C2D-Issue RFP Claims Administration Services For Workers' Compensation-General LCOMMISSION ITEM SUMMARY
Condensed Title:
Request For Approval To Authorize The lssuance Of A Request For Proposals (RFP) For Claims
Administration Services By A Third Party Administrator For Workers' Compensation And General
Liabil
lntended Outcome S
Ensure Trends Are Sustainable Over the Lonq Term
Environmenta!
Item Sum marv/Recommendation :
ffre eity 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 of the State of Florida requires that the claims
administration be provided by a State Certified Workers' Compensation Claims Administrator, also
known as a third-party administrator (TPA).
Currently, the City has a contract with the Johns Eastern Company, as the State Certified Workers'
Compensation Claims Administrator. The current Agreement expires on January 31,2015, with no
further options to renew.
To continue services upon expiration of the current agreement, the City is seeking approval to
release Request for Proposals (RFP) 2014-302-SW, for the required services. The City is seeking a
three-year contract proposal with two (2) 1-year option to renew periods. The commencement date
of the replacement contract will be February 1,2015.
Through the RFP, the City of Miami Beach is seeking proposals for third party claims administration
services for its self-insurance Worker's Compensation program. 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 the RFP.
RECOMMENDATION
the lssuance of the RFP
Financial lmpact Summary:
540-1790-000312
Alex Denis Tabak
T:\AGENDA
Agenda ftem C?D.
Date ?'l* | V(B AAIAnnIBEACH 149
City Commissioner Memorandum - Claims Administration Service by a TPA for Workers' Compensation and General Liability
July 23,2014
Page 3 of 3
MIAMIBEACH
City of Miomi Beoch, I200 Convention Center Drive, Miomi Beoch, Florido 33139, www.miomibeochfl.gov
COMMISSION MEMORANDUM
TO: Mayor Philip Levine and Members
FROM: Jimmy L. Morales, City Manager
DATE: July 23,2014
SUBJECT: REQUEST FOR APPROVAL TO THE ISSUANCE OF A REQUEST FOR
pRoposALS (RFp) FOR CLAIMS ADMTNTSTRATION SERVICES BY A THIRD PARTY
ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY.
ADMINISTRATION RECOMMENDATION
Authorize the issuance of the RFP.
KEY INTENDED OUTCOME
Ensure Expenditure Trends Are Sustainable Over the Long Term
BACKGROUND
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.
On December 9, 2009, the Mayor and City Commission authorized the Administration to execute an Agreement
with Johns Eastern Company, as the State Certified Workers' Compensation Claims Administrator. The
Agreement period was for two years with renewal options for three additional one-year periods. The
Administration has continued the Agreement through option years one, two and three for a total service
agreement period of five years. The current Agreement expires on January 31,2015, with no further options to
renew.
The City is seeking a two-year contract proposal with three (3) 1-year option to renew periods. Proposals to
handle only selected parts of the scope will not be considered. lt 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. The
City's current claims administrator is John Eastern Company. Johns Eastern has provided administration for the
City's self-insured worker's compensation program since 1986.
SCOPE OF SERVICES
The City of Miami Beach is seeking proposals for third party claims administration services for its self-insurance
Worker;s Compensation program. 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 418 open claims. Prior to October
1996, the City purchased excess workers'compensation insurance. The City does not currently purchase
excess workers' compensation insurance.
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City Commissioner Memorandum - Claims Administration Service by a TPA for Workers' Compensation and General Liability
July 23,2014
Page 3 of 3
ln agreement with Ordinance No. 1335, the City pays Supplemental lnjury 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 lnjury Pay is the amount equal to the difference between their normal City pay and the amount of
compensation payabte 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. ln 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. ln 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 attachment A 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. lf the amount of prior claim files to
be taken over is 25o/o greater than represented in this RFP, the City will consider a proportionate adjustment to
the proposer's flat annual fee. lt is the responsibility of the proposer to review prior claim files to determine the
additional proposed cost, if any, to take over these files. lt 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 specificatly 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.
MAJOR RFP REQUIREMENTS
1, MINIMUMQUALIFICATIONS
Please Reference Section 0300, RFP 2014-302-SW.
2, SUBMITTAL REQUIREMENTS
Please Reference Section 0300, RFP 2014-302-SW.
3. CRITERIA FOR EVALUATION
Please Reference Section 0400, RFP 2014-302-SW.
CONCLUSION
The Administration recommends that the Mayor and Commission authorize the issuance of the RFP for Claims
Administration Services by a Third Party Administrator for Workers' Compensation and General Liability.
ATTACHMENTS
Attachment A: RFP 2014-302-SW for Claims Administration Services by a Third Party Administrator for Workers'
Compensation and General Liability.
lLMt&tscr/AD
T:\AGENDA\2014Uuly\Procurement\RFP lssuance-Memo- TPA for Workers Comp and Gen Liab MEMO.doc
151
REQUEST FOR PROPOSALS (RFP)
FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR
WORKERS' COMPENSATION AND GENERAT IIABIIITY
20r4-302-SW
%Tffifi tr
RFP ISSUANCE DATET.JULY 24,2A14 ^_.,,,,.*
PROPOSALS DUE: AUGUST 26,2A14 @ 3:00'PM
ISSUED EY:
.:..]#f+ ,lu
"iiii!i='
# nAIAMIBEACH
Steven Wi I I iams, Proertfement Goordi nator
DEPARTMENT OF PRQCUREMENT MANAGEMENT
17OO Convention Center Drive, Miomi Beoch, FL 33,l39
305.673.7000x6650 | Fox: 786.373. 4330 | www.miomibeochfl.gov
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TABLE OF CONTENTS
SOLICITAT!ON SECT!ONS:PAGE
0100 NoT uTtLtzED ."..."... .......... N/A
O2OO INSTRUCTIONS TO PROPOSERS & GENERAL CONDITIONS ........ .......3
O3OO PROPOSAL SUBMITTAL INSTRUCTIONS & FORMAT ...-u-.-....................10
0400 PROPOSAL EVALUATION ....... ,,=:::t .- = .........12
APPENDIGES:PAGE
APPENDIX A PROPOSAL CERTIFICATON, QUESTIONNAIRE AND AFF{.E S ........14
AppENDtX B "NO pROpOSAL', FORM ...................,i.
'\N-- ',.':. :,"
APPENDIX C MINIMUM REQUIREMENTS & SPECTFJCATIONS ,,,,....,..........24
.:..;: ..............35APPENDIX E COST PROPOSAL FORM .....................
'l Ll i ill i ti*a-^ "::::::::=:,APPENDlXFlNSURANCEREQUlREMENfsIl.ilif&--=
,
APPENDIX G CLAIMS EXPER|ENCE...........rlr
.*5^s.'-:1
.3,I=" ..................41
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RFP 20.l4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility
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SECTION ()2()O 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, condltions 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 automatiG-notification of competitive solicitation
opportunities and document fulfillment, including the issuance of any''a'ddendum td',this RFP. Any prospective
Proposer who has received this RFP by any means other than thro.$PgblicPurchaie must register immediately
with PublicPurchase to assure it receives any addendum issu-edfu th|S"RFP. Failure to receive an addendum
mayresultindisquaIificationofproposalsubmitted.
=
2. PURPOSE.
The City of Miami Beach (the "City") is approved by of Labor and Employment
Email:
StevenWilliams@miamibeachfl .gov
the
Security/Division of Workers' Compensation to seltinsure for . The Division of Workers'
Compensation requires that the claims adminisliation be provided by Certified Workers' Compensation
Claims Administrator, Therefore the City is seekin$ the professional service$,b. -..q1- perienced and qualified firm to
provide services as a third party administrator for WorkerS Compensation and G ettl Liability.
4. PROCUREMENT CONTACT. Any questions or clarifications concerning this solicitation shall be submitted to the
Procurement Contact named herein, in writing, with a copy to the City Clerk's Office, Rafael E. Granado via e-mail:
RafaelGranado@miamibeachfl.qov ; or facsimile: 786-394-4188, The Bid title/number shall be referenced on all
correspondence. All questions or requests for clarification must be received no later than seven (7) calendar days
prior to the date proposals are due as scheduled in Section 0200-3. All responses to questionslclarifications will be
sent to all prospective Proposers in the form of an addendum.
Procurement Contact:
Steven Williams
Telephone:
(305)673-74e7
TI he tentative schedule for this-solicitation,is as follows
,:ri:i!t::::1'l$FP lssued July 24,2014
Pre-Pro$@l Meeting AugUst 5,2014.@ 10:00 a.m.
August 19,2014
:' ReSFofi56s Due August 26, 2014@ 3;00p.m,
EvaluationComm,!$, Review TBD
P ser Pre$$$Jatiohs TBD
Tentative co m m issio n ononrr|.t3flilill:TBD
Contract Negotiations Following Commission Approval
RFP 20.l4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility
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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 - 4ttt FIoor
City Manager's Large Conference Room
1700 Convention Center Drive
Miami Beach, Florida 33139
Attendance (in person or via telephone) is encouraged and recommendii as a iotrfce of information, but is not
mandatory" Proposers interested in participating in the Pre-Proposal.Submission Meetin$1ia telephone must follow
these steps:.t:::: l
-.r l:: '
(1) Dialthe TELEPHONE NUMBER: 1- 888-270-9936 (TolLffiNorth Amenea) :
(2) Enter the MEETING NUMBER:1142644 'i:::l
Proposers who are interested in participating via telephone should seiO.,ih e-mail to the contact person Iisted in this
RFP expressing their intent to participate via telephone,
6. PRE-PROPOSAL INTERPRETATIONS. Oral information or responses lf ,,qgeiilons 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,.$@U11!1 will be released through Publiclurchase.
7. CONE OF SILENCE.:{*$uant to Sffin 2-486 of the City Code, all procurement solicitations once advertised
and until an award recommHfl$atron has,Een fonrvarded to the,Gity Commission by the City Manager are under the
"Cone of Silence." -ffin. Conq*- of . Silence ordinance is available at
http://library.municode.con/index,a=SpH,?elientlD!'f3097$statblD=9&statename=Florida. Any communication or
inquiry in re,ferehteio this&licitation wifi y City employee or City official is strictly prohibited with the of exception
communicatons with the Piocurement'Bifutor, or his/her administrative staff responsible for administering the
procuremefiLprocess for this solicitation prffii6glrid communication is limited to matters of process or procedure
regarding solicitation, CommU'hications., iegarding this solicitation are to be submitted in writing to the
Procurement Contact named herein With a copy to the City Clerk at rafaelgranado@miamibeachfl.gov.
Balance of Paqe lntentionallv Left Blank
RFP 20.I4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobiliry
155
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8. SPECIAL NOTICES. You are hereby advised that this solicitation is subject
City Of Miami
to the following
Beach website:ordinances/resolutions, which may be found on the
http ://web. miamibqAqhl. gov/procu remenUscroll,aspx?id=235 1 0
. CONE OF S|LENCE..., CITY CODE SECTION 2486
. PROTEST PROCEDURES CITY CODE SECTION 2-371
o DEBARMENT PROCEEDINGS CITY CODE SECTIONS 2-397 THROUGH 2485.3
o LOBBYIST REGISTMTION AND DISCLOSURE 0F FEES.... CITY CODE SECTIONS 2481 THROUGH 2-406
o CAMPAIGN CONTRIBUTIONS BY VENDORS CITY CODE SECTION 2487 ,,.:.r
o CAMPAIGN CONTRIBUTIONS BY LOBBYISTS ON PROCUREMENT
ISSUES.. ...... . CITY CODE SECTION 2"488 i
o REQUIREMENT FOR CITY CONTMCTORS TO PROVIDE EQUAL
BENEFITS FOR DOMESTIC PARTNERS...., CITY CODE SECT]€N'2-373'
. LIVING WAGE REOUlREMENT......,...,. LOCAL PREFERENCE FOR MIAMI BEACH-BASED VENDORS.........
o PREFERENCE FOR FLORIDA SMALL BUSINESSES OWNED AND
CONTROLLED BY VETEMNS AND TO STATE.CERTIFIED SERVICE.
DISABLED VETEMN BUSINESS ENTERPRISES. FALSE CLAIMS ORDINANCE.,..
o ACCEPTANCE OF GIFTS, FAVORS & SERVICES...
:. :{ t
crTY CODE SECT_|ONS 2407 THRQIJGH2-410
CITY CODE SECTiON 2-372 . ;T
t:
CITY CODE SECTION 2-374 E ir^
CITY CODE SECTION 7O-3OO -I LII I
C I TY..CODE S ECT I OI\I 2449
9. POSTPONEMENT OF DUE DATE FOR RECEIPT OF PROPOSALS. The City reserves the right to postpone the
deadline for submittal of proposals and will mak 'a.reasonable effort to give at least three (3) calendar days written
notice of any such postponement to all prospective.$ffiffi,,,]f rough PublicP@ase.
'St '"'i{sii;;::l4tt = -
10. PROTESTS. Protests concerning the specificatib.Is, reqti'i'i.€ en:taand/or s; or protests after the proposal
due date in accordance with City Code Section 2-371,ryhic1+-stablf$-h-e.s-..pr edures for protested proposals and
proposed awards. Protests notsuhmitted in a timely mhhn'5i pursuant io the requirements of City Code Section 2-
371 shall be barred.
11. MIAMI BEACH.BASED VEN9ORS ;iiFERENCE. puEuant,to City of Miami Beach Ordinance No. 201 1-3747,
a five (5) point preference will be given to a responsive and responsible Miami Beach-based Proposer.
1 2. VETERA}JAUSiNESS'ENTE RPRI SES P RE F ERENC E.Pursuant to City of Miami Beach Ordinance No. 2011-
3748, thei,City shall give E='fiV ) point preference to a responsive and responsible Proposer which is a small
businpsq icoa.cern owned and eontfulled by a veteran(s) or which is a service-disabled veteran business enterprise.
13. DETERMINfiTJON OFAWARgiThefinal ranking resultsof Step 1 &2outlined in Section 0400, Evaluation of
Proposals, will be Considered by the City Manager who may recommend to the City Commission the Propose(s)
s/he deems to be in tftFjest inter.est of the City or may recommend rejection of all proposals. The City Manage/s
recommendation need be ccnSistent with the scoring results identified herein and takes into consideration Miami
Beach City Code Section ffi9;'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 Cloims Adminisirotion for Workers Comp ond Gen Liobllity
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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 Propose(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, eachfroposer all be solely responsible for
making anyand all investigations, evaluations, and examinations, as itdeems nece5S@to ascertain all conditions
and requirements affecting the full performance of the contract. ,LgQr,ance of such cOnditions and requirements,
and/or failure to make such evaluations, investigations, and exafiihations, 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 whatsoevei fo-r any monetary consideration on the part of the
Proposer.
16. COSTS INCURRED BY PROPOSERS. Allexpenses involved with the-Lpgeparation 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 reimburced by 16s 6;1r.
..
17. RELATIONSHIP TO THE CITY. lt is the intent of the City, and Proposers htireby acknowledge and agree, that
the successful Proposer is considered to be an independeflt contractor, and that neither the Proposer, nor the
Proposer's employees, agents, ,nd/oa contractors, shall, under any circumstances, be considered employees or
agents of the City. .
18. TAXES. The City of Miatiiflffil 'rf O, from all Federal Excise and State taxes.
19. MISTAKES,'Proposers ,rc .\ Ht J-to e*amine the terms, conditions, specifications, delivery schedules,
proposed pricihg, and all instructions pertai{10 to the goods and services relative to this RFP. Failure to do so will
be at the Propose/s risk and m ult in:tffitoRosal being non-responsive,
20. PAYMENf.; Payment will beEide 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. lnvoices must be
consistent with Purchase Order format.
21. PATENTS & ROYALTTIES. 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. lf 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.
6RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility
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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 with/of 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,Wp,.qk complies with all
applicable laws. The contractor shall be liable for any damagqjOr loss to the City occasioned,by gligence of the
Proposer, or its officers, employees, contractors, and/or agents rJailure to comply with applicabl'C.==I,rws.
23. SPECIAL CONDITIONS.Any and all Special Conditions thEtr.'rr+ vary'from these General Terms and
Conditions shall have precedence.
24. ANTI-DISCRIMINATION. The Proposer certifies that he/she is i
'*llLlffin,,
is in compli6ffiffi\gyyitft i the non-discriminatiination clause
wxecutiveOrder11246,asamehdedoyr',ecuii*iF,.oio.'11375,relativetoequal
employment opportunity for all persons without regard to race, c-EE@on$r national origin.
25. DEMONSTRATION OF COMPETENCY.
A. Pre-award inspectio the PropdSer's facility may be made prior to the award of contract.
B. Proposals will on$.-,5ii=- nsidered fiom 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 demonstra.@ .,ga-Qd re=.qqrd of performance for a reasonable period of time, and
have sufficientfiMncialcapacity, equipment, anO biganization to ensure that they can satisfactorily perform the
services if awarded a contract under the terms and conditions of this solicitation.
D. .th terms "equipmeiitlf,,ftflrorganif6,tEa-',.as used herein shall, be construed to mean a fully equipped and
well*sthblished company iqli|lq with the best business practices in the industry, and as determined by the City
of MiamiBeach. --"$r
E. The Cityi6sr.onsider anyb,liidence available regarding the financial, technical, and otherqualifications and
abilities of a PiO#ser, includingpast performance (experience), in making an award that is in the best interest of
the City, '''i,
,*:
F. The City may reqtliffi,fl,400'dser s to show proof that they have been designated as authorized representatives
of a manufacturer or sff$1plier, which is the actual source of supply. ln 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 othenrise 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.
7RFP 2014-302 SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility
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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. lt is the intent of the,City to purchase the goods
and services specifically listed in this solicitation from the contractor, Howevdl, the "Gity reserves the right to
purchase any goods or services awarded from state or other governmental co,ptract, or on an as-needed basis
through the City's spot market purchase provisions, "l; -'
..
,
30. DISPUTES. ln the event of a conflict between the documents, the ofdei f priorityBf the documents shall be as
follows: .i
A. Any contract or agreement resulting from the award oflhis solicitation; then ..: =B. Addendum issued for this solicitation, with the latest Addendum taking precedence; then:, '=:'-
C. The solicitation; then
D.TheProposer,sproposalinresponsetothesolicitation.
31. INDEMNIFICATION. The contractor shall ffi$ nilJ and hold harmless the City and its officers, employees,
agents and instrumentalities from any and all lia'ffit$}is,.,,,..lp,,Sses or damages, including attorney's fees and costs of
defense, which the City or its officers, employeesfu,a$eht$ utslnStrumentalitieb may incur as a result of claims,
demands, suits, causes of actions or proceedings of any kind oi nature arising.out of, relating to or resulting from the
performance of the agreement by the contractor or its emploiees- a$enis, 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 attorneyls fees which may be incurred thereon. The contractor
expressly understands and agiees that any insurance proteCiion iequired by this Agreement or othenuise provided
by the contractor shall in no way,limit the responsibility to indemnify, keep and save harmless and defend the City or
its officers, emp,.,,.!gy-.. g, agents and instrumentalities as herein provided. The above indemnification provisions shall
survive the exp' tion 0f'xtH',gliiination of this Agreement.
gZ. C€F+$'rcf eXfeNSfON. The City reseres the right to require the Contractor to extend contract past the
stated termiii!-lien date for a peiiOd,of up to 120 days in the event that a subsequent contract has not yet been
awarded. Additidiielextensions past the 120 days may occur as needed by the City and as mutually agreed upon by
the City and the Cohtraqtor
7 liir,. ,tlF
ffi Balance of Pase lntentionallv Left Blank
RFP 2014-302 SW TPA Cloims Administrotion for Workers Comp ond Gen Liobllity
159
b ,VlAturil Sil&C$-{
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), Ar1..1 of the State Constitution until such time as the City provides
notice of an intended decision or untll thirty (30) days after opening of the proposals, whichever is earlier.
Additionally, Contractor agrees to be in full compliance with Florida Statute 119.070'1 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 othenruise 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 th6 publir*gency all public records in
possession of the contractor upon termination of the contract and destroy any dupficate 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.
.. i
34. MODIFICATIONMITHDRAWALS OF PROPOSALS.N P;di$sel may submit a modified Proposal to replace all
or any portion of a previously submitted Proposal up until the Proffi,S=f;t date'and time. Modifications received
after the Proposal due date and time will not be considered.all be irrevocable until contract award
unless withdrawn in writing prior to the Proposal due date, or after expira 120 calendar days from the opening
of Proposals without a conhact award" Letters of withdrawal received after due date and before said
expiration date, and letters of withdrawal received after contraCl award will not be Snsidered.
35. EXCEPTIONS TO RFP. Proposgrp must clearly indicate any exceptions they wish to take to any of the terms in
this RFP, and outline what, if any, altematrve is being offeied. All exceptioni and alternatives shall be included and
clearly delineated, in writing, in the Prbpbsal. The City, at its sole and absolute discretion, may accept or reject any
or all exceptions and altematives. ln cases in which exceptions and alternatives are rejected, the City shall require
the Proposer to comply with th$, $articulaftrm and/or condition of the RFP to which Proposer took exception to (as
said term and/or condition was originally set forth on $e RFP).
36. ACGEP,IANCE OF-GIFT,,9JAVORfl fiFRVICES. Proposers shall not offer any gratuities, favors, or anything of
monetary value to any officiaf'employee$id.l;,.:- ertt.of the City, for the purpose of influencing consideration of this
PropoSal. , F.,ursuant to Sec. 2-449 ctf 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 Page lntentionallv Left Blank
RFP 20.l4 302 SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 9
160
b Ar,,la Ar I Rilaru
PROPOSAL SUBMITTAL INSTRUCTIONS AND FORMATsEcTtoN 0300
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 rqected,
2. LATE BIDS. Bid Proposals are to be received on or before the due date established hOrein 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 othenruise.
3. PROPOSAL FORMAT. ln 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 referencds. Electronic copie$;should also be tabbed and contain a
table of contents with page references, Proposals that do not include the- requir6d 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 Propos6r$edf roposer Primary Contact for the
purposes of this solicitation.
1.2 Proposal Certification, Questionnaire & Requirements Affid'atit=,,({pp€hdix A). Attach Appendix A fully
1.3 Minimum Qualifications Requirements. Submitverifiable information documenting compliance with the minimum
qualifications requirements established in Appendix C, Minimum Requirements and Specifications.
ce & Qualifications
2.1 Qualifications of Proposing Fifm. SubEtt'detailed. information regarding the firm's history and relevant experience
and proven tr4ck recoil of providing the scope of serviies similar as identified in this solicitation, including experience in
providing sil.nilar lcope of services to publiC sector agencies. For each project that the Proposer submits as evidence of
similar -expEiience, the followinglisrequired;,project description, agency name, agency contact, contact telephone &
emailpd y,.q'1$)and term of eii$$fiement.
2.2 Qualificatids of Proposer TdA,E, Provide an organizational chart of all personnel and consultants to be used for
this prolect if awarded, the role tnat 6[ch team member will play in providing the services detailed herein and each team
members'qualificati0ns,,A resumg;Y0f each individual, including education, experience, and any other pertinent
information, shall be included a::rqih Proposal team member to be assigned to this contract.
2.3 Financial Capacity. Eddh'Pfoposer shall arrange for Dun & Bradstreet to submit a Supplier Qualiflcation Report
(SOR) directly to the Procurement Contact named herein. No proposalwill 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//supplierportal.dnb.com/webapp/wcs/stores/servleUSupplierPortal?storeld=11696
Proposers are responsible for the accuracy of the information contained in its SQR. !t 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 at800-424-2495.
RFP 201 4 302 SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility t0
161
b r. ,4 I A .r .{:nr- A /'i IJV\l,iliV\r ffit}\r.-If
of Services
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 comolete a fullv review and score the
h 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: implementation plan, project timeline,
on time and within
Cost Proposal
considered non-responsive and not further considered. ,". .
SubmitacompletedCostProposalForm(AppendixE).=
=:::,
.
-..,i.::Proposers must submit pricing for allthree options.
The City will review each option and reserves the right to select the option that is most advantageous to the City.
lf pricing is included or at no additioral charge, proposer must indicate "lncluded" or 'MAdd itional Ch arge," as
appricabre, within the cost proposar.
=^**. =Failure to submit pricing for all three options request in the Cost Proposal Form will result in the proposals being
No'te: After proposal submittal, the City reserves the right;to requiie additional information from Proposers (or
Proposer team members or sub+onsultants) to determintil qualification- (including, but not limited to, litigation
history, regulatory action, o.r additional*ferences); 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),
,, LLI i$$iTiijllli\\,,,,,-
::::::::::::: .:.:-:::::.: :rl \:.::::r:::::::=
=U6=g
::::::':-l !.
i :..:
j
Hh
n
,,in
,iliiri'
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility il
162
sEcTtoN 0400
@ i\,\iA,\AiSf,&Cl-"I
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. lf 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. lt 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'Felow to be considered by the
Evaluation Committee. The second step will consist of quantitativesteria established below to be added to the
Evaluation Committee results bythe Departmentof Procurement...[.4a - Cment. An Evaluation Committee, appointed
by the City Manager, shall meet to evaluate each Proposal in ac-.Eordance with the qualifications criteria established
belowforStep 1, Qualitative Criteria. ln doing so, the Evaluation Committee may:. review and score all proposals received, With orr urithout conducting interview sessions; or. review all proposals received and short-list one or more Proposers to be further considered during
subsequentinterviewsession(s)(usingthesamecriteria).
Proposer Experience and Qualifications, includin$,:.Finanera.l Capability
Scope of Services Proposed l:' ll:t'
.
.
,,,
Approach and Methodology :.'
. -:'':i *
,,
25
25
3. Step 2 Evaluation. fOh;ng the reffi of Step
additional quantitative criteria polnts to be added by
1 Evatuation of qualitative criteria, the Proposers may receive
the Department of Procurement Management to those points
Cost Proposal (Based on AveraQe Total Points)
earned in Step 1, as follows.
Miami Beach-Based Vendor Preference
Veterans Preference
4" Cost Proposal EvalUdion. The cost proposal points shall be developed in accordance with the following formula:
Samole Obiective Formula for Cost
Vendor Vendor
Cost
Proposal
Example Maximum
Allowable Points
(Points noted are for
illustrative purposes only.
Actual points are noted
above.)
Formula for Calculating Points
(lowest cost I cost of proposal
being evaluated X maximum
allowable points = awarded
points)
Round to
Total
Points
Awarded
Vendor A $100.00 20 $100 / $100 x20 -- 20 20
Vendor B $150.00 20 $100 / $150 X 20 = 13 13
Vendor C $200.00 20 S100, $200 X 20 = 10 10
RFP 20.14-302-SW TPA Cloims Adminiskotion for Workers Comp ond Gen Liobility 12
163
b ,^,r\lAIv'\i Bf AC$-l
Note: ln evaluating cost proposals, the City will evaluate each option from all proposals in accordance with
the methodology established above (lowest price / proposers price x maximum number of points = assigned
points) and then calculate the Average Total Points for each proposer as indicated below.
Aver Cost Points:
A B c
Vendor Total Option 1 Total Option 2 TotalOption 3 Average Total
Points
(A+B+C/3)*
Proooser X 15 12 14 14
Proooser Y 10 15 12 12
*Pointswillberoundedtothenearestwholenumber.
The Average Total Points will be utilized in the Step 2 Qualiftive eriteria portion of the evaluation noted
above.
5. Determination of Final Ranking. At the conclusion of the Et@plion Committee Step 1 scoring, Step 2 Points
will be added to each evaluation committee member's scores by thdDep.,,?ilment of Procurement Management. Step
1 and2scores will be converted to rankings in accordance with the example below:
irli l'
: '= i!$
' ttl:
. Comm[tteg,r
Membgr.fr
Step 1
Points rLsE2 "7:6 80
Step 2
Points i.,:?2 -fu* "*12
Total 104 91 92
t' Rank 1 3 2
,ii,i Comfi-iftee
:MemhEi 2
Step 1
Faints 85 72
Step 2
Points 22 15 12
Total Lilol 't 00 84
Rahk '1 2 3
Committee
Membei 2
Step 1
Points 80 74 66
, 6tep,2til Points 22 't5 12
,rl.i':.:: Totaf 102 89 78
Ra*k I 2 3
*.F-inal Ranki@ is presented to the City Manager for further due diligence and
rebommend'ation to the City Commission. Final Ranking does not constitute
an awfficommendation until such time as the Ci[ Manager has made his
recommendation to the City Commission, which may be different than final
ranking results.
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility t3
164
APPENDIX A
& &AiA$*iffiffi-qffi$s
Proposol C
auestionhoire &
:.:=rl ,,ii
,,,,,,r, :.. llr.p''-"
;.r,,,= RFP 201 4r302-SWr
-Y
a a YY-
CLAIMS ADMIN ISTRATION SERVICES
=BY==+l R D PARTY ADM| N TSTRATOR
.* lffin = FoR WORKERS' coMpENSATIoN
"€* AN,b GENERAL LIABILITY
DEPARTMENI OF PROCUREMENT MANAGEMENT.l700 Convention Center Drive
Miomi Beoch, Florido 33.l39
='==.'tt==11fu'
\
ertifi"bomn,
Requiretr ts Affidovit
,,,rrl..r.,.
Urrr,
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility t4
165
Solicitation No:
20'14-302-SW
Solicitation Title:
CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY
ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL
LIABILITY
Procurement Contact:
Steven Williams
Tel:
305-673-7000, x. 6650
Email:
Stevenwilliamsdmiamibeachfl .oov
PROPOSAL CERTIFICATION, QUESTIONNAIRE & REQUIREMENTS AFFIDAVIT
Purpose: The purpose of this Proposal Ceilfication, Questionnaire and Requirementslffidavit 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 ex.ecuted.
1. GeneralProposer lnformation. - '111111
nlwi''ifr
FIRM NAME:
No of Years in Business:No of Years in Business [ocally;.
OTHER NAME(S) PROPOSER HAS OPERATED UNDER IN THE LAST 1O YEARS: \
FIRM PRIMARY ADDRESS (HEADQUARTERS):ir
"ti:=.;::.,\U
]ITY:t-:::ar.!;tt \:
;.r,='.,:::.1\s
STATE:ZIP COBE]
TELEPHONE NO.:
ULL FKEE NU.:
FAX NO.:
IL
FIRM LOCAL ADDRESS:
ITY:
STATE;ZIP CODE:
PRIMARY ACCOUNT REPRESENTATIVE FOR T:t11$:$GAGEMENT:
ACCOUNT REP TELEPHONE NO:
ACCOUNT REP TOLL FREE NO.:
ACCOUNT REP EI\/AIL:
FEDERAL TAX IDENTIF]CATION NO.,
:::::
The City reserves the right to sedk 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.
RFP 20.l4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility t5
166
Miami Beach Based (Local)Vendor. ls Proposer claiming Miami Beach based firm status?[-l vEs [--l tto
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. ls Proposer claiming a veteran owned business status?
[__-l vrs l---l r.ro
5.
6.
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..
- .t:::
Conflict 0f lnterest. All Proposers must disclose, in their Proposal, the name(sfnf any offlcer, 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 tne n ) of any officer, director, agent, or immediate family member
(spouse,parent,srbling,andchild)whoisalsoanemployeeoftheCityofMiamiBeach. Proposersmustalsodisclosethenameof
any City employee who owns, either directly or indirectly, an interesf'6f. (10%) percent or more in the Proposer entity or any of
its affiliates
References & Past Performance. Proposer shallsubmit at least three (3) r..ier.n.., for whom the Proposer has completed work
similar in size and nature as the work referenced in soliCitation
SUBMITTAL REQUIREMENT: For each reference $mitted;$.ft1f-,o.1ving informati0n is required: 1) Firm Name, 2) Contact
lndividual Name & Title, 3) Address, 4) Telephone, 5) Gry.t r .!.$]tlF.trl, _*;t1y-.
on Scope of Services Provided.
Suspension, Debarment or Contracl Cancellation. H.i=p .r. ever uffiUarred, suspended or other legal violation, or had
a contract cancelled due to non-performance by any public Sector agency? "'
dr. +
SUBMITTAL REQUIREMENT; lf answer to above is "YES," Prilposer shall submit a statement detailing the reasons that led to
action(s) dn
:t:::uu
Litigation Histoff:.lt poser shall submit a statement of any litigation or regulatory action that has been filed against your firm(s)
in th6last five years.-lf.an action has been'fi,led, state and describe the litigation or regulatory action filed, and identify the court or
agency before which the hqtion-was institu{$the applicable case or file number, and the status or disposition for such reported
eaffi lf no litigation or regulat$,{ action ha#en filed against your firm(s), provide a statement to that effect. lf "No" litigation or
regukt action has been filed against your{rm(s), please provide a statement to that effect. Truthful and complete answers to
this que$iOn may not necessari[y disqualify a firm from consideration but will be a factor in the selection process. Untruthful,
misleadin$ ot fql!€ answers to thiS question shall result in the disqualification of the firm for this project.
SUBMITTAL REQUIREMENT roposer shall submit history of litigation or regulatory action filed against proposer, or any
proposer team member firm,::i[ the past 5 years. lf Proposer has no litigation history or regulatory action in the past 5 years, submit
a statement accordingly.
I
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.
o.
RFP 201 4-302-SW TPA Cloims Adminisirotion for Workers Comp ond Gen Liobility t6
167
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 Department of Procurement Management 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. ln 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/procuremenV.
.::::::. ':.:a;...
Living Wage. Pursuant to Section 2-408 of the Miami Beach City Code, as same m.qgibO amended from time to time, Proposers
shall be required to pay all employees who provide services pursuant to this Agreerndiitir{he hourly living wage rates listed below:
. Commencing with City fiscal year 2012-13 (October 1,2012), the hourl Ving'iatewill be $11.28/hr with health
benefits, and $12,92/hr without benefits. iiiii llLls
The living wage rate and health care benefits rate may, by Resolution of the 0{ty Commissi0n::b dexed annually for inflation
using the Consumer Price lndex for all Urban Consumers (CP|-U) Miami/Ft. Laudefuale, issued by'ti.6{S. Department of Labo/s
Bureau of Labor Statistics. Notwithstanding the preceding, no annual index shall exceed three percerit={,3:%). The City may also, by
resolution, elect not to index the living wage rate in any particul?r year, if it determines it would not be fiS€ll} und to implement
same (in a particular year'). :"r , .::r .a,, ===
Proposers' failure to comply with this provision shall be deemed a matefifureabh'undei 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
availableatwww.miamibeachfl.goviprocurement/:|i|.u,i.,
SUBMITTAL REQUIREMENT: No additional submittal is iequii -.=,=Q.y..1irtue of executlng this affidavit document, Proposer agrees
to the tiving wage requirement. ;" ."je\.
-....,,.=
=
::.= .:::!i:a" i::::=i;::ri:ii ='
Equal Benefits for Employees with Spouses and Employees with Dom'estic,Partners. When awarding competitively solicited
contracts valued at ovei $t00,000 whose contractors maintiin 51 or more fuffie employees on their payrolls during 2b or more
calendar work weeks, the Equal Benefit5 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 employe-es with spouses. The Ordinance applies to all employees of a
Contractor who work within the City limits of the-Clty of Miami Bedch, Florida; and the Contracto/s employees located in the United
States, butputsid,e,*of the City of Miami Beach liniits, who are directly performing work on the contract within the City of Miami
Beach, T! #i,
",,.,fiiffitt
vour compEnv o'l,$,']*-t'*f
iE"nv
oeneffSmplovees with spouses or to spouses of emplovees?
"" B.,lLlrrm.ks your company profi@r offer access to any benefits to employees with (same or opposite sex) domestic partners* or to
domestrc partners of employees?
-':::;t;:; 1:. .:::.::- f--l VgS [--l UO
C. Please ch all benefits .that apply to your answers above and list in the "othe/' section any additional benefits not already
specified. Nbte: sq{ne b.effts are provided to employees because they have a spouse or domestic partner, such as bereavement
leave; other beiiEfits 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
Sick Leave
Familv Medical Leave
Bereavement Leave
RFP 201 4 302 SW TPA Cloims Administrotion for Workers Comp ond Gen Liobiliry )7
168
10.
lf Proposer cannot offer a beneflt to domestic partners because of reasons outside your control, (e.9., 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.miamibeachfl .gov/procuremenU.
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 conshuction 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 nol kansact 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. ..,.. , '
.,ri
SUBMITTAL REQUIREMENT: No additional submittal is required. AV Vii{l8xUf erecuting this affidavit document, Proposer agrees
with the requirements of Section 287 .133, Florida Statutes, and certifiei it has not been placed on convi vendor list.
Acknowledgement of Addendum. After issuance of soticitatidfii thg,lity may release one or more aOJenOum to the solicitation
which may provide additional information to Proposers or alter iQlicitation requirements. The City will skive to reach every
Proposer having received solicitation through the City's e-procuremEhF,.:Sy_s.te ; PublicPurchase.com. However, Proposers are
solely responsible for assuring they have received any and all addenduntissueti,pursuant to solicitation. This Acknowledgement of
Addendum section certifies that the Proposer has received all addendum reE$bd by the City pursuant to this solicitation. Failure
to obtain and acknowledge receipt of all addendum nmy result in proposal OisqBi$iaiion.
lnitial to Confirm
Receint
lnitial to Cqnfirm
Receint
lnitialti$$ffih
Rccdr*
Addendum 1 Addendum 6 Addendum 1 1
Addendum 2 Addendum 7 Addendum 12
AddendiiifriS Addendum 8 Addendum 13
Addenddm 4 'l:1,Addendum 9 Addendum 14
i,Addendum 5 Addendum 10 Addendum'15
:of addendu€s required, submit uhder separate cover.lf additional
11.
RFP 20.l4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobiliry 1B
169
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.
ln 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. ln its sole discretion, the City may
determine the qualifications and acceptability of any party or parties submitting Proposals in respon_!,,,9.....lo itils licitation.
Following submission of a Bid or Proposal, the applicant agrees to deliver such further detd"fr information and assurances, including
financial and disclosure data, relating to the Proposal and the applicant including, withoUtrliriiirtation, the applicanls affiliates, officers,
directors, shareholders, partners and employees, as requested by the City in its discretion.
. -:,:::l
The information contained herein is provided solely for the convenience of prospective Proposers. lt ia the responsibility of the recipient to
assure itself that information contained herein is accurate and complete. The Cit@es not paovide any assuraftcesas to the accuracy of any
information in this solicitation. t!, tri.,
Any reliance on these contents, or on any permitted communications withCity officials, shall be at the recipient's own risk P.roposers should
rely exclusively on their own investigations, interpretations, and analyses. The solicitation is being provided by the City wittrout any warranty
or representation, express or implied, as to its content, its accuracy, or its complefeness. No aranty or representatioR is made by the City
or its agents that any Proposal conforming to these requirements will be selected fOi considdration, negotiation, or approval.
The City shall have no obligation or liability with respect to.thls solicitation, the selection and the award process, or whether any award will be
made. Any recipientof this solicitation who responds herekifiillyaknowledges allthe provisiilns of this Disclosure and Disclaimer, is totally
relying on this Disclosure and Disclaimer, and agrees to be \i,Si- ry the terms hereof. Any Proposals submitted to the City pursuant to this
solicitation are submitted at the sole risk and responsibility of thb,p' sul,,_f,:$g such Proposal,
This solicitation is made subject to correction of errors, omissions, or withdrawal frqgtrthe market without notice. lnformation is for guidance
only, and does not constitute all or any part of an agreement. ' "'" ,
The City and all Proposers will be bound only as, if and when a Proposal (or Proposals), as same may be modified, and the applicable
definitive agreements pertaining thereto, are approved and executed by the parties, and then only pursuant to the terms of the definitive
agreements executed among the parties. Any response to this solicitatidh may be accepted or rejected by the City for any reason, or for no
reason, without any resultant liability to the City.
The City is governed by the Government-in-thqSunshine Law, and all Pro$b'ials and supporting documents shall be subject to disclosure as
required by such layv-rflf['Pg,p9sals shatl be submitted in sealed pr.oposal form and shall remain confidential to the extent permitted by
Florida Statutes-,,until,.8.i l ii{biftd llme selected for opening the resfonses. At that time, all documents received by the City shall become
public records.
:
Proposers a.@-gpected to make all dffiI*ures andiJeclarations as requested in this solicitation. By submission of a Proposal, the Proposer
acknowled$6@d agrees that the City:hasthe right to make any inquiry or investigation it deems appropriate to substantiate or supplement
information contajned in the Proposal, and authorizes the release to the City of any and all information sought in such inquiry or investigation.
Each Proposer cerlifigp"that the information contained in the Proposal is true, accurate and complete, to the best of its knowledge,
Notwithstanding the fore$'bing or anything contained in the solicitation, all Proposers agree that in the event of a final unappealable judgment
by a court of competent juriSdictton-...,ghich imposes on the City any liability arising out of this solicitation, or any response thereto, or any
action or inaction by the City with.iffiect 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.
ln 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 conskued in accordance with the laws of the State of Florida"
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility t9
170
I hereby certify that; l, 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 Certification, Questionnaire and Requi Affidavit are true and accurate.
Name of Propose/s Authorized Representative:Titleof Propose/sAutrorizedft epresentative':1.s..=E
#
Signafu re of Propose/s Authorized Representative:Date.:-. ,. *,llxlllimNls
ili,:ri:_r:
V,*,u
On this _day of _, 20_, personally
appeared before me who
State of FLORIDA )
)
of
County of _) stated that (s)he is the
, 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:
"a1;;:i4_:::::1i:t:t
';::::.:t lliutl
RFP 2014 302 SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 20
171
APPENDIX B
E MIAMIMffiAilN
"No Bid"Torm
---
RFP 20T4.392_SWW
cLAIMS,,.PMINlSrRATlGN SERVICES
BY A-...I I RffiPARTY ADMI N ISTRATOR
FOR W9RffiER'..S' COMPENSATTON. AND GENTRAL LIABILITY
"*m,:'\ffi
DEPARTMENT OF PROCUREMENT MANAGEMENT,l700 Convention Center Drive
Miomi Beoch, Florido 33,l39
172
WE HAVE ELECTED NOT TO SUBMIT A PROPOSAL AT THIS TIME FOR
REASON(S) CHECKED AND/OR TNDTCATED BELOW:
_ Workload does not allow us to proposal
_lnsufficient 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 producVservice
_OTHER. (Please specify)
'\)"N:::Nl
We do _.'do not _ want to be retained on your mailing list for future proposals
of this type'product and/or service. =
Signature:
,;.;:,ffiiLl llkr,r"' ililet ..:
Legal ComB-nfi:Name:
:SN, lll.€l I
submitting a proposal or this completed form,
removed from our vendors list.
DEPT. OF PROCUREMENT MANAGEMENT
ATTN: Steven Williams
PROPOSAL#2014-080-SW
1700 Gonvention Center Drive
MIAMI BEACH, FL 33139
CITY OF MIAMI
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility
173
APPENDIX C
g MIAMI mffiAilH
M i n i m u m,,,,ffi,,,,_ q U
& SpeGif c
\
RFP 201 4-302-SW
CLAIMS NDMI N ISTRATION SERVICES
BY A THIRD P{RTY ADMINISTRATOR
FOR WORKERS' COMPENSATION
=AND GENERAL LIABILITY
..:,: ""::: "$i"t::
Fe ments
tiohs
DEPARTMENT OF PROCUREMENT MANAGEMENT,l700 Convention Center Drive
Miomi Beoch, Florido 33,l39
RFP 2014 302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobiliiy )')
174
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 691-5-229 Florida
Administrative Code)
2. The proposer must have experience as a Third Party Administrator ("TPA) for Workers'
Compensation and General Liability for Florida local gover nt(s) for a minimum of five
(5) consecutive years. For each experience proposer must submit as evidence: agency
name, agency contact, contact telephone, email andyears(s) of eiperience for verification
purposes,
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. Priorto October 1996, the City purchased excess workers'compensation insurance. The
City does not currently purchase excess workers'compensation insurance.
3. The proposer must have a staffed office in p'itate-f Florida, with a :qualified staff
member of the firm to serye as the primary dbntact for the City of Miami Beactr, and a
secondary contact to serve in the absens iof,lfhg primaryi,,q.ontact. The proposer must
submit as evidence: a primary and secondary name, a primary and secondary contact
telephone, a primary and secondary email ad(1pqji'and h copy of primary and
secondary's resumes for verifiqation purposes. r,
C2. Statement of Work Required. fne Ciiy o-f Miami Beach ttf,. ;City') Ir approved by the Florida
Department of Labor and Employment Security/Division of Workers' Comfensation to seltinsure
for Workers' Compensation. The Division of Workens' Compensation requires that the claims
administration be providgdiy a State Certified Workers' Compensation Claims Administrator.
Therefore, the City
i*s,,, $ bk 'proposals for third party claims administration services for its self-
insurance Worker€ompensatio-lr, prog ram.
i:#,
Proposers must sub-mitgst prOf!ry| for the entire-fupe of services requested. Proposals to
handle only selected parts of thelbcope will not be considered. lt is understood by the successful
proposer that-alt services aie to be provided by the proposer's employees and cannot be
contracted out to anotier partyffihout the prior approval of the City. The commencement date of
the contract will be February 1,2A$.
C3. Specifications. The administraf6r will provide all specified adjusting services for all claims as
well aslll other required services, such as administrative, managed care/medical case
management,tomputerizdd claims/loss statistical information (RMIS) and banking/loss fund
reconciliation, ''The specific required services are outlined in greater detail within this request for
Klr lU l4-JUZ-5VV lfA Lloims Administrotion tor VVorkers Lomp ond Gen Liobilii'y 24
175
ln agreement with Ordinance No. '1335, the City pays Supplemental lnjury 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 lnjury 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. ln view of this, temporary total
indemnity benefits will not need to be paid by the claims administrator unless thg.injured employee
is eligible for temporary total benefits in excess of 32 weeks. ln addition, certain nredical conditions
and work related activities are covered under workers'compensation:::f police and fire personnel
lI r,-::.:;i:e the comprete handrins ora, ruture;[i,,Jffin*-.eing handred
by our present Claims Administrator (see Attachment G for openlclosed claims foi atiyears), along
with all new claims. The information provided regarding the volume and type of pend@claims to
be assumed is based on the latest information provided toihe City and cannot be guarantee-d as to
its accuracy. lf 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.groposer's flat annualfee.
It is the responsibility of the proposer.fu,r'.eview prior claim nf., to determine the additional
proposed cost, if any, to take over these files; ! .u
It is also required that the claim data associfu with'alltolqifuo,occurring prior to February 1,2015,
be transferred into the propose/s computer infifuatidil systdnt,iSdlHat future loss runs will contain
a complete history of all dlaim ye,ars. The transf{of all claims $ata must be completed by June 1,
2015. The proposer is responsible for specifically indicating in their proposal the fees, if any, for
assumption ofprioiilaims and th-e data conversion.
,,. .,i.
The program is run on an="occurrence" basis, thereffu, all claims occurring in the contract year,
regar4le 1$$|When reported, are to be handled per the requirements of this agreement. The claim
adminlstiatoi id iqgililpd to handlerll claims to their conclusion or to the conclusion of the contract,
,,Wfibhrr", occurs firs.Ffuo additifial charge to the City other than the annual fee, The contract
""iti,?ybe terminated by'€.ittier party With ninety (90) days written notice to the other. However, any
caneellation does not altOllithe administrator's obligation to handle all claims prior to the terminationdate'
+r, r
The City re("tiifuhat the selected TPA provide, at a minimum, the following professional services
related to the'n:,frffministration of the City's self-insured Workers' Compensation and GeneralLiability: jj,,,
. 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
Kf f ZU l4-JUZ-5VV ll'A Llorms Adminrstrotion tor Workers Lomp ond Uen Liobilily )\
176
usual and customary to the administration and management of workers' compensation
claims, if not othenrvise noted herein"
TPA shall provide, on behalf of the City, all self-insurer reporting to the Self lnsurance
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"
l's.'t" =TPA shall accept all current claims and/or re-opened claims as ru+in claims to the TPA if
TPA shall provide the City with the ability to report firs!.. ports of injUfl,{n( loss notices
electronically, by facsimile or by phone based on the severity, circumstances or nature of
TPA shall provide automated acknowledger#upon the receipt of each .frir. fh.
acknowledgement shall include, but not be limited, to the following: claim number,
assigned adjuster name, email and telephone number,':ffimant's name, and date of loss"
TPA shall set up all new daims@fl tW,.errty-tour (24) hours after notification, Assigned
adjuster, supervisor or nurse case manager shall make all contacts and initiate
investigation within forty-eight (a8) hours of receipt of new claims.
....:::;1S :::::: :rl:::::::r ...11
TPA shall [qv6 B Sbitrty to provide prescription drug authorization on the same day as
injury to altinjured employees,
TPA shall triage e.uery notice of injury with an initial review by a claims supervisor, a
registered nursa €ffiediffi.,,1+.B..4 sSigned adjuste/s review of entire claim file.
TPA shall ulilize any'TE ended medical primary care physicians or specialists as
directed by eity, even if nof in,the TPA's network, if it is in the best interest of the injured
employee or the Oity. This would include authorizing treatment by non-occupational or
non-network physicians oi 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 Citfiresefues 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
Klf ZU l4-JU2-5W IPA Lloims Administrotion tor Workers Comp ond Gen Liobilily
177
City's chosen workers' compensation defense counsel. ln 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 othenrrise designated by the City, with duties and respohdibilities 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,ndt limited to, filing new losses, coordinating light
duty assignments, assisting employees with'tdlqir= queEtidhs, filing wage statements,
updating diary notes, assisting attorneys with liti$a.{ lbs, and working with the City's
reg u |arly assig ned workers' com pensation cl ai ms aOl US4{1f
TPA shall provide, on an as needed'tAsis, an on-sit. O.tist*O,Jicensed liability claims
adjuster at the City's Risk Management Divrq.,,,!, , Office tfil the Human Resources
Department, or as othenruise designated by the'0i$.;!g..assist tFre City's Risk Manager with
claims administration services for the City of Miami Be@'s self-insured liability program.
The City is self,ihsBred and self-administered for liability claims management. The adjuster
shall perf@ claims adrtmistration services for automobile and general liability claims.
The scope. signm#includes, but not limited to, investigations, creating file diaries,
record keeBing4d o(.-!uq1i,*p-.qrvices necessary or proper for, or incidental to, performing
claims s61ustin$,= .===s=\NVffilffiL,L
rir
TPA shalt provide tli' with telephonic case management services on all workers'
compensation claims as an aUocated loss adjustment expense, unless othenruise directed
lt: t rl
TPA shall provide a list of PPO networks affiliated with the TPA, as requested by City.
TPA shall evaluatO and qualify various service providers recommended by the City to
service iFaccount, 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
Rl-P 20 l4-302-SW IPA Cloims Adminisiroiion lor Workers Comp ond Gen Liobility
178
NN
a
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 additionalcharge.
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 r.porting.e-=ffi.s at ,o additional cost,
as requested by City. E i,!.
t.
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 shallifidlirLpro$eed
with any legal action against a third-party tortfeasor without the City's Risk lt{ffiAger'sapproval. :''':";'
TPA shall review and seek ap-oroval from the City for any loss reserve adjustment
increases greater than twenty-fiv,
-
o.1=ggd dollars ($25,000). ,i:, , _
TPA agrees all negotiated settle nt @iee._ments 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 attomey fee, or any other type of
settlement that is nOt,otherwise considBred an administration of a medical, indemnity or
allocated expense that would othenruise OU"tt;;ld owed in accordance with Florida law.
TPA shall attend in person or via telephonic"lill! all mediations. The City shall endeavor to
n?.[g..'..'+$Managemenfstaff member, ordbsignee, at all mediations as well as hearings.
TPA sh-@r,ee to quaffifulaim reviews, whether in person or telephonically at the City's
discretion, to@iew all liti$ated cases, legacy cases, catastrophic cases, or non-litigated
complex cases.
l
tl,l|.ttt :::.1
[f$ shall agree -4ffllaim files, reports, and other data prepared or provided in connection
wlih,"alofajm ar f shall remain the property of the City.
TPA shalL;,kEEp complete and accurate records and accounts in connection with each
claim, Sugh 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. lncomplete 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.
RIP 20 I4-3O2-5W IPA Cloims Administrotion tor Workers Comp ond Gen Liobility 2B
179
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'cornpensation carrie(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 chailges iii workers' compensation
regulatory requirements or legislative acts that may affect the City's'til$ims-
TPA shall agree to maintain a SSAE 16 audit on controls placed in operatid@and tests for
operating effectiveness, and agrees to prov,lde'copies to the City as requested-ii,.Ni,
TPA shall utilize the City's solely selected and approved financial institution for th6 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 nst tutjon for fraud detection-
TPA shatl send weekty invoices ilr ;iiJlilno trrnrr.r ,.or.i-",0 reptenish the City's
account. Exceptions are made for special requeits for unexpected large losses or claim
settlements for,w,,hioh specific dedicated invoice for wire fund transfer requests shall be
made.
..,4
. The Cit|
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
nd at 16.? fifty percent (50Y0) times the City's average weekly spend on
workers' comp"g9fiftioQ.1$.].gj, s, Presently the City's fund maintains an average weekly
balape of two li''ffffi,;ep;efid fifty Lll.,, at d.dollars ($250,000).
. TPA iharr sFno origi;Ullffihices to the attention of the City's Risk Manager, or designee,
by e-mail to eity of Miami Beach, unless othenruise instructed.
. ,,-$:,'o IPA 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.
Klf lO l4-JU2-5W ll'A Lloims Administrotion tor Workers Comp ond Gen Liobilil'y 29
180
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 lnformation System to monitor the adjuster's claim
activity on a file, ,,'..,,,...
TPA shall provide the City with electronic loss ru, ,,clai 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 whenrequired. . . *-, ,,
','t: ir:'
.r\riffii,,
TPA shall provide safety englneering services as re'Q$'dbted by City, and fees shall be
negotiated and approved by the City as an allocated loss adjustment expense per
applicable claim file, o*sr
TPA, as a custodian of records for. City, sf.raif eompfy and cooperate with all applicable City
and State reco.,[-d up,9,.,.!qntion and exemptions laws such as, but not limited to, Florida
Statutes, S-e,.qlidn$111 ,440,760 and 112 as they pertain to protected medical, personal
and/or work product information
TPA agrees 1$fA.11,9fer oi ship the electronic file data or hard copy file data at the request
and.as directed by the City?et'no,,0orlffier'than actual incurred reasonable shipping fees.
TP agrees there Shall be no chaiges to transfer electronic data on a per data file basis or
othertransferrelated fee@;charges unless agreed upon in writing by City. All electronic
data transferre@ hard copy data shipped shall be done within sixty (60) days of receipt of
written notice'f City. Papbr data shall be shipped overnight by FED EX, UPS or
equivalent common carrier igreed to by City. Electronic dati shall be transferred by
disk/tape or over linternet as requested by City, provided the data files are adequately
protected and secured. Electronic file data means all claims information and related claim
file infffiation maintained in an electronic computer file format, whether stored on a hard
drive, tap6-,backup or CD"
.:;.;1.
Other clalms adjusting services for Workers' Compensation and General Liability, as
needed.
KIP 2U l4-3U2-5W ll'A Cloims Administrotion for Workers Comp ond Gen Liobilily 30
181
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 required maximum open case loads per adjusters ''(may
adjuster assigned to the account) are to be as f6l'lows (claims
handle files):
The City reserves the right to the final prior approval of the hirin$= and/or assignment of
the claims manager, supervisors and adjusters that are toffile'tffiity's claims.
haVe *ore than one
, r. rg,_,H.$ii r.*.i.:.],
" "
workers' compensation (lost time) - il00
workers'compensation (medical only) - 500
The administrator agrees to add staff as necessary to maintain these maximum pending
caseload levels. Explain how the otfrc€,"2,gJ_ unit will be staffed and explain the level of
supervision that will be provided. Cl,e=ttls,.personnel muSt be employees of the
administrator. The use of independent adjusters, subcontractois or temporary adjusters
is not acceptable without prior approval of the City Adjuster trainees are not acceptable
for handling of the City's claims. nOditi.,qngl reSu .9 of all claims professionals
specificatly assigned to this account are [6jie submitted4itfr tfris proposal. All claims
professionals must possess a current Florida Workers, Compensation adjuster's license.
LOSS FUND MANAGEMENT:
t ,L$g'Cl,e-im Palhent Aedount will be maintained at the City's commercial banking
. ':':iiIitit tiii..r:.,.= The account will be classified as part of the analysis group of City
=" ,""ornfi*e City willpay all service fees that are normal and cusiomary in thiiI account. Elltinterest earned or service credits generated will accrue to the
benefit of the City.
216fltllg claims adrrilnistrator is required to follow Florida law concerning public
dd'po.sits. Failure to comply with Florida law is sufficient cause for the City to
*"ffi
_?r,.OlhercoEtractual
agreement with the claims administrator.
3. All clainlsiie*pense and legal payments will be made by the claims administrator
on check$'drawn on an account set up by the administrator and funded monthly
by the City. lt 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.
Kf f ZU l4-JU2-5VV ll'A Llorms Administroiion tor VVorkers Lomp ond Uen Liobilily 3l
182
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
.:::::::::::::: i
SUPPLEMENTAL QUESTIoNS ,,$R.=-= %
In addition to information that may be provided in your p&-\osal and (eguired elsewhere in
the RFP, please answer the following (restate question in each answer): ,,;,,;L
6.
1.
2.
3.
4.
5.
Where is your office located?
Number of professional claim, clerical and/or support staff at that location.
Name, experience, resume and professional d $l$n-qtions of claim manager.
Name, experience, ticenle tlpe, resume and professionat designations of any
supervisory level employees that will have responsibility'for this account.
Name;xp.g.,,,,l,, nce, license type, resume and professional designations of the
desig*:dteil ffislers that will have responsibility for this account.
:Advise.the curreff pending case load for each designated adjuster.
What iS'thB.eu ent'itum,F,.er of mo hly new assignments to each adjuster?
|i ris
Will the awaiff,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 February1,2015?
.d
Name the'4 law firms (2 workers'compensation,2liability) that you currently
handle the most cases with. Provide a contact person and phone number,
Estim& the percentage of time your adjusters are out of the office doing field
work" lf all are telephone adjusters, please indicate.
Do you utilize independent contracted adjusters? lf so, under what circumstances?
Name, address, phone and contact person for independents you utilize.
Can you provide all the required services with your own personnel?
o.
7.
8.
11.
12.
'13,
10.
KLf 2U l4-3U2-5W ll'A Lloims Administrotion tor VVorkers Lomp ond Gen Liobiliiy 2)
183
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 allthe 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, mOdicat'.ease management, bill
review, utilization review and rehabilitation services. Thes€"areiot to be included
in the annualfee proposed, '''
.
19. Explain, in detail, any deviation from lhi services or fee structure type required,
specifically indicating any serviceslo.r,l. not perfp,.;1l, Specifically indicate what
you consider as allocated expenses an ,, reforg#dtrincluded in your annual fee
ProPosal amount. ";:
.i-
Balance of Pase lntentionallv Left Bli=frlii,;;i .= .,
RFf 2U l4-3U2-5W IPA Uloims Administrotion tor Workers Lomp ond Uen Liobiliiy
184
APPENDIX D
& &AtAAAIRw&flH'rE , V \11 \I V ti*',sk-$r \W$ I
Specio$onditions
''' RF-.P 2014q302-SW
C LAIMS+ DMI N ISTRATION S ERVICES
IHIRD PARTV ADMINISTRATORBYA
'
**
fiM: ru 5ffi ; s^? Tl=-f#'|
o N
,sdr^ DEPARTMENT oF:)3r?::ffil#t{13:X5[
Miomi Beoch, Florido 33,l39
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 34
185
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' Co.mpensation (per 691-5-
.:::::=
4. ADDITIONAL SERVICES. lf during the contractual period addilionat ices 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 writtOn request frofi:..the City's Risk
Manager, provide a proposal for such services and the Ci$ ieserves the option to isSue a purchase
order for the specified work as approved by both 011.r :
:i::::::::='"'ti't,tl'ra. ',.,,ii,,
) $$'i
:
go
Balance of Page lntentionallv Left Blank
RFP 20.l4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility J5
186
APPEN DIX E
g e^t,&,&&$ffiffi&ffh"|
Cost Prbpos 'l furm
.r'
'*i,
201 4-302-sw
C LAIMSADffi I N IiS RATIO N S E RVIC ES
,-.
'-t-"
BY A THIRD%RTY ADMINISTRATOR
. FOR WORKERS' COMPENSATION
= AND GENERAL LIABILITY
DEPARTMENT OF PROCUREMENT MANAGEMENT
1700 Convention Center Drive
Miomi Beoch, Florido 33,l39
RFP 20.l4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility JO
187
APPENDIX E
COST PROPOSAL FORM
Bidder affirms that the prices stated on the proposal price form below represents thercntire cost of the items in
full accordance with the requirements of this RFP, inclusive of its terms, cond.itioiiS*pecifications and other
requirements stated herein, and that no claim will be made on account of any increase in wage scales,
material prices, travel, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation
provision is allowed herein and has been exercised by the City Managbr in a@.q.c . The Proposal Tender
Form shall be completed mechanically or, if manually, in ink. Cost Proposal Foniiss;;ompleted in pencil
shall be deemed non-responsive. All corrections on the Proposal Tender Form shall be.initialed.
Failure to follow the price proposal format as identifie$may result in the RFP response being considered
non-res ponsive an d the RF P su bm ittal wil I not be $on sid"6ied for eval u ation.
i -i.OPTION #1: FLAT,ANNUAL FEE OPTION
1. Flat Annual Fee -(for 345 claims ihcluding
new and orior claims
Flat Annual Fee
$_
(per contract yea0
2. Per Claim Fee fgJ
Glaims inJxcess 6f
345fer Y$ai (per excesS ciaim)
Excess Claim Fee Per
Year
$_
(ColumnlxColumn2)
* Proposer shall includ$a,g-).1unt, whlchthe City may negotiate at its discretion.
Rf P 2U l4-3U2-5W IPA Cloims Administrotion for Workers Comp ond Gen Liobilily
188
OPTION #2: FIXED PER CLAIM FEE OPTION
1" lndemnity Per Glaim
(Litigated Or Non-
(Columnl xColumn2)
2. Medical Only Claim
(Litigated Or Non-
(ColumnlxColumn2)
3. Medical Only Claim
Transferred To
lndemnity Claim
(Litigated Or Non-
Quantitv
25 per year
(ColumnlxColumn2)
4. lndemnity Per Claim
(Litigated Or Non-
(Column 'l x Column 2)
5. Medical Only Claim
(Litigated Or Non-
(ColumnlxColumn2)
N #3: FIXED PER CLAIM BLENDED FEE OPTIONI
1" lndemnity Or
Only Per Cl{m
(LitiQated Or (ColumnlxColumn2)
2. lndemnity Or
Only Pei{laim
(Litigated= Or (per claim)(Column l xColumn2)
Rf P 2U l4-3U2-5W IPA Cloims Adminisirotion tor Workers Comp ond Gen Liobilily JO
189
ADDITIONAL SERVICES
List of services. as needed. which are in addition to tl re fees orooosed in Ootions 1 - 3.
Telephonic Medical Case Management Fee On AllClaims:$
Per Bill/Flat Fee
Bill Review Fee To lnclude State Fee Schedule Reduction:$
Per Bill/Flat Fee
Percentage Of PPO Savings - Network Discount Savings Below State
Fee Schedule:o/o
Percentage Of Utilization Review And Reasonable & Customary
Savinqs:olto
Subrogation And/Or Liens Fee Percentage:
oh
Osha 300 Log Reporting:
$
Electronic Data lnterchange Filed With State:
$
Safety Consulting Services
A-:; ia \"i: -iv
Notice Of lnjury Entry:
$
CustomlAd Hoc Reports:
.$
Data And File Conversion Fee:$
One-Time Setuo Flat Fee
Medicare Repoff ng Costs:
Liability Claims Adjuster (Ciff 0f Miami B,Each ln-House Adjuster)
..,'.-..i. .Wl
$
Workers Compensatidh Cl-imsAdjuster ($.ity Of Miami Beach ln-
$
$
$
Description CfrA{dihonal Service:
'::::::t:. ::.i::::
=:r,i,:i;:+i11;$
Description of Addrtiffife;
$
Company: .,'i
Authorized Representative:
Address:
Telephone:
Email:
Authorized Representative's Signature:
RFP 20 I 4 302 SW TPA Cloims Adminiskotion tor Workers Comp ond Gen Liobilily 39
190
APPEN DIX F
MN&&AI ffir* & "s$ !
ffiffis&ur*$
$Tfl
lnsuronce ReqUiremehts
=. R:FP 2}ltttry3gr-S,W
CLAIMS ADMINISTRATION SERVICES
BJ,A THTRD PARTYADMI N ISTRATOR
H irl
F o R ffi str; s^? Ti'*t', +'
I o N
:a;::=
liT,t,+
DEPARTMENT OF PROCUREMENI MANAGEMENT
1700 Convention Center Drive
Miomi Beoch, Florido 33139
RFP 201 4 302 SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 40
191
,h AAtAr\Aiffiw&ffHi t, t I g t , cd f, 1 s s s a B q - r s: J Y tld \, Y !I WNwg B\eBdl S
PROFESSIONAL SERVICES !NSURANCE 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
lnsurance which indicate that insurance coverage has been obtained which meets the requirements as
outlined below:
A. Worker's Compensation and Employer's Liability lnsurance for all employees of the
provider as required by Florida Statute 440.
B. Commercial General Liability on a comprehensive -bdsis'ln ,n amount not less than
$1,000,000 combined single limit per occurrence-,aii '$2;OOO,OO0 in the aggregate, for
bodily injury and property damage. Gity of Mi mi Beach must be shown as an
additiona! insured with respect to this coverage.
:
.C. Professional Liability lnsurance in an amount not teis_tnan $'1,000,000 with the deductible
per claim, if any, not to exceed 10Yo of the limit of liabititVl;1ffi*
The insurance coverage above must include= waiver of subrogation=:iaftvor of the City. The insurance
coverage required shall include those classificatiOns, as listed in standard liability insurance manuals,
which most nearly reflect the operations of the provider':- -'
All insurance policies required-a.-pgve shall be issued by companies authorized to do business under the
lawsoftheStateofFloridal....Yiffi!pttowingqualifications:
:::::::::::
The company rnU$it,Oe rated less than "B" as to management, and no less than "Class
V" as to finanCial'i5ftgngth, by. the latest edition of Best's lnsurance Guide, published by
A.M. Best CompanflltpJOwic.!1,ilqNew Jersey, or its equivalent, subject to the approval of the
City Ris\ anagement'iQiV,isfOn.
or
,=,
.T,,IIb company must hold a valld:'F.f,eida Certificate of Authority as shown in the latest "List
6Fall lnsurance Companies Authdijied or Approved to Do Business in Florida" issued by
the State of Florida Department-,of lnsurance and are members of the Florida Guaranty
Certificates will indic5te no modification or change in
advance notice to the Certificate holder.
CERTIFICATE HOLDER MUST READ:
CITY OF MIAMI BEACH
17OO CONVENTION CENTER DRIVE
3'd FLooR
MIAMI BEACH, FL 33139
insurance shall be made without thirty (30) days
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 Cloims Administroiion for Workers Comp ond Gen Liobility 41
192
APPENDIX G
g MIA&A$ffiffi&ffhd
C|oims Exp6riifehce
,,, ,,,RFP 201 4-302-SW
CLAIMS ADMINISTRATION SERVICES BY A
T=H]RD PARTY ADMINISTRATOR FOR
wCffiKERS' COMPENSATION AN D GEN ERAL
=' "- LIABILITY
:::::::::ii*v
DEPARTMENT OF PROCUREMENT MANAGEMENT.l700 Convention Center Drive
Miomi Beoch. Florido 33,l39
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen LiobiliV 42
193
CLAIMS EXPERIENCE
AVAILABLE UNDER SEPARAIE COVER
(-'\\
rul ilM
!::::t; '.::::::t:::
\,,,i!fr.
.:
::::::::
RFP 2014-302-SW TPA Cloims Administroiion for Workers Comp ond Gen Liobility 43
194