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HomeMy WebLinkAboutResolution - 2016-R0294 - Contract - York Risk Services Group - Third Party Admin. Liability Services - 08/25/2016Resolution No. 2016-RO294 Item No. 6.27 ,August 25, 2016 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, Contract No. 12883 for Third Party Administrator Liability Claim Services, by and between the City of Lubbock and York Risk Services Group, Inc., and related documents. Said Contract is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on August 25, 2016 DANIEL M. OPE, MAYOR ATTEST: Reb cca Garza, City Se retary APPROVED AS TO CO TENT: Leisa Hutc eson, Director of Human Resources And Risk Management APPROVED AS TO FORM: Assistant City Attorney v.v:ccdocs RES.Contract-York Risk Services August 10, 2016 Resolution No. 2016-RO294 AGREEMENT FOR AUTOMOBILE LIABILITY/ GENERAL LIABILITY AND OTHER LIABILITY CLAIMS ADMINISTRATION SERVICES This Agreement (the "Agreement") is effective as of the 5th day of August , 2016 (the "Effective Date") between CITY OF LUBBOCK, ("PRINCIPAL"), a public entity, organized under the laws of Texas, having offices at 1625 13TH Street, Lubbock, Texas, 79401, and YORK RISK SERVICES GROUP, INC., ("YORK"), a Corporation organized under the laws of the State of New York with its principal place of business at 99 Cherry Hill Road, Parsippany, New Jersey 07054. WHEREAS, PRINCIPAL desires to retain YORK pursuant to the terms and provisions of this Agreement to provide Claims Administration Services on claims arising out of PRINCIPAL'S self-insured AUTOMOBILE/ GENERAUOTHER LIABILITY program (the "Program") during the term of this Agreement; and WHEREAS, YORK desires to be retained by PRINCIPAL pursuant to the terms and provisions of this Agreement to provide Claims Administration Services on claims arising out of the Program during the term of this Agreement; and WHEREAS, YORK, by entering into this Agreement, shall be obligated to provide Claims Administration Services to PRINCIPAL on the terms and conditions set forth herein; NOW THEREFORE, for and in consideration of the promises set forth hereinabove, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, YORK and PRINCIPAL agree as follows: DEFINITIONS A. "PRINCIPAL" shall mean CITY OF LUBBOCK. B. "CLAIMS ADMINISTRATION SERVICES" shall include the administration, adjustment, management, and oversight of claims arising out of PRINCIPAL'S self-insured AUTOMOBILE/ GENERAL / OTHER LIABILITY program. C. CLAIMS ADMINISTRATION SERVICES shall also include, but not limited to, the following services: 1. Providing supervision of the loss adjustment process; 2. Determining and implementing appropriate claims practices to adjust assigned claims in accordance with YORK'S established practices; 3. Adhering to high standards of professional conduct; Page 1 of 14 GL Agr REV. 10-04-13 4. Adjusting and managing assigned claims to assure that PRINCIPAL and claimants receive high quality service; 5. Establishing, monitoring and timely revisions of case reserves; 6. Settling claims within the applicable coverage terms and conditions; 7. Maintaining current knowledge of applicable adjustment practices and procedures, local practices, applicable insurance coverage, court decisions, current guidelines in the claims function, and Program changes and modifications (as advised by PRINCIPAL); 8. Assisting in the preparation of claims for suit, hearing, trial, or subrogation as appropriate; 9. Acting as PRINCIPAL'S liaison with medical personnel, first notice of loss reporting services and defense counsel; 10. Reviewing bills of service providers; 11. Preparing and submitting status and administrative reports in accordance with YORK'S established practices; 12. Preserving subrogation rights and overseeing subrogation recovery. D. "CLAIMS" shall mean claims, arising under the Program and which are referred to YORK for adjusting during the term of this Agreement. E. "INFORMATION" or "CONFIDENTIAL INFORMATION" shall mean documentation, data or information relevant to PRINCIPAL or claimant that is created by YORK or that comes into its possession as a result of the rendering of services by YORK to PRINCIPAL, pursuant to the Agreement. F. "CONFIDENTIAL INFORMATION" is information not publicly available and includes, without limitation, the work product, investigation materials, trial preparation materials including but not limited to opinions and mental impressions of YORK personnel, communications with defense and coverage counsel and non-public personal information of insureds. G. "LOSS ADJUSTMENT EXPENSE" shall mean, in addition to fees to be paid in accordance with items listed or inferred herein Agreement, all reasonable expenses necessary to the adjustment of a claim in accordance with this Agreement, including but not limited to, legal fees, court costs and fees for court reporters, expert witnesses, investigation, photocopies, subpoenas, photographs, maps, accounting, chemical or physical analysis, independent medical exams or other evaluations, depositions, appraisal fees and expenses, bill review, utilization review and any other similar cost, fee or expense reasonably chargeable to the investigation, negotiation, settlement or defense of a claim or loss or subrogation actions. YORK may, but need not, elect to utilize Page 2 of 14 GL Agr REV. 10-04-13 its own staff to perform these services. H. "SYSTEMS" shall mean severally or collectively, YORK's proprietary claims handling system. II. TERM OF AGREEMENT The term of this Agreement shall commence on October 1, 2016 and shall continue until and through September 30, 2017 (the "Term") renewable for two (2) additional one year terms if mutually areed to by PRINCIPAL and YORK. The PRINCIPAL may renew upon the same terms and conditions upon approval by the City Manager's designee. This Agreement will be deemed extended to cover each additional claim that PRINCIPAL refers to YORK after the end of the aforesaid period (subject to the extensions as aforesaid) and which YORK accepts for handling. III. CLAIMS ADMINISTRATION SERVICES (the "Services") PRINCIPAL hereby retains YORK to provide Claims Administration Services, as set forth in this Agreement, including any Exhibits attached hereto, for the Claims that arise out of PRINCIPAL'S self-insured automobile/ general/ professional liability program and that are assigned by PRINCIPAL to YORK. A. The Services to be rendered by YORK shall be in conformance with the requirements and provisions of this Agreement together with all applicable rules, orders, and interpretations issued by the applicable regulatory authorities as of the date hereof. B. YORK acknowledges its obligation to comply with all applicable statutes and any rules or regulations of the applicable regulatory authorities. C. YORK shall perform Claims Administration Services for each Claim assigned to it hereunder during the life of the contract. D. YORK acknowledges that execution of this Agreement does not guarantee that YORK will be assigned any particular number of Claims by PRINCIPAL. PRINCIPAL may assign claims to other adjusters or may decline to assign any claim to YORK in its sole discretion. IV. DUTIES OF YORK A. YORK shall maintain sufficient staff with the necessary experience and management oversight. Adjusters assigned to Claims shall have a case load that Page 3 of 14 GL Agr REV. 10-04-13 allows proper attention to the work. B. To the extent required by law, YORK shall utilize only licensed adjusters and licensed private investigators, where applicable and such adjusters and investigators shall in the rendering of their services conform to the provisions of all applicable laws, rules, orders, or written interpretations issued by the applicable regulatory authorities. C. YORK shall investigate, evaluate, negotiate, settle, or deny Claims within the standing authority granted to YORK from time to time by PRINCIPAL. YORK may settle Claims in excess of its standing authority limits only with prior written approval of PRINCIPAL, which the PRINCIPAL shall, in writing, promptly grant or deny upon York's request for authority. D. Upon termination of the Agreement, all hard copy and electronic files will be transferred at PRINCIPAL'S expense. E. YORK acknowledges that all of the Claims files in its possession are the property of PRINCIPAL and agrees to promptly provide access to or deliver any such file to PRINCIPAL, at PRINCIPAL'S expense, at any time upon PRINCIPAL'S request. In exchange for PRINCIPAL'S absolute right to obtain the Claims files, PRINCIPAL agrees that it shall not have the right to set off any sums claimed due from YORK against fees due YORK under this Agreement. F. YORK expressly agrees to hold all funds and assets of PRINCIPAL that come into its control or possession during the term of this Agreement as a fiduciary of PRINCIPAL. G. YORK shall make available, through YORK'S proprietary claims system, claim -related data with "web -enabled" access. PRINCIPAL will have "view only" access to the system. PRINCIPAL will bear its own hardware, software, connection and similar costs for accessing YORK'S electronic claims management system. H. During the Term of this Agreement and at all times that there are open Claims being handled by YORK, YORK shall fully cooperate with PRINCIPAL. I. During the Term of this Agreement and thereafter until all Claims assigned hereunder are closed, YORK agrees to: 1. Maintain in force a fidelity bond or equivalent insurance, such as Third Party Crime insurance, for the protection of PRINCIPAL, at a limit not less than one million dollars ($1,000,000), to cover the risk of loss due to the wrongful conversion of any funds and assets of PRINCIPAL by YORK or its employees or independent contractors during the term of this Agreement. YORK shall maintain said bond or insurance for a period of two (2) years after the expiration of this Agreement; 2. Maintain in force an errors and omissions policy, at a limit not less than one million dollars ($1,000,000) per occurrence and to maintain Page 4 of 14 GL Agr REV. 10-04-13 coverage for a period of at least two (2) years after the expiration of the last contract with PRINCIPAL, or if the errors and omissions coverage is claims -made, YORK agrees that, for said two (2) year period, the "retro" date will not be later than the inception date of this Agreement; 3. Maintain in force a general liability policy, which names PRINCIPAL as an Additional Insured and which provides limits not less than one million dollars ($1,000,000) per occurrence, two million dollars ($2,000,000) aggregate and two million dollars ($2,000,000) products/completed operations aggregate; 4. Maintain in force a workers' compensation and employers liability policy, which provides coverage to employees of YORK at limits not less than one million dollars ($1,000,000); 5. Maintain in force an automobile liability policy, which names PRINCIPAL as an additional insured and which provides a limit of no less than one million dollars ($1,000,000); 6. Provide that the aforementioned policies contain a waiver of subrogation in favor of PRINCIPAL. J. YORK shall notify PRINCIPAL's insurer of all claims which may affectthe insurer's coverage in excess of PRINCIPAL's Self -Insured Retention layer in accordance with the instructions of PRINCIPAL's insurer as provided to YORK pursuant to Section V.(A) of this Agreement. K. Notwithstanding anything to the contrary contained herein, and to the extent applicable, YORK agrees to comply with all obligations imposed upon it by law. L. YORK shall provide services in accordance with its response to RFP 16 -12883 -MA — reference Exhibit A. In the event of a conflict between the terms of the contract and the response to the RPF, the contract shall prevail. V. DUTIES OF PRINCIPAL A. PRINCIPAL shall promptly provide YORK with such information as YORK may require, including, but not limited to, any copy of documents describing its self-insured AUTOMOBILE/ GENERAL/ OTHER LIABILITY program, and all amendments thereto including but not limited to documents submitted to any governmental tribunals for approval of the Program, as well as incident reports and information related thereto in PRINCIPAL'S possession and otherwise cooperate with YORK in carrying out YORK'S tasks hereunder. B. Upon receipt of loss notices, PRINCIPAL may assign the loss to YORK. C. PRINCIPAL shall establish a loss fund account to fund claims and expenses pursuant to Exhibit B. Page 5 of 14 GL Agr REV. 10-04-13 D. PRINCIPAL shall provide YORK with training material, along with initial and subsequent training on PRINCIPAL'S forms and other documents affecting PRINCIPAL'S obligations which are provided to YORK and any written interpretation thereof issued by PRINCIPAL or any applicable regulatory body. During the term of this Agreement and at all times that there are open Claims being handled by York, PRINCIPAL shall fully cooperate with YORK. E. PRINCIPAL covenants and agrees that PRINCIPAL, its employees, agents or independent contractors, will not misuse the information contained within the Claims files. PRINCIPAL further covenants and agrees to maintain the confidentiality of the information contained within the Claims files, as required by applicable State and Federal law and regulations. VI. SYSTEMS AND DATA PROCESSING A. Although YORK authorizes PRINCIPAL to use or have access to its Systems in performance of Claims Administration Services enumerated in this Agreement, this does not license YORK's system to PRINCIPAL nor shall PRINCIPAL have, or assert, any property interest whatsoever in the Systems or any improvements or additions YORK makes to its Systems during and/or in the course of YORK's performance under this Agreement, whether or not such improvements or additions were made at the suggestions, request or direction of PRINCIPAL. Notwithstanding the foregoing, the data entered or maintained thereon pursuant to this Agreement is the property of PRINCIPAL. B. This Agreement grants to PRINCIPAL no right to possess or reproduce all or any part of the Systems used, owned or controlled by YORK performing all or any part of Claims Administration Services and PRINCIPAL covenants that it shall not do so. C. YORK expressly agrees that claim -related data generated and/or maintained in connection with this Agreement or any Exhibit hereto shall be and remain the sole property of PRINCIPAL and YORK shall have no right, title, or interest in such data other than such rights necessary to perform Claim Administration Services. VII. COMPENSATION A. YORK shall be entitled to receive and PRINCIPAL shall be obligated to pay only such fees, allowances, costs, reimbursements, or other compensation as are specified as follows: PRINCIPAL shall pay YORK the compensation listed as EXHIBIT C. B. PRINCIPAL shall pay YORK the fees due under VII. A of this Agreement no later than thirty (30) days after PRINCIPAL'S receipt of York's invoice as Page 6 of 14 GL Agr REV. 10-04-13 rendered from time to time. Timely payment is an express condition of York's obligations hereunder. VIII. AUDIT A. YORK shall maintain books, records, reports and other documents, in electronic or other format reasonably acceptable to PRINCIPAL relating to its Claims Administration Services performed under this Agreement. All such records and documents pertaining to Claims and the services rendered by York shall be the property of PRINCIPAL and be open for inspection, audit and copying, at PRINCIPAL'S expense, by PRINCIPAL and its agents or their representatives during all regular business hours with reasonable prior notice to YORK. YORK shall cooperate fully with all such agents or other representatives of PRINCIPAL during audits or examinations conducted by PRINCIPAL or its agents. B. At any time during the Term of this Agreement, or thereafter, provided PRINCIPAL is not in default under this Agreement, PRINCIPAL may conduct, or cause to have conducted, an audit of YORK's operations to determine whether YORK has performed its obligations hereunder in compliance with this Agreement. C. Audits pursuant to this Section VIII shall be conducted in a manner that does not interfere with YORK'S daily operations. IX. CONFIDENTIALITY A. Both parties hereto acknowledge and agree that PRINCIPAL'S information, data and documentation, including but not limited to, non-public and personal information subject to the provisions of the Gramm -Leach -Bliley Act, 15 U.S.C. Subchapter 1, Sections 6801-6809 et. seq., personal health information under the Health Insurance Portability and Accountability Act, 42 U.S.C. 1301, et. seq., and further including, without limitation, all information, data and documentation related to manuals, lists, policyholder information, operating and other systems, business practices and procedures, any information regarding insureds insurance policies, claimants, and Claims, any business, governmental or regulatory matters of PRINCIPAL, and other information furnished to or obtained by YORK, pursuant to or in connection with this Agreement or in connection with the Services to be rendered, may be confidential ("Confidential Information"). YORK shall not divulge, disclose or use the Confidential Information except for purposes of this Agreement, or as may be expressly agreed in writing by the parties, or as may otherwise be required or directed by applicable law or judicial process. This Section IX shall survive the termination of this Agreement, regardless of the reason for termination. B. During the Term of this Agreement, and after its termination for any reason, PRINCIPAL shall have the right to request in writing and receive from Page 7 of 14 GL Agr REV. 10-04-13 York either: (i) the immediate return or (ii) confirmation of the immediate destruction of any tangible records, documents, e-mails, computer files, CDs, disks, and any other tangible item that contains, represents, or otherwise includes any Confidential Information of PRINCIPAL. In addition, PRINCIPAL shall have the right, during the Term of this Agreement and after its termination, to request that YORK permanently delete and destroy any Confidential Information contained in any computers, hard drives, servers or other data storage systems of YORK. YORK agrees that PRINCIPAL may seek an injunction by a court of competent jurisdiction enjoining YORK from violating any terms of this Agreement or the confidentiality and non-use provisions of this Section IX. Injunctive relief shall be in addition to any other remedies that PRINCIPAL may have under the law. Notwithstanding the foregoing, YORK may retain a record copy of Claims files and the data therein, for accounting, insurance and similar purposes. YORK shall secure said record copy against improper use or disclosure. C. YORK acknowledges and agrees that any Confidential Information disclosed to, or acquired by it is disclosed and/or acquired solely for the purposes of facilitating the provision of the services to be rendered by the YORK for and on behalf of PRINCIPAL . YORK shall be solely responsible for informing its employers, officers, and directors of the provisions of the Section and for any acts of its employees, officers or directors that violate the provisions of the Section. D. Notwithstanding the foregoing, PRINCIPAL agrees that information used for adjusting claims is not subject to statutory or regulatory restrictions against disclosure for that purpose. X. BREACH AND TERMINATION A. If a material breach by either party of this Agreement occurs, the non - breaching party shall identify the breach by delivery of written notice thereof to the breaching party. B. Upon delivery of written notification of breach, the breaching party shall have a period of fifteen (15) business days or an agreed upon date made within the fifteen (15) business days within which time the breaching party shall cure the breach. Should the breaching party fail to fully cure the breach within the designated time frame, the non -breaching party may terminate this Agreement by delivery of thirty (30) days written notice of termination to the breaching party. Any notice of breach or termination shall be delivered pursuant to Section XII. A hereto. C. This Agreement may be terminated by a party without the necessity of any notice or right to cure, upon the occurrence of any of the following events: 1. The expiration of the Term set forth in Section II or any renewal thereof; Page 8 of 14 GL Agr REV. 10-04-13 2. The commencement of bankruptcy, insolvency or conservatorship proceedings by the other party, or, if such proceedings are brought against the other party, the other party's failure to have such proceedings dismissed within 45 days. D. Either party may, without reason, terminate this Agreement with at least sixty (60) days prior written notice to the other party. XI. EQUITABLE ADJUSTMENT A. PRINCIPAL shall have the right to direct YORK to perform additional services or to perform services in a specific or different way. B. This Agreement contemplates that the standards applicable to this Agreement are those in effect on the date of this Agreement, whether such standards are set forth in statutes, regulations, rules, orders, case law or otherwise. C. In the event of a directive from PRINCIPAL as set forth in Section XII. A or a change in a standard as set forth in Section XII B., YORK shall be entitled to an equitable adjustment in its compensation if such directive or change increases YORK's cost of providing the services YORK renders under this Agreement. XII. GENERAL A. YORK shall not be liable or deemed to be in default for any delay or failure in performance under this Agreement or any Exhibit of this Agreement, or any interruption of Claims Administration Services resulting, directly or indirectly, from acts of God, civil or military authority, or any similar cause beyond the reasonable control of YORK for as long as such condition exists. YORK shall give immediate notice to PRINCIPAL of any delay orfailure in performance or of any interruption of Claims Administration Services that has or may occur as soon as YORK becomes aware of such events. B. If any dispute or claim arises hereunder that the parties are not able to resolve amicably, the parties agree and stipulate that such litigation shall be resolved in a court of competent jurisdiction in the State of Texas. Venue shall be in the Lubbock County, Texas. The PRINCIPAL and YORK agree that nothing in this Agreement shall compel PRINCIPAL to submit any dispute regarding this Agreement to arbitration. C. All notices which are required to be given or submitted pursuant of this Agreement shall be in writing and shall be transmitted or delivered by certified mail, return receipt requested or by a commercial overnight delivery service to the parties at the addresses set forth below, or to such other addresses as a party may, by notice, specify: Page 9 of 14 GL Agr REV. 10-04-13 Notices to YORK shall be delivered to: York Risk Services Group, Inc. York Risk Services Group, Inc. 333 City Boulevard West, Suite 1500 One Upper Pond Rd. Bldg F 4th flr Orange, CA 92868 Parsippany, New Jersey 07054 Attention: Jody A. Moses, Sr. VP Attn: Michael Krawitz, General Counsel, Sr. VP Notices to PRINCIPAL shall be delivered to: City of Lubbock 1625 13th Street, Room 204 Lubbock, Texas 79401 Attention: Lainey Morrison, Risk Management Coordinator D. This Agreement and any Exhibit or Schedule made a part hereof constitute the entire Agreement between the parties and supersedes and merges any and all prior discussions, representations, negotiations, correspondence, writing, and other agreements and together states the entire understanding and agreement between PRINCIPAL and YORK with respect to Claims Administration Services to be provided hereunder. Except for unilateral changes made by the PRINCIPAL pursuant to Section XII, for which YORK shall, be entitled to an equitable adjustment in its compensation, this Agreement may be amended or modified only in writing if agreed to and signed by PRINCIPAL and YORK and shall be deemed to have been entered into and executed in the State of Texas and shall be construed, performed and enforced in all respects in accordance with the laws of the State of Texas. E. No party hereto shall be deemed to have waived any rights or remedies accruing to it hereunder unless such waiver is in writing and signed by such party. No delay or omission by either party hereto in exercising any right shall operate as a waiver of said right on any future occasion. All rights and remedies hereunder shall be cumulative and may be exercised singularly or concurrently. F. The descriptive headings of this Agreement are intended for reference only and shall not affect the construction or interpretation of this Agreement. G. Wherever the singular of any term is used herein it shall be deemed to include the plural wherever the plural thereof may be applicable. H. No party may assign its rights or obligations under this Agreement; provided, however, that YORK may subcontract all or part of the Services required hereunder with PRINCIPAL'S written consent, (which consent shall not be unreasonably delayed or withheld) and may at its discretion delegate to a subsidiary such of its duties as it deems appropriate, provided that such subcontracting or delegation shall not relieve YORK of any of its obligations hereunder. I. It is expressly understood and agreed that the relationship of YORK to PRINCIPAL shall be that of an independent contractor at all times, and nothing Page 10 of 14 GL Agr REV. 10-04-13 herein shall constitute either the YORK or PRINCIPAL as the partner, agent, or legal representative of the other, for any purpose whatsoever, except to the extent that YORK is the agent of PRINCIPAL for the purpose of adjusting claims YORK shall have no right or authority to bind or obligate PRINCIPAL with respect to any matter that is not specifically provided for in this Agreement without the prior approval of PRINCIPAL. All employees or agents of YORK performing duties hereunder for YORK shall be solely and exclusively underthe direction and control of YORK and shall not be deemed employees of PRINCIPAL. J. Nothing in this Agreement is intended to require YORK to engage in the practice of law. K. PRINCIPAL shall not utilize YORK's trade names, logos, trademarks, service marks or other identification in any press release, advertisement, marketing materials, promotional literature, article, presentation orother type of communication without the prior written consent of YORK, which consent may be withheld or denied in YORK's sole discretion. IN WITNESS WHEREOF, the parties hereto have read and signed this Agreement as dated below and the Agreement is effective as of Augu.0 95 2016. CITY OF LUBBOCK Daniel M. Pope, VIAYOR ATTEST: JRe ca Garza, City Secretary YORK RISK SERVICE GROUP, INC. Jody A. Moso, Senior Vice President Page 11 of 14 GL Agr REV. 10-0413 APPROVED AS TO CONTENT: Leisa Hutcheson. Director of Human Resources and Risk Management APPROVED AS TO FORM: Aeffffrtsell ,Assistant City Attorney Page 12 of 14 GL Agr REV. 10-04-13 EXHIBIT A Page 13 of 14 GL Agr REV. 10-04-13 Exhibit A T'oClaims Service Agreement proposal for with i City of Lubbock City of Lubbock, Texas r►� ciTy of Lubbock TEXAS Request for Proposal for Liability Claims Services Submitted by: Patrick O'Toole Vice President aSales, Public Entity Patrick. Otoole@yorkrsg.com (512) 427-2429 55010 LBJ Freeway, Suite 300 Dallas, Texas 75240 July 11, 2016 Proposal for City of Lubbock, Texas ity of ock TEXAS Table of Contents Checklist.........................................................................................................................................................1 CoverLetter...................................................................................................................................................3 SectionA: Proposal Format............................................................................................................................6 Section B: Proposal Questionnaire..............................................................................................................17 1. Claim Handling Company Qualifications...........................................................................................17 2. Staffing and Training.........................................................................................................................20 3. Contact Personnel.............................................................................................................................23 4. Billing and Cost..................................................................................................................................24 S. Claim Management...........................................................................................................................25 6. Claim Handling................................................................................................................ ...26 ............... 7. Reserving...........................................................................................................................................28 B. Reporting...........................................................................................................................................30 9. Claims/File Reviews...........................................................................................................................32 10. Structured Settlements....................................................................................................................33 SectionC: Cost Proposal..............................................................................................................................34 SectionD: Required Forms...........................................................................................................................35 SectionE; Attachments................................................................................................................................44 .-� city of 5 Lubbock YO FI I&I YORK July 8, 2016 Checklist CM OF LUBBOCK, TX RFP 16 -12883 -MA Liability Claims Services Checklist Please ensure that you complete and return the following documents and information to the City of Lubbock Purchasing and Contract Management Deparunent before the deadline. Any corrections must be initialed by person making the correction- Late submittals will not be accepted X The Request for Proposal Form MUST be completed. Clearly mark the RFP number, title, due date and time, and your company time and address an the outside X of the sealed envelope or container. X Completed and signed SUSPENSION AND DEBARMENT CERTIFICATION. Please include Company Fedeml TAX ID number or Social Security number X Completed Non -Collusion Affidavit X Completed Insurance Requirement Affidavit X FAILURE rU PRUv1UE ANY OF THE ABOVE MAY RESULT IN YOUR PROPOSAL BEING DEEMED NON- RESPONSIVE. Invitation to Proposal Form SIUST be completed York Risk Services Group, Inc. Print Name of company Patrick OToole, Vice Presldent of Sales, Public Entity 512.427-2429 Contact Person/Phone PLEASE INCLUDE THIS COMPLETED PAGE AS THE FIRST PAGE OF YOUR SUBMITTAL. '` Otyof Lubbock 1 YO R K July 2016 Legal Review Comments 20. "tib CITY RIGHT TO AUDIT At any time dun ag the term of the contract, or thereaf ", the City, or a duty WAonzed audit representative of the City or the State of Texas, at its cqx mse and at reasonable times, reserves the right to audit Contractor's records and books relevant to all services provided to the City under this ICa ntra In the event such an audit by the City reveals any euars or overpayments by the City. Contractor shall refund the City the full amount of such overpayments withua Hurry (30) days of such audit f vdin;{gs or the City, at its option and with mutual consent, reserves the right to deduct such amounts owing the City from any payments due Contractor. Comment: If auditor is not City employee, outside representative shall sign a non- disclosure/confidentiality agreement and present results to Contractor. Contract shall add any comments or clarification to be submitted with the original audit to the City. If Lubbock irrai July 8, 2016 YORK i YORK July 11, 2016 Purchasing Department — City Hall, Room 204 Attention: Marta Alvarez, Director of Purchasing and Contract Management 162513 th Street Lubbock, TX 79401 55010 LBJ Freeway, Suite 300 Dallas, Texas 75240 www.yorkrsg.com Re: York's Response to Request for Proposal for Liability Claims Services for the City of Lubbock, Texas Dear Honorable Mayor and City Council, Ms. Alvarez and the City's Evaluation Committee: York Risk Services Group, Inc. ("York") appreciates this opportunity to partner with the City of Lubbock ("City") for liability claims services, and we believe our approach to the City's program will deliver the greatest possible savings to you and the best possible outcomes on claims. York is able to reduce costs while delivering exceptional service by achieving maximum efficiency and greater control over the quality of services through an integrated model of liability claims services, backed by extensive resources and expertise. Here are some of the ways our approach can deliver results for the City: Expertise Serving Cities & Government Agencies York is the largest public entity TPA in the nation and we serve over 5,800 public entity clients. We have a deep understanding of the unique nuances associated with administering claims for many Texas public entities. York provides liability claims services administration and has done so for nearly 30 years. York currently serves more than 420 public entities in the State of Texas including the City of Fort Worth, City of Austin and the City of Corpus Christi and as a result we understand the unique challenges cities like Lubbock face. Customization York is an organization focused on the needs of our clients which allows us to offer truly tailored services and customized claims solutions for a wide variety of the Texas agencies we serve. We recognize the City's program is unique and requires a team experienced in managing a program like yours. As such, we are proposing a claims unit that consists of an Assistant Vice President to provider oversight, Account Executive, and a Lubbock based liability field Adjuster. The entire adjusting team will be based in Texas as will the claims support that is needed. We are completely committed to recruiting and hiring an adjuster that that will meet or exceed the service requirements of the City's account and have budgeted for a compensation and benefits package to do so. We will also provide the Lubbock based Adjuster with all the resources to insure the City receives the highest level of service. York understands the relationship between the City and the claims team is crucial to the success processing your liability claims. Lubbock July 8, 2016 loop - YORK Innovation & State -of -the -Art Claims System At the heart of our claims management services are our claims and risk management information systems, York Claims Expert'" and FOCUS. These tools enable us to deliver a best -in -class risk management program to our public entity partners by supporting an efficient, paperless claims management process and by offering cutting edge risk management data in an easy-to-use platform. Our proprietary claims system is fully integrated and intuitive, thereby enabling our Adjusters to operate efficiently and dedicate their attention to reducing claims costs and providing outstanding customer service to the City. This system provides the analysis the City needs through claims and loss reporting, ad hoc reporting, loss trending, scheduling routine reports, and much more. Poised for Transition York takes pride in making the claims transition a seamless one for the City. We have a dedicated implementation team led by Jennifer Sims who will ensure that the City's expectations and timeframes are met. York has experience transitioning accounts similar in size and scope to the City. For example, we have recently successfully transitioned the City of Fort Worth. Our goal is to adapt our structure and process to become a unified extension of the City of Lubbock's claims administration program so that we can meet your unique needs. Upon review of our proposal, if any questions should arise, please contact Patrick O'Toole, Vice President of Sales, at patrick.o'toole@yorkrsg.com or via telephone at (512) 427-2429. Best Regards, Patrick O'Toole Vice President of Sales, Public Entity York understands of the services to be provided. f C1ryad Lubbock 4 YO R K nus July B, 2016 Section A Proposal Format The original copy of the proposal must be organized into the following response item sections and submitted in an indexed binder. i) Cover letter addressed to the Honorable Mayor and City Council that states the Offeror understands of the services to be provided. Include any additional information believed necessary that is not requested elsewhere in the RFP. York has provided a cover letter addressed to the Honorable Mayor and City Council. We have provided additional information for the City's program. Please refer to cover letter previously provided on pages 2 and 3. ii) A description of the methodology to be used to complete the project to include, but not be limited to, how recommendations will be formulated and commitment of adequate appropriate resources to the project. York is the largest public entity TPA in the nation and we serve over 5,800 public entity clients. We have a deep understanding of the unique nuances associated with administering claims for many Texas public entities. York provides Liability Claims Services Administration and has done so for nearly 30 years. York currently serves more than 420 public entities in the state of Texas including the City of Fort Worth, City of Austin and the City of Corpus Christi and as a result we understand the unique challenges cities like Lubbock face.. The City's Designated Account Executive and Implementation Specialist The City will be assigned an Account Executive, Susan Mullins, who is responsible for overseeing the implementation and conducting program and trend analysis in order to monitor program performance and provide detailed benchmarking. Susan will take an active role in the scheduling and preparation of regular account reviews and functions as the primary client contact, communicating with the Risk Management and/or Human Resources department to resolve issues and maintain account continuity. Additionally, Susan will provide the City with regulatory/legislative updates and monthly plan management and performance reports. This is provided as York's standard service at no additional cost to the City. Because of our extensive experience working with public entities in Texas, we are well-positioned for a timely implementation to begin working with City of Lubbock. If awarded the contract, the City's specific policy and procedures will be reviewed during the implementation process. Although we have transitioned accounts within as little as 10 days, the optimal implementation is 60 days from date of recommendation to contract start date. The implementation time schedule is contingent upon notice of approval of York as the TPA. York has a dedicated team of implementation specialists who have perfected the art and science of transitioning programs with minimal disruption to your staff and injured employees. Upon notice of award, York's implementation team will begin working to transition your claims administration program to ensure a smooth transition when the program goes "live." We have developed a sound project management methodology that includes the appropriate strategies, structure, processes, and resources for a successful implementation. rbbock r4y 8, 2016 14011, YORK York's implementation plan encompasses a detailed data conversion process that addresses key claims data (including transfer of all historical financial records, such as payments and reserves, along with claim notes, EDI and other key components necessary for successful claims management), banking arrangements, personnel issues, communication procedures, system access and training, and much more The detailed conversion also allows York to provide the necessary data to create loss triangles for actuarial or excess reporting needs. Susan Mullins, Account Executive, will hold weekly meetings with the York implementation team. The implementation meetings continue until a full transition is completed. These weekly meetings will also include key personnel at the City and will include a weekly updated version of the implementation plan. The IT Specialist will facilitate RMIS set up and data conversion. A programmer and project manager from our RMIS division will also assist in program transition, providing subject matter expertise regarding technical issues. We have successfully converted from a wide -variety of systems. The size of conversions have ranged from very small to our largest which was over 100,000 workers' compensation claims, which included over 1 million financial transactions and covered claims for over 30 years. We have been able to work with downloads out of both commercial software systems as well as proprietary/in-house systems. One of the keys to converting data successfully is the utilization of a robust "test bed" environment that we call the Model Office which is used for on -boarding new clients, providing demonstrations of our systems capabilities, and training for new and existing system users. What is the Model Office? Model Office is a secure, isolated replica of our systems environment that is "fenced off" from our production systems environments. The Model Office provides a working model of our systems/operational infrastructure for use by our IT, Operations, Finance and Client Services teams for demonstrations, training and on -boarding new clients in a controlled environment. Access to the Model Office (MO) is strictly controlled on a project -by -project basis, and there are specific protocols that govern: ♦ Gaining access to the Model Office (physical and virtual) ♦ Ensuring all systems releases are kept in synch with production systems ♦ Loading of data into the Model Office On -boarding a new client via the Model Office At York we recognize that data is our clients' life blood, and we take our responsibility for managing this data very seriously. Frequently, when bringing on a new client we face the challenge of loading data from another system into our proprietary system's framework. Effectively managing the quality of your data begins with a tightly -controlled process for the initial configuration and load of data to our system. Aft. aaor Lubbock 7 July 8, 2016 YORK The Model Office provides a controlled environment for loading, testing and validating data prior to going "live." There is a well-defined script for on -boarding a new client in the Model Office, encompassing the following: ♦ Controls for mapping data to our system ♦ Validating data loads ♦ Identifying, communicating and resolving inconsistencies that arise ♦ Completing the client configuration ♦ Verifying balances and counts ♦ Testing all phases of processing and reporting ♦ Acquiring signoff from designated approvers as each stage of migration is completed ♦ Communicating with all stakeholders throughout the process ♦ Training and demonstrations, as required Team leaders from all major stakeholder disciplines such as IT, Operations, Finance and Client Services are intimately involved in managing all phases of the on -boarding process under the direction of your assigned Implementation Specialist. In addition, our Project Management Office ensures that activities are closely monitored, coordinated and executed according to plan. The data for a newly on -boarded client is never "turned on" in production until all requisite controls have been validated and approved. Our commitment to data quality therefore starts with day one. Once our on -boarding has been completed, the Adjusters follow the established liability best practices. Please refer to Attachment A: Liability Best Practices. York's standard for Adjuster diaries is a 30 -day review on all open/active cases. York does not allow for delinquent diaries, which are defined as any diary that is not current as of the previous Friday's date. In the event the Adjuster does have delinquent diaries, Susan Courtney, Assistant Vice President, will work with the Adjuster for an action plan on how those will be worked to completion the following week. Action plans are developed and followed on files. On each diary the City will see an action plan from the Adjuster and confirmation of that plan during Susan Courtney, Assistant Vice President will review that confirm whether or not the plan was followed as well as to provide additional direction when necessary. dek.- City or Lubbock �1f�E July 8, 2016 10010, YORK iii) Offeror's specific expertise in areas pertinent to the project to include a listing and brief description of similar projects completed (with the dates of completion) or in progress and a list of references by name, address, and telephone number for each project listed. This list of projects in progress shall include the phase of work that each project is currently in (i.e. design, bid, construction), and the estimated completion date. Travis County Texas Council Risk Management Fund G.ubbock County 1010 Lavaca St !William "Bill" Paterson, (512) Ausdn, TX 78701 4 Risk Manager 8549650 Gulf Coast Center Mrs. Mary Lou Flynn - 1401 McKinney, Du Part, Board Chair Suite 1900 Houston, Texas 77010 ' 916 Main Street, Suite 1206 Lubbock, TX 79401 AW. aty Lubbock neu Greg George, 752-4200 wk July 8, 2016 ..num n.,ia,cnunl WWI L11 1, cvu-- Lialms co.travis.tx.us Present administration Services- claims — In Progress administration, including workers' compensation claims and liability claims — Managed care for workers' compensation claims I mdupart@jw.com 1988—Present __ Claims ! Services: The Fund administration offers workers' — In Progress compensation, general liability, automobile liability, professional liability, public officials' errors and omission liability, and a variety of property GGeorge@ co.lubbock.tx.us I January 2014— Claims Present administration Services: Third — In Progress Party Administration for Workers' Compensation Claims and Managed Care Services. I YORK iv) A brochure (if applicable) of past work, with emphasis on comparable projects. Please see the following brochure. YORK. Why Choose York? At York, we see things your way. what doe tier n:art lt n,eeos sac .re und�fprsd ilio unlpr needs d Tem prtlk ardCies skit b�iiy extxl�ss Verb currently ran= mere than 42O public entities In the gUte of yeaas InsJudby she City W Fort Womb, City of Austin saill the City of Corpus ChrbO and as a result we understand the uolaar challenges cities like Lubbock face especially for Your liability proarom Cvm more Important s how we do this Your local team w,N operate as an estensren of You from our offices across Texas That proximity and that approach at erw us to Wirt the long term relationships that sit cr hal to mea,ng your needs Public enhues experience more public scrutiny than private We've been helping pub5c ent ties manage clams and risk for companies As a result we know you need a partner that near'y 30 years. continuously baldbsg our understanding of w+ll what makes pubic entities ddfermt, interesting, and special a Communicate proactively with the Gty and injured claimants That i what sve do • Cnwie that the chi mant's firms experience n positive • Offer wperlor expertne with Texas statutes and regulations • Deriver eacepuvml customer wrvsee - the kind it -at bu Ids a long term relationship built on mutual respect and trust • Provide custom reperes with the information you need to mania. your —1; • Help you manage the Inst of risk through proactive damn strategies 10 rLub-�ot'& YO R K riff July 8, 2016 WHY CHOOSE YORK? YORK PURUC ENTITY At Yank, we use our nearly 30 years of Experience to design the CONTINUOUS IMPROVEMENT products and services that wil meet your reeds. At Park, we have a culture of continuous hnprnvenrent We perform ongoing Itrai audhs or claims files, identify areas for EI(PERTISE In Texas. we are honored to carve a number at public emdy clients, and we look forward to expanding our relationships through our team of dedicated claims professionals, who provide unmatched service and an expert eye toward managing costs They understand the unique 5abllity exposures that you fare and ms quakly detenm ere the most effmerrt cost-effective approach to managing each dams CUSTOMER SERVICE 6 COMMUNICATION At York, we think of ourselves as claims service representatives first and forrmust Our outstanding custanser seance starts with an Account Manager who serves as your single paint of contact for all your needs York encourages dally interaction with the claims examines managm,g your program We understand that, by communkaturg Professionally and an a regular haws with you and the claimant, WE are able to achieve the best outcomes an claim Frequent, clear and concise cammunfcatum means there are no surprbes when it rimes to reserves and claim autmmes. CUSTOMIZATION We understand that every public errlhty Is ddferent We are able to adapt our procedures, systems, and Infrastructures to meet your specific reeds, rang -ng from communmtans preferences to claims management practices to reporting procedures YORK RISK SERVICES GROUP aaEi�e� unprovemem, and Implemert transing to address these duns We understand that trairina Is one of the most Impansm ways we lin s anvil in our clamp prorfeessanah so they mvest in you, aur diens, and we bene this a one of the reason we are successful in rationing highlyquardued Balms prokssrurats Because we we Tour Panner in cominsaus Improvement we welcome your participation In In house training programs and are able to custmnae trammg to meet your needs SUPPORTED BY SUPER,OR TECHNOLOGY York's claims professionals use our state of the an claims system to manage claims pmnctively and eff.dentiy Built using feedback from our clients, our Bairns system can be customized to caplwe the sprssfc data each client needs to manage risk eHectnely Alk. city of 11 k LubbocYO R K reser July 8, 2016 v) List of principal(s) of the Offeror and amount of time that principal(s) will be involved in the project. York has identified the following team for the City's program: ♦ Susan Mullins, Account Executive — During the implementation, the percentage will be much greater until this partnership is meeting our customer service standards and then approximately 10% of time allocated to this partnership. ♦ Susan Courtney, Assistant Vice President, Field Services — 15% and will provide oversight to the Adjuster ♦ On -Site Field Adjuster in Lubbock (to be hired) — 100% — Please note: York is more than willing to hire the existing Adjuster, if the City prefers. This lends experience to your program. ♦ Patrick O'Toole, Vice President, Sales — As needed to assist the City with any program needs and to act as a liaison for program communication and ensure we are meeting the City's expectations. He will also be involved throughout the implementation process. ! Jennifer Sims, Client Implementation — During implementation, Jennifer will be designated to ensure the City's successful implementation. Her percentage dedicated to implementation would be approximately 50% during implementation period. Once completed, the amount of time will be lower since implementation period will be concluded. For a list of York's principals, please see Attachment B: York Principals, and please also see Attachment C: Staff Resumes for resumes of the principal key leadership for the City's program. vi) List of other professionals to be used, if applicable, with a record of experience in projects of this nature. Identification of principal(s) and percentage of time the principal(s) will be involved in the project. York's software, systems and staff are direct resources of our company. For the City's program, we will not outsource or utilize any significant subcontractors. / cityof Lubbock 12 July 8, 2016 10,11' YORK vii) The organizational structure of the employees who will be assigned to this project along with resumes of those individuals. If a joint venture is expected, then provide the organizational structure of the sub -contractor and resumes of those persons who will be involved in the project. AccountExecutive Jennifer Sims Chent Implementation I Patrick O'Toole 'Please note: York is more than willing to hire the existing Adjuster, If the City prefers. This lends experience to your program. York's software, systems and staff are direct resources of our company. For the City's program, we will not outsource or utilize any significant subcontractors. Please refer to Attachment C: Staff Resumes. viii) The Offeror must assure the City that he/she will to the best of his/her knowledge, information and belief, be cognizant of, comply with, and enforce, where applicable and to the extent required, all applicable federal or state statutes and local ordinances including, but not limited to the Davis -Bacon Federal minimum wage requirements. York assures the City we will be cognizant of, comply with, and enforce, where applicable and to the extent required, all applicable federal or state statutes and local ordinances including, but not limited to the Davis -Bacon Federal minimum wage requirements. We provide training to our staff to insure they are familiar with any and all changes in State or Federal statutes related to any aspect of our business that could impact the City. ix) Describe the Offeror's methodology for handling errors and omissions. On errors and omissions losses, in keeping with York's legal interests, we retain counsel immediately, regardless of whether the matter is in litigation. The defense attorney will handle the matter so as to present the situation in the best possible light during the proceedings. x) Disclosure of any obligations posing a potential conflict of interest, including service on City boards and/or commissions and any current contracts with the City. This would apply to the Offeror as well as consultants subcontracted by the Offeror. York currently has no conflict of interest, and we agree to disclose any conflict of interest whether directly with York or with our subcontractors which may arise. VLubb" & 11111 13 July 2016 lop - YORK xi) Offerors are strongly encouraged to explore and implement methods for the utilization of local resources, and to outline how they would address outreach issues in their proposal. It is also the desire of the City that the City program serve, as much as practicable, to stimulate growth in all sectors of the local business community. Describe how your firm would facilitate this process, and provide any relevant information about similar efforts on previous projects. York believes in the importance of "buying" local whenever possible. With our current contracts with other public entity agencies in the Lubbock area, and Texas as a whole, we have established relationships with service partners that we have subcontracted with to provide services to our clients. That includes property appraisals, field investigation, and private investigators to name a few. We also would like to entertain the possibility of interviewing and hiring the current Adjuster handling the liability claims for the City if the City agrees with that approach. xii) Any material which the proponent wishes to submit and which is not specifically requested in the above categories. York would like to provide a brief overview of the following topics. In addition, if given the opportunity we would like to demonstrate our proprietary RMIS and reporting module that we feel the City would find most beneficial. Program Service Technical and Comprehensive Investigation Process Our prompt contact (within 24 hours) with the claimant(s) or claimant's(s') attorney and concise initial investigations can significantly influence future settlement value. This contact also represents our commitment to providing quality customer service. During the first five (5) days after receiving a new claim, our investigation includes contact with the City personnel and any witnesses, documented with statements, if possible. We secure all applicable records and other documents to verify injuries and property damage. We obtain all official reports, photographs and diagrams of the scene, conduct a social media search, or use numerous other investigative tools at our disposal as well as using video when appropriate. During the course of our investigation, we ask ourselves: ♦ What is the potential of this claim? ♦ What are the facts? ♦ Who is the best source? ♦ How much is enough? ♦ Does the file speak for itself? In other words, we quickly identify issues at hand and how to resolve those issues, documenting the file as our investigation addresses the facts, coverage, liability and damages. We perform the investigation necessary to make our liability and damages assessment, not over -investigating those matters, but considering resolution at every opportunity. We will promptly identify indemnity and defense rights owed to the City through contracts and additional insured endorsement and aggressively pursue tenders on their behalf. We report all injury claims to the Index Bureau and have them re -indexed once or twice a year while the claim remains open. 14 !c ly 8,1016 YORK Authority Levels Reserve and settlement authorization thresholds will be based upon client specific established procedures and can be set at the City's comfort level. Typically, our Adjusters have set levels of authority within which they may work autonomously. Each Adjuster's abilities will be evaluated, and an appropriate level will be set based on years of experience and understanding of applicable laws and procedures. Supervision and technical guidance will be provided upon file setup, on each diary date, and at regular meetings with the claims staff. Evaluation of these levels is monitored by supervision and management and adjusted as appropriate based on the City's instructions and requirements in conjunction with our staff's abilities. These limits are set-up in the claims system and if a reserve increase is requested in excess of an adjuster's pre -determined limit the request is escalated to the next level of authority for review and approval. Emergency Response Time For the City's field investigations, we will either hire the City's existing On -Site Field Adjuster, or will hire an experienced On -Site Field Adjuster with comparable experience. The On -Site Field Adjuster will be designated to your program, based in Lubbock, and provide field investigation to the City. In line with our best practices, your On -Site Field Adjuster will be made available 24 -hours, around-the-clock, when immediate field investigations are warranted and prompt response time. The On -Site Field Adjuster will investigate the circumstances and events leading up to the incident, evaluate the damages and follow best practices through the processing of the claim. MMSE Administration and Reporting York is capable of meeting the full spectrum of Medicare Secondary Payer Compliance to include: the Mandatory Insurer Reporting Requirements under Section 111 of the MMSEA, conditional payment identification and resolution, and Medicare Set -Asides. York, on behalf of its clients, is currently reporting directly to CMS with our own proprietary reporting system: Medicare Reporting Compliance Expert (MRCE). In addition when directed, we are able to complete the mandatory reporting process through an external reporting vendor. In this instance, the Reporting Agents (RA) ensures compliance with the Section 111 reporting requirements by collecting and transmitting the required data as well as responding to Medicare. Management Information Loss Reports Throughout the pendency of the claim, we provide written status reports that update significant events in the file, particularly those that impact the value and assessment of the claim. Each status report will provide comment and an update of the plan of action. It is our practice to provide status reports every 30 days; however, the frequency and format of these reports can be modified to best meet the City's needs. At the conclusion of each claim, we provide the City with a written report that confirms the basis on which the claim was closed; e.g. tolling of the statute of limitations, settlement, defense verdict, etc. This report also provides a summary of the payments made on the claim and any releases or other closing documents. Access to Claims Management System and Flexibility of Reporting York's Risk Management Information System (RMIS), FOCUS, has the ability to capture key claim information in an innovative capacity that allows us to guide your program by conceptualizing key strategies and approaches to reduce your liability costs. FOCUS is a powerful yet easy-to-use customer interface that provides data visualization, an expanding library of customizable reports and interactive tools which transform volumes of data into useful, impactful information that can be understood at a glance. Aft, c5cy d Lubbock 15 YO R K riris July 8, r?i11f� Financial Capacity Insurance Certificates York has provided our certificates of insurance with our response. Please see Attachment D: York's Certificates of Insurance. Funding Transfers for Payment of Claims York's claims management system has the ability to issue checks for payments. Our system integrates with most major banking institutions such as positive pay, positive pay payee, daily reconciliation of loss fund bank accounts, ACH electronic funds transfer, treasury management services, and more. Via EDI, York can establish an automated process that will send the data to a City designed bank and to the City Finance Department once it is setup. York has provided our banking procedures. Please see Attachment F: Banking Procedures Overview. 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If initial contact can not be completed by end of next business day the claim shall be documented as to the specific reasons why the contact could not be completed or was not necessary. Therefore, initial investigation contacts must be completed by end of next business day after adjuster notification. If 2 attempted contacts were unsuccessful, contact letter must be sent by the end of the next business day. Contact: Transferred File To meet or exceed expectations, the file should reflect that the insured, client, claimant, and vendors have been notified of change in adjuster. Use of reassignment template called "File transfer Contact letter" found in York Claims Expert is acceptable. Notice must be provided within 14 calendar days. CMRs Accurate and Timely: Claims Management Reviews (CMR) are to be completed by the 30th day if the loss is reported to the client/carrier. On claims that are not reported and fall within York's office authority a "CMR" must be completed by the 90th day of the file. The CMRs are also required when the indemnity reserve reaches the $50,000 level on all bodily injury &/or general liability property PD claims. Subsequent CMRs are to be completed every 90 days. The CMRs must be timely, thorough and accurately reflect current claim circumstances including any significant changes that have occurred since the previous review. The plan of action must be proactive and provide a rationale for claim resolution. The CMR should be grammatically correct with proper spelling and reflect a logical thought process. CMRS are not necessary when: • The client wishes their own form to be completed in lieu of the CMR • CMRs are not required on collision, comprehensive, med-pay, PIP/No Fault and third party auto PD losses unless they are reportable to the client/carrier. Reportables - Accurate and Timely: Claims may be reportable (to client, excess, carrier, etc) because of defined "triggers". Reports are to be sent within fourteen (14) calendar days of recognizing any reportable trigger and thereafter as specified by account instructions or those we are reporting to. Claims will meet expectations if the reporting is timely, complies with required format and contains information that accurately reflects changing claim circumstances. Failure to recognize reportable triggers, and/or send an initial report within 45 days of recognizing the trigger, will be considered unacceptable and will automatically result in failure of the entire File Management category. York PLUS Confidential and Proprietary York Risk Services Group — August 20, 2015 Accurate and Timely Communication: Appropriate action must be taken on all written communication (mail, email, fax, etc), including supervisory instructions, within 5 business days and a response to any telephonic communication or time sensitive correspondence is required by the end of the next business day. Responses are professional in both content and format. Reporting has complied with jurisdictional requirements in those states which require notification/reporting. Documentation of communication should be summarized, not copied and pasted into file notes. File Notes Timely and Appropriate: Best Practices require that documented activity is clear and made at regular intervals based on claim activity. Incoming documents are to be properly annotated in the claim within five business (5) days of receipt (time sensitive material by the end of the next business day). File notes should support when claim reviewed and reflect current plan of action. File notes should be clear, concise, properly categorized, and reflect changing claim dynamics. Proper grammar, and spelling, should be utilized. Acronyms and abbreviations should be limited. File notes should not be based on emotion or opinions but factually supported, nor any comments related to race, religion, etc that are not pertinent to the investigation. A clear rationale for decisions made that affect claim resolution should be evident. Effective Use of Hot List/Diary: Effective use of diary to monitor all case activity is an integral part of claim management. Adjusters are required to use diary to track and coordinate planned activity as well as acting on prioritized diary types. Diary should be set as facts warrant. At time of diary review, the Plan of Action items shall be updated and addressed, as appropriate. Therefore, diaries are completed/appropriate actions taken within 7 days of effective due date. Claims System Data Accurate and Timely/Proper Coding: Data integrity relies on up-to-date coding within the claim file. Coding should be complete and updated upon receipt of appropriate information. Proper coding includes but is not limited to: cause, coverage, litigation log, recovery tab, and loss description coding along with marking the third party deductible box. It is also imperative that the initial fields pertaining to Medicare (Social Security or HICN, Gender, DOB, First and Last Name) are completed timely and accurately on ALL Bodily Injury claims. Claims found "Medicare Eligible = YES" have appropriate subsequent coding completed in a timely and accurate manner, consistent with Best Practices. If the claim is not subject to Medicare reporting, the file must contain documentation as to why. Adherence to Special Account Instructions: Claim supports that special client specific account instructions were followed. This includes adherence to assignment requests, client instructions, and billing guidelines. Therefore, claim documentation reflects compliance with client specific instructions. Public Entity Compliance: Proper application of public entity claim filing requirements and defined liability dictated by applicable government code. This includes, but is not limited to claims filing, immunities, defense obligations for public employees, judgment offsets, risk transfer, etc. Application of the claim requirements and various defenses will help avoid exposure to the government entity, including increased monetary exposure. York PLUS Confidential and Proprietary York Risk Services Group — August 20, 2015 2 State Specific Compliance: Proper understanding and application of State laws and Department of Insurance regulations to meet our local obligations in each state is reflected in the file documentation. This includes, but is not limited to proper application of claim requirements and various defenses in the claim venue. Please refer to the California Fair Claims Settlement Practices Regulations. Coverage Timely and Accurate Verification: File contains evidence that a valid policy/MOC was in force and the date of loss was within policy period. File notes document how coverage was confirmed. A complete copy of policy is attached to the claim file. Applicable coverage details are documented in the claim. Coverage was confirmed within 7 days of receipt of loss. When confirmation within 7 days is not possible, file notes contain a clear explanation as to what is being done to confirm coverage. Where claim is subject to MOC, the examiner is responsible to identify any potential coverage issues and refer to management within 7 day of receipt of facts that indicate a coverage issue. All coverage issues and actions are to be clearly documented. When a claim is reassigned from one adjuster to another, the new adjuster must document in the file notes, within 7 days that coverage has been reviewed and enter a plan of action if there are any coverage issues. If the prior adjuster did not adequately document coverage, the new adjuster must document a detailed analysis. Coverage Investigation: Necessary investigation was done to determine that insured was a covered party/entity and all applicable endorsements were evaluated. All coverage issues are clarified and addressed. Coverage Correctly Analyzed and Applied: There is a clear and concise review of the policy and proper application to the facts of the loss and parties involved. Coverage is correctly evaluated and applied, or a plan is laid out as to what will be done to obtain missing information. Coverage Approvals: Coverage situations that require management or client approval show evidence that necessary authority was requested with timely follow up, and was obtained in a timely manner. Coverage Letters: All necessary letters, such as Reservation of Rights, denials, or tenders, were sent to applicable parties timely and contained requisite language. Preapproval was obtained and documented where required. Letters were sent certified where required by jurisdiction or client instructions. Letters state all pertinent information in a concise and accurate manner. York PLUS Confidential and Proprietary York Risk Services Group — August 20, 2015 Investigation Investigation Plan Timely and Appropriate: Investigation needed is explained in claim documentation and the Plan of Action (POA) clearly states how this will be achieved. All investigations should reflect plan of action as to the issues to be investigated; i.e. the appropriate individuals to be interviewed, and the information to be obtained (signed statements, personnel records, medical records/permits, contracts, tenders to/from third parties, etc.) The investigation required should reflect proactive attempts to complete in-house; or if warranted, referral to field investigation. If referral is necessary, approval is documented from the client. Therefore, all key issues are addressed in POA and POA is completed within 3 days. Investigation Thorough — Planned and Executed: The claim is documented as to the progress and results of the investigation per the plan of action and identifies further activity necessary. Investigation addresses all issues identified in the plan of action. Also, there is adherence to timelines set in POA/assignment instructions. SIU/Surveillance Utilized Appropriately: When investigation reveals factual discrepancies or "red flags" are identified, referral for an SIU and/or surveillance investigation is made. A budget is obtained and followed. SIU and/or surveillance investigation results are followed up timely and applied. When necessary, client approval is obtained and evident in the claim. The action should be initiated within 5 working days and the SIU investigation results are utilized appropriately. Statement was Timely and on Point: In those circumstances where need for a recorded or written statement is identified, the statement should be completed as soon as the need is identified. A recorded statement summary should reflect that mandated legal disclosures were made to the party being interviewed, the statement covers all pertinent issues raised by the claim, and the claim is documented as to what further issues need to be addressed. If not taken by the claim examiner, reason for additional assistance is documented. Appropriate Management of Field Services/Expense Control: Clear instructions were given with field assignments. There is evidence of follow up with and control of the vendor (York or external), and the work product submitted by the vendor has been thoroughly reviewed. All assignment issues were appropriately addressed. The vendor's service invoice was proper. Evaluation Timely and Appropriate Liability Analysis: Claim reflects a timely and accurate liability analysis. The elements of negligence are addressed and all pertinent statutes are discussed. Any liability defenses are also addressed. York PLUS Confidential and Proprietary York Risk Services Group — August 20, 2015 4 Timely Damage Verification and Analysis: All specials received have been verified and analyzed. This includes documentation that specials have been reviewed and any unrelated portions have been recognized. There is a clear plan of action to address any gaps in documentation and information received is properly summarized. Mitigating and Aggravating factors are addressed. Collateral Source/Liens Considered: All liens are documented and addressed in a timely matter, especially Medicare/Medicaid eligibility. Any potential collateral sources are addressed and if jurisdiction has a collateral source rule or lien requirements, they are explained. Exposure Analysis: The analysis of coverage, liability, and damages is combined in a clear evaluation of exposure. Reserves should reflect resulting analysis. For claims with a reserve over $25,000, a Reserve and Settlement Evaluation worksheet is required. When not required, the evaluation of damages must be clearly explained in claim notes. The exposure analysis is detailed and logical. It is supported by details from earlier evaluations and is utilized in establishing timely reserves. Reserving Section Timely Reserving of Exposure: Reserves were based on available facts and probable ultimate cost/exposure of the claim. Reserves will be re- evaluated and adjusted as material changes occur. Reserves should always be reviewed on adjuster and/or supervisor diary. Initial reserve will be established within the first five (5) days of receipt of the claim. Subsequent reserve changes are to be adjusted within 14 days upon receipt of material changes. Any deviation is documented in the claim file. Evidence of stair stepping reserves to cover payments is considered unacceptable. Reserve Rationale: A reserve worksheet shall be completed on all files where a CMR is required. When a CMR is not required, documentation in the file notes must clearly justify the amounts for both indemnity and expense reserves. Documentation is clear and accurate and justifies amounts held in reserve for probable ultimate cost/exposure. Negotiation Negotiation Plan Timely and Appropriate: There is evidence that a negotiation plan is in place, supported by the exposure analysis. Negotiations are the responsibility of the adjuster. Any delegation must be clearly documented. If no current plan is in place, notes explain what is necessary to develop it. The negotiation plan is being followed and when circumstances warrant, the plan is adapted to address any changes. Authority is obtained where necessary. York PLUS Confidential and Proprietary York Risk Services Group — August 20, 2015 Timely Initiation of Negotiations: Claim indicates that negotiations are initiated and responded to timely. This includes making offers, responding to demands, addressing counteroffers, etc. Negotiations may be initiated before all damages are documented as long as the negotiations are based only on documentation that have been analyzed and confirmed. Proper Documentation of Settlement Demands and Offers: Claim documents what demands and offers have been made — when, by whom, and what was done as a result. When case is settled, proper documentation is attached. Settlement process is done timely. Case Negotiated Effectively and Within Authority: Claim demonstrates that negotiation plan was followed. Any authority required to settle case was obtained timely and settlement was within authority. Litigation Appropriate litigation referral: Lawsuit is reviewed for coverage issues. Such issues are identified and addressed before referral to defense counsel. Before referral, settlement and/or stipulation was considered. Claim documentation identifies the need for litigation referral. Litigation is assigned to approved counsel. Written referral to counsel includes clear instructions is completed within 5 working days and includes vendor referral letter (York Claims Expert template) advising client will be responsible for payment of service invoices. Litigation log is complete. Appropriate Documentation of Defense Strategy and Budget: Once counsel has been assigned, claim should reflect that adjuster discussed claim with counsel and agreed on litigation strategy. The adjuster will oversee counsel's litigation reporting to ensure that counsel complies with the agreed plan and stays within the submitted budget. Discussions are evident with defense counsel and reports are received timely or the claim supports efforts to obtain the report. Claim reflects appropriate evaluation and summary of agreed strategy and budget. On-going Direction from Adjuster to Defense Counsel: The claim file will reflect that there is proactive communication with defense counsel on development of a viable litigation strategy to resolve the claim. There is confirmation that the agreed strategy is followed and effectively implemented. If not, has client been advised? Legal Bills Reviewed for Accuracy and Appropriateness: Upon receipt of billing invoices, the claim should reflect that the adjuster has reviewed them for accuracy, client guidelines, excessive and/or duplicative billing, and compliance with budget plan. Appropriate corrective action has been taken with counsel when billing inconsistencies are discovered. The claim documents that the bills were reviewed within 5 days of receipt. Inconsistencies are addressed with counsel. York PLUS Confidential and Proprietary York Risk Services Group — August 20, 2015 Litigation Date Management: The claim should contain documentation that all upcoming mediations, arbitrations, hearings, and trial dates have been addressed. If needed, client authority and notification is documented in the claim file. Recovery Contribution Potential Identified and Pursued: The claim documentation shall reflect that potential contribution (incl. other coverage, excess, reinsurance, etc) has been identified and responsible parties placed on notice of their exposure. Claim documentation will state the percentage of allocation and reflect aggressive pursuit for contribution. Subrogation Potential Recognized and Pursued*: All potential third parties and their potential insurance is identified, put on notice at first knowledge, and pursued within the statute of limitations. Claim documentation will reflect aggressive pursuit. Recovery tab is completed. Timely Reporting of Recovery Potential to Specialist: The claim is referred within five (5) days of sending notice to any potential third party, to the appropriate specialist. Salvage Properly Handled and Identified: Salvage is identified and plans to address its disposal are clear. Effort to leave salvage with owner and apply credit is attempted. If vendor is used for disposal, claim indicates location of salvage, plans for disposal, and any associated costs. Recovery of Third Party Deductibles pursued: There is evidence in the claim as to whether a third party deductible applies. Necessary and timely (5 days) notification was sent so that deductible could be recovered. In cases where adjuster is required to make recovery, there is evidence that the deductible was recovered and processed appropriately. Supervision 1. Did the Supervisor review and provide initial direction when appropriate? • Was initial file direction given when necessary? Was it file specific or generic? • If issues were apparent initially that called for specific instructions, were they given? • Given the complexity of the case and the experience level of the claim professional, if guidance was needed, was it provided? York PLUS Confidential and Proprietary York Risk Services Group — August 20, 2015 2. Was appropriate follow-up guidance provided? • Given the complexity of the case and the experience level of the claim professional, if guidance was needed, was it provided? • Notwithstanding case complexity and the experience level of the claim professional, did the direction and progress of the claim warrant Supervisor intervention? • Did the direction provided address outstanding issues and/or any deficiencies in the file? This would include a review of the adjusters reserving practices and rationale. • Did supervisor approve necessary reports, reserve changes forms etc. • Was the frequency of direction appropriate based on the needs of the file? 3. Is there evidence of effective supervision? • If appropriate direction was provided but not responded to by the adjuster, is there evidence of the Supervisor taking appropriate action to follow-up and assure compliance over and above a repeat of the original request? Such actions could be discussing the issue with the adjuster, providing training or counseling reference the missed issue etc. (Note it is not appropriate to document adjuster performance improvement plans or HR issues in the claim file, however the claim file must show that the supervisor coordinated action on the file if the adjuster is not responsive to supervisory notes.) York PLUS Confidential and Proprietary York Risk Services Group — August 20, 2015 '0000� YORK Risk Services Group York PLUS BEST PRACTICE GUIDELINES# PROPERTY CLAIMS Confidential and Proprietary York Risk Services Group — September 2015 File Management/Reporting Initial Contact: To meet and/or exceed expectations, the claim should reflect that the insured (or their representative) have been contacted by end of next business day (from date of adjuster's receipt). The contact person to whom the adjuster spoke should be identified and information obtained from each contact thoroughly documented. Sufficient information must be documented in the claim file to determine what issues are present that are relevant. If initial contact cannot be completed by end of next business day, the claim shall be documented as to the specific reason(s) why the contact could not be completed or was not necessary. If 2 attempted contacts were unsuccessful, contact letter must be sent by the end of the next business day. Contact: Transferred File(s): To meet or exceed expectations, the file should reflect that the insured, client, claimant, and vendors have been notified of change in adjuster. Use of reassignment template called "File Transfer Contact Letter" found in York Claims Expert is acceptable. Notice must be provided within 14 calendar days. Take over files (TRIAGE): Same rules apply to Transferred Files. CIVIR's Accurate and Timely: Best Practices require that the first Claims Management Review (status report for non -York Claims Expert claims) be completed within thirty (30) days of the claim being reported and updated every 30 days. Acceptable deviations from these timeframes must be documented in the Client Instructions. To meet expectations, the CMR's should be timely, thorough, and accurately reflect current claim circumstances including any significant changes that have occurred since the previous review. The plan of action should be proactive and provide a rationale for the claim resolution. The CMR should be grammatically correct with proper spelling, and reflect a logical thought process so that anyone can have a clear understanding of the claim from the current CMR. Reportables - Accurate and Timely: Claims may be reportable (to client, excess, carrier, etc) because of defined "triggers". Reports are to be completed and sent within thirty (30) calendar days of recognizing any reportable trigger and every thirty (30) days thereafter or as specified by account instructions or those we are reporting to. Claims will meet expectations if the reporting is timely, complies with required format and contains information that accurately reflects changing claim circumstances. Failure to recognize reportable triggers, and/or send an initial report within 30 days of recognizing the trigger, will be considered unacceptable and will automatically result in failure of the entire File Management category. Accurate and Timely Communication: Appropriate action must be taken on all written communication (mail, email, fax, etc), including supervisory instructions, within 5 business days and a response to any telephonic communication or time sensitive correspondence is required by the end of the next business day. York PLUS Confidential and Proprietary York Risk Services Group — September 2015 Responses are professional in both content and format. Reporting has complied with jurisdictional requirements in those states which require notification/reporting. Documentation of communication should be summarized, not copied and pasted into file notes. File Notes Timely and Appropriate: Best Practices require that documented activity is clear and made at regular intervals based on claim activity. Incoming documents are to be properly annotated in the claim within five business (5) days of receipt (time sensitive material by the end of the next business day). File notes should support when claim reviewed and reflect current plan of action. File notes should be clear, concise, properly categorized, and reflect changing claim dynamics. Proper grammar and spelling should be utilized. Acronyms and abbreviations should be limited. File notes should not be based on emotion or opinions but factually supported, nor any comments related to race, religion, etc. that are not pertinent to the investigation. A clear rationale for decisions made that affect claim resolution should be evident. Effective Use of Hot List/Diary: Effective use of diary to monitor all case activity is an integral part of claim management. Adjusters are required to use diary to track and coordinate planned activity as well as acting on prioritized diary types. Diary should be set as facts warrant. At time of diary review, the Plan of Action items shall be updated and addressed, as appropriate. Therefore, diaries are completed and appropriate actions taken within 7 days of effective due date. Claims System Data Accurate and Timely/Proper Coding: Data integrity relies on up-to-date coding within the claim file. Coding should be complete and updated upon receipt of appropriate information. Proper coding includes but is not limited to: cause, coverage, litigation log, recovery tab, and loss description coding. All required fields are completed. Payment coding must also be accurate and consistent. Adherence to Special Account Instructions: Claim supports that special client specific account instructions were followed. This includes adherence to assignment requests, client instructions, and billing guidelines. State Specific Compliance: Proper understanding and application of State laws and Department of Insurance regulations to meet our local obligations in each state is reflected in the file documentation. This includes, but is not limited to proper application of claim requirements and various defenses in the claim venue. Please refer to the California Fair Claims Settlement Practices Regulations. Coverage Timely and Accurate Verification: Evidence in claim that policy was confirmed as active, as well as date of loss was within policy period. Claim documents how coverage was confirmed and a copy of pertinent policy forms are in the file. York PLUS Confidential and Proprietary York Risk Services Group — September 2015 2 Applicable policy details, including relevant limits and presence of coinsurance, are documented. Coverage was confirmed timely. When not possible, clear explanation is given as to what is being done to confirm coverage. Coverage Investigation: Necessary investigation was done to determine that party filing the claim was "an insured", has an insurable interest, and all applicable endorsements were evaluated. Any coverage issues are clarified and addressed. Coverage Correctly Analyzed and Applied: There is a clear and concise review of the policy and proper application to the facts of the loss and parties involved. Coverage is correctly evaluated and applied, or a plan is laid out as to what will be done to obtain missing information. Coverage Approvals: Coverage situations that require management or client approval show evidence that necessary authority was requested with timely follow up, and was obtained in a timely manner. Coverage Documents: All necessary documents, such as Reservation of Rights, denials, or non -waivers, were sent to applicable parties timely and contained requisite language. Preapproval was obtained and documented where required. Letters were sent certified where required by jurisdiction or client instructions. Documents state all pertinent information in a concise and accurate manner. Letters were sent timely and per guidelines. Investigation Investigation Plan Timely and Appropriate: Investigation needed is explained in claim documentation and the Plan of Action (POA) clearly states how this will be achieved. All investigations should reflect plan of action as to the issues to be investigated; i.e. the appropriate individuals to be interviewed, and the information to be obtained. The investigation required should reflect proactive attempts to complete in-house; or if warranted, referral to a field investigator. If referral is necessary, approval is documented from the client. All key issues are addressed in POA and POA is updated within 3 days of issue identification. Take over files (TRIAGED): 1-10 files: Same rules apply as outlined in "Investigation Plan Timely and Appropriate". 11-30 files: All key issues are addressed in POA and POA is completed within 20 days. 31-50 files: All key issues are addressed in POA and POA is completed within 30 days. 51 files or more: All key issues are addressed in POA and POA is completed within 45 days. York PLUS Confidential and Proprietary York Risk Services Group — September 2015 Investigation Thorough — Planned and Executed: The claim is documented as to the progress and results of the investigation per the plan of action and identifies further activity necessary. Investigation addresses all issues identified in the plan of action. Aggressive action is taken to drive investigation to completion. Adherence to timelines set in POA/assignment instructions is evident. SIU Utilized Appropriately: When investigation reveals factual discrepancies or "red flags" are identified, referral for an SIU and/or surveillance investigation is made. A budget is obtained and followed. SIU and/or surveillance investigation results are followed up timely and applied. When necessary, client approval is obtained and evident in the claim. Action initiated within 5 working days. 51U investigation results utilized appropriately. Statement(s) Timely and on Point: Necessary statements should be completed and summarized as soon as possible. The statement summary should reflect that mandated legal disclosures were made to the party being reviewed and covers all pertinent issues. If not taken by the adjuster, a reason for additional assistance is documented. A thorough statement is completed timely, addresses relevant issues, and contains pertinent details. A summary is attached. Appropriate Management of Field Services/Experts: When field assistance or experts are necessary, there are clear instructions for the requested services. There is evidence of follow up with and control of the vendor (York or external), and the work product submitted by the vendor has been thoroughly reviewed. All assignment issues were appropriately addressed. The vendor's service invoice was proper. Documentation Detailed Scope Obtained and Analyzed: File contains a detailed scope of damages which includes accurate quantities, measurements, material quality, and description of damaged property. Operations are described and lump sums are only used where appropriate. Other portions of loss such as business interruption or extra expense are detailed. There is evidence that scope was agreed upon, and with whom. Appropriate Pricing Applied to Scope: Estimate includes proper use of unit costs, debris removal, overhead and profit, sales tax, etc. Any deviation from standard pricing is explained. Estimate is complete, and any price deviations are explained. ITV Determined/Coinsurance Properly Applied: Claim contains complete and accurate replacement cost and actual cash value calculations for the risk. Values are properly applied to the loss per policy conditions, and any reductions are fully explained. York PLUS 4 Confidential and Proprietary York Risk Services Group — September 2015 Proper Determination of ACV: The Actual Cash Value (ACV) determination and methodology used are evident. ACV methodology is applied by line item or category, but not as a lump amount for the claim. Where ACV is not applicable, the reason is clearly explained. Adequate Loss Support (i.e. photos, receipts, etc.): The file contains documents which support the estimate. The notes confirm that the presented documentation has been analyzed and verified and is adequate to validate the claim. Reserving Timely Reserving of Exposure: Reserves were based on available facts and probable ultimate cost/exposure of the claim. Reserves will be re-evaluated and adjusted as material changes occur. Reserves should always be reviewed on adjuster and/or supervisor diary. Initial reserve will be established within the first five (5) days of receipt of the claim. Subsequent reserve changes are to be adjusted within 14 days upon receipt of material changes. Any deviation is documented in the claim file. Evidence of stair stepping reserves to cover payments is considered unacceptable. Reserve Rationale: Documentation in the file notes and/or CMR must clearly justify the amounts for the indemnity and expense reserves; based on current evaluation of coverage and damages. Settlement Accurate and Timely Adjustment: There is evidence that a timely adjustment was proposed to the insured or their representative. If the proposed adjustment is not accepted, notes outline a plan of action to resolve remaining issues. Partial payments or payment of undisputed damages shall be considered when appropriate. All supplements, or recoverable depreciation, are paid timely and per policy provisions. Inspections performed when necessary. Policy Conditions Properly Applied: The file clearly indicates that all applicable policy conditions have been applied. These conditions include coinsurance, depreciation, limits and sub -limits. Insurable Interests/Liens Addressed: All known insurable interests/liens are identified, protected and addressed in a timely matter. Reasonable efforts made to identify all existing insurable interests/liens. York PLUS Confidential and Proprietary York Risk Services Group — September 2015 Proper Settlement Authorization Obtained: Authority required to settle the claim was obtained timely and settlement was within adjuster's and York's authority. Authority and settlement plan are documented. Accurate and Proper Settlement Documents: Settlement documents properly completed and executed. Unsolicited, inaccurate, incomplete or altered settlement documents have been appropriately addressed. Settlement documents may include Proofs of Loss, Policyholder's Release and Replacement Cost Agreement. Accurate and Timely Payments: Once valid documentation is received, payment is issued/requested within statutory and/or client guidelines. Payment includes proper settlement amount, language, payee and description. Dispute Resolution Appropriate Referral: Demand for appraisal/lawsuit is reviewed and any issues identified are addressed before referral to appropriate party, and reported to the carrier where necessary. Before referral, settlement was attempted. The claim documentation reflects and identifies the need for referral and is assigned appropriately. Written referral with clear instructions is completed within 5 working days. Litigation Log is utilized. Appropriate Documentation of Defense Strategy and Budget: Once appropriate party has been assigned, claim should reflect that adjuster discussed claim with defense and agreed on strategy. The adjuster will oversee reporting to ensure that defense complies with the agreed plan and stay within the submitted budget, when applicable. Ongoing Direction from Adjuster to Defense: The claim file will reflect that there is proactive communication with defense on development of a viable strategy to resolve the claim, within client guidelines. There is confirmation that the agreed strategy is followed and effectively implemented. If not, client has been advised. Legal Bills Reviewed for Accuracy and Appropriateness: Upon receipt of billing invoices, the claim should reflect that the adjuster has reviewed them for accuracy, client guidelines, excessive and/or duplicative billing, and compliance with budget plan within 5 days of receipt. Appropriate corrective action has been taken when billing inconsistencies are discovered. York PLUS Confidential and Proprietary York Risk Services Group — September 2015 6 Legal Date Management: The claim should contain documentation that all upcoming mediations, settlement conferences, arbitrations, hearings, and trial dates have been addressed. If needed, proper authority and notification is documented in the claim file. All dates are documented, addressed, and reported to client as required. Recovery Contribution Potential Identified and Pursued: The claim documentation shall reflect that potential contribution (including other insurance, reinsurance, excess, etc.) has been identified and contributing parties placed on notice. Claim documentation will address basis for contribution and reflect aggressive pursuit. Subrogation Potential Recognized and Pursued: All potential third parties and their potential insurance are identified, put on notice at first knowledge, and pursued within the statute of limitations. Claim documentation will reflect aggressive pursuit. Recovery tab is completed. Timely Reporting of Recovery Potential to Specialist: The claim is referred within five (5) days of sending notice to any potential third party, to the appropriate specialist. Salvage Properly Handled and Identified: Salvage is identified and plans to address its disposal are clear. Efforts to leave salvage with owner (and apply credit) are attempted. If vendor is used for disposal, claim indicates location of salvage, plans for disposal, and management of any associated costs. Proper Disbursement of Recovery: Whenever recovery is obtained, any portion owed to the insured is properly calculated and disbursed timely. Relevant statutes are explained in the file. Supervision 1. Did the Supervisor review and provide initial direction when appropriate? • Was initial file direction given when necessary? Was it file specific or generic? • If issues were apparent initially that called for specific instructions, were they given? • Given the complexity of the case and the experience level of the claim professional, if guidance was needed, was it provided? York PLUS Confidential and Proprietary York Risk Services Group — September 2015 2. Was appropriate follow-up guidance provided? • Given the complexity of the case and the experience level of the adjuster, if guidance was needed, was it provided? • Notwithstanding case complexity and the experience level of the adjuster, did the direction and progress of the claim warrant Supervisor intervention? 3. Is there evidence of effective supervision? • If appropriate direction was provided but not responded to by the adjuster, is there evidence of the Supervisor taking appropriate action to follow-up and assure compliance over and above a repeat of the original request? Such actions could be discussing the issue with the adjuster, providing training or counseling reference the missed issue etc. (Note it is not appropriate to document adjuster performance improvement plans or HR issues in the claim file, however the claim file must show that the supervisor coordinated action on the file if the adjuster is not responsive to supervisory notes.) • Did the direction provided address outstanding issues and/or any deficiencies in the file? This would include a review of the adjuster's reserving practices and rationale. • Did supervisor approve necessary reports, reserve changes forms etc.? • Was the frequency of direction appropriate based on the needs of the file? York PLUS Confidential and Proprietary York Risk Services Group — September 2015 'Lubbock ILMI Attachment B: York Principals 46 July 8, 2016 1100, YO R K YORK RISK SERVICES GROUP, INC. New York Corporation Director: Richard H. Taketa Officers: Richard H. Taketa, Chairman, Chief Executive Officer and President Saswata Mukhedee, Executive Vice President, Chief Financial Officer, Treasurer E. Harry Creasey, Executive Vice President, Chief Operating Officer, Commercial Businesses Michael Lindberg, Executive Vice President Douglas J. Markham, Executive Vice President Daniel Miller, Executive Vice President Patrick J. Walsh, Executive Vice President Michael Krawitz, Senior Vice President, Secretary John Bannon, Senior Vice President Peter Bellisano Jr., Senior Vice President Larry Brinton, Senior Vice President John Brockschmidt, Senior Vice President Christopher Brown, Senior Vice President - Controller BJ (William) Dougherty, Senior Vice President Dennis Duchene, Senior Vice President Francis Fey, Senior Vice President Scott Gaffner, Senior Vice President Lucy Ann Galioto, Senior Vice President Mundy Hebert, Senior Vice President William Hughes, Senior Vice President Carolyn Kho, Senior Vice President David Jamison, Senior Vice President Mark Kissick, Senior Vice President Debra Levy, Senior Vice President Carol Montgomery, Senior Vice President Christopher Moosher, Senior Vice President Jody Moses, Senior Vice President Curt Neel, Senior Vice President Lisa Oskoui, Senior Vice President Randy Paez, Senior Vice President David Panico, Senior Vice President John Paolacci, Senior Vice President Richard Pappa, Senior Vice President Jon Pease, Senior Vice President Pamela Ochs-Piasecki, Senior Vice President Steven Rodriguez, Senior Vice President Donald Sams, Senior Vice President Eric Siegmund, Senior Vice President Richard Stasi, Senior Vice President James Stanilious, Senior Vice President Jeffrey L. Steiner, Senior Vice President George Suder, Senior Vice President Randy Thornton, Senior Vice President Vince Trimarchi, Senior Vice President William R. Vener, Senior Vice President Rodney Winkler, Senior Vice President rL.bUock Attachment C: Staff Resumes 47 July 8, 2016 YORK i YORK. Susan Mullins - Account Executive 10535 Boyer Boulevard, Suite 100 Austin, TX 78758 T: (512) 427-2381 Email: Susan.mullins@yorkrsg.com Industry Experience: 35 years Overview: Account Executive well -versed in acquiring and retaining top accounts. Areas of emphasis include implementation of new accounts and services, project management as well as global solutions. Cultivates and maintains strong customer relationships. Thoroughly understands client preferences and needs, and effectively participates sales teams to optimize customer satisfaction and increase new client base. Accomplishments: Developed Client Profile Tool for Account Executives to manage contract compliance Project Leader for development of a 504 Physician Panel Represented Account Management in company -wide claims system migration Developed the transition and implementation templates used for new accounts or services Developed Performance Metrics template and measurements for compliance of TDI- DWC Rules and Regulations Education: Criminal Justice, Austin Community College - Austin, Texas, USA Type 08 Adjuster License, Texas Department of Insurance Business Administration West Virginia State College - Institute, West Virginia, USA Certifications: • Registered Nurse (BSN, RN), Texas Board of Nursing, February 1985 —June 2013 • Certified Professional Coder — Hospital, American Academy of Professional Coders • February 1999 —April 2004 • Licensed Adjuster - Workers' Compensation, Texas Department of Insurance, 1998— 2004 Previous Work History: In December of 2011, York Risk Services Group, Inc. acquired A Companies. Account Executive, JI Companies - Austin, TX May 1989 to Current • Held various positions with the company including Indemnity Adjuster, Team Leader, Claims Supervisor and since 2008 Account Executive • Handled Lost Time Claims • Represented clients at Benefit Review Conferences • Participated in all claims system upgrades including configuration development Managed numerous projects involving various departments Claims Adjuster, Royal Insurance - Austin, TX Jan 1989 to May 1989 • Handled Lost Time Claims for Texas clients Obtained recorded statements for claims investigation Industrial Accident Board representative for Royal Insurance Claims Adjuster GAB - Austin, TX Jan 1988 to Dec 1988 Handled Lost Time Claims for Coca-Cola Corporation with operations in Texas Investigated claims including recorded statements Attended Pre -Hearing Conferences as employer representative Claims Adjuster, Employers Service Corporation - Charleston, WV Jun 1980 to Oct 1987 • Investigated any potentially fraudulent claims with a focus on thoroughness, quality and cost control. • Investigated claims, conducted field audits, determined losses and reported findings. • Interviewed claimants, medical specialists and employers to determine pertinent claim information. • Handled occupational disease claims including hearing loss and black lung/asbestos and attended Administrative Hearings as the employer representative i YORK. Susan Courtney - Manager Service with York: 1 year Overview: Susan Courtney joined York Field Services in 2015 as an Assistant Vice President in Texas and Oklahoma. Susan graduated from University of North Texas with a Bachelor's degree in Human Resources Management. She started her insurance career as an inside adjuster for Allstate Insurance, working theft and lightning claims for Texas. Susan has worked as an adjuster and claims manager on over 5,000 claims across the United States for multiple clients. She has a comprehensive background as a claims adjuster/manager having worked/supervised daily, catastrophe (hurricanes, hailstorms, tornados and fires), liability, and large loss claims. She has used the following estimating platforms: Xacitimate, Symbility, MSB and Simsol. She enjoys spending time with her twin boys, playing and watching sports, fishing, and enjoys being outside and active. Susan is located in the DFW area and services Texas and Oklahoma. Formal Education: • University of North Texas, Bachelor of Science Degree Licenses in States: • All Lines / General Adjuster: TX • Property and Casualty (Excl WC): OK Responsibilities include: . Oversight of claim unit operation • Ongoing interaction with supervisors and adjusters to ensure: • Superior work product • Training and development opportunities are identified and met • File reviews for: • Accurate technical handling • Compliance with customer account instructions Business Experience: • Commercial Property • Commercial Property: Church Properties • Commercial Property: Condominium, Townhouse, Apartment • Commercial Property: Damage • Commercial Property: Hotel & Resort Properties • Commercial Property: Product Liability • General Liability: Builders Risk • General Liability: Construction Defect • General Liability: Country Clubs/Golf Courses • General Liability: Product Liability • General Liability: Property Damage • Personal Lines Property • Product Liability • Professional Liability Commercial Property: Restaurants • Recovery Languages: • English • Spanish i YORK, On -Site Field Liability Adjuster - Sample Resume General Summary To investigate, evaluate, negotiate and resolve claims within assigned authority in accordance with departmental performance standards. Qualifications • Holds a professional degree, or equivalent experience and training • More than two years of adjusting experience to include first and third party claims • Experience in litigation management practices. AIC or similar professional designation desired. • Proficient in MS Office applications. Good written and oral communication skills. Responsibilities: • Investigates, analyzes, negotiates and settles claims. • Determines whether or not proper coverage exists for the type of claim assigned by Manager or Supervisor. • Investigates thoroughly to obtain all relevant facts concerning all aspects of the claim, including liability where appropriate. • Makes contact with all insureds, witnesses and third party claimants and/or their legal representatives. • Determines whether field assistance is needed and assigns investigation as needed. • Determines the value of the damages/injuries being presented and obtains all necessary documentation to support that evaluation. • Establishes and reviews proper reserves for each claim based upon thorough investigation, evaluation, and past experience. • Monitors ongoing medical treatment or other ongoing procedures for appropriateness; negotiates timely and appropriate settlements with authority. Refers claims exceeding authority to manager or supervisor with recommendations. • Files appropriate reports so that the Claims Manager or Supervisor is advised at all times of the current status of the claim. • Within authority, negotiates the settlement of claims with insureds, claimants, vendors, attorneys, and other insurance companies. • Maintains effective and ongoing communications with all insureds, claimants, agents, attorneys and other insurance companies; representatives, vendors, and company personnel. • Performs other duties as assigned. i YORK Jennifer Sims - Client Implementation Manager Industry Experience: 20 years Formal Education: • Attended The Ohio State University, Liberal Arts concentration • Multiple seminars and in-house training sessions • Participated in two leadership training pilot programs • Attended national leadership conference offered through CompManagement, Inc. /Sedgwick CMS Responsibilities include: • Coordinate implementations and exits to ensure a smooth transition for clients • Provide consulting and project management services Previous Work History: • Compensation Consultants (July 2008 —December 2008) Independent Contractor — provided consulting and project management services; duties included creation of training and reference materials for both internal and customer use, claims quality assurance reviews and departmental structure and process review. • CompManagement, Inc., a Sedgwick CMS Company (March 1997—January 2008) Client Services Manager (5 years) — supervised a 12 -person team serving in customer service and quality assurance roles for State Fund workers' compensation clients in three jurisdictions; duties included all aspects of departmental planning, oversight and staffing, workflow assessment, customer satisfaction surveys and evaluation, systems development and enhancement, quality assurance project management. Senior Account Manager (3 years) — served as assistant manager in the OH State Fund workers' compensation claims department. Department consisted of 36 team members and duties included interviewing, creating and presenting training and related materials, participating in client or prospect presentations, assisting in developing a new claims system, and managing claims for several major accounts. Account Manager (2 years) — served compensation claims contact for Sate region. as team lead and primary workers' Fund clients in the southwestern OH • Harrington Benefit Services (March 1991 — December 1996) State Fund Supervisor — supervised a team of 7 people in the OH State Fund workers' compensation claims department. Significant Accomplishments/Areas of Expertise: • Account Management • Experienced claims adjuster • Hearing representative (OH) • Ohio Managed Care Operations • Strong organizational and problem -solving skills Attachment D: York's Certificates of Insurance gLubbock ,,,1 48 July 8, 2016 1000, YORK �® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDI"M 1213012015 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsementlsl_ PRODUCER I.NIALJ MARSH USA, INC. N 445 SOUTH STREET FM pAX MORRISTOWN, NJ 07960-6454 E " Arc No l Attn: MOrd$kM.Cedrequest@marsh.com Fax 212-948 0979 DDS INSURE S AFFORDINGCOVERAGE NAICq 123456—GAWUC45.16 INSURER A: Zurich American Insurance Co 16535 INSURED Onex York Holdings Corp. INSURERS ; American Guarantee & Liability Ins Co 9247 and Its Subsidiaries INSURER C : Chubb Insurance Company of NJ 41386 1 Upper Pond Road INSURER D BuldkV F, 4th Floc Parsippany, NJ 07054 INSURER E: INSURER F COVERAGES CERTIFICATE NUMRFR' Myr 076911am-Ie - — -- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED nLm Vio1V1`I RUIeICICK: 17 NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED TO WHICH THIS HEREIN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IS SUBJECT TO ALL THE TERMS, INSR S B POLICY EFF POLICY EXP TR TYPE OF INSURANCE WVDPOLICY NUMBER MMIDDNYYYI (MMIDDNYrn LIMITS A X COMMERCIAL GENERAL LIABILITY CPO 5820234-02 12/1512015 12/15/2016EACH CLAIMS MADE a OCCUR OCCURRENCE D S 1,000,000 PRE S Ea oa nce 9 1,000,000 MED EXP (Any one person) $ 5,000 PERSONALS ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY ❑ jECT � LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG S 2,000,000 OTHER: S A AUTOMOBILE LIABILITY BAP 5820233-02 12115/2015 12/15/2016 MIT $ X EOeacMBINEDISINGLE 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS PROP R DAMAGE $ S B X UMBRELLA LIAR X OCCUR AUC 4900329.02 12/1512015 12/1512016 EACH OCCURRENCE i 10,000,000 EXCESS L1Ae CLAIMS -MADE AGGREGATE S 10,000,000 DED RETENTIONS $ A WORKERS COMPENSATION WC 5820235.02 1211512015 12/1512016 X PER oTH- AND EMPLOYERS' LIABILITY YIN STAT ANY MEEX�ECITVE OFFICER/MER EXCLUDED? FN7 NIA E.L. EACH ACCIDENT S 11000,000 E.L. DISEASE - EA EMPLOYE S 11000,000 (Mandatory N NH) DESLtRIPT�10 OF OPERATIONS beknv E.L DISEASE - POLICY LIMIT 1 $ 1,000,000 C CRIME OOD-5714 06130/2015 06/30/2016 LIMIT 5,000,000 DEDUCTIBLE 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Evidence Only I+Gr%I Ir11.,l11 C KULUCK CANCELLATION Onex York Holdings Carp. and Its Subsidiaries 99 Cherry H II Road Suite 102 Parsippany, NJ 07054-1102 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE of Manch USA Inc. Maneshi Mukherjee �tx:Luool.: ®19all-20141 ACORD CORPORATION. All rights reserved. AC RO V AGENCY MARSH USA, INC. POLICY NUMBER CARRIER AGENCY CUSTOMER ID: 123456 Loc #: Morristown ADDITIONAL REMARKS SCHEDULE NAMED INSURED Onex York Holdings Corp and ils Subsiftes 1 Upper Pond Road Building F, 4th Floor NAIC CODE Parsippany, NJ 07054 EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance NAMEDINSUREDS: ADIN HEALTHCARE, INC. ALAMED HOLDINGS, INC ARIC OF MISSISSIPPI, INC. ARROWOOD INVESTMENT GROUP, LLC ATLANTIC GATEWAY INTERNATIONAL (SAC) LTD. ATTENTA SERVICES, LLC AXIS (EASTERN CARIBBEAN) LIMITED AXIS (JAMAICA) LIMITED AXIS DE ARGENTINA SA. AXIS INTERNATIONAL SERVICES LTD BICKMORE BROWN REHABILITATION MANAGEMENT, INC. CAREWORKS LTD. CAREWORKS OF OHIO LTD, CAREWORKS TECHNOLOGIES LTD. CAREWORKS USA LTD. CCI INVESTMENTS, LLC CCO, INC. CMI, A YORK RISK SERVICES COMPANY INC. DONALD K. SAMS h ASSOCIATES, INC F.A. RICHARD & ASSOCIATES, INC. FARA ADJUSTING SERVICES, INC FARA BENEFIT SERVICES, INC. FARA BUSINESS SERVICES, INC. FARA GENERAL AGENCY, INC. FARA SECURITY SERVICES, INC. FOX HILL HOLDINGS, INC. FRANK GATES (BERMUDA) LTD. FRANK GATES ACCLAIM, INC. FRANK GATES ALTERNATIVE RISK, LLC FRANK GATES OF NEW YORK INC. G2 TECHNOLOGIES, INC. INTEGRATED RISK MANAGEMENT, INC JI SPECIAL RISKS INSURANCE AGENCY, INC A SPECIALTY SERVICES, INC. JOSEPH IVY FINANCIAL GROUP, INC. NATIONAL EMPLOYERS NETWORK AWANCE, INC, NEXUS ASSET ACOUISITION CO. OHP, INC. OMAC AGENCY, INC. ONEX YORK FINANCE LLC ONEX YORK FINANCE LP ONEX YORK MID CORP. PERSI, LLC PUSUC ENTITY RISK SERVICES OF ILLINOIS, LLC PUBLIC ENTITY RISK SERVICES OF OHIO, INC. Page 2 Of 3 AL:UKD 101 (2008/01) _ _ ___ ® 2008 ACORD CORPORATION. All rights reserved, AGENCY MARSH USA, INC POLICY NUMBER CARRIER AGENCY CUSTOMER ID: 123456 LOC #: Morristown ADDITIONAL REMARKS SCHEDULE Page 3 of 3 NAIC CODE NAMED INSURED Onex York Holdings Corp. and Its Subsidadas 1 Upper Pond Road Building F, 4th Floor Parsippany, NJ 07054 EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: _Certificate of Liability Insurance RISK CONTROL 360, LLC RISK MANAGEMENT SOLUTIONS, INC RISKCONTROL SERVICES, LLC RMS ACQUISITION, INC. ROCKPORT COMMUNITY NETWORK, INC. SAMS & ASSOCIATES, INC, SAMS INVESTIGATIONS UNLIMITED, INC. THE FRANK GATES COMPANIES, INC. THE FRANK GATES SERVICE COMPANY THE FRANK GATES SERVICE COMPANY INTEGRATED MANAGED CARE HEALTH PLAN, INC. THE RISK MANAGEMENT PLANNING GROUP, INC. VANTAGE HEALTH PLAN, INC. VISUAL RISK SOLUTIONS, INC. VOCWORKS LTD. WELLCOMP MANAGED CARE SERVICES, INC. YORK INSURANCE ACQUISITION, LLC YORK INSURANCE HOLDINGS, INC, YORK INSURANCE PARENT CORP. YORK INSURANCE SERVICES GROUP, INC. - CALIFORNIA YORK PRO, INC. YORK RISK CONTROL SERVICES, LLC YORK RISK POOLING SERVICES, INC. YORK RISK SERVICES GROUP INTERNATIONAL HOLDINGS, LTD. YORK RISK SERVICES GROUP, INC. YORK RISK SERVICES GROUP, INC. - FLORIDA YORK RISK SERVICES HOLDING CORP. YORK RISK SERVICES ORGANIZATION, INC. YORK RSG (INTL) COLOMBIA SAS YORK RSG (INTL) LTD. YORK RSG (INTL) MEXICO S. DE R.L. DE C.V. YORK SPECIAL INVESTIGATIONS, INC. YORK WMCS CORP. THE FOLLOWING ARE INCLUDED AS ADDITIONAL NAMED INSUREDS UNDER THE ONEX YORK PROGRAM EFFECTIVE 01105/2015: MCMC LLC MCMC INDEPENDENT EXAMS, LLC COMPEVAL DD EXAMS, LLC LITIGATION SOLUTIONS, LLC MANAGED CARE NETWORK SERVICES, LLC COMPPARTNERS INC, THE FOLLOWING ARE INCLUDED AS ADDITIONAL NAMED INSUREDS UNDER THE ONEX YORK PROGRAM EFFECTIVE 0910112015: QUICK CAT, LLC 0 2008 ACORD CORPORATION. All rights reserved. COKE" CERTIFICATE OF LIABILITY INSURANCE DATE( VaamIYYJ 7H412016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIRCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the form and conditions of the policy, certain policies may require an endomemant. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement a . PRODUCER MARSH USA, INC. 445 SOUTH STREET MORRISTOWN, NJ 079MM54 NAI ONE AX AD DWRER AFFORDING COVERAGE MAIC N 123456 -CYBER 16.16 INSURER A : National Union Fke Ina. CA of Pittsburgh. PA 10446 INSURED Onax Yak Holdings Corp. INSURER B: INSURER C: and 0a BUhrtdletl9a 99 Cherry 1011 Road, Suile 102 Parefppany, NJ 07054.1102 INsuReTo INSURER E INSURER F: ...- ------- --- nnve:nwn_ee ..�..�.......�........��__ v.s THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR TYPE OF INSURANCE ADDL SPOLICY POLICY NUMBERM EFF LIMITS COMMERCIAL GENERAL LIABILITY CLMMS-MADE a OCCUR EACH OCCURRENCE $ AMAGE TO PREMISES Me a ae i MED EXP one an S PERSONAL&AOVINJURY S GEAGGREGATE LIMIT APPLIES PER: PO ❑ JECT ❑LOC GENERAL AGGREGATE S PRODUC78-COMPIOPAGG S i AUT OBILELIABILITY S NYAUTO ALLOWNEDSCHEDULED AUTOS AUTOS HIRED AUTOS AUTO EO SODILY INJURY (Par pawn) S BODILY INJURY (Per ecddenl) $ P O TY S S UMBRELLA UABOCCUR EXCESSLIAB HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE S ON WO RB COMPENSATION AND PLOYERS'LU18n.IW YIN ANY ROPRIETONIPARTNERID(ECUTIVE (OMFI abs Ian !BIRO EXCLUDED7 Bwibeunder D deONOFOPERATIONBbebw = H- NIA ELEACHACCIDW S EL.DISEASE-EAEMPLOYE S EL DISEASE -POLICY LIMIT S A CYB LIABILITY 01-462.70-14 0613012016 06130f2016 LIMIT 10,000,000 SIR 500,000 DESCFUPI ION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlBonal Remarlts Schedule, may be attached If more space Is requlred) Evidence —AL—n— .._. _-- x York Holdings Corp. its Subeldladea g, Cherry HII Road Sub 102 PJaaOWY, NJ 07064-1102 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Mash USA Inc. Manashl Mukherlee 0.u4oti �+ ce. All rlahts reserved AGUKU 20 JZU141011 The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 123456 _ LOC III: Morristown AADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA, INC. Onex Yak Hdits Corp. and ib SObsi Wft 99 Cheny HIB Rud, Sub 102 POLICY NUMBER Pw9ppany, NJ 070%1102 GAMIER MAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance REGULATORY ACTION SUBLIMIT.$1,00%00D. EVENT MANAGEMENT LIMIT: $1,000,000. SIR $100,000. NAMED INSURMS, ADW HEALTHCARE, INC. ALAMED HOLDINGS, INC. ARIC OF M BSISSIPPI, INC. ARROWQQD INVESTMENT GROUP, LLC A I GATEIYAYINTERNATIONAL(SAC)LTO, ATTENTA SERVICES, LLC AXIS I CARIBBEAN) LIMITED AXIS (J ) LIMBED AXIS DE GENTINA SA AXIS! RNATIONALSERVtCESLTD. BICKMO LE BROWN ILtTATION MANAGEMENT, INC. CAR S LTD. CAREW SOF OHIO LTD. CAREW RKS TECHNOLOGIES LTD. CAREWORKS USA LTD. CGI IN STMENTS,LLC CCO, IN,. CMI, A Y RISK SERVICES COMPANY, INC. DONALL K SAMS & ASSOCIATES. INC, F. A. RIC HARD & ASSOCIATES, INC, FARA Al DUSTING SERVICES, INC, FARA 81 NEFIT SERVICES, INC. FARA III SINESS SERVICES, INC. FARA 0 NERAL AGENCY, INC. FARA S CURITY SERVICES, INC. FOX H HOLDINGS, INC.' FRANK TES(BERMUDA)LTD. FRANK ATES ACCLAIM, INC. FRANK AMES ALTERNATIVE RISK, LLC FRANK TES OF NEWYORK, INC. 02TE NOLOGIE6,INC, UNTEG TED RISK MANAGEMENT, INC. JI SPEC RISKS INSURANCE AGENCY, INC, JI EPEC TY SERVICES, WC. JOSEPH FINANCIAL GROUP, INC. NATI EMPLOYERS NETWORK ALLIANCE, INC. NEXU6 SET ACQUISITION CO, OHP, IN . OMAC A ENCY, INC. ONEX YORK FINANCE LLC ONEX = FMllWCE LP OND( MID CORP. ACORD 101 (2008/01) 0 2008 ACORD CORPORATION. All rights reserved. me ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 123456 LOc iv: Morristown ADDITIONAL REMARKS SCHEDULE Boge 3 of 3 AGENCY MARSH USA, INC, NAMED INSURED ONX York HoMr pe Cap. POUCY NUMBER 'w Ila SulSidwiea 89 Cherry HillRovA fte 102 Pardppany, NJ 07054-1102 CARRIER NAIC CODE IVE EFFECTDATE THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CeHiflcate of Uabllity Insur PERSI, LLC PUBLIC ENTITY RISK SERVICES OF ILUNOIS, LLC PUBLIC ENTITY RISK SERVICES OF OHIO, INC. RISK CONTROL 380, LLC RISK MANAGEMENT SOLUTIONS, INC. RISKCONTROL SERVICES, LLC RMSACOUISITION,INC, ROCKPORT COMMUNITYNETWORK, INC. SAMS 8 ASSOCIATES, INC, SAMS KIIESTIGATIONS UNLIMITED, INC. THE FRANK GATES COMPANIES, INC, THEK GATES SERVICE COMPANY THE FRA K GATES SERVICE COMPANY INTEGRATED MANAGED CARE HEALTH PLAN, INC. VANTAG HEALTH PLAN, INC, VISUAL ISKSDLUTIONS,INC. VOCWOKS LTD. TVELLCOI MANAGED CARE SERVICES, INC. YORK IN URANCEACOUISDION, LLC YORK IN URANCE HOLDINGS, INC. YORK IN URMICEPARENT CORP. YORK IN URANCESERVICES GROUP,INC -CALIFORNIA YORK PRO, INC. YORK RI KC ONTROL SERVICES, LLC YORK RI K POOLING SERVICES, INC. YORK RI SERVICES GROUP INTERNATIONAL HOLDINGS, LTD. YORK RI K SERVICES GROUP, INC. YORKRI SERVICES GROUP, INC, -FLORIDA YORK RI SERVICES HOLDING CORP. YORK RI K SERVICES ORGANIZATION, INC. YORK RS a INTL) COLOMBIA SAS YORK R3 3 (INTL) LTD. YORK RS 3 QNTL)MEXICO S.DEILL DEC.V. YORK SP 'CUIL INVESTIGATIONS, INC. YORK VA CS CORP. THE FOU DINING ARE INCLUDED AS ADDITIONAL NAMED INSUREDS UNDER THE ONEX YORK PROGRAM EFFECTIVE 1202014: MCMC LI. MCMC IN EPENDENTEXAMS,LLC COMPEV L DD EXAMS, LLC LITIGATK 4 SOLUTIONS, LLC MANAGE CARE NETWORK SERVICES, LLC COMPPAI,TNERS INC, 101 (2008/01) ® 2008 ACORD CO The ACORD name and logo are registered marks of ACORD aR� CERTIFICATE OF LIABILITY INSURANCE DATE onte /DDrrYYY) 071,42015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Rau of such endorsement(s). PRODUCER MARSH USA, INC. 445 SOUTH STREET CNAOINO CT PHONE F ADDRESS: MORRISTOWN, NJ 07MM54 INSURBR AFFORDING COVERAGE NAIL e INSURER A , Aspen Specialty Insurance COrMSBY 10717 123456-MI6C-16.16 INSURED Onex York Minos Corp. INSURER B : and Bs SubeFdieries INSURER C : INSURER D : 99 Cherry Ha Road, Suite 102 Parsippany, NJ 07054-1102 INSURER 2: INSURER F: DAMA $ COVERAnFA CERTIFICATE NLIMBER: NYC-007D5M1N7 REVISION NLIMBEFZ9 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FON THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L TYPEOFINSURANCII SSSSSSpppppplllIIIto 102 B POLICYNUMBER POLICY II LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S CLAIMS -MADE F -I OCCUR DAMA $ MED EXP one $ PERSONAL &ADV [NARY $ GENERALAGGREGATE S PRODUCTS- COMP/OP AGO S IGEN!LAGGREGATELIMITAPPLIESPER: JE8 E] LOC IIIPOUCY❑ (OTHER S AUT MOBILE LIABILITYINGLE e a U $ BODILY INJURY (Par person) $ ANY AUTO SODILYINJIRY(Par asden0 S,LOASTO� LLOMFD SCHEDULED HIRED ALITGS AUTOS fR TY GE S S UMBRELLA UAB HOCCUR EACH OCCURRENCE S AGGREGATE S EXCESS UAB CLAIMS4AADE OED RETE S $ WOR ERS COMPENSATION Rn AND PLOYERV LIABILrK ANY ROPRIETORIPARTNERIEXECUTIV£ YIN OFF (Mglory in NHI If vk describe Under DESCRIPTIONDESCRIPTiON OFOPERATIONS berow NIA EL EACH ACCIDENT E E.L. DISEASE -EA EMPLOYEE S EL DISEASE -POLICY LIMIT S A PROESSIONALLIABILITY 0613012015 OW36 M6 =10,000,000UM1T4500,000SIR A MIS .PROFESSIONALUABILITY I ILROMTG16 LRO03TH15 06=015 06130Y1ole $MD,000UMITIS15,00081R DESCRIP ON OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Evidence C nIY e-coriChi-Arm Hni nPR CANCFLLATIAN x Yak Holdlnps Corp. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE d Ila Subsldlaies THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Che" HII Road ACCORDANCE WITH THE POLICY PROVISIONS. SSSSSSpppppplllIIIto 102 P�rslppany, NJ 07054-1102 AUTHORrzPn REPRESENTATIVE II cf Mash USAIno. Manaahl Mukherlee .Ma s+vtmrt�:.� ALwttk 001988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD AC RUm L—�- AGENCY CUSTOMER ID: 123456 Loc 0: Morristown ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH LISA, INC. Ortex Yak WOW Corp. and Its Sulaoaxlee 99 C!" HID Road, Suke 102 POLICY NUMBER Pamfp M, NJ 070544102 CARRIER NpIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance PROFESSIONAL LIABUTY: POLICY-LRO03TGIS RETENTION: SIM (PER CLAIM) APPLIES TO CLASS ACTM CLAIMS. NAMED PISUREDS: ADN HE LTHCARF, INC. ALAMEC HOLDINGS, INC, ARIC OF MISSISSIPPI, INC. ARROW INVESTMENT GROUP, LLC ATLANTIC GATEWAY INTERNATIONAL (SAC) LTD. ATTENT SERVICES, LLC AyJS (ErTERN CARIBBEAN) LIMITED NGS (J )LIMITED AXIS DE ARGENTINA SA. AXIS ERNATIONAL SERVICES LTD. BI E BROWN 8WILITATXRI MANAGEMENT, INC. CAR RKS LTD, OF OHIO LTD. CAREW MKSTECHNOLOOIES LTD. CAR RKSUBALTD. CCI INV STMENTS, LLC CCO, I . CMI, A I ORK RISK SERVICES COMPANY, INC. DONA K. SAMS & ASSOCIATES, INC. F.0. PJ HARD 8 ASSOCIATES, INC, FARA USTING SERVICES, INC. FARAB NEFITSERVICES, INC. FARA B ISINESS SERVICES, INC, FARAG WERAL AGENCY, INC, FARA S CURITY SERVICES, INC. FOX HI HOLDINGS, INC. FRANK TES (BEAMUDA) LTD. FRANK TESACCWM,INC. FRANK TES ALTERNATIVE RISK, LLC FRANK TES OF NEW YORK INC. G2 TEC NOLOGIES,INC. INTE TED RISK MANAGEMENT, INC. A SP RISKS INSURANCE AGENCY, INC. A SPE TY SERVICES, INC. JOSEP IVY FINANCIAL GROUP, INC, NAT AL EMPLOYERS NETWORK ALLIANCE, INC. NEXUS Sc ACQUISITION CO. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved Fhe ACURD name and logo are registered marks of ACORD A AGENCY CUSTOMER ID: 123456 LOC #: Morristown ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED MARSH USA, INC. Onax York HoklkvBCMP. and IS Subsicbries 99 ChenY Hill Read, Sub 102 POLICY NUMBER Pals) M, NJ 070541102 CARRIER NAIL CGDE EFFECTIVE DATE: A 1'IHITtn\/AI eruwnve THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance OHP, INC. GMAC AGENCY, W. ONEX YORK FINANCE LLC ONEX YORK FINANCE LP ONEX YORK MID CORP. PERSI, LLC PUBLIC ENTITY RISK SERVICES OF ILLINOIS, LLC PUBLIC ENTITY RISK SERVICES OF OHIO, INC. RISK CONTROL 360. LLC RISK MANAGEMENT SOLUTIONS, INC. RISKCONTROL SERVICES, LLC RMS ACQUISrra. NO. ROCKF`WCOMMUNITY NETWORK, INC. SAMS 6 SOCIATES, INC, am TIGATIONS UNLIMITED, INC. THE KGATES COMPANES,INC. THEE GATES SERVICE COMPANY THE KGATES SERVICE COMPANY INTEGRATED MANAGED CARE HEALTH PLAN, INC. VANTAG HEALTH PLAN, INC. VISUAL I SK SOLUTIONS. INC. VOcwO1 a LTD. WELLCO IP MANAGED CARE SERVICES, INC, YORK IN URANCEACWSMON,LLC YORKtN LIRANCE HOLDINGS, INC. YORK IN URANCE PARENT CORP. YORK IN URANCE SERVICES GROUP, INC. • CALIFORNIA YORK P , INC. YORK RI K CONTROL SERVICES, LLC YORK RI K POOLING SERVICES, INC. YORK RI K SERVICES GROUP INTERNATIONAL. HOLDINGS, LTD. YORK PJ K SERVICES GROUP, INC. YORK Rif K SERVICES GROUP, INC. -FLORIDA YORK RIIK SERVICES HOLDING CORP. YORK Rif K SERVICES ORGANVATION, INC. YORK R (INTL) COLOMBIA SAS YORK RS (INTI.) LTD. YORK RSP (INTL) MEXICO S. OE RL. DE C.V. YORK SPfCIAL INVESTIGATIONS, INC. YORK WMCS CORP. ACORD 02008 The ACORD name and logo are registered marks of ACORD rights reserved. r -r ACORO CERTIFICATE OF LIABILITY INSURANCEDA76(MMMU"YY) ILTR SR TYPEOFINSURANCE 07/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SJ AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polley(les) must be endorsed. H SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such andarseme s . PRODUCER MARSH USA, INC. 445 SOUTH STREET MORRISTOWN, NJ 079666454 CO LACY NA PHONE N ; NAILLAIC. 0 INSUR 6 AFFOR131NG COVERAGE NAIL A 123456-Ea0.16.16 INSURERA: Lexington lnsu mice Company 19437 INSURED Onex York Holdings Corp. end Its SUwd'adea 99 Cheq HII Road, SUke 102 ParWppany, NJ 07054-1102 INSURER B r INSURER C: INSURER D INSURER E: PERSONAL&ADVINJURY S INSURER F -. envaaer_oc f'.C�TIBIA�Te� •O,uw,�w_ ----- - •-- •-- •--...— "CV1011.114 nufflbbmn THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR SR TYPEOFINSURANCE P CYN NB POLlC POLICY LIMITS CONMERCUIL GENERAL LIABIUTII CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE i i MED EXP one on 6 PERSONAL&ADVINJURY S GEN AGGREGATE LRIIMpIITAPPLIES PER.* DUCY El Mi ❑ LOC GENERAI.AGGREGA7E S PRODUCTS-COMPIOPAGO i OTHER: S AUT MOSILUABIL" AUTO HEDUIED UTOSAUTOS AUUTTOSS IREDAUTOS NON4"51) AUTOSi a i BODILY INJURY (Per peraon) S BODILYINJURY (Par acddanQ I -MAGE i NERELLA UAB CESS UAB F1 OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S D I I RETEN im SI WO ERSCOMPENSATION AND PLOYERS'LIA8ILITY ANY ROPRIE. LARTNER/EDorCUTNE YIN OFF ERIMBABER EXCLUOED7 Q (Man ebrybeund 1(yea I�0 OF�ERA71 TONS DE MIA El EACH ACCDENT i EL DISEASE-EAEMPLO i El DISEASE -POLICY LIMIT I i A GED CARE Edo 01.462-99.98 06130/2016 08!3012016 LIMIT 10,000,000 SIR 260,000 DESCRIPTI OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Ramaft Schedule, may be attached N male apace Is mqulrsd) EYMence 01ly xYak HaiMV Corp. b SUM12 Ma Uny K0 Road 1102 Wany, NJ 07054-1102 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Ina. Manenhl Mukhades .lyt 0.�rtrada:: reserved. na.VMLP ea lwrw/u,) I ne AGORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 123456 LOC III: Morristown '`, ADDITIONAL REMARKS SCHEDULE Paas 9 of AGENCY NAMED INSURED MARSH USA, INC. mp� Corp, ildx 99 Cheng HN Road, Sutra 102 POLICY NUMBER PaISIPPeny, NJ 07054-1102 CARRIER NAIC CODE EFFEC7NE DATE: Annlr1nMA1 OCANA22V& THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability insurance NAMED INSUREDS: BROWN REHABKLTATKIN MANAGEMENT, INC. WELLCOMP MANAGED CARE SERVICES, INC, FORTE, INC, FRANK C AM MANAGED CARE SERVICES, INC. ADIN HE kLTICARE, INC. CAR KS OF ONTO, LTD. RKS USA LTD. CCI INVE STMENTS, LLC VOCWOF KS, I.M. THE FOLLOWING ARE INCLUDED AS ADDITIONAL NAMED INSUREDS UNDER THE ONEX YORK PROGRAM EFFECTIVE 12=14; MCMC MCMC IN EPENDENTEXAMS,LLC COMP EV DO EXAMS, LLC LITIGAT SOLUTIONS, LLC MANA CARE NETWORK SERVICES, LLC COMPP TNERS INC. ACORD 101 (2008101) ® 2008 ACORD CORPORATION. All rights reserved. I nO ACURV name and logo are registered marks of ACORD A1FmLub MAI Attachment E: RMIS Sample Reports 49 July 8, 2016 YORK L,Af�* FOCUS SAMPLE REPORTS SCREENSHOTS 0 YORK FOCUS CLIENT - 31982 Loss Run of Open Claims by Coverage and Loss Year Filters 0 Status is equal to Open or Reopened and Line of Business is equal to General Liability Groups ® Line of Business then Date of Loss Annually Sorts 15 No Sorts Additional Options � 0 Incurred Formula is Net Incurred 9!02014 Pape 1 of 8 Loss Run of C FOCUS CLIENT - 31982 Claim Nuirpbe / CI imant I�oc�tion a�e rosoduatln Retorted / Status LossDesc�rptron neo us nes Line of Business: General Liability 0.00 Date of Loss: 2001 0.00 4500341 Frank, Rhiannon 44049_10173612/26/2001 12/26/2001 Open 4 General Liability Clmt Jumped A Chair & Injured Arm Totals for 2001 - 1 Claim(s) 0.00 Date of Loss: 2009 75,000.00 4501909 Mcmillan, Reed 44046_1017363/5/2009 3/5/2009 Open 29 General Liability Reinjury To Knee/forced To Do Squats After Surgery 4502062 Goodwin, Deacon 44049_10173610/5/2009 10/5/2009 Open 32 General Liability Altercation 000 4502009 Daniels, Anika 44052_10173611/19/2009 11/19/2009 Open 66 General Liability (visitor) Fell In Bleachers At Basketball Game 4502008 Underwood, Doris 44052_10173611119/2009 11/19/2009 Open 7 General Liability ,visitor) Fell In Bleachers At A Basketball Game Totals for 2009 - 4 Claim(s) 0.00 Date of Loss: 2010 0,00 4502056 Soto, Fleur 44050_101736511212010 5/12/2010 Open 75 General Liability Exposed To Bleach Poured Out By Other Student 9/8/2014 Page 2 of 9 Loss Run of C Med/61/C�rrl Exp�na Ind/PD/Rol Lpl� FIS Incurrel Incurred Incurrel Incurrei Inc 0.00 000 0.00 11,670.86 10,000 00 0.00 0.00 20,000.00 0.00 0.00 0.00 11,670.86 10,000.00 0.00 0.00 20,000.00 0.00 0.00 0.00 1,343.75 75,000.00 9.00 0.00 15,000.00 0.00 0.00 0,00 843.75 10,000.00 9.00 0.00 10,000 00 000 000 0.00 000 000 0.00 0.00 0.00 0.00 000 0.00 22,368.03 150,000.00 9.00 0.00 25,000.00 0.00 0.00 0.00 24,555.53 235,000.00 27.00 0.00 50,000.00 0,00 0.00 0.00 0.00 10,00000 000 0.00 10,000 00 FOCUS CLIENT - 31982 Claim Nu e / CI imant I�oc�tior�6a1{e p��oss�Raty Retorted / Status arr aus neo Loss eseriptron us nes 4502046 Preston, Madaline 44049_1017365/13/2010 5/13/2010 Reopened 5 General Liability Hit In Head With A Coffee Pot 4502234 Preston, Signe 44045_1017369/23/2010 9/23/2010 Open 97 General Liability Punched In The Face By Another Student Totals for 2010 - 3 Clalm(s) Date of Loss: 2011 4502193 Booth, Chava 440451017361/24/2011 1/24/2011 Open 27 General Liability Officer Hit Student With Stun Gun 4502400 Lambert, Chancellor 44043_10173610/13/2011 10/13/2011 Open 84 General Liability Fell Off Bench 000 4502372 Hutchinson, Hayley 44054_10173612/8/2011 12/8/2011 Open 46 General Liability Door Shut On Finger 0.00 Totals for 2011 - 3 Claims) 0.00 Date of Loss: 2012 0.00 4502374 Rowland, Reed 44048_1017362/14/2012 2/14/2012 Open 50 General Liability Tripped Over Door Stop And Fell 4502373 Dyer, Shannon 44043_1017364/13x'2012 4/13/2012 Open 18 General Liability Running On Playground/fell On Metal Rod : ?6=1a Page 101 Loss Run of C Mad/BI/Cprr,g Exp�n1Ind1PD/Cc�l LpgpFii Incurred Incur�e� Incurred Incurred Inc 7,50000 0.00 000 000 7,50000 000 000 000 96,109.52 0.00 000 24,624.38 192,232.22 000 000 32,000 00 103,609.52 0.00 0.00 24,624.38 209,732.22 0.00 0.00 42,000.00 0.00 0.00 0.00 0.00 5,000,00 0,00 0.00 7,500.00 000 0.00 0.00 6,027.60 20,000.00 000 0.00 20,000.00 0.00 0.00 0.00 725.00 5,800.00 0.00 0.00 10,000.00 0.00 0.00 0.00 6,752.60 30,800.00 0.00 0.00 37,500.00 0.00 0.00 0.00 1,195.85 25,000.00 18.00 0.00 15,000.00 0.00 0.00 0.00 2,208.00 19,999.00 000 000 10,600 00 FOCUS CLIENT - 31982 Claim Nu e / Cl imant I�oc�tioq us p��ossJRatn Re�orted / Status aus neo us nes Loss Description 4502549 Schmidt, Kaitlin 44049_1017368/15/2012 8/15/2012 Open 58 General Liability Stepped In Hole On Playground 4502543 Cole, Gloria 44045_1017369/14/2012 9/14/2012 Open 82 General Liability Stepped In Hole On Playground 4502555 Wong, Reed 44049_101736912812012 9/28/2012 Open 93G General Liability Left In Wal Mart Parking Lot On The Way To A Game 4502551 Lambert, Kaye 44043_10173611/912012 11/9/2012 Reopened 65 General Liability Slipped On Stairs And Fell 4502617 Kemp, India 44043_101736 8118/2012 9/20/2013 Open 2 General Liability Claimant began to ascend the bleachers in the gymnasium. While doing so, the claimant lost his footing on a large gap between bleacher sections, which caused a laceration on his right leg. Laceration required stitches. Claimant required medical treatment and fallow treatment for several months and continues to suffer discomfort in the injury area from time to time. 4502265 Vasquez, Whoopi 44048_101736 5/21/2012 4/5/2013 Open 85 General Liability Cla4mant was leaving school to return back to work when she fell off the first step Totals for 2012 - 8 Claim(s) Date of Loss: 2013 978!2018 Page 4 618 Loss Run of C Med/BI/CPrrll Exp?na1 Ind/PD/R.11 Lgi� Fir IncurreIncurreil IncurrN IncuFMad Inc 000 000 10.000 00 000 0.00 0.00 7,500.00 1800 000 0.00 10,000 00 18.00 0.00 0.00 2,500.00 9.00 000 1,275.00 coo 10,000.00 000 2,250.00 000 5,000.00 000 1,258.50 0.00 9.650.00 000 0.00 000 0.00 000 0.00 0.00 425.00 50000 900 000 5,000.00 0.00 9.00 0.00 1,75000 15,000.00 20.00 0.00 25,000.00 250,( 0.00 9.00 0.00 10,362.35 90,499.00 92.00 0.00 80,250.00 250,0 FOCUS CLIENT - 31982 Claim Nu e / Cl Imant �ocatio? atefoss/Batt Rejorted / Status arr aus L ne s. us nes Loss escriptron 4502567 Armstrong, Wyoming 44045_1017363/21/2013 4/22/2013 Open 5 General Liability Student poked with sewing needle by other student 4502570 Newton, Eve 44045_101736 4/12/2013 4/24/2013 Reopened General Liability Insured employee, Lance Duhon, under investigation for sexual abuse.. 4502581 Maynard, Tad 44043_101736 3/21/2013 5/6/2013 Open 41 General Liability Claimant was struck in arm with needle by another student. 4502582 Newton, Uriah 44047_1017363/21/2013 5/6/2013 Open 90 General Liability Claimant was stuck in left arm with needle. 4502586 Schmidt, Arthur 44047_1017365/6/2013 5/13/2013 Open 90 General Liability Student threw ball into crowd and hit clmt. 4502590 Moreno, Abel 44047_101736 5/13/2013 5/16/2013 Open 76 General Liability Clmt was walking outside to vehicle and stepped in a broken hole in concrete and fell 4502598 Cole, Uta 44049_101736 5/13/2013 5/28/2013 Open 58 General Liability Clmt slipped and fell on something on the floor causing injury to right knee and shoulder. 4502600 Holden, Justine 44049_1017365/16/2013 5/31/2013 Open 74 General Liability Clmt was struck by rubber band in eye. 918201® Page 5 of 9 Loss Run of C Med/BI/CPall EXPIna11 Ind/PD/�ag� Log Fl, Incurre Incurre Incurre Incurre Inc 000 0.00 000 000 000 0.00 0.00 900 0.00 0.00 000 000 0.00 000 0.00 10,000-00 0.00 000 0.00 000 110.00 000 0.00 0.00 0.00 0.00 0.00 000 184.00 0.00 0.00 0.00 0.00 0.00 0.00 1,150.00 99.00 0.00 0.00 4,500.00 0.00 9.00 0.00 0.00 500.00 1800 0.00 000 0.00 9.00 0.00 0.00 2.50000 18.00 0.00 0.00 0.00 0.00 0.00 000 200.00 18.00 0.00 000 FOCUS CLIENT - 31982 Claim Nu gar., CI imant Claim ate I I O;Rats Reuorted / Status a aus neo us nes Loss Descriptron 4502601 Newton, Gavin 44043_101736 5/3/2013 6/5/2013 Open 6 General Liability Cimt and another student were fighting and clmt sustained injury 4502610 Hutchinson, Reagan 44043_101736 6/17/2013 6/18/2013 Open General Liability A rock thrown from a mower at Sulphur 9th Grade Campus hit claimant's vehicle. shattering the front passenger window. 4502615 Drake, Imogene 44043_1017366/28/2013 7/2/2013 Open 14 General Liability SEXUAL ABUSE 4507984 Luna, Chloe 44045_101736 8/19/2013 9/16/2013 Open 15 General Liability The student was entering the main building when the metal part fell on top of his head 4507987 Bartlett, Caryn 44048_101736 9/20/2013 9/25/2013 Open 29 General Liability Walking down the front steps of school and stepped down foot slipped and fell down the stairs to the bottom side 4507988 Fulton, Uta 44052_101736 9/5/2013 9/25/2013 Open 40 General Liability Clmt walking on the track and fell in a hole cuased by removal of the runway board for the jumping pit which had been removed b/c it was rotten 4507989 Hughes, Kyle 44046_1017369/24;2013 9/26/2013 Open 11 General Liability Clmt received insect b'te on forearm 4507992 Hebert, Justine 918/2014 page B of 9 Loss Run of C Med/BI/Cprr:I Exqe11 Ind/PD/Pa11� 1 -pp Fir Incurre Incurre Incurre Incurre Inc 0.00 0.00 0.00 0.00 100.00 900 0.00 000 0.00 0.00 0.00 000 0.00 0.00 1,000.00 0.00 0.00 0.00 000 000 1.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,500.00 9.00 0.00 0.00 000 9.00 0.00 0.00 500.00 9.00 0.00 0.00 0.00 0.00 0.00 0.00 100.00 9.00 0.00 0.00 0.00 0.00 0.00 0.00 350.00 9.00 0.00 0.00 FOCUS CLIENT - 31982 Claim Nu er / CI Imant l�oc�Uor�6ate ptros's atT Reported / Status Loss Desc�ipiron neo us nesS 44048_1017369/26/2013 10/3/2013 Open 86 General Liability Clmt was hit in the face by another student 4507994 Drake, Darrel 44043_101736 10/8/2013 10/8/2013 Open 30 General Liability Clmt was jumping in the wallway and his legs crossed and fell on knee 4508005 Hutchinson, Astra 44044_10173610/18/2013 10/23/2013 Open 8 General Liability Clmt was injured while playing tackle football 4508014 Newton, Kimberley 44048_10173610/22/2013 10/25/2013 Open General Liability Claim for bullying/harrassment. Title IX violations, etc. 4508009 Frank, Garrett 44045_101736 7/1/2013 10/30/2013 Open 91 General Liability Student was attacked at school by other students resulting in mental and physical injuries. 4508011 Holmes, Ulla 44047_10173610/3/2013 11/6/2013 Open General Liability Clmt slipped in the gravel parking lot 4502530 Calhoun, Morgan 44047_10173611112013 1/1/2013 Reopened 59 General Liability (visitor) Tripped Over Broken Chair Totals for 2013 - 22 Claim(s) Date of Loss: 2014 4787089 Jones, Doug UNKNOWN 610/2014 7/6/2014 Open General Liability sfav2r"4' page 7 of 9 Loss Run of C Med/Bt/Cgrrll ExpVra�� Ind/PD /Pa�� L01ti Fir Incurre Incurre Incurre Incurre Inc 0.00 0.00 000 0.00 99.00 9.00 000 0.00 0.00 0.00 0.00 0.00 500.00 9.00 0.00 000 0.00 0.00 000 0.00 1,500.00 9.00 0.00 0.00 000 0.00 000 0.00 99.00 900 0.00 4.500.00 0.00 0.00 0.00 0.00 000 0.00 0.00 000 0.00 0.00 0.00 0.00 000 000 0.00 0.00 0.00 9.00 000 0.00 2,500.00 1800 000 0.00 0.00 36.00 0.00 1,150.00 10,842.00 162.00 1,000.00 19,000.00 FOCUS CLIENT - 31982 Claim Nu or / Cl Imant 8ocatio?4 ate Ft oss st? Regorted / Status arri aus neo us nes Los s%escript�on Soda vending employee was stacking cans of soda in vending machine when he slipped and fell to the Floor in the cafeteria.. 4787466 Johnson, Stephanie UNKNOWN 6/14/2014 7/7/2014 Open General Liability Two people from the school district were entering the buidling from the south entrance and slipped and fell on ice.. 4787464 Bush, Barbara 44054_101736 6/3/2014 7/7/2014 Reopened 32 General Liability Slipped and fell outside of building on sidewalk. Ice was noticed on sidewalk.. 4787465 Davis, George UNKNOWN 6/14/2014 7/7/2014 Open 32 General Liability Two people from the school district were entering the buidling from the south entrance and slipped and fell on ice.. 4787468 Glass, Scott UNKNOWN 5/31/2014 7/7/2014 Open 32 General Liability Former employee exited location to obtain final checks, fell down the stairs and through a windor injuring multiple body parts and breaking glass. 4787469 Glass, Scott UNKNOWN 5/31/2014 7/7/2014 Open General Liability Former employee exited location to obtain final checks, fell down the stairs and through a windor injuring multiple body parts and breaking glass.. 4787470 Smith, Robert UNKNOWN 5/31/2014 7/7/2014 Reopened General Liability Former employee exited location to obtain final checks, fell down the stairs and through a windor injuring multiple body parts and breaking glass.. 9/82014 Page 8 of 9 Loss Run of C Med/BI/Cpqg Expt a1 Ind/PD/�c�l Lo�fd Fif Incurred Incurre Incurre Incurred Inc 0.00 0.00 0.00 000 5,000.00 0.00 0.00 3,500.00 0.00 0.00 3,500,00 1,500.00 000 0.00 1,500.00 500.00 0.00 0.00 2,50000 20000 0.00 0.00 4,50000 100.00 0.00 0.00 000 1,50000 000 000 000 3,000.00 000 0.00 000 2.200.00 0.00 0.00 0.00 000 0.00 0.00 0.00 0.00 000 0.00 2,500-00 50000 0.00 0.00 0.00 0.00 5,00000 50000 0.00 500.00 FOCUS CLIENT - 31982 Claim Nuer / Cl Imant I�oc�tio? ate p��oss{gat1 Resorted / Status arr aus neo us nes Loss Descriptlron 4789031 White, Don UNKNOWN6/15/2014 7/11/2014 Open General Liability descriptin o f 4789032 Knotts, Don UNKNOWN6/15/2014 7/11/2014 Open General Liability descriptin o f Totals for 2014 - 9 Claim(s) Totals for General Liability - 50 Claim(s) Grand Totals - 50 Claim(s) 9i'W2014 Page 9 of 9 Loss Run of C Med/BI1Cpa I ExpWnj Ind/PD/Fc�l L��1 Fii Incurred Incurrei Incurre� Incurr! Inc 0.00 000 0.00 000 0.00 0.00 0.00 0.00 0.00 0.00 22,000.00 2,800.00 103,609.52 45.00 608,873.22 3,081.00 103,609.52 45.00 608,873.22 3,081.00 0.00 0.00 0.00 0.00 000 0.00 0.00 0.00 0.00 0.00 2,500.00 11,200.00 0.00 79,115.72 3,500.00 259,950.00 260,0 0.00 79,115.72 3,500.00 259,950.00 250,0 FOCUS CLIENT - 31982 Filters FQ No Filters Groups Total Incurred Level (100,500,1000,10000,50000,100000,500000) Sorts No Sorts Additional Options Incurred Formula is Net Incurred, Graph Top N equals 10, Do not cap financials, Graph Data 2_is Avg Incurred, Graph Data 1 Is Total Incurr 7/2112014 Page 1012 FOCUS CLIENT - 31982 w w 50 000 01 - 1 DD 000 J 10 000.01 - 50 000 1000.01 - 10 000 0 500.01 - 1.000• I— M 41111111W91-11 0 -100 - Avg -100- Avg Incurred 0 200.ODD 400.000 600.Cm 800.000 1.0DD,000 1 200 001 5. ODD 000 10, ODD 000 15 ODD.00D 20000 DOD Total Incurred Total Incurred Level Claim Count Total Incurred Total Paid 0 - 100 5,054 31,483 31,482 100.01 -500 1,699 407.585 404,961 500.01 -1,000 446 319,705 308,115 1,000.01 - 10,000 1.119 3914,058 3,781,885 10,000.01 - 50,000 392 8,590,413 7,798,489 50,000.01 - 100,000 74 5.301,479 4,659,361 100,000.01 - 500,000 110 22,276,201 20.105,784 500,000.01+ 3 3,956,480 3,744,409 Grand Totals: 8,897 44,797,403 40,834,486 ?n,rn,q Page 2.12 Total Outstai 1 13 79 64 2,17 21 3,96 FOCUS CLIENT - 31982 Filters rz. Total Incurred is greater than 200,000.00 Groups ® No Groups Sorts L,K�, No Sorts Additional Options 0 Show Reserve N Months Out equals 6 T,q,cc iz Page t of 2 FOCUS CLIENT - 31982 Claim Number 4502623 4502624 4502620 4502622 4502646 4503613 4504125 4503711 4504325 4504309 4504772 4505227 4506333 4506560 4507092 4507079 4507102 4507121 4507534 4502234 4507363 4507701 Grand Totals - 22 Claim(s) Claimant Mcmillan, Cairo Lynn, Kay Holmes, Ruth Booth, Jayme Soto, Brett Frank, Brett Conrad, Jenette Park, Chloe Kemp, Drake Dale, India Hurst, Byron Newton, Elvis Maynard, Devin Hutchinson, Kimberley Soto, Chloe Fulton, Quynn Hughes, Audra Rivera, Jenette Holden, Vernon Preston, Signe Luna, Chloe Rowland, Iona Date of Loss 4/19/1979 9/5/1980 9/25/1981 2/8/1983 9/2/1994 9/24/1999 12/12/2000 4/3/2001 12/3/2001 5/30/2002 11/22/2002 1/3/2003 5/15/2007 8/24/2007 8/14/2008 12/4/2008 3/19/2009 10/16/2009 9/13/2010 9/23/2010 11/312010 10/5/2011 Initial Reserve 106,835 14 83,610.65 132,941.50 121,007.99 8,717.43 38,516.00 266.00 29,702.84 27,048.69 104.00 468.00 1,104.00 292.59 95.00 54.42 1,632.80 469.80 122.00 528.18 3,257.19 1,07320 22.11 557,869.53 6 Months Reserye 106,835.14 83,610.65 132, 941.50 121,007.99 8,717.43 38,516.00 0.00 0.00 0.00 755.94 7,55309 5,220.76 25,264.38 10,778.53 17,952.27 25,132.86 41,622.96 3,572.67 41, 964.34 6,434.52 17,261.51 70, 615.81 765,758.35 Max Reserve 276,750.40 698, 244.50 309, 775.29 456, 093.28 273,266.47 257,689.82 545, 585.00 376,654.80 240, 372.01 281,077-41 403,677.98 342, 260.94 249,138.41 268,383 45 214,350.23 410,574.18 329,667.48 204,439.76 224, 442.41 224,232.22 253,037.99 282, 876.99 7,122,591.02 Curre 7 If Alk. Lubbock c�ryor Attachment F: Banking Procedures Overview 50 July & 2016 /'' YORK BANKING PROCEDURES AND CONTROLS York has a rigorous internal control policy implemented at each level of the company's financial operations. Our check issuing process utilizes laser check technologies, which provides a higher level of security and control. York's Claims System ensures that all payments are verified and authorized by a supervisor in accordance with the client's authority levels. Additionally, the actual check printing process is controlled by York's Finance Team to further strengthen the segregation of duties. York is able to work with the client to set up a bank account for claims payments in a manner that will both ensure client needs as well as safety of client funds. York will encourage the client to implement Positive Pay to provide another level of security with the client's banking institution. Positive Pay, one of the leading methods of check fraud deterrence available today, will provide the client's bank with an approved list of checks to be paid when presented by the payee. When checks are presented for payment against the positive pay protected account, selected check information will be compared to the file submitted to the bank. Checks presented for payment that fail to match with the bank's file are rejected and a "suspect check" list will be presented to the client or York for "pay / no pay" decisions. Suspect checks are resolved before the bank authorizes payment and the client or York will retain the right to reject any checks that are believed to be fraudulent. All Post Office returned checks will be forwarded to York's Finance Team and tracked until a final resolution is processed and documented in the Claims System. A copy only of the returned check will be forwarded to the Claims Team and documented in the Claims System by the designated claims assistant. If necessary, the supervisor will document notes in the system to prevent a gap in procedures (such as overriding duplicate payments) or if there is a problem with a specific provider. This also provides feedback to York's Bill Review team on any tax identification issues, provider name changes, etc. that could require a W-9 for the record. York will run a daily process for workers' compensation claims and a client specified schedule for nonsubscriber claims to transfer audited bills to the Claims System so that payments can be issued. If no amount was recommended, no transaction will be created. The Claims System will check for the following: • Duplicates . Payments over the limit of authority of • Disputed claims the adjuster • Reserves• Payments over a pre -approved amount • Questionable claims set by client, if desired BANKING PROCEDURES AND CONTROLS Once the checks are cleared for printing, they are printed and matched to the Explanation of Reimbursement (EOR) to be mailed the same day. If there is no recommended payment, the EOR is mailed to the provider without any attachments. The check stock is special tamper resistant micro printed security paper that has no account information on it. The magnetic MICR coding, all account and client information and signatures are affixed by special laser printing. We manage all refunds, providing all of our clients with monthly statements that correspond with the deposits. Additionally, York will supply the client with a total list of pay category reports, financial reports, and monthly check registers. York will keep in constant communication with the client to ensure any inconsistency or irregularity is promptly resolved. kvo�orfor, Lubbock 1[Fii Attachment G: SSAE16 Audit Results si July 8, 2016 YORK '0190� YORK. April 30, 2016 To York Risk Services Group Clients: The purpose of this letter is to provide our customer organizations with an update regarding material changes in York's internal control environment for one or more of the York claims systems outlined in the table on the next page. York uses external CPA firms to provide independent Service Organization Control (SOC) reporting opinions for all of York's applicable claims systems. These reports are issued under SSAE-16 standards. The table references how frequently each report is produced, the relevant "Report Period End" date for each report, as well as the expected date of issuance for the next report. York recognizes the importance of maintaining an appropriate internal control environment and reporting on the effectiveness of, as well as material changes to, its internal controls. To the best of our knowledge, there have been no material changes to the controls, or the description of controls, contained in York's claims processing systems and control activities through April 30, 2016, that would adversely affect the Auditor's Opinion reached in the most recent issuance for any of the reports listed in the attached table. Material changes are those changes that would require disclosure to York's applicable Service Auditor in the process of their performance of the work required to produce these reports. The controls for all York claims systems were designed with certain responsibilities that may be required of system users (see "Complementary Controls at User Entities" in the SOC reports). York's controls must always be evaluated in conjunction with an assessment of the strength of the identified user control considerations documented within each individual report. Finally, in order to conclude upon the design and effectiveness of internal controls for any York claims system, system users must request and read the current report for that system. This letter is not meant to be a substitute for any of the listed reports, to provide a certification of internal controls, or to suggest that York has performed a separate evaluation of internal controls for the purposes of producing this letter. This letter is confidential information of York, but may be shown to your external auditors under an obligation of confidentiality. 964�ve ames G. Norris, Jr. CPA/MBA VP - Internal Audit York Risk Services Group Office Telephone: 973-404-1290 e-mail: Ilm_nurrtsavorkrso com York Risk Services Group, One Upper Pond Road, Building F, 4'h Floor, Parsippany, NJ 07054 '1000� YORK. Claims Systems Reports: * Formerly BrightLine York Risk Services Group, One Upper Pond Road, Building F, 4'h Floor, Parsippany, NJ 07054 Report Next Report System Period End Frequency SOC -1 Audit Firm Published by Last Day of: YCE-a June 30, November 30 Semi -Annual Schellman & Co. * August 2016 g YCF,b (Claims Connect) June 30, November 30 Semi -Annual Schellman & Co. * August 2016 iVos September 30 Annual Schellman & Co. * November 2016 SMS March 31 Annual Schellman & Co. * April 2017 CaseWorks January 31 Annual Schellman & Co. * March 2017 RMS January 31 Annual Clark Schaeffer March 2017 Conduit April 30 Annual Schneider Downs June 2016 * Formerly BrightLine York Risk Services Group, One Upper Pond Road, Building F, 4'h Floor, Parsippany, NJ 07054 Lubbock rra�a Attachment H: Sample Agreement sz July 8, 2016 r YORK AGREEMENT FOR AUTOMOBILE LIABILITY/ GENERAL LIABILITY AND OTHER LIABILITY CLAIMS ADMINISTRATION SERVICES This Agreement (the "Agreement") is effective as of the day of 2016 (the "Effective Date") between CITY OF LUBBOCK, ("PRINCIPAL"), a public entity, organized under the laws of Texas, having offices at 162513TH Street, Lubbock, Texas, 79401, and YORK RISK SERVICES GROUP, INC., ("YORK"), a Corporation organized under the laws of the State of New York with its principal place of business at 99 Cherry Hill Road, Parsippany, New Jersey 07054. WHEREAS, PRINCIPAL desires to retain YORK pursuant to the terms and provisions of this Agreement to provide Claims Administration Services on claims arising out of PRINCIPAL'S self-insured AUTOMOBILE/ GENERAUOTHER LIABILITY program (the "Program") during the term of this Agreement; and WHEREAS, YORK desires to be retained by PRINCIPAL pursuant to the terms and provisions of this Agreement to provide Claims Administration Services on claims arising out of the Program during the term of this Agreement; and WHEREAS, YORK, by entering into this Agreement, shall be obligated to provide Claims Administration Services to PRINCIPAL on the terms and conditions set forth herein; NOW THEREFORE, for and in consideration of the promises set forth hereinabove, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, YORK and PRINCIPAL agree as follows: DEFINITIONS A. "PRINCIPAL" shall mean CITY OF LUBBOCK. B. "CLAIMS ADMINISTRATION SERVICES" shall include the administration, adjustment, management, and oversight of claims arising out of PRINCIPAL'S self-insured AUTOMOBILE/ GENERAL / OTHER LIABILITY program. C. CLAIMS ADMINISTRATION SERVICES shall also include, but not limited to, the following services: 1. Providing supervision of the loss adjustment process; 2. Determining and implementing appropriate claims practices to adjust assigned claims in accordance with YORK'S established practices; 3. Adhering to high standards of professional conduct; Page 1 of 14 GL Agr REV. 10-0413 4. Adjusting and managing assigned claims to assure that PRINCIPAL and claimants receive high quality service; 5. Establishing, monitoring and timely revisions of case reserves; 6. Settling claims within the applicable coverage terms and conditions; 7. Maintaining current knowledge of applicable adjustment practices and procedures, local practices, applicable insurance coverage, court decisions, current guidelines in the claims function, and Program changes and modifications (as advised by PRINCIPAL); 8. Assisting in the preparation of claims for suit, hearing, trial, or subrogation as appropriate; 9. Acting as PRINCIPAL'S liaison with medical personnel, first notice of loss reporting services and defense counsel; 10. Reviewing bills of service providers; 11. Preparing and submitting status and administrative reports in accordance with YORK'S established practices; 12. Preserving subrogation rights and overseeing subrogation recovery. D. "CLAIMS" shall mean claims, arising under the Program and which are referred to YORK for adjusting during the term of this Agreement. E. "INFORMATION" or "CONFIDENTIAL INFORMATION" shall mean documentation, data or information relevant to PRINCIPAL or claimant that is created by YORK or that comes into its possession as a result of the rendering of services by YORK to PRINCIPAL, pursuant to the Agreement. F. "CONFIDENTIAL INFORMATION" is information not publicly available and includes, without limitation, the work product, investigation materials, trial preparation materials including but not limited to opinions and mental impressions of YORK personnel, communications with defense and coverage counsel and non-public personal information of insureds. G. "LOSS ADJUSTMENT EXPENSE" shall mean, in addition to fees to be paid in accordance with items listed or inferred herein Agreement, all reasonable expenses necessary to the adjustment of a claim in accordance with this Agreement, including but not limited to, legal fees, court costs and fees for court reporters, expert witnesses, investigation, photocopies, subpoenas, photographs, maps, accounting, chemical or physical analysis, independent medical exams or other evaluations, depositions, appraisal fees and expenses, bill review, utilization review and any other similar cost, fee or expense reasonably chargeable to the investigation, negotiation, settlement or defense of a claim or loss or subrogation actions. YORK may, but need not, elect to utilize Page 2 of 14 GL Agr REV. 10-04-13 its own staff to perform these services. H. "SYSTEMS" shall mean severally or collectively, YORK's proprietary claims handling system. II. TERM OF AGREEMENT The term of this Agreement shall commence on 12016 and shall continue until and through , 2017 (the "Term") renewable for two (2) additional one year terms. This Agreement will be deemed extended to cover each additional claim that PRINCIPAL refers to YORK after the end of the aforesaid period (subject to the extensions as aforesaid) and which YORK accepts for handling. III. CLAIMS ADMINISTRATION SERVICES (the "Services") PRINCIPAL hereby retains YORK to provide Claims Administration Services, as set forth in this Agreement, including any Exhibits attached hereto, for the Claims that arise out of PRINCIPAL'S self-insured automobile/ general/ professional liability program and that are assigned by PRINCIPAL to YORK. A. The Services to be rendered by YORK shall be in conformance with the requirements and provisions of this Agreement together with all applicable rules, orders, and interpretations issued by the applicable regulatory authorities as of the date hereof. B. YORK acknowledges its obligation to comply with all applicable statutes and any rules or regulations of the applicable regulatory authorities. C. YORK shall perform Claims Administration Services for each Claim assigned to it hereunder during the life of the contract. D. YORK acknowledges that execution of this Agreement does not guarantee that YORK will be assigned any particular number of Claims by PRINCIPAL. IV. DUTIES OF YORK A. YORK shall maintain sufficient staff with the necessary experience and management oversight. Adjusters assigned to Claims shall have a case load that allows proper attention to the work. Page 3 of 14 GL Agr REV. 10-04-13 B. To the extent required by law, YORK shall utilize only licensed adjusters and licensed private investigators, where applicable and such adjusters and investigators shall in the rendering of their services conform to the provisions of all applicable laws, rules, orders, or written interpretations issued by the applicable regulatory authorities. C. YORK shall investigate, evaluate, negotiate, settle, or deny Claims within the standing authority granted to YORK from time to time by PRINCIPAL. YORK may settle Claims in excess of its standing authority limits only with prior written approval of PRINCIPAL, which the PRINCIPAL shall, in writing, promptly grant or deny upon York's request for authority. D. Upon termination of the Agreement, all hard copy and electronic files will be transferred at PRINCIPAL'S expense. E. YORK acknowledges that all of the Claims files in its possession are the property of PRINCIPAL and agrees to promptly provide access to or deliver any such file to PRINCIPAL, at PRINCIPAL'S expense, at any time upon PRINCIPAL'S request. In exchange for PRINCIPAL'S absolute right to obtain the Claims files, PRINCIPAL agrees that it shall not have the right to set off any sums claimed due from YORK against fees due YORK under this Agreement. F. YORK expressly agrees to hold all funds and assets of PRINCIPAL that come into its control or possession during the term of this Agreement as a fiduciary of PRINCIPAL. G. YORK shall make available, through YORK'S proprietary claims system, claim -related data with "web -enabled" access. PRINCIPAL will have "view only" access to the system. PRINCIPAL will bear its own hardware, software, connection and similar costs for accessing YORK'S electronic claims management system. H. During the Term of this Agreement and at all times that there are open Claims being handled by YORK, YORK shall fully cooperate with PRINCIPAL. I. During the Term of this Agreement and thereafter until all Claims assigned hereunder are closed, YORK agrees to: 1. Maintain in force a fidelity bond or equivalent insurance, such as Third Party Crime insurance, for the protection of PRINCIPAL, at a limit not less than one million dollars ($1,000,000), to cover the risk of loss due to the wrongful conversion of any funds and assets of PRINCIPAL by YORK or its employees or independent contractors during the term of this Agreement. YORK shall maintain said bond or insurance for a period of two (2) years after the expiration of this Agreement; 2. Maintain in force an errors and omissions policy, at a limit not less than one million dollars ($1,000,000) per occurrence and to maintain coverage for a period of at least two (2) years after the expiration of the last contract with PRINCIPAL, or if the errors and omissions coverage is Page 4 of 14 GL Agr REV. 10-04 13 claims -made, YORK agrees that, for said two (2) year period, the "retro" date will not be later than the inception date of this Agreement; 3. Maintain in force a general liability policy, which names PRINCIPAL as an Additional Insured and which provides limits not less than one million dollars ($1,000,000) per occurrence, two million dollars ($2,000,000) aggregate and two million dollars ($2,000,000) products/completed operations aggregate; 4. Maintain in force a workers' compensation and employers liability policy, which provides coverage to employees of YORK at limits not less than one million dollars ($1,000,000); 5. Maintain in force an automobile liability policy, which names PRINCIPAL as an additional insured and which provides a limit of no less than one million dollars ($1,000,000); 6. Provide that the aforementioned policies contain a waiver of subrogation in favor of PRINCIPAL. J. YORK shall notify PRINCIPAL's insurer of all claims which may affect the insurer's coverage in excess of PRINCIPAL's Self -Insured Retention layer in accordance with the instructions of PRINCIPAL's insurer as provided to YORK pursuant to Section V.(A) of this Agreement. K. Notwithstanding anything to the contrary contained herein, and to the extent applicable, YORK agrees to comply with all obligations imposed upon it by law. V. DUTIES OF PRINCIPAL A. PRINCIPAL shall promptly provide YORK with such information as YORK may require, including, but not limited to, any copy of documents describing its self-insured AUTOMOBILE/ GENERAL/ OTHER LIABILITY program, and all amendments thereto including but not limited to documents submitted to any governmental tribunals for approval of the Program, as well as incident reports and information related thereto in PRINCIPAL'S possession and otherwise cooperate with YORK in carrying out YORK'S tasks hereunder. B. Upon receipt of loss notices, PRINCIPAL shall promptly assign the loss to YORK. C. PRINCIPAL shall promptly make funds available for Claim and Loss Adjustment Expense payments with respect to claims referred to YORK and respond to YORK's requests to issue checks in payment of Claims and such checks shall be distributed in accordance with PRINCIPAL's Claims processing procedures. Alternatively, PRINCIPAL may direct that YORK open and maintain an escrow account to pay Claims and Loss Adjustment Expenses with Funds provided by PRINCIPAL as required for that purpose. All bank charges Page 5 of 14 GL Agr REV. 10-04-13 VI M associated with these accounts shall be borne by PRINCIPAL. Any interest earned on funds in such accounts may be used by YORK to defray administrative expenses. D. PRINCIPAL shall provide YORK with training material, along with initial and subsequent training on PRINCIPAL'S forms and other documents affecting PRINCIPAL'S obligations which are provided to YORK and any written interpretation thereof issued by PRINCIPAL or any applicable regulatory body. During the term of this Agreement and at all times that there are open Claims being handled by York, PRINCIPAL shall fully cooperate with YORK. E. PRINCIPAL covenants and agrees that PRINCIPAL, its employees, agents or independent contractors, will not misuse the information contained within the Claims files. PRINCIPAL further covenants and agrees to maintain the confidentiality of the information contained within the Claims files, as required by applicable State and Federal law and regulations. SYSTEMS AND DATA PROCESSING A. Although YORK authorizes PRINCIPAL to use or have access to its Systems in performance of Claims Administration Services enumerated in this Agreement, this does not license YORK's system to PRINCIPAL nor shall PRINCIPAL have, or assert, any property interest whatsoever in the Systems or any improvements or additions YORK makes to its Systems during and/or in the course of YORK's performance under this Agreement, whether or not such improvements or additions were made at the suggestions, request or direction of PRINCIPAL. Notwithstanding the foregoing, the data entered or maintained thereon pursuant to this Agreement is the property of PRINCIPAL. B. This Agreement grants to PRINCIPAL no right to possess or reproduce all or any part of the Systems used, owned or controlled by YORK performing all or any part of Claims Administration Services and PRINCIPAL covenants that it shall not do so. C. YORK expressly agrees that claim -related data generated and/or maintained in connection with this Agreement or any Exhibit hereto shall be and remain the sole property of PRINCIPAL and YORK shall have no right, title, or interest in such data other than such rights necessary to perform Claim Administration Services. 1010 u��TTA GIZI A. YORK shall be entitled to receive and PRINCIPAL shall be obligated to pay only such fees, allowances, costs, reimbursements, or other compensation as are specified as follows: PRINCIPAL shall pay YORK the compensation listed as EXHIBIT A. Page 6 of 14 GL Agr REV. 10-04-13 B. PRINCIPAL shall pay YORK the fees due under VII. A of this Agreement no later than thirty (30) days after PRINCIPAL'S receipt of York's invoice as rendered from time to time. Timely payment is an express condition of York's obligations hereunder. VIII. AUDIT A. YORK shall maintain books, records, reports and other documents, in electronic or other format reasonably acceptable to PRINCIPAL relating to its Claims Administration Services performed under this Agreement. All such records and documents pertaining to Claims and the services rendered by York shall be the property of PRINCIPAL and be open for inspection, audit and copying, at PRINCIPAL'S expense, by PRINCIPAL and its agents or their representatives during all regular business hours with reasonable prior notice to YORK. YORK shall cooperate fully with all such agents or other representatives of PRINCIPAL during audits or examinations conducted by PRINCIPAL or its agents. B. At any time during the Term of this Agreement, or thereafter, provided PRINCIPAL is not in default under this Agreement, PRINCIPAL may conduct, or cause to have conducted, an audit of YORK's operations to determine whether YORK has performed its obligations hereunder in compliance with this Agreement. C. Audits pursuant to this Section VIII shall be conducted in a manner that does not interfere with YORK'S daily operations. IX. CONFIDENTIALITY A. Both parties hereto acknowledge and agree that PRINCIPAL'S information, data and documentation, including but not limited to, non-public and personal information subject to the provisions of the Gramm -Leach -Bliley Act, 15 U.S.C. Subchapter 1, Sections 6801-6809 et. seq., personal health information under the Health Insurance Portability and Accountability Act, 42 U.S.C. 1301, et. seq., and further including, without limitation, all information, data and documentation related to manuals, lists, policyholder information, operating and other systems, business practices and procedures, any information regarding insureds insurance policies, claimants, and Claims, any business, governmental or regulatory matters of PRINCIPAL, and other information furnished to or obtained by YORK, pursuant to or in connection with this Agreement or in connection with the Services to be rendered, may be confidential ("Confidential Information"). YORK shall not divulge, disclose or use the Confidential Information except for purposes of this Agreement, or as may be expressly agreed in writing by the parties, or as may otherwise be required or directed by applicable law or judicial process. This Section IX shall survive the termination of this Agreement, regardless of the reason for termination. Page 7 of 14 GL Agr REV. 10-04-13 B. During the Term of this Agreement, and after its termination for any reason, PRINCIPAL shall have the right to request in writing and receive from York either: (i) the immediate return or (ii) confirmation of the immediate destruction of any tangible records, documents, e-mails, computer files, CDs, disks, and any other tangible item that contains, represents, or otherwise includes any Confidential Information of PRINCIPAL. In addition, PRINCIPAL shall have the right, during the Term of this Agreement and after its termination, to request that YORK permanently delete and destroy any Confidential Information contained in any computers, hard drives, servers or other data storage systems of YORK. YORK agrees that PRINCIPAL may seek an injunction by a court of competent jurisdiction enjoining YORK from violating any terms of this Agreement or the confidentiality and non-use provisions of this Section IX. Injunctive relief shall be in addition to any other remedies that PRINCIPAL may have under the law. Notwithstanding the foregoing, YORK may retain a record copy of Claims files and the data therein, for accounting, insurance and similar purposes. YORK shall secure said record copy against improper use or disclosure. C. YORK acknowledges and agrees that any Confidential Information disclosed to, or acquired by it is disclosed and/or acquired solely for the purposes of facilitating the provision of the services to be rendered by the YORK for and on behalf of PRINCIPAL . YORK shall be solely responsible for informing its employers, officers, and directors of the provisions of the Section and for any acts of its employees, officers or directors that violate the provisions of the Section. D. Notwithstanding the foregoing, PRINCIPAL agrees that information used for adjusting claims is not subject to statutory or regulatory restrictions against disclosure for that purpose. X. INDEMNIFICATION A. YORK agrees to indemnify, defend and hold harmless PRINCIPAL and PRINCIPAL directors, officers, employees, and agents, from and against any and all causes of action, claims, damage, loss, costs and expenses (including, without limitation, fines, damages, liabilities, liens, losses, costs and expenses, including reasonable attorney's fees and litigation expenses) incurred by PRINCIPAL or any of PRINCIPAL directors, officers, attorneys, employees and agents by reason and to the extent of any material breach of this Agreement by YORK, or by reason and to the extent of any negligent, or otherwise wrongful act or omission of YORK or of its officers directors, attorneys, employees or agents. B. PRINCIPAL agrees to indemnify, defend and hold harmless YORK and its directors, officers, employees and agents from and against any and all causes of action, claim, damage, loss, costs and expenses (including, without limitation, fines, damages, liabilities, liens, losses, costs and expenses, including reasonable attorneys fees and litigation expenses) incurred by YORK and its Page 8 of 14 GL Agr REV. 10-04-13 directors, officers, employees and agents, to the extent such cause of action, claim, damage, loss, cost or expense is not attributable to the negligent or otherwise wrongful act or omission of York. C. The above defense, indemnification and hold harmless undertakings shall survive the termination of this Agreement. D. PRINCIPAL acknowledges that YORK has been engaged to provide professional services and that it is not the intent of the parties that YORK assumes any insurance risk. The parties agree that the foregoing defense, indemnification and hold harmless undertakings represent a reasonable allocation of commercial risk between the parties. XI. BREACH AND TERMINATION A. If a material breach by either party of this Agreement occurs, the non - breaching party shall identify the breach by delivery of written notice thereof to the breaching party. B. Upon delivery of written notification of breach, the breaching party shall have a period of fifteen (15) business days or an agreed upon date made within the fifteen (15) business days within which time the breaching party shall cure the breach. Should the breaching party fail to fully cure the breach within the designated time frame, the non -breaching party may terminate this Agreement by delivery of thirty (30) days written notice of termination to the breaching party. Any notice of breach or termination shall be delivered pursuant to Section XII. A hereto. C. This Agreement may be terminated by a party without the necessity of any notice or right to cure, upon the occurrence of any of the following events: 1. The expiration of the Term set forth in Section 11 or any renewal thereof; 2. The commencement of bankruptcy, insolvency or conservatorship proceedings by the other party, or, if such proceedings are brought against the other party, the other party's failure to have such proceedings dismissed within 45 days. D. Either party may, without reason, terminate this Agreement with at least thirty (30) days prior written notice to the other party. XII. EQUITABLE ADJUSTMENT A. PRINCIPAL shall have the right to direct YORK to perform additional services or to perform services in a specific or different way. B. This Agreement contemplates that the standards applicable to this Agreement are those in effect on the date of this Agreement, whether such Page 9 of 14 GL Agr REV. 10-04-13 standards are set forth in statutes, regulations, rules, orders, case law or otherwise. C. In the event of a directive from PRINCIPAL as set forth in Section XII. A or a change in a standard as set forth in Section XII B., YORK shall be entitled to an equitable adjustment in its compensation if such directive or change increases YORK's cost of providing the services YORK renders under this Agreement. XIII. GENERAL A. YORK shall not be liable or deemed to be in default for any delay or failure in performance under this Agreement or any Exhibit of this Agreement, or any interruption of Claims Administration Services resulting, directly or indirectly, from acts of God, civil or military authority, or any similar cause beyond the reasonable control of YORK for as long as such condition exists. YORK shall give immediate notice to PRINCIPAL of any delay or failure in performance or of any interruption of Claims Administration Services that has or may occur as soon as YORK becomes aware of such events. B. If any dispute or claim arises hereunder that the parties are not able to resolve amicably, the parties agree and stipulate that such litigation shall be resolved in the District Court in the State of Texas. In the event of a dispute between the parties resulting in litigation, the prevailing party may, in addition to any other relief obtained, recover its court costs and reasonable attorney's fees. C. All notices which are required to be given or submitted pursuant of this Agreement shall be in writing and shall be transmitted or delivered by certified mail, return receipt requested or by a commercial overnight delivery service to the parties at the addresses set forth below, or to such other addresses as a party may, by notice, specify: Notices to YORK shall be delivered to: York Risk Services Group, Inc. York Risk Services Group, Inc. 333 City Boulevard West, Suite 1500 One Upper Pond Rd. Bldg F 0 fir Orange, CA 92868 Parsippany, New Jersey 07054 Attention: Jody A. Moses, Sr. VP Attn: Michael Krawitz, General Counsel, Sr. VP Notices to PRINCIPAL shall be delivered to: City of Lubbock 162513 th Street, Room 204 Lubbock,Texas 79401 Attention: Marta Alvarez, Director of Purchasing and Contract Management Page 10 of 14 GL Agr REV. 10-04-13 D. This Agreement and any Exhibit or Schedule made a part hereof constitute the entire Agreement between the parties and supersedes and merges any and all prior discussions, representations, negotiations, correspondence, writing, and other agreements and together states the entire understanding and agreement between PRINCIPAL and YORK with respect to Claims Administration Services to be provided hereunder. Except for unilateral changes made by the PRINCIPAL pursuant to Section XII, for which YORK shall, be entitled to an equitable adjustment in its compensation, this Agreement may be amended or modified only in writing if agreed to and signed by PRINCIPAL and YORK and shall be deemed to have been entered into and executed in the State of New Jersey and shall be construed, performed and enforced in all respects in accordance with the laws of the State of Texas. E. No party hereto shall be deemed to have waived any rights or remedies accruing to it hereunder unless such waiver is in writing and signed by such party. No delay or omission by either party hereto in exercising any right shall operate as a waiver of said right on any future occasion. All rights and remedies hereunder shall be cumulative and may be exercised singularly or concurrently. F. The descriptive headings of this Agreement are intended for reference only and shall not affect the construction or interpretation of this Agreement. G. Wherever the singular of any term is used herein it shall be deemed to include the plural wherever the plural thereof may be applicable. H. No party may assign its rights or obligations under this Agreement; provided, however, that YORK may subcontract all or part of the Services required hereunder with PRINCIPAL'S written consent, (which consent shall not be unreasonably delayed or withheld) and may at its discretion delegate to a subsidiary such of its duties as it deems appropriate, provided that such subcontracting or delegation shall not relieve YORK of any of its obligations hereunder. I. It is expressly understood and agreed that the relationship of YORK to PRINCIPAL shall be that of an independent contractor at all times, and nothing herein shall constitute either the YORK or PRINCIPAL as the partner, agent, or legal representative of the other, for any purpose whatsoever, except to the extent that YORK is the agent of PRINCIPAL for the purpose of adjusting claims. YORK shall have no right or authority to bind or obligate PRINCIPAL with respect to any matter that is not specifically provided for in this Agreement without the prior approval of PRINCIPAL. All employees or agents of YORK performing duties hereunder for YORK shall be solely and exclusively under the direction and control of YORK and shall not be deemed employees of PRINCIPAL. J. Nothing in this Agreement is intended to require YORK to engage in the practice of law. K. PRINCIPAL shall not utilize YORK's trade names, logos, trademarks, service marks or other identification in any press release, advertisement, Page 11 of 14 GL Agr REV. 10-04-13 marketing materials, promotional literature, article, presentation or other type of communication without the prior written consent of YORK, which consent may be withheld or denied in YORK's sole discretion. L. ADDITIONAL information to update RFP and referred to therein is attached hereto as EXHIBIT B. IN WITNESS WHEREOF, the parties hereto have read and signed this Agreement as dated below and the Agreement is effective as of , 2016. YORK RISK SERVICES GROUP, INC. CITY OF LUBBOCK Jody A. Moses Senior Vice President Execution Date: Printed Name: Printed Title: Execution Date: Page 12 of 14 GL Agr REV. 10-04-13 YORK RISK SERVICES GROUP, INC. ASSISTANT SECRETARY'S CERTIFICATE OF AUTHORITY TO EXECUTE CONTRACTS F4WU INCUMBENCY 1. I, Michael Krawitz, am the Secretary of York Risk Services Group, Inc. (the "Corporation"). 2. Article IV.II, of the Corporation's By -Laws provides as follows: a. The President, Treasurer, Secretary and such Executive Vice Presidents as the Board may from time -to -time elect shall be the Executive Officers of the Corporation; b. All of the Executive Officers of the Corporation shall have the power to execute and deliver any deeds, contracts, mortgages, bonds and other documents of and in the name of the Corporation. 3. I am familiar with the roster of officers of the Corporation. 4. Richard H. Taketa is the duly elected President of the Corporation. 5. Jody A. Moses is a duly elected Senior Vice President of the Corporation. Richard H. Taketa has delegated the power to execute certain contracts and other documents to Jody A. Moses, including those relating to Public Entity Responses to Requests for Proposals and related documents. -�� d-�e�4�5K Michael Krawitz Secretary Dated: l �o EXHIBIT B Page 14 of 14 GL Agr REV. 10-04-13 Lubbock fill Attachment I: Signing Authority 53 July 8, 2016 YORK Exhibit B To Claims Service Agreement With City of Lubbock Loss Fund Account (1) On or before the effective date of this Agreement, Client will provide an initial imprest deposit to Service Company in the amount equivalent to five (5) banking days of average anticipated claim and/or loss and associated allocated expense payments or ten thousand dollars ($10,000), whichever is greater, to be maintained by Service Company as a loss fund deposit, hereinafter referred to as 'Deposit", for payment of claims and/or losses and associated allocated expense from Service Company's "Loss Fund Account". (2) Reimbursement to the 'Loss Fund Account" will be made by a weekly direct debit executed by Service Company's bank against Client's designated bank account for deposit into Loss Fund Account at Service Company's bank. Service Company computing the average claim and/or loss and associated allocated expense payments made weekly for Client will determine the amount of the weekly direct debit. Each week the same average amount will be deposited into Service Company's Loss Fund Account via direct debit drawn against Client's designated bank account. Client shall monitor the weekly direct debits and specifically reserves the right to refuse any direct deposit that exceeds amounts as defined herein. If actual payments exceed the average weekly direct debit allowed by Client, Client will be responsible for assessed penalties if caused as a direct result of lack of funds. At the end of each month, beginning with the end of the first month from the effective date of this Agreement, Service Company will compare the total deposits to Loss Fund Account, including all direct debits resulting from the average weekly budgeted amount and any amount as and specified in (4) below, made during the month to Service Company's Loss Fund Account to the actual claim payment account detailed in the Monthly Loss Fund Activity and Loss Run Reports and an adjustment direct debit will be made, so the monthly deposits are equal to the totals shown on such Loss Fund Activity and Loss Run Reports which reflect payments based on checks issued. Bank Fees will be a pass-thru expense paid by the Client. (3) Service Company will conduct a quarterly analysis of the adequacy of the Deposit in Service Company's Loss Fund Account based upon the most current three (3) months of Loss Fund Account activity. If the analysis determines that the current average Loss Fund Account activity exceeds the then existing Deposit, then Service Company will authorize its bank to initiate an adjustment direct debit in the amount necessary to bring the Deposit to the level stipulated in (1) above. Service Company will adjust the average weekly direct debit to the revised average weekly Loss Fund Account activity in accordance with (2) above. (4) Client agrees, upon written notification from Service Company, to prefund individual claim payments of ten thousand dollars ($10,000) or more, or in the event total claim payments exceed the weekly account balance. Service Company will not consider such amounts in arriving at the weekly budgeted direct debits and will not consider such amounts in computing the necessary Deposit required of Client as set forth in (3) above. (5) An appropriate letter, hereinafter referred to as the 'letter of Authority", will be provided, within fifteen (15) days from the effective date of this contract, to Service Company's bank authorizing the Service Company's bank to initiate the necessary weekly direct debits against Client's designated bank account for deposit to the Loss Fund Account at Service Company's bank. In addition, Client will furnish Service Company with such account documentation with respect to the Loss Fund Account that may be required by Service Company's bank and the Service Company respectively. (6) Service Company may draw and authorize checks, drafts, and other items on the Loss Fund Account only if Service Company determines that it has sufficient funds in the Loss Fund Account to cover such checks, drafts, and other items. (7) Service Company will issue checks from the Loss Fund Account for amounts in excess of Client's per occurrence self-insurance retention unless Client specifically instructs Service Company to the contrary so long as the Loss Fund Account balance is adequate to accommodate such amounts such amounts or necessary additional deposits are made by Client to the Loss Fund Account to adequately accommodate such amounts or necessary additional deposits are made by Client to the Loss Fund Account in payment of any amount in excess of Client's specific per occurrence self-insurance retention, as identified by Client to Service Company until such time as Client transfers fund for the full amount of such payment into the Loss Fund Account. Service Company assumes and has no responsibility or obligation to recover from any of Client's excess insurer(s) any amounts represented by checks issued from the Loss Fund Account. V5 EXHIBIT C Page 14 of 14 GL Agr REV. 10-04-13 Exhibit C To Claims Service Agreement With Citi, of Lubbock Cost Proposal PRICING/RUNOFF Include a listing of those allocated char es not included in your pricing. These forms must be used to submit your pricing options and they may be copied. A detailed written explanation of your offer can be provided to support your position or plan. TYPE OF CLAIM PRICING Option I — Fiat Option II — Option III - Option lY Fixed Fee for Fee for Two Flat Fixed Fee Other Pricing Lite of the Year Claim for Contract Structure You Claim Service Period Care to Submit Automobile Liability No No Yes No General Liability No No Yes No Other Liability (Law No No Yes No Enforcement, Employment Practices, Public Officials) Catastrophic Claims (10 or No No Yes No more claimants) MMSE Administration and No No Yes No Mandatory Reporting Option III — Flat Fixed Fee 159,800 1 164,594 1 169,531 • Flat annual fee is based on up to 350 claims of any type per year. $600 per claim for each claim over 350. • One time data conversion fee of $5,000. • The annual flat contemplates all activity associated with administering the City of Lubbock's program including: o Dedicated Lubbock Based Adjuster o Access to our proprietary RM IS system for up to 10 users. o Designated Account Executive. o Administration of Tail/Runoff claims • Allocated Charges not included in pricing o Legal fees o Private investigator fees o Investigation and surveillance costs o Medical cost containment fees o Appraisal fees o Court Costs and Attorney fees o Index bureau fees o Witness fees and expenses All other vended services that could arise will be allocated at cost. un d 34 YORK Lubbock PI i43 July S, 2016