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PSA with Corvel Enterprise Corp, Inc.DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D9127705AD3 PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF MIAMI BEACH AND CORVEL ENTERPRISE COMP, INC. FOR Contract no. 21-224-01 26 21 - 319 30 CLAIMS ADMINISTRATION BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS COMPENSATION, PURSUANT TO RFQ 2021 -224 -WG 3/8/2022 1 12:51 EST This Professional Services Agreement ("Agreement") is entered into this 1st day of February. 2022 ("Effective Date"), between the CITY OF MIAMI BEACH, FLORIDA, a municipal corporation organized and existing under the laws of the State of Florida, having its principal offices at 1700 Convention Center Drive, Miami Beach, Florida, 33139 (the "City"), and CORVEL ENTERPRISE COMP, INC., a Delaware corporation, whose address is 1920 Main Street, Suite 900 Irvine CA 92614 ("Consultant"). SECTION 1 Agreement: This Agreement between the City and Consultant, including any exhibits, schedules, and amendments thereto. The Agreement may be referred to as the "Master Agreement". City Manager: The chief administrative officer of the City. City Manager's Designee: The City staff member who is designated by the City Manager to administer this Agreement on behalf of the City. The City Manager's designee shall be the Office of the City Manager's Department Director. Consultant: For the purposes of this Agreement, Consultant shall be deemed to be an independent contractor, and not an agent or employee of the City. Services: All services, work and actions by the Consultant performed or undertaken pursuant to the Agreement. Fee: Amount paid to the Consultant as compensation for Services. Proposal Documents: Proposal Documents shall mean City of Miami Beach RFQ No. 2021 -224 - WG for Claims Administration by a Third Party Administrator For Workers DocuSign Envelope ID: 6EEOD36E-ASE7416C-887C-9D91277D5AD3 Compensation, together with all amendments thereto (the "RFQ"), issued by the City in contemplation of this RFQ, and the Consultant's proposal in response thereto ("Proposal"), all of which are hereby incorporated and made a part hereof; provided, however, that in the event of an express conflict between the Proposal Documents and this Agreement, the following order of precedent shall prevail: this Agreement; the RFQ; and the Proposal. Risk Manager: The Risk Manager of the City, with offices at 1700 Convention Center Drive, Third Floor, Miami Beach, Florida 33139; telephone number (305) 673-7000, Ext. 6435; and fax number (305) 673-7023. SECTION 2 SCOPE OF SERVICES 2.1 In consideration of the Fee to be paid to Consultant by the City, Consultant shall provide the work and services described in Exhibit "A" hereto (the "Services"). Although Consultant may be provided with a schedule of the available hours to provide its Services, the City shall not control nor have the right to control the hours of the Services performed by the Consultant; where the Services are performed (although the City will provide Consultant with the appropriate location to perform the Services); when the Services are performed, including how many days a week the Services are performed, how the Services are performed, or any other aspect of the actual manner and means of accomplishing the Services provided. Notwithstanding the foregoing, all Services provided by the Consultant shall be performed in accordance with the terms and conditions set forth in Exhibit "A" and to the reasonable satisfaction of the City Manager. If there are any questions regarding the Services to be performed, Consultant should contact the following person: Sonia Bridges, Division Director Risk Management Division Human Resources Department 305 673-7000 # 6515 SoniaBridgesamiamibeachfl.gov 2.2 Consultant shall provide its Online Software system the "CareMC Application" pursuant to the "CareMC License Agreement" attached as Exhibit "C" hereto. 2.3 Consultant shall provide its Smartphone application "the My Care App' for access by City's injured claimants pursuant to the attached Exhibit D hereto. SECTION 3 TERM The term of this Agreement ("Term') shall commence upon execution of this Agreement by all parties hereto (the Effective Date set forth on p. 1 hereof), and shall have an initial term of three (3) years, with three (3) one-year renewal options, to be exercised at the City Manager's sole option and discretion, by providing Consultant with written notice of same no less than thirty (30) days prior to the expiration of the initial term. 2 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Notwithstanding the Term provided herein, Consultant shall adhere to any specific timelines, schedules, dates, and/or performance milestones for completion and delivery of the Services, as same is/are set forth in the timeline and/or schedule referenced in Exhibit A hereto. SECTION 4 FEE 4.1 In consideration of the Services to be provided, Consultant shall be compensated pursuant to the attached Exhibit B ("Fees'). 4.2 The fee shall be paid in equal monthly installments of $12,916.67, at the end of each month of the term. The Monthly installments shall become payable upon execution of this Agreement. 4.3 INVOICING Upon receipt of an acceptable and approved invoice, payment(s) shall be made within forty-five (45) days for that portion (or those portions) of the Services satisfactorily rendered (and referenced in the particular invoice). Invoices shall include a detailed description of the Services (or portions thereof) provided, and shall be submitted to the City at the following address: Accounts Payable: Payables a�.miamibeachfl.00v SECTION 5 TERMINATION 5.1 TERMINATION FOR CAUSE If the Consultant shall fail to fulfill in a timely manner, or otherwise violates, any of the covenants, agreements, or stipulations material to this Agreement, the City, through its City Manager, shall thereupon have the right to terminate this Agreement for cause. Prior to exercising its option to terminate for cause, the City shall notify the Consultant of its violation of the particular term(s) of this Agreement, and shall grant Consultant ten (10) days to cure such default. If such default remains uncured after ten (10) days, the City may terminate this Agreement without further notice to Consultant. Upon termination, the City shall be fully discharged from any and all liabilities, duties, and terms arising out of, or by virtue of, this Agreement. Notwithstanding the above, the Consultant shall not be relieved of liability to the City for damages sustained by the City by any breach of the Agreement by the Consultant. The City, at its sole option and discretion, shall be entitled to bring any and all legal/equitable actions that it deems to be in its best interest in order to enforce the City's rights and remedies against Consultant. The City shall be entitled to recover all costs of such actions, including reasonable attorneys' fees. 5.2 TERMINATION FOR CONVENIENCE OF THE CITY DocuSign Envelope ID; 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 THE CITY MAY ALSO, THROUGH ITS CITY MANAGER, AND FOR ITS CONVENIENCE AND WITHOUT CAUSE, TERMINATE THE AGREEMENT AT ANY, TIME DURING THE TERM BY GIVING WRITTEN NOTICE TO CONSULTANT OF' SUCH TERMINATION; WHICH SHALL BECOME EFFECTIVE WITHIN NINETY (90) DAYS FOLLOWING RECEIPT BY THE CONSULTANT OF SUCH NOTICE. ADDITIONALLY, IN THE EVENT OF A PUBLIC HEALTH, WELFARE OR SAFETY CONCERN, AS DETERMINED BY THE CITY MANAGER, IN THE CITY MANAGER'S SOLE DISCRETION, THE CITY MANAGER, PURSUANT TO A VERBAL OR WRITTEN NOTIFICATION TO CONSULTANT, MAY IMMEDIATELY SUSPEND THE SERVICES UNDER THIS AGREEMENT FOR A TIME CERTAIN, OR IN THE ALTERNATIVE, TERMINATE THIS AGREEMENT ON A GIVEN DATE. IF THE AGREEMENT IS TERMINATED FOR CONVENIENCE BY THE CITY, CONSULTANT SHALL BE PAID FOR ANY SERVICES SATISFACTORILY PERFORMED UP TO THE DATE OF TERMINATION; FOLLOWING WHICH THE CITY SHALL BE DISCHARGED FROM ANY AND ALL LIABILITIES, DUTIES, AND TERMS ARISING OUT OF, OR BY VIRTUE OF, THIS AGREEMENT. 5.3 TERMINATION FOR INSOLVENCY The City also reserves the right to terminate the Agreement in the event the Consultant is placed either in voluntary or involuntary bankruptcy or makes an assignment for the benefit of creditors. In such event, the right and obligations for the parties shall be the same as provided for in Section 5.2. SECTION 6, INDEMNIFICATION AND INSURANCE REQUIREMENTS 6.1 Consultant agrees to indemnify, defend and hold harmless the City of Miami Beach and its officers, employees, agents, and contractors, from and against any and all actions (whether at law or in equity), claims, liabilities, losses, and expenses, including, but not limited to, attorneys' fees and costs, for personal, economic or bodily injury, wrongful death, loss of or damage to property, which may arise or be alleged to have arisen from the negligent acts, errors, omissions or other wrongful conduct of the Consultant, its officers, employees, agents, contractors, or any other person or entity acting under Consultant's control or supervision, in connection with, related to, or as a result of the Consultant's performance of the Services pursuant to this Agreement. To that extent, the Consultant shall pay all such claims and losses and shall pay all such costs and judgments which may issue from any lawsuit arising from such claims and losses, and shall pay all costs and attorneys' fees expended by the City in the defense of such claims and losses, including appeals. The Consultant expressly understands and agrees that any insurance protection required by this Agreement or otherwise provided by the Consultant shall in no way limit the Consultant's responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The parties agree that one percent (1%) of the total compensation to Consultant for performance of the Services under this Agreement is the specific consideration from the City to 4 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-887C-9D91277D5AD3 the Consultant for the Consultant's indemnity agreement. The provisions of this Section 6.1 and of this indemnification shall survive termination or expiration of this Agreement. 6.2 6.2.1 The Consultant shall maintain the below required insurance in effect prior to awarding the agreement and for the duration of the agreement. The maintenance of proper insurance coverage is a material element of the agreement and failure to maintain or renew coverage may be treated as a material breach of the contract; which could result in withholding of payments or termination of the Agreement. A. Worker's Compensation Insurance for all employees of the vendor as required by Florida Statute 440, and Employer Liability Insurance for limits no less than $1,000,000 for bodily injury or disease. B. Commercial General Liability Insurance on an occurrence basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence,.and $2,000,000 general aggregate. C. Professional Liability Insurance in an amount not less than $1,000,000 with the deductible per claim, if any, not to exceed 10% of the limit of liability. D. Cyber Liability with limits no less than $1,000,000 per occurrence and $2,000,000 general aggregate, covering claims involving privacy violations, information theft, damage to or destruction of electronic information, intentional and/or unintentional release of private information, alteration of electronic information, extortion and network security. 6.2.2 Additional Insured - City of Miami Beach must be included by endorsement as an additional insured with respect to all liability policies (except Professional Liability and Workers' Compensation) arising out of work or operations performed on behalf of the Consultant including materials, parts, or equipment furnished in connection with such work or operations and automobiles owned, leased, hired or borrowed in the form of an endorsement to the Consultant's insurance. 6.2.3 Notice of Cancellation - Each insurance policy required above shall provide that coverage shall not be cancelled, except with notice to the City of Miami Beach c/o EXIGIS Insurance Compliance Services. 6.2.4 Waiver of Subrogation — Consultant agrees to obtain any endorsement that may be necessary to affect the waiver of subrogation on the coverages required. However, this provision applies regardless of whether the City has received a waiver of subrogation endorsement from the insurer. 6.2.5 Acceptability of Insurers — Insurance must be placed with insurers with a current A.M. Best rating of A:VII or higher. If not rated, exceptions may be made for members of the Florida Insurance Funds (i.e. FWCIGA, FAJUA). Carriers may also be considered if they are licensed and authorized to do insurance business in the State of Florida. 6.2.6 Verification of Coverage —Consultant shall furnish the City with original certificates and amendatory endorsements, or copies of the applicable insurance language, effecting coverage 5 Doc Sign Envelope ID: 6EEOD36E-ABE7<16C-887C-9D91277D5AD3 required by this contract. All certificates and endorsements are to be received and approved by the City before work commences. However, failure to obtain the required documents prior to the work beginning shall not waive the Consultant's obligation to provide them. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements, required by these specifications, at any time. CERTIFICATE HOLDER ON ALL COI MUST READ: CITY OF MIAMI BEACH c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta, CA 92564 Kindly submit all certificates of insurance, endorsements, exemption letters to our servicing agent, EXIGIS, at: Certificates -m iami beach(a)riskworks. com 6.2.7 Special Risks or Circumstances - The City of Miami Beach reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. Compliance with the foregoing requirements shall not relieve the vendor of his liability and obligation under this section or under any other section of this agreement. SECTION 7 LITIGATION JURISDICTIONNENUE/JURY TRIAL WAIVER This Agreement shall be construed in accordance with the laws of the State of Florida. This Agreement shall be enforceable in Miami -Dade County, Florida, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for the enforcement of same shall lie in Miami -Dade County, Florida. By entering into this Agreement, Consultant and the City expressly waive any rights either party may have to a trial by jury of any civil litigation related to or arising out of this Agreement. SECTION 8 LIMITATION OF CITY'S LIABILITY The City desires to enter into this Agreement only if in so doing the City can place a limit on the City's liability for any cause of action, for money damages due to an alleged breach by the City of this Agreement, so that its liability for any such breach never exceeds the sum of $10,000. Consultant hereby expresses its willingness to enter into this Agreement with Consultant's recovery from the City for any damage action for breach of contract to be limited to a maximum amount of $10,000. Accordingly, and notwithstanding any other term or condition of this Agreement, Consultant hereby agrees that the City shall not be liable to the Consultant for damages in an amount in excess of $10,000 for any action or claim for breach of contract arising out of the performance or non-performance of any obligations imposed upon the City by this Agreement. DocuSign Envelope ID: 6EE0036E-ABE7-416G8B7G9D91277D5AD3 Nothing contained in this section or elsewhere in this Agreement is in any way intended to be a waiver of the limitation placed upon the City's liability, as set forth in Section 768.28, Florida Statutes. SECTION 9 DUTY OF CARE/COMPLIANCE WITH APPLICABLE LAWS/PATENT RIGHTS; COPYRIGHT; AND CONFIDENTIAL FINDINGS Alli 0111l1[+7X9_1C7 With respect to the performance of the Services contemplated herein, Consultant shall exercise that degree of skill, care, efficiency and diligence normally exercised by reasonable persons and/or recognized professionals with respect to the performance of comparable work and/or services. 9.2 COMPLIANCE WITH APPLICABLE LAWS In its performance of the Services, Consultant shall comply with all applicable laws, ordinances, and regulations of the City, Miami -Dade County, the State of Florida, and the federal government, as applicable. 9.3 PATENT RIGHTS: COPYRIGHT: CONFIDENTIAL FINDINGS Any work product arising out of this Agreement, as well as all information specifications, processes, data and findings, are intended to be the property of the City and shall not otherwise be made public and/or disseminated by Consultant, without the prior written consent of the City Manager, excepting any information, records etc. which are required to be disclosed pursuant to Court Order and/or Florida Public Records Law. All reports, documents, articles, devices, and/or work produced in whole or in part under this Agreement are intended to be the sole and exclusive property of the City, and shall not be subject to any application for copyright or patent by or on behalf of the Consultant or its employees or sub -consultants, without the prior written consent of the City Manager. SECTION 10 GENERAL PROVISIONS 10.1 AUDIT AND INSPECTIONS Upon reasonable verbal or written notice to Consultant, and at any time during normal business hours (i.e. 9AM — 5PM, Monday through Fridays, excluding nationally recognized holidays), and as often as the City Managermay, in his/her reasonable discretion and judgment, deem necessary, there shall be made available to the City Manager, and/or such representatives as the City Manager may deem to act on the City's behalf, to audit, examine, and/ or inspect, any and all other documents and/or records relating to all matters covered by this Agreement. Consultant shall maintain any and all such records at its place of business at the address set forth in the "Notices" section of this Agreement. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 10.2 INSPECTOR GENERAL AUDIT RIGHTS 10.2.1 Pursuant to Section 2-256 of the Code of the City of Miami Beach, the City has established the Office of the Inspector General which may, on a random basis, perform reviews, audits, inspections and investigations on all. City contracts, throughout the duration of said contracts. This random audit is separate and distinct from any other audit performed by or on behalf of the City. 10.2.2 The Office of the Inspector General is authorized to investigate City affairs and empowered to review past, present and proposed City programs, accounts, records, contracts and transactions. In addition, the Inspector General has the power to subpoena witnesses, administer oaths, require the production of witnesses and monitor City projects and programs. Monitoring of an existing City project or program may include a report concerning whether the project is on time, within budget and in conformance with the contract documents and applicable law. The Inspector General shall have the power to audit, investigate, monitor, oversee, inspect and review operations, activities, performance and procurement process including but not limited to project design, bid specifications, (bid/proposal) submittals, activities of the Consultant, its officers, agents and employees, lobbyists, City staff and elected officials to ensure compliance with the contract documents and to detect fraud and corruption. Pursuant to Section 2-378 of the City Code, the City is allocating a percentage of its overall annual contract expenditures to fund the activities and operations of the Office of Inspector General. 10.2.3 Upon ten (10) days written notice to the Consultant, the Consultant shall make all requested records and documents available to the Inspector General for inspection and copying. The Inspector General is empowered to retain the services of independent private sector auditors to audit, investigate, monitor, oversee, inspect and review operations activities, performance and procurement process including but not limited to project design, bid specifications, (bid/proposal) submittals, activities of the Consultant its officers, agents and employees, lobbyists, City staff and elected officials to ensure compliance with the contract documents and to detect fraud and corruption. 10.2.4 The Inspector General shall have the right to inspect and copy all documents and records in the Consultant's possession, custody or control which in the Inspector General's sole judgment, pertain to performance of the contract, including, but not limited to original estimate files, change order estimate files, worksheets, proposals and agreements from and with successful subcontractors and suppliers, all project -related correspondence, memoranda, instructions, financial documents, construction documents, (bid/proposal) and contract documents, back -change documents, all documents and records which involve cash, trade or volume discounts, insurance proceeds, rebates, or dividends received, payroll and personnel records and supporting documentation for the aforesaid documents and records. 3 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 10.2.5 The Consultant shall make available at its office at all reasonable times the records, materials, and other evidence regarding the acquisition (bid preparation) and performance of this Agreement, for examination, audit, or reproduction, until three (3) years after final payment under this Agreement or for any longer period required by statute or by other clauses of this Agreement. In addition: A. If this Agreement is completely or partially terminated, the Consultant shall make available records relating to the work terminated until three (3) years after any resulting final termination settlement; and B. The Consultant shall make available records relating to appeals or to litigation or the settlement of claims arising under or relating to this Agreement until such appeals, litigation, or claims are finally resolved. 10.2.6 The provisions in this section shall apply to the Consultant, its officers, agents, employees, subcontractors and suppliers. The Consultant shall incorporate the provisions in this section in all subcontracts and all other agreements executed by the Consultant in connection with the performance of this Agreement. 10.2.7 Nothing in this section shall impair any independent right to the City to conduct audits or investigative activities. The provisions of this section are neither intended nor shall they be construed to impose any liability on the City by the Consultant or third parties. 10.3 ASSIGNMENT, TRANSFER OR SUBCONSULTING Consultant shall not subcontract, assign, or transfer all or any portion of any work and/or service under this Agreement without the prior written consent of the City Manager, which consent, if given at all, shall be in the Manager's sole judgment and discretion. Neither this Agreement, nor any term or provision hereof, or right hereunder, shall be assignable unless as approved pursuant to this section, and any attempt to make such assignment (unless approved) shall be void. 10.4 PUBLIC ENTITY CRIMES Prior to commencement of the Services, the Consultant shall file a State of Florida Form PUR 7068, Sworn Statement under Section 287.133(3)(a) Florida Statute on Public Entity Crimes with the City's Procurement Division. 10.5 NO DISCRIMINATION In connection with the performance of the Services, the Consultant, shall not exclude from participation in, deny the benefits of, or subject to discrimination anyone on the grounds of race, color, national origin, sex, age, disability, religion, income or family status. Additionally, Consultant shall comply fully with the City of Miami Beach Human Rights Ordinance, codified in Chapter 62 of the City Code, as may be amended from time to time, DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 prohibiting discrimination in employment, housing, public accommodations, and public services on account of actual or perceived race, color, national origin, religion, sex, intersexuality, gender identity, sexual orientation, marital and familial status, age, disability, ancestry, height, weight, domestic partner status, labor organization membership, familial situation, or political affiliation. 10.6 CONFLICT OF INTEREST Consultant herein agrees to adhere to and be governed by all applicable Miami -Dade County Conflict of Interest Ordinances and Ethics provisions, as set forth in the Miami -Dade County Code, as may be amended from time to time; and by the City of Miami Beach Charter and Code, as may be amended from time to time; both of which are incorporated by reference as if fully set forth herein. Consultant covenants that it presently has no interest and shall not acquire any interest, directly or indirectly, which could conflict in any manner or degree with the performance of the Services. Consultant further covenants that in the performance of this Agreement, Consultant shall not employ any person having any such interest. No member of or delegate to the Congress of the United States shall be admitted to any share or part of this Agreement or to any benefits arising therefrom. 10.7 CONSULTANT'S COMPLIANCE WITH FLORIDA PUBLIC RECORDS LAW 10.7.1 Consultant shall comply with Florida Public Records law under Chapter 119, Florida Statutes, as may be amended .from time to time. 10.7.2 The term "public records" shall have the meaning set forth in Section 119.011(12), which means all documents, papers, letters, maps, books, tapes, photographs, films, sound recordings, data processing software, or other material, regardless of the physical form, characteristics, or means of transmission, made or received pursuant to law or ordinance or in connection with the transaction of official business of the City. 10.7.3 Pursuant to Section 119.0701 of the Florida Statutes, if the Consultant meets the definition of "Contractor' as defined in Section 119.0701(1)(a), the Consultant shall: A. Keep and maintain public records required by the City to perform the service; B. Upon request from the City's custodian of public records, provide the City with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes or as otherwise provided by law; C. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed, except as authorized by law, for the duration of the contract term and following completion of the Agreement if the Consultant does not transfer the records to the City; D. Upon completion of the Agreement, transfer, at no cost to the City, all public records in possession of the Consultant or keep and maintain public records required by the City to perform the service. If the Consultant transfers all public records to the City upon completion of the Agreement, the Consultant shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Consultant keeps and maintains public records upon completion of the Agreement, the Consultant shall meet all applicable requirements for retaining public records. All records stored 10 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 electronically must be provided to the City, upon request from the City's custodian of public records, in a format that is compatible with the information technology systems of the City. 10.7.4 REQUEST FOR RECORDS, NONCOMPLIANCE. A. A request to inspect or copy public records relating to the City's contract for services must be made directly to the City. If the City does not possess the requested records, the City shall immediately notify the Consultant of the request, and the Consultant must provide the records to the City or allow the records to be inspected or copied within a reasonable time. B. Consultant's failure to comply with the City's request for records shall constitute a breach of this Agreement, and the City, at its sole discretion, may: (1) unilaterally terminate the Agreement; (2) avail itself of the remedies set forth under the Agreement; and/or (3) avail itself of any available remedies at law or in equity. C. A Consultant who fails to provide the public records to the City within a reasonable time may be subject to penalties under s. 119.10. 10.7.5 CIVIL ACTION. A. If a civil action is filed against a Consultant to compel production of public records relating to the City's contract for services, the court shall assess and award against the Consultant the reasonable costs of enforcement, including reasonable attorneys' fees, if: 1. The court determines that the Consultant unlawfully refused to comply with the public records request within a reasonable time, and 2. At least 8 business days before filing the action, the plaintiff provided written notice of the public records request, including a statement that the Consultant has not complied with the request, to the City and to the Consultant. B. A notice complies with subparagraph (1)(b) if it is sent to the City's custodian of public records and to the Consultant at the Consultant's address listed on its contract with the City or to the Consultant's registered agent. Such notices must be sent by common carrier delivery service or by registered, Global Express Guaranteed, or certified mail, with postage or shipping paid by the sender and with evidence of delivery, which may be in an electronic format. C. A Consultant who complies with a public records request within 8 business days after the notice is sent is not liable for the reasonable costs of enforcement. 10.7.6 IF THE CONSULTANT HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONSULTANT'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: CITY OF MIAMI BEACH ATTENTION: RAFAEL E. GRANADO, CITY CLERK 1700 CONVENTION CENTER DRIVE MIAMI BEACH, FLORIDA 33139 E-MAIL: RAFAELGRANADO(cDMIAM IBEACH FL.GOV 11 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277DSAD3 PHONE: 305-673-7411 10.8 FORCE MAJEURE (A) A "Force Majeure" event is an event that (i) in fact causes a delay in the performance of the Consultant or the City's obligations under the Agreement, and (ii) is beyond the reasonable control of such party unable to perform the obligation, and (iii) is not due to an intentional act, error, omission, or negligence of such party, and (iv) could not have reasonably been foreseen and prepared for by such party at any time prior to the occurrence of the event. Subject to the foregoing criteria, Force Majeure may include events such as war, civil insurrection, riot, Fres, epidemics, pandemics, terrorism, sabotage, explosions, embargo restrictions, quarantine restrictions, transportation accidents, strikes, strong hurricanes or tornadoes, earthquakes, or other acts of God which prevent performance. Force Majeure shall not include technological impossibility, inclement weather, or failure to secure any of the required permits pursuant to the Agreement. (B) If the City or Consultant's performance of its contractual obligations is prevented or delayed by an event believed by to be Force Majeure, such party shall immediately, upon learning of the occurrence of the event or of the commencement of any such delay, but in any case within fifteen (15) business days thereof, provide notice: (i) of the occurrence of event of Force Majeure, (ii) of the nature of the event and the cause thereof, (iii) of the anticipated impact on the Agreement, (iv) of the anticipated period of the delay, and (v) of what course of action such party plans to take in order to mitigate the detrimental effects of the event. The timely delivery of the notice of the occurrence of a Force Majeure event is a condition precedent to allowance of any relief pursuant to this section; however, receipt of such notice shall not constitute acceptance that the event claimed to be a Force Majeure'event is in fact Force Majeure, and the burden of proof of the occurrence of a Force Majeure event shall be on the requesting party. (C) No party hereto shall be liable for its failure to carry out its obligations under the Agreement during a period when such party is rendered unable, in whole or in part, by Force Majeure to carry out such obligations. The suspension of any of the obligations under this Agreement due to a Force Majeure event shall be of no greater scope and no longer duration than is required. The party shall use its reasonable best efforts to continue to perform its obligations hereunder to the extent such obligations are not affected or are only partially affected by the Force Majeure event, and to correct or cure the event or condition excusing performance and otherwise to remedy its inability to perform to the extent its inability to perform is the direct result of the Force Majeure event with all reasonable dispatch. (D) Obligations pursuant to the Agreement that arose before the occurrence of a Force Majeure event, causing the suspension of performance, shall not be excused as a result of such occurrence unless such occurrence makes such performance not reasonably possible. The obligation to pay money in a timely manner for obligations and liabilities which matured prior to the occurrence of a Force Majeure event shall not be subject to the Force Majeure provisions. 12 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 (E) Notwithstanding any other provision to the contrary herein, in the event of a Force Majeure occurrence, the City may, at the sole discretion of the City Manager, suspend the City's payment obligations under the Agreement, and may take such action without regard to the notice requirements herein. Additionally, in the event that an event of Force Majeure delays a party's performance under the Agreement for a time period greater than thirty (30) days, the City may, at the sole discretion of the City Manager, terminate the Agreement on a given date, by giving written notice to Consultant of such termination. If the Agreement is terminated pursuant to this section, Consultant shall be paid for any Services satisfactorily performed up to the date of termination; following which the City shall be discharged from any and all liabilities, duties, and terms arising out of, or by virtue of, this Agreement. In no event will any condition of Force Majeure extend this Agreement beyond its stated term. 10.9 E -VERIFY (A) Consultant shall comply with Section 448.095, Florida Statutes, "Employment Eligibility" ("E -Verify Statute"), as may be amended from time to time. Pursuant to the E -Verify Statute, commencing on January 1, 2021, Consultant shall register with and use the E - Verify system to verify the work authorization status of all newly hired employees during the Term of the Agreement. Additionally, Consultant shall expressly require any subconsultant performing work or providing services pursuant to the Agreement to likewise utilize the U.S. Department of Homeland Security's E -Verify system to verify the employment eligibility of all new employees hired by the subconsultant during the contract Term. If Consultant enters into a contract with an approved subconsultant, the subconsultant must provide the Consultant with an affidavit stating that the subconsultant does not employ, contract with, or subcontract with an unauthorized alien. Consultant shall maintain a copy of such affidavit for the duration of the Agreement or such other extended period as may be required under this Agreement. (B) TERMINATION RIGHTS. (1) If the City has a good faith belief that Consultant has knowingly violated Section 448.09(1), Florida Statutes, the City shall terminate this Agreement with Consultant for cause, and the City shall thereafter have or owe no further obligation or liability to Consultant. (2) If the City has a good faith belief that a subconsultant has knowingly violated the foregoing Subsection 10.9(A), but the Consultant otherwise complied with such subsection, the City will promptly notify the Consultant and order the Consultant to immediately terminate the Agreement with the subconsultant. Consultant's failure to terminate a subconsultant shall be an event of default under this Agreement, entitling City to terminate the Consultant's contract for cause. (3) A contract terminated under the foregoing Subsection (B)(1) or (B)(2) is not in breach of contract and may not be considered as such. (4) The City or Consultant or a subconsultant may file an action with the Circuit or County Court to challenge a termination under the foregoing Subsection (B)(1) or (B)(2) no later than 20 calendar days after the date on which the contract was terminated. (5) If the City terminates the Agreement with Consultant under the foregoing Subsection (B)(1), Consultant may not be awarded a public contract for at least 1 year after the date of termination of this Agreement. (6) Consultant is liable for any additional costs incurred by the City as a result of the termination of this Agreement under this Section 10.9. 13 DowSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 SECTION 11 NOTICES Until changed by notice, in writing, all such notices and communications shall be addressed as follows: TO CONSULTANT: CORVEL ENTERPRISE COMP, INC. 1920 Main Street, Suite 900 Irvine CA 92614 Debbie Popovich(a)corvel.com Phone: 954-233-5906 TO CITY: Sonia Bridges, Division Director Risk Management Division Human Resources Department Phone: 305-673-7000 # 6515 SoniaBndges(a)miamibeachfl.gov All notices mailed electronically to either party shall be deemed to be sufficiently transmitted. SECTION 12 MISCELLANEOUS PROVISIONS This Agreement cannot be modified or amended without the express written consent of the parties. No modification, amendment, or alteration of the terms or conditions contained herein shall be effective unless contained in a written document executed with the same formality and of equal dignity herewith. 12.2 SEVERABILITY If any term or provision of this Agreement is held invalid or unenforceable, the remainder of this Agreement shall not be affected and every other term and provision of this Agreement shall be valid and be enforced to the fullest extent permitted by law. 12.3 WAIVER OF BREACH A party's failure to enforce any provision of this Agreement shall not be deemed a waiver of such provision or modification of this Agreement. A party's waiver of any breach of a provision of this Agreement shall not be deemed a waiver of any subsequent breach and shall not be construed to be a modification of the terms of this Agreement. 12.4 JOINT PREPARATION The parties hereto acknowledge that they have sought and received whatever competent advice and counsel as was necessary for them to form a full and complete understanding of all rights and obligations herein and that the preparation of this Agreement has been a joint effort of the 14 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277DSAD3 parties, the language has been agreed to by parties to express their mutual intent and the resulting document shall not, solely as a matter of judicial construction, be construed more severely against one of the parties than the other. 12.5 ENTIRETY OF AGREEMENT The City and Consultant agree that this is the entire agreement between the parties. This Agreement supersedes all prior negotiations, correspondence, conversations, agreements or understandings applicable to the matters contained herein, and there ,are no commitments, agreements or understandings concerning the subject matter of this Agreement that are not contained in this document. Title and paragraph headings are for convenient reference and are not intended to confer any rights or obligations upon the parties to this Agreement. [BALANCE OF PAGE INTENTIONALLY LEFT BLANK] 15 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 DocuSign Envelope ID: 8CD5551D-DC86-413D-8668-DB7469614014 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their appropriate officials, as of the date first entered above. FOR CITY: ATTEST: DocuBlgned by: Ka rl f. GratAade By: ABBBADBFB5E4CF . City Clerk: Rafael E. Granado 3/8/2022 1 12:51 EST Date: FOR CONSULTANT: ATTEST: Dxuslgny: ad b CC& F41(yls By' — E1ASA15CSW4A .. CITY OF MIAMI BEACH, FLORIDA 9•1' 1. ..- fin -k d- CORVEL ENTERPRISE COMP, INC. EBocaSigndedby: {^aAn,p41n, i��Urll.t4. OBEC30BLB4094FF... Scott Farris Senior Corporate Paral@glitlldon O'Brien Print Name and Title Print Name and Title Date: 2/14/2022 2/14/2022 CFO APPROVED AS TO FORM & LANGUAGE ^n& FOREXE UTION City Altotney Dote F: ATTO/TORO/Agrccmcnts/Pmfacsional Scrviccs Ag=ncnt 2017 moditicd 12.19.2017 lic DocuSlgn Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 EXHIBIT A THE SERVICES The administrator will provide all specified adjusting services for all claims as well as all other required services, such as administrative, managed care/medical case management, computerized claims/loss statistical information (RMIS) and banking/loss fund reconciliation. 3.1. City Workforce, Ordinances and Collective Bargaining The City has approximately 2,184 employees, and averages 365 claims annually with approximately two- thirds of the claims being medical -only. As of May 31, 2021, there were approximately 366 open claims. The City has five (5) Collective Bargaining Units that have specific language with regards to the handling of leave related to compensable claims (see chart below). For employees that are not a part of a Collective Bargaining Unit, the Unclassified Leave Ordinance No. 1613.11 governs Workers' Compensation Supplemental Injury Pay as follows: Employees who are absent due to restrictions for a work-related injury are entitled up to thirty-two (32) weeks of Supplemental Pay. The Supplemental Pay is the amount equal to the difference between their normal City pay and the amount of compensation payable under the provisions of the Workers' Compensation law of the State of Florida. This benefit allows employees to receive their full pay while absent due to an approved work-related injury. In view of this, temporary total indemnity benefits will not need to be paid by the TPA unless the injured employee is eligible for temporary total benefits in excess of 32 weeks. UNION TIME LIMIT NOTES IAFF Two sixteen -week periods May be extended with the approval of Fire Chief, IAFF President and City Manager. Decision not sub'ect to rievance or arbitration. FOP Two sixteen -week periods May be extended with the approval of Fire Chief, IAFF President and City Manager. Decision not subject to grievance or arbitration. AFSCME Sixteen (16) weeks May be extended by City Manager or his/her designee. CWA Not to exceed Sixteen (16) CBA is silent; May be extended for additional weeks sixteen (16) weeks, subject to approval of City Manager. Refer to Classified Leave Ordinance No. 1335-13. GSA Not to exceed Sixteen (16) CBA is silent; May be extended for additional weeks sixteen (16) weeks, subject to approval of City Manager. Refer to Classified Leave Ordinance No. 1335-13. Note: Information regarding Supplemental Pay is subject to change with Collective Bargaining or administrative changes to the current Ordinances. Any changes to this information will be provided to the selected TPA for proper handling. 3.2. Excess Workers' Compensation Liability Insurance The City purchased excess workers' compensation insurance for a period from 1986 through 1997. Excess Workers' Compensation Insurance coverage resumed in 2017 and continues to date. The self-insured 17 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 retention is $1.5 million, except for Police and Fire claims that is $2 million. • TPA shall comply with all excess workers' compensation coverage agreements in place; including reporting requirements affording potential or existing coverage on all and any open (or re -opened) claims such as, but not limited to reporting. TPA shall be responsible for any penalties, declined coverage, reservation of rights issued, diminished coverage benefits imposed by City's TPA's failure to properly report new or existing agreement reporting requirements. excess workers' compensation carrier(s) due to claims as required by each carriers' coverage 3.3. Claims Handling of Past and Future Claims All proposers are to assume the complete handling of all future and past claims now being handled by our present TPA, along with all new claims. The information provided regarding the volume and type of pending claims to be assumed is based on the latest information provided to the City and cannot be guaranteed as to its accuracy The program is run on an "occurrence" basis, therefore, all claims occurring in the contract year, regardless of when reported, are to be handled per the requirements of this agreement. The TPA is required to handle all claims to their conclusion or to the conclusion of the contract, whichever occurs first, at no additional charge to the City other than the annual fee. The contract may be terminated by either party with ninety (90) days written notice to the other. However, any cancellation does not alter the administrator's obligation to handle all claims prior to the termination date. 3.4. Claims Administration The City requires that the selected TPA provide, at a minimum, the following professional services related to the administration of the City's self-insured Workers' Compensation Program: TPA shall provide workers' compensation third -party claims administration services to the City of Miami Beach's self-insured workers' compensation program in accordance with Florida Statute, Section 440, applicable Florida Administrative Code(s), and applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s). City shall provide TPA with copies of applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s) as necessary. Services include the necessary medical benefits, expenses, and other services usual and customary to the administration and management of workers' compensation claims, if not otherwise noted herein. • TPA shall provide, on behalf of the City, all self -insurer reporting to the Self Insurance Bureau, Division of Workers' Compensation, State of Florida, all annual reports, unit statistical, modification factor, assessment indemnity, medical and any and all forms required by the State of Florida which a self -insurer for workers' compensation must provide. • TPA shall accept all current claims and/or re -opened claims as run-in claims to the TPA if selected as the new TPA for the City. • TPA shall provide the City with the ability to report first reports of injury and loss notices electronically for all claims, and, by phone based on the severity, circumstances or nature of injury, in DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9091277D5AD3 at no additional cost. • TPA shall provide automated acknowledgement upon the receipt of each claim. The acknowledgement shall include, but not be limited, to the following: claim number, claimant's name, and date of loss, one-time prescription drug authorization. • TPA shall set up all new claims within twenty-four (24) hours after notification. Assigned adjuster, supervisor, telephonic case manager, or nurse case manager shall make all contacts and initiate investigation within forty-eight (48) hours of receipt of new claims. • TPA shall triage every notice of injury with a with appropriate claims professional or triage system. • TPA shall utilize any recommended medical primary care physicians or specialists as directed by City's Risk Manager, even if not in the TPA's network, if it is in the best interest of the injured employee or the City. This would include authorizing treatment by non -occupational or non -network physicians or providers who have treated an injured employee under emergency or exigent circumstances in an emergency room or other facility, if such treatment would be considered prudent and reasonable for continuity of rare purposes. • The City reserves the right, but not the obligation, to approve all vendor partners and ancillary services used by the TPA that are part of the workers' compensation allocated claim expense or reserve. • City reserves the right to select its own workers' compensation defense counsel to manage any and all litigation for the City's workers' compensation and employer's liability program, and/or to seek pre -litigation legal advice and claim strategy. The City's Risk Manager has the authority to approve the workers' compensation defense counsel's fee, cost schedule and/or any allocated legal claim adjustment expenses. TPA shall agree to work with the City's chosen workers' compensation defense counsel. In the event the TPA is unable to work with the City's workers' compensation defense counsel or has a conflict of interest, then City reserves the right to deem the TPA's proposal non-responsive, or terminate the TPA's Contract. • TPA must provide access to Spanish and Creole speaking adjusters for situations when injured workers are more comfortable conversing in Spanish or Creole. TPA should clearly outline the staffing which will be provided. The adjuster shall perform all the usual and customary worker's compensation claim adjustment in accordance with the laws, rules and regulations of the State of Florida. • TPA shall provide the City with field case management services, catastrophic case management services, medical cost projections, life care planning, Medicare set-aside assessments, development of reports, surveillance, peer review, utilization review and reasonable and customary savings review, bill review, percentage of PPO savings and any other usual and customary workers' compensation claims administration claims practice, strategy or activity as all allocated loss adjustment expenses, unless such expenses are more appropriately allocated as a medical expense under the claim per Florida Statutes or TPA's judgment. 19 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 • TPA shall provide the City with telephonic case management services on all workers' compensation claims as an allocated loss adjustment expense, unless otherwise directed by City. • TPA shall provide a list of PPO networks affiliated with the TPA, as requested by City. • TPA shall evaluate and qualify various service providers recommended by the City to service its account, provided such service providers do not present a perceived or potential conflict of interest. • TPA shall process and handle all electronic data interchange requirements on behalf of the City as required by the State of Florida at no additional charge. • TPA shall be responsible for all Medicare reporting obligations under the Medicare Secondary Payor Act, and/or under similar or new legislation at no additional cost to the City. • TPA shall provide the City with OSHA 300 log reporting capabilities at no additional cost, as requested by City. • TPA shall handle subrogation claims and file lien notices on behalf of the City to protect the City's interests in rights of recovery from third -party tortfeasors. TPA shall not proceed with any legal action against a third -party tortfeasor without the City's Risk Manager's approval. • TPA agrees all negotiated settlement agreements shall require City approval. Such settlements would include but may not be limited to, agreements to wash-out an entire claim, settle a negotiated lien, settle a negotiated attorney fee, or any other type of settlement that is not otherwise 'considered an administration of a medical, indemnity or allocated expense that would otherwise be due and owed in accordance with Florida law.. • TPA shall attend in person or via telephonically all mediations. The City shall endeavor to have a Risk Management staff member, or designee, at all mediations as well as hearings. • TPA shall review and seek approval from the City for any loss reserve adjustment increases greater than twenty-five thousand dollars ($25,000). • TPA shall agree to quarterly claim reviews, whether in person or telephonically at the City's discretion, ,to review all litigated cases, legacy cases, catastrophic cases, or non -litigated complex cases. 3.5. Record Keeping and Audits • TPA shall agree all claim files, reports, and other data prepared or provided in connection with a claim are and shall remain the property of the City. TPA shall keep complete and accurate records and accounts in connection with each claim. Such records shall be available at all reasonable times for examination by the City, or its' designee, and shall be kept for a period of no less than three (3) years after the completion of all work to be performed. Incomplete or incorrect entries in such records may be grounds for disallowance by City of any fees or expenses based upon such entries. TPA shall send City all closed claim files that are 20 DocuSign Envelope ID: 6EEOD36E-ABE7-016C-8B7C-9D91277D5AD3 mutually agreed upon to be inactive. • TPA agrees to notify the City of proposed or enacted changes in workers' compensation regulatory requirements or legislative acts that may affect the City's claims. • TPA shall agree to maintain a SSAE 16 audit on controls placed in operations and tests for operating effectiveness and agrees to provide copies to the City as requested. • TPA shall take extraordinary measures, if is selected as the new TPA for the City, to ensure data and file conversion and transfer is done with as little disruption to the City and its injured employees to ensure continuity in care and continued best workers' compensation claims management practices. • TPA, as a custodian of records for City, shall comply and cooperate with all applicable City and State record retention and exemptions laws such as, but not limited to, Florida Statutes, Sections, 119, 440, 760 and 112 as they pertain to protected medical, personal and/or work product information. • TPA agrees to transfer or ship the electronic file data or hard copy file data at the request and as directed by the City at no cost other than actual incurred reasonable shipping fees. TPA agrees there shall be no charges to transfer electronic data on a per data file basis or other transfer related fees or charges unless agreed upon in writing by City. All electronic data transferred, or hard copy data shipped shall be done within sixty (60) days of receipt of written notice from City. Paper data shall be shipped overnight by FED EX, UPS or equivalent common carrier agreed to by City. Electronic data shall be transferred be electronic format as requested by City, provided the data files are adequately protected and secured. Electronic file data means all claims information and related claim file information maintained in an electronic computer file format. 3.6. Banking, Reporting and Billing • TPA shall utilize the City's solely selected and approved financial institution for the funding of workers' compensation claim payments and settlements. TPA agrees to comply with the City's Positive Pay (fraud detection) banking standards and must do a daily data feed to the City's financial institution for fraud detection. • TPA shall send weekly invoices for wire fund transfer requests to replenish the City's account. Exceptions are made for special requests for unexpected large losses or claim settlements for which specific dedicated invoice for wire fund transfer requests shall be made. • The City shall fund at least fifty percent (50%) times the City's average weekly spend on workers' compensation claims. Presently the City's fund maintains an average weekly balance of two hundred and fifty thousand dollars ($250,000). • TPA shall send original invoices to the attention of the City's Risk Manager, or designee, by e-mail to City of Miami Beach, unless otherwise instructed. • TPA shall mail the City monthly financial institution reconciliations. 21 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 • TPA shall issue 1099's to all vendor issued allocated claims payments pursuant to the applicable tax laws in effect. • TPA shall be audited by the City at the City's sole discretion and cost. • TPA shall invoice the City quarterly for its administrative claim fee. • TPA will be required to manage the claims with a comprehensive data base system which allows computer access to notes, correspondence and other pertinent information needed by the City to generate analytical data reports upon demand; which will allow secure web based communication between the City and the TPA adjusters. This program should also allow the City to add information to the adjuster notes section of the TPA computer system. TPA shall provide the City's Risk Manager and it's designees, with access and training to utilize the TPA's Risk Management Information System to monitor the adjuster's claim activity on a file. • TPA shall provide the City with electronic loss runs, claim reports or ad hoc reports as required by City within seven (7) working days of month-end. • TPA shall provide quarterly claims data and other periodic information to the City's actuarial service provider when required. • TPA shall provide safety engineering services as requested by City, and fees shall be negotiated and approved by the City as an allocated loss adjustment expense per applicable claim file. • Other claims adjusting services for Workers' Compensation, as needed. 3.7. Staffing and Personnel It is the City's claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control the City's self-insured loss payments is to ensure the TPA hires and retains the appropriately qualified professionals to handle the City's claims. Additionally, the adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services. The City therefore requires that the proposer agree to staffing, qualifications and caseload criteria established by the City. The City reserves the right to the final prior approval of the hiring and/or assignment of the claims manager, supervisors and adjusters that are to handle the City's claims. The required maximum open caseloads per is as follows: Lost time - 100 Medical only - 500 The TPA agrees to add staff as necessary to maintain these maximum pending caseload levels. Claims personnel must be employees of the TPA. The use of independent adjusters, subcontractors or temporary adjusters is not acceptable without prior approval of the City. Adjuster trainees are not acceptable for 22 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 handling of the City's claims. Additionally, resumes of all claims professionals specifically assigned to this account are to be submitted with this proposal. All claims professionals must possess a current Florida Workers, Compensation adjuster's license. 3.8. Loss Fund Management 1. The Claim Payment Account will be maintained at the City's commercial banking institution. The account will be classified as part of the analysis group of City accounts. The City will pay all service fees that are normal and customary in this account. All interest earned or service credits generated will accrue to the benefit of the City. 2. The TPA is required to follow Florida law concerning public deposits. Failure to comply with Florida law is sufficient cause for the City to terminate the contractual agreement with the TPA. 3. All claims, expense and legal payments will be made by the TPA on checks drawn on an account set up by the TPA and funded monthly by the City. It is understood that all funds in this account are City funds and are to be returned to the City upon request or at termination of this contract. 4. The TPA is responsible for the monthly reconciliation of this account and will provide bank statements to the City monthly, along with a request for a deposit from the City to maintain the monthly balance in the loss fund, as determined by the City. 5. The monthly reconciliation statement submitted by the TPA to the City will include the following: - balance at inception of statement period . - total disbursements which cleared, by date and claimant/payee - balance at close of statement period - amount of deposit required 6. A list of all checks is to be submitted monthly. 23 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9091277D5AD3 EXHIBIT B FEES (for 375 claims or less, including new Per Claim Fee for I stlmatea Claims in Excess $ 529.40 after 375 a ye r Quantity of 375 Per Year (per excess claim) 40 per year No carry over 3t annual Fee Total Lines 1-2 will be used to allocate points Column 3 Flat Annual Fee $ 155,000 (per contract year) Year $ 21.176.08 (Column 1 x Column 2) 176,176.08 ADDITIONAL SERVICES List of services, which mail be needed which are in addition to the fees proposed. Description of Service Fee Medical Case Management Fee on All Claims: $100.43 Per Bill/Flat Fee Bill Review Fee to Include State Fee Schedule Reduction: $ 4.a5 Per Bill/Flat Fee Percentage of PPO Savings — Network Discount Savings Below State Fee, Schedule: 22%incrementap/, Percentage Of Utilization Review and Reasonable & Customary Savings: Hospital capped 3,999 max total billina 22% total % Subrogation andtor Liens Fee Percentage: 25% of recovery% Osha 300 Log Reporting: $ included Electronic Data Interchange Fled with State: $inNuded Safety Consulting Services $ included Notice Of Injury Entry: $ 33.43 CustomtAd Hoc .Reports: The city reports are all at no cost $200.001 hrl if programming is required the ci 24 has never required this DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 'Pharmacy Discounts will remain as is: MAIL ORDER: BRAND -AWP -13% GENERIC- AWP -45% dispensing $1.50 RETAIL: BRAND AWP -10% GENERIC AWP- 35% dispensing $2.50 Description of Services $ Data and File Conversion Fee: $ Not applicable er Month Based on Frequency: One -Time Setup Flat Fee NIA Medicare Reporting Costs: $250.00 3i -Weekly File $ included Daily File $ $ Additional Description Of Additional Service: Pharmacy discounts* $ Description Of Additional Service: $ Des4fion Of Additional Service: $ Description Of Additional Service: $ 'Pharmacy Discounts will remain as is: MAIL ORDER: BRAND -AWP -13% GENERIC- AWP -45% dispensing $1.50 RETAIL: BRAND AWP -10% GENERIC AWP- 35% dispensing $2.50 Description of Services Fees utbound Electronic Data Feed Transmission Services er Month Based on Frequency: onthly File $250.00 3i -Weekly File $600.00 Daily File $2,000.00 25 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 EXHIBIT C CAREMC LICENSE AGREEMENT This CAREMC LICENSE AGREEMENT (the "CareMC License Agreement') is incorporated by reference into the Services Agreement (the "Professional Services Agreement') to which it is attached and shall be between City of Miami Beach and CorVel Enterprise Comp, Inc. (the "Parties") The Parties The parties acknowledge and agree that the terms and conditions under which the Third Party Administration and bundled Managed Care Services are provided by CorVel and received by Customer shall be governed by the Master Agreement (including without limitation all additional Exhibits and applicable Schedules attached thereto), while the terms and conditions under which Customer may access and use the Online Services shall be governed by the terms and conditions of this CareMC License Agreement. Any conflict in terms between the Master Agreement and the CareMC License Agreement shall be superseded by the Master Agreement. All defined terms used herein and not otherwise defined shall have the meaning ascribed to such terms in the Master Agreement. 1. ACCESS TO THE CAREMC APPLICATION A. Registration Information. Prior to accessing the CareMC Application, Customer shall provide CorVel with certain registration information requested therein ("Registration Information"). To the best of Customer's knowledge, information and belief, the Registration InformationCustomer provides will be true, accurate, current and complete and will be updated as necessary to it so. B. Passwords and Levels of Access. As soon as practicable after the execution of this Agreement, CorVel shall create a unique username and password for each individual Authorized User identified by Customer as requiring access to the Online Services. Customer shall then designate two groups of Authorized Users. The first group of Authorized Users ("Restricted Users") shall have access to only the data available on the CareMC Site that relates to claims specific to that Authorized User and such other data that Customer specifically requests in writing be accessible to such Authorized User. The second group of Authorized Users ("Non -Restricted Users") shall have access to all data available on the CareMC Site that relates to claims specific to Customer. Access by Individual Users and Non -Restricted Users to data available on the CareMC Site shall be subject in all cases to any limitations imposed by applicable law. C. PH Data. Authorized Users shall have access to all data available through the CareMC Application, including data that constitutes or contains "personally identifiable information" ("PII Data") as such term is defined in applicable state and federal privacy laws, but shall only have access to PII Data to the extent necessary for Customer to read only a claim, and then only to those portions or amounts of PII Data that are determined by CorVel, in its sole discretion, to be the minimum necessary for Customer to edit such claim. D. Security of Passwords. Customer acknowledges and agrees that it shall be solely responsible for (i) selecting Authorized Users, (ii) assigning the various levels of authority and access each Authorized User may have to the CareMC Application, Online Services and Customer Data, including by determining which Authorized Users shall be Non -Restricted Users, (iii) ensuring that only Authorized Users have access to the passwords provided by CorVel or changed by Authorized Users, (iv) implementing a system to control, track and account for all passwords, (v) strictly maintaining the confidentiality and integrity of all passwords and levels of authority among Authorized Users, and (vi) ensuring that Authorized Users shall at all times comply with the terms and conditions of this Agreement. Customer further agrees that it shall notify CorVel immediately in writing if the security or integrity of a password has been compromised. CorVel will provide reasonable cooperation to Customer in the event of a security breach. Such support will include but not be limited to suspending service for passwords whose security or integrity has been violated. Passwords may be changed at any time by Authorized Users, and must be changed at least once every ninety (90) days. E. Customer Data. Responsibility for ensuring that the content and data provided by or for Customer ("Customer Data") to be entered into the CareMC Application by CorVel is accurate and reflects Customer's requirements lies solely with Customer. All data generated by and through Customer's use of the CareMC Application and Online Services shall reside on CorVel's server. CorVel reserves the right to temporarily suspend access to any Customer Data that it determines, in its sole discretion, violates the terms and conditions of this CareMC License Agreement or any applicable laws. F. Customer Representations. Customer represents that (i) it has the legal authority to provide the Customer Data to CorVel hereunder, and (it) it is fully aware and knowledgeable of and shall comply with its duties and DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7G9D91277D5AD3 responsibilities with respect to the privacy and confidentiality of medical records and protected health information under applicable federal and state laws, including but not limited to those imposed by HIPAA. 2. LICENSE AND RESTRICTIONS A. Limited License. Subject to the terms and conditions of this CareMC License Agreement, CorVel grants to Customer during the License Term (as defined in Section 5A below) a limited, non-exclusive, non -transferable, non- sublicensable license to access and use, and allow Authorized Users to access and use, the CareMC Application via the CareMC Site solely for Customer's own internal business use and operations. Customer shall access and use the CareMC Application in accordance with the user's guides and online instruction provided to Customer by CorVel ("Documentation") and all applicable laws, statutes, rules and regulations. B. Restrictions. Customer shall not, and shall not allow Authorized Users or any third party to (i) rent, lease, re -license or otherwise provide access to the CareMC Application or Online Services to any third party, (ii) alter, modify or create derivative works of the CareMC Application, (iii) use any reverse compilation, decompilation or disassembly techniques or similar methods to determine any design structure, concepts and construction method of ,the CareMC Application or replicate the functionality of the CareMC Application for any purpose, or (iv) copy the CareMC Application or any content, materials, information and other data provided by CorVel on the CareMC Site or used in providing the Online Services ("CorVel Content") and/or Documentation without CorVel's prior written consent. C. Third Parties. Third Parties. Customer shall not allow any third party to have access to the CareMC Application or Online Services without prior written consent of CorVel and ensuring that (i) such third party enters into a legally enforceable written agreement with CorVel, or (ii) CorVel and Customer enter into an agreement whereby Customer assumes all responsibility and liability for access by such third party. D. Ownership and Changes. CorVel owns and shall retain all right, title and interest in and to the CareMC Application, Documentation, CareMC Site, Online Services, CorVel Content and any intellectual property rights inherent therein or arising therefrom. In addition to CorVel's rights in the individual elements of the CorVel Content, CorVel owns a copyright in the selection, coordination, arrangement and enhancement of the CorVel Content. Neither Customer nor any Authorized User shall obtain any ownership rights, express or implied, or any other rights other than those expressly set forth herein in the CareMC Application, Documentation or CorVel Content. CorVel reserves the right, at any time in its sole discretion and without liability to Customer, to delete or change features of the CareMC Application, CareMC Site or Online Services provided such changes do not materially alter the functionality of the CareMC Application. E. Compliance Monitoring and Audits. CorVel may monitor and perform remote audits of Customer's use of the CareMC Application and CareMC Site for the purpose of verifying that Customer and Authorized Users are using the CareMC Application in compliance with the terms of this CareMC License Agreement. CorVel reserves the right to temporarily suspend Customer's or any Authorized User's access to the CareMC Application in the event Customer or such Authorized User engages in, or CorVel in good faith suspects is engaged in, any unauthorized conduct. To the extent CorVel requires access to Customer's facilities to conduct an audit hereunder, Customer agrees to provide such access upon reasonable advanced notice and during Customer's regular business hours. 3. INFRASTRUCTURE, MAINTENANCE AND SUPPORT A. CorVel Infrastructure Obligations. Subject to Customer's compliance with the terms and conditions of this CareMC License Agreement, CorVel shall be responsible for providing and maintaining the hardware, software and other equipment required to host the CareMC Application for Customer ("CareMC Infrastructure"). The CareMC Infrastructure is subject to modification by CorVel from time to time for purposes such as adding new functionality, maximizing operating efficiency and upgrading hardware, provided such modifications shall not in the aggregate degrade the performance of the Online Services utilized by Customer. Customer acknowledges and agrees that such modifications may require changes to Customer's Internet access and/or telecommunications infrastructure to maintain Customer's desired level of performance. CorVel shall give Customer reasonable prior written notice of any required modifications. B. Customer Infrastructure Obligations. Except for the CareMC Infrastructure, which will be provided by CorVel, Customer shall be responsible for obtaining and maintaining all hardware, software, equipment, Internet access and/or telecommunications services and other items or services furnished by third party venders or providers 27 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 ("Third Party Providers") required to enable Customer to access and use the CareMC Application and CareMC Site as contemplated hereunder. C. Support. CorVel will provide general support regarding questions on the CareMC Application via email and by telephone from Monday through Friday between the hours of 5:00 a.m. and 6:00 p.m. Pacific Standard Time, excluding holidays. D. Scheduled Maintenance. CorVel will use reasonable efforts to (i) perform any scheduled downtime outside of Customer's normal business hours, (ii) notify Customer of all scheduled downtimes at least seventy-two (72) hours in advance, and (iii) perform software updates to the CareMC Application with minimal disruption to Customer's use of the Online Services. E. System Monitoring. CorVel will use reasonable efforts to continuously monitor its web servers and database servers to ensure that they are functioning properly. F. Security. CorVel will implement and use reasonable efforts to maintain secure systems through the use of firewalls, virtual private networks (VPN) and other security technologies. Any security violations that affect the data of Customer will be promptly reported to Customer. G. Disaster Recovery and Backup. CorVel will use reasonable efforts to perform nightly backups of essential data on its web servers and database servers. CorVel has implemented third party backup and restoration technology to enable high speed recovery of data. CorVel utilizes redundant load balanced Win 2000 servers for 240, 365 day access, except for regularly scheduled system maintenance and upgrade processes. SQL Server databases are hosted on clustered servers offering fall -over capability, redundant communication links, and load balanced application servers. Backup tapes are restored into a test environment not less than quarterly to confirm validity of backups. The CareMC Site has redundant inbound Internet and Intranet connectivity. 4. APPLICATION SPECIFIC DISCLAIMERS A. Disclaimers. TO THE EXTENT ALLOWED BY APPLICABLE LAW, EXCEPT FOR THE LIMITED WARRANTIES DESCRIBED IN THE MASTER AGREEMENT, CORVEL MAKES NO OTHER WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AND EXPRESSLY DISCLAIMS ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, GOOD TITLE, SATISFACTORY QUALITY AND NONINFRINGEMENT. B. Internet Usage. Customer acknowledges that the Internet is essentially an unregulated, insecure and unreliable environment, and that the ability of Customer to access and use the CareMC Application is dependent on the Internet and hardware, software and services provided by various Third Party Providers. CORVEL SHALL NOT BE RESPONSIBLE FOR CUSTOMER'S INABILITY TO ACCESS OR USE THE CAREMC APPLICATION TO THE EXTENT CAUSED BY FAILURES OR INTERRUPTIONS OF ANY HARDWARE, SOFTWARE OR SERVICES PROVIDED BY CUSTOMER OR THIRD PARTY PROVIDERS. C. CareMC Application. CUSTOMER ACKNOWLEDGES AND AGREES THAT CORVEL DOES NOT WARRANT THAT THE CAREMC APPLICATION OR ONLINE SERVICES ARE ERROR FREE, THAT CUSTOMER WILL BE ABLE TO ACCESS OR USE THE CAREMC APPLICATION OR ONLINE SERVICES WITHOUT PROBLEMS OR INTERRUPTIONS, OR THAT THE CAREMC SITE AND CAREMC APPLICATION ARE NOT SUSCEPTIBLE TO INTRUSION, ATTACK OR COMPUTER VIRUS INFECTION. 5. LICENSE TERM AND TERMINATION A. License Tenn. This CareMC License Agreement shall be effective as of the Effective Date and, unless terminated earlier as provided below, shall automatically terminate upon expiration or termination of the Master Agreement (the term of this CareMC License Agreement, the "License Tenn"). B. Termination for Convenience. Either party shall have the right to terminate this CareMC License Agreement for any reason or for no reason, upon ninety (90) days written notice to the other party. C. Termination for Cause. This CareMC License Agreement may be terminated by either party for cause as follows: (i) upon thirty (30) days written notice if the other party breaches or defaults under any material provision of this Agreement and does not cures such breach prior to the end of such thirty (30) day period, (ii) effective immediately and without notice if the other party ceases to do business, or otherwise terminates its business operations, except as a result of an assignment, as permitted under the terms and conditions of this CareMC License Agreement, or (iii) effective immediately and without notice if the other party becomes insolvent or seeks protection under any bankruptcy, receivership, trust deed, creditors arrangement, composition or comparable proceeding, or if any such proceeding is instituted against the other (and not dismissed within ninety (90) days). 28 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 D. Effect of Termination. Expiration or termination of this CareMC License Agreement shall have the following effects: (i) CorVel shall provide Customer with any proprietary data belonging to Customer, in the current format in which it is stored at CorVel at the termination of this CareMC License Agreement, (ii) all licenses granted under this CareMC License Agreement shall terminate immediately, (iii) all rights to use the CareMC Application and Online Services shall cease immediately, and (iv) each party shall promptly return all information, documents, manuals and other materials belonging to the other party related to this CareMC License Agreement, whether in printed or electronic form, including without limitation all confidential information of the other party then currently in its possession, provided each party may retain one (1) copy of such materials for archival purposes. E. Survival. Except to the extent expressly provided to the contrary herein or in the Master Agreement, any right of action for breach of the CareMC License Agreement prior to termination, and the following provisionsshall survive the termination of this CareMC License Agreement: Sections 1B -F, 2B, 21), 4 and 5E. DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 EXHIBIT D END USER LICENSE AGREEMENT Terms are non-negotiable PLEASE READ THIS LICENSE AGREEMENT BEFORE USING THE APP. USE OF THE APP INDICATES END USER'S ACCEPTANCE OF THIS END USER LICENSE AGREEMENT. IF END USER DOES NOT AGREE WITH THE TERMS, END USER SHOULD NOT USE THE APP. 1. License Grant; License Restrictions. Either of CorVel Enterprise Comp, Inc. or CorVel Healthcare Corporation, as applicable, ("CorVel") provides the mobile software application program and user manual(s) or help files contained therein, and any modifications, updates, revisions, or enhancements thereto received by End User from CorVel (collectively, the "App"), and licenses its use solely pursuant to the terms stated below: a. End User is granted a nontransferable license to use the App under the terms stated in this Agreement for personal use. End User may not use the App for commercial purposes. Title and ownership of the App and of the copyright in the App remains with CorVel; b. The App may be used by End User on a single mobile device, which End User owns or uses and for which the App is designed to operate; C. End User may not make copies, translations, or modifications of or to the App. End User may not alter, obscure, or remove the copyright notice on any copy of the App; d. End User may not assign, sell, distribute, lease, rent, sublicense, or transfer the App or this license or disclose the App to any other person. End User may not reverse -engineer, disassemble, or decompile the App or otherwise attempt to discover the source code or structural framework of the App; and e. CorVel may terminate this Agreement and the license granted hereunder at any time. This Agreement and the license granted hereunder automatically terminates if End User fails to comply with any provision of this Agreement. End User agrees upon termination to: (i) cease using the App and providing or accessing any data or information by or through the App, and (ii) destroy the App, together with all copies, modifications, and merged portions in any form, including any copy on End User's mobile device or on any computer. 2. Limited Warranty. The App is provided "AS IS" and with all faults. NO WARRANTIES ARE EXPRESSED AND NONE SHALL BE IMPLIED. CORVEL SPECIFICALLY EXCLUDES ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NONINFRINGEMENT. CORVEL DOES NOT WARRANT THAT USE OF THE APP WILL BE UNINTERRUPTED OR ERROR -FREE. 3. Maintenance & Support. The App is maintained by CorVel or its subcontractors. From time to time, CorVel may provide modifications, updates, revisions, or enhancements, all of which are offered pursuant to the terms.and conditions of this Agreement. CorVel does not provide support to End Users. All support requests should be directed at End Users employer or other person responsible to manage End User's claims and not at CorVel. 30 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 4. Consent to use Data. All data or information submitted by End User through the App shall be used by CorVel in accordance with CorVel's Privacy Policy posted at: http://www.corvel.com/privacy-policy/ 5. Limitations of Liability (End User). IN NO EVENT WILL CORVEL'S LIABILITY FOR ACTUAL DIRECT DAMAGES ARISING OUT OF THIS AGREEMENT OR THE USE OR PERFORMANCE OF THE APP EXCEED $100. IN NO'EVENT WILL CORVEL BE LIABLE FOR ANY LOST PROFITS, SALES, BUSINESS, DATA, COSTS OF PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES OR ANY INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES RESULTING FROM THE USE OF THE APP OR OTHERWISE ARISING FROM THIS AGREEMENT, AND NOTWITHSTANDING ANY FAILURE OF ESSENTIAL PURPOSE OF ANY LIMITED REMEDY. The parties agree that the above limits represent a reasonable allocation of risk. 6. Governing Law; Exclusive Jurisdiction. This Agreement is governed by the laws of California. End User agrees that the federal or state courts sitting in State of California shall be the exclusive courts of jurisdiction and venue for any litigation, special proceeding or other proceeding as between the parties that may be brought, or arise out of, or in connection with, or by reason of this Agreement. The United Nations Convention on Contracts for the International Sale of Goods is expressly disclaimed. 7. Indemnification (End User). End User shall defend, indemnify and hold harmless CorVel from and against damages, liabilities and reasonable costs and expenses, including reasonable legal fees arising out of or relating to: (i) End User's use of the App in violation of the terms of this Agreement, (ii) data or content included in or omitted from content and data input into the App by End User or any other third party using End User's mobile device, and (iii) any claim by an employee of End User or End User's insureds brought against CorVel due to the recommendations made by CorVel through the App. 8. Disclaimer. CorVel shall not be responsible or liable for any third party claims arising from the negligent acts, errors, omissions, willful misconduct or fraud caused by End User in connection with its use of the App or otherwise attributable this Agreement. 9. Assignment. End User may not assign any of End User's rights or delegate any of End User's obligations under this Agreement without the prior written consent of CorVel. Subject to the foregoing, this Agreement will bind and inure to the benefit of the parties, their respective successors and permitted assigns. 10. Notice. All notices required to be sent hereunder shall be in writing and shall be deemed to have been given when mailed by first class mail to the address listed below. 11. Severability. If any provision of this Agreement is held to be invalid or unenforceable, the remaining provisions of this Agreement will remain in full force. 12. Waiver. The waiver by either party of a breach of any provision of this Agreement or the failure by either party to exercise any right hereunder shall not operate or be construed as a waiver of any subsequent breach of that right or as a waiver of any other right. 13. Export Administration. End User agrees to comply fully with all relevant export laws and regulations of the United States ("Export Laws") to assure that neither the App nor any direct product thereof is (1) exported, directly or indirectly, in violation of Export Laws; or (2) are used for 31 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 any purposes prohibited by the Export Laws, including, without limitation, nuclear, chemical, or biological weapons proliferation. 14. Entire Agreement. This Agreement shall constitute the complete agreement between the parties and supersede all prior or contemporaneous agreements or representations, written or oral, concerning the subject matter of this Agreement. This Agreement may not be modified or amended except in writing signed by a duly authorized representative of each party; no other act, document, usage or custom shall be deemed to amend or modify this Agreement. 15. Survival. The provisions of Sections 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 and 14 shall survive the termination of this Agreement. Copyrights Copyright © 2014 CorVel. All rights reserved. This documentation and the corresponding App are the property of CorVel and are licensed to the user under the terms of this End User License Agreement. Unauthorized use or copying of the App, documentation, or any other associated materials is a violation of state and federal laws. These materials must be returned to CorVel if so demanded. 32 Dow&gn Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 RESOLUTION NO. 2021-31930 A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, ACCEPTING THE RECOMMENDATION OF THE CITY MANAGER, PURSUANT TO REQUEST FOR PROPOSALS (RFP) NO. 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION; AND AUTHORIZING THE ADMINISTRATION TO ENTER INTO NEGOTIATIONS WITH CORVEL ENTERPRISE COMP, INC, AS THE TOP RANKED PROPOSER; AND FURTHER AUTHORIZING THE CITY MANAGER AND CITY CLERK TO EXECUTE AN AGREEMENT UPON CONCLUSION OF SUCCESSFUL NEGOTIATIONS BY THE ADMINISTRATION. WHEREAS, on July 28, 2021, the Mayor and City Commission- approved issuance of Request for Proposals (RFP) RFP 2021 -224 -WG for Claims Administration Services by a Third - Party Administrator for Workers Compensation (the "RFP"); and WHEREAS, RFP responses were due and received on September 8, 2021; and WHEREAS, the City received proposals from the following four firms: CorVel Enterprise Comp, Inc.; Johns Eastern Company, Inc.; PMA Management Corp.; and USIS, Inc.; and WHEREAS, the proposal submitted by USIS, Inc., was deemed non-responsive for failure to comply with the City's Equal Benefits requirement, and therefore received no further consideration; and WHEREAS, the City Manager appointed an Evaluation Committee (the "Committee"), comprised of Eddie Beecher, Director, Human Resources Department, City of Pompano Beach; Monica Beltran, Director, City's Parking Department; Sonia Bridges, Director, City's Risk Management (Division; Frank Estevez, City's Compensation Manager, Human Resources Department; and Anne Marie Sharpe, Director, Risk Management, City of Miami; and WHEREAS, the Committee received an overview of the project, information relative to the City's Cone of Silence Ordinance and the Government Sunshine Law, general information on the scope of services, and a copy of each proposal; and WHEREAS, the Committee was instructed to score and rank each proposal pursuant to the evaluation criteria established in the RFP; and WHEREAS, the Committee ranked the proposals in the following order: 1st—CorVel Enterprise Comp, Inc. 2nd — USIS, Inc. 3rd — Johns Easter Company, Inc. 4th — PMA Management Corp. WHEREAS, after reviewing all of the submissions and the Evaluation Committee process, the City Manager concurs with the Evaluation Committee and recommends that the City negotiate an agreement with Florida CorVel Enterprise Comp, Inc., as the best qualified firm to provide third -party administration services for the City's workers compensation claims. DocuSign Envelope ID: 6EE6D36E-ABE7-416C-8B7C-9D91277D5AD3 NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Commission hereby accept the recommendation of the City Manager, pursuant to Request for Proposals (RFP) 2021 -224 -WG for Claims Administration Services by a Third -Party Administrator for Workers Compensation; and authorize the Administration to enter into negotiations with, CorVel Enterprise Comp, Inc., as the top-ranked proposer; and further authorize the City Manager and City Clerk to execute an Agreement upon conclusion of successful negotiations by the Administration. DEC 1 3 2021 day of [)ecemb['12021. DAN GELBER, MAYOR APPROVED AS TO FORM & LANGUAGE & FOR EXECUTION M10 —'a7 —Z) City Attorney A/W Date DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Resolutions - C7 E MIAMI BEACH COMMISSION MEMORANDUM TO: Honorable Mayor and Members of the City Commission FROM: AlinaT. Hudak, City Manager DATE: December 8, 2021 SUBJECT:A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, ACCEPTING THE RECOMMENDATION OF THE CITY MANAGER, PURSUANT TO REQUEST FOR PROPOSALS (RFP) NO. 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD - PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION; AUTHORIZING THE ADMINISTRATION TO ENTER INTO NEGOTIATIONS WITH CORVEL ENTERPRISE COMP, INC.; AS THE TOP-RANKED PROPOSER; AND FURTHER, AUTHORIZING THE CITY MANAGER AND CITY CLERK TO EXECUTE AN AGREEMENT UPON CONCLUSION OF SUCCESSFUL NEGOTIATIONS BYTHEADMINISTRATION. RECOMMENDATION It is recommended that the Mayor and City Commission approve the Resolution authorizing the Administration to enter into negotiations with CorVel Enterprise Comp, Inc., as the top-ranked proposer, for thins -party claims administration services for workers' compensation. The Resolution also authorizes the Mayor and City Clerk to execute an Agreement upon conclusion of successful negotiations by the Administration and the City Attorneys Office. BACKGROUND/HISTORY The City of Miami Beach (the "City') is approved by the Florida Department of Labor and Employment Security/Division of Workers' Compensation to self -insure for workers' compensation. However, the Division of Workers' Compensation requires that the claims administration be provided by a State Certified Workers' Compensation Claims Administrator, usually a third -party. The City has approximately 2,184 employees and averages 365 claims annually. On February 1, 2014, the City entered into an Agreement with CorVel Enterprise Comp, Inc. to provide third -party claims administration services for its self-insurance worker's compensation program pursuant to RFP 2014-302SW. The Agreement had an initial term of two (2) years, which commenced on February 1, 2014, and ended on January 31, 2016. Three (3) one-year renewals were exercised, from February 1, 2017 through January 31, 2019. On October 16, 2019, pursuant to Resolution No. 2019-31021, the Mayor and City Commission approved by 5/7th vote Amendment No.1 extending the Agreement for two (2) additional years. The Page 380 of 1357 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7G9D91277D5AD3 Agreement is presently scheduled to expire on January 31, 2022. Accordingly, the Administration prepared an RFP for a subsequent agreement. ANALYSIS On July 28, 2021, the Mayor and City Commission approved the issuance of RFP 2021 -224 - WG for claims administration services by a third -party administrator for workers` compensation. RFP responses were due and received on September 8, 2021. The City received proposals from the following four firms: CorVel Enterprise Comp, Inc., Johns Eastern Company, Inc., PMA Management Corp., and USIS, Inc. On October 1, 2021, the City Manager appointed Evaluation Committee convened to consider proposals received. The Committee was comprised of Eddie Beecher, Director, Human Resources Department, City of Pompano Beach; Monica Beltran, Director, Parking Department; Sonia Bridges, Director, Risk Management Division; Frank Estevez, Compensation Manager, Human Resources Department; and Anne Marie Sharpe, Director, Risk Management, City of Miami. The Committee was provided an overview of the project, information relative to the Citys Cone of Silence Ordinance and the Government Sunshine Law. The Committee was also provided with general information on the scope of services and a copy of each proposal. The Committee was instructed to score and rank each proposal pursuant to the evaluation criteria established in the RFP. The evaluation process resulted in the proposers being ranked by the Evaluation Committee in the following order (See Attachment A): 1st— CorVel Enterprise Comp, Inc. $176,176.08 2nd —USIS, Inc. $181,800.00 3rd —Johns Easter Company, Inc. $372,000.00 4th— PMA Management Corp. $499,000.00 The incumbent firm and top-ranked proposer CorVel Enterprise Comp, Inc., proposed a decrease in the flat annual fee for an annual savings of $11,369.97. Additionally, the amount of annual claims included in the flat annual fee increased from 345 to 375 annually. A summary of the top-ranked firm follows: CorVel Enterprise Comp, Inc. CorVel has over 35 years of experience as a national provider of healthcare management solutions for employers, insurance companies and government agencies seeking to control costs and promote positive outcomes. The firm has approximately 3,800 associates who serve more than 1,000 customers through a national branch office network covering all 50 states. Its decentralized management model allows them to provide strong local support to its customers, while being supported by national resources, processes and systems. CorVel has been the Citys service providerfor over 7 years. CorVel's dedication to the City has a proven track record of high responsiveness and collaboration with the medical and adjusting team. SUPPORTING SURVEY DATA Page 381 of 1357 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Not Applicable. FINANCIAL INFORMATION The costs of the related services are subject to funds availability approved through the City's budgeting process. Grant funding will not be utilized for this project. CONCLUSION After reviewing all of the submissions and the Evaluation Committee process, I concur with the Evaluation Committee and find Florida CorVel Enterprise Comp, Inc., to be the top qualified firm to provide third -party administration services for the City's workers' compensation claims. CorVel has vast experience providing third -party administration services for more than 110 municipalities and public entities across the United States, including cities, counties, states, public transportation, and public education clients. The firm has served as the City's third -party administrator since 2014 and has made a positive impact on our workers' compensation program year over year during our 7 -year partnership. In addition, CorVel has successfully provided historical savings for the City of Miami Beach and provided the most cost-effective proposal to the City prior to negotiations. Lastly, their system allows for notes to be entered by staff and shared with assigned Adjusters. For the reasons stated herein, I recommend that the Mayor and City Commission approve the Resolution authorizing the Administration to enter into negotiations with CorVel Enterprise Comp, I nc., as the top-ranked proposer, and further, authorizing the City Manager and City Clerk to execute an Agreement upon conclusion of successful negotiations. Is this a "Residents Right to Know" item. pursuant to City Code Section 2-14? No Legislative Tracking Human Resources/Procurement ATTACHMENTS: Description D Attachment A D Resolution Does this item utilize G.O. Bond Funds? No Page 382 of 1357 RFP 2021.224-WG CLAIMS ADMINISTRATION ' SERVICES BYATRIRD6 Eddle Beecher m �` Monica Beltran e " Sonia Bridges Frank Estevez e 4 Anno Meda Sharpe Lowc c Aggregate PARTY c e 'y9 c ¢ Totals ADMINISTRATOR FOR WORKERS' COMPENSATION taQuangta6ve Subtotal Qualitative Quarrutadvo Subtotal Qualitative Quardltat a Subtotal Quamative Ouanitau" SuftAal QueNetive Ouaemetive SuMotal CmVel Enterprise Comp, Ins, fib 30 88 30 9B 1 30 96 1 66 30 98 1 66 30 98 1 5 1 Johns Eastem Company, 7OUva Ine. 60 /4 Z743 53 14 89 4o 14 74 3 58 14 72 3 66 14 82 3 ifi 3 PM57 11 83 71 74 30 17 87 4 80 11 71 4 fib 71 77 4 19 4 U61S, Inc. 59 29 00 29 89 23 29 82 2 57 2g 86 2 65 29 94 121 1 2 Page 383 of 1357 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 ATTACHMENT B ADDENDA (2) AND RFP SOLICITATION DocuSign Envelope ID: 6EEOD36E-ABE7416C-BB7C-9D91277D5AD3 MIAMI BEACH PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 31d Floor Miami Beach, Florida 33139 www.miamibeachf.gov ADDENDUM NO.2 REQUEST FOR PROPOSALS NO. 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION September 3, 2021 This Addendum to the above -referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only (deletions are shown by strikethrough and additions are underlined). ATTACHMENTS: Exhibit A, Existing Agreement Claims Administration Services for Workers Compensation (refer to Bidsync.com) Exhibit B 5 -Year Loss Run Report (refer to Bidsync.com) II. RESPONSES TO QUESTIONS RECEIVED: Q1: Are you also looking for pharmacy benefits management services as well? Al: Yes. Q2: Can companies from Outside USA apply for this? (like, from India or Canada)? A2: Yes. Please refer to Appendix A, Minimum Requirements and Specifications. Q3: Whether we need to come over there for meetings? A3: In presence meetings may be required. Please refer to Appendix A, Minimum Requirements and Specifications, Paragraph A.2. Q4: Can we perform the tasks (related to RFP) outside USA? (like, from India or Canada)? A4: Please refer to Appendix A, Minimum Requirements and Specifications, Paragraph A.2. Q5: Can we submit the proposals via email? A5: No. Please refer to Section 0300 Proposal Submittal Instructions and Format. Q6: Will the city also accept a fee per claim pricing model? A6: No. REQUEST FOR PROPOSALS NO. 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION DoaSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 MIAMI BEACH PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3b Floor Miami Beach, Florida 33139 www.miamibeachfl.gov Q7: Under A2. Scope of Work it states having a fully staffed office near the City or the ability to arrive within two hours request to attend meetings and provide training is important to the City. Is this a local preference requirement for the City of Miami Beach? A7: There are no local preference requirements pursuant to this solicitation. 08: Is the City willing to release the current agreement with the Incumbent? If the City intends not to disclose the incumbent's contract in total, will the City disclose aspects of the contract, or a redacted version, which would include pricing exhibits, scope of work, staffing model, ancillary fees? A8: Yes. Please refer to Bidsync.com for Exhibit A, Existing Agreement Claims Administration Services for Workers Compensation 09: Is the City operating under any restrictions related to COVID-19? A9: Yes. Some departments have instituted staggered work shifts to limit the number of employees in the office at one time; masks inside all City buildings are mandated; effective 813012021 city employees must present weekly a negative test result from a PCR COVID test or opt out of testing by producing proof of full vaccination. 010: Does the City have a Broker of Record involved in this RFP? Who is the Broker? A10: No. 011: Can you please identify, either by number of claim files, or percentage of claim files, whether the City has approved Nurse Case Management or VOC rehab? Can you please identify which service providers you currently use for Nurse Case Management and VOC rehab? A11: Nurse Case Management (6 Medical Case Management; 20 Telephonic Case Management); VOC Rehab = 0. CorVel Enterprise Comp, Inc. is the service provider used by the city for these services. Q12: How many data sources comprise the City's claim data? Al2: The City's claim data is comprised of one (1) data source. Q13: The RFP provides that the TPA will manage claims with a comprehensive data base system and provide the City access to notes, correspondence and pertinent information on demand. Can you please advise us of the number of users of this system the City intends? A13: The City anticipates 2 to 3 users of the system. Q14: How many individual adjusters comprise the claim handling team for the incumbent TPA? A14: The current TPA claim handling team is comprised of 4 Loss Time Adjusters and 1 Medical Only Adjuster. 2 1 ADDENDUM NO.2 REQUEST FOR PROPOSALS NO. 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 MIAMI BEACH PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3b Floor Miami Beach, Florida 33139 www.miamibeachf.gov Q15: What is the current number of open claims broken out by Lost time and Medical only? A15: The current number of open claims are as follows: Lost Time Cases = 361; Medical Only Cases = 22. 016: Is the City willing to provide a loss run for the last five policy years? A16: Yes. Please refer to Bidsync.com for Exhibit B 5 -Year Loss Run Report. 017: Would the vendor need to communicate with the current COBRA administrator? Who is your current COBRA administrator? A17: No communications with the current COBRA administrator are required. The current COBRA administrator is Benefits Outsource, Inc. Q18: Who is your current Benefits administrator? A18: The City is self-insured for medical insurance and the plan administrator is Cigna. Q19: What is the contract length for COBRA services? A19: The current contract length for COBRA services is continuous until cancelled by the City. Q20: What is the current COBRA administration compliance pricing? A20: The current COBRA administration pricing is 2% of Medical Premium. Q21: Can you provide a copy of the current contract? A21: Yes. Please refer to Bidsync.com for Exhibit A, Existing Agreement Claims Administration Services for Workers Compensation. Q22: Can you provide a copy of the current in -force Workers Compensation TPA contract to including all pricing/cost components? A22: Yes. Please refer to Bidsync.com for Exhibit A, Existing Agreement Claims Administration Services for Workers Compensation. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Contact: Telephone. Email: William Garviso, CPPB, CPP 305-673-7000 ext. 7490 WilliamGarviso miamibeachfl. ov 3 1 ADDENDUM NO.2 REQUEST FOR PROPOSALS No. 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277DSAD3 MIAMI BEACH PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3" Floor Miami Beach, Florida 33139 www.miamibeachfi.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Bidders" questionnaire with the reason(s) for not submitting a proposal. Sincerely, Alex Denis Procurement Director REQUEST FOR PROPOSALS NO. 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9091277D5AD3 MIAMI BEACH procurement Department, 1755 Meridian Avenue, 3rd Floor, Miami Beach, Florida 33139, w .miamibeachfl.gov, 305673.7490 Submitted via E-mail to: sharon oconnoria)corvel.com March 25, 2020 Sharon O'Connor CorVel Enterprise Comp, Inc. 2010 Main Street Suite 600 Irvine, California 92614 Subject: AGREEMENT PURSUANT TO REQUEST FOR PROPOSAL (RFP) 2014 -302 - SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS COMPENSATION AND GENERAL LIABILITY. Dear Sir/Madam This letter shall serve as notification that the City Manager has approved a two (2) years extension of the Agreement with CorVel Enterprise Comp, Inc., for claims administration services by a third - party administrator for workers compensation and general liability, pursuant to the above referenced RFP. The Agreement shall now be effective through January 31, 2022. Additionally, pursuant to Resolution No. 2019-31021, the City Manager has approved a retroactive 2% rate increase, as noted in Appendix E, "Cost Proposal." The new rates shall now be effective January 1, 2020. Should you have any questions or need additional information, please contact Febe Perez at 305- 673-7490 or febeoerez(a)miamibeachfl.00v yoeni ) Procurement DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Appendix "D" PURSUANT TO RFP 2014 -302 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS COMPENSATION AND GENERAL LIABILITY effective retroactively on January 1, 2020 Approved CPI -U Rate 2.0% 3/12/2020 2019 2020 Annual Fees Life of Contract Fiat Annual Fee, 345 Claims Per Year $ 163,107.81 $ 166,369.97 Per Claim Fee after 345 claims; Med Only & Ind $ 501.47 $ 511.50 Annual Administration Fee $ 5,278.57 $ 5,384.14 Intake FNOI Reported via Call Center $ 31.67 $ 32.30 Incident Reported via Call Center $ 31.67 $ 32.30 Additional Services Medical &Telephonic Case Management $ 95.13 $ 97.03 Bill Review Fee $ 4.75 $ 4.85 Auto Liability Bodily Injury $ 822.03 $ 838.47 Property Damage $ 511.83 $ - 522.07 General Liability Bodily Injury $ 568.70 $ 580.07 Property Damage $ 361.90 $ 369.14 All Other $ 718.63 $ 733.00 Product Liability $ 718.63 $ 733.00 3/12/2020 DowSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 MIAMIBEACH Pr Umment Department, 1755 Meridian Avenue, 3" Floor, Miami Beach, Fonda 33139, w-miamibeochfl.gov, 305-673-7490 Submitted via E-mail to: sharon oconnorCcDcorvel.com January 16, 2019 Sharon O'Connor CorVel Enterprise Comp, Inc. 2010 Main Street Suite 600 Irvine, California 92614 Subject: RENEWAL OF AGREEMENT PURSUANT TO REQUEST FOR PROPOSAL (RFP) 2014 -302 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS COMPENSATION AND GENERAL LIABILITY. Dear Sir/Madam: This letter shall serve as notification that the City Manager has approved a one (1) year extension of the Agreement with CorVel Enterprise Comp, Inc., for claims administration services by a third party administrator for workers compensation and general liability, pursuant to the above referenced RFP. The Agreement shall now be effective through January 31, 2020. In addition, the City Manager approved a 3.4% rate increase, as noted in Appendix C, revised exhibit B, "Fees," pursuant to RFP No. 2014 -302 -SW to reflect changes in CPI -U for October 2017 through October 2018. The new rate shall now be effective February 1, 2019. Should you have any questions or need additional information, please contact Monica Garcia at 305-673-7490 or monicaearcia0miamibeachfi.eov Tha ou, lex Denis Procurement Director DocuSign Envelope ID: 6EEOD36E-ABE7416C-BB7C-9D91277D5AD3 MIAMIBEACH Proaranent Department 1755 Mendian Avenue.r Floor. Miami Beach. Florida 33139.w ,rnamibeachkgov. 305-673-7690 Submitted via E-mail to: ienna ando(cDcorvel.com December 19, 2018 Richard Schweppe, Treasurer CorVel Healthcare Corporation 2010 Main Street, Suite 600 Irvine, California 92614 Subject: RENEWAL OF AGREEMENT PURSUANT TO REQUEST FOR PROPOSAL (RFP) NO. 2014-302SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS COMPENSATION AND GENERAL LIABILITY. Dear Sir/Madam: The current Agreement between the City of Miami Beach (the 'City") and Corvel Healthcare Corporation ('Contractor'), pursuant to RFP 2014 -302 -SW for claims administration services by a third party administrator for workers compensation and general liability (the "Agreement), expires on January 31, 2019. This letter serves as notification that the City Manager has approved a one (1) year renewal of the Agreement through January 31, 2020. Therefore, the City seeks concurrence from the Contractor to renew the Agreement at the same terms, conditions, and pricing as set forth pursuant to the above -referenced RFP. Please indicate your acceptance of the aforementioned renewal by executing below as indicated. Should you have any questions or need additional information please contact Febe Perez at 305- 673-7490 or febeoerezArniamibeachfl gov Thank you, Alex Denis Procurement Director Please sign below as your acceptance and return this letter via email to: febeperezArniamibea hfi. ov Signature: _ N Printed Name: Name: Richard Schweppe TAW Treasurer DowSign Envelope ID: 6EEOD36E-ABE7-416C-607C-9D91277D5AD3 MIAM BEACH Procurement Department, 1755 Meridian Avenue, 3'd Floor, Miomi Beach, Florida 33139, v .miomibeochfl.gov, 305473.7490 Submitted via E-mail to: sharon oconnor(deorvel.com January 22, 2018 Sharon O'Connor CorVel Enterprise Comp, Inc. 2010 Main Street Suite 600 Irvine, California 92614 Subject: RENEWAL OF AGREEMENT PURSUANT TO REQUEST FOR PROPOSAL (RFP) 2014 -302 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS COMPENSATION AND GENERAL LIABILITY. Dear Sir/Madam: This letter shall serve as notification that the City Manager has approved a one (1) year extension of the Agreement with CorVel Enterprise Comp, Inc., for claims administration services by a third party administrator for workers compensation and general liability, pursuant to the above referenced RFP. The Agreement shall now be effective through January 31, 2019. In addition, the City Manager approved a 2.1% rate increase, as noted in the attached Revised Exhibit B entitled "Fees," to reflect changes in CPI -U for November 2016 through November 2017. The new rate shall now be effective February 1, 2018. Should you have any questions or need additional information, please contact Febe Perez at 305-673-7490 or febeoerez(a)miamibeachfl.00v. Ta you A x De ' P c ment Director DowSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 MIAMIBEACK Clty of Mlaml Beach, 1755 Merlpian, Mleml Beach, Flarklo 33139, a .mlamgmach0.goa PROCUREMENT DEPARTMENT Tal: 305-613-7490 Submitted via E-mail to Richard schweppenc corvel.com November 1, 2016 Richard Schweppe Corvel Enterprise Comp, Inc. 2010 Main Street Suite 600 Irvine, California 92614 Subject: RENEWAL OF AGREEMENT PURSUANT TO REQUEST FOR PROPOSAL (RFP) No. 2014-302•SW FOR CLAIM ADMINISTRATION SERVICES BY A THIRD PARTY ADMISNISTRATROR FOR WORKERS COMPENSATION AND GENERAL LIABILITY Dear Mr. Schweppe The Agreement, pursuant to RFP No. 2014 302 -SW (the "Agreement"), between the City of Miami Beach (the "City') and Corvel Enterprise Camp, Inc. ("Contractor), pursuant to the above -referenced solicitation, expires on January 31, 2017.The Agreement allows for an additional one (1) year period through January 31, 2018. The purpose of this letter is to seek Contractor concurrence to extend the Agreement, at the same terms, conditions, and pricing as set forth in the Agreement. If the Contractor agrees to extend the term of the'Agreement for the additional period, please sign in the space provided below and return this document to Adu Yudasto at the City's Procurement Department by November 4, 2016. This letter does not constitute an extension to the Agreement. If Contractor agrees to extend the Agreement, the City Manager/City Commission will consider the extension and, if approved, Contractor will be notified of said extension of Agreement under separate cover. Should you have any questions or need additional information, please contact Adu Yudasto at 305.6PPf 90 or aduvudastoMmiamibeachfl.00v. Procurement Director I agree to a revised term for the above referenced contract at the same terms and conditions through January 31, 3218p��� Signature: Printed Name: 4 Title: DowSign Envelope ID: 6EE0036E-ABE7-416C-8B7C-9D91277D5AD3 MIAMIBEACH City of Miami Beath, 1755 Meridian, Miami Beach, Florida 33139, w .miamibeachR.gov PROCUREMENT DEPARTMENT Tel: 305673-7490 Submitted via E-mail to: Richard schweppe(o)corvel.com November 22. 2016 Richard Schweppe Corvel Enterprise Comp, Inc. 2010 Main Street, Suite 600 Irvine, California 92614 Subject: RENEWAL OF AGREEMENT PURSUANT TO REQUEST FOR PROPOSAL (RFP) No. 2014 -302 -SW FOR CLAIM ADMINISTRATION SERVICES BY A THIRD PARTY ADMISNISTRATROR FOR WORKERS COMPENSATION PROGRAM Dear Richard Schweppe, This letter shall serve as notification that the City Manager has approved a one (1) year extension of the Agreement with Corvel Enterprise Comp, Inc., for claim administration services by a third party administrator for workers compensation program, pursuant to the above - referenced RFP. The Agreement shall now be effective through January 31, 2018. Should you have any questions or need additional information, please contact Febe Perez at 305-673-7490 or febeperezamiamibeachfl.aov. Director DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF MIAMI BEACH AND CORVEL ENTERPRISE COMP, INC. FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS COMPENSATION AND GENERAL LIABILITY, PURSUANT TO RFP#2014-302-SW This Professional Services Agreement ("Agreement") is entered into this 15I day of February, 2014, ("Effective Date"), between the CITY OF MIAMI BEACH, FLORIDA, a municipal corporation organized and existing under the laws of the State of Florida, having its principal offices at 1700 Convention Center Drive, Miami Beach, Florida, 33139 ("City"), and CORVEL ENTERPRISE COMP, INC., a California corporation, whose address is 2010 Main Street Suite 600 Irvine, CA 92614 (Consultant). SECTION 1 Agreement: This Agreement between the City and Consultant, including any exhibits and amendments thereto. City Manager: The chief administrative officer of the City. Consultant: For the purposes of this Agreement, Consultant shall be deemed to be an independent contractor, and not an agent or employee of the City. Services: All services, work and actions by the Consultant performed or undertaken pursuant to the Agreement. Fee: Amount paid to the Consultant as compensation for Services. Proposal Documents: Proposal Documents shall mean City of Miami Beach RFP, No. 2014- 302 -SW for Third Party Administration for Workers Compensation and GL claims, together with all amendments thereto, issued by the City in contemplation of this Agreement (the RFP), and the Consultant's proposal in response thereto (Proposal), all of which are hereby incorporated and made a part hereof; provided, however, that in the event of an express conflict between the Proposal Documents and this Agreement, the following order of precedent shall prevail: this Agreement; the RFP, and the Proposal. Risk Manager: The Risk Manager of the City, with offices at 1700 Convention Center Drive, Third Floor, Miami Beach, Florida 33139: telephone number (305) 673-7000, Ext. 6435: and fax number (305) 673-7023. DowSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 SECTION 2 SCOPE OF SERVICES (SERVICES) 2.1 In consideration of the Fee to be paid to Consultant by the City, Consultant shall provide the work and services described in Exhibit "A-1" hereto (the Services). 2.2 Consultant's Services, and any deliverables incident thereto, shall be completed in accordance with the timeline(s) and/or schedule(s) in Exhibit A hereto. 2.3 Consultant shall provide its Online software system the "CareMC Application," pursuant to the "CareMC License Agreement", attached as Exhibit "C" hereto. SECTION 3 TERM The term of this Agreement (Term) shall commence upon execution of this Agreement by all parties hereto, which shall be the Effective Date on page 1 hereof, and shall have an initial term of two (2) years, with three (3) one year renewal options, to be exercised at the City Manager's sole option and discretion, by providing Consultant with written notice of same no less than thirty (30) days prior to the expiration of the initial term (or a renewal option, as the case may be). Notwithstanding the Term provided herein, Consultant shall adhere to any specific timelines, schedules, dates, and/or performance milestones for completion and delivery of the Services, as same is/are set forth in the timeline and/or schedule referenced in Exhibits "A" and "A-1" hereto. SECTION 4 FEE 4.1 In consideration of the Services to be provided, Consultant shall be compensated pursuant to the attached Exhibit B ("Fees"). 4.2 INVOICING Upon receipt of an acceptable and approved invoice, payment(s) shall be made within thirty (30) days for that portion (or those portions) of the Services satisfactorily rendered (and referenced in the particular invoice). Invoices shall include a detailed description of the Services (or portions thereof) provided, and shall be submitted to the City at the following address: City of Miami Beach Human Resources 1700 Convention Center Drive 3`d Floor Miami Beach, Florida 33139 Attention: Sonia Bridges Risk Manager DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9091277D5AD3 SECTION 5 TERMINATION 5.1 TERMINATION FOR CAUSE If the Consultant shall fail to fulfill in a timely manner, or otherwise violates, any of the covenants, agreements, or stipulations material to this Agreement, the City, through its City Manager, shall thereupon have the right to terminate this Agreement for cause. Prior to exercising its option to terminate for cause, the City shall notify the Consultant of its violation of the particular term(s) of this Agreement, and shall grant Consultant ten (10) days to cure such default. If such default remains uncured after ten (10) days, the City may terminate this Agreement without further notice to Consultant. Upon termination, the City shall be fully discharged from any and all liabilities, duties, and terms arising out of, or by virtue of, this Agreement. Notwithstanding the above, the Consultant shall not be relieved of liability to the City for damages sustained by the City by any breach of the Agreement by the Consultant. The City, at its sole option and discretion, shall be entitled to bring any and all legal/equitable actions that it deems to be in Its best interest in order to enforce the City's right and remedies against Consultant. The City shall be entitled to recover all costs of such actions, including reasonable attorneys' fees. 5.2 TERMINATION FOR CONVENIENCE OF THE CITY THE CITY MAY ALSO, THROUGH ITS CITY MANAGER, AND FOR ITS CONVENIENCE AND WITHOUT CAUSE, TERMINATE THE AGREEMENT AT ANY TIME DURING THE TERM BY GIVING WRITTEN NOTICE TO CONSULTANT OF SUCH TERMINATION; WHICH SHALL BECOME EFFECTIVE WITHIN THIRTY (30) DAYS FOLLOWING RECEIPT BY THE CONSULTANT OF SUCH NOTICE. IF THE AGREEMENT IS TERMINATED FOR CONVENIENCE BY THE CITY, CONSULTANT SHALL BE PAID FOR ANY SERVICES SATISFACTORILY PERFORMED UP TO THE DATE OF TERMINATION; FOLLOWING WHICH THE CITY SHALL BE DISCHARGED FROM ANY AND ALL LIABILITIES, DUTIES, AND TERMS ARISING OUT OF, OR BY VIRTUE OF, THIS AGREEMENT. 5.3 TERMINATION FOR INSOLVENCY The City also reserves the right to terminate the Agreement in the event the Consultant is placed either in voluntary or involuntary bankruptcy or makes an assignment for the benefit of creditors. In such event, the right and obligations for the parties shall be the same as provided for in Section 5.2. SECTION 6 INDEMNIFICATION AND INSURANCE REQUIREMENTS 6.1 INDEMNIFICATION Consultant agrees to indemnify and hold harmless the City of Miami Beach and its officers, employees, agents, and contractors, from and against any and all actions (whether at law or in equity), claims, liabilities, losses, and expenses, including, but not limited to, attorneys' fees and costs, for personal, economic or bodily injury, wrongful death, loss of or damage to property, which may arise or be alleged to have arisen from the negligent acts, errors, omissions or other DocuSign Envelope ID: 6EEOD36E-ASE7-016C-8B7C-9D91277D5AD3 wrongful conduct of the Consultant, its officers, employees, agents, contractors, or any other person or entity acting under Consultant's control or supervision, in connection with, related to, or as a result of the Consultant's performance of the Services pursuant to this Agreement. To that extent, the Consultant shall pay all such claims and losses and shall pay all such costs and judgments which may Issue from any lawsuit arising from such claims and losses, and shall pay all costs and attorneys' fees expended by the City In the defense of such claims and losses, including appeals. The parties agree that one percent (1%) of the total compensation to Consultant for performance of the Services under this Agreement is the specific consideration from the City to the Consultant for the Consultant's Indemnity agreement. The provisions of this Section 6.1 and of this indemnification shall survive termination or expiration of this Agreement. 6.2 INSURANCE REQUIREMENTS The Consultant shall maintain and carry in full force during the Term, the following insurance A. Worker's Compensation and Employers Liability Insurance for all employees of the provider as required by Florida Statute 440. B. Commercial General Liability on a comprehensive basis in an amount not less than $1,000,000 combined single limit per occurrence and $2,000,000 in the aggregate, for bodily injury and property damage. City of Miami Beach must be shown as an additional insured with respect to this coverage. C. Professional Liability Insurance in an amount not less than $1,000,000 with the deductible per claim, if any, not to exceed 10% of the limit of liability. The insurance must be furnished by insurance companies authorized to do business in the State of Florida. All insurance policies must be issued by companies rated no less than "B+-" as to management and not less than "Class VI" as to strength by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All of Consultant's certificates shall contain endorsements providing that written notice shall be given to the City at least thirty (30) days prior to termination, cancellation or reduction in coverage in the policy. Original certificates of insurance must be submitted to the City's Risk Manager for approval (prior to any work and/or services commencing) and will be kept on file in the Office of the Risk Manager. The City shall have the right to obtain from the Consultant specimen copies of the insurance policies in the event that submitted certificates of insurance are Inadequate to ascertain compliance with required coverage. The Consultant is also solely responsible for obtaining and submitting all Insurance certificates for any sub -consultants. Compliance with the foregoing requirements shall not relieve the Consultant of the liabilities and obligations under this Section or under any other portion of this Agreement. The Consultant shall not commence'any work and or services pursuant to this Agreement until all insurance required under this Section has been obtained and such insurance has been approved by the City's Risk Manager. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 SECTION 7 LITIGATION JURISDICTION/VENUE/JURY TRIAL WAIVER This Agreement shall be construed in accordance with the laws of the State of Florida. This Agreement shall be enforceable in Miami -Dade County, Florida, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for the enforcement of same shall lie in Miami -Dade County, Florida. By entering Into this Agreement, Consultant and the City expressly waive any rights either party may have to a trial by jury of any civil litigation related to or arising out of this Agreement. SECTION 8 LIMITATION OF CITY'S LIABILITY The City desires to enter into this Agreement only if in so doing the City can place a limit on the City's liability for any cause of action, for money damages due to an alleged breach by the City of this Agreement, so that its liability for any such breach never exceeds the sum of $10,000. Consultant hereby expresses its willingness to enter into this Agreement with Consultant's recovery from the City for any damage action for breach of contract to be limited to a maximum amount of $10,000. Accordingly, and notwithstanding any other term or condition of this Agreement, Consultant hereby agrees that the City shall not be liable to the Consultant for damages in an amount in excess of $10,000 for any action or claim for breach of contract arising out of the performance or non-performance of any obligations imposed upon the City by this Agreement. Nothing contained in this section or elsewhere in this Agreement is in any way intended to be a waiver of the limitation placed upon the City's liability, as set forth in Section 768.28, Florida Statutes. SECTION 9 [INTENTIONALLY DELETED] SECTION 10 GENERAL PROVISIONS 10.1 AUDIT AND INSPECTIONS Upon reasonable verbal or written notice to Consultant, and at any time during normal business hours (i.e. 9AM — 5PM, Monday through Fridays, excluding nationally recognized holidays), and as often as the City Manger may, in his/her reasonable discretion and judgment, deem necessary, there shall be made available to the City Manager, and/or such representatives as the City Manager may deem to act on the City's behalf, to audit, examine, and/ or inspect, any and all other documents and/or records relating to all matters covered by this Agreement. Consultant shall maintain any and all such records at its place of business at the address set forth in the "Notices" section of this Agreement. 10.2 [INTENTIONALLY DELETETD] DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 10.3 ASSIGNMENT, TRANSFER OR SUBCONSULTING Consultant shall not subcontract, assign, or transfer all or any portion of any work and/or service under this Agreement without the prior written consent of the City Manager, which consent, if given at all, shall be in the Manager's sole judgment and discretion. Neither this Agreement, nor any tern or provision hereof, or right hereunder, shall be assignable unless as approved pursuant to this Section, and any attempt to make such assignment (unless approved) shall be void. 10.4 PUBLIC ENTITY CRIMES Prior to commencement of the Services, the Consultant shall file a State of Florida Form PUR 7068, Sworn Statement under Section 287.133(3)(a) Florida Statute on Public Entity Crimes with the City's Procurement Division. 10.5 EQUAL EMPLOYMENT OPPORTUNITY In connection with the performance of the Services, the Consultant shall not discriminate against any employee or applicant for employment because of race, color, national origin, religion, sex, gender identity, sexual orientation, disability, marital and familial status, or age. 10.6 CONFLICT OF INTEREST The Consultant herein agrees to adhere to and be governed by all applicable Miaml-Dade County Conflict of Interest Ordinances and Ethics provisions, as set forth in the Miami -Dade County Code, and as may be amended from time to time; and by the City of Miami Beach Charter and Code (as some may be amended from time to time); both of which are incorporated by reference herein as if fully set forth herein. The Consultant covenants that it presently has no interest and shall not acquire any interest, direct or indirectly, which could conflict in any manner or degree with the performance of the Services. The Consultant further covenants that in the performance of this Agreement, no person having any such interest shall knowingly be employed by the Consultant. No member of or delegate to the Congress of the United States shall be admitted to any share or part of this Agreement or to any benefits arising there from. SECTION 11 NOTICES All notices and communications in writing required or permitted hereunder, shall be delivered personally to the representatives of the Consultant and the City listed below or may be mailed by U.S. Certified Mail, return receipt requested, postage prepaid, or by a nationally recognized overnight delivery service. Until changed by notice in writing, all such notices and communications shall be addressed as follows: DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TO CONSULTANT: CorVel Enterprise Comp, Inc. 2010 Main Street Suite 600 Irvine CA 92614 Attn: Sharon O'Connor Director of Legal Services Phone: 949.851.1473 Fax: 949-851.1469 TO CITY: City of Miami Beach Sylvia Crespo=Tabak, Director Human Resources Department 1700 Convention Center Drive 3rd Floor Miami Beach, FL 33139 COPIES TO: City of Miami Beach Alex Denis, Director Procurement Department 1700 Convention Center Drive 3'd Floor Miami Beach, FL 33139 Notice may also be provided to any other address designated by the party to receive notice if such alternate address is provided via U.S. certified mail, return receipt requested, hand delivered, or by overnight delivery. In the event an alternate notice address is properly provided, notice shall be sent to such alternate address in addition to any other address which notice would otherwise be sent, unless other delivery instruction as specifically provided for by the party entitled to notice. Notice shall be deemed given on the day on which personally served, or the day of receipt by either U.S. certified mail or overnight delivery. SECTION 12 MISCELLANEOUS PROVISIONS 12.1 CHANGES AND ADDITIONS This Agreement cannot be modified or amended without the express written consent of the parties. No modification, amendment, or alteration of the terms or conditions contained herein shall be effective unless contained in a written document executed with the same formality and of equal dignity herewith. 12.2 SEVERABILITY If any term or, provision of this Agreement is held invalid or unenforceable, the remainder of this Agreement shall not be affected and every other term and provision of this Agreement shall be valid and be enforced to the fullest extent permitted by law. 12.3 ENTIRETY OF AGREEMENT The City and Consultant agree that this is the entire Agreement between the parties. This Agreement supersedes all prior negotiations, correspondence, conversations, agreements or understandings applicable to the matters contained herein, and there are no commitments, DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9091277D5AD3 agreements or understandings concerning the subject matter of this Agreement that are not contained in this document. Title and paragraph headings are for convenient reference and are not intended to confer any rights or obligations upon the parties to this Agreement. 12.4 CONSULTANT'S COMPLIANCE WITH FLORIDA PUBLIC RECORDS LAW Pursuant to Section 119.0701 of the Florida Statutes, if the Consultant meets the definition of "Contractor" as defined in Section 119.070'1(1)(a), the Consultant shall: a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the service; b) Provide the public with access to public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law; c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law; and d) Meet all requirements for retaining public records and transfer to the City, at no City cost, all public records created, received, maintained and/or directly related to the performance of this Agreement that are in possession of the Consultant upon termination of this Agreement. Upon termination of this Agreement, the Consultant shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City in a format that is compatible with the information technology systems of the City. For purposes of this Article, the term "public records" shall mean all documents, papers, letters, maps, books, tapes, photographs, films, sound recordings, data processing software, or other material, regardless of the physical form, characteristics, or means of transmission, made or received pursuant to law or ordinance or in connection with the transaction of official business of the City. Consultant's failure to comply with the public records disclosure requirement set forth in Section 119.0701 of the Florida Statutes shall be a breach of this Agreement. In the event the Consultant does not comply with the public records disclosure requirement set forth in Section 119.0701 of the Florida Statutes, the City may, at the City's sole discretion, avail itself of the remedies set forth under this Agreement and available at law. [REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK] DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D9127705AD3 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their appropriate officials, as of the date first entered above, FOR CITY: CITY OF MIAMI BEACH, FLORIDA �N ..L5 n< ATTEST: \�-'`�� ,"��ri'•, 0 FOR CONSULTANT: ATTEST: a CORVEL ENTERPP,ISE COMP, INC, f3Y: �i,virrt✓ �f(;yl� UY �ylfiYi� By:G�¢strcr.� c��N�25VP Secr.iar fes'% President p,6M t;' PO WCC f Vp P'g viai Be ie Stoner SVP Print Name 0411(f Print Name APPPO3 EO AS TO FORM &LANGUAGE $ FOR MCiiTION (134(ty Attom Y ....011ie 9 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D9127705AD3 EXHIBIT "A" SCOPE OF SERVICES DocuSign Envelope ID: 6EEOD36E-ABE7-416C-807C-9D91277D5AD3 EXHIBIT A Workers' Compensation Claims Management Services Terms and Conditions I. DESCRIPTION OF WORKERS' COMPENSATION CLARKS MANAGEMENT SERVICES (a) Customer shall promptly notify CorVel of all incidents subject to the services described in this Agreement. (b) First report of loss services involve gathering pertinent information related to a work injury and reporting such information to the appropriate state industrial accident board or commission as required by law, and is used to facilitate CorVel's initial review of the claim to determine whether the claim is likely to be medical -only or lost time and to help guide the initial determination of Services that may be required ("First Report Services"). (c) CorVel's Workers' Compensation Claims Management services provide Customer with a process to comply with Customer's workers' compensation issues in the applicable jurisdiction. CorVel shall provide workers' compensation claims management services set forth herein to Customer on behalf of employees that sustain work related injuries ("Injured Employees"). CorVel may subcontract with a third party to provide some portion or all of its claims management services obligations hereunder. II. DELIVERY OF FIRST REPORT OF LOSS SERVICES (a) CorVel shall provide First Report Services to Customer upon receipt by CorVel of specific requests from Customer. Prior to the implementation of CorVel First Report Services and as required during the Term of this Agreement, Customer may provide CorVel with instructions regarding the scope and extent of the Fust Report to be performed by CorVel. Absent such instruction, CorVel First Report Services shall be performed as described below. (b) Customer shall initiate First Report Services by (i) entering such information online through CareIVIC, (ii) calling CorVel via a toll free number provided by CorVel, or (iii) faxing such information to the CorVel intake specialist. Customer or the Customer representative entering such information on CareMC, making such calls, or faxing such information shall provide CorVel with all information required to complete the First Report of Loss form required by the applicable state ("Reeuired information"). Required Information generally includes the following: nameAddress of claimant, date of incident, description of injuries, social security number, date of birth, employer, salary, and other descriptive information reasonably required by CorVel, and may include information required by applicable statute (e.g., employer TIN). CorVel shall (i) provide sufficient staff to handle all incoming calls, and (u) be prepared to complete First Report of Loss forms for all applicable states. (c) Once the Required Information is validated and confirmed by a CorVel representative, First Report of, Loss forms will be made available to Customer through the CareMC Application. CorVel will, upon request of Customer, provide a hard copy of the completed First Report of Loss form to the Customer. An electronic copy shall be available to Customer via CareMC. To the extent permitted by the applicable state industrial accident board or commission, the Required Information shall be transmitted electronically. (d) To the extent required by applicable statute or otherwise agreed in writing by CorVel, CorVel will file additional reports on earlier -filed First Reports of Loss ("Subsequent Reports"). to DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 (e) Unless agreed to otherwise in writing by the parties, any questions or concerns from an industrial accident board or commission concerning First Reports of Loss forms completed by CorVel hereunder will be handled directly by CorVel. All such inquiries will receive an initial response within the next business day following CorVel's receipt of the inquiry. CorVel will keep Customer apprised of any inquiries it receives and the response thereto. CorVel will send a written response to the inquiry within five (5) business days outlining the nature of the inquiry and the resolution of same by CorVel. A copy of such response will also be sent to the attention of the designated Customer representative if requested in writing by Customer. Customer shall have the right, but not the obligation, at any time and at Customer's expense, to interject itself into the inquiry between CorVel and the industrial accident board or commission, and in connection therewith to resolve the inquiry in a manner acceptable to Customer at its sole discretion, in which case Customer shall defend, indemnify and hold harmless CorVel from and against any claim, liability, damages or costs arising from Customer's handling of such inquiry or the resolution thereof. III. DELIVERY OF CLARVIS MANAGEMENT SERVICES (a) Customer shall arrange so that all claims and all related bills of any type, as well as all other correspondence that Customer receives relating to such claims, are sent directly to CorVel. CorVel shall perform all of the following "Claims Services" in connection with each portion of a Claim related to Workers' Compensation benefit payments for lost income (each an "Indemnity Claim') and one or more of such Claims Services with respect to that portion of a Claim related to Workers' Compensation benefits other than payments for lost income (each a "Non -Indemnity Claim"). All Claims Services provided by CorVel under this Agreement shall be performed in accordance with the guidelines set forth in Sections H -IV of this Exhibit A: (i) CorVel shall immediately assign each new Indemnity Claim and Non -Indemnity Claim to CorVel's designated claims professional. (ii) Utilizing CorVel's CareNIC Application or other applicable CorVel Online System, CorVel shall maintain a chronological record of all Claims Services performed by CorVel. (iii) CorVel shall make all filings related to Indemnity Claims and Non -Indemnity Claims with the appropriate state Workers' Compensation regulatory authorities. (iv) CorVel shall maintain a complete and accurate claim file for each Indemnity Claim and Non -Indemnity Claim. (v) CorVel shall perform reasonable and necessary administrative and clerical work including, without limitation, the following: (A) Investigate all Indemnity Claims and Non -Indemnity Claims.. (Ii) Determine and evaluate any coverage and/or compensability issues and provide Customer with appropriate recommendations and advice regarding the same. (C) Adjust, handle, or settle to a conclusion those Indemnity Claims and Non -Indemnity Claims that CorVel believes the Customer is legally obligated to pay under applicable state law and regulations, and in accordance with the authority granted to CorVel by Customer under the Agreement. (D) Prepare checks for payments of Indemnity claims, Non -Indemnity Claims and Allocated Loss Adjustment Expenses. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9091277D5AD3 (E) Prepare documents as necessary to close out Indemnity Claims and Non - Indemnity Claims. (vi) CorVel Shall perform Bill Review Services which will include CorVel's proprietary computerized bill review software program enables an application of the appropriate Fee Schedule, and further value-added applications subscribed to by client which includes PPO, Professional Review, Enhanced Bill Review (CEM), Onsite, and Check writing Services applied to medical provider bills ("Provider Bills"), hospital bills ("Hospital Bills") and, both together, "Bills"). (A) Professional Review Services. CorVel may provide professional review services to verify coding by providers are valid. This can include clinical review to validate coding is correct for all applicable Provider bills, Ambulatory Surgical Center bills, and all Hospital Bills (inpatient and outpatient) including: (1) review and analysis of codes, charges and billing structure for incorrect coding, incorrect billing, bundling, and up -coding of procedures which effect Fee Schedule values; (2) review of bills, records, and documentation by a nurse and/or coder; (3) separation of charges not related to the compensable injury; (4) diagnostic related group validation (i.e., verification that the diagnostic related group billed is appropriate for the services rendered); and (5) cost shifting of revenue and CPT codes. (B) Hospital Line Itemization Review Services. CorVel's Enhanced Bill Review Services (CERiS) are performed on Hospital Bills (inpatient and outpatient) in excess of two thousand five -hundred dollars ($2,500) and consist of procurement of actual bill itemization, (i) a line -by-line validation and comparison of the itemization description charges actually billed by a particular hospital to what CMS billing guidelines allow to be separately billed for in order to disallow inappropriate charges, and then will compare the valid itemization descriptions to the average itemization description charges utilized by other hospitals within a pre -designated geographic area, and and (ii) a review of charges that fall outside of any pre -contracted discounts or fee schedules, and generates payment recommendations in accordance with the Customer's "Payors Allowable" language. This service does not itself include negotiation services nor Implant Cost Services. (C) Negotiation Services. CorVel's Enhanced Bill Review Services (CERiS) can provide negotiation services with respect to all Hospital Bills (inpatient and outpatient) in excess of two thousand five -hundred dollars ($2,500). CorVel will contact the provider for agreement of the negotiated rate. A signed agreement regarding such rates will be maintained by CorVel. CorVel will use its commercially reasonable efforts to enter into an agreement regarding negotiated rates in accordance with a mutually agreed upon schedule. (D) Implant Cost Review Service. CorVel's Enhanced Bill Review Services 12 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 (CERiS) can include Implant Cost Review services with respect to the applicability of the Customer's "Payors Allowable" plan or policy language that specifically addresses implant payments. CorVel will identify and provide the manufacturers implant cost through its proprietary repository of national implant invoice data. CorVel then determines the recommended payment in accordance with the Customer's "Payors Allowable". In the event there is insufficient implant invoice data for the requested implant, CorVel will notify the Customer and CorVel shall not be responsible for any costs, fees, damages or penalties for any such inability of CorVel to produce a cost savings per Customer's request. (E) CorVel's preferred provider organization is a network of hospitals, physicians and other health care providers ("Participating Providers") that offer services at pre -negotiated rates ("PPO Network"). (b) CorVel shall process claims and process the disbursement of benefit payments to claimants and providers entitled to such payments from Customer. Funding for the payment of all benefits to claimants, providers, vendors and "allocated loss adjustment expenses" (as defined below) is the sole responsibility of Customer and Customer agrees to be liable for and fund all proper claims processed by CorVel. Such payment shall be made through a bank account established by CorVel. There shall be one account established for claims relating to both First Reports of Loss arising on or after Februray 1, 2015, and for claims relating to First Reports of Loss that arose prior to January 31 2015 that were administered by Wells Faruo (the "bank account"), if applicable (i.e., if CorVel is assuming responsibility for providing Claims Administration services for claims occurring prior to the effective date of the Agreement). CorVel shall provide Customer with a check register in a mutually agreed format for each ebeckrun drawn on a bank account prior to mailing of the checks. CorVel also will provide Customer information as necessary for Customer to prepare periodic bank account reconciliation reports. Customer agrees to pay into the bank account funds sufficient to pay approved claims and to maintain the advance deposit set forth below and to provide CorVel with such authorizations as shall be necessary to make the required instruments valid claims against Customer. Notwithstanding the other provisions of this Agreement, if payments are not made when due, Customer shall be in default and subject to immediate termination without notice, and CorVel shall have no liability for claims, penalties or other damages arising out of or relating to any such failures on the part of Customer. (i) Customer shall make an initial advance deposit into the bank account in an amount equal to Dollars ($ �. (ii) "Allocated loss adjustment expenses" or "ALAE" shall mean claim adjustment costs and expenses incurred by CorVel or its subcontractor and allocated by CorVel to the investigation, adjustment and settlement or defense of a claim for benefits, including, without limitation, attorneys' fees and disbursements, pre and post judgment interest, court reporter services and transcripts, deposition charges and transcripts, fees for service of process, court costs, courier/express mail, long distance, appeal bonds, printing costs related to trials and appeals, witness and expert fees, medical examination and review, laboratory costs, engineering, independent adjuster fees, surveillance, photography, and similar costs and expenses reasonably incurred and related to the investigation and defense of claims or the protection and collection of subrogation rights of the Customer. (c) CorVel shall provide Customer with payment services through Check Writing services in accordance with specifications mutually agreed by Customer and CorVel. 13 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 (i) The checks referred to in Section 11(d) will be drawn on CorVel's account at Wells Fargo Bank, Portland, Oregon or CorVel's account at such other bank as the parties of this Agreement may mutually accept, as evidenced by a letter or written document signed by both parties (hereafter, the `Bank"), with Customer identified on each check as the insurer or any insurance carrier as such may be required. Check Writing services shall also include IRS form 1099 Sling and associated follow-up, bank reconciliation, and bank fees specifically related to such processing if Customer is using CorVel's bank account. Otherwise, such services will be subject to an additional fee. (d) CorVel agrees to provide the following services to Customer relating to the processing and payment of claims: (i) to receive claims and process payment of benefits in accordance with applicable State(s) program guidelines required for the payment of workers' compensation claims; (ii) to correspond with the claimants, providers of services and vendors if additional information is deemed necessary to complete the processing of claims; (iii) to determine the amount of benefits payable; (iv) to provide notice to claimants as to the reason(s) for denial of benefits (when such are denied) and to provide for the review of such denied claims; (v) to receive and process for payment claims for benefits incurred prior to the Effective Date in consideration for the separate fees established in Exhibit B; and (vi) at Customer's request, to provide specified additional services for such fees as the parties mutually agree; (e) Subject to applicable law, all claims files, data, systems and records and associated documents and notices regarding the administration of claims and provision of services pursuant to this Agreement and the payment of claims and allocated loss adjustment expenses, may be audited, examined, and copied by Customer, its representatives, excess carriers, reinsurers or any state insurance department or other regulatory body that so requires, at Customer's expense, at any time or times during CorVel's normal business hours and with not less than thirty (30) days advance notice; and notwithstanding anything to the contrary contained in this Agreement. (f) CorVel is and shall remain an independent contractor with respect to the services being performed hereunder and shall not for any purpose be deemed an employee of Customer, nor shall CorVel and Customer be deemed partners, joint venturers or governed by any legal relationship other than that of independent contractor as set forth herein. CorVel does not assume any responsibility for the adequacy of the funding of benefits or any act or omission or breach of duty by Customer. (g) CorVel is not in any way to be deemed an insurer, underwriter or guarantor with respect to any benefits payable under Customer's workers' compensation program. (h) CorVel may rely on instructions received from such person or persons as Customer may from time to time designate in writing, provided that no such instruction may vary the terms of this Agreement. (i) Unless otherwise directed by Customer or precluded by law, CorVel shall seek subrogation recoveries on behalf of Customer and shall provide Customer with any recoveries obtained, minus the attorneys' fees and costs incurred in obtaining such recoveries. Customer represents and warrants that its workers' compensation program provides for rights of subrogation. Customer delegates and/or assigns these subrogation 14 DocuSign Envelope ID: 6EEOD36E.ABE7Al6C•6B7C•9D91277D5AD3 rights and third party recovery rights to CorVel as its agent for purposes of subrogation only. Customer shall assist CorVel in its subrogation efforts by providing requested information and documentation. CorVel may engage the services of a subrogation management firm to assist with the identification and management of subrogation cases. The fees charged by the subrogation management firm will be deducted from any recovery. In those cases where the subrogation recovery efforts of the claimant's attorney should be compensated, Customer delegates to CorVel full authority to act on behalf of the Customer to negotiate reasonable attorneys' fees. In those instances where Customer's subrogation lien, in the opinion of CorVel, should be compromised or abandoned, Customer delegates to CorVel full authority to act on behalf of Customer to compromise or abandon the lien. Any determination by CorVel with respect to subrogation liens shall be final and conclusive, unless overturned by order of a limited arbitrary and capricious standard of review. (j) CorVel shall consult and cooperate with Customer with respect to any loss or claim resulting in a lawsuit being instituted against Customer. Nothing in this paragraph shall be construed in any way as a waiver by CorVel of any attorney/client, work product or other applicable privilege with respect to any materials or documents prepared by CorVel or its counsel in anticipation of litigation. (k) CorVel shall assist, cooperate and participate with Customer, carriers and reinsurers in connection with claim reviews and audits and catastrophic injury claim analysis and excess claim related reporting. IV. SERVICE CRITERIA, STANDARDS AND GUIDELINES (a) Assignments: Customer will notify CorVel, either via CareMC, telephone or facsimile, that Customer's employee has sustained a work related injury. All new Lost Time claims will be acknowledged and established by CorVel within the next business day following such notice. The acknowledgement will included the name and contact information of the assigned Adjuster. (b) Contacts: As warranted, and always with regard to lost time, or anticipated lost time claim situations, initial contact with the injured employee will be made within the next business day following receipt of a new assignment claim. Contact with the Physician, and employer, if required will be made by the next business day. (c) Investigation: Completed and documented within 30 days from date of assignment is DocuSign Envelope ID: 6EEDD36E-ABE7-416C-BB7C-9D91277D5AD3 EXHIBIT A — 1 Property and Liability Claims Management Services Terms and Conditions I. GENERAL SERVICES (a) Subject to the Customer's direction, CorVel shall supervise and administer the Liability Claims Adjustment Program for the Customer and shall act as the Customer's representative in connection with the investigation, adjustment, processing, supervision and resolution of liability claims by third parties against the Customer. (b) CorVel shall undertake periodic program and administrative reviews on at least a quarterly basis to Customer as to any CorVel recommendations for changes or improvements in the administration of the third party claims program. (c) CorVel shall manage the following types of claims: ❑ General Liability ❑ Personal Injury ❑ Professional Liability ❑ Product Liability ❑ Property ❑ Auto Liability ❑ Auto Physical Damage ❑ Other (Specify): lI. INVESTIGATIVE SERVICES (a) CorVel shall provide investigative services to include, but not limited to: (i) Receipt and examination of all reports of accidents, incidents, and claims cases which are or may be the subject of such liability claims; (ii) Investigation of such accidents, incidents, claims or cases where examination warrants such investigation to include on-site investigation, photographs, statements of clients, claimants and witnesses, evaluation and determination of losses, and other such investigative services necessary to determine liability and losses, but not to include extraordinary investigative services as set forth in Section b(iii) below; (iii) Timely and periodic reporting to the Customer of the in -progress investigation efforts and the results of the investigations, as well as offering recommendations to the Customer of extraordinary investigative services, if required, (b) To the extent extraordinary investigative services are required: 16 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 (i) Customer agrees to pay the cost of all reasonable and supportable extraordinary investigative services such as, but not limited to, service performed by other adjusting and/or investigating companies, professional photographs, independent medical examinations, professional engineering services, laboratory services and legal services. CorVel shall order such extraordinary investigative services only with prior written authorization from the Customer. To the extent circumstances do not permit prior written authorization from the Customer, CorVel shall obtain verbal authorization from the Customer to proceed with the recommended extraordinary investigative services and CorVel shall promptly confirm in writing the verbal authorization provided by the Customer. M. CLAIMS ADJUSTMENT SERVICES (a) CorVel shall provide reasonable and customary Property and Liability claims adjustment services. (b) CorVel shall create, maintain and keep current a claim file on each potential or actual claim reported to CorVel. The Customer will be entitled to access and review the claim files of CorVel. (c) If CorVel's investigation results in a determination that the Customer has sustained a property or liability loss, CorVel shall process any such claim or potential claim for settlement in accordance with the instructions and policies established by the Customer for settlement of such claims. CorVel shall document all processing efforts and timely report to the Customer on all such processing and settlement efforts.. (d) Subject to the Customer's direction, CorVel shall serve as a liaison and be responsible for communications between insurance and excess carriers, if any, and the Customer on any matters affecting the adjustment of such claim or potential claim. (e) CorVel shall obtain all necessary written Release Agreements on settlement of any claim or potential claim (other than those in litigation), and shall maintain fully -executed originals or copies in the claim file. (i) Upon the Customer's request, CorVel shall provide the Customer with a copy of the executed Release Agreement(s); (ii) Upon the Customer's request, CorVel shall seek to incorporate in standard Release Agreements such further provisions as the Customer may reasonably request by reason of the nature and specifics of the claim or potential claim being processed and settled. (f) Pursuant to CorVel's Liability Claims Handling Best Practices, each adjuster will be assigned a reasonable and manageable number of claims files. Adjusters assigned to the Customer's account shall also be supervised to assure proper, competent, timely, and complete services for the Customer. (g) CorVel's adjusters shall work, on average, no more than one hundred fifty (150) files for the Customer. IV. CLAIMS ADMINISTRATIVE SERVICES (a) CorVel shall provide reasonable and customary administrative services as required and appropriate for First and Third Party claims administration services on behalf of the Customer. 17 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 (b) CorVel shall enter all new claims and tail claims into the RIMS system and provide to the Customer a Monthly Status Report for the term of this Agreement. (i) The Monthly Status Report shall be provided within thirty (30) days of the close of each calendar month; (ii) The Monthly Status Report shall indicate the status of each reported claim assigned to CorVel, the details of each claim, the outstanding reserves for each claim, and the details of all claim payments during the month; (iii) CorVel shall, upon written and reasonable request from the Customer, add additional reporting categories to the Monthly Status Report. (c) CorVel shall periodically review and adjust reserves on all open claims. (d) CorVel will set up the appropriate Trust account to process claim payments suggested in the client instructions. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 EXHIBIT "B" FEES DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 ADDITIONAL SERVICES List of services, as needed, which are in addition to the fees proposed in Options 1 -3. Telephonic Medical Case Management Fee On All Claims: $92,00 Per Hour Per Bill/Flat Fee Bill Review Fee To Include State Fee Schedule Reduction: $4.50/Per Bill Per BilllFlat Fee Percentage Of PPO Savings— Network Discount Savings Below State Fee Schedule: 27% Percentage Of Utilization Review And Reasonable & Customary Savings: 20% Subrogation And/Or Liens Fee Percentage: 25% of recoveries Osha 300 Lag Reporting: $ Included Electronic Data Interchange Filed With State: $ Included Safety Consulting Services Per case basis review of case at no cost. $ Notice Of Injury Entry: $Into CareMC at no cost Custom/Ad Hoc Reports: $ Included Data And File Conversion Fee: $ No Cost One -Time Setup Flat Fee Medicare Reporting Costs: $2 000 Flat fee life of contract Liability Claims Adjuster (City Of Miami Beach In -House Adjuster) see below Option 1: Workers Compensation Claims Adjuster (City Of Miami Beach In - House Ad'uster Included Descdptlan Of Addknal Servlce: DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 Option 1: Life of Contract Handling Fee: Auto Liability: Bodily Injury $795 Property Damage $495 General Liability: Bodily Liability $5 000 Description Of Additlanal Service: $350 All Other $ Waived _ Descrptlon Of Additional Service: - $695 $35 Per Intake Description Of Additional Service: $ Option 1: Life of Contract Handling Fee: Auto Liability: Bodily Injury $795 Property Damage $495 General Liability: Bodily Liability $550 Property Damage $350 All Other $695 Product Liability $695 Designated GL Adjuster included will handle on a per -case basis according to GL fee schedule. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9091277D5AD3 Indexing Claims Administration The above pricing per claim is based on handling of all claims that occur and are reported during the agreement period. They will be handled until closed or until the end of the agreement period, whichever comes first. Rates on claims that occur outside of the United States are subject to alternative pricing to be discussed prior to start of the contract. Pricing is valid for 9rst year of the contract At the end of the first year, all flat rate fees are subject to an annual increase not to exceed the greater of CPI or 3.5% (1) Fees for Additional Professional Services: If Customer requires any additional professional services from CorVel relating to the Services or the CareMC Application, including but not limited to integration of the CareMC Application with EDI or other Customer systems, Customer shall submit a written request to CorVel for such services. CorVel shall, in good faith, consider providing such services at its then -current professional services fee rate and standard terms and conditions. Dom ataConversion Included u First Notice of Loss Intake If submitted via CareMc Fee Waived ($30.00 per claim) or app If reported by $30.00 perclaim Incident Only Reporting If submitted via CareMc Fee Waived ($30.00 perclaim) If reported by phone or fax $30.00 per claim 24/7 Nurse Triage Included Option 1: Life of Contract Flat Annual Fee 345 Claims per Year $154500.00 Per claim Fee after 345 claims: Medical -Only $475.00 Option 2: Life of Contract Claims Handling Fee Medical -Only $150.00 Indemnity $950.00 Indemnity Tail $550.00 Claims Medical- $ 95.00 Option 3: Life of Contract Blended Rate Medical -Only & $475.00 ' indemnity $425.00 ' Annual Administration Fee Includes all state filing requirements, etc. $ 5000.00 CareMC User IDs Included Annual Banking Fees (per account) One account included Carrier TPA Oversight Fees Bill from carrier to client Bill Claims from carrier to client _Tail Subrogation 25% of Recoveries $10.00 perIndex Indexing Claims Administration The above pricing per claim is based on handling of all claims that occur and are reported during the agreement period. They will be handled until closed or until the end of the agreement period, whichever comes first. Rates on claims that occur outside of the United States are subject to alternative pricing to be discussed prior to start of the contract. Pricing is valid for 9rst year of the contract At the end of the first year, all flat rate fees are subject to an annual increase not to exceed the greater of CPI or 3.5% (1) Fees for Additional Professional Services: If Customer requires any additional professional services from CorVel relating to the Services or the CareMC Application, including but not limited to integration of the CareMC Application with EDI or other Customer systems, Customer shall submit a written request to CorVel for such services. CorVel shall, in good faith, consider providing such services at its then -current professional services fee rate and standard terms and conditions. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 (2) Fees Adjustments for Regulatory Changes: If, at any time during the Term of this Agreement, regulatory or legislative changes impact CorVel's business operations and add to CorVel's costs of providing the Services, CorVel may (a) increase its fees for one or more Services upon written notice to Customer, or (b) terminate this Agreement upon ninety (90) days written notice to Customer. (3) Billing and Payments for Pharmacy Program: Retail Mail order INNP -4%+4.50 AWP -8%+$4.50I AWP -10%-$4 AWP -18%+$4 (a) Charges for medications processed through the Pharmacy Program will be applied to the claim file. (b) CorVel uses the Medi -Span AWP at pre -settlement levels. To maintain pricing neutrality CorVel applies the established multiplier to impacted prescriptions. (c) Relative to state fee schedules, CorVel will apply the lesser of the Customer's contracted pharmacy rate or the applicable state fee schedule. The following exceptions apply: (i) All Florida pharmacy prescriptions will be priced at the Florida fee schedule. (d) Both parties understand that pricing indices historically used (including under this Agreement) for determining the financial components of pharmacy billing rates are outside the control of CorVel and Customer. The parties also understand there are extra -market industry, legal, governmental and regulatory activities which may lead to changesrelating to, or elimination of, these pricing indices that could alter the financial positions and expectations of both parties as intended under this Agreement. Both parties agree that, upon entering into this Agreement and thereafter, their mutual intent has been and is to maintain pricing neutrality as intended and not to benefit one party to the detriment of the other. Accordingly, to preserve this mutual intent, if CorVel undertakes any or all of the following: (i) Changes the AWP source across its book of business (e.g., from Medi -Span to First Databank); or (ii) Maintains AWP as the pricing index with an appropriate adjustment in the event the AWP methodology and/or its calculation is changed, whether by the existing or alternative sources; or (iii) Transitions the pricing index from AWP to another index or benchmark (e.g., to Wholesale Acquisition Cost). (e) Pharmacy rates will be modified as reasonably and equitably necessary to maintain the pricing intent under this Agreement. CorVel shall provide Customer with at least ninety (90) days prior written notice of the change (or if such notice is not practicable, as much notice as is reasonable under the circumstances), and written illustration of the financial impact of the pricing source or index change (e.g., specific drug examples). If Customer disputes the illustration of the financial impact of the pricing source, both parties agree to cooperate in good faith to resolve such disputes. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 EXHIBIT CCU CareMC License Agreement DocuSign Envelope ID: 6EE9D36E-ABE7-416C-6B7C-9D91277D5AD3 EXHIBIT C CareMC License Agreement This CAREMC LICENSE AGREEMENT (the "CareMC License A2reement'7 is incorporated by reference into the Services Agreement (the "Professional Services Agreement") to which it is attached and shall be between City of Miami Beach and CorVel Enterprise Comp, Inc. (the "Parties") The Parties The parties acknowledge and agree that the terms and conditions under which the Third Party Administration and bundled Managed Care Services are provided by CorVel and received by Customer shall be governed by the Master Agreement (including without limitation all additional Exhibits and applicable Schedules attached thereto), while the terms and conditions under which Customer may access and use the Online Services shall be governed by the terms and conditions of this CareMC License Agreement. Any conflict in terms between the Master Agreement and the CareMC License Agreement shall be superseded by the Master Agreement. All defined terms used herein and not otherwise defined shall have the meaning ascribed to such terms in the Master Agreement. 1. ACCESS TO THE CARENIC APPLICATION A. 'Re5ristration Information. Prior to accessing the CareMC Application, Customer shall provide CorVel with certain registration information requested therein ("Registration Information"). Customer covenants that the Registration Information Customer provides will be true, accurate, current and complete and will be updated as necessary to it so. B. Passwords and Levels of Access. As soon as practicable after the execution of this Agreement, CorVel shall create a unique usemame and password for each individual Authorized User identified by Customer as requiring access to the Online Services. Customer shall then designate two groups of Authorized Users. The first group of Authorized Users ("Restricted Users") shall have access to only the data available on the CareMC Site that relates to claims specific to that Authorized User and such other data that Customer specifically requests in writing be accessible to such Authorized User. The second group of Authorized Users ("Non -Restricted Users") shall have access to all data available on the CareMC Site that relates to claims specific to Customer. Access by Individual Users and Non -Restricted Users to data available on the CareMC Site shall be subject in all cases to any limitations imposed by applicable law. C. PHI Data. Authorized Users shall have access to all data available through the CareMC Application, including data that constitutes or contains "protected health information" ("PHI Data") as such term is defined in 45 CFR Section 164.501 of the regulations promulgated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 ("HIPAA"), but shall only have access to PHI Data to the extent necessary for Customer to render payment on a claim, and then only to those portions or amounts of PHI Data that are determined by CorVel, in its sole discretion, to be the minimum necessary for Customer to render payment on such claim. D. Security of Passwords. Customer acknowledges and agrees that it shall be solely responsible for (i) selecting Authorized Users,, (ii) assigning the various levels of authority and access each Authorized User may have to the CareMC Application, Online Services and Customer Data, including by determining which Authorized Users shall be Non -Restricted Users, (iii) ensuring that only Authorized Users have access to the passwords provided by CorVel or changed by Authorized Users, (iv) implementing a system to control, track and account for all passwords, (v) strictly maintaining the confidentiality and integrity of all passwords and levels of authority among Authorized Users, and (vi) ensuring that Authorized Users shall at all times comply with the terms and conditions of this Agreement. Customer further agrees that it shall. notify CorVel immediately in writing if the security or integrity of a password has been compromised. CorVel will provide reasonable cooperation to Customer in the event of a security breach. Such support will include but not be limited to suspending service for passwords whose security or integrity has been violated. Passwords may be changed at any time by Authorized Users, and must be changed at least once every ninety (90) days. E. Customer Data. Responsibility for ensuring that the content and data provided by or for Customer ("Customer Data") to be entered into the CareMC Application by CorVel is accurate and reflects Customer's requirements lies solely with Customer. All data generated by and through Customer's use of the CareMC Application and Online Services shall reside on CorVel's server. CorVel reserves the right to temporarily 19 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D9127705AD3 suspend access to any Customer Data that it determines, in its sole discretion, violates the terms and conditions of this CareMC License Agreement or any applicable laws. F. Customer Representations. Customer represents that (i) it has the legal authority to provide the Customer Data to CorVel hereunder, and (ii) it is fully aware and knowledgeable of and shall comply with its duties and responsibilities with respect to the privacy and confidentiality of medical records and protected health information under applicable federal and state laws, including but not limited to those imposed by HIPAA. 2. LICENSE AND RESTRICTIONS A. Limited License. Subject to the terms and conditions of this CareMC License Agreement, CorVel grants to Customer during the License Term (as defined in Section 5A below) a limited, non-exclusive, non- transferable, non-subhcensable license to access and use, and allow Authorized Users to access and use, the CareMC Application via the CareMC Site solely for Customer's own internal business use and operations. Customer shall access and use the CareMC Application in accordance with the user's guides and online instruction provided to Customer by CorVel ("Documentation') and all applicable laws, statutes, rules and regulations. B. Restrictions. Customer shall not, and shall not allow Authorized Users or any third party to (i) rent, lease, re -license or otherwise provide access to the CareMC Application or Online Services to any third party, (ii) alter, modify or create derivative works of the CareMC Application, (iii) use any reverse cornpilation, decompilation or disassembly techniques or similar methods to determine any design structure, concepts and construction method of the CareMC Application or replicate the functionality of the CareMC Application for any purpose, or (iv) copy the CareMC Application or any content, materials, information and other data provided by CorVel on the CareMC Site or used in providing the Online Services ("CorVel Content") and/or Documentation without CorVel's prior written consent. C. Third Parties. Customer shall not allow any third party to have access to the CareMC Application or Online Services without prior written consent of CorVel and ensuring that (i) such third party enters into a legally enforceable written agreement with CorVel, or (ii) such third party enters into a legally enforceable written agreement with Customer consistent with the terms of this CareMC License Agreement and which shall include terms at least as protective of CorVel as the following Sections of this CareMC License Agreement: Sections lA-1F, 213, 21), 3B, and 4A -4E. D. Ownership and Changes. CorVel owns and shall retain all right, title and interest in and to the CareMC Application, Documentation, CareMC Site, Online Services, CorVel Content and any intellectual property rights inherent therein or arising therefrom. In addition to CorVel's rights in the individual elements of the CorVel Content, CorVel owns a copyright in the selection, coordination, arrangement and enhancement of the CorVel Content. Neither Customer nor any Authorized User shall obtain any ownership rights, express or implied, or any other rights other than those expressly set forth herein in the CareMC Application, Documentation or CorVel Content. CorVel reserves the right, at any time in its sole discretion and without liability to Customer, to delete or change features of the CareMC Application, CareMC Site or Online Services provided such changes do not materially alter the functionality of the CareMC Application. E. Compliance Monitoring and Audits. CorVel may monitor and perform remote audits of Customer's use of the CareMC Application and CareMC Site for the purpose of verifying that Customer and Authorized Users are using the CareMC Application in compliance with the terms of this CareMC License Agreement. CorVel reserves the right to temporarily suspend Customer's or any Authorized User's access to the CareMC Application in the event Customer or such Authorized User engages in, or CorVel in good faith suspects is engaged in, any unauthorized conduct. To the extent CorVel requires access to Customer's facilities to conduct an audit hereunder, Customer agrees to provide such access upon reasonable advanced notice and during Customer's regular business hours. 3. INFRASTRUCTURE, MAINTENANCE AND SUPPORT A. CorVel Infrastructure Obligations. Subject to Customer's compliance with the terms and conditions of this CareMC License Agreement, CorVel shall be responsible for providing and maintaining the hardware, software and other equipment required to host the CareMC Application for Customer ("CareMC Infrastructure"). The CareMC Infrastructure is subject to modification by CorVel from time to time for purposes such as adding new functionality, maximizing operating efficiency and upgrading hardware, provided such modifications shall not in the aggregate degrade the performance of the Online Services utilized by Customer. Customer acknowledges and agrees that such modifications may require changes to Customer's Internet access and/or 20 DocuSign Envelope ID: 6EE0036E-ABE7-416C-8B7C-9D91277D5AD3 telecommunications infrastructure to maintain Customer's desired level of performance. CorVel shall give Customer reasonable prior written notice of any required modifications. B. Customer Infrastructure Obligations. Except for the CareMC Infrastructure, which will be provided by CorVel, Customer shall be responsible for obtaining and maintaining all hardware, software, equipment, Internet access and/or telecommunications services and other items or services furnished by third party venders or providers ("Third Party Providers") required to enable Customer to access and use the CareMC Application and CareMC Site as contemplated hereunder. C. Support. CorVel will provide general support regarding questions on the CareMC Application via email and by telephone from Monday through Friday between the hours of 5:00 a.m. and 6:00 p.m. Pacific Standard Time, excluding holidays. D. Scheduled Maintenance. CorVel will use reasonable efforts to (i) perform any scheduled downtime outside of Customer's normal business hours, (ii) notify Customer of all scheduled downtimes at least seventy- two (72) hours in advance, .and (iii) perform software updates to the CareMC Application with minimal disruption to Customer's useof the Online Services. E. System Monitoring, CorVel will use reasonable efforts to continuously monitor its web servers and database servers to ensure that they are functioning properly. F. Security. CorVel will implement and use reasonable efforts to maintain secure systems through the use of firewalls, virtual private networks (VPN) and other security technologies. Any security violations that affect the data of Customer will be promptly reported to Customer. G. Disaster Recovery and Backup. CorVel will use reasonable efforts to perform nightly backups of essential data on its web servers and database servers. CorVel has implemented third party backup and restoration technology to enable high speed recovery of data. CorVel utilizes redundant toad balanced Win 2000 servers for 240, 365 day access, except for regularly scheduled system maintenance and upgrade processes. SQL Server databases are hosted on clustered servers offering fall -over capability, redundant communication links, and load balanced application servers. Backup tapes are restored into a test environment not less than quarterly to confirm validity of backups. The CareMC Site has redundant inbound Internet and Intranet connectivity. 4. APPLICATION SPECIFIC DISCLAIMERS A. Disclaimers. TO THE EXTENT ALLOWED BY APPLICABLE LAW, EXCEPT FOR THE LIMITED WARRANTIES DESCRIBED N THE MASTER AGREEMENT, CORVEL MAKES NO OTHER WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AND EXPRESSLY DISCLAIMS ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, GOOD TITLE, SATISFACTORY QUALITY AND NONNFRINGEMENT. B. Internet Usage. Customer acknowledges that the Internet is essentially an unregulated, insecure and unreliable environment, and that the ability of Customer to access and use the CareMC Application is dependent on the Internet and hardware, software and services provided by various Third Party Providers. CORVEL SHALL NOT BE RESPONSIBLE FOR CUSTOMER'S INABILITY TO ACCESS OR USE THE CAREMC APPLICATION TO THE EXTENT CAUSED BY FAILURES OR INTERRUPTIONS OF ANY HARDWARE, SOFTWARE OR SERVICES PROVIDED BY CUSTOMER OR THIRD PARTY PROVIDERS. C. CareMC Application. CUSTOMER ACKNOWLEDGES AND AGREES THAT CORVEL DOES NOT WARRANT THAT THE CAREMC APPLICATION OR ONLINE SERVICES ARE ERROR FREE, THAT CUSTOMER WILL BE ABLE TO ACCESS OR USE THE CAREMC APPLICATION OR ONLINE SERVICES WITHOUT PROBLEMS OR INTERRUPTIONS, OR THAT THE CAREMC SITE AND CAREMC APPLICATION ARE NOT SUSCEPTIBLE TO INTRUSION, ATTACK OR COMPUTER VIRUS INFECTION. D. Network Intrusions. CUSTOMER AGREES THAT CORVEL WILL NOT BE LIABLE FOR DAMAGES ARISING FROM ANY BREACH, UNAUTHORIZED ACCESS TO, MISUSE OF, OR INTRUSION INTO, CUSTOMER DATA RESIDING ON COR.VEL'S SERVER(S) OR ANY NETWORK USED BY CUSTOMER TO THE EXTENT SUCH DAMAGES WERE BEYOND CORVEL'S REASONABLE CONTROL. 21 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-887C-9D91277D5AD3 5. LICENSE TERM AND TEMMINATION A. License Term. This CareMC License Agreement shall be effective as of the Effective Date and, unless terminated earlier as provided below, shall automatically terminate upon expiration or termination of the Master Agreement (the term of this CareMC License Agreement, the "License Term"). B. Termination for Convenience. Either party shall have the right to terminate this CareMC License Agreement for any reason or for no reason, upon ninety (90) days written notice to the other party. C. Termination for Cause. This CareMC License Agreement may be terminated by either party for cause as follows: (i) upon thirty (30) days written notice if the other party breaches or defaults under any material provision of this Agreement and does not cures such breach prior to the end of such thirty (30) day period, (ii) effective immediately and without notice if the other party ceases to do' business, or otherwise terminates its business operations, except as a result of an assignment, as permitted under the terms and conditions of this CareMC License Agreement, or (iii) effective immediately and without notice if the other party becomes insolvent or seeks protection under any bankruptcy, receivership, trust deed, creditors arrangement, composition or comparable proceeding, or if any such proceeding is instituted against the other (and not dismissed within ninety (90) days). D. Effect of Termination. Expiration or termination of this CareMC License Agreement shall have the following effects: (i) CorVel shall provide Customer with any proprietary data belonging to Customer, in the current format in which it is stored at CorVel at the termination of this CareMC License Agreement, (ii) all licenses granted under this CareMC License Agreement shall terminate immediately, (iii) all rights to use the CareMC Application and Online Services shall cease immediately, and (iv) each party shall promptly return all information, documents, manuals and other materials belonging to the other party related to this CareNIC License Agreement, whether in printed or electronic form, including without limitation all confidential information of the other party then currently in its possession, provided each party may retain one (1) copy of such materials for archival purposes. E. Survival, Except to the extent expressly provided to the contrary herein or in the Master Agreement, any right of action for breach of the CareMC License Agreement prior to termination, and the following provisions shall survive the termination of this CareMC License Agreement: Sections 1B -F, 2B, 2D, 4 and 5E. 22 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 RFP 2014 -302 -SW AND ADDENDUMS DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D9127705AD3 Y I \` Y II Bf. AC 1 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE ADDENDUM NO. 4 REQUEST FOR PROPOSAL 2014 -302 -SW FOR CLAIMS ADMINISTRATION SERVICES BYA THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY (the RFP) September 10, 2014 This Addendum to the above -referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. REVISIONS: Effective Wednesday, September 10, 2014, the Mayor and City Commission have approved an ordinance repealing Section 2-372 of Division 3, Article VI, of Chapter 2 of the Miami Beach City Code titled "Procedure to provide preference to Miami Beach based vendors in contracts for goods and contractual services". Due to this change, the Miami Beach -based vendor preference specified in the solicitation has been deleted in its entirety and is no longer applicable. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado(a miamibeachfl qov Contact: Telephone: Email: Lourdes Rodriquez 305-673-7000 ext. 6652 lourdesrodriouezOmiamlbeachfl.qov Bidders are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential bidders that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Bidders" questionnaire with the reason(s) for not submitting a proposal. actor DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 I71 Y ll E 1 I City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE RFP No, 2014 -302 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITYADDENDUM NO. 3 September 4, 2014 This Addendum to the above -referenced RFP is issued In response to questions from prospective bidders, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. 1. REVISION: a) The deadline for receipt of proposals Is extended until 3:00p.m. Friday, September 12, 2014. Late submittals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays for which the Proposer is solely responsible. b) Section 0300, Proposal Submittal Instructions and Format has been amended. 1. SEALED RESPONSES. One original Proposal (preferably in 3 -ring binder) must be submitted in an opaque, sealed envelope or container on or before the due date established for the receipt of proposals. Additionally, ten (49) seven 7 bound copies and one (1) electronic format (CD or USB format) are to be submitted. c) Appendix E, Cost Proposal Form has been amended. Proposers are required to submit the amended Appendix E — Cost Proposal Form in order to be deemed responsive. 2. RESPONSES TO QUESTIONS RECEIVED: Q #1: What company currently provides the medical case management services on behalf of the City of Miami Beach? If it Is Johns Eastern Company, how much are they paid for these services? A #1: Johns Eastern Company is the current provider of medical case management services for the City of Miami Beach. Johns Eastern Company is compensated at $195 per lost time and medical only exposure. Please refer to Attachment C, Service Contract for further information. Q #2: If another company is used for case management, how much are they paid? Are their services paid as allocated expenses off each file? A #2: Johns Eastern Company is the only provider. Q #3: The RFP requested loss control and surveillance services? Who currently provides these services for the City of Miami Beach? Is there an estimate of the amount of these services the City will utilize? A #3: Proven Investigations, LLC, (formerly Horizon Investigators) of Ft. Lauderdale, Florida currently provides the surveillance services. In the past two (2) fiscal years, the City of Miami Beach has not utilized any loss control services. There is no estimate of loss control or surveillance services as they are requested on an as needed basis. DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 RFP No. 2014 -302 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO, 2 September 4, 2014 Q #4: For medical bill payments and bill review services, the proposer would like to know the following information for the fiscal year 2013 — 2014. Q #4.1: Number of medical bills processed (excluding duplicates. A #4.1: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.2: Total Medical Charges A #4.2: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.3: Total Fee Schedule Reductions A #4.3: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.4: Total Audit Reductions A #4.4: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.5: Total PPO Reductions A #4.5: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.6: Total Bill Review Fees A #4.6: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.7: Total Audit Fees A #4.7: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.8: Total PPO Fees A #4.8: Please refer to Attachment D, Copy of COMB Medical Costs for further Information. Q #5: Is there any way to receive the Loss History in an excel format? A #5: Please refer to Attachment A, Open Claims and Attachment B, Closed Claims. Q #6: Will the City of Miami Beach utilize the Third Party Administrator's Bank? A #6: The City reserves the right to approve the bank utilized by the Third Party Administrator, or select its own. Q #7: Based on the required maximum claim counts of 100 lost time claims, the City of Miami Beach program will need two (2) dedicated Worker's Compensation lost time adjusters. Does the City of Miami Beach want a third dedicated adjuster as the on-site Workers' Compensation adjuster or will the on-site dedicated adjuster handle a case load? A #7: The City is looking for one (1) Worker's Compensation lost time on-site adjuster, who will not handle a case load, but be the intermediary between the Third Party Administrator, the City of Miami Beach and its employees. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 RFP No. 2014.302 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO. 2 September 4, 2014 Q#8: Does the City of Miami Beach want the designated liability adjuster to handle field investigations only or will the adjuster handle assigned liability claims to conclusion? A#8: Yes, the designated liability adjuster will be required to handle field investigations only. Q #9: Please provide a copy of your current contract with Johns Eastern Company. A 99: Please refer to Attachment C, Service Contract. Q#10: Please provide the total amount of fees paid to Johns Eastern Company for the past three (3) full years of contract periods, by year. A#10: Please refer to Attachment E, Copy of Johns Eastern FY 11.12.13-14 Fees Paid. Q#11: Are the fees paid to Johns Eastern Company all-inclusive or are they also paid for any services as an allocated expense from the claims? A411: Please refer to Attachment C, Service Contract. Q#12: Does the City of Miami Beach currently have a dedicated onsite worker's compensation adjuster from Johns Eastern Company or is this a new requirement? A#12: The City does not currently have a dedicated onsite worker's compensation adjuster. This is a new requirement. Q#13: For any onsite adjuster(s), will the City of Miami Beach provide office space, phones and internet access? Is there any charge to the Third Party Administrator for these services? A#13: Yes, the City will provide office space, phone, internet access for any onsite adjuster services requested by the City of Miami Beach. There is no additional charge for these services to the Third Party Administrator. Q#14: Please clarify the City of Miami Beach's need for an onsite liability adjuster? Section C,3, of the RFP indicates this adjuster is to be used on an as needed basis. A#14: For clarification, the City is looking for a liability claims adjuster to handle investigative work on an as needed basis to handle 15.30 Claims per fiscal year. This service will not require a dedicated on-site adjuster for liability adjusting services. Q#15: What is the annual volume of liability claim services the city expects to utilize? A#15: Approximately 15-30 liability claims per fiscal year. Q#16: How much was the Johns Eastern Company paid for liability services for the last three (3) full years? A#16: This service was not a part of Johns Eastern Company's contract. Q#17: The RFP indicates there are currently 421 open claims. It shows the open claim breakdown as 292 indemnity/ lost time claims, and 129 medical only claims. Please confirm this is accurate in both total and the indemnity /MC breakdown. A#17: Yes, the total number of open claims is 421; with 292 indemnityllost time claims and 129 medical only claims. Q#18: The RFP indicated a required caseload cap of 100 open claims maximum per adjuster. Does the current Third Party Administrator comply with that caseload cap and have approximately three (3) indemnity adjusters assigned to handle this volume on your account? A#18: Yes DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 RFP No. 2014.302 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO.2 September 4, 2014 Q#19: Is the caseload cap of 100 open claims maximum per adjuster a requirement or will a model with higher caseloads be considered? A#19: The City requires the caseload cap of 100 open claims per adjuster. Q#20: Regarding the Cost Proposal Form, Option #2, Fixed per Claim Fee Option. Does it have a liability fixed per claim fee? A#20: Option #2, Fixed per Claim Fee Option on the Cost Proposal Form is only referring to Worker's Compensation. For liability fixed per claim fee, please utilize the Liability Claims Adjuster option In the "Additional Services" section of the Cost Proposal Form. Q#21; Does the Liability Claims adjuster work fulltime in-house at the City of Miami Beach? A#21: No. Please note also on the revised Cost Proposal Form that the Liability Claims Adjuster will handle approximately 15-30 Claims, per fiscal year. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranedo@mlamibeachfl.gov. Contact: Telephone: Email: Lourdes Rodriguez 305.673.7000 x6652 lourdesrodrmiamibeachfl.gov iquez@ Proposers are reminded to acknowledge receipt of this addendum as part of your ITN submission. Potential proposers that have elected not to submit a response to the ITN are requested to complete and return the "Notice to Prospective Bidders' questionnaire with the reason(s) for not submitting a proposal. Si cerely, ex Denis ocurement Director DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPENDIX E MIAMIAII Cost Proposal "REVISED" September 4, 2014 Form RFP 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP 2014 -302 -SW TPA s Administration or Workers CaimComp and Gen lia i ily 1 0 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPENDIX E "REVISED" COST PROPOSAL FORM Bidder affirms that the prices stated on the proposal price form below represents the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, travel, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance. The Proposal Tender Form shall be completed mechanically or, if manually, in ink. Cost Proposal Forms completed in pencil shall be deemed non-responsive. All corrections on the Proposal Tender Form shall be initialed. Failure to follow the price proposal format as identified may result in the RFP response being considered non-responsive and the RFP submittal will not be considered forevaluation. FLAT ANNUAL FEE OPTION (for 345 claims including Claims in Excess of $ 345 Pe: I (per excess claim) (per contract year) 40 per year Year (Column 1 x Column 2) RFP 7.014-302SW TPA Claims Administration for Wor ers Comp dnd Gen Lia ity 2 ', .' NEW;CL'AIMS Claims With dates of accident after contract inception. February 1, 2015 DocuSign Envelope ID: 6EEOD36E-ABE7416C-6B7C-9D91277DSAD3 ADDITIONAL SERVICES List of services. as needed. which are in addition to the fees Dronosed in Options 1 - 3. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liabilily 4 Telephonic Medical Case Management Fee On All Claims: $ Per B111/Flat Fee Bill Review Fee To Include State Fee Schedule Reduction: $-- _Per Per BIII/Flat Fee Percentage Of PPO Savings — Network Discount Savings Below State Fee Schedule: % Percentage Of Utilization Review And Reasonable & Customary Savings: Subrogation and/or Liens Fee Percentage: Osha 300 Log Reporting: $ Electronic Data Interchange Filed With State: Safety Consulting Services Notice Of Injury Entry: Custom/Ad Hoc Reports: Data And File Conversion Fee: $ One -Time Setup Flat Fee Medicare Reporting Costs: Liability Claims Adjuster(15-30Claims per fiscal year) Workers Compensation Claims Adjuster (City Of Miami Beach In - House Adjuster) $ k r� Desaiptian Of AddiUmal Service: Oesaiplm Of Addillwal Service: Oesolptim Of Additional ServU; $ Description OfAddital Service; $ RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liabilily 4 r 31 -ins Eastern Company, Inc. escription: Work Comp Loss Run In Excel Format eport Run: 7/8/2014 11:43:06AM ate Range: 1/1/1950 thru 6/30/2014 aim Status: Open aim Type(s) : INDEMNITY, MEDICAL, REPORT ormat Type: Long Format :rt Order: Claim Number (Asc) irget Type: Total Incurred >= 60.00 16497 INDEMNITY Open 12/11/1991 12/30/1991 INTERNAL BLEEDING/HEART DISEASE 325,648.25 16500 INDEMNITY Open 02/19/1989 03/07/1989 CHASING SUBJECT IN POLICE BOAT 935,346.55 16513 MEDICAL Open 10/23/1991 11/05/1991 HYPERTENSION 140,793.25 16611 INDEMNITY Open 11/18/1991 12/04/1991 FELT PAINS IN CHEST AND ARMS 994,753.06 16657 INDEMNITY Open 10/26/1992 11/23/1992 SHORTNESS OF BREATH (HEART) 187,170.53 16681 INDEMNITY Open 03/21/1987 04/06/1987 VEHICLE ACCIDENT 70,334.02 17281 INDEMNITY Open 10/09/1991 10/22/1991 HYPERTENSION 5,070.87 17334 INDEMNITY Open 01/03/1992 01/13/1992 SHOT BY .45 PISTOL 160,859.07 17431 MEDICAL Open 01/23/1992 04/1311992 HYPERTENSION 64,022.93 17485 INDEMNITY Open 04/07/1988 04/29/1988 RACING HEARTBEAT WITH DIZZINESS 255,406.39 17493 MEDICAL Open 02/19/1992 03/17/1992 HIGH BLOOD PRESSURE 74,886.54 17548 INDEMNITY Open 01/23/1992 03/03/1992 HYPERTENSION 53,855.45 17663 INDEMNITY Open 10/03/1991 10/22/1991 Hypertension 182,613.62 17681 INDEMNITY Open 06/19/1992 07/09/1992 FELT CHEST PAIN/MYOCARDIO INFARCTION 134,288.98 17748 MEDICAL Open 10/09/1991 11/05/1991 HYPERTENSION 36,672.61 17755 INDEMNITY Open 06/28/1990 07/18/1990 RESPONDING TO DEMONSTRATORS 1,120,684.39 17791 INDEMNITY Open 09/02/1992 10/01/1992 Subject punched employee in the head. 705,060.68 17814 INDEMNITY Open 08/22/1991 09/01/1991 HIGH BLOOD PRESSURE 70,674.54 17834 INDEMNITY Open 02/01/1992 04/06/1992 HYPERTENSION 64,964.72 17896 MEDICAL Open 02/24/1992 03/03/1992 HIGH BLOOD PRESSURE 26,915.77 18016 INDEMNITY Open 09/21/1989 10102/1989 FIGHT WITH ARMED ROBBERIGUNSHOT WOUND 93,931.92 18040 INDEMNITY Open 09/19/1992 10/09/1992 FELL DURING FOOT CHASE - HBP 57,738.08 18076 INDEMNITY Open 09/20/1991 10/14/1991 FELL ON RIGHT KNEE 861,889.61 18084 INDEMNITY Open 01131/1992 05/05/1992 DEVELOP HYPERTENSION DUE TO STRESS 55,214.87 18194 INDEMNITY Open 03109/1991 03/26/1991 MVA 125,638.68 18399 INDEMNITY Open 01/24/1990 01/30/1990 TWISTED LEFT ANKLE LANDED DURING RAPELLING 66,609.08 18419 INDEMNITY Open 09/2011989 09/26/1989 SLIPPED ON SHOP FLOOR 32,040.45 18476 INDEMNITY Open 02/02/1989 02/17/1989 INCREASE IN HEART BFAT rd 0 0 UC -0135 -OE ® (649826) CRY ®f Miami Beach M m >hns Eastern Company, Inc. 5 ascription: `Work Comp Loss Run in Excel Format`" - m port Run: 7/8/2014 12:17:45PP1 ate Range. 1/1/1950 thru 6/30/2014 aim Status: Closed a"" Types) : INDEMNITY, MEDICAL, REPORT Irmat Type: Long Format in Order: Claim Number (Asc) irget Type., Total Incurred >= $0.00 16494 16495 MEDICAL INDEMNIT ClosedY Closed 08/03/1992 09/08/1989 08124/1992y 11/11/1992 VICTIM OF AGGRAVATED o 16496 MEDICAL Closed 04/02/1991 09/19/1989 10/21/1991 ASSAULT RINGING IN EARS 94.60 0 16498 MEDICAL Closed 12/20/1988 04/17/1991 02/19/1992 CHEST PAINS 5,680.80 16499 MEDICAL Closed 03/30/1990 01/03/1989 09/01/1989 GOING UP STAIRS/CAUGHT FINGER 3.865.15 16501 MEDICAL Closed 09/07/1988 04/18/1990 07/17/1990 R VEHICLE 52.80 16502 REPORT Closed 12/27/1989 10/10/1988 04/11/1989 EFFECTING AN ARRESBY BECAME ILL 0.00 16503 MEDICAL Closed 02/10/1990 01/12/1990 02/22/1990 01/12/1990 VEHICLE DOOR CLOSED ON THUMB 1,061.05 16504 MEDICAL Closed 02/09/1991 03/01/1991 06/14/1990 LIFTING PATROL BIKE INTO TRUNK 0.00 16505 MEDICAL Closed 08/23/1987 11/25/1987 04/15/1991 SLIPPED AND FELL ON WET ROCKS 565.00 16506 REPORT Closed 08/13/1989 08/23/1989 04/08/1988 MOVING CHAIRS 169.04 16507 16508 MEDICAL Closed 06/05/1987 06/26/1987 08/23/1989 06/21/1988 ATTEMPTING TO BRING SUBJ UNDER CONTROL 129.80 16509 MEDICAL Closed 11/03/1992 11/12/1992 12/09/1992 STRUCK BY VEHICLE 0.00 16510 MEDICAL Closed 04/22/1990 04/30/1990 06/06/1990 AFTER LUNCH EMP. BECAME ILUDIZZY. 19.00 16511 MEDICAL Closed 09/19/1992 10/01/1992 01/14/1993 ARRESTING SUBJECT/SUBJECT SPIT IN EYE 0.00 16512 MEDICAL Closed 05/08/1988 05/20/1988 08/15/1988 PHYSICALLY SUBDUING A RESISTING SUBJECT 121.40 16514 REPORT Closed 02/25/1988 03/30/1988 03/30/1988 SLIPPED OFF REAR STEPS OF A HOUSE 171.00 16515 REPORT Closed 01/19/1992 01/31/1992 01/31/1992 CHEMICAL MIXTURE SPRAYED ON FACE 0.00 MEDICAL Closed 08/06/1988 08/22/1988 TAKING PRISONER INTO CUSTODY 0.00 16516 MEDICAL Closed 09/26/1992 10/18/1988 OTHER CAR FAILED TO YEILD RIGHT 0.00 16517 MEDICAL Closed 11/16/1988 10/13/1992 12/14/1992 OF WAY EXITING VEHICLE 63.00 16518 REPORT Closed 02/26/1987 12/12/1988 03/06/1987 11/02/1990 ENGAGING IN ROUTINE BOAT MAINTENANCE 0.00 16519 16520 REPORT Closed 04/12/1990 05/03/1990 03/06/1987 05/03/1990 SLIPPED & FELL ON RUG (CARPET) 2.324.40 16521 MEDICAL REPORT Closed Closed 09/21/1992 03/28/1991 10/01/1992 01/14/1993 ONOSCHOO DFIRE SCENEISLIPPED EfAIUSO ETHING 0.00 0.0054 S� 16522 MEDICAL Closed 12/27/1991 04/17/1991 04/17/1991 IN EYE STRUCK BY DRIVER IN CROSSWALK 93.92 16523 MEDICAL Closed 08/20/1989 01/27/1992 08/28/1989 09/10/1993 EFFECTING ARREST 0.00 16524 MEDICAL Closed 06/09/1992 06/23/1992 11/13/1989 ASSISTING IN ARRESTING VIOLENT SUBJECT 229 04 10/22/1992 CHEST PAINS 159.80 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-eB7C-9D91277DSAD3 ONJOHNS EASTERN d."<]M7',t NY, 6,t1(M ClalmAdlustmand ThitdPaetyAdmInistrators SERVICE CONTRACT FOR WORKERS' COMPENSATION CLAMS HANDLING THIS SERVICE CONTRACT FOR WORKERS' COMPENSATION CLAIMS HANDLING -is made and entered into this 11th day of January 2010, but is effective for all purposes as of the 1st day of February 2010, by and between the CITY OF MIAMI BEACH (referred to as the "Client"), and JOHNS EASTERN COMPANY, INC. (referred to as the "Service Agent"). WITNESSETH: WHEREAS, the Client has undertaken to self -insure its Workers' Compensation liability in accordance with the Workers' Compensation Law and other applicable statutes and regulations; and WHEREAS, the Service Agent is engaged in the supervision and administration of programs for self-insured employers; WHEREAS, the Client desires to engage the Service Agent for, and the Service Agent desires to assist the Client in workers' compensation claims handling; NOW, THEREFORE, for and ,in consideration of the premises and of the mutual obligations, performance of services, and payment of compensation set forth herein, the parties agree as follows; Engagement. The Client hereby engages the Service Agent to supervise and administer the Self -Insured Workers' Compensation Program of the Client in accordance with the Workers' Compensation Law as adopted and amended by the State of Florida (the "Law") and the applicable rules and regulations as promulgated by the applicable agencies of the State of Florida relating to the Law (the "Rules"), all in accordance with the Service Agent's proposal dated September 3, 2009 a copy of which is attached hereto and incorporated herein by this reference (the "Proposal"). 2. MW,' Subject to termination pursuant to Paragraph 9, the term of this Agreement shall begin as of &1L vOI'0:`afld :hall. -terminate- oxl January' 31, provided. 3. Fund for Payment of Claims. The Client has the sole obligation and responsibility for funding the payment of claims made by its employees under the Law and Rules. The Service Agent assumes no duty to fund any such claims at any time and shall have no obligation to advance funds for any such payment, The Client agrees to maintain all necessary funds for payment of claims in accordance with the Law and Riles and to inform the Service Agent of all relevant details with DocuSign Envelope ID: 6EEOD36E-ABE7416C-887C-9D91277D5AD3 respect to any such accounts in order for the Service Agent to perform its duties under this Agreement. The Client shall add to or increase the amount in any such accounts as needed, and, in any event, within five (5) business days from the Service Agent's notice to the Client to such effect, 4. Allocated Claims Expenses, Charges for services below are billed at negotiated rates for vendors selected by CLIENTMERVICE AGENT unless otherwise outlined below. "Allocated Claims Expenses" shall be defined as expenses arising in connection with the settlement of claims, which shall be defined as expenses directly allocated to a particular claim to be discharged from the accounts funded by the CLIENT specified in Paragraph 3, including, but not limited to: a. Attorneys' and legal assistants' fees for claim and any lawsuits, before and at trial, on appeal, or otherwise; b. Court and other litigation and settlement expenses, including, without limitation: (i) Medical examinations to determine extent.of _liability; (ii) Expert medical and other testimony; (iii) Laboratory, X-ray and other diagnostic tests; (iv) Autopsy, surgical reviews, and other pathology services; (v) Physician and related fees and expenses in reading, interpreting, or performing any of the foregoing tests or services; (vi) Stenographer, process server, and other related trial preparation, trial, settlement, and court costs; (vii) Witnesses fees and expenses before and at trial, deposition, settlement discussions, or otherwise; and c. Fees and expenses for surveillance, private investigators, or otherwise, d. Fees for the indexing of injured employees, C. Fees for any work done outside the office, including, but not limited to, field investigations necessary to determine compensability, liability, Special Disability Trust Fund or subrogation recoverability, claimant control, attendance at mediations, hearings and depositions, attendance at management meetings, attendance at medical consultations or hearings, appraisals, case management, recorded statements, DocuSign Envelope ID:. 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 f Telephonic medical management will be $195.00 per lost time and medical only exposure whose dates of loss fall between February 1, 2010 and January 31, 2013. This fee applies only to cases handled by the Service Agent. g, Fees for over -night or special mail service for various documents, h. Fees for examining and reducing hospital and medical bills as appropriate are $5.95 per bill and 30% of savings over and above Fee Schedule savings. L Photocopying and/or CD-ROM copies, review of relevant documentation. j. Pre -Certification of Hospital Admissions, On -Site Case Management, Peer Review, Medical Care Audits, and Hospital Bill Audits, k. Medicare Set -Aside (MSA) services to include; recommendation for MSA submission, MSA cost projection, MSA submission, liability MSA services, comprehensive drug utilization review, lien search, conditional lien dispute, projection update. Compensation for the Service Agent, For performing its services under this Agreement, the Service Agent shall be entitled to the following compensation: a. Fees for claims handling for the Client's exposures whose dates of loss fall between February 1, 2010 and January 31, 2011 will be a minimum and deposit of $200,000.00. The Service Agent will bill this minimum and deposit quarterly, with the first payment due upon program inception. The annual minimum and deposit covers handling 450 workers' compensation exposures. If the number of exposures exceeds 450, the Service Agent will increase the fees proportionately. This fee covers all claims management/administration and data processing services outlined in the original proposal. All years are subject to audit. b. Fees for claims handling for the Client's exposures whose dates of loss fall between February 1, 2011 and January 31,.2012 will be a minimum and deposit of $200,000,00. The Service Agent will bill this minimum and deposit quarterly, with the first payment due upon program inception. The annual minimum and deposit covers handling 450 workers' compensation exposures. If the number of exposures exceeds 450, the Service Agent will increase the fees proportionately. This fee covers all claims management/administration and data processing services outlined in the original proposal. All years are subject to audit. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D6AD3 c. Fees for claims handling for the Client's exposures whose dates of loss fall between February 1, 2012 and January 31, 2013 will be a minimum and deposit of $200,000.00. The Service Agent will bill this minimum and deposit quarterly, with the first payment due upon program inception. The annual minimum and deposit covers handling 450 workers' compensation exposures. If the number of exposures exceeds 450, the Service Agent will increase the fees proportionately. This fee covers all claims managementladministration and data processing services outlined in the original proposal. All years are subject to audit. 1Sn By@t c ;yQ'iYS20'19/l:;an'd201'4/15will- riotek6Ccd7.S%—over-thrplevions, +yegr's fees. e, Allocated expenses are costs associated with investigation and/or adjustment of a claim. The Service Agent will'charge the allocated expense to the claim file. Fees for any field investigation will be $95,00 per hour, $0.55 a mile, and 1.00 per color photograph, and administrative expenses. The Service Agent will bill at these rates all activities involving handling, controlling or settling an employer's liability on a claim. f. Loss control services are available through the Service Agent's consultant at a rate of $95.00 per hour. The Service Agent can customize Safety/Loss Control services to meet the Client's program and risk needs. This service is offered on an as needed basis. Excess Reporting Obligation - Unless otherwise specified in this addendum, Service Agent agrees that reporting claims to excess insurance carrier is the Service Agent's responsibility. It is the responsibility of the Client to provide accurate coverage information regarding any insurance policies insuring claims covered by this contract. The information for all claim years that the Service Agent is handling will be made available to the Service Agent within 90 days of contract inception. New insurance information on renewal years will be made within 90 days of renewal date. Excess information will include name and claims reporting address and phone number of all carriers, policy number, effective dates, limits of liability, deductibles, specific retentions and loss funds. Actual policies will be provided, This information is required for each claim year that the Service Agent is handling for the Client. If this information is not made available as outlined in this Paragraph, Service Agent will not be responsible for any penalties, interest, or reductions in excess recoveries because of late reporting. Continuing Handling of Claims After Termination of Contract or Legally Imposed Mandates. Upon termination of this Agreement as set forth in paragraph 8, the Service Agent agrees to continue handling all claims that have been made and reported to it prior to such date of termination for thirty (30) days unless the parties have agreed otherwise in writing. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 Upon repeal of any service mandated by the workers' compensation law and/or _ other applicable statutes and/or regulations, the Service Agent agrees to continue handling all claims under the repealed service that have been reported to it prior to the date of such repeal for thirty (30) days unless the parties have agreed otherwise in writing, Upon exiting, client data will be provided to the new TPA either by a series of attachments to one or more email messages containing zip files which can be password -protected or via CD ROMS. The claim files may exist as paper files and will be shipped as such. If the claim files are stored as images in a document retrieval system, they will be provided via CD ROM or the most current means of providing data. The cost for this will be no greater than $3,500.00. The Client will be billed for any additional programming to help in data transfer, 8. Disputes Subject to Arbitration. Any dispute or claim arising out of or relating to this Agreement or any breach thereof shall be resolved by submission of such dispute or claim to an arbitration panel composed as follows; The Client and the Service Agent shall each select one member of the panel and the two selected _. members shall select a third member. The parties agree to follow the rules of the American Arbitration Association, 9. Termination. This Agreement may be terminated by either the Client or the Service Agent by giving prior written notice of ninety (90) days. In the event of such termination, compensation paid or payable to Service Agent under Paragraph 5 shall be prorated as appropriate, Notwithstanding anything in this Paragraph 8 to the contrary, the insolvency or filing for relief from creditors of any party pursuant to the United States Bankruptcy Code or the material breach of a material provision of this Agreement by any party shall permit the other party to cancel this Agreement immediately upon written notice. 10. Covenants of the Service Agent and the Client. Each of the Service Agent and the Client agrees to use its normal and ordinary professional care and diligence in the performance of its duties under this Agreement and will use its best efforts to comply at all times with the Law and the Rules. 11. Indemnification. Service Agent agrees to indemnify and hold harmless the Client and its officers, employees, and agents, from and against any and all actions, claims, liabilities, losses and expenses, including but not limited to, attorneys' fees, for personal, economic or bodily injury, wrongful death, loss of or damage to property, at law or in equity, which may arise or be alleged to have arisen from the negligent acts, errors, omissions or other wrongful conduct of the Service Agent, its employees, agents, sub -contractors, or any other person or entity acting under Service Agent's control, including without limitation any and all temporary personnel assigned to the Client pursuant to this Agreement, in connection with the Service Agent's performance of the Services pursuant to this Agreement; and to that extent, the Service agent shall pay all such claims and losses and shall pay 0 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 such costs and judgments which may issue from any lawsuit arising from such claims and losses, and shall pay all costs and attorneys' fees expended by the Client in the defense of such claims and losses, including appeals. The parties agree that one percent (1%) of the total compensation to the Service Agent for performance of the Services under this Agreement is the specific consideration from the Client to the Service Agent for the Service Agent's Indemnity Agreement. The Service Agent's obligation under this Subsection shall not include the obligation to indemnify the Client and its officers, employees and agents, from and against any actions or claims which arise or are alleged to have arisen from the sole negligent acts or omissions or other wrongful conduct of the Client and its officers, employees and agents. The parties each agree to give the other party prompt notice of any claim coming to its knowledge that in any way directly or indirectly affects the other party. 12. Miscellaneous. a. Each party represents and warrants that it has full power and authority to _._ .... enter into this Agreement. _.. - ._ . _ —..... .._ .. b. All notices, requests, demands and other communications which are required or may be given under this Agreement shall be in writing and shall be deemed to have been duly given when received if personally delivered; when transmitted if transmitted by telecopy, electronic telephone line facsimile transmission, or other similar electronic or digital transmission method; the day after it is sent, if sent by recognized expedited delivery service; and five (5) days after it is sent, if mailed, certified or registered mail, return receipt requested, postage prepaid. In each case, notice shall be Scotto: If to the Client: City of Miami Beach 1700 Convention Center Dr. City Hall ibliamiBeach,FL 33139 If to the Service Agent: Johns Eastern Company, Inc, Post Office Box 110259 Lakewood Ranch,FL 34211-0004 or to such other address as either party may have specified in writing to the other using the procedures specified above in this Paragraph. c, (i) This Agreement shall be construed pursuant to and governed by the substantive laws of the State of Florida (and any provision of Florida law shall not apply if the law of a DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 state or jurisdiction other than Florida would otherwise apply). (ii) The headings of the various Paragraphs in this Agreement are inserted for the convenience of the parties and shall not affect the meaning, construction, or interpretation of this Agreement. (iii) Any provision of this Agreement which is determined by a coni of competent jurisdiction to be prohibited, unenforceable or not authorized in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of such prohibition, unenforceability or non - authorization without invalidating the remaining provisions hereof or affecting the validity, enforceability or legality of such provision in any other jurisdiction, In any such case, such determination shall not affect any other provision of this Agreement, and the remaining provisions of this Agreement shall remain in full force and effect. If any provision or term of this Agreement is susceptible to two or more constructions or interpretations, one or more of which would render the provision or term void or unenforceable, the parties agree that a construction or interpretation .which renders the term or provision valid shall be favored, d. This Agreement constitutes the entire Agreement, and supersedes all prior agreements and understandings, oral and written among the parties to this Agreement with respect to the subject matter hereof. e, (i) If, within ten (10) days after demand to comply with the obligations of one of the parties to this Agreement served in writing on the other, compliance or reasonable assurance of compliance is not forthcoming, and the other party takes steps to enforce rights under this Agreement pursuant to Paragraph 8 or otherwise, the prevailing party in any action shall be entitled to recover all reasonable costs and expenses (including reasonable attorneys' and legal assistants' fees before and at trial, on appeal, or otherwise.) (ii) If any monies shall be due either of the parties to this Agreement hereunder and shall not be paid within forty-five (45) days from the due date of such payment, interest shall accrue on such unpaid amount at the rate of 1% per month in accordance with the Florida Prompt Payment Act - F. S.218,70-79. This Agreement shall be binding upon and inure to the benefit of the successors in interest and assigns of the parties. g. The parties to this Agreement will execute and deliver, or cause to b executed and delivered, such additional or further documents, agreements, DocuSign Envelope ID: 6EE0D36E-ABE7416C-8B7C-9D91277D5AD3 or instruments and shall cooperate with one another in all respects for the purpose of carrying out the transactions contemplated by this Agreement. h. This Agreement may be executed in any number of counterparts, each of which shall be considered an original, but all of which together shall constitute one and the same instrument and shall become effective when each of the parties has executed at least one of the counterparts even if all the parties have not executed the same counterpart. IN WITNESS WHEREOF, the parties have executed this Agreement effective for all purposes as of February 1, 2010. City Clerk CITY OF MIAMI $EAdf Matti Herrera Bowers Mayor JOHNS EASTERN COMPANY, INC. $ ver y AdkiW AIM, AIC Executive Vice President APPROVED AS TO FORM & LANGUAGE a FOR EXECUTION ity Att h Date DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 ;..,I—xvionlys E.49rol y C43"pgN4, IANC _:s:.><�1� OalmAdjustersandTf+irdfMrlY+Nlmiufsuutrns ADDENDUM NUMBER TO SERVICE CONTRACT FOR WORKERS' COMPENSATION CLAIMS HANDLING This is the F(rst Addendum to the Agreement entered Into between Johns Eastern Company, I nc„ hereinafter ca (led the SERVICE AGENT, and City of M(a mi Beach, hereinafter called the CLIENT, dated the 1" day of February 2010, ThisAddendum affects the remuneration to be paid by the CLIENTto the SERVICE AGENT for the handling of claims with a date of loss of February 1, 2013 through January 31, 2014. All other terms of the original Contract remain unchanged. The remuneration to be paid to the SERVICE AGENT under this Agreement by the CLIENT for workers' compensation claims handling and safety services during the term of this Agreement shal I be as follows; 4. Allocated Claims Expenses. Charges far services below are billed at negotiated rates for vendors selected by CLIENT/SERVICE AGENT unless otherwise outlined below. "Allocated Claims Expenses" shall be defined as expenses arising in connection with the settlement of claims, which shall be defined as expenses directly allocated to a particular claim to be discharged from the accounts funded by the CLIENT specified in Paragraph 3, including, but not limited to: a. Attorneys' and legal assistants' fees for claim and any lawsuits, before and at trial, on appeal, or otherwise; Court and other litigation and settlement expenses, Including, without limitation: (i) Medical examinations to determine extent of liability; (ii) Expert medical and other testimony; (iII) Laboratory, X-ray and other diagnostic tests; (Iv) Autopsy, surgical reviews, and other pathology services; (v) Physician and related fees and expenses in reading, interpreting, or performing any of the foregoing tests or services; (vi) Stenographer, process server, and other related trial preparation, trial, settlement, and court costs; (vil) Witnesses fees and expenses before and at trial, deposition, settlement discussions, or otherwise; and Fees and expenses for surveillance, private Investigators, or otherwise, d. Fees for the indexing of injured claimants, e, fees for any work done outside the office, hcluding, but not limited to, field DowSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Investigations necessary to determine compensabillty, liability, Special Disability Trust Fund orsubrogation recoverability, claimant control, attendance at 7mediations, hearings and depositions, attendance at management meetings, attendance at medical consultations or hearings, appraisals, case management, recorded statements, fTelephonfc medical managementwill be $195.00 per lost time and medical only exposure. This fee only applies to cases handled by the Service Agent g. Fees for over-nlghtor special mail service for various documents, h. Fees for examining and reducing hospital and medical bills as appropriate will be $5.95/blll and 30% of savings over and above Fee Schedule savings, Photocopying and/or CD-ROM copies, review of relevant documentation. j. Pre -Certification of Hospital Admissions, On -Site Case Management, PeerRevlew, Medical Care Audits, and Hospital Bill Audits. k. Medicare Set -Aside (MSA) services to include; recommendation for MSA submission, MSA cost projection, MSA submission, liability MSA services, comprehensive drug utilization review, lien search, conditional lien dispute, projection update. Compensation for the Service Agentt For performing its services under this Agreement, the Service Agent shall be entitled to the following compensation: a. Fees for claims handling for the Client's exposures whose dates of loss fall between February 1, 2013 and January 31, 2014 will be a minimum and deposit of $200,000.00. The Service Agent will bili this minimum and deposit quarterly, with the first payment due upon program inception. The annual minimum and deposit covers handling 450 workers' compensation exposures. If the number of exposures exceeds 450, the Service Agent wil Increase the fees proportionately. This fee covers all claims management/administration and data processing services outlined in the original proposal. All years are subject to audit. b. Fees for years 2014/15 will not exceed 7.5% over the previous year's fees, c. Allocated expenses are costs associated with investigation and/or adjustment of a claim. The Service Agent will charge the allocated'expense to the claim file. Fees for any field Investigation will be $95.00 per hour, $055 a mile, and 1.00 per color photograph, and administrative expenses. The Service Agent will bill at these rates all activities Involving handling, controlling orsettling an employer's liability on a claim. d: Loss control services are available through the ServlceAgent's consultant at a rate of $95,00 per hour. The Service Agent can customize Safety/Loss Control services to meet the Client's program and risk needs. This service is offered on an as needed basis. DocuSign Envelope ID: 6EE0D36E-ABE7416C-8B7C-9D9127705AD3 6. Excess Reporting Obligation -Unless otherwise specified In this addendum, Service Agent agrees that reporting claims to excess insurance carrier is the Service Agent's responsibility, It Is the responsibility of the Client to provide accurate coverage Information regarding any insurance policies insuring claims covered bythls contract. The Information forall claim years thatthe Service Agent Is handling will be made available to the Service Agent within 90 days of contractinception, New Insurance Information on renewal years will be made within 90days of renewal elate. Excess Information will include name and claims reporting address and phone number of all carriers, policy number, effective dates, limits of liability, deductibles, specific retentions and loss funds. Actual policies will be provided. This information is required for each claim year that the Servlce Agent is handling for the Client. If this Information is not made available as outlined In this paragraph, Service Agent will not be responsible for any penalties, interest, or reductions in excess recoveries because of late reporting, The Service Agent shall not be responsible for costs, judgments', settlements, damages, etc, resulting from the excess carrier's denial of a claim due to untimely reporting at the fault of the prior administrator(s) for claims assumed under the current contract. The Service Agent shall not be responsible for reporting to excess or collecting recoverable(s) for closed claims at time of contract inception, unless so directed by Client. 7. Continuing Handling of Claims After Termination of Contractor Legally Imposed Mandates, Upon termination of this Agreement as set forth In paragraph 8, the Service Agent agrees to continue handling all claims that have been made and reported to it prior to such date of termination for thirty (30) days unless the parties have agreed otherwise in writing. Upon repeal of any service mandated by the workers' compensation law and/or otherappiicable statutes and/or regulations, the Service Agent agrees to continue handling all claims under the repealed service that have been reported to it prior to the die of such repeal for thirty (30) days unless the parties have agreed otherwise In writing. Upon exiting, client data will be provided to the new TPA either by a serles of attachments to one or more email messages containing zip files which can be password -protected or via CD ROMS, The claim files may exist as paper flies and will be shipped as such. If the claim files are stored as images In a document retrieval system, they will be provided via CD ROM or the most current means of providingdata. The cost for this will be no greater than$3,500.00. The Client will be billed for any additional programming to help in data transfer. 12. Miscellaneous. b. Ali notices, requests, demands and other communications which are required or may be given under this Agreement shall be in writing and shall be deemed to have been duly given when received if personally delivered; when transmitted If transmitted by telecopy, electronic telephoneline facsimile transmission, or other similar electronic or digital transmission method; the day after It is sent, if sent by recognized expedited delivery service; and five (5) days after It Is sent, if mailed, certified or registered mail, return receipt requested, postage prepaid. In each case, notice shall be sent to; If to Client; City of Miami Beach 1700 Convention Center Drive—City Hall Miami Reach, FL 33139 If to the Service Agent; Johns Eastern Company, Inc. Post Office Box 110259 Lakewood Ranch, FL 3 42 11-0 00 4 DowSign Envelope ID: 6EEOD36E-ABE7416C-BB7C-9D91277D5AD3 or to such other address as either party may have specified in writing to the other using the procedures specified above In this Paragraph. All otherterms of the contract remain unchanged. IN W ITNESS W H EREOF, the SERVICE AGENT and the CLIENT have each caused this Addendum to be executed by its duly authorized representative to be effective thel" day of February 2013. WITNESSES: CITY OF MIAMI�EA WITNESSES: CL Z10 -me JOHNS EASTERN COMPANY, INC. BkyIyAdVns, AIC, AIM Executive Vice President Special Account Services APPROVED AS TO FORM & LANGUAGE FOR EXECUTION A rnet_ , Date DocuSign Envelope 10: 6EE0D36E-ABE7-416C-8B7C-9D91277D5AD3 INVOICEDT Type DCN Claim # Provider Transfer Dt 10/31/12 1 632547 542662 ORTHOPAEDIC ASSOCIATES USA 10/02/12 10/31/12 1 632561 288001 ORTHOPAEDIC ASSOCIATES USA 10/02/12 10/31/12 1 632577 542707 ORTHOPAEDIC ASSOCIATES USA 10/02/12 10/31/12 1 632580 542846 ANNE BATES LEACH EYE HOSP. 10/02/12 10/31/12 1 632584 542846 ANNE BATES LEACH EYE HOSP. 10/02/12 10/31/12 1 632596 542846 ANNE BATES LEACH EYE HOSP. 10/02/12 10/31/12 1 632606 264529 JOSEPH I FERNANDEZ MID 10/02/12 10/31/12 1 632616 434063 WORKERS HEALTH SOLUTIONS INC 10/02/12 10/31/12 1 632641 544082 MOUNT SINAI MEDICAL CTR 10/02/12 10/31/12 1 632655 544318 MOUNT SINAI MEDICAL CTR 10/02/12 10/31/12 1 632706 542764 STERLING EM SVC OF MIAMI BEACH 10/02/12 10/31/12 1 632710 542226 SUNRISE MEDICAL GROUP I LLC 10/02112 10/31/12 1 632713 540597 PRESCRIPTION PARTNERS LLC 10/02/12 10/31/12 1 632774 540511 PHYSICIANS HEALTH CENTERANCS 10/02/12 10/31/12 1 632776 540511 PHYSICIANS HEALTH CENTERANC5 10/02/12 10/31/12 1 632802 543542 ANNE BATES LEACH EYE HOSP. 10/02/12 10/31/12 1 632843 535607 GULFSTREAM EMERG PHYS 10/02/12 10/31/12 1 632886 470122 JON D DONSHIK MD PA 10/02/12 10/31/12 1 632953 277541 PRESCRIPTION PARTNERS LLC 10/02/12 10/31/12 1 632962 541243 JACKSON HEALTH SYSTEM 10/02/12 10/31/12 1 633065 470122 JON D DONSHIK MD PA 10/02/12 10/31/12 1 633069 540597 JON D DONSHIK MD PA 10/02/12 10/31/12 1 633087 542707 PRESCRIPTION PARTNERS LLC 10/02/12 10/31/12 1 633118 539855 FLORIDA BRACING CENTERS, INC. 10/02/12 10/31/12 1 633146 525377 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 1 633155 537610 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 1 633156 513267 STEPHEN B MEISEL, M.D. 10/02/12 10/31/12 1 633157 543545 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 1 633161 542662 MARKSCHOENFELD 10/02/12 10/31/12 1 633163 532327 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 1 633164 288001 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 1 633184 542819 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 1 633208 543276 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 1 633260 513267 HOME CARE CONNECT LLC 10/02/12 10/31/12 1 633273 460888 JON D DONSHIK MD PA 10/02/12 10/31/12 1 633311 470122 JON D DONSHIK MD PA 10/02/12 10/31/12 1 633331 543276 RX DEVELOPMENT ASSOCIATES INC 10/02/12 10/31/12 1 633352 541282 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 1 633355 541282 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 1 633357 540084 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 1 633360 540084 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 1 633362 543276 DOCTORS MEDICAL 10/02/12 10/31/12 1 633369 544800 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 1 633376 538826 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 1 633379 538826 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 Fiscal) Invoice Year Doc# Invoice Date Document Date Check Transfer Date Vendor Name Total Amount Description 2011 2346052 12/16/2010 12/16/2010 1/20/2011 JOHNS EASTERN COMPANY, INC. $50,000.00 WORKERS COMPENSATION CLAIMS HANDLING 20112351934 1/26/2011 2/1/2011 2/8/2011 (JOHNS EASTERN COMPANY, INC. $50,000.00 WOR KERS COMPENSATION CLAIMS HANDLING 2011 2364912 5/3/2011 5/3/2011 5/10/2011 JOHNS EASTERN COMPANY, INC. $50,000.001WORKER'S COMPENSATION CLAIMS HANDLING 2011 2388356 8/15/2011 8/15/2011 8/15/2011 JOHNS EASTERN COMPANY, INC. `V $50,000.00 HANDLING FEES $200,000.00 2012 2395313 11/4/2011 11/4/2011 11/8/2011 JOHNS EASTERN COMPANY, INC. $50,000.OD WORKERS COMPENSATION CLAIMS HANDLING 2012 2411996 3/7/2012 3/7/2012 3/22/2012 JOHNS EASTERN COMPANY, INC. $50,000.00 WORKERS COMPENSATION CLAIMS HANDLING 2012 2416900 5/2/2012 5/2/2012 5/22/2012 JOHNS EASTERN COMPANY, INC. $50,000.00 WORKER'S COMPENSTION CLAIMS HANDLING 20122433643 8/1/2012 8/14/2012 9/11/2012 JOHNS EASTERN COMPANY, INC. $50,000.00 WORKER'S COMPENSTION CLAIMS HANDLING $200,000.00 201312447497 10/30/2012 11/1/2012 11/9/2012 JOHNS EASTERN COMPANY, INC. $50,000.00 WORKERS COMP CLMS HANDLING 11/12-01/13 2013 246169D 2/22/2013 2/22/2013 2/28/2013 JOHNS EASTERN COMPANY, INC. $50,000.00 WIRE -WORKERS COMP CLAIMS HANDLING 02/01/13 - 04130/13 2013 2470792 5/1/2013 5/2/2013 5/7/2013 JOHNS EASTERN COMPANY, INC. $50,000.00 WORKERS COMP CLMS HANDLING 511/2013-7/3112013 2013 2482703 7/1/2013 8/1/2013 8/12/2013 JOHNS EASTERN COMPANY, INC. $50,000.00 WORKER'S COMP CLAIMS HANDLING 8/1 THROUGH 10/31/2013 $200,000.00 2014 2498810 11/1/2013 12/2/2013 12/17/2013 JOHNS EASTERN COMPANY, INC. $50,000.00 4TH QUARTER WORKERS' COMPENSATION CLAIMS HANDLING 11/01-01/31/14 2014 2506738 1/28/2014 1/29/2014 2/4/2014 JOHNS EASTERN COMPANY, INC. $50,000.00 IST QTR CLAIMS HANDLING FOR WORKERS' COMPENSATION 2014 2521400 5/5/2014 5/14/2014 5/16/2014 IJOHNS EASTERN COMPANY, INC. $50,000.00 WORKERS COMPENSATION CLAIMS HANDLING 5/01/2014-7/31/2014 $150,000.00 DocuSign Envelope ID: 6EEOD36E-ABE7416C-BB7C-9D91277D5AD3 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miarnibeachfi.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE ADDENDUM NO.2 REQUEST FOR PROPOSAL 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BYA THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY (the RFP) August 25, 2014 This Addendum to the above -referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. REVISIONS: The deadline for receipt of proposals is extended until 3:00p.m. Tuesday, September 9, 2014. Late submittals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays for which the Proposer is solely responsible. YOU ARE HEREBY ADVISED THAT THIS INVITATION TO NEGOTIATE IS UNDER THE CONE OF SILENCE—ORDINANCE NO. 2002-3378 WHICH MAY BE FOUND ON THE CITY OF MIAMI BEACH WEBSITE: http://www.miamibeachfl.gov/newcitv/der)ts/purchase/bidintro.as1) Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado(a)miamibeachfl.gov Contact: Telephone: Email: Steven Williams 305-673-7000 ext. 6650 Stevenwilliams@miamibeachfl.gov_ Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Proposers" questionnaire with the reason(s) for not submitting a proposal. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 ! Y IA Y BEAC 1 city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, w, w+.miamibeachll.gov PROCUREMENT DEPARTMENT Tel: 305-673-7490 For. 786394-4002 ADDENDUM NO. 1 REQUEST FOR PROPOSAL 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY (the RFP) August 20, 2014 This Addendum to the above -referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. REVISIONS: The due date for receipt of proposals has been extended until 3:00p,m. Tuesday, September 2, 2014. YOU ARE HEREBY ADVISED THAT THIS INVITATION TO NEGOTIATE IS UNDER THE CONE OF SILENCE—ORDINANCE NO. 2002-3378 WHICH MAY BE FOUND ON THE CITY OF MIAMI BEACH WEBSITE; http://www.miamlbeachfl.gov/newcity/depts/purchase/bidintro.asP Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranadoC@miamibeach&M Contact: Telephone: Email: Steven Williams 305-673-7000 ext. 6650 Stevenwilliams@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Proposers' questionnaire with the reason(s) for not submitting a proposal. Si Director RFP No. 2014 -302 -SW Addendum 41 812012014 DowSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 REQUEST FOR PROPOSALS {RFP) FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY RFP 2014 -302 -SW RFP ISSUANCE DATE-: JULY 24, 2014 PROPOSALS DUE: AUGUST 26, 2014 @ 3:00 PM ISSUED BY: Steven Williams MIAMBEACH Steven Williams, Procurement Coordinator PROCUREMENT DEPARTMENT 1700 Convention Center Drive, Miami Beach, FL 33139 305.673.7000 x6650 I Fax: 7B6.373. 4330 1 www.miamibeachfl.gov DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 /,IAM1BEACH TABLE OF CONTENTS SOLICITATION SECTIONS: PAGE i 0100 NOT UTILIZED........................................................................................................ f N/A 0200 INSTRUCTIONS -TO PROPOSERS & GENERAL CONDITIONS................................3 0300 PROPOSAL SUBMITTAL INSTRUCTIONS & FORMAT............................................10 0400 PROPOSAL EVALUATION.......................................................................................12 APPENDICES: PAGE APPENDIX A PROPOSAL CERTIFICATON, QUESTIONNAIRE AND AFFIDAVITS ........14 APPENDIX B "NO PROPOSAL" FORM............................................................................21 APPENDIX C MINIMUM REQUIREMENTS & SPECIFICATIONS.....................................23 APPENDIX D SPECIAL CONDITIONS.............................................................................34 APPENDIX E COST PROPOSAL FORM..........................................................................36 APPENDIX F INSURANCE REQUIREMENTS.................................................................40 APPENDIX G CLAIMS EXPERIENCE................................................................................42 RFP 2014 -302 -SW TPA Claims Adminisiralion for Workers Comp and Gen babili / 2 DocuSign Envelope to: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 ,MIAMI BEACH SECTION 0200 INSTRUCTIONS TO RESPONDENTS & GENERAL CONDITIONS 1. GENERAL. This Request for Proposals (RFP) is issued by the City of Miami Beach, Florida (the "City"), as the means for prospective Proposers to submit their qualifications, proposed scopes of work and cost proposals (the "proposal") to the City for the City's consideration as an option in achieving the required scope of services and requirements as noted herein. All documents released in connection with this solicitation, including all appendixes and addenda, whether included herein or released under separate cover, comprise the solicitation, and are complementary to one another and together establish the complete terms, conditions and obligations of the Proposers and, subsequently, the successful Proposer(s) (the "contractor[s]") if this RFP results in an award. The City utilizes, PublicPurchase (www.publicpurchase.com) for automatic notification of competitive solicitation opportunities and document fulfillment, including the issuance of any addendum to this RFP. Any prospective Proposer who has received this RFP by any means other than through PublicPurchase must register immediately with PublicPurchase to assure it receives any addendum issued to this RFP. Failure to receive an addendum may result in disqualification of proposal submitted. 2. PURPOSE. The City of Miami Beach (the "City") is approved by the Florida Department of Labor and Employment Security/Division of Workers' Compensation to self -insure for Workers' Compensation. The Division of Workers' Compensation requires that the claims administration be provided by a State Certified Workers' Compensation Claims Administrator. Therefore the City is seeking the professional services of an experienced and qualified firm to provide services as a third party administrator for Workers Compensation and General Liability, 3. SOLICITATION TIMETABLE. The tentative schedule for this solicitation is as follows: RFP Issued July 24, 2014 Pre -Proposal Meeting August 12, 2014 @ 10:30 a.m. Deadline for Receipt of Questions August 19, 2014 Responses Due August 26, 2014 @ 3:00p.m. Evaluation Committee Review TBD Proposer Presentations TBD Tentative Commission Approval Authorizing Negotiations TBD Contract Negotiations Following Commission Approval 4. PROCUREMENT CONTACT. Any questions or clarifications concerning this solicitation shall be submitted to the Procurement Contact named herein, in writing, with a copy to the City Clerk's Office, Rafael E. Granado via e-mail: RafaelGranado(a miamibeachfl.gov ; or facsimile: 786-394-4188. The Bid title/number shall be referenced on all correspondence. All questions or requests for clarification must be received no later than seven (7) calendar days prior to the date proposals are due as scheduled in Section 0200-3. All responses to questions/clarifications will be sent to all prospective Proposers in the form of an addendum. Procurement Contact: Telephone: Email: Steven Williams (305)673.7497 StevenWilliams@miamibeachE.gov RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 3 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D6AD3 MIAMIBEACH 5. PRE -PROPOSAL MEETING OR SITE VISIT(S). Only if deemed necessary by the City, a pre -proposal meeting or site visit(s) may be scheduled. A Pre -PROPOSAL conference will be held as scheduled in Solicitation Timeline above at the following address: City of Miami Beach City Hall - 4th Floor City Manager's Large Conference Room 1700 Convention Center Drive Miami Beach, Florida 33139 Attendance (in person or via telephone) is encouraged and recommended as a source of information, but is not mandatory, Proposers interested in participating in the Pre -Proposal Submission Meeting via telephone must follow these steps: (1) Dial the TELEPHONE NUMBER: 1- 888-270-9936 (Toll-free North America) (2) Enter the MEETING NUMBER: 1142644 Proposers who are interested in participating via telephone should send an e-mail to the contact person listed in this RFP expressing their intent to participate via telephone, 6. PRE -PROPOSAL INTERPRETATIONS. Oral information or responses to questions received by prospective Proposers are not binding on the City and will be without legal effect, including any information received at pre - submittal meeting or site visit(s). Only questions answered by written addenda will be binding and may supersede terms noted in this solicitation. Addendum will be released through PubiloPurchase, 7, CONE OF SILENCE. Pursuant to Section 2-486 of the City Code, all procurement solicitations once advertised and until an award recommendation has been forwarded to the City Commission by the City Manager are under the "Cone of Silence." The Cone of Silence ordinance is available at http://library.municode.comfiindex.aspx?clientlD=13097&statelD=9&statename=Florida. Any communication or inquiry in reference to this solicitation with any City employee or City official is strictly prohibited with the of exception communications with the Procurement Director, or his/her administrative staff responsible for administering the procurement process for this solicitation providing said communication is limited to matters`of process or procedure regarding the solicitation. Communications regarding this solicitation are to be submitted in writing to the Procurement Contact named herein with a copy to the City Clerk at rafaelgranado@miamibeach0.gov. Balance of Pape Intentionally Left Blank RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 4 DocuSign Envelope ID: 6EEDD36E-ABE7-416C-8B7C-9D91277DSAD3 MIAMI BEACH 8. SPECIAL NOTICES. You are hereby advised that this solicitation is subject to the following ordinances/resolutions, which may be found on the City Of Miami Beach website: http://web.miamibeachfl.gov/procuremenUscroll.aspx?id=23510 • CONE OF SILENCE..................................................................... • PROTEST PROCEDURES............................................................ • DEBARMENT PROCEEDINGS ........................ • LOBBYIST REGISTRATION AND DISCLOSURE OF FEES .................. • CAMPAIGN CONTRIBUTIONS BY VENDORS .............. I.................... • CAMPAIGN CONTRIBUTIONS BY LOBBYISTS ON PROCUREMENT ISSUES............................... ....................... • REQUIREMENT FOR CITY CONTRACTORS TO PROVIDE EQUAL BENEFITS FOR DOMESTIC PARTNERS.. .............................. • LIVING WAGE REQUIREMENT ....................... • LOCAL PREFERENCE FOR MIAMI BEACH -BASED VENDORS.......,. • PREFERENCE FOR FLORIDA SMALL BUSINESSES OWNED AND CONTROLLED BY VETERANS AND TO STATE -CERTIFIED SERVICE - DISABLED VETERAN BUSINESS ENTERPRISES • FALSE CLAIMS ORDINANCE......................................................... • ACCEPTANCE OF GIFTS, FAVORS & SERVICES .............................. CITY CODE SECTION 2A86 CITY CODE SECTION 2-371 CITY CODE SECTIONS 2-397 THROUGH 2-485.3 CITY CODE SECTIONS 2-481 THROUGH 2-406 CITY CODE SECTION 2487 CITY CODE SECTION 2488 CITY CODE SECTION 2-373 CITY CODE SECTIONS 2-407 THROUGH 2.410 CITY CODE SECTION 2-372 CITY CODE SECTION 2-374 CITY CODE SECTION 70-300 CITY CODE SECTION 2A49 9. POSTPONEMENT OF DUE DATE FOR RECEIPT OF PROPOSALS, The City reserves the right to postpone the deadline for submittal of proposals and will make a reasonable effort to give at least three (3) calendar days written notice of any such postponement to all prospective Proposers through PublicPurchase. 10. PROTESTS, Protests concerning the specifications, requirements, and/or terms; or protests after the proposal due date in accordance with City Code Section 2-371, which establishes procedures for protested proposals and proposed awards. Protests not submitted in a timely manner pursuant to the requirements of City Code Section 2- 371 shall be barred. 11. MIAMI BEACH -BASED VENDORS PREFERENCE. Pursuant to City of Miami Beach Ordinance No. 2011-3747, a five (5) point preference will be given to a responsive and responsible Miami Beach -based Proposer, 12, VETERAN BUSINESS ENTERPRISES PREFERENCE. Pursuant to City of Miami Beach Ordinance No. 2011- 3748, the City shall give a five (5) point preference to a responsive and responsible Proposer which is a small business concern owned and controlled by a veteran(s) or which is a service -disabled veteran business enterprise. 13, DETERMINATION OF AWARD. The final ranking results of Step 1 & 2 outlined in Section 0400, Evaluation of Proposals, will be considered by the City Manager who may recommend to the City Commission the Proposer(s) s/he deems to be in the best interest of the City or may recommend rejection of all proposals, The City Manager's recommendation need not be consistent with the scoring results identified herein and takes into consideration Miami Beach City Code Section 2-369, including the following considerations: (1) The ability, capacity and skill of the Proposer to perform the contract. (2) Whether the Proposer can perform the contract within the time specified, without delay or interference. (3) The character, integrity, reputation, judgment, experience and efficiency of the Proposer. (4) The quality of performance of previous contracts. (5) The previous and existing compliance by the Proposer with laws and ordinances relating to the contract. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen liability 5 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 MiAM BEACH The City Commission shall consider the City Manager's recommendation and may approve such recommendation. The City Commission may also, at its option, reject the City Manager's recommendation and select another Proposal or Proposals which it deems to be in the best interest of the City, or it may also reject all Proposals. Upon approval of selection by the City Commission, negotiations between the City and the selected Proposer(s) will take place to arrive at a mutually acceptable Agreement. 14, ACCEPTANCE OR REJECTION OF PROPOSALS. The City reserves the right to reject any or all proposals prior to award. Reasonable efforts will be made to either award the Contract or reject all proposals within one - hundred twenty (120) calendar days after proposals opening date, A Proposer may not withdraw its proposals unilaterally before the expiration of one hundred and twenty (120) calendar days from the date of proposals opening. 15. PROPOSER'S RESPONSIBILITY, Before submitting a Proposal, each Proposer shall be solely responsible for making any and all investigations, evaluations, and examinations, as it deems necessary, to ascertain all conditions and requirements affecting the full performance of the contract. Ignorance of such conditions and requirements, and/or failure to make such evaluations, investigations, and examinations, will not relieve the Proposer from any obligation to comply with every detail and with all provisions and requirements of the contract, and will not be accepted as a basis for any subsequent claim whatsoever for any monetary consideration on the part of the Proposer. 16. COSTS INCURRED BY PROPOSERS. All expenses involved with the preparation and submission of Proposals, or any work performed in connection therewith, shall be the sole responsibility (and shall be at the sole cost and expense) of the Proposer, and shall not be reimbursed by the City, 17. RELATIONSHIP TO THE CITY. It is the intent of the City, and Proposers hereby acknowledge and agree, that the successful Proposer is considered to be an independent contractor, and that neither the Proposer, nor the Proposer's employees, agents, and/or contractors, shall, under any circumstances, be considered employees or agents of the City. 18. TAXES. The City of Miami Beach is exempt from all Federal Excise and State taxes. 19. MISTAKES, Proposers are expected to examine the terms, conditions, specifications, delivery schedules, proposed pricing, and all instructions pertaining to the goods and services relative to this RFP. Failure to do so will be at the Proposer's risk and may result in the Proposal being non-responsive. 20. PAYMENT. Payment will be made by the City after the goods or services have been received, inspected, and found to comply with contract, specifications, free of damage or defect, and are properly invoiced. Invoices must be consistent with Purchase Order format. 21. PATENTS & ROYALTIES. Proposer shall indemnify and save harmless the City of Miami Beach, Florida, and its officers, employees, contractors, and/or agents, from liability of any nature or kind, including cost and expenses for, or on account of, any copyrighted, patented, or unpatented invention, process, or article manufactured or used in the performance of the contract, including its use by the City of Miami Beach, Florida. If the Proposer uses any design, device or materials covered by letters, patent, or copyright, it is mutually understood and agreed, without exception, that the proposal prices shall include all royalties or cost arising from the use of such design, device, or materials in any way involved in the work. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen tiobility 6 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 AnWAI BEACH 22. MANNER OF PERFORMANCE. Proposer agrees to perform its duties and obligations in a professional manner and in accordance with all applicable Local, State, County, and Federal laws, rules, regulations and codes. Lack of knowledge or ignorance by the Proposer withlof applicable laws will in no way be a cause for relief from responsibility. Proposer agrees that the services provided shall be provided by employees that are educated, trained, experienced, certified, and licensed in all areas encompassed within their designated duties. Proposer agrees to furnish to the City any and all documentation, certification, authorization, license, permit, or registration currently required by applicable laws, rules, and regulations. Proposer further certifies that it and its employees will keep all licenses, permits, registrations, authorizations, or certifications required by applicable laws or regulations in full force and effect during the term of this contract. Failure of Proposer to comply with this paragraph shall constitute a material breach of this contract. Where contractor is required to enter or go on to City of Miami Beach property to deliver materials or perform work or services as a result of any contract resulting from this solicitation, the contractor will assume the full duty, obligation and expense of obtaining all necessary licenses, permits, and insurance, and assure all work complies with all applicable laws. The contractor shall be liable for any damages or loss to the City occasioned by negligence of the Proposer, or its officers, employees, contractors, and/or agents, for failure to comply with applicable laws. 23. SPECIAL CONDITIONS. Any and all Special Conditions that may vary from these General Terms and Conditions shall have precedence. 24, ANTIDISCRIMINATION. The Proposer certifies that he/she is in compliance with the non-discrimination clause contained in Section 202, Executive Order 11246, as amended by Executive Order 11375, relative to equal employment opportunity for all persons without regard to race, color, religion, sex or national origin. 25. DEMONSTRATION OF COMPETENCY, A. Pre -award inspection of the Proposer's facility may be made prior to the award of contract. B. Proposals will only be considered from firms which are regularly engaged in the business of providing the goods and/or services as described in this solicitation. C. Proposers must be able to demonstrate a good record of performance for a reasonable period of time, and have sufficient financial capacity, equipment, and organization to ensure that they can satisfactorily perform the services if awarded a contract under the terms and conditions of this solicitation. D. The terms "equipment and organization", as used herein shall, be construed to mean a fully equipped and well established company in line with the best business practices in the industry, and as determined by the City of Miami Beach. E. The City may consider any evidence available regarding the financial, technical, and other qualifications and abilities of a Proposer, including past performance (experience), in making an award that is in the best interest of the City. F. The City may require Proposers to show proof that'they have been designated as authorized representatives of a manufacturer or supplier, which is the actual source of supply. In these instances, the City may also require material information from the source of supply regarding the quality, packaging, and characteristics of the products to be supply to the City. 26. ASSIGNMENT. The successful Proposer shall not assign, transfer, convey, sublet or otherwise dispose of the contract, including any or all of its right, title or interest therein, or his/her or its power to execute such contract, to any person, company or corporation, without the prior written consent of the City. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 7 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 MiArVi BEACH 27. LAWS, PERMITS AND REGULATIONS. The Proposer shall obtain and pay for all licenses, permits, and inspection fees required to complete the work and shall comply with all applicable laws. 28. OPTIONAL CONTRACT USAGE. When the successful Proposer (s) is in agreement, other units of government or non-profit agencies may participate in purchases pursuant to the award of this contract at the option of the unit of government or non-profit agency. 29. VOLUME OF WORK TO BE RECEIVED BY CONTRACTOR. It is the intent of the City to purchase the goods and services specifically listed in this solicitation from the contractor. However, the City reserves the right to purchase any goods or services awarded from state or other governmental contract, or on an as -needed basis through the City's spot market purchase provisions. 30. DISPUTES. In the event of a conflict between the documents, the order of priority of the documents shall be as follows; A. Any contract or agreement resulting from the award of this solicitation; then B. Addendum issued for this solicitation, with the latest Addendum taking precedence; then C. The solicitation; then D. The Proposer's proposal in response to the solicitation, 31. INDEMNIFICATION. The contractor shall indemnify and hold harmless the City and its officers, employees, agents and instrumentalities from any and all liability, losses or damages, including attorney's fees and costs of defense, which the City or its officers, employees, agents or instrumentalities may incur as a result of claims, demands, suits, causes of actions or proceedings of any kind or nature arising out of, relating to or resulting from the performance of the agreement by the contractor or its employees, agents, servants, partners, principals or subcontractors. The contractor shall pay all claims and losses in connection therewith, and shall investigate and defend all claims, suits or actions of any kind or nature in the name of the City, where applicable, including appellate proceedings, and shall pay all costs, judgments, and attorney's fees which may be incurred thereon. The contractor expressly understands and agrees that any insurance protection required by this Agi&eement or otherwise provided by the contractor shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The above indemnification provisions shall survive the expiration or termination of this Agreement. 32, CONTRACT EXTENSION, The City reserves the right to require the Contractor to extend contract past the stated termination date for a period of up to 120 days in the event that a subsequent contract has not yet been awarded. Additional extensions past the 120 days may occur as needed by the City and as mutually agreed upon by the City and the contractor. Balance of Page Intentionally Left Blank RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liabilily 8 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 MIAMI BEACH 33. FLORIDA PUBLIC RECORDS LAW. Proposers are hereby notified that all Bid including, without limitation, any and all information and documentation submitted therewith, are exempt from public records requirements under Section 119.07(1), Florida Statutes, and s. 24(a), Art, 1 of the State Constitution until such time as the City provides notice of an intended decision or until thirty (30) days after opening of the proposals, whichever is earlier. Additionally, Contractor agrees to be in full compliance with Florida Statute 119.0701 including, but not limited to, agreement to (a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the services; (b) provide the public with access to public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law; (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law; (d) Meet all requirements for retaining public records and transfer, at no cost, to the public agency all public records in possession of the contractor upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the public agency in a format that is compatible with the information technology systems of the public agency. 34. MODIFICATIONIWITHDRAWALS OF PROPOSALS, A Proposer may submit a modified Proposal to replace all or any portion of a previously submitted Proposal up until the Proposal due date and time. Modifications received after the Proposal due date and time will not be considered. Proposals shall be irrevocable until contract award unless withdrawn in writing prior to the Proposal due date, or after expiration of 120 calendar days from the opening of Proposals without a contract award. Letters of withdrawal received after the Proposal due date and before said expiration date, and letters of withdrawal received after contract award will not be considered. 35. EXCEPTIONS TO RFP. Proposers must clearly indicate any exceptions they wish to take to any of the terms in this RFP, and outline what, if any, alternative is being offered. All exceptions and alternatives shall be included and clearly delineated, in writing, in the Proposal. The City, at its sole and absolute discretion, may accept or reject any or all exceptions and alternatives. In cases in which exceptions and alternatives are rejected, the City shall require the Proposer to comply with the particular term and/or condition of the RFP to which Proposer took exception to (as said term and/or condition was originally set forth on the RFP). 36. ACCEPTANCE OF GIFTS; FAVORS, SERVICES. Proposers shall not offer any gratuities, favors, or anything of monetary value to any official, employee, or agent of the City, for the purpose of influencing consideration of this Proposal. Pursuant to Sec. 2-449 of the City Code, no officer or employee of the City shall accept any gift, favor or service that might reasonably tend improperly to influence him in the discharge of his official duties. Balance of Pape fntentfonalty Left Blank RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen liability 9 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277DSAD3 .N,IAMI BEACH SECTION 0300 PROPOSAL SUBMITTAL INSTRUCTIONS AND FORMAT 1. SEALED RESPONSES. One original Proposal (preferably in 3 -ring binder) must be submitted in an opaque, sealed envelope or container on or before the due date established for the receipt of proposals. Additionally, ten (10) bound copies and one (1) electronic format (CD or USB format) are to be submitted. The following information should be clearly marked on the face of the envelope or container in which the proposal is submitted: solicitation number, solicitation title, Proposer name, Proposer return address. Proposals received electronically, either through email or facsimile, are not acceptable and will be rejected. 2. LATE BIDS. Bid Proposals are to be received on or before the due date established herein for the receipt of Bids. Any Bid received after the deadline established for receipt of proposals will be considered late and not be accepted or will be returned to Proposer unopened. The City does not accept responsibility for any delays, natural or otherwise. 3. PROPOSAL FORMAT. In order to maintain comparability, facilitate the review process and assist the Evaluation Committee in review of proposals, it is strongly recommended that proposals be organized and tabbed in accordance with the sections and manner specified below. Hard copy submittal should be tabbed as enumerated below and contain a table of contents with page references. Electronic copies should also be tabbed and contain a table of contents with page references. Proposals that do not include the required information will be deemed non- responsive and will not be considered. Cover Letter & Minimum Qualifications Requirements 1.1 Cover Letter and Table of Contents. The cover letter must indicate Proposer and Proposer Primary Contact for the purposes of this solicitation. 1.2 Proposal Certification, Questionnaire & Requirements Affidavit (Appendix A). Attach Appendix A fully completed and executed. 1.3 Minimum Qualifications Requirements. Submit verifiable information documenting compliance with the minimum qualifications requirements established in Appendix C, Minimum Requirements and Specifications. 2.1 Qualifications of Proposing Firm. Submit detailed information regarding the firm's history and relevant experience and proven track record of providing the scope of services similar as identified in this solicitation, including experience in providing similar scope of services to public sector agencies. For each project that the Proposer submits as evidence of similar experience, the following is required: project description, agency name, agency contact, contact telephone & email, and year(s) and term of engagement. 2.2 Qualifications of Proposer Team. Provide an organizational chart of all personnel and consultants to be used for this project if awarded, the role that each team member will play in providing the services detailed herein and each team members' qualifications. A resume of each individual, including education, experience, and any other pertinent information, shall be included for each Proposal team member to be assigned to this contract. 2.3 Financial Capacity. Each Proposer shall arrange for Dun & Bradstreet to submit.a Supplier Qualification Report (SQR) directly to the Procurement Contact named herein. No proposal will be considered without receipt, by the City, of the SQR directly from Dun & Bradstreet. The cost of the preparation of the SQR shall be the responsibility of the Proposer. The Proposer shall request the SQR report from D&B at: https:llsuppl ierportal.dnb.comfwebappfwcslstoreslservl etlSupplierPortal? storeld=11696 Proposers are responsible for the accuracy of the information contained in its SQR. It is highly recommended that each Proposer review the information contained in its SQR for accuracy prior to submittal to the City and as early as possible in the solicitation process. For assistance with any portion of the SQR submittal process, contact Dun & Bradstreet at 800.424.2495. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 10 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277DSAD3 V11AMI BEACH Submit detailed information addressing how Proposer will achieve each portion of the scope technical requirements outlined in Appendix C, Minimum Requirements and Specifications. Responses shall be in sufficient detail and include supporting documentation, as applicable, which will allow the Evaluation Committee to complete a fully review and score the proposed scope of services. Approach and Methodology Submit detailed information on how Proposer plans to accomplish the required scope of services, including detailed information, as applicable, which addresses, but need not be limited to; implementation plan, project timeline, phasing options testing and risk mitigation options for assuring project is implemented on time and within budget. Proposers must submit pricing for all three options. The City will review each option and reserves the right to select the option that is most advantageous to the City. If pricing is included or at no additional charge, proposer must indicate "Included" or't`bAdditional Charge," as applicable, within the Cost Proposal. Failure to submit pricing for all three options request in the Cost Proposal Form will result in the proposals being considered non-responsive and not further considered. Note: After proposal submittal, the City reserves the right to require additional information from Proposers (or Proposer team members or sub -consultants) to determine: qualifications (including, but not limited to, litigation history, regulatory action, or additional references); and financial capability (including, but not limited to, annual reviewed/audited financial statements with the auditors notes for each of their last two complete fiscal years). RFP 2014 -302 -SW TPA Claims Adminislrolion for Workers Comp and Gen tiabilily 1 1 DocuSign Envelope ID: 6EEOD36E-ASE7-416C-8B7C-9091277D5AD3 MIAMI BEACH SECTION 0400 PROPOSAL EVALUATION 1. Evaluation Committee. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the requirements set forth in the solicitation. If further information is desired, Proposers may be requested to make additional written submissions of a clarifying nature or oral presentations to the Evaluation Committee. The evaluation of proposals will proceed in a two-step process as noted below. It is important to note that the Evaluation Committee will score the qualitative portions of the proposals only. The Evaluation Committee does not make an award recommendation to the City Manager, The results of Step 1 & Step 2 Evaluations will be forwarded to the City Manager who will utilize the results to make a recommendation to the City Commission. 2. Step 1 Evaluation. The first step will consist of the qualitative criteria listed below to be considered by the Evaluation Committee. The second step will consist of quantitative criteria established below to be added to the Evaluation Committee results by the Procurement Department. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the qualifications criteria established below for Step 1, Qualitative Criteria. In doing so, the Evaluation Committee may: • review and score all proposals received, with or without conducting interview sessions; or • review all proposals received and short-list one or more Proposers to be further considered during subsequent interview session(s) (using the same criteria). Proposer Experience and Qualifications, Including Financial Capability 25 Scope of Services Proposed 25 Approach and Methodology h%>, v iy.a €'7,CxFy✓ ti 5aS y a't V�'°&( ,s}il ws?t }*r A. 2-N35q .3 Iq,�r,t�T1yTOTALAVI11LnaBLESTEPIPOINTSyNI=g 85a 3. Step 2 Evaluation, Following the results of Step 1 Evaluation of qualitative criteria, the Proposers may receive additional quantitative criteria points to be added by the Procurement Department to those points earned in Step 1, as follows. Cost Proposal (Based on Average Total Points) Miami Beach -Based Vendor Preference 15 Veterans Preference 5 4. Cost Proposal Evaluation, The cost proposal points shall be developed in accordance with the following formula: RF 2P 014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 12 Sample Objective Formula for Cost Vendor Vendor Example Maximum Formula for Calculating Points Total Cost Allowable Points (lowest cost 1 cost of proposal Points Proposal (points noted are for being evaluated X maximum Awarded Illustrative purposes only. allowable points = awarded Actual points are noted points) above.) Roundto Vendor A $100.00 20 $1001$100 X 20 = 20 20 Vendor B$150.00 20 $100 I $150 X 20 =13 13 Vendor C $200.00 7g $1001$200 X 20 =10 10 RF 2P 014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 12 DomSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9091277D5AD3 MIAMI BEACH Note: In evaluating cost proposals, the City will evaluate each option from all proposals in accordance with ` the methodology established above (lowest price i proposers price x maximum number of points = assigned points) and then calculate the Average Total Points for each proposer as indicated below. Averaged Cost Proposal Points: * Points will be rounded to the nearest whole number. The Average Total Points will be utilized in the Step 2 Qualitative Criteria portion of the evaluation noted above, 5. Determination of Final Ranking, At the conclusion of the Evaluation Committee Step 1 scoring, Step 2 Points will be added to each evaluation committee member's scores by the Procurement Department Management. Step 1 and 2 scores will be converted to rankings in accordance with the example below: recommendation to the City Commission. Final Ranking does not constitute an award recommendation until such time as the City Manager has made his recommendation to the City Commission, which may be different than final ranking results. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 13 A B C Vendor Total Option 1 Total Option 2 Total Option 3 Average Total Points A+B+Cl3 * Pro oserX 15 12 14 14 Proposer Y 10 15 12 12 * Points will be rounded to the nearest whole number. The Average Total Points will be utilized in the Step 2 Qualitative Criteria portion of the evaluation noted above, 5. Determination of Final Ranking, At the conclusion of the Evaluation Committee Step 1 scoring, Step 2 Points will be added to each evaluation committee member's scores by the Procurement Department Management. Step 1 and 2 scores will be converted to rankings in accordance with the example below: recommendation to the City Commission. Final Ranking does not constitute an award recommendation until such time as the City Manager has made his recommendation to the City Commission, which may be different than final ranking results. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 13 DocuSign Envelope ID: 6EEDD36E-ABE7-416C-6B7C-9D91277D6AD3 APPENDIX A MIAMI BEACH Proposal Certification, Questionnaire & Requirements Affidavit RFP 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP 2014-302-§W TPA Claims Administration for Workers Comp and Gen Liability 14 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Solicitation No: Soricital' nTIUo: 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY FIRM PRIMARY ADDRESS (HEADQUARTERS): ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL STATE: LIABILITY Procurement contact Tel: Emall: Steven Williams 305-673-7000, x. 6650 Stevenwilliams miamibeachfl. ov PROPOSAL CERTIFICATION, QUESTIONNAIRE & REQUIREMENTS AFFIDAVIT Purpose: The purpose of this Proposal Certification, Questionnaire and Requirements Affidavit Form is to inform prospective Proposers of certain solicitation and contractual requirements, and to collect necessary information from Proposers in order that certain portions of responsiveness, responsibility and other determining factors and compliance with requirements may be evaluated. This Proposal Certification, Questionnaire and Requirements Affidavit Form is a REQUIRED FORM that must be submitted fully completed and executed. General Proposer Information. No of Years inBusiness: No of Years in Business Locally: No. of Employees: OTHER NAME(S) PROPOSER HAS OPERATED UNDER IN THE LAST 10 YEARS: FIRM PRIMARY ADDRESS (HEADQUARTERS): CITY; STATE: ZIP CODE: TELEPHONE NO.: TOLL FREE NO.: 'FAX NO.: FIRM LOCAL ADDRESS: CITY: STATE: ZIP CODE: PRIMARY ACCOUNT REPRESENTATIVE FOR THIS ENGAGEMENT: The City reserves the right to seek additional information from Proposer or other source(s), including but not limited t0: any firm or principal information, applicable licensure, resumes of relevant individuals, client information, financial information, or any information the City deems necessary to evaluate the capacity of the Proposer to perform In accordance with contract requirements. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 15 DocuSign Envelope ID: 6EEOD36E-ABE7416C-6B7C-9D91277D5AD3 Miami Beach Based (Local Vendor. Is Proposer claiming Miami Beach based firm status? YES = NO SUBMITTAL REQUIREMENT: Proposers claiming Miami Beach vendor status shall submit a Business Tax Receipt issued by the City of Miami Beach and the proof of residency requirement, as required pursuant to ordinance 2011.3747, as amended, to demonstrate that the Proposer is a Miami Beach Based Vendor. Veteran Owned Business. Is Proposer claiming a veteran owned business status? =YES = NO SUBMITTAL REQUIREMENT: Proposers claiming veteran owned business status shall submit a documentation proving that firm is certified as a veteran -owned business or a service -disabled veteran owned business by the State of Florida or United States federal government, as required pursuant to ordinance 2011.3748, as amended.. Conflict Of Interest, All Proposers must disclose, in their Proposal, the name(s) of any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach, Further, all Proposers must disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more In the Proposer entity or any of its affiliates. SUBMITTAL REQUIREMENT: Proposers must disclose the name(s) of any officer, director, agent, or Immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Proposers must also disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates 4. References & Past Performance. Proposer shall submit at least three (3) references for whom the Proposer has completed work similar in size and nature as the work referenced in solicitation. SUBMITTAL REQUIREMENT: For each reference submitted, the following information Is required: 1) Firm Name, 2) Contact Individual Name & Title, 3) Address, 4) Telephone, 5) Contact's Email and 6) Narrative on Scope of Services Provided. 5. Suspension, Debarment or Contract Cancellation, Has Proposer ever been debarred, suspended or other legal violation, or had a contract cancelled due to non-performance by any public sector agency? = YES NO SUBMITTAL REQUIREMENT: If answer to above is 'YES," Proposer shall submit a statement detailing the reasons that led to action(s). 6, Litigation History. Proposer shall submit a statement of any litigation or regulatory action that has been fled against your firm(s) in the last five years. If an action has been fled, state and describe the litigation or regulatory action filed, and identify the court or agency before which the action was instituted, the applicable case or file number, and the status or disposition for such reported action. If no litigation or regulatory action has been filed against your firm(s), provide a statement to that effect. If "No" litigation or regulatory action has been fled against your firm(s), please provide a statement to that effect. Truthful and complete answers to this question may not necessarily disqualify a firm from consideration but will be a factor in the selection process. Untruthful, misleading or false answers to this question shall result in the disqualification of the firm for this project. SUBMITTAL REQUIREMENT: Proposer shall submit history of litigation or regulatory action filed against proposer, or any proposer team member firm, in the past 5 years. If Proposer has no litigation history or regulatory action in the past 5 years, submit a statement accordingly, . Vendor Campaign Contributions. Proposers are expected to be or become familiar with, the Citys Campaign Finance Reform laws, as codified in Sections 2-487 through 2490 of the City Code. Proposers shall be solely responsible for ensuring that all applicable provisions of the City's Campaign Finance Reform laws are complied with, and shall be subject to any and all sanctions, as prescribed therein, including disqualification of their Proposals, in the event of such non- compliance. SUBMITTAL REQUIREMENT: Submit the names of all individuals or entities (including your sub -consultants) with a controlling financial interest as defined in solicitation. For each individual or entity with a controlling financial interest indicate RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen liability 16 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 whether or not each individual or entity has contributed to the campaign either directly or indirectly, of a candidate who has been elected to the office of Mayor or City Commissioner for the City of Miami Beach. 8. Code of Business Ethics, Pursuant to City Resolution No.2000-23879, each person or entity that seeks to do business with the City shall adopt a Code of Business Ethics ("Code") and submit that Code to the Procurement Department with its proposallresponse or within five (5) days upon receipt of request. The Code shall, at a minimum, require the Proposer, to comply with all applicable governmental rules and regulations including, among others, the conflict of interest, lobbying and ethics provision of the City of Miami Beach and Miami Dade County. SUBMITTAL REQUIREMENT: Proposer shall submit firm's Cade of Business Ethics. In lieu of submitting Code of Business Ethics, Proposer may submit a statement Indicating that it will adopt, as required in the ordinance, the City of Miami Beach Code of Ethics, available at vn^nv.miamibeachfi.govlprocurementl. Living Wage. Pursuant to Section 2-408 of the Miami Beach City Code, as same may be amended from time to time, Proposers shall be required to pay all employees who provide services pursuant to this Agreement, the hourly living wage rates listed below: • Commencing with City fiscal year 2012-13 (October 1, 2012), the hourly living rate will be $11.281hr with health benefits, and $12.921hr without benefits. The living wage rate and health care benefits rate may, by Resolution of the City Commission be indexed annually for Inflation using the Consumer Price Index for all Urban Consumers (CPI -U) MiarnVFt. Lauderdale, issued by the U.S. Department of Labor's Bureau of Labor Statistics. Notwithstanding the preceding, no annual Index shall exceed three percent (3%). The City may also, by resolution, elect not to index the living wage rate in any particular year, If It determines it would not be fiscally sound to Implement same (in a particular year). Proposers' failure to comply with this provision shall be deemed a material breach under this proposal, under which the City may, at its sole option, immediately deem said Proposer as non-responsive, and may further subject Proposer to additional penalties and fines, as provided in the City's Living Wage Ordinance, as amended. Further information on the Living Wage requirement is available at www.miamibeachfl.gov/procuremeng. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document Proposer agrees to the living wage requirement. 10. Equal Benefits for Employees with Spouses and Employees with Domestic Partners. When awarding competitively solicited contracts valued at over $100,000 whose contractors maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks, the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive proposals, to provide "Equal Benefits' to their employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a Contractor who work within the City limits of the City of Miami Beach, Florida; and the Contractor's employees located in the United Slates, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? 0 YES = NO B. Does your company provide or offer access to any benefits to employees with (same or opposite sex) domestic partners* or to domestic partners of employees? = YES 0 NO C. Please check all benefits that apply to your answers above and list in the °other" section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave; other benefits are provided directly to the spouse or domestic partner, such as medical insurance. BENEFIT Firm Provides far Employees with Spouses Firm Provides for Employees with Dcmestic Partners Firm does not Provide Benefit Health Sick Leave Family Medical Leave RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 17 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277DSAD3 Bereavement Leave If Proposer cannot offer a benefit to domestic partners because of reasons outside your control, leg., there are no Insurance providers in your area willing to offer domestic partner coverage) you may be eligible for Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent and submit a completed Reasonable Measures Application (attached) with all necessary documentation. Your Reasonable Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval Is not guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement Is available at www.miamlbeachfl.gov/procurementY. 11. Public Entity Crimes. Section 287.133(2)(a), Florida Statutes, as currently enacted or as amended from time to time, states that a person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a proposal, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a proposal, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit proposals, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in s. 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document. Proposer agrees with the requirements of Section 287.133, Florida Statutes, and certifies It has not been placed on convicted vendor list. 12. Acknowledgement of Addendum. After issuance of solicitation, the City may release one or more addendum to the solicitation which may provide additional Information to Proposers or alter solicitation requirements. The City will stove to reach every Proposer having received solicitation through the City's e•procurement system, PubllcPurchase.com. However, Proposers are solely responsible for assuring they have received any and all addendum issued pursuant to solicitation. This Acknowledgement of Addendum section certifies that the Proposer has received all addendum released by the City pursuant to this solicitation. Failure to obtain and acknowledge receipt of all addendum may result in proposal disqualification. Initial to confirm Recel InWel to ConfirInitial to Confan Reel tm Receipt Addendum 1 Addendum 6 Addendum 11 Addendum 2 Addendum 7 Addendum 12 Addendum 3 Addendum 8 Addendum 13 Addendum 4 Addendum 9 Addendum 14 Addendum 5 Addendum 10 Addendum 15 fad itional confirmation of addendum Is reauired. submit under separate rover. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 18 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 The solicitation referenced herein is being furnished to the recipient by the City of Miami Beach (the "City") for the recipient's convenience. Any action taken by the City In response to Proposals made pursuant to this solicitation, or in making any award, or in failing or refusing to make any award pursuant to such Proposals, or in cancelling awards, or in withdrawing or cancelling this solicitation, either before or after issuance of an award, shall be without any liability or obligation on the part of the City. In its sole discretion, the City may withdraw the solicitation either before or after receiving proposals, may accept or reject proposals, and may accept proposals which deviate from the solicitation, as it deems appropriate and in its best interest In its sole discretion, the City may determine the qualifications and acceptability of any party or parties submitting Proposals in response to this solicitation. Following submission of a Bid or Proposal, the applicant agrees to deliver such further details, Information and assurances, including financial and disclosure data, relating to the Proposal and the applicant Including, without limitation, the applicant's affiliates, officers, directors, shareholders, partners and employees, as requested by the City in Its discretion. The Information contained herein Is provided solely for the convenience of prospective Proposers. It is the responsibility of the recipient to assure Itself that information contained herein is accurate and complete. The City does not provide any assurances as to the accuracy of any information in this solicitation. Any reliance on these contents, or on any permitted communications with City officials, shall be at the recipient's own risk. Proposers should rely exclusively on their own investigations, interpretations, and analyses. The solicitation is being provided by the City without any warranty or representation, express or implied, as to Its content, Its accuracy, or its completeness. No warranty or representation is made by the City or its agents that any Proposal conforming to these requirements will be selected for consideration, negotiation, or approval. The City shall have no obligation or liability with respect to this solicitation, the selection and the award process, or whether any award will be made. Any recipient of this solicitation who responds hereto fully acknowledges all the provisions of this Disclosure and Disclaimer, is totally relying on this Disclosure and Disclaimer, and agrees to be bound by the terms hereof. Any Proposals submitted to the City pursuant to this solicitation are submitted at the sole risk and responsibility of the party submitting such Proposal. This solicitation is made subject to correction of errors, omissions, or withdrawal from the market without notice. Information is for guidance only, and does not constitute all or any part of an agreement. The City and all Proposers will be bound only as, if and when a Proposal (or Proposals), as same may be modified, and the applicable definitive agreements pertaining thereto, are approved and executed by the parties, and then only pursuant to the terms of the definitive agreements executed among the parties. Any response to this solicitation may be accepted or rejected by the City for any reason, or for no reason, without any resultant liability to the City. The City is governed by the Government -in -the -Sunshine Law, and all Proposals and supporting documents shall be subject to disclosure as required by such law. All Proposals shall be submitted in sealed proposal farm and shall remain confidential to the extent permitted by Florida Statutes, until the date and time selected for opening the responses. At that time, all documents received by the City shall become public records. Proposers are expected to make all disclosures and declarations as requested in this solicitation. By submission of a Proposal, the Proposer acknowledges and agrees that the City has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement Information contained in the Proposal, and authorizes the release to the City of any and all Information sought in such inquiry or investigation. Each Proposer certifies that the information contained in the Proposal is true, accurate and complete, to the best of its knowledge, information, and belief. Notwithstanding the foregoing or anything contained in the solicitation, all Proposers agree that in the event of a final unappeasable judgment by a court of competent jurisdiction which imposes on the City any liability arising out of this solicitation, or any response thereto, or any action or inaction by the City with respect thereto, such liability shall be limited to $10,000.00 as agreed-upon and liquidated damages. The previous sentence, however, shall not be construed to circumvent any of the other provisions of this Disclosure and Disclaimer which Imposes no liability on the City. In the event of any differences in language between this Disclosure and Disclaimer and the balance of the solicitation, it is understood that the provisions of this Disclosure and Disclaimer shall always govem. The solicitation and any disputes arising from the solicitation shall be governed by and construed in accordance with the laws of the Slate of Florida. RFP 2014.302 -SW TPA Claims Administration for Workers Comp and Gen Liability 19 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 I hereby certify that: I, as an authorized agent of the Proposer, am submitting the following information as my firm's proposal; Proposer agrees to complete and unconditional acceptance of the terms and conditions of this document, inclusive of this solicitation, all attachments, exhibits and appendices and the contents of any Addenda released hereto, and the Disclosure and Disclaimer Statement; Proposer agrees to be bound to any and all specifications, terms and conditions contained in the solicitation, and any released Addenda and understand that the following are requirements of this solicitation and failure to comply will result in disqualification of proposal submitted; Proposer has not divulged, discussed, or compared the proposal with other Proposers and has not colluded with any other Proposer or party to any other proposal; Proposer acknowledges that all information contained herein is part of the public domain as defined by the State of Florida Sunshine and Public Records Laws; all responses, data and information contained in this proposal, inclusive of the Proposal Certification. Questionnaire and Requirements Affidavit are true and accurate, Name of Proposers Authorized Representative: Title of Proposals Aulhodzed Represenlative: SignaWre of Proposers Authorized Representative: Date: State of ) On this _day of , 20_, personally appeared before me who County of ) stated that (s)he is the of ! a corporation, and that the instrument was signed in behalf of the said corporation by authority of its board of directors and acknowledged said instrument to be its voluntary act and deed. Before me: Notary Public for the State of Florida My Commission Expires: RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 20 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPENDIX B "No Bid" Form RFP 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 r RFP 2014 302 SW TPA Claims Administration for Workers Comp and Gen Liabili y 21 DomSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Statement of No Bid WE HAVE ELECTED NOT TO SUBMIT A PROPOSAL AT THIS TIME FOR REASON(S) CHECKED AND/OR INDICATED BELOW: _ Workload does not allow us to proposal _Insufficient time to respond _ Specifications unclear or too restrictive Unable to meet specifications _Unable to meet service requirements _Unable to meet insurance requirements _Do not offer this product/service _OTHER. (Please specify) We do _ do not _ want to be retained on your mailing list for future proposals of this type product and/or service. Title: Legal Company Name: Note: Failure to respond, either by submitting a proposal or this completed form, may result in your company being removed from our vendors list. PLEASE RETURN TO: CITY OF MIAMI BEACH DEPT. OF PROCUREMENT MANAGEMENT ATTN: Steven Williams PROPOSAL #2014 -302 -SW 1700 Convention Center Drive MIAMI BEACH, FL 33139 RFP 2014.302 -SW TPA Claims Ad ministration or Wor ers Comp and Gen Lia i ily 22 DowSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 APPENDIX C MIAMI BEACH ' Minimum Requirements & Specifications RFP 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP 2014 -302 -SW TPA Caims A ministration or Wor ers Comp and Gen Lia i iN 23 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 C1: Minimum Requirements. The Minimum Eligibility Requirements for this solicitation are listed below. Proposer shall submit detailed verifiable information affirmatively documenting compliance with each minimum requirement. Proposers that fail to comply with minimum requirements will be deemed non-responsive and will not be considered. 1. The proposer must be a Qualified Servicing Entity with the State of Florida, Department of Financial Services, Division of Workers' Compensation (per 69L-5-229 Florida Administrative Code) 2. The proposer must have experience as a Third Party Administrator ("TPA") for Workers' Compensation and General Liability for Florida local government(s) for a minimum of five (5) consecutive years. For each experience proposer must submit as evidence; agency name, agency contact, contact telephone, email and years(s) of experience for verification purposes. 3. The proposer must have a staffed office in the state of Florida, with a qualified staff member of the firm to serve as the primary contact for the City of Miami Beach, and a secondary contact to serve in the absence of the primary contact. The proposer must submit as evidence; a primary and secondary name, a primary and secondary contact telephone, a primary and secondary email address, and a copy of primary and secondary's resumes for verification purposes. C2. Statement of Work Required, The City of Miami Beach (the "City") is approved by the Florida Department of Labor and Employment Security/Division of Workers' Compensation to self -insure for Workers' Compensation. The Division of Workers' Compensation requires that the claims administration be provided by a State Certified Workers' Compensation Claims Administrator. Therefore, the City is seeking proposals for third party claims administration services for its self- insurance Worker's Compensation program. Proposers must submit cost proposal for the entire scope of services requested. Proposals to handle only selected parts of the scope will not be considered. It is understood by the successful proposer that all services are to be provided by the proposer's employees and cannot be contracted out to another party without the prior approval of the City. The commencement date of the contract will be February 1, 2015. C3. Specifications. The administrator will provide all specified adjusting services for all claims as well as all other required services, such as administrative, managed care/medical case management, computerized claims/loss statistical information (RMIS) and banking/loss fund reconciliation. The specific required services are outlined in greater detail within this request for proposals. The City has approximately 1,900 employees, and averages 345 claims annually. The breakdown is estimated at 239 medical only and 106 lost time. Currently there are approximately 421 open claims. Prior to October 1996, the City purchased excess workers' compensation insurance. The City does not currently purchase excess workers' compensation insurance. ).Pf ..•.•'4F" . 'f�_r+nwueaB: eY ..-...._. r_. nw "'n "tff'R`r+. �:NUn41 �-�- �Y'Tt"(4.': �.. _..r."axc j 1 • �1 •� • '• • • • ��• - • • • • -- •• DocuSign Envelope ID: 6EEOD36E-ABE7-016C-8B7C-9D91277D5AD3 In agreement with Ordinance No. 1335, the City pays Supplemental Injury Pay for a maximum of 32 weeks, for employees who have a work-related injury but remain absent due to restrictions resulting from their injury. The Supplemental Injury Pay is the amount equal to the difference between their normal City pay and the amount of compensation payable under the provisions of the Workers' Compensation law of the State of Florida. This benefit allows employees to receive their full pay while absent due to an approved work-related injury. In view of this, temporary total indemnity benefits will not need to be paid by the claims administrator unless the injured employee is eligible for temporary total benefits in excess of 32 weeks. In addition, certain medical conditions and work related activities are covered under workers' compensation for police and fire personnel pursuant to union contract. All proposers are to assume the complete handling of all future and past claims now being handled by our present Claims Administrator (see Appendix G for open/closed claims for all years), along with all new claims. The information provided regarding the volume and type of pending claims to be assumed is based on the latest information provided to the City and cannot be guaranteed as to its accuracy. If the amount of prior claim files to be taken over is 25% greater than represented in this RFP, the City will consider a proportionate adjustment to the proposer's Flat annual fee. It is the responsibility of the proposer to review prior claim files to determine the additional proposed cost, if any, to take over these files. It is also required that the claim data associated with all claims occurring prior to February 1, 2015, be transferred into the proposer's computer information system, so that future loss runs will contain a complete history of all claim years. The transfer of all claims data must be completed by June 1, 2015. The proposer is responsible for specifically indicating in their proposal the fees, if any, for assumption of prior claims and the data conversion. The program is run on an "occurrence" basis, therefore, all claims occurring in the contract year, regardless of when reported, are to be handled per the requirements of this agreement. The claim administrator is required to handle all claims to their conclusion or to the conclusion of the contract, whichever occurs first, at no additional charge to the City other than the annual fee. The contract may be terminated by either party with ninety (90) days written notice to the other, However, any cancellation does not alter the administrator's obligation to handle all claims prior to the termination date. The City requires that the selected TPA provide, at a minimum, the following professional services related to the administration of the City's self-insured Workers' Compensation and General Liability: TPA shall provide workers' compensation third -party claims administration services to the City of Miami Beach's self-insured workers' compensation program in accordance with Florida Statute, Section 440, applicable Florida Administrative Code(s), and applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s). City shall provide TPA with copies of applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s) as necessary. This includes the necessary medical benefits, expenses and other services ^ra 1 �+ '' • • • oft S•�• - • • • • •• DocuSign Envelope ID: 6EE6D36E-ABE7-416C-8B7C-9D91277D5AD3 usual and customary to the administration and management of workers' compensation claims, if not otherwise noted herein. • TPA shall provide, on behalf of the City, all self -insurer reporting to the Self Insurance Bureau, Division of Workers' Compensation, State of Florida, all annual reports, unit statistical, modification factor, assessment indemnity, medical and any and all forms required by the State of Florida which a self Insurer for workers' compensation must provide. • TPA shall accept all current claims and/or re -opened claims as run-in claims to the TPA if selected as the new TPA for the City. • TPA shall provide the City with the ability to report first reports of injury and loss notices electronically, by facsimile or by phone based on the severity, circumstances or nature of injury at no additional cost. • TPA shall provide automated acknowledgement upon the receipt of each claim. The acknowledgement shall include, but not be limited, to the following: claim number, assigned adjuster name, email and telephone number, claimant's name, and date of loss. • TPA shall set up all new claims within twenty-four (24) hours after notification. Assigned adjuster, supervisor or nurse case manager shall make all contacts and initiate investigation within forty-eight (48) hours of receipt of new claims. • TPA shall have the ability to provide prescription drug authorization on the same day as injury to all injured employees. • TPA shall triage every notice of injury with an initial review by a claims supervisor, a registered nurse review of medicals, and assigned adjuster's review of entire claim file. • TPA shall utilize any recommended medical primary care physicians or specialists as directed by City, even if not in the TPA's network, if it is in the best interest of the injured employee or the City. This would include authorizing treatment by non -occupational or non -network physicians or providers who have treated an injured employee under emergency or exigent circumstances in an emergency room or other facility, if such treatment would be considered prudent and reasonable for continuity of care purposes. • The City reserves the right, but not the obligation, to approve all vendor partners and ancillary services used by the TPA that are part of the workers' compensation allocated claim expense or reserve, • City reserves the right to select its own workers' compensation defense counsel to manage any and all litigation for the City's workers' compensation and employer's liability program, and/or to seek pre -litigation legal advice and claim strategy. The City's Risk Manager has the authority to approve the workers' compensation defense counsel's fee, cost schedule and/or any allocated legal claim adjustment expenses: TPA shall agree to work with the _RH 20 1 aims Administration tor orkers Camp an en Liabi ity 26 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 City's chosen workers' compensation defense counsel. In the event the TPA is unable to work with the City's workers' compensation defense counsel or has a conflict of interest, then City reserves the right to deem the TPA's proposal non-responsive, or terminate the TPA's Contract. TPA shall provide the City with an on-site experienced, dedicated adjuster to provide professional workers' compensation adjusting services and employee claim assistance on- site at the City's Risk Management Division Office of the Human Resources Department, or as otherwise designated by the City, with duties and responsibilities to be mutually agreed upon by the TPA and the City. TPA must provide access to Spanish and Creole speaking adjusters for situations when injured workers are more comfortable conversing in Spanish or Creole. TPA should clearly outline the staffing which will be provided. The adjuster shall perform all. the usual and customary worker's compensation claim adjustment services and assistance as done by the City's Risk Management staff in accordance with the third -party claims administrator agreement between the City and TPA. The scope of assignment includes, but is not limited to, filing new losses, coordinating light duty assignments, assisting employees with claim questions, filing wage statements, updating diary notes, assisting attorneys with litigated files, and working with the City's regularly assigned workers' compensation claims adjusters. TPA shall provide, on an as needed basis, an on-site dedicated licensed liability claims adjuster at the City's Risk Management Division, Office of the Human Resources Department, or as otherwise designated by the City, to assist the City's Risk Manager with claims administration services for the City of Miami Beach's self-insured liability program. The City is self-insured and self-administered for liability claims management. The adjuster shall perform claims administration services for automobile and general liability claims. The scope of assignment includes, but not limited to, investigations, creating file diaries, record keeping, and other services necessary or proper for, or incidental to, performing claims adjusting. • TPA shall provide the City with telephonic case management services on all workers' compensation claims as an allocated loss adjustment expense, unless otherwise directed by City. • TPA shall provide a list of PPO networks affiliated with the TPA, as requested by City. • TPA shall evaluate and qualify various service providers recommended by the City to service its account, provided such service providers do not present a perceived or potential conflict of interest. • TPA shall provide the City with field case management services, catastrophic case management services, medical cost projections, life care planning, Medicare set-aside assessments, development of reports, surveillance, peer review, utilization review and reasonable and customary savings review, bill review, percentage of PPO savings and any other usual and customary workers' compensation claims administration claims practice, strategy or activity as all allocated loss adjustment expenses, unless such expenses are rix-�a>r.;a _.. .r :,. �. -�yror- :..i-x,ea✓u.m. ageti•�z +:r: .>_tan :.v r•.rxw.x..wn.. ,rt. �:xae �-.' x:,uw mac: -e;ns. saa_ e �SS:bLx Si DocuSign Envelope ID: 6EE9D36E-ABE7-416C-8B7C-9D9127705AD3 more appropriately allocated as a medical expense under the claim per Florida Statutes or TPA's judgment. • TPA shall process and handle all electronic data interchange requirements on behalf of the City as required by the State of Florida at no additional charge. • TPA shall be responsible for all Medicare reporting obligations under the Medicare Secondary Payor Act, and/or under similar or new legislation at no additional cost to the City. • TPA shall provide the City with OSHA 300 log reporting capabilities at no additional cost, as requested by City. • TPA shall handle subrogation claims and file lien notices on behalf of the City to protect the City's interests in rights of recovery from third -party tortfeasors. TPA shall not proceed with any legal action against a third -party tortfeasor without the City's Risk Manager's approval. • TPA shall review and seek approval from the City for any loss reserve adjustment increases greater than twenty-five thousand dollars ($25,000). • TPA agrees all negotiated settlement agreements shall require City approval. Such settlements would include but may not be limited to, agreements to wash-out an entire claim, settle a negotiated lien, settle a negotiated attorney fee, or any other type of settlement that is not otherwise considered an administration of a medical, indemnity or allocated expense that would otherwise be due and owed in accordance with Florida law. • TPA shall attend in person or via telephonically all mediations. The City shall endeavor to have a Risk Management staff member, or designee, at all mediations as well as hearings, • TPA shall agree to quarterly claim reviews, whether in person or telephonically at the City's discretion, to review all litigated cases, legacy cases, catastrophic cases, or non -litigated complex cases. • TPA shall agree all claim files, reports, and other data prepared or provided in connection with a claim are and shall remain the property of the City. • TPA shall keep complete and accurate records and accounts in connection with each claim. Such records shall be available at all reasonable times for examination by the City, or its' designee, and shall be kept for a period of no less than three (3) years after the completion of all work to be performed. Incomplete or incorrect entries in such records may be grounds for disallowance by City of any fees or expenses based upon such entries. TPA shall send City all closed claim files that are mutually agreed upon to be inactive. . • •�.: 3 M r !nT iLtl-^$5 a R'J� .' V'.1 teR4 hA'f IR ... r3^f Y/ U.\FG^4 ��nt'^ai f,Y[' r yr y .m.y:.flP 1( InA. �, :� . 1, i..Yhrf �lM. YurYiQP.hf" 3 ,N+)�(d+�. DowSign Envelope ID: 6EEOD36E-ABE7-416C;8B7C-9D91277D5AD3 • The City of Miami Beach has not purchased excess coverage since 1997. However, TPA shall comply with all excess workers' compensation coverage agreements in place, including reporting requirements affording potential or existing coverage on all and any open (or re -opened) claims such as, but not limited to reporting. • TPA shall be responsible for any penalties, declined coverage, reservation of rights issued, diminished coverage benefits imposed by City's excess workers' compensation carder(s) due to TPA's failure to properly report new or existing claims as required by each carriers' coverage agreement reporting requirements, • TPA agrees to notify the City of proposed or enacted changes in workers' compensation regulatory requirements or legislative acts that may affect the City's claims, • TPA shall agree to maintain a SSAE 16 audit on controls placed in operations and tests for operating effectiveness, and agrees to provide copies to the City as requested. • TPA shall utilize the City's solely selected and approved financial institution for the funding of workers' compensation and liability claim payments and settlements. TPA agrees to comply with the City's Positive Pay (fraud detection) banking standards and must do a daily data feed to the City's financial institution for fraud detection. • TPA shall send weekly invoices for wire fund transfer requests to replenish the City's account. Exceptions are made for special requests for unexpected large losses or claim settlements for which specific dedicated invoice for wire fund transfer requests shall be made. • The City shall fund at least fifty percent (50%) times the City's average weekly spend on workers' compensation claims. Presently the City's fund maintains an average weekly balance of two hundred and fifty thousand dollars ($250,000), • TPA shall send original invoices to the attention of the City's Risk Manager, or designee, by e-mail to City of Miami Beach, unless otherwise instructed, • TPA shall mail the City monthly financial institution reconciliations. • TPA shall issue 1099's to all vendor issued allocated claims payments pursuant to the applicable tax laws in effect. • TPA shall be audited by the City at the City's sole discretion and cost. • TPA shall invoice the City quarterly for its administrative claim fee. • TPA shall take extraordinary measures, if is selected as the new TPA for the City, to ensure data and file conversion and transfer is done with as little disruption to the City and Yt. � _...5`iW-.:.K.'Y'-3: :Mile �v gKT!CAn: NEH.... !'4R".iM.MtfGY14Y4.✓ A:M1. :IT R.Ii�[4g,•�. 1h:4'f[. :"T3�J.V�Tm^..^nt 'n,JlatWl,i1 ' ' 1 1� ' • Y '• • • • �� • • • • • - • • • DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 its injured employees to ensure continuity in care and continued best workers' compensation claims management practices. TPA will be required to manage the claims with a comprehensive data base system which allows computer access to notes, correspondence and other pertinent information needed by the City to generate analytical data reports upon demand; which will allow secure web based communication between the City and the TPA adjusters, This program should also allow the City to add information to the adjuster notes section of the TPA computer system. TPA shall provide the City's Risk Manager and it's designees, with access and training to utilize the TPA's Risk Management Information System to monitor the adjuster's claim activity on a file, • TPA shall provide the City with electronic loss runs, claim reports or ad hoc reports as required by City within seven (7) working days of month-end. • TPA shall provide periodic information to the City's actuarial service provider when required. • TPA shall provide safety engineering services as requested by City, and fees shall be negotiated and approved by the City as an allocated loss adjustment expense per applicable claim file. • TPA, as a custodian of records for City, shall comply and cooperate with all applicable City and State record retention and exemptions laws such as, but not limited to, Florida Statutes, Sections, 119, 440, 760 and 112 as they pertain to protected medical, personal and/or work product information, • TPA agrees to transfer or ship the electronic file data or hard copy file data at the request and as directed by the City at no cost other than actual incurred reasonable shipping fees. TPA agrees there shall be no charges to transfer electronic data on a per data file basis or other transfer related fees or charges unless agreed upon in writing by City. All electronic data transferred or hard copy data shipped shall be done within sixty (60) days of receipt of written notice from City. Paper data shall be shipped overnight by FED EX, UPS or equivalent common carrier agreed to by City. Electronic data shall be transferred by disk/tape or over internet as requested by City, provided the data files are adequately protected and secured. Electronic file data means all claims information and related claim file information maintained in an electronic computer file format, whether stored on a hard drive, tape backup or CO. • Other claims adjusting services for Workers' Compensation and General Liability, as needed. N "M.YY. t': .W-+J`v-SN15^va u"1. ••:TryY^'.'Wn ..z Mi....rzs Yw:^I.z. �x.v DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 STAFFING AND PERSONNEL: It is the City's claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control the City's self-insured loss payments is to ensure the administrator hires and retains the appropriately qualified professionals to handle our claims. Additionally, the adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services. The City therefore requires that the, proposer agree to staffing, qualifications and caseload criteria established by the City. The City reserves the right to the final prior approval of the hiring and/or assignment of the claims manager, supervisors and adjusters that are to handle the City's claims. The required maximum open case loads per adjusters (may have more than one adjuster assigned to the account) are to be as follows (claims manager should not handle files): workers' compensation (lost time) - 100 workers' compensation (medical only) - 500 The administrator agrees to add staff as necessary to maintain these maximum pending caseload levels. Explain how the office or unit will be staffed and explain the level of supervision that will be provided. Claims personnel must be employees of the administrator. The use of independent adjusters, subcontractors or temporary adjusters is not acceptable without prior approval, of the City. Adjuster trainees are not acceptable for handling of the City's claims. Additionally, resumes of all claims professionals specifically assigned to this account are to be submitted with this proposal. All claims professionals must possess a current Florida Workers, Compensation adjuster's license. LOSS FUND MANAGEMENT: 1. The Claim Payment Account will be maintained at the City's commercial banking institution. The account will be classified as part of the analysis group of City accounts. The City will pay all service fees that are normal and customary in this account. All interest earned or service credits generated will accrue to the benefit of the City. 2. The claims administrator is required to follow Florida law concerning public deposits. Failure to comply with Florida law is sufficient cause for the City to terminate the contractual agreement with the claims administrator. 3. All claims, expense and legal payments will be made by the claims administrator on checks drawn on an account set up by the administrator and funded monthly by the City. It is understood that all funds in this account are City funds and are to be returned to the City upon request or at termination of this contract. 4. The administrator is responsible for the monthly reconciliation of this account and will provide bank statements to the City monthly, along with a request for a deposit from the City to maintain the monthly balance in the loss fund, as determined by the City. ,r#�-Tn'ino. - .P�L:e .iw :1.:'v:+II. Viu . n�YY:^`.'RNTY ..JaFr. +�nYwas'. t6ez'.y. '.RSTfo --�•..�•. [t.t..ti1544.'tius.+'�.N.` ' DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 5. The monthly reconciliation statement submitted by the administrator to the City will include the following: - balance at inception of statement period - total disbursements which cleared, by date and claimanUpayee - balance at close of statement period - amount of deposit required A list of all checks is to be submitted monthly. SUPPLEMENTAL QUESTIONS In addition to information that may be provided in your proposal and required elsewhere in the RFP, please answer the following (restate question in each answer): 1. Where is your office located? 2. Number of professional claim, clerical and/or support staff at that location. 3. Name, experience, resume and professional designations of claim manager. Name, experience, license type, resume and professional designations of any supervisory level employees that will have responsibility for this account. 5. Name, experience, license type, resume and professional designations of the designated adjusters that will have responsibility for this account. 6. Advise the current pending case load for each designated adjuster. What is the current number of monthly new assignments to each adjuster? 8. Will the award of this contract necessitate an increase in your staff size to meet the City's staffing and caseload requirements and will that be in place by February 1, 2015? 9. Name the 4 law firms (2 workers' compensation, 2 liability) that you currently handle the most cases with. Provide a contact person and phone number. 10. Estimate the percentage of time your adjusters are out of the office doing field work. If all are telephone adjusters, please indicate. 11. Do you utilize Independent contracted adjusters? If so, under what circumstances? 12. Name, address, phone and contact person for independents you utilize, 13. Can you provide all the required services with your own personnel? a.m v:.?A^.R �'Y tJ':yY]' -.xtl$ n>;, v.1 �µ%.nL:sa 13'W:.'.sttx x....e+Re:.vt n,•l.' '2r' DocuSign Envelope ID: 6EEOD36E-ABE7416C-BB7C-9D91277D5AD3 14, Do your adjusters receive any continuing education and training? Explain. 15. Do you currently file state and excess insurance forms on behalf of your clients? Explain. 16. Do you have the capability to provide all the loss data reports required? Explain. 17. Do you have the ability to transfer the City's prior claims data to your information system by June 1, 2015? 18. Explain any fees proposed for managed care, medical case management, bill review, utilization review and rehabilitation services. These are not to be included in the annual fee proposed. 19, Explain, in detail, any deviation from the services or fee structure type required, specifically indicating any services you cannot perform. Specifically indicate what you consider as allocated expenses and therefore not included in your annual fee proposal amount. Balance of Page lnfeMonally Leff Blank +v 'ryr:Y( :,3,y.r.'���M3M L'iryniMwi.`.^p�1.�1>S .H'+'tih..F�}6. YF(r[^t9M 3+M X?At•E: _,.. Yi}. rlY^':'1;�.'h' FY:fWilt,....Y. Y. .S�"i•• DocuSign Envelope ID: 6EEOD36E-ABE7416C-BB7C-9D91277D5AD3 APPENDIX D MIAMI B.ACH Special Conditions RFP 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR- WORKERS' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 DocuSign Envelope ID: 6EEDD36E-ABE7-416C-8B7C-9D91277D5AD3 1. TERM OF CONTRACT. The contract shall commence upon the date of notice of award and shall be effective for a period of two (2) years, 2, OPTIONS TO RENEW, The City, through its City Manager, will have the option to extend for three (3) additional one (1) years periods. 3. REQUIRED CERTIFICATIONS, The proposer must be a Qualified Servicing Entity with the State of Florida, Department of Financial Services, Division of Workers' Compensation (per 691-.5- 229 Florida Administrative Code). 4, ADDITIONAL SERVICES. If during the contractual period additional services are needed, the selected Contractor may, at the option of the City of Miami Beach, be engaged to perform these services. The selected contractor shall upon receipt of the written request from the City's Risk Manager, provide a proposal for such services and the City reserves the option to issue a purchase order for the specified work as approved by both parties. I Balance of Pape Intentionally Left Blank . , RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen liability 35 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 0 APPENDIX E MIAMI BEACH Cost Proposal Form RFP 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP 2014 302 SW TPA Claims Administration for Workers Comp and Gen Lia iliry 36 DocuSign Envelope ID: 6EEOD36E-ABE7-016G8B7C-9D91277D5AD3 APPENDIX E COST PROPOSAL FORM Bidder affirms that the prices stated on the proposal price form below represents the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, travel, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance, The Proposal Tender Form shall be completed mechanically or, if manually, in ink. Cost Proposal Forms completed in pencil shall be deemed non-responsive, All corrections on the Proposal Tender Form shall be initialed. Failure to follow the price proposal format as identified may result in the RFP response being considered non-responsive and the RFP submittal will notbe considered forevaluation. may w/. C' KV u F •M'rxM�'�An ♦ �Y9 'x � °n3:it Claims with datesaf accident after contrack,mception -February 1;;2015 DocuSign EnvelDpe ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 ADDITIONAL SERVICES List of services, as needed. which are In addition to the fees Droaosed in Options 1 -3. SE1 Telephonic Medical Case Management Fee On All Claims: $ Per Bill/Flat Fee Bill Review Fee To Include State Fee Schedule Reduction: $ Per Bill/Flat Fee Percentage Of PPO Savings — Network Discount Savings Below State Fee Schedule: % Percentage Of Utilization Review And Reasonable & Customary Savings: Subrogation And/Or Liens Fee Percentage: Osha 300 Log Reporting: $ Electronic Data Interchange Filed With State: Safety Consulting Services Notice Of Injury Entry: $ Custom/Ad Hoc Reports: Data And File Conversion Fee: $ One -Time Setup Flat Fee Medicare Reporting Costs: $ Liability Claims Adjuster (City Of Miami Beach In -House Adjuster) Workers Compensation Claims Adjuster (City Of Miami Beach In - House Ad'uster) $ Description Of Additional Service: $ Description Of Additlonal Service: $ Descdptlon OfAddidonal Service: Description Of Additional Service: $ ...:,a. n.. O". .0 - u DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 APPENDIX F MIAMI. Insurance Requirements RFP 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP FP14- 20302 -SW TPA CaA ministration orWor ers Comp an Gen Liaily 40 DocuSign Envelope ID: 6EE0D36E-ABE7416G8B7C-9D91277D8AD3 i-, PROFESSIONAL SERVICES INSURANCE REQUIREMENTS The provider shall furnish to the Human Resources Department, Risk Management Division, City of Miami Beach, 1700 Convention Center Drive, 3`d Floor, Miami Beach, Florida 33139, Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets the requirements as outlined below: A. Worker's Compensation and Employer's Liability Insurance for all employees of the provider as required by Florida Statute 440. B. Commercial General Liability on a comprehensive basis in an amount not less than $1,000,000 combined single limit per occurrence and $2,000,000 in the aggregate, for bodily injury and property damage. City of Miami Beach must be shown as an additional insured with respect to this coverage. C. Professional Liability Insurance in an amount not less than $1,000,000 with the deductible per claim, if any, not to exceed 10% of the limit of liability. The insurance coverage above must include a waiver of subrogation in favor of the City. The insurance coverage required shall include those classifications, as listed in standard liability insurance manuals, which most nearly reflect the operations of the provider. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: The company must be rated no less than "B" as to management, and no less than "Class V' as to financial strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent, subject to the approval of the City Risk Management Division. or The company must hold a valid Florida Certificate of Authority as shown in the latest "List of All Insurance Companies Authorized or Approved to Do Business in Florida" issued by the State of Florida Department of Insurance and are members of the Florida Guaranty Fund. Certificates will indicate no modification or change in insurance shall be made without thirty (30) days advance notice to the certificate holder. CERTIFICATE HOLDER MUST READ: CITY OF MIAMI BEACH 1700 CONVENTION CENTER DRIVE 3`d FLOOR MIAMI BEACH, FL 33139 Compliance with the foregoing requirements shall not relieve the vendor of his liability and obligation under this section or under any other section of this agreement. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 41 A DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPENDIX G MIAMI BEACH Claims Experience 129 E1419160AT21 CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP 2014-302SW TPA Claims Administration for Workers Comp and Gen liability 42 a DocuSlgn Envelope ID: 6EEOD36E-ABE7-016C-8B7C-9D91277D5AD3 RESPONSE TO RFP 2014 -302 -SW CORVEL ENTERPRISE CORP., INC. }) \ m \\ %.^'4 \ \ !41 I =2��/ . - � !• �� a� x� � ��xs� DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS TAB 1: Cover Letter & Minimum Qualifications Requirements September 12, 2014 C O R V E L Page 2 DocuSign Envelope ID: 6EEOD35E-ADE7-416C-887C-9D91277D5AD3 CORVEL September 12, 2014 The City of Miami Beach 1700 Convention Center Drive Miami Beach, FL 33139 Attn: Procurement Thank you for considering CorVel Corporation as a strategic partner to help the City reach its risk management goals. We offer extensive experience in the government industry, and our top priority is to return your employees back to work. We appreciate the opportunity to present this proposal, and we believe it will confirm why CorVel is the right choice. Our approach to claims management is distinguished by these key differentiators: a A single platform for all elements of the claim handling data a One source for all services a No pass through or bridge to third party vendors In business, it is the personal connections that are often the biggest contributors of success, At CorVel you will find that every associate is personally committed to making the claims experience a more positive one. We look forward to creating win-win strategies that can help you achieve your most important claims management goals. It is the strength that comes from more than three decades of experience, a passion for a better solution, together with the personal attention of our entire team that delivers meaningful results. I will serve as the primary contact for this proposal and look forward to answering any questions you may have. I can be reached via telephone at (954) 233-5906. Thank you again for your consideration. We look forward to working with you. :gional Sales 1550 Sawgrass Corporate Parkway, Suite 100, Sunrise, FL 33323 1(800) 929-0107 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS TABLE OF CONTENTS Tab 1: Cover Letter & Minimum Qualifications Requirements..............................................2 1.1 Cover Letter and Table of Contents...................................................................................3 1.2 Proposal Certification, Questionnaire & Requirements Affidavit (Appendix A) ...................7 1.3 Minimum Qualifications Requirements............................................................................15 Tab2: Experience & Qualifications.......................................................................................53 2.1 Qualifications of Proposing Frim......................................................................................54 2.2 Qualifications of Proposer Team......................................................................................56 2.3 Financial Capacity...........................................................................................................56 Tab3: Scope of Services Proposed......................................................................................57 Tab 4: Approach and Methodology.......................................................................................59 Tab5: Cost Proposal..............................................................................................................61 Attachments............................................................................................................................63 i September 12, 2014 C O R V E L Page 4 DocuSign EXECUTIVE SUMMARY "As with general health, the workers comp line continues to migrate to being a medical management business, with policy makers, employers, and carriers struggling to manage and control the costs of medical care" (NCCI). Risk Managers are focusing more on the health and well-being of the employee, making this a primary goal versus focusing solely on the cost. Similarly, while the liability industry is fueled by the fear associated with keeping lawsuits at bay, Risk Managers are choosing to confidently contract with experienced Adjusters to facilitate litigation management and protect their brand. CorVel is uniquely positioned in this space. With extensive experience in managing the medical care and functional restoration of the Injured worker, in addition to an extensive understanding in the liability sector, we work closely with employers to reverse the stigmas of an adversarial and costly program. Our unique workers' compensation and liability claims management service model applies technology, intelligence and the human touch throughout the healthcare and disability continuum. Our company's reputation is grounded in financial stability, extensive workers' compensation and liability expertise, renowned customer service and strong relationships within the industry. Furthermore, we are experts in proactive decision-making, patient advocacy and instant access to real-time information. The bottom line: We provide tailored solutions that deliver real results. Our proactive healthcare approach puts patients first. When an employee is hurt, proper medical care is priority one. With CorVel's early intake process and precise protocols, we connect claimants to appropriate medical services from the very onset of injury— ultimately driving timely access to treatment and saving both time and money. Our solution starts with access to a 24/7 nurse hotline for first aid advice or referral to preferred providers, capturing first fill prescriptions and simplifying complex processes. We are passionate about patient advocacy and process improvement. We are with you at every step. CorVel serves as your experienced. partner, managing claims through every milestone — from claims receipt, file documentation and investigation to litigation management. Our Liability Adjusters average over 20 years of experience and our Workers' Compensation Adjusters average 10 years of experience. Combined with the utilization of our proven best practices, we achieve better results. CorVel protects your brand as if it were our own. By embodying your company's values as an extension of our service offering, we facilitate collaborative, strategic processes for superior program results. We help you move at the speed of information. In the world of claims management, time is often the enemy. We use our industry -unique Caremc platform, call center and responsive workflows to speed decision-making and reduce costly lag -time. Both workers' compensation and liability incidents are immediately processed by our proprietary rules engine and a Claims Adjuster is assigned within one business day. For added convenience, we offer direct access via smart phone and tablet devices. Everything is connected in a single database—and the minute an update is made, it is online and available. Leveraging our own technology is a stand -out advantage. You get immediate access to Information—when and how you want it. Empowered account management team. Powerful results start with performance -driven partnerships. Account Managers enabled with the right resources can make a real difference in taking your claims management process to the next level of efficiency and cost-effectiveness. We offer the best of both worlds — national resources backed by the stability of a public company and local service our clients have come to know and trust. Regardless of the challenges that may arise, we are committed to finding solutions. Taking a collaborative approach. Our claims and medical management teams work together in one system to deliver a single, streamlined solution. The disjointed service models that are typical to the industry are susceptible to costly delays and information getting lost in translation. By maintaining all services in-house and having all parties collaborate within a single platform, CorVel aligns with your patient -centered goals, maximizes efficiency and returns your employees to work sooner. September 12, 2014 C O R V E L page 5 DocuSign Envelope ID: 6EE9D36E-ABE7-416C-8B7C-9D91277D5AD3 EXECUTIVE SUMMARY A better bottom line. Using intelligently designed technology and leading medical expertise from the moment an incident is reported can truly transform your workers' compensation and liability programs. You cannot always control a claim, but making significant decreases—even for small claims—adds up over time. It is all about getting more value from every dollar spent—and partnering with an expert that can help you reach results. It Is the CorVel difference at work. September 12, 2014 C O R V E L Page 6 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 1.2 Proposal Certification, Questionnaire & Requirements Affidavit (Appendix A) PROPOSAL CERTIFICATION, QUESTIONNAIRE REQUIRBAENTS AFFIDAVIT Purpose: The Mose of this Proposal Certification, Questiormaim and Requirements Atfdavit I= is to inform Prospective Proposers of certain Webtlon and amaactual requirements, and fo Coact necessary information from Proposers th order that oortaln portims of responsiveness, responsbCity and other detemmrtrrg factors and comprence with requirements may be evaluated. This Proposal Cert'ffication, Questionnaire and Requirements Affidavit Fan is a REQUIRED FORM [hat must be submitted fluffy completed and executed. 1. General Proposer Information. mmw The 1 remne4 n5nim 9kk eati9ontl i m 9r Wre vJwce(s ach4uy ary 9nnse FrindWlado3nafim, ePFOWble ricmak, remrtxa M releuar9vdm'tuah, dlerrt6Wn3kl=ao, frtardal inf9artdoM1 raaayir&ame5m Q10 Chi 9Wm6 nECd558710 SYdIWk the C99drJh'Cf9U flepf6H (09=rfNmiR OIXLMsn2 VA91 CYeladldR'jflEmpta. NP2014jt),rSW rPACalmnAminiftr'm lrr one's compand Orn kbl'dv 2111d302SW CLAWS ADMINISTRATION SERNCES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' C011PENSATIN'd AAD rWJNN� (brYtl Fnlerprtre Comp, fne anotoonsc Over J9 )¢are emnavurss ut 3.100 Y� OCm'rd A�)dtnmroe�ro 9�w�.4�mmm,d�opmw oE�'lo dM�s.YdfmmmiavwtarimJdk�v6mermny vRN�WymaLCla'Sd MrPaOlKivtsi HUMS x.SWte 6U0 GENERAL Llaeafrc ap9 8$114]7 'w�aTsraoB tg94 196:7935 s" m"w ><�so �m.�sdme dm, PROPOSAL CERTIFICATION, QUESTIONNAIRE REQUIRBAENTS AFFIDAVIT Purpose: The Mose of this Proposal Certification, Questiormaim and Requirements Atfdavit I= is to inform Prospective Proposers of certain Webtlon and amaactual requirements, and fo Coact necessary information from Proposers th order that oortaln portims of responsiveness, responsbCity and other detemmrtrrg factors and comprence with requirements may be evaluated. This Proposal Cert'ffication, Questionnaire and Requirements Affidavit Fan is a REQUIRED FORM [hat must be submitted fluffy completed and executed. 1. General Proposer Information. mmw The 1 remne4 n5nim 9kk eati9ontl i m 9r Wre vJwce(s ach4uy ary 9nnse FrindWlado3nafim, ePFOWble ricmak, remrtxa M releuar9vdm'tuah, dlerrt6Wn3kl=ao, frtardal inf9artdoM1 raaayir&ame5m Q10 Chi 9Wm6 nECd558710 SYdIWk the C99drJh'Cf9U flepf6H (09=rfNmiR OIXLMsn2 VA91 CYeladldR'jflEmpta. NP2014jt),rSW rPACalmnAminiftr'm lrr one's compand Orn kbl'dv 2111d302SW CLAWS ADMINISTRATION SERNCES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' C011PENSATIN'd AAD rWJNN� (brYtl Fnlerprtre Comp, fne anotoonsc Over J9 )¢are emnavurss ut 3.100 Y� OCm'rd A�)dtnmroe�ro 9�w�.4�mmm,d�opmw oE�'lo dM�s.YdfmmmiavwtarimJdk�v6mermny vRN�WymaLCla'Sd MrPaOlKivtsi HUMS x.SWte 6U0 pIDy�PO iTPM G ap9 8$114]7 tg94 196:7935 049) 951-9469 r415605aw uCA nk Par4wa ,Suitt 190 ' 9unrtra d PL a9 rmoz m ♦ c r. vtch. Vke PKrident.& d$aks M�Debb(eP L957)23�15G0� RF9TCLLfi.YE'a0.: am sas-79Js �debMe�e�rch®wrrefwm 3®@N. ryx ICFImiTi4Ta1 A0. 4a-n94sw September 12, 2014 C O R V E L Page 7 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Solicitation No: Solicllation Title; 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY Procurement Contact: Tel: Emall: Steven Williams 305-673.7000, x. 6650 Stevenwllllams miamibeachfi, ov PROPOSAL CERTIFICATION, QUESTIONNAIRE & REQUIREMENTS AFFIDAVIT Purpose: The purpose of this Proposal Certification, Questionnaire and Requirements Affidavit Form is to inform prospective Proposers of certain solicitation and contractual requirements, and to collect necessary information from Proposers in order that certain portions of responsiveness, responsibility and other determining factors and compliance with requirements may be evaluated. This Proposal Certification, Questionnaire and Requirements Affidavit Form is a REQUIRED FORM that must be submitted fully completed and executed. General Proposer Information. FIRMNAME: CorVel Enterprise Comp, Inc. No of Years In Business: Over 30 years Noof 6e ear Buslness Locally. No. of Employees: 3,300 Y OTHER NAMES) PROPOSER HAS OPERATED UNDER IN THE LAST 10 YEARS: CorVel Enterprise Comp, Inc. Is a wholly-owned operating subsidiary of CorVel Corporadon, a pabliely-traded healthcare manageme FIRM PRIMARY ADDRESS (HEADQUARTERS): 2010 Main Street Suite 600 CITY: Irvine STATE: ZIP CODE: CA 926t4 TE EPH NE NO.: 949 851-1473 TOLL FREE NO.: 888 726-7835 FAXNO.: 949)851-1469 FIRM LOCALADDRESS: 1560 Saw ss Corporate Parkwa , Suite 100 CITY: Sunrise STATE: ZIP CODE FL 33323 PRIMARYACCOUNT REPRESENTATME FOR THIS ENGAGEMENT: Debbie Po ovich, Vice President, Regional Sales ACCOUNT REP TELEP14ONE NO.: (954 233-5906 ACCOUNT REP TOLL FREE NO.: (888)726-7835 ACCOUNT REP EMAIL: debbie—popovich@corvel.com FEDERAL TAX IDENTIFICATION NO 42-1704550 t reserves the night to seek ad Ilio al 0 o no to: an ,t company. The City g d ninformation from Prop ser r other source(s), including butt limitedy firm or principal information, applicable licensure, resumes of relevant individuals, client information, financial information, or any Information the City deems necessary to evaluate the capacity of the Proposer to perform in accordance with contract requirements. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen nobility 15 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 1. Miami Beach Based (Local) Vendor. Is Proposer claiming Miami Beach based firm status? ❑ YES t] NO SUBMITTAL REQUIREMENT: Proposers claiming Miami Beach vendor status shall submit a Business Tax Receipt Issued by the City of Miami Beach and the proof of residency requirement, as required pursuant to ordinance 2011-3747, as amended, to demonstrate that the Proposer is a Miami Beach Based Vendor. Not applicable. CorVel is not claiming Miami Beach based firm status. 2. Veteran Owned Business. Is Proposer claiming a veteran owned business status? ❑ YES ❑X NO SUBMITTAL REQUIREMENT: Proposers claiming veteran owned business status shall submit a documentation proving that firm is certified as a veteran -owned business or a service -disabled veteran owned business by the State of Florida or United States federal government, as required pursuant to ordinance 2011-3748, as amended. Not applicable. CorVel is not claiming a veteran owned business status. 3. Conflict Of Interest. All Proposers must disclose, in their Proposal, the name(s) of any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, all Proposers must disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates. SUBMITTAL REQUIREMENT: Proposers must disclose the name(s) of any officer, director, agent, or Immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Proposers must also disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates. CorVel does not have any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. CorVel Enterprise Comp, Inc. is a wholly-owned operating subsidiary of CorVel Corporation, a publicly traded healthcare management company (NASDAQ GS: CRVL) held to the standards of NASDAQ and the SEC. CorVel Corporation is incorporated in the state of Delaware. September 12, 2014 C O R V E L Page 8 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7G9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 4. References & Past Performance. Proposer shall submit at least three (3) references for whom the Proposer has completed work similar in size and nature as the work referenced in solicitation. SUBMITTAL REQUIREMENT: For each reference submitted, the following information is required: 1) Firm Name, 2) Contact Individual Name & Title, 3) Address, 4) Telephone, 5) Contact's Email and 6) Narrative on Scope of Services Provided. 5. Suspension, Debarment or Contract Cancellation. Has Proposer ever been debarred, suspended or other legal violation, or had a contract cancelled due to non-performance by any public sector agency? D YES I] NO SUBMITTAL REQUIREMENT: If answer to above is "YES," Proposer shall submit a statement detailing the reasons that led to action(s). Not applicable. CorVel has never been debarred, suspended or other legal violation, or had a contract cancelled due to non-performance by any public sector agency. September 12, 2014 C O R V E L Page 9 ..- . City of Pompano Ed Beecher, Risk P.O. Box Drawer 1300 1 "client requests _ Eddie.beecher Beach Manager Pompano Beach, FL I email contact @copbfl.com 33061 only Scope: Third Party Claims Administration and Managed Care services. City of West Palm Kathy 401 Clematis St. 561-494-1135 kstakermann@wpb.org Beach Stakermann, West Palm Beach, FL Risk Manager 33401 Scope: Third Party Claims Administration and Managed Care services. Florida League of Jay Goldrick, P.O. Box 538135 407-367-1746 jgoldrick@flcities.com Cities Workers' Orlando, FL 32853 Compensation Scope: Third Party Claims Manager Claims Administration and Managed Care services. 5. Suspension, Debarment or Contract Cancellation. Has Proposer ever been debarred, suspended or other legal violation, or had a contract cancelled due to non-performance by any public sector agency? D YES I] NO SUBMITTAL REQUIREMENT: If answer to above is "YES," Proposer shall submit a statement detailing the reasons that led to action(s). Not applicable. CorVel has never been debarred, suspended or other legal violation, or had a contract cancelled due to non-performance by any public sector agency. September 12, 2014 C O R V E L Page 9 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 6. Litigation History. Proposer shall submit a statement of any litigation or regulatory action that has been filed against your firm(s) in the last five years. If an action has been filed, state and describe the litigation or regulatory action filed, and identify the court or agency before which the action was instituted, the applicable case orfile number, and the status or disposition for such reported action. If no litigation or regulatory action has been filed against your firm(s), provide a statement to that effect. If "No" litigation or regulatory action has been filed against your firm(s), please provide a statement to that effect. Truthful and complete answers to this question may not necessarily disqualify a firm from consideration but will be a factor in the selection process. Untruthful, misleading or false answers to this question shall result in the disqualification of the firm for this project. SUBMITTAL REQUIREMENT: Proposer shall submit history of litigation or regulatory action filed against proposer, or any proposer team member firm, in the past 5 years. If Proposer has no litigation history or regulatory action in the past 5 years, submit a statement accordingly. In the last five years, there has not been any investigatory or regulatory action undertaken against CorVel that would affect our performance of any duties or responsibilities contemplated by five other than as disclosed in our publicly -filed financial statements. Vendor Campaign Contributions. Proposers are expected to be or become familiar with, the City's Campaign Finance Reform laws, as codified in Sections 2-487 through 2-490 of the City Code. Proposers shall be solely responsible for ensuring that all applicable provisions of the City's Campaign Finance Reform laws are complied with, and shall be subject to any and all sanctions, as prescribed therein, including disqualification of their Proposals, in the event of such non- compliance, SUBMITTAL REQUIREMENT: Submit the names of all individuals or entities (including your sub - consultants) with a controlling financial interest as defined in solicitation. For each individual or entity with a controlling financial interest indicate whether or not each individual or entity has contributed to the campaign either directly or indirectly, of a candidate who has been elected to the office of Mayor or City Commissioner for the City of Miami Beach. Not applicable. CorVel does not have any controlling financial interest as defined in this solicitation. 8. Code of Business Ethics. Pursuant to City Resolution No.2000-23879, each person or entity that seeks to do business with the City shall adopt a Code of Business Ethics ("Code") and submit that Code to the Procurement Department with its proposal/response or within five (5) days upon receipt of request. The Code shall, at a minimum, require the Proposer, to comply with all applicable governmental rules and regulations including, among others, the conflict of interest, lobbying and ethics provision of the City of Miami Beach and Miami Dade County. SUBMITTAL REQUIREMENT: Proposer shall submit firm's Code of Business Ethics. In lieu of submitting Code of Business Ethics, Proposer may submit a statement indicating that it will adopt, as required in the ordinance, the City of Miami Beach Code of Ethics, available at www.miamibeachfl.gov/procurementt. Please see Attachment A: CorVel's Code of Ethics. September 12, 2014 C O R V E L Page 10 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 9. Living Wage. Pursuant to Section 2-405 of the Miami Beach City Code, as same may be amended from time to time, Proposers shall be required to pay all employees who provide services pursuant to this Agreement, the hourly living wage rates listed below: • Commencing with City fiscal year 2012-13 (October 1, 2012), the hourly living rate will be $11.28/hr with health benefits, and $12.92/hr without benefits. The living wage rate and health care benefits rate may, by Resolution of the City Commission be indexed annually for inflation using the Consumer Price Index for all Urban Consumers (CPI -U) Miami/Ft. Lauderdale, issued by the U.S. Department of Labor's Bureau of Labor Statistics. Notwithstanding the preceding, no annual index shall exceed three percent (3%). The City may also, by resolution, elect not to index the living wage rate in any particular year, If it determines it would not be fiscally sound to implement same (in a particular year). Proposers' failure to comply with this provision shall be deemed a material breach under this proposal, under which the City may, at its sole option, Immediately deem said Proposer as non- responsive, and may further subject Proposer to additional penalties and fines, as provided in the City's Living Wage Ordinance, as amended. Further information on the Living Wage requirement is available at www.miamibeachfi.gov/procurement/. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, Proposer agrees to the living wage requirement. CorVel agrees and will comply with the living wage requirement. Please see the attached affidavit document. 10. Equal Benefits for Employees with Spouses and Employees with Domestic Partners. When awarding competitively solicited contracts valued at over $100,000 whose contractors maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks, the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive proposals, to provide "Equal Benefits" to their employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a Contractor who work within the City limits of the City of Miami Beach, Florida; and the Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? d YES❑ NO B. Does your company provide or offer access to any benefits to employees with (same or opposite sex) domestic partners* or to domestic partners of employees? EI YESo NO CorVel shall offer benefits to its employees with (same or opposite sex) "registered" domestic partners or to "registered" domestic partners of employees upon award of an RFP to CorVel for the CorVel office location(s) where services shall be provided. September 12, 2014 C O R V E L Page 11 DomSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS C. Please check all benefits that apply to your answers above and list in the "other" section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave; other benefits are provided directly to the spouse or domestic partner, such as medical insurance. BENEFIT Firm Provides for Employees with Spouses Firm Provides for Employees with Domestic Partners Firm does not Provide Benefit Health X X Sick Leave X X Family Medical Leave X X Bereavement Leave X X CorVel shall offer benefits to its employees with (same or opposite sex) "registered" domestic partners or to "registered" domestic partners of employees upon award of an RFP to CorVel for the CorVel office location(s) where services shall be provided. If Proposer cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage) you may be eligible for Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent and submit a completed Reasonable Measures Application (attached) with all necessary documentation. Your Reasonable Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval is not guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement is available at www.miamibeachfi.gov/procurement]. 11. Public Entity Crimes. Section 287.133(2)(a), Florida Statutes, as currently enacted or as amended from time to time, states that a person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a proposal, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a proposal, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit proposals, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in s, 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, Proposer agrees with the requirements of Section 287.133, Florida Statutes, and certifies it has not been placed on convicted vendor list. CorVel agrees with the requirements of Section 287.133, Florida Statutes, and certifies it has not been placed on a convicted vendor list. September 12, 2014 C O R V E L Page 12 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 12. Acknowledgement of Addendum. After Issuance of solicitation, the City may release one or more addendum to the solicitation which may provide additional information to Proposers or alter solicitation requirements. The City will strive to reach every Proposer having received solicitation through the City's e -procurement system, PublicPurchase.com. However, Proposers are solely responsible for assuring they have received any and all addendum issued pursuant to solicitation. This Acknowledgement of Addendum section certifies that the Proposer has received all addendum released by the City pursuant to this solicitation. Failure to obtain and acknowledge receipt of all addendum may result in proposal disqualification. Initial to Confirm Receipt Initial to Confirm Receipt Initial to Confirm Receipt Addendum 1 Addendum 6 Addendum 11 Addendum 2 Addendum 7 Addendum 12 Addendum 3 Addendum 8 Addendum 13 ✓ Addendum 4 Addendum 9 Addendum 14 Addendum 5 Addendum 10 Addendum 15 If additional confirmation of addendum is required, submit under separate cover. September 12, 2014 C O R V E L Page 13 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 Y o f 1M1 1.+r EAC 1 City of Miami Beach, 1700 Convention Center Drive, Mlam! Beach, Florida 33139, w .mlamtbeachn.gov PROCUREMENT DEPARTMENT Tel: 305-673-7490 Fax: 786-3944002 ADDENDUM NO, 1 REQUEST FOR PROPOSAL 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY (the RFP) August 20, 2014 This Addendum to the above -referenced RFP is Issued In response to questions from prospective proposers, or other clarifications and revisions Issued by the City. The RFP is amended In the following particulars only. -- .- __-- - -_-----__.-- ---_--- I. REVISIONS: The due date for receipt of proposals has been extended until 3:0013.m., Tuesday, 1 September 2, 2014. YOU ARE HEREBY ADVISED THAT THIS INVITATION TO NEGOTIATE IS UNDER THE CONE OF SILENCE—ORDINANCE NO. 2002-3378 WHICH MAY BE FOUND ON THE CITY OF MIAMI BEACH WEBSITE: http://www.mlamlbeachfl.aov/newclty/depts/purchase/bidintro.aso Any questions regarding this- Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at Rafael Granado(a)m!amlbeachfl.uov Contact: 1 Telephone; Email: Steven Williams 305-673-7000 ext. 6650 Stevenwilllams miamibeachfl. ov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission, Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Proposers' questionnaire with the reason(s) for not submitting a proposal. J r1.Den rement Director o.2014302SW Addendum #1 8/2 012 01 4 DocuSign Envelope 10: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Y I 11 Y it BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamlbeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE ADDENDUM NO.2 REQUEST FOR PROPOSAL 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY (the RFP) August 25, 2014 This Addendum to the above -referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. REVISIONS: The deadline for receipt of proposals is extended until 3:00p.m. Tuesday, September 9, 2014, Late submittals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays for which the Proposer is solely responsible. YOU ARE HEREBY ADVISED THAT THIS INVITATION TO NEGOTIATE IS UNDER THE CONE OF SILENCE—ORDINANCE NO. 2002-3378 WHICH MAY BE FOUND ON THE CITY OF MIAMI BEACH WEBSITE: htti)://www.mlamlbeachfl.gov/newcity/dapts/purchase/bidintro.asp Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RefaelGranadoa mlarnibeachfl oov Contact: Telephone: Email; Steven Williams 1 305-673-7000 ext. 6650 Stevenwilliams@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Proposers" questionnaire with the reason(s) for not submitting a proposal. DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 MI \7 Y IIFJi.ACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.mlamlbeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE RFP No. 2014.302 -SW FOR CLAIMS ADMINISTRATION SERVICES BYA THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITYADDENDUM NO.3 September 4, 2014 This Addendum to the above -referenced RFP is issued in response to questions from prospective bidders, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. 1. REVISION: a) The deadline for receipt of proposals is extended until 3:00p.m., Friday, September 12, 2014. Late submittals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays for which the Proposer is solely responsible. b) Section 0300, Proposal Submittal Instructions and Format has been amended. 1. SEALED RESPONSES. One original Proposal (preferably In 3 -ring binder) must be submitted in an opaque, sealed envelope or container on or before the due date established for the receipt of proposals. Additionally, ten (19) seven 7 bound copies and one (1) electronic format (CD or USB format) are to be submitted. c) Appendix E, Cost Proposal Form has been amended. Proposers are reouired to submit the amended Appendix E — Cost Proposal Form in order to be deemed responsive. 2. RESPONSES TO QUESTIONS RECEIVED: Q #1: What company currently provides the medical case management services on behalf of the City of Miami Beach? If it is Johns Eastern Company, how much are they paid for these services? A#1: Johns Eastern Company Is the current provider of medical case management services for the City of Miami Beach. Johns Eastern Company is compensated at $195 per lost time and medical only exposure. Please refer to Attachment C, Service Contract for further information. Q #2: If another company Is used for case management, how much are they paid? Are their services paid as allocated expenses off each file? A #2: Johns Eastern Company is the only provider. Q #3: The RFP requested loss control and surveillance services? Who currently provides these services for the City of Miami Beach? Is there an estimate of the amount of these services the City will utilize? A #3: Proven Investigations, LLC, (formerly Horizon Investigators) of Ft, Lauderdale, Florida currently provides the surveillance services. In the past two (2) fiscal years, the City of Miami Beach has not utilized any loss control services. There Is no estimate of loss control or surveillance services as they are requested on an as needed basis. DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 RFP No. 2014.802 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO. 2 September 4, 2014 Q #4: For medical bill payments and bill review services, the proposer would like to know the following Information for the fiscal year 2013 — 2014. Q #4.1: Number of medical bills processed (excluding duplicates. A #4.1: Please refer to Attachment D, Copy of COMB Medical Costs forfurther information. Q #4.2: Total Medical Charges A #4.2: Please refer to Attachment D, Copy of COMB Medical Costs for further Information. Q #4.3: Total Fee Schedule Reductlons A #4.3: Please refer to Attachment D, Copy of COMB Medical Costs for further Information. Q #4.4; Total Audit Reductions A #4.4: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.5: Total PPO Reductions A #4.5: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.6: Total BIII Review Fees A #4.6: Please refer to Attachment D, Copy of COMB Medical Costs for further Information. Q #4.7: Total Audit Fees A #4.7: Please refer to Attachment D, Copy of COMB Medical Costs for further Information. Q #4.8: Total PPO Fees A #4.8: Please refer to Attachment D, Copy of COMB Medical Costs for further 'Information. Q #5: Is there any way to receive the Loss History In an excel format? A #5: Please refer to Attachment A, Open Claims and Attachment B, Closed Claims. Q #6: Will the City of Miami Beach utilize the Third Party Administrator's Bank? A #6: The City reserves the right to approve the bank utilized by the Third Party Administrator, or select its own, Q #7: Based on the required maximum claim counts of 100 lost time claims, the City of Miami Beach program will need two (2) dedicated Worker's Compensation lost time adjusters. Does the City of Miami Beach want a third dedicated adjuster as the on-site Workers' Compensation adjuster or will the on-site dedicated adjuster handle a case load? A 97: The City is looking for one (1) Worker's Compensation lost time on-site adjuster, who will not handle a case load, but be the Intermediary between the Third Party Administrator, the City of Miami Beach and Its employees. Docusign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 RFP No. 2014 -302 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO.2 September 4, 2014 Q #8: Does the City of Miami Beach want the designated liability adjuster to handle fleld Investigations only or will the adjuster handle assigned liability claims to conclusion? A #8: Yes, the designated liability adjuster will be required to handle field investigations only. Q #9: Please provide a copy of your current contract with Johns Eastern Company. A #9: Please refer to Attachment C, Service Contract. Q#10: Please provide the total amount of fees paid to Johns Eastern Company for the past three (3) full years of contract periods, by year. A#10: Please refer to Attachment E, Copy of Johns Eastern FY 11-12.13-14 Fees Paid. Q#11: Are the fees paid to Johns Eastern Company all -Inclusive or are they also paid for any services as an allocated expense from the claims? A#11: Please refer to Attachment C, Service Contract, Q#12: Does the City of Miami Beach currently have a dedicated onsite worker's compensation adjuster from Johns Eastern Company or is this a new requirement? A#12: The City does not currently have a dedicated onsite worker's compensation adjuster. This Is a new requirement. Q#13: For any onsite adjuster(s), will the City of Miami Beach provide office space, phones and internet access? Is there any charge to the Third Party Administrator for these services? A#13: Yes, the City will provide office space, phone, internet access for any onsite adjuster services requested by the City of Miami Beach. There Is no additional charge for these services to the Third Party Administrator. Q#14: Please clarify the City of Miami Beach's need for an onsfte liability adjuster? Section C.3, of the RFP Indicates this adjuster is to be used on an as needed basis. A#14: For clarification, the City is looking for a liability claims adjuster to handle investigative work on an as needed basis to handle 15.30 Claims per fiscal year. This service will not require a dedicated on-site adjuster for liability adjusting services. Q#15: What is the annual volume of liability claim services the city expects to utilize? A#15: Approximately 15.30 liability claims per fiscal year. Q#16: How much was the Johns Eastern Company paid for liability services for the last three (3) full years? A#16: This service was not a part of Johns Eastern Company's contract. Q#17: The RFP indicates there are currently 421 open claims. It shows the open claim breakdown as 292 indemnity/ lost time claims, and 129 medical only claims. Please confirm this is accurate in both total and the Indemnity /MO breakdown. A#17: Yes, the total number of open claims is 421; with 292 indemnity/lost time claims and 129 medical only claims. Q#18: The RFP Indicated a required caseload'cap of 100 open claims maximum per adjuster. Does the current Third Party Administrator comply with that caseload cap and have approximately three (3) indemnity adjusters assigned to handle this volume on your account? A#18: Yes DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 RFP No. 2014.302 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO.2 September 4, 20'14 Q#19: Is the caseload cap of 100 open claims maximum per adjuster a requirement or will a model with higher caseloads be considered? A#19: The City requires the caseload cap of 100 open claims per adjuster. Q#20: Regarding the Cost Proposal Form, Option #2, Fixed per Claim Fee Option. Does it have a liability fixed per claim fee? A#20: Option #2, Fixed per Claim Fee Option on the Cost Proposal Form is only referring to Worker's Compensation. For liability fixed per claim fee, please utilize the Liability Claims Adjuster option In the "Additional Services" section of the Cost Proposal Form. Q#21: Does the Liability Claims adjuster work fulltime In-house at the City of Miami Beach? A#21: No. Please note also on the revised Cost Proposal Form that the Liability Claims Adjuster will handle approximately 15.30 Claims, per fiscal year. Any questions regarding this Addendum should he submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranedo@miamibeachfl.gov. Proposers are reminded to acknowledge receipt of this addendum as part of your ITN submission. Potential proposers that have elected not to submit a response to the ITN are requested to complete and return the "Notice to Prospective Bidders" questionnaire with the reason(s) for not submitting a proposal. —S I cerely, ex Denis rccuremont Director DocuSlgn Envelope ID: 6EEDD36E-ABE7416C-8B7C-9D91277D5AD3 APPENDIX E MIANt±AC� Cost Proposal "REVISED" September 4, 2014 Form RFP 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES - BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP 2014.302 -SW TP C alms Administration for Wor ers Comp and Gen ala i iN 1 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D9127705AD3 APPENDIX E "REVISED" COST PROPOSAL FORM Bidder affirms that the prices stated on the proposal price form below represents the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, travel, delivery delays, taxes, insurance, cost Indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance, The Proposal Tender Form shall be completed mechanically or, if manually, In Ink. Cost Proposal Forms completed in pencil shall be deemed non-responsive. All corrections on the Proposal Tender Form shall be initialed. Failure to follow the price proposal format as Identified may result In the RFP response being considered non-responslve and the RFP submittal wlll not be considered forevaluatlon. OPTION #1: FLAT ANNUAL FEE OPTION Column 1 Column 2 Column 3 1. Flat Annual Fee Flat Annual Fee (for 345 claims Including $ new and prior clams) (per contract year) 2. Per Claim Fee for uantli Excess Claim Fee Per Claims In Excess of $ 40 per year Year 345 Per Year (per excess claim) $ (Column 1 x Column 2) TOTAL O• $ otal Lines 1 -2 RFP -26143b2-SW TPA Claims A ministralion or Workers Comp and Gen Lia i ity 2 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 OPTION #2: FIXED PER CLAIM FEE OPTION OPTION #3: FIXED PER CLAIM BLENDED FEE OPTION Column 1 I Column 1 NEW CLAIMS Column 2 1 Column 3 with dafes Claims with dates of accident after contract I incept.lon - February 1, 2015 1. Indemnity Per Claimuantit $ 300 per year $ (Lltigat6d Or (Litigated Or Non- $___100peryear (Column 1 x Column 2) Lltl ated $ Litl ated(per claim 'PRIOR CLAIMS (Column l x Column 2) 2. Medical Only Claim of accident prior to contract inception - February Quantit 2. Indemnity Or Medical (Litigated Or Litigated) Non- $ Only Per Claim 175 per year $ (column 1 x column 2) (per claim 3. Medical Only Claim Non- (per claim) Quantli (column1xColumn 2) Liti ated Transferred To $ 25 per year $ 3 (Fixed Pair Claim Blended Indemnity Claim $ (Column lxColumn 2) (per claim) (Litigated Or Non - Litigated), PRIORClaims with date s of accident prior to contract .. 4. Indemnity Per Claim Quantity (Litigated Or Non- $ 292 per year $ Litigated) (pe r claim (column t x column z) 5. Medical Only Claim Quanti (Litigated Or Non- $ 129 per year $ Litl ated(ger claim (Column 1 x Column 2) TOTALOPTION 2 (Fixed Per Claim FeL-Option)' $ _ •_ _ (Total Lines 1 •6 OPTION #3: FIXED PER CLAIM BLENDED FEE OPTION Column 1 I Column 2 Column 3 Claims with dafes NEW CLAIMS of accident after contract ..n - Fe2015 1. Indemnity Or Medicalu ntit Only Per Claim $ 300 per year $ (Lltigat6d Or No (per claim) (Column 1 x Column 2) Lltl ated 'PRIOR CLAIMS Claims vvith dates of accident prior to contract inception - February 2015, 2. Indemnity Or Medical Quantlt Only Per Claim $ 421 per year$ (Litigated Or Non- (per claim) (column1xColumn 2) Liti ated TOTAL60TION 3 (Fixed Pair Claim Blended Fee • $ Total Lines 1 - 2) 3 RFP 2014 -302 -SW TPA C alms A ministration or Wor ars Comp and Gen Lla i ty DocuSign Envelope ID: 6EEDD36E-ABE7-416C-8B7C-9D91277D5AD3 ADDITIONAL SERVICES List of services, as needed, which are in addition to the fees nr000sed In Ontions 1 -3. Descriptioa of Service Fee Telephonic Medical Case Management Fee On All Claims: $ Per Bill/Flat Fee Bill Review Fee To Include State Fee Schedule Reduction: $ Per Bill/Flat Fee Percentage Of PPO Savings — Network Discount Savings Below State Fee Schedule: Percentage Of Utilization Review And Reasonable & Customary Savings: Subrogation and/or Liens Fee Percentage: Osha 300 Log Reporting: Electronic Data Interchange Filed With State: Safety Consulting Services Notice Of Injury Entry: Custom/Ad Hoc Reports: Data And File Conversion Fee: $ One -Time Setup Flat Fee Medicare Reporting Costs: Liability Claims Adjuster (15-30 Claims per fiscal year) $ Workers Compensation Claims Adjuster (City Of Miami Beach In-, House Adjuster) $ Additional Desalpson DlAdditional Service: $ Descdpllon OfAddlganal 8er*e: Desaiptlon OlAdtlltlonal Service: Desorption OtAddldonal SeMce: biddees Affirmation Company; Authorized Representative: Address: Telephone: Email: Authorized Representative's Slgnaluro: RFP 2014 302 S1N TPA C alms A ministralion or Workers Comp an Gen tfa i Ity 4 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 MIAMIBEACH �Ity of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497. Fax: 786-394-4330 PUBLIC NOTICE ADDENDUM NO.4 REQUEST FOR PROPOSAL 2014 -302 -SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY (the RFP) September 10, 2014 This Addendum to the above -referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. REVISIONS: Effective Wednesday, September 10, 2014, the Mayor and City Commission have approved an ordinance repealing Section 2-372 of Division 3, Article VI, of Chapter 2 of the Miami Beach City Code titled "Procedure to provide preference to Miami Beach based vendors in contracts for goods and contractual services". Due to this change, the Miami Beach -based vendor preference specified in the solicitation has been deleted in its entirety and is no longer applicable. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranadoomiamibeachfl.4ov Contact: Telephone: Email: Lourdes Rodriguez 305-673-7000 ext. 6652 lourdesrodriguez@miamibeachfl.gov Bidders are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential bidders that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Bidders" questionnaire with the reason(s) for not submitting a proposal. actor DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Appendix A Continued MIWW IMmYy bnI MYY%hi%tlY.q M nN bf Mmbrgaamm�bmm�mraanmaYm � �'...a'm'�°.aa swoam°"M. Y.ywb�vu Y"0`��YY nne.Y"%ymPows�Y�nm PoWYSNppmhµMNwn mn Y OmMn M try.e/rfenb ud,pjNAbmaty eMp {gnyg epwryyu� OQrq'4�in�WYbL. M6nM bbG. nl4n.iPOf.0Ydh4 W MR64bYbNM1N Yup LF/amlPoPfnW Y4Ygmbvna�AVYbMpibm, bWYYY.aYJJYdfybNbpup Nb,bN MyNyY�1M�M.5n5 M�MPUYo.YNW JMq NNWIMbYYrybMmAwW%N{HYbfgy NbnbbWblY4cfq 0.hbub veblYNbpnYLnmybAOMYnyitpttlpnq LYbnMYNatlNrYY MA'h+' .MmYMYIbrd4NeMY SOI (naVPA Y1wYm IbN FNa/ag16.r1nlAbYNh Mf SOV JmN¢NnPY ni w.Iblmrt,Y'atNYYLbu}y! NJ4bNp4M N,M Ym(yn ICYYmI UYMIUMMWIVM4mAWnLtl Mn.m MWNB4YTYm' M1h a1�dN I.mnryaeAv4lq upsPNtl mbbm�lnLbnyJnY4mmWu.AYnnyv4immM1 tltgALbv4gpMghinLmipreambuyYpni4 MMhmWb6h gGnvw XwM � 6nN+4...rw�..YNwYamm�bnrsm.Nm.LNMY>mP+.Mq,..Y oNi�.Yuwirn�vn�A.e`�n .Yo�.aw! eb�ew°' uwM�u JrY aam...a N Q/nMbb tlnnp141tlyy,M6np.NYjIN44e4YfgWMA�IY�d lA mNa{y Y .M Ygs1 b mnm tl nal, e.Uw, v YbwJ hn N rottl ymt iMY 1gm4n b b W b uN nl M MUG tlP M W 1 N b nnnlmi mCgNY ppk¢wJYhagN/aLNmN ImPwYbYryY44unMbetwr/, nlhb}Y •�n�nbOO�vm�mYmPMwr�WMivwn�bMiMm�,n%bmµ�ivq�mq gbraj mMMI%N.Y.mAYNw Y.zl�ml.PoYmgNYYtw,nn,aw�i..e.euml �Y��AO`�'YbYspn P^nY%{b[ISYWfNbYYls Yktltl4'd9nnW'bYbN4JIsva nMJl a tryal6mnnYYbmfl 14YNbM{bYlgiw�MM IMa�eN�JtlnlnifnlgaYNnb YYTyWb NVnNlYrtlmmxnabb Ary4 NYPYSNIa jY>I�LP41 gItlJX�iom�ingYm Yp N bkbi. Ibep..NKd NbYMYbwYMbM11¢W bN ®mMngAbM M'n„nblbbyYlnmmA Ntlslhad9lY\YumnpLbNMaIYO Npe4Y ae�aYq�YbmpA�anpMm rymY�q PoNCYYnv.Ytln.mm.hvgmnr lrybal[arq� mpMY�wbn, hw•YrYJ MY lM •MMaM MtlNfr mlgMN,4M EIWNY W tltltlNJMkpnmlMelmhpry. h NYnlpl ^aY¢1ey.bA4 Mnnmm'MIMPMx PiaYbm tlb mYYgEYmfnbel NYb R� dgN¢nm,Mbmv� 44�nYP.ISumNid4 MNtl9(a M6pMbtlMm ! 116]5'MI NCPN W+mNaa. Wv n eb .b ,b i ibl:W PoraOp.~� (]u(lLuet61(Imr ' w n_b,,,umu M.tl GVMe J,N I-aLMv+i GVMpI MPJ e01%tM binbAN.I6yy�u IPN=�lmgatibl NPllM W W�mnwJptlMMaYd nolN mrywExryY.lmt/N1. hatlddanlN YN.eHpM W Ft M4TgmIryMMCN &blrrc ;u atael� er n 'YiSwR nevmen emtvgw Jm bMn yp nananm.bmaMJlAYnmmmlmmN l-0bJM lbhgl4.axomM aa.sbM.mfi.b. M1.+i.embmrsY'«vv�rmem.N 6Wad CYMN4 OibNW wneYnmblw Y+mnlbbem % f;Irn�ml umrey�r y44�Ga ppwJNINmMGSduWblx/M:LW A/NI.LmnY b4 MplIM MU WROF]%be me (J IJ 4A.IYbI M/ wmbE b M M M Nu dWsvWY��am n.�re b N m nm.,Wm OPTIONAL �NWnwrb4YMArIu%YnYnqur nMb w NmawgnYnwunlr�mnxmw��e��N , Nit Nvyee. a M YueNn mNen^ AVIpYD_ �— September 12, 2014 C O R V E L Page 14 DocuSign Envelope ID: 6EEOD36E-ABE7-016C-BB7C-9D91277D5AD3 The solicitation referenced hereln Is being furnished to the recipient by the City of Miami Beach (the "City") for the recipient's convenience. Any action taken by the City In response to Proposals made pursuant to this solicitation, or in making any award, or In failing or refusing to make any award pursuant to such Proposals, or In cancelling awards, or in withdrawing or cancelling this solicitation, either before or after issuance of an award, shall be without any liability or obligation on the part of the City. In its sole discretion, the City may withdraw the solicitation either before or after receiving proposals, may accept or reject proposals, and may accept proposals which deviate from the solicitation, as It deems appropriate and in its best interest, In Its sole discretion, the City may determine the qualifications and acceptability of any party or parties submitting Proposals in response to this solicitation, Following submission of a Bid or Proposal, the applicant agrees to deliver such further details, information and assurances, including financial and disclosure data, relating to the Proposal and the applicant including, without limitation, the applicant's affiliates, officers, directors, shareholders, partners and employees, as requested by the City in its discretion. The Information contained herein is provided solely for the convenience of prospective Proposers. It is the responsibility of the recipient to assure itself that Information contained herein Is accurate and complete, The City does not provide any assurances as to the accuracy of any Information In this solicitation. Any reliance on these contents, or on any permitted communications with City officials, shall be at the recipient's own risk. Proposers should rely exclusively on their own Investigations, Interpretations, and analyses. The solicitation is being provided by the City without any warranty or representation, express or Implied, as to its content, its accuracy, or Its completeness. No warranty or representation is made by the City or Its agents that any Proposal conforming to these requirements will be selected for consideration, negotiation, or approval. The City shall have no obligation or liability with respect to this solicitation, the selection and the award process, or whether any award will be made. Any recipient of this solicitation who responds hereto fully acknowledges all the provisions of this Disclosure and Disclaimer, is totally relying on this Disclosure and Disclaimer, and agrees to be bound by the terms hereof. Any Proposals submitted to the City pursuant to this solicitation are submitted at the sole risk and responsibility of the party submitting such Proposal. This solicitation is made subject to correction of errors, omissions, or withdrawal from the market without notice. Information Is for guidance only, and does not constitute all or any part of an agreement. The City and all Proposers will be bound only as, if and when a Proposal (or Proposals), as same may be modified, and the applicable definitive agreements pertaining thereto, are approved and executed by the parties, and then only pursuant to the terms of the definitive agreements executed among the parties. Any response to this solicitation may be accepted or rejected by the City for any reason, or for no reason, without any resultant liability to the City. The City is governed by the Govemment-in-the-Sunshine Law, and all Proposals and supporting documents shall be subject to disclosure as required by such law. All Proposals shall be submitted In sealed proposal form and shall remain confidential to the extent permitted by Florida Statutes, unl t the date and time selected for opening the responses. At that time, all documents received by the City shall become public records. Proposers are expected to make all disclosures and declarations as requested in this solicitation. By submission of a Proposal, the Proposer acknowledges and agrees that the City has the right to make any inquiry or investigation It deems appropriate to substantiate or supplement Information contained In the Proposal, and authorizes the release to the City of any and all information sought In such Inquiry or Investigation. Each Proposer certifies that the information contained in the Proposal is true, accurate and complete, to the best of Its knowledge, Information, and belief. Notwithstanding the foregoing or anything contained in the solicitation, all Proposers agree that in the event of a final unappeasable judgment by a court of competent jurisdiction which imposes on the City any liability arising out of this solicitation, or any response thereto, or any action or inaction by the City with respect thereto, such liability shall be limited to $10,000.00 as agreed-upon and liquidated damages. The previous sentence, however, shall not he construed to circumvent any of the other provisions of this Disclosure and Disclaimer which imposes no liability on the City. In the event of any differences in language between this Disclosure and Disclaimer and the balance of the solicitation, It is understood that the provisions of this Disclosure and Disclaimer shall always govern. The solicitation and any disputes arising from the solicitation shall be governed by and construed In accordance with the laws of the State of Florida. RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen Liability 19 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7G9D91277D5AD3 I hereby certify that; I, as an authorized agent of the Proposer, am submitting the following Information as my firm's proposal; Proposer agrees to complete and unconditional acceptance of the terms and conditions of this document, inclusive of this solicitation, all attachments, exhibits and appendices and the contents of any Addenda released hereto, and the Disclosure and Disclaimer Statement `Proposer agrees to be bound to any and all specifications, terms and conditions contained in the solicitation, and any released Addenda and understand that the following are requirements of this solicitation and failure to'comply will result In disqualification of proposal submitted; Proposer has not divulged, discussed, or compared the proposal with other Proposers and has not colluded with any other Proposer or party to any other proposal; Proposer acknowledges that all information contained herein is part of the public domain as defined by the State of Florida Sunshine and Public Records Laws; all responses, data and information contained in this proposal, Richard Schweppe I Chief Financial Officer xi QLAa �D/J/ I August 12, 2014 If CorVel is awarded this OF and Agreement, City agrees to negotiate terms and conditions of the Agreement with CorVel. State of California ) On this 1z day of August 2014, personally appeared before me Richard Schweppe who County of Orange 1 Stated that (s)he IS the Chief Financial Officer of -WI at..pd.e coat,, las- a corporation, and that the instrument was signed in behalf of the said corporation by authority of its board of directors and acknowledged said Instrument to be its voluntary act and deed. Before me: Notary Public for the State of Florida My Commisslon Exp s: see Own( ied RFP 2014 -302 -SW TPA Claims Administration for Workers Comp and Gen liability 20 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 ❑ See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) z Signature of Document Signer No. 1 Signature of Document Signer No. 2 (9 any) State of California County of Oyani e Placa Notary Seal Above Subscribed and swom to (or affirmed) before � Mme on this 12- day of NV*at 20 1`i by Data MQdth Year c i IGV'1od Sctt�veDe� Name of Signer proved to me on the basis of satisfactory evidence to be the person who appeared before me (and (2) Name of Signer proved to me on the basis of satisfactory evidence to be the person who .ad before me.) Signature' �._ 1 9 lure of Notary Publla e s Though the information below is not required bylaw, It may prove valuable Top of thumb here Top of thumb here to persons reMng on the document and could prevent fraudulent removal and reattachment of this form to another document. Further Description of Any Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Then Named Above: 0 2010 National Notary Association , NetlonalNotary.org • 1 -am -Us NOTARY (1A00­870Ee27) Item #5910 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS C1. Minimum Requirements. The Minimum Eligibility Requirements for this solicitation are listed below. Proposer shall submit detailed verifiable information affirmatively documenting compliance with each minimum requirement. Proposers that fail to comply with minimum requirements will be deemed non-responsive and will not be considered. 1. The proposer must be a Qualified Servicing Entity with the State of Florida, Department of Financial Services, Division of Workers' Compensation (per 69L-5-229 Florida Administrative Code) CorVel is a Qualified Servicing Entity with the State of Florida. Please see Attachment B: Florida Certification. 2. The proposer must have experience as a Third Party Administrator ("TPA") for Workers' Compensation and General Liability for Florida local government(s) for a minimum of five (5) consecutive years. For each experience proposer must submit as evidence: agency name, agency contact, contact telephone, email and years(s) of experience for verification purposes. CorVel has experience as a Third Party Administrator for Workers' Compensation and General Liability for Florida local government(s) for a minimum of five consecutive years. The following references are a testament to our experience. September 12, 2014 C O R V E L Page 15 City of Pompano Beach Ed Beecher, P.O. Box Drawer 1300 *client requests Eddie.beecher Risk Manager Pompano Beach, FL email contact @copbfl.com Scope: Third Party Claims 33061 only Administration and Managed Care services, Contract Years. 2008 -Present Miami Dade County Dan Cullen, 111 N.W. 1st Street 305-375-3216 Dcullen Director Suite 2340 @miamidade.gov Scope: CorVel serves as the Miami, FL 33128 medical management arm with network solutions forthe sell. - - ----- - administered WC and GL government client Por over five years plus a contract for EDI medical bill review with the network. Contract Years: 2009 -Present September 12, 2014 C O R V E L Page 15 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-867G9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS City of West Palm Beach Kathy 401 Clematis St. 561-494-1135 Kstakermann Stakermann, West Palm Beach, FL @wpb.org Scope: Third party Claims Risk Manager 33401 Administration and Managed Care services. Contract Years., 2011 -Present Prince George's County Rick 14741 Governor Oden 301-952-3742 fwschnabele@ Schnabele, Bowie Dr. co.pg.md,us Scope: Third Party Claims Risk Manager Suite 3200 Administration, Managed Caro, Upper Marlboro, MD and Auto and General Liability 20772 services. Contract Years: 2005 -Present 3. The proposer must have a staffed office in the state of Florida, with a qualified staff member of the firm to serve as the primary contact for the City of Miami Beach, and a secondary contact to serve in the absence of the primary contact. The proposer must submit as evidence: a primary and secondary name, a primary and secondary contact telephone, a primary and secondary email address, and a copy of primary and secondary's resumes for verification purposes. CorVel's Tampa, Florida office will handle the City's workers' compensation claims and our Sunrise, Florida office will manage the City's liability claims. Debbie Popovich, Vice President, .Regional Sales, will serve as the City's primary contact and Jenna Cargill will serve as the secondary contact. Debbie Popovich, Vice President, Regional Sales (954) 233-5906 debble—popovich@corvel.com Jenna Cargill, Account Manager (954) 233.5946 jenna—cargill@corvel.com Please see Attachment C: Staff Resumes. C2. Statement of Work Required. The City of Miami Beach (the "City") is approved by the Florida Department of Labor and Employment Security/Division of Workers' Compensation to self -insure for Workers' Compensation. The Division of Workers' Compensation requires that the claims administration be provided by a State Certified Workers' Compensation Claims Administrator. Therefore, the City is seeking proposals for third party claims administration services for its self- insurance Workers Compensation program. CorVel is a State Certified Workers' Compensation Claims Administrator. We are capable of providing third party claims administration services for the City's self-insurance Workers' Compensation program. September 12, 2014 C p R V E L Page 16 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Proposers must submit cost proposal for the entire scope of services requested. Proposals to handle only selected parts of the scope will not be considered. It is understood by the successful proposer that all services are to be provided by the proposer's employees and cannot be contracted out to another party without the prior approval of the City. The commencement date of the contract will be February 1, 2015. Please see Attachment D: CorVel's Cost Proposal. C3. Specifications. The administrator will provide all specified adjusting services for all claims as well as all other required services, such as administrative, managed care/medical case management, computerized claims/loss statistical information (RMIS) and banking loss fund reconciliation. The specific required services are outlined in greater detail within this request for proposals. The City has approximately 1,900 employees, and averages 345 claims annually. The breakdown is estimated at 239 medical only and 106 lost time. Currently there are approximately 421 open claims, Prior to October 1996, the City purchased excess workers' compensation insurance. The City does not currently purchase excess workers' compensation insurance. In agreement with Ordinance No. 1335, the City pays Supplemental Injury Pay for a maximum of 32 weeks, for employees who have a work-related injury but remain absent due to restrictions resulting from their injury. The Supplemental Injury Pay is the amount equal to the difference between their normal City pay and the amount of compensation payable under the provisions of the Workers' Compensation law of the State of Florida. This benefit allows employees to receive their full pay while absent due to an approved work-related injury. In view of this, temporary total indemnity benefits will not need to be paid by the claims administrator unless the injured employee is eligible for temporary total benefits in excess of 32 weeks. In addition, certain medical conditions and work related activities are covered under workers' compensation for police and fire personnel pursuant to union contract. All proposers are to assume the complete handling of all future and past claims now being handled by our.present Claims Administrator (see Appendix G for open/closed claims for all years), along with all new claims. The information provided regarding the volume and type of pending claims to be assumed is based on the latest information provided to the City and cannot be guaranteed as to its accuracy. If the amount of prior claim files to be taken over is 25% greater than represented in this RFP, the City will consider a proportionate adjustment to the proposer's flat annual fee. It is the responsibility of the proposer to review prior claim files to determine the additional proposed cost, if any, to take over these files. It is also required that the claim data associated with all claims occurring prior to February 1, 2015, be transferred into the proposer's computer information system, so that future loss runs will contain a complete history of all claim years. The transfer of all claims data must be completed by June 1, 2015. The proposer is responsible for specifically indicating in their proposal the fees, if any, for assumption of prior claims and the data conversion. The program is run on an "occurrence" basis, therefore, all claims occurring in the contract year, regardless of when reported, are to be handled per the requirements of this agreement. The claim administrator is required to handle all claims to their conclusion or to the conclusion of the contract, whichever occurs first, at no additional charge to the City other than the annual fee. The contract may be terminated by either party with ninety (90) days written notice to the other. However, any cancellation does not alter the administrator's obligation to handle all claims prior to the termination d ate. September 12, 2014 C O R V E L Page 17 DowSign Envelope ID: 6EE6D36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS The City requires that the selected TPA provide, at a minimum, the following professional services related to the administration of the City's self-insured Workers' Compensation and General Liability: TPA shall provide workers' compensation third -party claims administration services to the City of Miami Beach's self-insured workers' compensation program in accordance with Florida Statute, Section 440, applicable Florida Administrative Code(s), and applicable City Code(s), Resolutfon(s) or Collective Bargaining Agreement(s). City shall provide TPA with copies of applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s) as necessary. This includes the necessary medical benefits, expenses and other services usual and customary to the administration and management of workers' compensation claims, if not otherwise noted herein. CorVel agrees and will comply. CorVel Is active in the regulatory environment of our industry. Our involvement starts at the state level with the primary office in Florida. Information for Florida is gathered nationally and collated. We track both state and federal legislative and regulatory changes that affect any of the services we provide. CorVel hosts training and Informational meetings to keep our claims personnel current on recent updates to workers' compensation laws, claims handling techniques, and rules and regulations. Meetings also including up to date information about investigations, fraud identification, subrogation and litigation management. • TPA shall provide, on behalf of the City, all self -insurer reporting to the Self Insurance Bureau, Division of Workers' Compensation, State of Florida, all annual reports, unit statistical, modification factor, assessment indemnity, medical and any and all forms required by the State of Florida which a self insurer for workers' compensation must provide. CorVel agrees and will provide all reports and forms as required by the State of Florida, Including but not limited to all self -insurer reporting to the Self Insurance Bureau, Division of Workers' Compensation, State of Florida and all annual reports. CorVel will report to all states in which state reporting is required on behalf of the City and according. to the state's guidelines. If required by the state, we will submit the reporting data via EDI. We run state reports on. a weekly basis. Our system reports to states based on the submitter information provided by the state. TPA'shall accept all current claims and/or re -opened claims as run-in claims to the TPA if selected as the new TPA for the City. CorVel will accept all current claims and/or re -opened claims as run-in claims if selected as the new TPA for the City. The City's current open claims data will be mapped and integrated into CorVel's claims system and will require an Adjuster to review the claim file before any payments can be made on the fife. If the City's current system does not use a paperless environment, all necessary documents will be scanned into our system in accordance with our claims handling best practice process. Medical bills and supporting documentation will be scanned into our system or an EDI will be established from the current vendor allowing September 12, 2014 C O R V E L Page 18 DacuSign Envelope ID: 6EEOD36E-ABE7-016C-8B7C-9D9127705AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS the bill image to be uploaded into our system so the Claims Adjuster can process the bills. We will request a data transfer of all claim activity from the City's previous vendor with corresponding control totals, record layouts, code translations, etc. Optimum time from contract signing to complete the transition of data is 90 days. This timeframe can be shortened depending on the complexity of converting and loading historical data into our system. If there is no historical data to convert to the system we can be ready to accept new claims within 30 days of contract signing. CorVel is able to create up to a 6 tier organizational structure from which reporting can be generated at any level. We can accept and map your data to appropriate fields within our system which includes: • transactional data • file notes • reserve history • subrogation and litigation information scanned documents • exhibits in PDF, Word and Excel formats • assigned departments • employee occupation • accident locations • injury, body part and cause We have experience capturing data from most of the country's largest insurers and TPAs and seamlessly integrating it into our claims management system. Successful system integration provides the Adjuster with the appropriate data integrity to perform their work while being assisted by operations support to ensure all necessary physical file data is scanned into our system to maintain a paperless file environment. • TPA shall provide the City with the ability to report first reports of injury and loss notices electronically, by facsimile or by phone based on the severity, circumstances or nature of injury at no additional cost. Claims can be reported online via CorVel's website, 2417 Nurse Advocacy service, toll free call center, faxed, or Input via mobile apps available for smart phones and tablet devices. CorVel's early intake process promotes immediate and convenient access to report an injury or incident to improve return to work results. For immediate care, we recommend reporting incidents to our 2417 Nurse Triage call center. All other non -urgent or retrospective injuries can be reported via CorVel's website, toll free call center, faxed, or entered via mobile apps available for smart phones and tablet devices. Claims are Immediately processed by our proprietary rules engine where medical management begins immediately as needed, and the claim is assigned to a Claims Adjuster within one business day or less of initial receipt. TPA shall provide automated acknowledgement upon the receipt of each claim. The acknowledgement shall include, but not be limited, to the following: claim number, assigned adjuster name, email and telephone number, claimant's name, and date of loss. CorVel will provide automated acknowledgements upon the receipt of each claim. The acknowledgement will include the information specified by the City. September 12, 2014 C O R B E L Page 19 DocuSign Envelope ID: 6EEOD36E-ABE7-016C-887C-9091277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • TPA shall set up all new claims within twenty-four (24) hours after notification. Assigned adjuster, supervisor or nurse case manager shall make all contacts and initiate investigation within forty-eight (48) hours of receipt of new claims. CorVel agrees and will comply. Investigation begins within 24 hours of claim receipt and involves timely and thorough fact gathering. The assigned Adjuster will make all initial contacts. All claims identified as complex will have a comprehensive initial investigation performed with detailed file documentation that addresses compensability, evaluates possible exposure and outlines the future plan of action. Three point contact with the injured worker, the City, and physician .will be initiated within 24 hours and completed within 48 hours. Situations preventing completion within 48 hours will be documented and additional efforts will be made to contact each party, including the use of email and regular mail (certified letter to the injured worker). Once the investigation phase is complete, a determination of compensability is made. The initial plan of action is initiated within two business days of claim receipt. On all open active claims, where compensation benefits are being paid, the file will be updated at a minimum of every 30 days. For all other indemnity claims, the file will be updated every 90 days. Upon completion of the initial contacts and investigation, an accurate reserve reflecting the expected cost of the claim is entered into the CorVel system no later than five days after the initial receipt of the claim. Reserve levels are based on the information known about the claim at that time. The reserve review performed at 30 days includes a reserve worksheet detailing the reserve amount and any additional information received. Reserves will be reviewed every 90 days thereafter. • TPA shall have the ability to provide prescription drug authorization on the same day as injury to all injured employees. CorVel will provide prescription drug authorization on the same day as the injury to all injured employees. We offer mobile technology that allows us to connect more quickly, effectively and efficiently through the use of smart phones and/or tablet devices. We have the capabilities to text pharmacy ID card information to injured workers so they can quickly obtain their first fill prescription. CorVel's new Claimant App provides injured workers with access to essential claim information conveniently on their smart phone or tablet device. Injured workers have access to their initial treatment guide, permanent pharmacy card and their CorVel contacts' information Including their Adjuster and Case Manager, if applicable. The newest release from our suite of mobile technology capabilities requires a secure log- in and is maintained upon a secure authentication path. Additionally, CorVel's pharmacy program has a toll free number where our staff is available 24 hours a day, 7 days a week to provide medication authorization that an injured worker may need. Additionally, CorVel's pharmacy benefits software has drug September 12, 2014 CC) R V E L Page 20 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D6AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS utilization review (DUR) edits as an integral part of the program. These edits include Information on standard dosages and utilization. The pharmacy program clinical department develops prior authorization criteria based upon guidelines established by various Workers' Compensation entities, i.e. NCCI; or may be tailored to meet the City's current protocols. The pharmacy will receive a message stating that the prescription requires a prior authorization and the telephone number to call to obtain this authorization. The authorization process can be handled by the pharmacy program clinical department or the pharmacy staff will notify the appropriate the City personnel for final determination on the prior authorization request. The pharmacy will be notified of the final outcome of their request. • TPA shall triage every notice of injury with an initial review by a claims supervisor, a registered nurse review of medicals, and assigned adjuster's review of entire claim file. CorVel agrees and will comply. Triage Process Advocacy 2417 As a part of CorVel's early Intake process, incidents can be reported to our 24/7 Nurse Triage call center In order to facilitate medical management at the onset of an injury and to improve return to work results. . At the time of the incident, employees can call and speak with a 24/7 Advocacy Nurse — a live, registered nurse who will evaluate the nature of the incident or injury and determine the employee's immediate medical needs. The nurse creates a report Including her recommendations within our system, which starts the claim reporting process. Important healthcare information including comorbidities is also collected at this time to most accurately assess the injured worker's needs and assist with the set- up of the claim file. By addressing the medical treatment needs when the injury first occurs, we are able to provide quick and accurate care intervention, often helping to prevent a minor injury from becoming an expensive claim. This initial phase of triage also creates the possibility to make a shift in the claims mix. Because a nurse initiates the management of the claim by providing medical advice, it allows us to identify cases that cannot be managed by self-care. These potentially complex cases have immediate access to healthcare resources and are directed into our network for additional savings. The employer is notified of an incident report and direct as a claim if time loss from work has occurred. CorVel's staff of registered nurses are licensed in all 60 states and advocate timely return to work with, quality care for the City's employees. Our nurses' use nationally recognized triage protocols with industry standards to facilitate appropriate treatment options. Our advocacy services include; immediate intervention and evaluation, channeling to preferred network of providers, channel to CorVel's pharmacy program by providing a First Fill number, employer access to online case information and 24f7 access to nurses that specialize in occupational injuries. September 12, 2014 t,'^-„ ®R V E L Page 21 DocuSign Envelope ID: 6EEOD36E-ABE7-016C-6B7C-9D91277D6AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Claim Intake Should an incident become a claim, the Triage Nurse's report is sent to the FNOL department to determine additional information that may be needed for the claim file. Employers are immediately notified when an incident occurs, after which they can report the claim via the call center, mobile apps or our online web portal, www.caremc.com. Triage Processes —Smart Triage After being entered into the system, smart triage begins. All incidents and claims are Immediately processed by our proprietary rules engine where medical management begins immediately as needed. The claim is also assigned to a Claims Adjuster within one business day or less of Initial receipt. CorVel's industry-leading technology is used to identify and prioritize claims. We process the FNOL and separate non-complex claims, such as medical only, from potentially complex claims, such as potentially ongoing indemnity and medical only claims that need management beyond the typical medical only model. During this level of triage, the claim is also assigned to a specific office and Case Manager— if necessary — all within one business day. Additional Triage If a claim is identified as potentially complex in nature, an additional level of nurse triage Is performed. The Triage Nurse examines the claim and based on numerous factors including the type of injury, patient's comorbidities and age, will determine if the claim is non-complex or complex. Non-complex claims are directed to the claims team, while complex claims will be routed to a nurse and claims team. Three Point Contact Upon assignment, preliminary investigation begins by the Adjuster. In complex cases, a nurse assigned to the file works with the patient and physician while the Adjuster conducts three point contact. CorVei's best practices require three point contact with the City, the injured worker and physician within one business day of receipt of an indemnity claim or medical only claim with lost time potential. However, our claims staff regularly exceed this expectation and perform three point contact within four business hours of receipt of the claim. Written and/or recorded statements will be obtained where appropriate, claims will be indexed and onsite investigations will occur as needed. Continuous Rules Engine Processing Throughout the life of the claim, the rules engine continuously fires, alerting the Adjuster of any events or information that may Impact the claim or affect its return to work status. This processing calls immediate attention to claims, avoiding costly delays. Our integrated model houses all claims and managed care information on one platform, allowing insight into every aspect of our clients' programs and continuous predictive modeling throughout the life of a claim. With our system's predictive modeling functionality, CorVel can identify cases requiring other efforts (including medication September 12, 2014 C O R V E L Page 22 DocuSign EnvelopelD:6EEOD36E-ABET-416C-887C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS review and ongoing return to work initiatives) and redirect a claim to the most appropriate, quality care at any time. 2417 Advocacy — Nurse Review CorVel offers a nurse triage call center for the City's employees, 24 hours a day, 7 days a week. At the time of the incident, employees can call and speakwith a registered nurse who will evaluate the nature of the incident or injury and determine the employee's Immediate medical needs. By addressing the case when it first occurs, we are able to provide quick and accurate care intervention, often helping to prevent a minor injury from becoming an expensive claim. CorVel's staff of registered nurses are licensed in all 60 states and advocate timely return to work with quality care for the City's employees. Our nurses use nationally recognized triage protocols with industry standards to facilitate appropriate treatment options. Our advocacy services include; immediate intervention and evaluation, channeling to preferred network of providers, employer access to online case information and 2417 access to nurses that specialize in occupational injuries. Claims Supervisor and Adiuster Review The Claims Supervisor conducts an initial review prior to assigning the claim to an Adjuster. Upon assignment, the Adjuster will review the entire claim file and begin a preliminary investigation prior to completing three point contact. • TPA shall utilize any recommended medical primary care physicians or specialists as directed by City, even if not in the TPA's network, if it is in the best interest of the injured employee or the City. This would include authorizing treatment by non -occupational or non -network physicians or providers who have treated an injured employee under emergency or exigent circumstances in an emergency room or other facility, if such treatment would be considered prudent and reasonable for continuity of care purposes. CorVel agrees and will comply. CorVel offers a proprietary national PPO network comprised of more than 760,000 provider locations and specialties, including over 63,200 in Florida, to offer our clients local insight with,national coverage. Providers are selected from a demanding criteria based on quality, range of services and location. Each provider is thoroughly evaluated and credentialed, then re -credentialed every three years. Through this extensive evaluation process, we are able to provide significant hospital, physician and ancillary medical savings while maintaining high quality care. Additionally, the City can request that providers be added to the network in a variety of formats including an internet nomination form (found on the CorVel website or system website), a faxed or emailed provider nomination form, or by telephonic request. Once a provider is nominated, CorVel's local PPO Developer will begin immediate recruitment of the provider. This process can take 4-8 weeks due to the credentialing requirements; however, CorVel will work diligently to make sure the credentialing and application processes of the existing the City preferred providers is expedited to ensure enrollment by the program start date. As CorVel owns and maintains its own provider network, addition of providers is an easy process for us to complete. September 12, 2014 C O R V E L Page 23 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS The City reserves the right, but not the obligation, to approve all vendor partners and ancillary services used by the TPA that are part of the workers' compensation allocated claim expense or reserve. CorVel agrees and will comply. CorVel's software, systems and staff are direct resources of our company. We currently do not outsource or utilize any significant subcontractors with the exception of defense counsel, outside Investigation and appraisals. The City will be able to approve all vendor partners and ancillary services used. City reserves the right to select its own workers' compensation defense counsel to manage any and all litigation for the City's workers' compensation and employer's liability program, and/or to seek pre -litigation legal advice and claim strategy. The City's Risk Manager has the authority to approve the workers' compensation defense counsel's fee, cost schedule and/or any allocated legal claim adjustment expenses. TPA shall agree to work with the City's chosen workers' compensation defense counsel. In the event the TPA is unable to work with the City's workers' compensation defense counsel or has a conflict of interest, then City reserves the right to deem the TPA's proposal non-responsive, or terminate the TPA's Contract. , CorVel agrees and will comply. Legal referrals are closely monitored for need and effectiveness. Specific attorneys, rather than firms, generally provide the most effective representation. CorVel will work closely with counsel in evaluating and making recommendations for claims management. We are accustomed to working In partnership with various reputable law firms. CorVel will work closely with the City in evaluating legal counsel and make recommendations regarding suitable panel attorneys. We can use existing the City attorneys if preferred. We understand that the City's Risk Manager has the authority to approve the workers' compensation defense counsel's fee, cost schedule and/or any allocated legal claim adjustment expenses. ' TPA shall provide the City with an on-site experienced, dedicated adjuster to provide professional workers' compensation adjusting services and employee claim assistance on-site at the City's Risk Management Division Office of the Human Resources Department, or as otherwise designated by the City, with duties and responsibilities to be mutually agreed upon by the TPA and the City. TPA must provide access to Spanish and Creole speaking adjusters for situations when injured workers are more comfortable conversing in Spanish or Creole. TPA should clearly outline the staffing which will be provided. The adjuster shall perform all the usual and customary worker's compensation claim adjustment services and assistance as done by the City's Risk Management staff in accordance with the third -party claims administrator agreement between the City and TPA. The scope of assignment includes, but is not limited to, filing new losses, coordinating light duty assignments, assisting employees with claim questions, filing wage statements, updating diary notes, assisting attorneys with litigated files, and working with the City's regularly assigned workers' compensation claims adjusters. September 12, 2014 C O R V E L Page 24 M DocuSign Envelope ID: 6EEOD36E-ASE7-416C-6B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS CorVel will provide the City with an on-site experienced, dedicated Adjuster to provide professional workers' compensation adjusting services and employee claim assistance on-site. CorVei recognizes the importance of ongoing contact with injured workers and will maintain regular contact with employees. We will work with the City during the implementation process to select Adjusters that are bilingual or multilingual in languages that Include Spanish, Creole, Vietnamese, Korean, Chinese, French and Russian. The following staffing will be provided to the City: • Carrie Rath, Workers' Compensation Claims Manager • Felipe Benitez, Liability Claims Manager • Jennifer Johns, Claims Supervisor • Anita Alvarez, Senior Claims Adjuster • On-site Claims Adjuster, to be hired The Adjuster assigned to the City's program will perform all the usual and customary workers' compensation claim adjustment services and assistance.as done by the City's Risk Management staff. CorVel's Adjuster will perform the scope of assignment including, but not limited to, filing new losses, coordinating light duty assignments, assisting employees with claim questions, filing wage statements, updating diary notes, assisting attorneys and working with the City's regularly assigned workers' compensation Claims Adjusters. TPA shall provide, on an as needed basis, an on-site dedicated licensed liability claims adjuster at the City's Risk Management Division, Office of the Human Resources Department, or as otherwise designated by the City, to assist the City's Risk Manager with claims administration services for the City of Miami Beach's self-insured liability program. The City is self-insured and self-administered for liability claims management. The adjuster shall perform claims administration services for automobile and general liability claims. The scope of assignment includes, but not limited to, Investigations, creating file diaries, record keeping, and other services necessary or proper for, or incidental to, performing claims adjusting. M1 The City will have a designated liability claims unit based on claim volume. We are willing to discuss an on-site designated licensed liability claims Adjuster on an as needed basis. If an Adjuster on the City's team does not carry a full caseload of the City's claim files, that Adjuster may be utilized on another account. Adjusters that will be designated to the City's account, and the percentage of time each individual will be designated to the account, will be determined once the proposed organizational chart is finalized. All permanent, designated team members will be located in the Sunrise, Florida office. CorVel's Adjuster will perform claims administration services for automobile and general liability claims according to the scope of assignment, including investigations, creating file diaries, record keeping and otherservices necessary for performing claims adjusting. September 12, 2014 C O R V E L Page 25 DocuSign Envelope ID: 6EEOD36E-ASE7416C-6B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • TPA shall provide the City with telephonic case management services on all workers' compensation claims as an allocated loss adjustment expense, unless otherwise directed by City. - CorVel agrees and will comply, Telephonic case management is a cost efficient evaluation and coordination of medical care delivery, conducted over the phone by a nurse. It is geared toward less medically and vocationally complex cases, and is usually targeted to a time limited intervention of 30 to 60 days, focusing on early return to work, maximum medical improvement, and aggressive negotiation with medical providers. Y TPA shall provide a list of PPO networks affiliated with the TPA, as requested by City. CorVel agrees and will comply. CorVel offers a proprietary national PPO network comprised of more than 750,000 provider locations and specialties, including over 63,200 in Florida, to offer our clients local insight with national coverage. Providers are selected from a demanding criteria based on quality, range of services and location. Each provider is thoroughly evaluated and credentialed, then re -credentialed every three years. Through this extensive evaluation process, we are able to provide significant hospital, physician and ancillary medical savings while maintaining high quality care. CorVel works closely with its customers to ensure maximum usage of the PPO network. Network channeling occurs along all points of the managed care continuum, beginning having adequate provider panels posted atthe City's locations. We work with all treating physicians to make sure all specialty referrals are directed to an In -network provider. Each time provider channeling occurs during the course of treatment, it is noted within the system. CorVel also has directed care networks in specific states to direct care to the most appropriate provider, along with achieving maximum savings. We offer many channeling tools to the City Including online provider look up, demographic file downloads, online directories, toll free scheduling number, provider inquiry email, toll free provider inquiry line and an online referral process. Also, our network providers are contractually obligated to refer to other network providers whenever possible and according to state laws. CorVel's online provider lookup functionality also includes enhanced features for the specialized needs of the City. Features include printable directories and customized provider panels. Specific directories, based on physician specialty or geographic location can be generated directly by the City and printed instantly for a readily available reference. The City can also hand select a panel of preferred providers for any given location, print the preformatted one page panel and post as any easy access resource guide for employees. The panel and directories are customized with your company's name and location(s). These enhanced services proactively assist you In directing employees to preferred care providers. We can provide the City with a link to our network directory to facilitate easy access for employees, Occupational Benefit Specialist and the City's treating providers. September 12, 2014 C O R V E L Page 26 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • TPA shall evaluate and qualify various service providers recommended by the City to service its account, provided such service providers do not present a perceived or potential conflict of interest. CorVel agrees and will comply. The City can request that providers be added to the network In a variety of formats including an internet nomination form (found on the CorVel website orsystem website), a faxed or emailed provider nomination form, or by telephonic request. Once a provider is nominated, CorVel's local PPO Developer will begin immediate recruitment of the provider. This process can take 4-8 weeks due, to the credentialing requirements; however, CorVel will work diligently to make sure the credentialing and application processes of the existing the City preferred providers is expedited to ensure enrollment by the program start date. As CorVel owns and maintains its own provider network, addition of providers is an easy process for us to complete. TPA shall provide the City with field case management services, catastrophic case management services, medical cost projections, life care planning, Medicare set-aside assessments, development of reports, surveillance, peer review, utilization review and reasonable and customary savings review, bill review, percentage of PPO savings and any other usual and customary workers' compensation claims administration claims practice, strategy or activity as all allocated loss adjustment expenses, unless such expenses are more appropriately allocated as a medical expense under the claim per Florida Statutes or TPA's judgment. CorVel will provide the City with the services mentioned above as well as any other usual and customary workers' compensation claims administration claims activity as allocated loss adjustment expenses, unless such expenses are more appropriately allocated as a medical expense under the claim per Florida Statutes or our judgment. Our managed care services include the following: Field Case Management Field case management is a method of evaluating and coordinating medical care for claims characterized by high severity or related difficulty and complexity. It is the preferred method when intervention should be intensive In nature and involves Field Case Managers with expert knowledge of the local medical communities and labor markets who engage in face to face meetings with key parties to ensure medical care Is appropriate, high quality and cost effective. Catastrophic Case Management CorVel's catastrophic case management service provides access to an on-call nurse, 24 hours per day, 7 days per week, to facilitate an immediate response to a catastrophic Injury. Upon notification, the claim will be immediately referred to a Catastrophic Case Manager experienced in critical care and acute injuries. Instant communication Is established as the Case Manager coordinates treatment while guiding the patient through the critical episode of care and recovery. The Catastrophic Case Manager will contact the hospital where the injured worker has been admitted and arrange an onsite visit with the injured worker, the injured worker's family and the medical providers involved with their treatment. The Catastrophic Case September 12, 2014 C O R V E L Page 27 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Manager will continue to communicate with the providers and injured worker on a daily basis until the acute phase has passed. Early intervention in catastrophic cases can result in significant medical, indemnity, legal and overall claims savings. Medical Cost Proiections CorVel realizes that reserving can have a significant impact on the financial well being of our customers. They must be established timely and accurately to reflect our best judgment considering the injury, estimated period of disability, ability to return to aform of wage earning capacity, along with environmental considerations. As CorVel offers a fully integrated claims management and managed care program, our Claims Adjusters work closely with Case Managers via our online, real time claims management portal to manage reserves, RTW objectives, and case closure. Our Adjusters consider the particular circumstances of each claim and maintain contact with the injured worker, Case Manager, physicians and the City to develop a reserve that is current, realistic and based on the probable cost of each claim. Reserves are based on the medical Information received from Case Managers and treating physicians. Reserves may be adjusted as: • New medical information is received • Prognosis is updated • Injured worker obtains legal representation • Settlement is anticipated • Additional pertinent information is received It is CorVel's practice to avoid the stair step methodology or have reserves continually increase or decrease. However, reserves will be adjusted as the claim develops and additional information is received throughout the life of the claim. Reserve changes, payments and file closings are input into the system within 24 hours. Reserves on all open claims are reviewed every 90 days or more frequently based on our event driven diary system. All reserve activity Is documented in the claim file. Life Care Plannino CorVel offers certified Life Care Planners to aid in cost containment for catastrophic injuries, while advocating quality care for patients. Life Care Planning is a tool used to project long-term future needs, services and related costs associated with a catastrophic injury. CorVel's Life Care Plans summarize extensive amounts of medical data and compiles it into a comprehensive report for future care requirements. The report assists claims payors with future cost,projections while identifying the continuing medical care needs of the injured individual. Medicare Set -Aside Assessments The Centers for Medicare/Medicaid Services (CMS) requires their interests be protected prior to any settlement of the medical portion of a claim for qualified individuals. CorVel offers our clients CMS compliance by utilizing qualified and specially trained Medicare Set Aside specialists experienced with CMS requirements. Our services are comprehensive and seamless, from development and submission of the MSA allocation report through the completion of settlement documents. September 12, 2014 C O R V E L Page 28 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D9127705AD3 TAB 1: COVER LETTER & MINIMUM QUALI Program Services: • Development of comprehensive allocation report " • Free initial consultation to determine need for Medicare Set Asides • Obtain any necessary rated age information • Assistance with outstanding conditional payment status • Assistance with Social SecuritylMedlcare status • Assist and prepare all necessary forms, Program Benefits: • CorVel offers a strong working relationship with CMS • Comprehensive solution to meet all of your needs • Fast turnaround time • Continuous communication and follow up with necessary parties • Free onsite claim file copying • Expedited settlement agreement services CorVel will continue to query the SSNI, name, gender and date of birth of injured workers on all open claims on a monthly basis to determine if Medicare eligibility has begun. This is not explicitly required in the CMS regulations, but It is the only way an RRElAgent can be sure of an injured worker's eligibility on ORM or other types of long- term claims. Development of Reports CorVel's reporting capabilities are extensive. The City will have access to a variety of reports via the claims system, allowing you to create reports to meet your specific needs. Every report allows the user to group, total or sort by various data fields with an assortment of filters. All reporting can be grouped and totaled by multiple location tiering. CorVel's reports are user friendly, well organized, intuitive and simple to use. Surveillance It is CorVel's practice to discuss any outside investigation activities with the City prior to assignment. Before a referral, the Claims Adjuster conducts a cost1benefit analysis to determine if the investigation has the potential to derive the savings necessary to employ the expense. We do not recommend investigation assignments on files with very limited potential exposure. Any request by the City for outside investigation will be honored. Criteria for initiating investigation include: • Injured worker may be working while collecting temporary disability or salary continuation • Injured worker may be engaging in activities outside of their restrictions • Injured worker's permanent disability is grossly inconsistent with reported activities or objective findings September 12, 2014 C® R V E L Page 29 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS CorVel has a provider list for investigators and will honor any vendor selection by the City for case referrals. Outside investigation assignments will be completed and submitted within 30 days. Peer Review CorVel has a large consultant panel of physician advisors that perform peer reviews. These physician advisors are board certified In their specialty and In an active medical practice. Peer reviews are performed between like specialties, i.e. Neurosurgeon to Neurosurgeon, Orthopedic to Orthopedic. CorVel recruits providers as needed in each state to accommodate the volume of peer reviews. The peer reviewer professionals must go through the same certification process as the providers that are in the PPO network. CorVel has peer review capabilities for the following specialties: Occupational Medicine • Acupuncture • Orthopedic Surgery • Pain Management • Physical Medicine and Rehabilitation • Neurology • Podiatry • Internal Medicine • Toxicology • Oncology Psychiatry • Anesthesiology • Cardiovascular • Dentistry • General Surgery • Hand Surgery • Hematology • Neurosurgery • Plastic Surgery • Rheumatology • Thoracic Surgery and Urology The specialty of the treating provider will determine which peer specialty will be utilized. CorVel only utilizes peer review physicians who support their findings with medically based evidence and are URAC IRO accredited. Utilization Review CorVel's utilization review program provides prospective, concurrent and retrospective review of specific treatments. Our experienced staff of Utilization Review Case Managers, board certified Medical Directors and peer review physicians utilize medical treatment protocols and expert systems technology to determine the medical appropriateness of care as well as frequency, duration and setting. The goal of our utilization review program is to avoid unnecessary treatments and their associated costs and to ensure high quality, timely, cost effective medical care for injured workers. Key utilization review features include: • Medical treatment plan review • Patient referral to select CorVel PPO providers • Pre -certification of an admission and approval of a specific length of stay • Coordination of discharge planning, DME and other services • Timeliness of service: compliance with Florida legislation September 12, 2014 C O R V E L Page 30 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM Confirmation letter to the provider, injured worker and Adjuster of any certification or denial Reasonable and Customary Savings Review CorVel's rules engine has more than 10 million rules that apply fee schedule and appropriate reasonable and customary rules as well as pricing as defined by each state. This reduces medical costs from 10%- 40% depending on state regulations. Bill Review CorVel offers an innovative medical bill review program with up to 75% average savings per bill in the state of Florida. We offer a complete medical savings solution for all in - network and out -of -network medical bilis, including PPO management, medical bill repricing, line -item review, expert fee negotiations, professional review, automated adjudication and electronic reimbursement. Each feature focuses on increasing processing efficiencies and maximizing savings opportunities. Our company specializes in reducing the cost of all medical bills through a combination of rules -based technology, clinical expertise, expert review and a proprietary PPO network. We offer a winning formula by combining these elements into a single, powerful savings solution. CorVel offers up to 28% higher savings than leading competitors. Rules Engine Our proprietary rules engine Is highiyflexible and can be configured by line of business, company location, state and customer. Populated with more than 10 million rules, the system ensures accurate and consistent bill review to maximize savings for our clients. Through the electronic intake of medical bilis and expert review of all charges, CorVel is able to identify unbundled services, re -bundling opportunities, reasonable and customary review, fee schedule analysis, and pharmacy and PPO review. Enhanced Bill Review CorVel's enhanced bill review program adjusts individual line item charges on specific bills to reasonable and customary levels while removing all error and billing discrepancies with professional review. The service Is designed to maximize savings opportunities and increase efficiencies for customers. Reporting and Analytics CorVel's reporting and analytic capabilities, via our online portal, offer extensive access to important claims data including scanned medical bills and Explanations of Review (EOR) in addition to all other associated bill review information. With online access to comprehensive data, the City can track medical costs throughout the life of a claim and review bills being processed instantly and at your convenience. In the next year, CorVel will save our customers over $4 billion. We offer the City the most comprehensive solution in the marketplace. From smart processing to payment resolution, we focus on increasing efficiencies and maximizing savings opportunities, Percentage of PPO Savings We deliver discounts below workers' compensation fee schedule and reasonable and customary rates,through our national, proprietary network. Our network consists of more than 750,000 provider locations and specialties, with more than 53,200 providers in the state of Florida. Providers are selected using demanding criteria based on quality, September 12, 2014 C O R V E L Page 31 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS range of services and location. Our solutions extend beyond traditional PPO programs via our directed care networks which offer significant discounts with ancillary providers combined with utilization management and increased penetration. Pharmacy CorVel's clinical expertise, investments In technology and customer service can provide the City with significant reductions in your pharmacy costs. Our comprehensive pharmacy solution includes formulary management, maximum network penetration and aggressive utilization management. We provide access to a network of more than 4,400 retail pharmacies in Florida, with over 65,000 retail pharmacies nationwide. Clinical Modeling ' CorVel is able to proactively identify significant cost -drivers in pharmacy utilization before they become high dollar claims through clinical mcdeling analysis of all bill review data. We have developed a proprietary set of rules in our system to flag specific indicators such as high narcotics usage, multiple prescribers, and certain drug combinations that can contribute to rising costs or lead to harmful conditions such as addiction and prescription abuse. Integration with CorVel's bill review program provides us with full visibility into a patient's entire drug history including drugs obtained from retail, mail order and out -of -network pharmacies, third party billers and physician dispensed medications so we can manage the City's entire pharmacy exposure. Once a potential costly or harmful claim is identified, It will be forwarded for Intervention by our medication review program, with prior approval from the City. Medication Review CorVel's medication review program reduces costs by working with treating physicians to ensure injured workers get the most appropriate care In the most cost effective manner. Our locally based physicians consult with treating physicians to review prescriptions, determine medical necessity, consider alternative medications and obtain the physician's sign off for the new drug plan. This can result in significant reductions in overall medication costs and ensure the injured worker's safety during their episode of care. Directed Care Network CorVel's directed care services are based on four elements in cost containment - utilization, rate reduction, timeliness and reporting. We have contracted with the nation's most respected medical imaging, physical therapy and ancillary service networks to offer convenient access, timely appointments and preferred rates. We manage the entire coordination of care from appointment scheduling through reimbursement, working to achieve timely recovery and Increased savings. • TPA shall process and handle all electronic data interchange requirements on behalf of the City as required by the State of Florida at no additional charge. CorVel will process and handle all electronic data interchange requirements on behalf of the City as required by the State of Florida at no additional charge. CorVel has an extensive and documented process in place for electronic data interface (EDI) projects. We will work with the appropriate personnel at the City to reviewfile formats and specific system requirements for data fields in both systems. We approach each desired piece of the EDI process with test file exchanges, reviews of September 12, 2014 C O R V E L Page 32 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS results, and acceptance before moving on to the next piece. Data is exchanged via secure file transfer protocol (SFTP) with or without encrypting files, or via file transfer protocol (FTP) with encrypted files. CorVel also supports Web Services and ANSI X12. Encryption is based on PGP's public -key cryptography and an exchange of public keys between CorVel and the City. CorVel's electronic data interface has the ability to deliver EDI files by FTP or virtual private network (VPN), We currently transmit data to approximately 6,000 users and conduct hundreds of data file transfers to our customers on a daily basis. We can tailor data transfer files according to the City's specifications. • TPA shall be responsible for all Medicare reporting obligations under the Medicare Secondary Payor Act, and/or under similar or new legislation at no additional cost to the City. CorVel agrees and will comply. CorVel offers solutions to help the City manage the requirements mandated by the Centers for Medicare and Medicaid Services (CMS). As an assigned agent, we will provide agent services for the City as the Responsible Reporting Entity (RRE). As an experienced information processing provider, we will electronically submit files to the CMS in compliance with timelines and reporting requirements. CMS periodically releases updates to their policies and procedures as they pertain to the reporting process. CorVel is in regular contact with CMS as part of our effort to provide an efficient and cost effective solution for timely compliance. We will provide the City with pertinent updates from CMS when appropriate. Summary of CorVel's agent services: . ' CorVel's Medicare Secondary Payer (MSP) reporting solution has the capacity to receive data through electronic file transfer and manual entry, integrating the data seamlessly into a web based form. If the City claims have not been confirmed by CMS as Medicare eligible, CorVel will queue the claims for the monthly query, automatically informing the Adjuster when a claim is tagged as reportable. • Alerts, notifications and work queues are all managed from the web interface, letting the user know what data is missing or not compliant for any record. This ensures that all information flows smoothly based on the City's quarterly report date. • Once the data has been finalized and the report sent, CorVel will Integrate the response file back into the work queue, automatically notifying the Adjuster of any compliance issues or missing data. If required by CMS, the claim will be queued again for reporting once the problem elements have been corrected. a CorVel handles all Non -Group Health Plans (NGHP) to include both ongoing responsibility for medicals (ORM) and Total Payment Obligations, to the Claimant (TPOC). • CorVel offers reporting technology to provide statistics on report submissions, missing data and compliance Issues, as well as varying elements of the claim data. We also offer the capacity to provide a copy of the actual report and its response directly back to the City. September 12, 2014 C O R V E L Page 33 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • TPA shall provide the City with OSHA 300 log reporting capabilities at no additional cost, as requested by City. CorVel agrees and will comply. J CorVel's claims system tracks lost time, and maintains absence information so that OSHA 300 reports are accurate using the Federal reporting standards. Our system pre - populates the OSHA form. We are able to accommodate employers who continue to provide full salary to employees disabled by a compensable work Injury while still recording the time as "lost" for insurance and actuary purposes. TPA shall handle subrogation claims and file lien notices on behalf of the City to protect the City's interests in rights of recovery from third -party tortfeasors. TPA shall not proceed with any legal action against a third -party tortfeasor without the City's Risk Manager's approval. CorVel agrees and will comply. Upon receipt of the claim, CorVel's rules engine evaluates the claim for potential subrogation. If the potential exists the claim is routed to oursubrogation specialistteam who will complete a thorough investigation that includes collecting, evaluating, and preserving the evidence. Evidence may include statements, photographs, and documents such as receipts, logs, maintenance, and tangible evidence (stored when feasible). Claim types that may include potential subrogation: • Accident involving machinery • Motor vehicle accident • Slip and fall hazard • Explosion or fire • Animal bite • Construction site accident • Accident involving tools or equipment • Product liability • Aircraft, train or boat accident • Claim involving a third party Reserves will be addressed at each claim review and rationale document in the Adjuster's plan of action review. Applicable statute of limitations will also be,outlined In the plan of action with aggressive efforts being undertaken to secure recovery of costs as soon as possible. Once identified, the appropriate parties will be placed on notice of lien. We will provide information to the injured worker, the City or the courtof the current lien amount. CorVel will receive prior approval from the City for any waiver or reduction of any lien or other settlement. September 12, 2014 C O R V E L Page 34 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D6AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS The City designee is kept up to date of the subrogation efforts and status at a minimum of every 90 days. The designee may also viewsubrogation efforts as noted in the claims system and subrogation report. • TPA shall review and seek approval from the City for any loss reserve adjustment Increases greater than twenty-five thousand dollars ($25,000). CorVel will review and seek approval from the City for any loss reserve adjustment increases greater than $25,000. • TPA agrees all negotiated settlement agreements shall require City approval. Such settlements would include but may not be limited to, agreements to wash-out an entire claim, settle a negotiated lien, settle a negotiated attorney fee, or any other type of settlement that is not otherwise considered an administration of a medical, indemnity or allocated expense that would otherwise be due and owed in accordance with Florida law. CorVel agrees and will comply. Upon receipt of appropriate medical documentation, CorVel will rate all reports and calculate the remaining exposures on the file. Our Adjusters are trained to take various other factors into consideration when analyzing reports. Often times, this may Involve Input from the employer. If the injured worker continues to work for the City, we will recommend a stipulation. However, if the injured worker no longerworks for the City, we will provide the City with a recommendation for a future medical buy out through a Compromise and Release, in addition to the stipulation recommendation. CorVel will conduct settlement negotiations on behalf of the City with the opposing attorney. We are confident in our Adjusters' skills in resolving cases prior to trial. We attempt to establish and maintain a good working relationship with applicant counsel in order to reach final settlements quickly, fairly and at the lowest possible price. We do feel there are times it is necessary to take a file to trial and times it would be more cost efficient to settle a claim. CorVel will discuss the claim with the City to guarantee we are all in agreement before we move forward. Prior to recommending a settlement, we will provide the City with an in-depth analysis of our options including a cost benefit evaluation and a suggested plan of action. CorVei will contact the City to obtain authorization before entering any settlement agreements or taking a claim to trial. CorVel Adjusters prepare Compromise and Release Agreements and Stipulations with Request for Awards in specific cases on our claims systems. The Claims Supervisor will maintain firsttier approval.before our Adjuster makes settlement recommendations to the City. CorVel understands that the City may prefer taking a claim to trial Instead of settling the claim. Our Adjusters are well trained to obtain the most qualified attorney for each individual claim and are able to direct an attorney to timely" move a file towards settlement or to file the appropriate paperwork to move the claim towards trial. September 12, 2014 C 0 R V E L Page 35 Docuftn Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9091277D5AD3 TAB 1: COVER LETTER & MINIMUM Settlement authority is granted to an Adjuster based on the claims handling agreement established with the City. Written contact is also made for authority, prior to settling a file. We can tailor any program to meet the City's objectives. As the case develops and information is received, ,settlement always remains a consideration. Alternative methods of resolution are reviewed such as mediation, structured settlements, etc. When a settlement Is pursued, a strategy is put together with defense counsel including an initial offer, target settlement amount and maximum settlement amount. Documentation in support of these figures will be placed in the file. In most instances, ,our Adjuster will do the negotiating. Our Adjusters are experienced at properly evaluating claims and negotiating settlements. • TPA shall attend in person or via telephonically all mediations. The City shall endeavorto have a Risk Management staff member, or designee, at all mediations as well as hearings. CorVel will attend all mediations In person or telephonically. TPA shall agree to quarterly claim reviews, whether in person or telephonically at the City's discretion, to review all litigated cases, legacy cases, catastrophic cases, or non -litigated complex cases. CorVel agrees and will comply. CorVel will participate In quarterly claim review meetings at the frequency requested by the City. We will work with the City to establish the parameters of the claim file review process. Meetings may be held telephonically or in-person and will be attended by the Account Manager, Claims Supervisor and the City. Claim review meetings serve as an opportunity to discuss specific claims, review all litigated cases, legacy cases, catastrophic cases, or non -litigated complex cases, and ensure they are being managed appropriately, timely and have a clear plan for closure. • TPA shall agree all claim files, reports, and other data prepared or provided in connection with a claim are and shall remain the property of the City. CorVel agrees and will comply. We understand all claim records, as well as claim files, reports and other data, are the City's property and we will therefore provide unlimited access. TPA shall keep complete and accurate records and accounts in connection with each claim. Such records shall be available at all reasonable times for examination by the City, or its' designee, and shall be kept for a period of no less than three (3) years after the completion of all work to be performed. Incomplete or incorrect entries in such records may be grounds for disallowance by City of any fees or expenses based upon such entries. TPA shall send City all closed claim files that are mutually agreed upon to be inactive. CorVel agrees and will comply. In accordance with established best practices and the City's specific claim handling instructions, claim files will contain electronic or scanned copies of all correspondence September 12, 2014 C O R V E L Page 36 DocuSign 277D5AD3 TAB 1: COVER LETTER & MINIMUM Including letters, faxes, reports and emails. Adjuster and Case Manager notes will summarize documents received and sent. Electronic file documentation will include the following as appropriate: monetary transactions, recorded statements and summaries, index reports, expert reports, legal opinions, medical authorizations, medical bills, medical reports, independent Adjuster reports, excess carrier reports, official reports, scene diagrams, photos and damage verifications. Guidelines require that all loss reports Identify the time and date the loss was received. Phone calls will be documented in online file notes to reflect Adjuster activity. Claim files are updated in real-time and can be viewed at any time via our online claims system. CorVel maintains electronic copies of all claim files indefinitely. Hard copies are maintained for a period of seven years or in accordance with corresponding jurisdictional requirements, whichever is longer. We will send the City all closed claim files that are mutually agreed upon to be inactive. The City of Miami Beach has not purchased excess coverage since 1997. However, TPA shall comply with all excess workers' compensation coverage agreements in place; including reporting requirements affording potential or existing coverage on all and any open (or re- opened) claims such as, but not limited to reporting. CorVel agrees and will comply. Any case that has reached 50% of the City's self-insured retention level, or has the potential to exceed it, shall be reported to the City and the excess insurer in accordance with the reporting criteria established by the excess insurer. All cases that meet the established reporting criteria are to be reported to the City within 30 days of when the known criterion is met. In addition to claims which have an incurred value equal to or greater than 50% of retention, CorVel customarily reports the following claims immediately without regard to the reserves: • Fatalities • Spinal cord injuries • Brain damage • Third degree burns covering 10% of the body • Second degree burns covering 30% of the body • Amputations Impairment of vision or hearing by 50°/u or more • Nerve damage -causing paralysis or loss of sensation in arm, hand or leg • Massive internal injuries affecting a body organ or organs • Multiple fractures -involving more than one limb • Fracture of both heel bones • Occupational diseasesuch as asbestosis, black lung disease or long-term chemical exposure September 12, 2014 C O R V E L Page 37 DocuSign Envelope ID: 6EE0036E-ABE7416C-8B7C-9D9127705AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • Back injury -requiring surgery or disability of one year or more • Disability of more than one year (some contracts have nine months) • Permanent total disability workers' compensation claims • Cardiac failure workers' compensation claims • Paralytic stroke workers' compensation claims • Environmental claims Sexual assault and molestation • TPA shall be responsible for any penalties, declined coverage, reservation of rights issued, diminished coverage benefits imposed by City's excess workers' compensation carrier(s) due to TPA's failure to properly report new or existing claims as required by each carriers' coverage agreement reporting requirements. CorVel agrees and will comply. CorVel shall defend and hold the City harmless for any workers' compensation claim whereby we were negligent or caused errors or omissions in the performance of its duties and obligations under the Agreement. Penalties are coded in the claims system by paymenttype. Separate codes are assigned for penalties related to medical payments, temporary disability payments and permanent disability payments. Each penalty is also coded in reference to the source of the penalty. Separate codes are given for employer caused penalties and TPA caused penalties. Management reports can be generated capturing all penalty payments and sorted by any of the coding options. • TPA agrees to notify the City of proposed or enacted changes in workers' compensation regulatory requirements or legislative acts that may affect the City's claims. CorVel agrees and will comply. CorVel Is active in the regulatory environment of our industry. Our involvement starts at the state level with the primary office in Florida. Information for Florida is gathered nationally and collated. We track both state and federal legislative and regulatory changes that affect any of the services we provide. CorVel hosts training and informational meetings to keep our claims personnel current on recent updates to workers' compensation laws, claims handling techniques, and rules and regulations. Meetings also including up to date information about investigations, fraud identification, subrogation and litigation management. • TPA shall agree to maintain a SSAE 16 audit on controls placed in operations and tests for operating effectiveness, and agrees to provide copies to the City as requested. CorVel agrees and will comply. September 12, 2014 C O R V E L Page 38 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS As a publicly traded company (NASDAQ GS: CRVL), CorVel is audited annually and required to comply with all Federal and State regulations, including the Sarbanes-Oxley Act of 2002. CorVel's claims management services and bill review systems have received Service Organization Control (SOC1) reviews in accordance with SSAE16 for the most recent service period July 1, 2013 to June 30, 2014. • TPA shall utilize the City's solely selected and approved financial institution for the funding of workers' compensation and liability claim payments and settlements. TPA agrees to comply with the City's Positive Pay (fraud detection) banking standards and must do a daily data feed to the City's financial institution for fraud detection. CorVel agrees and will comply. Customers wanting to use their own bank will be responsible for submitting the positive pay file on their own. • TPA shall send weekly invoices for wire fund transfer requests to replenish the City's account. Exceptions are made for special requests for unexpected large losses or claim settlements for which specific dedicated invoice for wire fund transfer requests shall be made. , CorVel agrees and will comply. We will send the proper funding based on the City's account instructions. • The City shall fund at least fifty percent (50%) times the City's average weekly spend on workers' compensation claims. Presently the City's fund maintains an average weekly balance of two hundred and fifty thousand dollars ($250,000). CorVel agrees and will comply. • TPA shall send original invoices to the attention of the City's Risk Manager, or designee, by e- mail to City of Miami Beach, unless otherwise instructed. CorVel will send original invoices to the attention of the City's Risk Manager, or designee, by email to City of Miami Beach, unless otherwise instructed. • TPA shall mail the City monthly financial institution reconciliations. CorVel will mail the City monthly financial institution reconciliations. • TPA shall issue 1099's to all vendor issued allocated claims payments pursuant to the applicable tax laws in effect. CorVel agrees and will comply. CorVel, gathers form 1099 information from all our accounting systems and merges them into one database. Tax ID numbers that meet the 1099 criteria are generated and mailed out on or before January 31. 1099 data is sent to the IRS electronically prior to the reporting deadline. We can supply the City with a report that shows the tax ID and amount they contributed to the 1099 if necessary. September 12, 2014 C O R V E L Page 39 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • TPA shall be audited by the City at the City's sole discretion and cost. CorVel agrees to make the City's claim files and records available for review in our offices with appropriate lead time notification so as not to disrupt the day-to-day claims handling activities of the claims staff, CorVel Supervisors are available for questions and consultation to assist the City or any outside party in their review. • TPA shall invoice the City quarterly for its administrative claim fee. CorVel will invoice the City quarterly. • TPA shall take extraordinary measures, if is selected as the new TPA for the City, to ensure data and file conversion and transfer is done with as little disruption to the City and its injured employees to ensure continuity in care and continued best workers' compensation claims management practices. CorVel agrees and will comply. The City's current open claims data will be mapped and integrated into CorVel's claims system and will require an Adjuster to review the claim file before any payments can be made on the file. If the City's current system does not use a paperless environment, all necessary documents will be scanned into our system in accordance with our claims handling best practice process. Medical bills and supporting documentation will be scanned into our system or an EDI will be established from the current vendor allowing the bill Image to be uploaded into our system so the Claims Adjuster can process the bills. We will request a data transfer of all claim activity from the City's previous vendor with corresponding control totals, record layouts, code translations, etc. Optimum time from contract signing to complete the transition of data is 90 days. This timeframe can be shortened depending on the complexity of converting and loading historical data into our system. If there is no historical data to convert to the system we can be ready to accept new claims within 30 days of contract signing. CorVel is able to create up to a 6 tier organizational structure from which reporting can be generated at any level. We can accept and map your data to appropriate fields within our system which includes: transactional data • file notes • reserve history • subrogation and litigation Information • scanned documents • exhibits in PDF, Word and Excel formats • assigned departments • employee occupation • accident locations • injury, body part and cause We have experience capturing data from most of the country's largest insurers and TPAs and seamlessly integrating it into our claims management system. Successful system integration provides the Adjuster with the appropriate data integrity to perform September 12, 2014 C 0 R V E L Page 40 DocuSign EnvelopeID: 6EE6D36E-ABET-016C-867C-9D9127705AD3 TAB 1: COVER LETTER & MINIMUM their work while being assisted by operations support to ensure all necessary physical file data is scanned into our system to maintain a paperless file environment. TPA will be required to manage the claims with a comprehensive data base system which allows computer access to notes, correspondence and other pertinent information needed by the City to generate analytical data reports upon demand; which will allow secure web based communication between the City and the TPA adjusters. This program should also allow the City to add information to the adjuster notes section of the TPA computer system. TPA shall provide the City's Risk Manager and it's designees, with access and training to utilize the TPA's'Risk Management Information System to monitor the adjuster's claim activity on a file. CorVel's proprietary claims management system has been developed and supported by our in-house, full time Information systems division. We have invested millions of dollars into the development of our integrated system that offers tremendous cost and timesaving benefits. Unlike most industry platforms, we do not rely on data feeds from third parties that can delay critical information. Our system supports our claims and medical management teams by supplying extensive, real-time information to better assist injured workers and Improve outcomes. We offer a secure system that provides the City with complete program visibility, streamlined processes, and allows you to stay connected throughout the entire claims process. The City will be provided with 2417 access to real time data including claim activities, diaries, claim notes, reserves, medical bill documentation and financial information. Detailed reports can also be generated In various time periods and formats, and can be sorted in a variety of grouping and filtering options. Features of CorVel's claim system include: • Tailored User Setup — User ability to set up custom alerts and preferences • Dashboards — User friendly dashboards intelligently organize data and provide useful tools for effective claims management • Transparency — 2417 online access to all claims and financial data • Data Security — Password protected via a secure Internet connection and HIPAA compliant Please see Attachment E: Screenshots of Claims System. Access to Notes Claims Adjuster and Case Manager activity notes are categorized by activity type, in order of date. This allows the City to filter the claim notes so only pertinent notes are viewed. For example, if a client is interested in the basis for a compensability decision, the Investigation note category can be selected and only activities related to the claim investigation will be displayed. All Field Case Managers have Wads and use our proprietary apps to track the status of milestones and events for their cases. This mobile technology enables real-time updates to CorVel's system and allows Case Managers to immediately add notes about appointments and completed tasks for their assigned caseload. An additional feature of the !Pad is the ability to electronically approve and email signed case management forms and documentation — providing a virtual sign and send approval process. September 12, 2014 C O R V E L Page 41 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Correspondence All of CorVel's claims staff has personalized email and voicemall making us accessible through many avenues of communication. Our claim system also offers the ability to gain remote access to review claim data and read Adjuster notes. The claims system allows associates to copy and paste client communication via email, as well as other documents, into the notes. This feature, in effect, enables our clients to type notes in the claim file by simply emailing their comments to the Adjuster. Report Capabilities Many of our reports can be created on demand through CorVel's online system. Rather than inputting a request for specific reports and waiting for the report to be created, the City will have the flexibility to access the online system and create reports instantly. Reports can be printed, emailed and shared which allows for all stakeholders to instantly view and analyze data related to your program. Client Notes Clients are able to enter claim notes. They are denoted in our system as "client added notes" and are a permanent part of the claim file. Training CorVel will coordinate with the City to develop a tailored training program. These planned sessions will incorporate the needs expressed by the City, as well as the expected teamwork needed between the CorVel team and the City's staff. We offer a variety of training options including online meeting conferencing and onsite training at pre -established hubs. Besides hands on training by CorVel's designated Account Manager, we offer online training that consists of updates, bulletins and newsletters. All training materials are included in the primary pricing structure. TPA shall provide the City with electronic loss runs, claim reports or ad hoc reports as required by City within seven (7) working days of month-end. CorVel will provide the City with comprehensive reports detailing every aspect of your program, enabling the City to make a proper analysis of its exposure. Loss reporting information is available on a monthly basis and in various time formats, history periods, including "as of," and actual time. The City will also have access to create reports through the online reporting center where more than 1,000 data fields can be sorted to organize reports by any lapsed time period, hierarchical sub group, dollar range, time of day/week, coverage or sub classification, or any one of thousands of other combinations. CorVel can consolidate information based on the number of incidents or injuries, costs, etc., per department or division and provide various comparative ratios and averages. Safety/risk management reports will include the same detailed accident listings and accountability. We summarize incidents or injuries by coverage line, injured worker name, type, and age, cause, injury type, occupation, location, supervisor, and Incident or injury date/time of day. Loss experience, payments comparisons and localized benchmarking reports are also available. The following are examples of CorVel's standard claims reports: Program Summary Scorecard Report September 12, 2014 CORVEL • General Claims Listing for Open/Closed/All Claims Page 42 DocuSign ID: 6EE0D36E-ABE7-416C-6B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • New Claims Received Report • Status Change Activity Report • Claim Payment Register • Claim Payment Summary • Overall Payment Summary by Type of Payment • Overall Payment Register for Period • Detailed Loss Report • Loss Summary by Policy Period Please see Attachment F: Sample Claims Reports. • Financial Analysis Report • Safety Analysis Report • Loss Development Report • Demographics • Mechanism of Injury • Lag Time Report • Escrow Activity Report • Lost Day Reporter • Location Loss Summary • Denied Claim Report • Litigated Claim Report CorVel's standard reporting capabilities are extensive; however we have the ability to provide ad hoc reports at the City's request for any special reporting needs. Ad hoc report inquiries can be made with data elements that we capture in the claims system, We will provide all reports within seven working days of month-end, • TPA shall provide periodic information to the City's actuarial service provider when required, CorVel agrees and will provide periodic information to the City's actuarial service provider when required. • TPA shall provide safety engineering services as requested by City, and fees shall be negotiated and approved by the City as an allocated loss adjustment expense per applicable claim file. CorVel delivers a variety of safety analysis reports that identify loss trends, analyze derivatives and detail financial impacts. We offer an interactive safety report that will allow the City to tailor reports with specific parameters in an intuitive and user-friendly format. Our Account Managers regularly review loss data and will inform the City of areas that may need further inquiry or analysis. CorVel has developed a recommended panel of safety experts throughout the country. We find that most of our clients have different needs for safety and loss consulting (i.e. ergonomic, OSHA compliance, safety engineering, risk management, 'industrial hygiene, environmental control, etc.) As a result, we will match the City's needs to safety consultants with that specific expertise for your review and determination. • TPA, as a custodian of records for City, shall comply and cooperate with all applicable City and State record retention and exemptions laws such as, but not limited to, Florida Statutes, Sections, 119, 440, 760 and 112 as they pertain to protected medical, personal and/or work product information. September 12, 2014 CORVEL Page 43 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D912771)5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS CorVel agrees and will comply with all applicable City and State record retention and exemptions laws. CorVel understands the sensitivity of health Information and we continue to make company -wide initiatives to protect informational privacy and security. Our systems, software and services are continually enhanced to safeguard Protected Healthcare Information (PHI) and assure our clients and trading partners that exchanging data with CorVel will take place within the bounds of HIPAA compliance. Access to our network and web -based services entails user -specific authentication and role based security. In addition to ourtechnical safeguards, administrative and physical safeguards have been put into place throughout CorVel. Our staff is fully trained in HIPAA compliance and we continue to keep our staff updated through a corporate driven initiative which encompasses all aspects of training, documentation and execution pertaining to HIPAA. ' TPA agrees to transfer or ship the electronic file data or hard copy file data at the request and as directed by the City at no cost other than actual incurred reasonable shipping fees. TPA agrees there shall be no charges to transfer electronic data on a per data file basis or other transfer related fees or charges unless agreed upon in writing by City. All electronic data transferred or hard copy data shipped shall be done within sixty (60) days of receipt of written notice from City. Paper data shall be shipped overnight by FED EX, UPS or equivalent common carrier agreed to by City. Electronic data shall be transferred by disk/tape or over internet as requested by City, provided the data files are adequately protected and secured. Electronic file data means all claims information and related claim file information maintained in an electronic computer file format, whether stored on a hard drive, tape backup or CD. CorVel agrees and will comply. • Other claims adjusting services for Workers' Compensation and General Liability, as needed. CorVel will provide claims adjusting services for Workers' Compensation and General Liability as needed. STAFFING AND PERSONNEL: It is the City's claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control the City's self-insured loss payments is to ensure the administrator hires and retains the appropriately qualified professionals to handle our claims. Additionally, the adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services. The City therefore requires that the proposer agree to staffing, qualifications and caseload criteria established by the City. CorVel agrees to the City's staffing, qualifications and caseload criteria. CorVel knows that superior service for the City depends on the experience and training of all our associates. The Adjusters assigned to the City's account will have substantial experience reading medical reports, performing investigations, taking recorded statements, estimating the value of bodily injury/medical disability, returning Injured workers to work and closing claims. Our Adjusters possess appropriate state licensure and are experienced at proper documentation as well as subrogation/recovery techniques. They know how to determine which claims are compensable and how to establish reserves. Our Adjusters work effectively September 12, 2014 C O R V E L Page 44 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS with all constituents Including clients, injured workers, injured worker representatives, excess insurers, government regulators, physicians and defense attorneys. CorVel recruits associates that have established an exceptional reputation in the industry combined with significant work experience. We are able to attract and retain talent by providing competitive compensation and by maintaining caseloads at or below industry averages. We regularly solicit client input regarding personnel in an effort to build effective teams for our clients. The City reserves the right to the final prior approval of the hiring and/or assignment of the claims manager, supervisors and adjusters that are to handle the City's claims. CorVel will include the City during hiring and/or assignment of the Claims Manager, Supervisors and Adjusters that are to handle the City's claims. The required maximum open caseloads per adjusters (may have more than one adjuster assigned to the account) are to be as follows (claims manager should not handle files): i Workers' compensation (lost time) - 100 Workers' compensation (medical only) - 500 CorVel will comply with the City's maximum caseloads. The administrator agrees to add staff as necessary to maintain these maximum pending caseload levels. Explain how the office or unit will be staffed and explain the level of supervision that will be provided. Claims personnel must be employees of the administrator. The use of independent adjusters, subcontractors or temporary adjusters is not acceptable without prior approval of the City. Adjuster trainees are not acceptable for handling of the City's claims. Additionally, resumes of all claims professionals specifically assigned to this account are to be submitted with this proposal. All claims professionals must possess a current Florida Workers, Compensation adjuster's license. CorVel agrees and will comply. When possible areas for staffing change or improvement are recognized, the CorVel Account Manager will make recommendations regarding the possible changes to the City. We will work with the City to implement any staffing modifications that the City and CorVel determine would be of benefit or improve outcomes for the program. LOSS FUND MANAGEMENT: 1. The Claim Payment Account will be maintained at the City's commercial banking institution. The account will be classified as part of the analysis group of City accounts. The Citywill pay all service fees that are normal and customary in this account. All interest earned or service credits generated will accrue to the benefit of the City. CorVel agrees and will comply. September 12, 2014 COR VEL Page 45 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 2. The claims administrator is required to follow Florida law concerning public deposits. Failure to comply with Florida law is sufficient cause for the City to terminate the contractual agreement with the claims administrator. CorVel will follow all Florida law concerning public deposits. We understand that failure to comply with Florida law is sufficient cause for the City to terminate the contractual agreement with the claims administrator. 3. All claims, expense and legal payments will be made by the claims administrator on checks drawn on an account set up by the administrator and funded monthly by the City. It is understood that all funds in this account are City funds and are to be returned to the City upon request or at termination of this contract. CorVel agrees and will comply. 4. The administrator is responsible for the monthly reconciliation of this account and will provide bank statements to the City monthly, along with a request for a deposit from the City to maintain the monthly balance in the loss fgnd, as determined by the City. CorVel agrees and will comply. 6. The monthly reconciliation statement submitted by the administrator to the City will include the following: - balance at Inception of statement period - total disbursements which cleared, by date and claimant(payee - balance at close of statement period - amount of deposit required CorVel will provide a monthly reconciliation statement to the City that will include the Information listed above. 6. A list of all checks is to be submitted monthly. CorVel will submit a list of all checks monthly. September 12, 2014 C O R V E L Page 46 DocuSign 277D5AD3 TAB 1: COVER LETTER & MINIMUM SUPPLEMENTAL QUESTIONS In addition to information that may be provided in your proposal and required elsewhere in the RFP, please answer the following (restate question in each answer): 1. Where is your office located? Our Tampa, Florida office will manage the City's workers' compensation claims and our Sunrise, Florida office will manage your liability claims. They are located at: 5401 W Kennedy Blvd. 1560 Sawgrass Corporate Pkwy Suite 535 Suite 100 Tampa, FL 33609 Sunrise, FL 33323 2. Number of professional claim, clerical and/or support staff at that location. Our Tampa, Florida office houses 24 professional claims staff members. 3. Name, experience, resume and professional designations of claim manager. The following staff will serve as Claims Managers for the City's program: • Carrie Rath, Workers' Compensation Claims Manager — Carrie has more than 11 years of workers' compensation claims experience, with 9 years' experience in supervision and management. She has been with CorVel for two years. Carrie has extensive knowledge of Florida workers' compensation administrative code, state law and regulations, and case law. Her professional designations include her State of Florida All Lines Adjuster License and that she holds an accredited claims Adjuster designation in Florida. • Felipe Benitez, General Liability Claims Supervisor— Felipe has more than 34 years of experience in operations, logistics, financial and human capital management. He has been with CorVel for two years. Felipe's professional designations include serving as a Florida All Lines Adjuster and as a member of the Workers' Compensation Claim Professional Association. Please see Attachment C: Staff Resumes. 4. Name, experience, license type, resume and professional designations of any supervisory level employees that will have responsibility for this account. The following supervisory level employees will have responsibility for this account: • Tom Cassette, Area Vice President. Tom has been with CorVel for 6 years. He has extensive experience with workers' compensation insurance as well as niche market experience including professional employer organizations, self-insured retention and high deductible programs. • Debbie Popovich, Vice President, Regional Sales. Debbie has been with CorVel for 8 years and has more than 17 years of experience in the Florida workers' compensation market. Currently she participates in acquisition sales in the Florida region and serves as an expert for claims and medical management services. September 12, 2014 C O R V E L Page 47 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICA • Chris Oliphant, Case Management Manager. Chris has been with CorVel for 9 years. She is knowledgeable in Florida 440 Workers' Compensation Law and manages telephonic and field case managers to ensure the delivery of optimal, cost-effective medical care. Her professional designations include serving as the State Legislative Chair for International Association of Rehabilitation Professionals and as a member of the Broward Association of Registered Nurses. Please see Attachment C: Staff Resumes. 5. Name, experience, license type, resume and professional designations of the designated adjusters that will have responsibility for this account. The following designated claims staff will have responsibility for this account: Jennifer Johns, Claims Supervisor. Jennifer has over 17 years of workers' compensation experience with 10 years' experience with multi -jurisdiction claims management supervision. She holds a State of Florida Workers' Compensation Adjuster License. Anita Alvarez, Senior Claims Adjuster. Anita has over 19 years of workers' compensation claims experience, including extensive knowledge of Florida Workers' Compensation Administrative Code, State Law and Regulations and case law. She is a Licensed Adjusterand fluent in Spanish. Her professional designations include her membership with the Workers' Compensation Claims Professionals Association. Please see Attachment C: Staff Resumes. 6. Advise the current pending case load for each designated adjuster. CorVel's Best Practices dictate the following caseloads: Indemnity Adjuster Up to 100 files Medical Only Adjuster Up to 500 files Liability Adjuster 125 —150 files 7. What is the current number of monthly new assignments to each adjuster? Claim volume and the experience level of the Adjuster dictate new claim assignments. The Supervisor reviews the claim, assigns it to the appropriate Adjuster and provides direction on the future handling of the claim. The Claims Supervisor does not carry a caseload and will review Adjuster caseloads monthly. Management reports are utilized to provide caseloads by claim type at the Adjuster, office and client level. If an Adjuster is nearing a saturation point, either temporary support is provided from a Supervisor or case files are transferred to another Adjuster to decrease caseload. September 12, 2014 CORVEL Page 48 DocuSign TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 8. Will the award of this contract necessitate an increase in your staff size to meet the City's staffing and caseload requirements and will that be in place by February 1, 2015? No, the award of this contract will not necessitate an increase in our staff size to meet the City's staffing and caseload requirements. Staffing will be in place by February 1, 2015. 9. Name the 4 law firms (2 workers' compensation, 2 liability) that you currently handle the most cases with. Provide a contact person and phone number. 10. Estimate the percentage of time your adjusters are out of the office doing field work_ If all are telephone adjusters, please indicate. Our Adjusters are all telephone Adjusters. CorVel is currently in partnership with G4S Compliance and Investigation, a nationwide surveillance company that provides onsite investigations and appraisals. The CorVel Adjuster will always maintain responsibility for the claim during the investigation. 11. Do you utilize independent contracted adjusters? If so, under what circumstances? No, we do not utilize Independent contracted Adjusters. 12. Name, address, phone and contact person for independents you utilize. Not applicable. 13. Can you provide all the required services with your own personnel? CorVel's software, systems and staff are direct resources of our company. We currently do not outsource or utilize any significant subcontractors with the exception of defense counsel, outside investigation and appraisals. 14. Do your adjusters receive any continuing education and training? Explain. Yes, we conduct initial and ongoing training and development programs for all our claims personnel. We ensure claims personnel stay current on new developments in workers' September 12, 2014 C O R V E L Page 49 Hurley, Rogner, Miller, Cox Gregory White, 407.571-7400 gwhite@hrmcw.com Waranch & Wescott, PA Esq. Sponsler, Bennett, Jacobs Gwen Jacobs, 813-272-1400 gjacobs@sponslerbennet.com & Adams, PA Esq. Hinshaw & Culbertson, LLP Cheryl Wilke, 941-467-7900 cwilke@hinshawlaw.com Esq. Eraclides, Gelman, Hall, Morgan A. Indek 407-660-0333 mindek@eraclides.com Indek & Goodman, LLP 10. Estimate the percentage of time your adjusters are out of the office doing field work_ If all are telephone adjusters, please indicate. Our Adjusters are all telephone Adjusters. CorVel is currently in partnership with G4S Compliance and Investigation, a nationwide surveillance company that provides onsite investigations and appraisals. The CorVel Adjuster will always maintain responsibility for the claim during the investigation. 11. Do you utilize independent contracted adjusters? If so, under what circumstances? No, we do not utilize Independent contracted Adjusters. 12. Name, address, phone and contact person for independents you utilize. Not applicable. 13. Can you provide all the required services with your own personnel? CorVel's software, systems and staff are direct resources of our company. We currently do not outsource or utilize any significant subcontractors with the exception of defense counsel, outside investigation and appraisals. 14. Do your adjusters receive any continuing education and training? Explain. Yes, we conduct initial and ongoing training and development programs for all our claims personnel. We ensure claims personnel stay current on new developments in workers' September 12, 2014 C O R V E L Page 49 . . DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS compensation laws and regulations to further enhance their skills, ensuring they continue to meet CorVel's customer service standards. Our training program addresses the needs of the highly specialized lines of insurance coverage in today's environment including entry level claims management to advanced claims techniques, telephone etiquette to address difficult callers, and policies and procedures regarding the latest benchmark management reporting. In addition to our own internal and industry sponsored staff training programs, CorVel also conducts bi-annual seminars for our claims personnel. These workshop style conferences allow us to share our experiences as well as those of our clients, and provide clear, step- by-step advice about claims management, industry trending and reporting procedures. CorVel also promotes professional development of our staff through our educational reimbursement program. This program encourages Claims Assistants, Adjusters and Supervisors to pursue educational opportunities. Claims Assistants are encouraged to take Insurance Education Association courses. All relevant education opportunities are fully reimbursed by CorVel. We will also pay the costs to take a self-insured certification test. CorVel also provides ongoing training sessions as they relate to changes to legislation. In addition, we invite various consultants and experts to provide training sessions in their particular areas of specialty, 15. Do you currently file state and excess insurance forms on behalf of your clients? Explain. Yes, we currently file state and excess insurance forms on behalf of our clients. CorVel will report to all states in which state reporting is required on behalf of the City and according to the state's guidelines. If required by the state, we will submit the reporting data via EDI. We run state reports on a weekly basis. Our system reports to states based on the submitter information provided by the state. Any case that has reached 50% of the City's self-insured retention level, or has the potential to exceed it, shall be reported to the City and the excess insurer in accordance with the reporting criteria established by the excess insurer. All cases that meet the established reporting criteria are to be reported to the City within 30 days of when the known criterion is met. 16. Do you have the capability to provide all the loss data reports required? Explain. Yes, CorVel's reporting capabilities are extensive. The City will have access to a variety of reports via the claims system, allowing you to create reports to meet your specific needs. Every report allows the user to group, total or sort by various data fields with an assortment of filters. All reporting can be grouped and totaled by multiple location tiering. CorVel's reports are user friendly, well organized, intuitive and simple to use. The following are examples of CorVel's standard claims reports: • Program Summary Scorecard Report • General Claims Listing for Open/Closed/All Claims • New Claims Received Report • Status Change Activity Report • Claim Payment Register September 12, 2014 C O R V E L Page 50 DocuSign Envelope ID: 6EEOD36E-ABE7416C-6B7C-9D91277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • Claim Payment Summary • Overall Payment Summary by Type of Payment • Overall Payment Register for Period Detailed Loss Report • Loss Summary by Policy Period • Financial Analysis Report • Safety Analysis Report Please see Attachment F: Sample Claims Reports. • Loss Development Report • Demographics • Mechanism of Injury • Lag Time Report • Escrow Activity Report • Lost Day Reporter • Location Loss Summary • Denied Claim Report Litigated Claim Report 17. Do you have the ability to transfer the City's prior claims data to your information system by June 1, 20157 Yes, CorVel will transfer the City's prior claims data to our information system by June 1, 2015. The City's current open claims data will be mapped and integrated into CorVel's claims system and will require an Adjuster to review the claim file before any payments can be made on the file. If the City's current system does not use a paperless environment, all necessary documents will be scanned into our system in accordance with our claims handling best practice process. Medical bills and supporting documentation will be scanned into our system or an EDI will be established from the current vendor allowing the bill image to be uploaded into our system so the Claims Adjuster can process the bills. We will request a data transfer of all claim activity from the City's previous vendor with corresponding control totals, record layouts, code translations, etc. Optimum time from contract signing to complete the transition of data is 90 days. This timeframe can be shortened depending on the complexity of converting and loading historical data into our system. If there is no historical data to convert to the system we can be ready to accept new claims within 30 days of contract signing. CorVel is able to create up to a 6 tier organizational structure from which reporting can be generated at any level. We can accept and map your data to appropriate fields within our system which includes: transactional data . file notes • reserve history • subrogation and litigation information scanned documents • exhibits in PDF, Word and Excel formats • assigned departments • employee occupation • accident locations • Injury, body part and cause We have experience capturing data from most of the country's largest insurers and TPAs and seamlessly integrating it into our claims management system. Successful system Integration provides the Adjuster with the appropriate data integrity to perform their work while being assisted by operations support to ensure all necessary physical file data is scanned into our system to maintain a paperless file environment. September 12, 2014 C O R V E L Page 51 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9091277D5AD3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Please see Attachment G: Sample Implementation Plan. 18. Explain any fees proposed for managed care, medical case management, bill review, utilization review and rehabilitation services. These are not to be included in the annual fee proposed. Please see Attachment D: CorVel's Cost Proposal for explanation of fees. 19. Explain, in detail, any deviation from the services or fee structure type required, specifically indicating any services you cannot perform. Specifically indicate what you consider as allocated expenses and therefore not included in your annual fee proposal amount. Please see Attachment D: CorVel's Cost Proposal and Attachment H: CorVel's Exceptions. September 12, 2014 C O R V E L Page 52 DocuSign Envelope ID: 6EE6D36E-ABE7-416C-687C-9D91277D5AD3 TAB 2: EXPERIENCE & QUALIFICATIONS TAB 2: Experience & Qualifications September 12, 2014 C O R V E L Page 53 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 2: EXPERIENCE & QUALIFICATIONS 2.1 Qualifications of Proposing Firm. Submit detailed information regarding the firm's history and relevant experience and proven track record of providing the scope of services similar as identified In this solicitation, including experience in providing similar scope of services to public sector agencies. For each project that the Proposer submits as evidence of similar experience, the following is required: project description, agency name, agency contact, contact telephone & email, and year(s) and term of engagement. Company History CorVel has over 30 years of experience as a national provider of healthcare management solutions to employers, insurance companies and government agencies. We are publicly traded (NASDAQ:CRVL) and annual revenues exceeded $480 million in fiscal year 2014. Our continued customer growth is a testament to our financial stability and our significant investments in new systems and technologies allow us to continue to deliver industry-leading solutions to the marketplace. We are an industry leader in claims administration solutions. Throughout the years, we have enjoyed long-term relationships with many of the largest and most innovative payors in the nation. Using the expertise gained In those relationships, our entire client base is able to take advantage of the pooled insights of many of the leaders in the casualty Insurance industry. CorVel's claims management program is a unique approach to claims administration, healthcare and disability management We offer a comprehensive claims management solution directed toward the self-insured and municipal markets that proactively manages the entire episode of a claim. By incorporating a strong medical management component in claims management, CorVel is able to control the cost of claims more effectively than the traditional claims management model, saving customers time and money. Municipality Experience CorVel offers a unique approach to claims administration and cost containment for municipalities. Our experience with municipalities across the country provides an innovative, integrated service model that controls claims by advocating medical management at the onset of the injury. Nurse advocacy services are available by telephone before and after working hours to ensure immediate access to care for your unique mix of occupations that can include government administrators, maintenance workers, engineers and planners, parks and recreation, utility services, law enforcement and fire, construction, and human services. Our services decrease administrative costs and improve return to work outcomes. CorVel offers a personalized treatment program that uses precise treatment protocols — advocating timely, quality care for municipal employees. CorVel currently provides third party administration services for more than 470 municipalities and public entities across the United States. They range from small cities and municipalities to some of the largest counties in the country. September 12, 2014 C O R V E L Page 54 DocuSign TAB 2: EXPERIENCE & QUALIFICATIONS Please see Attachment I: Case Studies for further evidence of our experience. September 12, 2014 C O R V E L Page 55 City of Pompano Ed Beecher, P.O. Box 'client requests Beach Risk Manager Drawer 1300 email contact lEdcdie.beecher opbfl.com Pompano only Scope: Third Parry Beach, FL Claims Administration 33061 and Managed Care services. Contract Years., 2008 -Present City of West Palm Kathy 401 Clematis 561-494-1135 kstakermann@ Beach Stakermann, St. wpb.org Risk Manager West Palm Scope: Third Party Beach, FL Claims Administration 33401 and Managed Care services. Contract Years., 2019 -Present Prince George's Rick Schnabele, 14741 301-952-3742 fwschnabele@ County Risk Manager Governor Oden co.pg.md.us Bowie Dr. Scope: Third Party Suite 3200 Claims Administratlon, Upper Managed Cam, and Auto and General Liabil/ty Marlboro, MD services. 20772 Contract Years., 2005 -Present Please see Attachment I: Case Studies for further evidence of our experience. September 12, 2014 C O R V E L Page 55 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 2: EXPERIENCE & QUALIFICATIONS 2.2 Qualifications of Proposer Team. Provide an organizational chart of all personnel and consultants to be used for this project if awarded, the role that each team member will play in providing the services detailed herein and each team members' qualifications. A resume of each individual, including education, experience, and any other pertinent information, shall be included for each Proposal team member to be assigned to this contract. Please see Attachment C: Staff Resumes. 2.3 Financial Capacity. Each Proposer shall arrange for Dun & Bradstreet to submit a Supplier Qualification Report (SQR) directly to the Procurement Contact named herein. No proposal will be considered without receipt, by the City, of the SQR directly from Dun & Bradstreet. The cost of the preparation of the SQR shall be the responsibility of the Proposer, The Proposer shall request the SQR report from D&B at: https://s upplierportal. d n b.com/weba pptwcs/stores/se rviet/Supplie rPortal?storeld=11696 Proposers are responsible for the accuracy of the information contained in its SQR. It is highly recommended that each Proposer review the information contained in its SQR for accuracy prior to submittal to the City and as early as possible in the solicitation process. For assistance with any portion of the SQR submittal process, contact Dun & Bradstreet at 800-424-2495. CorVel has arranged for Dun & Bradstreet to submit a Supplier Qualification Report directly to the Procurement Department. The report was submitted August 7, 2014. Please see Attachment J: Copy of Dun & Bradstreet Report submitted September 12, 2014 C O R V E L Page 56 DocuSign TAB 3: SCOPE OF SERVICES PROPOSED TAB 3: Scope of Services Proposed September 12, 2014 C O R V E L Page 57 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 3: SCOPE OF SERVICES PROPOSED Submit detailed information addressing how Proposer will achieve each portion of the scope of services and technical requirements outlined in Appendix C, Minimum Requirements and Specifications. Responses shall be in sufficient detail and include supporting documentation, as applicable, which will allow the Evaluation Committee to complete a fully review and score the proposed scope of services. Please see CorVel's response to item 1.3 Minimum Qualifications and Requirements, pages 15 through 52. September 12, 2014 C O R V E L Page 58 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 TAB 4: APPROACH AND METHODOLOGY TAB 4: Approach and Methodology September 12, 2014 C O R V E L Page 59 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 4: APPROACH AND METHODOLOGY Submit detailed information on how Proposer plans to accomplish the required scope of services, including detailed information, as applicable, which addresses, but need not be limited to: implementation plan, project timeline, phasing options, testing and risk mitigation options for assuring project is implemented on time and within budget. Implementation Plan CorVel will utilize the core principals of quality assurance and project management for the City's program, beginning with implementation through continued account management. Utilizing project management methodologies, CorVel and the City will work together to develop strategies, structure, processes and resources for implementation. The plan will consist of major implementation categories including staffing, data transfer and conversion, claims management, banking, communications, personnel, training and lnformatiog technology. The plan Is separated into a pre and post Implementation timeline, which includes the task owner and tracks ongoing program deliverables such as task status and date far completion. Based on the implementation plan, we will develop an account management plan which contains the City's specifications, including a special handling section to ensure CorVel's solution is tailored to the exact needs and specifications of the City. The document will be reviewed and signed by the City and CorVel to ensure there is a complete understanding of the service and program deliverables. Next, the City's account management plan and special handling instructions are uploaded and maintained in our claims system to ensure all stakeholders are aware of the program deliverables to ensure compliance and quality. The City's designated Account Manager will ensure that all components of Implementation and service delivery are being delivered and all expectations are being met. Upon notification of any issues, the Account Manager will work with the appropriate parties to resolve the Issue. The Account Managerwill also keep the City fully informed of the status and plan for resolution. All quality assurance measures and best practices will be reviewed during formal claim review meetings. At CorVel, we are committed to providing quality services that exceed customer expectations and add value to the partnership. Proiect Timeline Please see Attachment G: Sample Implementation Plan. Phasing Options CorVel will work with the City to transition the start-up and review the files at no cost prior to taking over the claims. We have a transition team in place ready to assess the tail and review trending for early Intervention measures we may recommend. Phasing coincides with our Implementation Manager and the sample implementation plan referenced above under Attachment G. Testing and Risk Mitigation Options CorVel offers all of our customers tailored programs; therefore, we will work with the City to establish performance measures based upon your specific needs and preferences. If CorVel's performance begins to approach non-compliance, we will act proactively and diligently to resolve any issues before they become complex. Based on the combination of these factors, CorVel has every reason to believe we will meet all of the City's performance standards. Please see Attachment K: Sample Performance Guarantee. September 12, 2014 C O R V E L Page 60 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TAB 5: COST PROPOSAL TAB 5: Cost Proposal Page 61 September 12, 2014 C O R V E L DocuSlgn Envelope ID: 6EE9D36E-ABE7-416C-6B7C-9D91277D5AD3 APPENDIX E MIAMMEACH110, Cost Proposal- Form "REVISED" September 4, 2014 R FP 2014-302-S W CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miamf Beach, Florida 33139 RFP 201 02 SVd TPA C alms A minlsfrafton or Wor ers Comp cnd Gen lla illy I e i DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPENDIX E "REVISED" COST PROPOSAL FORM In full accordance with the requirements of this RFP, Inclusive of Its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any Increase In wage scales, material prices, travel, delivery delays, taxes, Insurance, cost Indexes or any other unless a cost escalatlon provision Is allowed herein and has been exercised by the City Manager in advance. The Proposal Tender Form shall be completed mechanically or, if manually, In Ink. Cost Proposal Forms completed In pencil shall be deemed non-responsive. All corrections on the Proposal Tender Form shall be Initialed, Failure to follow the pdceproposai format as Identified may result In the RFP response being considered non-responsive and the RFP submittal will notbe considered forevaluallon, " Industry standard is 2,5 times the average monthly payout. RFP 201 302 S TPA Cialms Adminisl atlon or War errs Comp an Gon ha I,Ify 2 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 "Prior claim fees (tall files) lines 4 and 5 may be staggered on a monthly basis over life of contract. OPTION #3; FIXED PER CLAIM BLENDED PEE OPTION Per Clalm $ 476 1 3110 per year 1 $ 142,600 ted Or Non- (per clalm) I (Column l X Column 2) Only Per -'claim $ 425 1 421 per year 1 $ 178,925 (Litigated Or Non• (per claim) (column t uCo(umn 2) RFP 201 302 S TPA Claims A minlsfrgtlon or Wor ors Comp qn Gen Qq I Ity 3 DocuSign Envelope 10: 6EEOD36E-ABE7.416C-8B7C-9D91277D5AD3 ADDITIONAL SERVICES List of services, as needed. which are in addition to the fees or000sed In Ootiona 1.3, r Telephonic Medical Case Management Fee On Al Claims; $_12 Per Hour Free Triage Per BIIVFIat Fee BIII Review Fee To Include State Fee Schedule Reduction: $ 4.50/per Bill Per 511)/Flat Fee Percentage Of PPO Savings - Network Discount Savings Below State Fee Schedule; 27 Percentage Of Utliizatlon Review And Reasonable & Customary Savings: 20 % Subragallon andlar Llens Fee Percentage: 25% of recoveries % Oahe 300 Log Reporting; $ Included Electronic Data Interchange Flied With State; $ Included Safety Consulting Services Per case basis review of case at no co Notice Of Injury Entry; _Into CareMC at no cost CustomlAd Hoc Reports; -$ $Included Data And File Converslon Fee; $ nl„� One -Time Setup Flat Fee Medicare Reporting Casts: $,2,000 Flat fee life of cont Llablllty Cialme Adjuster (15.30 Claims per fscal year) $ Sse attached Workera Compensallon Claims Adjuster (City 0` Miaml Beach In - House Adusler $ Included MO* DescrbUon OfAddidmal Serke: Annual Administration Fee $ 5,000 Deealpdon OfPddl6enal8enl®: CMS monthly fees waved with 50 allocation reports per year $ Waved Descdplfm OfAddlNrrial Ss w: 1-800 toll free FN01 $ 35 Per Intake _ Desadpgon Of Addldmal 8eWa: $ ' Company: Corvel Enterprise Comp, Inc. Aulhodxed RepressaletFre: Richard Schweppe MOM: 2010 Main Street, Suite 600, TrAne, CA 91614 Telaphane; 949-851-1473 small: richard_schweppe@coml.cnm ' Autharlad Rapresentalive's Sfgnalun: Iv lot FFP 201 302 SW TPA Claims A minislraflon or Wor ers Comp an Gen a I IN 4 `The In-house MO adjuster Is at no cost to the City. The MO adjuster will handle the cases on a per -claim basis and charge accordingly to the pricing option the City has selected. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 I APPENDIX E COST PROPOSAL FORM Attachment Option 1: Life of Contract Handling Fee Auto Liability: Bodily Injury $795 Property Damage $495 General Liability: Bodily Injury $550 Property Damage $350 All Other $695 Product Liability $695 Designated GL Adjuster included will handle on a per -case basis according to the GL fee schedule. CONFIDENTIAL DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 TAB 5: COST PROPOSAL Submit a completed Cost Proposal Form (Appendix E). Proposers must submit pricing for all three options. The City will review each option and reserves the right to select the option that is most advantageous to the City. If pricing is included or at no additional charge, proposer must indicate "Included" or "No Additional Charge," as applicable, within the Cost Proposal. Failure to submit pricing for all three options request in the Cost Proposal Form will result in the proposals being considered non-responsive and not further considered. CorVel has submitted pricing for all three options. Please see Attachment D: CorVel's Cost Proposal. September 12, 2014 G O R V E L Page 62 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 ATTACHMENTS Attachments Attachment A: CorVel's Code of Ethics Attachment B: Florida Certification Attachment C: Staff Resumes Attachment D: CorVel's Cost Proposal Attachment E: Screens hots of Claims System Attachment F: Sample Claims Reports Attachment G: Sample Implementation Plan Attachment H: CorVel's Exceptions Attachment I: Case Studies Attachment J: Copy of Dun & Bradstreet Report Attachment K: Sample Performance Guarantee i September 12, 2014 CORBEL Page 63 a DocuSign Envelope ID: 6EEOD36E-ABE7-016C-6B7C-9D91277DSAD3 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 CORVEL CORPORATION CODE OF ETHICS I. INTRODUCTION AND GENERAL POLICY CorVel Corporation is committed to the highest standards of legal and ethical business conduct, and seeks to foster an environment of awareness where the prompt reporting of any unethical or illegal behavior, or any violations of our corporate policies, is protected, encouraged and dealt with fairly. Ethical conduct is an inherent obligation of our directors, officers and employees and, in furtherance of our commitment, we have adopted a Code of Ethics and Conduct to promote the high standards of ethical conduct we value. This Code does not cover every issue that may arise, but is intended to provide a basic summary of the legal, ethical and regulatory principles that should guide the conduct of all our directors, officers and employees. We encourage our directors, officers and employees to read all of our other policies in conjunction with this Code to gain a full understanding of their responsibilities. We expect all of our directors, officers and employees at every level to conduct themselves in strict compliance with all legal and ethical obligations, and to avoid even the appearance of improper behavior, Our philosophy can be implemented only if our directors, officers and employees recognize their responsibility to treat everyone in an honest and fair manner. Compliance with this Code and high standards of ethical business conduct is mandatory for every director, officer and employee. Accordingly, a director's, officer's or employee's failure to fulfill his or her responsibilities under this Code may result in disciplinary action, up to and possibly including immediate termination. This Code requires at a minimum: 1. Honest, prudent and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and professional relationships; 2. Full, fair, accurate, timely and understandable disclosures in reports and documents that we file with, or submit to, the Securities and Exchange Commission and in any other of our public communications; 3. Compliance with our other corporate policies and with applicable governmental laws, rules and regulations; 4. The prompt internal reporting of violations of this Code, including any illegal activity, to the appropriate person or persons identified in this Code; and This document is considered Confidential and Proprietary to CorVel Corporation DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 5. Accountability for adherence to this Code. II. CONFLICTS OF INTEREST AND CORPORATE OPPORTUNITIES Our directors, officers and employees should not be involved in any activity that creates or gives the appearance of a conflict of Interest. A "conflict of interest" exists when a person's private interest interferes in any way with the interests of the Company. A conflict situation can arise when a director, officer or employee takes actions or has interests that may make it difficult to perform his or her work for the Company objectively and effectively. Accordingly, directors, officers and employees are prohibited from taking for their own personal gain opportunities that are discovered through the use of the Company's property, information or position, without the consent of our Board of Directors. A conflict situation may even arise when a director, officer or employee has a financial interest, including significant stock ownership, in any entity with which we do business, or provides service to or otherwise operates an outside business whose demands interfere with such person's responsibilities to us. Conflicts of interest also may arise when a director, officer or employee, or members of his or her family, receives improper personal benefits as a result of his or her position in the Company. Loans to, or guarantees of obligations of, directors, officers or employees, or their family members, by the Company or any entity with.which we do business, may create conflicts of interest. It is almost always a conflict of interest for a director, officer or employee to have other duties, responsibilities or obligations that run counter to his or her duty to the Company, such as working or providing service simultaneously for a competitor, customer, supplier or other business. The best policy is to avoid any direct or indirect business connection with the Company's customers, suppliers or competitors, or with any other outside business, except on behalf of the Company. Directors, officers and employees should notify in writing the appropriate person or persons identified in Section VI I of this Code of the existence of any actual or potential conflict of interest. Ill. FAIR DEALING We require our directors, officers and employees to deal honestly and fairly with, and respect the rights of, our customers, suppliers, competitors, employees and other third parties. Stealing proprietary information, possessing trade secret information that was obtained without the owner's consent or inducing such disclosures by past or present employees of other companies is prohibited. Each director, officer and employee should endeavor to make our contracts, advertising, literature and other public statements clear and precise and to eliminate any misstatement of fact or misleading impressions. No director, officer or employee should take unfair advantage of anyone through This document is considered Confidential and Proprietary to CorVel Corporation DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 manipulation, concealment, abuse of privileged information, misrepresentation of material facts or any other unfair -dealing practice. No bribes, kickbacks or any other form of improper payment, direct or indirect, should ever be offered, given, provided or accepted by any director, officer or employee, their family members or agents. In addition, no gifts, favors or business entertainment should ever be offered, given, provided or accepted by any director, officer or employee, their family members or agents, unless it: (1) is not a cash gift; (2) is consistent with customary business practices; (3) is of nominal value; (4) cannot be construed as a bribe or payoff; and (5) does not otherwise violate our corporate policies or any laws or regulations. IV. RECORD-KEEPING AND PUBLIC DISCLOSURES We require honest and accurate recording and reporting of information. All of our books, records, accounts and financial statements must be maintained in reasonable detail, accurately and fairly reflect our transactions, not contain false or misleading entries, comply with generally accepted accounting principles at all times and conform both to applicable legal requirements and to our system of internal accounting controls. Unrecorded or "off the books" funds or assets should not be maintained unless permitted by applicable law or regulation. We maintain a system of internal accounting controls that will provide reasonable assurances to our management that all transactions are properly recorded and that material information about the Company is made known to management, particularly during the periods in which our periodic reports are being prepared. We expect our directors, officers and employees to notify in writing our Chief Financial Officer of any: (1) material information or unreported transactions that affect the disclosures made in our public filings; (2) information concerning significant deficiencies and material weaknesses in the design or operation of our internal control over financial reporting . which are reasonably likely to adversely affect our ability to record, process, summarize and report financial information; and (3) fraud, whether or not material, that involves management or other employees who have a significant role in our internal control over financial reporting. Directors, officers and employees should avoid exaggeration, derogatory remarks, guesswork, and inappropriate characterizations of people and companies in their e-mail, correspondence, internal memos, reports and other records and communications, as these things often become public and can be easily misunderstood. Records always should be retained or destroyed according to our record retention policies. No director, officer or employee should communicate to the public any nonpublic information except through our Chief Executive Officer or Chief Financial Officer. V. COMPLIANCE WITH LAWS AND CORPORATE POLICIES This document is considered Confidential and Proprietary to CorVel Corporation DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Our corporate policies have been created to ensure that our directors, officers and employees comply with applicable laws and governmental regulations. We expect our directors, officers and employees to respect and obey the law, both in letter and spirit. Reading and understanding our general corporate policies Is a good start to learning some of the laws, rules and regulations that govern our lives. By following these policies, our directors, officers and employees can fulfill our commitments to, among other things: (1) maintaining a safe and healthy work environment; (2) promoting a workplace that is free from discrimination or harassment based on race, color, religion, sex, age, national origin, disability or other factors that are unrelated to our business interests; (3) supporting fair competition and laws prohibiting restraints of trade and other unfair trade practices; (4) conducting our activities in full compliance with all applicable environmental laws; (5) keeping the political activities of our directors, officers and employees separate from our business; (6) prohibiting any direct or indirect illegal payments, gifts, favors or gratuities to any government officials, candidates or political parties; (7) prohibiting the unauthorized use, reproduction, or distribution of any third party's trade secrets, copyrighted information or confidential information; (8) prohibiting the sale or export, either directly or through our representatives, of our products to countries where technology related goods such as ours may not be sold; and (9) complying with all applicable state and federal securities laws. Our directors, officers and employees are prohibited from trading our securities while in possession of material, nonpublic ("inside") information about the Company. Our Insider Trading Policy (see Policy 801) describes the nature of inside information and the related restrictions on trading. We encourage our directors, officers and employees to seek advice regarding the details of the policies, laws, rules and regulations with which they must comply, by submitting a written request to our Director of Legal Services. VI. CONFIDENTIALITY AND CORPORATE ASSETS Our directors, officers and employees are entrusted with our confidential information and with the confidential information of our suppliers, customers or other business partners. This information may include without limitation: (1) trade secrets, patents, trademarks, copyrights and other proprietary information and ideas; (2) technical or scientific information about current and future products, services or research; (3) business, marketing or service plans or projections; (4) earnings and other internal financial data; (5) personnel information; (6) supply and customer lists; and (7) other non-public information that, if disclosed, might be of use to our competitors, or harmful to our suppliers, customers or other business partners. This information is our property, or the property of our suppliers, customers or business partners, and in many cases was developed at great expense. Our directors, officers and employees must not discuss or disclose confidential information with, in the presence of or to any unauthorized persons, including family members and friends, and must not use This document is considered Confidential and Proprietary to CorVel Corporation DocuSign Envelope ID: 6EEDD36E-ABE7-416C-6B7C-9D91277D5AD3 confidential information or other Company property or resources for personal gain, for the personal benefit of anyone else or for anything other than our legitimate business purposes. These obligations are fully described In our Confidentiality/Non-Solicitation Agreement that we require every director, officer and employee to execute upon commencement of service to the Company. VII. REPORTING AND CONSEQUENCES OF VIOLATIONS Reporting_Violations and Askino Questions We hold all directors, officers and employees individually responsible for carrying out and monitoring compliance with this Code. Directors and officers immediately should report in writing any known or suspected illegal or unethical behavior to the Chair of our Audit Committee. Employees who are not directors or officers immediately should report in writing any known or suspected illegal or unethical behavior to their Regional Vice President, our Director of Legal Services or the Chair of our Audit Committee. When in doubt, we encourage directors, officers and employees to seek counseling about the best course of action to take in any particular situation. Directors, officers and employees may contact our Director of Legal Services in writing with any questions or concerns about this Code or a business practice. If your complaint or question concerns accounting, internal accounting controls or auditing matters, or financial fraud, securities fraud or other securities law violations, and you wish to submit these complaints, concerns or questions anonymously, you may do so by following the procedures set forth in our Policy Regarding Accounting and Auditing Matters (see Policy 113). If anyone feels uncomfortable reporting potential or actual violations to the person or persons identified in this Code, he or she may instead report those matters in writing to any member of our Audit Committee. Such member will identify and forward the violation report to the appropriate person or persons, not involved in the matter giving rise to the violation, who have sufficient status and authority within the Company to adequately deal with the violator of the Code. The names, addresses and telephone numbers of these individuals are listed at the end of our Policy regarding Accounting and Auditing Matters (see Policy 113). Any questions or reported violations will be addressed immediately and seriously. Investigations and Non -Retaliation The person or persons to whom a potential or actual violation is reported or forwarded will promptly investigate any such violation and will oversee an appropriate response, including corrective action and preventative measures, involving the Chair of our Audit Committee or Chief Executive Officer when required. All reports will be treated confidentially to every extent possible. This document is considered Confidential and Proprietary to CorVel Corporation DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 It is our policy to not allow reprisal or retaliation of any kind against a director, officer or employee who acts In good faith in reporting any known or suspected illegal or unethical behavior, or who asks any questions regarding this Code or appropriate actions in light of the Code. We do, however, expect all directors, officers and employees to fully cooperate in internal investigations of misconduct. Consequences of a Violation Directors, officers and employees who violate any laws, governmental regulations, or any provisions of this Code will face appropriate, case -specific disciplinary action, which may include demotion or Immediate discharge. Any director, officer or employee who engages in illegal activity will be reported to the appropriate governmental authorities. Administration Our Board of Directors and Audit Committee have established the standards of business conduct contained in this Code and generally oversee compliance with this Code. Our Board of Directors and Audit Committee also are responsible for updating these standards as they deem appropriate to reflect changes in the legal and regulatory framework applicable to the Company, the business practices within our industry, our own business practices and the prevailing ethical standards of the communities in which we operate. Our Corporate Governance Committee will oversee the procedures designed to implement this Code to ensure that they are operating effectively. Training on this Code will be included in the orientation of new employees and provided to existing directors, officers and employees on an on-going basis. To ensure familiarity with the Code, directors, officers and employees will be asked to read the Code and sign the Compliance Certificate annually. Vill. CHANGES IN OR WAIVERS OF THE CODE Any approval by the Company of a material departure from any provision of this Code, or any failure by the Company to take action within a reasonable period of time regarding a material departure from any provision of this Code that has been made known to an executive officer, is considered to be a waiver of this Code. Any change in or waiver of this Code for directors or officers (including our president, principal executive officer, principal financial officer, principal accounting officer or controller, or persons performing similar functions, any vice-president In charge of a principal business unit, division or function, or any other officer who performs a policy-making function) may be made only by the Company's Board of Directors, and the fact of and reasons for such change or waiver must be publicly disclosed in a Form 8-K filed by the Company with the Securities and Exchange Commission within four business days of such change or waiver. No waiver shall be granted except where necessary and warranted, and where such waiver is limited and qualified so as to protect the Company to the greatest extent possible. This document is considered Confidential and Proprietary to CorVel Corporation DocuSign Envelope ID: 6EEOD36E-ABE7-016C-8B7C-9D91277D5AD3 DocuSign Envelope ID: 6EEOD36E-ABE7-4I6C-BB7C-9D91277D5AD3 CHIEF FINANCIAL OFFICER TEFF ATWATER STATE OF FLORIDA February 28, 2014 Ms. Abigail Keenan Corporate Paralegal CorVel Enterprise Comp, Inc. 2010 Main Street, Suite 600 Irvine, CA 92614 RE: Annual Report Dear Ms. Keenan: The Qualified Servicing Entity Annual Report Form for your company has been received. I have reviewed this report and found that your company is in compliance with Rule Chapter 69L- 5.230(11) F.A.C. (Retaining Authorization as a Service Company). This letter will confirm that your company bas been recertified for the period March 1, 2014 through February 28, 2015. Attached is a copy of Form DFS -F2 -SI -23 (Qualified Servicing Entity Annual Report Form), to be used for future filing as we no longer mail the form prior to the due date. Also attached is a copy of Form DFS -F2-81-19 (Certification of Servicing for Self -Insurers), this farm is to be completed thirty (30) days of entering into a contract for servicing. Your next annual report is due in our office no later than March 1, 2015. Should you have any questions or need further assistance, please contact me at (850) 413-1784. U S erely, . wa g 1 ce Administrator Attachments FLORIDA DEPARTMENT OF FINANCIAL SERVICES Dwayne Manning • Insurance Administrator Division of Workers' Compensation a Bur= of Monitoring and Audit 200 East Gaines Street • Tallahassee, Florida 31399-4224 • Tel. 850-413-1784 v Fax 850414-2244 Email • Dwayne.Manning@Myfloridacfo.wm AFFIRMATIVE ACTION • EQUAL OPPORTUNITYEMPLOYER DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 ANITA ALVAREZ CLAIMS ADJUSTER SUMMARY OF QUALIFICATIONS • Over 19 years of Workers' Compensation claims experience • Extensive knowledge of Florida Workers' Compensation Administrative Code, State Law and Regulations, and case law • Experienced in all aspects of claims management including handling catastrophic and complex claims • Experienced in claim auditing • Multi -jurisdictional experience for workers' compensation claims PROFESSIONAL HISTORY • February 2011— Present: CorVel Corporation, Claims Adjuster/Senior Claims Adjuster. Anita is a Senior Claims Specialist for the Tampa, Florida claims office. Prior to joining CorVel, Anita gained experience in the workers' compensation and Professional Employee Leasing industries. Anita has also worked as a claims auditor working to accelerate claim closures. In the 19 years that Anita has spent in the workers' compensation claims industry, she has managed claims in a number of jurisdictions and handled large loss and catastrophic claims. EDUCATION • Hillsborough Community College • Erwin Technical and Vocational Center • Tampa Catholic High School • Workers' Compensation Claims Professionals Association, Licensed Adjuster CREDENTIALS AND AFFILIATIONS • .Fluent in Spanish DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 CLAIMS MANAGER SUMMARY OF QUALIFICATIONS • More than 11 years of workers' compensation claims experience, with 9 years in supervision and management • Extensive knowledge of Florida workers' compensation administrative code, state law and regulations, and case law • Experienced in all aspects of claims management including reporting to and communicating with clients, carriers, and excess carriers, reserving, investigations, compensability decisions, medical management, and litigation • Proficient in claims auditing and due diligence • Professional experience in education and corporate training PROFESSIONAL HISTORY • June 2012—Present: CorVel Corporation, Claims Manager • February 2012—June 2012: CorVel Corporation, Claims Supervisor • Prior to working at CorVel, began in the workers' compensation industry as a claim's adjuster and was promoted into a claims supervisory position and lead the department as it continued to grow and manage claims in "multi -state jurisdictions. Additional professional experience in the education and corporate training fields. • Educational Specialist Degree/Doctorate Degree, Leadership & Policy Studies — University of South Florida, Tampa (Currently Enrolled) • Master of Arts, Reading Education - University of South Florida, St. Petersburg (2010) • Bachelors of Science, Elementary Education - University of South Florida, Sarasota/Manatee (2008) 'CREDENTIALS ANo AFFILIATIONS • State of Florida All Lines Adjuster License— 520 • Accredited Claims Adjuster Designation, Florida DocuSign Envelope ID: 6EEOD36E-ABE7-416C-867C-9D91277D5AD3 CASE MANAGEMENT MANAGER SUMMARY OF QUALIFICATIONS • Workers' Compensation Case Manager knowledgeable in Florida 440 Workers' Compensation Law PROFESSIONAL HISTORY • 2008—present: CorVel Corporation, Case Management Manager. Manage Telephonic and Field Case Managers, ensure the delivery of optimal, cost-effective medical care and facilitate return to gainful employment, ensure quality and timely medical care, reporting and communication from case management team, oversee triage and ensure injured parties are receiving medical treatment immediately after an injury, assist in determining whether an injured patient should receive case management. Responsible for researching medical, length of disability and return to work criteria of diagnoses assigned to injured parties by physicians and questioning physicians about any diagnosis, treatment or functional limitations they assign to the patient; if medically necessary and causally related to the injury of focus. • 2006-2008: Blue Cross Blue Shield, Florida, Workers' Compensation Telephonic Nurse Case Manager. • 2003-2006: CorVel Corporation, Workers' Compensation Field and Telephonic Nurse Case Manager. ® 1996-2003: Cross Country/Med Staff Inc. (Nursing Traveling Agencies), Critical Care/Cardiovascular Intensive Care Nurse. • 1997-1999: Hamilton Medical Center, Critical Care Nurse. • 1993-1996: Florida Medical Center, Intern Nurse, Unit Secretary, Floor Nurse, Charge Nurse of the Cardio/Pulmonary Unit, Critical Care Nurse. EDUCATION • Bachelors Degree in Nursing - University of Phoenix • Associates in Nursing - Broward Community College; Ft. Lauderdale, Florida CREDENTIALS AND.AFFmiAT1®NS • State Legislative Chair for International Association of Rehabilitation Professionals - Florida • Member of Broward Association of Registered Nurses DocuSlgn Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 ACCOUNT EXECUTIVE SUMMARY OF QUALIFICATIONS • Acquisition sales and management of accounts to ensure service quality and governmental regulations. • Provide leadership and coaching to other sales associates. • Negotiate contracts with hospitals, physicians and private accounts. • Workers Compensation managed medical consulting expertise; 17 plus years in the Florida market. • Department of Financial Services Florida Educator for the administration of CEU's. PROFESSIONAL HISTORY • 2006 to present- CorVel Corporation. Account Executive. Acquisition sales in Florida Region for Enterprise Comp Services. Consultative account executive for claims and medical management. • 1997 to 2005: CorVel Corporation. Vice President Sales. Developed Florida area through the direct handling of Managed Care Programs. Identified key accounts, developed market plans and supervised/serviced multiple national clients and government programs. • 1990 to 1997: CorVel Corporation. Account Manager. Managed the southern Florida client territory, functioning as a Marketing Account Manager for CorVel Corporation. • Associate Science (2004) Broward Community College Ft. Lauderdale, Fl • Broward Community College Nursing 2001 -Davie, Fl CREDENTIALS AND AFFILIATIONS • Department of Financial Services Educator Provider No.: 366326 • Member -PRIMA, FLORIDA -1998 -Present • Member- RIMS -1998 -Present DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9091277D5AD3 Results -oriented leader with 35 logistics, financial and human ca LIABILITY CLAIMS MANAGER `s of extensive knowledge and experience in operations, management • Possesses outstanding record of achievement in operational profitability, expense control, continuous quality improvement and personnel management v Advanced skills in all aspects of operations and human resources leadership including Customer Relationship Management, Change Management, Budgeting, Business Process Reeugineering, Human Capital Development, Quality Assurance, Business Development, General liability, Workers' Compensation, Claims Management, Litigation, and Customer Service. PRO FESS (O.NAL HISTORY • 2012—present: CorVel Corporation, Liability Claims Manager. Responsible for the management of the General Liability Unit. • 2010-2012: Ascendant Commercial Insurance, Vice President of Claims. 2005-2010: AON Risk Services, Senior Claims Consultant. • 2004: AON Risk Consultants, Consultant. • 2002: Hicks, Anderson and Kneale, Consultant. • 19954001: Travelers Insurance Company, Associate Service Center Manager, Florida EDucAT1oN • Bachelor of Science — University of Connecticut Casualty • Claim Law Associate (Liability I & II, Legal Principles) CREDENTIALS AND AFFILIA T IONS • Florida All Lines Adjuster (2010) • Member of Workers' Compensation Claim Professionals DocuSign Envelope ID: 6EEOD36E-ABE7416G8B7C-9D9127705AD3 JENNA M. CARGILL JENNA CARGILLCaCORVEL.COM SUNRISE, FLORIDA SUMMARY OF QUALIFICATIONS Result and detail oriented, hands-on professional with the ability to manage multiple tasks in challenging environments. PROFESSIONAL HISTORY Account Manager. Jeuna Cargill started her professional career six years ago in the healthcare industry. She began at CorVel as a Customer Service Representative and quickly moved into an account manager role where she displayed a passion for teamwork and working closely with her colleagues to achieve results. Prior to CorVel, Jenna was the Supervisor of the Durable Medical Equipment Dept. for Mcdcare Infusion Services, Inc. Currently manages many municipal accounts and is familiar with the budget consciousness that cities and governments must adhere to. Jenna administers the analytic process and stewardship results to the client with meetings to discuss trending and impact. Recently Jenna has been instrumental in managing a national payer with EDI state processes and is efficient and has timely follow up. Bachelor of Science, Business Healthcare Administration. Florida Atlantic University, 2008 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 CLAIMS SUPERVISOR SUMMARY OF QUALIFICATIONS • 17 years Workers' Compensation Experience with 10 years multi -jurisdiction claims management supervision • Extensive knowledge of Florida's workers' compensation state law, regulations and industry standards. • Extensive experience in workers' compensation claims auditing PROFESSIONAL HISTORY • November 2013—Present: CorVel Corporation, Claims Supervisor. • 2004-2113: PEO, Worker's Compensation Claims Manger. • Vale National Insurance School—Dallas, TX CREDENTIALS AND AFFILIATIONS • State of Florida Worker's Compensation Adjuster License DocuSign AREA VICE PRESIDENT SUMMARY OF QUALIFICATIONS Documented history of building winning teams and business growth in both the corporate work environment as well as several entrepreneurial ventures. Tom is a licensed 2-20 All Lines agent specializing in workers' compensation. PROFESSIONAL HISTORY 2009 — Current: CorVel Corporation, Area Vice President. Tom joined CorVel in 2009 bringing experience in managing business growth and an expertise in workers' compensation insurance. His prior experience was with a large, regional PEO where he was the agent in charge of the on-site insurance agency as well as the corporate trainer where he trained the outside sales team on the basics of workers' compensation and salesmanship. Prior to this, Tom had several entrepreneurial ventures ranging from commercial printing to medical weight loss business. EDUCATION • Bachelor of Science, Business Administration, Slippery Rock University, 1991 CREDENTIALS AND AFFILIATIONS • Florida All Lines Producer (FL 2-20) — 2006 • Florida Life & Health Agent (FL 2-15) — 2007 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPENDIX E MIAMBEACH Cost Proposal- Form "REVISEW September 4, 2014 RFP 2014 -302 -SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY I PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP 20 { 4 3 2 S4V TPA C alms Adminlsirgtlon or or -els Comp and Gen a Iliry { 0 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 APPENDIX E "REVISED" COST PROPOSAL FORM In full accordance with the requirements of this RFP, Inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any Increase in wage scales, material prices, travel, delivery delays, taxes, Insurance, cost Indexes or any other unless a cost escalation provision Is allowed herein and has been exercised by the City Manager In advance, The Proposal Tender Form shat( be completed mechanically or, If manually, In Ink, Cost Proposal Forms completed In pencil shall be deemed non-responsive. All correctlons on the Proposal Tender Form shall be initialed, Failure to follow the price proposal format as Identified may result In the RFP response being considered non-responslve and the RFP submittal will not be considered forevaluadon. " Industry standard Is 2.6 times the average monthly payout. RFP 2014.302-S TPA Claims Administration or Wor rs Comp an Gen Ua ility 2 DocuSign Envelope ID: 6EE9D36E-ABE7-416C-8B7C-9D91277D5AD3 "Prior claim fees (tall flies) lines 4 and 5 may be staggered on a monthly basis over life of contract. RFP 2014.302•SW 1PA C Ims A ministrailon or or ors Comp and Gen Lla iN 3 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 ADDITIONAL SERVICES Lint AF enMlnnc. ac marinrl u,h lnh ern in edrlill.n M fhe peee nrnnnce i in /1n41nna 4.9 oompanyl Colvel Enterprise Comp, Inc.r Aulherized Reprmantatival Richard Schweppe Address: 2010 Main street, Suite 600, Irvine, CA 92614 7elephanR 949-851-1473 small: richard_schweppe@wr t.com ` Au9tadEetl Repreae�dallve's 6lgnaluta: 1V lot RFP 201 302 SW IPA C alms Adminis rollon for Wor rs Comp an Gen Llc I fly 4 "The in-house MO adjuster Is at no cost to the City. The MO adjuster will handle the cases on a per-cfalm basis and charge accordingly to the pricing option the City has selected. Telephonic Medical Case Management Fee On All Claims; $92 Per our Free Triage Per DPW Fee Bill Review Fee To Include State Fee Schedule Reduction: $ 4.50/Per Bill Per BIIIIFlat Fee Percentage Of PPO Savings - Network Discount Savings Below State Fee Schedule; 27 % Percentage Of Utilization Review And Reasonable & Customary Savin s: Subrogation and/or Liens Fee Percentage; 25% of recoveries%, Osha 300 Log Reporting; Inciuded Electronic Data Interchange Filed Wllh State; Included Safety Consulting Services Per case basis review of case at no co $ Notice Of Injury Entry; $ Into CareMC at no cost Custom/Ad Hoc Reports: Included Date And File Conversion Fee; $ Nn co't One -Time Setup Flat Fee Madloare Reporting Costs; $_2,100 Flat fee life of cont < Liability Clalms Adjuster (15.30 Claims per fiscal year) $ See attached N!o tcers Compensation Claims Adjuster (City Of Miami Beach In- HouseAduster $ Included MO* Owiipilon Of Addltlonal Sellae, Annual Administration Fee $ 5,000 Dea pticn OfAdd&nel8e*9: CMS monthly fees waved with 50 alfecation reports per year $ Waved Dealptlm OlAddllknal Service: 1-800 toll free FNOI 35 Per Intake Desadpdon OtPAdltlmel SeiNas; oompanyl Colvel Enterprise Comp, Inc.r Aulherized Reprmantatival Richard Schweppe Address: 2010 Main street, Suite 600, Irvine, CA 92614 7elephanR 949-851-1473 small: richard_schweppe@wr t.com ` Au9tadEetl Repreae�dallve's 6lgnaluta: 1V lot RFP 201 302 SW IPA C alms Adminis rollon for Wor rs Comp an Gen Llc I fly 4 "The in-house MO adjuster Is at no cost to the City. The MO adjuster will handle the cases on a per-cfalm basis and charge accordingly to the pricing option the City has selected. DomSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPENDIX E COST PROPOSAL FORM Attachment Option 1: Life of Contract Handling Fee Auto Liability: Bodily Injury $795 Property Damage $495 General Liability: Bodily Injury $550 Property Damage $350 All Other $695 Product Liability $695 Designated GL Adjuster Included will handle on a per -case basis according to the GL fee schedule, CONFIDENTIAL i DocuSign Envelope ID: 6EEOD36E-ABE7-016C-8B7C-9D91277D5AD3 I DocuSign Envelope ID: 6EEOD36E-ABE7.416C-8B7C-9Dg1277D5AD3 CORVE L Sample Screenshots Claims Management CoNel offers tools to bettermanage Leam more about Careue and how healthcare and daims activities. to access services and resources. MareaboutcarC Reauest Access C cld9nt C 2013 CUNa Caroaraaon NI •ighb re rved. cd—" elate-..[ 119ebmaetjc 1 Site Been than mrd Caremc Home Page Quick access for login, PPO lookup and service requests © 2014 CorVel Corporation. All rights reserved. Confidential CorVers form of License Agreement (Caremc Agreement) must be signed before access to the Caremc system. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 C O RV E L Sample Screenshots Claims Management Care"' Home Screen Select tiles for tailored screen display. © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (Caremc Agreement) must be signed before access to the Careme system. DocuSign Envelope ID: 6EE0036E-ABE7416C-8B7C-9D91277D5AD3 CORVE L Sample Screenshots Claims Management 0 Openlcaerdary DetaOV1ew(8ErA) 0 Cloimsgolety Codes Bashbaard a CWnos3corecard This list can mntam a large number ar recarda. Therefore exporting to and viewing the inrormatmn .n Excel is recommended. Select the department level shown in the grid below; Lev01 1 _ Dapadmeot� Escort tP Excel'°J Notification Center Drop down notification center streamlines claim information and displays real-time key information specific to each claim © 2014 CorVel Corporation, All rights reserved. Confidential CorVel's form of License Agreement (Caremo Agreement) must be signed before access to the Careuo system. Oct.] C Iascome Q0.11 nc Inc1ge0g Lo'onal _ylalm 5[aM Clalmaet InNTred Paid ._.rv_astq.. ev L ei....i ..l)ate..__...._1_:_....T.voe .. __ .. _ - Ae-La-0'10058 ACME %Vest - Sales 10/20120/3 Vic IND DC Reid Ud SB.Oo to -on Brands iABda-0100''>9 ACME west- WC DID DC Smith, Bob Oco JIM Brands ManufacturingManufacturing10/25/2013 AS -t4-0'10065 ��s west - sales 10/25/2013 V/C IND DC fenee,m4a ^�0-.Qg 10,00 ... ;A13 -W -0t0053 -gran_.. _. .. - .._ Wast -sates _ _._... ........ 10/22/2013 VC .. .. IND ... DC Jones, Tom _. So -on 10103 e2nids . _..__ _ Ae-t4g0SO0S4 -.._._.� .....__.. ACME .-. _ west - sates _.__......... .. 10/21/2013 ..:.... . .. WC ___ ... NO ..._.._...._ DC — Smith, Sob $UOQ AMOR Brands � AB•LP-010060 ACME WW- 10/!5/2013 WC MO OC )toes. Adam SO -00 53.39 � ersnds Oparatians AS -la -010064 ACME Woe 10/14/2013 WC t10 CC Jack a, Sana �0. 3 1494 Brands Op dcns 'A6.1a-010050 ,C1iE_ Wast-5a1es 10/09/2013 WC vo OR Ca, -.Test 56.03 9330 Notification Center Drop down notification center streamlines claim information and displays real-time key information specific to each claim © 2014 CorVel Corporation, All rights reserved. Confidential CorVel's form of License Agreement (Caremo Agreement) must be signed before access to the Careuo system. DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Customer. ACME Brands Sample Screenshots Claims Management ' Alerts s i TWO a Body Parts ny Incurrnn -Ail Locations u Count Alan xsmay. j' B Ceteslroohlc Claims yw_wo� 0 Clelms Exceeding Threshold 2 Nedlcal Bills Excaadlnn Threshold IfMaml r Action Items V sagwj A' •Inw Count Attlm w' issies,_�T—.�__—_, V 0 INE Completed V a WE Ran uwled V 0 Pear Review Completed ✓ J 0 Pear 0.avlew ReRueetadLik T --- __ _ Top 10 Claim Types By Incurred Amount Deahbosrds .II Clelms Score<erd ww mv• — uaavo J, A Natlicsl BI11 Review Outcome• aamnJ nl Clelms Sntehr Code Dechimurd yyO,Nd! cm+mei umevoJ rmawt u Y Claims Dashboard Displays summary of top ten injuries by body part and links to additional dashboards and reporting. © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (Caremc Agreement) must be signed before access to the Caremc system. DocuSign Envelope ID: 6EEOD36E-ABE7416C-BB7C-9D91277D5AD3 C ® R V E L Sample Screenshots Claims Management ® Customer: Al.. Brand. ' Clmm9 S.Cli Codes Bae11E<drd FOW, SM1rt sae I Ead nets j, Baty FaT. Clean syP<: Ieloy Co...: Ielury NeOute, , e<eWatim, Briar BY: rylCM: ._ � 114040:0 .._ � i All 'SI'� Ally? � All _Y::i AA _ All—� —= In e . Claims 0reakdoYrn 9y CI0Im Tyne F4—X Clalma Breakdown By Body Per, Arn$_ Claims Breakdown 9y Imm? Cause Hu]5— s1BB1d08 15900A9 -- . SI SJJCS s1.50o.md � :Ir all n 8 13a9.em ss7 s1.01.0.Q0 < 5119 49' y . pC11.000 926559 -1¢633 d = 55U.pp S non SS'.5 3ICA01B y 3y2I1 55 Indamnily IAed1i lwu nl,' Ny PityYd f Y pe 'B.vkfvp M Yy MYv 3eu4' C °ems` Assayraw Vw ..rmv rko' as 4 :_19-:.iak a7 F Gnot_ S 7Cl are Bieakdaem By uccdp6,mn Iep yX_ .galm38reakdawn BylnlurYBmure ®'.X— Oyam, sl<e Miss E W - Baaered =OXBe Buell9v CM1emr 1 gH5,953.as s22],1<S5B ,iiY ovn solo nr ] 590]93.1] R06,9Ba.00 596 5$ In 1 5185,391.77 5199,752,00 six6 0 g RIC"rI 589.899.85 5173.105.58 41W000 'if Cy391YfL I S28,118.55 9159,179.73 '[r Y0�"^ 'e in 7 493,734.13 1117,599.59 5,,0.0,0 8' Willh 1 S38,988.69 399,30198 328 F!rsBUW92 2 :52,160.45 591,910.37 9 Z95iptlYp! 1 575,520.65 :63,529 95 0 -mn Snm I— Csl.0 � qy� 2 522.214.88 56p.e5781 ane a.w. , 5e all: C 121 Claims Safety Dashboard Displays breakdown of claims by injury, body part, occupation and nature of injury. © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (Care"A0 Agreement) must be signed before access to the Caremc system. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 C® R Y G L Sample Screenshots Claims Management ed,ral Rill Review Outcomes rt Ala-- EBC El-- PePrlse 5lefe I LOe of Bualness - �n r;Repoll5 AUE B•a+df Bdb from Seo 3011 to <eP 2013 Idr ed 511:ef end aP 1081 . lid Mork $OI0IIo115 Samos Top 10 Plocedure aad R2v99ur Codee �[+ 91 . � e5 bs2 leNd C) si21 ]099i " 5 ' K 1 n r�ssn •, NL "� SI asS yy�V,aff�l r Top IB IC09 Codes �„ Tao 10 0mg and SPPPI9 Code.]+ W � bl%�#r ,M- ] + - Medical Bill Review Outcomes Displays claims savings including top ICD9 codes, top procedures and drugs. @2014 CorVel Corporation. All rights reserved, Confidential CorVel's form of License Agreement (CareR10 Agreement) must be signed before access to the Care"e system. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 e• � Sample Screenshots Claims Management • claims scoraca7d Summary of CW., Expeadtlu'ef Recovery Pinot mom.1y Parmenency Nedkal Eiperua Total Fe<m<r4 Nov. Palo, 6L•y1 $160 198,805 $1,571 65g26r 10 Cat.3010 910.629 1920 525,337 51,681 18.550 10 Sep. 2010 31].57) $5.116 526,935 611176 118,850 10 Total 13. 3 IFa16 ."IV H411 5199.666 5P • Paymeal Comparmpa Manly Over With Y..'Over Yee/ Oc1.2810 Nov. 2010 Py 2010 to Nov. 30. 2008 PY 9111. Nov, Pa, 2610 ULn9e 5}5,550 150,387 } 111,737 H2.955 1231,236 } 1180A81 • Claim Elpeadltef09 Recovery Km utxa orx um — Pa2 mNa — yvP N 0eu fiA3 J2a 201 Feb.2010 Na,2PNO kr 22010 Atxy20N J. 2010 J4 2010 At,2110 S1,2010 Oct 3110 N.r.2610 Change to Claim Volumi, Pypd SP"N xaw fia.pen Cl..ed Emil change Nov. 2010 26 5 0 2 26 } 3 Oct 2010 19 7 0 0 j6 ? 7 Sep. 2610 20 2 0 Z 19 { •1 Taw 3 9 } 1 Claims Scorecard Track and compare payments for claims In the CorVel system. © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (CareMO Agreement) must be signed before access to the Care"" system. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 C ® r' 4 V E L. New incident/Lijury weat Sales mdrevtes rq.ved tnr-".Uo Injured 4Jorkar• mjurad worker: ssn - —_ -_�........ eate of lniurv` +lis/mvi(mnddd/a»Yf Sfate • OK -- O,ew Y Pteam cho.e Me option whlN I'mom•d:ul heavnanr,..W.dmm xru.rd,;, •.o..d. beat de.r bee y..r fiW.6 n • • Flwrt.l a•.em.m m a.Pe10. Sample Screenshots Claims Management m7vrae Wvaer s m • Mao- 7 Oataaf rn)wV' 4]UNi3 PkaA CMOr<mC <pdan xM1Wr .Ye m.du.r d.nm.nC d•Inm 4nl.id.n•a .¢ SertdHVSayWratw40a' 0 Bras' ortgw Ynwbrar rvr •alu eex Mcna muaEerroeontaa lnNrH wodxr' ----.. ----- -7....___... Wart@Tm. of (nlu•y•nl]W2012a6 .rOV Yqq 'pN SevCMY' ' • del.n d.rnMY teal � � • IY T1.0e 7 N'dl'a Wa 441 _O V. h; i7;Mayttmma.'M .O nanda�o-r aryLTeM ' • lelott T.. G�• .Yplvfa dlnrVY ••'1+IaR WvL 11*, SLY Oart fnl•>K'J ••9aea P;;, .1 bdvD+H •cdy Part Lde -sai.a o.a sdx or may�� .ddH PvWSLrtU 3.tly Oq.md I R 0; e* . ii u+al RI adii f Tep Report an Incident/injury A simplified way to report incident and injuries to CorVel. © 2014 CorVef Corporation. All rights reserved. Confidential CorVel's form of License Agreement (Caremc Agreement) must be signed before access to the Caremo system. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-3B7C-9D91277D5AD3 Sample Screenshots Claims Management Ssermeea B DPeument axotas 0lnlej101e0no3a BFin ancf. 1 BMemest BLeast 0Referenee Bal Claim Type Me ... my two) Dale er E4t, WHIM" flaps - SSM 333-002173 NulOpk'Cones Re tape... flame Seat, -Nanuhctuna4 O.te of Hire OfJ.Y/1G.7 Data of lneldent 0 610 0 /101 0 Ad)ualer Ad)usteri. DEeO Policy effective oele foil, Tarn Data Palley Number n.rfUl statue Jutboldien State KV 1a111WO11.a Claim No Mead o Sxc.l LeJ Service Sen SUNS aereml Opened Uased Caw Caze Olary:&oaf OOCYT.JIf Xum Data Dow Date ft.. Workers Hetes Notes Cever Invoreas WBW Gari a01. as 1010ah0t1 10/1Wxo11 s ani M or EDL 1W301eau mT-1 03 1/30/111 10M2Y11 10,11:00 g1 Pn TCM. AC Wagn. t t L1/5(1Y11 - Be g 3.. .A 4 -5 iRP-L ACT imaing LY//0011. _. �i • Q ' i •••.'A .. _g . . _ DlsPlaylpg records l to 4 of 4 t nate 1 of t RTW Profile .;para 1/6/20120x36906 n14 s - ._,,.... J.._o�:.... � ,E4timata�R �Det6p g/15/2010 .i. .. .... ........... ..'... �hys,dari Release.baEe: -� Return to Modified Duty - Light Physical Demand jype^ level k t7re60M�'.Y,a.9ei. ..�.+Z72 Do""scPlp�l hl no use of right arm offwork 6/]3.24 for surgery :.85{4�l'FlaMie i with carom to modified duty expected post cv� Claim Summary View View detailed claim information from a single spot in CareMo. The information is organized under a series of tabs for quick access to critical information such the Return to Work Profile: Gander R.I. SW.. oea.d © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (CareMo Agreement) must be signed before access to the CareMo system. I DocuSign Envelope ID: 6EEOD36E-ABE7-016C-887C-9D91277D5AD3 C O R V E L Sample Screenshots Claims Management Claim Reports ® Reports O My Reperts 0 My Schedules 0 Generated Reports (Complete: 6/0enerating: D) Expand an Collapse a0 3i Claim Reports+ J Financial .*] Liability I Liability Accident Reports &j Loss Experience •+.� Payment Reports Specialty Reports '33 State Reports •.+El Subrogation Recov L Claim Reports u Workers' Compens 0 Reports O My Reports O My Schedules O Generated Reports (Complete: WGenerating: D) Expand all Collapse an J Claim aIportau-.-.^.... .- . - . Claim Detail Claim Log Claim Repeaters Claims Received Count Combined Claim Detail Finance Amount Summary Safety Reporter Salary Continuation B Financial Claims Reserve Change Claim Reports Create and view reports with filtering and grouping options. Detailed reserve history, subrogation and recovery are also availble. © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (Caremc Agreement) must be signed before access to the Care"'o system. DocuSign Envelope ID: 6EE0036E-ABE7416C-8B7C-9D91277D5AD3 CORVEL Sample Screenshots Claims Management Treat men l Calendar Filters Tre]ImeAl Ty Pe .-^.h000e Treannom ay0e to filler-. • Direct St." Dole i4!EDta of irevmenl February 2011 Su 00 T4 We Th Fr Sa is t7 18 19 20 21 22 23 24 25 26 27 20 Turn 2011 Su 40 Tu Vie Th P• So 1 2 3 4 5 6 7 3 9 30 Il 12 13 t4 15 16 17 IS 19 20 21 22 23 24 25 26 27 28 29 30 March 2011 Su MO Tv IV Th %r Sa 1 2 3 1 5 yqpry 6 7 dZE$1 9 10 11 12 13 14 15 15 17 19 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2011 Su Mo Tu 'No Th ii, So 1 2 3 4M 6 7 a 9 10 11 12 13 14 15 15 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 November 2011 Su M0 To We Th er So 1 2 3 4 S 6 7�8 9 10 11 12 Ti` 13 14 16 17 18 19 20 21 22 23 24 25 25 27 28 29 30 April 2011 S. MO % %Ye Th Fr Sa 1 2 3 4 IN 6 7 8 9 LQ 1l 12 13 14 15 l6 V 18 19 Q 21 22 23 24 25 26 27 23 29 30 Au9uet 2011 Si Mo Tu We Th 4r Sa 1 2 3 4 5 5 7 3 9 10 It 13 13 14 15 [a V 15 19 20 21 22 23 24 25 26 27 26 29 30 3t Oeeember 2011 October 2011 Su Me Su 110 Tu We Th Fr 58 1 3 3 4 5 5 1 2 3 4 5 a 7 8 9 10 11 12 13 t4 15 16 17 18 19 20 21 22 23 24 25 25 27 23 29 30 31 March 2011 Su MO Tv IV Th %r Sa 1 2 3 1 5 yqpry 6 7 dZE$1 9 10 11 12 13 14 15 15 17 19 19 20 21 22 23 24 25 26 27 28 29 30 31 July 2011 Su Mo Tu 'No Th ii, So 1 2 3 4M 6 7 a 9 10 11 12 13 14 15 15 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 November 2011 Su M0 To We Th er So 1 2 3 4 S 6 7�8 9 10 11 12 Ti` 13 14 16 17 18 19 20 21 22 23 24 25 25 27 28 29 30 April 2011 S. MO % %Ye Th Fr Sa 1 2 3 4 IN 6 7 8 9 LQ 1l 12 13 14 15 l6 V 18 19 Q 21 22 23 24 25 26 27 23 29 30 Au9uet 2011 Si Mo Tu We Th 4r Sa 1 2 3 4 5 5 7 3 9 10 It 13 13 14 15 [a V 15 19 20 21 22 23 24 25 26 27 26 29 30 3t Treatment Calendar View color -coded treatment calendar. Sort by treatment type and date to view various procedures. Pj Ae hesh _— pray 2011 O Su HO T4 We Th Ff 51 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 t7 16 l9 20 21 22 23 24 25 26 27 23 29 30 31 Oeeember 2011 Su Me Tu We Th F- Sa 1 3 3 4 5 5 7 9 9 10 11 12 13 12 15 16 V 18 19 20 21 22 23 24 25 25 27 26 29 30 31 Treatment Calendar View color -coded treatment calendar. Sort by treatment type and date to view various procedures. Pj Ae hesh _— pray 2011 O Su HO T4 We Th Ff 51 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 t7 16 l9 20 21 22 23 24 25 26 27 23 29 30 31 January 2012 Si, alp Tu We Th Fr So 2 3 5 6 7 8 9 10 OEM 13 14 15 IN it MIN 20 21 22 EM 24 OMEN 27 28 29 ® 31 © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (CareMo Agreement) must be signed before access to the CareMo system. i i September 2011 Se M0 Tu 'Ira Th F• Sa 1 2 3 a 5 6 7 S 9 10 11 12 13 44 15 16 17 16 19 20 21 22 23 24 23 26 27 28 29 30 January 2012 Si, alp Tu We Th Fr So 2 3 5 6 7 8 9 10 OEM 13 14 15 IN it MIN 20 21 22 EM 24 OMEN 27 28 29 ® 31 © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (CareMo Agreement) must be signed before access to the CareMo system. i i DocuSign Envelope ID: 6EECD36E-ABE7416G-8B7C-9D91277D5AD3 CORVEL I Case Notes Sample Screenshots Claims Management Claim: A0-10-500007 Perry. Sharon 'kalc';Adjusting r Claim Level Case Level Close 0, 5earch ,"te— me , Userz�� ego 12/29/2011 05:3SPNI Case toil PT Other Doctor appointment scheduled for Ntanager 12130/20119:30am. Case Worker is still unable to -mark. Next 1212912011 05:34PAI Manager PT Comments doctor appointment should be scheduled by Friday. accepted: left leg Work status. release to full duty Diagnosis: left femoral neck fracture Salad Continuance or TTD: No ordered by NCtC to discontinue TTD benefits When Does Salary Continuance Expire; WA Medical/Current treatment: Client has reached HMI, and recd a 40% rating DEMO given to left leg. Case management: 10/1212011 05.46AM Adjuster AD) Plan of none Subro Status: no 3 party Action potential Legal Status: none Reserves: Pled Reserves Ik to pay Claim Notes View notes from adjusters and case managers. Search options include by note type and date ranges. @ 2014 CorVol Corporation. All rights reserved. Confidential CorVel's form of License Agreement (Care"O Agreement) most be signed before access to the Caremc system. I DowSign Envelope ID: 6EEOD36E-ABE7-416G8B7C-9091277D5AD3 C®RVE L Sample Screenshots Claims Management Action lest oete i t ruidennea Eat Adult -- any Pete oyf Tell Days. ILo[Og worked RM Ohio RlW nine lidded, Bid Return to Modified Oaty - no vee right arm FD foleafe syge<led next Vlew/Fdd 08/178010 calisnote Light Physical Demand 796 Loyal feet Return to Modified Duly - VlewlFdk 07!1012010 09/15/1010 Light PhPidel (lemaSol 126 ne uee fight efm next spot 06116110 Level Return to Modified Duty - VIewlEat 07106,2010 09115r20f0 Light Phy01c01 Ocmend 796 n00e0 of light arm LGy01 Return to Modified Duty - no use of right err off wars 6113-24 for I ,J.t 06/092010 0911511010 Llghl Physical (looked 755 eo19ery wilk return to mgdlDed duty level exPeded duel furgery Vlyddl 091142010 09/158040 Released to Full Dol, end 666 Released fro. Ca,a I : Restrictions: Robinson, Andrew: AS -11-500019 1 Carrying shave sheuldere IW should not rift anything above 9h0vidws Brown, John 01/122012 Return to Work Information View return to work plan, work restrictions, date last worked, estimated return to work date, actual return to work date, total days off and claim specific notes © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (Care1AC Agreement) must be signed before access to the CareNi" system. DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D6AD3 CORVEL Sample Screenshots Claims Management •C1.Im Malts laoe.JPlhey: AS -10400004 fEC13 o lenl[a, QOueYm.nts.m., elarvn,Ob9nea. 0"-w" n,.edie,l eL.Oa 0......... aul uslm rypa Na+menyluwf oete.leW. 1Vo6lt]ed MO, ss. »a.ad-sv3 u.mpl. Wam. x. employ,nlam. s.utn .v.nur.dud.5 Otle.l Nlry rile]'' w. et b1,61.1 woo,,, O. 4*W' dpnnt 0eu0 PeNCy Elf.c4Y. 0.1E pe6<y T.tm 0.. ftlr XYme.l Oeee„ p,b u.Med sl... lYMsdldM. Blal. lr 24M,acx.n a.im no sato n.,.a mu0."to,, f Adjuster: Adfvst.n, DEMO fmart b GW �' i..OGSG L16C9CSJ(it S L@^� QgyS O yynd P2,nl—1 / oX� �1 �� M9f pN. Dea[,inH.n Qyyl{1fy.9uenv +may®p$y _[M1an el 0.elvAn. XD tlOM=� PpjQlj(pey eJ�fe uJ [(fig ftlyn ee\ed- sm�mw� OQt09/]ow coowl.pw. G.ft am. C NN fAP 500Me /d parm.ry au'eA.zPoM P.A lSCA+ S51" I... Th'Vd PaM Ovmrdw �' 05t2o- TO%YGDC(.XE/ACRAVNOPMBI :6N'Wm�ee/ el SL. PoW • tl ¢L.Td 4m 00'1�98fi $flwmq P1M Ofdt00ota �� fMu(c .'OCVCOMP/ACIYAMMOPNEM m PmE SLL9] slsn M t$dwfanf OS Opmte iysgs. }MAt4DOI, MY00.DLHGWDyK Stmuirel myd PfM 09/3L30W Cenerle AP.nfm ONb TAB us -i W Ph° M sve M.26 kid .36 f5].]B 'ea OS SdW.N d9884 $bnhiYV W14120]B hoRN Wrcnc 09b- TTMNOCLMYORC04DRbE/PC 50 Plot—,dupvaM Nd M16 i5;ld 4W OS 9 4o,u Si]l0. $c.O emN \L]p/tllld Dexile 0]21- NHi ,,E T/9 PS1XG 50 ,L.grtary PaM Poet t:9\.]d yt9Lie 440 t0 Diu $t<nenvcr W, 'M 0]/]312at3 Gexxe METP wfi Tq 6WMc 50 PIT—, bVm Pelea[d 6308.50 S00 SL'SSO t0 S.M-. +99N. 1]PfwOVL Mv090PNANUF/AL Sbre�nV ihiM P.M 02/33/30L1 Pp,nisb finene 00. Me I7.53 SL Bolen PeleCed 15136 100 s1136 NOaw Duate Thad Piny wva faNk 0.51 W2011 eo,c Gwwo 000500. y40tw0OLN6TAB58MG of Phvm.aY eta. MD Pa'd s 5 Miff 17. 000 S.YMns effect, flPJpy$AAsp1ENQ rAB w Ovl8=,f Ge,ayk s8i9' Petry oeW eoilk et P.d SSP.]t M" 5\O.la 09 l Sdwv MD Wh, ONIB/TIIt3 ,1 G.nenc ]e60 iPANADaLH6 TAB 54NG .14 Ph,moM.Y pkoertsn MD Pod t0E40 1. W.O3 S.I U.ro Drug History View pharmacy information including prescriptions, generic or brand dispensing, and amount paid In and out of network © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (Carema Agreement) must be signed before access to the Caremc system. DocuSign Envelope ID: 6EEOD36E-ABE7416C-6B7C-9091277D5AD3 CORVE L Sample Screenshots Claims Management Art.M°n: me 0.mm OSHA's Form 300 MMdm arL t ,b,a w,,,,m., allpxp°«°mwmwlx.meax°m�m.rm,l J Log of Work -Related Injuries and IllnessesD.P..ar U.S.U. oeponm°ntarlae« or°�a'N�aw»ursi°u „mmumxnb rvol„mhr ammaeiaJYnYa.avagemNNapdNyah.m6q NrvlNeM«R B.au �IKKIl N.1.aa®°ubb. minmdv Dl[+a. masa � ��bv4 mpgAfpn911ay»v.bnbWgrrvNogv�»ImNrN Ypn e-cYY6Lv^Nvw ACME 6,mtla ray vmem slxe on MMMEMMEMEM r) (a w 10lo) IEI WW dm,.n.w. b.M 1NnIN.Nmw1 dssbMfa ha{pmdM/.Lxln e.l.q�ty..! c1.n NM1YNVM.ni AS.rLN, ryr1U :airaN^I m>N. ml rtplmv9PsbeHrlMOw4mrnl �-n ama»�M1»»dn.: �U � YpWwgµAmNepalY rWmnO#NFY dp dF�9 ssnab Wwa IwM zWU }n bcl o w as I rs n n a u. µII i.m a /&Mglµi Gnn vel <q . aq .YfRIrM Y6uv �aaMO Lf mMn bUEmrl l� 'M 4•.*AY vw 16gb1wuamavYs»bmq . IM Y wM sa«Ma seMbv�i'm»+.t'Ub6 aq «Y..nduvd.WlAtlWaLµ.YGmulw 90sun A»w yavYEN�t1 Tµl^II OSHA This is an internal screen that can be used to capture information for OSHA reporting. © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (CareMc Agreement) must be signed before access to the Care Mo system. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-gDg1277D5AD3 CORVE L Sample Screenshots Claims Management D Senlaee B.... 1.1.o.. QlplVrylpngnpel. 011n ... I., QMedleel QLegel 0R.1...... CA.I ury ,,,I AW.LlIUMY pale ol94N 0.1WIV. m2s CCW Summery o/ (ALSO weww sgnme.E 33!e t%.II.ISe me egl.j$-Ilp1 YVRIVI. Qeloe Ra NAwlldita SevM-pvenb]n0 • 9aOly lnloemetlon —_— Q.Ntr"M pale el lndGmE q'IRN01t <dlwlef A4,terl, oz.. FOYty eIIVCW. W. "I, Te/m poli ivpry RVmOer Glider Ylle xeNtol Stalua ) r,IW WO SWI OR esvvau.. Tyve 31 SW.. ABWe • LlnpNlV 91 [.e.c. MpnMAbAwI Nlgh qb. PXb+ � vn N.mre SOWAev}mRX n.lm.nr. emRl.Ye. ARman./R - C.we VMb-Emi clam..n a....rbo pmr A.mwvl St. Z' amAmtNnnYRun H.W. a Savn Pr IRbn Rf/eCITh[rtv} YedRel Treelmwl ConNael+lievel0!n9 pvG9y dNM1 It—IS... ye)p}Jyq AdNew mW..A. ury Poalme pvwa! di.v h4tq ptr b mp&9 wpl nv el NlrumS a, Summery o/ wa/Y Pow. EOS1Y6}r21 weww sgnme.E me..0a ml.an+me ma..w Suwm gelg.umn upon Aegre.+ ]01 xc1./e.v+ev NeM AMe EN]1%I}I] wa/Y Pow. EOS1Y6}r21 N> ]S 33!e t%.II.ISe Lme.n pe suana n.e.rteq S. nXegl • 9aOly lnloemetlon —_— AcnawtiYw Vlgcle tYPe Apegv VertY bvrye 3geW Elmg a Abual Ogvee 0 pelertM NprMr E.bmO+ � v.MticY gve NI.ru930.I0ee. F AttYwlrueeWeMMrI+ i [.e.c. MpnMAbAwI Nlgh qb. PXb+ � vn N.mre SOWAev}mRX s}P. p.uW En.xvnmenl be'fLN C.we VMb-Emi tenaNlMf Slntpl 0.4v/ Pobnb Ofe Auto Liability Claim Details Liability Claim Professionals and customers can view information about non -Workers Comp Auto Liability claims under Claim Details in Careh90. © 2014 CorVel Corporation. All rights reserved. Confidential CorVel's form of License Agreement (CareA10 Agreement) must be signed before access to the Caremc system. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Sample Claims Management Reports © 2014 CorVel Corporation. All Rights Reserved. Sample Claims Management Reports Workers' Compensation Claim Detail Report..................................................................................................Page 3 Payment Register Detail Report .................................................................................................... .. .......Page 6 Loss Experience Summary Report ............................. ................................................................................Page 9 OSHAForm 300, 300A and 301................................................................. ., ..................... ....................Page 12 Workers' Compensation Lag Time Report .....................................................................................................Page 16 ClaimsScorecard......................................................................................................................................Page 18 ClaimsSafety Dashboard...........................................................................................................................Page 23 AdHoc Reporting.....................................................................................................................................Page 25 ..•Ctalm Reports CRoporle Uli Reports 01ty Schedules toGenerated ReportS(CUMPiale. arGanereling: g) Expand at Collapse all -U Claim Reports - W Financial Expand all _Collapse at f7 Liability ; .L+1 Lobllity .Accident Reports 'U Claim Reports -L+1 Loss Experience Claim Detail i .IJ Pay mznt Reports Claim Lag C+ Specialty Reports Claim Repeaters }; . State Reports Claims Receivad Count L43Subrogation Recovery Reporters Combined Claim Detail ti)Workers' Compensation Reports Finance Amount Summary . Safety Reporter Salary Continuation .1�) Financial :txi Liability 9 2014 Co Vel Corporation. All Rights Reserved. el 0 0 n N ro m GOYS Y E L a m Workers' Compensation Claim Detail Report Description The Workers' Compensation Claim Detail Report includes individual claim information that can be filtered and arranged according to a multitude of report parameters and valuations. This report includes individual claim information that can be valued as of different points in time. Features • Displays a large variety of claim related information including claim detail for all claims, all open claims or closed claims. • Data can be categorized by numerous filters including accounting code, claimant name, class code, coverage line, injury year, location levels, purpose code, denied or delayed status, status date, claim specialist, classification code, social security number, injury date range, nature of injury, type of accident, occupation, part of body injured and financial information. • Due to the amount of detail provided, this report is great for analytical work. • Reports can be generated as an Adobe PDF, CSV or Microsoft Excel file and can be emailed to the user. 3 0 M4 CorVel Corpambon. Mi Rights Resewetl. COR 9f E L Claim Detail For all claims Claim status and finance amounts as of 07/15/2012 ABC Company - EC `Additional filters applied, see first page for details. HIPAA WARNING -This report contains protected patient information Claim Number: CE -09-000014 Location Level 1: Subrogation: No Cov/Cless1SubCI.ss: WC/MO/ Status: Closed Status Date: 07/122010 Recovery: Claimant: Jurisdiction: Ohio Injury Date: 10/062009 Avg WW: $0.00 Accident Description: Raising baker scaffold from 4'to 6' high. While Claimant Age: 46 Received: 10/092009 Comp Bate: $0.00 doingthis right calf muscle popped. O Nature of Injury: STRAIN Occupation: Category Level Paid -to -Date Reserved Incurred Part of Body: Right Ankle ALE $99.17 $0.00 $99.17 Accident Type: Strain or injury by lifting MED $1,347.89 $0.00 $1,347.89 Source of Injury. HOISTING EQUIPMENT Total $1,447.06 $0.00 $1,447.06 Claim Number: CE -09-000015 Location Level lc Subrogation: No Cov/Class/BnbClass; WC/MO/ Status: Closed Stams Date: 0 110 8 20 1 0 Recovery: Claimant: Jurisdiction: Ohio Injury Date: 09/022009 Avg WW: - $0.00 Accident Description: Moving stack of drywall with palletjack to Claimant Age: 30 Received: 10/142009 Comp Rate: $0.00 contioue hewing wall. Left knee twisted and felt a Pop 0 Nature of Injury: STRAIN Occupation: Category Levc12 Paid -to -Date Reserved Incurred Part of Body: Left Knee ALE S130.00 $0.00 $130.00 Accident Type: Twisting, strain or injury by Total $130.00 $0.00 $130.00 Source of Injury: WALK/PATH/SIDEWALK Claim Number: CE -09-000016 Location Level l: Subrogation: No Cov/Class/subClass: WCIIND/ Status: Open Status Date: 111052009 Recovery: Claimant: Jurisdiction: Ohio Injury Date: 10272009 Avg WW: $a01 Accident Description: Employee was carrying steel grating across job Claimant Age: 47 Received: 11/052009 Comp Rate: $0.01 site then pulling pieces up to mezz floor and laying them out He fait a pull and tightening in lower back - Nature of Iojury: STRAIN Occupation: Category Level Paid -to -Date Reserved Incurred Part of Body: Back, lower ALE $2,929.62 $3,57038 $6,500.00 Accident Type: Strain MED $6,408.55 $591.45 $7,000.00 Source of Injury: HEAVY OBJECT Total $9,338.17 54,161.83 $13,500.00 02014 CorVel Corporation. All Rights Reserved. 4 0 0 0 m ro m m 0 a m I MKOIZATAMEM Claim Detail For all claims Claim status and finance amounts as of 07/15/2012 ABC Company - EC *Additionat filters applied, see first page for details. IIIPAA WARNING - This report contains protected patient information CategoryLevel2 Paid -to -Date Reserved Incurred ALE $21,351.64 $8,964.05 $30,315.69 IND $35,300.76 $14,482.29 $49,783.05 MED $76,056.89 $11,584.42 $87,64131 PER $3,202.64 $0.00 53,202.64 ReportTotal $135,911.93 $35,030.76 $170,942.69 Open Closed Total # of Claims 4 27 31 02014 CorVel Corporation. A11 RlgNs Reserved. 5 CORVE,L Payment Register Detail Report Description The Payment Register Detail Report summarizes payments issued between two dates and can be filtered and arranged according to different report parameters. Features • The report provides payment information sorted by check number and additional parameters based on filters and groups selected. • The report body lists checks that match the parameters selected. • Shows each payment issued on or within the check date range selected and matching other parameters. • Report parameters, groups and filter combinations can be saved for future reports. • Reports can be generated as an Adobe PDF, CSV or Microsoft Excel file and can be emailed to the user. O 2014 CoNel Corporation. All Rights Resewed. 6 Payment Register Detail For all Checks dated 06/01/2010 - 06/30/2012 ABC Company - EC *Additional filters applied, seeflrst page for details. HIPAA WARNING -1Lis report contains protected patient information Check Number Date Issued Payee Type Description Payment Amount Class Claim Number Service Dates Claimant Check Number: 1007598 1007598 06/09/2010 DOCTOR 011012569641 $117.05 IND CH -10-000070 05/05/2010-05/052010 Patient Category Level MED $11705 Total for Check Number: 1007598 # of Payments: 1 $117.05 Check Number: 1007602 1007602 06/092010 DOCTOR 011012456831 $79.29 IND CH-IM00432 11242009-11/242009 Patient Cateeory Level 2 Total for Check Number: 1007602 # of Payments: 1 $79.29 Check Number. 1007607 1007607 06/092010 DOCTOR 011012594941 $189.78 IND CH -10-000070 05/102010-05/122010 Patient Cateeory Level Total for Check Number: 1007607 # of Payments: 1 $189.78 0 2014 CorVel Corporation. All Rights Reserved. 7 I z Payment Register Detail For all Checks dated 06/01/2010 - 06/30/2012 ABC Company - EC *Additional filters applied, see first page for details. HIPAA WARNING -This report contains protected patient information Category Level Payment Amount ALE $28,277.49 IND $4,340.76 MED $11,016.49 Report Total # of Payments: 288 $43,634.74 0 2014 CoNel Corporation. All Rights Reserved. s Loss Experience Summary Report Description The Loss Experience Summary Repgrt shows the number of open and closed claims and associated financial information that can be filtered and arranged according to different report parameters. I Features i • Boundaries for the report can be tailored per client's request via CorVel's claims management system. • Data is sorted by the fiscal year selected. I • Reports can be generated as an Adobe PDF, CSV or Microsoft Excel file and can be emailed to the user. I i I I I I I I I I I I I ® 2014 corvel corporation. All Rights Reserved. 9 I C] 0 n C r m 0 m Totals for Month Issued: 03 March 0 0 2 67 69 97.10% Paid $13,166.24 $301.03 $98,163.49 $22,842.23 n Reserves $ 0.00 S 16,996.34 $ 2,006.69 $ 6,522.53 rn Incurred �'o pp�-� �p pp�--� CORVE pp L S 100,170.18 $ 29,364.76 S 159,998.55 Totals for Quarter Issued: Qtr 1 G m 12 237 249 95.18% Paid $ 74,181.77 S44,953.92 S 360,653.41 $ 152,000.30 c m Loss Experience Summary Reserves $ 31,913.21 $ 253,498.51 $ 43,488.20 $ 55,372.58 0 ABC Company - EC " Incurred S106,094.98 5298,452.43 $404,141.61 $207,372.88 0 For all claims with Injury Year (FY) 2012 m m 0 0 Quarter Issued: Qtr 1 w m D Claims to In Open Close Total %Closed indemnity Permanency Medical Expense V Total Recovery Month Issued: 01 January e1 m Totals for Month Issued: 01 January m n 7 90 97 92.78% paid S52,728.94 $ 0.00 S 143,779.54 $ 78,030.68 co $ 274,539.06 $ 0.00 Reserves $ 31,913.21 $ 184,146.34 $ 35,821.31 $ 32,614.88 $ 284,495.74 Incurred $84,642.05 $ 184,146.34 $ 179,600.85 $110.645.56 V $ 559,034.80 � Month Issued: 02 February o Totals for Month Issued: 02 February 3 80 83 96.39% Paid S 8,286.69 $ 44,652.89 $ 118,710.38 $ 51,127.39 $ 222,777.35 $ 0.00 Reserves $ 0.00 $ 52,355.83 $ 5,660.20 $ 16,235.17 S74,251.20 Incurred $ 8,286.69 S 97,008.72 $ 124,370.58 $ 67,362.56 $ 297,028.55 Month Issued: 03 March Totals for Month Issued: 03 March 2 67 69 97.10% Paid $13,166.24 $301.03 $98,163.49 $22,842.23 $134,472.99 $0.00 Reserves $ 0.00 S 16,996.34 $ 2,006.69 $ 6,522.53 S 25,525.56 Incurred $ 13,166.24 S 17,297.37 S 100,170.18 $ 29,364.76 S 159,998.55 Totals for Quarter Issued: Qtr 1 12 237 249 95.18% Paid $ 74,181.77 S44,953.92 S 360,653.41 $ 152,000.30 S 631,789.40 $ 0.00 Reserves $ 31,913.21 $ 253,498.51 $ 43,488.20 $ 55,372.58 $ 384,272.S0 Incurred S106,094.98 5298,452.43 $404,141.61 $207,372.88 51,016,061.90 0 2014 CorVel Corporation. All Rights Reserved. 10 Loss Experience Summary For all claims with -Injury Year (FY) 2012 Claims Open Close Total %Closed Report 37 987 1024 96.39% raid Totals Reserves Incurred 0 2014 CoNel Corporation. A8 Rights Reserved. 0 0 P y m m 0 ABC Company - EC o Indemnity Permanency Medical Expense Total Recovery $318,741.66 $230,752.98 $1,067,715.59 $344,298.92 $1961$09.15 $ 66,608.27 $ 339,006.21 $ 142,520.35 $ 118,933.49 $ 667,068.32 $ 385,349.93 $ 569,759.19 $ 1,210,235.94 $ 463,232.41 3 2,628.577.47 11 OSHA Form 300, 300A and 301 . Description • OSHA Form 300 — This is the OSHA Log of Work -Related Illness and Injuries. Federal law requires employers to record all reportable injuries and illness that occur in the workplace on this form. • OSHA Form 300A — This is the OSHA Summary of Work -Related Injuries and Illnesses. Federal law requires employers to post this form in the workplace annually. • OSHA Form 301 — This is the OSHA Injury and Illness Incident Report which is required by the Unites States Department of Labor's Occupational Safety and Health Administration (OSHA) for employer provided workplace incident records. Features Easily create all OSHA Forms and print instantly Enter date ranges to get information for each calendar year O 2014 CorVel Corporation. All Rights Reserved. 12 A Attention: This form Contains information relating to OSHA's Form 300 (Rev. 011200e) employee health and must be used in a manner that protects the confidentiality of employees W the extent Log of Work -Related Injuries and Illnesses Possible While the infonnalJon Is being used for occupational safely and health purposes. Youmusreawrdtheyondon aCaut You must retl Injuryorienei k -relater! ibrieofmmdoueness,tone diagnosed bliapysicitransfer,daysawehcare worksl medicmtalso record ontlfirstaid.You mustakoremfdatmeat anyoftrelatediftmories andglaftedaneseas that one diagnosedbya physician04.12. eleechcafettecifnetfor You must also record work-related Injuries and i0nesses thaimml airy of the speciM recording criteria Os1ed'm 29 CFR 1904.8 through 1904.12 Feel free to um Mro Wes Mr a single case Ayou need to. You mot crmplen an Injury and Unrest Incident report(OSHA Fon 301) ofequlvalenitorm for each injury or dress remmed on NS form. Ifyoum not sure whethera raze Is recordable, ca9 yourlocal OSHAoffim for help. IMMUNE a. OltI3 and complete aM rerbw Ne m3ec[onoflnlolmaWn. Persona are notre9ubedw espondb Nemaec5pn allnbmufion urJeuddlsplap acmren0y nfid OM6 molal nwnher.If (A) (B) (C) (D) (E) (F) Case No. Employee's Name Job Title Date of Where The event occurred Descnbe Injury or fitness, pans of body affected, and (e.g.. Welder) injuryur (eg. Loading dock north end) oblecusubslarxe that directly Injured or made person 01 A&12-010053 onto( 02119 fog. Second degree bums on dghlfolealm from acetylene X nlners 0data fact) Year 2013 C U.S. Department of Labor Oceupanonel Solely end Health Adminievins0on FOIIe"nreedeMana.121e 7e Establishment name ACME Brands City Portland Slate OR Enterme rutruber of ® days me Injured Check%&'Injury' column crillwodrer.: or chose one type of Illness: Remained at Work on pb Daysaway Joblrander ONerramld- Awayhom transferor Death fromwork orresblc0on able Cues work restriction eta nn m AR-IN10020 Janes, Mask OltI3 and complete aM rerbw Ne m3ec[onoflnlolmaWn. Persona are notre9ubedw espondb Nemaec5pn allnbmufion urJeuddlsplap acmren0y nfid OM6 molal nwnher.If x -p datts ,edays x A&12410044 SmM, John 0202 (6)A0ouzr x Oaays Odays % A&12-010053 Fritz. Johnny 02119 X 0daye 0data X A&12-010059 June, lecrey ON29 x Odayz 0Me, X A&12010074 Janes, Jemr, 0313 X 0days 0days X A&12-010106 Maxwrit Jore. NMI X 0days Odays X A&12410111 Colecen,Yxky 04M1 X 0days Odays X A&12410114 Coleman, Ye'ry 0412 x odent Ode,,, % AB -12-010140 SmM, Mare OLIO X o4we coats X A9-12410147 slab; Lusa 0519 X 0days odays X A&12410157 TesbrsmiN. Frank 06,01 X Odzyz 0date X A9-13010023 Fredndor., Fred Cant 1e0down(wming) x 0d,,, edays x Ae-13010077 Piacm,,Amold 12113 IwaWn'enareen) x odays 0daye X A&13010079 Sea, 601 12116 (Odmg P-runi) X edays 0days X M-13010080 Smith, San 12117 L'fMO apaMm test boom add full N one Mar injuring feet and hand. (Uh ng a pof'A X Cdays edays X .. u u u 15 u u lS 0 0 0 0 0 Pubk prre.gonden for 0is mlkcdon ofinfomladon¢ ttaroad b every, N mInNas perresperse, iluJnfng tine to review the Instructor, seargl and seldom. dela needed is)Inm (4)Poboniig and complete aM rerbw Ne m3ec[onoflnlolmaWn. Persona are notre9ubedw espondb Nemaec5pn allnbmufion urJeuddlsplap acmren0y nfid OM6 molal nwnher.If (2)Skin GsaNer (5)Heartnp busyouhave mycwNnents aboulNeze estinafes many azpetls Of N's data mMCLnn,mnhrt USDepaN Mol Labor,06HAOI of6%54m RoomN W.2000=6",nAve, NW Washinglon. DC 20210. 0o not and the completed trams to this office. Prepared 01/1612013 Page l oft (3) proportion, (6)A0ouzr 02014 CoeVel Corponadon. All Rights Reserved, eenddpn 1a Marcos OSHA's Form 300A (Rev.01noo4) Summary of Work -Related Injuries and Illnesses A(estabfshmenls covered by Part 1904 must complete this Summary page, even lino work-related injuries orAnnses occurred during the year. Remember w review the Log b verify that the entries are complete and accurate before completing this summary. Using the lug, count the individual entries you made for each category. Then write Me totals below, making sum you've added the entries from every page of the Log. If you had no eases, wride'0' Employees, former employees, and Neirmpresentatives have me dghl to review the OSHA Form 3001n its entirely. They also have limned access to the OSHA Pon 301 or its equivalent See 29 CFR Part 7904.35, in OSHA's recoNFeeping role, forfudherdetails on the access provisions for these forms. Total number of Total number of Total number of Total number of deaths cases with days cases Win job etherremrdable array from Work transfer or festlfcdon =sea 0 0 0 15 (G) (H) (I) (J) Total nu mber of days Total number of days of jab away from work transfer or restriction 0 0 (K) lL) Total number of... (M) (1) Injuries 15 (4) Poisonings 0 (2) Skin disorders 0 (5) Hearing loss 0 (3) Respiratory conditions 0 (6) All other illnesses 0 Post this Summary page from February 1 co April 30 01 Ne year following ese year covered by M. form. PubrereponnB budenlorilus co(echan of Nfomauon is eaLnNm b avuage 5 oosh.tes parr.rponse, ialiond drrx to reser Ne Nstlucfwns, sea a aamvlhedaa needed, and mmpr b,e rsvaw em co(ednn of mfd rias.Pw.s are mtrequimtlbmspontlb M.Wesdonofbforould. odess 3 dophv aarmntlyvab'd DMB control nmMer. 6youhare amy wmeds aboulthexe estimates orany otheraspeds ofth's data coGeetiA contact US 0eparmmn[o(Labon OSNAOifico ofShGsliralAnalysis, Roan 83644, 200 Constx ion Avenue, NW, Wasirr an,002021(. Do raise] qe completed formsb Ihbomce. ®2014 CoNel CamoraOan. All Rights Reserved. Year 2013 *1 U.S. Department of Labor Occupatlonal Satery and Healon Adro nlatradan Farm appmve4 OHa no. 127 eA Establishment information Your establishment name ACME Brands Street 601 SW Second Ave, Ste 1400 city Portland Stale OR ZIP 97204 Industrydescnption (e.g., Manufacture ofmotortrucktrailers) Standard Industrial Class'dica0on (SIC), If known (e.g., 3715) OR North American Industrial Classification (NAICS), if known (e.g., 336212) Employment Information Annual average number of employees Total hours worked by all employees last year Sign Here Knowingly falsifying this document may result in a fine. 1 cerfiy that I have examined Use document and that to the bast of my knowledge the entries are true, accurate, and complete. cam.aay...cawa ru. Ph— or. 4 Pre red:0UI52013 11a 0 D c ts Its m m 0) 0 a rp A Thislnjury and illness Incident RePmr is one of the first forms you must fill out when a recordable work- related orkrelated injury or illness has occurred. Together with the Lag of Work-Refafed 1nJvries and Illnesses and the accompanyingSaMrrzary, these forms help the employer and OSHA develop a picture of the extent and severity of work-related incidents. Within 7 calendar days after you receive information that a recordable work- related injury or illness has occurred, you must fill out this form or an equivalent. Some state workers' compensation, insurance, or other reports may be acceptable substimms. To he considered an equivalent form, any substitute most contain all the information asked for on this form. According to Public Law 91-596 and 29 CFR 1914, OSHA's recordkeeping rule, you must keep this from on file for 5 years following the year to Which it pertains. If you need additional copies of this form, you may photocopy and use as many as you need. rd. /nlormation about Ne employee I)Fuumame Jones,MarK n Slreu 41121,teslem Ave ,,y Mattoon Slue IL ZIP 97204 3)Dvleof hush _ 4)DmehirM - 1) 0 Male ❑ Femea I.tormation about the phyerclan or other health care Prolesslonal 6)Newe afphyddva arolher heanL <arcprormioml 1) rtrcrolm<mrwa, gnro.war fro. m<warkvlr,whe.<wased.tax Fault" Shn1 Ery B) Was emplya VeaIW ie au..erre..'rounx ❑ Yes © No S.I. _ UP 9) Was employee bnpivazrd wemighlmav im-pad my ❑ Yes © No poen appme.d CN mo.1212-0176 lnlormatian about the case IB) Caseumber from the(nd AB42.010020 (a.,u�J<r..<•,e..s.r/ u.r gyrry„e•.a•,I nr<e,y 11) Dmleaf;ap,millmeae 0111 MM2 12) That, —play. beeam wm4 13)Lmeofwemt 12:00:00 PM ❑Pbe<4;r.. n000tbedetenniu<d 14) sabaetw m. kyr nmma/.r./egyew Me%a'4✓era.w+neerDmnibe wractivitY. %s well as the mdr, equipmmS or marrdal the emplaynwas using. De Spedfie lsumpfa: `4limhiog. ladder whoa nrryrmg roopag materials"; "spraying thinner from hand sIlles ; N.ay rompmer kry-tarry•'. 15) IMru(hpp.vadrTeB mhow we injury ocmroeJ. Ecmmpfr: ^Wham ladder Yipped on wn nomr, worker @1120fen"p"Worker was sprayed with ehlorime whin gmke[ bakeduringseplaeeme la,nWorker developed sorem es in wrist over Orme," 16) Maar esu rM lgfsvyoruasevsrrB ata win pan prthr body wales sartecne.nu bow uwaa arfrrtrd;b a tuned ym moend s,mdr wan "hurt/"'Pa;n;' or ford' Erun•plee •Svahed Uak"; ^rhers;ral burghamtl"� 4arpel rome" n) Ionaee�.mU.ux.dfrerN'e.•mreeee�fmJ..r Ermmp/e: •'Cquenw @tuna•; ••pnariue••; radial arm saw." If this question Jon not apply to the imddeml, leave it bhnk. te) afhe.mplayeadMCaaoessmar eNee.•n fAverfas.A aubfic reporting burden for this co9ecgon of information is esdm ned maveage22 minuses pn response, inducting dmefor reviewing inmuuloln, seasrrvlg eriddng tlam smumas 8adedng ab mainmudnp ate dais reacted, and mmgedn0 and reviewing mo mllom on orinrormmdonPmsons re notift&9fi`a lMe rsonksplays a umenovafid OMB mnool number. If you have any mmmenu ahour wesa estimatuor anyower aspecu of Nis dela mllenion intluNng suggessionsfor reduon8 shis buNen mnmcc US Deparunentdfl.abor.OSHA Mao dSmdsm s. Room N-3694, 200 Cgr6tiLLtion Ave, M. Washington, DC20210. Do ams a sal Ne mmplemtl roams m Nu office. Pra,ra ."IsRp9 6ph4emse.N.m..ACAMUmma p.g�t.Hm Attention: This form contains information relating to OSHA' s Form 301 em loyee health and must be used in a manner ha[ P �� protects the confidenfiafity of employees [o the extent `� d� �a ,�o�' I n ®®®h AncI /� en ®®� possible while the info ma on is being used for �9®� ry ocrllpational safety antl health purposes. U.S-Oe artment otLabor uavpaUeval.y/eyauC N YMCtlwma4�t/an Thislnjury and illness Incident RePmr is one of the first forms you must fill out when a recordable work- related orkrelated injury or illness has occurred. Together with the Lag of Work-Refafed 1nJvries and Illnesses and the accompanyingSaMrrzary, these forms help the employer and OSHA develop a picture of the extent and severity of work-related incidents. Within 7 calendar days after you receive information that a recordable work- related injury or illness has occurred, you must fill out this form or an equivalent. Some state workers' compensation, insurance, or other reports may be acceptable substimms. To he considered an equivalent form, any substitute most contain all the information asked for on this form. According to Public Law 91-596 and 29 CFR 1914, OSHA's recordkeeping rule, you must keep this from on file for 5 years following the year to Which it pertains. If you need additional copies of this form, you may photocopy and use as many as you need. rd. /nlormation about Ne employee I)Fuumame Jones,MarK n Slreu 41121,teslem Ave ,,y Mattoon Slue IL ZIP 97204 3)Dvleof hush _ 4)DmehirM - 1) 0 Male ❑ Femea I.tormation about the phyerclan or other health care Prolesslonal 6)Newe afphyddva arolher heanL <arcprormioml 1) rtrcrolm<mrwa, gnro.war fro. m<warkvlr,whe.<wased.tax Fault" Shn1 Ery B) Was emplya VeaIW ie au..erre..'rounx ❑ Yes © No S.I. _ UP 9) Was employee bnpivazrd wemighlmav im-pad my ❑ Yes © No poen appme.d CN mo.1212-0176 lnlormatian about the case IB) Caseumber from the(nd AB42.010020 (a.,u�J<r..<•,e..s.r/ u.r gyrry„e•.a•,I nr<e,y 11) Dmleaf;ap,millmeae 0111 MM2 12) That, —play. beeam wm4 13)Lmeofwemt 12:00:00 PM ❑Pbe<4;r.. n000tbedetenniu<d 14) sabaetw m. kyr nmma/.r./egyew Me%a'4✓era.w+neerDmnibe wractivitY. %s well as the mdr, equipmmS or marrdal the emplaynwas using. De Spedfie lsumpfa: `4limhiog. ladder whoa nrryrmg roopag materials"; "spraying thinner from hand sIlles ; N.ay rompmer kry-tarry•'. 15) IMru(hpp.vadrTeB mhow we injury ocmroeJ. Ecmmpfr: ^Wham ladder Yipped on wn nomr, worker @1120fen"p"Worker was sprayed with ehlorime whin gmke[ bakeduringseplaeeme la,nWorker developed sorem es in wrist over Orme," 16) Maar esu rM lgfsvyoruasevsrrB ata win pan prthr body wales sartecne.nu bow uwaa arfrrtrd;b a tuned ym moend s,mdr wan "hurt/"'Pa;n;' or ford' Erun•plee •Svahed Uak"; ^rhers;ral burghamtl"� 4arpel rome" n) Ionaee�.mU.ux.dfrerN'e.•mreeee�fmJ..r Ermmp/e: •'Cquenw @tuna•; ••pnariue••; radial arm saw." If this question Jon not apply to the imddeml, leave it bhnk. te) afhe.mplayeadMCaaoessmar eNee.•n fAverfas.A aubfic reporting burden for this co9ecgon of information is esdm ned maveage22 minuses pn response, inducting dmefor reviewing inmuuloln, seasrrvlg eriddng tlam smumas 8adedng ab mainmudnp ate dais reacted, and mmgedn0 and reviewing mo mllom on orinrormmdonPmsons re notift&9fi`a lMe rsonksplays a umenovafid OMB mnool number. If you have any mmmenu ahour wesa estimatuor anyower aspecu of Nis dela mllenion intluNng suggessionsfor reduon8 shis buNen mnmcc US Deparunentdfl.abor.OSHA Mao dSmdsm s. Room N-3694, 200 Cgr6tiLLtion Ave, M. Washington, DC20210. Do ams a sal Ne mmplemtl roams m Nu office. Pra,ra ."IsRp9 6ph4emse.N.m..ACAMUmma p.g�t.Hm 0 0 n � N tp 0 M q y � COR a1 E L 0 a 0 Workers' Compensation Lag Time Report M M 0 O Description M The Workers' Compensation Lag Time Report shows the lag time between the date the injury occurred, the date the employer was m notified and the date the injury was reported to CorVel. This report helps to understand how costly lag times may be affecting your workers' compensation program. n Features • Data is sorted by parameters, groups and filters. • Save a date and time for the report to be created automatically. • Report can be exported to an Adobe PDF file, CSV and Microsoft Excel file and can be emailed to the user. 0 2014 CerVel COTOMOon. A4 Rights Rese"etl. 16 02014 CorVei Corpormtio 17 w 'tJ O R Y E L Workers' Compensation Lag ACM Brands Loradaa Lere11:10 lI'0rl ers' C'ampeaaatiam Lag Rapmt Por Claims with 3tddoor D.I.Fz Lll2012-1273LC01- Dote Dale Of Etapleyer Date Emplgee bLtaager Total Claim Number CL.,lvddenr Notified Reported Lan Lig L g Gbfm Qntrat CeaSral-ALmnf 6cnw AB -12-010020 Jaoea,Atark 171b2012 1R31UL' 219/2012 0 27 27 AH -12-010014 tmirh, Jahn 2+11201' M1012 -12PD12 0 0 0 AB -12-010074 JOner, reffrey 311311633 3,1302012 3.1341012 0 0 0 An -12-010106 Ma>,men, lames a••1N2012 -111 AIL' 9?112012 0 0 0 AB -12-010111 bryaat, keim x11_0)2 4/11261: x1772012 1 0 1 AB -1241011+ C4maa, lshy x1212012 412/1912 4:1211012 0 0 0 AB -12-010140 somk Mann M02012 5111ML 739!3012 1 69 70 AB -12-0101+7 Ba mLaa 51142012 3!1412012 S 152012 0 1 1 8 COaim(5) Aircrage: 0 12 12 C-5ales Ck Ceawd-Sa7es AB -12-010059 Jeoe5, Jefbry 1,29n012 ln0 12 2232012 0 0 0 2 chim(s) Average: 6 0 0 E -Mau 1' SIEeSI-]S3mfa(ImiOg AB-L'W10053 FssQJahnay 7/99.•2012 '1101012 Dao: -1012 1 0 ! AB -12-010357 TesxM di F,.k Nlaan 6IM112 6'112092 0 0 0 2 C3asm(s) Average: I 0 I N -Sales 1V-art➢2io11p-$ales AB -13-010079 Smvh, Btt1 1Lle,2012 1b161612 M12012 0 1 l 2Claim(5) Average: 0 1 1 WOO wutwnt-OperN " AB -13-01(1077 pabm .A Id 12413.201+- /2/131012 1VIM1_012 0 0 0 AB -13-010000 Sndtl, Sam 121172012 IVMw 12 ),17M12 0 0 0 2Oatm(s) Average: 0 0 0 u1sales wmrwva-Sales AB -I3-010023 Ftednd.meq Aad &3141012 &13MM2 &3101' 0 0 0 liialm(91 Arerage: 6 9 9 311PAAilriF_-�'L-`CG-IEisa0ra5coeoicsp�evaipuen o7fa®nao. . A*[gIA%Rw wed. Pahadm Daa0171512013 O;ahe[s'Ctmps aL•g 17 w Description 0 0 n c N a' M M 0 m Claims Scorecard o The Claims Scorecard easily compares major data elements over certain time periods. In addition, the Claims Scorecard will provide exception reporting commonly requested by Risk Manager to help manage specific claims responsible for the majority cost of your program. Features • The Claims Scorecard is populated on the Friday after the third day of the month with a snapshot of the previous month's data. • Data includes: Summary of Claim Expenditures + Recovery, Payment Comparison, Changes in Claim Volume, Largest Claim Costs, Largest Paid Exposure, Largest Paid Payees by Payline and Largest Reserves. • The largest group categories display ten claims; however, the Claims Scorecard Dashboard allows for additional claims to be viewed. • Ability to drill down into various divisions or regions. • The Claims Scorecard can be exported to an Adobe PDF file and Microsoft Excel file. © 2014 CoNel Corporation. All Rights Reserved. 18 Claims Scorecard m 2014 CoNel Corporation- All Rights Reserved. 19 Summary of Claim Expenditures + Recovery [1] Periad Tnderrmity Pertt�anenc�y Hediaal Expense Total Aemaery Nw. 2010 $LI,371 SS69 $36,865 }1.3]1 j50.20)s0 Oa. 2010 _. $10.629 1920 525.33] 51,664 $30,550 $0 Sep. 2010 $13.573 $5,146 $26,939 $1,176 $4b,839 }0 Total § 35 573 $6 T26 $69,Y57 $4,4111$115.866 $0 Payment Comparison taonfh Over Hanth year over Year Oct. 2010 f[ov. 2010 Chang. $38,53011 $50,287 8) $31,737 FY 2010 <o Nov. 30, 2009 $42,95911 N 2011 t. IT , 30. 2010 Change 523i,336�t� $I58.381I Summary of Claim Expenditures + Recovery [2] Periad 2.demm"ty Permanency HedEd Expense I Total Remvery Nov, 2010 511,371 $460 536,885 $1,01 $30.267 $0 Oct. 2010 410,629 $920 525,337 }1,664 $36,550 $0 Sep. 2010 $13,573 $5,146 $26,935 $1,176 $46.830 $0 Aug. ?910 35,400 $1,347 Imes 0 $487 $36,595 $0 ]ul. 2019 ;61309 s0 ;50,254 }1,213 159,575 }0 Jun. 2010 ;2.399 0 $23,505 $3.516 $29,419 $0 May 2030 $6,015 50 $17,916 $1,461 $25,395 $6 A. 201D 48,585 50 140,270 $4,328 $53,163 $0 mar. 2010 $5084 SO $52,94] $734 $59,165 $0 Feb. 2010 14,732 ge 50,31] 5853 $13.902 }0 3a n. 2010 $4, ill g0 $5,699 SL497 $11.307 j0 Dec. 2009 $2,361 ;O 81,256 1467 $4,08. $D Tota( _ $8 W3 $].873 $318,181 $181967 $427.793 $0 Change fa Claim Volume Periad Begin Ne v Reopeo - dlg d boffirg flhange Nov. 2010 2fi S 0 2 29 1: 3 Oct. 2010 19 7 0 0 261'4;t 7 Sep. 2010 20 0 31 1914! -1 Total - 141 01 54! 9 Fiscal Activity Recap - [Nov. 20101 Begin New Aeopeg Clwed End Totat Chian Change Current Paymapts Ctatge In Reseve I Tolallnonred I Chvgaln Sncuvad Claim Average 2011 13 5 01 2 16 19,411 3 $32,946 $51.844 $221.758;51 }04,790 $11,671 2010 10 0 0 0 19 16 =, 0 $14,462 {$12,429 $]02.232;4; $2.033 $39,013 2004 2 9 0 0 2 2 20071 0 0 0 1 l p'.. 0 $966 (5986) Total 26 5 01 2 2gI 31 7 06,536 $1,227,810 i 686,823 $30,695 m 2014 CoNel Corporation- All Rights Reserved. 19 Claims Scorecard Largest Closed Fxposures-[Nov. 20 to] aSlm Nrlmua wJm3nr inly,r mn - oon vx]apip np-uaPaOa6 v w.u.m p/xOaola ]n<urroJ M724 Slsa Larges[:Ctased F PDSures - [FY 2011 to Nov. 30, 20101 upSn. Nopkr wlmanr mturrmm lvcv„ea np ioSapPax z. wmwn. u$./zmD ,Yio.la PaN n. np2. va6/SOSP StO.]Gx [tY 2o11 to Nov. 30, 2010] Mio•5apos0 a. Wpy .1 1;94 /10-10.500055 W. NaWr b/IV3a10 59] Lljury0av m rvlw,JnplpdSM ClvwJdr,bPNv+.iPi6 Cain NurvlW vY).raerM on. Yvple riJm Nv,v6 du,inyry3p11b N—ak LI5p, Largest I,xur,od Decreases - )Nov. 20101 Largest IS rred D=eases - [tY 2o11 to Nov. 30, 2010] QJm Numem ax(mun5 Lljury0av Smm�id Cain NurvlW w)mint 1nIury DVb ]nru,rid -iY500011 T. ildyo )/3L203D --al n0.1Pmv&4 AV—* l/)6/101U (i63]ilj 35-Sp00]6 V. W.tivti 9jS0/$DlD (5150) m4owawi ). WlYwru )/Sd/20io (Sb.ylll IY500pa9 0. ROWlenn 9/L9/31110 30 v0-Sp+Jpp9l5 W. Nlller 6/5U1030 4Tayly n9-li-500030 ). Yldn M.ISd00Y3. SO SIYIO.50D010 A4urp al/]5/3009 t al]i (S0)61 W-II-SppO]S 1. llan�llmn 7n U2D:D )/16/x010 y0 m.:0.SOtl4O1 N lWrnavn 2/6/1010 IS)J M-11.500034 L kluy p(9)SpaO Sp n0.v0.5p WOY J. iuuye 6/9/]Otp yp 5p0024 D. Lvv a/3L$Ov0 Sa no -:p-500009 LPomOR-11 )Sau/±005 IJ1-11-5000$5 a trJSv 9!B)bl0 30 i0-Sp001> ]. W16vr O µ-16500000 LL yD0120tp SO in50001dIVSl/2pap uZaI 30 SO SB -11.500011 J. ler[xm 04ki” Btx)ISOIp S. SrdSMnyltvr -IO-SOOOp+ P.Ilanuairur x/0)20]0 SS) avlrr9 Mr.2a. W pest bauawd Noealu d-vp rl 3011 m.1. ]D. MIO. 5ar9W 5nbrrrN rlvvadfv OurSnp NJr. 1L 10. y.ryYt Mcurt3d dvcnisb derinp PV loylb Nov.]p.3p10. Largest Incurred inueivses - IN... 20301 Largest IoMr ed locrsases - [FY 2011 to Nov. 30, 20101 CIa5v1>)amY6r G4Wurtt inlur pita Narmd tYYM Nvmmr tl9lmaei NJ, pile %—e d n0-ty-500003 E. S )Vin/E0:0 S>0,M6 Tnvb 5]f15/E006 SIt9.651 q0-iL5040D W.v . E. WOWa ittiWal0 S1.i16 b-iosaoo" q(5-SpID000> S. Vid13010 3)L500 PB -i1-5000]] G IlcnOervGn SOrlWuia 5)6.)00 1P500p00 ko"A 0. Wuvn ]/]413030 369.060 PB-1Y50p401 4Tayly ]0/I/$Oi0 412.601 M.ISd00Y3. B. 4! 0/1])1010 339.940 IO -]]-5040]5 P. IId�IDvrwv as/W101Y y5.00Y MlOh00013 L"U9Lri 6/3/2009 14.631 nTl YS4pp5] T. Ilurp _ iV>/2010 3].150 eD.11-500002 C SYvmov ia(aU30v0 $30.0.56 g0-SP50DM6 S. WaSlrlryga 1/IN]O50 03.001 Mil-YOOCOi 0.rayAy iNi/3010 535.045 - BI>J3OSD St]S al-SGYO]) a511>ISDiD 533.136 NS-10.10W1DY/1000 n0.l]-9000]2 4WWwv 9/19)3010 gFib50001_` 0 TMI•tr ili012P 010 50 M->0-5040]6 S. SrdSMnyltvr 1110/3010 219.611 IarY65t h r.. Nuc65N avlrr9 Mr.2a. W pest bauawd Noealu d-vp rl 3011 m.1. ]D. MIO. 9 2014 CorVel Corporation. NI Rights Reserved. 20 0 0 0 c rn 0 ID Claims Scorecard p Largest Paid EDpD. - [Nov. 20101 Largest Gain Cask - [N.y. 20101 _ Largest Clal t C.St3 - [FY 2011 t. Nov. 30, 2010] pail adm lWminr M.n JDWd .f Daf9 Vala o.Im nYmOar Clalms.rE Lada.nS D.a v.W Awl YtpOaZn B I.m W.Woto SlOals Ao-D]-533301 D. xpvlru Plssl`DOa 513.092 A04 L50CDip AY)63@0011 A AYOWnn C. ttna 9119120]9 9/SHS@la 15.79, @a.)Sl A8-].500)1 AW10.5@.. D. Lw C.Nmn 0(15/5010 4Mto10 531,579 12.,261 10.)0-SOODO) S. Vvnvv WIW/ 10 F4,345 A0.1D-5.0002 S. Vury 111612013 2,An P 0.11-500003 v. T.ryNr 10/E/3010 H.392 AA-Ib5.000< 1. )orivf 0112010 $26.005 $20A.6 AD-i65pOD0E 1. 3voas H9/3033 x1.090 0-10.500006 Il. luiklva i1/@120.9 NfD A0.165o0013 [. HupBn NVI004 SI.Od. AB -50.500003 I. WJLavu LSa12010 113.102 AB -10-530054 4. WY1e 1/29/20]0 {l.l tv 0-OR50o003 f. 4ova 1/20/50.9 530.26 x407.500001 v. Tmlvl l3/15i260a 1944 AO -1630003. 4. eYWv 4/29/2010 54.166 AO -IO -500 16 S. Wa5WY91[w 1/192030 Im nOg0.50.01fi S. V1351Wp1m 1/10(2010 37.263 CLlmv vilXSM lupe.. mIN 1uW 6winaNw. 1030. pNm1wIN NVlvpbl mYl mbBrvrnpW>vil bNov.bll, Sp10. Largest Paid EDpD. - [Nov. 20101 Largest Paid Exposure - [FY 2011 tD Now. 30, 20101 _ %yvu fyypm pail pntte paypaa PaIJ yr Or WouvW�enmin.>[ x60 FI>tlrmrW HYO[v 0.aVlu.aYlWSyr41 rlr¢rnvvrur Nrru>4euaml lwawwl n'W Sp,lbS Ve nJount $¢rYoy CErrW MnaY MEp FS.SOA WGvi Wl hanJ1Ln11abBilGw-flnWruOl Nari WiU1 MFv S1J.339 eLraay Di4n1<OLPGOu>'ta. LlV ryED 14.3S3 /]nYraxxa WllraVamllc lloiVM1 MED 39.44. vYt¢w1YVVa NO. NFD .2 DIS IvremVunl sulyuY r -A nne Dr Nraa NPD SS.S.4 AILnv[C KW[AiW AemMttr - MED fi594 NvJlVlant iuAJlnV MED .35.451 L[a hdrlbrWY IIIU 31.141 uv Darwrrllwvyhal MED 54.543 leu Danlarnln 1113 53.311 Ilupra3Yv D[{DVVvOIe AvuiW[ea. LLP NED H.203 i11vIPm401YWOn Aouusw NfD I1.3E9 rlmva.[lu4 PER 241131 Gv (vnn6 Gnuaw pre: Ate" SI.El3 i¢wNA lmaului NED n.133 Ne40VWWnrW61u1 Cmrtm. llS NED 51.191 5 CA U.91.9W Smyury U.., NED 33,112 lnpex[W.vE. rwwilduv6 Faa ryYi^JUNny fvvr.f03a. Yrpm[m331 vmxanl3pvW m>Nx]¢VaxmaurMy IN301twXag10.50ta. v4ly uruun[I>yraU lat a W,cd du 801011 In nvr. Sp. 3011. Largest Paid Payees By Pay[I0e - [Nov- 28101 largest Pald Payees By Paylille- [FY 2011 D. Now. 30, 20103 VayaV Pp11.. YaW payee P ",I P.W N¢blasYe ONlrVpaeMC'-pai! ]1ED {9.140 FI>tlrmrW HYO[v 0.aVlu.aYlWSyr41 MfD 320.565 Peraauunl SwY.+)Centri Dl xtae xEL SS,SDa 0.[[Y AWyall fNO 519.1.2 Xe O. d>ka.[YtpVc6%A>.Vovtv4 L1P Nf4 SS.U$ Corrtll UvYo[nYux S]].3E9 Pury AWyvtl IIIL {4,l]. rro Granu>uvlrmYlr[aly-GlnWavt Nurw 51[Y 310,]]9 Im D.nHrmn XED Carel MEL RED VIJo.muwY..u1-- {],130 (live xWs401411vn 0.u>uurcea .Eo M. 58.1]5 MYs4Ga AlWaq..0. E. 1].049 tv>OulHnrllr IID 30,064 W[wlC X[D 5].]19 Ilvpp6al MEY 56.016 Rlerna4 Nc14 ArN MtuJ>t¢ K.1 HFD S{.SY4 P.rr N'OunlSwyev [un[u o)naF xFL LS.SO4 Elnl PriraWlOaVari0.ouu[na HED Sl.` -E9 xaJlYlanl Pwitilrry nED )SAS] SaNutmWvauurrupWJmJnpW paSa>Ou,MYNar. 30 t0. Yrpm[m331 vmxanl3pvW m>Nx]¢VaxmaurMy IN301twXag10.50ta. C 2014 CorVel Corporation. All Rights Reserved. 21 O 0 0 c N a' m e 0 m Claims Scorecard o 1a39etNew CJaili]s- Nov -20101 CVm Nbmies kyiNgo[ loiury UYly Repeaters W9th We]I t]a3n19 - [Nov. 2030] Laye#Newflainss-[FY 2011 to Nov. 30, 2010] 6+LnNwJly CMLmnI Snlw b". S.mm.d >N t1-500003 AO Sv-Sa00J/ nu ii -560023 Ril RepaaV - [Nov. 2010] Galnam mmn ^m135).36] D, LYW. v. ManJerren 0 L°n 0 ] S32.NB )62A19 Aii-0l-$00001 Cblmim f].Im.T 3nnn.4 U. t.vW a. 'is[tle ] iii),563 A .Nb 2 S83ALL 1'. rnYm )11112010 GSlwnnaO wpb�..raw.n..gaarw..4.pw.[Y4n. An -LO -x00019 0]. DaM.m. elm wdl.le eylm[(epanw[IVW)Iry N4.l mat 1a39etNew CJaili]s- Nov -20101 CVm Nbmies kyiNgo[ loiury UYly Sncu[Le0 Laye#Newflainss-[FY 2011 to Nov. 30, 2010] 6+LnNwJly CMLmnI Snlw b". S.mm.d >N t1-500003 AO Sv-Sa00J/ nu ii -560023 K. Si.— IL/iV3alil E. +YwEe a!/W36im P.UWmaen ii/a/2070 {'x.0.4 f_`],i]6 {3.006 Ab 315000+f .01 i-SU90O+ 01 ]2 t2 O. tctl C.5)n.mom O. Yaybr e. woma Saerun Of33/2010 SVSUtO i./VZOA SS9.500 5=046 425,005 3.i]eL0 S]9/39/3x10131d0a Aii-0l-$00001 ei p.m.rm.. wwa.x..>mw N...mm, 3•a�iv6 2) p, I1uY 1'. rnYm )11112010 =boll 39 A. Fupmaen An -LO -x00019 0]. 00.591 0J5 Y. IgnUur.On V.1Yanx. 9/20/2030- ......v3 v//2bsx s3./sB u[9w1a�..m...nn wp.m e. it muwNw.]a a9aa {aa,a3B O 2014 CorVel Corporation. All Rights Reserved. 22 Largest Reserve- {Nov. 20103 Largest New Closures- [Nov. 2010) a.w N.mbn iLLm.W uaaep[ow A o.p. x.mwr tm[wm Aii-0l-$00001 O. Y.yur 1443/2>OL 3•a�iv6 Ltl-]]-50001] 1'. rnYm )11112010 {1,r3+ An -LO -x00019 GWbo- a}39(2dlU 00.591 AUa Y500p36 V.1Yanx. 9/20/2030- 1 St50 o-mwxe v30/mw {aa,a3B - Iu-10.500005 1 YweL e6.,055 VWa.09 PtrlU5U0aJ] S, Yory I]45t=, uvp-500073 f 1-3.N3 6)5/2009 01,42 F,.. Ptr30-30003a C.Mmeu VlY/EOtY 01.936 C4 of-il-5000[ a. Sm >n]/±UW i]b.]h vbaB0U2 c. bnvup v/L V:aW r]1a 300 Yt-30-500016 5 wnnmg3m 1I10/Na0 SM,I]e O 2014 CorVel Corporation. All Rights Reserved. 22 0 0 P ur 0 M ®® p � C® R V E L 0 a m Claims Safety Dashboard Description The Claims Safety Dashboard is an interactive tool that allows the user to view information sorted by various filters and displayed on easy -to -read graphs. Information is displayed on up to six different information panels based on each user's account and dashboard preference settings. Features • Injury cause and nature are NCCI driven. • Occupation can be pre -populated with the specific occupations of the employer. • View additional information related to speck claims — Ability to view specific information about claims that are populated in each bar within the bar graph and into various divisions or regions. • The Claims Safety Dashboard sorts data by start date, end date, body part, claim type, injury cause, injury nature and occupation. • Graphs reflect the filters chosen by the user. • Ability to hover the cursor over graphs to show additional information such as claim type, number of claims, total amount paid and incurred, reserves, number of claims closed, average amount incurred and paid, average reserve amount, etc. 0 2014 CorVel Corporation. All Rights Reserved. 23 Claims Safety Dashboard 1. L13IMS Safety Codes Dashboara i'Falers Siad D81e bpd Dete Body Pad; • .. _. _ Clelm Type: Infury Ce Ye a: 10 Nature: uPetlan: Order By: . 1t3H2pa9 l flIJP2D10 J�JnJury . . - A)l _ ...._... II` . Claims Breakdown By Claim Type l.- Claims Breakdown By Uoay Part _ :r•Clalms Breakd"n By Idlary Cause ClalmdvOB %Clelme, Peltl _ In¢Trrea : Bad Part ,Cia 1 Paid IncurroE' nu castle �Clelmei Paid cP, m �y :1adanity, 29 S9T0,150.00. $1,633,051.91, 14.va.r Oeck Area 6. 588,768.08 3262,908.49: �P. iWelnteneata incurred F1edldel Only 11 57,276.69 37.278.69 'Lumber endldr u - t{g1i5,853.0215223�165.58 ,S 'Reoart Only Sacral Varlabrne Olkcr_ tdee Not W 2 3185,954.58 5197,324.81 p 1 5D.00 $0.00 g ) $180,54p.23 fy^ftebre HOC $244,198.23 ru LIFif hI .__9 2 544,587.82'5175,650.75 t�yyIUdOer Beeh Area 3 3108,27p.15 108,p.15 $232,206.41 Taal p wereQ 1 589,099.85 5173,105.58 113165,391.TT:3198,752. 00 [Jo I Dr Vat le ae :�Ii3beYtaerf5l 3 593,604-59 .3176.077.38 LIDnnee $, 392.031.65 4167,004.42 py F1a I11Dla Unbar "Yi I�v1yi, P.11..1 H..dllnu 2 $386215.65 5119,989.31 '$•q''ENrbmdlee 2 561,769.56 3724,293.T1 tyl'•Gleand/TIDGr 1. 338,306.69. 589,304.98 V.n;Lower Arm 1' 536,306.68 389,3041.08 a Olhar Pafeea 2' $45,266.79 $93,113.69 t-4:14ultlole Trunk 1 $75,520.85 $83,529,85 A':Onor - Dock 1 575,520.65 583,529.96 wrlel 2 514,849.44• $46,065.82 & IJelefial Hnadling 1 454,112.38 S77,937.82 ;F1u1Da Badv 1234 flncludina ••CfblmS BreaktlOVln By OCcuybllUn _ fciParts 'Boav 6vatemn 2 543,392.86 $45,928.97 mro end BDdv Portal 146 12 Jauav - ^Claims Bfuakdown By lalury Na1Yre ny" 5^meq, 6�. 1pdy8y mK GYiI�Y'Cbegk�i l^Iury Ware Clelme. Paid� I...rrod 1p �� r^g1 amlm �CI�Im4:: •, �p 5 -'Alin 10.5213,629.7D:3466,727.78 L:.h. Paid: $145,053.01 t 7:Soreln 9 52]9,202.08:5415,511.17 [ .Nolen lw0 .d: 11212.144.69 All Olbnr Sneelllc 3 a4a.rvaa: R7.102.6eil2lurle5 Nor 4 5191}01.50 5221,543.62 R1dn .Cl4nd aoum: D ffr;FfaCmf0 5$202.047.33 S214,207.56 Average Inacm.d: 3211,146AS 9'1Raeture 1 $89,899.85 $173,105.59 Av.lage Paid: $146.040.02 o AvmOa 8owaral7.10i64 _ uanw C Indamnlep Mal..: 1 Xr Guff mfilve al., 1 $5.867.94 530,004.32 IndemnitY PwamaOY S OMxm .Imc: Wdlaa1 Cialme: D -ODatialsn 3 535,829.85 335,829.88 _ . ' _ 'a _ .I IJ.dlaal Nrc.n1: 0 i I r . CrueM1ln9 1 524,679.52 324,579.62 _.__.. _._-_..... _.-. .. _. ....1 "�. gP 4�.Henle 2 517,157,53 321,157.59 xee:mu 1 naa a, 'IraWrmem 1 $4,260.70 $16,975.00 i2 0 2014 CorVel Corporation. All Rights Reserved. 24 0 0 N M m 0 m Ad Hoc Reporting CorVel's standard reporting capabilities are extensive; however, we have the ability to provide ad hoc reports for any special reporting.needs. Ad hoc report inquiries can be made with data elements that we capture in the claims system. Most ad hoc reports are available in PDF and Excel formats. These reports can be run instantly or scheduled for regular output. • Claim He0otL q RsLOela DaYRapon. QLiy 3cFeeulae Cis ...ato. Rep. n.(C.m.lme: 9 ......... rl: 0) Wena en Counne..e W Clem Repaele Crum, oeun E,f] Clew Lep I } Clelm Repeaters Claw. Recavee C ... I Comet...,elm dent. Men.1 A .... I Summery surety ..P...' eatery Cennnvan.n 'b Finan C101 Cleu.. Re Lerve CTanpe Choose which report to create DACDedS DYYReP.ne ouysmeaulec }8o1..am.[R.Pu,tl, On.plmn. ur.;e.at j,v u. .Report Deme' .;a�'I RepOrl ea Of 'DaandllOn Rveuast Dale 'viewed Bate _sletua View Dv!ep 0elele Clelm Dvle!! {POFf -clone Dean -5y 1)1&2013 1f18R01. ,:38:05:ww Onllne Vie."1 r Level l r Level 2 r Level 3 r LSY.. 4 r - Lem S ' Jurisdiction. Location 6:38:11 A4 All Veen pp1a115¢Iele Safely Repnrler POF Srl.lYReporl4r-ACtlE09- 1f1612013 1lM)2013 View Onllnv Viewed ' Blends 12 8:30:58 AM 11:07:45 AN Vlan Oalell!Eelelv'S6fe And."" ' :POF Walt Reporter -ACME 1fl8a013 111620135:30:14 View online Viewed ppr Ise,1V.. Studds 8:29:31 AN Ay eIaII View ODelete Claim Dated :POF claim 0Mdll-ACME 51. on. 1116a%3111&201 38:28:38 View onune Viewed me11 828:58 AY All Customer ACPEHrtnds RepOrl ea Of p1118nsi3 Ivu "YYy, wsD r Open end LIOIm Stsl.. r Ali ClslmC r Reopened only r Clased l- poen Q/. 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' pop 111 Emla ml on V wO.ms n Vp .—o —�� c wo....do. L.. .:.:.PPY 1}� Open the report in PDF or save the report 'uJ 2014 Col -Vel Corporation, A I Rights Reserved. 26 ,r DocuSign Envelope ID: 6EE0036E-ABE7-416GBB7C-9D91277D5AD3 CorVel_ Enterprise Comp;. Inc.:. lmplementation,for City of Miami Beach cn�3rpr'' `u p. `us Omer IiyoiI I��5�t 7's, "syfj1, �.� � NewClalr�sGo'Lwe 02 dsp"+-vr.i'mxei--sxg,`z,s''x-:.'T.�3%j Cord Account int Manager g +2._d>a9^v�..d=X6'2". ,�-T•^w'�` 'a'�'s'`'x"vP.4+'�' ��..'"` c.'f�yf� Jenna Cargll(��h ��� Tall Clalms=Go Llve 02/OS/15 I ESC.. 3� T3e�i.5"'' S s2.�."�+f 41P• t i4i y i RA; COU f Iie UYIV2D2MrlIE �x�> P, D OVIC s. awaRes;�� ''i+..ta;✓".f'3#C'a'h#'7.'sFue A lh rkv sYve '. .r+t.E` �c yt, Y, a ,�^. s`x „hof x i 5 as a Reglondl Systems Director y h Ii""6ss< .<„ `4' r Tv" Item#°Respo'`jtslb4eparty '�p`rea�pctox `'=�. IteCn'r ,P'`� •'��'"'Dater�'"�" gam,-: "`.;;Target�C mpletedr;,o en C Initia I implementation kick off meeting & Account ongoing implementation calls scheduled CorVel & the City -jurisdictions, for all ManagementTo-nfirmcoverage(.) m rify Carrier Vesecure policy details, & secure carrier ■_ 1 r -® �,Secure historical policy details for open inventory by coverage line &jurisdiction �contract prepared &sentto the City for review, response, & to execute contract iSecure existing location structure, identify ® enhancements, & prepare draft ■_ , r ■® CorVel&theCtystructure count location structure for team's review m •_ , ' -® ©MI New Account®Setup needed mapping to CorVel standards m SystemSetup Requests hierarchy, safety codes, payment types, & any necessary mapping Cor.Uellnterprise Cotrip,.Inc. Impleme,ntation'for City of Miami Beach u 5a 3ewI a i< muum payment register to identity - appropriate fundin level 01/13/15 Open Outline escrow account options, identify Sb funding option, confirm replenishment 01/14/15 Open New Account Bank Account Setup method,& frequency with the City CorVel&the City Setup &Checkwriting Sc Bank Account Set Up &Funding Completed by CorVel treasury service department 01/23/15 Open Sd Distribution list for banking notifications, reconciliations, & replenishments established 01/27/15 Open 6a Forward claim frequency information to RVPs Anticipate Staffing Needs for review & to outline any staffing needs 01/01/15 Open Secure from RVPs for any staffing needs the 66 recruiting & hiring process and timeline as 01/06/15 Open arwrooriate Confirm claim team members from RVPs & 6c Claim Team develop claim handling matrix by jurisdiction 01/20/15 Open for distribution to the City CorVel Operations Confirm managed care team, include as 6d Managed Care Team appropriate in claim handling matrix & 01/20/15 Open ca ture in service instructions 6e Hold program training sessions for CorVel Program Handling team to orient to the'City service instructions 01/22/15 Open Account access established as appropriate for 6f CorVel team members &workflow groups 01/29/15 Open established Secure list of the City CareMC users, 7a establish access roles, submit user requests, 01/29/15 Open CorVel&the City Care a Customer Logins & confirm distribution of CareMC login CareMC Agreement executed (contained 7b...:a6:.. !',..1-,.-....«_.»._.....i_._r 01/30/15 Open CorVel'Eriterprise Cp p; Inc. Implementatiori'for City of Miarrii``Beach Page 3 of 7 a CorVel.:'Enterprise Comp; Inc 'linplementati6*r City of -Miami Beach Page 4 of 7 Q Secure number of claim history files, 9a anticipated file size, years of historical claims tbd included, & date CorVel will receive final file Open Secure test claim history file to include 9b format/layout documentation, tbd CorVel &incumbent Tail Claim Setup Claim History records and data dictionaly Open Identify dates of CareMc claim history load 9c TPA based upon anticipated file dates - tbd Open _ Secure claim history file & load into CareMc tbd Open 9d - Confirm loaded financials match control 9e records from incumbent, reconcile any tbd Open djfferignces in financials Secure inventory of claim files to be shipped 10a from incumbent to include jurisdiction & secure anticipated date physical files to be Open shinned hd 10b Supply shipping address & contact for claim file inventory to incumbent tbd Open 10c Confirm files shipped, shipment date & CorVel & incumbent TPA Tail Claim Setup Physical File Transfer inventoryof all claim file boxes shipped tbd Open Confirm receipt of all physical files as 10d outlined in inventory. supplied by incumbent & identify any missing file detail Open tbd Identify files held In storage facility,. identify owning party of the storage files, & establish 10e transition of ownership to either CorVel or Open the City as appropriate tbd Request indemnity benefits will be pre -paid 6 weeks post -transfer date by incumbent TPA, 11 CorVel Tail Claim Setup Indemnity Payments establish date of payments, documentation Open to include, & secure payment register to tbd Page 4 of 7 Q CorVei.•Enterpr.ise Comp,.Inc. Implementationtfor: City of Miami:Beach Establish pharmacy group number & confirm 12a utilization of standard formulary - 01/16/15 Open New Account Setup CorVel Pharmacy Setup _ 12b Provide first fill program details & identify - process for distribution to the City 01/28/15 Open 12c CorVel Establish current pharmacy vendor &open Tail Claim Setup Pharmacy Transfer pharmacy cards with current vendor tbd Open Provide temporary pharmacy benefit cards to 12d those tail claims with active pharmacy vendor the Open — cards 12e Provide permanent cards to open tail claims as appropriate tbd Open Secure Medical Bill Review Historyfrom 13 CorVel Bill Review Tail Bill History current vendor & load file for bill review Claim Setup utilization to identify duplicates & ability to tbd Open rocess reconsiderations Identify Image types to be transferred, - 14a volume of claim images, & method to tbd Open CorVel & incumbent TPA CareMC tail Claim Setup Image Import transfer images 14b - Secure Image files& accompanying index file tbd Open 14c Load images to CorVel CareMC Files tbd Open Identify reporting needs of the City, identify 15a preferred report format, frequency of 010615 / / Open CorVel Account Management Client Reporting reports, & method of delivery 15b Publish sample reporting portfolio for review & feedback from client 01/20/15 Open 15c Publish reporting matrix to outline account re ortln re uirements 01/30/15 O P en 16a EDI Communication identi an carrier EDI needs 12/31/2014 O en 166 CorVel/Carrier(s) r6im Hlcinn, Control Total ...:n..,a:.... Confirm any needed confirmations of control ....,L.-1 _i,:... 1,;-- 1--,J , �..,, Oen P Page 5 of 7 :Co VelEnterptisdiCor.hp,,inci: lffiplementzitio .�.Beach vor'City of Miami... Page 6 of 7 m 0 I CorVel i Enterprise Comp,.Inc. Implementation for City of-Miami..Beach Page 7 of 7 0 0 0 c y m m 0 a a m DocuSlgn Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 DocuSign Envelope ID: 6EEOD36E-ABE7416C-6B7C-9D91277D5AD3 CORVEL CorVel's Exceotions CorVel Enterprise Comp Inc.'s Legal Exceptions to the Miami Beach Request for Proposal (RFP 2014-302-SW)for Claims Administration Services by a Third Party Administrator for Workers' Compensation and General Liability Page 8 Section 28 Optional Contract Usage - CorVel will provide services under this Agreement to other entities, provided the City is responsible and liable for the actions of the other entities as well as payment for such services. If not then CorVel is willing to provide similar services to other entities with similar terms and conditions to this Agreement and fees shall be based on the volume and types of services provided to those entities. Page 8 Section 31 Indemnification — See redlined version: The contractor shall indemnify and hold harmless the City and its officers, and employees, agepts and Instrumentalities from any and all liability, losses or damages, including attorney's fees and costs of defense, which the City or its officers, and employees, agents and instrumentalities may incur as a result of third party claims, demands, suits, causes of actions or proceedings of any kind or nature arising out of, relating to or resulting to the extent from the negligent acts, errors, omissions, willful misconduct or fraud under the performance of the agreement by the contractor or its employees, agents, servants, partners, principals or subcontractors. The contractor shall pay all third party claims and losses in connection therewith, and shall Investigate InGluding appellate PFOGeedings, and shall pay all Ggsts, judgments, and aftemey's fees whIGh may be IRG-IrPSH The contractor expressly understands and agrees that any insurance protection required by this Agreement or otherwise provided by the contractor shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, and employees, age ms and inStFlIMPRtAlites as herein provided. Notwithstanding that, contractor shall not responsible or liable to the extent of City's negligent acts, errors, omissions, willful misconduct or fraud under the performance of the agreement. The above indemnification provisions shall survive the expiration or termination of this Agreement. © 2014 CorVel CONFIDENTIAL DocuSign Envelope ID: 6EEOD36E-ABE7-016C-8B7C-9D91277D5AD3 DocuSlgn Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 8x7/2014 D&B Supplier Qualifier Report: CORVEL CORPORATION o Decide with Confidence Supplier Qualifier Report To save report(s) to your PC, click here for instructions. ® Print this Report Copyright 2014 Dun & Bradstreet - Provided under contract for the exclusive use of subscriber 100150009 ATTN: CORVEL CORPORATION Report Printed: AUG 07 2014 In Date BUSINESS INFORMATION CORVEL CORPORATION CORVEL 2010 Main St Ste 600 Irvine, CA 92614 This is a headquarters location. Branch(es) or divislon(s) exist. Telephone: 949 851-1473 Fax: 949 851-1469 Chief executive: V GORDON CL.EMONS SR, CHB-PRES Stock symbol: CRVL Year started: 1987 Employs: 3,172 (Undetermined here) All amounts are displayed in local currency. Financial statement date: ]UN 30 2014 Sales F: 429,310,000 Net worth F: 130,521,000 History: CLEAR Financial condition: STRONG D&8 PAYDEX© D&B PAYDEX: 74 When weighted by dollar amount, payments to suppliers average 9 days beyond terms, a Q tau 123 days siovr 30 days slow prompt Anticipates Based on up to 24 months of trade. D -U -N -Sp Number: D&B Rating: Financial strength: Composite credit appraisal: D&B Supplier Risk: 62-036-6708 SAS 5A Is $50 million and over. 1 is high. I SUPPLIER EVALUATION RISK (SER) RATING FOR THIS FIRM : 1 Q 9 8 7 6 5 4 3 2 i High Medium Low httpstl/suppilerportal.dnb.cond�ebappfmslstores/serdeUSQRReportDisplay?reporlFormal=hardcopy&printPrort,�)t 1113 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 817/2014 SUMMARY ANALYSIS D&B Suppiler Qualifier Report CORVEL CORPORATION D&B Rating: SAI Financial strength: SA Indicates $50 million and over. Composite credit appraisal: 1 is high. This credit rating was assigned because of D&B's assessment of the company's financial ratios and Its cash flow, For more information, see the D&B Rating Key. Below Is an overview of the company's rating history since 12/14/01: D&B Rating Date Applied SAI 06/12/12 SA2 06/13/11 SAI 05/16/11 SA2 08/24/09 SAI 07/07/06 1R2 06/30/06 SAI 12/06/05 IR2 07/06/05 5AI 10/12/04 5A2 12/14/01 The Summary Analysis section reflects Information in D&B's file as of August 6, 2014. RISK SCORE ANALYSIS SER COMMENTARY: - Higher risk Industry based on Inactive rate for this Industry. PROBABILITY OF CEASED OPERATIONS/BECOMING INACTIVE SUPPLIER EVALUATION RISK RATING: 1 The probability of ceased operations/becoming inactive Indicates what percent of U.S, businesses is expected to cease operations or become Inactive over next 12 months. Probability of Supplier Ceased 1.3% (130 PER 10,000) Operations/ Becoming Inactive : Percentage of US business with same SER 130/6 (1,300 PER 10,000) score : Average Probability of Supplier Ceased 5.60% (560 PER 10,000) Operations/Becoming Inactive : - Average of Businesses In D&B's Supplier Database CREDIT DELINQUENCY SCORE: 546 DIVERSITY Minority -Owned Business: N/A Historically Underutilized Business: N/A Women -Owned Business: N/A Veteran -Owned Business: N/A Disadvantaged Business Enterprise: N/A Vietnam Veteran Business: N/A Small Disadvantaged Business: N/A Disabled -Owned Business: N/A HUB -Zoned Certified Business: N/A Historical College Classification: N/A SBA 8(a) Certified: N/A Labor surplus area: YES (2014) https:ttsuppl ierportal,dnb.comMebappAws/stores/s ordettSQRReportOlspl aytreportFormat-hardcopy&printPrormt 2/13 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 8102014 D&B Supplier Qualifier Report: CORVEL CORPORATION Small Business: N/A SPECIAL EVENTS 07/29/2014 EARNINGS UPDATE: According to published reports, comparative operating results for the 3 months ended June 30, 2014: Revenue of $124,364,000, Net Income of $8,299,000; compared to Revenue of $118,113,000, Net Income of $8,609,000 for the comparable period In the prior year. 05/30/2014 EARNINGS UPDATE: According to published reports, comparative operating results for the year ended March 31, 2014: Revenue of $478,816,000, Net Income of $34,392,000; compared to Revenue of $429,310,000, Net Income of $26,730,000 for the comparable period in the prior year. 01/30/2014 EARNINGS UPDATE: According to published reports, comparative operating results for the 9 months ended December 31, 2013: Revenue of $358,570,000, Net Income of $26,059,000; compared to Revenue of $317,351,000, Net Income of $19,150,000 for the comparable period in the prior year. CUS70ME R SERI/ICE If you have questions about this report, please call our Customer Resource Center at 1,800,234.3867 from anywhere within the U.S. If you are outside the U.S, contact your local D&B office, *** Additional Decision Support Available *** Additional D&B products, monitoring services and specialized Investigations are available to help you evaluate this company or Its industry. Call Dun & Bradstreet's Customer Resource Center at 1.800.234.3867 from anywhere within the U.S. or visit our website at www.dnb.com. HISTOR'y The following Information was reported 11/18/2013: Officer(s): V GORDON CLEMONS SR, CHB-PRES-CEO-000 SCOTT F MCCLOUD, CFO DONALD C MCFARLANE, CHIEF INFORMATION OFFICER DIANE J BLAHA, V PRES SLS & ACCOUNT MANAGEMENT DIRECTOR(S): The officers Identified by (+) and Steven J Hamerslag, Alan R Hoops, R Judd Jessup, Jean H Macino and Jeffrey J Michael. , The company was Incorporated In the State of Delaware on May 29, 1992. Business started 1987. The company was incorporated in 1987 and reincorporated in 1992. The company's common stock Is traded on the NASDAQ Global Select Market under the symbol "CRVO, As of May 28, 2013, there were 1,390 shareholders of record. As of March 31, 2013, those shareholders identified by the company as beneficially owning 5% or more of the outstanding shares were: Corstar Holdings Inc (34.70% ); Wellington Management Company LP (6.660/%); FMR LLC (6.26°/.); HealthCor Management, LP (5.30%); Jeffrey J Michael (35.68%) and V Gordon Clemons Sr (9,34%). As of the same date, officers and directors as a group beneficially owned 46.61% of the outstanding shares. V GORDON CLEMONS SR. Director of the company. He has served as the company's CHB since April 1991, He was recently reappointed as the company's CEO, President and COO in April 2012 upon the resignation of Daniel Starck from those positions, He also served as the company's CEO from January 1988 until August 2007, when he was appointed to that office and as President from January 1988 until May 2006, when Mr Starck was appointed to that office, SCOTT F MCCLOUD, He has been the CFO since August 2005, From June 1997 to August 2005, he was the company's Controller. DONALD C MCFARLANE. He has been the company's Chief Information Officer since February 2007. Before https9/suppllerportal.dnb,caMvebappA, IstareslserNet/SQRReparOlsplay?reporrFormat=hardcapy&printProrrpt 3113 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D9127705AD3 £/7/2014 D&B Supplier Qualifier Report CORVEL CORPORATION becoming Chief Information Officer, he was Vice President, Information Technology from 1995 through January 2007. DIANE J BLAHA. She has been the company's Senior Vice President, Sales and Account Management since November 2010. From November 2008 to November 2010, she served as Vice President of Sales. From 1996 to November 2008, she served as Vice President of Regional Sales. STEVEN J HAMERSLAG. Director since 1991. He has been the Managing Partner of TVC Capital since April 2006. ALAN R HOOPS. Director since 2003. He has been the CHB and CEO of CareMore California Health Plan, since March 2006 until 2012. R JUDD JESSUP. Director since 1997, He has been CEO and a director of Combimatrix Corporation, from August 2010 to March 2013. JEAN H MACINO. Director since 2008, She was elected as the Managing Director of Marsh and McLennan Companies, from 1980 to 1995. JEFFREY J MICHAEL. Director since 1990. He has been President and CEO of Corstar Holdings, Inc., since March 1996. BUSINESS REGISTRATION CORPORATE AND BUSINESS REGISTRATIONS REPORTED BY THE SECRETARY OF STATE OR OTHER OFFICIAL SOURCE AS OFAPR 21 2012: Registered Name: CORVEL CORPORATION Business type: CORPORATION Corporation type: NOT AVAILABLE Date incorporated: MAY 29 1992 State of incorporation: DELAWARE Filing date: MAY 29 1992 Registration ID: 2299227 Status: STATUS NOT AVAILABLE Where filed: SECRETARY OF STATE/CORPORATIONS DIVISION, DOVER, DE Registered agent: INCORPORATING SERVICES, LTD., 3500 SOUTH DUPONT HIGHWAY, DOVER, DE, 199010000 OPERATIONS 11/18/2013 Description: The company provides medical cost containment and managed care services to manage the medical costs of worker's compensation and auto claims. The company offers network solutions, including bill review, PPO management, professional review, reimbursement, pharmacy, directed care and clearinghouse services, as well as medicare solutions. It also provides patient management services comprising claims management, case management, nurse triage, utilization management, vocational rehabilitation, life care planning, disability management, liability claims management and auto claims management. Revenues are derived from services. Sells to commercial concerns. Territory : United States. Business slow in 3rd quarter. Employees: 3,172 which Includes officer(s). Undetermined employed here. Facilities: Leases 12,000 sq, ft. In a building. Branches: This business has multiple branches, detailed branch information Is available in D&B's linkage or family tree products, httpsd/supplierportal.dnb.ccnVv bappMcs/stares/serNeUSQRReporlDisplaylreportFcrmat=hardcopyBprintPrompt 4113 DocuSign Envelope ID: 6EE0D36E-ABE7-416C-BB7C-9D91277D5AD3 8(712014 D&E Supplier qualifier Report CORVEL CORPORATION Subsidiaries: This business has multiple subsidiaries, detailed subsidiary Information Is available in D&B's linkage or family tree products. FAMILY LINKAGE This business is at the head of Its corporate family tree. It is not a subsidiary of any other business. UNSPSC UNSPSC (United Nations Standard Product and Services Code) is a globally accepted commodity (Productand Services) classification system. CORVEL CORPORATION offers the following product(s) and service(s): 84131602 Health or hospitalization insurance 85101601 Nursing services 85121600 Medical doctors specialist services NAICS Beginning in 1997, the Standard Industrial Classification (SIC) was replaced by the North American Industry Classification System (NAICS). This six digit code Is a major revision that not only provides for newer Industries, but also reorganizes the categories on a production/process-oriented basis. This new, uniform, Industry- wide classification system has been designed as the Index for statistical reporting of all economic activities of the U.S., Canada, and Mexico. 561110 Office Administrative Services 621111 Offices of Physicians (except Mental Health Specialists) 621491 HMO Medical Centers SIC Based on information In our file, D&B has assigned this company an extended 8-dlgtt SIC. D&B's use of 8 -digit SICs enables us to be more specific to a company's operations than if we use the standard 4 -digit code. 87419907 Nursing and personal care facility management 80110100 Internal medicine practitioners 80110300 Medical Insurance associations D&B PAYDEX The D&B PAYDEX is a unique, dollar weighted indicator of payment performance based on up to 225 payment experiences as reported to D&B by trade references. 3 -Month D&B PAYDEX: 73 When weighted by dollar amount, payments to suppliers average 11 days beyond terms. o 17 ma 120 days Slaw �0 days slow Prompt Anddpates Based on trade collected over last 3 months. PAYMENT SUMMARY . D&B PAYDEX: 74 When weighted by dollar amount, payments to suppliers average 9 days beyond terms. 0E tea 120 days stow 30 days slow Piampt Andclpares Based on up to 24 months of trade. When dollar amounts are not considered, then approximately 86% of the company's payments are within terms. https:ifsuppllerportal.dnb.corrAwbappAc IstoreslseMeUSQRRepertDisplay?reportForm t-hardcopy&printProrryl &13 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 8!712014 0&B Supplier QualiOer Report: QORVEL CORPORATION The Payment Summary section reflects payment Information In D&B's file as of the date of this report. Below is an overview of the company's dollar -weighted payments, segmented by its suppliers' primary industries: Total Total Dollar Largest High Within Days Slow Rcv'd Amts Credit Terms <31 31-60 61-90 90> M ($) ($) NO (°/a) Top industries: Public finance 14 157,250 100,000 100 - - - - Help supply service 12 56,100 15,000 71 29 - - - Short-trm busn credit 10 85,750 40,000 97 2 1 - Whol office equipment 8 13,850 7,500 91 - - 9 - Nonclassified 6 87,600 45,000 100 - - - - Misc business service 5 25,000 10,000 30 70 - - - Employment agency 4 38,500 20,000 99 - - 1 - Who[ office supplies 3 60,750 60,000 100 - - Data processing svcs 1 95,000 95,000 5o 50 - - - Gravure printing 1 60,000 60,000 So So - - OTHER INDUSTRIES 101 83,200 5,000 81 5 4 3 7 Other payment categories: Cash experiences 52 10,050 1,000 Payment record unknown 8 2,400 500 Unfavorable comments 0 0 0 Placed for collections: With D&B 0 0 Other 0 N/A Total in D&B's file 225 775,450 100,000 The highest Now Owes on file is $60,000 The highest Past Due on file is $10,000 Dun & Bradstreet has 225 payment experiences in its file for this company. For your convenience, we have displayed 80 representative experiences In the PAYMENTS section. PAYMENT DETAILS Detailed payment history Date Reported Paying Record High Credit Now Owes Past Due Selling Terms Last Sale (mm/yy) M ($) M Within (months) 07/14 Ppt 500 0 Ppt 5,000 0 0 Ppt 1,000 1,000 0 I mo 6-12 mos 1 mo httpsa/suppfierportd.dnb.waAebapp/wcsistoreslseMettFSQRReportDlsoay?repor(Format=hwdmpy&printPrompt 03 I DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 8(7/2014 O&B Suppller Qualifier Report: CORVEL CORPORATION Ppt 750 0 0 1 mo Ppt 750 0 0 N30 6-12 mos Ppt 250 0 0 . 6.12 mos Ppt 100 100 0 1 mo Ppt 100 50 0 1 mo (009) 100 Cash account 1 mo AAAA 0009Cash own option. 05/14 Ppt 250 0 1 mo Ppt So0 0 1 mo Ppt 40,000 20,000 0 1 m0 Ppt 20,000 7,500 0 1 mo Ppt 15,000 15,000 0 N30 1 mo Plot 15,000 15,000 0 1 mo Plot 7,500 7,500 0 1 mo ppt 5,000 2,500 0 1 mo Ppt 5,000 2,SO0 0 1 mo Ppt 5,000 0 0 2-3 mos .Ppt 5,000 5,000 0 N60 1 mo Ppt 2,500 1,000 0 1 mo Ppt 2,500 0 1 mo Ppt 2,500 2,500 0 N30 1 m0 Ppt 2,500 1,000 0 1 mo Ppt 2,500 0 0 4-5 mos Plot 2,500 1,000 0 1 mo Plot 2,500 2,500 0 1 mo Ppt 2,500 0 2-3 mos Ppt 1,000 0 1 mo Ppt 1,000 100 0 N30 1 mo Ppt 1,000 1,000 0 N30 1 mo Ppt 1,000 750 0 1 mo ppt 1,000 S00 0 N30 1 mo Ppt 1,000 0 0 2-3 mos Ppt 1,000 1,000 0 N30 1 mo Ppt 750 50 0 Lease Agreemnt 1 mo Ppt 750 50 0 6-12 mos Ppt 750 0 0 6-12 mos Ppt 750 0 0 6-12 mos Ppt 750 0 0 6-12 mos Ppt 750 0 0 N30 1 mo Ppt 750 0 0 2-3 mos Ppt 750 0 1 mo Ppt 750 0 0 Lease Agreemnt 6-12 mos Ppt 500 0 0 6-12 mos Ppt 500 250 0 1 mo ppt 500 500 0 1 mo Plot 500 0 0 2-3 mos Ppt 500 500 0 N30 1 mo Ppt 500 100 0 1 mo Ppt 250 0 0 2-3 mos Ppt 250 0 0 6-12 mos ppt 2S0 100 0 1 mo https://supplierportal.dnb,mmwebappMcslstorestser,AeUSQRReWD[splay?reportForm t=hudcopy&printPrornpt 7/13 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-867C-9D91277D5AD3 6!7/2014 O&B Supplier Qualifier Report: CORVEL CORPORATION 1 Ppt 250 0 0 6-12 mos J11 Ppt 100 0 0 6-12 mos Plot 100 100 0 Lease Agreemnt 1 mo Ppt 100 0 0 iJ1 6-12 mos Pot 100 100 0 1 mo j Ppt 100 0 0 6-12 mos Plot 50 50 0 1 mo i Ppt 50 1 mo I Ppt 50 50 0 1 mo Ppt 50 0 0 1 mo j Plot 0 0 0 6-12 mos ' Ppt 0 0 0 2-3 mos Plot 0 0 0 2-3 mos 1 Ppt 0 0 0 4-5 mos Ppt-Slow 30 100 0 1 mo I Ppt-Slow 30 1,000 0 1 mo Ppt-Slow 30 60,000 45,000 0 1 mo Ppt-Slow 30 15,000 NIS 1 mo Ppt-Slow 30 2,500 0 0 2-3 mos Ppt-Slow 30 500 0 0 1 mo Ppt-Slow 60 1,000 250 0 1 mo Ppt-Slow 90 1,000 0 0 N30 6-12 mos Slow 30 10,000 5,000 0 1 mo Slow 30-60 50 0 0 6-12 mos (078) 0 0 0 Cash account 6-12 mos 03/14 Slow 90+ 500 0 0 6-12 mos 09/12 Slow 120+ 50 50 50 Payment experiences reflect how bills are met in relation to the terms granted. In some instances payment beyond terms can be the result of disputes over merchandise, skipped invoices etc. Each experience shown Is from a separate supplier. Updated trade experiences replace those previously reported, PAYMENT TRENDS SUPPLIER VERSUS INDUSTRY PAYDEX -> PRIOR 4 QTRS CURRENT 12 MONTH TREND 2012 --- 2013 --- --- --- --- --- 2014 --- --- --- --- --- --- --- SEP DEC MAR JUN SEP OCT NOV DEC JAN FEB MAR APR MAY ]UN JUL AUG Supplier 75 75 76 77 75 75 76 76 77 76 75 75 75 75 74 74 PAYDEX Industry PAYDEX (Based on 25 establishments in SIC 8741) UP QRT 80 80 80 80 80 80 80 80 MEDIAN 77 77 78 78 78 78 76 78 LO QRT 69 70 71 70 70 70 70 70 PAYDEX scores are updated daily and are based on upto 13 months of trade experiences from the Dun& Bradstreet trade rile, https:llsupplierportal.dnb.comMmbappAAcslstoresfseNeVSQRReportDisplay7reportFormat=hardwpy&printProrrpt 8113 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 8f7/2014 D&B Supplier Quallfier Report CORVEL CORPORATION All amounts displayed within this report are In local currency, STATEMENT UPDATE 08/06/2014 Interim Consolidated statement dated JUN 30 2014: Assets Fiscal Liabilities Consolidated Cash 34,134,000 Accts Pay 19,439,000 Accts Rec 57,186,000 Accruals 44,995,000 Customer Deposits 13,005,000 62,141,000 1.82 Deferred Income Taxes 7,139,000 36,485,000 40,145,000 Prepaid 4,933,000 89,482,000 92,390,000 Curr Assets 116,397,000 Curr Liabs 64,434,000 Fixt & Equip 51,832,000 Deferred Income Taxes 16,119,000 Goodwill 36,814,000 COMMON STOCK 3,000 Other Intanglbles-Net 5,079,000 ADDIT. PD. -IN CAP 120,255,000 Other Assets 952,000 TREASURY STOCK (334,204,000) RETAINED EARNINGS 344,467,000 Total Assets 211,074,000 Total 211,074,000 From APR 01 2014 to JUN 30 2014 sales $124,364,000; cost of goods sold $96,664,000. Gross profit $27,700,000; operating expenses $14,205,000. Operating Income $13,495,000; net Income before taxes $13,495,000; Federal Income tax $5,196,000; net Income $8,299,000. Statement obtained from Securities And Exchange Commission, Prepared from books without audit. Explanations The net worth of this company Includes intangibles. FINANCE 11/18/2013 Three-year statement comparative: Current Assets Current Llabs Current Ratio Working Capital Other Assets Net Worth Sales Long Term Llab Net Profit (Loss) Fiscal Fiscal Interim Consolidated Consolidated Consolidated Mar 31 2012 Mar 31 2013 Sep 30 2013 81,247,000 92,900,000 100,369,000 44,762,000 52,755,000 62,141,000 1.82 1.76 1.62 36,485,000 40,145,000 38,228,000 90,635,000 89,482,000 92,390,000 110,382,000 111,402,000 112,393,000 412,668,000 429,310,000 - 16,738,000 18,225,000 18,225,000 26,552,000 26,730,000 Interim Consolidated statement dated SEP 30 2013: Assets Liabilities https:llsuppilerponal.dnb.caT*w bapplmcslstorestseMeUSORReportDlsplaylreportFormat=hardcopye£printPrompt 9/13 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 8/7/2014 Cash Accts Rec Customer Deposits Deferred Income Taxes Prepaid Curr Assets Fixt & Equip Goodwill Other Intangibles -Net Other Assets Total Assets 088 Supplier Qualifier Report CORVEL CORPORATION Pending 22,192,000 Accts Pay 17,203,000 54,392,000 Accruals 44,938,000 12,497,000 (Supplier) Return of Sales: 6,801,000 Return of Sales: 6.2 4,487,000 Current Ratio: 118 100,369,000 Curr Liabs 62,141,000 50,007,000 Deferred Income Taxes 18,225,000 36,814,000 COMMON STOCK 3,000 5,427,000 ADDIT. PD. -IN CAP 114,383,000 142,000 TREASURY STOCK (321,053,000) Total Liability / Net Worth: RETAINED EARNINGS 319,060,000 192,759,000 Total 192,759,000 From APR 01 2013 to SEP 30 2013 sales $237,472,000; cost of goods sold $183,234,000. Gross profit $54,238,000; operating expenses $25,066,000. Operating Income $29,172,000; net Income before taxes $29,172,000; Federal Income tax $11,888,000. Net Income $17,284,000. Statement obtained from Securities And Exchange Commission. Prepared from books without audit. Explanations The net worth of this company includes Intangibles. The report was updated using Information the company filed with the Securities and Exchange Commission. KEY BUSINESS RATIOS Statement date: JUN 30 2014 Based on this number of establishments: 25 Firm Pending Industry Median 201400004510C Quartile Rank PETTIE, RICHARD, BALTIMORE, MD Defendant: CORVEL CORP, WHITE MARSH, MD AND OTHERS Cause: (Supplier) Return of Sales: 6.7 Return of Sales: 6.2 N/A Current Ratio: 118 Current Ratio: 1.7 2 Quick Ratio: 1.4 Quick Ratio: 1.1 1 Assets / Sales: UN Assets / Sales: 103.7 N/A Total Llability / Net Worth: UN Total Liability / Net Worth: 176.0 N/A UN = Unavailable PUBLIC FILINGS The following Public Filing data is for Information purposes only and Is not the official record, Certified copies can only be obtained from the official source. SUITS Status: Pending DOCKET NO.: 201400004510C Plaintiff: PETTIE, RICHARD, BALTIMORE, MD Defendant: CORVEL CORP, WHITE MARSH, MD AND OTHERS Cause: APPEAL Where filed: BALTIMORE COUNTY CIRCUIT COURT, BALTIMORE, MD Date status attained: 04/25/2014 Date filed: 04/25/2014 Latest Info Received: 05/02/2014 Status: Pending CASE NO.: 14502348 httpslisuppllerportal.dnb.coneebappMcslstorelser\ieOSQRReportDlsplaylreportFormal=hardcopy&prinlPrornpt 10113 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 i IM% 088 Supplier qualifier Report CORVEL CORPORATION Plaintiff: WOODARD YOLANDA Defendant: CORVEL CORPORATION, ORANGE, CA Cause: SMALL CLAIMS (LIMITED JURISDICTION) Where filed: LOS ANGELES COUNTY SMALL CLAIMS COURT/INGLEWOOD, INGLEWOOD, CA Date status attained: 04/07/2014 Date filed: 04/07/2014 Latest Info Received: 04/14/2014 Status: Pending DOCKET NO.: 201300097246C Plaintiff: SIMMS, PATRICIA A, COLUMBIA, MD Defendant: CORVEL ENTERPRISE COMP INC, BALTIMORE, MD AND OTHERS Cause: TORT Where filed: HOWARD COUNTY CIRCUIT COURT, ELLICOT CITY, MD Date status attained: 12/09/2013 Date filed: 12/09/2013 Latest Info Received: 12/27/2013 Suit amount: $1,880 ` Status: Pending CASE NO.: CC2013129932 Plaintiff: NELS LARSON DC Defendant: CORVEL CORP Cause: Breach of contract Where filed: MARICOPA COUNTY JUSTICE COURT/SOUTH MOUNTAIN, PHOENIX, AZ Date status attained: 07/23/2013 Date filed: 07/23/2013 Latest Info Received: 10/04/2013 Status: Pending CASE NO.: 2013661878CJC Plaintiff: NANCIE NGUYEN Defendant: CORVEL CORPORATION Where filed: ORANGE COUNTY SUPERIOR COURT, SANTA ANA, CA Date status attained: 07/10/2013 Date filed: 07/10/2013 Latest Info Received: 08/06/2013 Lf It is Indicated that there are defendants other than the report subject, the lawsuit may be an action to clear title to property and does not necessarily Imply a claim for money against the subject. There are additional Sults in D&B's file on this company available by contacting 1-800-234-3867. LIENS A lienholder can file the same lien In more than one filing location. The appearance of multiple liens riled by the same lienholder against a debtor may be indicative of such an occurrence. Amount; $74 Status: Open CASE NO.: 13-1612095 Type: County Tax Filed by: TAX COLLECTOR Against: CORVEL CORPORATION, CUCAMONGA, CA Where filed: LOS ANGELES COUNTY RECORDER OF DEEDS, NORWALK, CA Date status attained: 11/13/2013 Date filed: 11/13/2013 Latest Info Received: 12/20/2013 Amount: $74 Status: Void CASE NO.: 13-1613962 Type: County Tax Filed by: TAX COLLECTOR https://supplierportal.dnb.comAwbappimsistarestseMeVSQRReportOls0ay?raportFormat=hardc pySprintPrompt 11/13 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 8r72014 O&S Supplier Qualifier Report CORVEL CORPORATION Against. CORVEL CORPORATION, CUCAMONGA, CA Where filed: LOS ANGELES COUNTY RECORDER OF DEEDS, NORWALK, CA Date status attained: 02/06/2014 Date filed: 11/13/2013 Latest Info Received: 02/24/2014 UCC FILINGS Collateral: All Inventory - All Account(s) - All Chattel paper - All Contract rights - and Type: OTHERS Type: Original Sec, party: BRCP RIVERVIEW PLAZA, LLC, SEATTLE, WA KASTNER, WILLIAMS, SEATTLE, Filing number: WA Debtor: CORVEL CORPORATION, TUKWILA, WA Filing number: 2008 3009741 Filed with: SECRETARY OFSTATE/UCC DIVISION, DOVER, DE Date filed: 09/05/2008 Latest Info Received: 10/02/2008 Collateral: Business machinery/equipment Type: Original Sec. party: U.S. BANK EQUIPMENT FINANCE, MARSHALL, MN Debtor: CORVEL CORPORATION, MINNEAPOLIS, MN Filing number: 2012 2635979 Filed with: SECRETARY OF STATE/UCC DIVISION, DOVER, DE Date flied: 07/09/2012 Latest Info Received: 08/10/2012 Collateral: Equipment Type: Original Sec. party: US BANCORP, MARSHALL, MN Debtor: CORVEL CORPORATION, MINNEAPOLIS, MN Filing number: 2010 2541062 Filed with: SECRETARY OF STATE/UCC DIVISION, DOVER, DE Date filed: 07/21/2010 Latest Info Received: 08/11/2010 Collateral: Equipment Type: Original Sec, party: US BANCORP, MARSHALL, MN Debtor: CORVEL CORP, ANCHORAGE, AK Filing number: 2010-691137-7 Filed with: SECRETARY OF STATE/UCC DIVISION, ANCHORAGE, AK Date filed: 02/01/2010 Latest Info Received: 02/10/2010 Collateral: Equipment Type: Original Sec. party: US BANCORP, MARSHALL, MN Debtor: CORVEL CORPORATION, MINNEAPOLIS, MN Filing number: 2009 3228142 Filed with: SECRETARY OF STATE/UCC DIVISION, DOVER, DE Date filed: 10/07/2009 Latest Info Received: 11/04/2009 There are additional UCC's In O&B's file on this company available by contacting 1-800-234-3867. The public record Items contained in this report may have been paid, terminated, vacated or released prior to the date this report was printed. GOVERNMENT ACTIVITY httpsllsuppllerporW.dnb.comMebapp&wslstaesise geYSQRReportDisplay7reportFormat=hardcopy&printProWt 12113 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 MY2014 D86 Supplier qualifier Report: CORVEL CORPORATION Activity summary Congressional District: 45. The details provided in the Government Activity section are as reported to Dun & Bradstreet by the federal government and other sources. Copyright 2014 Dun & Bradstreet - Provided under contract for the exclusive use of subscriber 100150009 https:llsupplierporlal.dnb.corn'webappA&cslstoreslserNet'SORReportDispiay7reportFormat=hardcopy&prinRorryt 13113 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 DocuSign Envelope ID: 6EEDD36E-ABE7416C-6B7C-9D91277D5AD3 C O R V E L Sample Performance Guarantee Implementation CorVel understands that change can be a challenge and that well executed implementations are crucial to a successful partnership. CorVel invests significantly in our implementation plans that include dedicated resources and implementation specialists. CorVel will put at risk $XXX to ensure a successful implementation that will meet or exceed Waste Industries' expectations. Once implementation is completed, we will solicit your feedback to ensure all expectations were met. While it is difficult to identify specific parameters around this performance guarantee, CorVel will provide Waste Industries the opportunity to express your satisfaction with our overall implementation performance. Claim Administration Impact to Total Cost of Loss - Reduce the Percentage of Lost Time Claims* Through CorVel's Enterprise Comp model, CorVel will reduce the percentage of lost time claims as a component of the overall claims mix. This is measured by calculating the percentage of medical only claims versus the percentage of lost time claims at eighteen months for claims occurring with a date of loss in the first year of the contract and comparing that to the same time intervals of development for the last year of the prior claims administration contract. $XXX will be at risk so that should the percentage of lost time claims be reduced by less than X% , a penalty will be paid by CorVel and if the percentage of lost time claims is reduced by more than X%, CorVel will be incented the same amount. *requires mandated use of CorVel's 24/7 Nurse Advocacy program with compliance rate of XX% or better. © 2013 CorVel vAwv.corvel.corn DocuSign Envelope ID: 6EE0D36E-ABE7416C-887C-9D91277D5AD3 MIAMIBEACH PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3b Floor Miami Beach, Florida 33139 www.miamibeachfi.gov ADDENDUM NO.1 REQUEST FOR PROPOSALS NO. 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION August 26, 2021 This Addendum to the above -referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only (deletions are shown by strikethrough and additions are underlined). REVISION: RFQ DUE DATE AND TIME. The deadline for the electronic receipt of bids is extended until 3:00 p.m., on Wednesday, September 8, 2021. All bids received and time stamped through BidSync, prior to the bid submittal deadline shall be accepted as timely submitted. Bids will be opened promptly at the time and date specified. Hard copy bids or bids received electronically, either through email or facsimile, submitted prior to or after the deadline for receipt of bids are not acceptable and will be rejected. Late bids cannot be submitted, bidders are cautioned to plan sufficiently. The City will in no way be responsible for delays caused by technical difficulty or caused by any other occurrence. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Contact: Telephone: Email: William Garviso, CPPB, CPP 305-673-7000 ext. 7490 1 WilliamGarviso@miamibeachfi.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Bidders' questionnaire with the reason(s) for not submitting a proposal. S' cerely� lex enis Pro rement Director 1 1 ADDENDUM NO.1 REQUEST FOR PROPOSALS NO. 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 MIAMIBEACH TABLE OF CONTENTS SOLICITATION SECTIONS: 0100 INSTRUCTIONS TO PROPOSERS 0200 GENERAL CONDITIONS 0300 PROPOSAL SUBMITTAL INSTRUCTIONS & FORMAT 0400 PROPOSAL EVALUATION APPENDIX A MINIMUM REQUIREMENTS & SPECIFICATIONS APPENDIX B COST PROPOSAL FORM APPENDIX C INSURANCE REQUIREMENTS APPENDIX D CLAIMS EXPERIENCE (See Periscope Attachment) APPENDIX E SUPPLEMENTAL QUESTIONS 2021-224 WG CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-909127705AD3 • W.Med SECTION 0100 INSTRUCTIONS TO PROPOSERS 1. GENERAL. This Request for Proposals (RFP) is issued by the City of Miami Beach, Florida (the "City', as the means for prospective Proposers to submit their qualifications, proposed scopes of work and revenue proposals (the "proposal's to the City for the City's consideration as an option in achieving the required scope of services and requirements as noted herein. All documents released in connection with this solicitation, including all appendixes and addenda, whether included herein or released under separate cover, comprise the solicitation, and are complementary to one another and together establish the complete terms, conditions and obligations of the Proposers and, subsequently, the successful Proposer(s) (the "contractor[s)l if this RFP results in an award. The City utilizes Periscope S213 (formally known as BidSync) (www.Deriscoyeholdings.com or www.bidsync.com) for automatic notification of competitive solicitation opportunities and document fulfillment, including the issuance of any addendum to this RFP. Any prospective Proposer who has received this RFP by any means other than through Periscope S2G must register immediately with Periscope S2G to assure it receives any addendum issued to this RFP. Failure to receive an addendum may result in disqualification of proposal submitted. 2. PURPOSE. The City of Miami Beach (the "City's is approved by the Florida Department of Labor and Employment Security/Division of Workers' Compensation to self -insure for workers' compensation. The Division of Workers' Compensation requires that the claims administration be provided by a State Certified Workers' Compensation Claims Administrator. Therefore, the City is seeking the professional services of an experienced and qualified firm to provide services as a third -party administrator for workers compensation. The City is self-insured for workers compensation and the selected third -party administrator pays all claims and allocated loss adjusting expenses from the Risk Management Claims account. There is a separate account for legal fees incurred by our two outside workers' compensation attorneys. The budget for both accounts are set each year based an actuarial projections. The City has approximately 2,164 employees, and averages 365 claims annually with approximately two-thirds of the claims being medical -only. On February 1, 2014, the City entered into an Agreement with CorVel Enterprise Comp, Inc. to provide third parry claims administration services for its self-insurance Worker's Compensation program pursuant to RFP 2014 -302 -SW. The Agreement had an initial term of two (2) years, that commenced on February 1, 2014, and ended on January 31, 2016. Three (3) one-year renewals were exercised, from February 1, 2017 through January 31, 2019. On October 16, 2019, pursuant to Resolution No. 2019-31021, the Mayor and City Commission approved by 5/7th vote Amendment No.1 extending the Agreement for two (2) additional years. The Agreement is presently scheduled to expire January 31, 2022. 3. ANTICIPATED RFP TIMETABLE. The tentative srhedule for this snlir-itatinn Ira,; fnllnws- RFP Issued July 30, 2021 Pre -Proposal Meeting August 11, 2021 910:00AM EST Deadline for Receipt of Questions August 23, 2021 Lw 5:OOPM EST Responses Due September 1, 2021 93:OOPM EST Evaluation Committee Review TBD Proposer Presentations TBD (if applicable) Tentative Commission Approval Authorizing TBD 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 MIAMI BEACH Negotiations Contract Negotiations IFollowing Commission Approval 4. PROCUREMENT CONTACT. Any questions or clarifications concerning this solicitation shall be submitted to the Procurement Contact noted below: Procurement Contact Telephone, Email: William Garviso, CPPB (305) 673-7490 Will iamGarviso@miamibeachffoov The Bid title/number shall be referenced on all correspondence. All questions or requests for clarification must be received no later than ten (10) calendar days prior to the date proposals are due as scheduled in Section 0200-3. All responses to questions/clarifications will be sent to all prospective Proposers in the form of an addendum. 5. PRE -PROPOSAL MEETING OR SITE VISIT(S). Only if deemed necessary by the City, a pre -proposal meeting or site visit(s) may be scheduled. Attendance for the pre -proposal meeting shall be via telephone and recommended as a source of information but is not mandatory. Proposers interested in participating in the Pre -Proposal Meeting must follow these steps: (1) Dial the TELEPHONE NUMBER: +1786-636-1480 (Toll-free North America) (2) Enter the MEETING NUMBER 302186 817# Proposers who are participating via telephone should send an e-mail to the contact person listed in this RFP expressing their intent to participate via telephone. 6. PRE -PROPOSAL INTERPRETATIONS. Oral information or responses to questions received by prospective Proposers are not binding on the City and will be without legal effect, including any information received at pre - submittal meeting or site visit(s), The City by means of Addenda will issue interpretations or written addenda clarifications considered necessary by the City in response to questions. Only questions answered by written addenda will be binding and may supersede terms noted in this solicitation. Addendum will be released through Periscope S2G. Any prospective proposer who has received this RFP by any means other than through Periscope S2G must register immediately with Periscope S2G to assure it receives any addendum issued to this RFP. Failure to receive an addendum may result in disqualification of proposal. Written questions should be received no later than the date outlined in the Anticipated RFP Timetable section. 7. CONE OF SILENCE. This RFP is subject to, and all proposers are expected to be or become familiar with, the City's Cone of Silence Requirements, as codified in Section 2-486 of the City Code. Proposers shall be solely responsible for ensuring that all applicable provisions of the City's Cone of Silence are complied with, and shall be subject to any and all sanctions, as prescribed therein, including rendering their response voidable, in the event of such non- compliance. Communications regarding this solicitation are to be submitted in writing to the Procurement Contact named herein with a copy to the City Clerk at rafaelgranadogmiamibeachfl.gov 8. ADDITIONAL INFORMATION OR CLARIFICATION. After proposal submittal, the City reserves the right to require additional information from Proposers (or Proposer team members or sub -consultants) to determine: qualifications (including, but not limited to, litigation history, regulatory action, or additional references); and financial capability (including, but not limited to, annual reviewed/audited financial statements with the auditors notes for each of their last two complete fiscal years). 9. PROPOSER'S RESPONSIBILITY. Before submitting a response, each Proposer shall be solely responsible for making any and all investigations, evaluations, and examinations, as it deems necessary, to ascertain all conditions and requirements affecting the full performance of the contract. Ignorance of such conditions and requirements, and/or DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 MIAMI BEACH failure to make such evaluations, investigations, and examinations, will not relieve the Proposer from any obligation to comply with every detail and with all provisions and requirements of the contract, and will not be accepted as a basis for any subsequent claim whatsoever for any monetary consideration on the part of the Proposer. 10. DETERMINATION OF AWARD. The City Manager may appoint an evaluation committee to assist in the evaluation of proposals received. The evaluation committee is advisory only to the city manager. The city manager may consider the information provided by the evaluation committee process and/or may utilize other information deemed relevant. The City Manager's recommendation need not be consistent with the information provided by the evaluation committee process and takes into consideration Miami Beach City Code Section 2-369, including the following considerations: (1) The ability, capacity and skill of the Proposer to perform the contract. (2) Whether the Proposer can perform the contract within the time specified, without delay or interference. (3) The character, integrity, reputation, judgment, experience and efficiency of the Proposer. (4) The quality of performance of previous contracts. (5) The previous and existing compliance by the Proposer with laws and ordinances relating to the contract. The City Manager may recommend to the City Commission the Proposer(s) s/he deems to be in the best interest of the City or may recommend rejection of all proposals. The City Commission shall consider the City Manager's recommendation and may approve such recommendation. The City Commission may also, at its option, reject the City Manager's recommendation and select another Proposal or Proposals which it deems to be in the best interest of the City, or it may also reject all Proposals. 11. NEGOTIATIONS. Following selection, the City reserves the right to enter into further negotiations with the selected Proposer. Notwithstanding the preceding, the City is in no way obligated to enter into a contract with the selected Proposer in the event the parties are unable to negotiate a contract. It is also understood and acknowledged by Proposers that no property, contract or legal rights of any kind shall be created at any time until and unless an Agreement has been agreed to; approved by the City; and executed by the parties. 12. E -VERIFY. As a contractor you are obligated to comply with the provisions of Section 448.095, Fla. Stat., "Employment Eligibility." Therefore, you shall utilize the U.S. Department of Homeland Security's E -Verify system to verity the employment eligibility of all new employees hired by the Contractor during the term of the Contract and shall expressly require any subcontractors performing work or providing services pursuant to the Contract to likewise utilize the U.S. Department of Homeland Security's E -Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the Contract term. Balance of Page Intentionally Left Blank DomSign Envelope ID: 6EE0D36E-ABE7-416C-887C-9D91277D5AD3 MIAMIBEACH SECTION 0200 GENERAL CONDITIONS TERMS & CONDITIONS —SERVICES. By virtue of submitting a proposal in response to this solicitation, proposer agrees to be bound by and in compliance with the Terms and Conditions for Services (version dated April 13, 2020), incorporated herein, which may be found at the following link: httys://www.mimnibeachfl.gov/city-hall/procurement/standard-terms-and-conditions/ 2021.224*G CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION DocuSign Envelope ID: 6EEOD36E-ABE7-416C-887C-9D91277D5AD3 MIAMI BEACH SECTION 0300 PROPOSAL SUBMITTAL INSTRUCTIONS AND FORMAT 1. ELECTRONIC RESPONSES (ONLY). Proposals must be submitted electronically through Periscope S2G (formerly BidSync) on or before the date and time indicated. Hard copy proposals or proposals received through email or facsimile are not acceptable and will be rejected. A proposer may submit a modified proposal to replace all or any portion of a previously submitted proposal until the deadline for proposal submittals. The City will only consider the latest version of the bid. Electronic proposal submissions may require the uploading of attachments. All documents should be attached as separate files in accordance with the instructions included in Section 4, below. Attachments containing embedded documents or proprietary file extensions are prohibited. It is the Bidder's responsibility to assure that its bid, including all attachments, is uploaded successfully. Only proposal submittals received, and time stamped by Periscope S2G (formerly BidSync) prior to the proposal submittal deadline shall be accepted as timely submitted. Late bids cannot be submitted and will not be accepted. Bidders are cautioned to allow sufficient time for the submittal of bids and uploading of attachments, Any technical issues must be submitted to Periscope S2G (formerly BidSync) by contacting (800) 990-9339 (toll free) or S2GOperiscopeholdings.com. The City cannot assist with technical issues regarding submittals and will in no way be responsible for delays caused by any technical or other issue. It is the sole responsibility of each Bidder to ensure its proposal is successfully submitted in BidSync prior to the deadline for proposal submittals. 2. NON -RESPONSIVENESS. Failure to submit the following requirements shall result in a determination of non- responsiveness. Non-responsive proposals will not be considered. 1. Bid Submittal Questionnaire 2. Failure to comply with Minimum Eligibility Requirement (See Appendix A, Section Al). 3. Cost Proposal (Tab 4). 3. OMITTED OR ADDITIONAL INFORMATION. Failure to include the Bid Submittal Questionnaire (completed and submitted electronically) and the Cost Proposal with its bid and by the deadline for submittals shall render a proposal non-responsive. Non -Responsive proposals will not be considered. With the exception of the Bid Submittal Questionnaire (completed and submitted electronically) and the Cost Proposal, the City reserves the right to seek any omitted information/documentation or any additional information from Proposer or other source(s), including but not limited to: any firm or principal information, applicable licensure, resumes of relevant individuals, client information, financial information, or any information the City deems necessary to evaluate the capacity of the Proposer to perform in accordance with contract requirements. Failure to submit any omitted or additional information in accordance with the City's request shall result in proposal being deemed non-responsive. 4. ELECTRONIC PROPOSAL FORMAT. In order to maintain comparability, facilitate the review process and assist the Evaluation Committee in review of proposals, it is strongly recommended that proposals be organized and tabbed in accordance with the tabs, and sections as specified below. The electronic submittal should be tabbed as enumerated below and contain a table of contents with page references. The electronic proposal shall be submitted through the "Line Items" attachment tab in Periscope S2G. DomSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 MIAMI BEACH Cover Letter & Minimum Qualifications Requirements 1.1 Cover Letter and Table of Contents. The cover letter must indicate Proposer and Proposer Primary Contact for the purposes of this solicitation. 1.2 Minimum Qualifications Requirements. Submit verifiable information documenting compliance with the minimum qualification requirements established in Appendix A, Minimum Requirements and Specifications. 1.3 Supplemental Questions. Submit verifiable information in response to the supplemental questions established in Appendix E, Supplemental Questions. Experience & Qualifications 2.1 Qualifications of Proposing Firm. Submit detailed information regarding the relevant experience and proven track record of the firm and/or its principals in providing the scope of services similar as identified in this solicitation, including experience in providing similar scope of services to public sector agencies. As part of its response list project(s) with experience being a Third -Party Administrator ('TPA") for Workers' Compensation for Florida local government(s) for a minimum of five (5) consecutive years. For each project that the Proposer submits as evidence of similar experience for the firm and/or any principal, the following is required: project description, agency name, agency contact, contact telephone & email, and year(s) and term of engagement. For each project, identify whether the experience is for the firm or for a principal (include name of principal). 2.2 Qualifications of Proposer Team. Include proposed primary contact for the City of Miami Beach, and a secondary contact to serve in the absence of the primary contact. Submit resumes of proposed primary and secondary contact persons for verification purposes. Additionally, provide an organizational chart of all personnel and consultants to be used for this project if awarded, the role that each team member will play in providing the services detailed herein and each team members' qualifications. A resume of each individual, including education, experience, and any other pertinent information, shall be included for each Proposal team member to be assigned to this contract. and Submit detailed information on how Proposer plans to accomplish the required scope of services, including detailed information, as applicable, which addresses, but need not be limited to: • Excess Workers' Compensation Liability Insurance • Claims Handling of Past and Future Claims • Claims Administration • Record Keeping and Audits • Banking, Reporting and Billing • Staffing and Personnel • Loss Fund Management. Cost Proposal Submit a completed Cost Proposal Form (Appendix B). Balance of Page Intentionally Left Blank DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 SECTION 0400 PROPOSAL EVALUATION 1. EVALUATION OF PROPOSALS. All responsive proposals will be evaluated in accordance with this section. If more than one proposal is received, the City Manager may appoint an Evaluation Committee to consider and provide feedback on the qualitative factors of each proposal. In the event that only one responsive proposal is received, the City Manager, after determination that the sole responsive proposal materially meets the requirements of the RFP, may, without an evaluation committee, recommend to the City Commission that the Administration enter into negotiations. In the evaluation of proposals, Proposers may be requested to make additional written submissions of a clarifying nature or oral presentations to the Evaluation Committee. Failure to provide the requested information within the time prescribed may result in the disqualification of proposal. 2. QUALITATIVE FACTORS (QUALIFICATIONS, SCOPE AND APPROACH), COST PROPOSAL AND VETERAN'S PREFERENCE. The Evaluation Committee shall only consider qualitative factors. The Evaluation Committee shall not consider quantitative factors (e.g., cost) in its review of proposals. The Evaluation Committee shall act solely in an advisory capacity to the City Manager. The results of the Evaluation Committee process do not constitute an award recommendation. The. City Manager may utilize, but is not bound by, the results of the Evaluation Committee process, as well as consider any feedback or information provided by staff, consultants or any other third - party in developing an award recommendation in accordance with Sub -section 4 below. In its review of proposals received, the Evaluation Committee may review and score all proposals, with or without conducting interview sessions, in accordance with the following criteria. The Procurement Department will assign points for Veteran's Preference, pursuant to Ordinance No. 2011-3748, as applicable. EVALUATION COMMITTEE RANKING FOR QUALITATIVE CRITERIA ONLY. The sum of qualitative scores will be converted to rankings in accordance with the example below. Committee DocuSign Envelope to: 6EEOD36E-ABE7-416C-aB7C-9D91277D5AD3 &QUANTITATIVE FACTORS. Quantitative factors shall not be considered by the Evaluation Committee. Cost Proposal Evaluation. The cost proposal points shall be developed in accordance with the following formula: 4. DETERMINATION OF AWARD. The City Manager shall consider qualitative and quantitative factors, in accordance with Sub -section 2 and 3 above, to recommend the proposer(s) he deems to be in the best interest of the City or may recommend rejection of all proposals. The City Manager's recommendation need not be consistent with the information provided by the evaluation committee process and takes into consideration Miami Beach City Code Section 2-369, including the following considerations: (1) The ability, capacity and skill of the Proposer to perform the contract. (2) Whether the Proposer can perform the contract within the time specified, without delay or interference. (3) The character, integrity, reputation, judgment, experience and efficiency of the Proposer. (4) The quality of performance of previous contracts. (5) The previous and existing compliance by the Proposer with laws and ordinances relating to the contract. The City Manager may recommend to the City Commission the Proposer(s) s/he deems to be in the best interest of the City or may recommend rejection of all proposals. The City Commission shall consider the City Manager's recommendation and may approve such recommendation. The City Commission may also, at its option, reject the City Manager's recommendation and select another Proposal or Proposals which it deems to be in the best interest of the City, or it may also reject all Proposals. Balance of Page Intentionally Left Blank Sample Objective Formula for Cost Example Maximum Formula for Calculating Points Vendor Allowable Points (lowest cost 1 cost of proposal being Total Points Vendor Cost (Points noted are for illustrative evaluated X maximum allowable Awarded Proposal purposes only. Actual points are points = awarded points) noted above.) Round to Vendor A $100.00 20 $1001$100 X 20 = 20 20 Vendor B $150.00 20 $1001$150 X 20 =13 13 Vendor C $200.00 20 $1001$200 X 20 =10 10 4. DETERMINATION OF AWARD. The City Manager shall consider qualitative and quantitative factors, in accordance with Sub -section 2 and 3 above, to recommend the proposer(s) he deems to be in the best interest of the City or may recommend rejection of all proposals. The City Manager's recommendation need not be consistent with the information provided by the evaluation committee process and takes into consideration Miami Beach City Code Section 2-369, including the following considerations: (1) The ability, capacity and skill of the Proposer to perform the contract. (2) Whether the Proposer can perform the contract within the time specified, without delay or interference. (3) The character, integrity, reputation, judgment, experience and efficiency of the Proposer. (4) The quality of performance of previous contracts. (5) The previous and existing compliance by the Proposer with laws and ordinances relating to the contract. The City Manager may recommend to the City Commission the Proposer(s) s/he deems to be in the best interest of the City or may recommend rejection of all proposals. The City Commission shall consider the City Manager's recommendation and may approve such recommendation. The City Commission may also, at its option, reject the City Manager's recommendation and select another Proposal or Proposals which it deems to be in the best interest of the City, or it may also reject all Proposals. Balance of Page Intentionally Left Blank DocuSign Envelope ID. 6EEOD36E-ABE7♦16C-8B7C-9D91277D5AD3 APPENDIX A MIAMIRFA�' Minimum Requirements & Specifications 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 31d Floor Miami Beach, Florida 33139 DowSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 Al. Minimum Eligibility Requirements. The Minimum Eligibility Requirements for this solicitation are listed below. Bidder shall submit the required submittal(s) documenting compliance with each minimum requirement. Proposers that fail to comply with minimum requirements shall be deemed non-responsive and shall not have its bid considered. The proposer must be a Qualified Servicing Entity with the State of Florida, Department of Financial Services, Division of Workers' Compensation (per 69L-5-229 Florida Administrative Code) A2. Scope of Work. Statement of Work Required. The City of Miami Beach (the "City's is approved by the Florida Department of Labor and Employment Security/Division of Workers' Compensation to self -insure for Workers' Compensation. The Division of Workers' Compensation requires that the claims administration be provided by a State Certified Workers' Compensation Claims Administrator. Therefore, the City is seeking proposals for third party claims administration services for its self- insurance Worker's Compensation program. Maintaining a fully staffed office, including the Accounts Manager, near the City of Miami Beach or with the ability to arrive within two (2) hours request to attend meetings and provide training is important to the City. Proposers must submit cost proposal for the entire scope of services requested. Proposals to handle only selected parts of the scope will not be considered. It is understood by the successful proposer that all services are to be provided by the proposer's employees and cannot be contracted out to another party without the prior approval of the City. The anticipated commencement date of the contract will be February 1, 2022. A3. Specifications. The administrator will provide all specified adjusting services for all claims as well as all other required services, such as administrative, managed care/medical case management, computerized claims/loss statistical information (RMIS) and banking/loss fund reconciliation. The specific required services are outlined in greater detail within this request for proposals. 3.1. City Workforce, Ordinances and Collective Bargaining The City has approximately 2,184 employees, and averages 365 claims annually with approximately two-thirds of the claims being medical -only. As of May 31, 2021, there were approximately 366 open claims. The City has five (5) Collective Bargaining Units that have specific language with regards to the handling of leave related to compensable claims (see chart below). For employees that are not a part of a Collective Bargaining Unit, the Unclassified Leave Ordinance No. 1613.11 governs Workers' Compensation Supplemental Injury Pay as follows: Employees who are absent due to restrictions for a work-related injury are entitled up to thirty-two (32) weeks of Supplemental Pay. The Supplemental Pay is the amount equal to the difference between their normal City pay and the amount of compensation payable under the provisions of the Workers' Compensation law of the State of Florida. This benefit allows employees to receive their full pay while absent due to an approved work-related injury. In view of this, temporary total indemnity benefits will not need to be paid by the TPA unless the injured employee is eligible for temporary total benefits in excess of 32 weeks. DocuSlgn Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 UNION TIME LIMIT NOTES IAFF Two sixteen -week periods May be extended with the approval of Fire Chief, IAFF President and City Manager. Decision not subject to grievance or arbitration. FOP Two sixteen -week periods May be extended with the approval of Fire Chief, IAFF President and City Manager. Decision not subject to grievance or arbitration. AFSCME Sixteen (16) weeks May be extended by City Manager or his/her designee. CWA Not to exceed Sixteen (16) CBA is silent; May be extended for additional weeks sixteen (16) weeks, subject to approval of City Manager. Refer to Classified Leave Ordinance No. 1335-13. GSA Not 'to exceed Sixteen (16) CBA is silent; Maybe extended for additional weeks sixteen (16) weeks, subject to approval of City Manager. Refer to Classified Leave Ordinance No. 1335-13. Note: Information regarding Supplemental Pay is subject to change with Collective Bargaining or administrative changes to the current Ordinances. Any changes to this information will be provided to the selected TPA for proper handling. 3.2. Excess Workers' Compensation Liability Insurance The City purchased excess workers' compensation insurance for a period from 1986 through 1997. The City does not currently purchase excess workers' compensation insurance. Excess Workers' Compensation Insurance coverage resumed in 2017 and continues to date. The self-insured retention is $1.5 million, except for Police and Fire claims that is $2 million. • TPA shall comply with all excess workers' compensation coverage agreements in place; including reporting requirements affording potential or existing coverage on all and any open (or re -opened) claims such as, but not limited to reporting. • TPA shall be responsible for any penalties, declined coverage, reservation of rights issued, diminished coverage benefits imposed by City's excess workers' compensation carrier(s) due to TPA's failure to properly report new or existing claims as required by each carriers' coverage agreement reporting requirements. 3.3. Claims Handling of Past and Future Claims All proposers are to assume the complete handling of all future and past claims now being handled by our present TPA (see Appendix G for open/closed claims for all years), along with all new claims. The information provided regarding the volume and type of pending claims to be assumed is based on the latest information provided to the City and cannot be guaranteed as to its accuracy. If the amount of prior claim files to be taken over is 25% greater than represented in this RFP, the City will consider a proportionate adjustment to the proposer's Flat annual fee. It is the responsibility of the proposer to review prior claim files to determine the additional proposed cost, if any, to take over these files. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 It is also required that the claim data associated with all. claims occurring prior to February 1, 2022, be transferred into the proposer's computer information system, so that future loss runs will contain a complete history of all claim years. The transfer of all claims data must be completed by June 1, 2015. The proposer is responsible for specifically indicating in their proposal the fees, if any, for assumption of prior claims and the data conversion. The program is run on an "occurrence" basis, therefore, all claims occurring in the contract year, regardless of when reported, are to be handled per the requirements of this agreement. The TPA is required to handle all claims to their conclusion or to the conclusion of the contract, whichever occurs first, at no additional charge to the City other than the annual fee. The contract may be terminated by either party with ninety (90) days written notice to the other. However, any cancellation does not alter the administrators obligation to handle all claims prior to the termination date. 3.4. Claims Administration The City requires that the selected TPA provide, at a minimum, the following professional services related to the administration of the City's self-insured Workers' Compensation Program: TPA shall provide workers' compensation third -party claims administration services to the City of Miami Beach's self-insured workers' compensation program in accordance with Florida Statute, Section 440, applicable Florida Administrative Code(s), and applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s). City shall provide TPA with copies of applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s) as necessary. Services include the necessary medical benefits, expenses, and other services usual and customary to the administration and management of workers' compensation claims, if not otherwise noted herein. • TPA shall provide, on behalf of the City, all self -insurer reporting to the Self Insurance Bureau, Division of Workers' Compensation, State of Florida, all annual reports, unit statistical, modification factor, assessment indemnity, medical and any and all forms required by the State of Florida which a self -insurer for workers' compensation must provide. P • TPA shall accept all current claims and/or re -opened claims as run-in claims to the TPA if selected as the new TPA for the City. • TPA shall provide the City with the ability to report first reports of injury and loss notices electronically for all claims, and, by phone based on the severity, circumstances or nature of injury, at no additional cost. • TPA shall provide automated acknowledgement upon the receipt of each claim. The acknowledgement shall include, but not be limited, to the following: claim number, claimant's name, and date of loss, one-time prescription drug authorization, • TPA shall set up all new claims within twenty-four (24) hours after notification. Assigned adjuster, supervisor, telephonic case manager, or nurse case manager shall make all contacts and initiate investigation within forty-eight (48) hours of receipt of new claims. DocuSign Envelope I0:6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 TPA shall triage every notice of injury with a with appropriate claims professional or triage system. TPA shall utilize any recommended medical primary care physicians or specialists as directed by City's Risk Manager, even if not in the TPA's network, if it is in the best interest of the injured employee or the City. This would include authorizing treatment by non- occupational or non -network physicians or providers who have treated an injured employee under emergency or exigent circumstances in an emergency room or other facility, if such treatment would be considered prudent and reasonable for continuity of care purposes. • The City reserves the right, but not the obligation, to approve all vendor partners and ancillary services used by the TPA that are part of the workers' compensation allocated claim expense or reserve. City reserves the right to select its own workers' compensation defense counsel to manage any and all litigation for the City's workers' compensation and employer's liability program, and/or to seek pre -litigation legal advice and claim strategy. The City's Risk Manager has the authority to approve the workers' compensation defense counsel's fee, cost schedule and/or any allocated legal claim adjustment expenses. TPA shall agree to work with the City's chosen workers' compensation defense counsel. In the event the TPA is unable to work with the City's workers' compensation defense counsel or has a conflict of interest, then City reserves the right to deem the TPAs' proposal non-responsive, or terminate the TPA's Contract. • TPA must provide access to Spanish and Creole speaking adjusters for situations when injured workers are more comfortable conversing in Spanish or Creole. TPA should clearly outline the staffing which will be provided. The adjuster shall perform all the usual and customary worker's compensation claim adjustment in accordance with the laws, rules and regulations of the State of Florida. TPA shall provide the City with field case management services, catastrophic case management services, medical cost projections, life care planning, Medicare set-aside assessments, development of reports, surveillance, peer review, utilization review and reasonable and customary savings review, bill review, percentage of PPO savings and any other usual and customary workers' compensation claims administration claims practice, strategy or activity as all allocated loss adjustment expenses, unless such expenses are more appropriately allocated as a medical expense under the claim per Florida Statutes or TPA'sjudgment. • TPA shall provide the City with telephonic case management services on all workers' compensation claims as an allocated loss adjustment expense, unless otherwise directed by City. 9 TPA shall provide a list of PPO networks affiliated with the TPA, as requested by City. DowSign Envelope ID: 6EEOD36E-ABE7416C-6B7C-9D91277D5AD3 • TPA shall evaluate and qualify various service providers recommended by the City to service its account, provided such service providers do not present a perceived or potential conflict of interest. • TPA shall process and handle all electronic data interchange requirements on behalf of the City as required by the State of Florida at no additional charge. • TPA shall be responsible for all Medicare reporting obligations under the Medicare Secondary Payor Act, and/or under similar or new legislation at no additional cost to the City. • TPA shall provide the City with OSHA 300 log reporting capabilities at no additional cost, as requested by City. • TPA shall handle subrogation claims and file lien notices on behalf of the City to protect the City's interests in rights of recovery from third -party tortfeasors. TPA shall not proceed with any legal action against a third -party tortfeasor without the City's Risk Manager's approval. • TPA agrees all negotiated settlement agreements shall require City approval. Such settlements would include but may not be limited to, agreements to wash-out an entire claim, settle a negotiated lien, settle a negotiated attorney fee, or any other type of settlement that is not otherwise considered an administration of a medical, indemnity or allocated expense that would otherwise be due and owed in accordance with Florida law. • TPA shall attend in person or via telephonically all mediations. The City shall endeavor to have a Risk Management staff member, or designee, at all mediations as well as hearings. • TPA shall review and seek approval from the City for any loss reserve adjustment increases greater than twenty-five thousand dollars ($25,000). • TPA shall agree to quarterly claim reviews, whether in person or telephonically at the City's discretion, to review all litigated cases, legacy cases, catastrophic cases, or non -litigated complex cases. 3.5. Record Keeping and Audits • TPA shall agree all claim files, reports, and other data prepared or provided in connection with a claim are and shall remain the property of the City. TPA shall keep complete and accurate records and accounts in connection with each claim. Such records shall be available at all reasonable times for examination by the City, or its' designee, and shall be kept for a period of no less than three (3) years after the completion of all work to be performed. Incomplete or incorrect entries in such records may be grounds for disallowance by City of any fees or expenses based upon such entries. TPA shall send City all closed claim files that are mutually agreed upon to be inactive. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 • TPA agrees to notify the City of proposed or enacted changes in workers' compensation regulatory requirements or legislative acts that may affect the City's claims. • TPA shall agree to maintain a SSAE 16 audit on controls placed in operations and tests for operating effectiveness and agrees to provide copies to the City as requested. • TPA shall take extraordinary measures, if is selected as the new TPA for the City, to ensure data and file conversion and transfer is done with as little disruption to the City and its injured employees to ensure continuity in care and continued best workers' compensation claims management practices. • TPA, as a custodian of records for City, shall comply and cooperate with all applicable City and State record retention and exemptions laws such as, but not limited to, Florida Statutes, Sections, 119, 440, 760 and 112 as they pertain to protected medical, personal and/or work product information. • TPA agrees to transfer or ship the electronic file data or hard copy file data at the request and as directed by the City at no cost other than actual incurred reasonable shipping fees. TPA agrees there shall be no charges to transfer electronic data on a per data file basis or other transfer related fees or charges unless agreed upon in writing by City. All electronic data transferred or hard copy data shipped shall be done within sixty (60) days of receipt of written notice from City. Paper data shall be shipped overnight by FED EX, UPS or equivalent common carrier agreed to by City. Electronic data shall be transferred by disk/tape or over internet as requested by City, provided the data files are adequately protected and secured. Electronic file data means all claims information and related claim file information maintained in an electronic computer file format, whether stored on a hard drive, tape backup or CD. 3.6. Banking, Reporting and Billing • TPA shall utilize the City's solely selected and approved financial institution for the funding of workers' compensation claim payments and settlements. TPA agrees to comply with the City's Positive Pay (fraud detection) banking standards and must do a daily data feed to the City's financial institution for fraud detection. TPA shall send weekly invoices for wire fund transfer requests to replenish the City's account. Exceptions are made for special requests for unexpected large losses or claim settlements for which specific dedicated invoice for wire fund transfer requests shall be made. • The City shall fund at least fifty percent (50%) times the City's average weekly spend on workers' compensation claims. Presently the City's fund maintains an average weekly balance of two hundred and fifty thousand dollars ($250,000). • TPA shall send original invoices to the attention of the City's Risk Manager, or designee, by e-mail to City of Miami Beach, unless otherwise instructed. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D912771)5AD3 • TPA shall mail the City monthly financial institution reconciliations. • TPA shall issue 1099's to all vendor issued allocated claims payments pursuant to the applicable tax laws in effect. • TPA shall be audited by the City at the City's sole discretion and cost. • TPA shall invoice the City quarterly for its administrative claim fee. • TPA will be required to manage the claims with a comprehensive data base system which allows computer access to notes, correspondence and other pertinent information needed by the City to generate analytical data reports upon demand; which will allow secure web based communication between the City and the TPA adjusters. This program should also allow the City to add information to the adjuster notes section of the TPA computer system. TPA shall provide the City's Risk Manager and it's designees, with access and training to utilize the TPA's Risk Management Information System to monitor the adjuster's claim activity on a file. • TPA shall provide the City with electronic loss runs, claim reports or ad hoc reports as required by City within seven (7) working days of month-end. TPA shall provide quarterly claims data and other periodic information to the City's actuarial service provider when required. TPA shall provide safety engineering services as requested by City, and fees shall be negotiated and approved by the City as an allocated loss adjustment expense per applicable claim file. • Other claims adjusting services for Workers' Compensation, as needed. 3.7. Staffing and Personnel It is the City's claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control the City's self-insured loss payments is to ensure the TPA hires and retains the appropriately qualified professionals to handle the City's claims. Additionally, the adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services. The City therefore requires that the proposer agree to staffing, qualifications and caseload criteria established by the City. The City reserves the right to the final prior approval of the hiring and/or assignment of the claims manager, supervisors and adjusters that are to handle the City's claims. The required maximum open caseloads per is as follows: Lost time - 100 Medical only - 500 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-SB7C-9D91277D5AD3 The TPA agrees to add staff as necessary to maintain these maximum pending caseload levels. Claims personnel must be employees of the TPA. The use of independent adjusters, subcontractors or temporary adjusters is not acceptable without prior approval of the City. Adjuster trainees are not acceptable for handling of the City's claims. Additionally, resumes of all claims professionals specifically assigned to this account are to be submitted with this proposal. All claims professionals must possess a current Florida Workers, Compensation adjuster's license. 3.8. Loss Fund Management 1. The Claim Payment Account will be maintained at the City's commercial banking institution. The account will be classified as part of the analysis group of City accounts. The City will pay all service fees that are normal and customary in this account. All interest earned or service credits generated will accrue to the benefit of the City. 2. The TPA is required to follow Florida law concerning public deposits. Failure to comply with Florida law is sufficient cause for the City to terminate the contractual agreement with the TPA. 3. All claims, expense and legal payments will be made by the TPA on checks drawn on an account set up by the TPA and funded monthly by the City. It is understood that all funds in this account are City funds and are to be returned to the City upon request or at termination of this contract. 4. The TPA is responsible for the monthly reconciliation of this account and will provide bank statements to the City monthly, along with a request for a deposit from the City to maintain the monthly balance in the loss fund, as determined by the City. 5. The monthly reconciliation statement submitted by the TPA to the City will include the following: balance at inception of statement period total disbursements which cleared, by date and claimandpayee balance at close of statement period amount of deposit required 6. A list of all checks is to be submitted monthly. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 A4. Special Conditions 1. TERM OF CONTRACT. The term of the Agreement resulting from this RFP shall be for an initial term of three (3) years. 2. OPTION TO RENEW. The City, through its City Manager, will have the option to extend for three (3) additional one-year periods at the City's sole discretion. The successful contractor shall maintain, forthe entirety of any renewal period, the same terms and conditions included within the originally awarded contract. Continuation of the contract beyond the initial period, and any option subsequently exercised, is a City prerogative, and not a right of the successful contractor. 3. ADDITIONAL SERVICES. Services not specifically identified in this request may be added to, or deleted from, any resultant contract upon successful negotiations and mutual consent of the contracting parties, and approval by the City Manager. DocuSign Envelope ID- 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 MIAMI BEACH Cost Proposal Form 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPENDIX B COST PROPOSAL FORM Proposer affirms that the prices stated on the cost proposal form below represent the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance. The Cost Proposal Form (Appendix B) shall be completed in its entirety. All corrections on the Cost Proposal Form (Appendix B) shall be initialed. FLAT ANNUAL FEE ADDITIONAL SERVICES List of services, which may be needed, which are in addition to the fees proposed. Description Telephonic Medical Case Management Fee on All Claims: $ Per Bill/Flat Fee Bill Review Fee to Include State Fee Schedule Reduction: $ Per Bill/Flat Fee Percentage of PPO Savings — Network Discount Savings Below State Fee Schedule: % Percentage Of Utilization Review and Reasonable & Customary Savin s: Subrogation and/or Liens Fee Percentage: Osha 300 Log Reporting: Electronic Data Interchange Filed with State: Safety Consulting Services Notice Of Injury Entry: Custom/Ad Hoc Reports: DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 $ Data and File Conversion Fee: $ One -Time Setup Flat Fee Medicare Reporting Costs: $ Additional Description Of Additional Service: $ Description Of Additional Service: Description Of Additional Service: ' $ Description Of Additional Service: $ DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPENDIX C MIAMIBEACH Insurance Requirements 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 MIAMI BEACH INSURANCE REQUIREMENTS The vendor shall maintain the below required insurance in effect prior to awarding the contract and for the duration of the contract. The maintenance of proper insurance coverage is a material element of the contract and failure to maintain or renew coverage may be treated as a material breach of the contract, which could result in withholding of payments or termination of the contract. A. Worker's Compensation Insurance for all employees of the vendor as required by Florida Statute 440, and Employer Liability Insurance for limits no less than $1,000,000 for bodily injury or disease. Commercial General Liability Insurance on an occurrence basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence, and $2,000,000 general aggregate. C. Professional Liability Insurance in an amount not less than $1,000,000 with the deductible per claim, if any, not to exceed 10% of the limit of liability. D. Cyber Liability with limits no less than $1,000,000 per occurrence and $2,000,000 general aggregate, covering claims involving privacy violations, information theft, damage to or destruction of electronic information, intentional and/or unintentional release of private information, alteration of electronic information, extortion and network security. Additional Insured - City of Miami Beach must be included by endorsement as an additional insured with respect to all liability policies (except Professional Liability and Workers' Compensation) arising out of work or operations performed on behalf of the contractor including materials, parts, or equipment furnished in connection with such work or operations and automobiles owned, leased, hired or borrowed in the form of an endorsement to the contractor's insurance. Notice of Cancellation - Each insurance policy required above shall provide that coverage shall not be cancelled, except with notice to the City of Miami Beach c/o EXIGIS Insurance Compliance Services. Waiver of Subrogation - Vendor agrees to obtain any endorsement that may be necessary to affect the waiver of subrogation on the coverages required. However, this provision applies regardless of whether the City has received a waiver of subrogation endorsement from the insurer. Acceptability of Insurers - Insurance must be placed with insurers with a current A.M. Best rating of A:VII or higher. If not rated, exceptions may be made for members of the Florida Insurance Funds (i.e. FWCIGA, FAJUA). Carriers may also be considered if they are licensed and authorized to do insurance business in the State of Florida. Verification of Coverage - Contractor shall furnish the City with original certificates and amendatory endorsements, or copies of the applicable insurance language, effecting coverage required by this contract. All certificates and endorsements are to be received and approved by the City before work commences. However, failure to obtain the required documents prior to the work beginning shall not waive the Contractor's obligation to provide them. The City DowSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 reserves the right to require complete, certified copies of all required insurance policies, including endorsements, required by these specifications, at any time. CERTIFICATE HOLDER MUST READ: CITY OF MIAMI BEACH Go EXIGIS Insurance Compliance Services P.O. Box 4668 - ECM #35050 New York, NY 10163-4668 Kindly submit all certificates of insurance, endorsements, exemption letters to our servicing agent, EXIGIS, at: Certificates-miamibeach@riskworks.com Special Risks or Circumstances - The City of Miami Beach reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. Compliance with the foregoing requirements shall not relieve the vendor of his liability and obligation under this section or under any other section of this agreement. DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 APPENDIX D MIAMI BEACH Claims Experience REFER TO ATTACHMENT ON BIDSYNC/PERISCOPE 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION PROCUREMENT DEPARTMENT 1 755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 DocuSign Envelope ID. 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPENDIX E MIAMI BEACH Supplemental Questions 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A THIRD -PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 DocuSign Envelope ID: 6EEOD36E-ABE7-416C8B7C-9D91277D5AD3 Supplemental Questions In addition to information that may be provided in your proposal and required elsewhere in the RFP, please answer the following (restate question in each answer): 1. Where is your office located? 2. Number of professional claim, clerical and/or support staff at that location. 3. Name, experience, resume and professional designations of claim manager. 4. Name, experience, license type, resume and professional designations of any supervisory level employees that will have responsibility for this account. 5. Name, experience, license type, resume and professional designations of the designated adjusters that will have responsibility for this account. 6. Advise the current pending case load for each designated adjuster. 7. What is the current number of monthly new assignments to each adjuster? 8. Will the award of this contract necessitate an increase in your staff size to meet the City's staffing and caseload requirements and will that be in place by February 1, 2022? 9. Name two (2) law firms that you currently handle the most cases with. Provide a contact person and phone number. 10. Estimate the percentage of time your adjusters are out of the office doing field work. If all are telephone adjusters, please indicate. 11. Do you utilize independent contracted adjusters? If so, under what circumstances? 12. Name, address, phone and contact person for independent service providers you utilize. 13. Can you provide all the required services with your own personnel? 14. Do your adjusters receive any continuing education and training? Explain. 15. Do you currently file state and excess insurance forms on behalf of your clients? Explain. 16. Do you have the capability to provide all the loss data reports required? Explain. 17. Do you have the ability to transfer the City's prior claims data to your information system by June 1, 2022? 18. Explain any fees proposed for managed care, medical case management, bill review, utilization review and rehabilitation services. These are not to be included in the annual fee proposed. 19. Explain, in detail, any deviation from the services or fee structure type required, specifically indicating any services you cannot perform. Specifically indicate what you consider as allocated expenses and therefore not included in your annual fee proposal amount. DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 ATTACHMENT C SUNBIZ & PROPOSAL RESPONSE TO RFP DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Detail by Entity Name D.VISION OF CORPOR TIONS tr SJ1Y1r wi arl y..owwwO�1 as &rabid Saar u/Ffvi4/d iveLrllr Department of Slate I Division of Corpo i n / Search Records / Search 4y ntty Name / Detail by Entity Name Foreign Profit Corporation CORVEL ENTERPRISE COMP, INC. Filing Information Document Number F08000001441 FEI/EIN Number 42-1704550 Date Filed 03/31/2008 State DE Status ACTIVE 1920 MAIN STREET SUITE 900 IRVINE, CA 92614 Changed: 04/03/2021 Mailing Address 1920 MAIN STREET SUITE 900 IRVINE, CA 92614 Changed: 04/03/2021 @egistered Agent Name & Address CORPORATION SERVICE COMPANY 1201 HAYS STREET TALLAHASSEE, FL 32301-2525 Officer0rector Detail Name & Address Title DIRECTOR, PRESIDENT COMBS, MICHAEL G. 111 SW 5TH AVENUE SUITE 200 PORTLAND, OR 97204 Idle DIRECTOR SCHWEPPE, RICHARD J. https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inqui"pe=EnftyName&diredionType=lnitial&searchNameOrder--CORVEL... 112 DowSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 1920 MAIN STREET SUITE 900 IRVINE, CA 92614 Title SECRETARY O'CONNOR, SHARON 1920 MAIN STREET SUITE 900 IRVINE, CA 92614 Title TREASURER O'BRIEN, BRANDON T. 1920 MAIN STREET SUITE 900 IRVINE, CA 92614 Annual Reports Report Year Filed Date 2019 02/26/2019 2020 01/31/2020 2021 04/03/2021 Document imago 04/03/2021 —ANNUAL REPORT View image in PDF format 01/31/2020—ANNUAL REPORT View image in PDF format 02/26/2019— ANNUAL REPORT View image in PDF format 01/10/2018— ANNUAL REPORT View image in PDF format 04/05/2017 —ANNUAL REPORT View image in PDF format 04/19/2016 — ANNUAL REPORT View image in PDF format 04/25/2015 —ANNUAL REPORT View image in PDF format 04/29/2014 — ANNUAL REPORT View image in PDF format 04/17/2013 — ANNUAL REPORT View image in PDF format I 04/18/2012 — ANNUAL REPORT View image in PDF format 04/20/2011 — ANNUAL REPORT View image in PDF format 04/13/2010 — ANNUAL REPORT View image in PDF format 05/01/2009—ANNUAL REPORT View image in PDF format 03/31/2008 — Foreign Profit View image in PDF format Detail by Entity Name https://search.sunbiz.org/Inquiry/CorporationSeamhtSearchResultDetail?inq uirytype=EntityName&d imctionType=Initial&searGhNameOrderCORVEL... 2/2 DomSign Envelope ID: 6EEOD36E-ASE7-416C-8B7C-9D91277D5AD3 00i0 CORVEL September 8, 2021 �} City of Miami Beach 1700 Convention Center Drive Miami Beach, FL 33139 Attn: William Garviso, CPPB Re: Solicitation 2021 -224 -WG Claims Administration Services by a 31 -Party Administrator for Workers Comp Dear William: CorVel appreciates the opportunity to have built and strengthen our relationship with the City of Miami Beach ("the City") since 2014. We look forward to the privilege of continuing to help you reach your risk management goals. Our purpose is to manage your risk and provide patient advocacy, while reducingyour workers' compensation costs. During our 7 year partnership, there have been numerous achievements CorVel and the City have accomplished by working together. Below are a few results we feel best illustrate the impact on your program: a Maintained a Network Utilization rate of 75%, which is above the state average of 69%. This has resulted in 29% of savings to the City spend • 83% of the City's medication dispensing has been routed through our PBM, which has saved the City an average of $300,000 a year on prescription medications • Maintained a 98.8% generic efficiency rate, resulting in 24% of savings to the City spend • Provided City of Miami results as an "A" submitter in all five criteria measured by the State of Florida As you know, we value our partnership with the City. We know your company, your team and your program — and we know how to deliver the results to make the greatest impact to meet the City's needs. I will continue to serve as the primary contact for the City's program and for this proposal. Please do not hesitate to ask me any questions you may have. I can be reached by telephone at (954) 218-4807 or by email at debbie—popovich@corvel.com. Thank you again for the opportunity to continue to build upon this already strong partnership. Sincerely, Debbie Popovich Senior Vice President, Sales CoNel Corporation 1 1560 Sawgrass Corporate Pkwy, Suite 100 1 Sunrise, FL 33323 1 p 954.233.5901 1 f 866.910.1259 F. - DocuSign Envelope ID: 6EEOD36E-ABE7-416C-887C-9D91277D5AD3 MIAMI BEACH + C.O CORVEL Response to Request for Proposal City of Miami Beach CLAIMS ADMINISTRATION SERVICES BY A 3rd -PARTY ADMINISTRATOR FOR WORKERS COMP Solicitation 2021 -224 -WG September 8, 2021 RVEL DEBBIE—POPOVICH, SENIOR VICE PRESIDENT CORVEL ENTERPRISE COMP, INC. DEBBIE POPOVICH@CORVEL.COM T 954.233.5906 C 954.218.4807 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 MIAMIBEACH Table of Contents ExecutiveSummary ...............................................................................................................................3 Tab 1—Cover Letter and Minimum Qualifications.............................................................................5 SupplementalQuestions..........................................................................................:.......................5 Tab2 - Experience & Qualifications...................................................................................................11 Tab 3—Approach and Methodology..................................................................................................15 Tab4 — Cost Proposal..........................................................................................................................51 Attachments........................................................................................................................................53 C VEL 2 DowSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 EXECUTIVE SUMMARY MIAMIBEACH In an industry concentrated on dollars, CorVel is focused on long-term partnerships to best provide our clients with innovative cost containment and claims management practices in an environment of advocacy for their injured workers. We understand your program. CorVel has been providing the City with workers' compensation services since 2014. During our partnership, we have maintained a Network Utilization rate of 75%, which is above the state average of 69%. This has resulted in 29% of savings to the City spend. In addition, 83% of the City's medication dispensing has been routed through our PBM, which has saved the City an average of $300,000 a year on prescription medications. We have also maintained a 98.8% generic efficiency rate, resulting in 24% of savings to the City spend. In addition, CorVel has provided City of Miami results as an "A" submitter in all five criteria measured by the State of Florida. Our history lays the foundation for our future. At CorVel, we believe our longevity and stability within the industry has allowed us to gain extensive experience to develop technological advances to capture pertinent data and trends. We work closely with employers to reverse the stigmas of an adversarial and costly program. Our unique claims management service model applies technology, intelligence and a human touch throughout the healthcare and disability continuum. Let's keep the conversation going. CorVel hopes you have enjoyed your access to complete visibility of your program and the successes we have shared. In these specific times, challenges are presented and as a team, we have worked through them to create the best outcomes for the City. Cathy Reid, your dedicated Adjuster, will remain for the continuity of the program. Your success is our success, and the accomplishments we have achieved would not be possible without your constant contributions and collaboration. Empowered account management team. Powerful results start with performance -driven partnerships. Jenna Ando, your Account Manager, is enabled with the right resources to continue to make a difference in taking your claims management process to the next level of efficiency and cost-effectiveness. Regardless of the challenges that may arise, we are committed to finding solutions. Taking a collaborative approach. Our claims and medical management teams work together in one system to deliver a single, streamlined solution. The disjointed service models that are typical to the workers' compensation industry are susceptible to costly delays and information getting lost in translation. By maintaining all services in-house and having all parties collaborate within a single platform, CorVel aligns with your patient -centered goals, maximizes efficiency and returns your employees to work sooner. QRVEL DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 EXECUTIVE SUMMARY MIAMIBEACH A better bottom line. Using intelligently designed technology and leading medical expertise from the moment an incident is reported can truly transform your workers' compensation program —your program is a testament to our ability to deliver the right results. We value your business and look forward to an opportunity to continue to build upon our already successful partnership. It is all about getting more value from every dollar spent—and partnering with an expert that can help you reach results. It is the CorVel difference at work. QRVEL DowSign Envelope ID: 6EEOD36E-ABE7116C-887C-9D91277D5AD3 COVER LETTER AND MINIMUM REQUIREMENTS MIAMIBEACH Tab 1—Cover Letter and Minimum Qualifications 1.1 Cover Letter and Table of Contents. The cover letter must indicate Proposer and Proposer Primary Contact for the purposes of this solicitation. Please see pages above for cover letter, table of contents, and executive summary. 1.2 Minimum Qualifications Requirements. Submit verifiable information documenting compliance with the minimum qualification requirements established in Appendix A, Minimum Requirements and Specifications. CorVel has submitted verifiable information under Tab 2—Approach and Methodology. In addition, we confirm that we are a Qualified Servicing Entity with the State of Florida, Department of Financial Services, Division of Workers' Compensation. Please see Attachment A: Florida TPA License. CorVel agrees to the term of contract and option to renew listed in Section A4 of the RFP. We understand that services not specifically identified in this request may be added to, or deleted from, any resultant contract upon successful negotiations and mutual consent of the contracting parties, and approval by the City Manager. 1.3 Supplemental Questions. Submit verifiable information in response to the supplemental questions established in Appendix E, Supplemental Questions. Supplemental Questions In addition to information that may be provided in your proposal and required elsewhere in the RFP, please answer the following (restate question in each answer): 1. Where is your office located? The office that currently services the City is located at: 1560 Sawgrass Corporate Parkway, Suite 100 Sunrise, FL 33323 2. Number of professional claim, clerical and/or support staff at that location. There are about 50 employees located in our Sunrise location. RVEL 5 DowSign Envelope ID: 6EEOD36E-ASE7416C-867C-9D91277DSAD3 COVER LETTER AND MINIMUM REQUIREMENTS MIAMIBEACH 3. Name, experience, resume and professional designations of claim manager. The current Claims Manager for the City's account is John Klasko. He has been on the City's account since April 2020 and will continue to serve on your account. Please see Attachment B: Resumes of Key Personnel for his resume. 4. Name, experience, license type, resume and professional designations of any supervisory level employees that will have responsibility for this account. The current Claims Supervisor for the City's account is Janet Ondina. She has been assigned to your account since February 2020 and will continue to serve on your account. Please see Attachment B: Resumes of Key Personnel for her resume. Name, experience, license type, resume and professional designations of the designated adjusters that will have responsibility for this account. The following Adjusters are currently assigned to the City's account: • Cathy Reid, Dedicated Senior Claims Adjuster • Sara Dreffer, Senior Claims Adjuster • Tina Ross, Claims Adjuster • Kathy Riggins, Claims Adjuster • Gladymar Aponte, Medical Only Adjuster All of the current Adjusters will continue to serve on your account. Please see Attachment B: Resumes of Key Personnel for their resumes. 6. Advise the current pending caseload for each designated adjuster. The Lost Time Adjusters currently assigned to the City's account hold a maximum of between 100-150 files at one time. Medical Only Adjusters carry a maximum of 200-250, per our best practices. Col -Vel has added an additional Adjuster to the program to help with the overflow and we are continuing to re -assign claims in order to meet the claim count requirements. 7. What is the current number of monthly new assignments to each adjuster? 00 CORVEL 1 i. DocuSign Envelope ID6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 COVER LETTER AND MINIMUM REQUIREMENTS MIAMIBEACH Indemnity Adjusters receive an average of - 12 new claims per month. Medical Only Adjusters receive 32 - 40 new claims per month. Adjusters are assigned new claims according to their current caseload and experience level. The Supervisor reviews the claim, assigns it to the appropriate Adjuster and provides direction on the future handling of the claim. We manage claims based on a claim being complex or non-complex and assign the claim to an Adjuster experienced in that type of claim. A complex claim may be a claim that has an open or extended period of disability benefits paid. A non-complex claim may be a simple medical only claim. We also have individuals that specialize in subrogation, recoveries and offsets, litigation management, hearing file preparation, medical fee bill management processing and complex claims. 8. Will the award of this contract necessitate an increase in your staff size to meet the City's staffing and caseload requirements and will that be in place by February 1, 2022? No, CorVel already has personnel assigned to the City's account and will not require an increase in staff size. Should caseload increase, CorVel will assign more personnel to your account. 9. Name two (2) law firms that you currently handle the most cases with. Provide a contact person and phone number. CorVel currently works with the following local law firms: Law Offices of Luis Estrada, LLC Handles all presumption cases Contact: Luis Estrada, Esq. Phone: 786-505-2306 Email: lestrada@estradalaw.net Neret, Finaly and Nguyen, LLC. Contact: Peter Nguyen, Esq. Phone: 305-423-3820 Email: peter@nguyen-law.com 10. Estimate the percentage of time your adjusters are out of the office doing field work. If all are telephone adjusters, please indicate. CorVel's Adjusters do not spend any time out of the office doing field work. Our Adjusters are all telephone Adjusters. RVEL 7 DowSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 COVER LETTER AND MINIMUM REQUIREMENTS MIAMIBEACH CorVel is currently in partnership with G4S Compliance and Investigation, a nationwide surveillance company that provides onsite investigations and appraisals. The CorVel Adjuster will always maintain responsibility for the claim during the investigation. 11. Do you utilize independent contracted adjusters? If so, under what circumstances? No, we do not utilize independent contracted Adjusters. All of our Adjusters are employed by CorVel. 12. Name, address, phone and contact person for independent service providers you utilize. CorVel does not utilize independent service providers. 13. Can you provide all the required services with your own personnel? Yes, an advantage of our service model is that we provide all core claims and managed care services in-house through a fully integrated program. Services are delivered by CorVel employees who are all working together on one system, using real time information and smart technologyto better assist injured workers and improve outcomes. We only use subcontractors for support services such as defense counsel, legal bill review and outside investigation. 14. Do your adjusters receive any continuing education and training? Explain. Yes, CorVel conducts initial and ongoing training and development programs for all our claims personnel. We ensure claims personnel stay current on new developments in workers' compensation laws and regulations to further enhance their skills, ensuring they continue to meet CorVel's customer service standards. Our training program addresses the needs of the highly specialized lines of insurance coverage in today's environment including entry level claims management to advanced claims techniques, telephone etiquette to address difficult callers, and policies and procedures regarding the latest benchmark management reporting. In addition to our own internal and industry sponsored staff training programs, CorVel also conducts bi-annual seminars for our claims personnel. These workshop style conferences allow us to share our experiences as well as those of our clients, and provide clear, step-by-step advice about claims management, industry trending and reporting procedures. QRVEL DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 COVER LETTER AND MINIMUM REQUIREMENTS MIAMIBEACH CorVel also promotes professional development of our staff through our educational reimbursement program. This program encourages Claims Assistants, Adjusters and Supervisors to pursue educational opportunities. Claims Assistants are encouraged to take Insurance Education Association courses. All relevant education opportunities are fully reimbursed by CorVel. We will also pay the costs to take a self-insured certification test. CorVel also provides ongoing training sessions as they relate to changes to legislation. In addition, we invite various consultants and experts to provide training sessions in their particular areas of specialty. 15. Do you currently file state and excess insurance forms on behalf of your clients? Explain. Yes, we currently file state and excess insurance forms on behalf of our clients. CorVel will report to all states in which state reporting is required on behalf of the City and according to the state's guidelines. If required by the state, we will submit the reporting data via EDI. We run state reports on a weekly basis. Our system reports to states based on the submitter information provided by the state. Any case that has reached 50% of the City's self-insured retention level, or has the potential to exceed it, shall be reported to the City and the excess insurer in accordance with the reporting criteria established by the excess insurer. All cases that meet the established reporting criteria are to be reported to the City within 30 days of when the known criterion is met. 16. Do you have the capability to provide all the loss data reports required? Explain. Yes, CorVel will continue to provide the City with comprehensive reports detailing every aspect of your program, enabling the City to make a proper analysis of its exposure. Loss reporting information is available on a monthly basis and in various time formats, history periods, including "as of," and actual time. The City also has access to create reports through the online reporting center where more than 1,000 data fields can be sorted to organize reports by any lapsed time period, hierarchical sub group, dollar range, time of day/week, coverage or sub classification, or any one of thousands of other combinations. We can consolidate information based on the number of incidents or injuries, costs, etc., per department or division and provide various comparative ratios and averages. Safety/risk management reports will include the same detailed accident listings and accountability. We summarize incidents or injuries by coverage line, injured worker name, type, and age, cause, injury type, occupation, location, supervisor, and incident or injury date/time of day. Loss experience, payments comparisons and localized benchmarking reports are also available. �wRVEL 9 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 COVER LETTER AND MINIMUM REQUIREMENTS MIAMIBEACH The following are examples of CorVel's standard claims reports • Claims Scorecard Report • Financial Analysis Report • General Claims Listing for • Safety Analysis Report Open/Closed/All Claims • Loss Development Report • New Claims Received Report • Demographics • Status Change Activity Report • Mechanism of Injury • Claim Payment Register • Workers' Compensation Lag Report • Claim Payment Summary • Escrow Activity Report • Overall Payment Summary by Type • Lost Day Reporter of Payment • Location Loss Summary • Overall Payment Register for Period • Denied Claim Report • Detailed Loss Report • Litigated Claim Report • Loss Summary by Policy Period Please see Attachment C: Sample Claims Reports. 17. Do you have the ability to transfer the City's prior claims data to your information system by June 1, 20227 As the incumbent, all of the City's claim data is in or system. 18. Explain any fees proposed for managed care, medical case management, bill review, utilization review and rehabilitation services. These are not to be included in the annual fee proposed. Please see the Tab 4 - Cost Proposal for explanation of fees. 19. Explain, in detail, any deviation from the services or fee structure type required, specifically indicating any services you cannot perform. Specifically indicate what you consider as allocated expenses and therefore not included in your annual fee proposal amount. Deviations Appendix C Insurance Requirements Exceptions: • Waivers of Subrogation shall be provided for Workers' Compensation and General Liability coverages only. • Section 16 Form: CorVel will review the City's form of Ethics. Based on the current onsite relationship, this has not posed any issues. Allocated Expenses Allocated loss adjustment expenses (ALAE) are defined as expenses associated with handling a claim other than payments for the loss itself. These include legal fees, court costs, expert witness fees and investigation fees. QRVEL 10 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 EXPERIENCE & QUALIFICATIONS Tab 2 - Experience & Qualifications MIAMIBEACH 2.1 Qualifications of Proposing Firm. Submit detailed information regarding the relevant experience and proven track record of the firm and/or its principals in providing the scope of services similar as identified in this solicitation, including experience in providing similar scope of services to public sector agencies. As part of its response list project(s) with experience being a Third -Parry Administrator ("TPA") for Workers' Compensation for Florida local government(s) for a minimum of five (5) consecutive years. For each project that the Proposer submits as evidence of similar experience for the firm and/or any principal, the following is required: project description, agency name, agency contact, contact telephone & email, and year(s) and term of engagement. For each project, identify whether the experience is for the firm or for a principal (include name of principal). Company History CorVel has over 35 years of experience as a national provider of healthcare management solutions for employers, insurance companies and government agencies seeking to control costs and promote positive outcomes. We apply technology, intelligence, and a human touch to the challenges of workers' compensation, allowing us to facilitate early intervention and medical management at the onset of an injury while being connected to the critical information needed to proactively manage claims. We have approximately 3,800 associates who serve more than 1,000 customers through a national branch office network covering all 50 states. Our decentralized management model allows us to provide strong local support to our customers, while being supported by national resources, processes and systems. CorVel is publicly traded (NASDAQ:CRVL) with annual revenues exceeding $552 million in fiscal year 2021. Our financial strength and the depth of our comprehensive service offering have enabled our company to remain independent and stay focused on delivering innovative, technology -driven solutions that achieve industry-leading results. Municipality Experience CorVel and the City have had a partnership for over 7 years. Working with the large majority of municipal community in the tri -county south Florida area, we gain experience with all of our partners that create better results in the state of Florida. The City has been on the forefront of legislative changes and local evolving high profile first responder rules. As a mutual team, we have always placed the City as a partner of value. CcrVel's dedication to the City has a proven track record of high responsiveness and collaboration with the medical and adjusting team. Every partnership has nuances that come up, but together we have resolved and built an advocating program for the City. CRVEL 17 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 EXPERIENCE & QUALIFICATIONS MIAMIBEACH During the current COVID-19 crisis, the City has been impacted and this situation has affected many of the employee's lives, most of them first responders. CorVel's Case Managers have been medically managing these employees and evaluating their care. Our medical case management team makes sure that the employees are treated in a quick manner. Our follow through supports return to their normal job duties as they were pre -exposure. Our statistics reflect most of our COVID-19 cases have been closed within 3 months. We could have never expected the times that came upon the world but through it all, our partnership rose to the occasion and worked through the challenges. Across the nation, CorVel provides third party administration services for more than 110 municipalities and public entities across the United States which include cities, counties, states, public transportation and public education clients. Although there are many similarities with municipal customers, there are also unique pieces to each program which include: • Wages for benefit calculations with different payment types and rates • Employees who work various shifts (police/fire) • Presumptive laws for cancer, heart/lung and PTSD • Light duty programs if unions do not allow cross over work in other departments • Multiple unions Our Adjusters are well versed in working through these challenges and partnering with our municipal customers to implement processes and special account instructionsto properly manage these claims while ensuring injured workers are getting the treatment they need to return to work. Florida governments we currently serve include: • City of West Palm Beach • City of Fort Lauderdale • City of Hollywood, FL • City of Orlando • City of Pompano • Miami -Dade County- full medical management self-administered • Florida League of Cities — Network and state of Florida EDI/re-pricing For an example of our success in managing large municipal customers, please see Attachment D: State of Tennessee Case Study. Experience with City of Miami Beach CorVel has served as the City's third party administrator since 2014 and has made a positive impact on your workers' compensation program year over year during our 7 year partnership. We've worked closely together from the beginning to learn about your organization, valued employees and program goals in order to deliver tailored solutions that provide meaningful results. We continue to cultivate a strong partnership by taking the time to understand your changing needs through proactive communication and account managementand adjustingthe program to ensure quality and consistent service is provided across your organization. 4 RVEL 12 DowSign Envelope ID: 6EE0D36E-ABE7-416C-887C-9D91277D5AD3 EXPERIENCE & QUALIFICATIONS MIAMIBEACH We are highly experienced in managing workers' compensation programs in Florida and leverage our jurisdictional expertise to ensure your claims are handled in compliance with local rules and regulations while serving as an advocate for your injured workers. Recently, CorVel worked with the City on a case where your injured worker had bilateral wrist fractures and a head injury. CorVel's Case Manager was able to get a sedentary release after the wrist surgeries and your injured worker was accommodated until released to full duty. Because of the early intervention and the physicians securing releases to return to work, the City experienced considerable savings in ISC payments togetherwith lowered medical costs. Normally, Replacement costs alone would be 3 months for the 2 claims noted. Once a worker can return to work, the physical therapy costs go down since we can get them transferred to a local facility and out of the surgeon's offices. TPA of the Year Award CorVel has been named Third Party Administrator Team of the Year at Business Insurance's 2020 U.S. Insurance Awards for our innovative work with the State of Tennessee. The U.S. Insurance Awards program honors teams of professionals who demonstrate excellence through their work on specific projects. We are also a finalist for TPA of the Year Award for 2021. Please see Attachment E: 2020 TPA Award. References The following are references demonstrating CorVel's experience as a workers' compensation third party administrator for Florida local governments. City of West Palm Beach Description: Workers' compensation and managed care services. Contact: Timothy Scott, Director Phone: (561) 494-1136 Email: tscott@wob.org Tenn: 2011— current Miami Dade County Description: Workers compensation medical management, network, RX and RMIS. Contact Baunie McConnell, Director Phone: 305-375-3583 Email: Baunie.McConnell@miamidade.gov Term: 2012 -current City of Pompano Beach Description: Workers' compensation TPA services, managed care services, and liability services. Contact: Cindy Lawrence, Director of Risk Phone: (954) 786-4636 Email: cindv.lawrence@coobfl.com Term: 1999 — current CORVEL 13 DowSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 EXPERIENCE & QUALIFICATIONS MIAMIBEACH 2.2 Qualifications of Proposer Team. Include proposed primary contact for the City of Miami Beach, and a secondary contact to serve in the absence of the primary contact. Submit resumes of proposed primary and secondary contact persons for verification purposes. Additionally, provide an organizational chart of all personnel and consultants to be used for this project if awarded, the role that each team member will play in providing the services detailed herein and each team members' qualifications. A resume of each individual, including education, experience, and any other pertinent information, shall be included for each Proposal team member to be assigned to this contract. Debbie Popovich, Senior Vice President of Sales, will continue to serve as the primary contact for the City's program and for this proposal. She can be reached by telephone at (954) 218-4807 or by email at debbie_popovich@corvel.com. Jenna Ando, your Account Manager, will serve as a secondary contact and can be reached by telephone at (954) 547-6707 or by email at jenna_ando@corvel.com. Cathy Reid, your dedicated Adjuster will continue to serve as the main Adjuster liaison to the City. The key personnel that are currently assigned to the City's account will remain on your account. Your current claims teams and key personnel include: • Jenna Ando, Account Manager • Cathy Reid, Dedicated Senior Claims Specialist • Sara Dreffer, Senior Claims Specialist • Tina Ross, Claims Adjuster • Kathy Riggins, Claims Adjuster • Gladymar Aponte, Medical Only Adjuster • Janet Ondina, Claims Supervisor • John Klasko, Claims Manager • Gina Pollard, Case Management Manager Please see Attachment B: Resumes of Key Personnel and Attachment F: Organizational Chart. �WRVEI 14 DowSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 APPROACH AND METHODOLOGY Tab 3—Approach and Methodology MIAMIBEACH Submit detailed information on how Proposer plans to accomplish the required scope of services, including detailed information, as applicable, which addresses, but need not be limited to: • Excess Workers' Compensation Liability Insurance — TPA shall comply with all excess workers' compensation coverage agreements in place; including reporting requirements affording potential or existing coverage on all and any open (or re -opened) claims such as, but not limited to reporting. CorVel maintains responsibility for excess carrier reporting and will report claims that have reached 50% of the City's self-insured retention level to the excess carrier in accordance with their reporting requirements. Depending on the requirements, claims may be reported immediately or up to 30 days after the claim becomes reportable. Updates are provided every 90 days or when there are significant changes in the direction of the claim. In addition to the requirements above, we report all catastrophic claims to the excess carrier, regardless of the dollar amount. These may include: • Fatalities • Amputation of a major extremity • Spinal cord — quadriplegic, hemiplegic and paraplegic injuries • Brain and brain stem injuries • Comas • Burns over more than 25% of the body • Severe disfigurement and scarring, where applicable • Loss of eyesight • Loss of hearing • Heart attacks • Strokes • Multiple surgical interventions • Rape and sexual assault • Post -Traumatic Stress Disorder • Occupational disease claims • Non-union of bone fractures • Damage to organs— lungs, liver, heart, stomach, etc. TPA shall be responsible for any penalties, declined coverage, reservation of rights issued, diminished coverage benefits imposed by Citys excess workers' compensation carrier(s) due to TPA's failure to properly report new or existing claims as required by each carriers' coverage agreement reporting requirements. CorVel will be responsible for any penalties, declined coverage, reservation of rights issued, diminished coverage benefits imposed by City's excess workers' compensation carrier(s) due to our failure to properly report new or existing claims as required by each carriers' coverage agreement reporting requirements. RVEL 15 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY • Claims Handling of Past and Future Claims MIAMIBEACH All proposers are to assume the complete handling of all future and past claims now being handled by our present TPA (see Appendix G for open/closed claims for all years), along with all new claims. The information provided regarding the volume and type of pending claims to be assumed is based on the latest information provided to the City and cannot be guaranteed as to its accuracy. If the amount of prior claim files to be taken over is 25% greater than represented in this RFP, the City will consider a proportionate adjustment to the proposer's flat annual fee. It is the responsibility of the proposer to review prior claim files to determine the additional proposed cost, if any, to take over these files. It is also required that the claim data associated with all claims occurring prior to February 1, 2022, be transferred into the proposer's computer information system, so that future loss runs will contain a complete history of all claim years. The transfer of all claims data must be completed by June 1, 2015. The proposer is responsible for specifically indicating in their proposal the fees, if any, for assumption of prior claims and the data conversion. The program is run on an "occurrence" basis, therefore, all claims occurring in the contract year, regardless of when reported, are to be handled per the requirements of this agreement. The TPA is required to handle all claims to their conclusion or to the conclusion of the contract, whichever occurs first, at no additional charge to the City other than the annual fee. The contract may be terminated by either party with ninety (90) days written notice to the other. However, any cancellation does not alter the administrator's obligation to handle all claims prior to the termination date. As the City's current TPA, all of the City's current claims are being handled by our Adjusters and are in our system. CorVel will continue to work diligently to close claims quickly and effectively. We agree to handle all claims to their conclusion or to the conclusion of the contract, whichever occurs first, at no additional charge to the City other than the annual fee. • Claims Administration The City requires that the selected TPA provide, at a minimum, the following professional services related to the administration of the City's self-insured Workers Compensation Program: — TPA shall provide workers compensation third -party claims administration services to the City of Miami Beach's self-insured workers' compensation program in accordance with Florida Statute, Section 440, applicable Florida Administrative Code(s), and applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s). City shall provide TPA with copies of applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s) as necessary. Services include the necessary medical benefits, expenses, and other services usual and customary to the administration and management of workers' compensation claims, if not otherwise noted herein. 4; CORVEL �6 DowSign E vWwe ID: SEEOD36E-ABE7d16C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH CorVel is aware of the Collective Bargaining Unit and will continue to follow the City's account guide as to the rules regarding Supplemental Pay in the State of Florida. We stay active in the regulatory environment of our industry. Our involvement starts at the state level with the primary office in Florida. Information for Florida is gathered nationally and collated. We track both state and federal legislative and regulatory changes that affect any of the services we provide. CorVel hosts training and informational meetings to keep our claims personnel current on recent updates to workers' compensation laws, claims handling techniques, and rules and regulations. Meetings also including up to date information about investigations, fraud identification, subrogation and litigation management. — TPA shall provide, on behalf of the City, all self -insurer reporting to the Self Insurance Bureau, Division of Workers' Compensation, State of Florida, all annual reports, unit statistical, modification factor, assessment indemnity, medical and any and all forms required by the State of Florida which a self -insurer for workers' compensation must provide. CorVel will continue to provide all reports and forms as required by the State of Florida, including but not limited to all self -insurer reporting to the Self Insurance Bureau, Division of Workers' Compensation, State of Florida and all annual reports. If required by the state, we will submit the reporting data via EDI. We run state reports on a weekly basis. Our system reports to states based on the submitter information provided by the state. — TPA shall accept all current claims and/or re -opened claims as run-in claims to the TPA if selected as the new TPA for the City. As the City's current TPA, all of the City's current claims are being handled by our Adjusters and are in our system. — TPA shall provide the City with the ability to report first reports of injury and loss notices electronically for all claims, and, by phone based on the severity, circumstances or nature of injury, at no additional cost. CorVel's early intake process promotes immediate and convenient access to report an injury or incident to improve return to work results. For immediate care, we recommend reporting incidents through our Advocacy 24/7 program. Claims can also be reported through our website (www.caremc.com), toll free call center or faxed. The data for all reported claims is immediately entered and an electronic file is created typically within four hours of claim receipt. Claims are processed by our proprietary rules engine and assigned to an Adjuster within one business day or less of initial receipt while medical management begins immediately as needed. QRVEL 17 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D6AD3 APPROACH AND METHODOLOGY MIAMIBEACH — TPA shall provide automated acknowledgement upon the receipt of each claim. The acknowledgement shall include, but not be limited, to the following: claim number, claimant's name, and date of loss, one-time prescription drug authorization. CorVel will continue to provide automated acknowledgement upon the receipt of each claim. The acknowledgement includes claim number, claimant's name, and date of loss, one-time prescription drug authorization. We can text or email pharmacy card information directly to an injured worker's mobile device so they can quickly obtain a one-time prescription drug authorization for their first fill. — TPA shall setup all new claims within twenty-four (24) hours after notification. Assigned adjuster, supervisor, telephonic case manager, or nurse case manager shall make all contacts and initiate investigation within forty-eight (48) hours of receipt of new claims. All new claims are typically set up in the system within 4 hours of receipt. Claims are processed by our proprietary rules engine and assigned to an Adjuster within one business day or less of initial receipt while medical management begins immediately as needed. CorVel's best practices require three point contact with the City, the injured worker and physician within one business day of receipt of an indemnity claim or medical only claim with lost time potential. However, our claims staff regularly exceed this expectation and perform three point contact within four business hours of receipt of the claim. Investigation begins within 24 hours of claim receipt and involves timely and thorough fact gathering. All claims identified as complex will have a comprehensive initial investigation performed with detailed file documentation that addresses compensability, evaluates possible exposure and outlines the future plan of action. Three point contact with the injured worker, the City, and physician will be initiated within 24 hours and completed within 48 hours. Situations preventing completion within 48 hours will be documented and additional efforts will be made to contact each party, including the use of email and regular mail (certified letter to the injured worker). Once the investigation phase is complete, a determination of compensability is made. The initial plan of action is initiated within two business days of claim receipt. On all open active claims, where compensation benefits are being paid, the file will be updated at a minimum of every 30 days. For all other indemnity claims, the plan will be updated every 90 days. Upon completion of the initial contacts and investigation, an accurate reserve reflecting the expected cost of the claim is entered into the claims system no later than five days after claim receipt. Reserve levels are based on the information known about the claim at that time. The reserve review performed at 30 days includes a reserve worksheet detailing the reserve amount and any additional information received. Reserves will be reviewed every 90 days thereafter. luRVEL 18 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH — TPA shall triage every notice of injury with a with appropriate claims professional or triage system. CorVel provides an Advocacy 24/7 program for the City's employees, 24 hours a day, 7 days a week. At the time of the incident, employees can call and speak with a registered nurse who will evaluate the nature of the incident or injury and determine the employee's immediate medical needs. By addressing the case when it first occurs, we are able to provide quick and accurate care intervention, often helping to prevent a minor injury from becoming an expensive claim. CorVel's staff of registered nurses are licensed in all 50 states and advocate timely return to work with quality care for your employees. Our nurses use nationally recognized triage protocols to help determine the appropriate level of care needed with industry standards to facilitate appropriate treatment options. These protocols, developed by our clinical team, include Telehealth as a level of care. The nurse serves as a health advocate for the injured worker in addition to serving as the initial historian of the incident as reported by the injured worker. In addition to our triage protocols, we transitioned the industry standard pain scale to our own proprietary orthopedic based pain assessment tool, which has reduced unnecessary referrals to brick and mortar providers. This pain scale provides a more accurate assessment of the pain level and level of care needed for the injured worker. We also have the unique ability to view lacerations and burns by using the same HIPAA compliant software that we use forTelehealth. The nurse can make a better clinical determination of care needed in cases where the injured worker can't articulate an accurate description of the wound, i.e. sutures, medical examination, etc. Once the triage nurse determines the appropriate level of care, based on the responses provided by the injured worker and based on the triage protocols, the care setting is discussed with the injured worker for agreement. We provide an opportunity to educate the injured worker on the level of care whether an outpatient clinic, the emergency room or Telehealth. Upon consent of the injured worker, the call is then transferred to a concierge agent to assist the injured worker with provider selection. Emergency Room — closest emergency room to the injured worker Outpatient Clinic— closes network facility either to the job location or home Telehealth — assist with downloading the Virtual Medicine app and entry into the virtual waiting room. The app will indicate the wait time to the caller and the agent will offer to stay on the line with the caller until the physician is ready to see the injured worker. RVEL 19 DowSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277DSAD3 APPROACH AND METHODOLOGY IAT�N MINA/■ — TPA shall utilize any recommended medical primary care physicians or specialists as directed by City's Risk Manager, even if not in the TPA's network, if it is in the best interest of the injured employee or the City. This would include authorizing treatment by non -occupational or non - network physicians or providers who have treated an injured employee under emergency or exigent circumstances in an emergency room or other facility, if such treatment would be considered prudent and reasonable for continuity of care purposes. CorVel agrees to continue to recommended medical primary care physicians or specialists as directed by City's Risk Manager, even if the physician is not in -network, if it's determined to be in the best interest of the injured employee or the City. For in -network care, we provide the City with a proprietary national PPO network comprised of more than 53,200 providers and specialties in Florida, and 750,000 nationwide, to offer the City local insight with national coverage. Providers are selected from a demanding criteria based on quality, range of services and location. Each provider is thoroughly evaluated and credentialed, then re -credentialed every three years. Through this extensive evaluation process, we are able to provide significant hospital, physician and ancillary medical savings while maintaining high quality care. Local Development CorVel has a nationwide team of local PPO developers with community knowledge in order to develop a network that offers quality and choice. Our dedicated PPO developers are responsible for local recruitment, contract negotiations, credentialing and re-credentialing of providers as well as developing customer specific networks. We use a proprietary, national database of CorVel providers that is managed and updated locally by our developers. Provider Look -Up CorVel offers provider look -up on our website, www.corvel.com, or our healthcare portal, www.caremc.com, where users can locate providers in their area, see a map, get door to door driving directions, or print a directory. We offer other avenues in which to channel injured workers to our providers including case manager referrals, inquiry emails and customized provider panels. The Advantage CorVel's network of providers offer the City the most comprehensive casualty specific network available. We maintain direct contracts with our providers, allowing us to deliver significant discounts below workers' compensation fee schedules and reasonable and customary rates. We offer penetration and savings reports that are available in real time on our healthcare portal, www.caremc.com. Additional advantages include: • Specific provider panels for the City's locations • Network managed locally, supported by national secure database • Providers are evaluated with casualty specific criteria • Ability to refer care to CorVel's ancillary benefit management program • Integrated with our proprietary bill review solution QRVEL 20 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH — The City reserves the right, but not the obligation, to approve all vendor partners and ancillary services used by the TPA that are part of the workers' compensation allocated claim expense or reserve. CorVel agrees and will comply. CorVel's software, systems and staff are direct resources of our company. We currently do not outsource or utilize any significant subcontractors with the exception of defense counsel, outside investigation and appraisals. The City is able to approve all vendor partners and ancillary services used. City reserves the right to select its own workers' compensation defense counsel to manage any and all litigation for the City's workers' compensation and employers liability program, and/or to seek pre -litigation legal advice and claim strategy. The City's Risk Manager has the authority to approve the workers' compensation defense counsel's fee, cost schedule and/or any allocated legal claim adjustment expenses. TPA shall agree to work with the City's chosen workers' compensation defense counsel. In the event the TPA is unable to work with the City's workers' compensation defense counsel or has a conflict of interest, then City reserves the right to deem the TPA's proposal non-responsive, or terminate the TPA's Contract. CorVel acknowledges the City's right to select its own workers' compensation defense counsel to manage any and all litigation. We are experienced in working with City's preferred defense counsel and maintain clear and proactive communication with all parties to help facilitate a successful outcome. We honor the City's Risk Managers authority to approve the workers' compensation defense counsel's fee, cost schedule and/or any allocated legal claim adjustment expenses. — TPA must provide access to Spanish and Creole speaking adjusters for situations when injured workers are more comfortable conversing in Spanish or Creole. TPA should clearly outline the staffing which will be provided. The adjuster shall perform all the usual and customary workers compensation claim adjustment in accordance with the laws, rules and regulations of the State of Florida. CorVel provides the City's injured workers with access to Spanish and Creole speaking staff either through an Adjuster or our translation services. We can coordinate onsite and telephonic translation services and offer support for more than 200 languages including Spanish and Creole. The claims staff assigned to the City include: • Cathy Reid, Dedicated Senior Claims Adjuster • Sara Dreffer, Senior Claims Adjuster • Tina Ross, Claims Adjuster • Kathy Riggins, Claims Adjuster RVEL 21 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY • Gladymar Aponte, Medical Only Adjuster • Janet Ondina, Claims Supervisor • John Klasko, Claims Manager • Gina Pollard, Case Management Manager r�t', ■ .•■ Claims Adjusters are responsible for providing all usual and customer workers' compensation claim adjustment in accordance with the laws, rules and regulations of the State of Florida. All claims staff receive comprehensive training related to the developing changes and case law decisions affecting permanent disability, apportionment and utilization review. Every month CorVel's claims staff receive an in-service training focusing on new industry developments and legislation. In addition, we offer a bi-annual training seminar which focuses on new legislation, industry trending, medical or investigation advances, and/or ergonomics. Please see Attachment B: Resumes of Key Personnel — TPA shall provide the City with field case management services, catastrophic case management services, medical cost projections, life care planning, Medicare set-aside assessments, development of reports, surveillance, peer review, utilization review and reasonable and customary savings review, bill review, percentage of PPO savings and any other usual and customary workers' compensation claims administration claims practice, strategy or activity as all allocated loss adjustment expenses, unless such expenses are more appropriately allocated as a medical expense under the claim per Florida Statutes or TPA's judgment. CorVel will continue to provide the City with the services mentioned above as well as any other usual and customary workers' compensation claims administration claims activity as allocated loss adjustment expenses, unless such expenses are more appropriately allocated as a medical expense under the claim per Florida Statutes or our judgment. Field Case Management Services Field case management is a method of evaluating and coordinating medical care for claims characterized by high severity or related difficulty and complexity. It is the preferred method when intervention should be intensive in nature and involves Field Case Managers with expert knowledge of the local medical communities and labor markets who engage in face-to-face meetings with key parties to ensure medical care is appropriate, high quality and cost effective. Catastrophic Case Management Services CorVel's catastrophic case management service provides access to an on-call nurse, 24 hours per day, 7 days per week, to facilitate an immediate response to a catastrophic injury. Upon notification, the claim will be immediately referred to a Catastrophic Case Manager experienced in critical care and acute injuries. Instant communication is established as the Case Manager coordinates treatment while guiding the patient through the critical episode of care and recovery. �WRVEL 22 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D6AD3 APPROACH AND METH 0 DO LO GV MIAMIBEACH The Catastrophic Case Manager will contact the hospital where the injured worker has been admitted and arrange an onsite visit with the injured worker, the injured worker's family and the medical providers involved with their treatment. The Catastrophic Case Manager will continue to communicate with the providers and injured worker on a daily basis until the acute phase has passed. Early intervention in catastrophic cases can result in significant medical, indemnity, legal and overall claims savings. Medial Cost Projections CorVel sets reserves that are current, realistic and based on the probable cost of each claim. Within 24 hours of assignment, the Adjuster initiates three point contact with the injured worker, physician and the City to gather information to set an initial reserve which is reviewed and approved by the Claims Supervisor. The reserve is set within five business days of claim receipt and put into one or more of the following categories: medical, indemnity or allocated loss adjustment expense. Our Adjusters use a detailed reserve worksheet to help determine the expected costs of the claim. The worksheet requires the Adjuster to document the reasoning behind their projections which can include the nature and extent of the injury, level of investigation required and if the claim involves lost time, litigation or vocational rehabilitation benefits. Adjusters review reserves every 90 days and within 5 days of receipt of new information. We have an event driven diary that alerts Adjusters of activity that may affect the value of the claim so they know when to review reserves for possible adjustments. Claims Supervisors review reserves for accuracy at 14 days, 45 days, then every 90 days as part of their regular claim review process. Our Adjusters are fully trained in rating medical reports and accurately assessing the extent of disability. This skill, along with the support of our event driven diary system ensures that reserves remain accurate through claim closure. Reserve authority is granted to an Adjuster based on the claims handling agreement established with the City. Life Care Planning CorVel offers certified Life Care Planners to aid in cost containment for catastrophic injuries, while advocating quality care for patients. Life Care Planning is a tool used to project long-term future needs, services and related costs associated with a catastrophic injury. CorVel's Life Care Plans summarize extensive amounts of medical data and compiles it into a comprehensive report for future care requirements. The report assists with future cost projections while identifying the continuing medical care needs of the injured individual. RVEL 23 DowSign Envelope ID: 6EEOD36E-ABE7-416G8B7G9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH Medicare Set -Aside Assessments CorVel has provided Medicare services since 2001. Our certified Medicare Secondary Payer Consultants nurses are members of the National Alliance of MSA Professionals and have a long standing relationship with the Centers for Medicare/Medicaid Services (CMS). We provide a complete Medicare Secondary Payer compliance option with Medicare Set -Aside (MSA) report preparation and Medicare Conditional Payment resolution both completed by the same nurse familiar with the claim. We reference the Official Disability Guidelines to allocate MSA cost projections based upon experience with CMS and evidenced based medicine. With the City's approval, CorVel's Medicare services team will collaborate with professional administration companies to assist the City with the attractive settlement options. Utilizing professional administration companies to process post settlement medical payments can extend the longevity of the funds through PPO savings and utilization of fee schedule pricing. MSA services include: • Comprehensive allocation reports • List of treatment and associated costs • Verification of Medicare beneficiary and Social Security Disability eligibility status • Rated age • Submission of MSA reports to CMS for review and approval • Submission of final executed settlement documents to CMS to finalize MSA review process and request Final Demand of Medicare Conditional Payments Program benefits include: • One-on-one customer support with each referral • Strong working relationship with CMS • Fast turnaround times Continuous communication and follow up with necessary parties Expedited MSA allocation report option CorVel's experience leads to reliable settlement costs and set aside amounts while providing rapid turnaround times. We maintain ongoing communication with all interested parties in order to expedite settlement agreements. Development of Reports CorVel provides the City with comprehensive reports detailing every aspect of your program, enabling the City to make a proper analysis of its exposure. Loss reporting information is available on a monthly basis and in various time formats, history periods, including "as of," and actual time. The City also has access to create reports through the online reporting center where more than 1,000 data fields can be sorted to organize reports by any lapsed time period, hierarchical sub group, dollar range, time of day/week, coverage or sub classification, or any one of thousands of other combinations. QRVEL 24 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH We can consolidate information based on the number of incidents or injuries, costs, etc., per department or division and provide various comparative ratios and averages. Safety/risk management reports will include the same detailed accident listings and accountability. We summarize incidents or injuries by coverage line, injured worker name, type, and age, cause, injury type, occupation, location, supervisor, and incident or injury date/time of day. Loss experience, payments comparisons and localized benchmarking reports are also available. Surveillance Referrals for outside investigation are discussed with the City prior to assignment. Before a referral, the Adjuster conducts a cost/benefit analysis to determine if the investigation has the potential to derive the savings necessary to justify the expense. We don't recommend outside investigation on claims with limited potential exposure. Criteria for initiating outside investigation include injured workers who may be: Collecting temporary disability or salary continuation while working Engaging in activities outside of their restrictions Claiming permanent disability that is highly inconsistent with reported activities or objective findings We have partnered with a nationwide investigation companyto provide these services and can also use the City's preferred vendor. Outside investigation assignments will be completed and submitted within 30 days. Peer Review CorVel has a large consultant panel of physician advisors that perform peer reviews. These physician advisors are board certified in their specialty and in an active medical practice. Peer reviews are performed between like specialties, i.e. Neurosurgeon to Neurosurgeon, Orthopedic to Orthopedic. CorVel recruits providers as needed in each state to accommodate the volume of peer reviews. The peer reviewer professionals must go through the same certification process as the providers that are in the PPO network. CorVel has peer review capabilities for the following specialties: • Occupational Medicine • Orthopedic Surgery • Pain Management • Physical Medicine and Rehabilitation • Neurology • Podiatry • Internal Medicine • Toxicology • Oncology • Psychiatry • Acupuncture • Anesthesiology • Cardiovascular QRVEL 25 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 APPROACH AND METHODOLOGY • Dentistry • General Surgery • Hand Surgery • Hematology • Neurosurgery • Plastic Surgery • Rheumatology • Thoracic Surgery and Urology MIAMIBEACH The specialty of the treating provider will determine which peer specialty will be utilized. CorVel only utilizes peer review physicians who support their findings with medically based evidence and are URAC IRO accredited. Utilization Review CorVel's utilization review program provides prospective, concurrent and retrospective review of specific treatments. Our experienced staff of Utilization Review Case Managers, board certified Medical Directors and peer review physicians utilize medical treatment protocols and expert systems technology to determine the medical appropriateness of care as well as frequency, duration and setting. The goal of our utilization review program is to avoid unnecessary treatments and their associated costs and to ensure high quality, timely, cost effective medical care for injured workers. Key utilization review features include: • Medical treatment plan review • Patient referral to select CorVel PPO providers • Approval of an admission and approval of a specific length of stay • Coordination of discharge planning, DME and other services • Timeliness of service: compliance with Florida legislation • Confirmation letter to the provider, injured worker and Adjuster of any certification or denial Reasonable and Customary Savings Review CorVel's rules engine has millions of rules that apply fee schedule and appropriate reasonable and customary rules as well as pricing as defined by each state. Bill Review CorVel offers an innovative medical bill review program with an average savings of 68% per bill in Florida. We have a complete medical savings solution for all in -network and out -of -network medical bills that includes PPO management, expert fee negotiations and professional review. Each feature focuses on increasing processing efficiencies and maximizing savings opportunities. We offer a winning formula that delivers up to 28% higher savings than leading competitors. �wRVEL 26 DocuSign Envelope 10: 6EE0036E-ABE7416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH Bill Intake Our bill review system has the ability to receive medical bills directly from providers through an electronic data interface or online provider portal. When paper bills are received, we use IBML scanners and our own proprietary data capture software to transfer the bills into electronic form and load them directly into our bill review system for processing. Rules Engine Populated with millions of rules, our rules engine ensures accurate and consistent bill review to maximize savings for the City. Our rules engine is highly flexible and can be configured to meet your specific needs. Once the bill is in the system, our proprietary rules engine applies individual rules for reasonable and customary review, fee schedule analysis and pharmacy review. It also automatically identifies CPT.4 code unbundling, fragmented billings, upcoding, etc. and will identify charges that have more accurate coding or should be re -bundled. Analyst Review Our technology uses the rules engine application to route the bill to the most appropriate Bill Review Analyst. This provides Analysts in each diagnosis category, regulatory jurisdiction or benefit category access to bills through our secure server so they can apply their expert knowledge and provide optimum review for each bill. Professional Review/Complex Review CorVel's rules engine allows for bills meeting pre -established thresholds to be flagged and electronically forwarded for professional review. We employ an experienced team of Registered Nurses and Certified Professional Coders to review bills against actual medical files in order to find inconsistencies between services provided and services billed. Our nurses have clinical backgrounds in all areas of medicine and certified coders are thoroughly versed in medical billing and coding to ensure an accurate, consistent and thorough review. Integrated, Proprietary PPO Network CorVel delivers additional discounts below workers' compensation fee schedules and reasonable and customary rates through the integration of our proprietary PPO network and bill review service. We maintain direct contracts with more than 750,000 providers and specialties nationally, generating the maximum possible savings through discounted rates established with our network providers. Payment and Explanation of Review After the bill review process is complete, the bill is immediately available to the Adjuster through the Edge, CorVel's online Adjuster workstation, where they can review the bill and either approve it for payment or send it back to the Analyst for further review. Once the Adjuster approves, the EOR and attached check is mailed to the provider within 48 hours. EORs can be viewed and printed through the claims system. lu RVEL 27 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH Percentage of PPO Savings We deliver discounts below workers' compensation fee schedule and reasonable and customary rates through our national, proprietary network. Our network consists of more than 750,000 providers and specialties, with more than 53,200 providers in the state of Florida. Providers are selected using demanding criteria based on quality, range of services and location. Our solutions extend beyond traditional PPO programs via our directed care networks which offer significant discounts with ancillary providers combined with utilization management and increased penetration. Pharmacy CorVel's pharmacy solution and cost containment program manages our clients' total exposure and offers maximum network penetration, a first fill program, formulary management, brand to generic conversion, a mail order program and aggressive drug utilization management. Combining these services with access to a network of over 67,000 retail pharmacies nationwide and management of all bills with prescription medications, the City experiences significant reductions in their pharmacy exposures and spend. Our solution focuses on four key components: Integrated Bill Review Platform CorVel delivers industry leading value through the integration of our pharmacy and bill review services which provides us with 100% visibility into your pharmacy data. This type of visibility allows CorVel to manage in -network transactions as well as identify and address pharmacy transactions that were not prospectively managed including bills from out -of -network pharmacies, third party billers and physician dispensed medications. We leverage this data to maximize network penetration as well as identify and proactively manage significant cost - drivers in pharmacy utilization before they become high dollar claims including increased use of narcotics, multiple prescribers, and inappropriate prescribing. This can result in a significant reduction in overall medication costs and ensure the injured worker is receiving the most appropriate medications in the most cost effective manner. Network Penetration CorVel offers a first fill and pharmacy ID card program to our clients to maximize penetration into the pharmacy program from claim inception. A mail order program is offered to injured workers with long term drug needs to ensure network utilization. For new clients, CorVel's average penetration rate is approximately 70%; clients in a mature pharmacy program average approximately 80% penetration. Brand to Generic Conversion Brand drugs cost 3-5 times more than their generic substitutes therefore generic substitution is an important aspect of reducing drug spend. Point-of-sale messaging to the pharmacy will indicate generic substitution is required for payment when a claim is transmitted online. Therefore, if a generic substitution is available, the pharmacist is required to substitute the generic unless the physician has indicated Dispense -as -Written (DAW). DAWs are not dispensed automatically. Our formulary will trigger a prior authorization for all brand drugs with generic equivalents. We will then call the prescribing physician's office to request a substitution. CorVel targets an 85% generic dispensing rate for our clients. �wRVEL 28 DowSign Envelope ID: 6EE0036E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH Drug Utilization Review Prospective, concurrent and retrospective drug utilization review edits satisfy market requirements and ensure appropriate drug dispensing to all injured workers. Prospective review utilizes CorVel's standard formulary which indicates which drugs and drug classes require prior authorization before dispensing. Concurrent review is conducted at the same time as the injured workers course of treatment and promotes appropriate dispensing of prescription drugs at the pharmacy. Drug utilization review edits applied at the point of sale monitor for therapeutic duplication, drug interactions, appropriate dosages and durations, dispensing limits and early refills. The edits will also notify the pharmacist to obtain prior authorization for non -formulary drugs, narcotics, and brand name drugs when generic equivalents are available. Retrospective review occurs after the course of treatment and evaluates prescription drug usage history and monitors trends. This includes the use of clinical modeling to determine which cases can benefit from proactive intervention by our medication review program. Clinical Modeling CorVel is able to proactively identify significant cost -drivers in pharmacy utilization before they become high dollar claims through clinical modeling analysis of all bill review data. We have developed a proprietary set of rules in our system to flag specific indicators such as high narcotics usage, multiple prescribers, and certain drug combinations that can contribute to rising costs or lead to harmful conditions such as addiction and prescription abuse. Integration with CorVel's bill review system provides us with full visibility into a patient's entire drug history including drugs obtained from retail, mail order and out -of -network pharmacies, third party billers and physician dispensed medications so CorVel can manage the City's entire pharmacy exposure. Once a potential costly or harmful claim is identified, it is flagged for intervention. Medication Review CorVel's medication review program reduces costs by working with treating physicians to ensure injured workers get the most appropriate care in the most cost effective manner. Our locally based physicians consult with treating physicians to review prescriptions, determine medical necessity, consider alternative medications and obtain the physician's sign off forthe new drug plan. This can result in significant reductions in overall medication costs and ensure the injured workers safety during their episode of care. — TPA shall provide the City with telephonic case management services on all workers' compensation claims as an allocated loss adjustment expense, unless otherwise directed by City. CorVel will continue to provide the City with telephonic case management services on all workers' compensation claims as an allocated loss adjustment expense, unless otherwise directed by City. ;W RVEL 29 Dow&gn Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH Telephonic case management is a cost efficient evaluation and coordination of medical care delivery, conducted over the phone by a nurse. It is geared toward less medically and vocationally complex cases, and is usually targeted to a time limited intervention of 30 to 90 days, focusing on early return to work, maximum medical improvement, and aggressive negotiation with medical providers. Upon assignment, the Case Manager initiates discussions with all parties involved while gathering and analyzing medical treatment information. The Case Manager also discusses the current job requirements of the injured worker with the City, accommodations for modified work, and gathers additional information that may assist in caring for the injured worker. The Telephonic Case Manager continues to impact the direction of the case, focusing on early return to work, maximum medical improvement (MMI) and appropriate duration of disability. Facilitation of appropriate treatment, aggressive negotiation with medical providers and oversight of the injured worker's care is the Case Manager's role until the closure criteria is met. — TPA shall provide a list of PPO networks affiliated with the TPA, as requested by Clty. CorVel agrees and will comply. CorVel's provider listings can be accessed through our website at www.corvel.com or healthcare portal, www.caremc.com, where users can locate providers in their area, see a map, get door to door driving directions, or print a directory. Both websites are updated nightly with all uploads on data additions, deletions and edits done in the previous day. — TPA shall evaluate and qualify various service providers recommended by the City to service its account, provided such service providers do not present a perceived or potential conflict of interest. CorVel agrees to evaluate and qualify various service providers recommended by the City to service its account that do not present a perceived or potential conflict of interest. We perform a rigorous due diligence on all subcontractors by investigating all facets of the potential partner including theirfinancial stability, executive staff member resumes, insurance coverage, privacy practices and other company policies. We also ensure that the business services being provided by the subcontractor are the best match for the City. After the decision is made to use a specific subcontractor we work with the City as well as the subcontractor to ensure that the objectives of the project are clearly outlined and that the services can be met. Services provided by the subcontractor are regularly monitored for quality and compliance to established objectives. ; RVEL 30 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METH 0 DO LO GV MIAMIBEACH — TPA shall process and handle all electronic data interchange requirements on behalf of the City as required by the State of Florida at no additional charge. CorVel agrees and will comply. We have an extensive and documented process in place for electronic data interface (EDI) projects. We will work with the appropriate personnel at the City to review file formats and specific system requirements for data fields in both systems. We approach each desired piece of the EDI process with test file exchanges, reviews of results, and acceptance before moving on to the next piece. Data is exchanged via secure file transfer protocol (SFTP) with or without encrypting files, or via file transfer protocol (FTP) with encrypted files. CorVel also supports Web Services and ANSI X12. Encryption is based on PGP's public -key cryptography and an exchange of public keys between CorVel and the City. CorVel's electronic data interface has the ability to deliver EDI files by FTP or virtual private network (VPN). We currently transmit data to approximately 5,000 users and conduct hundreds of data file transfers to our customers on a daily basis. We can tailor data transfer files according to the City's specifications. — TPA shall be responsible for all Medicare reporting obligations under the Medicare Secondary Payor Act, and/or under similar or new legislation at no additional cost to the City. CorVel will continue to be responsible for all Medicare reporting. We provide solutions to help the City manage the requirements mandated by the Centers for Medicare and Medicaid Services (CMS). As an assigned agent, we provide agent services for the City as the Responsible Reporting Entity (RRE). As an experienced information processing provider, we electronically submit files to the CMS in compliance with timelines and reporting requirements. CMS periodically releases updates to their policies and procedures as they pertain to the reporting process. CorVel is in regular contact with CMS as part of our effort to provide an efficient and cost effective solution for timely compliance. We provide the City with pertinent updates from CMS when appropriate. Summary of CorVel's agent services: • CorVel's Medicare Secondary Payer (MSP) reporting solution has the capacity to receive data through electronic file transferand manual entry, integratingthe data seamlessly into a web based form. • If the City claims have not been confirmed by CMS as Medicare eligible, CorVel will queue the claims for the monthly query, informing the Adjuster when a claim is tagged as reportable. • Alerts, notifications and work queues are all managed from the web interface, letting the user know what data is missing or not compliant for any record. This ensures that all information flows smoothly based on the City's quarterly report date. RVEL 31 DowSign Envelope ID: 6EEOD36E-ABE7416C-6B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH Once the data has been finalized and the report sent, CorVel will integrate the response file back into the work queue, notifying the Adjuster of any compliance issues or missing data. If required by CMS, the claim will be queued again for reporting once the problem elements have been corrected. CorVel handles all Non -Group Health Plans (NGHP) to include both ongoing responsibility for medicals (ORM) and Total Payment Obligations to the Claimant (TPOC). At the City's request, CorVel offers reporting technology to provide statistics on report submissions, missing data and compliance issues, as well as varying elements of the claim data. We also offer the capacity to provide a copy of the actual report and its response directly back to the City. TPA shall provide the City with OSHA 300 log reporting capabilities at no additional cost, as requested by City. CorVel will continue to provide the City with OSHA 300 log reporting capabilities at no additional cost, as requested by City. CorVel tracks lost time through our OSHA module and can pre -populate the information in our online system. The log will populate the form then require the City to review and update the information before submitting. CorVel's system maintains absence information so that OSHA 300 reports are accurate using the Federal reporting standards. — TPA shall handle subrogation claims and file lien notices on behalf of the City to protect the City's interests in rights of recovery from third -party tortfeasors. TPA shall not proceed with any legal action against a third -party tortfeasor without the City's Risk Managers approval. Upon claim receipt, CorVel's rules engine evaluates the claim for potential subrogation. If the potential exists the claim is routed to our subrogation specialist team who complete a thorough investigation that includes collecting, evaluating, and preserving the evidence. Evidence may include statements, photographs, and documents such as receipts, logs, maintenance, and tangible evidence (stored when feasible). Claim types that may include potential subrogation: • Accident involving machinery • Motor vehicle accident • Slip and fall hazard • Explosion or fire • Animal bite • Construction site accident • Accident involving tools or equipment • Product liability • Aircraft, train or boat accident • Claim involving a third party �wRVEL 32 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D6AD3 APPROACH AND METHODOLOGY MIAMIBEACH Reserves are addressed at each claim review and rationale documented in the Adjuster's plan of action review. Applicable statute of limitations is also outlined in the plan of action with aggressive efforts being undertaken to secure recovery of costs as soon as possible. Once identified, the appropriate parties are placed on notice of lien. We provide information to the injured worker, the City or the court of the current lien amount. The City is kept up to date of the subrogation efforts and status at a minimum of every 90 days. The designee may also view subrogation efforts as noted in the claims system and subrogation report. We agree to obtain the City's Risk Managers approval prior to taking any legal action against a third party tortfeasor. TPA agrees all negotiated settlement agreements shall require City approval. Such settlements would include but may not be limited to, agreements to wash-out an entire claim, settle a negotiated lien, settle a negotiated attorney fee, or any other type of settlement that is not otherwise considered an administration of a medical, indemnity or allocated expense that would otherwise be due and owed in accordance with Florida law. Upon receipt of appropriate medical documentation, CorVel will rate all reports and calculate the remaining exposures on the file. Our Adjusters are trained to take various other factors into consideration when analyzing reports. Often times, this may involve input from the City. If the injured worker continues to work for the City, we will recommend a stipulation. However, if the injured worker no longer works for the City, we will provide the City with a recommendation for a future medical buy out through a Compromise and Release, in addition to the stipulation recommendation. CorVel will conduct settlement negotiations on behalf of the City with the opposing attorney. We are confident in our Adjusters' skit Is in resolving cases prior to trial. We attem pt to establish and maintain a good working relationship with applicant counsel in order to reach final settlements quickly, fairly and at the lowest possible price. We do feel there are times it is necessary to take a file to trial and times it would be more cost efficient to settle a claim. We will discuss the claim with the City to guarantee we are all in agreement before we move forward. Prior to recommending a settlement, we will provide the City with an in-depth analysis of our options including a cost benefit evaluation and a suggested plan of action. CorVel will contact the City to obtain authorization before entering any settlement agreements or taking a claim to trial. Our Adjusters prepare Compromise and Release Agreements and Stipulations with Request for Awards in specific cases on our claims systems. The Claims Supervisor will maintain first tier approval before our Adjuster makes settlement recommendations to the City. l4wRVEL 33 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY ►I AMIATR D MW CorVel understands that the City may prefer taking a claim to trial instead of settling the claim. Our Adjusters are well trained to obtain the most qualified attorney for each individual claim and are able to direct an attorney to timely move a file towards settlement or to file the appropriate paperwork to move the claim towards trial. Settlement authority is granted to an Adjuster based on the claims handling agreement established with the City. Written contact is also made for authority, prior to settling a file. We can tailor any program to meet the City's objectives. As the case develops and information is received, settlement always remains a consideration. Alternative methods of resolution are reviewed such as mediation, structured settlements, etc. When a settlement is pursued, a strategy is put together with defense counsel including an initial offer, target settlement amount and maximum settlement amount. Documentation in support of these figures will be placed in the file. In most instances, our Adjuster will do the negotiating. Our Adjusters are experienced at properly evaluating claims and negotiating settlements. TPA shall attend in person or via telephonically all mediations. The City shall endeavor to have a Risk Management staff member, or designee, at all mediations as well as hearings. CorVel will continue to attend all mediations and hearings in person or telephonically as required. We will defend our recommendations in arbitrations, mediations and court. We serve as a valuable asset by: • Providing a timely copy of the entire claim file where necessary • Providing detailed reports of payments and reserve estimates • Providing a detailed case synopsis including: o Issue in dispute o Section of code o Evidence relied upon o Recommendations for handling o Statute of limitations toll or procedural rule o Theory of liability • Attending meetings • Contacting witnesses • Providing nationally recognized disability duration norms • Arranging independent medical examinations We will attend hearings to support defense counsel, answer questions and provide necessary information should the attorney desire justification for a denial or clarification concerning a file note. We can provide a recommendation for settlement based on permanency ratings, itemized benefits to date, present value of future benefits, and evaluation of the injured worker's ability to market residual skills. 4 RVEL 34 DocuSign Envelope ID'. 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY "AAMIBEACH — TPA shall review and seek approval from the City for any loss reserve adjustment increases greater than twenty-five thousand dollars ($25,000). CorVel will continue to review and seek approval from the City for any loss reserve adjustment increases greater than $25,000. — TPA shall agree to quarterly claim reviews, whether in person or telephonically at the City's discretion, to review all litigated cases, legacy cases, catastrophic cases, or non -litigated complex cases. CorVel will continue to participate in quarterly formal claim review meetings to review all litigated cases, legacy cases, catastrophic cases, or non -litigated complex cases. Our standard claim review process includes: • Regular reviews of predetermined files based on mutually agreed upon parameters. This includes the appropriate stakeholders from the City, any outside partner of the City, such as defense counsel or consultant, CorVel Account Manager and claims team including; Adjuster(s), Supervisor(s) and Branch Claim Manager • Discuss current highlights of each claim and financial picture. Discussion to support any outstanding reserves and a detailed review of the plan of action to obtain file closure • Account Manager or Supervisor will maintain a listing of all claims reviewed and any specific action items required as a result of the review • Follow-up on the action items and their status will be provided to the City 30 days after the review We provide a highly effective process to conduct electronic claims review meetings through our Claims Summary Screen. This screen displays all key elements of a claim on one screen and in real time so our claims staff can take live action directly from this screen and all stakeholders can see the exact status of a claim including claim details, medical status, return to work status, financials, claim timeline and actions. • Record Keeping and Audits TPA shall agree all claim files, reports, and other data prepared or provided in connection with a claim are and shall remain the property of the City. CorVel agrees and will comply. We understand all claim records, as well as claim files, reports and other data, are the City's property and we will therefore provide unlimited access. IRVEL 35 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C•9D91277D6AD3 APPROACH AND METHODOLOGY MIAMIBEACH — TPA shall keep complete and accurate records and accounts in connection with each claim. Such records shall be available at all reasonable times for examination by the City, or its' designee, and shall be kept for a period of no less than three (3) years after the completion of all work to be performed. Incomplete or incorrect entries in such records may be grounds for disallowance by City of any fees or expenses based upon such entries. TPA shall send City all closed claim files that are mutually agreed upon to be inactive. CorVel agrees and will comply. In accordance with established best practices and the City's specific claim handling instructions, claim files will contain electronic or scanned copies of all correspondence including letters, faxes, reports and emails. Adjuster and Case Manager notes will summarize documents received and sent. Electronic file documentation will include the following as appropriate: monetary transactions, recorded statements and summaries, index reports, expert reports, legal opinions, medical authorizations, medical bills, medical reports, independent Adjuster reports, excess carrier reports, official reports, scene diagrams, photos and damage verifications. Guidelines require that all loss reports identify the time and date the loss was received. Phone calls will be documented in online file notes to reflect Adjuster activity. Claim files are updated in real-time and can be viewed at anytime via our online claims system. CorVel maintains electronic copies of all claim files indefinitely. Hard copies are maintained for a period of seven years or in accordance with corresponding jurisdictional requirements, whichever is longer. We send the City all closed claim files that are mutually agreed upon to be inactive. TPA agrees to notify the City of proposed or enacted changes in workers' compensation regulatory requirements or legislative acts that may affect the City's claims. CorVel will continue to notify the City of proposed or enacted changes in workers' compensation regulatory requirements or legislative acts that may affect the City's claims. Our employees are heavily involved in legislation and its impact on our clients' programs. Customer training is hands on through the City's designated Account Manager, the direct liaison for updating the City on legislative changes and compliance. We have a committee dedicated to reviewing all new and pending legislation and educating our Account Managers, who are responsible for sharing all information with their clients. Types of media include, but are not limited to, worksite posters, reference guides, wallet cards and email campaigns. In addition to online bulletins and newsletters, CorVel offers a variety of live training options including online sessions, conference calls and onsite training at designated locations. We will provide ongoing training and online webinars as they relate to changes in the law. In addition, we invite various providers to provide training sessions in their particular areas of specialization. RVEL 36 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH — TPA shall agree to maintain a SSAE 16 audit on controls placed in operations and tests for operating effectiveness and agrees to provide copies to the City as requested. As a publicly traded company (NASDAQ GS: CRVL), CorVel is audited and required to comply with all Federal and State regulations, including the Sarbanes-Oxley Act of 2002. Our claims management services and bill review systems have received Service Organization Control reviews bi-annually for SOC 1 for the most recent service period of May 1, 2020 through October 31, 2020 and annually for SOC 2 for the period of November 1, 2019 through October 31, 2020 conducted in accordance with Attestation Standards established by the American Institute of Certified Public Accountants. CorVel will provide copies to the City as requested. — TPA shall take extraordinary measures, if is selected as the new TPA for the City, to ensure data and file conversion and transfer is done with as little disruption to the City and its injured employees to ensure continuity in care and continued best workers' compensation claims management practices. As the City's current TPA, all of the City's current claims are being handled by our Adjusters and are in our system. CorVel will continue to work diligently to close claims quickly and effectively. — TPA, as a custodian of records for City, shall comply and cooperate with all applicable City and State record retention and exemptions laws such as, but not limited to, Florida Statutes, Sections, 119, 440, 760 and 112 as they pertain to protected medical, personal and/or work product information. CorVel will continue to comply and cooperate with all applicable City and State record retention and exemptions laws. We maintain electronic data for a period of seven years or in accordance with corresponding contractual orjurisdictional requirements, whichever is longer. Physical copies are converted to electronic copies by default unless contractual or jurisdictional requirements requires physical retention. — TPA agrees to transfer or ship the electronic file data or hard copy file data at the request and as directed by the City at no cost other than actual incurred reasonable shipping fees. TPA agrees there shall be no charges to transfer electronic data on a per data file basis or other transfer related fees or charges unless agreed upon in writing by City. All electronic data transferred or hard copy data shipped shall be done within sixty (60) days of receipt of written notice from City. Paper data shall be shipped overnight by FED EX, UPS or equivalent common carrier agreed to by City. Electronic data shall be transferred by disk/tape or over internet as requested by City, provided the data files are adequately protected and secured. RVEL 37 DomSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D9127705AD3 APPROACH AND METHODOLOGY MIAMIBEACH Electronic file data means all claims information and related claim file information maintained in an electronic computer file format, whether stored on a hard drive, tape backup or CD. CorVel agrees and will comply with the above requirements for transferring electronic and hard copy file data. • Banking, Reporting and Billing — TPA shall utilize the City's solely selected and approved financial institution for the funding of workers' compensation claim payments and settlements. TPA agrees to comply with the City's Positive Pay (fraud detection) banking standards and must do a daily data feed to the City's financial institution for fraud detection. CorVel has established a Wells Fargo bank account funded by the City to be used for timely payment of all legitimate, authorized expenses associated with handling the City's claims. This includes medical bills, TTD payments, TPD payments, legal fees, investigation costs, rehabilitation expenses and other allocated loss expenses. Utilizing our Wells Fargo account, injured workers and providers have the option to setup direct deposit. The City of funds the account on Tuesdays & Thursdays. Checks are printed daily. Given there are adequate funds in the bank account, it is CorVel's policy to pay all bills within 14 days of receipt to avoid double payments and potential penalties. Funding for the bank account can be in the form of an ACH credit, ACH debit initiated by CorVel, wire or check. CorVel sends the City daily, weekly or monthly check registers that document all the payments processed. Additionally, CorVel performs monthly bank reconciliations. CorVel will continue to require a special funding request for any payments $50,000 or greater. Special funding requests must go through a pre -approval process at the City. All requests above $50,000 will continue to go from our banking team, however, we make every attempt possible to notify the City before large payments are submitted. CorVel will continue to comply with the City's Positive Pay banking standards and do a daily data feed to Wells Fargo for fraud detection. — TPA shall send weekly invoices for wire fund transfer requests to replenish the City's account. Exceptions are made for special requests for unexpected large losses or claim settlements for which specific dedicated invoice for wire fund transfer requests shall be made. CorVel will continue to send weekly invoices for wire fund transfer requests to ensure the City's account always has an appropriate amount of funds. �wRVEL 38 DoeuSipn Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D6AD3 APPROACH AND METHODOLOGY — The City shall fund at least fifty percent (50%) times the City's average weekly spend on workers' compensation claims. Presently the City's fund maintains an average weekly balance of two hundred and fifty thousand dollars ($250,000). CorVel will continue this process with the City, based on your special handling instructions. — TPA shall send original invoices to the attention of the City's Risk Manager, or designee, by e- mail to City of Miami Beach, unless otherwise instructed. CorVel will continue to send original invoices to the attention of the City's Risk Manager, or designee, by email to City of Miami Beach, unless otherwise instructed. — TPA shall mail the City monthly financial institution reconciliations. Customer bank accounts are reconciled monthly by the Accounting Manager and reviewed and approved by the Treasury Services Manager. CorVel will continue to supply a payment register summary, payment reconciliation report, bank statement and signed balance sheet to the City monthly. The payment reconciliation report details checks that have cleared and checks that are still outstanding. Accounts are reconciled within 5 days of month end. — TPA shall issue 1099's to all vendor issued allocated claims payments pursuant to the applicable tax laws in effect. CorVel gathers form 1099 information from all our accounting systems and merges them into one database. Tax ID numbers that meet the 1099 criteria are generated and mailed out on or before January 31. 1099 data is sent to the IRS electronically prior to the reporting deadline. We can supply the City with a report that shows the tax ID and amount they contributed to the 1099 if necessary. Upon notification of an error, CorVel will re -issue 1099s and file a correction with the IRS within 48 hours. — TPA shall be audited by the City at the City's sole discretion and cost. CorVel agrees to make the City's claim files and records available for review in our offices with appropriate lead time notification so as not to disrupt the day-to-day claims handling activities of the claims staff. CorVel Supervisors are available for questions and consultation to assist the City or any outside party in their review. — TPA shall invoice the City quarterly for its administrative claim fee. CorVel will continue to invoice the City quarterly for our administrative claim fee. �wRVEL 39 DowStgn Envelope ID: 6EEOD36E-ASE7416C-6B7C-9D97277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH — TPA will be required to manage the claims with a comprehensive database system which allows computer access to notes, correspondence and other pertinent information needed by the City to generate analytical data reports upon demand; which will allow secure web based communication between the City and the TPA adjusters. This program should also allow the City to add information to the adjuster notes section of the TPA computer system. TPA shall provide the City's Risk Manager and it's designees, with access and training to utilize the TPA's Risk Management Information System to monitor the adjusters claim activity on a file. Claims Management System CorVel's proprietary claims management system has been developed and supported by our in- house, full time information systems division. We have invested millions of dollars into the development of our integrated system that offers tremendous cost and timesaving benefits. Unlike most industry platforms, we do not rely on data feeds from third parties that can delay critical information. Our system is highly codified and supports our claims and medical management teams by supplying extensive, real-time information to enable faster intervention and improved outcomes for injured workers. We offer a secure system that provides the City with complete program visibility, streamlined processes, and allows you to stay connected throughout the entire claims process. The City is provided with 24/7 access to real time data including claim activities, diaries, claim notes, reserves, medical bill documentation and financial information. Detailed reports can also be generated in various time periods and formats, and can be sorted in a variety of grouping and filtering options. Features of CorVel's claim system include: • Tailored User Setup — User ability to set up custom alerts and preferences • Dashboards — User friendly dashboards intelligently organize data and provide useful tools for effective claims management • Transparency— 24/7 online access to all claims and financial data • Data Security— Password protected via secure internet connection and HIPAA compliant Care"^ Home Screen IRVEL 40 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D9127705AD3 APPROACH AND METHODOLOGY MIAMIBEACH Our system's user-friendly dashboards keep you connected to your workers' compensation program by providing real time information that can be viewed and filtered in various ways. Dashboard include: • Claims Safety Dashboard - Displays breakdown of claims by injury, body part, occupation and nature of injury. • Claims Scorecard- Allows users to track and compare claim payments. • Claims Summary View - View detailed claim information from a single location. Organized under a series of tabs for quick access to critical data such as the return to work profile. • Claim Notes - View activity notes from Adjusters and Case Managers on one screen. Search options include by note type and date ranges. • Medical Bill Review Outcomes - Displays claims savings including top ICD -10 codes, top procedures and drugs. • Treatment Calendar - Displays a twelve month rolling calendar showing treatments overtime and is color coded for different types and variations of treatments. • Return to Work - View return to work plan, work restrictions, date last worked, estimated return to work date, actual return to work date, total days off and claim specific notes. • Drug History - View pharmacy information including prescriptions, generic or brand dispensing, amount paid in and out of network and pharmacy risk scores. Online Reporting Center Many of our reports can be created on demand through CorVel's online system. Rather than inputting a request for specific reports and waiting for the report to be created, the City will have the flexibility to access the online system and create reports instantly. There are a variety of reporting options with the "as of reporting capability combined with extensive grouping and filtering options. Reports can be scheduled to run on any interval, i.e., daily, weekly, monthly, quarterly, etc. Reports can be printed, emailed and shared which allows for all stakeholders to instantly view and analyze data related to your program. CareMc Edge Our newest system enhancement, Caremc Edge, has revolutionized the way claims are managed through artificial intelligence and machine learning tools that continually improve our predictive analytic capabilities and recommendations for intervention. CaremC Edge offers a dynamic and integrated workspace that helps Adjusters take informed action on claims, drive better outcomes for injured workers and reduce the total cost of risk. It provides a unique user experience allowing the Adjuster to move from a reactive task -based environment to an intuitive experience that supports the knowledge and expertise of the Adjuster. RVEL 41 DowSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH Care' Edge turns data into insights by consolidating and prioritizing complex information across claims such as financials, drug utilization and pharmacy eligibility, treatment guidelines, and work status and brings the most urgent action items front and center so the Adjuster can proactively act on them. Features include: • My Claims: Transforms how Adjusters manage their caseload and identify claims needing immediate attention and intervention • Action Cards: Provides actionable insight, integrating multiple managed care activities in real time so Adjusters can make informed decisions based on the total care of the patient • Return to Work: Identifies barriers to RTW, estimated and expected RTW, and clearly tracks RTW progress • Insights: Provides access to open claim information including medical status, drug history, documents, RTW plan, reserves, financials, and notes Additional features of Care" Edge include: Claims Summary Screen The Claims Summary Screen provides a highly effective process to conduct online claim reviews with real time data. Users can see the exact status of a claim including claim details, medical status, return to work status, financials, claim timeline and actions. Adjusters, Supervisors, Managers, and the City have the ability to access this claim summary at any time and dive into the most important claim screens and take action. Edge WIIbW01! SIT!. S;a1v 111 SSIlu Claims Summary Screen ; RVEI 42 DowSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH Executive Dashboard CorVel's Executive Dashboard provides a dynamic and interactive high-level overview of the City's entire program. It offers complete visibility and real time updates, helping you proactively manage your program. Features include: • Identification of trends and safety concerns • Dynamic display allows drilling down on details driving outcomes • Litigation information • Financials that include a claims triangle view and a cumulative financial trend graph • Injury profile that displays injury details by body part and division • Benchmarking view to compare book of business and industry specific results 0®® AM Executive Dashboard Screenshots Program Management Dashboard The Program Management Dashboard provides Claims Supervisors, Claims Managers and the Account Manager with a high level glimpse of when elements of your program are in or out of best practice. Green numbers indicate the number is within best practice range, while red numbers indicate the program's numbers are outside of the best practice range. Blue numbers indicate the number is not compared against a best practice. Initially, CorVel will set best practice numbers, however the County will be able to tailor the best practice numbers on your own. �WRVEL 43 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH Network tl UMDn 11.2 7.1% S52.8%52.8% 50.1% 31 6.8% 17.7% 2.4% 37 Program Management Dashboard Client Notes The City is able to enter claim notes into the system. They are denoted in our system as "client added notes" and are a permanent part of the claim file. System Training All system training is hands on through your designated Account Manager, the direct liaison for coordinating system and software training as needed. The Account Manager is the point person for any day-to-day technical needs or training requests. We offer a variety of more formal training options including online webinars, conference calls and onsite training at designated locations. We have designed user-friendlyand comprehensive training modules on our system website, www.caremc.com, that the City can access at anytime. - TPA shall provide the City with electronic loss runs, claim reports or ad hoc reports as required by City within seven (7) working days of month-end. Claim Reports Loss reports are provided on a monthly basis and are available in various time formats and history periods including "as of and actual time. Reports are provided to the City within seven working days of month-end. The City can also run loss reports at your convenience through CorVel's online reporting center. Standard loss reports include: • Open and closed claims summary report for all years, date of injury, employee department, employee job class, claim number, employee name, cause of injury, nature of injury and body part • Open claims summary report — all years • Check register by check number • Summary of losses by year �wRVEL 44 DowSign Envelope 10: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH • Claims scorecard showing a summary of largest cost changes for the period and YTD, top claim repeaters and other claim diagnostic information Besides providing detailed loss data, CorVel strives to provide meaningful insights into what is driving a customers loss experience. In addition to our standard reports, we offer a wide variety of safety and analytical reporting capabilities which include loss triangle reports. Please see Attachment C: Sample Claims Reports. Ad Hoc Reports CorVel's standard reporting capabilities are extensive; however, we have the ability to provide ad hoc reports at the City's request for any special reporting needs. Ad hoc reports can be created based on any data element we capture in the claims system. The City also has access to run ad hoc reports at your convenience through our online reporting center. Reports can be printed, emailed and shared which allows for all stakeholders to instantly view and analyze data related to your program. — TPA shall provide quarterly claims data and other periodic information to the City's actuarial service provider when required. CorVel agrees to provide quarterly claims data and other periodic information to the City's actuarial service provider when required. We provide stewardship reporting to the City that detail cost trends and other analytics. The City also has access to real time data analytics through our Executive Dashboard. TPA shall provide safety engineering services as requested by City, and fees shall be negotiated and approved by the City as an allocated loss adjustment expense per applicable claim file. CorVel delivers a variety of safety analysis reports that identify loss trends, analyze derivatives, and detail financial impacts. We provide an interactive safety report that allows the City to tailor reports with specific parameters in an intuitive and user-friendly format. Your Account Manager, Jenna Ando, regularly reviews loss data and informs the City of areas that may need further inquiry or analysis. We partner with Risk Consultants of America, Inc. (RCI), a loss control provider, to ensure our clients receive the highest quality safety and loss control consulting. RCI provides various safety service resource tools, including on-site regulatory training, safety committee support, and safety briefings and policies. To facilitate loss prevention, and improve the overall safety culture of your organization, we can work with RCI to align these tools with your company - specific goals and initiatives. All fees for safety engineering shall be negotiated and approved by the City as an allocated loss adjustment expense per applicable claim file. IURVEL 45 DowSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277DSAD3 APPROACH AND METHODOLOGY MIAMIBEACH — Other claims adjusting services for Workers' Compensation, as needed. Telehealth We provide telehealth services as part of our Advocacy 24/7 program, offering injured workers a convenient way to see a doctor. With telehealth, injured workers have immediate access to providers, eliminating wait and travel times, cutting lag time and costly delays. After being screened by a triage nurse, telehealth enables injured workers to connect with a provider through a virtual visit via a computer or smart device to facilitate more immediate care. The average savings experienced by customers using our Telehealth service is 5% below fee schedule, the discounted rate of network access for first fill prescriptions, physical therapy, diagnostic imaging and DME needed to treat the injured worker, combined with productivity cost savings by not having the employee absent from the workplace. Care Advocates The first 30 days are critical to the outcome of a claim especially in complicated cases. We employ Care Advocates who immediately review potentially complex claims and gather any additional information needed from the physician, injured worker and employerto make recommendations to the Claim Adjuster and ensure the best medical outcomes. As Registered Nurses, our Care Advocates use their clinical expertise to establish an appropriate treatment plan, coordinate optimal care for the injured worker, initiate return to work data, identify barriers to return to work, determine disability duration and educate the injured worker on their injury and recovery process, all while working collaboratively with the Claim Adjuster. Through proactive management and a high level of attention at the front end of a claim, Care Advocates minimize costly delays, improve return to work outcomes, reduce claim costs and increase claim closure rates. Return to Work Coordinator Having a dedicated advocate to coordinate your return to work program is critical for an effective Return to Work (RTW) Program. CorVel's RTW Coordinators work with you to develop, coordinate and implement transitional work strategies, including a job bank of transitional tasks, to facilitate your employees' successful return to the workplace. In addition to identifying and addressing obstacles, the Coordinators engage all key stakeholders to foster positive outcomes. On average, we return employees to work 23 days sooner than expected, resulting in significant savings. With a comprehensive RTW program, we can help you to minimize production challenges, while also enabling employees to go back to work in a functional capacity rather than remaining isolated at home. 7w RVEL 46 DawSign Envelope 10: 6EEOD36E-ABE7-416C-887C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH Mobile Technology My Care App CorVel's My Care App provides injured workers with access to essential claim information conveniently on their smart phone or tablet device. Injured workers have access to their initial treatment guide, permanent pharmacy card, disability payment information, appointments and theirCorVel contacts' information including their Adjuster and Case Manager, if applicable. The app requires a secure log -in and is maintained upon a secure authentication path. Injured workers will receive notifications for pending payments, change of payment status, available payments and when a claim is closed or re -opened. The app is available in English and Spanish. Our technology is user-friendly and promotes efficiency — injured workers know they are receiving quality care, while employers are assured that proactive claims management will result in expedited closure rates and reduced claim costs overall. 8 P6armary[ards ® Initial Treatment Guides 4c Payments 19 Appointments a Preemption History Y Cie. • Rain Level survey Cnma,ts 7/08/2013 $ 270.31 er¢a 7/02/2013 $473.04 9nyo 6124/2013 $ 473.04 e W1712013 $ 473.04 ®.a 6/10/2013 $ 473.04 9 0. 6703/2013 immmiiii My Care App n ACME BRANOS ROBERT BROWN 17517137VO3302010 004335 RT2847 AOV PeerWell App CorVel's Case Managers are equipped with a new tool to help support injured workers facing an upcoming surgery or experiencing back pain. Combining clinical expertise with technology, this easy-to-use app is a musculoskeletal recovery platform designed to improve the injured worker's physical conditioning and preparedness for return to work. The app is a customizable program that leaves your employees feeling supported during their recovery. It tracks program compliance, recovery metrics, activity levels, and patient reported outcomes that allows our Case Managers to simultaneously monitor progress. RVEL 47 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-91)91277D6AD3 APPROACH AND METHODOLOGY Medically proven results include: • $3,154 average savings per patient • 57% faster return to work • 28% less temporary total disability days • 38% less than average medical costs 22% less in physical therapy paid • Staffing and Personnel Vaca lwnr MxrC um O nwnsb lc 1 q YIIW iup�w rcwM l� PeerWell App r R 42...... wrr..p�Mw� 22�� INw hMtlm 10' • 40_ MIAMIBEACH It is the City's claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control the City's self-insured loss payments is to ensure the TPA hires and retains the appropriately qualified professionals to handle the City's claims. Additionally, the adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services. The City therefore requires that the proposer agree to staffing, qualifications and caseload criteria established by the City. CorVel agrees to staffing, qualifications and caseload criteria established by the City. We worked with the City during the implementation phase to staff your account with an adequate number of qualified professionals based on your claims volume. The Account Manager, Jenna Ando, regularly reviews staffing ratios and makes recommendations regarding possible changes to the claims staff as needed. We invest in our Adjusters by providing them with a prospective, proactive, engaging and comprehensive approach to managing claims compared to traditional reactive models. Caremc Edge has evolved from the outdated diary system to an intuitive data -driven guide focused on immediate intervention that eliminates the gaps traditionally seen in workers' compensation. The platform enhances decision-making and prioritizes workload efficiencies, empoweringthe Claims Adjuster to spend more time on strategic planning and connecting with the injured worker and other key stakeholders. Our technology supports the Claims Adjuster, so that each claim benefits from a high-quality and consistent approach. QRVEL 48 DowSign Envelope ID: 6EEOD36E-ABE7416C-6B7C-9D91277D5AD3 APPROACH AND METHODOLOGY MIAMIBEACH The City reserves the right to the final prior approval of the hiring and/or assignment of the claims manager, supervisors and adjusters that are to handle the City's claims. CorVel agrees to let the City have final prior approval of the hiring and/or assignment of our claims staff that handle the City's claims. The required maximum open caseloads per is as follows: Lost time -100 Medical only - 500 The Lost Time Adjuster's currently assigned to the City's account hold a maximum of between 100-150 files at one time. Medical Only Adjusters carry a maximum of 200-250, per our best practices. CorVel has added an additional Adjuster to the program to help with the overflow and we are continuing to re -assign claims in order to meet the claim count requirements. The TPA agrees to add staff as necessary to maintain these maximum pending caseload levels. Claims personnel must be employees of the TPA. The use of independent adjusters, subcontractors or temporary adjusters is not acceptable without prior approval of the City. Adjuster trainees are not acceptable for handling of the City's claims. Additionally, resumes of all claims professionals specifically assigned to this account are to be submitted with this proposal. All claims professionals must possess a current Florida Workers, Compensation adjuster's license. CorVel agrees to add staff as necessary to maintain these maximum pending caseload levels. All of our claims personnel are employees of CorVel and possess a current Florida Workers' Compensation Adjuster's license. Please see Attachment B: Resumes of Key Personnel. • Loss Fund Management. 1. The Claim Payment Account will be maintained at the City's commercial banking institution. The account will be classified as part of the analysis group of City accounts. The City will pay all service fees that are normal and customary in this account. All interest earned or service credits generated will accrue to the benefit of the City. CorVel has already implemented a bankaccount with Wells Fargo the City. All of CorVel's bank accounts are non-interest bearing accounts. RVEL 49 Dow Sign Envelope ID: 6EEOD36E-ABE7116C.BB7C.9D91277DSAD3 APPROACH AND METHODOLOGY MIAMIBEACH 2. The TPA is required to follow Florida law concerning public deposits. Failure to comply with Florida law is sufficient cause for the City to terminate the contractual agreement with the TPA. CorVel will continue to follow all Florida law concerning public deposits. We understand that failure to comply with Florida law is sufficient cause for the City to terminate the contractual agreement with CorVel. 3. All claims, expense and legal payments will be made by the TPA on checks drawn on an account setup by the TPA and funded monthly by the City. It is understood that all funds in this account are City funds and are to be returned to the City upon request or at termination of this contract. CorVel currently draws checks from our Wells Fargo bank account that is funded by the City to pay all claims, expense, and legal payments. CorVel understands that all funds in this account are City funds and are to be returned to the City upon request or at termination of this contract. 4. The TPA is responsible for the monthly reconciliation of this account and will provide bank statements to the City monthly, along with a request for a deposit from the City to maintain the monthly balance in the loss fund, as determined by the City. Customer bank accounts are reconciled monthly by the Accounting Manager and reviewed and approved by the Treasury Services Manager. CorVel will continue to provide bank statements to the City monthly, along with a request for a deposit from the City to maintain the monthly balance in the loss fund. 5. The monthly reconciliation statement submitted by the TPA to the City will include the following: — balance at inception of statement period — total disbursements which cleared, by date and claimant/payee — balance at close of statement period — amount of deposit required Your Account Manager, Jenna Ando, will continue to provide a monthly reconciliation statement to the City that will include the information listed above. 6. A list of all checks is to be submitted monthly. CorVel will continue to submit a list of all checks monthly. ; RVEL 50 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D9127705AD3 CHIEF FINANCIAL OFFICER JIMMY PATRONIS STATE OF FLORIDA February 24, 2021 Ms. Sarah Pak Administrative Assistant 1920 Main Street, Suite 900 Irvine, CA 92614 Re: Qualified Servicing Entity Annual Report CorVel Enterprise Comp, Inc. Dear Ms. Pak The Qualified Servicing Entity Annual Report for your company has been received. The Division has reviewed this annual filing and found that your company is in compliance with Rule 69Ir5.230(11) F.A.C. (Retaining Authorization as a Qualified Servicing Entity). This letter confirms that your company has been recertified for the period March 1, 2021 through February 28, 2022. Attached is a copy of Form DFS -F2 -SI -23 (Qualified Servicing Entity Annual Report Form), to be used for future filing of this report with the Division. Also attached is a copy of Form DFS -F2 -SI -19 (Certification of Servicing for Self -Insurers), this form is to be completed within thirty (30) days after entering into a contract for servicing of workers compensation claims. Your next annual report is due in our office no later than March 1, 2022, Should you have any questions or need further assistance, please contact me at (850) 413-1784. S' cerely, Wa Q u Dw eM g ce Admtms for Attachments FLORIDA DEPARTMENT OF FINANCIAL SERVICES Dwayne Manning a Insurance Administrator Division of Workers' Compensation • Bureau of Financial Accountability 200 East Gaines Street • Tallahassee, Florida 32399-4221 • Tel. 850-413-1784 • Fax 850414-2244 Email • Dwayne.M&mmng@Myaoridacfb.com AFFIRMATIVE ACTION • EQUAL OPPORTI)NITYEMPLOYER STATEMENT OF QUALIFICATIONS Extensive experience handling catastrophic injuries in State of Florida. Experienced in litigated claims to include PTD, Florida municipality, and Heart & Lung Act. Licensed Worker Compensation adjuster in the State of Florida since 1980. Performing at high skill level to bring claims to conclusion at lowest financial cost. PROFESSIONAL HISTORY Senior Claims Specialist CorVel Corporation / 2015 - present Dedicated onsite Adjuster for the City of Miami Beach. Claims Specialist FARA/york RSG / 2014 - 2015 Handled Broward County School Board and Sarasota County Government workers' compensation claims. EDUCATION Associate of Arts / Core Studies Hillsborough Community College CREDENTIALS AND AFFILIATIONS AIC/ARM Supervisory/management training completed with emphasis on EEOC STATEMENT OF QUALIFICATIONS Supervision of Telephonic and Field Case Managers. Over years of experience in the Worker's Compensation arena. Knowledgeable in Work Comp Law, pre and post 10-1-2003, and Heart Lung Bill. Over 10 years of experience as a Registered Nurse, specializing in the area of Diabetic, Telemetry, Medical Surgical, pre and post-operative patient care in the hospital setting. Excellent working relationships with employers and adjusters from a variety of companies. Excellent facilitation of communication between carriers, injured workers, physicians, and providers. PROFESSIONAL HISTORY Case Management Manager CorVel Corporation /2014 - present Responsible for the direct management of a teamof Field Case Managers forthe South Florida Region. Case Management Supervisor CorVel Corporation /2007- 2013 Responsible for the direct management of a dedicated team of Telephonic Nurse Case Managers forthe State of Florida Division of Risk Management account. Direct management, coordination and facilitation of medical care of individuals who incurred injury or illness, helping to ensure injured parties receive appropriate treatment. Direct collaboration with carriers, physicians, family members to provide medical coordination of services with DME suppliers, home health, and social services as needed. Discharge Planner/ Utilization Review Nurse West Side Regional Medical Center/2010-2012 Disease Management Case Management Matria/Alere Heath Care/ 2007-2007 Registered Nurse Ma)dm Home Health Services /2006-2007 EDUCATION Associate Degree/ Nursing Broward Community College CREDENTIALS AND AFFILIATIONS Certified Rehabilitation Registered Nurse STATEMENT OF QUALIFICATIONS A results -driven problem solver who possesses outstanding customer service, data entry, negotiation and managerial skills who values excellence. Educated business professional who is always committed to bringing a positive impact to the team. PROFESSIONAL HISTORY Medical Only Claims Specialist CorVel Corporation / 2019 - present Duties include determining compensability through prompt and thorough contacts with clients, injured workers and medical providers. Coordinate and conduct numerous file reviews for clients. Work closely with all entities to provide the injured worker the best care to ensure a safe full duty return to work. Clerical Assistant CorVel Corporation / 2017 - 2019 EDUCATION Bachelor of Arts / Business Administration Universidad Metropolitana CREDENTIALS AND AFFILIATIONS 6-20, State of Florida All Lines License Fluent in Spanish STATEMENT OF QUALIFICATIONS Dedicated workers' compensation claims professional who inspires teams to provide exemplary customer service and satisfaction while maintaining a high degree of attention to detail and accuracy in fast -paced environments. Adept at cultivating good working relationships with all parties, with a keen ability to manage "challenging" clients. PROFESSIONAL HISTORY Workers' Compensation Claims Supervisor CorVel Corporation /2019 — present Responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. Oversee claims staff in their day-to-day operations, supports Claims Manager in staff recruitment, ensures staff compliance with Workers' Compensation laws and mandated regulatory reporting requirements. Provides technical and jurisdictional guidance to claims staff regarding complex compensability, investigation, litigation issues, and service account instructions. Functions as liaison implementing final resolution for clients. Senior Claims Examiner Enstar /2013 — 2018 Initially hired to evaluate claims of company -purchased accounts/companies in distress, with the goal of expediently negotiating settlements. After company's acquisition of two insurers, handled new claims. Transferred to reinsurance group after four years'tenure. Workers' Compensation Claims Supervisor Sedgwick CMS / 2003 — 2010 Led a staff of between 9 and 21 at any given time, handling performance management, staff development and training. Effectively managed numerous TPA claims for a diverse roster of clients with unique claims handling specifications. Handled high volume, well-known national accounts, working with their risk managers on specific claims protocols. Audited claims files, attended claims audits, ensured adjusters and clients worked effectively together, and intervened when necessary. Promoted from Senior Claims Examiner to Supervisor. EDUCATION Bachelor of Arts, Criminal Justice California State University, Chico CREDENTIALS AND AFFILIATIONS FL- 5-20 All lines License IEA CA Workers Compensation Certificate CA Self- Insurance Certificate Multiple Workers' Compensation State Licenses STATEMENT OF QUALIFICATIONS Over 9 years of experience in the healthcare industry. Results and detail oriented, hands-on professional with the ability to manage multiple tasks in challenging fast -paced environments. PROFESSIONAL HISTORY Account Manager CorVel Corporation / 2013 - present Work closely with clients to achieve the best outcomes and results. Conducts on-site visits to discuss cost management, programs and claims specific resolutions. Coordinate and manage communication with customer teams and CorVel's claims team. Service delivery continuance includes tailored first notice of loss reporting, early intervention, medical outcomes management, claims referral and litigation management, regulation compliance as well as comprehensive online claims and medical reporting. Served as a liaison between operations and customer teams for healthcare management programs in the state of Florida, including municipalities and government agencies. Monitored workers' compensation cost containment service offering for existing accounts. Customer Service Representative CorVel Corporation Performed a variety of key functions that included addressing inquiries of current and potential customers. Planned, budgeted, and supervised engagements for Florida customers. Implemented customer specific healthcare management service needs and instructions. Supervisor of Durable Medical Equipment Medcare Infusion Services, Inc. EDUCATION Bachelors of Science / Business Healthcare Administration Florida Atlantic University STATEMENT OF QUALIFICATIONS Talented leader directing highly skilled claims service teams to support achievement of overall corporate goals and objectives. Over 15 years of experience in management and claims adjusting within the insurance industry. PROFESSIONAL HISTORY Workers' Compensation Claims Manager CorVel Corporation / 2020 - present Strong knowledge of medical only claims, complex litigation, and catastrophic claims. Responsible for directing the operation of the claims department. Participates in formulating and administering company best practices as well as supporting the goals of claims department and of CorVel. Director of Complex Workers' Compensation Claims Liberty Mutual/ 2018 - 2020 Responsible for the management, investigation, and resolution of high exposure, complex, and emerging risk claims. Lean Management Consultant Liberty Mutual/ 2015 — 2017 I worked with multiple departments to provide consultative support to senior leadership and frontline managers during the implementation of Lean/Six Sigma transformations. Director of Complex Workers' Compensation Claims Liberty Mutual/ 2010 - 2015 Responsible for the management, investigation, and resolution of high exposure, complex, and emerging risk claims. Team Manager Liberty Mutual/ 2005 - 2010 Provided quality case management to ensure claims were properly reserved and moving towards resolution. EDUCATION Bachelor of Arts / Finance and Management University of South Florida CREDENTIALS AND AFFILIATIONS AIC- American Institute for Chartered Property Casualty Underwriter STATEMENT OF QUALIFICATIONS Twenty (20) years' experience in the Workers' Compensation Industry working with insured and self- insured employers. Exceptional knowledge of the Division of Florida Department of Workers' Compensation Laws and Rules. Outstanding written and verbal communication skills. Good interpersonal skills. Noble decision making and problem solving skills. PROFESSIONAL HISTORY Medical Only Claims Specialist Bill Review Analyst CorVel Corporation / 2010 - present Manages non-complex and non -problematic, medical only claims and minor lost -time workers' compensation claims under close supervision, supporting the goals of claims department and of CorVel. Bill Review Analyst Genex Services / 2001 - 2010 EDUCATION Associates Degree / All Lines Adjuster Seminole Community College CREDENTIALS AND AFFILIATIONS State of Florida All Lines License W STATEMENT OF QUALIFICATIONS 26 years in the workers' compensation claims insurance industry handling multiple jurisdictions. 3 years in mid-level management in workers' compensation claims as a Supervisor. Experience handling both carriers and third party administrators across many industries including: municipalities (presumption claims), school boards, airline, trucking companies, healthcare industry, and hospitality workers. PROFESS I ONAL H I STORY Senior Claims Specialist CorVel Corporation/ 2021 -present Manages claims within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due. Works closely with Case Managers and Attorneys. Manages subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel. Has knowledge of the workers' compensation law and procedures includes managing lost time litigated claims and complex catastrophic claims. Senior Claims Adjuster Amtrust / 2019 - 2021 Handled ALT markets, employee leasing, small to mid-sized businesses and multiple state captive programs. Senior Claims Adjuster Sedgwick / 2017 - 2019 Senior Claims Adjuster Patriot Risk Services / 2014 - 2017 Senior Claims Adjuster/Supervisor Advizent/York/Gallagher / 2011 - 2014 CREDENTIALS AND AFFILIATIONS All Lines Adjuster experience in the following jurisdictions: FL, GA, LA, NC, Mississippi and TN. Florida All Lines Adjuster License (520) including CCA designation (Certified Claims Adjuster) Board Certification Workers Compensation adjuster- CWC 2009 Board Certification Workers Compensation Litigation adjuster - CWCL 2014 STATEMENT OF QUALIFICATIONS Determined, reliable and results -driven problem solver who possess over 15 years of outstanding customer service, data entry, and supportive skills. Strengths include; time management, project management, and excellent written and verbal communication skills. PROFESS I ONAL H I STORY Claims Specialist CorVel Corporation / 2018 - present Responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. Integral to the success of the company and requires regular and consistent attendance, supporting the goals of claims department and of CorVel. Assistant Manager of Food and Beverage Hojej Branded Foods / 2016 - 2018 Supervisor of Retail and Food and Beverage HMS Host / 2005 - 2016 EDUCATION Associate of Arts / Business Administration Hillsborough Community College CREDENTIALS AND AFFILIATIONS State of Florida All Lines Adjuster License DocuSign Envelope ID: 6EEOD36E-ABE7416C-BB7C-9D91277D5AD3 140 CORVEL Claims Management Analytics Capabilities Workers' Compensation Claim Detail Report ............................................................................................................................2 PaymentRegister Detail Report ................................................................................................................................................5 Loss Experience Summary Report.............................................................................................................................................8 OSHAForm 300, 300A and 301...............................................................................................................................................11 Workers `Compensation Lag Time Report ...............................................................................................................................16 ClaimsScorecard....................................................................................................................................................................19 ClaimsSafety Dashboard........................................................................................................................................................24 AdHoc Reporting....................................................................................................................................................................26 0 2021 CorVel Corporation. All Rights Reserved. 1 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-016C-8B7C-9D91277D5AD3 CORVEL Workers' Compensation Claim Detail Report Description The Workers' Compensation Claim Detail Report includes individual claim information that can be filtered and arranged according to a multitude of report parameters and valuations. This report includes individual claim information that can be valued as of different points in time. Features • Displays a large variety of claim related information including claim detail for all claims, all open claims or closed claims. • Data can be categorized by numerous filters including accounting code, claimant name, class code, coverage line, injury year, location levels, purpose code, denied or delayed status, status date, claim specialist, classification code, social security number, injury date range, nature of injury, type of accident, occupation, part of body injured and financial information. • Due to the amount of detail provided, this report is great for analytical work. • Reports can be generated as an Adobe PDF, CSV or Microsoft Excel file and can be emailed to the user. 0 2021 CorVel Corporation. All Rights Reserved. 2 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Standard Loss Run: Claim Detail For open and reopened claims For Finance Amount Detail Level: None Claim status and finance amounts as of 04/07/2017 ABC Company Location Level 2: All Locations Finance Detail Level 2: All Claim Number: Cov/Class/SubClass: Claimant: Accident Description: Nature of Injury: AB -14-000207 Location Level 1: 619 WCQND/ Status: Open xxxxxxxxxxxx Jurisdiction: California Employee was cleaning up the trash and e- Claimant Age: 44 commerce orders and as she lifted a box, she 01/302014 Accident State . felt a very sharp pain in her right arm. PER $0.00 (Cleaning up the trash and E-commerce $3,360.00 Gross orders) $35,331.30 $90,497.07 Strain Jurisdiction Claim 50.00 Part of Body: Multiple Upper Extremities Accident Type: -Captured Data Source of Injury: Lifting Occupation: Third Assistant Manager Job Class: 8017/Store: Retail NOC & Drivers Policy Number: 21 WNS 17605 Policy Termination Date: 01/302014 Accident State . California CORVEL No: Type of Loss: Trauma Benefit Type: Temporary Total Injury Litigation: Yes Policy Effective Date: 04/082013 Company Claim No 2013—WC-5117 HIPPA WARNING - This report contain protected Patient information Status Date: 08/19/2013 Subrogation: No Injury Date: 08/16/2013 Avg WW: $202.74 Administrative 08/192013 Comp Rate: $160.00 Notified Date: $18,191.83 $19,722.61 $37,914.44 Finance Detail Level Paid -to -Date Reserved Incurred ALE $29,019.66 $9,815.81 $38,835.47 IND $7,954.28 $2,432,88 $10,387.16 MED $18,191.83 $19,722.61 $37,914.44 PER $0.00 $3,360.00 $3,360.00 Gross $55,165.77 $35,331.30 $90,497.07 Recoveries 50.00 $0.00 Net $55,165.77 $90,497.07 0 2021 CorVel Corporation. All Rights Reserved. 3 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Standard Loss Run: Claim Detail For open and reopened claims For Finance Amount Detail Level: None ABC Company Location Level 2: All Locations Finance Detail Level 2: All Report Total Open Reopened Total # of Claims 156 14 170 �CORVEL Finance Detail Level 2 HIPPA WARNING - This report contain protected patient information Paid -to -Date Reserved Incurred ALE $534,809.13 $262,464.86 $797,273.99 EI $0.00 $128,350.00 $128,350.00 IND $275,411.18 $103,280.67 $378,691.85 MED $681,852.87 $512,627.30 $1,194,480.17 N/A $0.00 $0.00 $0.00 PD $0.00 $100.00 $100.00 PER $89,507.30 $192,735.57 _ $282,242.87 Gross $1,581,580.48 $1,199,558.40 52,781,138.88 Recoveries $0.00 $0.00 Net $1,581,580.48 $2,781,138.88 © 2021 CorVel Corporation. All Rights Reserved. 4 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 CORVEL Payment Register Detail Report Description The Payment Register Detail Report summarizes payments issued between two dates and can be filtered and arranged according to different report parameters. Features • The report provides payment information sorted by check number and additional parameters based on filters and groups selected. • The report body lists checks that match the parameters selected. • Shows each payment issued on or within the check date range selected and matching other parameters. • Report parameters, groups and filter combinations can be saved for future reports. • Reports can be generated as an Adobe PDF, CSV or Microsoft Excel file and can be emailed to the user 0 2021 CorVel Corporation. All Rights Reserved. 5 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 ;OCORVEL Payment Register Detail For all Checks dated 03/01/2017 - 03/31/2017 ABC Company Locations: All HIPAA WARNING -This report contain protected patient information Check PaymentCode -Date Issued DateAflnjury Payee Type _Description Payment Amount Number Class I Claim Number _ Service Dates , Claimant , 1017566 CHECK 03/01/2017 12/02/2015 Butler Memorial Hospital HOSPITAL 040010262541 $91.56 IND AB16-000700 12/28/2015 - 12/28/2015 xxxxxxxxxxxxx 1017567 EFT 03/01/2017 12/02/2015 CorVel Corporation BILL REVIEW ALE 040010262541 $8.50 IND AB -16-000700 12/28/2015 - 12/28/2015 xxxxxxxxxxxxx 1017568 EFT 03/01/2017 12/02/2015 CorVel Corporation BILL REVIEW ALE 040010261731 $8.50 IND AB -16-000700 02/11/2016-02/11/2016 xxxxxxxxxxxx 1017569 CHECK 03/01/2017 12/02/2015 Butler Memorial Hospital HOSPITAL 040010261741 $112.50 IND AB -16-000700 04/21/2016-04/21/2016 xxxxxxxxxxxx 1017570 EFT 03/01/2017 12/02/2015 CorVel Corporation BILL REVIEW ALE 040010261741 $8.50 IND AB -16-000700 04/21/2016 - 04/21/2016 xxxxxxxxxxxx 1017571 EFT 03/01/2017 11/29/2015 CorVel Corporation TELEPHONIC CASE C29505089097 $731.50 IND AB -16-000678 02/07/2017 - 02/28/2017 xxxxxxxxxxxx 1017572 CHECK 03/01/2017 12/02/2015 Butler Memorial Hospital HOSPITAL 040010261751 $2,415.48 IND AB -16-000700 12/29/2015 - 12/29/2015 xxxxxxxxxxxxx 1017573 EFT 03/01/2017 - 12/02/2015 CorVel Corporation BILL REVIEW ALE 040010261751 $8.50 IND AB -16-000700 12/29/2015 - 12/29/2015 xxxxxxxxxxxx 1017574 EFT 03/02/2017 07/15/2014 CorVel Corporation BILL REVIEW ALE 040010274431 $8.50 IND AB -15-000249 01/06/2017 - 01/06/2017 xxxxxxxxxxx 1017575 EFT 03/03/2017 11/29/2015 MD Now Medical Centers, Inc. MED OTHER 046036304931 $264.13 IND AB -16-000678 02/09/2017 - 02/09/2017 xxxxxxxxxxxx 1017576 EFT 03/03/2017 11/29/2015 CorVel Corporation BILL REVIEW ALE 046036304931 $14.70 IND AB 16-000678 02/09/2017 - 02/09/2017 tocxxxxxxxxx 1017577 CHECK 03/03/2017 01/28/2016 Susan Bennett, PT PC PHYS THERAPY 040010253631 $49.60 © 2021 CorVel Corporation. All Rights Reserved. 6 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 CORVEL Payment Register Detail For all Checks dated 03/01/2017 - 03/31/2017 ABC Company Locations: All IHPAA WARNING -This report contain protected patient information Finance Detail Level 2 Payment Amount ALE $39,271.93 B1 $2,302.26 IND $26,961.35 MED $82,782.13 PER $55,649.58 Report Total # of Payments: 671 $206,967.25 © 2021 CorVel Corporation. All Rights Reserved. 7 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-016C-887C-9D91277D5AD3 CORVEL Loss Experience Summary Report Description The Loss Experience Summary Report shows the number of open and closed claims and associated financial information that can be filtered and arranged according to different report parameters. Features • Boundaries for the report can be tailored per client's request via CorVel's claims management system. • Data is sorted by the fiscal year selected. © 2021 CorVel Corporation. All Rights Reserved. 8 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 CORVEL Loss Experience Summary For all claims with Injury Year (FY) 2017 For Finance Amount Detail Level: None Location Level 5: All Locations Claims Open Closed Total %Closed Category Level 2 Paid -to -Date Reserved Incurred Recovery Quarter Issued: Qtr 1 Month Issued: 02 February 0 34 36 94.44% N/A $ 0.00 $ 0.00 $ 0.00 $ 0.00 ALE $ 20,773.82 $ 8,656.40 $ 29,430.22 Bl $ 6,200.00 $ 0.00 $ 6,200.00 IND $ 8,537.93 $ 5,516.27 $ 14,054.20 MED $ 68,017.94 $ 10,070.21 $ 78,088.15 PD $ 2,304.53 $ 0.00 $ 2,304.53 PER $ 210.00 $ 4,273.87 $ 4,483.87 Total S 106,044.22 $ 28,516.75 $ 134,560.97 Month Issued: 03 March 0 37 38 97.37% ALE $ 23,488.15 $ 3,418.80 $ 26,906.95 $ 0.00 BI $ 0.00 $ 0.00 $ 0.00 IND $ 22,949.69 $ 2,500.00 $ 25,449.69 MED $ 57,422.11 $ 5,092.58 $ 62,514.69 PER $ 9,236.03 $ 50,000.00 $ 59,236.03 Total $ 113,095.98 $ 61,011.38 S 174,107.36 Month Issued: 01 January 0 17 30 56.67^% ALE $ 1,142.74 $ 4,558.05 $ 5,700.79 $ 0.00 BI $ 0.00 $ 2,600.00 $ 2,600.00 IND $ 3,220.22 $ 2,923.46 $ 6,143.68 MED $ 14,595.45 $ 16,226.80 $ 30,822.25 PER $ 0.00 $ 1,051.88 $ 1,051.88 Total $ 18,958.41 $ 27,360.19 $ 46,318.60 Total for Quarter Issued: Qtr 1 © 2021 CorVel Corporation. All Rights Reserved. 9 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Loss Experience Summary For all claims with Injury Year (FY) 2017 For Finance Amount Detail Level: None Location Level 5: All Locations ;OCORVEL Claims Open Closed Total %Closed Category Level 2 Paid -to -Date Reserved Incurred Recovery 16 88 104 84.62% N/A - $ 0.00 $ 0.00 $ 0.00 $ 0.00 ALE $ 45,404.71 $ 16,633.25 $ 62,037.96 BI $ 6,200.00 $ 2,600.00 $ 8,800.00 IND $ 34,707.84 $ 10,939.73 $ 45,647.57 MED $ 140,035.50 $ 31,389.59 $ 171,425.09 PD $ 2,304.53 $ 0.00 $ 2,304.53 PER $ 9,446.03 $ 55,325.75 $ 64,771.78 Total $ 238,098.61 $ 116,888.32 $ 354,986.93 © 2021 CorVel Corporation. All Rights Reserved. 10 www.corvel.com DocuSign Envelope ID. 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 0 CORVEL OSHA Form 300, 300A and 301 Description • OSHA Form 300 — This is the OSHA Log of Work -Related Illness and Injuries. Federal law requires employers to record all reportable injuries and illness that occur in the workplace on this form. • OSHA Form 300A — This is the OSHA Summary of Work -Related Injuries and Illnesses. Federal law requires employers to post this form in the workplace annually. • OSHA Form 301—This is the OSHA Injury and Illness Incident Report which is required by the Unites States Department of Labor's Occupational Safety and Health Administration (OSHA) for employer provided workplace incident records. Features • Easily create all OSHA Forms and print instantly • Enter date ranges to get information for each calendar year © 2021 CorVel Corporation. All Rights Reserved. 11 www.corvel.com DocuSign Envelope ID: 6EEOD35E-ABE7-0I6C-BB7C-9D91277D5AD3 OSHA's Form 300 (Rev. 01/20(14) Log of Work -Related Injuries and Illnesses Attention: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes. You must record information about every work-related injury or illness that Involves loss of consciousness, restdcfed work activity orjob transfer, days away from work, or medical treatment beyond first aid. You must also record signfcantwork-related injuries and illnesses that are diagnosed by a physician or licensed health can: professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR 1904.8 through 1904.12, Feel has to use two lines for a single case if you need to. You must complete an injury and ![bass incident report (OSHA Fool 301) or equivalent farm for each injury or igness recorded on this form. If you're not sure whether a case is recordable, call your local OSHA office far help. Establishment name City Remained at Work Year 20174 U.S. Department of Labor Occupational Safety and Health Administration Farm approwd OMB no.12184176 State Enter the number of days the Injured Check the oinjury"column or Ill worker was: or chose onetype_of Illness: Daysaway Jobtransfer Otherrawd- Away from Death from work or restriction able cases work G H 1 J (K) On job transferor restriction (L) 1 2 3 4- 5 6 KI -17-000957 xnop Team Member 0106 Team Memberwas stockingjaned candies on shelfand in the process X Describe X (A) (R) (C) (D) (E) (F) Case No. Employee's Name Job Title Date of Where the event occurred Describe injury or illness, parts of body affected, and (e.g., Welder) injury or (e.g. Leading dock north end) objecthiubstance that directly Injured or made person ill onset of (e.g. Second degree bums an right forearm from acetylene KI -17-000958 nvs Team Member 0107 Employee was rearranging supplies. She moved a ladder and knocked iMess tomh) Establishment name City Remained at Work Year 20174 U.S. Department of Labor Occupational Safety and Health Administration Farm approwd OMB no.12184176 State Enter the number of days the Injured Check the oinjury"column or Ill worker was: or chose onetype_of Illness: Daysaway Jobtransfer Otherrawd- Away from Death from work or restriction able cases work G H 1 J (K) On job transferor restriction (L) 1 2 3 4- 5 6 KI -17-000957 xnop Team Member 0106 Team Memberwas stockingjaned candies on shelfand in the process X 0days 0days X fell a pain in her left hand. (StabuSpaln) KI -17-000958 nvs Team Member 0107 Employee was rearranging supplies. She moved a ladder and knocked X 0days 0days X a riseraf.f a shelf striking her an the head. (Struck by) KI -17-000961 awn STORE 0109 Employee was setting an on easel and the top pad ofteh easel Fell on X 0days Ddays X MANAGER her finger.0 KI -17-000969 ssvM Thhd Assistant 01112 Employee was unloading the height buck She picked up a wry large X 0days 0days X Manager leaner minor and strained her lower back(StraMprain) _ KI -17-000978 aaaq Team Member 01113 Employee was on a ladder assisting another TMwlh getting dam couple ofswings. The swings started to fad and the employee hvisled X 0days 0days X her back in preventing herselffiom falling with the swings. (StraimSp i in) Pubic reporting burden for this collection of information is estimated to average 14 minutes per response, including time to review the instruction, search and gather the data needed, and complete and review the collection ofinformation. Persons are not required t6 respond to the collection ofinfomatun unless G displays a cmrentyvaGd OMB control number. If you have any comments about these estunahs or any aspects of this data collection, contact DS Oepartnonef tabor, OSHA Office ofStatis6re. Room N-3694, 200 Constitution Ave, NW, Washington, DC 20210. Do not send the completed firms to this once. (1)injury (4)Poboning (2) Skin disorder (5)Heanng less (3)Respiratory (6)AD other condition illnesses DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7G9D91277D5AD3 _ /`J OSHA's Form 3004 (Rev. 0112004) Year 2017 Summary_of Work -Related Injuries and Illnesses _ °.S. Department efLabor Occupational Sahly and Health Atlminlatmtlon All establishments covered by Part 1904 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the Lag to verify that the entries are complete and accurate before completing this summary. Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you've added the entries from every page of the Log. If you had no cases, write T.' Employees, farmer employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or As equivalent. See 29 CFR Part 1904.35, in OSHA's recookeeping rule, for further details on the access provisions for these forms. Numberof Cases Total number of Total number of Total number of Total number of deaths cases with days away from work 0 17 (G) (H) Total number of days away from work cases withjob other recordable transfer or restriction cases a 64 (1) W) Total number of days of job transfer or restriction 397 199 (K) (L) Injury and Illness Types Total number of... (M) (1) Injuries 69 (4) Poisonings 0 (2) Skin disorders 0 (5) Hearing loss 0 (3) Respiratory conditions 0 (6) All other illnesses 0 Post this Summary page from February 1 to April 30 of the year following the year covered by the farm. Public reloading burden for this collection of information is estimated to average 58 minutes per response, including time to review the instructions, search and gather the dada needed, and complete and review the collection of information. Persons are net required to respond to the selection of information unless itdisplays aewrengy wild OMB normal number. 11 you have any comments about these estimates or any other aspects of this data nollectbn, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room &3644, 200 ConsfitMon Avenue, NW, Washington, DC 20210. Do ml send the completed tons to this office. Form approver) OMB no. 13184176 Establishment information Your establishment name Street City State ZIP Industry description(e,g.,Manufactumofmotortmcktmiters) Standard Industrial Classification (SIC), if known (e.g., 3715) OR North American Industrial Classification (NAICS), if known (e.g., 336212) Employment Information Annual average number of employees Total hours worked by all employees 100.00 Sign Here Knowingly falsifying this document may result in a fine. I certify that 1 have examined this document and that to the best of my knowledge the entries are true, accurate, and complete. campanyeaecuave Title Plwne Date © 2021 CorVel Corporation. All Rights Reserved. 13 www.cowel.com DowSign Envelope ID: 6EEOD36E-ABE7-416C887C-9D91277D5AD3 s • • Calculating Injury and Illness Incidence Rates Worksheet Total number of injuries and illnesses 89 X 200,000 Number of entries in column H + column I 25 X 200,000 - Number of hours worked by all employees Total recordable case rate 100.00 = 178,000.00 Number of hours worked by all employees DART incidence rate 100.00 = 1 16,000.17 0 2021 CorVel Corporation. All Rights Reserved. 14 - www.coNel.com DocuSign Envelope Kh 6EEOD36E-ABE7416C- B7C-9D9127705AD3 OSHA' s Form 301 /nj&oy and ///nese /naldent This Injury and Illness Incident Report isoneofthe first forms you must fill out when a recordable work- related injury or illness has occurred. Together with the Log ofWork-Relatedinjurier andilinesses andthe accompanying Summary, these forms help the employer and OSHA develop a picture of the extent and severity of work-related incidents. Within 7 calendar days after you receive information that a recordable work- related injury or illness has occurred, you must fill out this form or an equivalent. Some state workers' compensation, insurance, or other reports may be acceptable substitutes. To be considered an equivalent forth, any substitute must contain all the information asked for on this form. According to Public Law 91-596 and 29 CFR 1904, OSHA's recordkeeping rate, you must keep this form on file for 5 years following the year to which it pertains. If you need additional copies of this form, you may photocopy and use as many as you need. by U= Date _/_/_ lnfonsration about the employee I)Fullnnme Grey,Daryl ])Street 1750 Meadow Glen Drive City Wake Forest Sure NC ZIP 37067 a) Dale of bhth 10/1311971 4) Data hired 5) a❑ M.I. ❑ Femrle /n/ormatian about the physician or other health rare Professional 6)3ame of phyrirfav or other health rare Peanuts onul 1)11 treatment was given away from the workdtq when was it given? Facility street City 8) war employee treated to as emergency mom? ❑ Yes © No State _ ZIP 9) Was employee limpltatlred overnight n ao in -paused? ❑ Yes © No Attention: This form contains information relating to �` employee health and must be used in a manner that `�, protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes. U.S.0martment of Labor oanapan /s bandxxrmnbdn/acne/an Form approved OMa no.1318-0176 lnfa matfon about the case 10) Ceeaumbofromthal, RI.17-099943 (Dovc,ch, rnawnerpw de foro)eryoo mod lee cors 11) Date ofinjury or Muss DIMV2017 12) Time employee began work 13) That arena Q3 -IS -0D PM ❑ Check R time cannot be determined 14) rahsr otos mm/mica"hq(mf�fM4sealastaoevrmtllDeseribe the activity, as well as the tools, equipment, or material the employee was ming. He Specific Example: "combing a ladder while carrying moMg materials' ; "spraying chlorine from hand sprayer"; "daily computer lacy -entry". 15) ~AaapwuwOiTell us how the injury occurred. Example, "When ladder slipped an wet Door, worker fell 29 feet' ; "Worker war sprayed with ehlOrWe when Rmkct hroke durlvg replacement";"Worker developed soreness in wrist over time." 16) 112ag cos htµgrywr ? TeR us the part of the body that was affected and how h wed aRected; be more specific than "hurt,""Pain,'or"sore." Example: '4irelved back"{"checmlcal bum,hmd"; "em pal luvnel syndnme-" 17) n8at'OW�w�dhw*basmM eN Vo FEx pie: "Concrete floor"; "Chlorine"; "radial arm raw." If this question does not apply to the Incident, leave it blank. 18) Daleojdeath Public reporting human for this collection of information is estimated to average 22 minutes per response, including time for reviewing inshuctions, searching washing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of inforrnation.Persons are not required m respond to the collection of information unless it dsplays a current valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection, including suggestions for reducing this burden contact, US Department of Labor, OSHA Offmcf Statisgag Room N-3644,2000onsuWuon Ave,NW.Washington, DC20210. Do not send the completed forms to this office. is www.eorvel.eom O 2021 CorVel Corporation. All Rights Reserved. DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D6AD3 0 CORVEL Description Workers' Compensation Lag Time Report The Workers' Compensation Lag Time Reports hows the lag time between the date the injury occurred, the date the employer was notified and the date the injury was reported to CorVel. This report helps to understand how costly lag times may be affecting your workers' compensation program. Features • Data is sorted by parameters, groups and filters. • Save a date and time for the report to be created automatically. • Report can be exported to an Adobe PDF file, CSV and Microsoft Excel file and can be emailed to the user. 0 2021 CorVel Corporation. All Rights Reserved. 16 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 l CORVEL Workers' Compensation Lag For Claims with a Date Administrator Notified From 03/01/2017 - 03/31/2017 Location Level 1: All Location Level 2: (East) East ACME Brands HIPAA WARNING - This report contains protected patient information. F, Average: 0.00 0.00 4.67 4.67 Location Level 2: (East) East *Totals* 3 Claim(s) Average: 0.00 0.00 4.67 4.67 © 2021 CorVel Corporation. All Rights Reserved. 17 www.corvel.com Date Date Date Date of Employer Incident Administrator Employee Manager FNOL Total Claim Number Claimant Injury Notified Reported Notified Lag Lag Lag Lag E -Man East -Manufacturing AB -17-010087 2/16/2017 2/16/2017 2/16/2017 3/1/2017 0 0 13 13 AB -17-010092 3/2/2017 - 3/2/2017 3/2/2017 3/2/2017 0 0 0 0 AB -17-010094 3/8/2017 3/8/2017 3/9/2017 0 1 1 F, Average: 0.00 0.00 4.67 4.67 Location Level 2: (East) East *Totals* 3 Claim(s) Average: 0.00 0.00 4.67 4.67 © 2021 CorVel Corporation. All Rights Reserved. 17 www.corvel.com DocuSign Envelope ID: GEEOD36E-ABE7-016C-GB7C-9D91277D5AD3 C CORVEL Workers' Compensation Lag For Claims with a Date Administrator Notified From 03/01/2017 - 03/31/2017 Location Level 1: All ACME Brands HIPAA WARNING -This report contains protected patient information. Date Date Date Date of Employer Incident Administrator Employee Manager FNOL Total Claim Number Claimant Injury Notified Reported Notified Lag Lag Lag Lag *Grand Total* 3 Claim(s) Average for All Location Level(s)1: 0.00 0.00 4.67 4.67 © 2021 CorVel Corporation. All Rights Reserved. 18 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-416C-887C-9D91277D5AD3 CORVEL Claims Scorecard Description The Claims Scorecard easily compares major data elements over certain time periods. In addition, the Claims Scorecard will provide exception reporting commonly requested by Risk Manager to help manage specific claims responsible for the majority cost of your program. Features • The Claims Scorecard is populated on the Friday after the third day of the month with a snapshot of the previous month's data. • Data includes: Summary of Claim Expenditures + Recovery, Payment Comparison, Changes in Claim Volume, Largest Claim Costs, Largest Paid Exposure, Largest Paid Payees by Payline and Largest Reserves. • The largest group categories display ten claims; however, the Claims Scorecard Dashboard allows for additional claims to be viewed. • Ability to drill down into various divisions or regions. • The Claims Scorecard can be exported to an Adobe PDF file and Microsoft Excel file. © 2021 CorVel Corporation. All Rights Reserved. 19 www.corvel.com C1DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Period Ending: 3/31/2017 Claims Scorecard 0 CORVEL ® 2021 CorVel Corporation. All Rights Reserved. 20 www.corvel.com Summary of Claim Expenditures + Recovery [3] Period Indemnity Permanency Medicat Expense Total Recovery Mar. 2017 $28,372 $55,010 $82,590 $37,40D $203,371 $0 Feb. 2017 $14,480 $2,517 $45,6'1 $48,8311 $111,499 $0 ]an. 2017 $24,797 $15,1091 $40,D361 $171,471 $173 Total $67,6501 $72,6361 $219,71191 $126,267 $/86,341 1 $173 Payment Comparison Month Over Month Year Over Year Feb. 2017 Mar. 2017 Chanqe FY 2017 to Mar. 31, 2016 FV 2018 to Mar. 31, 2017 Change $111,499 $203,371E::::: $91,8]3 $305,700 $314,870 Summary of Claim Expenditures + Recovery [2] Period Indemnity Permanency Medial Expense Total Recovery Mar. 2017 $28,372 $55,010 $82,590 $37,400 $203,371 $0 Feb. 2017 $140480 $2,517 $45,671 $48,831 $111,499 $0 ]an. 2017 $24,797 $15,109 $91,529 $40,036 $171,471 $173 Dec. 2016 $29,152 $25,053 $67,636 $37,973 $159,813 $0 Nov. 2016 $18,462 $44,300 $59,729 $33,1D2 $155,593 $0 Oct. 2016 $14,583 $8,641 $53,837 $31,354 $108,414 $0 Sep. 2016 $23,520 $6,721 $55,267 $33,941 $119,449 $0 Aug. 2016 $20,441 $21,769 $86,995 $34,769 $163,974 $0 lul. 2016 $26,426 $2,612 $80,84] $35,269 $115,154 $0 lun. 2016 $17,229 $23,560 $61,768 $34,088 $136,64S $0 May 2016 $19,920 $6,080 $71,949 $31,4041 $129,353 $0 Apr. 2016 1 $14,2661 $3,6761 $511,3661 $24,6111 $100,919 $0 Total 1 $251,64131 $215,0471 $alfi,1821 $422,7781 $1,705,656 $173 Change In Claim Volume Period Begin I New I Reopen I CMfed I Ending Change Mar, 2017 144 36 1 31 150 f 6 Feb. 2017 146 33 3 38 144 4 -2 ]an. 2017 1 1451 361 21 371 146 t 1 Total 1 1051 61 IWI I t 5 Fiscal Activity Recap - [Mar. 2017] Begin New Reopen Closed End Total Clalms Change Current Payments; Change In Reserve Total Incurred Change In Incurred palm Average 2018 24 35 0 3 56 64 t 32 $15,926 $132,312 $212,444 } $148,238 $3,319 2017 95 1 1 27 70 425 4 -25 $108,439 ($52,222) $1,533,038 f $56,216 $3,607 2016 11 0 0 0 11 394 = 0 $17,137 ($4,419) $1,452,3771L*_' $12,718 $3,686 2015 8 0 0 0 8 314 = 0 $60,065 ($56,065) $1,389,353 [}�: $4,000 $4,425 2014 6 0 0 1 5 271 4 -1 $1.805 (f31, 590) $1,939,706 i (f 29.765) $7,158 Total 144 36 1 31 150 1,468.$ 6 $203,371 ($11,985) $6,526,919 -f 5391,387 $4,418 0 CORVEL ® 2021 CorVel Corporation. All Rights Reserved. 20 www.corvel.com C1 Dow Sign El eicpj ID: 6EEOD35E-ABE7-416C-BB7C-9091277D5AD3 Period Ending: 3/31/2017 Largest Incurred Decreases - [Mar. 2017] Largest Incurred Decreases - [FY 2018 to Mar. 31, 2017] Claim Number Claimant Injury Date Incurred Claim Number Claimant Injury Date Incurred KI -14-000382 11/29/2013 ($51,726) KI -14-000382 11/29/2013 ($51,726) Kr -17-000793 11/23/2016 ($5,256) KI -17-000661 12/10/2016 ($9,189) KI -17-000850 12/7/2016 ($3,924) KI -17-000547 8/28/2016 ($6,921) KI -17-000821 11/26/2016 ($3,665) KI -17-000012 2/4/2016 ($6,725) KI -14-000443 12/7/2013 ($3,639) KI -17-000396 7/11/2016 ($6,689) KI -16-000027 2/8/2017 ($2,840) KI -17-000765 11/17/2016 ($6,248) KI -17-001017 1/30/2017 ($2,542) KI -17-000793 11/23/2016 ($5,256) KI -17-000939 12/30/2016 ($2,476) KI -17-000902 12/19/2016 ($4,796) KI -17-000598 9/18/2016 ($2,000) KI -17-000821 11/26/2016 ($3,665) KI -17-000897 12/17/2016 ($1,887) KI -14-000443 12/7/2013 ($3,639) largest Incurred decreases during Mar. 2017. largest Incurred Increases during Mar. 2017. largest incurred decreases during FY 2018 to Mar. 31, 2017. Largest Incurred Increases during FY 2018 to Mar. 31, 2017. Largest Incurred Increases - [Mar. 2017] Largest Incurred Increases - [FY 2018 to Mar. 31, 20171 Claim Number Claimant Injury Date Incurred Claim Number Claimant Injury Date Incurred KI -17-0004447/15/2016 $62,543 KI -17-000444 7/15/2016 $62,943 KI -18-000090 3/3/2017 $25,920 KI -18-000090 3/3/2017 $25,920 KI -14-000207 8/16/2013 $25,580 KI -14-000207 8/16/2013 $25.580 Kr -18-000088 3/6/2017 $10,000 KI -17-000065 3/2/2016 $12,336 KI -17-000986 1/21/2017 $7,487 KI -18-000021 2/6/2017 $11,500 K1-18-000046 2/15/2017 $6,834 KI -18-000088 3/6/2017 $10,000 KI -18-000061 2/20/2017 $5,516 KI -17-001016 1/27/2017 $9,721 KI -18-000074 2/25/2017 $5,500 KI -17-000442 7/14/2016 $9,500 KI -18-000122 3/15/2017 $5,480 KI -1 B-000010 2/3/2017 $9,229 KI -18-000031 2/9/2017 $5,000 KI -18-000061 2/20/2017 $9,016 largest Incurred Increases during Mar. 2017. Largest Incurred Increases during FY 2018 to Mar. 31, 2017. CORVEL © 2021 CorVel Corporation. All Rights Reserved. 21 www.corvel.com ClDowSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 Period Ending: 3/31/2017 Largest Paid Exposure Largest Claim Costs - [Mar. 2017] Largest Paid Payees By Payline - [FY 2018 to Mar. 31, 2017] Largest Claim Costs - [FY 2018 to Mar. 31, 2017] . Claim Number Claimant Incident Date Paid Claim Number Claimant Incident Date Paid KI -15-000163 5/22/2014 $51,884 KI -15-000163 5/22/2014 $54,845 KI -17-000598 9/18/2016 $31,010 KI -17-000598 9/18/2016 $32,039 KI -15-000141 5/4/2014 $6,796 KI -17-000065 3/2/2016 $9,334 KI -17-000694 10/22/2016 $5,272 KI -17-000255 5/17/2016 $8,949 KI -16-000071 3/18/2015 $4,986 KI -17-000694 10/22/2016 $7,952 KI -17-000484 8/4/2016 $4,878 KI -17-000563 9/2/2016 $7,927 KI -17-000198 4/7/2016 $4,865 KI -15-000141 5/4/2014 $7,126 KI -17-000210 5/2/2016 $4,556 KI -17-000516 8/13/2016 $7,071 KI -17-000897 12/17/2016 $4,060 KI -15-000249 7/15/2014 $6,864 KI -17-000516 8/13/2016 $3,829 KI -17-000196 4/7/2016 $6,438 $3,489 Claims with the largest total paid during Mar. 2017. payee during Mar. 2017. Claims with the largest total paid during FY 2018 to Mar. 31, 2017. payee during FY 2018 to Mar. 31, 2017. Largest Paid Exposure - [Mar. 2017] Largest Paid Payees By Payline - [FY 2018 to Mar. 31, 2017] Largest Paid Exposure - [FY 2018 to Mar. 31, 2017] Paid Payee Payline Paid Payee Payline I Paid Mary Bienkoski C/O Chandler Law Firm PER $49,874 Mary Bienkoski C/O Chandler law Firm PER $49,874 Sierra Providence East Medical Center MED $26,770 Sierra Providence East Medical Center MED $26,770 Debbie Collins And Her Attorney Ted Williams IND $6,387 St. Michaels Emergency Center MED $7,840 Mhhs Southeast Hospital MED $4,547 Debbie Collins And Her Attorney Ted Williams IND $6,387 Felipe Viveros C/O Morgan And Akins PER $4,035 Hall Booth Smith Pc ALE $5,990 Morgan & Akins, Pic ALE $4,034 Mhhs Southeast Hospital MED $4,547 Corvel Corporation ALE $3,489 Richard, Thorson, Graves & Rayer LLP ALE $4,449 Butler Memorial Hospital MED $2,415 Felipe Viveros C/O Morgan And Akins PER $4,035 Chandler Regional Medical Center MED $2,415 Morgan & Akins, Pile ALE $4,034 Thorndal, Armstrong, Delk, Balkenbush, Elsinger ALE $2,177 Corvel Corporation ALE $3,489 Largest single amount Issued for a payee during Mar. 2017. Largest single amount Issued for a payee during FY 2018 to Mar. 31, 2017. Largest Paid Payees By Payline - [Mar. 2017] Largest Paid Payees By Payline - [FY 2018 to Mar. 31, 2017] Payee Payline Paid Payee Payline I Paid Mary Blenkoskl C/O Chandler Law Firm PER $49,674 Mary Bienkoski C/O Chandler Law Firm PER $49,874 Sierra Providence East Medical Center MED $26,770 Sierra Providence East Medical Center MED $26,770 Corvel Corporation ALE $14,106 Corvel Corporation ALE $22,319 Careiq Transportation MED $6,875 Richard, Thorson, Graves & Royer, LLP ALE $11,956 Debbie Collins And Her Attorney Ted Williams IND $6,387 Careiq Transportation MED $11,768 Morgan & Akins, PIIc ALE $5,829 Hall Booth Smith Pc ALE $8,949 Mhhs Southeast Hospital MED $4,547 St. Michaels Emergency Center MED $7,840 Felipe Viveros C/O Morgan And Akins PER $4,035 Morgan It Akins, File ALE $7,203 Christy Winkle IND $3,993 Debbie Collins And Her Attorney Ted Williams IND $6,387 Vocational Solutions Inc. ALE $3,399 Gallivan, White & Boyd, Pa ALE $4,971 Largesttotal amounts paid to single payee during Mar. 2017. Largest total amounts paid to single payee during FY 2018 to Mar. 31, 2017. 0 CORVEL C 2021 CorVel Corporation. All Rights Reserved. 22 www.corvel.com Clbocusign Envelope ID: 6EEOD36E-ABE7.416C-897C-9D91277D5AD3 Period Ending: 3/31/2017 Largest Reserves -[Mar. Repeaters With Open Claims - [Mar. 2017] Largest New Claims - [FY 2018 to Mar. 31, 2017] All Repeaters - [Mar. 2017] Claim Number Claim Number Claimant Claims. Incurred Incurred Claim Number' Claimant Claims Incurred KI -18-0000901 G. Lynch 4 $6,913 L. Halt 6 $62,311 J. Tone 4 $4,736 R. Davis 5 $5,186 L. Lafond 4 $4,306 T. Lunsford 4 $42,012 J. Sayers 3 $5,284 T. Webb 4 $14,905 S. Martin 2 $92,362 A. ]ones 4 $13,939 J. Kelley 2 $55,239 G. Lynch 4 $6,913 J. Young 2 $28,846 J. Trone 4 $4,736 P. Buegel 2 $17,648 L. Lafond 4 $4,306 K. Houck 310,183 $3,900 C. Wllllams 4 $2,432 M. Thomas 2 $6,872 G. Spears 4 $507 $30,780 Claimants with multiple accidents and a current open claim. 11/26/2016 Largest Incurred on Clalmanb with multiple claims (open or closed) by total cost. Largest Reserves -[Mar. Largest New Claims - [Mar. 2017] Largest New Claims - [FY 2018 to Mar. 31, 2017] - [Mar, 2017] Claim Number Claim Number Claimant Injury Date Incurred Claim Number' Claimant Injury Date Incurred KI -18-0000901 Incurred 3/3/2017 $25,920 KI -18-000090 3/3/2017 $25,920 KI -18-000088 3/6/2017 $10,000 KI -18-000021 2/6/2017 $11,500 KI -18-000122 3/15/2017 $5,480 KI -18-000088 3/6/2017 $10,000 KI -18-000093 3/7/2017 $4,761 KI -18-000010 2/3/2017 $9,229 KI -18-000110 3/6/2017 $4,500 KI -IB -000061 2/20/2017 $9,016 KI-18-OD0107 3/9/2017 $4,500 KI -18-000054 2/19/2017 $8,527 KI -18-000101 3/10/2017 $4,432 KI -18-000046 2/15/2017 $7,934 KI -18-000116 3/16/2017 $4,015 KI -18-000074 2/25/2017 $5,500 KI -18-000121 3/17/2017 $3,900 KI -18-000122 3/15/2017 $5,480 KI -18-000128 3/20/201) $3,900 KI-18-OD0031 2/9/201) $5,000 $30,780 Largest Incurred on new claims during Mar. 2017. 11/26/2016 Largest Incurred on new claims during ry 2018 to Mar. 31, 2017. Largest Reserves -[Mar. 2017] Largest New Closures - [Mar, 2017] Claim Number Claimant Incident Date Reserves Claim Number Claimant Incident Date Incurred KI -17-000065 3/2/2016 $63,260 KI -17-000026 2/9/2016 $6,853 KI -17-000444 7/15/2016 $62,225 KI -17-000291 5/31/2016 $5,738 KI -17-000372 7/4/2016 $57,940 KI -17-000897 12/17/2016 $5,613 KI -16-000678 11/29/2015 $39,885 KI-17-OD0627 9/26/2016 $2,836 KI -15-000163 5/22/2014 $35,644 KI-17-OOOSSO 12/7/2016 $2,331 KI -14-000207 8/16/2013 $35,331 KI -17-000947 12/31/2016 $2,219 KI -17-000483 8/4/2016 $33,765 KI -17-000746 11/7/2016 $2,137 KI -16-000203 6/7/2015 $30,912 KI -17-000714 10/31/2016 $2,133 KI -1S-000457 11/20/2014 $30,780 KI -37-000821 11/26/2016 $1,335 KI -16-000348 8/4/2015 $29,431 KI -37-001017 1/30/2017 $1,158 Largest reserve balances during Mar. 2017. Largest Incurred on a first time closure during Mar. 2017. 0 CORVEL © 2021 CorVel Corporation. All Rights Reserved. 23 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 CORVEL Claims Safety Dashboard Description The Claims Safety Dashboard is an interactive tool that allows the user to view information sorted by various filters and displayed on easy -to -read graphs. Information is displayed on up to six different information panels based on each user's account and dashboard preference settings. Features • Injury cause and nature are NCCI driven. • Occupation can be pre -populated with the specific occupations of the employer. • View additional information related to specific claims—Ability to view specific information about claims that are populated in each bar within the bar graph and into various divisions or regions. • The Claims Safety Dashboard sorts data by start date, end date, body part, claim type, injury cause, injury nature and occupation. • Graphs reflect the filters chosen by the user. • Ability to hover the cursor over graphs to show additional information such as claim type, number of claims, total amount paid and incurred, reserves, number of claims closed, average amount incurred and paid, average reserve amount, etc. 0 2021 CorVel Corporation. All Rights Reserved. 24 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7416C-6B7C-9D91277D5AD3 CORVEL o cunomer. U.. arwa. =n r U- Snr10.1. C.1 MY rlN.PN �CIW 1pN' Iurr Cau.e rr x.lure o..up.lon. oreer ar u.rm.. xr...ao..x B.i- •cum.er..am«„6r 610r Nen B.i_ e'Jx- r.xoaoo.. ssu vra tmm am.xo a ,.mii awmD a m �ovl cum. a ............Pm.. uvmo sorra �^^^^^ s.a.m IXb SW N15511 .r'AW]r m c D Claims Safety Dashboard 0 2021 CorVel Corporation. All Rights Reserved. 25 www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7416C-6B7C-9D91277D5AD3 111111111110 CORVEL Ad Hoc Reporting CorVel's standard reporting capabilities are extensive; however, we have the ability to provide ad hoc reports for any special reporting needs. Ad hoc report inquiries can be made with data elements that we capture in the claims system. Most ad hoc reports are available in PDF and Excel formats. These reports can be run instantly or scheduled for regular output. Choose which report to create Open the report in PDF, email or save the report Choose parameters, groups and filters 0 Completd reports are ready to view 0 2021 CorVel Corporation. All Rights Reserved. 26 www.corvel.com The Company The State of Tennessee Division of Claims and Risk Management administers the State's workers' compensation, tort liability, loss prevention, property, and other insurance programs for 38 agencies, 49 higher learning institutions, 6 hospitals, and 2 medical schools. The State provides service to 80,000 employees and 6.3 million Tennessee residents. The Partnership After working with the some TPA for 20 years, the State partnered with CorVel in 2014 to implement their integrated workers' compensation claims management services. CorVel's integrated model and technology expertise were key factors that drew the State to CorVel's program. The Power of One Prior to partnering with CorVel, the State's workers' compensation program incurred over $17.8 million per year, and was managed by a TPA and various managed care providers. There was no statewide return -to -work program or formal procedures for how to report a work related injury, which lead to a disconnect between employees, employers, the TPA, and the Treasury department in the workers' compensation program. In 2014, for the first time, the State's Treasury Department combined the Claims Administration and Risk Management Divisions under a new Director and chose an integrated model for claims and managed care. Previously, the divisions had been managed in silos with little communication. Now, the Director could focus efforts on improving the State's program and creating a return -to -work program. CorVel implemented a Return -to -Work Coordinator to assist the agencies to return injured workers to the workforce by performing job tasks that were compliant with their medical restrictions. The implementation of a statewide return -to -work Program led to indemnity costs decreasing 64% by 2017, and total paid decreased 17%, resulting in significant savings. Additionally, the State also experienced average bill review savings of 64% since 2015, generating on additional $9.4 million in savings for the State of Tennessee. * 2021 CorVel Corporation Bill Review Savings Over Last 2 Years RTW Program • Reduction in TTD Paid vs. Prior Years Claims Management m Reduction in Total Incurred Costs The State of Tennessee has exceeded their own expectations for cost savings. CorVel's innovative solutions have decreased total incurred costs from $17.8 million in 2012 to $11 million in 2017, a 38% reduction. The State looks forward to continuing to take their program to the next level of efficiency and cost-effectiveness. Care _] Risk awareness has greatly improved as part of the organization's culture. All departments and higher learning institutions manage their own claims through CorVel's Care1C software system. ;OCORVEL DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9091277D5AD3 00 CORVEL "ONO BUSINESS INSURANCE 2020 U.S. INSURANCE AWARDS TPA TEAM OF THE YEAR 2020 U.S. Insurance Awards TPA Team of the Year CorVel has been named Third Party Administrator (TPA) Team of the Year at Business Insurance's 2020 U.S. Insurance Awards for our innovative work with the State of Tennessee. The State partnered with CorVel in 2014 to increase the efficiency and cost effectiveness of its program by leveraging CorVeI'S integrated claims management services. CorVel worked with the State to implement a statewide return to -work program, comprehensive pharmacy solutions, and an innovative intake process that includes Advocacy 24/7 nurse triage and virtual care through telehealth. CorVel's team effectively managed the State's risk and continues to achieve significant results by proactively identifying and addressing cost drivers. PROGRAM HIGHLIGHTS • 88% utilization of Advocacy 24/7 and telehealth program • 26% increase in medical bill review savings • 38% reduction in total incurred costs • 61% reduction in open claims • $2.9 million reduction in TTD payments • $40 million reduction in total reserves We were looking for a partner that could provide innovative solutions to transform our traditional claims process, which had remained static for nearly two decades. CorVel implemented an integrated program that helped us meet and surpass our goals. They are a trusted —Am and a valued part of our team. Rodney Escobar, Director of Claims and Risk Management Tennessee Department of Treasury CORVEL.COM i t !•M h.,' • Pea p�� ��� pr . IY6! r, r AR,II /d DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D6AD3 CORVEL I Organizational Chart C 2021 CorVel Corporation. All Rights Reserved. www.corvel.com DocuSign Envelope ID: 6EEOD36E-ABE7-416C-887C-9D91277D5AD3 D&B Credit CORVEL CORPORATION- Full Company View Saved by Kale Covers 109-25-2018 Summary Order Reference: cowansk adwadnb cnm I Report as of: 09-25-2018 1.13 PM I us ng Currency as USD CORVEL CORPORATION Tradestyle(s) CORVEL «1 Address: 2010 Main St Ste 600, Irvine, CA, 92614, UNITED STATES Phone: (949)851-1473 D41 -NS: 62-0366708 In Portfolio: No Failure Score Delinquency Score Age of Business Employees 92 83 31 years 3,788 1987 Year Started Company Profile DLI -N -S Nailing Address Annual Sales 62-036-6708 United States Legal Form Telephone Em ployees Corporation (US) (949) 851-1473 History Record Fax Age (Year Started) Gear (949) 851-1469 Date Incorporated Wellsite Named Principal 05-15-1991 www.cowel.com State of Incorporation Present Control Succeeded Line of Business Delaw are 19fl7 Ownership Ribli,. CRVI (NGS) DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277DSAD3 Risk Assessment Overall Business Risk f MODERATE -HIGH_ nW a a r • , [MODERATE - r — HIGH Dun & Bradstreet Thinks.. L • Overall assessment of this organization over the next 12 months: STABLE CONDITION • Based on the predicted risk of business discontinuation: HGH LIKELIHOOD OF CONTINUED OPERATIONS • Based on the predicted risk of severely delinquent payments: LOW POTENTIAL FOR SEVERELY DELINQUENT PAYMENTS D&B Viability Rating Portfolio Comparison Score Low Risk )1) Failure Score Formerly Financial Stress Scare Low Risk (100) Company's risk level is: aMMEM Probability of failure over the next 12 months. 0.06 Y Maximum Credit Recommendation The recommended limit is based on a low probability of severe delinquency. Company's risk level is: High Risk (9) Probability that a company w Y go out of business, become dormanVinactive, or fie for bankruptcylinsolvency w Thin the next 12 months: 0.10 % Delinquency Score Formerly Commercial Credit Score High Risk (1) Low Risk (100) High Risk (t) Company's risk level is: Probability of delinquency over the next 12 months: 2.23 % PAYDEX Low Risk (100) High Risk (0) Days Beyond Terms :6 D&B Rating Current Rating as of 02-10-2015 Previous Rating Past 12 Months Past 12 Months Past 24 Months DocuSign Envelope Di 6EEOD36E-ABE7416C-8B7C-9091277D5AD3 Financial Strength Risk Indicator 5A S 50,000,000 and 2 Low Risk er in Net Worth or Equity SMALL BUSINESS RISKINSIGHT (SERI) PAYMENTS Financial Strength SA: US$ 50,000,000 and over in Net Worth or Equity Risk Indicator j :Very Low Risk Number of Open Accounts Total Bcposure Number of Charge-offs 111 US$ 582.855 14 Total Open Ended Credit Utilization 11 , SBRI Origination Lease Score 0 ®Commentaries Liens . Recency of delinquencies isk(0) Low Risk (999) . Proportion of satisfactory payment experiences High Risk of serious delinquency over the next 12 months. - Proportion of Lease Accounts w ripen off SBRI Origination Card Score Commentaries . Proportion of satisfactory payment experiences sigh Risk (0) Low Risk (999) Industry classification Moderate Risk of serious delinquency over the next 12 months. . Recency, of delinquencies SBRI Origination Loan Score ®Commentaries . Length of time trade Ines have been established High Risk (0) Low Risk (999) Industry classification High Risk of serious defnquency over the next 12 months. . Recency of delinquencies Legal Events Trade Payments Events Occurrences Last Filed Highest Past Due Bankruptcies 0 Judgements 0 - , 'r Liens 4 08-232017 Suits 11 0.5-232018 UCC 7 04-05-2018 Highest Now Owing Total Trade Experiences US$ 35,000 164 Largest High Credit Average High Credit US$ 65,000 US$ 5,090 DocuSign Envelope ID. 6EEOD36E-ABE7-416C-867C-9D91277D5AD3 Ownership This company is a Global lAtimate, Domestic Ultimate, Headquarters, Parent Financial Overview Amount (In Single hits) Last 3 Years Sales: Source: Edgar ®ft: US$ 47,903,000 Balance sheet 03-31-2018 Amount (in Single Units) Last 3 Years Net Worth: US$ 171,176,000 0.60 Total Current Assets: US$ 163,317,000 Total Assets: US$ 274,004,000 Total Current Liabilities: US$ 97,989,000 Working Capital/Net Current Assets: US$ 65,328,000 Total Liabilities: US$ 102,828,000 Long Term Liabilities: US$ 4,839,000 Profit & Loss 03-31-2018 Amount (In Single hits) Last 3 Years Sales: US$ 558.350,000 ®ft: US$ 47,903,000 EBrrDA: US$ 69,678,000 Net income: US$ 35,695,000 Key Business Ratios Ratio for the Business Current Ratio: 1.67 Quick Ratio: 1.23 Current Liabilities/Net Worth: 0.57 Sales to Net Working Capital: 8.55 Debt to Equity: 0.60 Country / Region Insight United States Risk Category Low Risk High Risk Second-quarter real GDP grows faster than originally estimated. DowSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Risk Assessment D&B Risk Assessment Overall Business Risk F Low . . Dun & Bradstreet Thinks.. MODERA MODERATE HIGH . Overall assessment of this organization over the next 12 months: STABLE CONDITION . Based on the predicted risk of business discontinuation: HGH LIMIHOOD OF CONTINUED OPERATIONS . Based on the predicted risk of severely delinquent payments: LOW POTENTIAL FOR SEVERELY DELINQUENT PAYMENTS D&B Viability Rating Portfolio Comparison Score Low Risk (1) Probability of becorring no longer viable 0.10% Failure Score Formerly Financial Stress Score Low Risk (100) Level of Risk Low High Risk (9) Percentage of businesses ranked w ith this score 23.00% DCC Filings reported High number of enquiries to D&B over last 12 months Level of Risk Probability of Failure Low -Mo, 0.06% Business and Industry Trends Maximum Credit Recommendation The recommended limit is based on a low probability of severe delinquency. Rating Confidence Level Robust Predictions Average probability of becoming no longer viable 0.60% High Risk (1) Average Probability of Failure for Businesses in D&B Database 0.48% Doc.iSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 100 8 ' BO 70 80 50 -- -------------------------------------------------------- 40 30 20 10 ' 0 OCTI NOVI DWI JAIIIII MI WAIIIII MPR 180' I JUNI JUL AUG CURRI 2017 1017 2017 2018 2018 1018 2018 2818 2018 2018 2018 2018 Failure Score Industry Median Quartile --- Delinquency Score Formerly Commercial Credit Score Low Risk (100) Higher risk industry based on delinquency rates for this industry Proportion of past due balances to total amount owing Evidence of open suits and hens Proportion of slow payments in recent months Level of frisk Probability of Delinquency Low -Moderate 2.23% Business and Industry Trends 10D , SOso ' 70 80 50 40 ----------------------------------------------- 30 20 10 ; 0 High Risk (1) Compared to Businesses in D&B Database 10.20% OCT 1 NOV 1 DEC I JAN I FEB I IBIR 1 APR I MW I JUN I JUL I AUG I CUFIRI 2017 1017 2017 2018 2018 2818 2018 2018 2018 2018 2018 2018 Delinquency Score -CF- Industry Median Quartile --- PAYDIX Low Risk 11011 Business and Industry Trends High Risk (0) 9 Wm24mums as Fisk of Slow Pay Payment Behavior Low 5 Days Beyond Terns 8741 -Management services DowSign Envelope ID: 6EE0O36E-ABE7-416C-8B7C-9D91277D5AD3 100 90 so 70 — — — — — — — — — — — — — — — — — --- -zc�rza—zry 80 50 40 '30 20 10 I 0 JAN I F® INR APR WO' I J JULIAUGI SW JAN I F® IatR APR IMV I JUN JUI LI"IM 2018 2016 2018 1017 1017 2017 3017 2817 1017 2017 2817 1817 2017 2017 2017 2018 1018 2018 2018 2018 2818 2818 2018 2018 PAYDEX Industry Upper Quarb4 D&B Rating Current Rating as of 02-10-2015 Financial Strength 5A: uss w000.0o0 and over in Net Worth or Equity -- Industry Median Quartile Industry Lower Quartile Risk Indicator 2 Low Rsk Small Business Risk Insight (SBRI) SBRI Payment Summary Total Open Ended Credit Utilization 11% Percent of All Dollar Obligations in Cycle 2+ 1% Total Exposure US$ 5823855 SER Attributes Previous Rating Financial Strength MUSS 50,000.000 and over in Net Worth or Equity Trade Payment Summary Largest High Credit US$ 65,000 Payment Behavior 5 Days Beyond Terms Risk Indicator 9 Very Low task Number of Open Accounts Time Since Most Recent Cycle US$ 516,085 111 2 1 Months DocuSign Envelope ID- 6EEOD36E-ABE7-416C-8870-9D91277D5AD3 Credit Card Balance: USS 8.420 Number of SBRI Accounts 3 Worst Delinquent AN Opened in the last 12 Accounts: Lease Balance: USS 595.290 months: Past 1 - 3 Months: 5 Cycles Maximum Age of All Open 26 Years. Past 1 - 12 Months: 5 Cycles Accounts: 10 Months SBRI Origination Lease Score ®Commentaries Recency of delinquencies High Risk (0) Low Risk (999) . Proportion of satisfactory payment experiences High Risk of serious delinquency over the next 12 months. . Proportion of Lease Accounts w ritten oft SBRI Origination Card Score Commentaries Proportion of satisfactory payment experiences High Risk (0) Low Risk (999) . Industry classification Moderate Risk of serious delinquency over the next 12 months. . Recency of delinquencies SBRI Origination Loan Score ® Commentaries Length of Ume trade lines have been established High Risk (0) Low Risk (999) . Industry classification High Risk of serious delinquency over the next 12 months. . Recency of delinquencies Account Summaries DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Trade Payments Summary Overall Payment Behavior 5 Days Beyond Tenns Highest Now Owing: USS 35 000 Trade Payments By Credit Extended o/ Trade Within Term 84% Total Trade 13tperiences: 164 Largest High Credit: US$ 65.000 Average High Credit. US$ 5,090 Highest Past Due US$ 53000 Total Unfavorable Comments 3 Largest High Credit: US$ 0 Total Placed in Collections: 0 Largest High Credit'. US$ 0 Past Past Past Past Past`+% -.0; Total Due Due Due Due Due.: Current Past cycle cycle cycle cycle cycp*N. Date Open Close Balance Secured/ Due 1 2 3 4 5 :!::+ Type- Lender Reported Date Date (US$) Unsecured (US$) (US$) (US$) (US$) (US$) Credit - 08-31-2018 10-28- 12-14- 0 No 0 0 0 0 0 0 Card 1998 2004 Credit - 08-31-2018 05-09- 03-09- 0 No 0 0 0 0 0 - Card 2004 2005 Credit - 08-31-2018 02-26- 03-06- 0 No 0 0 0 0 0 0 Card 2004 2012 Credit - 08-31-2018 12-06- 11-25- 0 No 0 0 0 0 0 - Card2003 2014 Credit - 08-31-2018 10-28- 03-06- 0 No 0 0 0 0 0 0 Card 2003 2012 Credit - 08-31-2018 08-30- 11-25- 0 No 0 0 0 0 0 - Card 2003 2014 ?°f Credit - 08-31-2018 06-11- 04-14- 0 No 0 0 0 0 0 0 '±+ Card 2003 2009 M. Credit Credh - 08-31-2018 05-11- 09-08- 0 No 0 0 0 0 0 0. Card 1999 2009' Credit - 08-31-2018 08-01- 10-29- 0 No 0 0 0 0 0 0 Card 1994 2007 Credit - 08-31-2018 04-01- 04-02- 0 No 0 0 0 0 0 0 x?k Card 1994 2009 :5•Fj Totals US$ o US$ 0 US$ 0 US$ o US$ o US$ o US$ {??1 :?4 items per page 10 120 130 150 1100 2 3 d ... 39 Trade Payments Trade Payments Summary Overall Payment Behavior 5 Days Beyond Tenns Highest Now Owing: USS 35 000 Trade Payments By Credit Extended o/ Trade Within Term 84% Total Trade 13tperiences: 164 Largest High Credit: US$ 65.000 Average High Credit. US$ 5,090 Highest Past Due US$ 53000 Total Unfavorable Comments 3 Largest High Credit: US$ 0 Total Placed in Collections: 0 Largest High Credit'. US$ 0 DocuSign Envelope ID: 6EEOD36E-ABE7.416C-BB7C-9D91277D5AO3 Range of Credit Extended (l1S$) Number of Payment Experiences Total Value %Within Terms 100,000 8 over 0 US$ 0 0 50,000-99,999 2 US$ 120,000 100 15,000-49,999 10 US$ 225,000 97 5,000 - 14,999 21 US$ 140,000 B8 1,000-4,999 28 US$ 53,500 75 Less than 1,000 47 US$ 11,300 79 Trade Payments By Industry 31 - Largest % Within 1.30 60 61-90 91 + Number of High Terms Days Days Days Days Payment Credit (Expand to Late Late Late Late Industry Category - Experiences (US$) View) N M N M - 17 - Construction - Special Trade Contractors 1 7,500 1796 - Erects building equip 1 7,500 50 0 0 0 50 - 20 - Food and Kindred Products 1 250 2086 - Mfg soft drinks 1 250 100 0 0 0 0 - 26 - Paper and Allied Products 1 2,500 2677 - MIg envelopes 1 2,500 0 100 0 0 0 - 27 - Printing, Publishing and Abed Industries 1 55,000 2754 - Gravure printing 1 55,000 100 0 0 0 0 - 38 - Wasurng Analyzing and Controlling 5 10,000 Instuments; Photographic Medical and Optical Goods; Watches and Clocks 3861 - Mfg photograph equip 5 10,000 97 3 0 0 0 - 42 - Motor Freight Transportation and 2 35,000 Warehousing 4213 - Truckng non -local 2 35,000 100 0 0 0 0 - 48 - Communications 13 2,500 4812 - Radiotelephone common 1 50 100 0 0 0 0 4813 - Telephone communictns 11 2,500 83 16 0 1 0 4899 - Msc communiclns svcs 1 50 100 0 0 0 0 - 49 - Electric, Gas and Sanitary Services 1 50 4911 - Electric services 1 50 100 0 0 0 0 - 50 - Wholesale Trade - Durable Goods 4 2,500 5044- Mot office equipment 2 2,500 100 0 0 0 0 5045 -Mot conputers/softwr 1 1,000 100 0 0 0 0 5085 -"hot industrial suppl 1 250 100 0 0 0 0 - 51 - Vvholesale Trade - Nondurable Goods 2 250 5112 - Mol office supplies 1 250 100 0 0 0 0 5113 - Mol service paper 1 50 100 0 0 0 0 - 59 - Mscellaneous Retail 6 10,000 5943 - Rel stationery 5 10,000 99 1 0 0 0 5961 - Ret mit-order house 1 50 100 0 0 0 0 - 60- Depository Institutions 4 500 6021 - Natnl commercial bank 2 500 100 0 0 0 0 6035- Federal savings bank 1 50 100 0 0 0 0 DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 6091 - Nondeposit trust 1 100 100 0 0 0 0 61 - Nondeposltory, Credit Institutions 21 20,000 (USS) (USS) (USS) Sale 6153 - Short-trm bush credit 9 20,000 98 1 0 0 1 6159 - Msc business credit 12 2,500 65 0 17 18 0 62 - Security and Commodity Brokers Dealers 4 1,000 - 100 0 1 Exchanges and Services Pays Promptly - - 750 0 1 6211 - Security broker/deal 3 1,000 81 19 0 0 0 6282 - Investment advice 1 1,000 100 0 0 0 0 73 - Business Services 23 65,000 25,000 0 0 1 7359 - Msc equipment rental 1 50 100 0 0 0 0 7361 - Er ployment agency 6 65,000 95 5 0 0 0 7363 - Help supply service 6 15,000 59 22 15 0 4 7389 - Msc business service 10 20,000 83 6 0 0 11 87 - Engineering Accounting Research 2 5,000 10,000 50 - 1 Management and Related Services Pays Promptly - 7,500 0 0 Between 6 and 12 8748 - Business consulting 2 5,000 100 0 0 0 0 - 91 - Executive Legislative and General 3 2,500 Government except Finance 9111 - Executive office 3 2,500 100 0 0 0 0 w 93 - Public Finance Taxation and Monetary 6 15,000 Policy 9311 - Public finance 6 15,000 100 0 0 0 0 - 96 - Administration of Economic Programs 1 250 9651 - Reg misc cord sector 1 250 100 0 0 0 0 99 - Mriclassifiabla Establishments 7 35,000 9999 -Nonclassified 7 35.000 100 0 0 0 0 Trade Lines Date of Selling Htgh Credit Now Owes Past Due Months Since Last Biperlence - Payment Status Terms (USS) (USS) (USS) Sale 09/18 Pays Promptly - 50 0 0 Between 6 and 12 Months 08/18 Pays Promptly - - 100 0 1 08/18 Pays Promptly - - 750 0 1 08/18 Pays Promptly - - 500 0 1 08/18 Pays Promptly N30 65,000 20,000 0 1 08/18 Pays Promptly - 25,000 0 0 1 08/18 Pays Promptly - 25,000 5.000 0 1 08/18 Pays Promptly - 20,000 15,000 0 1 08/18 Pays Promptly - 15,000 7,500 0 1 08/18 Pays Promptly N30 10,000 0 0 1 08/18 Pays Promptly - 10,000 50 - 1 08/18 Pays Promptly - 7,500 0 0 Between 6 and 12 Months DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 08/18 Pays Pronptly Regular terms 7,500 2,500 0 1 08/18 Pays Promptly - 5,000 0 - Between 2 and 3 Months 08/18 Pays Prorrptly N30 51000 750 0 1 08/18 Pays Pronpty - 5,000 2,500 0 1 08/18 Pays Promptly - 5,000 2,500 0 1 08/18 Pays Promptly - 5,000 0 0 Between 6 and 12' Months 08/18 Pays Promptly - 2,500 500 0 1 08/18 Pays Prorrptly - 2,500 0 0 Between 4 and 5 Months 08/18 Pays Pronpty - 1,000 500 0 1 08/18 Pays Promptly - 1,000 0 0 Betw een 4 and 5 Months 08/18 Pays Promptly Lease 1,000 0 0 Between 4 and 5 Agreernnt Months 08/18 Pays Prorrptly - 1,000 50 0 1 08/18 Pays Promptly N30 1,000 750 0 1 08/18 Pays Promptly N30 1,000 1,000 0 1 08/18 Pays Pronpty - 500 0 0 Between 6 and 12 Months 08118 Pays Promptly Lease 500 500 0 1 Agreerml 08/18 Pays Promptly - 250 250 0 1 08118 Pays Pronptly - 250 250 0 1 08/18 Pays Promptly - 250 250 0 1 08/18 Pays Promptly - 250 50 0 1 08118 Pays Promptly N30 250 250 0 1 08/18 Pays Prorrptly - 250 250 0 1 08/18 Pays Promptly - 250 250 0 1 08/18 Pays Prorrptly Lease 250 250 0 1 Agreermt 08/18 Pays Prorrptly - 100 0 - 1 08/18 Pays Prorrptly - 100 0 0 Between 4 and 5 Nbnths 08/18 Pays Prorrpty - 100 0 0 Betw een 6 and 12 Months 08/18 Pays Promptly - 100 50 0 1 08/18 Pays Promptly - 100 50 0 1 08/18 Pays Prorrptly - 50 50 0 1 i 08118 Pays Pronptly - 50 0 0 Betw een 4 and 5 Months 08118 Pays Promptly - 50 0 - Between 6 and 12 Months 08/18 Pays Prorrptly - 50 0 0 Between 6 and 12 Months 08/18 Pays Pronpt to Slow N30 7,500 5,000 2,500 1 15+ 08/18 Pays Prompt to Slow - - 500 0 1 30+ 08/18 Pays Pronpt to Slow N30 2,500 2,500 1,000 1 30+ 08/18 Pays Prompt to Slow N30 750 750 500 1 30+ DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 08/18 Pays Prompt to Slow - 100 100 50 1 30+ 08/18 Pays Prompt to Slow Lease 750 0 0 Betw een 4 and 5 60+ Agreemnt Months 08/18 Pays Prompt to Slow - 2,500 500 0 1 90+ 08/18 Pays Slow 30+ - 50 50 0 Betty een 2 and 3 Months 08/18 Pays Slow 30+ - 50 0 0 Between 6 and 12 Months 08/18 Pays Slow 30-60+ - 50 0 0 Betw een 6 and 12 Months 08/18 Pays Slow 30-90+ - 250 100 100 Betty een 2 and 3 Months 08/18 Pays Slow 30-150+ - 500 250 100 Betty een 4 and 5 Months 08/18 cash ow n option Cash account 50 - - 1 08/18 - Cash account 0 0 0 Betty een 6 and 12 Months 08/18 - Cash account 0 0 0 Between 2 and 3 Months 07/18 Pays Promptly N30 2,500 2.500 500 1 07/18 Pays Promptly N30 2,500 500 0 1 07/18 Pays Promptly Lease 750 0 0 Between 2 and 3 Agreemnt Months 06/18 Pays Promptly - 1,000 50 0 Betw een 4 and 5 Months 05/18 Pays Promptly - 250 0 0 Betty een 6 and 12 Months 05/18 Pays Promptly N30 50 0 0 Between 6 and 12 Months 04/18 Pays Promptly - 250 0 0 Between 6 and 12 Months 01/18 Pays Promptly - 2,500 - - 1 12/17 cash ow n option - 50 - - 1 11/17 Pays Promptly - 2,500 2,500 0 1 10/17 Pays Promptly - 50 0 0 Betty een 6 and 12 Months 09/17 cash own option - - - - 1 09/17 cash ow n option - - - - 1 09/17 cash own option - - - - 1 08/17 Pays Promptly - 100 0 0 Betw een 6 and 12 Months 08/17 cash ow n option Cash account 100 - - 1 07/17 Pays Promptly - 2,500 - - 1 07/17 Pays Promptly - 2,500 0 0 Between 6 and 12 Months 05/17 Pays Promptly - 55,000 0 0 Between 6 and 12 Months 03/17 Pays Prompt to Slow N10 250 0 0 Between 6 and 12 60+ Months Legal Events The follow ing Public Filing data is for information purposes only and is not the official record. Certrfied copies can only be obtained from the official source. DocuSign Envelope ID'. 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 I Judgements Liens Suits UCC Filings 0 4 11 7 Latest Filing. - Latest Filing 08-29-2017 Latest Filing'. 05-23-2018 Latest Filing. 04-05-2018 Debtors CORVEL ENTERPRISE COW INC, CHARLESTON, SC Creditors STATE OF SOUTH CAROLINA Eve nts CHARLESTON COUNTY REGISTER OF DEEDS, CHARLESTON, SC Lien - Tax Lien Lien - Tax Lien Filing Date 08-29-2017 Filing Number 2017-14429 Status Released Date Status Attained 11-03-2017 Received Date 11-17-2017 Amount US$ 941 Debtors CORVEL ENTERPRISE COW INC, CHARLESTON, SC Creditors STATE OF SOUTH CAROLINA Court CHARLESTON COUNTY REGISTER OF DEEDS, CHARLESTON, SC Lien - Tax Lien Filing Date 08-01-2016 Filing Number 2016000352513 Status Released Date Status Attained 10-19-2016 Received Date 11-09-2016 Amount 12,1101 Debtors CORVEL CORPORATION, ORANGE, CA Creditors CA EMPLOYMENT DEVELOPMENT DEPARTMENT Court ORANGE COUNTY FECOF03R OF DEEDS, SANTA ANA. CA Lien - Tax Lien Filing Date 07-29-2016 Filing Number 16-7539339470 Status Terminated Date Status Attained 10-06-2016 Received Date 12-11-2017 Amount US$ 2,104 Debtors CORVEL CORPORATION, ORANGE, C4 Creditors EMPLOYMENT DEVELOPMENT DEPARTMENT Court SECRETARY OF STATFJUCC DIVISION, SACRAMENTO, CA Lien - Tax Lien Filing Date 11-13-2013 Filing Number 13-1612095 Status Open Date Status Attained 11-13-2013 DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Received Date Amount Debtors Creditors Court Suit - 09 -03-2015 US$ 74 CORVEL CORPORATION, CUCAMONGA, CA TAX COLLECTOR LOS ANGELES COUNTY RECORDER OF DEEDS, NORWALK, CA Filing Date 05-23-2018 Filing Number 49001 -1805 -CT -020202 Status Pending Date Status Attained 05-23-2018 Received Date 08-08-2018 Plaintiffs MDWISE CIO DISCOVERY HEALTH PARTNERS Defendant CORVB- CORP, INDIANAPOLIS, IN Court MARION COUNTY CIRCUIT COURT, INDIANAPOLIS, IN Suit - Fling Date 02-01-2018 Fling Number 201800005403SCSOCTL Status Disrrissed Date Status Attained _ 07-24-2018 Received Date 08-26-2018 Plaintiffs THE CHECK CASHING PLACE INC Defendant CORVEL CORPORATION Court SAN DIEGO COUNTY SMALL CLAMS COURTISAN DECO, SAN Court DIEGO, CA Suit - Filing Date 01-10-2018 Filing Number 201800000808CAL Status Pending Date Status Attained 01-10-2018 Received Date 01-26-2018 Plaintiffs JAWS PSANDACZ, UFPEfi MARLBORO, MID Defendant CORVEL CORPORATION, BALTIMORE; MD Defendant AND OTHERS Court PRINCE GEORGES COUNTY CIRCUIT COURT, UPPER MARLBORO, MID Suit - Filing Date 09-25-2017 Filing Number 201700009417C Status Pending Date Status Attained 09-25-2017 Received Date 10-06-2017 Plaintiffs WALKER, VANESSA, BALTIMORE, MD Defendant CORVEL CORP, BALTIMORE, MD Defendant AND OTHERS Court BALTIMORE COUNTY CIRCUIT COURT, BALTmRF- MD Suit - DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Filing Date 04-13-2017 Filing Number 201700009845CAL Status Dismissed Date Status Attained 05-12-2017 Received Date 08-11-2017 Plaintiffs MICHAEL BYERS, BOWIE, MD Defendant CORVEL CORPORATION, BALTIMORE, MD Defendant AND OTHERS Court PRINCE GEORGES COUNTY CIRCUIT COURT, UPPER MARLBORO, MD Suit - Filing Date 03-09-2017 Filing Number 201700006700CAL Status Pending Date Status Attained 03-09-2017 Received Date 08-11-2017 Plaintiffs RENEE PATTERSON, UPPER MARLBORO, MD Defendant CORVEL CORPORATION, BALTWARE, MD Defendant AND OTHERS Court PRANCE GEORGES COUNTY CIRCUIT COURT, UPPER MARLBORO, MD Suit - Filing Date 09-09-2015 Filing Number 201500003658-001 Status Pending Date Status Attained 09-09-2015 Received Date 09-18-2015 Cause Breach Of Contract Amount US$ 1,800 Plaintiffs STEPI-IANE WWEILLARD LLC, LAUREL, MD Defendant CORVEL CORPORATION, BALTIMORE NO Court HOWARDCOUNTY OISTRICTOOURT, ELLICOTI-CITY, MD Suit - Filing Date 07-28-2015 Filing Number 2015SC004754 Status Pending Date Status Attained 07-28-2015 Received Date 08-13-2015 Plaintiffs BEJISH, SARAH Plaintiffs BENISH, CHRISTOPHER Defendant CORVEL CORPORATION, BALTIMORE MD Defendant AND OTHERS Court DANE COUNTY CIRCUIT COURT, MADISON, WI Suit - Filing Date 12-15-2014 Filing Number 201400021048-001 DowSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Status Date Status Attained Received Date Amount Plaintiffs Defendant Court Suit - Pending 12-15-2014 _ 12-19-2014 US$ 750 WLUNGMYRF, GEORGET, SPENCERVLLF, MD CORVEL CORPORATION, NOTTINGHAM, MD . MONTGOMERY COUNTY DISTRICT COURT, ROCKVILLE, MD Filing Date 07-11-2014 Filing Number _ 14A703685 Status Closed Date Status Attained 10-15-2014 Received Date 01-15-2016 Amount US$ 20,000 Plaintiffs LORI GRAMMER Plaintiffs STEVEN GRAMMER Defendant CORVEL CORPORATION, IAS VEGAS, NV Defendant AND OTHERS Court CLARK COUNTY DISTRICT COURT -8TH, LAS VEGAS, NV UCC Fling - Original Filing Date 04-05-2018 Filing Number 2018 2323125 Received Date 05-11-2018 Collateral Leased Equipment including proceeds and products Secured Party INFOMAX OFFICESYSTEv1S HNC., CEDARRAPIDS, IA Debtors CORVEL CORPORATION Filing Office SECRETARY OF STATEUCC DIVISION, DOVER, DE UCC Fling - Original Filing Date Filing Num be r Received Date Collateral Secured Party Debtors Filing Office UCC Fling - Original Filing Date Filing Number Received Date Collateral Secured Party Debtors Filing Office UCC Fling - Original 02-28-2017 20171357851 04-04-2017 Business machinery/equipment and proceeds U.S. BANK EQUIPMENT FINANCE, MARSHALL, MHN CORVEL CORPORATION, MINNEAPOLIS, MIN SECRETARY OF STATE/UCC DIVISION, DOVER, DE 06-22-2016 167532248179 07-08-2016 Leased Business machinery/equiprrent and proceeds WIELLS FARGO FINANCIAL LEASING, INC., DES MOINES, IA CORVEL HEALTHCARE CORPORATION SECRETARY OF STATE/UCC DIVISION, SACRAMENTO, CA DocuSign Envelope ID: 6EEOD36E-ABE7-416C-887C-9D91277D5AD3 Filing (late Filing Number Received Date Collateral Secured Party Debtors Filing Office UCC Filing - Original Filing Date Filing Number Received Date Collateral Secured Party Debtors Filing Office UCC Fling - Original Filing Date Filing Number Received Date Collateral Secured Party Debtors Filing Office UCC Fling - Original Filing Date Filing Number Received Date Collateral Secured Party Debtors Debtors Filing Office 12-31-2015 20156368350 02-05-2016 Leased Computer equipment and proceeds COMJOC, DES MOLES, N CORVEL CORPORATION, DUBLIN, OH SECRETARY OF STATE/UCC DIVISION, DOVER, DE 02-03-2015 15020339999 03-24-2015 Leased Equipment CRYSTAL ICE COMPANY, INC., RICHMOND, VA CORVEL INSURANCE CORP., GLENALLEN, VA SECRETARY OF THE COMAOMAEALTWUCC DIVISION, RICHMOND, VA 07-09-2012 2012 2635979 08-10-2012 Business machinery/equipment U.S. BANK EQUIPMENT FINANCE. MARSHALL, MJ COINS CORPORATION, W*,EAPOLIS, Md SECRETARY OF STATFJUCC DIVISION, DOVER, DE 07-09-2012 201228889450 07-20-2012 Unspecified MJ RADIOLOGY. ®NA, t•.N CORVEL MED CHECK, MNJEAPOLIS, Md and OTHERS SECRETARY OF STATE/UCC DIVISION, SAW PAUL, MJ The public record items contained in this report may have been paid, termnated, vacated or released prior to the date this report w as printed. This information may not be reproduced in w hole or in part by any means of reproduction IThere may be additional UCC Filings in D&B's file on this company available by contacting 1-800-234-3867. There may be additional suits, liens, or judgements in D&B's file on this company available in the U.S. Public Records Database, also covered under your contract. If you w ould like more information on this database. please contact the Customer Resource Center at 1-800- 234-3867. DocuSign Envelope ID: 6EEOD36E-ASE7-416C-887C-9D91277D5AD3 Flt is indicated that there are defendants other than the report subject, the lawsuit may bean action to clear title to property and does not necessarily inply a claim for money against the subject. A Fen holder can file the same lien in more than one fang location. The appearance of multiple liens filed by the same lien holler against a debtor may be indicative of such an occurrence. Special Events There are no Special Events recorded for this business. Company Profile Company Overview D -U -N -S Mailing Address Corporation Type Uiited States Legal Form Telephone Corp,. JS) -.1-1473 History Record Fax Clear ,1-1469 Date Incorporated Website 05-15-1991 www.corvel.com State of Incorporation Present Control Succeeded are 1987 ownership (:RVL (NGS) Business Registration Annual Sales USS 558.350.000 Employees 3 788 Age (Year Started) 31 years (1987) Named Principal V Gordon Clemons. CHB -CEO Line of Business Management services Corporate and business registrations reported by the secretary of state or other official source as of: 07-20-2018 This data is for informational purposes only, certification can only be obtained through the Office of the Secretary of State. Registered Name C,ORVEL CORPORATION Corporation Type Corporation (US) Business Commenced On 1987 State of Incorporation DELAWARE Date Incorporated 05-16-1991 Registration ID 2263186 Registration Status STATUS NOT AVAILABLE Filing Date 05-16.1991 Where Filed SECRETARY OF STATEICORPOMTIONS Cli Registered Agent Name THE PREffICE-HALL CORPORATION SYSTEM INC. Address 251 LITTLE FALLS DRIVE yvLhNGTON , DE 198080000 DocuSign Envelope ID: 6EE0036E-ABE7.416C-8B7C-9D91277D5AD3 Principals Officers V GORDON CLEMONS, CHB -COO -CEO+ MCHAEL G COMBS, PRES KENNETH S CRAGUN, CFO DIANE BLAFA, CMO MAXIM SHISHN, CIO MICHAEL D SAVEREN, EXEC V PRES RICHARD J SCHNEPPF- V PRIES FN Directors DIRECTOR(S): The officers identified by (+) and Steven J Flamerslag, Alan R Hoops, R Judd Jessup, Jean H Macino and Jeffrey J Michael. Company Events The following information was reported on: 07.12-2018 The Delaw are Secretary of State's business registrations file showed that CorVel Corporation was registered as a Corporation on May 29, 1992, under the file registration number 2299227. Business started 1987. The company was originay incorporated in Delaware in 1987 and was re -incorporated in May 1992. The corrpany's corrmon stock is traded on the NASDAQ Global Select Market under the symbol"CRVL". As of June 5, 2018, there were approximately 1,016 holders of record of the company's common stock. As of March 31, 2018, those shareholders identified by the company as beneficiay ow ning 5% or more of the outstanding shares w ere: Corstar Holdings, Inc. (37.93%); Renaissance Technologies Holdings Corporation (7,79%); Blackrock, Inc. (6.88%); Jeffrey J Michael (39.12%); and V Gordon Clemons (10.51 %). As of the same date, officers and directors as a group beneficiay ow ns 51.40% of the outstanding shares. V GORDON CLEMONS. Fie has served as Chairman of the Board since April 1991. Fie currently serves as CEO and COO of the company. Fla served as CEO from January 1988 until August 2007 and as Resident from January 1988 until May 2006. Fie w as reappointed as CEO, Resident and COO in April 2012 and served in the role of Resident until April 2017. MICHAEL G COMBS. He w as promoted to Resident in April 2017 and previously served as Chief Information Officer from April 2015 to April 2017. Fie has been w ith the company for 25 years, joining the cornpany inbay as a softw are engineer in October 1991. KENNETH S CRAGUN. Fla has been the CFO of the company since January 2018. Fie also serves as a Partner of Hardesty, LLC (Hardesty). Fie has been a Partner of Hardesty's Southern California Practice since October 2016. DIANEJ BLAHA. She w as promoted to Chief Marketing Officer (CMO) in November 2016. She has been with the company for 24 years and previously w as the Senior Vice President of Sales and Marketing from June 3, 2015 to November 2016 and the Senior Vice Resident, Sales and Account Management from November 2010 to June 2015. MAXIM SHISHN. She w as promoted to Chief Information Officer (CIO) in 2017. He has been with the company since 2002, holding the positions of Vice President of Information Systems, Director of Software Engineering, Software Development Manager and Senior Software Engineer. MICHAEL D SAVERS N. Fie w as promoted to Executive Vice President, Rask Management Services in March 2017 and w as previously the Senior Vice Resident since January 2012. Prior to being a Senior Vice President, he served as Vice President of the company. Fie joined the company in 2003. RICHARD SCFNVEPPE He resigned from the CFO position effective January 2018 but remains as Vice President of Finance. He has been w Rh the company for 29 years. STEVEN J HAMFRSLAG. Director since 1991. Fie has been a Managing Partner of TVC Capital, since April 2006 and a Managing Director of Titan Investment Partners since November 2002. ALAN R HOOPS. Director since 2003. Fie has been the Executive Chairmn of Health Essentials since 2012. DocuSign Envelope ID. 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 R JUDD JESSUP, Director since 1997. He was the CEO of CombiMatrix Corporation from August 2010 to March 2013. JEAN H MACINO. Director since 2008. She w as a Managing Director of Marsh and McLennan Companies, from 1980 to 1995 and Office Head of the New port Beach office of Marsh, Inc from 1995 to 2005. JEFFREY J MICHAEL. Director since 1990. He has been the President and CEO of Corstar Holdings, Inc. since March 1996. Business Activities And Employees The following information was reported on: 07-12.2018 Business Information Trade Names CORVEL; SCAN ONE Description The company provides medical cost containment and managed care services to address the medical costs of w orkers' corrpensation and auto claims. The company offers netw ork solutions, including automated medical fee auditing, preferred provider services, retrospective utilizabon review, independent medical examinations and inpatient bill review services; directed care networks for CT and bone scans, diagnostic imaging, physical and occupational therapy, independent medical evaluations, durable medical equipment and transportation and translation services; pharmacy and clearinghouse services; and medicare solutions. it also provides a range of patient management services comprising claims management, case management, 24/7 nurse triage, utilization management, vocational rehabilitation, life care planning, disability management, liability claims management and auto claims management services. Terns are cash and contract basis. Sells to general public and commercial concerns. Territory United States. Employees 3,788 which includes officer(s). Undetermined employed here. Financing Status Unsecured Financial Condition Good Seasonality The company is not directly impacted by seasonal shifts, the company is affected by the change 80110300 in working days in a given quarter. There are generally few er working days for the company's employees to generate revenue in the third fiscal quarter as the company experience vacations, inclement w eather and holidays. Facilities Leases 13,000 sq. fl. in a budding. SIC/NAICS Information SIC Codes SIC Description Percentage of Business 8741 Management services - 87419907 Pursing and personal care facility management - 80110100 Internal medicine practitioners - 80110300 Medical insurance associations - NAICS Codes NAICS Description 561110 Office Adrministrative Services 621111 Offices of Physicians (except Mental Heafth Specialists) 621491 HMO Medical Centers DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Government Activity Activity Summary Borrow a r(Dir/Guar) No Administrative Debt No Contractor No Grantee No Party excluded from federal No program(s) Financials Income Statement Annual 614.2M 491.3M 368.5M 245.7M 122.8M 0 2016 Total Current Assets Sales (Revenue) Cost of Revenue Gross Profit Sales and General Admin Research and Development Expense Non -Recurring Expenses Other Operating Items Operating Income Net Total Other Income and Expenses Earnings Before Interest and Taxes Interest Expense Earnings Before Tax Source: Edgar I Currency: All figures shown in USDunless otherwise stated M Net income a Sales (Revenue) 4 Profit Margin 0 07 0 ri 0 04 0 i3 201- 2 Fiscal Fiscal Fiscal Consolidated Consolidated Consolidated 03.31.2018 03.31.2017 03.31-2016 Last 3 Years 558,350,000 518,686,000 503,584,000 451,097,000 413,894,000 399,040,000 107,253,000 104,792,000 104,544,000 59,350,000 57,243,000 58,484,000 47,903.000 47,549,000 46,060,000 47,903,000 47,549,000 46,060,000 47,903,000 47,549.000 46,060,000 ��� DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Income Tax Expense 12,208,000 18,070,000 17,535,000 Equity Earnings or Loss Minority Interest Expense Net Income from Continuing Operations 35,695,000 29,479,000 28,525,000 Discontinued Operations - - - - Effect of Accounting Changes - - - Extraordinary Items - - - Net Income 35,696,000 29,479,000 26,626,000 Preferred Stocks 8 Other Adjustments - - - Net Income Applicable to Common Shares 35,695,000 29,479,000 28,525,000 Quarterly 165.4M 132AM 99.3M 66.2M 33.1 M 0 � 02 2018 Net Inc. M Sales (Revenue) 4 Profit Margin Total Current Assets Sales (Revenue) Cost of Revenue Gross Profit Sales and General Admin Research and Development Expense Non -Recurring Expenses Other Operating Items Operating Income Net Total Other Income and Expenses Earnings Before Interest and Taxes Interest Expense Earnings Before Tax 0.09 0.07 0.05 0.04 0.02 0 032018 11,595,000 042018 01 2019 Q1 04 03 02 06-30-2018 03-31-2018 12.31.2017 09.30-2017 Last 4 Quarters 150,398,000 143,573,000 140,734,000 136,431,000 119,045,000 116,422,000 115,167,000 110,679,000 31,353,000 27,151,000 25,567,000 25,752,000 15,937,000 15,556,000 15,495,000 13,670,000 15,416,000 11,595,000 10,072,000 12,082,000 15,416,000 11,595,000 10,072,000 12,082,000 15,416,000 11,595,000 10,072,000 12,082,000 ���� DocuSign Envelope ID. 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Income Tax Expense 3.638,000 2,637,000 503,000 3,689,000 =�—M Equity Earnings or Loss Minority Interest Expense Net Income from 11,778,000 8,958,000 9,569,000 8,393,000 Continuing Operations Discontinued Operations - - - - - Effect of Accounting - - - - - Changes Extraordinary Items - - - - Net Income 11,778,000 8,958,000 9,569,000 8,393,000 Preferred Stocks 8 - - - - - Other Adjustments Net Income Applicable to 11,778,000 8,958,000 9,569,000 8,393,000 Common Shares Statement Information Profit and Loss Information From APR 01 2018 to JUN 30 2018 sales $150,398,000: cost of goods sold $119,045,000. Gross profit $31,353.000; operating expenses $15,937.000- Operating income $15,416,000; net income before taxes $15,416,000; Federal income tax $3,638,000; net income $11,778,000. Source Information Statement obtained from Securities And Exchange Comrrission. Prepared from books without audit. Statement Explanation Explanations: The net worth of this company includes intangibles. Balance Sheet Source: Edgar I Currency: All figures show n in USD unless otherw Ise stated Annual Total Assets Total Liabilities 4 Liabilities to Assets 301 AM 0.45 2411M 0.36 180.8M 0.27 120.6M 0.18 603M0.09, , , 00 2016 2017 2018 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-BB7C-9D91277D5AD3 Fiscal Fiscal Fiscal Consolidated Consolidated Consolidated Assets 03-31-2018 03-31-2017 03-31-2016 Last 3 Years Cash and Cash Equivalents 55,771,000 28,611,000 32,779,000 Short Term Investments - - - - NetTradeReceivables 64,940,000 62,841,000 59,747,000 Inventory - - - - OtherCurrentAssets 42,606,000 37,415,000 30,582,000 Total Current Assets 163,317,000 128,867,000 123,108,000 Fixed Assets 69,356,000 63,042,000 53,268,000 Long Term Investments - - - - Deferred Long Term Asset Charges - - - - Other Assets 1,102,000 2,809,000 2,792,000 Goodwill 36,814,000 36,814,000 36,814,000 Total Assets 274,004,000 235,383,000 220,269,000 Accumulated Amortization - - - - Intangible Assets 3,415,000 3,851,000 4,287,000 Fiscal Fiscal Fiscal Consolidated Consolidated Consolidated Liabilities 03-31-2018 03-31-2017 03-31-2016 Last 3 Years Accounts Payable 97,989,000 90,051,000 80,415,000 Short Term and Current Long Term Debt - - - - Other Current Liabilities - - - - TotalCurrentLiabilities 97,989,000 90,051,000 80,415,000 Long Term Debt - - - - Deferred Long Term Liability Charges 4,839,000 6,686,000 7,906,000 Negative Goodwill - - - Minority Interest - - - - Other Liabilities - - - - Misc Stocks, Options & Warrants - - - - Total Liabilities 102,828,000 96,737,000 88,321,000 Fiscal Fiscal Fiscal Consolidated Consolidated Consolidated Shareholder Equity 03-31-2018 03-31-2017 03-31-2016 Last 3 Years Preferred Stocks - - - - Common Stocks 3,000 3,000 3,000 Retained Earnings 458,457,000 422,762,000 393,283,000 Treasury Stocks 430,989,000 419,802,000 391,803,000 Capital Surplus 143,705,000 135,683,000 130,465,000 Other Equity - - - - Total Equity 171,176,000 138,646,000 131,948,000 ��� DocuSign Envelope l0. 6EEOD36E-ABE7416C-8B7C-9O91277D5AD3 Quarterly 320.3M 256.3M 192.2M 128.1M 64.1 M 0 11 022018 Assets Cash and Cash Equivalents Short Term Investments Net Trade Receivables Inventory Other Current Assets Total Current Assets Fixed Assets Long Term Investments Deferred Long Term Asset Charges Other Assets Goodwill Total Assets Accumulated Amortization Intangible Assets Liabilities Accounts Payable Short Term and Current Long Term Debt Other Current Liabilities Total Current Liabilities Long Term Debt Deferred Long Term Liability Charges Negative Goodwill 11 032018 Q1 06-30-2018 73,340,000 66,124,000 43,692,000 183,156,000 66,849,000 1,085,000 36,814,000 291,210,000 8 Total Assets M Total Liabilities O Liabil8ies to Assets 6,4 03-31-2018 55,771,000 64.940.000 42,606,000 163,317,000 69,356,000 1,102,000 36,814,000 274,004,000 11 042018 Q3 12-31-2017 53,593,000 63,487,000 49,510,000 166,590,000 63,657,000 1,410.000 36,814.000 271,995,000 3,306,000 3,415,000 3,524,000 Q1 6,4 Q3 06-30-2018 03-31-2018 12-31-2017 104,801,000 97,989,000 109,875.000 104,801,000 97,989,000 109,876,000 4,544,000 4,839,000 1,940,000 0.46 0.37 0.28 0.18 1 0.09 0 01 2019 Q2 09-30-2017 Last 4 Quarters 38,133,000 M��. 65.996.000 mmmm 44,172,000 ��mm 148,301,000 mmm� 64,149,000 2,646,000 36,814,000 mmmm 255,629,000 3,619,000 Q2 09-30-2017 Last 4 Quarters 101.706.000 ��mm 101,706,000 6,127,000 ��—� DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9O91277D5AD3 Minority Interest - - - - Other Liabilities - - - - - Misc Stocks, Options & - - - - - Warrants Total Liabilities 109,345,000 102,828,000 111,815,000 107,833,000 mmmm Cash Flow Source: Edgar I Currency: AN figures shown in USD unless otherw ise stated Annual 71.5M 49.1 M 26.8M 4.4M (18.OM) (40.311A M Operating Cash Flow M Investing Cash Flow @ Financing Cash Flow ME 2016 Depreciation Net Income Adjustments Changes in Liabilities Changes in Accounts Receivables Changes in Inventories 01 Q4 Q3 Q2 8 Shareholder Equity 06-30-2018 03-31-2018 12-31-2017 09-30-2017 Last 4 Quarters Preferred Stocks - - - - - Common Stocks 3,000 3,000 3,000 3,000 mmmm Retained Earnings 470,235,000 458,457,000 449,499,000 439,930,000 mmmm Treasury Stocks 434,475,000 430,989,000 430,988,000 430,989,000 mmmm Capital Surplus 146,102,000 143,705,000 141.666,000 138,752.000 Other Equity - - - - - Total Equity 181,866,000 171,176,000 160,180,000 147,696,000 Cash Flow Source: Edgar I Currency: AN figures shown in USD unless otherw ise stated Annual 71.5M 49.1 M 26.8M 4.4M (18.OM) (40.311A M Operating Cash Flow M Investing Cash Flow @ Financing Cash Flow ME 2016 Depreciation Net Income Adjustments Changes in Liabilities Changes in Accounts Receivables Changes in Inventories 2017 8 Fiscal Fiscal Fiscal Consolidated Consolidated Consolidated 03-31-2018 03-31-2017 03-31-2016 Last 3 Years 21,775,000 20,948,000 19,952,000 6,048,000 4,280,000 2,179,000 4,913,000 2,814,000 (2,004,000) (4,658,000) (5,429,000) (3,567,000) �_� DocuSign Envelope ID. 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Changes in Other Operating Activities (1.621.000) (40,000) 6,226,000 Net Cash Flows - Operating Activities 62,152,000 52,052,000 51,311,000 Capital Expenditures (27,689,000) (31,041,000) (16,756,000) Investments 0 34,000 (600.000) —_ Other Cash Flows from Investing Activities - - - Net Cash Flows - Investing Activities (27,689,000) (31,007,000) (17,356,000)—� Dividends Paid - - - - Sale and Purchase of Stock (7,303,000) (25,213,000) (27,405,000) Met Borrowings - - - - Other Cash Flows from Financing Activities - - - Net Cash Flows - Financing Activities (7,303,000) (25,213,000) (26,692,000) Effect of Exchange Rate - - - - Change in Cash and Cash Equivalents 27,160,000 (4,168,000) 7,263,000 -- Quarterly a Operating Cash Flow a Investing Cash Flow M Financing Cash Flow 26.2M 18.OM 9.8M 1.6M . . (6.6Po1) ■ , _ _ (14.8M) Q2 2017 Q3 2017 Q4 2018 Q1 2018 Q1 04 03 Q2 06-30-2018 03-31-2018 12.31.2017 09.30-2017 Depreciation 5,633,000 5,762,000 5,473,000 5,237,000 Met Income Adjustments 2,149,000 4,449,000 (708,000) 1,149,000 Changes in Liabilities 6,613,000 (5,482.000) 5,307,000 (1,042,000) Changes in Accounts Receivables (2,497,000) (2,221,000) 1,605,000 (3,839,000) Changes in Inventories - - - - Changes in Other Operating Activities (871,000) 808,000 (1,965,000) (680,000) Net Cash Flows - Operating Activities 22,805,000 12,274,000 19,281,000 9,218,000 Capital Expenditures (2,969,000) (11,353,000) (4,908,000) (6,129,000) Investments - 0 0 0 Other Cash Flows from Investing Activities - - - Net Cash Flows - Investing Activities (2,969,000) (11,353,000) (4,908,000) (6,129,000) DocuSign Envelope ID: 6EEOD36E-ABE7416C-8B7C-9D91277D5AD3 Dividends Paid - - - - Sale and Purchase of Stock (2,267,000) 1,257,000 1,087,000 803,000 Net Borrowings - - - - Other Cash Flows from Financing Activities - - - - Net Cash Flows -Financing Activities (2.267,000) 1,257,000 1,087,000 35,000 Effect of Exchange Rate - - - - Change in Cash and Cash Equivalents 17,569,000 2,178,000 15,460,000 3,124,000 Financial Ratios Source: D&B I Currency: All figures show n in USD unless otherw ise stated Annual Fiscal Fiscal Fiscal Consolidated Consolidated Consolidated Solvency Ratios 03-31-2018 03-31-2017 03-31-2016 Current Ratio 1.67 1.43 1.53 Quick Ratio 1.23 1.02 1.15 Current Liabilities to Net Worth (%) 57.24 64.95 60.94 Total Liabilities/Net Worth (%) 60.07 69.77 66.94 Current Liabilities to Inventory (%) - - - Fixed Assets to Net Worth (%) 40.52 45.47 40.37 Cash Ratio 0.57 0.32 0.41 Fiscal Fiscal Fiscal Consolidated Consolidated Consolidated Efficiency Ratios 03-31-2018 03-31-2017 03-31-2016 Accounts Payable to Sales Ratio 0.18 0.17 0.16 Sales to Working Capital Ratio 8.55 13.36 11.80 Sales To Inventory (%) - - - Assets/Saks 49.07 45.38 43.74 ROCS(%) 27.22 32.72 32.93 Fiscal Fiscal Fiscal Consolidated Consolidated Consolidated Profitability Ratios - 03-31-2018 03-31-2017 03-31-2016 Return On Net Worth (%) 20.85 21.26 21.62 Return on Assets (%) 13.03 12.52 12.95 Return on Sales 1%) 8.58 9.17 9.15 Gross Profit Margin (%) 19.21 20.20 20.76 Operating Margin (%) 8.58 9.17 9.15 Pre -Tax Profit Margin (%) 8.58 9.17 9.15 Profit Margin 1%) 6.39 5.68 5.66 Pre -Tax Return on Equity (%) 27.98 34.30 34.91 After Tax Return on Equity (%) 20.85 21.26 21.62 Operating Income to Interest Ratio - - - DowSign Envelope ID: 6EEOD36E-ABE7416C-887C-9D91277D5AD3 Fiscal Fiscal Fiscal Consolidated Consolidated Consolidated Leverage Ratios 03-31-2018 03-31-2017 03.31-2016 EBITDA to ®IT Ratio 1.45 1.44 1.43 Debt to Income Ratio 2.88 3.28 3.10 Debt to Equity Ratio 0.60 0.70 0.67 Equity Ratio (%) 62.47 58.90 59.90 Interest Coverage Ratio - - - Interest Coverage to EBITDA Ratio - - - Quarterly Q1 Q4 03 Q2 Solvency Ratios 06-30-2018 03-31-2018 12-31-2017 09-30-2017 Current Ratio 1.75 1.67 1.52 1.46 Quick Ratio 1.33 1.23 1.07 1.02 Current Liabilities to Net Worth (%) 57.63 57.24 68.59 68.86 Total Liabilities/Net Worth (%) 60.12 60.07 69.81 73.01 Current Liabilities to Inventory (%) - - - - Fixed Assets to Net Worth (%) 36.76 40.52 39.74 43.43 Cash Ratio 0.70 0.57 0.49 0.37 Q1 04 Q3 Q2 Efficiency Ratios 0630.2018 03-31.2018 12-31-2017 09-30-2017 Accounts Payable to Sales Ratio 0.70 0.68 0.78 0.75 Sales to Working Capital Ratio 1.92 2.20 2.48 2.93 Sales To Inventory (%) - - - - Assets/Sales 193.63 190.85 193.27 187.30 ROCE(%) 8.27 6.59 6.21 7.85 Q1 Q4 Q3 Q2 Profitability Ratios 06-30-2018 03-31.2018 12-31-2017 09-30-2017 Return On Net Worth (%) 6.48 5.23 5.97 5.68 Return on Assets (%) 4.04 3.27 3.52 3.28 Return on Sales (%) 10.25 8.08 7.16 8.86 Gross Profit Margin 1%) 20.85 18.91 18.17 18.88 Operating Margin (%) 10.25 8.08 7.16 8.86 Pre -Tax Profit Margin (%) 10.25 8.08 7.16 8.86 Profit Margin (%) 7.83 6.24 6.80 6.15 Pre -Tax Return on Equity (%) 8.48 6.77 6.29 8.18 After Tax Return on Equity (%) 6.48 5.23 5.97 5.68 Operating Income to Interest Ratio - - - - Q1 Q4 Q3 Q2 Leverage Ratios 06-30-2018 03-31-2018 12-31-2017 09-30-2017 EBITDA to ®IT Ratio 1.37 1.50 1.54 1.43 Debt to Income Ratio 9.28 11.48 11.69 12.85 Debt to Equity Ratio 0.60 0.60 0.70 0.73 Equity Ratio (%) 62.45 62.47 58.89 57.80 DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 Interest Coverage Ratio Interest Coverage to EBITDA Ratio This infomration may not be reproduced in whole or in part by any meansof reproduction. @Dun & Bradstreet, Inc. 2018. All fights reserved DocuSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 APPENDIX B COST PROPOSAL FORM Proposer affirms that the prices stated on the cost proposal form below represent the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance. The Cost Proposal Form (Appendix B) shall be completed in its entirety. All corrections on the Cost Proposal Form (Appendix B) shall be initialed. FLAT ANNUAL FEE ADDITIONAL SERVICES List of services, which may be needed, which are in addition to the fees or000sed. Description Telephonic Medical Case Management Fee on All Claims: $100.43 Per Bill/Flat Fee Bill Review Fee to Include State Fee Schedule Reduction: $ 4.65 Per Bill/Flat Fee Percentage of PPO Savings — Network Discount Savings Below State Fee Schedule: 22% incrementap/o Percentage Of Utilization Review and Reasonable & Customary Savings: Hospital capped 3,999 max mw hin nq 22% total Subrogation and/or Liens Fee Percentage: 25% of recovery% Osha 300 Log Reporting: $ included Electronic Data Interchange Filed with State: $ included Safety Consulting Services $ included Notice Of Injury Entry: $_M 43 Custom/Ad Hoc Reports: The city reports are all at no cost $200.00 / hr/ if programming is required the cit has never required this DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 'Pharmacy Discounts will remain as is: MAIL ORDER: BRAND -AWP -13% GENERIC- AWP -45% dispensing $1.50 RETAIL: BRAND AWP -10% GENERIC AWP- 35% dispensing $2.50 $ Data and File Conversion Fee: $Not applicable One -Time Setup Flat Fee N/A Medicare Reporting Costs: $ included $ $ Additional Description Of Additional Service: Pharmacy discounts" $ Descripfion Of Additional Service: $ Desorption Of Additional Service: $ Description Of Addifional Service: $ 'Pharmacy Discounts will remain as is: MAIL ORDER: BRAND -AWP -13% GENERIC- AWP -45% dispensing $1.50 RETAIL: BRAND AWP -10% GENERIC AWP- 35% dispensing $2.50 DocuSlgn Envelope to: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 JNNAIRE W-0 LIVING WAGE W EQUAL BEN. -FINAL 5.7.21 BID SUBMITTAL QUESTIONNAIRE SECTION 1 - BID CERTIFICATION FORM This document is a REQUIRED FORM that must be submitted fully completed and submitted. Solicitation No: Solicitation Title: 2021 -224 -WG CLAIMS ADMINISTRATION SERVICES BY A 3rd -PARTY ADMINISTRATOR FOR WORKERS COMP BIDDER'S NAME: (UnWl EnblpHw Comp, Iw. N0. OF YEARS IN BUSINESS'. 36 N0. OF YEARS IN BUSINESS LOCALLY: 36 N0. OF EMPLOYEES: 3,000 OTHER NAME(S) BIDDER HAS OPERATED UNDER IN THE LAST 10 YEARS: BIDDER PRIMARY ADDRESS (HEADQUARTERS): 190 M01n 5bost, 5o1le MO CITY OMtm STATE: CA ZIP CODE:0ri10 TELEPHONE NO.: (114111) "14173 TOLL FREE NO.: NIA FAX NO.: BIDDER LOCAL ADDRESS: IMO SavMn m Cmpm3le Pa b y, Sulk 1M CITY: ft STATE: FL ➢P CODE: 33333 PRIMARY ACCOUNT REPRESENTATIVE FOR THIS ENGAGEMENT Dit M PopoMoh ACCOUNT REP TELEPHONE NO.: (9")133.60" ACCOUNT REP TOLL FREE NO.: NIA ACCOUNT REP EMAIL: CeOMOyopovlOh@0onol.eom FEDERAL TAX IDENTIFICATION NO.: "1470"60 By virtue of submitting a bid, bidder agrees: a) to complete and unconditional acceptance of the terms and conditions ( this document, inclusive of this solicitation, all specifications, attachments, exhibits and appendices and the contents I any Addenda released hereto; b) to be bound, at a minimum, to any and all specifications, terms and condition contained herein or Addenda; c) that the bidder has not divulged, discussed, or compared the proposal with other bidder and has not colluded with any other bidder or party to any other bid; d) that bidder acknowledges that all informatio contained herein is part of the public domain as defined by the State of Florida Sunshine and Public Records Laws; e) th file:///C:/use' bidder agrees if this bid is accepted, to execute an appropriate City of Miami Beach document for the purpose < establishina a formal contractual relationship between the bidder and the Citv of Miami Beach. Florida. for th DocuSign Envelope ID: 6EEOD36E-ABE7-416C-667C-9D91277D5AD3 JNNAIRE W-0 LIVING WAGE W EQUAL BEN. - FINAL 5.7.21 performance of all requirements to which the bid pertains; and f) that all responses, data and information contained in th bid submittal are true and accurate. The individual named below affirms that s/he: is a principal of the applicant duly authorized to execute this questionnaire and that the contents of said document(s) are complete, true, and correct to the best of his/her knowledge and belief. Name of Bidder's Authorized Representative: Title of Bidder's Authorized Richard Schweppe Representative: Assistant Treasurer and Director 1ile://1C:/Uses DoaSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9091277D5AD3 JNNAIRE W O LIVING WAGE W_EQUAL BEN. - FINAL 5.7.21 SECTION 2 - ACKNOWLEDGEMENT OF ADDENDUM After issuance of solicitation, the City may release one or more addendum to the solicitation, whic may provide additional information to bidders or alter solicitation requirements. The City will strive t reach every bidder having received solicitation through the City's e -procurement system. Howeve bidders are solely responsible for assuring they have received any and all addendum issued pursuar to solicitation. This Acknowledgement of Addendum section certifies that the bidder has received a addendum released by the City pursuant to this solicitation. Failure to obtain and acknowledg receipt of all addenda may result in proposal disqualification. Enter Initial to Confirm Receipt Enter Initial to Confirm Receipt Enter Initial to Confirm Receipt RS Addendum 1 Addendum 6 Addendum 11 Addendum 2 Addendum 7 Addendum 12 Addendum 3 Addendum 8 Addendum 13 Addendum 4 Addendum 9 Addendum 14 Addendum 5 Addendum 10 Addendum 15 If additional confirmation of addendum is required, submit under separate cover. SECTION 3 - CONFLICT OF INTEREST All bidders must disclose the name(s) of any officer, director, agent, or immediate family membe (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, a bidders must disclose the name of any City employee who owns, either directly or indirectly, a interest of ten (10%) percent or more in the bidder entity or any of its affiliates. YES 0 NO If yes, please disclose the name(s): F Ik5I AND LAST NAME OCCUPATION 1 2 3 4 5 6 SECTION 4 - FINANCIAL CAPACITY When requested by the City, each bidder shall arrange for Dun & Bradstreet to submit a Supplie Qualification Report (SQR) directly to the City. No proposal will be considered without receipt, by th City, of the SQR directly from Dun & Bradstreet. The cost of the preparation of the SQR shall be th. responsibility of the bidder. The bidder shall request the SQR report from D&B at: https://su pplierporta l.dn b.com/weba pplwcs/sto res/serviet/Su pplierPortal?storeld=11696 Bidders are responsible for the accuracy of the information contained in its SQR. It is highl recommended that each bidder review the information contained in its SQR for accuracy pric file:///C:/User to submittal to the City and as early as possible in the solicitation process. For assistant with any portion of the SQR submittal process, contact Dun & Bradstreet at 800-424-2495. DowS`gn Envelope ID: 6EEOD36E-ABE7-416C-887C-9D91277D5AD3 JNNAIRE W-0 LIVING WAGE W EOUAL BEN. -FINAL 5.7.21 At time of request, bidder shall request that Dun & Bradstreet submit its Supplier Qualifier Repo directly to the City, with bid or within three (3) days of request. SECTION 5 - MORATORIUM ON TRAVEL TO AND THE PURCHASE OF GOODS OR SERVICES FROM MISSISSIPPI Pursuant to Resolution 2016-29375, the City of Miami Beach, Florida, prohibits official City travel t the state of Mississippi, as well as the purchase of goods or services sourced in Mississippi. Bidde shall agree that no travel shall occur on behalf of the City of Miami Beach to Mississippi, nor shall an product or services it provides to the City be sourced from this state. By virtue of submitting bid, bidder agrees it is and shall remain in full compliance with Resolutio 2016-29375 https://www. miamibeachfl.gov/wp-content/uploads/2017/11 /2016-29375-Resolution-Vendor- Moratorium-for-Services-Sources-from-North-Carolina-Mississippil .pdf file.///C:/User DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 .JNNAIRE W O LIVING WAGE W_EQUAL BEN. - FINAL 5.7.21 SECTION 6 - REFERENCES AND PAST PERFORMANCE Project No. 2021 -224 -WG Project Title CLAIMS ADMINISTRATION SERVICES BY A 3rd -PARTY ADMINISTRATOR FOR WORKERS COMP Bidder shall submit at least three (3) references for whom the bidder has completed work similar i size and nature as the work referenced in solicitation. Reference No.1 Firm Name: City of West Palm Beach Contact Individual Name and Title: Timothy Scott, Director Address: 401 Clematis St. West Palm Beach, Florida 33401 Telephone: (561) 494-1136 Contact's Email: tscott@wpb.org Narrative on Scope of Services Provided: Workers compensation and managed care services. Reference No.2 Firm Name: Miami Dade County Contact Individual Name and Title: Baunie McConnell, Director Address: 111 NW 1st Street Suite 2340 Miami, Florida 33128 Telephone: (305) 375-3583 Contact's Email: Baunie.McConnell@miamidade.gov Narrative on Scope of Services Provided: Workers compensation medical management, network, RX and RMIS. Reference No.3 Contact Individual Name and Title: Cindy Lawrence, Director of Risk Address: 100 W. Atlantic Blvd. Pompano Beach, FL 33060 Telephone: (954) 786-4636 Contact's Email: cindy.lawrence@copbfl.com file:///C'./Uses Narrative on Scope of Services Provided: Workers comnensation TPA services. managed care services. and liability services. DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 , JNNAIRE W O LIVING WAGE W EQUAL BEN. - FINAL 5.7.21 rile:///C:/User Additional Reference Firm Name. City of Hollywood Contact Individual Name and Title: Tammie L. Hechler, Director of Human Resources City c Hollywood Office of Human Resources Address: 2600 Hollywood Blvd, Suite 206 P.O. Box 229045 Hollywood, FL 33022-9045 Telephone: 954-921-3218 Contact's Email: THECHLER@hollywoodfl.org Narrative on Scope of Services Provided: Workers compensation TPA services, managed care services, and liability services. SECTION 7 - STANDARD TERMS AND CONDITIONS The Standard Terms and Conditions are available at https://www.miamibeachtl.gov/cit) hall/ p rocurement/standard-terms-and-conditions/ By virtue of submitting a bid, bidder attests that the have read and understand the applicable Standard Terms and Conditions as indicated in th solicitation. Project No. 2021 -224 -WG Project Title CLAIMS ADMINISTRATION SERVICES BY A 3rd -PARTY ADMINISTRATOR FOR WORKERS COMP SECTION 8 - VENDOR CAMPAIGN CONTRIBUTIONS Bidders are expected to be or become familiar with, the City's Campaign Finance Reform laws, a codified in Sections 2-487 through 2-490 of the City Cod nodeld=SPAGEOR CH2AD ARTVIISTCO DIV5CAFIRE Bidders shall be solely responsible for ensuring that all applicable provisions of the City's Campaig Finance Reform laws are complied with, and shall be subject to any and all sanctions, as prescribe therein, including disqualification of their bid submittal, in the event of such non-compliance. Are there any individuals or entities (including your sub -consultants) with a controlling financia interest which have contributed to the campaign either directly or indirectly, of a candidate who ha been elected to the office of Mayor or City Commissioner for the City of Miami Beach. = YESp� NO If amount and date: DocuSign Envelope ID: 6EE6D36E-ABE7-016C-8B7C-9D91277D5AD3 ,JNNAIRE W-0 LIVING WAGE W EQUAL BEN. - FINAL 5.7.21 file://1C:/User DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277DSAD3 ..JNNAIRE W O LIVING WAGE W EQUAL BEN. - FINAL 5.7.21 SECTION 9 — SUSPENSION, DEBARMENT, OR CONTRACT CANCELLATION Has bidder ever been debarred, suspended or other legal violation, or had a contract cancelled due to non-performance by any public sector agency.? = YES L I NO If answer to above is "YES," bidder shall submit a statement detailing the reasons that led t action(s): SECTION 10 - EQUAL BENEFITS FOR EMPLOYEES WITH SPOUSES AND EMPLOYEES WITH DOMESTIC PARTNERS When awarding competitively solicited contracts valued at over $100,000 whose contractors maintain 51 c more full time employees on their payrolls during 20 or more calendar work weeks, the Equal Benefits fc Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Mian Beach, who are awarded a contract pursuant to competitive bids, to provide "Equal Benefits" to the employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to a employees of a Contractor who work within the City limits of the City of Miami Beach, Florida; and th Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who ar directly performing work on the contract within the City of Miami Beach. Does bidder provide or offer access to any benefits to employees with spouses or to spouses of employees? 0 YES = NO Does bidder provide or offer access to any benefits to employees with (same or opposite sex) domesti partners or to domestic partners of employees? YES NO Please check all benefits that apply to your answers above and list in the 'other" section any additiom benefits not already specified. Note: some benefits are provided to employees because they have a spouse c domestic partner, such as bereavement leave; other benefits are provided directly to the spouse or domesti partner, such as medical insurance. If Bidders cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there ar no insurance providers in your area willing to offer domestic partner coverage) you may be eligible fc Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent an submit a completed Reasonable Measures Application with all necessary documentation. Your Reasonabl file:///C:/Uses Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval is nc guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement i Bidder Provides for Bidder Provides for BENEFIT Employees with Employees with Bidder does not Spouses Domestic Partners Provide Benefit Health x x Sick Leave x x Family Medical Leave x x Bereavement Leave x x If Bidders cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there ar no insurance providers in your area willing to offer domestic partner coverage) you may be eligible fc Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent an submit a completed Reasonable Measures Application with all necessary documentation. Your Reasonabl file:///C:/Uses Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval is nc guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement i DowSign Envelope ID: 6EEOD36E-ABE7-416C-6B7C-9D91277D5AD3 JNNAIRE W-0 LIVING WAGE W EOUAL BEN. -FINAL 5.7.21 available at http:/h%ww.miamibeachfi.gQv/city-hall/procurement/procurement-related-ordinance-anc procedures/ file H/C:/UseF DocuSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 ,JNNAIRE W O LIVING WAGE W EQUAL BEN. - FINAL 5.7.21 SECTION 11- BYRD ANTI -LOBBYING AMENDMENT CERTIFICATION FORM APPENDIX A, 44 C.F.R. PART 18 — CERTIFICATION REGARDING LOBBYING Cer fica on for Contracts, Grants, Loans, and Coopera ve Agreements The undersigned Contractor cer lies, to the best of his or her knowledge, that: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to an person for influencing or a. emp ng to influence an officer or employee of an agency, a Member of Congres! an officer or employee of Congress, or an employee of a Member of Congress in connec0on with the awardin of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into c any coopera0ve agreement, and the extension, conMnuaDon, renewal, amendment, or modifica0on of an Federal contract, grant, loan, or coopera ve agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person fc influencing or attempMng to influence an officer or employee of any agency, a Member of Congress, an office or employee of Congress, or an employee of a Member of Congress in connec on with this Federal contras grant, loan, or coopera0ve agreement, the undersigned shall complete and submit Standard Form-LLI "Disclosure Form to Report Lobbying," in accordance with its instruc ons. 3. The undersigned shall require that the language of this cerOficaDon be included in the award documents fc all subawards at all Mers (including subcontracts, subgrants, and contracts under grants, loans, and coopera0v agreements) and that all subrecipients shall cer fy and disclose accordingly. This certNficaMon is a material representaDon of fact upon which reliance was placed when this transac0on wa made or entered into. Submission of this cerOficafflon is a prerequisite for making or entering into thi transac0on imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any perso who fails to file the required cer[dficaDon shall be subject to a civil penalty of not less than $10,000 and nc more than $100,000 for each such failure. The undersigned Contractor cerOfies or affirms the truthfulness and accuracy of each statement of it cer fica0on and disclosure, if any. In addiDon, the Contractor understands and agrees that the provisions of 3 U.S.C. § 3801 etseq., apply to this cerOficaOon and disclosure, if any. By virtue of submitting bid, bidder certifies or affirms its compliance with the Byrd Anti -Lobbying Amendmer Certification. Name of Bidder's Authorized Representative: Title of Bidder's Authorized Richard Schweppe Representative: Assistant Treasurer and Director file:///C:IUser DowSign Envelope ID: 6EEOD36E-ABE7-416C-8B7C-9D91277D5AD3 ,)NNAIRE W-0 LIVING WAGE W EQUAL BEN. -FINAL 5.7.21 SECTION 12 —SUSPENSION AND DEBARMENT CERTIFICATION The Contractor acknowledges that: (1) This Contract is a covered transac0on for purposes of 2 C.F.R. pt. 180 and 2 C.F.R. pt. 3000. As such th contractor is required to verify that none of the Contractor, its principals (defined at 2 C.F.R. § 180.995), or it affiliates (defined at 2 C.F.R. § 180.905) are excluded (defined at 2 C.F.R. § 180.940) or disqualified (defined z 2 C.F.R. § 180.935). (2) The Contractor must comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C and mus include a requirement to comply with these regula ons in any lower Oer covered transac®on it enters into. (3) This cerOfical]on is a material representalEon of fact relied upon by the City. If it is later determined that th Contractor did not comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C, in addi0on t remedies available to the City, the Federal Government may pursue available remedies, including but nc limited to suspension and/or debarment. (4) The Contractor agrees to comply with the requirements of 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 300( subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. Th Contractor further agrees to include a provision requiring such compliance in its lower Oer covere transacOons." By virtue of submitting bid, bidder certifies or affirms its compliance with the Suspension and Debarmer Certification. Name of Bidder's Authorized Representative: Title of Bidder's Authorized Richard Schweppe Representative: Assistant Treasurer and Director SECTION 13 - SMALL AND DISADVANTAGED BUSINESS CERTIFICATION Pursuant to Resolu on 2020-31519, the City is tracking the Small and Disadvantaged Businesses, as cerl8fie by Miami -Dade County that have been ceAHfied as Small or Disadvantaged Business by Miami -Dade County. Does bidder possess Small or Disadvantaged Business cer©fica on by Miami -Dade County? = YESp� NO SECTION 14 - LGBT BUSINESS ENTERPRISE CERTIFICATION Pursuant to Resolu on 2020-31342, the City is tracking the uOlizaOon of LGBT owned firms that have bee cerOfied as an LGBT Business Enterprise by the Na onal Gay and Lesbian Chamber of Commerce (NGLCC). Does bidder possess LGBT Business Enterprise CerOficaOon by the NGLCC? = YES F-6-7 NO SECTION 15 — CONE OF SILENCE Pursuant to SecOon 2-486 of the City Code, all procurement solicita0ons once adverOsed and un I an awar file:///C:/Uses recommendamon has been forwarded to the City Commission by the City Manager are under the "Cone c Silence." The Cone of Silence ordinance is availabl DowSign Envelope ID: 6EEOD36E•ABE7-416C-8B7C-9D91277D8AD3 SIRE W-0 LIVING WAGE W_EQUAL BEN. - FINAL 5.7.21 at b-Uli r ry.municode.com/fl/miami beach/codes/code of ordinances nodeld=SPAGEOR CH2AD ARTVIISTCO DIV4PR S2-486C05I Any communicaDon or inquiry in reference to this solicitafon with any City employee or City official is strictl prohibited with the of excepmon communica®ons with the Procurement Director, or his/her administra®v staff responsible for administering the procurement process for this solicita®on providing said communica®o is limited to matters of process or procedure regarding the solicita®on. CommunicaMons regarding thi solicita on are to be submitted in wri ng to the Procurement Contact named herein with a copy to the Cit Clerk at rafaelgranado miamibeachfl.gov . Vendor attests that they have read, understand, and are in compliance with the Cone of Silence Ordinance pursuant to SecMon 2-486 of the City Code? p� YES NO file:///C:/Uses DowSign Enelope ID: 6EE0D36E-ABE7-416C-6B7C-9D91277D6AD3­ ,)NNAIRE W-0 LIVING WAGE W EQUAL BEN. -FINAL 5.7.21 SECTION 16 — CODE OF BUSINESS ETHICS Pursuant to City Resolu©on No.2000-37879, the Bidder shall adopt a Code of Business Ethics ("Code") an submit that Code to the Procurement Division with its response or within three (3) days upon receipt c request. The Code shall, at a minimum, require the Bidder, to comply with all applicable governmental rule and regula®ons including, among others, the conflict of interest, lobbying and ethics provision of the City c Miami Beach and Miami Dade County. Bidder shall submit firm's Code of Business Ethics within three (3) of request by the City. In lieu of submittin Code of Business Ethics, Vendor may indicate that it will adopt, as required in the ordinance, the City of Mian Beach Code of Ethics, available at b- p://www.miamibeachfl.g v i y -h II procurement/procurement-relatec ordinance -and -procedures/ Bidder adopts the City of Miami Beach Code of Business Ethics? YES 0 NO Bidder will submit firm's Code of Business Ethics within three (3) days of request by the City? YES = NO SECTION 17 — DRUG FREE WORKPLACE CERTIFICATION The Drug Free Workplace Cer®ficamon is available at: haps://www.miamibeachfl.gguLp-content/uploads/2019/04/DRUG-FREE-WORKPLACE-CE RTI FICATI ON.pdf By virtue of submitting bid, bidder certifies or affirms it has adopted policies, practices and standard consistent with the City's Drug Free Workplace Certification. SECTION 18 — LOBBYIST REGISTRATION REQUIREMENTS This solicita on is subject to, and all bidders are expected to be or become familiar with, all City lobbyist law! Bidders shall be solely responsible for ensuring that all City lobbyist laws are complied with, and shall b subject to any and all sand3ons, as prescribed therein, including, without limita©on, disqualificamon of the responses, in the event of such non-compliance. By virtue of submitting bid, bidder certifies or affirms that they have read and understand the above Lobbyi: Registration Requirements. SECTION 19—NON-DISCRIMINATION The Non-Discrimina©on ordinance is available at: Ilu I' r ry,_municode.com/fl/miami beach/codes/code of ordinances? nodeld=SPAGEOR CH2AD ARTVIPR DIV3COPR 52-375NSCCOREWA By virtue of submitting bid, bidder agrees it is and shall remain in full compliance with Section 2-375 of the Cit of Miami Beach City Code. SECTION 20 — FAIR CHANCE REQUIREiVILN i The Fair Chance Ordinance No. 2016-4012 is available at: file:///ClUsei hht s:l/library.municode.com/fl/miami beach/codes/code of ordinances nodeld=SPAGEOR CH62HURE ARTVFACHOR DowSfpn Envelope ID: 6EEOD36E-ABE7.416C-8B7C-9D91277D5AD3V JNNAIRE W_O LIVING WAGE W_EQUAL BEN. - FINAL 5.7.21 By virtue of submitting bid, bidder certifies that it has adopted policies, practices and standards consistent wit the City's Fair Chance Ordinance. Bidder agrees to provide the City with supporting documentation evidencin its compliance upon request. Bidder further agrees that any breach of the representations made herein sha constitute a material breach of contract, and shall entitle the City to the immediate termination for cause of th agreement, in addition to any damages that may be available at law and in equity. SECTION 21— PUBLIC ENTITY CRIMES Please refer to Sed0on 287.133(2)(a), Florida Statutes, available at: https://www.flsenate.gov/Laws/Statutes/2012/287.133 By virtue of submitting bid, bidder agrees with the requirements of Section 287.133, Florida Statutes, an certifies it has not been placed on convicted vendor list. file:///C:/User DocuSign Envelope ID: 6EEOD36E-ABE7-416G867G9D91277D5AD3 ,JNNAIRE W-0 LIVING WAGE W EQUAL BEN. - FINAL 5.7.21 SECTION 22— VETERAN BUSINESS ENTERPRISES PREFERENCE Pursuant to City of Miami Beach Ordinance No. 2011 3748, https://Iibrary.municode.com/fl/miami beach/codes/code of ordinances nodeld=SPAGEOR CH2AD ARTVIPR DIV3COPR S2-374PRPRPRVECOGOCOSE the City shall give a preferenc to a responsive and responsible bidder which is a small business concern owned and controlled by a veteran(! or which is a service -disabled veteran business enterprise, and which is within five percent (5%) of the lowe! and best bidder, by providing such bidder an opportunity of providing said goods or contractual services fc the lowest responsive bid amount. Whenever, as a result of the foregoing preference, the adjusted prices c two (2) or more bidders which are a small business concern owned and controlled by a veteran(s) or a service disabled veteran business enterprise cons[9tute the lowest bid pursuant to an ITB, RFP, RFQ, ITN or oral c written request for quota0on, and such bids are responsive, responsible and otherwise equal with respect t quality and service, then the award shall be made to the service -disabled veteran business enterprise. Is the bidder a service -disabled veteran business enterprise certified by the State of Florida? = YES F_S__� NO Is the bidder a service -disabled veteran business enterprise certified by the United States Feder Govemment? = YES F-12 —] NO file ///C /Users/PURCGarW/Downloads/BID_SUBMITTAL_QUESTIONNAIRE_W O_LIVING_WAGE_W EQUAL_BEN._ _FINAL_5.7.21_8933861 ... 17117