HomeMy WebLinkAbout2021-05-18; City Council; Resolution 2021-118RESOLUTION NO. 2021-118
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD,
CALIFORNIA, AWARDING AN AGREEMENT FOR THIRD PARTY
ADMINISTRATION OF WORKERS' COMPENSATION CLAIMS TO ADMINSURE,
INC.
WHEREAS, the City Council of the City of Carlsbad, California has determined that the city
requires the professional services of a third party administrator that is experienced in managing and
administering the city's workers' compensation claims.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Carlsbad, California, as
follows:
1.The above recitations are true and correct.
2.The Agreement awarding the contract to AdminSure Inc. to provide third party
administration of workers' compensation claims (Attachment A) is approved.
PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City Council of the City of
Carlsbad on the 18th day of May, 2021, by the following vote, to wit:
AYES: Hall, Blackburn, Acosta, Bhat-Patel, Schumacher.
NAYS: None.
ABSENT: None.
MATT HALL, Mayor
BARBARA ENGLESON, City Clerk
(SEAL)
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ATTACHMENT A
AGREEMENT FOR THIRD PARTY ADMINISTRATION FOR WORKERS' COMPENSATION
CLAIMS ADMINISTRATION SERVICES
ADMINSURE
THIS AGREEMENT is made and entered into as of the 18th day of
May , 20 21 , by and between the CITY OF CARLSBAD, a municipal
corporation, ("City"), and AdminSure Inc., a corporation, ("Contractor").
RECITALS
A.City requires the professional services of an outside agency that is experienced in
third party administration of workers' compensation claims.
B.Contractor has the necessary experience in providing professional services and
advice related to the administration of workers' compensation claims.
C.Contractor has submitted a proposal to City and has affirmed its willingness and
ability to perform such work.
NOW, THEREFORE, in consideration of these recitals and the mutual covenants
contained herein, City and Contractor agree as follows:
1.SCOPE OF WORK
City retains Contractor to perform, and Contractor agrees to render, those services (the
"Services") that are defined in attached Exhibit "A". which is incorporated by this reference in
accordance with this Agreement's terms and conditions.
2.STANDARD OF PERFORMANCE
While performing the Services, Contractor will exercise the reasonable professional care and skill
customarily exercised by reputable members of Contractor's profession practicing in the
Metropolitan Southern California Area, and will use reasonable diligence and best judgment while
exercising its professional skill and expertise.
3.TERM
The term of this Agreement will be effective for a period of five years from June 1, 2021.
4.TIME IS OF THE ESSENCE
Time is of the essence for each and every provision of this Agreement.
5.COMPENSATION
The total fee payable for the Services to be performed during the initial Agreement year will be
two hundred thirty-eight thousand eight hundred dollars ($238,800). The total fee payable for the
Services to be performed shall increase by three percent (3%) per Agreement year in years two
through five. No other compensation for the Services will be allowed except for items covered by
subsequent amendments to this Agreement. The City reserves the right to withhold a ten percent
(10%) retention until City has accepted the work and/or Services specified in Exhibit "A".
Incremental payments, if applicable, should be made as outlined in attached Exhibit "A".
6.STATUS OF CONTRACTOR
Contractor will perform the Services in Contractor's own way as an independent contractor and
in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be
under control of City only as to the result to be accomplished, but will consult with City as
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necessary. The persons used by Contractor to provide services under this Agreement will not be
considered employees of City for any purposes.
The payment made to Contractor pursuant to the Agreement will be the full and complete
compensation to which Contractor is entitled. City will not make any federal or state tax
withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be
required to pay any workers' compensation insurance or unemployment contributions on behalf
of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty
(30) days for any tax, retirement contribution, social security, overtime payment, unemployment
payment or workers' compensation payment which City may be required to make on behalf of
Contractor or any agent, employee, or subcontractor of Contractor for work done under this
Agreement. At the City's election, City may deduct the indemnification amount from any balance
owing to Contractor.
7.SUBCONTRACTING
Contractor will not subcontract any portion of the Services without prior written approval of City.
If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the
acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly
employed by the subcontractor, as Contractor is for the acts and omissions of persons directly
employed by Contractor. Nothing contained in this Agreement will create any contractual
relationship between any subcontractor of Contractor and City. Contractor will be responsible for
payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of
a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically
noted to the contrary in the subcontract and approved in writing by City.
8.OTHER CONTRACTORS
The City reserves the right to employ other Contractors in connection with the Services.
9.INDEMNIFICATION
Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees
and volunteers from and against all claims, damages, losses and expenses including attorneys'
fees arising out of the performance of the work described herein caused by any negligence,
recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or
indirectly employed by any of them or anyone for whose acts any of them may be liable.
The parties expressly agree that any payment, attorney's fee, costs or expense City incurs or
makes to or on behalf of an injured employee under the City's self-administered workers'
compensation is included as a loss, expense or cost for the purposes of this section, and that this
section will survive the expiration or early termination of this Agreement.
10.INSURANCE
Contractor will obtain and maintain for the duration of the Agreement and any and all
amendments, insurance against claims for injuries to persons or damage to property which may
arise out of or in connection with performance of the services by Contractor or Contractor's
agents, representatives, employees or subcontractors. The insurance will be obtained from an
insurance carrier admitted and authorized to do business in the State of California. The insurance
carrier is required to have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus
line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating
in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by
the National Association of Insurance Commissioners (NAIC) latest quarterly listings report.
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10.1 Coverage and Limits.
Contractor will maintain the types of coverage and minimum limits indicated below, unless the
Risk Manager or City Manager approves a lower amount. These minimum amounts of coverage
will not constitute any limitations or cap on Contractor's indemnification obligations under this
Agreement. City, its officers, agents and employees make no representation that the limits of the
insurance specified to be carried by Contractor pursuant to this Agreement are adequate to
protect Contractor. If Contractor believes that any required insurance coverage is inadequate,
Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at
Contractor's sole expense. The full limits available to the named insured shall also be available
and applicable to the City as an additional insured.
10.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an
"occurrence" basis, including personal & advertising injury, with limits no less than $2,000,000 per
occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply
separately to this project/location or the general aggregate limit shall be twice the required
occurrence limit.
10.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work
for City). $2,000,000 combined single-limit per accident for bodily injury and property damage.
10.1.3 Workers' Compensation and Employer's Liability. Workers' Compensation limits as
required by the California Labor Code. Workers' Compensation will not be required if Contractor
has no employees and provides, to City's satisfaction, a declaration stating this.
10.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor's
profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a
period of five years following the date of completion of the work.
10.2 Additional Provisions. Contractor will ensure that the policies of insurance required under
this Agreement contain, or are endorsed to contain, the following provisions:
10.2.1 The City will be named as an additional insured on Commercial General Liability
which shall provide primary coverage to the City.
10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which
will be written as claims-made coverage.
10.2.3 This insurance will be in force during the life of the Agreement and any extensions
of it and will not be canceled without thirty (30) days prior written notice to City sent by certified
mail pursuant to the Notice provisions of this Agreement.
10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this
Agreement, Contractor will furnish certificates of insurance and endorsements to City.
10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance
coverages, then City will have the option to declare Contractor in breach, or may purchase
replacement insurance or pay the premiums that are due on existing policies in order to maintain
the required coverages. Contractor is responsible for any payments made by City to obtain or
maintain insurance and City may collect these payments from Contractor or deduct the amount
paid from any sums due Contractor under this Agreement.
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10.5 Submission of Insurance Policies. City reserves the right to require, at any time, complete
and certified copies of any or all required insurance policies and endorsements.
11.BUSINESS LICENSE
Contractor will obtain and maintain a City of Carlsbad Business License for the term of the
Agreement, as may be amended from time-to-time.
12.ACCOUNTING RECORDS
Contractor will maintain complete and accurate records with respect to costs incurred under this
Agreement. All records will be clearly identifiable. Contractor will allow a representative of City
during normal business hours to examine, audit, and make transcripts or copies of records and
any other documents created pursuant to this Agreement. Contractor will allow inspection of all
work, data, documents, proceedings, and activities related to the Agreement for a period of three
(3) years from the date of final payment under this Agreement.
13.OWNERSHIP OF DOCUMENTS
All work product produced by Contractor or its agents, employees, and subcontractors pursuant
to this Agreement is the property of City. In the event this Agreement is terminated, all work
product produced by Contractor or its agents, employees and subcontractors pursuant to this
Agreement will be delivered at once to City. Contractor will have the right to make one (1) copy
of the work product for Contractor's records. Contractor shall agree and understand that all
discussions with the Contractor and all information gained by the Contractor as a result of the
Contractor's performance under the contract, shall be confidential and that no reports,
documentation, or material prepared as required by the contract shall be released to the public
without the prior written consent of the City of Carlsbad.
14.COPYRIGHTS
Contractor agrees that all copyrights that arise from the services will be vested in City and
Contractor relinquishes all claims to the copyrights in favor of City.
15.NOTICES
The name of the persons who are authorized to give written notice or to receive written notice on
behalf of City and on behalf of Contractor under this Agreement.
For City
Name Ed Garbo
For Contractor
Name Alithia Vargas-Flores
Title President Title Risk Manager
Department Human Resources Address 3380 Shelby Street
City of Carlsbad
Address 1635 Faraday Ave
Carlsbad CA 92008
Phone No. 760-814-4288
Ontario CA 91764-5566
Phone No. 909-396-5814
Email Avargas-flores@adminsure.com
Each party will notify the other immediately of any changes of address that would require any
notice or delivery to be directed to another address.
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16.CONFLICT OF INTEREST
Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the
requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report
investments or interests in all categories.
YesE No El
17.GENERAL COMPLIANCE WITH LAWS
Contractor will keep fully informed of federal, state and local laws and ordinances and regulations
which in any manner affect those employed by Contractor, or in any way affect the performance
of the Services by Contractor. Contractor will at all times observe and comply with these laws,
ordinances, and regulations and will be responsible for the compliance of Contractor's services
with all applicable laws, ordinances and regulations.
Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986
and will comply with those requirements, including, but not limited to, verifying the eligibility for
employment of all agents, employees, subcontractors and consultants whose services are
required by this Agreement.
18.DISCRIMINATION AND HARASSMENT PROHIBITED
Contractor will comply with all applicable local, state and federal laws and regulations prohibiting
discrimination and harassment.
19.DISPUTE RESOLUTION
If a dispute should arise regarding the performance of the Services the following procedure will
be used to resolve any questions of fact or interpretation not otherwise settled by agreement
between the parties. Representatives of Contractor or City will reduce such questions, and their
respective views, to writing. A copy of such documented dispute will be forwarded to both parties
involved along with recommended methods of resolution, which would be of benefit to both
parties. The representative receiving the letter will reply to the letter along with a recommended
method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory
to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The
City Manager will consider the facts and solutions recommended by each party and may then opt
to direct a solution to the problem. In such cases, the action of the City Manager will be binding
upon the parties involved, although nothing in this procedure will prohibit the parties from seeking
remedies available to them at law.
20.TERMINATION
In the event of the Contractor's failure to prosecute, deliver, or perform the Services, City may
terminate this Agreement for nonperformance by notifying Contractor by certified mail of the
termination. If City decides to abandon or indefinitely postpone the work or services contemplated
by this Agreement, City may terminate this Agreement upon written notice to Contractor. Upon
notification of termination, City will make a determination of fact based upon the work product
delivered to City and of the percentage of work that Contractor has performed which is usable
and of worth to City in having the Agreement completed. Based upon that finding City will
determine the final payment of the Agreement.
Either party upon tendering thirty (30) days written notice to the other party may terminate this
Agreement. In this event and upon request of City, Contractor will assemble the work product and
put it in order for proper filing and closing and deliver it to City. Contractor will be paid for work
performed to the termination date; however, the total will not exceed the lump sum fee payable
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under this Agreement. City will make the final determination as to the portions of tasks completed
and the compensation to be made.
Upon expiration or termination of the contract, Contractor shall assist the City to ensure an
orderly transfer of responsibility and/or continuity of those services required under the terms of
the contract to an organization designated by the City, if requested in writing. Contractor shall
provide and/or perform any or all of the following responsibilities:
•Contractor shall deliver, FOB destination, prepaid, all records, documentation, reports,
data, recommendations, master, or printing elements, etc., which were required to be
produced under the terms of the contract to the City and/or to the City's designee within
seven (7) calendar days after receipt of the written request. Any and all records which
are on electronic media must be delivered in a format which is compatible with the
system(s) currently in use by the City of Carlsbad.
•Contractor shall agree to continue providing any part or all of the services in accordance
with the terms and conditions of the contract for a period not to exceed thirty (30)
calendar days after the expiration, termination or cancellation date of the contract for a
price not to exceed those prices set forth in the contract.
21.COVENANTS AGAINST CONTINGENT FEES
Contractor warrants that Contractor has not employed or retained any company or person, other
than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that
Contractor has not paid or agreed to pay any company or person, other than a bona fide
employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration
contingent upon, or resulting from, the award or making of this Agreement. For breach or violation
of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion,
to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the
fee, commission, percentage, brokerage fees, gift, or contingent fee.
22.CLAIMS AND LAWSUITS
By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must
be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation
of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is
submitted to City, it may be considered fraud and Contractor may be subject to criminal
prosecution. Contractor acknowledges that California Government Code sections 12650 et seq.,
the False Claims Act applies to this Agreement and, provides for civil penalties where a person
knowingly submits a false claim to a public entity. These provisions include false claims made
with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of
information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to
recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a
false claim may subject Contractor to an administrative debarment proceeding as the result of
which Contractor may be prevented to act as a Contractor on any public work or improvement for
a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is
grounds for City to terminate this Agreement.
23.JURISDICTION AND VENUE
Any action at law or in equity brought by either of the parties for the purpose of enforcing a right
or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the
County of San Diego, State of California, and the parties waive all provisions of law providing for
a change of venue in these proceedings to any other county.
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Mayor
ATTEST:
7/d/...a.- Z72. for
BARBARA ENGLESON
City Clerk
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24.SUCCESSORS AND ASSIGNS
It is mutually understood and agreed that this Agreement will be binding upon City and Contractor
and their respective successors. Neither this Agreement nor any part of it nor any monies due or
to become due under it may be assigned by Contractor without the prior consent of City, which
shall not be unreasonably withheld.
25.ENTIRE AGREEMENT •
This Agreement, together with any other written document referred to or contemplated by it, along
with the purchase order for this Agreement and its provisions, embody the entire Agreement and'
understanding between the parties relating to the subject matter of it. In case of conflict, the terms
of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions
may be amended, modified, waived or discharged except in a writing signed by both parties.
26.AUTHORITY
The individuals executing this Agreement and the instruments referenced in it on behalf of
Contractor each represent and warrant that they have the legal power, right and actual authority
to bind Contractor to the terms and conditions of this Agreement.
CONTRACTOR CITY OF CARLSBAD, a municipal
corporation of the State of California
By:
By:
(sign here)
Alithia Vargas-Flores, President
(print name/title)
By: gsLtui Sas
(sign here)
Ashley Sells, Secretary
(print name/title)
If required by City, proper notarial acknowledgment of execution by contractor must be attached.
If a corporation, Agreement must be signed by one corporate officer from each of the following
two groups.
Group A Group B
Chairman, Secretary,
President, or Assistant Secretary,
Vice-President CFO or Assistant Treasurer
Otherwise, the corporation must attach a resolution certified by the secretary or assistant
secretary under corporate seal empowering the officer(s) signing to bind the corporation.
APPROVED AS TO FORM:
CELIA A. BREWER, City Attorney
BY: Ciat,
Assistant City Attorney
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EXHIBIT "A"
SCOPE OF SERVICES
Contractor shall provide usual and customary claims administration services that shall include, at
minimum, the following:
1)Review all claims and loss reports filed against the City of Carlsbad and provide a copy of your
Best Practices for claim handling.
2)Thoroughly investigate all claims made against City of Carlsbad through appropriate claim
procedures as necessitated by the severiN of the injury and ensure correct payment of medical
and time loss claims.
3)Provide assistance with tracking COVID-19 claims pursuant to SB 1159 Section 3 and Section 4
and AB 685.
4)Provide cost containment services, including medical fee reductions and a preferred provider
network, provide quarterly report of cost containment services.
5)Integrate the current Medical Provider Network into the claims management process.
6)Prepare claim files for submission to a defense attorney.
7)Attend trials, mediations and /or settlement conferences as appropriate.
8)Develop and maintain an investigative file on each claim in accordance with an approved format
by the City of Carlsbad. Files are to be readily available for the City of Carlsbad to review and shall
be well documented and up-to-date.
9)Notify excess insurance carriers of claims and or occurrences at predetermined levels required by
Excess insurers within 30 days of recognition. Provide information and status of claims as
requested by the excess insurance carrier. Obtain reimbursements from Excess carrier and
maintain accurate refund records on the claim file.
10)Develop and maintain a claims database to be used in the administration of the claims and to
generate reports to the City of Carlsbad.
11)Provide the City of Carlsbad with a monthly report of account for individual claims and aggregate
loss experience analysis. This report shall show the status of each open claim and experience
year-to-date of all claims.
12)Have the capability of providing data necessary to prepare financial and statistical reports on
losses or claims.
13)Within 24 hours contact employees and/or injured parties regarding the status of their claim.
Return calls or inquiries from employees and/or injured parties within 24 hours of receipt of inquiry.
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14) Provide assistance as necessary to the City of Carlsbad staff for proper procedural handling of
claims.
15) Identify and investigate all subrogation possibilities for potential recovery including investigation,
evaluation and negotiation of subrogation cases. Maintain financial records of all recoveries on the
claim file..
16) Attend quarterly meetings with the City of Carlsbad staff.
17) Prepare administrative reports required by the State of California. Monitor the compliance of the
City's employer reporting requirements and record keeping requirements and advise of any
deficiencies in the City of Carlsbad overall self-insured compliance matters.
18) Prepare and/or assist City staff with all appropriate responses to audits and inquiries of all
regulatory agencies.
19) Provide 24/7 on-line electronic access to the City of Carlsbad's claims, including payments, claim
notes, status and messaging capabilities and ad-hoc report capability.
20) Provide sufficient data producing capability to provide the reporting requirements outlined in this
RFP as well as a sufficient records and electronic data retention and back-up and business
recovery plan.
21) Provide Bi-Annual program review of claim activity, claim frequency, total incurred, and payment
analysis.
22) Have, at a minimum, the following qualifications:
1.A claims administration office located in Southern California.
2.The Contractor's firm and staff should have five years of experience in handling claims for
self-insured public entities.
3.Sufficient staff to conduct field investigations, prompt reporting, prompt adjudication of
medical and time loss payments and the appropriate level of supervisory personnel to assure
compliance with the content of the proposal. The City shall be notified within 24 hours of
professional staff turnover and resumes for replacements shall be provided to the City prior to
selection.
4.The Contractor's third party administrator services shall be provided in compliance with all
applicable federal, state and local laws, requirements and/or ordinances relating to such
services.
23) Prepare data to provide to actuary upon request.
24) Maintain and keep all records directly related to the City of Carlsbad's accounts.
25) Upon reasonable notice and at a reasonable time during normal business hours, allow authorized
City Human Resources personnel the privilege, of inspecting, examining and/or auditing, any/all
records which are directly related to the City's accounts. All inspection, examination and/or
auditing shall be conducted at the Contractor's locations where records shall normally be kept. All
expenses related to such inspection, examination and/or auditing will be the responsibility of the
city.
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Workers' Compensation Claims Administration Services
Price Proposal — Guaranteed Pricing
City of Carlsbad
Price Proposal — Guaranteed Pricing
Workers' Compensation Program Services
Flat Fee — Claims Administration •
•
Year one shall not exceed $19,900 per month
3% increase for all litture years (Includes all open, closed and
future claims)
Electronic 5020 Process • No Additional Fee
Transition & Implementation . • No Additional Fee
City On-Line Access (All Data/Reports)
All Reports & Custom/Ad Hoc Reports
•
•
No Additional Fee — Unlimited Number of Read-Only Users
No Additional Fee
MMSEA, WC1S, 1SO/EDEX & 1099s • No Additional Fee
Training & Development of Special
Account Instructions/Procedures, MCM
Services, Internal MPN/Banking
Management
• No Additional Fee. Please note that any MGM, MI-W, or
banking fees charged by the City's choice of MCM, MPAT, or
bank shall he at-cost as we shall not add on any fee for our
internal assistance/services
All Meetings, Claim Reviews,
Forms, Correspondence, Posters,
Pamphlets, Checks, and Storage of
Claims
II
•
No Additional Fee
Note: Legal Representatives and Copy Services are
ancillary costs captured in each claim file and we do not
add on any additional fee
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