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
Ensure iture Trends Are Sustainable Over the Lonq Term
N/A
Item Summary/Recommendation :
The City of Miami Beach (the "City") is approved by the Florida Department of Labor and
Employment Security/Division of Workers' Compensation to self-insure for Workers' Compensation.
However, the Division of Workers' Compensation 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-pafi 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 Worke/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 lnformation:
Financial lmpact Summary:
540-1790-000312
Agenda 11sm C2D
Date 7-lY I Ll(D AAIAMIBEACH 149
City Commissioner Memorandum - Claims Administration Service by a TPA for Workers' Compensation and General Liability
July 23,2014
Page 3 of 3
City of Miqmi Beoch, I200 Convention Cenler Drive, Miomi Beoch, Florido 33139, www.miomibeochfl.gov
COMMISSION MEMORANDUM
MIAMIBEACH
TO:
FROM:
Mayor Philip Levine and Members
Jimmy L. Morales, City Manager
DATE: July 23,2014
SUBJECT: REQUEST FOR APPROVAL TO THE ISSUANCE OF A REQUEST FOR
pRoposALs (RFp) FoR cLAtMS ADMTNTSTRATTON SERVICES BY A THIRD PARTY
ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY.
ADMTNISTRATION RECOMMENDATION
Authorize the issuance of the RFP.
KEY INTENDED OUTCOME
Ensure Expenditure Trends Are Sustainable Over the Long Term
BACKGROUND
Tf'ercity of trliami Beach (the "City") is approved by the Florida Department of Labor and Employment
SecurityiDivision 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
fne 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 inedicai only and i06 lost time. Currently there are approximately 418 open claims. Prior to October
19g6, the City purthased excess workers' compensation insurance. The City does not currently purchase
excess workers' compensation insurance.
150
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 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 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 grealer 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 priorto February 1,2015, be transferred into the proposer's computer information system, so
that future loss runs will contain a complete history of all claim years. The transfer of all claims data must be
completed by June 1,2015. The proposer is responsible for specifically indicating in their proposal the fees, if
any, for assumption of prior claims and the data conversion.
The program is run on an "occurrence" basis, therefore, all claims occurring in the contract year, regardless of
when reported, are to be handled per the requirements of this agreement. The claim administrator is required to
handle all claims to their conclusion or to the conclusion of the contract, whichever occurs first, at no additional
charge to the City other than the annual fee. The contract may be terminated by either party with ninety (90)
dayJwritten 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\20'l4Uuly\Procurement\RFP lssuance-Memo- TPA for Workers Comp and Gen Liab MEMO.doc
151
REQUEST FOR PROPOSALS (RFP)
FOR CIAIMS AD'VIINISTRATION SERVICES BY A THIRD PARTY ADII/TINISTRATOR FOR
WORKERS' COMPENSATION AND GENERAT IIABIIITY
20r 4-302-SW
"".*#, I
=
*
RFp ISSuRucEoRrE: JULy 24,2014 '"'.*nu
pnoposALS DUE: nuGuSr ii,,zala@ 3:oo PM
ISSUED BY:
# &*IAMIBIACH
Steven Williams, Procurement Coordinator
DEPARTMENT OF PRO€UREMENT MANAGEMENT
1700 Convention Center Drive, Miomi Beoch, FL 33.l39
305.6737000 x6650 | Fox: 786.373.4330 | www.miomibeochfl.gov
152
E MIAMIBTACH
TABLE OF CONTENTS
SOLICITATION SECTIONS: PAGE
0100 NoT uTtLtzED ."..."... .......... N/A
O2OO INSTRUCTIONS TO PROPOSERS & GENERAL CONDITIONS ...............3
o3oo PRoPosAL suBMITTAL TNSTRUCTTONS & FORMAT..............Jl.ii........."............10\".
0400 PROPOSAL EVALUATION ....... ..........,rir'ir". ............12
-*-nus.-s$llN$
{L\.1:::= ''.=APPENDICES:PAGE
AppENDtX A PROPOSAL CERT|F|CATON, QUESTTONNAIRE AND AFFIR TS ........14
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APPENDIX B 'NO PROPOSAL" FORM ................:::,i............. ffi#r:;......23
".H
APPENDTX C MTNTMUM REQUTREMENTS & SPECTF,ICATTONS ...........................s$U':..24
APPENDTX D SPECTAL CONDTTTONS ............................................. ...............33
tPz,, =, '
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APPENDIX F INSURANCE REQUIREMENTS*:t:,:#li:,,..:.......................... ......39
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APPENDIX G CLAIMS EXPERIENCE.. .... ...'^ ...#.{fi,lii......':::::i,i: ':.................".................41
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RFP 20.l4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 2
153
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sEcTtoN 0200 INSTRUCTIONS TO RESPONDENTS & GENERAL CONDITIONS
1. GENERAL. This Request for Proposals (RFP) is issued by the City of Miami Beach, Florida (the "City"), as the
means for prospective Proposers to submit their qualifications, proposed scopes of work and cost proposals (the
"proposal") to the City for the City's consideration as an option in achieving the required scope of services and
requirements as noted herein" All documents released in connection with this solicitation, including all appendixes
and addenda, whether included herein or released under separate cover, comprise the solicitation, and are
complementary to one another and together establish the complete terms, conditions and obligations of the
Proposers and, subsequently, the successful Proposer(s) (the "contractor[s]') if this RFP results in an award.
The City utilizes PublicPurchase (www.publicpurchase.com) for automatic notification of competitive solicitation
opportunities and document fulfillment, including the issuance of any addendum to this RFP. Any prospective
Proposer who has received this RFP by any means other than through PublicPurchase must register immediately
with PublicPurchase to assure it receives any addendum issued to this RFP. Failure to receive an addendum
may result in disqualification of proposal submitted.
,,,.
2. PURPOSE.
The City of Miami Beach (the "City") is approved by the Florida Department of Labor and Employment
Security/Division of Workers' Compensation to self-insure for Workersl.0ompensation. The Division of Workers'
Compensation requires that the claims administration be provided by a State Certified Workers' Compensation
Claims Administrator. Therefore the City is seeking the professional services of an experienced and qualified firm to
provide services as a third party administrator for Workers Compensation and Gbneral Liability.
3. SOLICITATION TIMETABLE. The tentative schedule for thls Solicitatioh,'iS?S follows:
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 questions/clarifications will be
sent to all prospective Proposers in the form of an addendum"
Procurement Contact.
Steven Williams
Telephone:
(305)673-7497
Email:
StevenWilliams@miamibeachfl .gov
RFP lssued July 24,2014
Pre-Proposal Meeting August 5,2014 @ 10:00 a.m.
Deadline for Receipt of Questions August 19,24M
ReSponses Due August 26,2014 @ 3:00p.m.
Evaluation Committee Review TBD
Proposer P r0s6*tatioh s TBD
Tentative Commission Approval Autliorizing
Negotiations
TBD
Contract Negotiations Following Commission Approval
RFP 201 4-302-SW TPA Cloims Adminislroiion for Workers Comp ond Gen Liobility
154
tb AAIA/V\lmilAil$-{
5. PRE-PROPOSAL MEETING OR SITE VISIT(S). Only if deemed necessary by the City, a pre-proposal meeting or
site visit(s) may be scheduled.
A Pre-PROPOSAL conference will be held as scheduled in Solicitation Timeline above at the following address:
City of Miami Beach
City Hall .4th Floor
City Manager's Large Conference Room
1700 Convention Center Drive
Miami Beach, Florida 33139
:::::= L,t
Attendance (in person or via telephone) is encouraged and recommended as a Source of information, but is not
mandatory" Proposers interested in participating in the Pre-Proposal Submission Meetihgvia telephone must follow
these steps: i=-.."- , ._ ,
.
(1) Dial the TELEPHONE NUMBER: 1- 888-270-9936 (Tqh#de tlorth Am )
...:::::::::::_ .
Proposers who are interested in participating via telephone should r.ii.alluB-rail to the contact person listed in this
RFP expressing their intent to participate via telephone.
,i:
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6. PRE-PROPOSAL INTERPRETATIONS. Oral informatiO*'or responses 1i'ilffid$iions received by prospective
Proposers are not binding on the City and will be without legal effect, including any information received at pre-
submittal meeting or site visit(s). O5rly questions answered by wriften=addenda will be binding and may supersede
terms noted in this solicitatiokffd ill be released through PublicPurchase.
.-$fl t;,
7. CONE OF SILENCE.:Fu=!...q nt to Sei'6 n 2-486 of the City Code, all procurement solicitations once advertised
and until an award recommendation has been forwarded to the City Commission by the City Manager are under the
"Cone of Silence." @{he Cone of Silence ordinance is available at
http://library"municc@com/index.aspx?clientlD=f 3097&statelD=9&statename=Florida. Any communication or
inquiry in referende=ldthis solicitation wif,l1rgry City employee or City official is strictly prohibited with the of exception
communications with the Procurement Eiiector, or his/her administrative staff responsible for administering the
procurementrrocess for this solicitation prOviding said communication is limited to matters of process or procedure
regarding th6'solicitation. Communications iegarding this solicitation are to be submitted in writing to the
Procurement e0ntact,named hereihwith a copy to the City Clerk at rafaelgranado@miamibeachfl.gov.
'"..,' i,,, , 't.tlbalance of Paqe lntentionallv Left Blank
4RFP 20.I4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility
155
ID ,\{tAAAtS*&tF{
8. SPECIAL NOTICES. You are hereby advised that this solicitation is subject to the following
ordinances/resolutions, which may be found on the City Of Miami Beach website:
http ://web. miamibeachfl.gov/procuremenUscroll. aspx?id=235 1 0
. CONE OF SILENCE.". CITY CODE SECTION 2486
. PROTEST PROCEDURES CITY CODE SECTION 2-371
r DEBARMENT PROCEEDINGS CITY CODE SECTIONS 2-397 THROUGH 2-485.3
. LOBBYIST REGISTMTION AND DISCLOSURE OF FEES... CITY CODE SECTIONS 2481 THROUGH 2-406
. CAMPAIGN CONTRIBUTIONS BY VENDORS CITY CODE SECTION 2487 , LrL1o. CAMPAIGN CONTRIBUTIONS BY LOBBYISTS 0N PROCUREMENT 'lt"
ISSUES.. ..,...." CITY CODE SECTION 2{88'. REQUIREMENT FOR CITY CONTRACTORS TO PROVIDE EQUAL
BENEFITS FOR DOMESTIC PARTNERS..... CITY CODE SECI{.Q_$'2r3?3
o LIVING WAGE REOUIREMENT......,.,..
. LOCAL PREFERENCE FOR MIAMI BEACH-BASED VENDORS."........ PREFERENCE FOR FLORIDA SMALL BUSINESSES OWNED AND
CONTROLLED BY VETEMNS AND TO STATE.CERTIFIED SERVICE.
DISABLED VETEMN BUSINESS ENTERPRISES. FALSE CLAIMS ORDINANCE.... .,,......,......,...,..,.,..,:i. ACCEPTANCE OF GIFTS, FAVORS & SERVICES....
CITY CODE SE€:AONS 2407 T,I*EQUGH2-410
CITY CODE SECTION 2-372 \r..,\i
CITY CODE SECTION 2.374
CITYQQDE SECNON 7O.3OO
CITY CODE SECTION 2449
9. POSTPONEMENT OF DUE DATE FOR RECEIPT OF PROPOSALS. The City reserves the right to postpone the
deadline for submittalof proposals and will mak&reasonable effort to $ive at least three (3) calendar days written
notice of any such postponement to all prospectivffin6jry=,se,1s through PublicPurchase.
10. PROTESTS. Protests concerning the specificatiohs, reQuiie-m-Qffiand/or terms; or protests after the proposal
due date in accordance with City Code Section 2-371.;,.whictr,.6stEtiffr*$ffiprtocedures for protested proposals and
proposed awards, Protests nol submitted in a timely mait pursuant ti the requirements of City Code Section 2-
371 shall be barred..:..:,,:... \N.
11. MIAMI BEACH-BASED VENDORS PREFERENCE. Purs"uant'to City of Miami Beach Ordinance No. 201 1-3747 ,
a five (5) point preference will be given to rbsponsive and rej'ponsible Miami Beach-based Proposer,
Pursuant to City of Miami Beach Ordinance N0.201'l-
3748, th€ty shall give a':fr ) point Flq&rence to a responsive and responsible Proposer which is a small
business'$.ocern owned and eOnflfulled by a veteran(s) or which is a service-disabled veteran business enterprise.
." 4r"
13. DETERMINATI9N OF AWAREeIThe final ranking results of Step 1 & 2 outlined in Section 0400, Evaluation of
Proposals, will be:' idered by tE€ City Manager who may recommend to the City Commission the Propose(s)
s/he deems to be in=:!@ st inted of the City or may recommend rejection of all proposals. The City Manager's
recommendation need no=t be conSistent with the scoring results identified herein and takes into consideration Miami
Beach City Code Section , including the following considerations:
(1) The abffi, 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.
iiN
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility
156
E AAIA,\AImrACH
The City Commission shall consider the City Manager's recommendation and may approve such recommendation.
The City Commission may also, at its option, relect 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 reseryes 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 shall be solely responsible for
making any and all investigations, evaluations, and examinations, as it deer,ns necesSary, to ascertain all conditions
and requirements affecting the full performance of the contract. jgni.5.?,.nce of such conditions and requirements,
and/or failure to make such evaluations, investigations, and exatiinatioijs, will not relieve the Proposer from any
obligation to comply with every detail and with all provisions and requirements of the contract, and will not be
accepted as a basis for any subsequent claim whatsoever for any monetary consideration on the part of the
rr:,rS
16. COSTS INCURRED BY PROPOSERS. Allqpenses involved with tffireparation 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 reimbursdd bf$C tV
Wi.,l
17. RELATIONSHIP TO THE CITY. lt is the intent of the City-,'andrP.ro.rposers hEieby acknowledge and agree, that
the successful Proposer is conside.red to be an independd contractor, and that neither the Proposer, nor the
Proposer's employees, agents;:;,rinfl/oi ntractors, shall, uhder any circumstances, be considered employees or
agents of the City.
18. TAXES. The City of Miamift1,|
'rsffilllfrom
all FederalExcise and State taxes.
19. MISTAKE : PioBosers ,r. } td;o io .*r*ine-ihe terms, conditions, specifications, delivery schedules,
proposed pncing, and atl instructions pertaining to the goods and services relative to this RFP. Failure to do so will
be at t.-!,,9{pose/s risk and may sult inffiosal being non-responsive.
20. PAYMENI, Payment will be made by thdrCity 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 form"at.
21. PATENTS & ROYALTIES. Proposer shall indemnify and save harmless the City of Miami Beach, Florida, and its
officers, employees, contractors, and/or agents, from liability of any nature or kind, including cost and expenses for,
or on account of, any copyrighted, patented, or unpatented invention, process, or article manufactured or used in the
performance of the contract, including its use by the City of Miami Beach, Florida. 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.
RFP 2014 302 SW TPA Cloims Administrotion for Workers Comp ond Gen Liobllity 6
157
b ,\ilAtultBrAil-{
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 delivCIr qlaterials or perform work or
services as a result of any contract resulting from this solicitation, th ntractor will assume the full duty, obligation
and expense of obtaining all necessary licenses, permits, an-d.l.iii5uranCe, and assure all4rk complies with all
applicable laws. The contractor shall be liable for any damageS" r loss to the City occasioned"by negligence of the
Proposer, or its officers, employees, contractors, and/or ageh$,;rfQf re to'eo.mply with applicable1aws
23. SPECIAL CONDITIONS. Any and all Special Conditions aY vary from these General Terms and
Conditions shall have precedence.
,,r ..
24. ANTI-DISCRIMINATION. The Proposer certifies that he/she is in complldrice with the non-discrimination clause
contained in Section 202, Executive Order 11246, as amended by ExecutiffiiltOrder 11375, relative to equal
employment opportunity for all persons without regard to race, color, religion, sex*or national origin.
A. Pre-award inspection 0f the Prcipd$er's facility may be made prior to the award of contract.
B. Proposals will onf' consided fum firms which are regulady engaged in the business of providing the
goods and/or services as described in this solicitation.
C. Proposers must be able to demondtiate,,A.:gopd lecgrd of performance for a reasonable period of time, and
have sufficieffinanciat capaciti, equipmeni, anO orgrnization to ensure that they can satisfactorily perform the
services if awarded a contract under the terms and conditions of this solicitation.
D. ffi'terms "equipmeht',6 prganization", as used herein shall, be construed to mean a fully equipped and
weffiffiished company i ihie with the best business practices in the industry, and as determined by the City
of Miami Beach,
E. The Ci$pay.consider any'e$dence available regarding the financial, technical, and otherqualifications and
abilities of a Pio$ger, includin$,'past performance (experience), in making an award that is in the best interest of
F. The City may re{tliift$ ffiser s to show proof that they have been designated as authorized representatives
of a manufacturer or sUpplibr, 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 othenruise dispose of the
contract, including any or all of its right, title or interest therein, or his/her or its power to execute such contract, to
any person, company or corporation, without the prior written consent of the City.
RFP 2014 302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility
158
b MIAMISIAilH
27. LAWS, PEEtvtIS AND REGULATIONS. The Proposer shall obtain and pay for all licenses, permits, and
inspection fees required to complete the work and shallcomply 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 0....f,r: City to purchase the goods
and services specifically listed in this solicitation from the contractor. However, the'City reserves the right to
purchase any goods or services awarded from state or other governmentalo.c-o1tract, or on an as-needed basis
throughtheCity,sspotmarketpurchaseprovisions.
30. DISPUTES. ln the event of a conflict between the documents, the ordeirof priority 6f the documents shall be as
A. Any contract or agreement resulting from the award of this solicitation; then =\."=..==
...=
B.Addendumissuedforthissolicitation,withthelatestAddendumtakingprecedence;then
C. The solicitation; then
D. The Proposer's proposal in response to the solicitation.
31. INDEMNIFICATION. The contractor shall in$g.....mn1lV and hold n.il[ City and its officers, employees,
agents and instrumentalities from any and all liai{ili$,f llqges or damages, including attorney's fees and costs of
defense, which the City or its officers, employees, agents or in$lrumentalitieffiay incur as a result of claims,
demands, suits, causes of actions or proceedings of any kind oi nature arising out of, relating to or resulting from the
performance of the agreement by the contractor or=(s employeesllagents, servants, partners, principals or
subcontractors. The contractor shall pay all claims anf#ses in connbction therewith, and shall investigate and
defend all claims, suits or actions of any kind or nature in the name of the City, where applicable, including appellate
proceedings, and shall pay atlcosts, judgments, and attorneyls fees which may be incurred thereon, The contractor
expressly understands and agrees that any insurance protection iequired by this Agreement or othenruise provided
by the contractor shall in no way limit the rC5ponsibility to indemnify, keep and save harmless and defend the City or
its officers, emn[$,f,1B]ia, agents and inslrumentatities as herein provided, The above indemnification provisions shall
survive the.. piration oi t€ffi9,.._!19n of thi$ ement.
32, GO[-I...E&ACT EXTENSION. The City reserves the right to require the Contractor to extend contract past the-----..----.-.-
stated ter in$$$1 date for a period of up 120 days in the event that a subsequent contract has not yet been
awarded. Additidtiblextensions pastthe 120 days may occur as needed by the City and as mutually agreed upon by
the City and the iontiactlr
"::::;::.:i.i1l li t-
1i ll,1,r, Balance of Paqe lntentionallv Left Blank
RFP 201 4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility
159
b /\4tAMrmilAct--l
33. FLORIDA PUBLIC RECORDS LAW" Proposers are hereby notified that all Bid including, without limitation, any
and all information and documentation submitted therewith, are exempt from public records requirements under
Section 119,07(1), Florida Statutes, and s" 24(a), Art. 1 of the State Constitution untilsuch time as the City provides
notice of an intended decision or until thirty (30) days after opening of the proposals, whichever is earlier.
Additionally, Contractor agrees to be in full compliance with Florida Statute 119.0701 including, but not limited to,
agreement to (a) Keep and maintain public records that ordinarily and necessarily would be required by the public
agency in order to perform the services; (b) provide the public with access to public records on the same terms and
conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in
this chapter or as 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$6 public ,agency all public records in
possession of the contractor upon termination of the contract and deS@ any duplicale public records that are
exempt or confidential and exempt from public records disclosure,.--furements. All records stored electronically
must be provided to the public agency in a format that is compatiS with"the information %l:gy systems of the
34. MODIFICATIONMITHDRAWALS OF PROPOSALS.I pfiFar*r rnay suUmit a modified frofosal to replace all
or any portion of a previously submitted Proposal up until the Proposal due date and time. Modifications received
after the Proposal due date and time will not be considered. Proposals shall be irrevocable until contract award
unless withdrawn in writing prior to the Proposai due date, or after expiration of 120 calendar days from the opening
of Proposals without a contract award. Letters of withdiawal received after the Proposal due date and before said
expiration date, and letters of withdrawal received after ibntract award will not be considered.
35. EXCEPTIONS TO RFP. Prop_q,96r9 must clearly indicate any exceptions they wish to take to any of the terms in
this RFP, and outline wnat, if aflfilf.iiffitive is being offered. All exceptions and alternatives shall be included and
clearly delineated, in writing;in the Prdffi$hl, The City, at its sole and absolute discretion, may accept or reject any
or all exceptions and altei*atites, ln cas#n which exceptlons and alternatives are relected, the City shall require
the Proposer to comply with the,'particular:Grm and/or condition of the RFP to which Proposer took exception to (as
said term and/or condition was ori$igp-lly==d8Gforth on the RFP)
36. ACCEPTANCE OF GIFTS. FAVOE$].=$ERVCES. Proposers shall not offer any gratuities, favors, or anything of
theCity,forthepurpoSeofinfluencingconsideratiohofihis
Proposal. Pursuant to Sec. 2-449 of the City Code, no officer or employee of the City shall accept any gift, favor or
service that might reasonably tend improperty to influence him in the discharge of his official duties.
Balance of Paqe lntentionallv Left Blank
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen LiobillV 9
160
@ AAIAMIBTACH
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 rejected,
,,=
2. LATE BIDS. Bid Proposals are to be received on or before the due date established herein for the receipt of Bids.
Any Bid received after the deadline established for receipt of proposals will be considered late and not be
accepted or will be returned to Proposer unopened. The City does not accept responsibility for any delays,
3. PROPOSAL FORMAT. ln order to maintain comparability, facilitate the review pto..tt and assist the Evaluation
Committee in review of proposals, it is strongly recomme.nded that proposals be orgahized and tabbed in
accordance with the sections and manner specified below"=.l dtid copy submittal should be tabbed as enumerated
below and contain a table of contents with page referencdBlHd$gric copi ould also be tabbed and contain a
table of contents with page references. Proposals that do not incluildr,the,requii6d information will be deemed non-
responsive and will not be considered.
Cover Letter & Minimum Qualifications Requirements
1.1 Cover Lefter and Table of Contents. The coverletter musl indicate Propose(#fd,p;pposer Primary Contact for the
purposes of this solicitation. qF
1.2 Proposal Certification, Questionnaire & Requirements Affidavit (App6hdix A). Attach Appendix A fully
completed and executed.
1.3 Minimum Qualifications Requirements. Submit verifiable information documenting compliance with the minimum
irements established in Appendix C, Minimum Requirements and Specifications.
ce & Qualifications
2.1 Qualifications of Proposing Firm. Submit detailed information regarding the firm's history and relevant experience
and proven track,lefffl o{ prg.viding the scope of services similar as identified in this solicitation, including experience in
providing si,,.ry r scope of qgtmr to public sector agencies, For each project that the Proposer submits as evidence of
similar e ience, the follffig is required: [roject description, agency name, agency contact, contact telephone &
email, a*€lyear(s) and term of en$a$ement,
2.3 Financial Capacity.Eacn"eioposer shall arrange for Dun & Bradstreet to submit a Supplier Qualification Report
(SOR) directly to the t Contact named herein. No proposal will be considered without receipt, by the City, of
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. lt 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 20I 4-302-SW TPA Cloims Administroiion for Workers Comp ond Gen Liobility t0
161
Sc of Services
b ,,'\,\lA\ii mil&cF'{
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 a fully review and score the of services.
Submit a completed Cost Proposal Form (Appendix E).
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'MAdditional Charge," as
applicable, within the Cost Proposal.
i,
Failure to submit pricing for all three options requeSt in the Cost Proposal Form will result in the proposals being
considered non ve and not further considered.
No'te: After proposal submittal, the City reserves the right to requir:e itional information from Proposers (or
Proposer team members or sub-consultants) to determine: qualifications (including, but not limited to, litigation
history, regulatory action, or additional references); and financial capability (including, but not limited to, annual
reviewed/audited financial statements with the auditors notes for each of their last two complete fiscal years).
il
Submit detailed information on how Proposer plans to accomplish the required scqpe of services, including detailed
information, as applicable, which addresses, but need not be limited to: implementation plan, project timeline,
s, testinq and risk mitiqation ootions for assuri tis imoBm€fited on time and within
Cost Proposal
RFP 201 4 302 SW TPA Cloims Adminisirotion for Workers Comp ond Gen Liobility
162
b A/r
PROPOSAL EVALUATION
tAAAtSffi"&th{
sEcTtoN 0400
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 fonruarded to the City Managerwho will utilize the results to make a:r,ecommendation to the City
2. Step 1 Evaluation. The first step will consist of the qualitative critefisteOi.to* to be considered by the
Evaluation Committee. The second step will consist of quantitatives{teria established below to be added to the
Evaluation Committee results by the Department of Procurement Management. An EvaluationCommittee, appointed
by the City Manager, shall meet to evaluate each Proposal in accdrdance with the qualifications criteria established
below for Step 1, Qualitative Criteria. ln doing so, the Evaluation Committee.,may:. review and score all proposals received, with oi W.i,!,, 1condueting interview sessions; oro review all proposals received and short-list one oifure Proposers to be further considered during
su bseq uen t i nterview sessio n (s) (usi n g the same criteria).$\1iiir,,
Proposer Experience and Qualifications, including Fjnancial Capability
Scope of Services Proposed , -,-
Approach and Methodology rir,
3. Step 2 Evaluation. fomwing the results of Step 1 Evatuation of qualitative criteria, the Proposers may receive
additional quantitative criterib p.0j[rts to Eadded by the Department of Procurement Management to those points
earned in Step 1, as follows, "':::::
Cost P ro po s il ( Based o n Rr Ji*SF=totato i n tsy
Miami Beach-Based Vendor Pref@ce
Veterans Preference
4. Gost Proposal Evaluation. The cost proposal points shall be developed in accordance with the following formula:
Sample 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 / 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 $100 / $200 X 20 = 10 't0
RFP 201 4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 12
163
E AAtAMtsrA{ri
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.
Cost Points:
A B c
Vendor TotalOption 1 Total Option 2 Total Option 3 Average Total
Points
(A+B+Cl3)*
Proposer X 15 12 14 14
Proposer Y 10 15 '12 12
* Points will be rounded to the nearest whole number.
. , ,.E I .:, -
The Average Tota! Points will be utilized in the Step 2 Qu,.,J ive Giteria portion Of ttre evaluation noted
abovg'
*ft;. \ ?,, ,,,'===
5. Determination of Fina! Ranking. At the conclusion of the Effi1gn,ffiffifhittee Step 1 scoring, Step 2 Points
will be added to each evaluation committee member's scores by the=.EBioartment of Procurement Management, Step
1 and 2 scores will be converted to rankings in accordance with the exaftple below:
=r lJ:iLl l;lli t:
@. llii e,*
Mdrribei rti,,+
Step'1
Points "&2 76 l 80
Step 2
Points ,,15 12
Total 104 91 92
Rank .+3 2
..::=i,:il i
ii =
Cofimittee
nae66ei [,.
Step 1
Points .. 70 85 72
srep z
Points
'',ji;rl .d
15 12
Total .t1#01 100 84
!:rr:: rrlj.llirLLrrl
:]:ii ;rlil,::],:.Rhnk :, 1
,:::::;44 Step 1
F,.oints 80 74 66
$tep?
PoirrtS 22 15 12
Total 102 89 78
I {"
I#i.,,lr.gl Ranki is presented to the City Manager for further due diligence and
ree0.$_,g9ffi"{ition to the City Commission. Final Ranking does not constitute
an awfiFdftcommendation until such time as the City Manager has made his
recorT+mendation to the City Commission, which may be different than final
ranking results.
RFP 20.l4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility t?
164
APPENDIX A
& ,\A$A&AIrew&s*M=- f V tl/ \d v tEd' ax*--og $
Proposo I Certificotion,
auestionnoire & ft.
Req u ire melJs Affid ovit
. ,, _===,
l.. r r
,
i.;i:.',. RFP 2014.302-SW
CLAIMS ADMIN ISTRilTION SERVICES
BY A THIRD PARTY ADMINISTRATOR
Fon onKrRs'coMPENSATToN
,*#o GENERAL LIABILITY
nsi-'
DEPARTMENT OF PROCUREMENT MANAGEMENT
1700 Convention Center Drive
Miomi Beoch, Florido 33i39
RFP 20I 4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 14
165
PROPOSAL CERTIFICATION, QUISTIONNAIRE & REQUIREMENTS AFFIDAVIT
Purpose: The purpose of this Proposal Certification, Questionnaire and Requirements Affidavit Form is to inform
prospective Proposers of certain solicitation and contractual requirements, and to collect necessary information from
Proposers in order that certain portions of responsiveness, responsibility and other determining factors and
compliance with requirements may be evaluated. This Proposal Certification, Questionnaire and Requirements
Affidavit Form is a REQUIRED FORM that must be submitted fully completed and diecuted.
1, General Proposer lnformation. I
Solicitation No:
2014-302-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:
Stevenwi ll iams(E miam i beachfl .oov
FIRM NAI\4E:
No of Years in Business:No of Yeasriil siness Locatli;l
OTHER NAME(S) PROPOSER HAS OPERATED UNDER IN THE LAST 1O YEARS:
FIRIV PRIIVIARY ADDRESS (HEADQUARTERS):
CITY:
STATE:ZIP.CODET
TOLL FREE NO.:l; tlrl
FAX NO.:
,!:.
FIRM LOCAL ADDRESS:
CITY:
STATE:ZIP CODE:
PRIMARY ACCOUNT REPRESENTATIVE FOR THIS ENGAGEMENT:
ACCOUNT REP TELEPHONE NO.:
ACCOUNT REP TOLL FREE NO,:
ACCOUNT REP E['IAIL:
FEDERAL TAX IDENTIF:IOATION NO.r
The City reserves the right to seek 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 201 4-302 SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 15
166
3.
Miami Beach Based (Local)Vendor. ls Proposer claiming Miami Beach based firm status?
l--_l vrs [-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?f--l vrs [--l uo
SUBMITTAL REQUIREMENT: Proposers claiming veteran owned business status shall submit a documentation proving that firm
is certified as a veteran-owned business or a service-disabled veteran owned business by the State of Florida or United States
federal government, as required pursuant to ordinance 2011-3748, as amended..
Conflict Of lnterest. All Proposers must disclose, in their Proposal, the name(s) of any off[cer, director, agent, or immediate family
member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, all Proposers must
disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the
Proposer entity or any of its affiliates.
SUBMITTAL REQUIREMENT: Proposers must disclose the name(s) of any officer, director, agent, or immediate family member
(spouse,parent,srbling,andcnild)whoisalsoanemployeeoftheCityofMiamiBeach. Proposersmustalsodisclosethenameof
any City employee who owns, either directly or indirectly, an interest of ten (107d percent or more in the Proposer entity or any of
its affiliates
References & Past Performance. Proposer shall submit at least three (3) references for whom the Proposer has completed work
similar in size and nature as the work referenced in solicitation.
l
SUBMITTAL REQUIREMENT: For each reference si$mitted;,the,,foffg.y.ving information is required: 1) Firm Name,2) Contact
lndividual Name & Title, 3) Address, 4) Telephone, 5) Cq,,qlact's e ri llt@6]Narrative on Scope of Services Provided.
Suspension, Debarment or.ContractCancellation. HaJ',froposer.*, O..n l.Oarred, suspended or other legal violation, or had
a contract cancelled due to non-performance by any public sector agency?f--l vrs f--_l ruo'=
SUBMITTAL REQUIREMENT: lf answer,to above is "YES," Proposer shall submit a statement detailing the reasons that led to
action(s)., ;] :::.
. : "'
Litigation tlistory:@paser shall submit a statement of any litigation or regulatory action that has been filed against your firm(s)
in th*st five years.'lfA action has been filed, state and describe the litigation or regulatory action filed, and identify the court or
a@y before which the%ction was instituted, the applicable case or file number, and the status or disposition for such reported
aelf J no litigation or regUfatoty action has been filed against your firm(s), provide a statement to that effect. lf "No" litigation or
reg[i*sry action has been filed ftainst your firm(s), please provide a statement to that effect. Truthful and complete answers to
this quEstion may not necessari$:.disqualify a firm from consideration but will be a factor in the selection process. Untruthful,
misleading oi false answers to thls question shall result in the disqualification of the firm for this project.
SUBMITTAL RE€UIREMENT; Proposer shall submit history of litigation or regulatory action filed against proposer, or any
proposer team member firm, in the past 5 years. lf Proposer has no litigation history or regulatory action in the past 5 years, submit
a statement accordingfy.
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 elecied to the
office of Mayor or City Commissioner for the City of Miami Beach.
q
6.
6.
RFP 201 4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility t5
167
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/procuremenU.
Living Wage. Pursuant to Section 2-408 of the Miami Beach City Code, as same may be amended from time to time, Proposers
shall be required to pay all employees who provide services pursuant to this Agreerng-nt,,the. hourly living wage rates listed below:
. Commencing with City fiscal year 2012-13 (October 1,2012), the hourtffing rat€,.wil| be $1 1.28/hr with health
The living wage rate and health care benefits rate may, by Resolution of the City Commissioh be indexed annually for inflation
using the Consumer Price lndex for all Urban Consumers (CPl-U) Miami/Ft. Lauderdale, issued by fie U S Department of Labo/s
Bureau of Labor Statistics. Notwithstanding the preceding, no annual index shall exceed three percent {3Yo). The City may also, by
resolution, elect not to index the living wage rate in any particular year, if it determines it would not be fiscatly,,,,,9,, d to implement
same (in a particular year)
Proposers' failure to comply with this provision shall be deemed a materiaf breach under this proposal, under which the Ciiy may,
at its sole option, immediately deem said Proposer as non-responsive, and may fu(her 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.gov/procuremenU. .
SUBMITTAL REQUIREMENT: No additional submittalis reqi1il$lByrirtue of executing this affidavit document, Proposer agrees
to the living wage requirement.
Equal Benefits for Employees with Spouses and EmployeeS-with Domestie Partners. When awarding competitively solicited
contracts valued at over $100,000 whose contractors maintain 51 or more fulltime employees on their payrolls during 20 or more
calendar work weeks, the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business
with the City of Miami Beach, who are awarded a contract pursuant to competitive proposals, to provide "Equal Benefits" to their
employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a
Contracior who work within the City limits of the City of Miami Beach, Florida; and the Contracto/s employees located in the United
States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami
Beach,
A. Does your compa*y provide or offer access to any benefits to employees with spouses or to spouses of employees?
,j " i '. [=*l vrs f--l uo
B. I Does your company provide or offer access to any benefits to employees with (same or opposite sex) domestic partners* or to
domestic partners of employees?
,- ,r,l--l uo
C. Please chect:'all benefits that apply to your answers above and list in the "other" section any additional benefits not already
specified. Note=ome benefits are provided to employees because they have a spouse or domestic partner, such as bereavement
leave, other benefits are provided directly to the spouse or domestic partner, such as medical insurance.
BENEFIT Firm Provides for
Employees with
Soouses
Firm Provides for
Employees with
Domestic Partners
Firm does not
Provide Benefit
Health
Sick Leave
Family Medical Leave
Bereavement Leave
Rf P 2014 302 SW TPA Cloims Administrotion for Workers Comp ond Gen Liobillty 17
168
10
lf Proposer cannot offer a benefit 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 Managels decision is final. Further information on the Equal
Benefi ts 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 construction or repair of a public building or public work; may not submit
proposals, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor,
supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity
in excess of the threshold amount provided in s. 287.017 for CATEGORY TWOfor a period of 36 months following the date of
being placed on the convicted vendor lisi.
SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, Proposer agrees
with the requirements of Section 287.133, Florida Statutes, and certtfies it has not been placed on convicted vendor list.
Acknowledgement of Addendum. After issuance of solicitation;-lhe. City may release one or more addendumt the solicitation
which may provide additional information to Proposers or alter solicitation requife$ents. The City will strive to reach every
Proposer having received solicitation through the City's e-procuremenl $yqtem, PublibPurchase.com. However, Proposers are
solely responsible for assuring they have received any and all addendum'issued pursuant to solicitation. This Acknowledgement of
Addendum section certifies that the Proposer has received all addendum released by the City pursuant to this solicitation. Failure
to obtain and acknowledge receipt of all addendum may result in proposal disqualification.
lnitial to Confirm
Receint
lnitial to Conflrm
Receiot
lnitial togonlirm
Recni
Addendum 1 Addendum 6 Addendum 1 1
Addendum 2 Addendum 7 Addendum 12
AddendBm 3 Addendum 8 Addendum 13
Addendum 4 Addendum 9 Addendum 14
Addendum 5 Addendum 10 Addendum 15
11
lf additional confirmation of addendum is required, submit uhder separate cover
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility t8
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 respons,,e fikglicitation.
Following submission of a Bid or Proposal, the applicant agrees to deliver such further de$k, information and assurances, including
financial and disclosure data, relating to the Proposal and the applicant including, withot)t:J n, the applicant's affiliates, officers,
directors, shareholders, partners and employees, as requested by the City in its discretion- ',i*
,r,
The information contained herein is provided solely for the convenience of prospective Pryosers. lt Elth-S, sponsibility of the recipient to
assure itself that information contained herein is accurate and complete. The City.does not pfuvide any asSU s as to the accuracy of any
information in this solicitation.
Any reliance on these contents, or on any permitted communications with City officials, shall be at the recipient's OWd:,tis-k.f..fpposers should
rely exclusively on their own investigations, interpretations, and analyses. The solicitation is being provided by the Ci$ wiiiiout any warranty
or representation, express or implied, as to its content, its accuracy, or its completeness. No warranty or representation is made by the City
or its agents that any Proposal conforming to these requirements will be selected forpn;ideration, negotiation, or approval.
The City shall have no obligation or liability with respect to$is solicitation, the selection and,the award process, or whether any award will be
made. Any recipient of this solicitation who responds hereGf*llyt knowledges all the pioVisie of this Disclosure and Disclaimer, is totally
relying on this Dlsclosure and Disclaimer, and agrees to be hund by the terms hereof. Any Pioposals submitted to the City pursuant to this
solicitation are submitted at the sole risk and responsibility of the party submitting such Proposai.
marketwithout notice. lnformation is for guidanceThis solicitation is made subject to correction of errors, omissions, or
only, and does not constitute all or any part of an agreement. 1r"
.
The City and all Proposers will be bound ohty 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, dnO tnen only pursuant to the terms of the definitive
agreements executed among the parties. Any response to this solicitation may be accepted or rejected by the City for any reason, or for no
The City is governed by the Government-in-1he-Sunshine Law, and all Proliosals and supporting documents shall be subject to disclosure as
required by such law..=.,AllProposals shaff be submitted in'*led proposal form and shall remain confidential to the extent permitted by
reason, without any resultant tiabifity to the City.
Florida
public
):
[$1! ,trme selected for opening the responses. At that time, all documents received by the City shall become
q_:
to make all di$Esures and ddaratidhs as requested in this solicitation. By submission of a Proposal, the Proposer
agrees that the City:h he right to*ake any inquiry or investigation it deems appropriate to substantiate or supplement
information co'ii iaEd"in the Proposal, anf.dhorizes the release to the City of any and all information sought in such inquiry or investigation.
Each Proposer 0' ,tfrat the informalidg contained in the Proposal is kue, accurate and complete, to the best of its knowledge,
information, and bell6f""
" ;
Notwithstanding the fore{6in$.manything'tontained in the solicitation, all Proposers agree that in the event of a final unappealable judgment
by a court of competent jud$Qffi.ign,.$,,, iCh imposes on the City any liability arising out of this solicitation, or any response thereto, or any
action or inaction by the City withr ieh ct thereto, such liability shall be limited to $1 0,000,00 as agreed-upon and liquidated damages. The
previous sentence, however, shd 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 construed in accordance with the laws of the State of Florida"
RFP 2014 302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 19
170
I hereby ce(ify 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 Affidavit are true and accurate.
State of FLORIDA )
)
county of
-)
On this _day of _, 20_, personally
appeared before me who
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:
of
RFP 20I 4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 20
171
APPENDIX B
& &AIA&A$ffiw&ffM#IX/MXdS+da{&NSS\.Sffi H
"Nc Bid':Jorm
,
tti
RFP 201 4-302:Sw
C LAIMS A,DttztlN ISTRAIION S ERVIC ES
BY A.TH I RD'IPARTY ADMI N ISTRATO R
FOR WOR$RS', .QOMPENSATTON..... AND4ENH.RAT LIABILITY
DEPARTMENT OF PROCUREMENT MANAGEMENT,l700 Convention Center Drive
Miomi Beoch, Florido 33139
RFP 201 4-302-SW TPA Cloims Administroiion for Workers Comp ond Gen Liobility 21
172
WE HAVE ELECTED NOT TO SUBMIT A PROPOSAL AT THIS TIME FOR
REASON(S) CHECKED AND/OR TNDICATED 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 producUservice
_OTHER. (Please specify)
We do:$o not want to be retained on your mailing list for future proposals
of this tyBdproduct and/or service. '".41a,,
,
Signature:
'i'..
"is
..,Tit1g:
Legal Compaff.Name:
{.-
NotdliF,ailure to re$pond, either by submitting a proposal or this completed form,
,ry
%
y-our company being removed from our vendors list.
PLEASE RETURN TO:
CITY OF MIAMI'BEACH
DEPT. OF PROCUREMENT MANAGEMENT
ATTN: Steven Williams
PROPOSAL#2O14.O8O.SW
1700 Gonvention Center Drive
MIAMI BEACH, FL 33139
RFP 20.l4-302-SW TPA Cloims Administroiion for Workers Comp ond Gen Liobllity aaZZ
173
APPENDIX C
MIAffi$Mffi&ffiH
MinimumzpqUirernents
& SpeHY[ tjons
RFP 201 4-302-SW
c LAIMS,.A Dlrr N tsrRATr o N s E RV ! c ES
BY A THIRD P+ RTY ADMINISTRAToR
FOR WORKERS' COMPENSATION
AND GENERAL LIABILITY
DEPARTMENT OF PROCUREMENT MANAGEMENT
1700 Convention Center Drive
Miomi Beoch, Florido 33139
RFP 201 4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility a')LJ
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 government(s) for a minimum of five
(5) consecutive years, For each experience proposer must submit as evidence: agency
name, agency contact, contact telephone, email and years(s) of experience for verification
purposes.
3. The proposer must have a staffed office in the state of Florida, with a qualified staff
member of the firm to serve as the primary contact for the City of Miami Beach, and a
secondary contact to serve in the absence of -!.tp primary contact. The proposer must
submit as evidence: a primary and secondary name, a primary and secondary contact
telephone, a primary and secondary email ,ddress, and h copy of primary and
secondary's resumes for verification purposes, ==il-
'ri'\\:'"1nr11n'
C2. Statement of Work Required. The City of Miami Beach (tne tffi,1$-iApproved by the Florida
Department of Labor and Employment Security/Division of Workers' Compensation to seltinsure
for Workers' Compensation. The Division of Workers',Compensation requires that the claims
administration be providedty a State Certified Workers''Compehbation Claims Administrator.
Therefore, the City i"s." seeking proposals for third party claims administration services for its selt
insuranceWorker' mpendliffiprogram.
Proposers muSt sffil cost proposal for the entire scope of services requested. Proposals to
handle only selected parts of the scope will not be considered. lt is understood by the successful
proposer that all services aie to be*hibtided by the proposer's employees and cannot be
contracted out to ahother party
the contract will be February 1,
the prior approval of the City. The commencement date of
\J::
C3. Specifications. The administrator will provide all specified adjusting services for all claims as
well as all other requiied services, such as administrative, managed care/medical case
management, computeriz6d claims/loss statistical information (RMIS) and banking/loss fund
reconciliation.,,rTle specific required services are outlined in greater detail within this request for
proposals,
=
The City has approximately 1,900 employees, and averages 345 claims annually. The breakdown
is estimated at 239 medical only and 106 lost time. Currently there are approximately 421 open
claims. Priorto October 1996, the City purchased excess workers'compensation insurance, The
City does not currently purchase excess workers'compensation insurance.
Rlf 2.O l4-JU2-5VV lt'A Llolms Administrotion tor Workers Comp ond Gen Liobilil'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 oJ 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' compensatiep;{ffie and fire personnel
pursuant to union contract, +l= *
.._,,,,,,...,,,,
All proposers are to assume the complete handling of all future and past claims now being handled
by our present Claims Administrator (see Attachment G for open/closed claims for all years), along
with all new claims. The information provided regarding the volume and type of pending claims to
be assumed is based on the latest information provlded to the Ci[ end cannot be guarahteed as to
its accuracy. lf the amount of prior claim files to be taken 6,,.t1, r is 25Ya'greater than repre{Ehted in
this RFP, the City will consider a proportionate adjustment to the proposer's flat annual fee.
It is the responsibility of the proposer to,review prior claim files to determine the additional
proposed cost, if any, to take over these files.
It is also required that the claim data associated with ail claims occurring prior to February 1,2015,
be transferred into the proposer's computer informatffisysteffi} at 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 propos€i is responsibte 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" ba.sis, therefore, all claims occurring in the contract year,
regard.le=*-@!en reported, are to be handied per the requirements of this agreement. The claim
adr*i Stratoi="re red to handle all claims to their conclusion or to the conclusion of the contract,
wffchever occurs fiftlffirno additional charge to the City other than the annual fee. The contract
mayne terminated by di.Jler party with ninety (90) days written notice to the other. However, anyca ation does not altei the administrator's obligation to handle all claims prior to the termination
o'tt'=",
1,,,,, . 1q'
The City re(tiiresftat theiblected TPA provide, at a minimum, the following professional services
related to the it@,4{nistiation of the City's seltinsured Workers' Compensation and GeneralLiability:
=. TPA shall provide workers' compensation third-party claims administration services to the
City of Miami Beach's seltinsured 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 lfA Llorms Administrotion tor VVorkers Lomp ond Uen Liobilily
176
usual and customary to the administration and management of workers' compensation
claims, if not otherwise noted herein,
TPA shall provide, on behalf of the City, all self-insurer reporting to the Self 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 workersl compensation must
Provide"
._...i,,,
. ,',,..
TPA shall accept all current claims and/or re-opened claims as run-in claims to the TPA if
selected as the new TPA for the City, :'1
TPA shall provide the City with the ability to report first reports of injury and loss notices
electronically, by facsimile or by phone based on the severity, circumstances or nature of
injury at no additionalcost. '- ., .j
TPA shall provide automated acknowledgement=upon tho'receipt of each clalm, The
acknowledgement shall include, but not be limited, to the following: claim number,
assigned adjuster name, emailad telephone number, claimant's name, and date of loss.
TPA shall set up all new claims within twenty-four (24) hours after notification. Assigned
adjuster, supervisor or nurse case manager shall make all contacts and initiate
investigation within forty-eight (a8) hours of receipt of hew claims,
TPA shall have the ab,il to provide o r o,on or.*tj;,i.rization on the same day as
injury to e$,injured emp{oyees '
.,.
' :::""
h'"ih initirt review by a claims supervisor, aTPA shall triage+very notioe of injury witl
registered nurseEiiew of medicals, an9,-.lsigned adjuster's review of entire claim file,
TPA shall utilize any recommended medical primary care physicians or specialists as
directed by City, even if no[in the TPA's network, if it is in the best interest of the injured
employee or the City. This would include authorizing treatment by non-occupational or
non-network physfcians oi providers who have treated an injured employee under
emergency or exigent circumstances in an emergency room or other facility, if such
treatfient would be considered prudent and reasonable for continuity of care purposes.
The City reserves the right, but not the obligation, to approve all vendor partners and
ancillary services used by the TPA that are part of the workers' compensation allocated
claim expense or reserve.
City reserves the right to select its own workers'compensation defense counsel to manage
any and all litigation for the City's workers' compensation and employer's liability program,
and/or to seek pre-litigation legal advice and claim strategy" The City's Risk Manager has
the authority to approve the workers' compensation defense counsel's fee, cost schedule
and/or any allocated legal claim adjustment expenses. TPA shall agree to work with the
Klf 2U l4-3U2-5VV IPA Uloims Administrotion tor Workers Comp ond Gen Llobilily
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 otherwise designated by the City, with duties and responsibilities to be mutually
agreed upon by the TPA and the City, TPA must provide aeeess 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,....Sy the eity's Risk Management staff in
accordance with the third-party claims adminislrator agreement between the City and TPA.
The scope of assignment includes, but is not limited to, filing new losses, coordinating light
duty assignments, assisting employees with cl$!flI questidris, filing wage statements,
updating diary notes, assisting attorneys with litiS*ffiifiles, and working with the City's
regularly assigned workers'com=pensation claims rd,Oru
,
TPA shall provide, on an as,.eU .is, an on-site dediBdtbd*ligensed liability claims
adjuster at the City's Risk Managefient Division, Office of the Human Resources
Department, or as othenuise designated by the':City, to assist the City's Risk Manager with
claims administratig,,n services for theCity of Miami'Beach's self-insured liability program.
The City is selfrincBf$ffrand seltadministsred for liability claims management. The adjuster
shall pe;fe claims tdffiinistration services for automobile and general liability claims,
The spffi,of ,assignment includes, but not limited to, investigations, creating file diaries,
record keepiqand othei services necessary or proper for, or incidental to, performing
claims adjustin$. ftfiH &--#'
TPA Shall p-rovide th"6.=. with telephonic case management services on all workers'
compensatibn,claims as an allocated loss adjustment expense, unless othenruise directed
TPA shall provide a tist of PPO networks affiliated with the TPA, as requested by City.
TPA shalt evaluate and qualify various service providers recommended by the City to
service it-_s accoUnt, provided such service providers do not present a perceived or potential
conflict of interest.
. TPA shall provide the City with field case management services, catastrophic case
management services, medical cost projections, life care planning, Medicare set-aside
assessments, development of reports, surveillance, peer review, utilization review and
reasonable and customary savings review, bill review, percentage of PPO savings and any
other usual and customary workers' compensation claims administration claims practice,
strategy or activity as all allocated loss adjustment expenses, unless such expenses are
Krf ZU l4-JUZ-5VV lfA Lloims Adminisirotion tor Workers Uomp ond Gen Liobility ^-
178
more appropriately allocated as a medical expense under the claim per Florida Statutes or
TPA's judgment.
TPA shall process and handle all electronic data interchange requirements on behalf of the
City as required by the State of Florida at no additional charge.
TPA shall be responsible for all Medicare reporting obligations under the Medicare
Secondary Payor Act, and/or under similar or new legislation at no,,additional cost to the
City.
TPA shall provide the City with OSHA 300 log reporting capabitities at no additional cost,
as requested by City.
TPA shall handle subrogation claims and file lien notices on behalf of the fiity.,1o protect
the City's interests in rights of recovery from third-party tortfeasors. TPA shall ild-t:proceed
with any legal action against a third-party tortfeasor without the City's Risk Manager's
approval
TPA shall review and seek approval from the City for any loss reserve adjustment
increases greater than twenty-five thousand dollars ($25,000)-
TPA agrees all negotiated settlemenfur..*.nts shall *qrire City approval. Such
settlements would include but may not be limited toi-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 considered an administration of a medical, indemnity or
allocated expense that would othenruise be due and owed in accordance with Florida law.
TPA shall attend in person or via telephonicalty all mediations. The City shall endeavor to
have a Risk Managerne;rt staff member, or designee, at all mediations as well as hearings.
TPA shall'igt*e o qr claim reviews, whether in person or telephonically at the City's
discretion, to re w all litigated cases, legacy cases, catastrophic cases, or non-litigated
complex cases.
TPLAshall agree altclaim files, reports, and other data prepared or provided in connection
with+laim are and shall remain the property of the City.
TPA shall.l(eep complete and accurate records and accounts in connection with each
claim. S 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 l4-302-5W IPA Cloims Administrotion tor Workers Comp ond Gen Liobilily l6
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' co,grpensation carrie(s)
due to TPA's failure to properly report new or existing claims as reauj by each carriers'
TPA agrees to notify the City of proposed or enacted cnangesA workers' compensation
regulatory requirements or legislative acts that may affect the C'ty's clqims.
TPA shall agree to maintain a SSAE 16 audit on controls placed in oprrri-#.rnO tests for
operating effectiveness, and agrees to provide copies to the City as requesteffii'iliilil
TPA shall utilize the City's solely selected and approved financial institution for thd'funding
of workers' compensation and liability claim paym@ and settlements. TPA agrees to
comply with the City's Positive Pay (fraud detection)'banking standards and must do a
daily data feed to the City's financial institution for fraud detection.
TPA shall send weekly invoices for wire fund transfer requests to replenish the City's
account. Exceptions are made for special requests for unexpected large losses or claim
settlements fol hich specific dedicated invoice for wire fund transfer requests shall be
made. 6;-.'. :
The City shal[,{und at least fifty percent (50%) times the City's average weekly spend on
workers' compfnsalion,,"Qlatnl Presently the City's fund maintains an average weekly
balance of two hund d and:fffi ffuggsand dOllars ($250,000).
,,*ir,i"
qi4tii{;ii L iiit:
TPA shall send originiiliiliB,tisices to the attention of the City's Risk Manager, or designee,
by e-mail to City of Miami'Bffili;r[nless othenruise instructed.
TPA shall mail the City monlhly financial institution reconciliations.
t:
. t,:
TPA shall issue 1099's to all vendor issued allocated claims payments pursuant to the
applicable tax laws in effect.
TPA shall be audited by the City at the City's sole discretion and cost.
TPA shall invoice the City quarterly for its administrative claim fee.
TPA shall take extraordinary measures, if is selected as the new TPA for the City, to
ensure data and file conversion and transfer is done with as little disruption to the City and
RIP 2U l4 3U2-5W IPA Cloims Administrotion tor Workers Comp ond Gen Liobilily 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, wlth 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 runs, claim reports or ad hoc reports as
required by City within seven (7) working days of month-end.
TPA shall provide periodic information to the City's actuarial service prouruei''*h.n
required. - -'=,-- -- i'- '=
. TPA shall provide safety engineering services as re(Uested by City, and fees shall be
negotiated and approved by the City as an allocated Ioss adjustment expense per
applicable claim file. " ,"
TPA, as a custodian of records for City, shall comply and cooperate with all applicable City
and State record retention and exemptions laws such as, but not limited to, Florida
Statutes, Sectiohs; 11-9,.440,760 and 112 as they pertain to protected medical, personal
and/or work product information.
TPA agrees to transfer orship the electronic file data or hard copy file data at the request
and as directed by:th,efiy atnc$st,otherthan actual incurred reasonable shipping fees.
TPA agrees there shtiti be no charges to transfer electronic data on a per data file basis or
other transfer related fees or charges unless agreed upon in writing by City. All electronic
data transferred or hard Copy data shipped shall be done within sixty (60) days of receipt of
written notice from City. PaF€i data shall be shipped overnight by FED EX, UPS or
equivalent common carrier agreed to by City. Electronic data shall be transferred by
disk/tape or over internet as requested by City, provided the data files are adequately
protected and secured. Electronic file data means all claims information and related claim
file information maintained in an electronic computer file format, whether stored on a hard
drive, tape backup or CD.
Other claims adjusting services for Workers' Compensation and General Liability, as
needed.
Kf r lU l4-JU/-)VV lfA Llorms Administroiion tor VVorkers Lomp ond Uen Liobrlily ?n
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. **d':,
The City reserves the right to the final prior approval of the hiring;.q.nd/or assignment of
the claims manager, supervisors and adjusters that are to ffidlerffiQity's claims.
\{.na '': I
The required maximum open case loads per adju-sters '(rnay have 1n1*11.*q.1'e than one
adjuster assigned to the account) are to be as fdfuws (claims mand$Br,should not
workers'compensation (lost time) - 100
workers' compensation (medical only) , j'.500 =
The administrator agrees to add staff as necessary to maintain these maximum pending
caseload levels. Explain how the office.or unit will be staff@ and explain the level of
supervision that will be provided. CIA1$,,personnel must be employees of the
administrator. The use of independent adjU6ters,5iubcontractors or temporary adjusters
is not acceptable without prior approval 0f the Cil$f'fll{$d.jqster traihees are not acceptable
for handling of the City's claims. Addi.ttonglly') res6'rti,$.ft{Iof all claims professionals
specifically assigned to this account are tqbe submitted'with this proposal. All claims
professionals must,possess',:a+urrent Florida Workers, Compensation adjuster's license.
LOSS FUND MANAGEMENT: =
1" T..h=e==C]aim Paym,6'nt ACCount will be nraintained at the City's commercial banking
: iE=fitB1ic.. Jhe adcount will be classified as part of the analysis group of City..' accouht#,,he City will pay all service fees that are normal and customary in this
account. l interest eained or service credits generated will accrue to the
=,, benefit of the Ci$ =
2,,,Thg claims adrlti$istrator is required to follow Florida law concerning public
depesits. Failure{ }o comply with Florida law is sufficient cause for the City to
tefi*i:i the cohtractual agreement with the claims administrator.
3. All claimqlifi#pense and legal payments will be made by the claims administrator
on chec-($r'Urawn 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.
Rl-P 20 l4-302-5W IPA Cloims Adminislrotion tor Workers Comp ond Gen Liobilily 11JI
182
KIY lU l4-JUZ-5VV lfA Lloims Admrnislrotion tor VVorkers Lomp ond Uen Liobiliiy 32
183
14.
15.
16.
17.
18.
19.
Do your adjusters receive any continuing education and training? Explain.
Do you currently file state and excess insurance forms on behalf of your clients?
Explain,
Do you have the capability to provide all the loss data reports required? Explain.
Do you have the ability to transfer the City's prior claims data to your information
system by June 1,2015?
.::::t: :::, i:,.:r;:_,
Explain any fees proposed for managed care, nreOiiai lase management, bill
review, utilization review and rehabilitation serviCes. These are4t to be included
in the annualfee proposed,
Explain, in detail, any deviation fror.rft services or fee structure type required,
specifically indicating any service=s'yo-n:,',i.annot perfprm. Specifically indicate what
you consider as allocated expenses ahd therefore nOtrncluded in your annual fee
proposal amount, ,
.,0r.1i,, *Hllrl[,=
Ba/ance of Pase rn&It'opally left BIan "*"
Kl-P 2U l4-3U2-5W lt'A Uloims Administrotion ior Workers Comp ond Uen Liobllily {<
184
APPENDIX D
& &AIA&stRNeflHg , Y tl, \J Y Ll&*de*f \%"*l u
SpeciaLConeitions
. ' RF| 201 A4#Q2-SW
C LAIMS AD'MI N ISTNATION S ERVICES
.
-H
I RD, PARTY ADMI N ISTRATOR.r BYW','
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::::::::::::::
".i'* DEPARTMENT oF i?3f3::[',ill#t:lB:$,[
Miomi Beoch, Florido 33,l39
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RFP 2014-302-SW TPA Cloims Adminislrotion 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 T0 RENEW. The City, through its City Manager, will have the option to extend for
three (3) additional one (1)years periods.
3. REQUIRED CERTIFICATIONS" The proposer must be a Qualified Servicing Entity with the
State of Florida, Department of Financial Services, Division of Workers' Compensation (per 691-5-
229 Florida Administrative Code).
::::::,:
4. ADDITIONAL SERVICES. lf during the contractual period additionalservices are needed, the
selected Contractor may, at the option of the City of Miami Beach, be engaged to perform these
services. The selected contractor shall upon receipt of the written request from the City's Risk
Manager, provide a proposal for such services and the City ieserves the option to issue a purchase
order for the specified work as approved by both pa(es',
Balance of Page lntentionallv Left Blank
RFP 201 4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 35
186
APPENDIX E
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Cost PrGposol Fqrm
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RFP 201 4:302-SW
CLAIMS FNIS,T=RATION SERVICES
''BY A TltlBffilr TY ADMINISTRAToR
=.FOR W.bnTERS, COMPENSATION. AND GENERAL LIABILITY
DEPARTMENT OF PROCUREMENT MANAGEMENT,l700 Convenfion Center Drive
Miomi Beoch, Florido 33,l39
RFP 201 4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobility 36
187
Bidder affirms that the prices stated on the proposal price form below represents-theentire cost of the items in
full accordance with the requirements of this RFP, inclusive of its terms, cond-ittohS;'specifications and other
requirements stated herein, and that no claim will be made on account of any increase in wage scales,
material prices, travel, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation
provision is allowed herein and has been exercised by the City Manager in advarpe. The Proposal Tender
Form shall be completed mechanically or, if manually, in ink, Cost P@osal Foiiirs completed in pencil
shall be deemed non-responsive. All corrections on the Proposal Tendef Form shall be in$ialed,
APPENDIX E
COST PROPOSAL FORM
Failure to follow the price proposal format as iOeniifre* may result in the RFP response being considered
non-responsive and the RFP submittalwill not be consideied forevaluation.
OPTION
1. FlatAnnual Fee :..'"
(for 345 claims incfuding
new and prior claims
Flat Annual Fee
$_
(per contract year)
Excess Claim Fee Per
Year
$_
(ColumnlxColumn2)
* Proposer shall incftrcl€ mount, whieF,lhe City may negotiate at its discretion.
RFP 20 l4-302 SW TPA Cloims Administrotion tor Workers Comp ond Gen Liobility J/
188
OPTION #2: FIXED PER CLAIM FEE OPTION
1. lndemnity Per Claim
(Litigated Or Non-
(ColumnlxColumn2)
2. Medical Only Claim
(Litigated Or Non-
(eolumn "l x Column 2)
3" Medical Only Claim
Transferred To
lndemnity Claim
(Litigated Or Non-
(per claim)
Quantity
25 per year
,lF*"
(Column '1 x Column 2)
4" lndemnity Per Claim
(Litigated Or Non-
(ColumnlxColumn2)
5. Medical Only Claim
(Litigated Or Non-
(ColumnlxColumn2)
OPTION #3: FIXED PER CLAIM BLENDED FEE OPTIONI
1. lndemnity Or Medical
Only Per Claim
(Litigated Or ..' Non-(ColumnlxColumn2)
2. lndemnity Or
9l!v f"i claim.
(Litigated Or (Column '1 x Column 2)
Total Lines 1 -
Rl-P 20 l4-302-5W IPA Cloims Administrotion tor Workers Comp ond Gen Liobility 3B
189
ADDITIONAL SERVICES
List of sen ,ices. as needed. which are in addition to the fees proposed in Options 1 - 3.
Telephonic MedicalCase 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/
Percentage Of Utilization Review And Reasonable & Customary
Savinos:o/o
Subrogation And/Or Liens Fee Percentage:
Yo
Osha 300 Log Reporting:
$
$
Safety Consulting Services " : S,..i::i:+l
$
Notice Of lnjury Entry:rt:l
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Custom/Ad Hoc Reports:
$,,,,,,
Data And File Conversion Fee:r$
Ohe-Time Setuo Flat Fee
Medicare Reporting Costs:
$
Liability Claims Adjuster(-,.t f Miami$gh ln-House Adjuster)
$
Workers Compensation Chi.r$$fljuster ffirlty Of Miami Beach ln-
House Adiuster) +i, ":' #F-+$
Description Of A{dif$nal:Service;
$
Descript@!f Additional Service:
$
Description *tfrl|l[;"**
$
Description Of Additiofial $Sry,ice:
$
Company: ,.ii!
Authorized Representative:
Address:
Telephone:
Email:
Authorized Representative's Signature:
RFP 20.l4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobilily 39
190
APPEN DIX F
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I ns u ro n c e,,=R eqEjle m e nts
.=""'RFP 201+302.,5W
c LA|MS; DM r N TSTRATTO N S ERVI C ES
B-=Y4 THJ-R D= PA RTY A O M I N ISTRATO R==+-R RKtns'coMPENSATtoN
A AND GENERAL LIABILITY
=,,i_ ry$
:;;..
*:
-: :::= DEPARTMENT OF PROCUREMENT MANAGEMENT.l700 Conveniion Cenier Drive
Miomi Beoch, Florido 33,l39
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobiliry 40
191
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PROFESSIONAL SERVICES lNSURANCE 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 =.[asis in an amount not less than
$1,000,000 combined single limit per occurrence ,.ahd $2i000,000 in the aggregate, for
bodily injury and property damage. Gity of -M:idmi Beach must be shown as an
additional insured with respect to this covepee,= ,,,_,.=
C. Professional Liability lnsurance in an amount not 6istnan $t,OOO,OOOwith the deductible
per claim, if any, not to exceed 10o/o of the limit of tirOil't$,iil
ilf,The insurance coverage above must include,.a waiver of subrogatiofllinfavor of the City. The insurance
coverage required shall include those classifications,.as listed in stanifg;{*liability insurance manuals,
which most nearly reflect the operations of the provid6t,, lt, , , -_ -Sry:=':,.. 'ai
All insurance policies required.gp_gve shall be issued byCompaniesauthorized to do business underthe
laws of the State of Florida,$|ffi,p_llowing qualifications:
The company ,65 " rateo\H less than "8" as to management, and no less than "Class
V" as to financiaF:*1fi Oyft" latest edition oJ Best's lnsurance Guide, published by
A.M. Best Company;,Nsw$rsey, or its equivalent, subject to the approval of the
City Rist Managemenfl"0rnE@h:' .:!=
;d
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Tt!6 company must hdtd a val[d.:F=]a,,q|Qa Certificate of Authority as shown in the latest "List
of*ll lnsurance Companies Authori2ed or Approved to Do Business in Florida" issued by
tho'State of Florida Department oi lnsurance and are members of the Florida Guaranty
Certificates will indiCate no modification or change in insurance shall be made without thirty (30) days
advance notice to the,cErtificate holder.
CERT!FICATE HOLDER TVIUST READ:
CIry OF MIAMI BEACH
17OO CONVENTION CENTER DRIVE
3'd FLOOR
MIAMI BEACH, FL 33139
Compliance with the foregoing requirements shall not relieve the vendor of his liability and obligation
under this section or under any other section of this agreement.
RFP 2014-302-SW TPA Cloims Administrotion for Workers Comp ond Gen Liobllity 41
192
APPENDIX G
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::,RFP 201 4-302-5W
CLAIMS*OIVITN ISTNATION S ERVICES BY A
:u uu tl
TBiRP PARTY ADMINISTRATOR FOR
WGRKERS=,. COMPENSATION AN D GEN ERAL
:
LIABILITY
"i$
"" ',u
DE'ARTMENT oF pRocuREMENT MANAGEMENT:,ri L/L -\\ 'vtL ' - r;*.ffii::h:r.,.*::U;
RFP 20I 4-302-SW TPA Cloims Administrotion for Workers Comp ond Gen LiobiliV 42
193
CLAIMS EXPERIENCE
AVAILABLE UNDER SEPARATE COVER
RFP 20.l4-302-SW TPA Cloims Adminiskotion for Workers Comp ond Gen Liobility 43
194