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Home My WebLink AboutResolution - 2018-R0350 - Workers' Compensation Coverage From Texas Mutual - 09/27/2018Resolution No. 2018-RO350 Item No. 6.32 September 27. 2018 RkSt )l,l � Y )N BE IT RESOLVED BY TIIE CITY COUN'C'1L OF TlIE CITY OF LL'BB0CK: THAT the City Nilma er ❑f the [.'it}' oHLubbock is her'cbv autlu)ri/(:J and Liirecled 10 purchase: far at1t1 tin hCIMIl' of the City Of Lubbock, Svc}rkcrs' compensation Coverage from the 'texas MUtULtl 117SLIJUI ;C Company_ for a premium arnotn)t 1101 to exceed $1,123,904.00; and THAT the City Manager may execute ariv routine documents and lnrms associated with said coverage, Passed by the City Council this September 27, 2018 DANIEL M. R P' AYOR Rebea Garza, City Secrety7 APROVED AS TO CON'l l:NT: Lcisa Hutcheson, Director of 1 Iuman ResuLINC.S and Risk Management A11PROVED AS TO FORM: 7-1 JefM. e 1. Deputy Citv Atlomey ICES RIA hME. MFMutual 111SLIMIU a Co sep[cusuct 11, 201E Workers' Compensation Insurance Company: Texas Mutual Insurance Company Policy Term: 10/1/2018 to 10/1/2019 Coverage: Part One — Workers' Compensation agrees to pay the benefits required under the applicable State's Workers' Compensation Law. Part Two — Employers Liability for work -related injuries or disease other than that which is imposed by a state Workers' Compensation Law. Part Three — Other States in which you have no exposure on the policy inception date, but in which you may have a temporary or future worksite or exposure in during the policy term. If listed, statutory benefits will apply as if the state were listed in Part One; with the exception of excluded states, North Dakota, Ohio, Washington and Wyoming. Annual Premium: $1,123,904.00 Employers Liability - Each Accident $1,000,000 Employers Liability - Disease (Policy Limit) $1,000,000 Employers Liability - Disease (Each Employee) $1,000,000 Experience Mod N/A 5tatutory Limits Apply Yes Coverage is not automatic in all states. Please notify us immediately if you begin operations in another state. Workers' Compensation Schedule of Exposures State: TX 7539 Electric Light Or Power Co Noc--all Employees & Drivers 8107 Contractors' Machinery Dealer & Drivers 0011 Farm: Noc & Drivers 9409 Crisis Counselor Volunteers 3064 Sign Mfg --metal 4299 Printing - Copying & Duplicating 5ervice 4511 Analytical Chemist 4519 Exterminator & Drivers 5190 Traffic Signal Control Installation & Drivers $13,671,857 $50,051 $601,212 $26,000 $1,981 $57,459 $1,269,478 $204,101 $1,329,511 ® 0-'Hpr1te[ a-A..i YtA 5506 Street or Road Construction: Paving or Repaving & Drivers $1,555,215 7423 Aircraft or Helicopter Operation: All Other Employees & Drivers 51,581,401 7423 Aircraft Ground Support Equipment Repair & Drivers If Any 7520 Waterworks Operations & Drivers $5,744,4S8 7580 Sewage Disposal Plant Operation & Drivers $2,561,800 7590 Garbage Works $877,774 7704 Firefighters & Drivers $32,925,321 7720 Police Officers & Drivers $34,099,521 8107 Contractor's Heavy Equipment Repair & Drivers $664,506 8601 Engineer or Architect --Consulting $749,019 8742 Tax Appraisers $34,877 8810 Clerical Office Employees NOC $26,809,968 8831 Animal Shelter & Drivers $685,594 8833 Hospital: Professional Employees & Clerical $1,211,840 9040 Hospital: All Other Employees If Any 8838 Public Library/Museum: Professional Employees & Clerical $1,692,584 9015 Buildings --operations By Owner or Lessee $2,448,173 9101 Public Library or Museum: All Other Employees $71,121 9102 Park NOC--All Employees & Drivers $2,135,188 9220 Cemetery Operation & Drivers S265,016 9402 Refuse Collection & Drivers $2,177,145 9402 Street Cleaning & Drivers $580,188 Total Estimated Standard Premium (without Premium Adjustments) $1,811,510.00 Premium Adjustments Increased Limits Factor (0.014) Amount $25,361.00 Schedule Modifier (0.790) ($385,743.00) Healthcare Network Option (0.12) ($174,135.00) Premium Discount (0.12) (5153,239,00) Expense Constant $150.00 • • $1,123,904.00 W ArHeritaq,t-RM 146 IT IV Audit Provisions Audit based on Payroll $250.00 / $1,123,904.00 Premiums are calculated based on the insurance company's rules and rates. Premiums shown as advance or deposit premiums are subject to audit and adjustment at the close of each audit period. If the advance premium is less than the earned premium as determined by the audit, the insured pays the difference. If the advance premium is more than the earned premium as determined by the audit, the insurance company returns the difference to the insured. The insured must keep records of the information needed For the audit and the premium calculations and send copies to the insurance company when it requests them. Coverage Description TM LRC 2008 Limited Reimbursement for Texas Employees Injured in Other Jurisdictions TM MV 2011 Mutuals — Membership and Voting Notice TM PC 2003 Policy Conditions Endorsement WC 00 00 00 C Policy Conditions Form WC 00 00 018 Policy Coverage Document (Declarations Page) WC 00 04 06 Premium Discount Endorsement WC 00 04 14 Notification of Change in Ownership Endorsement WC 00 04 22 B Terrorism Risk Insurance Act Coverage Endorsement WC 42 03 011 Texas Amendatory Endorsement WC 42 03 05 A Texas Exempt Employees Coverage Endorsement WC 42 04 07 Texas — Audit Premium and Retrospective Premium Endorsement WC 42 04 08 A Network Discount Endorsement Excluded coverage or other coverages sought may be available: please discuss with USI Other exclusions and policy limitations may apply. Please refer to the actual policies for specific terms, conditions, limitations, exclusions and sublimity that will govern in the event of a loss. XHrritar a—Rm %� Tex,ISMutuai WORkEkS' t 0MPLNSAT10% INSUHANU Quote no quote k,%ue dale Proposed coverage period Version ❑llote Invoice QC0412 J4 l6 8, 15 18 10 I.18 to 10r N 19 a Atytrcant copy Applicant Producer Cf r, of -USBOCK U SI SOUT"'AEST r; The earliest eT'vctive dale of coverage wrfl be the date a complete submission and the proper payment are recerrrd by Trwas mut.,al I nS{Nance COmpany unless a rulure eftecti ve date has been rcque st ea This does not apply to Stan DWpuie5 NOTE Payment received d9rt, rsot rau.wuitev cuvcrage Please check one option below to indicate policy choice. Payment in full: Out -of -network 0 In -network 0 Eshnrated annual prr•t-lum S t _ 7" ' : i E,Ir't, ite J Of , u.r rrr, I ,rn S 1 1:3 J44 UQ Amount due: $1,277,143.00 Amount due: $1,123,904.00 WIII Ine policy premium ❑e financed? V-Yes" which Cnanre cUni(k-ime' Note A Copy of a sigrved prenuuni finance agreernent nlust accornpany this fonn Send payments to the PO Box as fisted below OR Installment payments: Out -of -network D In -network E ni.lt*•i] driilJ.11 ; n•,ii I^ '01 _7' vo 1 Jr r ijo i n•m.i.,r i 1 1_ r Amount due: $191-571.45 Amount due: $168,585.60 (Down GaYr-enll iDo+m p.Tyrnen[1 in5lac ment rifling plan • 15 � down pa)Tr)ent (Send payments to the PO Box as listed mlow i 10 monthly installments Financing 15 not permitted under lhis billing plan Please (11311 this farm along with Ih❑ amount due for the above selected option to Texas Mutual insurance Company PO Box 841 B43 Dallas, TX 75284-1843 Please include you( quote number 10004129416 an your check fur prompt handling Pl•,ase do not use She above address for other correspondence Thank you for your buslrlessl PO Box 12058 Austin. TX 787 t 1.2058 Documeri I❑ 0004129416 1 of t t,• tsmutual CUM ! i100859-5995 r Fax i800) 359-C650 OTINVIB to JrHerjta a-Rbd 148 Texasimutua:, WORKERS* COMPENSATION INSURANCE Workers' Compensation and Lrrlployer's Liability Policy ❑NE-1A Quote number Quote issue date Proposed coverage period Appllcant copy 060a129416 8't5 18 1011 to to 10 V19 Deductible Notice of Election Texas law porn fits an employer to ❑nt,li rl workpm compensatiCri trash rance whit a de0kictVe The insurance apple?s only to benefits payable untler Texas worFers compensation law When a derloctible is elected the policyholder is reiaLiired to reimburse the insurance carner for benefils payable under the lau up to the deductible amount and a credit is applied to the policy Premium credits are d?fi rrninCn based on the deductibli, selected and The hnZard grrnup The hazard groli;- i•� determined by the classirrcaticrin teal produce; the largest arrir'unl of estimated Texas slanciard premium You are not required to choose a deductible if you ao choo-.e pi iN yair insurance L•-)riip.iny %ill pay the deductible amcnint fnr you nut you must re:ruhur•,a tl.e3 insurance conipany within 30 days after tnPy sand ynu notice that paympn; is due 11 you tail to reimburse the insurancL• company they ma'{ cancel the policy upon ten days Ytr,Tien notice anC any resulting premium may be applied to the deduct,ble amount owerl It a deductible amount is desired please indlcate below ❑ Yes, I want a deductible of (select only oriel 1 per accident 2 per claim 3. medical only applied to benefits payable under 111e Texas Workers' Compensation Law ,I understand that the Company will pay the deductible amount and seek reimhur5r-me1l Monthly (monlhiy quarterly or others ❑ N I do not want a deductible applied to benefits payable under the Texas Workers compensation Law ❑ Ye; I do want a deductible policy• but airs unahle to obtain one for the following reason The deductible plans have been explained to me Signature and Title Employer Name i print or type) Texas Mutual Insurance Company Insurance Company 00 04 12 q4 1 G PolICV No Date Address 1100118 Effective Cale Po Eox 12058. Austin, TX 78711.205E s or 1 texasmuhiai com I f800i 559.5"51 Fax if!005 357-G£5a ❑NE 1A O'Herita a-IjM 149 Tex,qsmutuar' I%ORKEKS' COMPENiAT10N INYIMANCE Helping Build a Stronger Texas We are an Insurance company but many employers think or us more as a partner in workplace safety and elTective claim managon.ont our Customer sarvJce philosophy Is to provide per son anzad attention that exceeds your expi clations Consider what you will get for your premium dollar A Partner in Loss Prevention ■ On site safety surveys and recarnmendations by cansilltarlts who know your business 0 Loss run reports that help you analyze loss trends e Access to a library of safety videos posters and brochtire9 many available in Spanish • Seminars on workplace safety and lha return to work proce5s • Help with special issues_ such as ergonomics industrial hygiene and OSHA compliance Zero Tolerance for Fraud • Investigation of suspected claim fraud • Goordinalron with prosecutors statemap t0 ohlain convictions • A proven track record of fraud convictions Effective Claims Management and Cost Control • Professionals on stall to handle all aspects of claim management and cost control- ■ A designated regional service team voth expertise in your Industry • Rehabilitation nurses and a provider relations Seam tnal works to gel the right care for your injured workers ■ A catastrophic injury team to work with severely Injured workers • A special unit that handtes maritinie claims (HSWCA OCSLA, and Jones Act) • Specialists who audit medical bills • Subrogation specialists who recover millions from third parties responsible for injuries Information at Your Fingertips ■ Toil -Tree numbers for claim reporting and general Intormalion ■ An easy. to -us 9 re rerence notebook wtlh full Instructions on coverage notices, injury reportinq and tips oft ccsl control Compelltive Quotes Other States Coverage Safety Groups ❑eductlbles TO THE AGENT OR BROKER Our regional rnarketing teams are available to present snore about these services to your clients and your staff AO Box 12058 Au5bn. T3 78711-2058 1 of 1 to xtsrn u wa+com 1(800) 8 59 -599 5 I Fax IB('0) 359-01650 ❑T-1NFrl ® 0"Flertta a-RM I so iT:'�v Texd.smutul t:ik.i tip' t._CWPI NSATION INStlkllNCI: Medical Network SelectioTi from Texas; Mutual Through Texas Mutual's medical network, eligible policyholders have access to high quality providers with proven success treating workers' comp -related injuries and Illnesses Those who choose Texas Mutual's niedlcal network also receive a network discount and many other benefits Vial help to create a positive experience for employers, and their injured Vsomers Why choose the Texas Mutual network? ❑uallfy of care • Injured employees select their treating doctor from among the network's occupational health care providers who are focused on helping workers recover and return to a productive lire ■ Our providers have been Carefully selected and have a proven track record of quality care ■ Network medical providers have access to Texas Mutual training resources and Medical Director expertise to help them better understand the uniqueness of on-the-job Injuries • Medical case managers work with health care providers rniure-s workers and employers to identr'y and facilitate return -to -work opportunities Flnanclaf henefffs • Policyholders who choose Texas Mutual's medical network receive a network discount ■ On average injured workers return to work sooner than non -network patients resulting in lower than average indemnity benefits and medical costs compared with non- network policies • The network's retum-to-work focus helps improve productrvtty and reduce other costs associated w th workplace accidents Employers must notify employees of network requirements for the network provisions to take effect For Inure 11 iforruaW11 ❑n the Texas Mutual's medical network, visit texasmutual.coin PO Box 12-D58- Au5tur TX 7a71 t-2058 1 of t texasmutuai com 110DO) 859-5993 1 Fax (500) 3K9-0650 (DTINFO-PG2 OrHer'LUt e-RAt 1 51