce last years claims for any "live-in
dependent claims .'I
Summary
We find that the above recommended action is in the best interest of the City and its employees currently. The alternative would be to market the plan among competing carriers
to establish its competitiveness in the market place.
We find the plan is competitive now and the cost of marketing
the plan would probably exceed any savings potentials.
The plan is a negotiated program of carefully designed benefit plans and would have to be marketed exactly as designed (no exceptions). To do otherwise is to take away benefits and lose
creditability with employees at a time when it appears to be at
its highest peak in three years.
We think marketing the plan would create a lot of excitement in the market place, perhaps result in a politically charged and disgruntled brokerage community and save little, if any, real hard benefit dol 1 ars.
There are several advantageous group plan cash flow techniques which were discussed in our 1981 report that are still avai 1 ab1 e. They are:
o Hold your own plan reserves (the $116,392)
- or -
o Paying premiums 90 days late to offset the loss of
reserve/cash flow i nterest ($141,029)
THE COMPANY
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Assuming one of these two techniques meets with City budget
(account i ng) requi rements and management sty1 e, we endorse
either concepts adoption.
* * * * * *
This concludes our report. We are available to answer any
questions you have have as well as to perform further analysis, if
needed.
Sincerely,
THE WYATT COMPANY
Michael D. Baker Consultant
MDB:cr
THE 6k$# COMPANY
EXHIBIT A
CITY OF CARLSBAD
A Comparison of Plan Income and Expenses
for the Pooled versus Experience-rated Contracts Period 1978-1985
Paid P remi um
78 - 81
$589,652
82 - 83
407,553
83 - 84
Incurred C1 aims
$434,382
331,529
571,855"'
84 - 85
564 ,~6(~)
622,309
41 4, 308(4 )
Non-Benefi t
Costs for
Retention, Non-Benefit
Risk, & Costs as a
Charges Premi um Dividends Other Pool i ng % of
18.6% $197 -0-
- -
I
THE COMPANY
$155,270 26.3% N/A(~) $ - o -
75,827
87,725
79,294(4) 12.5%
15.2% -0- ( 138,179 ) (3 )
70,514(5) N/A
(l) Prior contract was pooled for experience purposes; claims and retention were
not accounted for and dividends were never payble under the contract.
(')
(3)
(4)
Incl ude a retrospecti ve premi um payment of $61,321.
After the retrospective premium payment, Crown wrote off the remaining de
in accordance with the aggregate pooling contract.
Twelve months estimated financial results based upon 10 month's claims
experience to date. dividend of $70,514 this year.
Assuming current trends continue, the City will rece
icit
ve a
(5) The City also has a $116,392 Claims Reserve on deposit with Crown. Any unused
portion of this reserve after contract termination and claims run out will be
refunded to the City.
EXHIBIT B
CITY OF CARLSBAD
Summary of Plan Design Changes and their Cost Impact If Made Effective 4/1/85
P1 an of Benefits
Life Insurance
No Change
Dental
TC h a n ge
Vision
TC h a n g e
tong-Term Di sabi 1 i ty
No Change
Medical Pay 100% of URC for:
o -8500 per person, per year accident (1)
o OP surgery w/o dollar limit (1)
o Preadmission testing (1)
o Second opinion surgery (1) o Home Health Care (2)
- Application of Separate $250 per Hospital
Admission deductible o Add "San Diego Foundations for Medical
Care Hospital Review" and Preferred
Provider Organi zati on Programs. (1 )
o Waive hospital deductible for PPO and
hospital review participants. (1)
o Retain current 90% of URC to $5,000 plus
100% thereafter per person per year
benefit payment level. (1)
- Pay mental and nervous outpatient doctor visits
and prescriptions at 90% rather than 50%. (1)
- Adopt alternative "Medical Review Service''
program for hospital review; No PPO. (2)
o Copayment reduction from 90% to 70%
on those participants not submitting to proper "hospital review" procedures, etc.
(1) Recommended to become effective 8/1/85
(2) Not Recommended at this time.
Impact Upon Costs
0%
0%
0%
0%
0%
0% 0% 0%
N/A
-16.0 %
t0.25 %
-5.0 %
THE %ft COMPANY 17
SPECIAL EXHIBIT
CITY OF CARLSBAD
SUMMARY RECOMMENDATIONS FOR
GROUP BENEFITS PROGRAM EFFECTIVE 8/1/85
o RENEW PROGRAM CONTRACT WITH CROWN LIFE EFFECTIVE 8/1/85 AT A
DECREASE IN COSTS RANGING FROM 6 PERCENT TO 16 PERCENT.
o CONTINUE TO NEGOTIATE WITH CROWN LIFE FOR LOWEST POSSIBLE
NONBENEFIT/INSURANCE COSTS THUS MAXIMIZING CITY'S DIVIDEND
(PREMIUM REFUND) AMOUNT FOR 1985.
o ADOPT THE HOSPITAL REVIEW, PREFERRED PROVIDER, PLAN DESIGN COST CONTAINMENT FEATURES TO MAXIMIZE BENEFITS, REDUCE COSTS, AND
UTILIZE COST EFFICIENT MEDICAL DELIVERY SYSTEMS.
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SPECIAL EXHIBIT I1
SPECIAL RETENTION ILLUSTRATIONS AFTER ADJUSTED FOR DIVIDtNDS AND DEFICIT WRnt OFFS
P1 an Unadjusted Di vi dend Deficit Net Year Retention Payments Write Offs Retent i on
82-83 $ 75,827 $ 197 N/A $75,630
83-84 87,725 N/A $138,179 ( 50,454.)
84-85 79,294 70,514
TOTAL $242,846 $70,711
N/A
$138,179
8,780
$33,956
THE 6b$Z#!f COMPANY I7
REPRESENTATIVE CLIENT LISTINGS
30 THE COMPANY
REPRESENTATIVE GROUP BENEFIT PROGRAM AND GOVERNMENT AGENCIES
CLIENT LISTING
CITY OF ANTIOCH, CALIFORNIA
CITY OF CARLSBAD, CALIFORNIA
CITY OF CHICAGO
CITY OF LA MESA, CALIFORNIA
CITY OF LONG BEACH, CALIFORNIA
CITY OF LOUISVILLE & BOARD OF HEALTH
CITY OF MODESTO, CALIFORNIA
CITY OF MADISON, WISCONSIN
CITY OF MILWAUKEE
CITY OF NATIONAL CITY, CALIFORNIA
CITY OF OCEANSIDE, CALIFORNIA
CITY OF SAN DIEGO, CALIFORNIA
COUNTY OF MARICOPA, ARIZONA
COUNTY OF SAN MATEO, CALIFORNIA
GOVERNMENT OF ONTARIO, CANADA
HENNEPIN COUNTY, MINNESOTA
MINNESOTA STATE TEACHERS RETIREMENT SYSTEM
ORANGE COUNTY WATER DISTRICT, CALIFORNIA
STATE OF CALIFORNIA
STATE OF ILLINOIS RETIREMENT SYSTEM
STATE TEACHERS RETIREMENT SYSTEM, CALIFORNIA
STATE OF VERMONT MUNICIPAL EMPLOYEES RETIREMENT SYSTEM
TEACHERS RETIREMENT SYSTEM, TEXAS
UNIVERSITY OF MINNESOTA
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AMERICAN MOTORS CORPORATION
ADDRESSOGRAPH-MULTIGRAPH CORP.
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BENDIX CORP.
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DOW CHEMICAL CO.
ESMARK, INC.
GENERAL ELECTRIC CO.
GENERAL MOTORS CORP.
GOODYEAR TIRE & RUBBER CO.
GULF & WESTERN INDUSTRIES, INC.
INTERNATIONAL BUSINESS MACHINES CORP.
KIMBERLY-CLARK CO.
K-MART CORPORATION
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RELIANCE ELECTRIC CO.
REPUBLIC STEEL CORP.
ROCKWELL INTERNATIONAL CORP.
SOUTHERN RAILWAY CO.
STANDARD BRANDS, INC.
STANDARD OIL CO. (INDIANA)
UNITED AIRLINES, INC.
WHITE CONSOLIDATED INDUSTRIES, INC.
22 THE %ff COMPANY
REPRESENTATIVE SAN DIEGO CLIENT LIST
"A" COMPANY, INC.
AMERDYNE INDUSTRIES, INC.
ATLAS HOTELS, INC.
CHEM-TRONICS, INC.
CITY OF CARLSBAD
CITY OF LA MESA
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COLUMBIA SAVINGS & LOAN ASSOCIATION
CONTINENTAL AIRLINES
FOODMAKER, INC.
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FRAZEE PAINTS
HOME FEDERAL
JOHN HINE PONTIAC
IMPERIAL CORPORATION OF AMERICA
IRVINE RANCH WATER DISTRICT
KYOCERA INTERNATIONAL, INC.
LA JOLLA COUNTRY CLUB
LUCE, FORWARD, HAMILTON & SCRIPPS
MONITOR LABS
NATIONAL PUMP & INJECTOR SALES & SERVICE
PALOMAR POMERADO HOSPITAL DISTRICT
PROVIDENT CAPITAL CORPORATION
SAN DIEGO HOSPITAL ASSOCIATION
SEA WORLD, INC.
SOUTHWEST BANK
SUN SAVINGS & LOAN ASSOCIATION
TITAN SYSTEMS, INC.
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