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HomeMy WebLinkAboutResolution - 2015-R0284 - Contract - TPSJSIF - Third Party Admin Liability Claim Service - 09_10_2015Resolution No. 2015-RO284 Item No. 6.8 September 10, 2015 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. 12371 for Third Party Administrator Liability Claim Services, by and between the City of Lubbock and Texas Political Subdivision Joint Self Insurance Fund of Dallas, Texas, 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 September 10, 2015 ATTEST: Rebe ca Garza, City Secretary APPROVED AS TO CONTENT: Quincy White&ssistant City Manager APPROVED AS TO FORM: Je art 11, Chief Litigation Attorney RES.Contract-Tex Pol. Joint Self Ins. Fund 8.25. 15 Resolution No. 2015-RO284 TEXAS POLITICAL SUBDIVISIONS PROPERTY/CASUALTY JOINT SELF-INSURANCE FUND INTERLOCAL AGREEMENT CONTRACT NUMBER 15-FO663 (Cash Flow Plan For Political Subdivisions) This Interlocal Agreement entered into by and between the Texas Political Subdivisions Property/Casualty Joint Self -Insurance Fund (hereinafter referred to as "Fund") and the undersigned political subdivision of the State of Texas (hereinafter referred to as "Fund Member") is for the purpose of providing liability, property and automobile physical damage self-insurance funding; insurance; reinsurance; claims administration; loss control services; and other risk management services as needed for the "Fund Members" and their employees. WITNESSETH: The undersigned Fund Member, in accordance with the Interlocal Cooperation Act, Chapter 791 of the Texas Government Code and the interpretation thereof by the Attorney General of the State of Texas (Opinion #MW-347, May 29, 1981), and in consideration of other political subdivisions executing similar Interlocal Agreements, does hereby agree to become a member of the Fund. The conditions of membership agreed upon by and between the parties are as follows: 1. Definition of terms used in this Interlocal Agreement. a. Allocated Loss Expense -- the costs incurred in processing claims, including but not limited to court costs, expenses for investigation and adjustment of claims, legal expenses, cost containment services (such as PPO discounts, rehabilitation services, medical management services), costs in protection and pursuit of subrogation/recovery rights, and similar expenses chargeable to a particular claim (excluding ordinary overhead expenses of the Fund and/or its designee such as salaries and other fixed expenses). b. Board -- the Board of Trustees of the Texas Political Subdivisions Property/Casualty Joint Self -Insurance Fund. C. Loss -- the sums actually paid or payable by the Fund in the settlement or satisfaction of any claim or suit for which a Fund Member is liable either by adjudication or settlement made with the written consent of the Fund. 2. At the Fund's discretion, each Fund Member may adopt any or all of (1) the TPS Joint Self - Insurance Fund General Liability Coverage, (2) the TPS Joint Self -Insurance Fund Automobile Liability and Physical Damage Coverage, or (3) the TPS Joint Self -Insurance Fund Property Coverage self-insurance plans. Whichever Self -Insurance Plan(s) the Fund Member accepts, the Fund Member agrees to adopt and accept the coverages, provisions, terms. conditions, exclusions and limitations of the applicable Self -Insurance Plan(s) Coverage Document(s). The limits of self-insurance, optimal coverages and deductibles selected by the Fund Member will be shown on the Declarations of each coverage document. If the Fund Member adopts the TPS Joint Self -Insurance Fund General Liability Coverage, or the TPS Joint Self -Insurance Fund Automobile Liability and Physical Damage Coverage self-insurance plan(s) which cover liability exposures, it is understood that by participating in this Self -Insurance pool, the Fund Member does not intend to waive any of the immunities that its officers or employees now possess. The Fund Member recognizes the Texas Tort Claims Act and its limitations to certain governmental functions as well as its monetary limitations, and that by executing this Agreement does not agree to expand those limitations. 4. This Interlocal Agreement shall commence at 12:01 a.m. on the date shown as "effective date" on the signatory page of this Agreement, and shall terminate at 12:01 a.m. on October 1, 2016 . This Agreement may be terminated by (a) mutual consent or by (b) either party giving sixty (60) days prior written notice of termination to the other party or (c) as otherwise specified in this Interlocal Agreement or the Bylaws of the Fund. The Fund member agrees to execute necessary authorization form(s) permitting the Fund and/or its designee to obtain from other parties experience rating information for the Fund Member. 6. The newly enrolling Fund Member who has not previously been a member of this Fund or the Fund Member who has not previously operated under this Cash Flow plan agrees to pay the Fund, on or before the inception date of this Interlocal Agreement, an initial payment of one (1) month's estimated Claims Administration Fee plus 1/12 of the estimated annual Contractor Charges such as Administrative Services Fees, Loss Control Services, or other charges as set forth in Exhibit A attached hereto. On or before the commencement of the third month after the inception date of this Interlocal Agreement, the Fund Member agrees to pay an amount equal to the actual Claims Administration Fee, the total Field Service Fee (if any) of the first month of membership plus any other associated Claims Administration Fee plus 1/12th of the estimated annual Contractor Charges. On or before the commencement of the fourth month of this Interlocal Agreement, a similar payment based upon the actual Claims Administration Fee of the second month shall be paid to the Fund, with subsequent monthly payments to be paid each and every month thereafter, based on the actual Claims Administration Fee and applicable charges. The actual Claims Administration Fee of the Fund Member are those fees paid by the Fund on behalf of the Fund Member in the month which is two months prior to the billing month. However, the Fund and the Fund Member may agree to a different payment plan. The Fund Member who was a member of this Fund immediately prior to the inception date of this Interlocal Agreement and has operated under this Cash Flow plan agrees to pay the Fund for those services described in this Agreement and the charges listed in Exhibit A attached hereto. Each month's billing will include 1/12th of the estimated annual Contractor Charges as described in Paragraph 6 above. Also included in this billing will be an amount equal to the actual Claims Administration Fee of the Fund Member plus any other associated Claims Administration Fee as set forth in Exhibit A. 8. The Fund will invoice the Fund Member monthly for these amounts due and the payment by the Fund Member is due in the office of the Fund and/or its designee on or before the beginning of the month. In the event the Fund Member fails or refuses to make the payments of charges as herein provided, the Fund reserves the right to terminate such Fund Member by giving ten (10) days written notice and to collect any and all outstanding charges or other required payments which were incurred prior to the date of the Interlocal Agreement termination. 9. It is further agreed that the Fund Member will create on or before the inception date of the Interlocal Agreement a loss deposit with the Fund equal to a minimum of two months estimated paid losses. This deposit will be adjusted periodically to accurately reflect realistic monthly loss payments and/or timely invoice payments. 10. After termination of this Agreement, the Fund will continue to handle claims with an accident date occurring during the term of this Agreement until such claims are ultimately and finally disposed of or closed. After termination of this Agreement, the Fund Member will pay the Fund each and every month, until all claims handled by the Fund are disposed of, the monthly claims administration charge calculated as described herein, and the monthly reimbursement of actual claims losses paid on behalf of the Fund Member as determined herein. The Fund Member also agrees to maintain with the Fund the loss deposit as determined herein. Upon expiration of this contract, the Fund or its designated agent will continue to adjust claims which occurred or are made during the Agreement Period. 11. In the event the Fund Member fails or refuses to make any required payment on a timely basis as described herein, the Fund reserves the right, by giving ten (10) days written notice, to cease all payments on behalf of the Fund Member and return any files on active property/casualty claims to the Fund Member. In such event, the Fund Member agrees to assume all liabilities and claims handling responsibilities on those claims from the date of notification forward. The Fund Member agrees to pay the Fund all charges and other required payments which were incurred prior to the date of notification. 12. After termination of this Agreement, the Fund is not obligated to provide any of the services as described herein except for claims administration services as described in Paragraph 12 above. 13. Loss Control Services will be supplied by the Fund and/or its designee to Fund Members to assist them in following a plan of loss control that may result in reduced losses. The undersigned Fund Member agrees that it will cooperate in instituting any and all reasonable loss control recommendations for the purpose of eliminating or minimizing hazards that would contribute to losses. The loss control services provided are, however, optional for the Fund Member. If the Fund Member elects this service, its election shall be indicated on Exhibit A attached hereto. 14. Pursuant to the terms and conditions of the applicable Self -Insurance Plan(s) Coverage Documents, the Fund and/or its designee, agrees to administer any and all claims after notice of claim has been given and to provide a defense where appropriate. The Fund Member hereby appoints the Fund and/or its designee as its agent to act in all matters pertaining to processing and handling of all claims and shall cooperate fully in supplying any information needed or helpful in the administration of those claims. 15. At the option of the Fund and/or its designee, a Fund Member may be allowed to choose the legal counsel it deems most appropriate for the handling of any individual claim. However, all decisions on individual claims shall be made by the Fund and/or its designee, which includes the decision to appeal or not to appeal a final adjudication at the trial court level. However, any Fund Member shall have the right to consult with the Fund and/or its designee on any claim and have the right to appeal any decision made by the Fund and/or its designee to the Board. Any suit brought or defended by the Fund shall be brought or defended only in the name of the Fund Member and/or its officers or employees. 16. The Fund Member will be solely responsible for future benefits payable and for funding its net reserve. The Fund Member agrees to hold the Fund harmless from any and all claims (including attorney fees) that may be asserted against the Fund for the non-payment of any claim due to the failure of the Fund Member to maintain adequate reserves for the payment of claims. 17. The Fund agrees that all Fund transactions will be audited annually by a certified public accounting firm. 18. The Fund Member agrees that it will appoint a coordinator of department head rank or higher, and that the Fund and/or its designee shall not be required to contact any other individual except this person. Any notice to or any agreements with the Coordinator shall be binding upon the Fund Member. The Fund Member may change the Coordinator by giving written notice to the Fund. 19. The Fund Member acknowledges that it has received a copy of the Bylaws of the Fund, and it agrees to abide by these Bylaws and any amendments thereto and any and all policies and procedures of the Fund. 20. The Fund Member shall have the right to appeal any decision or recommendation of the Fund and/or its designee to the Board whose determination will be final. Any appeal shall be made in writing to the Fund Secretary within 60 days of decision or recommendation of the Fund and/or its designee. 21. Any party hereto paying for the performance of governmental functions or services shall make payments from current revenues available to the paying party. 22. The Fund Member shall take no action to release, discharge or impair its right to seek recovery of any amounts paid under this Agreement from any person or entity legally responsible for the bodily injury, sickness or disease, or death for which such payment is made. Nor may the Fund Member assign such rights without the express, written approval of the Fund. 23. This Interlocal Agreement, together with all the Amendments, Supplements and other attachments hereto, constitutes the entire agreement between the parties and supersedes all previous Interlocal Agreements, promises, representations, understandings and negotiations, whether written or oral, between the parties with respect to the subject matter hereof. 24. If any portion of this Interlocal Agreement shall be declared illegal or held unenforceable for any reason, the remaining portions shall continue in full force and effect. 25. It is the intent of the Parties that the Fund and/or its designee and the Fund Member each shall bear responsibility for any of its own negligence or its own error or omission, including, but not limited to, claims alleging violations of the Texas Insurance Code, the Deceptive Trade Practices and Consumer Protection Act, and the common law duty of good faith. 26. The Fund and/or its designee shall not be held accountable for any increased cost or expense to the Fund Member involving payments of claims, under any contention by the Fund Member that a claim service, risk management service, loss control service, or administrative service could have been handled differently. 27. The Fund Member agrees to timely provide all necessary information to the Fund and/or its designee and to timely execute all necessary documents as may be needed or required for the administration of the Fund. 28. Periodically each Fund Member will be provided a computer printout containing a statement of claims cumulative for said Fund Member by Effective Date of that Fund Member. 29. All parties acknowledge the Agreement consists of the following amendments and exhibits which are attached hereto and incorporated herein by reference, listed in their order of priority in the event of inconsistent or contradictory provisions: a. This Agreement b. Amendment 1 — City's Terms C. Exhibit A — Fee Schedule d. Amendment 2 — City of Lubbock Self -Insurance Resolution e. Amendment 3 — Proposal f. Amendment 4 — Condition #4 g. Amendment 5 — Condition #8 City of Lubbock Fund Member Name September 10, 2015 Date TO BE COMPLETED BY FUND MEMBER ,-�v SignaftqqKAuthASed Official Glen C. Robertson Type Name Mayor Title THE PROPERTY/CASUALTY COORDINATOR FOR THE FUND MEMBER IS: Coordinator Name & Title: Ms. Lainey Morrison, Risk Management Coordinator Mailing Address: P.O. Box 2000, Lubbock, TX 79457 Street Address: 1625 13"' St., Lubbock, TX 70401 Telephone Number: (806) 775-2316 Fax Number: (806) 775-3316 TO BE COMPLETED BY TPS FUND OFFICE October 1, 2015 Effective Date of Agreement Signature of Fund Secretary APPROVED AS TO CONTENT: uincy Whi eputy City Manager 15-FO663 Contract Number August 25, 2015 Date APPROVED AS TO FORM: eV, Chief Litigation Attorney Page l of 2 AMENDMENT NO 1 -- TO THE INTERLOCAL AGREEMENT TEXAS POLITICAL SUBDIVISIONS PROPERTY CASUALTY JOINT SELF-INSU RANCE FUND CASH FLOW PLAN It is hereby agreed the Interlocal is amended to include the following wording: 1 The City shall not consider this service contract claim proposal complete unless the service company's planned contract specific to the City of Lubbock, Texas is attached as part of the proposal with proposed terms, conditions and pricing. 2 The service company warrants that all adjusters assigned to work on the City account shall be properly licensed to do business in the state of Texas. 3 The City will retain the right of approval regarding the assignment of personnel to service their account. 4 The City prefers an annual contract renewable for two (2) additional one year terms. However, the service company must agree that services may be terminated without cause upon thirty (30) days written notice. In the event of termination, the service company may be required to provide the necessary best effort to transfer records and cumulative loss data to a superseding service company for the City. 5 The service company shall be responsible and held accountable and responsible for any all erroneous payments and overpayments caused by the service company, its employees and subcontractors. 6 The service company shall notify the City of any imminent or pending court actions at the earliest opportunity. 7 The service company shall be responsible and held accountable for any and all payments to third -parties and legal expenses resulting from errors and omissions of the service company, its employees and subcontractors related to the claim handling process for Automobile, General and Other liability claims. 8 The service company shall defend, hold harmless and indemnify the City for any acts. error or omissions of their firm, employees, associates, or subcontractors arising out of the services provided. Insurance protection carried by the servicing company for services rendered shall be primary to policies that may be carried by the City. 9 Non -Arbitration The City reserves the right to exercise any right or remedy available to it by law, contract.equity, or otherwise, including without limitation, the right to seek any and all forms of relief in a court of competent jurisdiction. Further, the City shall not be subject to any arbitration process prior to exercising its unrestricted right to seek judicial remedy. The remedies set forth herein are cumulative and not and may be exercised concurrently. To the extent of any conflict between this provision and another provision in or related to this document, this provision shall control. 08/21/ 1 PCCF Page 2 of 2 10 Any and all materials/documents gathered or produced are the sole property of the City and shall be retained or destroyed in accordance with the I aws of the State of Texas and approval of the City Risk Management Coordinator. 11 Allocated expenses DO NOT include office operating expenses, telephones, and expenses for salaried employees of the service company or the subcontractor. 12 Each party paying for the performance of governmental functions or services under this Agreement must make those payments from current revenues available to the paying party. IN WITNESS WHEREOF, this Agreement is executed as of the Effective Date. CITY OF L U BBOCK. TX Glen C. Robe , Mayor ATTEST: JE� a'� �'A� — Rebec a Garza, City Secretary APPROVED AS TO CONTENT: mcy White uty City anager City of Lubbock Name of Member 15-FO633 CONTRACTOR Signature Print Name Title APPROVED AS TO FORM: i) I e a ll Chief Litigation Attorney October 1, 2015 Effective Date: 08/21 i 12 PCCF EXHIBIT A Section E: Fees & Expenses Liability Claims Administration TPS proposes to provide claims administration services for the City of Lubbock claims management program per the following schedule. Stated fees do not include loss or allocated loss adjustment expense (ALAS) payments. A sample listing of ALAE items is included at the end of this section. Life of Contract Handling* General Liability Property Damage <$25,000 Property Damage >$25,000 Bodily Injury Auto LiakL% Properfy Damage Bodgy Injury Med Pay/PIP Collision/Comprehensive Progg <$25,000 MUM Business Interruption Extra Expense Ottw Covemes Ergo Prional Liability Garage Keeper Public Official Liability Law Enforcement Liability Crime Tail File (take-over) Handling AL/physical Damage BI (GL or AL) PD (GL or AL) Property Other: Professional Liability L:1 $300 per claim $350 per claim $375 per claim $245 per claim $415 per claim $335 per claim $175 per claim $265 per claim $330 per claim $300 per claim $285 per claim $665 per claim $665 per claim $570 per claim $665 per claim $665 per claim $570 per claim $125 per claim $175 per claim $235 per claim $200 per claim $510 per claim TPS Additional Service Fees ram.-°ep ee . 40 fee— -- ces _ etr xD °s,, f ra.iflrig, (Ord' me.� COOL aversion o dor claiffs d6W 3,9�arie4ir e�"stYrf�,plicWe Option II - Annual Fixed Cost (Life of Contract Handling) 63 Allocated Loss Adjustment Expenses The following items are examples of allocated loss adjustment expenses, and are in addition to the stated per -claim service fees. They will be charged to the file "as vended". ❑ Independent medical examinations and medical records ❑ Medical cost containment services including hospital bill audit, provider bill audit, PPO utilization, telephonic and field nurse case management services ❑ Court costs and fees for service of process, outside attorney fees, court reporter and stenographer services and transcripts ❑ Witness fees and expenses ❑ Bond premiums and indexing ❑ Printing costs related to trials and appeals ❑ Testimony, opinions, appraisals, reports, surveys and analysis of professionals and/or experts • Trial and hearing attendance fees ❑ Depositions, video statements ❑ Private investigator fees ❑ Vocational rehabilitation fees ❑ Crisis management vendor fees ❑ Alternate dispute resolution fees ❑ Other vended services including, but not limited to field investigation ❑ Loss Control Services $135 per hour Invoicing Invoicing for claim service fees will be done monthly on an "as incurred" basis for per claim fees. The administration fee will be billed in full during the first months billing. All ALAE including any managed care fees will be paid though the file. Definitions of Injury categories Incident Only Claim: A claim reported for record only purposes. No contacts, bill payments, acknowledgements, or any other claim handling is anticipated or required. Indemnity Claim: Any claim which requires any one of the following: medical payments in excess of $5000; subrogation (or other offset) investigation or recovery; compensability investigation and/or dispute; fraud investigation; extent of injury disputes; payment of indemnity benefits of any kind; or lost time from work beyond the waiting period. Medical Only Claim: A claim that does not meet the definition of either an Incident Only or Indemnity claim. f 5 I 64 Pale 1 of 16 AMENDtiIENT NO 2 -- TO THE INTERLOCAL AGREEMENT TEXAS POLITICAL SUBDIVISIONS PROPERTY CASUALTI' JOINT SELF-INSURANCE FUND CASH FLOW PLAN It is hereb} as -reed the Interlocal is amended to include the following vwrdin2: Resolution No. 2005—RO196 May 12, 2005 Item go. 30 RESOLLMON WHEREAS, by Resolution. dated December 11, 1986 (Resolution No. 2481), the City of Lubbock established the City of Lubbock Self Insurance Fund; WHEREAS, by Resolution dated October 22, 1997 (Resolution No. 2672), the City of Lubbock repealed Section S of Resolution No. 2481, and in its stead adopted a new statement of coverage for the Cityof Lubbock Liability Self Insurance Program; WHEREAS, by Resolution dated December 13, 2001 (Resolution No. 2001- R051 Tj, the City of Lubbock further amended Resolution No. 2481 in certain respects not affected herein; WHEREAS, the City Council of the City of Lubbock now desires to amend Re:-olution No. 2672, regarding the Statement of Coverage Liability Self Insurance Program, attached to such Resolution as Exhibit "A"; NOW THEREFORE: BE IT RESOLED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: Section 1, THAT Section 2 of Resolution No. 2672 is hereby deleted in its entirety, and replaced with the follw.�ing: THAT the City of Lubbock Statement of Self Insurance Risk Program Coverage attached to this Resolution as Exhibit "A" and made a part hereof for all purposes is hereby adopted as the coverage to be afforded under the City of Lubbock's Self Insurance Fund. Section 2. THAT Exhibit "A' to Resolution No. 2672 is hereby deleted in its entirety and replaced with Exhibit "A", attached hereto. Section 3. Except as amended herein, Resolution. No. 2672 shall remain in full force and effect as originally provided. Passed by the City Council this orb day of Nap 2005 AR . c UGAL, MAYOR ATTEST Reb6cca Garza, City Secretary 0821 12 PC C F Pacye 2 of 16 :APPROVED AS TO CON7EatiT: Leisa Hutcheson, Risk Manager APPROVED AS TO FOPw: Jeff4fartsqll, Assistant City Attorney mllccdodSdI Imura= Ra Lms May 2, 2005 o8_' 1 12 PCCI Page 3 of 16 Resolution No. 2005-&019G May 12, 2005 Item No. 30 CITY OF LUBBOCK Statement of Self Insurance Risk Program Coverage I. DEFINITIONS The words and phrases in italics in this policy have special meanings: A. Actual Cash Value — Replacement cost less depreciation. B. Contractual Disputes — A dispute to a legally enforceable promise made by agreement between the City and another vendor. Contractual Disputes shall not include salaries, overhead or sufficiently budgeted items for the fulfillment of the contract. C. Covered Party — A person or organization set forth in Section H. D. City —The City Of Lubbock. E. Defense Expense — Fees and expenses related to the adjustment, investigation, defense or litigation of a claim, including attorney's fees, filing fees, court costs, arbitration/mediation costs, expert and consultation fees, and travel. Defense Expeirse shall not include the salaries, overhead or normally budgeted items such as training of employees of any Covered Party. F. First Party Claims — Damages to property (not including City owned fleet that has a value of less than $50,000) owned/leased by the City and within the City's self -insured retention. Such damages must be sudden and accidental in nature and not caused by failure to properly maintain. First Party Claims costs shall not include the salaries, overhead or normally budgeted items of employees of any Covered Party. G. Program — The City of Lubbock Self Insurance Risk Program H. Se1J-Insured Retention — Any deductible associated with insurance for property and casualty coverages purchased by the City. I. Subrogation — The recovery of money for loss to City assets, by the Risk Management Department for all other departments, as a result of anther's legal liability. J. Subrogation Expense — Fees and expenses related to the investigation and pursuit of recovery, including litigation expenses. Litigation expenses include attorney's fees, court costs, arbitration/mediation costs, expert and consultation fees and travel, but shall not include salaries, overhead or normally budgeted items of any Covered Party. ('182111 PU1` Page 4of16 K. Workers; Compensation — Coverage provided by the City to secure the: payment of compensation in accordance with all provisions of Title 5 of the Texas Labor Code. Coverage may be obtained through conventional insurance, use of a municipal pool or self-insurance, at the direction of the Council. II. WHO IS COVERED Each of the following is a covered party under the program: A. The City. B. While acting in the course and scope of their duties, current and previous: a. Elected or appointed officers and officials of the City. b. Board or commission members, either Officer of the City or Advisory, appointed by the City where no other commercial errors and omissions or directors and officers coverage exists. c. Employees or authorized volunteers of the City. C. Any person in B above when serving on boards, agencies or commissions of any ldnd at the direction of the City or with the consent of the City, D. Any entity the City is obligated by virtue of a written contract to provide any property and/or casualty coverage, but only with respect to operations performed by or on behalf of the City or facilities owned or used by the Cit}. M. WHAT IS COVERED The program will pay: A. Coverage provided by the City to secure the payment of property and casualty coverages. Coverage may be obtained through conventional insurance, use of a municipal pool or self-insurance. Premiums for commercial or municipal pool excess or primary insurance for property and casualty coverages as necessary to protect the City and subject to approval by the City Manager or designee if the premium amount is less than $25,000 or Council if the premium amount exceeds $25,000. B. Self -Insured Retentions or self-insurance, at the direction of the Council, or at the direction of a commercial insurance carrier, if required by written contract, on claims in accordance with the coverage document of excess liability or at the direction of the court, to include judgment and interest. 0921 12 PL'C'E Page 5 of 16 C. Self -Insured Retentions or self-insurance, at the direction of the Council, on Automobile Medical Payments and Uninsured/Underinsured Bodily injury on vehicles owned/leased by the City. D. Se 'Insured Retentions or self-insurance, at the direction of the Council, oa first party claims in accordance with the type and scale below: PROPERTY DEDUCTIBLES a. Minimum $10,000 per occurrence b. Claims over $25,000 would have an additional 10% of additional total cost c. Maximum $50,000 per occurrence Deductibles outlined above may be reduced or increased Upon the approval of the City Manager if such deductible would create an extraordinary financial hardship to the departmental budget. E. All other sums not covered by insurance, that the covered party shall become legally obligated to pay up to $1,000,000 per occurrence. Such obligations may include contractual disputes or other issues not covered by conventional insurance. The limit under this section is intended as seed money only and is designed to protect the program from being totally depleted for those items that are of such a nature as to require an increase in taxes or issuance of bonds. This would include contractual disputes or other issues not covered by conventional insurance. In all such instances that the department budgeted sufficient funds on any contractual dispute, the funds will be paid from the department's budget. F. Workers' Compensation liability under Title 5 of the Texas Labor Code, if Council has elected to self -insure workers' compensation during any given budget year. G. On matters covered by A, B, C, D, E and F above, defense expense incurred by the City or incurred with the consent of the City. H. On matters covered by A, B, C, D, E and F above, loss adjustment expenses. I. Defense Expenses associated with Civil Service arbitration or other legal actions. J. Defense Expenses associated with any claim. K. Subrogation Expenses associated with efforts to recover money for loss to City assets; however, any subrogation expenses paid will reduce the amount of recovery to the affected Fund. L. The actual cash value of damage to an employee's automobile, if such damage arises from the authorized use of the automobile on City business and oaly if there is no other collectable insurance. If there is other collectible insurance, the City shall only be liable for that portion that is not otherwise covered. 08 21 12 PCCF Pase 6 of 16 h1. Comprehensive safety measures, including equipment, repair of facilities and training for items that are an immediate risk to the general public or the City's work force that are not normally budgeted operating expenditures. N. Operational costs of the. Risk Management Department, and associated departments, as approved annually in the budget. IV. WHAT IS NOT COVERED The program does not apply to: A. Liability under disability benefits, unemployment compensation, health benefits or similar laws. R. Damages covered by insurance or other self-insurance programs applying to a covered party. C. City police officers while employed by others and not performing City law enforcement functions. D. A covered parry's damages or defense expense arising from a claim originally asserted by a covered party against another covered patty. E. Penalties, fines or associated fees relating to permitting or regulatory findings. F. Defense expenses associated with the collection of past due tax liens or uncolleetible receivables (excluding subrogation accounts). G. A covered parry's salaries, overhead or normally budgeted item. 09 ? 1 12 PCCF Page 7 of 16 Resolution No. 2001-RO51 December 13, 2001 Item No. 31 RESOLUTION WHEREAS, the City of Lubbock has heretofore on December 10, 1486, enacted Resolution No. 2481 establishing the City of Lubbock Self Insurance Fund; and WHEREAS, the City Council of the City of Lubbock deems it to be in the best interests of the citizens of the City of Lubbock to amend such Resolution with regard to the procedures for approval of disbursements from said fund in amounts of more than $50,000 and certain other administrative matters; NOW THEREFORE: BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LU13BOCK: SECTION 1. THAT subparagraph I of Section 7 of Resolution No. 2481 is hereby amended to read as follows: I . To keep the City Manager fully informed as to all aspects of the self- insurance fund and the City Manager also shall keep the City Council fully informed as to all aspects of the self-insurance fund. The claims settlement procedures contained in this Section shall have no application to workers compensation claims. SECTION 2. THAT subparagraph 3(b) of Section 7 of Resolution No. 2481 is hereby amended to read as follows: (b) In cases where the claim is more than ten thousand dollars but less than twenty thousand dollars, the administrator shall secure the approval of the Assistant City Manager over Finance. SECTION 3. THAT subparagraph 3(c) of Section 7 of Resolution No. 2481 is hereby amended to read as follows: (c) In cases where the claim is for twenty thousand dollars but less than fifty thousand dollars, the administrator shall secure the approval of the City Manager. SECTION 4. THAT a new subparagraph 3(d) is hereby added to Section 7 of Resolution No. 2481 which shall read as follows: (d) In all claims where the City Manager is alleged to be primarily a responsible party under the claim, the City Council's approval or rejection shall be secured in an open meeting of the City Council as required by the Texas Open Meetings Law. 08 21 12 PCCF Pa1re 8 of 16 SECTION 5. THAT a new subparagraph 3(e) is hereby added to Section 7 of Resolution No. 2481 which shall read as follows: (e) In cases where the claim is for fifty thousand dollars or more, the City Manager shall submit the claim to the City Council for approval or rejection in an open meeting of the City Council as stated above. Passed by the City Council this 13th day of December , 2001 WINDY SMO , MAYOR ATTEST: Rebecca Garza, City Secretary APPROVED AS TO CONTENT: 2, l " Bob Cass, City Manager APPROVED AS TO FORML : 7t�L d G. Vandiver, First Assistant City Attorney DDTr.VSt 1 firoAmaidres November 28, 20U 1 08 11 12 PCCF Pace 9 of 16 First Reading Second Reading December 3, 2001 December 13, 2001 Item No. 21 item No. 17 ORDINANCE NO, 2001-00095 AN ORDINANCE AMENDING SECTION 2-37 OF THE CITY OF LUBBOCK CODE OF ORDINANCES WITH REGARD TO APPROVAL AND PAYMENT OF CLAIMS AGAINST THE CITY; PROVIDING A SAVINGS CLAUSE; AND PROVIDING FOR PUBLICATION. WHEREAS, the City Council finds that it would be in the best interest of the citizens of the City of Lubbock to amend Section 2-37 of the Code of Ordinances of the City of Lubbock with regard to the procedures for approval of claims against the City of Lubbock; NOW THEREFORE: BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: SECTION 1. THAT Section 2-3 7 of the Code of Ordinances, City of Lubbock, Texas, is hereby amended to read as follows: Sec, 2-37. Approval of claims. The City Manager and/or the administrator of the City of Lubbock Self Insurance Fund shall make disbursements from the City of Lubbock Self Insurance Fund in settlement of claims (except workers compensation claims) in the following manner: 1) In cases where the self insurance claim is ten thousand dollars or less, the administrator of the City of Lubbock Self Insurance Fund shall have full authority. 2) In cases where the self insurance claim is more than ten thousand dollars but less than twenty thousand dollars, the administrator shall secure the approval of the Assistant City Manager over finance_ 3) In cases where the self insurance claim is more than twenty thousand dollars but less than fifty thousand dollars, the administrator shall secure the approval of the City Manager. 4) In all self insurance claims where the City Manager is alleged to be primarily a responsible party under the claim, the City Council's approval or rejection shall be secured in an open meeting of the City Council as required by the Texas Open Meetings Law, 5) In cases where the self insurance claim is fifty thousand dollars or more, the City Manager shall submit the claim to the City Council for approval or rejection in an open meeting of the City Council as required by the Texas Open Meetings Law. 08 2112 PccF Page 10 of 16 SECTION 2. THAT should any paragraph, sentence, clause, phrase or word of this Ordinance be declared unconstitutional or invalid for any reason, the remainder of this Ordinance shall not be affected thereby. SECTION 3. THAT the City Secretary is hereby authorized to cause publication of the descriptive caption of this Ordinance as an alternative method provided by law. AND IT IS SO ORDERED. Passed by the City Council on first reading this 3ra day of December . 2001, Passed by the City Council on second reading this 13tb day of December , 2001. We'll. Iv • ATTEST: Rebecca Garza, City Secretary APPROVED AS TO CONTENT: I __Q- Bob Cass, City Manager MAPOVED AS TO FORM: Wald G. V ver, First Assistant City Attorney DDOrd[Claim Approval.ord doc November 21, 2001 082112 PCCF JCR:da RESOLUTION Page 11 of 16 KeSoiutlon ?lb'L October 22, 199? Agenda Item #29 A R-ESOLUTION AMENDING RESOLUTION NO. 2481 BY REPEALING SECTION 5 THEREOF WHICH ADOPTED SELF INSURANCE COVERAGE FOR THE CITY CF LUBBOCK AS PROVIDED BY THE TEXAS MUNICIPAL LEAGUE JOINT SELF INSURANCE FUND AND IN ITS STEAD ADOPTING A NEW STATEMENT OF COVERAGE FOR THE CITY OF LUBBOCK LIABILITY SELF INSURANCE PROGRAM. WHEREAS, the City of Lubbock did heretofore by Resolution No. 2481 create the City of Lubbock's Self Insurance Fund; and WHEREAS, in said Resolution No. 2481 the City of Lubbock did adopt as its standard coverage a coverage heretofore provided by the Texas Municipal League Joint Self Insurance Fund; and WHEREAS, the City of Lubbock deems it to be in the best interest of the City of Lubbock to repeal the coverage adopted under Resolution No. 2481 and in its stead to substitute a new statement of coverage for the City of Lubbock Self Insurance Fund; NOW THEREFORE: BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: SECTION 1. THAT Section 5 of Resolution No. 2481 adopting the Texas Municipal League Joint Self Insurance Fund as the coverage document for the Lubbock Self Insurance Fund is hereby in all things repealed. SECTION 2. THAT the City of Lubbock Statement of Coverage Liability ! Self Insurance Program attached to this Resolution as Exhibit A and made a j part hereof for all purposes is hereby adopted as the coverage to be afforded under the City of Lubbock Self Insurance Fund. SECTION 3. Save and Except as herein repealed or amended, Resolution No. 2481 shall remain in full force and effect. Passed by the City Council this 22nd I i Ranett oyd, City Secretary APPROVED AS TO CONTENT: i i Robert Massengale Assistant City Manager for Financial Services APPROVED AS T�F�R�1: o C. Ross, Jr., City Attorney day of October , 1987. xf (f - * B-C. MCMINN, MAYOR 08 21 12 PC'( 1 Paee 12 of 16 Res. #2672 10-22-67 9/25/87 MY OF LUBBOCK STATEMENT OF COVERAGE LIABILITY SELF-INSURANCE PROGRAM L WHAT IS COVERED The program will pay: A. All sums the covered party shall become legally obligated to pay as damages. B. On matters covered by A above, defense expense incurred by the City or incurred with the consent of the City. C. The actual cash value of damage to an employee's automobile, if such damage arises from the authorized use of the automo- bile on City business. IL WHAT IS NOT COVERED The program does not apply to: A. Liability under workers' compensation, disability benefits, un- employment compensation or similar laws. B. Damage to property owned by the City. C. Damages covered by insurance or other self-insurance pro- grams applying to a covered party. D. City police officers while employed by others and not per- forming City law enforcement functions. E. A covered parry's damages or defense expense arising from a claim originally asserted by that covered party against another covered party. III. WHO IS COVERED Each of the following is a covered party under the program: A. The City. 0821 l 2 PCCF Page 13 of 16 B. While acting in the scope of their duties, current and previous: Elected or appointed officers and officials of the City. 2. Board or commission members appointed by the City. 3. Employees or authorized volunteers of the City. C. Any person in B above when serving on boards, agencies or commissions of any kind at the direction of the City or with the expressed or implied consent of the City, subject to that board, agency or commission in B(2) above having paid its allocated share of the self insurance cost. D_ Any entity the City is obligated by virtue of a written con- tract to provide liability coverage, but only with respect to operations performed by or on behalf of the City or facilities owned or used by the City. Iv. DEFINITIONS The words and phrases in italics in this memorandum have special meanings: A. Actual cash value - replacement cost, less depreciation. B. City - the City of Lubbock_ C Covered party - a person or organization set forth in Section III. D. Defense expense - fees and expenses related to the adjustment, investigation, defense or litigation of a claim, including attor- neys fees, court costs and interest due on judgments. Defense expense shall not include the salaries and overhead of employ- ees of any covered party. E. Program - the City of Lubbock Liability Self -Insurance Pro- gram. V. SUBROGATION In the event of payment by the program, the City shall be subrogated to all of the covered part Vs rights of recovery against any entity. The covered party shall do whatever is necessary to secure such rights and shall do nothing after a loss to prejudice such rights. 08?i 12 I'cc+ I` 1 �l 1 JCR:da f RESOLUTION Page 14 of 16 Resolution ; 2481 December 11, 1986 Agenda Item r27 A RESOLUTION CREATING AND ESTABLISHING THE CITY OF LUBBOCK SELF INSURANCE FUND; PROVIDING THE COVERAGE TO BE AFFORDED BY SUCH FUND AND PROVIDING FOR THE MAINTENANCE AND ADMINISTRATION OF SAID FUND. WHEREAS, the City of Lubbock has heretofore obtained liability insurance coverage through the Texas Municipal League Joint Self Insurance Fund; and WHEREAS, the cost of maintaining such liability insurance through the Texas Municipal League Joint Self Insurance Fund has dramatically risen over the past three years due to the unavailability to said fund of reasonable reinsurance; and WHEREAS, the premium cost to the City of Lubbock to maintain liability insurance with the Texas Municipal League Joint Self Insurance Fund for the fiscal year 1986-1987 will be approximately one third of the coverage limit provided; and WHEREAS, the City Council of the City of Lubbock finds that it would be wise and expedient to establish a liability self insurance fund for the City of Lubbock and to set forth the coverage to be provided by such fund; and WHEREAS, the City Council finds that it would be in the best interest of the citizens of the City of Lubbock to establish the City of Lubbock Self Insurance Fund, set forth the coverage to be provided by said fund, and to provide for the administration of said fund; NOW THEREFORE: BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: SECTION 1. THAT there is hereby created a fund within the City of Lubbock to be known as the City of Lubbock Self Insurance Fund. SECTION 2. THAT the City Manager is hereby directed to transfer the sum of Five Hundred Thousand Dollars ($500,000) from the City of Lubbock Insurance Fund to the City of Lubbock Self Insurance Fund here now created to establish said fund. SECTION 3. THAT the City Manager shall, in preparing the annual budget for the City of Lubbock, recommend to the City Council an appropriation to be made to said fund in order that the fund shall be maintained and increased to an amount sufficient to provide an actuarily sound fund. 09 21 12 PUT Paue 15 of 16 SECTION 4. THAT the City Manager is further authorized to transfer additional funds from the City of Lubbock Insurance Fund to the City of Lubbock Self Insurance Fund to the extent such funds are not needed for other insurance coverage. SECTION 5. THAT the City of Lubbock Self Insurance Fund shall provide liability insurance coverage to the City, its employees, officers, Board members and volunteers upon the same terms and conditions as hereto afforded to said named individuals by the Texas Municipal League Joint Self Insurance Fund all as set forth in the Texas Municipal League Joint Self Insurance Fund Liability Coverage Document dated October 1, 1985, a copy of which shall be deemed an official City document and filed with the City Secretary. SECTION 6. THAT the City of Lubbock Self Insurance Fund shall be authorized to pay for all necessary services to adjust and defend all liability claims made against the City of Lubbock for which no other policy of insurance exists and said fund is further authorized to, in the appropriate case, settle all such claims or to pay any judgments based upon such claims. SECTION 7. THAT the City Manager shall designate an officer or employee of the City of Lubbock to act as the administrator of the City of Lubbock Self Insurance Fund with the following powers and duties: 1. To keep the City Manager fully informed as to all aspects of said Self Insurance Fund. 2. To make all disbursements from said fund for claims adjusting and legal defense costs. 3. To make disbursements from said fund in settlement of claims in the following manner: (a) In cases where the claim is ten thousand dollars or less he shall have full authority. (b) In cases where the claim is more than ten thousand dollars but less than twenty thousand the administrator shall secure the approval of the Assistant City Manager for Finance. �i (c) In cases where the claim is for twenty thousand dollars or more the administrator shall secure the approval of the City Manager. SECTION 8. THAT the City Manager is further authorized to issue requests for proposals to insurance consultants to review and update coverage to be extended by this plan as well as its actuarial soundness. 0821 12 P(:C'F Page 16 of 16 SECTION 9. THAT the City Manager is further authorized to issue requests for proposals to secure claims adjusting and related services necessary for this fund. SECTION 10. THAT all claims handled under and through the City of Lubbock Self Insurance Fund shall be considered insured claims. Passed by the City Council this 11th day of December , 1986. B_ C. McMINN, MAYOR ATTEST: ane tte Boyd, City Secretary APPROVED AS TO CONTENT: Robert Massengale, Astistant City Manager for Financial Services APPROVED AS TO FORM: r� John C. Ross, Jr., City Atto ney AMENDMENT NO 3 — TO THE INTERLOCAL AGREEMENT TEXAS POLITICAL SUBDIVISIONS PROPERTY CASUALTY JOINT SELF-INSURANCE FUND CCONFIDENTIAL SERVICES PROPOSAL FOR LABILTfY CLAIMS ADMINISTRATION SERVICES (RFP No: 1 5-1237-MA) PREPARED EXCLUSNELY fo r bbciotyofk � TEXAS TEXAS POLITI SUBDMSDNS KEITH D. ALBERTS PO Box 803356 DALLAS, TEXAS 75380 (800) 588-0013 W W W TPSPOOLORG Table of Contents Section A TIPS Overview Executive Summary Organizational Chart Board Trustees Managing Staff Adjusting Staff Section B Scope of Services (detailed outline of handling procedures) Claims Reporting Best Practices — Propert Affability Claims Administration Client Services Loss Prevention & Control Section C Required RFP Information Checklist Request for Proposal Suspension & Debarment Certification Non -Collusion Affidavit Insurance Requirement Affidavit Pricing Sheet RFP Questions References Conflict of Interest Questionnaire Vendor Application W-9 TPA License Section D Supporting Documents Sample Contract (interiocal agreement) Insurance Certificates References Claim System, Reports and Claim Reporting Tool Financial Statements Section E Fees & Expenses Claims Administration Fees Allocated Loss Adjustment Expenses Section A: TPS Overview Executive Summary Texas Political Subdivisions has served Texas Schools since 1983. We offer a number of services ranging from fully insured workers' compensation and property/casualty insurance to loss control, managed care, and third -party claims administration for self - funded programs. We have a total risk management package that delivers the highest quality products and services that give you more. The Trustees made a ground breaking decision in 2008 to bring all services in-house, and eliminate all administration by its Third Party Administrator (TPA). Their decision commenced the sweeping events over the next three years' time which shaped the Fund into the success it is today. Their first order of business was to secure an Executive Director (ED) in October 2008. Their ED soon after coordinated the transition of marketing, loss control and accounting in April 2009. Continuing the transition, underwriting came in-house December 2009, PC claims January 2011 and finally WC claims in May 2011. Furthering the transition, TPS began offering all coverages (CR/LE/PO/SBL) in-house in July 2013, and the Trustees approved the purchase of a building in Dallas for its corporate operations in November of 2013. Since this transition TPS developed a comprehensive, well -structured and expertly managed approach to handle every claim. Its claims professionals communicate clearly with all parties involved and continuously monitor and manage all of the issues that can affect the cost of a claim. Through its experience in all aspects of claims management, TPS developed an exemplary set of best practices for the day-to-day conduct of the business. The result is a cohesive, consistent service delivery from the first report of a claim through to its successful resolution. TPS Loss Control focuses on prevention by identifying areas of risk through surveys and assessments. Recommendations generated by these surveys are followed by member consultations, education and training on ways to implement programs/procedures that will minimize hazards & exposures. TPS is governed by a nine -member Board of Trustees, all active and committed volunteers representing local governments all across Texas. Trustees are Fund Members themselves and operate the Fund on behalf of the Fund Members pursuant to TPS Bylaws. Trustees are elected by the membership to 4 year staggered terms. TPS is headquartered in Dallas. We also have claims offices in Austin, Dallas, Houston and Lubbock. TPS plans to comply with all of the RFP requirements and manage all contractors on the City's behalf. All of the City's claims and related services will be managed from the TPS office in Lubbock. TPS plans to dedicate one adjuster (Tammy Lucero), designate clerical and IT staff, as well as a project manager. The District's project manager, along with TPS's Director of Claims will manage all contractors and sub -contractors within guidelines set in the RFP. TPS is committed to a long-term partnership and we're confident the services provided by TPS will not only meet, but exceed your expectations. We appreciate your time and consideration. ��� ffi-J�� Authorized Representative and City's Project Manger Organizational Chart TPS Board Trustees Chairman Scott Payne is the Risk Manager for the City of Denton, and Chairman of the TPS Board of Trustees. He holds a BRA in Finance from Texas Tech University. Scott spent several years as an adjuster with Texas Employers `sy Insurance Association before being named Safety/Claims Administrator for the City of Abilene in 1991, and F was appointed Risk Manager there In 1994. He accepted his current position in 2003. Scott has been a member of the Texas Chapter of the Public Risk Management Association (PRIMA) since 1991, and has served an their r1l Board since 2003. He is a past Conference Chairman and part President of the Texas Chapter PRIMA. Scott was elected to the Board of Trustees of TPS in 1994, and has served as Chairman since 2004. Scott and his wife, Synette, have one son. Vice -Chair Archie Kountz is Director of Risk Management for Tom Green County. He attended Howard College and Texas Tech University, end had an extensive background in Petro -chemical and oil field construction and operations management prior to entering public service. Archie is a former member of the Board of Directors of the Howard County Appraisal District, and has been active in civic and charitable affairs. He was elected to the TPS Board of Trustees in 2005_ Archie and his wife, Cindy, have three sons. Secretary Larry Helgesen has sewed as Director of Risk Management and Non -Exempt Services for the Galena Park Independent School District since 2002. He holds a BS. in Industrial Education from Illinois State University, as well as the designation of Certified School Risk Manager, and is a faculty member for The I kitional Alliance for Insurance and Research. Larry is a member of Texas PRIMA and the Texas Association of School Business Officials, and is a farmer member of the Board of Texas Schools Risk Managers Association. Larry joined the k TPS Board of Trustees in 2008. He and his wife, Monica, have three daughters and one grandson. Board Trustee Jone Hays it the Director of Employee Benefits and Risk Management for Temple Independent School District. She majored in business at University of Texas at Arlington and Howard Payne University. Jane has been a licensed 6eneral Lines Agent for Life, Accident, Health and HMO since 1988, specializing in providing, administering and coordinating group insurance benefits for school districts and other public entities. Since joining Temple ISD, she has largely curtailed her private insurance practice. Jane holds designations as a Certified School Risk Manager, Employee Benefits Specialist, and Workers' Compensation Specialist, and fir coauthored the I latioual Alliance Employee Benefits Specialist course book. She was elected to the TPS Board of Trustees in 2002. She has three children and one grandson. Board Trustee Ernest 'Rayr Wolff is the Mayor of Stockdale, a position he has held since 2013. He is a graduate of Southwest University, and a Certified Public Accountant. Ray is active in civic affairs in his hometown of Stockdale and throughout Wilson County. He was elected to the TPS Board of Trustees in 2006. Ray and his wife, Teri, have three children and one grandchild. TPS Board Trustee Leisa Hutcheson is Director of Human Resources and Risk Management for the City of Lubbock She attended T Texas Tech and South Plains College, majoring in Business, obtained an Associate in Claims from the Insurance . Institute of America, and is now pursuing their Associate in Risk Management. After gaining experience as a claims adjuster, Leisa began her career with the City of Lubbock as Risk Management Coordinator in 1997, was named Risk Manager in 2006, and elevated to her current position in 2009. She was elected to the TPS Board 1 in 2010. She and her husband have one son. Trustee ti David Soucedo is in his second term as County Judge of Maverick County, after serving three consecutive i terns as County Commissioner. Prior to his election as County Judge, he taught social studies at Memorial kBoard Junior High School in Eagle Pass. David follows in the footsteps of his late father, who served as a popular County Judge for a period spanning three decades. He was elected to the TP5 Board in 2011. He and his wife -two wo children. v Board Trustee Gary Earnest assumed the position of Chief Executive Officer of the Taylor County Central Appraisal District in 2014, fallowing 10 years of service as their Chief Operations Officer. He joined the staff of the CAD in 1994. Gary has a B.S. in Business and a graduate degree in Organizational and Human Resources Development for Abilene Christian University. He is active in several state and national professional organizations, as well as numerous local civic and charitable activities. Gary joined the TPS Board of Trustees in 2014. Board Trustee Rene Vargas is Director of Bu+iress Services for the Socorro Independent School District. He earned a Bachelors Degree in Business Administration from the University of Texas at El Paso, following his service in the U.S. Marine Crops. Rene began work with Socorra I50 in 1999 as a Staff Accountant, became Accounting Officer and Business Manager in 2001, and was appointed to his current position in 2012. He was elected to the TPS Board of Trustees in 2014. Managing Staff Executive Director/CEO Randal Beach is the Executive Director and CEO of TPS. He is a former 6eneral Counsel and Deputy Commissioner of the Louisiana Department of Insurance, former Chief administrative Officer of the City of { Baton Rouge, and former Executive Director of the Louisiana Conference of Mayors. His legal practice focused $ on insurance regulatory law, and he has served on the boards of two property and casualty insurers and one life insurer, and served as Administrator of a workers' compensation self insurance fund. Mr. Beach has degrees from Louisiana State University in 5hreveport and Southern University School of Law. t Marketing Director _ Keith Alberts is the Marketing Director of TPS. He is a licensed all -lines adjuster in the State of Texas, as "? well as a hcensed general lines property1casualty, surplus, life, accident, health, and HMO agent. Mr. Alberts %•- formerly worked with Wausau Insurance Companies, Texas Mutual Insurance Company aid Dallas Area Rapid Transit. He has worked with the TPS program since 2001 and has been in the insurance field since 1992. Mr. Alberts attended I Borth Lake College in Dallas. Undarwriting Director + Rhonda Ruehle serves as the Underwriting Director for TP5. Ms. Ruehle was formerly Assistant Vice President and Underwriting Manager for Avizent Risk, and Assistant Vice President of Underwriting for Aon Insurance Management of Texas, Inc. In both of those positions she focused on underwriting and marketing the TPS program. Prior to that, she was a Supervisor of Commercial Casualty Underwriting for Employers Casualty Company where she worked on the TPS and TASB accounts. Ms. Ruehle has a Bachelor of Business Administration Degree from the University of Texas in Arlington. i 1 Accounting Director/CFO Amy Sedatole, CPA, is the Accounting Director for TPS. She received her BSA cum laude from Baylor University, and began her career with a national accounting firm. Amy has experience in the healthcare and j banking fields, and for several years prior to joining TPS she was the senior accountant for a casualty ¢ insurance company. 7 t d Loss Control Director Ridvad Haws is the Loss Control Director for TPS. He has more than 26 years of ogerieroc as a Lass Preverition/Control Consultant, irckiding 16 years with Ul" Mutual L serum Compay and most recently 6 Ye" with Arnerisnre Insurance Company. Ks stragths include risk asseswentouposure identrRoation, system analysis, root cause analysts, nwnagenteut and emplayee training. and perf- ma V--t for public entities He received a Bachelor of Architectuvl engineering from University of Texas at Austin. 0 Claims Diractor Stephen Koon has handled multi -line insurance chars since 200L This includes experience with National and International Risk Management departrrKnts. Lnuronce Carriers. TPA opuntions and Seff Laurance Groups. His interpersonal and orgmizational skills allow for successful canna cations with all pantie, to the claim. In addition, he is bilingual in Spanish. He graduated from SW Texas State University of San Marcos in 1991 with a Bachelor of Arts. Environvnental Resource Studies. and Minor in Science Adjusting Staff Claims Director Stephen Koon has handled milts-Ilne insurance claimer since 200L This includes experience with Rational and International Risk Mawgement departments, Insurance Carriers. TPA operations and Self Insurance &r o ps. His interpersonal and arganimtioral skills allow for successful communications with all parties to the claim In addition, he is bilingual in Spanish. He graduated from SW Teas State University of San Marcos in 1991 with a Bachelor of Arts, Emdrormentol PPseurce Studies, and Minor at Science. PC Adjuster Tommy Lucero has been a licensed adjuster since 1988. Tammy has worked far major ins ranoe caner throughout the state of Tans handling prop" and casualty chinas. Tommy has specialized in public entity work since 1988. She also has haxW product liability, EEOC, ADA. FMLA and workers compensation claims. T=vq is the dedicated property and casualty adjuster on the largest Prcperty and Casualty aaant for TPS. Tammy is bilingual in English and Spanish. Ta my works in our Lubbockoffice. PC Adjuster Richard Salve has been a licensed casucJty adjuster since 1992. Prior to adjusting Richard was a teacher with Katy ISD, Richard handles property and eowalty claims in our t *Lwten ckums office. Richard received his Bachelor of Arts from Trinity lhuNrrity in San Antonio, Texas. R:rhard is bilingual in SVI�-h and SPONA ,�. Claims Assistant Andrew l-krnandez !s the. Calms Assistant and Receptionist for the corporate Dallas office. Andrew has a background as a systems An*st with a major IT corporation in Dollar, Texas. Andrew has been with TPS since 20U. TPS la Section B: Scope of Services Claims Reporting Minutes can be critical when an injured employee is on the way to an emergency room or primary care facility, In a matter of days, a great deal of medical treatment may occur, and if not managed properly, that treatment can cost more than it should or may be inappropriate for the injury. Industry statistics indicate that for each day a loss report is delayed, the average total cost of the claim is increased by $1,600-$2,100. The sooner a claim is reported, the sooner we can gather and assess the facts, develop a plan of action for resolution and help you contain costs. The first report to injury can be received by the claims offices in the following manner: • Internet/web base reporting: claims(o)_tpspool.org • Facsimile: 1-866-888-3633 • 2417 emergency toll free reporting service • Mail: P O Box 803356 Dallas, TX 75380 Initial Set Up Upon receipt of the first report of injury, a claim number will be established and all pertinent claims data will be entered into the computer file within one (1) business day. A supervisor/manger will review for severity and assignment. Best Practices — Property & Liability Overview This Best Practices Guide is intended to provide the foundation for the thought process that goes into good claim handling. It is not a checklist to be used on every single claim. The Best Practices Guide is designed to assist adjusters in finding the best ways to bring those claims to a timely and fair conclusion. There are three major questions we ask ourselves when reviewing a claim file for proper handling: 1. Did the adjuster THINK? 2. Did the adjuster exercise sound JUDGMENT? 3. Was the best overall RESULT achieved? Critical Components There are three critical components of good claim handling: 1. Coverage 2. Investigation 3. Evaluation/Disposition When the adjuster thinks and applies sound judgment in these three areas, we see a positive impact to results. Set forth below are the Basic Questions and Best Practices for each Critical Component. While the Basic Questions must be satisfied for each Critical Component, the Best Practices should be considered on a file -by -file basis. They are designed to provide the adjuster with a foundation for critical thinking in order to bring the claim to a proper and timely conclusion. Remember that one of our main goals is to utilize our resources wisely in resolving claims. If completion of any of the Best Practices is required to satisfy any of the Basic Questions, then that activity should be completed and evaluated in light of the facts of the claim. If completing any of the Best Practices is redundant, or would not contribute to a proper resolution of the claim, then that activity should not be undertaken. Each claim file must speak for itself. It is the responsibility of the adjuster to document the claim file in a manner that demonstrates that all of the Basic Question of each Critical component have been answered satisfactorily and that the information contained in those answers has been utilized properly. This embodies the concept of file strategy. Critical Component One: Coverage Each file needs to answer these Basic Questions: 1. Was the coverage in force? 12 2. Did the policy/contract cover the loss? 3. Was there other insurance or were other sources available? If so, was the other insurance applied properly to the loss? 4. Was the coverage determination made in a timely manner? Best Practices: Coverage The following are points to consider in answering the Basic Questions: ❑ Confirm that the policy was in force. Verify the effective dates, limits, endorsement numbers and titles, edition dates, terms and conditions of the policy in accordance with established procedures. Review the policy language as appropriate. ❑ Determine whether occurrence or claims made with appropriate trigger data. ❑ Be sure the Special Account Instructions are reviewed for special coverage provisions. For example, concisely address special account provisions such as deductible amounts, SIRs, excess coverage/carrier(s). ❑ Determine if: ■ The individual or entity seeking coverage qualifies as a claimant; ■ The allegations against the insured are within the coverage delineated by the insuring agreement, exclusions, and definitions; ■ The type of damages claimed are the kind the policy covers; and ■ The policy conditions have been adhered to ❑ Advise the account immediately if further information is required before a final coverage determination can be made. Also advise the account to protect its interests, e.g., obtain an extension of time to avoid default, consider retaining own counsel. Conduct additional investigation on a priority basis, subject to a Non -waiver Agreement or Reservation of Rights. Indicate in the Reservation of Rights Letter that a final coverage determination will be communicated as soon as the coverage investigation has been completed. ❑ Upon completion of the coverage investigation, take a final coverage position involving the account manager as required by existing procedures. If a Disclaimer is approved, communicate that decision promptly to the account by letter. If the decision is to continue handling while reserving our rights under the policy, forward a final Reservation of Rights Letter to the insured. Be sure to follow the Special Account Instructions for the account. Make sure the letter specifically references all reasons under the policy for the disclaimer or reservation of rights. The letter should not cite policy provisions that are irrelevant to the claim. ❑ First communicate personally, (i.e., phone) and explain our coverage position to the account/personal representative, agent/broker (producer). ❑ Determine whether there is additional insurance (excess or reinsurance) that would cover the loss. Communicate with the representative of the other carrier with respect to cost sharing, if appropriate. Critical Component Two. Investigation Our objective is to achieve a level of investigation that will enable us to evaluate both the liability and damage exposures properly and timely. Tailor the investigation to the I3 exposure, taking into consideration what value is added prior to expending resources. Keep in mind our obligation to protect the interests of our account. The file needs to answer these Basic Questions: 1. What happened? What are the facts? 2. Who is responsible and why? 3. What are the verified damages? 4. Are the damages related to the loss in question? 5. Was the investigation done in a timely manner? Best Practices: Investigation Of Liability ❑ Avoid liability assumptions and tailor investigation to magnitude of exposure (e.g., rear -enders are not always 100% liability, left turns are not always 75%--25% liability) ❑ Consider obtaining recorded statements that would add value in the following instances: ■ When liability is unclear ■ When there is a potentially responsible third party and a right to contribution or subrogation ❑ When investigating suspicious claims: ■ Obtain copies of reports when they may be used to clarify or assist in evaluating the client's liability exposure. Examples of these reports are: police reports, fire department reports, weather reports, and the reports of investigations by private or governmental agencies. ■ Obtain tangible records, such as contracts, certificates of insurance, leases, maintenance records, driver's logs, maps, or other evidence that may be relevant to the event. ❑ If the claim arose out of a condition of land or premises, the investigation should address the following: ■ The relationship of all persons or entities relating to the ownership, maintenance, use, management and control of the land or premises ■ The existence of contracts or agreements between the persons or entities which may affect their respective obligations ❑ A description (photo/diagrams if warranted) of the condition out of which the claim arose. ■ Consider the applicability of building codes, local ordinances, statutes, etc. ■ The facts surrounding the last time the premises were inspected and maintained prior to the time of the loss. ■ If necessary, an expert's opinion regarding the condition out of which the claim arose. ❑ If the claim arose out of the client's products or warranty, the following areas should be explored: ■ What is the product? Was it manufactured or distributed by the client? ■ Understand the basic application and use of the product. ■ What is the specific nature of the defect alleged? ■ How was the product being used at the time of loss? rV6 14 • Was it being used according to, or contrary to, instruction and/or warnings (obtain all labels, instructions, warnings, if appropriate). ■ Was the product modified in any way? If so, how was it modified, when, and by whom? • Was the product produced by our client the "end product" or was it a component part for another end product? If the product was a component part, what is the significance? ■ Is there vendor's coverage or are there hold harmless agreements? ■ If possible, secure and preserve the product, including labels, instructions. Consider contacting counsel for guidance. ■ Is there a history of claims, recalls, or the like? • Consider statutes of repose. • Consider whether retention of expert is appropriate. Best Practices. Investigation Of Damages Bodily Injury Investigation ❑ Obtain all necessary information from medical service providers concerning the nature and extent of all claimed injuries, their causal relationship to the accident, the date of treatment, whether there were any pre-existing injuries or conditions, probable length of work disability, prognosis, and potential permanent disability. ❑ Consider obtaining a medical/wage authorization from claimant to obtain medical records directly from the medical providers. o Verify all claimed economic (past and future) injury damages. ❑ Consider a peer review, association of an HSR, the use of vendor services, or an independent medical examination. ❑ Confirm income loss directly with the employer, where warranted. ❑ Secure appropriate IRS returns. Consider obtaining personnel records from the employer where appropriate. In claims of long-term disability, review Workers' comp file or discuss with WC adjuster. Obtain copies of IRS returns for two years prior to the accident, the year of the accident, and for each year subsequent to the accident. ❑ Consider whether cost -sharing arrangements are appropriate. Property Damage Investigation ❑ Secure itemization of all claimed damages, including repair costs, loss of use, loss of profits, damage to business reputation, loss of business opportunities, and another direct or consequential damage. ❑ Consider retaining appraisers, accountants or experts if damages are questionable or significant. ❑ Consider whether cost -sharing arrangements are appropriate. ❑ Consider reductions for actual cash value (rather than replacement cost value) and salvage. Critical Component Three: Evaluation/Disposition The file needs to answer these Basic Questions: TPS 15 ❑ What is the exposure? ❑ Was the proper amount paid? ❑ Were reasonable means and resources used to mitigate and negotiate the loss? ❑ Were the evaluation and disposition accomplished in a timely manner? ❑ Were reserves accurate? ❑ Were reserves timely? Best Practices: Evaluation ❑ Once the investigation has addressed the appropriate issues, evaluate the claim in light of your investigation, the venue of the claim, the opposition and any other factors that should be considered. ❑ Be realistic in evaluation the liability and damage exposures. Consider the value added of further investigation; e.g., retention of experts, litigation, mediation and the like. ❑ Use Colossus as an aid in evaluating the bodily injury component of the claim. (In offices where Colossus is not being used, use the Evaluation Guide or equivalent format). ❑ Consider benefits of a face-to-face meeting of the claimant to evaluate the condition and demeanor. ❑ The use of developed mitigation opportunities is implicit in the proper disposition of a claim. (Mitigation is discussed below.) Best Practices: Mitigation Opportunities ❑ Analyze coverage, liability, and damage investigation to identify all mitigation opportunities. ❑ Contact the claimant periodically to maintain control. When telephone or written contact is inappropriate, involve an independent adjuster for a face-to-face meeting. ❑ Screen bills, wage claims, and other items of damages to be sure those damages are appropriate and reasonable. ❑ Consider the applicable doctrines of negligence and joint and several liabilities. Seek contribution or indemnity where it is appropriate. ❑ Determine if a per -existing injury or condition caused or contributed to the claimed damages. ❑ If appropriate, arrange an independent medical examination of the claimant. Provide the examining physician with copies of the claimant's medical records prior and subsequent to the loss involving our insured. Consider having a physician or peer review examine the claimant's medical records and provide an opinion regarding causation, disability, etc. ❑ Utilize the Central Index Bureau returns when information can assist current loss assessment. ❑ Consider activity checks to assist in determining a claimant's current physical activities and condition in the absence of medical documentation, or where the disability continues beyond a reasonable period. ❑ Refer claim to the Fraud Unit if fraud is suspected. TPS 16 Best Practices: Reserving Establish reserves timely for a current reflection of exposure. Be guided by the following: ❑ Avoid unnecessary file creation. The initial loss and damage description should justify a file's creation. ❑ Promptly establish proper loss/expense reserves. Continually evaluate appropriateness of loss/expense reserves. ❑ Establish the expense reserves. ❑ Avoid minor reserves changes (stair -stepping) and overpayment where payments exceed reserves. ❑ Consider need for excess letter to account (copy to agent/broker). Best Practices: Disposition The disposition process should be objective, timely, and designed to produce good results. ❑ Once you have evaluated the claim, form an appropriate strategy (considering the nature and the size of the claim) to bring the claim to a proper conclusion. ❑ Consider whether aggregate limits are an issue. ❑ Follow the special account procedures in disposition efforts. ❑ Proactively pursue settlement. ❑ Adequately document the negotiation process to show how the end results were achieved. ❑ Confirm verbal offers in writing. ❑ Communicate, in writing, the basis of your decision when disclaiming coverage or denying the claim. ❑ Consider resolution through med pay where appropriate. ❑ Consider first -call settlements, supported by telephone verification of specials. Project medical expenses to facilitate resolution. ❑ Conduct face-to-face settlement discussions when beneficial. ❑ Diary according to claim needs to ensure timely claim resolution. ❑ Consider advance payments when appropriate. ❑ Alternative Dispute Resolution may provide an effective means for negotiating face- to-face with the claimant's attorney. ❑ Use proper litigation management techniques to avoid paying unnecessary legal expenses. Best Practices: Documentation/Reporting Electronic or paper file will reflect concise documentation of activities, including dates, times and sources. ❑ Concisely address facts, allegations and plans in the activity log. Comments are to be professional, objective and factually based. 17 prepare a File Strategy within 30 days of assignment. This summary of activity should address coverage, liability, damages, settlement values, reserves, costs, and a disposition plan. Plans for future handling should include time frame for completion. The file strategy should be revised and updated as necessary to address the impact of new development and/or outstanding issues. ❑ The length and depth of the file strategy should depend on the nature and the size of the case. ❑ Briefly summarize supporting documentation (i.e., medical, police, and other investigative reports) in the adjuster notes. Verbatim copying of reports and documents is not necessary. ❑ Document photographs by providing the date and hour the photo was taken, the location of the scene, the direction the camera was facing, and the distance from the subject. Do not write on the photographs themselves since that may affect their admissibly as evidence. ❑ File submissions should set forth the reason for the submission, an analysis of pertinent issues, including reserve adequacy and recommendations, if necessary, and plans for disposition. ❑ File Risk Alerts to identify any undesirable risk characters and/or premium return considerations. ❑ Concisely address special account provisions such as deductible amounts, SIRs, excess coverage/carriers(s). Best Practices: Data Integrity ❑ Maintain data integrity throughout the life of the claim file. Update the claim system promptly. ❑ Utilize the proper nature of benefit code, location code and tax reportable codes when applicable. Accurate expense codes are critical to our profitability. ❑ Record the date the loss notice was received as the reported date. ❑ Utilize claim description code that accurately reflects the factual description without an over reliance on "NOC" codes. (Update codes when facts clarify information.) Be sure to enter the actual description of loss as opposed to examples supplied. This will provide specific information for loss control purposes. ❑ Select claim injury codes and coverage ID codes that accurately reflect the injury sustained and update via element change as needed. ❑ Ensure that the proper policy number, policy period, limit, aggregate and deductible are entered for the loss. ❑ if a claims -made policy, and a claim has actually been made, insert the claims -made data. ❑ Utilize directory tables for attorneys and medical providers. TPS 18 Claims Administration Claim Management TPS is proud to have served in the State of Texas since 1983. Our philosophy in delivering claim service is simple: the customer is number one. Our goal is to consult with each customer regarding his legal responsibilities to injured workers and inform him of his options. We work with you to make sure the options chosen are executed efficiently and cost-effectively. We work to achieve the maximum positive impact on medical treatment, with the ultimate goal of returning your injured employee to workplace as soon as possible. TPS Claim Protocols From the moment the call is made, an experienced professional begins processing your claim immediately. Our adjusters are trained and their performance evaluation is based on all aspects of solid claims management, including: ❑ Aggressive claims handling ❑ Prompt and thorough investigation ❑ Recorded statements taken on questionable files ❑ 3-point contact within 24 hours of assignment ❑ Supervisory review of all claims ❑ Individual loss reserving ❑ Payments made for all related workers' compensation benefits ❑ Medical management provided on each file ❑ Applicable state filings made ❑ Recovery of third party and second injury fund claims included In addition to superior claims management, TPS offers the following: Experienced Claim Teams ❑ Average claim experience of 20 years ❑ Account —specific, state specific adjuster assignments ❑ Adjuster assignment levels average 125 lost time files and 225 medical only ❑ Supervisor to adjuster ratio is 1:3 or 4 ❑ In-house continuing education program Legal Services ❑ In-house attorney as a resource and legal bill review ❑ File coordination with defense counsel Information Systems ❑ Full -service claims administrative computer system TPS z ❑ Web -based, on-line access to adjuster notes and financial information ❑ Pre -formatted reports as well as an ad hoc reporting facility ❑ Records retention program Most of our services are performed by our claim professionals. However, when a vended services partner is necessary, we understand that it remains our responsibility to direct and control the assignment to assure that a timely, cost-effective, quality product is delivered. Claim files are fully documented to indicate the reason for using outside resources and authorization to use them. Invoices are carefully reviewed to assure charges are reasonable, necessary and justified. Adjuster Experience We select our claims adjusters very carefully. Throughout the TPS system, we recruit and hire the very best adjusters available. We look for experienced candidates who exhibit leadership ability along with knowledge of claims, ambition, and excellent communication skills. The careful selection of adjusters has resulted in a claims team with an average of 20 years experience. With such a high level of professional expertise on the job, TPS has devised extremely effective management procedures that maximize our adjusters' time, allowing them the opportunity to apply their abilities throughout the company. Our adjusters work in teams of three and four, led by a veteran supervisor. This team leader carries a reduced caseload so that he or she can mentor and supervise the team. This approach has two Important advantages: ❑ It enables seasoned adjusters to maintain claim management proficiency while staying current on the latest legislative, statutory and healthcare developments ❑ It allows the veterans to share their expertise and knowledge with less experienced adjusters, ensuring that all team members' benefit. Our innovative team approach allows us to promote and reward our best adjusters while allowing them the opportunity for enhanced professional growth. At the same time, they share their knowledge and experience throughout the TPS family of claims adjusters, ensuring that our clients have the benefit of all levels of expertise within our company. Reserving Our reserving philosophy is simple —our adjusters promptly set reserves equal to the probable ultimate exposure of each claim. For large, complex cases, the adjuster will consult the supervisor and office manager to ensure that reserves are appropriate and that the full range of claim management and resolution options are explored. TPS 20 The reserve exposure is documented in the claim file and communicated to our clients as specified by the claim handling instructions. Reserves are refined, as necessary, when new developments that impact exposure occurs. TPS reserving philosophy, procedures, and quality assurance help prevent both under - and over -reserving, Our reserving practices are designed to head -off potential reserve surprises. Factors used to establish the reserves include: ❑ Coverage ❑ Compensability ❑ Negligence and Damages ❑ Nature of Injury ❑ Extent of Injury, damage or loss ❑ Anticipated Medical Treatment ❑ Age/Gender/Occupation ❑ Lost Wages ❑ Anticipated Permanent Disability ❑ Pre-existing Medical Conditions zi Mitigating Factors Client Services Account Management TPS understands that open, ongoing communication is the key to a mutually successful, long-term relationship. Our account management program is carefully designed to be an extension of your risk management department. We assign an Account Manager to you prior to the program inception. Your Account Manager is your single point of contact and acts as your advocate on all service issues. The Account Manager's primary responsibility is to ensure delivery of world -class service in addition to overseeing all aspects of your program. Your Account Manager is responsible for: ❑ Developing and implementing (jointly with your Risk Management Staff) the service plan for your account; ❑ Monitoring your on -going claim service; ❑ Addressing questions, issues, concerns, and needs; ❑ Communicating your special account instructions to our claim offices; ❑ Coordinating with your primary or excess carrier; ❑ Attending periodic meetings and file reviews; and ❑ Initiating renewal activities after the first cycle of service. Service Plan Led by your Account Manager, our team works with you develop a detailed Service Plan that defines our commitment to you. The Service Plan details the services we will provide, our responsibilities, and timetables specifying delivery dates and points of service. Your Service Plan includes: ❑ Claim management procedures, including mutually agreed upon claim management requirements ❑ Communication procedures ❑ Loss control strategies ❑ Managed Care services and objectives ❑ Risk Management Information Systems and Services Special Account Instructions Prior to program inception, your Account Manager will work with you and your broker to define your unique program preferences, standards and requirements. Your requirements are integrated with our critical core standards to create your customized account instructions. These written instructions become an integral part of your Service Plan and should be revised in writing if necessary. Your account instructions will cover a series of topics including: TPS 22 ❑ Client and claim related contacts, including who to contact when a loss occurs; ❑ Location coding information; ❑ Reserve and settlement consultations, consultation levels; ❑ Subrogation notification; ❑ Interval reporting; ❑ Loss run distributions; ❑ Managed care instructions; ❑ Litigation management instructions; ❑ Denial/Reservation of Rights Advisories; and ❑ Vendor assignments (surveillance, etc.) The written instructions are distributed to all involved claim offices so that your claim representatives have immediate access to your account instructions. A sample copy of your Claim Service Instructions follows. Quality Assurance TPS utilizes its operations management and client audit staffs to conduct internal audits of our claims operations. We conduct annual branch audits and adjuster audits on an ongoing basis. Supervisors are required to adhere to the following audit procedures: ❑ Total file sample should equal at least 5 per month per adjuster; ❑ A minimum of 15 files per individual should be reviewed quarterly; ❑ 40% of total files reviewed should be closed files; ❑ Files selected should cover a range of settlement amounts; and ❑ File sample should include cases in litigation. A Supervisor Checklist has been created for use in the review of claim files for compliance with the Best Practices and quality control standards established by TPS. Standards of satisfactory performance are outlined as well as standards for quality performance. All areas are essential elements of proper claims handling. The Checklist is used to assist in measuring compliance with company standards by individual performances, as well as overall performance by unit, office and division. Identification of strengths and weaknesses will assist in prioritizing training needs. The Regional Manager is also required to review a minimum of two files per Adjuster each quarter. The file selected for review will be from files previously reviewed by a Supervisor. The purpose of the Regional Manager review is to validate the results of the Supervisory Review. Who is Evaluated and Frequency of Evaluations Managers perform ongoing evaluations of Supervisors and Adjusters as required. If you desire, we will provide you with a complete copy of our review guidelines. In an effort to provide uniformity and consistency to a workers' compensation claim audit, each area of performance will be commented on by the Manager. The fact that TPS 23 acceptable scores for each area of performance varies should not be construed as meaning any area is not an essential element of proper claim handling. Procedures for selecting workers' compensation audit files are identical to our internal audit procedures presented above. A Supervisor Checklist is used in the review of claim files. Standards of satisfactory performance are outlined as well as standards for quality performance. All areas are essential elements of proper claim handling. A checklist is used to assist in measuring compliance with company standards by individual performances, as well as overall performance by unit, office and division. Identifying strengths and weaknesses assists with prioritizing training needs. Each category is rated as follows: N No or not satisfactory Y Yes or satisfactory NIA Not applicable A "No" rating requires an explanation. Best Practices Compliance When reviewing the claim files for compliance with the company's Best Practices standards and guidelines, the following issues are considered: 9. Coverage/Client Standards Timeliness: It is our policy to investigate the facts and issue Reservation of Rights and declinations where appropriate within the first thirty days from receipt of the loss. Our coverage defenses must not be waived or stopped due to inaction by the claim handler, A copy of the employer's first report and doctor's first report will be contained in the file. The claims will be entered in the system in a timely manner. Quality: Coverage issues must be recognized, properly analyzed, investigated and addressed, in prompt fashion. Where reservations are issued, the claim handler must remain aware that an open coverage issue exists and reanalyze the situation as new information is received. This follow-up analysis should lead to one of the following actions: ❑ Rescinding of the reservation; ❑ Denial of coverage; or ❑ Notice to the client that the coverage issue remains open and all or part of our Reservation of Rights remains in effect. 2. 24-Hour Contact Timeliness: The insured, physician and injured worker (or their attorney) must be contacted within 24 hours of receipt of the notice of loss. Witnesses must be contacted 24 as early in the investigation as possible. Follow-up contact must be completed in a timely manner. Quality: Contact is to secure as much information as possible regarding facts, injuries, etc. The quality of the contact must be meaningful. Questions from the client and injured workers must be answered including explanation of benefits. Issues of compensability and coverage must be explained. We must explain what type of documentation will be required and establish a date when we will be back in touch with them. Contact must be documented in the file notes with date indicated, and signed by the claim handler. Follow-up contact must be meaningful. 3. fnvestigation Timeliness: The basic investigation should be substantially complete prior to the file being case reserved. The investigation should start at the time of the initial contact with all parties. Recovery must be pursued vigorously. Quality: Each investigation must be specific to the individual situation. Form letters to the client, injured worker or witnesses are not an acceptable means of conducting an investigation. The pursuit of information must be aggressive and information cannot be developed entirely through "discovery" if the case is in suit. Each case must be investigated to the point where the claim handler can make a sound, reasoned decision to either pay, compromise, or deny the claim. 4. Reserves/Indemnity Benefits Timeliness: A reserve must be assigned at creation, which reflects the proper evaluation at that time. The claim must be reserved no later than 90 days from the date it is created. All revisions must be done within three days of developed additional information, which would necessitate a reassessment of exposure. TTD benefits should be paid timely and correctly utilizing wage information form. All notices according to state statute for TTD, Permanent Impairment and MMI should be filed timely. Quality: The reserve established must be supported by an evaluation prepared by the Adjuster. The reserve must be broken out between indemnity, medical and expense if it appears expenses will be incurred on the file. The reserve must be re-evaluated if information upon which the reserve is based changes. Any change in the reserve must be explained and reasons justifying the change documented in the claim file. The reserve must reflect our best estimate of the ultimate exposure for indemnity and expense. Over reserving and under reserving must be avoided. The process requires that the wage information be obtained within three (3) days from creation and payments be made with notices filed within the time frame of the state statute. 5. Subsequent Reporting/Delays and Denials Timeliness: The process begins when the initial assignment is made to the claim handler, at which time the Supervisor should highlight points to be covered. There should be a discussion on the salient points of the claim file between the claim handler and the Supervisor. These discussions should continue at critical stages in the TPS 25 development of the file. The necessary reports are to be completed timely and detailed to assist in the evaluation of the file. Any delay should be reasonable and notice made in a timely manner. The appropriate forms should be filed and the denial supported with accurate information released in a timely fashion. Quality: The process must be a collaborative effort between the Supervisor and the claim handler. The fact that the process occurred and the substance of the discussion must be clearly documented in the file. During the process, and at critical points in the file, there must be clear documented evidence of value added by the Supervisor. In addition, there must be evidence that the claim handler is an active participant in the discussion and reporting. The denial process should not be delayed, the investigation should be completed and the denial filed within the guidelines of the statute. The reason for the denial must be explained and within the confines of the state statute. 6. Medical Management Timeliness: The process of verification of injuries should start at the time of initial contact. Documentation of injuries must start as soon as the decision to either pay or compromise the claim is made. The Adjuster must start medical management from the creation of the file. The Adjuster is to maintain contact with the injured with the injured party and work with the Medical Manager to accelerate recovery and return to work. Quality: All medical treatment must be reviewed for appropriateness, causal relationship and cost. Medical reports must be reviewed and scrutinized for proper care. File documentation and interchanges are essential and must be in detail. All cost containment measures must be taken. All claim files must be supported by documentation of medical bills, medical reports and injuries. It is not acceptable to simply take the worker's word on expenses. The amount must be verified either through hard copy or telephone contact with provider. Severity of injuries and other aspects of claim will determine which method is required. 7. Litigation Management Timeliness: Initial instructions to counsel must be confirmed within two weeks of assignment_ All litigation must be handled in an aggressive, proactive style. Quality: There must be a written, documented plan for handling the litigation. A comprehensive legal plan must be evident and litigation management techniques applied. The file must reflect communication between the claim handler and defense counsel on litigation planning. The claim handler must discuss any problem with unsatisfactory legal service with the claim Supervisor who in turn must address the problem with the Managing Attorney or Senior Partner of the firm. 8. Vendor/Expense Control Timeliness: In order to control expenses, proper instructions to vendors must be given at time of assignment. Bills must be reviewed and paid or discussed with the vendor within 2 weeks. TPS 26 Quality: Effective claim handling includes obtaining quality work from vendors for a reasonable price. Vendors must know what is expected. We must communicate our expectations to our vendors and then review all billings prior to payment. Questionable items must be challenged and payment refused when explanations do not bring the billing within our guidelines. 9. Subrogation/Second Injury Fund/Deductibles & Retentions Timeliness: Any potential source for recovery must be identified as soon as the first report is reviewed and the investigation started. Recovery must be pursued vigorously whether it is subrogation, second injury fund or apportionment. Program information on coverage should be investigated to determine if a deductible exists or if there is a retention level to consider. Quality: The handler must complete the investigation and evaluate the recovery potential. Timely notice of recovery rights must be filed. Assignment to counsel, if needed, must be made in a timely manner. Final disposition with recovery must be clearly documented in the file. The confirmation of a deductible or retention should be completed within 24 hours of receipt of the claim and documented on the system and in the claim file. 10. C18/File Man agement/Reinsurance ❑ Claim Forms: Must be utilized and entries readable, dated and signed. The claim forms should be kept in date order in the file. ❑ Diary: There is no such thing as a standard diary. Each case must be diaried based upon the specific situation as evidenced in the individual claim file. The file must be diaried for specific reasons. A file will be judged not satisfactory if there is no current diary date. o Index Bureau Report: Use of the index system is mandatory. Indexing must be done initially when the claim is reported and when additional information is obtained and semi-annually during the life of the claim. If there is a specific reason for not filing a CIB, the file should be properly documented. Information requests must be sent to identified carriers when appropriate. ❑ Mail Date Stamped: All mail must be date stamped to reflect the date it is received and handled as required by state statutes or unfair claim practices. ❑ Special Handling Requirements Met: Special handling requirements must be documented in the file and followed. It is not possible to follow the requirements if they are not known. o State Filings: Complete all state reports in the time prescribed by the legislative/judicial law including Unfair Claim Practices. o File Notes: The file must have current file and progress notes with meaningful information documented. 27 CIBs: The initial and follow-up CIB's should be completed when the file and every six months thereafter depending on the type of file. created ❑ Supervisory Diary: The file should have a supervisory diary on all files over the Adjuster's authority threshold. 11. File Disposition Timeliness: The case should be resolved properly and the award paid in a timely manner. A structured settlement should be considered where appropriate. The file should be closed in a timely manner and approved by the Supervisor. All coding should be accurate and Large Loss Report procedures followed. Quality: The award should be paid according to the statute and proper notification sent. Structured settlements, where economically feasible, should be considered. File closure should be documented with an explanation of the closure and settlement reasoning. All Large Loss Reports should be in detail and filed in accordance with account agreements. ?g Loss Prevention & Control No one wants to see accidents happen —that's why loss control is at the core of the TPS philosophy. Our loss control professionals focus on prevention. By eliminating or mitigating potential causes of injury for our customers and their employees, we reduce the overall cost of loss. By listening to you and learning about your operations, we can design and implement a customized safety and loss prevention program that will significantly reduce the frequency and severity of injuries Our loss control professionals are concerned with the human cost of loss. By addressing safety issues before they cause injuries, we help protect our employer partners and their employees from the uncertainty and worry that accompanies every on-the-job injury. We care about safety and it shows in our work. Our team of loss control professionals averages over 33 years of experience in safety and loss prevention, workers' compensation, liability and property protection in a broad range of industries, including: ❑ Energy production and transmission ❑ Petrochemical production ❑ School Transportation ❑ School Safety ❑ Manufacturing ❑ Retail ❑ Construction ❑ Healthcare — including JCAHO standards ❑ Governmental entities ❑ Safety School Kitchens ❑ Transportation TPS offers comprehensive Loss Prevention and Control services. Our loss prevention professionals work closely with you to identify actual and potential workplace problems and causes, design safer workplaces and help you navigate today's complex and changing regulatory and environmental issues. Services provided include: ❑ Periodic loss control visits to your site to complete a safety survey and evaluation. ❑ Providing the results in a Client Service Report, identifying hazards, procedures, and operations that present potential dangers to employees. Suggestions and recommendations are made to help develop, implement, and enhance your in-house employee safety program. ❑ Working with client staff to design and implement a successful employee safety program as an integral part of the workers' compensation plan. ❑ Assistance in safety training for management, supervisors, and employees ❑ Hazard recognition and response training ❑ Accident investigation training ❑ Assistance in addressing required safety compliance standards 01 29 Loss control services are offered on an ad hoc or regularly scheduled basis, and are charged at a flat hourly or daily rate, Pricing specifics are included in the service fee section of this document. TPS 30 Section C: Required RFP Information Checklist "Tp C'11 Y OF LUBBOCK, TX RFP 15-12371-MA Liability Claims Services Cilgeklist Please rnsme that ruu ccmplete xnd return the Following dowmi=L% and udarriation to the City of I uhbc:: Purchtsmx and C'ontracf Manascntcni Dcputrnett beGrre the deadline Any errmoiam mutt be initialed by perion nraking th, aere;tiva. Lae submirah will tint he accepted The Request rorPmpnsal Form MUST he corapictrd. / Clenrly nmrk the RFP number, title, duc date and limy, and your company name and addeass on the outside yl of the s—aied enNaopc or cmuaimr. / Completed and signed SLSK.NSION rA`D DFH:\RhIE\1 C'ERTIFIC:AtIOV. Please indude Cvtnpany 1/ Federal LAX ID number or Social Sccurit} num`_er V Completed \on•Collusion Affidavit Completed Insurmce ItNuitehnenl AITdasit FAILURE TO PRO\TDE ANY OF THE AHOVt± MAY RI'SUI.F IV YO1"R PROPOSAI HLI\G DLL\ICD NON. KLSPUNSIAT. his itatian to Proposal I unn All S TS 1 he completed 1 eke,', 101ti j Sui'xyf.S; M, S S51 F" Print Name of Company Contact Person/Phooc PLFASF.INCLUDE THIS COMPLETED PAGE AS TIIE FIRST PACE OF YOUR SuBmiTTAI. 2 31 ,ME:: . I - -.- . MS400W. A Request for Proposal SCB\Ifr TO: CITY OF LUDUCCK Purchasing A C'onlma 'M iml-emarl ci'roi lubbock t625xLTx74GI-1}d „Ill CITY OF LUBBOCK,TEXAS 1.ubMxL Ts 79361-?E:B All EQUAL RhQI: FtiT FOR RICH TECIiIOLUCI' PROYDSA I. COSLtCFPt R�U\ N,rb.Ih.rr. nrrURTVNI i Y r.'.11'i t)YFR RFP 1:-12371-MA TEL: E14.T75.2572 FA.\_ JIMM5? Ib-1 hIIP-A1j;=hafirgci lckko:A n,lr, TTTI.F.: Liahili!y Clailai Sun icca %i M.N11 I I'Al i)EAM IN}-: June 11, 2015 at 3:00 p.m. (.W PRkPRUP(-',ALNIFEMil)AII,iIME \ULOC.*,ill)M.)wl¢J,1Q13• fr;�,` '.n..n.:fy .m.r..�«Ne+ ��+, ..r rt+, al I�tW.Inm.,r �,lislU'Room10-{3Ltlhf}oek.'Tk"79�� d�s.� Jtr..m+la�JarM�u;�J.>~.e..,J R}SPt}NF)EVI`IA.11E: _ ` _ F CAS fC, I�l( 5 ^ti151 is .15ir It RrTL'1, \f1,:.A�A �DAFSR,\Sr'PS rLSr hi aTF Rr ief))c AIAIIJI•C AUMM5S: t rLL Bao s('1!i✓ ��v CITY •SrAtl' -%IP Ikl(fct 5 IIit ci I) cr I 511t,e.h XL I tlll RIMII it JC(rm n[ RI II rr As %-,I) AlL P31) IJ\AL 5 IN U MULE UR ItPAR r AtJU tS •tlt E .L4'1 L\FURdt t1 RY _75 __ ,•„ _ _ .- TFLEPILU\E \O r.. TIIF rfl,',-.Pr TrVE PROrMAI PROCESS FURTHLR- III: CrrS' RF5LRYFS IHI RlfillT lu I:NTI R IYfO A\S CUA rAari ❑t f hlfl ro nF r.I)IE pL51 MI LFIL51 OF r)ILLOI 1'L lS T)ir MTF\T AYr)1'1 Rrti tsr OF TiiF Cr11' OF 1 LnruwK T-rl%r TIILS ULULLY1 P1.10111b, CUM&HIIVL VRIJW)hAL6 It 6 THL UFFLRURS RrSIY}NSIRp ITY TIT AO`llir Tllr =i Or LtlAsociz DtRrcwjrri or PLPLIIASIMG AM) CA, UNIR.1 MAVAGI\IENT IF ANY IA\GVAGt. FTDFRII T\X11)\() ORVI(I.11 51(,IIRI11 Rrc?i'MEIIrNTS t;C (:`P, .L`,Y COMBItiT1U\S nm.ttzUr, ,Co. F\ir)S FRTF\TL) ReSTRR TS OR 1IIIRS TILT RFQ1:1RFIIFN71, STATFn 75—l93/&r,0 7 L•, MIS RFP ,U A SINGtIL SLR)RCL SULFI NUILICAIIUN %lLSr BE SI MN ri-mr) rJ SS'Rr-, tm� ,LNn \n15T nr RiirivrD HY'mr rRlrCTITR Ur ILL.RCHASI.NIi AND CT rvI1LA( T MANalitML\'r \n LATER TII\\ I IVF 1 i) RL:SCIL55 DAYS PRR)R TO TIIE ADOVL 5L:8N1 rESL DFAULI:JL THE UFIFAUNII F. RfH):\CIS\UfS1.l.IH:FSRL(I:II'I'OF%NUAGHI1%IIr PROrti kI Is B1\FOoN AN% AOHF% 1IYI\rrpf)% BIBSIN CUM T1tr Crtr of IilF.ci 0an.r f(I c C.I� is t a,wrl fi n" an at ePaal. pb, wnrl iq 4Y..•c F`r Itk mub�+ral n it berrctand to Ike tZe bi:M: Ca} of it s+:;Hlu. eyupRlecL rra(nral v any Ics pr.,h,te d N' 11 jn nlliaa of rntl.nee u ncc CPr,. m rnmtw o(:Fo r owme l .le :asd•. bmcff pnm?rA —, ul Jim patnnal In dr A..c'I." "T_YIS htI I, romp!. UNCF RTHI DIE\ Sot irtimm DII 1INDI RSR:XI DOFF I R13P IIAVL\G I C IMIVI D Tilt RL(jL'k3t FOR Mfly. %I, A%I) rtl\G FA.IRLLU BT I H I HE 1-04 UII RI\S TU BE MU HE RF BI 5GHMI15 THE FOLI O:ST\r.1 AN INDIVIMAI AL FFWR V F D to @VD TII I CI )t)r l\Y MUSTSIGN MUM I UU M, NFCI IO\ FAIII RF TOF\FL'I:TF Tilt', •HTiITV At.i1 RMII. T IN PROIyiS tl RFIFCTTch\ O) m) uE—re I 11ut thi. ulkr s •:a.. n fh•a ow rrlriivdlSkng q-rr�R,Li, or corm" um uab ar•} cnrr.ra 1m.:S-m. br Lliv): Mir. to rz ,n ,.Iwimtg an u1Gr rw the .- rFI— yarptr., or w: ctini, re! rs m y1 r.mt 6e .-o unkq eeBAne.r v Bml 1 rmd'a -�_ :e that ,f fie olio r. a:eeral.?a• dlerw sti" :am iti. u'I asu m, m 'r3mle to the rqr all rk-w. nck tnl imRr1 in )n' ;n a1 eau'r: a(a-nnn I m.L. re•.:. m Im.11a aagmrr wru the .I:r.1 bast I— or U. L'nnr) Sales and it. 5! Ik .1 T—, Sr rst.r ni to Rlntnt to if.c p.U-.:ar eaerirtwrtPls} m rsnr la PLUIi W aathmeu M the C .O ur 1,11—i A; ca 01i% it. Clp t-.JeI, rau M} rsl b dr sor)ur =� Dlrcclr�r err iV1u.rlGt�ihu Intbnit"Ligc,arta" '� rid. KLiii�, D., 11 i Pnrt7,pe Wmc U* THIS 111111 W Sr 111: C OIIPLL TED A\D RF.TI R.\ED It I'rll VOI It RFSPO\SF_ TPS Suspension & Debarment Certification City of Lubbnek, "M RFP 13-12371•NA Liability Claims Services SUSPENSION AND DEBARMENT CERTIFICATION Rderal l.avv (A-102 Common Ruic and ONIB Circular A-110) prohibits non-Fcdcral entities from contractinz %Kith or makin_ sub -awards under covered transactions ti) parties that are suspended or dcburred or %rase principals arc suspended or dcbamd. Covcrcd transactions include procurement conlracts fur good.~ or services equal to or in excess of 525,000 and all non -procurement transactions (e.g.. suh•aysards to sub- rccipients). Contrecturs receiving individual awards of $25.000 or more and all sub -recipients mus: certify that their orgari7winn and its principals are not suspended or debarred by a Federal agency_ Before an award of $2?.000 or more can be made to your firm, you must certify that your organirrtitm and its principals are not suspended or debarred by a Federal agency. I, the undersigned agent far the firm named below. certify that neither this Linn nor its principals are suspended or debarred by a Federal agency. COMPANY NALNIF: Te Iy_i'ddr —A rr11 » r. 3S417 Si-nature of Company Of tclat: lbtc Sigred• Q(,0111115 Printed name areampany of icial signing abuvc:�trdk 'a) 41h l h Uk 33 Non -Collusion Affidavit aiv orLublwck,TX RFP 15-12371-51A Liability Claims SerAccs NON -COLLUSION AFFIDAVIT STATF, of I&X41S thin COUNTY �P-mb. j7, AtheA"S being first duly Sinn, on hiAier oath, says that the bid above submittal is a genuine and not at shunt ur collusive proposal, or mode in the interest or on behalf of any petson not therein named; and s.'he further says that the said oflcror has not directly induced or solicited any oftcmr on the above work or supplies to pot ir a sham proposal, or any other person or corporation to terrain from bidding: and that said bidder has not in any manner sought by collusion In .--cure to self an advantage over any outer oflcrur or ollcrius. CRil,S iu�si([u�. Slt��t1!'tSIL1M11 TSI� NANIF OF FIRM -� SIGNATURE OF fferer ..Dfcccb! 4—ftwiftin-- 'I'I f LE S . cricribed and s,.som to before me this ! I {1_.day of 1t)l!. a;y ; 2015 Kotan' Public in and for the State + LISA ANN QAVENr011T of _I r x p residina at Myc0aw"I" wm (iQ_� St.vcl�L Trnrl.,,GcLG; I'� �.,�ay� Junto 30.2011 \OIL: "101S MH%1 NI 5T n: COMPt_FILL) AND M LLUCD IN WITI THC 61U.PROPOSAL 12 TPS 34 Insurance Requirement Affidavit "Tp City of Lubbocl., TX RFP 15-12371-;11A Llubtlity Cbtitno Smiccs INSURANCE RF.QUIRF.MF.NT AFFIDAVIT E fu ►ir Complrted b, O1Trror AM Atuchcd to Submittal 1, the undcrsianed Otteror. cerdfl that the insurance rcquircments contained in thk prnpusal document it ve been nvicw;d by the and my Insurance AgenUllroker. If* I am awsded this comracl by the 01) of Luhhock. I will he aisle to, within ten (10) business days alter heing notiried orsceh amid by the City of Lubbock, furnish a valid insurance ccnificate to the City meeting all of the requirement; defined in This pntposa), �i Yc►lth Ix Yllh�e fts Contractor (tlriginal Sigteanre) Contractor (Print) CONTRACTOR'S 13USINL•5S NAME: (Print or lyre) CONTRACTOR'S rIRNI ADDRLSS: NUFF. TO (743Y7'RACTOR If the time requirement specified ahosc 6 nut mcl, the City has the r(ghI to reject this proposal and award the Contract to another contractor. if you have any questions concern Ing these requiremcau, please contact the Director of Purcha4ng & Cuntract Management of (806) 775-2572. 13 35 Pricing Sheet . Claim Sm:us Rcp;r,, • L pdatcs an i timely manner. I crmal repots si:all be submitted to the Cia Risk Manannteal Ccvrdinatur and flic :%cgs lial•r7lry cnrict when the powntial liability is d Lermir d to he 5250,110 ur ernler or they meet the mprtremcm ofil,e t'ity's ec:ess Iahihr: carric rcpxtin� rcquiremcm, PRICINGA I\OFF Inc:ude a listine or dwse allucetcd cllJreei not included inyutir Cticine l hese ft rm, roust be u•ed It, sut+rnit your prt:irw_� optsm; and they may he copied, A detai!cd Whtcn cxplmta6,3n ef%vurolTcrean be prosidcd to aurwrf your pnition or plun. C 11l, TTTTTllq:—.--- " Upon I — t1al ptwn ee Th+I'n),1111"-Hat )ptutn — I iaed 1•ee far Lifc for l wo Year Fixed Pee For met Pricing oftbeClaim C1a4115enica ContraetPeri+;1l Stn,cuue IV" Careh+Sri I, �uTtsTfiZcZiaiTt} peg CW M C-he t f Otis / fri.in+s Te+! yrat^ mnn .0 I itTi 1 y 1 ct is ity (Law iurc m-11, 1 Employment Pmt:,ccs, Public Il \\ t )111c1115) ! r A atasltcp i:c ChnimilU or mote ` claimants) 1 1CT1fST rCommntra:ntn m+ � ars Jtnn �� I l tija [��t NJ ion � r L-q,orng r" EVALUATION CRITERI % �1 All proopnali will be eulteued by a m.un to include bin not be limited to City of Lubbock members, legJl camscl. 4M irdepend=t Luitsultantisl. The fallowing criteria will be used to judi c and mnk submittals: Senim JO"A Includes ability 4n pm%We quabCed personnel. ability to prmide a trhnicai and comprehensive invcuigaticu proem, ab8ig to satiifi xilhnrin levels, ahilin to respond within 111 minuics in the nmi of art emerecmc-) and refermn 35 RFP Questions FJ--cLU3fU,mrT',r COMPANY —L TES SIT -. I 1-UNMENIS P. Dco IT If. pkk= -T -AMIC(Likeit!.<P—A. 20— 17' pixy'Evlui. F Mi y" c. — namerawc.1c'Um kp.r. No cc,5.+ F Ll,-A. x G Can 14,t R— he p—Sd,d in k—w f—, lq'rp4- heAS io O"'i" &Lq P"LlA iNll are ON ITS if 13— )a. wrparry h... th, .6; 1, 1. 1,; Ac.—m D=57- Seem I —1 .&, 'DOA If mi. I'Al It, Vt.. Iwl . It jj No (mi Wbx w Cx TYc dj# x la 14P4 stll— t. 1, ah a IL\CA " Ski 4 37 —sr-tFf Nr.—Xn A D:`r y,eu cvrrary Lxe r irlox ee mp+irg U-I'M pv,• n. Grchan;,•cnna9' p:rain B tLe: your wrrrny M:e mr in•Mex or ce_ai�: lr'ir.: na M.4-r.•n mo,&g WASP Epl;o= C R7ulc)uc a:•en�lsrntr; rs Yu a'c::rd' G tti'cri:yrur mcn_-'tan+trr ct•a f-r.r.aur_'. r � .. a't ds,�la t:7:r,^"='d:tr: ,n Y.a^f'< r1 h=x•I• r is^^.1r:1.:1:: kS lyF.ri F,h•n•._ry :•s:: :'. G Whalhycrra:a5e r_ Drd rra-"",_rapt: Irx ul7 tz.-ZIa7 Fk::c rNn,Nr tlt m_, d clerni tFY 5:.1 afj::_-tz F�:ltr ru .camin, rYe! i.�1.q Lis�hy �iJr !xrd:, J tia of c ria 4ux wu111.•a!,Js hd: �i-a:: nl � re• : clair� • t7ncr) t.rdllrp • t �rrauhic L,r3rI:H r • Ural ia!'i ty II f=ee yoc mtnfaayh w aebaJ >II.,�.,�nr Ifv, ___._ wR:lYutl:qI�In��l�ire of lu•ir:e' _ 1 0,:_"al .., C' G- Ar;wrrpl4Orknc,it. itpigJn m.ra~,rda•1:Y�'fc+Y"•� FA TEti 7W .w_�I COS. .i W:N a krr P—:n In • Ar Yin cicrr prhlm:-.w:I• rr." t . GmE-ar_rtir�iin' jl Is VnC 7netlr Dn 4e• Xi. YH ':.grtacmd�l;�aan hne la � s-_.•6vq• x rnylery c.se;.t n.)•r _t:f Fy n•: ; rs RA i �mpLrnev^ 1( •?.u.'tiury 4 nrra walc Ci:; ul Ln:Luk i?"rk gstary mPcr_:t rcr�arWiy� shL-asa: rsei' S 11 L• fs 4l:rae agr hr rre.r Alt-Lrl If+a hre n• v --• -.� —`_ X1; X1 �X (li WiIiRS p%�Jd��C.Si+'�i'Lr5 Qv1�f0/f.�. uc 4 iza i3T�ci�46uI Ritrzr IL1Ld u b tLA h0 c�l�Rl V+� of iL Al M. s� Thc. ItvG Qqj- e-C11>•1.)W A LA f2S wFa C(C reptc-w"AS Cl 011f Clturtit/1 C1t`C, ha— +t 111�G I�L•1'�i our IN9t" t alftiLeS yI.NC�iQ.i.1r�9 . NO cml 00 co'. V A�wT II:7 C�L�Ir f=rr:i!II� •rS: •r. all') Z)::If: w:L` )'.�^ prcrr.� Si 1 NO <1uu+11,2i tn? arr t fcc GP (tpr.n �, 7t• s trT CY1 lI f; aLL � U{?rl ml11 :cn Dpr:cn P. L_ S:r''':r• ^`ata;•nmi/via:l::nrLyrrn' Flm,.Ii' see_ beOrirM a for 04ta.& I A ri— )Px ccrrxy fu:r r<nrra r!aen Ear ��g•.Lnl:::'s 1, •�: arabdcL ruS':g 1 .Y9 FL— hlm"A R,�: :rT f>: •:r•1y vuell.115 IAtT • W)a: � tl•� auviarr diar alluee:e • Ate sor p�srnJn ry;q;eJ anJ FYFrcre rn Ere-.' 38 Ar:ucr ❑ of @ c Iw:,n.r ; �mtrns ai mtrr soh yII•u gr:{e�l See akLgjnecl best prackitf5 Aa;vcs a.l a(Itrf L :'rd7''nrlxS a'd Sohn-rE Hn}157utfi:•F.il ao�h ____------ - I� Aw-Ml. v Fl ' ---- --- - .5ee, S�ctcrn D p«�m [y 120 _ Nxias6eA`56«. o�Nr���� / �>�� -------- --- � IF 3 U DCLLJ S ^ | ^ Fk^`^"° --..`_--- ._-'- .`---_ ' � | @u/ost ' - ----------- '- ..�*= --- __ � 39 ^ it. 11.0. 'STRrMiT1.1151.1 I [.L%lL'N I-, I [A 11"'Xi 1014-mW ca:iimrq ftappmwh 1. C m-s mc.; wd .:ih tPu vmm? IL W. pk7�i V'�-Je minp! '�!= ol 40 References City of Luhbuck RFP 15-12371-NIA Liability Claims Services REFERENCE FORA Please hl ftce (31 rdcrcaceso`current cust.mxrs who am verity the glIalky (1tcel%ke }our crnnFst) Pmridc%. the Cit} prcrer; cuatnncr.; nFsimilar;i7e and scope ofworL to dri; RFP. T}n5 rt7RM .XIL 5T BF RFTi: RNFT) WIT II YOUR PRt�P05.11. REFERENCE ONE CiovcrrnentCompaay ,�lnrnc:_ C.j_— AddN,5_a00. N0(+k 5 Sfir'ce.j Garlu��c���k -75CAV ulc. 1 Pcp-0bb j Mali - } CommCommru�n aml'I D` f�.tr�lT" 0{. Plume, gl?,—a09, —aK9 C'cutra.. Period: (01011 tct4lr - KF.FFRF.\CI:'r%%O Omellummat c mip;oty Name 1.��'..l tC, -&C JIddr:;5t)C/ 11-j771yyYJt.t.lh /Un 14L=__ Cnntact Parson and Titic; r�{� itti'lR.. r �'L�tRtTi j*Auy{' wtL Ph;,ne.. �Il%0-34�t-7s3� t'nntraci Perwd: 10/411I rJ pysent REFF.RE'SCF.Tit REV. Go%cmmentCompen} \arnz: Addr��. Corms Pcrs1wn and Tith;lDl(t�jjC pvW. _, 0fEt(L114U.mC phone, CommoPtr6d; Iflioi Rw �prNSt?+ M Conflict of Interest Questionnaire CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business vAth local governmental entity This quNgonnaln rellects changes mad* Io the lwv by H.B 1491, Bath Leg- Regular £csslon OFFICE USE ONLY This questionnaire is being filed in acc,�rda-nce with Chapter 176. Local Goveminent Cede cam- n,--.,,a try a person nho has a busness relationship as defined by Section 176 001(1-2),NAti a'c+MI governnentat entity and the person meets requi: ernents under Section 176 00E(a). 6y la v tins questionnaire rnusl be fded yi1h the re`erds adrra ntstrator of the :cal gover "ntai enlq nat later than the 7th business day alter lF.e dalz Ire person becomes avra: a o' facts that require the statement to be filed Soo Secdor. 176.CD6. Lccaf Gcverrmert Cade A Fern commas an offense if the person knowingly violates Section 17E C06. Local Government Cede An offense t!nder this section is a Class C misdemeanor. Lj Nameof person who has a business relationship with local governmental entity_ x ❑ Check this box lfYOU are Ming 2nupdate toapreviously filed questionnaire, jive taw requires that you file an updated completed que3tzrin;re with the appropriate filing authority not later Iran tha 71h b-*muss day ar.er the dato tre ctignal!y Nod mr[shxnaire herrrr.es rimn:piwe or ina=ura-a ) J Nameof local government otficor with whom filar has employment or htrslnosa relationship. N ama cf OYcer This sector. {+tern 3 rrc'k aing subpar- A, B. C d DI must oe completed L.r each officer uth vrhoim.. the Ller has an employment er othe..- busness retarionsh.o 35 de`•rel oy St non 170 001;1•a) Local C»vernmenl Cade Allah s2di'mnal paves to this Form CIQ as recesaary A Is tha,oc2l gc•,,emrne-.t etcer named it Lhn s.2cL_n rece,•rrug cr h'�ety to rrxi:� t i,ob're .nccr.o omen Tian irrrr,,tme-•t frame. tram the titer of the questonnare? Ye> O No H Is the filer of Pa que39cnnaBe recevnq or ikety to rerxtve td,at-le ,nceme, ^Ihb' Utnr. inves:.•rent income. from or at the drechor. of thu local government officer named it the section AND line ta.able income is net received from tFe kcal gcra(nr-%nLal onLly) 17 Yes ED Ko C Is th-t f.ar of Ills gjvtstonnarre empL3yed by a ccrprra`On or otar bus: -ass entill wdn resaat to which ura local go•+ernmont officer awes as ar offrtr or d raC.cr or holds an enrtesrsts] of 10 pezent or acre? ED Ycs ED No D Ljmcrbe each empoyment or busir.trss relayCrShip vnth the loci: gr;+emm ; office- narec :n th.s s&von, i ei{k Its skJ Mini Of pemcn dctrg husiri -_ uih Ilht Go rmsdal LY.uy owe Aooplel 06.29R337 TPS 4? Vendor Application ��r city of lubbock Office of Purchasing and Conh'act Management Vendor Application Form M., IcnL,r f[r_[ u.J IRS tmm t} 4 to Cn, u!Lut—A PL=h:- sJ L •:rim sa! nm:U;y- Lvtomk f,:� 71IIV SIR Lax'a Cat? of Libb cA. LI tnrt of i'mch—,n_ •_.! Cnt:act war'l1:--1 fA Teo r�U' (I(tc_rc4, subct'V'S5ib�P!) _ -4 P M,-ms n'a, ifd,ffa ,t Grim ah— Y T _ - 1L•ot I i C� I Y.Lj..r,'po}. ca: E.n. G4ti1. i2ual'S,ic f:upt ctu OL'tal.ArAw' Gi'a,:ln-,L•ip .•tja 6. Ykver jl Aekl;rs "A poml'fa .411rm (a, it of near, .•n ay. , -aw%lP 1 q- Sa:c, ad'Iy1r_a L_F t'ulc C'da St. - Tdephnt hpmtrr Ltt Nerntrr 47L-- 30, 1 -Lo 3U3 1 Ca'ntar: I.— T f.Fr 11 icth 1 et IpccA pr.4 wand wn•ccn n^':r:d erd i rritl :ajw:1,d •iec lip Cs�: �3 a5N rnrr.11 T.-nm. i1ei UL A IWI TS C 1 T"57W-• C 1 n ..t1.. fjr.L..._ La %bLh CRT Nparmert 'CUT-1 MI lnr Irtrrna WO,.[G AJdrea C„}cur n:rrmrr: plaaa,aJa^ mltx Mlc,rni' ( i_,rav�:,a•„(.n. I:'py, m[h: hda'i.•t' 1:t!ter mmria�pAnte,. * u .d , pan cunfan. a l ml' Fah. • I'u le p1ur:J an Scar 6 iddtr; I� a and r..eisG beat nmticnens. ,egracnayh Ors 5+,e a uta}16iu�ne c[eg m call L n�.'ra]=/1lv • anh avtunl n+! f.nginecr r� tins, mica ral.ed 5[aos1 Frain 1 ifi Pan n, aaaiL-Mc a H91�J� 17T • L'uu:hu:hun eun;pr.its anJ•en ice pto.;Jer7 msnl ut�IsJe paw,f,r[mosmae w:ll, tier Vn.a*In [unaLrn Fmm. , f olm W-4 rt aaailatic at 11W Irlctral ar.cr:tc Cm'icc {%hate jma_q�,lQs The, Gtc d[.ubb«l rhe-1 .tak. that au urrrr w eemployer of M1t [ ih can herwill frnn an; restrict. jnh• wnrl or wnke for At MrsictaHh or be Isten.ted is the silk to the Uly of am supplies. tyulptenf4 met, 41 or artidtl pes"Is d. 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TPS 43 W-9 I NY-9 Request for Taxpayer Give Form to the Oi AuJu1]]17r Identification Number and Certification requester. Do not D,Js,rc .,td7rl, ' vtr.,.w ltf.+r•a Sr¢F send to the IRS. Iona kti ea)ar. aI yor rrCcmE li. filx- 1 e S col` ii {Q N e=� . r :r�rh•yu::.t �r lar •�:rrw. rar�.•,I Wn e:.•,r C 5 �rr',,C'oPF'=fx=a Ov. ltr'otlrcf :ems c'm:J�iPJt E.a,rrl,oml:aa rx�r'ilcr_: u Ya'nfltal' c C w AT' ❑ n c-p—t.n ❑ s f_-T.:, b✓ ❑ P..l r-n+li Ll T-- yI lv 0 � � Fur,�pr Cq,e cuh ;t try{ Irltl'xtl�tf ,Cr. d. Fnim nn tat cl7:tc:Yr:;;.Cal-wr:•a43-3 C=1�fJ'gr P- 7rae ml y► Yc F 3' R P C,vrda,f . rAifJrr-.[rl:) c-re.;r a+y1 Gctfar,•,oraetrLliar-':. Pu r Ards--r✓,-a ar. -uunay ! nenc-:er': +awni naefrC:(paeua' cep �e. "t7'dol'�A, 'Du I -Taxpayer Identification Number (TIN) EnI- y-71t: d the=Wo{scle tea. 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Fv real lulu t1:t;:=Ums, Brun 2 duos rat apply Fa rrcttgaau Intarmt pad. aequl*kort or atanikmrnrnt of m--Urrd pi oporly. cw cagla ur or : c.t eenbt'utors loan InLau Mal resre" v t ]IrwAgenint ;IFU), and gerleraay payrraml Pthcr th. i ir,•.rrraf sd dvd1Y 4 yw se.r. ^tiryl•eJ !a sgr trr_ crwcatre tut ysu must pr-we. your correct FIN See me inslrucxrs are ragr3. Sgn Hero D2.p—.0- 4Qlcv" Dart. General Instructions r.:r,c a-� u. rr kmapl, ne sa a u e ^_r yfrf,o, P, meted am< .b 3ee:un rlxvxa are Y the iNvnal Pa+mae Ccd_ Jiff dlr_rlrF. fc<-: a Cen fir 1-1 FA7CA ovd^.: C•Itr• J o, rhr, k . n V ;rw -jcs tlq Ifs I- r uu,pl Tun bV FAICA ravardq, b rgn-t Fob" brdorwril <Th. IRS. us=r3dlrJ i arpt Tr,, e13 Doc •cr Nub.' fw ua a U S. laar-en a,P arecacm a tors viw Tar. 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P --jIl Is 44 i TPA License Texas Department of Insurance A CERTIFICATE NO. 15217 COMPANY NO.30-096516 CERTIFICATE OF AUTHORITY THIS IS TO CERTIFY THAT TEXAS POLITICAL SUBDIVISIONS JOINT SELF INSURANCE FUND DALLAS, TEXAS has complied with the laws of the State of Texas applicable to the licensing of Third Party Administrators and is hereby authorized In accordance with Chapter 4151 to transact the business of AMMNISTRATOR within the State of Texas. This Certificate of Authority shall be in full force and effect until it is revoked, canceled, or suspended according to law, IN TESTIMONY WHEREOF witness my hand and seal of office at Austin, Texas, this day of September A.D. 2011 El EANOR KITZMAN COMMISSIONER OF NSURANCE BY DAVID MOSKOWITZ ASSISTANT CHIEF EXAMI FINANCIAL PROGRAM COMMISSIONER'S ORDER NO 09-0957 45 Section D: Supporting Documents Sample Contract TEXAS POLITICAL SUBDIVISIONS PROPERTY/CASUALTY JOINT SELF- INSURANCE FUND INTERLOCAL AGREEMENT (Cash Flow Plan for Political Subdivisions) This Interlocal Agreement entered into by and between the Texas Political Subdivisions Property/Casualty Joint Self -Insurance Fund (hereinafter referred to as "Fund") and the undersigned political subdivision of the State of Texas (hereinafter referred to as "Fund Member") is for the purpose of providing liability, property and automobile physical damage self-insurance funding; insurance; reinsurance; claims administration; loss control services; and other risk management services as needed for the "Fund Members" and their employees. WITNESSETH: The undersigned Fund Member, in accordance with the Interlocal Cooperation Act, Chapter 791 of the Texas Government Code and the interpretation thereof by the Attorney General of the State of Texas (Opinion #MW-347, May 29, 1981), and in consideration of other political subdivisions executing similar Interlocal Agreements, does hereby agree to become a member of the Fund. The conditions of membership agreed upon by and between the parties are as follows: Definition of terms used in this Interlocal Agreement. a. Allocated Loss Expense — the costs incurred in processing claims, including but not limited to court costs, expenses for investigation and adjustment of claims, legal expenses, cost containment services (such as PPO discounts, rehabilitation services, medical management services), costs in protection and pursuit of subrogation/recovery rights, and similar expenses chargeable to a particular claim (excluding ordinary overhead expenses of the Fund and/or its designee such as salaries and other fixed expenses). b. Board — the Board of Trustees of the Texas Political Subdivisions Property/Casualty Joint Self -Insurance Fund. C. Loss — the sums actually paid or payable by the Fund in the settlement or satisfaction of any claim or suit for which a Fund Member is liable either by adjudication or settlement made with the written consent of the Fund. 2. At the Fund's discretion, each Fund Member may adopt any or all of (1) the TPS Joint Self -Insurance Fund General Liability Coverage, (2) the TPS Joint Self - Insurance Fund Automobile Liability and Physical Damage Coverage, or (3) the TPS Joint Self -Insurance Fund Property Coverage self-insurance plans. Whichever Self -Insurance Plan(s) the Fund Member accepts, the Fund Member agrees to TPS 46 adopt and accept the coverages, provisions, terms, conditions, exclusions and limitations of the applicable Self -Insurance Plan(s) Coverage Document(s). The limits of self-insurance, optimal coverages and deductibles selected by the Fund Member will be shown on the Declarations of each coverage document. 3. If the Fund Member adopts the TPS Joint Self -Insurance Fund General Liability Coverage, or the TPS Joint Self -Insurance Fund Automobile Liability and Physical Damage Coverage self-insurance plan(s) which cover liability exposures, it is understood that by participating in this Self -Insurance pool, the Fund Member does not intend to waive any of the immunities that its officers or employees now possess. The Fund Member recognizes the Texas Tort Claims Act and its limitations to certain governmental functions as well as its monetary limitations, and that by executing this Agreement does not agree to expand those limitations. 4. This Interlocal Agreement shall commence at 12:01 a.m. on the date shown as "effective date" on the signatory page of this Agreement, and shall terminate at 12:01 a.m. on . This Agreement may be terminated by (a) mutual consent or by (b) either party giving sixty (60) days prior written notice of termination to the other party or (c) as otherwise specified in this Interlocal Agreement or the Bylaws of the Fund. 5. The Fund member agrees to execute necessary authorization form(s) permitting the Fund and/or its designee to obtain from other parties experience rating information for the Fund Member. 6. The newly enrolling Fund Member who has not previously been a member of this Fund or the Fund Member who has not previously operated under this Cash Flow plan agrees to pay the Fund, on or before the inception date of this Interlocal Agreement, an initial payment of one (1) month's estimated Claims Administration Fee plus 1/12 of the estimated annual Contractor Charges such as Administrative Services Fees, Loss Control Services, or other charges as set forth in Exhibit A attached hereto. On or before the commencement of the third month after the inception date of this Interlocal Agreement, the Fund Member agrees to pay an amount equal to the actual Claims Administration Fee, the total Field Service Fee (if any) of the first month of membership plus any other associated Claims Administration Fee plus 1/12th of the estimated annual Contractor Charges. On or before the commencement of the fourth month of this Interlocal Agreement, a similar payment based upon the actual Claims Administration Fee of the second month shall be paid to the Fund, with subsequent monthly payments to be paid each and every month thereafter, based on the actual Claims Administration Fee and applicable charges. The actual Claims Administration Fee of the Fund Member are those fees paid by the Fund on behalf of the Fund Member in the month which is two months prior to the billing month. However, the Fund and the Fund Member may agree to a different payment plan. 7 The Fund Member who was a member of this Fund immediately prior to the inception date of this Interlocal Agreement and has operated under this Cash Flow plan agrees to pay the Fund for those services described in this Agreement and the charges listed in Exhibit A attached hereto. Each month's billing will include 1/12th TPS 47 of the estimated annual Contractor Charges as described in Paragraph 6 above. Also included in this billing will be an amount equal to the actual Claims Administration Fee of the Fund Member plus any other associated Claims Administration Fee as set forth in Exhibit A. 8. The Fund will invoice the Fund Member monthly for these amounts due and the payment by the Fund Member is due in the office of the Fund and/or its designee on or before the beginning of the month. In the event the Fund Member fails or refuses to make the payments of charges as herein provided, the Fund reserves the right to terminate such Fund Member by giving ten (10) days written notice and to collect any and all outstanding charges or other required payments which were incurred prior to the date of the Interlocal Agreement termination. 9. It is further agreed that the Fund Member will create on or before the inception date of the Interlocal Agreement a loss deposit with the Fund equal to a minimum of two months estimated paid losses. This deposit will be adjusted periodically to accurately reflect realistic monthly loss payments and/or timely invoice payments. 10. After termination of this Agreement, the Fund will continue to handle claims with an accident date occurring during the term of this Agreement until such claims are ultimately and finally disposed of or closed. After termination of this Agreement, the Fund Member will pay the Fund each and every month, until all claims handled by the Fund are disposed of, the monthly claims administration charge calculated as described herein, and the monthly reimbursement of actual claims losses paid on behalf of the Fund Member as determined herein. The Fund Member also agrees to maintain with the Fund the loss deposit as determined herein. Upon expiration of this contract, the Fund or its designated agent will continue to adjust claims which occurred or are made during the Agreement Period. 11. In the event the Fund Member fails or refuses to make any required payment on a timely basis as described herein, the Fund reserves the right, by giving ten (10) days written notice, to cease all payments on behalf of the Fund Member and return any files on active property/casualty claims to the Fund Member. In such event, the Fund Member agrees to assume all liabilities and claims handling responsibilities on those claims from the date of notification forward. The Fund Member agrees to pay the Fund all charges and other required payments which were incurred prior to the date of notification. 12. After termination of this Agreement, the Fund is not obligated to provide any of the services as described herein except for claims administration services as described in Paragraph 12 above. 13. Loss Control Services will be supplied by the Fund and/or its designee to Fund Members to assist them in following a plan of loss control that may result in reduced losses. The undersigned Fund Member agrees that it will cooperate in instituting any and all reasonable loss control recommendations for the purpose of eliminating or minimizing hazards that would contribute to losses. The loss control services provided are, however, optional for the Fund Member, If the Fund Member elects this service, its election shall be indicated on Exhibit A attached hereto. 48 14. Pursuant to the terms and conditions of the applicable Self -Insurance Plan(s) Coverage Documents, the Fund and/or its designee, agrees to administer any and all claims after notice of claim has been given and to provide a defense where appropriate. The Fund Member hereby appoints the Fund and/or its designee as its agent to act in all matters pertaining to processing and handling of all claims and shall cooperate fully in supplying any information needed or helpful in the administration of those claims. The Fund and/or its designee shall carry on all negotiations with any third parties or their attorneys and negotiate within authority granted by the Fund. The Fund and/or its designee shall retain and supervise legal counsel on behalf of and at the expense of the Fund as necessary for the prosecution and defense of any litigation. 15. At the option of the Fund and/or its designee, a Fund Member may be allowed to choose the legal counsel it deems most appropriate for the handling of any individual claim. However, all decisions on individual claims shall be made by the Fund and/or its designee, which includes the decision to appeal or not to appeal a final adjudication at the trial court level. However, any Fund Member shall have the right to consult with the Fund and/or its designee on any claim and have the right to appeal any decision made by the Fund and/or its designee to the Board. Any suit brought or defended by the Fund shall be brought or defended only in the name of the Fund Member and/or its officers or employees. 16. The Fund Member will be solely responsible for future benefits payable and for funding its net reserve. The Fund Member agrees to hold the Fund harmless from any and all claims (including attorney fees) that may be asserted against the Fund for the non-payment of any claim due to the failure of the Fund Member to maintain adequate reserves for the payment of claims. 17. The Fund agrees that all Fund transactions will be audited annually by a certified public accounting firm. 18. The Fund Member agrees that it will appoint a coordinator of department head rank or higher, and that the Fund and/or its designee shall not be required to contact any other individual except this person. Any notice to or any agreements with the Coordinator shall be binding upon the Fund Member. The Fund Member may change the Coordinator by giving written notice to the Fund. 19. The Fund Member acknowledges that it has received a copy of the Bylaws of the Fund, and it agrees to abide by these Bylaws and any amendments thereto and any and all policies and procedures of the Fund. 20. The Fund Member shall have the right to appeal any decision or recommendation of the Fund and/or its designee to the Board whose determination will be final. Any appeal shall be made in writing to the Fund Secretary within 60 days of decision or recommendation of the Fund and/or its designee. 21. Any party hereto paying for the performance of governmental functions or services shall make payments from current revenues available to the paying party. IM 22. The Fund Member shall take no action to release, discharge or impair its right to seek recovery of any amounts paid under this Agreement from any person or entity legally responsible for the bodily injury, sickness or disease, or death for which such payment is made. Nor may the Fund Member assign such rights without the express, written approval of the Fund. 23. This Interlocal Agreement, together with all the Amendments, Supplements and other attachments hereto, constitutes the entire agreement between the parties and supersedes all previous Interlocal Agreements, promises, representations, understandings and negotiations, whether written or oral, between the parties with respect to the subject matter hereof. 24. If any portion of this Interlocal Agreement shall be declared illegal or held unenforceable for any reason, the remaining portions shall continue in full force and effect. 25. It is the intent of the Parties that the Fund and/or its designee and the Fund Member each shall bear responsibility for any of its own negligence or its own error or omission, including, but not limited to, claims alleging violations of the Texas Insurance Code, the Deceptive Trade Practices and Consumer Protection Act, and the common law duty of good faith. 26. The Fund and/or its designee shall not be held accountable for any increased cost or expense to the Fund Member involving payments of claims, under any contention by the Fund Member that a claim service, risk management service, loss control service, or administrative service could have been handled differently. 27. The Fund Member agrees to timely provide all necessary information to the Fund and/or its designee and to timely execute all necessary documents as may be needed or required for the administration of the Fund. 28. Periodically each Fund Member will be provided a computer printout containing a statement of claims cumulative for said Fund Member by Effective Date of that Fund Member. Sa Fund Member Name TO BE COMPLETED BY FUND MEMBER Signature of Authorized Official Date Type Name Title THE PROPERTY/CASUALTY COORDINATOR FOR THE FUND MEMBER IS: Coordinator Name & Title: Mailing Address: Street Address: Telephone Number: Fax Number; TO BE COMPLETED BY TPS FUND OFFICE Effective Date of Agreement Contract Number Signature of Fund Secretary Date a 51 Insurance Certificates ACC-)-RCERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF 91FOPMAMON 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 POUCM3 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE =LING INSURER(5), AUTHORIZED REPR£SERTATTVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: 5lha .emMmIC paid., Is an ACOITIONAL INSURED, tho poecy(les) muu be ondoraod. N SUBROGATION 13 WAIVED, oub*U to Ihn term. and ConmtbM d the poYcy. cwtain polci.s may require sn wWorsw=r&L A stat+neK on this CeMRCM don not Color flights to Ma Ce1ditwa toWaf in nou of soch endoxfamertgaJ. NICCVICM Yee• {WIC: A13ar� T.:-n Pot11aJ 5.id✓r--Ions JS:F �CJAro &. 972 35 t-0na .;"� "KI W :63�FJ51 1Wr,l N Callas PMxi, EJfe 1175 a ,C pInM ,Vlas,Ta.s7'5249 w3an:+_3?—Q•mnOmrrl..ct _wct nsu•ER s - chutt DCA2791 �*' ns�.4s! To3: Fe4irnl5ubCrr *:alp JSIF •_., Toot PoT al Sadv7ni JSIF !17VR9.:. TIa4k.i ._ 156MN C"tar Ptry S;.ata 1176••- DaT.rs•Ts.as752tC o akmI-'- rnV pR s{ rFiini: &r MIMrIFN•rM.— R,"q InN NIIMAp,,,___ TH3 M TO CERTVY TYAT TrE PCLCIaS CF IWW:kk!ICE LISTED BE -UM HAVE BEEN IS3JEC• M THE INSURED MOLIFO AR-MrE FOR THE PCLIClf %ER= MICATE•7 ACIMTHSN.OnK AN'! REWREW..M.. TERM OR CONMECH OF ANY MI -Pk. T OR OTHER DOCUI/E•JT'ATY RESP-ECT TC NMCH 1115 C=_RTIFICATE MAY BE 155UE3 OP Wµ PERTAIN, II-E ;NSIIR+kCc A.FFCRDEC EY THE PGA C:ES DESCROEC $- 7EXli i . SU5JECT TO ALL -PE TEPHS EYCI,JSC'S AND .CA1CM N5 C- SUCH PCLCM LLCTS 5h..'Mh M>.Y FAVE BMI iE:AJCE7 BY PAIN .La1.YS /IfP T"r w st9fMC2 R.M� P'rAILYM1Wfia Me. .C,[tV'lY L3T3 +"[Y, RALWRIrY , �tC�CL7R�fn:Y ! i.gCfl..^CD Xa_.^,F•IEa:: UA&LTY 1-•��I -SW�Ce TO if�TF_ - a„.zn ' f 7cr •tC0'_Iw: rsti A.esr iSOCO I q-1a!'�u:r �)O�.'U J d I I FW2 13•`.11f20'a iriCil�e:13 .CPSCIIA:t apl Cl;.RY f 1 .:f:0 • ntI±�ACr.Ti:n.•-E a2.0DC.D00 GFI,'I[pC3'E FE L'YfS i ?RyUCa-CC'IPV k•77 ! CF—F- i n Lrr S � )WALC �:Aw Y I l i I ku mr.e� a, � Q77 LY IILtii:' d9::r¢�I i X I E - %L ai�FiS+� (x 4.If5 I FOA�,I t .-1.70tt 1'1L U291; _ lJQiT'IY•iT �R-Crlctl S PR:1f1iY:.:WCE erJ18A•ee X NN}. AU•fi X IL•.TI;•J II 1 ! FLU LN S"- I f—, E+C.I CtYIiRR'eGE ' f i a .•Af rJtf: - _- ( ncrss We _ CAM�t1A i M01U[EAf Wm'etutgn Y { AMC lJ%r- MJWu rl- F- Q wm IYGPWifO•tIKi74Ei£ ECJf'.4 MI! r) F'C&i7 ' 1C/L7 c 11 1O.GLZUt3 F _ ewa•araE•r , tyaD.nea L-. 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Hickory, STE A Denton, TX 76205 Denton, TX 76205 940-349-7836 3) Diane Roberts, Office Manager City of Commerce 1119 Alamo St. Commerce, TX 75428 903-886-1101 4) Angel Alvarado, Human Resources Coordinator City of Marble Falls 800 Third St Marble Falls, TX 78654 830-798-7050 Claim System, Reports and First Reporting Tool Claim System r a _ .M Z M 's i pt`,_`,_ •^r �tt�v" � T • �y;� 1y n1 �trl - ,l,`'- Lt�� y � -, �ti 1�' I�tr`,` � � y��i�''� fit � �..+�-�' ,ti, t• �:; ,`"" ,� t , .•� �'i1i s4�L:� l u -,:x", j:r � : =4 , - y- ��L� x - 1 t{y -AN J 3, a 13 —+++. CtWOHh I Y,n @Y, YIb I •.{1r.ndelMma� � W r--Q ars W I/ :: r• rerr tse �� � , I � 54 -s •� 1 �� L "`. V 't' L a � v. --TT7-0 9 ul I D u L '11 I I i I 1 11 ill 'I Ok Aga �� 5f � $iB� 5, ��� ��� Asa ,'�� �;�`^����� �� 5 U. 3 C, sel 891 r O8aBft_ I R 988 9 A T. a it. t� --H -1 p Jr. 8 H H Claim Reporting Tool (Online Through TPS Website) Search TPS Online TPS Automobile Loss Notice enter aearcn term n.r. Your Name: Your .401all Address: Agency Name: r—� Membor Access Agency Telephone: (area Dade. number and extension) Agency FAX: (area code. numbv end eaterWMI Pmate Messages no a Agency e.Mall Address: Code: I I Sub Code: —� My TP5 Profile Agency Customer ID: My TPS Messages Customer. My TPS Fortes NAIC Code: Agent Applications Miscellaneous Info: Memter Claim Reporting enter site and location code: My TPS Downloads Agent Dovmloads Memter Dovmloads Policy Number Policy Type: Board Memter Da mloads Reference Number. Cat Number. My Event Photos EnxtWo Data: mm/dWryyy Expiration Date: mrn:ddryyyy My Safety Videos Date of Accident Contact the Board Time of Accident AM or PM: -rite nr . Previously Reported? Who's Online.9 Keith AJterts (Keith Alberts) 56 57 AMENDMENT NO. 4 TO THE INTERLOCAL AGREEMENT TEXAS POLITICAL SUBDIVISIONS PROPERTY/CASUALTY JOINT SELF-INSURANCE FUND CASH FLOW PLAN It is hereby agreed that Condition 4 of the Property Casualty Cash Flow Interlocal Agreement is amended as follows: 4. This Interlocal Agreement shall commence at 12:01 a.m. on the date shown as "effective date" on the signatory page of this Agreement, and shall remain in force and effect until terminated as hereinafter provided. This Agreement may be terminated by (a) mutual consent or by (b) either party by giving sixty (60) days prior written notice of termination to the other party or (c) as otherwise specified in this Interlocal Agreement or the Bylaws of the Fund. 15-F0633 Contract Number City of Lubbock Fund Member Glen C. IfobeRson, Mayor September 10, 2015 Date APPROVED AS TO CONTENT: uincy Whif�qbeiputy City Manager 10'01!15 Effective Date Texas Political Subdivisions Property Casualty Joint Self - Insurance Fund Secretary Date APPROVED AS TO FORM: J f arts lf, Chief Litigation Attorney 10i01' 13 PCCF-A 1 AMENDMENT NO. TO THE INTERLOCAL AGREEMENT TEXAS POLITICAL SUBDIVISIONS PROPERTY/CASUALTY JOINT SELF-INSURANCE FUND 107MI Q_fy I11WATAW W.1 1 It is hereby agreed that Condition 8 of the Property Casualty Cash Flow Interlocal Agreement is amended as follows: 8. Fund Member hereby agrees, upon written notification from Fund, to prefund individual claim payments in excess of $20,000. 15-FW 3 Contract Number City of Lubbock x Fund Member Glen C. Vbertson,4ayor September 10, 2015 Date APPROVED AS TO CONTENT: C;�u'incy i e Deputy City Manager W01 15 Effective Date Texas Political Subdivisions Property Casualty Joint Self - Insurance Fund Secretary Date APPROVED AS TO FORM: Hafisk, Chief Litigation Attorney 10'011,13 PCCF-Al A� 1Y CERTIFICATE OF LIABILITY INSURANCE I DAo8(26/fD2�19m 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: B the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 endomement(s). PRODUCER CONTACT NAME Keith Alberts Texas Political Subdivisions JSIF PHONE pIC No 15660 N Dallas Pkwy, Suite 1175 E-MAIL aooRE Dallas, Texas 75248 uenoeo,e� errnon,u, m�eeer_c Mein a INSURED Texas Political Subdivisions JSIF 15660 N Dallas Pkwy, Suite 1175 Dallas, Texas 75248 B: Texas Political S c : Travlers O: E: F: COVFRAGFS CFRTIFICATF Nl1MRFR- nnsnsnN REVISION NUMRFR: nns;nsnn 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. INSR LTR TYPE OF INSURANCE ADOLSLIC3{i POLICY NUMBER POLICY EFF (MMIDDNMI POLICY EXP IMWOWYYYY)LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL UABIUTY CLAIMS -MADE a OCCUR r 1 � F0482 10/01/2014 10/01/2015 EACH OCCURRENCE $ 1,000,000 PREMISES Es o unsnce $ 100,000 MED EXP (Any one person) $ 5 000 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO LOC PRODUCTS - COMP/OPAGG S $ B AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS HIRED AUTOS M NON -OWNED AUTOS F ' ^ r: I " F0482 10/01/2014 10/01/2015 (Ea arstlenl ED SINGLE LI IT $ 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROP°RTY DAMAGE Per accident S S UMBRELLA LIAR EXCESS LIAR HCLAIMS-MADE OCCUR F_ I I EACH OCCURRENCE S AGGREGATE $ DEO I I RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABI LIT' ANY PROPRIETORIPARTNERIEXECUTIVE Y I NN OFFICEIMEMBER EXCLUDED'] (Mandatory In NH) If yes, des&be wrier N / A H0633 10/01/2014 10/01/2015 X T WC STATU• OTH- Y E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000.000 A ER0 NY12MPL0042791C 05/15/2015 05/15/2016 $3,000,000 Each Claim $3,000,000 Aggregate $10,000 Each Claim Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks SchedWc, If more space Is required) C: TPA Bond: Travelers, policy# 105583027, Term 03116115-03/16/16, $500,000 limit w/$5,000 deductible. City of Lubbock Attention: Lainey Morrison PO Box 2000 Lubbock, Texas 7945 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU © 1988-2010 ACORD 25 (2D10/05) The ACORD name and logo are registered marks of ACORD All rights reserved. THIS ADDENDUM MODIFIES THE TEXAS POLITICAL SUBDIVISIONS PROPERTY/CASUALTY JOINT SELF-INSURANCE FUND F GENERAL LIABILITY COVERAGE DOCUMENT 0 AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE COVERAGE DOCUMENT PROPERTY COVERAGE DOCUMENT PLEASE READ IT CAREFULLY #1 ADDENDUM NO. 000 - GENERAL CHANGE ADDENDUM In consideration of no change in contribution, it is hereby agreed that the City of Lubbock is added as an Additional Covered Party and Waiver of Subrogation. Texas Political Subdivisions Name of Member 14-FO482 Interlocal Agreement Number 8/26/15 Effective Date (W (11/W9$)) ODD Mom THIS ADDENDUM MODIFIES THE TEXAS POLITICAL SUBDIVISIONS PROPERTY/CASUALTY JOINT SELF-INSURANCE FUND GENERAL LIABILITY COVERAGE DOCUMENT PLEASE READ IT CAREFULLY. ADDENDUM NO. 105 WAIVER OF SUBROGATION RIGHTS SCHEDULE Name of Person or Organization: City of Lubbock Attention: Lainey Morrison Location of Premises/Operations: 1625 13'h Street Lubbock, TX 79401 The Fund waives any right of recovery it may have against the person or organization shown in the Schedule because of payments we make for Bodily Injury, Property Damage, Personal Injury or Advertising Injury arising out of a Member's work done under contract with the person or organization shown in the Schedule. The waiver applies only to the person or organization shown in the Schedule. An additional contribution of $(Waived) will be retained by the Fund regardless of any termination of this addendum or the General Liability Coverage Document. This addendum will apply only to the extent allowable by law. Texas Political Subdivisions Name of Member 14-FO482 Interlocal Agreement Number TPS 105 06/2001 Page 1 of 1 8/26/15 Effective Date THIS ADDENDUM MODIFIES THE TEXAS POLITICAL SUBDIVISIONS PROPERTY/CASUALTY JOINT SELF-INSURANCE FUND GENERAL LIABILITY COVERAGE DOCUMENT PLEASE READ IT CAREFULLY. ADDENDUM NO.107 ADDITIONAL COVERED PARTY Additional Covered Party Schedule Name: City of Lubbock Attention: Lainey Morrison 162513th Street Address: Lubbock, TX 79401 The person or organization listed above in the Additional Covered Party Schedule is a Covered Party, but only with respect to legal responsibility for acts or omissions of a person for whom Liability Coverage is afforded under this self-insurance. The Member's authorized representative is authorized to act for the additional Covered Party in all matters pertaining to this self-insurance. The Fund will mail the additional Covered Party notice of any cancellation of the General Liability Coverage Document. If the cancellation is by the Fund, the Fund will give ten (10) days notice to the additional Covered Party. This addendum will apply only to the extent allowable by law. Texas Political Subdivisions Name of Member 14-FO482 Interlocal Agreement Number TPS 107 3/05 Page 1 of 1 8/26/15 Effective Date THIS ADDENDUM MODIFIES THE TEXAS POLITICAL SUBDIVISIONS PROPERTY/CASUALTY JOINT SELF-INSURANCE FUND AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE COVERAGE DOCUMENT PLEASE READ IT CAREFULLY. ADDENDUM NO.209 ADDITIONAL COVERED PARTY The provisions and exclusions that apply to LIABILITY COVERAGE also apply to this addendum. SCHEDULE City of Lubbock Attn: Lainey Morrison 162513`' Street Lubbock, TX 79401 (Name and Address of Additional Covered Party) is a Covered Party, but only with respect to their legal responsibility for acts or omissions of a Covered Party for whom LIABILITY COVERAGE is afforded under this self-insurance. The Member is authorized to act for the additional Covered Party in all matters pertaining to this self- insurance. The additional Covered Party named in the Schedule is not required to pay for any contributions stated in the Coverage Document or earned from the Coverage Document. Any return contribution shall be paid to the Member. The Fund will mail the additional Covered Party notice of any cancellation of this Coverage Document. If the cancellation is by the Fund, the Fund will give ten days notice to the additional Covered Party. This addendum will apply only to the extent allowable by law. Texas Political Subdivisions Name of Member 14-FO482 Interlocal Agreement Number TPS209 08/2006 Page 1 of 1 8/26/15 Effective Date THIS ADDENDUM MODIFIES THE TEXAS POLITICAL SUBDIVISIONS PROPERTY/CASUALTY JOINT SELF-INSURANCE FUND AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE COVERAGE DOCUMENT PLEASE READ IT CAREFULLY. ADDENDUM NO.210 WAIVER OF SUBROGATION The condition entitled "TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO THE FUND" does not apply to City of Lubbock Attn: Lainey Morrison 1625 13th Street Lubbock, TX 79401 (Name of Person or Organization) Additional Contribution $ (Waived) will be retained by the Fund regardless of any termination of this addendum or the Coverage Document. Texas Political Subdivisions Name of Member 14-FO482 Interlocal Agreement Number TPS210 06/2001 Page I of I 8/26/15 Effective Date TEXAS POLITICAL SUBDIVISIONS WORKERS' COMPENSATION JOINT SELF-INSURANCE FUND GUARANTEED COST PLAN GENERAL CHANGE AMENDMENT In consideration of no change in contribution it is hereby agreed and understood that a Waiver of Subrogation is added per attached WCGC-A4. Texas Political Subdivisions Name of Member 14-HO633 Contract Number 8/26/15 Effective Date: 10/ 15/99 WCGC-A3 SUPPLEMENT TO THE INTERLOCAL AGREEMENT TEXAS POLITICAL SUBDIVISIONS WORKERS' COMPENSATION JOINT SELF-INSURANCE FUND GUARANTEED COST PLAN WAIVER OF THE FUND'S RIGHT TO RECOVER FROM OTHERS The Fund has the right to recover its payments from anyone liable for an injury covered by this Interlocal Agreement. The Fund will not enforce its right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where the Fund Member is required by a written contract to obtain this waiver from the Fund. Name of Person or Organization: Operations: SCHEDULE City of Lubbock Attention: Lainey Morrison 1625131h Street Lubbock, TX 79401 Additional Contribution of $ (Waived) will be retained by the Fund regardless of any termination of this Interlocal Agreement. This addendum will apply only to the extent allowable by law. 14-HO633 S/26/15 Contract Number Effective Date Texas Political Subdivisions Fund Member Texas Political Subdivisions Workers' Compensation Joint Self -Insurance Fund Signature of Fund Secretary August 26, 2015 Date 01 /17/95 WCGC-A4