R26-069 RESOLUTION NO. R26-069
1 A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF BOYNTON
2 BEACH, FLORIDA, APPROVING A PIGGYBACK AGREEMENT BETWEEN
3 THE CITY AND PREFERRED GOVERNMENTAL CLAIM SOLUTIONS,INC.,
4 FOR THIRD-PARTY ADMINISTRATION SERVICES IN THE AMOUNT
5 NOT TO EXCEED 181,000; AND FOR ALL OTHER PURPOSES.
6
7 WHEREAS, the City of Riviera Beach awarded a professional services contract for Workers'
8 Compensation and Third-Party Administration services through Bid No. 107-22-3; and
9 WHEREAS, on August 22, 2022, the City of Riviera Beach entered into an Agreement
10 ("Master Agreement") with Preferred Governmental Claim Solutions, Inc., ("Vendor") for
11 Professional Services Related to Workers Compensation and Third-Party Administration Services
12 ("Services") through September 1, 2025, with an option to renew for two (2) additional one-year
13 periods; and
14 WHEREAS, the City desires to obtain the Services from Vendor; and
15 WHEREAS, the City's Purchasing Policy Section X — Alternatives to Formal Sealed Bids,
16 provides authority for the City to acquire or contract for services without utilizing a sealed
17 competitive method or the written quotations method where the desired services are the subject
18 of an agreement that utilizes another government entity's contract, provided that the contract
19 was awarded based strictly on competitive bidding; and
20 WHEREAS, the City and Vendor have agreed to allow the City to piggyback the Master
21 Agreement; and
22 WHEREAS, the City Commission, upon the recommendation of staff, has deemed it in the
23 best interests of the City's citizens and residents to approve a Piggyback Agreement between the
24 City and Preferred Governmental Claim Solutions, Inc., for Third-Party Administration Services in
25 the amount not to exceed 181,000.
26
27 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF BOYNTON
28 BEACH, FLORIDA, THAT:
29 SECTION 1. The foregoing "Whereas" clauses are hereby ratified and confirmed as
30 being true and correct and are hereby made a specific part of this Resolution upon adoption.
31 SECTION 2. The City Commission of the City of Boynton Beach, Florida, does hereby
RESOLUTION NO. R26-069
32 approve a Piggyback Agreement between the City and Preferred Governmental Claim Solutions,
33 Inc., for Third-Party Administration Services in the amount not to exceed 181,000 (the
34 "Agreement"), in form and substance similar to that attached as Exhibit A.
35 SECTION 3. The City Commission of the City of Boynton Beach, Florida, hereby
36 authorizes the Mayor to execute the Agreement. The Mayor is further authorized to execute any
37 ancillary documents required under the Agreement or necessary to accomplish the purposes of
38 the Agreement, including any term extensions as provided in the Agreement, provided such
39 documents do not modify the financial terms or material terms.
40 SECTION 4. The City Clerk shall retain the fully executed Agreement as a public record
41 of the City. A copy of the fully executed Agreement shall be provided to Kendra Brown to forward
42 to the Vendor.
43 SECTION 5. This Resolution shall take effect in accordance with the law.
44 [SIGNATURES ON THE FOLLOWING PAGE]
45
RESOLUTION NO. R26-069
46 PASSED AND ADOPTED this p I day of � Z— . \ 2026.
47 CITY OF BOYNTON BEACH, FLORIDA
48 YES NO
49 Mayor— Rebecca Shelton ✓
50
51 Vice-Mayor—Thomas Turkin V
52
53 Commissioner—Angela Cruz ✓
54
55 Commissioner— Mack McCray ✓
56
57 Commissioner—Aimee Kelley
58
59 VOTE
60 ATTEST:
61
VI'-''
62 (/1Q.,
63 Tammy Sta ione, CMC Rebecca Shelton
64 Interim City Clerk Mayor
65 /;O�gO .... ,v
66 .GpRPoRgT ..<9 ++ APPROVED AS TO FORM:
67 (Corporate Seal) � SEAL •
68 +++
: INCORPOA7'ED. Aae(M‘
G4 e69 + . I9 .
70 ++,�� '1% ..... Shawna Shawna G. Lamb
71 �. LORIDP_= City Attorney
. s _ .:
PIGGYBACK AGREEMENT BETWEEN THE CITY OF BOYNTON BEACH AND
PREFERRED GOVERNMENTAL CLAIM SOLUTIONS, INC. (PGCS) FOR THIRD-PARTY
ADMINISTRATION SERVICES
This Piggyback Agreement is made as of this L day of kr;i , 203c, by and between
Preferred Governmental Claim Solutions, Inc., a Florida corporation, with a principal address of
2301 Maitland Center Parkway, Suite 450, Maitland, Florida 32751, hereinafter referred to as
"Vendor," and the City of Boynton Beach, a municipal corporation organized and existing under
the laws of Florida, with a business address of 100 East Ocean Avenue, Boynton Beach, Florida
33435, hereinafter referred to as "City."
RECITALS
WHEREAS,the City of Riviera Beach awarded a professional services contract for Workers'
Compensation and Third-Party Administration services through Bid No. 107-22-3; and
WHEREAS, on August 22, 2022, the City of Riviera Beach entered into an Agreement
("Master Agreement") with Preferred Governmental Claim Solutions, Inc. (PGCS) ("Vendor") for
Professional Services Related to Workers Compensation and Third-Party Administration Services
("Services")through September 1, 2025, with an option to renew for two(2) additional one-year
periods; and
WHEREAS,the City desires to obtain the Services from Vendor; and
WHEREAS, the City's Purchasing Policy Section X — Alternatives to Formal Sealed Bids,
provides authority for the City to acquire or contract for services without utilizing a sealed
competitive method or the written quotations method where the desired services are the subject
of an agreement that utilizes another government entity's contract, provided that the contract
was awarded based strictly on competitive bidding; and
WHEREAS, the City and Vendor have agreed to allow the City to piggyback the Master
Agreement, a copy of which is attached as Exhibit A.
WHEREAS, the Vendor has provided the City with an initial proposal for Professional
Services Related to Workers Compensation and Third-Party Administration Services, attached as
Exhibit B, and the City may obtain additional Services on an as-needed basis pursuant to the
terms of this Agreement throughout the duration of the term.
Piggyback Contract—Preferred Governmental Claim Solutions,Inc.(PGCS) COBB Contract#26-041 PB 1
NOW, THEREFORE, in consideration of the mutual covenants contained herein, and for
other valuable consideration received, the receipt and sufficiency of which are hereby
acknowledged,the parties agree as follows:
AGREEMENT
1. The foregoing recitals are true and correct and are hereby incorporated into this
Agreement.
2. TERM:The term of this Agreement commences on April 1, 2026, and will remain in effect
until September 1,2027.The initial term and any subsequent renewals of this Agreement
are subject to the renewal or extension of the Master Agreement. The Mayor is
authorized to execute amendments to renew the Agreement on behalf of the City.
3. CONTRACT TERMS: The Vendor agrees to provide Services to the City on the same terms
and in the same manner outlined in the Master Agreement, except as otherwise provided
herein. All recitals, representations, and warranties of Vendor made by Vendor in the
Master Agreement are restated as if set forth fully herein, made for the benefit of the
City,and incorporated herein, except that all references to the"City of Riviera Beach"are
hereby replaced with the "City of Boynton Beach." The City shall compensate Vendor
pursuant to the rates outlined in the Master Agreement and Fee Proposal. The City may
purchase additional Services from Vendor on an as-needed basis pursuant to the terms
of this Agreement in an amount not to exceed One Hundred Eighty-One Thousand Dollars
($181,000.00). The Mayor is authorized to execute ordering documents up to the
aggregate annual not-to-exceed amount described herein; any purchase in excess of this
threshold shall require City Commission approval.
4. NOTICES: All Notices to the City shall be in writing by certified mail return receipt
requested, or customarily used overnight transmission with proof of delivery, sent to:
City: Daniel Dugger, City Manager
City of Boynton Beach
P.O. Box 310
Boynton Beach, Florida 33425
Telephone: (561) 742-6010/ Facsimile: (561) 742-6090
Copy: Shawna G. Lamb, City Attorney
City of Boynton Beach
P.O. Box 310
Boynton Beach, Florida 33425
Telephone: (561) 742-6010/Facsimile: (561) 742-6090
Vendor: Viviane Ruiz
Preferred Governmental Claim Solutions, Inc. (PGCS)
2301 Maitland Center Parkway
Piggyback Contract—Preferred Governmental Claim Solutions,Inc.(PGCS) COBB Contract#26-041PB 2
Suite 450
Maitland, Florida 32751
Telephone: (407) 373-6240
Email: Viviane.ruiz( usis-toa.com
With a copy to: LegalNoticesc us.davies-eroup.com
5. INVOICES AND PAYMENT: Invoices must identify the PO number and should be mailed
to:
Boynton Beach Finance Department
Attn: Accounts Payable
100 E. Ocean Avenue
Boynton Beach, FL 33435
Email: AP@bbfl.us
Invoices shall show the nature of the service and dates(s) of service. Invoices based on
hourly rates shall show the actual hours worked, the person performing services, the
nature of the service, the hourly rate, and the dates(s) of service. Invoices may be
submitted no more frequently than monthly. However, all services rendered before
September 30th of any given year must be invoiced by September 30th of that year.
Vendor shall provide a W-9 with the first invoice.
The fee shall be paid based on receipt of a proper invoice in accordance with the invoice
schedule indicated above. Payment will be made within 45 days of receipt of a proper
invoice in accordance with the Local Government Prompt Payment Act, Section 218.70,
et al., Florida Statutes. No payment made under this Agreement shall be conclusive
evidence of the performance of this Agreement by Vendor, either wholly or in part, and
no payment shall be construed to be an acceptance of or to relieve Vendor of liability for
the defective,faulty, or incomplete rendition of the services.
6. TAX EXEMPT: Prices applicable to the City do not include applicable state and local sales,
use, and related taxes. The City is exempt from state and local sales and use taxes and
shall not be invoiced for them. Upon request,the City will provide the Vendor with proof
of tax-exempt status.
7. SOVEREIGN IMMUNITY: Nothing contained in this Agreement nor contained herein shall
be considered nor construed to waive City's rights and immunities under the common law
or section 768.28, Florida Statutes, as may be amended.
8. ATTORNEY'S FEES: If either Party brings suit for enforcement of the Agreement, each
Party shall bear its own attorney's fees and court costs.
9. PUBLIC RECORDS:The City is a public agency subject to Chapter 119, Florida Statutes.The
Vendor shall comply with Florida's Public Records Law. Specifically, the Vendor shall:
Piggyback Contract—Preferred Governmental Claim Solutions,Inc.(PGCS) COBB Contract#26-041 PB 3
A. Keep and maintain public records required by the City to perform the service;
B. Upon request from the City's custodian of public records, provide the City with a
copy of the requested records or allow the records to be inspected or copied within
a reasonable time at a cost that does not exceed the cost provided in Chapter 119,
Fla. Stat., or as otherwise provided by law;
C. Ensure that public records that are exempt or that are confidential and exempt from
public record disclosure requirements are not disclosed except as authorized by law
for the duration of the contract term and, following completion of the contract,
Vendor shall destroy all copies of such confidential and exempt records remaining
in its possession once the Vendor transfers the records in its possession to the City;
and
D. Upon completion of the contract,Vendor shall transfer to the City, at no cost to the
City, all public records in Vendor's possession. All records stored electronically by
Vendor must be provided to the City, upon request from the City's custodian of
public records, in a format compatible with the City's information technology
systems.
E. IF THE VENDOR HAS QUESTIONS REGARDING THE APPLICATION OF
CHAPTER 119, FLORIDA STATUTES, TO THE VENDOR'S DUTY TO
PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT
THE CUSTODIAN OF PUBLIC RECORDS:
CITY CLERK'S OFFICE
100 E. OCEAN AVENUE
BOYNTON BEACH, FLORIDA, 33435
561-742-6060
CityClerk@bbfl.us
10. DISCRIMINATORY VENDOR AND SCRUTINIZED COMPANIES LISTS; COUNTRIES OF
CONCERN. Vendor represents that it has not been placed on the "discriminatory vendor
list" as provided in Section 287.134, Florida Statutes, and that it is not a "scrutinized
company" under Sections 215.473 or 215.4725, Florida Statutes. Vendor represents and
certifies that it is not, and for the duration of the Term, will not be, ineligible to contract
with City on any of the grounds stated in Section 287.135, Florida Statutes. Vendor
represents that it is and will remain in compliance with Section 286.101, Florida Statutes,
for the duration of the Term.
11. E-VERIFY. Vendor shall comply with Section 448.095, Fla. Stat., "Employment Eligibility,"
including registering and using the E-Verify system to verify the work authorization status
of employees. Failure to comply with Section 448.095, Fla. Stat. shall result in termination
of this Agreement.Any challenge to termination under this provision must be filed in the
Piggyback Contract—Preferred Governmental Claim Solutions,Inc.(PGCS) COBB Contract#26-04IPB 4
Circuit Court no later than 20 calendar days after the termination date. If this Agreement
is terminated for Vendor's violation of the statute, Vendor may not be awarded a public
contract for one (1) year after the termination date.
12. ENTITIES OF FOREIGN CONCERN. The provisions of this section apply only if Vendor or
any subcontractor will have access to an individual's personal identifying information
under this Agreement. Vendor represents and certifies: (i) Vendor is not owned by the
government of a foreign country of concern; (ii) the government of a foreign country of
concern does not have a controlling interest in Vendor; and (iii) Vendor is not organized
under the laws of and does not have its principal place of business in, a foreign country
of concern. On or before the effective date of this Agreement, Vendor and any
subcontractor that will have access to personal identifying information shall submit to
City executed affidavit(s) under penalty of perjury, in a form approved by City attesting
that the entity does not meet any of the criteria in Section 287.138(2), Florida Statutes.
Compliance with the requirements of this section is included in the requirements of a
proper invoice for purposes of Section 6.Terms used in this section that are not otherwise
defined in this Agreement shall have the meanings ascribed to such terms in Section
287.138, Florida Statutes.
13.ANTI-HUMAN TRAFFICKING. On or before the effective date of this Agreement, Vendor
shall provide City with an affidavit attesting that the Vendor does not use coercion for
labor or services, in accordance with Section 787.06(13), Florida Statutes.
14. PUBLIC ENTITY CRIME ACT. Vendor represents that it is familiar with the requirements
and prohibitions under the Public Entity Crime Act,Section 287.133, Florida Statutes, and
that its entry into this Agreement will not violate that Act.Vendor further represents that
there has been no determination that it committed a "public entity crime" as defined by
Section 287.133, Florida Statutes, and that it has not been formally charged with
committing an act defined as a "public entity crime" regardless of the amount of money
involved or whether Vendor has been placed on the convicted vendor list.
15. DISPUTES:Any disputes that arise between the parties regarding the performance of this
Agreement that cannot be resolved through negotiations shall be submitted to a court of
competent jurisdiction exclusively in Palm Beach County, Florida.This Agreement shall be
construed under Florida Law.
16. EXECUTION OF THE AGREEMENT: This Agreement will take effect once signed by both
parties. This Agreement may be signed by the parties in counterparts, which together
shall constitute one and the same agreement among the parties. A facsimile signature
shall constitute an original signature for all purposes. Each person signing this Agreement
on behalf of either Party individually warrants that he or she has full legal power to
execute the Agreement on behalf of the Party for whom he or she is signing and to bind
and obligate such Party concerning all provisions contained in this Agreement.
17.TERMINATION FOR CONVENIENCE: This Agreement may be terminated by the City for
convenience upon fourteen (14) calendar days of written notice by the terminating party
to the other party for such termination in which event the Vendor shall be paid its
Piggyback Contract—Preferred Governmental Claim Solutions,Inc.(PGCS) COBB Contract#26-041PB 5
compensation for services performed to the termination date, including services
reasonably related to termination. If the Vendor abandons the Agreement or causes it to
be terminated, the Vendor shall indemnify the City against loss pertaining to this
termination.
18.TERMINATION FOR CAUSE: In addition to all other remedies available to the parties, this
Agreement shall be subject to cancellation by the either party for cause should the other
party neglect or fail to perform or observe any of the material terms, provisions,
conditions, or requirements herein contained, if such neglect or failure continues for
thirty (30) calendar days after receipt of written notice of such neglect or failure.
19. INDEMNIFICATION: Vendor shall indemnify and hold harmless the City, its elected and
appointed officers,agents, assigns and employees, consultants, separate vendors, any of
their subcontractors, or sub-subcontractors,from and against claims,demands,or causes
of action whatsoever, and the resulting losses, damages, costs, and expenses, including
but not limited to attorneys' fees, including paralegal expenses, liabilities, damages,
orders, judgments, or decrees, sustained by the City arising out of or resulting from (A)
Vendor's performance or breach of Agreement, (B) the negligent, reckless, or intentional
acts or omissions by Vendor's, its agents, employees, subcontractors, participants, and
volunteers in the performance of services hereunder, and (C)Vendor's failure to take out
and maintain insurance as required under this Agreement.Vendor shall pay all claims and
losses in connection therewith and shall investigate and defend all claims,suits, or actions
of any kind or nature in the name of the City, where applicable, including appellate
proceedings, and shall pay all costs, judgments, and attorneys' fees which may issue
thereon.The obligations of this section shall survive indefinitely regardless of termination
of the Agreement.
20. INSURANCE: At the time of execution of this Agreement, the Vendor shall provide the
City with a copy of its Certificate of Insurance reflecting the insurance coverage required
by the Master Agreement. The Certificate of Insurance shall name the City of Boynton
Beach and its officers, employees, and agents as additional insured.
21. BONDING: If required by applicable Florida law,Vendor shall furnish performance and/or
payment bonds as required by Florida Statutes, regardless of whether such bonding was
required under the Master Agreement.Vendor shall provide proof of bonding to the City
prior to commencement of Services if bonding is required by law for the type of services
being provided under this Agreement.
22. LIMITATION OF LIABILITY: Notwithstanding any provision of the Agreement to which it is
applicable,City shall not be liable or responsible to Vendor beyond the amount remaining
due to Vendor under the Agreement, regardless of whether said liability be based in tort,
contract, indemnity or otherwise; and in no event shall City be liable to Vendor for
punitive or exemplary damages or lost profits or consequential damages.
23. INDEPENDENT CONTRACTOR: The Agreement does not create an employee/employer
relationship between the Parties. The Parties intend that Vendor is an independent
contractor pursuant to the Agreement and shall not be considered the City's employee
Piggyback Contract—Preferred Governmental Claim Solutions,Inc.(PGCS) COBB Contract#26-04IPB 6
for any purpose.
24. COMPLIANCE WITH LAWS: Vendor hereby warrants and agrees that at all times material
to the Agreement, Vendor shall perform its obligations in compliance with all applicable
federal, state, and local laws, rules, and regulations, including section 501.171, Florida
Statutes. Non-compliance may constitute a material breach of the Agreement.
25.ASSIGNMENT: If this Agreement and any interests granted herein shall be assigned,
transferred, or otherwise encumbered under any circumstances by Vendor,Vendor must
gain prior written consent from City thirty (30) business days before such transfer, which
consent shall not be unreasonably withheld. For purposes of this Agreement,any change
of ownership of Vendor shall constitute an assignment that requires the City's approval.
Notwithstanding the foregoing, Vendor may, without City's consent, assign this
Agreement in whole or in part as part of a corporate reorganization, consolidation,
merger, or sale of substantially all of its assets related to this Agreement. Vendor shall
provide City written notice of any such corporate reorganization, consolidation, merger,
or sale of substantially all of its assets related to this Agreement within thirty(30)calendar
days of such event.
26.AGREEMENT SUBJECT TO FUNDING: The Agreement shall remain in full force and effect
only as long as the expenditures provided for in the Agreement have been appropriated
by the City Commission of the City of Boynton Beach in the annual budget for each fiscal
year of this Agreement, and is subject to termination based on lack of funding. Early
termination by the City due to loss of funding shall obligate the Vendor to refund any
prepaid fees.
27. ENTIRE AGREEMENT. The Agreement, including the Master Agreement, sets forth the
entire Agreement between the City and the Vendor concerning the subject matter of this
Agreement. This Agreement supersedes all prior and contemporaneous negotiations,
understandings, and agreements, written or oral, between the parties. This Agreement
may not be modified except by the parties' mutual agreement set forth in writing and
signed by the parties.
28. SEVERABILITY. If any provision of this Agreement or application thereof to any person or
situation shall, to any extent, be held invalid or unenforceable, the remainder of this
Agreement and the application of such provisions to persons or situations other than
those as to which it shall have been held invalid or unenforceable, shall not be affected
thereby and shall continue in full force and effect, and be enforced to the fullest extent
permitted by law.
Signature Page to follow
Piggyback Contract—Preferred Governmental Claim Solutions,Inc.(PGCS) COBB Contract#26-041PB 7
IN WITNESS WHEREOF, the Parties hereto have executed this Agreement on the day and
year last set forth below.
CITY OF BOYNTON BEACH, FLORIDA PREFERRED GOVERNMENTAL CLAIM
SOLUTIONS, INC.
1J I
Rebel elton, Mayor (Signature),tompQny
Viviane Ruiz
Print Name of Authorized Official
President of WC, Casuality & Managed Care
Title
Approved as to Form:
to /M C<•1&#ri2.6
Shawna G. Lamb, City Attorney (Corporate Seal)
Attest/Authenticated:
Attested/Authenticated: `dietedkov"
(Signature), Witness
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Tammy Stanzi ne,Deputy Ci4 Clerk Print Name
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Piggyback Contract-Preferred Governmental Claims Solutions,Inc.(PGCS)COBB Contract#26-04IPB 8
EXHIBIT A
MASTER AGREEMENT BETWEEN CITY OF RIVIERA BEACH AND PREFERRED GOVERNMENTAL
CLAIM SOLUTIONS, INC. (PGCS)
Piggyback Contract—Preferred Governmental Claims Solutions,Inc.(PGCS)COBB Contract#26-041PB 9
CONTRACT FOR PROFESSIONAL SERVICES
This Contract is made as of this 17th day of August,2022,by and between the City of Riviera Beach,
a Municipal Corporation, hereinafter referred to as "CITY", whose address is 600 West Blue Heron
Boulevard, Riviera Beach, Palm Beach County, Florida, 33404 and Preferred Governmental Claim
Solutions,Inc.a Florida corporation,hereinafter referred to as"CLAIM ADMINISTRATOR",whose
address is 615 Crescent Executive Court,Suite 600.Lake Marv.FL 32746 and Federal Employer Tax
ID number is 201565528
In consideration of the mutual promises contained herein, the CITY and the CLAIM
ADMINISTRATOR agree as follows:
ARTICLE 1 -SERVICES
1
The CLAIM ADMINISTRATOR'S responsibility under this Contract is to provide professional
services in the area of Third Party Administration,as more specifically set forth in the Scope of Work
detailed in Exhibit"A"_
The CITY'S representative/liaison during the performance of this Contract shall be Steve Shields,Risk
Manager, Who may be contacted at telephone no, (561)840-4879.
The CLAIM ADMINISTRATOR'S representative/liaison during the performance of this Contract
shall be John Bledsoe, Executive Vice President, who may be contacted at telephone no. (407)
373-6500. •
ARTICIE.2.:101EDELE
The CLAIM ADMINISTRATOR shall commence services on September 1. 2022 and complete
all services by September 1,2025.New Claims will be serviced starting September 1,2022 and the
handling of Legacy Claims will commence on October 1,2022.
Reports and other items shall be delivered or completed in accordance with the detailed schedule set
forth in the CLAIM ADMINISTRATOR'S proposal.
ARTICLE 3 -PAYMENTS TO CLAIM ADMINISTRATOR
A. The total amount to be paid by the CITY under this Contract for all services and materials shall
not exceed a total annual contract amount of One Hundred Thirty One Thousand and One
Hundred Sixty Six Dollars ($131,166.00). The CLAIM ADMINISTRATOR shall notify the
• CITY's representative in writing when 90%of the "not to exceed amount"has been reached.
The CLAIM ADMINISTRATOR will bill the CITY on a monthly basis, or as otherwise
provided, at the amounts set forth in Exhibit "B" for services rendered toward the completion
of the Scope of Work.Where incremental billings for partially completed items are permitted,
the total billings shall not exceed the estimated percentage of completion as of the billing date.
B. Invoices received from the CLAIM ADMINISTRATOR pursuant to this Contract will be
reviewed and approved by the CITY's representative,to verify that services have been rendered
inconformity with the Contract. Approved invoices will then be sent to the Finance
Department for payment. Invoices will normally be paid within thirty(30)days following the
CITY representative's approval. Paye 1. of 21
C. Final Invoice: In order for both parties herein to close their books and records, the CLAIM
ADMINISTRATOR will clearly state "final invoice" on the CLAIM ADMINISTRATOR'S
final/last billing to the CITY. This shall constitute CLAIM ADMINISTRATOR'S
certification that all services have been properly performed and all charges and costs have been
invoiced to the CITY.Any other charges not properly included on this final invoice arc waived
by the CLAIM ADMINISTRATOR.
D. In order to do business with the City, CLAIM ADMINISTRATORS are required to create a
Vendor Registration Account OR activate an existing Vendor Registration Account through
the Procurement Department. If CLAIM ADMINISTRATOR intends to use sub-contractors,
CLAIM ADMINISTRATOR must also ensure that all sub-contractor are registered as claim
administrator in the vendor registration system. Additionally,subcontractor agreements must
include a contractual provision requiring that the sub-contractor register in the vendor
registration system. CITY will not finalize a contract award until the CITY has verified that
the CLAIM ADMINISTRATOR and all of its sub-contractor are registered with the CITY.
ARTICLE 4-TRUTH-IN-NEGOTIATION CERI1J4CATE
Signature of this Contract by the CLAIM ADMINISTRATOR shall also act as the execution of a
truth-in-negotiation certificate certifying that the wage rates, over-head charges, and other costs used
to determine the compensation provided for in this Contract are accurate, complete and current as of
the date of the Contract and no higher than those charged the CLAIM ADMINISTRATOR'S most
favored customer for the same or substantially similar service.
The said rates and costs shall be adjusted to exclude any significant sums should the CITY determine
that the rates and costs were increased due to inaccurate,incomplete or noncurrent wage rates or due
to inaccurate representations of fees paid to outside claim administrators. The CITY shall exercise its
rights under this Article 4 within three(3)years following final payment.
ARTICLE S-TERMINATION
This Contract may be terminatedby the CLAIM ADMINISTRATOR upon ninety (90) days' prior
written notice'to the CITY's representative in the event of substantial failure by the CITY to perform
in accordance with the terms of this Contract through no fault of the CLAIM ADMINISTRATOR. It
may also be terminated, in whole or in part, by the CITY, with cause upon five (5) business days
written notice to the CLAIM ADMINISTRATOR or without cause upon ten(10)business days written
notice to the CLAIM ADMINISTRATOR. Unless the CLAIM ADMINISTRATOR is in breach of
this Contract, the CLAIM ADMINISTRATOR shall be paid for services rendered to the CITY'S
satisfaction through the date of termination. After receipt of a Termination Notice,except as otherwise
directed by the CITY,in writing, the CLAIM ADMINISTRATOR shall:
A. Stop work on the date and to the extent specified.
B. Terminate and settle all orders and subcontracts relating to the performance of the
terminated work.
C. Transfer all work in process,completed work,and other materials related to the terminated
work to the CITY.
D. Continue and complete all parts of the work that have not been terminated.
Page 2 of 21
•
ARTICLEkaER ! L
•
The CLAIM ADMINISTRATOR represents that it has,or will secure at its own expense,all necessary
personnel required to perform the services under this Contract. Such personnel shall not be employees
• of or have any contractual relationship with the CITY.
All of the services required herein under shall be performed by the CLAIM ADMINISTRATOR or
under its supervision,and all personnel engaged in performing the services shall be fully qualified and,
if required, authorized or permitted under state and local law to perforin such services.
Any changes or substitutions in the CLAIM ADMINISTRA.TOR'S key personnel must be made
known to the CITY'S representative and written approval must be granted by the CITY'S
representative before said change or substitution can become effective.
The CLAIM ADMINISTRATOR warrants that all services shall be performed by skilled and
competent personnel to the highest professional standards in the field.
All of the. CLAIM ADMINISTRATOR'S personnel (and all Subcontractors), while on CITY
premises,will comply with all CITY requirements governing conduct,safety and security.
ARTYCLE 7 SUBCONTRACTING
The CITY reserves the right to accept the use of a subcontractor or to reject the selection of a particular
subcontractor and to inspect all facilities of any subcontractors in order to make.a determination as to
the capability of the subcontractor to perform properly under this Contract. The CLAIM
ADMINISTRATOR is encouraged to seek additional small business enterprises for participation in
subcontracting opportunities. If the CLAIM ADMINISTRATOR uses any subcontractors on this
project the following provisions of this Article shall apply:
If a subcontractor fails to perform or make progress, as required by this Contract, and it is necessary
to replace the subcontractor to complete the work in a timely fashion,the CLAIM ADMINISTRATOR
shall promptly do so,subject to acceptance of the new subcontractor by the CITY.
ARTICLE II-FEDERAL AND STATE TAX
The CITY is exempt from payment of Florida State Sales and Use Taxes. The CITY will sign an
exemption certificate submitted by the CLAIM ADMINISTRATOR. The CLAIM
ADMINISTRATOR shall n.cg be.exempted from paying sales tax to its suppliers for materials used to
fulfill contractual obligations with the CITY,nor is the CLAIM ADMINISTRATOR authorized to use
the CITY'S Tax Exemption Number in securing such materials.
The CLAIM ADMINISTRATOR shall he responsible for payment of its own and its share of its
employees'payroll,payroll taxes,and benefits with respect to this Contract.
AR__UCLE 9- ILAB ITY OF FIJNDS
The crrv'S performance and obligation to pay under this Contract for subsequent fiscal years are
contingent upon annual appropriations for its purpose by the CITY.
• Page 3 of 21
ARTICLE 10--- INBiJRArQ
See Exhibit C of this agreement which is incorporated herein by reference and made a part hereof.
ARTICLE 11 -INURMNIFI ATION
CLAIM ADMINISTRATOR shall indemnify and hold harmless the CITY,its elected officials,officers
and employees,from all liabilities, damages, losses and costs (including,but not limited to,reasonable
attorneys'fees and court costs,whether such fees and costs are incurred in negotiations,at the trial level
• or on appeal,or in the collection of attorneys'fees),to the extent caused by the negligence,recklessness,
or intentionally wrongful conduct of the firm's officers,employees,agents,and other persons employed
or utilized by the CLAIM ADMINISTRATOR or qualified individual in the performance of, or the
failure to perform, the Agreement.
In the event of a claim, the CITY shall promptly notify the firm or qualified individual in writing by
prepaid certified mail(return receipt requested)or by delivery through any nationally recognized courier
service(such as Federal Express or UPS)which provides evidence of delivery, at the address provided
for receipt of Notice in the Agreement.
The CITY shall provide all available information and assistance that the firm or qualified individual may
reasonably require regarding any claim.This agreement for indemnification shall survive termination or
completion of the Agreement. •
Nothing in this Agreement shall be deemed to affect the rights,privileges and immunities of the CITY
as set forth in Florida Statute§768.28.
ARTICLE 12-SUCCESSORS AND ASSIGNS
The CITY and the CLAIM ADMINISTRATOR each binds itself and its partners; successors,
executors, administrators and assigns to the other party and to the partners; successors, executors,
administrators and assigns of such other party, in respect to all covenants of this Contract. Except as
above,neither the CITY nor the CLAIM ADMINISTRATOR shall assign, sublet, convey or transfer
its interest in this Contract without the prior written consent of the other.
ARTICIILliz.BEMEDIES
This Contract shall be governed by the laws of the State of Florida. : Any legal action necessary to
enforce the Contract will be held in a court of competent jurisdiction located in Palm Beach County,.
Florida. No remedy herein conferred upon any party is intended to be exclusive of any other remedy,
and each and every such remedy shall be cumulative and shall be in addition to every other remedy
given hereunder or now or hereafter existing at law or in equity,by statute or otherwise. No single or
partial exercise by any party of any right, power, or remedy hereunder shall preclude any other or
further exercise thereof.
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Page 4 of 21
•
No provision of this Contract is intended to,or shall be construed to, create any third party beneficiary
or to provide any rights to any person or entity not a party to this Contract, including hut not limited
to any citizen or employees of the CITY and/or CLAIM ADMINISTRATOR.
ABTICJ,E 14-CONFLICT OF INTEREST
The CLAIM ADMINISTRATOR represents that it presently has no interest and shall acquire no
interest,either direct or indirect,which would conflict in any manner with the performance of services
required hereunder, as provided for in Chapter I l2, Part III, Florida Statutes,and the CITY Code of
' Ethics. The CLAIM ADMINISTRATOR further represents that no person having any such conflict
of interest shall be employed for said performance of services.
The CLAIM ADMINISTRATOR shall promptly notify the CITY'S representative, in writing, by
certified mail, of all potential conflicts of interest of any prospective business association,interest or
other circumstance which may influence or appear to influence the CLAIM ADMINISTRATOR'S
judgement or quality of services being provided hereunder. Such written notification shall identify
the prospective business association, interest or circumstance, the nature of work that the CLAIM
ADMINISTRATOR may undertake and request an opinion of the CITY as to whether the association,
interest or circumstance would, in the opinion of the CITY,constitute a conflict of interest if entered
intoby the CLAIM ADMINISTRATOR. The CITY agrees to notify the CLAIM ADMINISTRATOR
of its opinion by certified mail within thirty (30) days of receipt of notification by the CLAIM
ADMINISTRATOR. If, in the opinion of the CITY,the prospective business association, interest or
circumstance would not constitute a conflict of interest by the CLAIM ADMINISTRATOR,the CITY
shall so state in the notification and the CLAIM ADMINISTRATOR shall,at its option,enter into said
association, interest or circumstance and it shall be deemed not in conflict of interest with respect to
services provided to the CITY by the CLAIM ADMINISTRATOR under the terms of this Contract.
ARTICI,;E 15 -EXCUSABLE DELAYS
The CLAIM ADMINISTRATOR shall not be considered in default by reason of any failure in
performance if such.failure arises out of causes reasonably beyond the control of the CLAIM
ADMINISTRATOR or its subcontractors and without their fault or negligence. Such causes include,
but are not limited to,acts of God,force majeure,natural or public health emergencies, labor disputes,
• freight embargoes,and abnormally severe and unusual weather conditions.
Upon the CLAIM ADMINISTRATOR'S request, the CITY shall consider the facts and extent of any
failure to perform the work and, if the CLAIM ADMINISTRATOR'S failure to perform was without
it or its subcontractors fault or negligence, the Contract Schedule and/or any other affected provision
of this Contract shall be revised accordingly,subject to the CITY'S rights to change,terminate,or stop
any or all of the work at any time.
ARTICLE_115.- ARREARS
The CLAIM ADMINISTRATOR shall not pledge the CITY'S credit or make it a guarantor of payment
or surety for any contract,debt,obligation,judgement,lien,or any form of indebtedness. The CLAIM
ADMINISTRATOR further warrants and represents that it has no obligation or indebtedness that
would impair its ability to fulfill the terms of this Contract.
•
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_CLE 17-DISCLQSURE Alyj)OWNERSHIP OF Q)( UMEIyTS
The CLAIM ADMINISTRATOR shall deliver to the CITY's representative for approval and
acceptance, and before being eligible for final payment of any amounts due, all documents and
materials prepared by and for the CITY under this Contract.
To the extent allowed by Chapter 119, Florida Statutes, all written and oral information not in the
public domain or not previously known,and all information and data obtained,developed,or supplied
by the CITY or at its expense will be kept confidential by the CLAIM ADMINISTRATOR and will
not be disclosed to any other party, directly or indirectly, without the CITY'S prior written consent
unless required by a lawful court order. All drawings, maps, sketches, programs, data base, reports
' and other data developed,or purchased,under this Contract for or at the CITY'S expense shall be and
remain the CITY'S property and may be reproduced and reused at the discretion of the CITY.
All covenants, agreements,representations and warranties made herein,or otherwise made in writing
by any party pursuant hereto,including but not limited to any representations made herein relating to
disclosure or ownership of documents,shall survive the execution and delivery of this Contract and
the consummation of the transactions contemplated hereby.
Notwithstanding any other provision in this Contract, all documents, records, reports and any other
materials produced hereunder shall be subject to disclosure,inspection and audit,pursuant to the Palm
Beach County Office of the Inspector General,Palm Beach County Code, Sections 2-421 -2-440, as
amended.
ARTICLE 18 INDEPENDENT CONTRACTOR RELAT1ONS1J
The CLAIM ADMINISTRATOR is,and shall be,in the performance of all work services and activities
under this Contract, an Independent Contractor, and not an employee, agent, or servant of the CITY.
All persons engaged in any of the work or services performed pursuant to this Contract shall at all
times,and in all places, be subject to the CLAIM ADMINISTRATOR'S sole direction, supervision,
and control. The CLAIM ADMINISTRATOR shall exercise control over the means and manner in
which it and its employees perform the work, and in all respects the CLAIM ADMINISTRATOR'S
relationship and the relationship of its employees to the CITY shall be that of an Independent
Contractor and not as employees or agents of the CITY.
The CLAIM ADMINISTRATOR does not have the power or authority to bind the CITY in any
promise,agreement or representation.
ARTICLE 19-CONTINGENT FEES
The CLAIM ADMINISTRATOR warrants that it has not employed or retained any company or
person,other than a bona fide employee working solely for the CLAIM ADMINISTRATOR to solicit
or secure this Contract and that it has not paid or agreed to pay any person, company, corporation,
individual, or firm, other than a bona fide employee working solely for the CLAIM
ADMINISTRATOR, any fee, commission, percentage, gift, or any other consideration contingent
upon or resulting from the award or making of this Contract.
Page 6 of 21
ARTICLE 24 AccESS_AND AUDITS
The CLAIM ADMINISTRATOR shall maintain adequate records to justify all charges,expenses, and
costs incurred in estimating and performing the work for at least five (5) years after completion or
termination of this Contract. The CITY shall have access to such books, records,and documents as
required in this section for the purpose of inspection or audit during normal business hours, at the
CLAIM ADMINISTRATOR'S place of business.
Palm Beach County has established the Office of the Inspector General in Palm Beach Cqunty Code,
Section 2-421 - 2-440, as may be amended. The Inspector General's authority includes but is not
limited to the power to review past, present and proposed city contracts, transactions, accounts and
records, to require the production of records, and to audit, investigate, monitor, and inspect the
• activities of the CLAIM ADMINISTRATOR, its officers, agents, employees, and lobbyists in order
to ensure compliance with contract requirements and detect corruption and fraud.
Failure to cooperate with the Inspector General or interfering with or impeding any investigation shall
be in violation of Palm Beach County Code,Section 2-421 -2-440,and punished pursuant to Section
125.69; Florida Statutes, in the same manner as a second degree misdemeanor.
ARTICLE 21 -NONDISCIUMINATION
The CITY is committed to assuring equal opportunity in the award of contracts and complies with all
laws prohibiting discrimination.CLAIM ADMINISTRATOR warrants and represents that throughout
the term of the Contract, including any renewals thereof,if applicable, all of its employees are treated
equally during employment without regard to race,color,religion,disability,sex,age,national origin,
ancestry, marital status, familial status, sexual orientation, gender identity or expression, or genetic
information..Failure to meet this requirement shall be considered default of the Contract.
ARTICLE 22-AUTHORITY TOI'RACTICZ
The CLAIM ADMINISTRATOR hereby represents and warrants that it has and will continue to -
maintain all licenses and approvals required to conduct its business,and that it will at all times conduct
its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted
to the CITY's representative upon request.
ARTICLE 23-SEVERABILITY
If any term or provision of this Contract, or the application thereof to any person or circumstances
shall,to any extent,be held invalid or unenforceable,the remainder of this Contract,or the application
. of such terms or provision,to persons or circumstances other than those as to which it is held invalid
or unenforceable, shall not be affected, and every other term and provision of this Contract shall be
deemed valid and enforceable to the extent permitted by law.
ARTICLE 24-PUBLIC ENTITY CRIMES
As provided in F.S.287.132-133,by entering into this contract or performing any work in furtherance
hereof, the CLAIM ADMINISTRATOR certifies that it, its affiliates, suppliers, subcontractors and
claim administrators who will perform hereunder,have not been placed on the convicted vendor list
Page 7 of 21
• maintained by the State of Florida Department of Management Services within the 36 months
immediately preceding the date hereof. This notice is required by F.S. 287.133(3Xa),
"
The CITY reserves the right to make changes in Scope of Work, including alterations, reductions
therein or additions thereto. Upon receipt by the CLAIM ADMINISTRATOR of the CITY'S
notification of a contemplated change,the CLAIM ADMINISTRATOR shall, in writing: (1)provide
a detailed estimate for the increase or decrease in cost due to the contemplated change, (2)notify the
CITY of any estimated change in the completion date, and (3) advise the CITY if the contemplated
change shall affect the CLAIM ADMINISTRATOR'S ability to meet the completion dates or
schedules of this Contract. •
. .- If the CITY so instructs in writing,the CLAIM ADMINISTRATOR shall suspend work on that portion •
of the Scope of Work affected by a contemplated change, pending the CITY'S decision to proceed
with the change.
If the CITY elects to make the change,the CITY shall initiate a Contract Amendment and the CLAIM
ADMINISTRATOR shall not commence work on any such change until such written amendment is
signed by the CLAIM ADMINISTRATOR and approved and executed by the City of Riviera Beach
or its designated representative.
ARTICLE 26-NOTICE
All notices required in this Contract shall be sent by certified mail, return receipt requested, hand
delivery or other delivery service requiring signed acceptance. If sent to the CITY, notices shall be
addressed to:
City of Riviera Beach
ATTN: Steve Shields,Risk Manager
1481 West 15a Street
Riviera Beach,FL 33404
•
With copy to:
Office of the City Attorney
1481 West 15th Street
Riviera Beach,Florida 33404
If sent to the CLAIM ADMINISTRATOR,notices shall be addressed to:
•
Preferred Governmental Claim Solutions,Inc.
615 Crescent Executive Court,Suite 600
Lake Mary,FL 32746
Page 8 of 21
tTQQLE 27-ENTIRETY OF CONTRACTUAL AGREEMENT
The CITY and the CLAIM ADMINISTRATOR agree that this Contract sets forth the entire agreement
between the parties, and that there are no promises or understandings other than those stated herein.
None of the provisions, terms and conditions contained in this Contract may be added to, modified,
superseded or otherwise altered, except by written instrument executed by the parties hereto in •
accordance with Article 25-Modifications of Work.
AallOiralaiataailliESIS L LICENSING IsOU IREMENT$
The CLAIM ADMINISTRATOR shall comply with all laws, ordinances and regulations applicable
to the services contemplated herein, to include those applicable to conflict of interest and collusion.
CLAIM ADMINISTRATOR is presumed to be familiar with all federal, state and local laws,
ordinances,codes and regulations that may in any way affect the services offered.
ARTICLE 29-SCRUTINIZED COMPANIES •
A. As provided in F.S. 287.135, by entering into this Contract or performing any work in
furtherance hereof, the CLAIM ADMINISTRATOR certifies that it, its •affiliates,
suppliers,subcontractors and claim administrators who will perform hereunder,have not
been placed on the Scrutinized Companies that boycott Israel List, or is engaged in a
boycott of Israel, pursuant to F.S. 215.4725. Pursuant to F.S. 287.135(3)(b), if CLAIM
ADMINISTRATOR is found to have been placed on the Scrutinized Companies that
Boycott Israel List or is engaged in a boycott of Israel,this Contract may be terminated
at the option of the CITY. •
B. When contract value is greater than $1 million: As provided in F.S. 287.135, by
entering into this Contract or performing any work infurtherance hereof, the CLAIM
ADMINISTRATOR certifiesfu that it, its affiliates, suppliers, subcontractors and claim
administrators who will perform hereunder, have not been placed on the Scrutinized
Companies With Activities in Sudan List or Scrutinized Companies With Activities in
The Iran Petroleum Energy Sector List created pursuant to F.S.215.473 or is engaged in
business operations in Cuba or Syria.
If the CITY determines, using credible information available to the public, that a false
certification has been submitted by CLAIM ADMINISTRATOR, this Contract may be
terminated and a civil penalty equal to the greater of$2 million or twice the amount of
this Contract shall be imposed,pursuant to F.S. 287.135. Said certification must also be
submitted at the time of Contract renewal,if applicable.
ARTICLE 311-PUBLIC RECORDS
Notwithstanding anything contained herein,as provided under Section 119.0701, F.S., if the CLAIM
ADMINISTRATOR: (i) provides a service; and (ii) acts on behalf of the CITY as provided under
Section 119.011(2) F.S., the CLAIM ADMINISTRATOR shall comply with the requirements of
Section 119.0701, Florida Statutes, as it may be amended from time to time. The CLAIM
ADMINISTRATOR is specifically required to:
•
Page 9 of 21
A. Keep and maintain public records requiredby the CITY to perform services as provided
under this Contract.
Q. Upon request from the CITY'S,provide the CITY with a copy of the requested records
or allow the records to be inspected or copied within a reasonable time at a cost that
does not exceed the cost provided in Chapter 119 or as otherwise provided by law. The
CLAIM ADMINISTRATOR further agrees that all fees, charges and expenses shall be
determined in accordance with Florida Statutes.
• F
C. Ensure that public records that arc exempt, or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law for the
duration of the contract term and following completion of the Contract,if the CLAIM
ADMINISTRATOR does not transfer the records to the CITY.
I), . Upon completion of the Contract the CLAIM ADMINISTRATOR shall transfer, at no
cost to the CITY, all public records in possession of the CLAIM ADMINISTRATOR
unless notified by CITY'S rcprescntativelliaison, on behalf of the CITY'S Custodian
of Public Records,to keep and maintain public records required by the CITY to perform
the service. If the CLAIM ADMINISTRATOR transfers all public records to the CITY
upon completion of the Contract, the CLAIM ADMINISTRATOR shall destroy any
duplicate public records that are exempt,or confidential and exempt from public records
. disclosure requirements. If the CLAIM ADMINISTRATOR keeps and maintains
public records upon completion of the Contract,the CLAIM ADMINISTRATOR shall
meet all applicable requirements for retaining public records. All records stored
electronically by the CLAIM ADMINISTRATOR must be provided to CITY, upon
request of the CITY'S Custodian of Public Records,in a format that is compatible with
• the information technology systems of CITY,at no cost to CITY.
Failure of the CLAIM ADMINISTRATOR to comply with the requirements of this article shall be a
material breach of this Contract. CITY shall have the right to exercise any and all remedies available
to it, including but not limited'to, the right to terminate for cause. CI.AIM ADMINISTRATOR
acknowledges that it has familiarized itself with the requirements of Chapter 119, F.S., and other
requirements of state law applicable to public records not specifically set forth herein.
. IF THE CLAIM ADMINISTRATOR HAS QUESTIONS REGARDING THE APPLICATION
OF CHAPTER 11.9, FLORIDA STATUTES, TO THE CLAIM ADMINISTRATOR'S DUTY
TO PROVIDE PUBLIC RECORDS RELATING TO.THIS CONTRACT, CONTACT THE
CUSTODIAN OF PUBLIC RECORDS OR DESIGNEE AT: CLAUDENE ROBINSON,CITY
CLERK, CROBINSON@RIVIERABEACII.ORG, 600 WEST BLUE HERON BLVD.,
RIVIERA BEACH,FLORIDA 33404,561-845-4090.
ARTICLE 31 -COUNTERPARTS
This Contract, including the exhibits referenced herein,may be executed in one or more counterparts,
all of which shall constitute collectively but one and the same Contract. The CITY may execute the
Contract through electronic or manual means, CLAIM ADMINISTRATOR shall execute by manual
means only,unless the CITY provides otherwise.
Page 10 of 21
ARTICLE_32-E-yk$JFY-EMPLOYMENT ELIGIBILITY
CLAIM ADMINISTRATOR warrants and represents that it is in compliance with section 448.095,
Florida Statutes, as may be amended, and that it: (1) is registered with the E-Verify System (E-
Verify.gov), and beginning January 1, 2021, uses the E-Verify System to electronically verify the
employment eligibility of all newly hired workers; and (2) has verified that all of CLAIM
ADMINIS'TRATOR's subcontractors performing the duties-and obligations of this CONTRACT are
registered with the E-Verify System, and beginning January 1, 2021, use the E-Verify System to
electronically verify the employment eligibility of all newly hired workers.
CLAIM ADMINISTRATOR shall obtain from each of its subcontractors an affidavit stating that the
subcontractor does not employ,contract with,or subcontract with an Unauthorized Alien,as that term
is defined in section 448.095(1)(k),Florida Statutes,as may be amended.CLAIM ADMINISTRATOR
shall maintain a copy of any such affidavit from a subcontractor for, at a minimum,the duration of the
subcontract and any extension thereof. This provision shall not supersede any provision of this
CONTRACT which requires a longer retention period.
CITY shall terminate this CONTRACT if it has a good faith belief that CLAIM ADMINISTRATOR
has knowingly violated Section 448.09(1), Florida Statutes, as may be amended. If CITY has a good
faith belief that CLAIM ADMINISTRATOIVs subcontractor has knowingly violated section
448.09(1), Florida Statutes, as may be amended, CTTY.shall notify CLAIM ADMINISTRATOR to
• - terminate its contract with the subcontractor and CLAIM ADMINISTRATOR shall immediately
terminate its contract with the subcontractor. If CITY terminates this CONTRACT pursuant to the
above, CLAIM ADMINISTRATOR shall be barred from being awarded a future contract by CITY
for a period of one(1)year from the date on which this CONTRACT was terminated. In the event of
such contract termination, CLAIM ADMINISTRATOR shall also be liable for any additional costs
incurred by CITY as a result of the termination.
(Remainder of Page intentionally Left Blank)
Page 11 o1° 21
•
DocuSign Envelope ID:A5C2A1CF•7DC1.42DD-B2C2•E82F6U7E9213
•
•
CONTRACTWX`M1 TUE CITY OF RIVIERA BRACH
IN WITNESS WHEREQF,each of the Partieshereto has caused this Contract to be
executed and dafivcred in ita iiattae fluid c'fi.its behalf by its duly authorized officer.
CORPORATE SEAT,
CITY OF!RIVIERA BEACH CLAIM.gevIINISTRA:TOR.
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Page 12 of 21
EXHIBIT"A"
SCOPE of WORK
•
The Claim Administrator is expected to complete the following tasks, at a minimum:
OWNERSHIP OF CLAIM FILES
The City shall have all right, title,interest,and ownership to all loss statistics and claim files created as a result of the
services to be provided by the CLAIM ADMIN9STATOR,further,at the sole option of the City and upon ten(l0)days
written notice,the CLAIM ADMINISTRATOR shall return such files to the City.
At the termination of the contract, at the sole expense of the CLAIM ADMINISTRATOR, the CLAIM
ADMINISTRATOR shall provide the City with digital media containing all of the City's claim data. Such data shall be
made available in a format generally importable into a commonly recognized database for claims administration services.
AUDIT OF FILES AND PROCEDURES
At the sole option of the City, CLAIM ADMINISTRATOR shall agree,at no additional cost to the City, to any audits
conducted by the City nr its designee(hereinafter,"Auditor")of CLAIM ADMINISTRATOR'a claim files and procedures
as they relate to the services under the Agreement. The City shall have the right to audit during the contract period and
for five(5)years following the tennination of the Agreement,
TRANSITION SERVICES
CLAIM ADMINISTRATOR will transition City's claim files and data from the current TPA to CLAIM
' ADMINISTRATOR.
STEWARDSHIP REPORTS
CLAiM ADMINISTRATORs should provide Annual Stewardship Reports to the City.
CLAIMS MANAGEMENT AND INFORMATIONS_YST5M
The CLAIM ADMINISTRATOR shall provide the City with the ability to access comprehensive on-line real-time electronic
claim information data. CLAIM ADMINISTRATOR will provide staff and resources to assist City staff with training to
effectively use system.
The CLAIM ADMINISTRATOR must provide access to online claim information systems to all City designees,including
staff members. It is anticipated that at least 4 user logins will be needed.
The CLAIM ADMINISTRATOR agrees that the City shall have real-time access to all claim files,including all adjuster
notes,supervisory notes,field ease management notes,diary items,payment records,medical bills and expense bills in an
electronic manner with intemet••based access available to the City 24 hours a day,seven days a week.
Claims data must be maintained so that reporting can be provided for the City self-insurance fund, and on an individual
department basis.
' Check registers will be presented to the City for approval. CLAIM ADMINISTRATOR and City will agree upon a •
schedule for this process. Checks must be approved by the City prior to release.There must be a simple process in place
for the City personnel to verify there is adequate back up documentation for the check being written.
The Risk Management Information System (RMIS) must allow City personnel organization wide web-based access to
incident repotting farms,include electronic routing of incident reporting
forms for supervisor, management, and safety review, allow attachment of photos and documents, and provide
email notifications of new incidents and review tasks. Incidents within the RMIS would be managed by the City,
but must be capable of being linked to claims handled by CLAIM ADMINISTRATOR,
Payment records(check imager)should provide one-click access to supporting documentation.
The CLAIM ADMINISTRATOR shall provide the City with regular monthly reports,as agreed upon by the parties,
in such a format as is acceptable to the City. The CLAIM ADMINISTRATOR will provide ad-hoc reports as
requested by the City. Ad-hoc reporting should allow the City to build reports accessing all data fields available in
the claim management system.
All repotts required herein shall be emailed to the City within five(5)working days from the end of the reporting
period (i.e.,month,quarter,when requested by the City,etc.).
3.2 WORKERS' COMPENSATION CLAIMS ADMINISTRATION
. — SERVICES
STA FF[NCZ KPO[)jREMLYi'S
CLAIM ADMINISTRATOR will provide the City with input regarding staffing assigned to the City's
account.
COMPLIANCE W RULES OE DIVISIONS?F WORKERS'COMPENSATION
It shall be the responsibility of the CLAIM ADMINISTRATOR to comply with all rules and regulations
promulgated by the various state agencies prescribing the practices and procedures of self-insurer service
companies. CLAIM ADMINISTRATOR will be responsible for all required State of Florida EDI DWC
reporting.
CLAIM ADMINISTRATOR must agree to reimburse the City for payment of any fines, penalties or
ti assessments assigned by the State of Florida,or otherregiilatory agency,for failure to comply with such rules
and regulations,including RDI reporting, associated with the performance or responsibility of the service
company.
WORKERS'COMPENSATION REQUIRED SERVICES
CLAIM ADMINISTRATORS must agree to provide all of the following services:
• administrative services
claims services
• telephonic case management services
• first notice of injury services
• loss statistic services
• network access,managed care and development services
• medical bill review and audit services
pharmaceutical benefit management services
ADMINISTRATIVE SERVICES
CLAIM ADMINISTRATORS are requested to provide the following administrative services:
a. In accordance with state mandated time frames, prepare (with the City's assistance)and file with
the appropriate state agencies all applications,bonds,documentation,and data required(if any)for
implementation and continuance of the program.
b. In accordance with state mandated time frames,prepare,maintain,and file all records and reports as
may be required by legal authorities(slate,local,and federal).
c. Prepare,maintain,and file statistical or other records and reports as required by the City's excess
insurers. Report claims to the City's excess insurer(s)in accordance with the requirements of the
excess insurer(s). Provide a copy of the reports to the City.Follow specific written investigation
procedures for any case for which the Excess Workers' Compensation Insurer requires specific
notification or investigation. The current excess insurance program includes an aggregate loss
fund that requires tracking for exhaustion.
d. In accordance with state mandated time frames,prepare,maintain,and file statistical information required
, by Workers'Compensation Rating Bureaus or appropriate state agencies,including EDI and data necessary
for the promulgation of experience modifications.
e. Comply fully with all rules,regulations,guidelines or procedures established by The City and the State of
Florida, including EDI.
f. Recognize that the City will be continuing a Workers'Compensation program which focuses on respecting
the injured worker and the medical providers providing care, CLAIM ADMINISTRATORs must be
committed to work collaboratively with the City to effect program changes and enhancements as requested
by the City.
g. Annually,provide the City with a SSAE-1 8 audit,or equivalent,as required by the financial auditors,
h. Prepare and follow provisions specific to the City,for approval by the City,for ensuring that in the event
of an emergency,e.g.,hurricane preparedness,including how CLAIM ADMINISTRATOR'S services will
continue,how the City's employees will be paid indemnity in advance,and how they will be instructed on
obtaining medical*care and prescriptions.
i. Provide advance notice and coordinate in advance with the City any audits associated with the Workers'
Compensation program.
j, Assist the City with its Return to Work program, including identifying return to work opportunities and
appropriate use of outside vendors. The City will provide all needed job descriptions.
CLAiM SERVICES
CLAIM ADMINISTRATOR will provide the following claims services:
a. Establish reporting procedures which are compatible with the needs and organizational structure of the
City. Provide injured employees with appropriate claims information documents,as required by the State
of Florida.
b. Provide necessary forms and instructions for use, Such forms are to include appropriate First Reports of
Injury with mailing address of primary recipients preprinted thereon,
c. Provide toll-free customer service lines for employees.
d. Develop specific service instructions with the City for the handling of the City's claims.Develop specific
service instructions with the City for the handling of the City's catastrophic claims.
e. Conduct such investigation into the speoifcs of each individual report of employee injury as in the exercise
of professional judgment would seem necessary. Enhanced efforts shall be taken to identify possible
fraudulent claims including recorded statements from claimants and discussions with the claimant's
supervisors.Collaborate with the City on all investigations.
f. Subject to the exercise of professional judgment, recommend to the City the acceptance or denial of all
reported claims for employee injuries in accordance with the applicable Workers'Compensation Law or
law of damages.The City shall be notified of all claim denials prior to the denial being issued. The City
shall be notified of all potential settlements and the final decision for all settlements shall rest with the
City.Any settlement is to include preparation and actuation of all necessary stipulations,compromise,and
release agreements.
g. The City will select and employ outside professionals su ch as snrveillnnce personnel,expert witnesses,and
attorneys to assist in the investigation,adjustment,and defense of claims. If it is in the best interest of the
City to delegate any aspect of this function to the CLAIM ADMINISTRATOR,the City reserves the right
to do so.
(i) The City may select specific vendors and pricing schedules for the following services: Legal
services,Field Case Management,Translation services,Transportation services,Surveillance and
Investigation services,Medicare Set-Aside services and Court Reporting services.However,if it
is in the best interest of the City to use vendors the CLAIM ADMINISTRATOR has existing
relationships with and set pricing with,the City reserves the right to do so.
(ii) The CLAIM ADMINISTRATOR must be able to review all hills for such services for
reasonableness and conformity to any pie-established rates, fees, or contract requirements and
have the ability to adhere to any set pricing schedules.Bills not meeting the City's contract
requirements must he rejected to the vendor, or reduced by the amount of the error, with an
appropriate explanation to the vendor and appropriate record in the claim. CLAIM
ADMINISTRATOR will provide legal bill review services. A contractor may be used for this
service, •
(iii) The CLAIM ADMINISTRATOR must agree to work csllaboratively with these outside
professionals,including data sharing,portals and other methods for sharing information.
h. Review all medical bills and bills for other services for which a claim is being made for reasonableness
and conformity to rules,regulations,and legally imposed medical and surgical fee schedules.
i. Prepare and maintain files necessary for legal defense of claims and/or other litigation(such as actions for
subrogation,contribution,or indemnity)or other proceedings.
j. Where appropriate or desirable, attend hearings, depositions, mediations, and other proceedings, The
adjuster handling the claim file will provide an updated written file report within 48 hours eller the hearing,
deposition,mediation or other proceeding.
k. Al the request of the City, provide a complete copy of all files involving litigation,potential or actual
subrogation,or potential or actual recovery from special or second injury funds to the Risk Manager.
1. Aggressively pursue all possibilities of subrogation, excess insurance reimbursement, third party liens,
contribution or indemnity and/or recovery from special or second injury funds on behalf of the City.
Collaborate with the City prior to initiating subrogation or third party liens.
m, Periodically as appropriate,but at least every quarter,review all open cases and complete a strategic action
plan in order to assist in the settlement of the cases. Such written reviews shall include a review and
verification of outstanding reserves,all legal issues associated with the claim and any other issues identified
by Risk Management. Participate in quarterly reviews of claim progress and legal progress. A written
summary of the review shall be documented in the open case file and shall be provided to the City within
ten(10)working days after the end of the period for which the report is being made. Quarterly claim reviews
will be done with the Risk Manager at the City's office or virtually should conditions arise,
n. Provide rehabilitative services for injured employees including consultation for retraining or reassignment
of employees with limited physical performance arising froze►covered injuries:
cs. The supervising adjuster shall consult with the City's Risk Manager, or designee thereof, and refer all
questionable or contested cases and those with an estimated value in excess of 57,500 or a mutually agreed-
upon amount.
p. Aid in conununications/coordination with the City's safety and accident prevention program staff as
necessary including providing claims data needed to target safety and prevention initiatives.
q. Conduct adequate,timely and complete 24-hour contact investigation of claims regardless of exposure(24
hours from first notice to WC management organization,not 24 hours from when adjuster received notice).
r. Document and establish reserves on a periodic basis for all claims,Review previously set reserves on a
regular basis and adjust as necessary. Initial reserves and reserve changes greater than$25,00()require the
City's approval.
S. Pay vendor bills(attorneys,surveillance,etc.),within 20 days of delivery to CLAIM ADMINISTRATOR.
t. Develop and follow appropriate written policies when(i)the injured employee requests a second opinion,
(ii)medical evaluation is questioned,or(iii)grievance report is filed.
U. Assist,as appropriate,in the scheduling of independent medical examinations.
V. Monitor the purchase of items deemed to be medically necessary for the accommodation of an injured
employee and obtain approval from the Risk Manager,or designee thereof,for these items.
W. Follow all provisions of Florida Statutes in regard to medical benefit entitlement and administration.
X. Maintain a Florida office with service personnel available from 8:00 a.m.to 5:34 p.m.
y. Manage non-insurance claims.(TPA establishes claim files and pays claims in some instances where there
is no insurance coverage but the claim is paid out of the loss hind.)
TE,.BPHONIC CAST MANAGEMENT SERVICES
The successful CLAIM ADMINISTRATOR shall:
a. Use Registered Nurses and vocational counselors to provide telephonic case management services for all
appropriate claims.Telephonic case managers will be:
(I) licensed(Registered Nurses)and certified(Registered Nurses and vocational counselors)by the
Florida Division of Workers'Compensation as qualified rehabilitation providers;and
(2) experienced in Florida Workers'Compensation medical/disability case management.
b. Provide the following services in cooperation with the City:
(l) Medical care coordination, including evaluation of appropriate referrals and approvals for
specialty care,surgeries,physical therapy and diagnostics.
(2) Provide review of requests for DME,treatittents and other procedures.
Field Case Management services are only used for catastrophic casts and are assigned only with City pre-approval.
• 11RST NOTI )y Q):jNJURY.SERVICBS
CLAIM ADMINISTRATORs are requested to provide the following administrative services:
a. Provide 24 hour telephonic and Internet-based electronic claim reporting and intake capabilities.Send
First Notice of Injury to the State of Florida in a timely manner. CLAIM ADMINISTRATORs must
accept responsibility for penalties for late notice to the State of Florida when caused by other than the
delay of the City.
b. Receive and examine on behalf of the City all reports of employee injury claims. Coordinate data
between first report of injury and claims administration system Newly reported injuries must be in
the claims system as a claim within 24 hours of report.
C. Provide an email notice of claim to the City's Risk Manager,or designee,when claim number and
adjuster are assigned for all new claims.
d. The on-line claim security shall permit on-line input of accident reports by the City.
MEDICAL BII.,LI,F,ylf W ANll AUDIT SERVICES
CLAIM ADMINISTRATOR will provide the following medical hill review and audit services:
a For Medical Bill Review:
(a) Promptly review medical/surgical bills(in and nut of network) for accuracy including, but
not limited to,as they relate to the following:
(i) Duplicate billings
(ii) Unbundling of charges
(iii) Upcoding of charges
(Iv) Approval and appropriate precertification
(b) Review all medical bills that:
(I) Are not subject to fee schedule coding
(ii) Are for services not specifically addressed in the fee schedule
(iii) Need an in-depth medical interpretation of the rules and regulations
(iv) In the exercise of professional judgment,specifically warrant review
(c) Process,pay and mail bills within 20 days of receipt.
(d) Rejected bills should be recorded in the claim and visible to the City.
(e) The City values timely payment of its financial obligations. Rejected bills that contain
obvious obligations,or may relate to authorized treatment,even though less than the amount
billed,must be tracked and followed up on in a timely manner.
b. Reimburse the City for any overpayments made in the bill review process, indemnity payment
process, disability payment process,and other similar processes, within 30 days of identification of
overpayment. Reimburse the City for any penalties and/or interest associated with inaccurate
payments.This reimbursement obligation is independent of CLAIM ADMINISTRATOR's ability to
recover the overpayment.
e. For Medical Auditing Services:
(a) Audit in-network and out-network hospitaVprovider bills
(i) Exceeding$5,000,and
(ii) Others at the CLAIM ADMINISTRATOR's discretion or specific request by
the City for accuracy and appropriateness.
(b) Develop and follow written policies on how late charges,no show charges,and special
payment arrangements are to be handled and seek the City's approval of the policies.
d. Develop and provide communication materials to explain the policies and procedures of the Medical
Bill Review and Audit Services to:
(a) The City
(b) Medical providers
e. Develop and follow written grievance procedures for provider concerns.
PHARMACEUTICAL MANAGEMENT SERVICES
The CLAIM ADMINISTRATOR shall recommend and contract with a prescription benefit management
(PBM)vendor.
3.3 NON-WC CLAIMS ADMINISTRATION SERVICES
Third Party Claims include General Liability,Automobile Liability,Automobile Physical Damage claims including
subrogation,Public Officials Liability Claims,Law Enforcement Liability,Non-Catastrophic Property Claims,and
Crime claims.
STAFFING QUIREMENT
CLAIM ADMIPIISTRATORs must commit to providing the City with input regarding staffing assigned to
the City's account,
SIRED SERVICES
CLAIM ADMINISTRATORs must agree to provide all of the
following services:
• administrative services
• claim reporting services
• claims services
• loss statistic services
ADMINISTRATIVE SIiRVICES
CLAIM ADMINISTRATORS are requested to provide the following administrative services:
a, Prepare (with the City's assistance)and file with the appropriate state agencies all applications, bands,
documentation,and data required(if any)for implementation and continuance of the program.
b, Prepare,maintain,and file all records and reports as may be required by legal authorities(state,local,and
federal)including Form 1099 and all reporting required for Medicare Secondary Payer provisions.
c, Prepare,maintain,and file statistical or other records and reports as required by the City's excess insurers.
d. Prepare,maintain,and file statistical information required by Rating Bureaus or appropriate state agencies. •
C. Comply fully with all rules,regulations,guidelines or procedures established by the City and the State of
Florida,
CLAIM REPORTINO SERVICES
CLAIM ADMINISTRATORS are requested to provide the following claim reporting services:
a. Provide 24 hour telephonic and internee-based electronic claim reporting and intake capabilities.
b. Receive and examine on behalf of the City all reports of claims.Coordinate data between report of claim
and claims administration system.
c. Provide an email notice of claim to the City's Risk Manager,or designee,when claim number and adjuster
are assigned for all new claims.
d. The on-line claim security shall permit on-line input of accident/incident reportsby the City.
CLAIMS SERVICES
CLAIM ADMINISTRATORS are requested to provide the following claims services:
a. Establish reporting procedures which are compatible with the needs and organizational structure of the
City.
b. Provide necessary forms and instructions for use.Such forms are to include appropriate accident reports
with mailing address of primary recipients preprinted thereon.
c. Be available on a 24 hour basis and provide immediate response to claims investigation requests through
use of email or cellular telephones.
d. Provide toll-free customer service Iine.e.
e. Prepare and follow a work plan that has been approved by the City in the handling of the City's claims.
Prepare and follow a work plan that has been approved by the City in the handling of the City's catastrophe
claims.
f. Receive and examine on behalf of the City all reports of third-party claims including claims by an employee
of one Insured against another Insured.
g. Report claims to the City's exce a insurer(s)in accordance with the requirements of the excess insurer(s).
Provide a copy of the report to the City. Follow specific written investigation procedures for any case for
which the excess insurer requires specific notification,
h. Within 24 hours after notification of a serines(one requiring mare than first aid)third party bodily injury
claim,contact the claimant by telephone or in person. Within two(2)working days after notification of
any other third-party claim,contact the claimant by telephone or in person.
i. Subject to the exercise of professional judgment,recommend to the City the acceptance or denial of third-
party claims, The final decision for all settlements shall rest with the City,City Council,City Manager,
City Attorney,the Risk Manager or its designee. Any aetttement is to include preparation and
actuation of all necessary compromise and release agreements.
j. Conduct such investigation as in the exercise of professional judgment would seem necessary
in consultation with the City. Follow specific written investigation procednres for any case for
which the excess insurer requires specific notification,
k. The City will select and employ outside professionals such as surveillance personnel,expert witnesses,
• and attorneys to assist in the investigation, adjustment, and defense of claims. If it is in the best
interest of the City to delegate any aspect of this flmction to the CLAIM ADMINISTRATOR,the
City reserves the right to do so.
(a) The City has selected specific vendors and pricing schedules for the following services:
Legal services, Surveillance and Investigation services, Medicare Set-Aside (CMS)
services and Court Reporting services.However,if it is in the best interest of the City
to use vendors the CLAIM ADMINISTRATOR has existing relationships with and set
pricing with, the City reserves the right to do so.
(b) The CLAIM ADMINISTRATOR must be able to review all bills for such services
for reasonableness and conformity to any pre-established rates or fees and the
conditions of the City's contracts, and have the ability to adhere to any set pricing
schedules.
(c) The firm with whom the City contracts must agree to work collaboratively with these
outside professionals.
The City will be involved in the selection process for such outside professionals and will be
involved in establishing effective utilization decision making criteria.
1. Prepare and maintain files necessary for legal defense of claims and/or other litigation(such as
actions for subrogation,contribution,or indemnity)or other proceedings.
m. Where appropriate or desirable, attend hearings, depositions,mediations, and other proceedings.
The attorney or other party representing the City shall provide a written report to the City and the
CLAIM ADMINISTRATOR following the hearing,deposition,mediation or other proceeding.The
adjuster/mulling the claim file shall review the report and provide oral or written feedback to the-
Risk Manager within 10 days of receipt of the report.The adjuster shall ensure pertinent information
in any reports are included in excess reports.
ii. Pay in a timely manner alt claims and expenses pertaining to the City's claims.
U. At the request of the City, provide a complete copy of all files involving litigation,potential or
actual subrogation,or potential or actual recovery from special or second injury funds to the Risk
Manager or the designee thereof.
p. Aggressively pursue all possibilities of subrogation, excess insurance reimbursement, third party
liens, contribution or indemnity on behalf of the City with the City's approval. Services for
Automobile Liability shall include the pursuit of subrogation on behalf of the City for Automobile
Physical Damage losses.
q. Periodically as appropriate,but at least every six months,review all open cases in and complete a
strategic action plan in order to assist in the settlement of the cases-Such written review shall include
a review and verification of outstanding reserves. A written summary of the review shall be
documented in the open case file and shall be provided to the City within ten(10)working days after
the end of the period for which the report is being made.
r. The supervising adjuster shall meet with the City's Risk Manager,or the designee thereof,to consult
with and refer all questionable or contented cases and those with an estimated value in excess of
S l 0,000.
s. The City Risk Management personnel should be able to upload information to claim files, set
alerts fir adjusters,and set diary alerts.
EXHIBIT B
FEES
Tho following annual fees are inclusive of all related expenses including contract administration,technical
assistance to the City,personnel training and certification,services for safety,travel,and associated actions
necessary for the services outlines in the UP and Contract,
Year 1: S131,166
Ycar2: $131,166 •
Year 3: 5131,166
Year 4: S135,100*
Year 5: $139,154*
Total)'ee: 1667,752
For years 4 and 5,"Both parties reserve the right to negotiate for contract years 4 and 5."
Included in the flat fee: •
• Administration of all new and all old claims for the life of the contract plus an additional 90 days;
• First notice of injury reporting services;
• All bill review services;
• Access to intemet-based information system,including all reports required and agreed upon by the
parties;
• All indexing;
• All subrogation services(except approved legal involvement on specific claitns);
• All Medicare MMSEA reporting;
• Prescription benefit management(PBM)services;
• Legal Bill Review Services;
• Claim Administration Charges for Non-Catastrophic Property Insurance Claim;
• All provider network access;and
• Risk Management Information System access and use.
Additional Services NotIncluded in Flat F
• Telephonic Case Management: S79/hr
• Field Case Management*(Account Approval Required): Current Market Rates(Currently S85/hr)
(• 50.50 per mile plus expenses)
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revc.
REQUEST FOR PROPOSALS
For
THIRD PARTY ADMINISTRATION SERVICES
SOLICITATION NO. RFP #1072-22-3
Issue Date: May 31, 2022
Due Date: June 23, 2022 by 3:00pm (EST)
1. PURPOSE _ 3
1.1 BACKGROUND AND GENERAL INFORMATION 3
2. GENERAL CONDITIONS 3-6
3. SCOPE OF WORK 6-14
3.1 IN GENERAL 6-8
3.2 WORKERS' COMPENSATION CLAIMS ADMINISTRATION SERVICES ...8-12
3.3 NON-WC CLAIMS ADMINISTRATION SERVICES 12-14
4. MINIMUM QUALIFICTIONS REQUIREMENTS 15
5. SOLICITATION TIMELINE 15
6. CONE OF SILENCE 15
7. RESERVATIONS AND RIGHTS .15-17
8. ADDENDUM TO RFP 17
9. SUBMITTAL INSTRUCTIONS AND REQUIREMENTS 17-20
9.1 SUBMITTAL REQUIREMENTS 17
9.2 PROPOSAL FORMAT 18-19
9.3 SUBMITTAL INSTRUCTIONS 20
10.COST PROPOSAL 20
11.EVALUATION PROCESS AND CRITERIA 21-22
11.1 EVALUATION PROCESS 21
11.2 EVALUATION CRITERIA ..22
12.INSURANCE REQUIREMENTS 23
13. APPENDIX 24-32
ATTACHMENT A -REQUIRED STANDARD FORMS
1. Acknowledgement of Forms Required & Authorized Representative
2. Proposal Submittal Form
3. Addendum Acknowledgement
4. Proposer's Certification
5. Conflict of Interest Disclosure Form
6. Drug Free Workplace
7. Public Entity Crimes Form
8. Cost Proposal Form
SAMPLE CONTRACT 33-46
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si„Atii.ic
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RFP 1072-22-3 Third Party Administration Services
Page 2 of 46 ..r ..,'
MIMIMIMlt... 1.0 PURPOSE
1.1 BACKGROUND AND GENERAL INFORMATION
The City of Riviera Beach and the Riviera Beach Community Redevelopment Agency (hereinafter "City") are
seeking an experienced firm to provide Third Party Administration Services for the City's self insured Workers'
Compensation and Third Party Liability program. The City desires to enter into a professional services contract with
a qualified firm who can demonstrate competency and experience in providing Third Party Administration Services
for municipal governments.
NE ' r C P t I IONS
Proposer's Responsibility
Before submitting a response, each Proposer shall be solely responsible for making any and all investigations,
evaluations, and examinations, as necessary, to ascertain all conditions and requirements affecting the full
performance of the contract.
Costs Incurred by Proposers
All expenses involved with the preparation and submission of Proposals, or any work performed in connection
therewith,shall be the sole responsibility(and shall be at the sole cost and expense)of the Proposer,and shall not be
reimbursed by the City.
Relationship to City
It is the intent of the City and Proposers hereby acknowledge and agree, that the successful Proposer is an
independent contractor,and that neither the Proposer,nor the Proposer's employees,agents,partners,joint ventures,
and/or contractors, shall not under any circumstances, be considered employees or agents or the City. Proposers
must disclose any professional financial and familial relationships with any persons employed directly or
contractually by the City.
Contract Awards
The City anticipates entering into an Agreement with the Proposer who submits the proposal selected by the City to
be most advantageous.
The Proposer understands that this RFP does not constitute an offer or an Agreement with the Proposer. An offer or
Agreement shall not be deemed to exist and is not binding until proposals are reviewed, accepted by appointed staff,
the best proposal has been identified,approved by the appropriate level of authority within the City and executed by
all parties.
The City reserves the right to reject all proposals,to abandon the project and/or to solicit and re-advertise for other
proposals.
Contractual Agreement
This RFP and Proposer's proposal shall be included and incorporated in the final award. The order of contractual
precedence will be the Contract or Agreement document,original Terms and Conditions,and Proposer response.Any
and all legal action necessary to enforce the award will be held in Palm Beach County and the contractual obligations
will be interpreted according to the laws of Florida.
Term of Contract
The proposed effective date for the agreement will be October 1,2022.The initial term of the agreement will be for
a three year period beginning October 1,2022 with an ability to renew for two additional one year periods.The City
requires that the flat annual fees be guaranteed for a minimum of three (3) years, subject to annual negotiation
RFP 1072-22-3 Third Party Administration Services
Page 3 of 46
thereafter. Additional guarantees for the fees for years four (4) and five (5) of the agreement will be considered
favourably.
Obligations Not Terminated By Contract Period
The proposer shall be required to provide service on all claims occurring during the contract period and until three
(3)months after the termination of the contract(including renewals, extensions or replacements thereof), all legally
required reports for the contract period rendered, and all required reports to appropriate agencies. The proposer's
proposed fee shall include the full consideration for such continuing obligations and, except as noted herein, no
additional consideration shall be due for such obligations which extend beyond the contract period.
Licenses
Proposers must be fully licensed and certified in the State of Florida at the time of RFP submittal. The proposal of
any Proposer who is not fully licensed and certified shall be rejected. Copies of the required licenses must be
submitted with the proposal response indicating that the entity proposing, as well as the team assigned to the City
account,are properly licensed to perform the activities or work included in the contract documents. A Proposer with
an office within the City is also required to have a business tax receipt.
Contingent Fees Prohibited
The firm or qualified individual must warrant that it has not employed or retained a company or person,other than a
bona fide employee, contractor, or subcontractor working in its employ, to solicit or secure an agreement with the
City; and that it has not paid or agreed to pay any person,company,corporation,individual or firm other than a bona
fide employee, contractor or sub-consultant, working in its employ, any fee, commission, percentage, gift or other
consideration contingent upon or resulting from the award or making of an agreement with the City.
Public Entity Crimes
A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime
may not:
1. Submit a proposal on a contract to provide goods or services to a public entity;submit a proposal on a contract
with a public entity for the construction or repair of a public building or public work;
2. Submit proposals on leases of real property to a public entity;
3. Be awarded or perform work as a contractor, supplier,subcontractor or consultant under a contract with any
public entity;and
4. Transact business with any public entity in excess of the threshold amount provided in Section 287.017,FS,
for Category Two (currently $35,000) for a period of 36 months from the date of being placed on the
convicted vendor list.
Indemnification
The firm or qualified individual shall indemnify and hold harmless the CITY,its elected officials,officers and employees,
from all liabilities,damages,losses and costs(including,but not limited to,reasonable attorneys'fees and court costs,
whether such fees and costs are incurred in negotiations,at the trial level or on appeal,or in the collection of attorneys'
fees), to the extent caused by the negligence, recklessness,or intentionally wrongful conduct of the firm's officers,
employees,agents,and other persons employed or utilized by the Proposer or qualified individual in the performance
of,or the failure to perform,the Agreement.
In the event of a claim,the CITY shall promptly notify the firm or qualified individual in writing by prepaid certified mail
(return receipt requested)or by delivery through any nationally recognized courier service(such as Federal Express
or UPS)which provides evidence of delivery,at the address provided for receipt of Notice in the Agreement.
The CITY shall provide all available information and assistance that the firm or qualified individual may reasonably
require regarding any claim. This agreement for indemnification shall survive termination or completion of the
Agreement.
Nothing in this Agreement shall be deemed to affect the rights,privileges and immunities of the CITY as set forth
RFP 1072-22-3 Third Party Administration Services
Page 4 of 46
in Florida Statute§ 768.28.
Scrutinized Companies
Section 287.135,Florida Statutes,prohibits a company from bidding on, submitting a proposal for,or entering into
or renewing a contract for goods or services of any amount if, at the time of contracting or renewal,the company is
on the Scrutinized Companies that Boycott Israel List,created pursuant to Section 215.4725, Florida Statutes, or is
engaged in a boycott of Israel. Section 287.135, Florida Statutes, also prohibits a company from bidding on,
submitting a proposal for,or entering into, or renewing a contract for goods or services of$1,000,000 or more, that
are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities
in the Iran Petroleum Energy Sector Lists which were created pursuant to Section 215.473,Florida Statutes.
Florida Public Records Law
In accordance with Chapter 119, Florida Statutes, and,except as may be provided by Chapter 119, Florida Statutes,
and other applicable State and Federal Laws,all Proposers should be aware that the RFP and the responses thereto
are in the public domain and are available for public inspection and copying. If the Proposer is asserting that certain
information in its Proposal is confidential and/or proprietary and/or exempt from public disclosure,then the Proposer
is required to do the following:
A. Identify,with specificity,the information which the Proposer asserts is confidential and/or proprietary and/or
exempt from public disclosure;
B. Place such information(including any applicable electronic media on which such information is contained
in a sealed envelope that is separate from the Proposer's other Proposal documents;
C. Clearly label the envelope that contains the confidential,proprietary and/or exempt information as follows"
`EXEMPT FROM PUBLIC DISCLOSURE" with Proposer's name and the RFP number marked on the
outside;and,
D. Specifically cite the applicable Florida Statute(s) that exempts such information from public disclosure —
such citation must be placed on the sealed envelope and on a separate document contained within the sealed
envelope along with any relevant explanations.
The envelope that contains the Proposer's confidential/proprietary/exempt information must be submitted with the
Proposer's other Proposal documents. Proposer is advised that failure to follow the aforementioned instructions may
result in Proposer's alleged confidential/proprietary/exempt information being disclosed to the public. All submittals
received in response to this RFP will become the property of the City and will not be returned. In the event of an
award,all documentation produced as part of the contract will become the exclusive property of the City.
Be aware that the designation of an item as exempt from public disclosure by a Proposer may be challenged in court
by any person or entity. By designation of material in your proposal as exempt from public disclosure, Proposer
agrees to defend the City of Riviera Beach(and its employees,agents and elected and appointed officials)against all
claims and actions(whether or not a lawsuit is commenced)related to Proposer's designation of materials as exempt
from public disclosure and to hold harmless the City of Riviera Beach (and its employees, agents and elected and
appointed officials)for any award to a plaintiff for damages,costs and attorneys' fees,and costs and attorneys' fees
incurred by the City by reason of any claim or action related to your designation of material as exempt from public
disclosure.
Non-Collusion Statement
By signing its RFP,the proposer certifies that its RFP is made independently and free from collusion. Proposer shall
disclose below, to their best knowledge, any City of Riviera Beach officer or employee, or any relative of any such
officer or employee as defined in Section 112.3135(1)(c),Florida Statutes,who is an officer or director of,or has a
material interest in, the vendor's business, who is in a position to influence this procurement. Any City of Riviera
Beach officer or employee who has any input into the writing of specifications or requirements,solicitation of offers,
decision to award, evaluation of offers,or any other activity pertinent to this procurement is presumed,for purposes
hereof, to be in a position to influence this procurement. For purposes hereof, a person has a material interest if
he/she directly or indirectly owns more than five percent (5%) of the total assets or capital stock of any business
entity,or if they otherwise stand to personally gain if the contract is awarded to this proposer.
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Failure of a proposer to disclose any relationship described herein shall be reason for debarment in accordance with
the provisions of the City Procurement Code.
Proposer, if doing business under an assumed name, i.e., an Individual, Association, Partnership, Corporation, or
otherwise,shall be registered with the Florida Department of State,Division of Corporations.
Rights to Investigate and Audit-Office of the Inspector General
The Inspector General of Palm Beach County has the authority to investigate and audit matters relating to the
negotiation and performance of any awarded contract and in furtherance thereof may demand and obtain records and
testimony from the contractor and its subcontractors and lower tier subcontractors. The proposer understands and
agrees that in addition to all other remedies and consequences provided by law, the failure of the proposer or its
subcontractors or lower tier subcontractors to fully cooperate with the Inspector General when requested may be
deemed by the municipality to be a material breach of any contract entered into with the proposer as justification for
termination.
Proprietary and/or Confidential Information
Proposers are hereby notified that all information submitted as part of,or in support of submittals will be available
for public inspection after the opening of proposals in compliance with Chapter 119 of the Florida Statutes,popularly
known as the "Public Record Law."The Proposer shall not submit any information in response to this Solicitation,
which the Proposer considers to be a trade secret,proprietary,or confidential. The submission of any information to
the City in connection with this Solicitation shall be deemed conclusively to be a waiver of any trade secret or other
protection, which would otherwise be available to the Proposer. In the event that the Proposer submits information
to the City in violation of this restriction,either inadvertently or intentionally, and clearly identifies that information
in the RFP as protected or confidential,the City may,in its sole discretion,either(a)communicate with the Proposer
in writing in an effort to obtain the Proposer's withdrawal of the confidentiality restriction,or(b)endeavour to redact
and return that information to the Proposer as quickly as possible, and if appropriate, evaluate the balance of the
proposal. The redaction or return of information pursuant to this clause may render a proposal non-responsive.
3.0 SCOPE OF WORK
3.1 IN GENERAL
The City of Riviera Beach is seeking proposals from experienced and qualified Workers Compensation and
Third Party Liability Claims Administrators.
OWNERSHIP OF CLAIM FILES
The City shall have all right, title, interest, and ownership to all loss statistics and claim files created as a
result of the services to be provided by the proposer. Further, at the sole option of the City and upon ten
(10)days written notice, the proposer shall return such files to the City.
At the termination of the contract, at the sole expense of the proposer, the proposer shall provide the City
with digital media containing all of the City's claim data. Such data shall be made available in a format
generally importable into a commonly recognized database for claims administration services.
AUDIT OF FILES AND PROCEDURES
At the sole option of the City, TPA shall agree,at no additional cost to the City,to any audits conducted by
the City or its designee (hereinafter, "Auditor") of TPA's claim files and procedures as they relate to the
services under the Agreement. The City shall have the right to audit during the contract period and for five
(5)years following the termination of the Agreement.
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TRANSITION SERVICES
Proposers should clearly outline how services will transition from the current TPA to proposer. Include
information regarding experience transferring claims data from the current TPA to proposer, the time
needed to effectively and accurately transition,etc.
As electronic files contain various formats of documents,such as text files,word processing files, .pdf files,
.jpg files, .tiff files,and more, clearly outline any limitations to data transfer.
If you have previously converted or transferred data from Gallagher Bassett, provide the names of the
entities/organizations of the most recent conversions.
STEWARDSHIP REPORTS
Proposers should provide Annual Stewardship Reports to the City. Proposers should include sample reports.
CLAIMS MANAGEMENT AND INFORMATION SYSTEM
The proposer shall provide the City with the ability to access comprehensive on-line real-time electronic
claim information data.
The proposer must provide access to online claim information systems to all City designees,including staff
members. It is anticipated that at least 4 user logins will be needed.
The proposer agrees that the City shall have real-time access to all claim files, including all adjuster notes,
supervisory notes, field case management notes, diary items, payment records, medical bills and expense
bills in an electronic manner with internes-based access available to the City 24 hours a day, seven days a
week. Proposals should detail how this access to claim files will be provided.
Claims data must be maintained so that reporting can be provided for the City self-insurance fund, and on
an individual department basis.
Check registers will be presented to the City for approval. Proposer and City will agree upon a schedule
for this process. Checks must be approved by the City prior to release. There must be a simple process in
place for the City personnel to verify there is adequate back up documentation for the check being written.
The City prefers a provider with a robust risk management information system (RMIS). The RMIS must
allow City personnel organization wide web-based access to incident reporting forms, include electronic
routing of incident reporting forms for supervisor, management, and safety review, allow attachment of
photos and documents, and provide email notifications of new incidents and review tasks. Incidents within
the RMIS would be managed by the City,but must be capable of being linked to claims handled by proposer.
The proposal evaluation process may include review of the adequacy of proposed system and user-friendly
enhancements, such as dashboard and simple links to information, which will be preferred. Checks should
provide one-click access to supporting documentation.
The proposer shall provide the City with regular monthly reports, as agreed upon by the parties, in such a
format as is acceptable to the City. The proposer will provide ad-hoc reports as requested by the City. Ad-
hoc reporting should allow the City to build reports accessing all data fields available in the claim
management system.
All reports required herein shall be emailed to the City within five (5) working days from the end of the
reporting period (i.e., month, quarter, when requested by the City, etc.). The proposer will be subject to a
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penalty of$100 per day per report thereafter until the required reports are provided to the City. The penalty
shall be deducted from proposer's monthly invoice.
3.2 WORKERS' COMPENSATION CLAIMS ADMINISTRATION SERVICES
3.2.1 BACKGROUND
The City has been self-insuring its Workers' Compensation program for over twenty years. Claims
are currently administered by Gallagher Basset Services. The City is a qualified self-insured
government.
The City currently uses Concentra as their primary workers' compensation occupational provider and
anticipates continuing this relationship.
3.2.2 STAFFING REOUIREMENTS
Proposers are expected to commit to providing the City with input regarding staffing assigned to the
City's account.
3.2.3 COMPLIANCE WITH RULES OF DIVISION OF WORKERS'COMPENSATION
It shall be the responsibility of the proposer to comply with all rules and regulations promulgated by
the various state agencies prescribing the practices and procedures of self-insurer service companies.
Proposer will be responsible for all required State of Florida EDI DWC reporting.
Proposer must agree to reimburse the City for payment of any fines,penalties or assessments assigned
by the State of Florida, or other regulatory agency, for failure to comply with such rules and
regulations, including EDI reporting, associated with the performance or responsibility of the service
company.
3.2.4 W ORKERS ' COMPENSAT ION R EOU IRE D SER V
IC ES
Proposers must agree to provide all of the following services:
• administrative services
• claims services
• telephonic case management services
• first notice of injury services
• loss statistic services
• network access,managed care and development services
• medical bill review and audit services
• pharmaceutical benefit management services.
3.2.5 ADMINISTRATIVE SERVICES
Proposers are requested to provide the following administrative services:
a. In accordance with state mandated time frames, prepare (with the City's assistance) and file
with the appropriate state agencies all applications, bonds, documentation, and data required
(if any)for implementation and continuance of the program.
b. In accordance with state mandated time frames, prepare, maintain, and file all records and
reports as may be required by legal authorities(state, local,and federal).
c. Prepare, maintain, and file statistical or other records and reports as required by the City's
excess insurers. Report claims to the City's excess insurer(s) in accordance with the
requirements of the excess insurer(s). Provide a copy of the reports to the City.Follow specific
written investigation procedures for any case for which the Excess Workers' Compensation
Insurer requires specific notification or investigation. The current excess insurance program
includes an aggregate loss fund that requires tracking for exhaustion.
d. In accordance with state mandated time frames, prepare, maintain, and file statistical
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information required by Workers'Compensation Rating Bureaus or appropriate state agencies,
including EDI and data necessary for the promulgation of experience modifications.
e. Comply fully with all rules,regulations,guidelines or procedures established by The City and
the State of Florida, including EDI.
f. Recognize that the City will be continuing a Workers' Compensation program which focuses
on respecting the injured worker and the medical providers providing care. Proposers must be
committed to work collaboratively with the City to effect program changes and enhancements
as requested by the City.
g. Annually, provide the City with a SSAE-18 audit, or equivalent, as required by the financial
auditors.
h. Prepare and follow provisions specific to the City, for approval by the City, for ensuring that
in the event of an emergency, e.g.,hurricane preparedness, including how proposer's services
will continue,how the City's employees will be paid indemnity in advance,and how they will
be instructed on obtaining medical care and prescriptions.
i. Provide advance notice and coordinate in advance with the City any audits associated with the
Workers' Compensation program.
j. Assist the City with its Return to Work program, including identifying return to work
opportunities and appropriate use of outside vendors.
3.2.6 CLAIM SERVICES
Proposers are requested to provide the following claims services:
a. Establish reporting procedures which are compatible with the needs and organizational
structure of the City.
b. Provide necessary forms and instructions for use. Such forms are to include appropriate First
Reports of Injury with mailing address of primary recipients preprinted thereon.
c. Provide toll-free customer service lines for employees.
d. Develop specific service instructions with the City for the handling of the City's claims.
Develop specific service instructions with the City for the handling of the City's catastrophic
claims.
e. Conduct such investigation into the specifics of each individual report of employee injury as
in the exercise of professional judgment would seem necessary. Enhanced efforts shall be
taken to identify possible fraudulent claims including recorded statements from claimants and
discussions with the claimant's supervisors. Collaborate with the City on all investigations.
f. Subject to the exercise of professional judgment, recommend to the City the acceptance or
denial of all reported claims for employee injuries in accordance with the applicable Workers'
Compensation Law or law of damages. The City shall be notified of all claim denials prior to
the denial being issued. The City shall be notified of all potential settlements and the final
decision for all settlements shall rest with the City. Any settlement is to include preparation
and actuation of all necessary stipulations, compromise, and release agreements.
g. The City will select and employ outside professionals such as surveillance personnel, expert
witnesses, and attorneys to assist in the investigation, adjustment, and defense of claims. If it
is in the best interest of the City to delegate any aspect of this function to the proposer, the
City reserves the right to do so.
(i) The City may select specific vendors and pricing schedules for the following services:
Legal services,Field Case Management,Translation services,Transportation services,
Surveillance and Investigation services, Medicare Set-Aside services and Court
Reporting services. However, if it is in the best interest of the City to use vendors the
proposer has existing relationships with and set pricing with,the City reserves the right
to do so.
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(ii) The proposer must be able to review all bills for such services for reasonableness and
conformity to any pre-established rates, fees, or contract requirements and have the
ability to adhere to any set pricing schedules. Bills not meeting the City's contract
requirements must be rejected to the vendor, or reduced by the amount of the error,
with an appropriate explanation to the vendor and appropriate record in the claim.
The City currently uses a legal bill review service and would like to continue the use
of this type of service. Please provide details on the service you can provide and
provide the subcontractor, if applicable, and associated fee.
(iii) The firm with whom the City contracts must agree to work collaboratively with these
outside professionals, including data sharing, portals and other methods for sharing
information.
h. Review all medical bills and bills for other services for which a claim is being made for
reasonableness and conformity to rules,regulations,and legally imposed medical and surgical
fee schedules.
i. Prepare and maintain files necessary for legal defense of claims and/or other litigation (such
as actions for subrogation, contribution,or indemnity)or other proceedings.
j. Where appropriate or desirable, attend hearings, depositions, mediations, and other
proceedings. The adjuster handling the claim file will provide an updated written file report
within 48 hours after the hearing, deposition,mediation or other proceeding.
k. At the request of the City, provide a complete copy of all files involving litigation, potential
or actual subrogation, or potential or actual recovery from special or second injury funds to
the Risk Manager.
1. Aggressively pursue all possibilities of subrogation, excess insurance reimbursement, third
party liens, contribution or indemnity and/or recovery from special or second injury funds on
behalf of the City.Collaborate with the City prior to initiating subrogation or third party liens.
m. Periodically as appropriate, but at least every quarter, review all open cases and complete a
strategic action plan in order to assist in the settlement of the cases. Such written reviews shall
include a review and verification of outstanding reserves. Participate in quarterly reviews of
claim progress and legal progress. A written summary of the review shall be documented in
the open case file and shall be provided to the City within ten(10)working days after the end
of the period for which the report is being made. Quarterly claim reviews will be done with
the Risk Manager at the City's office or virtually should conditions arise.
n. Provide rehabilitative services for injured employees including consultation for retraining or
reassignment of employees with limited physical performance arising from covered injuries.
o. The supervising adjuster shall consult with the City's Risk Manager, or designee thereof, and
refer all questionable or contested cases and those with an estimated value in excess of$7,500
or a mutually agreed-upon amount.
p. Aid in communications/coordination with the City's safety and accident prevention program
staff as necessary including providing claims data needed to target safety and prevention
initiatives.
q. Conduct adequate, timely and complete 24-hour contact investigation of claims regardless of
exposure(24 hours from first notice to WC management organization,not 24 hours from when
adjuster received notice).
r. Document and establish reserves on a periodic basis for all claims. Review previously set
reserves on a regular basis and adjust as necessary. Initial reserves and reserve changes greater
than$25,000 require the City approval.
s. Pay vendor bills(attorneys, surveillance,etc.),within 20 days of delivery to proposer.
t. Develop and follow appropriate written policies when (i) the injured employee requests a
second opinion, (ii)medical evaluation is questioned,or(iii)grievance report is filed.
u. Assist, as appropriate, in the scheduling of independent medical examinations.
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r1.51---
v. Monitor the purchase of items deemed to be medically necessary for the accommodation of an
injured employee and obtain approval from the Risk Manager, or designee thereof, for these
items.
w. Follow all provisions of Florida Statutes in regard to medical benefit entitlement and
administration.
x. Maintain a Florida office with service personnel available from 8:00 a.m. to 5:30 p.m.
y. Manage non-insurance claims. (TPA establishes claim files and pays claims in some instances
where there is no insurance coverage but the claim is paid out of the loss fund.)
3.2.7 TELEPHONIC CASE MANAGEMENT SERVICES
The successful proposer shall:
a. Use Registered Nurses and vocational counselors to provide telephonic case management
services for all appropriate claims. Telephonic case managers will be:
(1) licensed (Registered Nurses) and certified (Registered Nurses and vocational
counselors) by the Florida Division of Workers' Compensation as qualified
rehabilitation providers; and
(2) experienced in Florida Workers' Compensation medical/disability case management.
b. Provide the following services in cooperation with the City:
(1) Medical care coordination,including evaluation of appropriate referrals and approvals
for specialty care, surgeries,physical therapy and diagnostics.
(2) Provide review of requests for DME, treatments and other procedures.
Field Case Management services are only used for catastrophic cases and are assigned only with City
pre-approval.
3.2.8 FIRST NOTICE OF INJURY SERVICES
Proposers are requested to provide the following administrative services:
a. Provide 24 hour telephonic and internet-based electronic claim reporting and intake
capabilities. Send First Notice of Injury to the State of Florida in a timely manner. Proposers
must accept responsibility for penalties for late notice to the State of Florida when caused by
other than the delay of the City.
b. Receive and examine on behalf of the City all reports of employee injury claims. Coordinate
data between first report of injury and claims administration system. Newly reported injuries
must be in the claims system as a claim within 24 hours of report.
c. Provide an email notice of claim to the City's Risk Manager, or designee,when claim number
and adjuster are assigned for all new claims.
d. The on-line claim security shall permit on-line input of accident reports by the City.
3.2.9 MEDICAL BILL REVIEW AND AUDIT SERVICES
Proposers are requested to provide the following medical bill review and audit services:
a. For Medical Bill Review:
(a) Promptly review medical/surgical bills(in and out of network)for accuracy including,
but not limited to,as they relate to the following:
(i) Duplicate billings
(ii) Unbundling of charges
(iii) Upcoding of charges
(iv) Approval and appropriate precertification
(b) Review all medical bills that:
(i) Are not subject to fee schedule coding
(ii) Are for services not specifically addressed in the fee schedule
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(iii) Need an in-depth medical interpretation of the rules and regulations
(iv) In the exercise of professional judgment, specifically warrant review
(c) Process,pay and mail bills within 20 days of receipt.
(d) Rejected bills should be recorded in the claim and visible to the City.
(e) The City values timely payment of its financial obligations. Rejected bills that contain
obvious obligations, or may relate to authorized treatment, even though less than the
amount billed,must be tracked and followed up on in a timely manner.
b. Reimburse the City for any overpayments made in the bill review process,indemnity payment
process, disability payment process, and other similar processes, within 30 days of
identification of overpayment. Reimburse the City for any penalties and/or interest associated
with inaccurate payments. This reimbursement obligation is independent of proposer's ability
to recover the overpayment.
c. For Medical Auditing Services:
(a) Audit in-network and out-network hospital/provider bills
(i) Exceeding$5,000, and
(ii) Others at the proposer's discretion or specific request by the City for accuracy
and appropriateness.
(b) Develop and follow written policies on how late charges,no show charges,and special
payment arrangements are to be handled and seek the City's approval of the policies.
d. Develop and provide communication materials to explain the policies and procedures of the
Medical Bill Review and Audit Services to:
(a) The City
(b) Medical providers
e. Develop and follow written grievance procedures for provider concerns.
3.2.10 PHARMACEUTICAL MANAGEMENT SERVICES
The proposer shall recommend a prescription benefit management(PBM) vendor. Details regarding
the PBM's services must be provided, including access, utilization review services, coordination of
claims data and reporting.
3.3 NON-WC CLAIMS ADMINISTRATION SERVICES
3.3.1 BACKGROUND
The City has been self-insuring its third party liability insurance program for over twenty years.
Claims are currently administered by Gallagher Basset Services. The Risk Management Division
employs a Risk Manager, Safety Officer, and Benefits Administrator.
Third Party Claims include General Liability, Automobile Liability, Automobile Physical Damage
claims including subrogation, Public Officials Liability Claims, Law Enforcement Liability, Non-
Catastrophic Property Claims, and Crime claims.
3.3.2 STAFFING REOUIREMENT
Proposers must commit to providing the City with input regarding staffing assigned to the City's
account.
3.3.3 REOUIRED SERVICES
Proposers must agree to provide all of the following services:
administrative services,
claim reporting services,
claims services, and
loss statistic services.
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Page 12 of 46
3.3.4 ADMINISTRATIVE SERVICES
Proposers are requested to provide the following administrative services:
a. Prepare(with the City's assistance)and file with the appropriate state agencies all applications,
bonds, documentation, and data required (if any) for implementation and continuance of the
program.
b. Prepare,maintain,and file all records and reports as may be required by legal authorities(state,
local, and federal) including Form 1099 and all reporting required for Medicare Secondary
Payer provisions.
c. Prepare, maintain, and file statistical or other records and reports as required by the City's
excess insurers.
d. Prepare, maintain, and file statistical information required by Rating Bureaus or appropriate
state agencies.
e. Comply fully with all rules, regulations, guidelines or procedures established by the City and
the State of Florida.
3.3.5 CLAIM REPORTING SERVICES
Proposers are requested to provide the following claim reporting services:
a. Provide 24 hour telephonic and internet-based electronic claim reporting and intake
capabilities.
b. Receive and examine on behalf of the City all reports of claims. Coordinate data between
report of claim and claims administration system.
c. Provide an email notice of claim to the City's Risk Manager, or designee,when claim number
and adjuster are assigned for all new claims.
d. The on-line claim security shall permit on-line input of accident/incident reports by the City.
3.3.6 CLAIMS SERVICES
Proposers are requested to provide the following claims services:
a. Establish reporting procedures which are compatible with the needs and organizational
structure of the City.
b. Provide necessary forms and instructions for use. Such forms are to include appropriate
accident reports with mailing address of primary recipients preprinted thereon.
c. Be available on a 24 hour basis and provide immediate response to claims investigation
requests through use of email or cellular telephones.
d. Provide toll-free customer service lines.
e. Prepare and follow a work plan that has been approved by the City in the handling of the City's
claims. Prepare and follow a work plan that has been approved by the City in the handling of
the City's catastrophe claims.
f. Receive and examine on behalf of the City all reports of third-party claims including claims
by an employee of one Insured against another Insured.
g. Report claims to the City's excess insurer(s)in accordance with the requirements of the excess
insurer(s). Provide a copy of the report to the City. Follow specific written investigation
procedures for any case for which the excess insurer requires specific notification.
h. Within 24 hours after notification of a serious (one requiring more than first aid) third party
bodily injury claim, contact the claimant by telephone or in person. Within two (2) working
days after notification of any other third-party claim, contact the claimant by telephone or in
person.
i. Subject to the exercise of professional judgment, recommend to the City the acceptance or
denial of third-party claims. The final decision for all settlements shall rest with the City,City
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Council,City Manager, City Attorney,the Risk Manager or its designee. Any settlement is to
include preparation and actuation of all necessary compromise and release agreements.
j. Conduct such investigation as in the exercise of professional judgment would seem necessary
in consultation with the City. Follow specific written investigation procedures for any case for
which the excess insurer requires specific notification.
k. The City will select and employ outside professionals such as surveillance personnel, expert
witnesses, and attorneys to assist in the investigation, adjustment, and defense of claims. If it
is in the best interest of the City to delegate any aspect of this function to the proposer, the
City reserves the right to do so.
(a) The City has selected specific vendors and pricing schedules for the following
services:Legal services, Surveillance and Investigation services,Medicare Set-Aside
(CMS)services and Court Reporting services.However,if it is in the best interest of
the City to use vendors the proposer has existing relationships with and set pricing
with,the City reserves the right to do so.
(b) The proposer must be able to review all bills for such services for reasonableness and
conformity to any pre-established rates or fees and the conditions of the City's
contracts, and have the ability to adhere to any set pricing schedules.
(c) The firm with whom the City contracts must agree to work collaboratively with these
outside professionals.
The City will be involved in the selection process for such outside professionals and will be
involved in establishing effective utilization decision making criteria.
1. Prepare and maintain files necessary for legal defense of claims and/or other litigation (such
as actions for subrogation, contribution,or indemnity)or other proceedings.
m. Where appropriate or desirable, attend hearings, depositions, mediations, and other
proceedings. The attorney or other party representing the City shall provide a written report
to the City and the proposer following the hearing, deposition, mediation or other proceeding.
The adjuster handling the claim file shall review the report and provide oral or written
feedback to the Risk Manager within 10 days of receipt of the report. The adjuster shall ensure
pertinent information in any reports are included in excess reports.
n. Pay in a timely manner all claims and expenses pertaining to the City's claims.
o. At the request of the City, provide a complete copy of all files involving litigation, potential
or actual subrogation, or potential or actual recovery from special or second injury funds to
the Risk Manager or the designee thereof.
p. Aggressively pursue all possibilities of subrogation, excess insurance reimbursement, third
party liens,contribution or indemnity on behalf of the City with the City's approval. Services
for Automobile Liability shall include the pursuit of subrogation on behalf of the City for
Automobile Physical Damage losses.
q. Periodically as appropriate, but at least every six months, review all open cases in and
complete a strategic action plan in order to assist in the settlement of the cases. Such written
review shall include a review and verification of outstanding reserves. A written summary of
the review shall be documented in the open case file and shall be provided to the City within
ten(10)working days after the end of the period for which the report is being made.
r. The supervising adjuster shall meet with the City's Risk Manager, or the designee thereof, to
consult with and refer all questionable or contested cases and those with an estimated value in
excess of$10,000.
s. The City Risk Management personnel should be able to upload information to claim files, set
alerts for adjusters, and set diary alerts.
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n �IULIFI RETE
In order to be responsive to this solicitation,proposers must demonstrate they are fully qualified to provide
the services required. At a minimum,the proposer shall meet the following qualifications:
• Be authorized as an administrator in the State of Florida;
• Be authorized by the City's excess carriers both Brit Global Specialty USA and Safety National
Casualty Corp.;
• Demonstrate experience administering a Workers' Compensation program since 2017 for one
Florida public entity client with oresumntion claims; and
• Demonstrate experience administering the third party liability program since 2017 for one Florida
public entity client.
The anticipated schedule and deadlines for this RFP are as follows. All times are Eastern Standard Time.
Event Date
Issue Request for Proposals May 31, 2022
Deadline for Questions and Inquiries June 08, 2022 by 3:00 pm
Response via Addendum June 16, 2022
Proposal Submittal Deadline June 23,2022 by 3:00 p.m.
The City Council of Riviera Beach has enacted a cone of silence, in Sec. 2-166 of the Code of Ordinances
that prohibits oral and written communications regarding all formal solicitations for goods and services
issued by the City. The Cone of Silence commences as of the deadline to submit the proposal,bid,or other
response to a competitive solicitation,and remains in effect until a contract is awarded/approved, all bids or
responses are rejected, or the solicitation is otherwise ended. Any contract entered into in violation of the
cone of silence provision is null and void. All inquiries shall be sent via email to Glendora Williams, Senior
Procurement Specialist vvwilliamsna,rivierabeach.ore.
RIG
The City reserves the right to accept or reject any or all proposals received and reserves the right to make
an award without further discussion of the proposals submitted;therefore,the proposals should be submitted
in a favourable manner. It is understood that the proposal will become a part of the City official file,without
obligation of the City.
Responsiveness
The City will not consider proposals found to be non-responsive to this RFP.A proposal may be determined
irregular and non-responsive for reasons that include, but are not limited to, failure to utilize or complete
RFP 1072-22-3 Third Party A. Services
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material prescribed forms,inadequate financials, incomplete responses, indefinite or ambiguous responses,
and improper,missing and/or undated signatures.
Waiver of Irregularities
The City may waive minor informalities or irregularities in responses or proposals received where such is
merely a matter of form and not substance, and the correction or waiver of which is not prejudicial to other
Proposers. Minor irregularities are defined as those that will not have an adverse effect on the City interests
and will not give a Proposer an advantage or benefit not enjoyed by other Proposers.
City Reserved Rights
In connection with this solicitation,the City reserves all rights(which rights shall be exercisable by the City
at its sole discretion)available to it under applicable law,including without limitation,with or without cause
and with or without notice,the right to:
1. Proceed with the project in any manner that the City, at its sole discretion, deems necessary. If the
City is unable to agree with the highest ranked Proposer or does not negotiate and execute a
satisfactory Agreement with the highest ranked Proposer, the City may negotiate with the next
highest ranked Proposer, terminate this solicitation and pursue other development or solicitations
relating to the project, or exercise such other rights under the provisions of State law as it deems
appropriate.
2. Cancel this RFP in whole or in part at any time prior to the execution of an Agreement, without
incurring any cost, obligations or liabilities.
3. Reject at any time, any and all submittals,responses,and Proposals.
4. Modify all dates set or projected in this RFP.
5. Terminate at any time evaluations and proposal.
6. Suspend and terminate Agreement discussions and clarifications at any time, and elect not to
commence Agreement discussions and clarifications with any responding Proposer and engage in
discussions and clarifications with a Proposer that is not the highest ranked Proposer.
7. Issue addenda, supplements and modifications to this RFP or any subsequent RFP.
8. Seek the assistance of outside technical experts and consultants in Proposal evaluation.
9. Require confirmation of information furnished by a Proposer, require additional information from
a Proposer concerning its Proposal and require additional evidence of qualifications to achieve the
purpose of the Agreement described in the RFP or subsequent RFP.
10. Seek or obtain data from any source that has the potential to improve the understanding and
evaluation of the responses to this RFP.
11.Permit clarification or supplements to a Proposal.
12.Disqualify a Proposer who changes its Proposal without City approval.
13.Make any adjustments it deems necessary to the technical evaluation criteria and weightings for
purposes of its evaluations.
14.Exercise any other rights reserved or afforded the City under this RFP or subsequent RFP and
applicable law; including waiving deficiencies in a Proposal or accept and review a non-conforming
Proposal;provided that such deficiency or non-conformance is not material in nature.
This RFP does not commit the City to enter into an agreement or to proceed with the solicitation described
herein. The City assumes no obligations, responsibilities, and liabilities, fiscal or otherwise, to reimburse
all or part of the costs incurred or alleged to have been incurred by parties considering a response to and/or
responding to this RFP,or any subsequent RFP. All such costs shall be borne solely by each Proposer.
RFP 1072-22-3 Third Part Administration Services
Page 16 of 46
In no event shall the City be bound by, or liable for, any obligations with respect to the contemplated
Agreements until such time (if at all) as the Agreements, in form and substance satisfactory to the City,
have been executed by the City and have become effective, and then, only to the extent set forth in the
Agreements.
8.0 ADDENDUM TO RF
No negotiations,decisions, or actions in connection with this solicitation request shall be initiated or relied
upon by a Proposer as a result of any oral discussions with a City or CRA employee, agent, officer, or
consultant. Only those communications regarding this RFP,which are in writing from the City Procurement
Department, will be considered as a duly authorized expression on behalf of the City or CRA. Written
responses of the City to a Proposer's questions will be forwarded by the City to all Proposers.
Only written communications from Proposers, which are signed by persons who are authorized to
contractually bind the Proposers, will be recognized by the City or CRA as duly authorized expressions on
behalf of the Proposers. Any questions arising from this RFP must be submitted via email to the contact
email address of Glendora Williams, Senior Procurement Specialist as provided under the section entitled
"Submission Instructions and Requirements". In order for technical questions to be answered in a timely
manner,they must be received no later than Wednesday,June 8, 2022,by 3:00pm, Eastern Standard Time.
9.0 SUBMITTAL INSTRUCTIONS and REQUIREMENT'S'
9.1 SUBMITTAL REQUIREMENTS
Proposers shall include the following information in their submittal responses to this solicitation. The following
format and sequence should be followed in order to provide consistency in the firm's responses and to ensure each
proposal receives full consideration.
All copies of the Proposer's submittal shall be on 8%" x 11"plain white paper, typed, with tabs or section dividers
to separate sections as defined herein. The submittal should be printed single-sided, limited to thirty pages or less,
and have a font size of 12 points. Undesignated information shall be inserted at the rear of each package. Place page
numbers at the bottom of every page, excluding tabs/dividers. Proposal documents should not contain links to other
web pages;as such,links will not be reviewed for evaluation purposes.
This document,which includes the scope of services shall be available for download and may be obtained by visiting
the City's website at www.rivierabch.com. The link to the City's solicitation portal:
Imos://network.demandstar.com/aeencies/florida/city-0f-riviera-beach/procurement-onnortunities/ac495 a 12-6345-
4238-86a0-6d5091f55c45/.Any uncertainty regarding the time a proposal is received shall be resolved against
the Proposer.Submittals sent by facsimile or email will not be accepted.
Refer all questions,comments,and inquiries to this RFP to the Procurement Department,point of contact,Glendora
Williams via E-Mail:gvwilliams@rivierabeach.org. Should files not be provided in the format as requested,Proposer
may be deemed non-responsive and therefore ineligible for award.
Proposals must be signedby the duly authorized official(s). Proposers may withdraw their proposals by notifying the
City in writing at any time prior to the opening. RFPs once opened become the property of the City and will not be
returned to the proposers.
RFP 1072-22-3 Third Part .administration Services
Page 17 of 46
---11111111111
9.2 PROPOSAL FORMAT
The following format must be followed by Finns submitting responses to the RFP.
Your firm's response must provide all information requested in the below items. A firm's non-compliance to the
outline below will hinder the Evaluation Committee's ability to find the responses to the RFP and could cost your
firm points for information that is not easily found.
While additional data may be presented,the information requested in the items 1 through 10,must be included. Items
1-10 represent the criteria after which the proposals will be evaluated.
1. Title Page
Provide the RFP#and title,the Firm's name; the name, address,telephone number and email of the contact
person;and the date of the proposal.
2. Table of Content
Include clear identification of the material by section and by page number.
3. TransmittAl Letter
A transmittal letter must be provided briefly stating the proposers' desire to be considered for the project,
understanding of the work to be done,the commitment to perform the work,a statement why the Firm believes
they are the best qualified to perform the work and a statement that the proposal is a firm and irrevocable
offer until such time as City Council awards a contract as a result of this RFP.
A duly authorized officer of your Firm, who is authorized to execute documents on behalf of the Firm,must
sign the transmittal letter.
4. General information
The Proposer shall submit an executive summary,which outlines its Proposal.The executive summary shall,
at a minimum,include an identification of the proposed team,responsibilities of the team,and a summary of
the proposed services. This section should highlight aspects of this Proposal, which make it superior or
unique in addressing the needs of the City.
5. Fir m' s Onalifications and Fxneriencc
a. Indicate the firm's number of years of experience in providing the required services. Experience with
Florida Governments and municipalities should be noted. The proposal must demonstrate the
qualifications and experience of the firm.
b. The proposal should indicate the total number of employees of the firm.Please also specify the location
of the office which will provide services to the City,and the number of employees located at that specific
office.
c. Demonstrate the firm's compliance with Section 4.0 Minimum Qualifications Requirements(MQR).
d. Provide a list of government and private clients your firm has contracted within the past ten(10)years.
List and describe any potential conflicts of interest between the City and your Firm's other clients that
may affect the Firm's representation of the City's interests.
e. Specify the Firm's particular area of expertise and how those strengths will benefit the City.
f. Specify what unique circumstances set the Firm apart from others who perform the same or similar
services.
6. Principal Point of Contact and Staffing
a. Provide the name of the person who will be assigned to the City as the principal point of contact and
having authorization to make representations and agreements on behalf of the Firm.
b. Provide details of how you propose to staff the requested services: number of adjusters, expertise,
supervisory oversight,etc.
c. For each individual,please provide a resume containing years of service with the firm and education.
RFP 1072-22-3 Third Part)Administration Services
Page 18 o146
7. Anoroach to the Project
Please provide details on how you will provide all services outlined in the Scope of Services of this RFP. If
any deviations are proposed,please specifically detail.
8. Cost Proposal
Proposals are reauired to provide flat,annual fees for the following services:
• Administration of all new and all old claims for the life of the contract plus an additional 90 days (See
Obligations Not Terminated by Contract Period);
• The winning proposer should timely convert all old claims data into their system so that the information
is accessible and reports can be run;
• First notice of injury reporting services;
• All bill review services;
• Access to internet-based information system, including all reports required and agreed upon by the
parties;
• All indexing;
• All subrogation services(except approved legal involvement on specific claims);
• All Medicare MMSEA reporting;
• Prescription benefit management(PBM)services;
• All provider network access;and
• Risk Management Information System access and use.
Fees should be payable in 12 equal monthly installments.
Proposals will not be considered which include variable pricing for any of the above noted services.No
Allocated Loss Adjusting Expenses, or similar claim charges, will be considered for any of these services.
Fees must include the taking over of all old claims.
In addition to the flat annual fee for the above services,proposers may offer variable pricing for:
• Telephonic case management services
• Field case management services
• Legal Bill Review Services
• Claims administration charges for Property Insurance Claim, if needed
9. past Performance—References
References are required as a component of due diligence to determine the capability of the proposing Firm
to be able to perform the required services.Proposing Firm must provide at least five(5)verifiable
references supporting the experience as stated in the RFP.
10. jIeauired Forms:
Please make sure all of the forms below are included in your proposal.
A. Acknowledge of Forms Required&Authorized Representative
B. Proposal Submittal Form
C. Addendum Acknowledgement
D. Proposer's Certification
E. Conflict of Interest Disclosure Form
F. Drug Free Workplace
G. Public Entity Crimes Statement
H. Cost Proposal Form
I. Reference Check Form
RFP 1072-22-3 Third Party Administration Services
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9.3 SUBMITTAL INSTRUCTIONS
PLEASE BE ADVISED, DUE TO INCREASE CONCERNS WITH COVID-19, ALL RESPONSES MUST BE
SUBMITTED ELECTRONICALLY.
Electronic responses shall be submitted via Demand Star (www.DemandStar.com) in response to RFP NO. 1072-
22-3 THIRD PARTY ADMINISTRATION SERVICES, prior to the designated proposals due date and time
(Thursday, June 23. 2022 by 3:00 nut) indicated in the solicitation. PAPER RESPONSES WILL NOT BE
ACCEPTED.
It will be the sole responsibility of the Contractor to become familiar with the scope of services,City's requirements,
and systems prior to submitting a proposal.
Submission of a proposal will be considered evidence that the proposer has familiarized themselves with the nature
and extent of the work,materials and labor required.
Proposers may withdraw their proposals by notifying the City in writing at any time prior to the deadline for proposal
submittal. After the deadline,the proposal will constitute an irrevocable offer,for a period of 90 days. Once opened,
proposals become a record of the City and will not be returned to the Proposer.
10.0 COST PROPOS
The City requires full and total transparency in its vendor relationships. Therefore,any commission, service fee
or other form of remuneration paid to any agent, broker, lobbyist or third party must be identified in the
submission and throughout the term of the contract.
Proposers must identify all sub-contractors who will be used to provide the services outlined in this RFP. The
flat fee paid by the City must be the only remuneration to the proposer for services provided to the City and
proposers must receive no revenue for these services from sub-contractors.
The City requires that the flat annual fees be guaranteed for a minimum of three (3) years, subject to annual
negotiation thereafter.
Additional guarantees for the fees for years four(4)and five(5)of the agreement will be considered favorably.
Firms must provide all costs for all services to be provided as requested and outlined in this RFP in the format
below. A detailed fee schedule that explains the cost for each contract year must be given by the Proposer.
This cost is inclusive of all related expenses. **
Fees should be invoiced monthly,in twelve(12)equal installments.
RFP 1072-22-3 Third Party Administration Services
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1.0 EVALUATION PROCESS and CRITERIA
11.1 EVALUATION PROCESS
The proposal must address all points outlined in the specifications of this RFP. The proposal must provide clear
and concise information of the Proposer's capability to satisfy the requirements of the RFP. The substance of
the proposals will carry more weight than their form or manner of presentation.
The procedure for response evaluation and selection is as follows:
a) Preliminary review of the Proposals by the Procurement staff for compliance with the submission
requirements of the RFP, including verification that each Response includes all required documents.
b) The Evaluation Committee, appointed by the City Manager, shall meet to evaluate each responsive
proposal in accordance with the requirements of the RFP. At the committee's option,the Proposers may
be required to attend a presentation and/or interview session. The Evaluation Committee may,at its sole
discretion, shortlist the Proposers.
c) The Evaluation Committee shall make a recommendation. The Evaluation Committee may submit a
recommended firm or shortlist the top firms and may require presentations by the highest ranked firms.
d) The City Manager may submit a recommended firm or "shortlist" of a combination of to the City
Council,and may require presentations by the highest ranked firms to the City Council.
e) If the City is unsuccessful in negotiating a Contract with the highest ranked firm, the City will attempt
to negotiate a Contract with the next highest ranked firm.
In general, the City wishes to avoid the expense to the City and to Proposers of unnecessary oral interviews.
Therefore, the City will make every reasonable effort to achieve the ranking using written submittals alone. If
oral presentations/interviews are scheduled with the Firm(s),the oral presentations are exempted from the public
meeting requirements of s. 286.011 F.S., however will be recorded for public record purposes in accordance
with sec. 119.07(1)F.S. as amended.
Oral presentations are to support what has been provided in the proposals by each Firm and to exhibit and
otherwise demonstrate and clarify and expand on the information contained therein. The City reserves the right,
where it may serve the City's best interest, to request additional information and clarification from Proposers.
Sufficient time will be provided to submit this information.
After Oral Presentations, proposals will be evaluated and ranked by the Evaluation Committee to obtain the
results for recommendation to award the Contract.
RFP 1072-22-3 Third Party Administration Services
Page 21 of 46
11.2 EVALUATION CRITERIA
EVALUATION CRITERIA MAXIMUM Potential Points
Firm's Qualifications and Experience
Indicate the firm's number of years of experience in providing the 30
required services. Experience with Florida Governments and
municipalities should be noted. The proposal must demonstrate the
qualifications and experience of the firm.
Principal Point of Contact and Staffing
Provide the name of the person who will be assigned to the City as
the principal point of contact and having authorization to make
representations and agreements on behalf of the Firm. For each 10
individual,please provide a resume containing years of service with
the firm and education.
Approach to the Scope of Work 25
Please provide details on how you will provide all services outlined
in the Scope of Services of this RFP.
References
Proposing Firm must provide at least five (5) verifiable references 10
supporting the experience as stated in the RFP.
Principal Office Location and Local Participation
Location Within: Possible Points:
Riviera Beach 15
Palm Beach County 10 15
Florida 05
Outside Florida 02
Required Forms 10
To include SBE or M/WBE certification and standard forms
attached.
TOTAL POINTS 100
RFP 1072-22-3 Third Party Administration Services
Page 22 of 46
URANCE REQUIREMENT
The successful firm or individual entering a resulting contract with the City shall provide,pay for and maintain in
full force and affect at all times during the services to be performed insurance as set forth below: (This may be
modified,as the City deems appropriate)
Tyne of Coverage Amount of Coverage
General Aggregate $2,000,000
Products/Completed Operations Aggregate $2,000,000
Personal and Advertising Injury $1,000,000
Each Occurrence $1,000,000 Annual Aggregate
Automobile(Body Injury and Property) $1,000,000 Each Occurrence
Worker's Compensation,as applicable $1,000,000 Per Accident
$1,000,000 Disease Each Employee
$1,000,000 Disease Policy Limit
Professional Liability Insurance $1,000,000 Per Occurrence/Annual Aggregate
Employee Dishonesty(Fidelity) $1,000,000 Each Occurrence
Cyber/Privacy Liability $1,000,000 Each Claim/Annual Aggregate
The successful proposer must maintain in full force and effect, during the life of this engagement. Certificates
of liability insurance,satisfactory to the City,shall be furnished to the City immediately upon commencement of
any services, with complete copies of policies to be furnished upon the City's request. Such certificates of
insurance will provide the City with thirty(30)days prior written notice of any cancellation or non-renewal.
The policies shall name the City as an additional insured,and proof of such coverage shall be furnished to the City by
way of an endorsement to same or a certificate of insurance no later than ten(10) days prior to the provision of
services under the awarded contract and upon renewal of each policy each year the awarded contract remains in
effect and for a period of one(1)year after the termination of the contract.
All such insurance must be with an insurance carrier approved and authorized to do business in the state of Florida,
and who must have a rating of no less than A VII by A.M.BEST RATING,or as mutually agreed upon by the City
and the successful Respondent.All such insurance policies may not be modified or terminated without the express
written authorization of the City. The insurance requirements set forth herein may be modified by the City in its
sole discretion in competitive negotiations.
Misrepresentation of any material fact, whether intentional or not, regarding the proposers insurance coverage,
policies or capabilities may be grounds for rejection of the proposal and rescission of any resulting. Evidence of
ability to obtain appropriate insurance coverage shall be provided in each bid.All policies shall be endorsed
to provide sixty (60) days prior written notice of cancellation, non-renewal or reduction in coverage or
limits to:
City of Riviera Beach
Attn: Risk Manager
1481 West 15'h Street
Riviera Beach,FL 33404
Email:risk(a�rivierabeach.org
RFP 1072-22-3 Third Pare Administration Services
Page 23 of 46
ATTACHMENT A
REQUIRED STANDARD FORMS
RFP 1072-22-3 Third Party Administration Services
Page 24 of 46
UTHORIZED REPRESENTATIVE 1=111.
A Proposer must complete and include all the following forms with the proposal submission, including
the proposal on the USD drive.
1. Acknowledgement of Forms Required&Authorized Representative
2. Proposal Submittal Form
3. Addendum Acknowledgement
4. Proposer's Certification
5. Conflict of Interest Disclosure Form
6. Drug Free Workplace
7. Public Entity Crimes Statement
8. Cost Proposal Form
NOTE: Please ensure that all of these documents are completed and submitted with your proposal in
accordance. Failure to do so may result in your proposal not being considered for award.
SIGNATURE of AUTHORIZED REPRESENTATIVE
This signature page must be completed and included with the submittal.
By signing below, the undersigned acknowledges they are an expressly authorized agent of the
Company/firm listed below.
Date:
Full Legal Name of Company:
Signature:
Printed Name:
Title:
RFP 1072-22-3 Third Part,Administration Services
Page 25 of 46
- PROPOSAL SUBMITTAL FORM j
Company/Firm:
Address:
City,State,Zip:
Telephone: Fax Number:
Email Address: Date of RFP:
Name&Title(Printed or Typed):
Signed by:
We (I), the above signed hereby agree to furnish the item(s), service(s) and have read all
attachments including specifications, terms and conditions and fully understand what is
required.
The Request for Proposals, specifications, Proposal Forms, and/or any other pertinent
document form a part of this proposal and by reference made a part hereon. Signature
indicates acceptance of all terms and conditions of the RFP.
RFP 1072-22-3 Third Parte Administration Services
Page 26 of 46
ppia
iimilomiL ADDENDUM ACKNOWLEDGEMENT Ad1611111LJ
INSTRUCTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES
PART I: List below the dates of issue for each addendum received in connection with this
Solicitation:
Addendum #1, Dated
Addendum #2, Dated
Addendum #3, Dated
Addendum#4,Dated
PART II:
10 ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS QUALIFICATION
Firm Name
Signature
Name and Title(Print or Type)
Date
RFP 1072-22-3 Third Party Administration Services
Page 27 of 46
---'...411411111117
nor
' ' 1 t ATION
I have carefully examined the Request for Proposal, Instructions to Proposers, General and/or Special Conditions,
Specifications,Proposal and any other documents accompanying or made a part of this invitation.
I hereby propose to furnish the goods or services specified in the Request for Proposal at the prices or rates quoted in my
proposal. I agree that my proposal will remain firm for a period of up to ninety(90)days in order to allow the City adequate
time to evaluate the proposals. Furthermore,I agree to abide by all conditions of the proposal.
I certify that all information contained in this proposal is truthful to the best of my knowledge and belief. I further certify that
I am duly authorized to submit this proposal on behalf of the vendor/contractor as its act and deed and that the vendor/
contractor is ready,willing and able to perform if awarded the contract.
I further certify that this proposal is made without prior understanding, agreement, connection,discussion,or collusion with
any person, firm or corporation submitting a proposal for the same product or service; no officer, employee or agent of the
CITY OF RIVIERA BEACH or of any other proposer interested in said proposal; and that the undersigned executed this
Proposer's Certification with full knowledge and understanding of the matters therein contained and was duly authorized to do
so.
NAME OF BUSINESS E-MAIL ADDRESS
BY:
SIGNATURE OF AUTHORIZED OFFICER Sworn to and subscribed before me this
day of ,20
PRINTED NAME AND TITLE
SIGNATURE OF NOTARY
MAILING ADDRESS
MY COMMISSION EXPIRES:
CITY, STATE,ZIP CODE PERSONALLY KNOWN
OR PRODUCED IDENTIFICATION
TELEPHONE NUMBER
TYPE:
FAX NUMBER
CONFLICT 0 _A _ REST.. ' C •.. . F 0
The award of this contract is subject to the provisions of Chapter 112,Florida Statutes. All Proposer's must
disclose within their proposals: the name of any officer,director,or agent who is also an employee of the City
of Riviera Beach.
Furthermore, all Proposer's must disclose the name of any City employee who owns, directly, or indirectly, an
interest of more than five percent(5%)in the Proposer's firm or any of its branches.
The purpose of this disclosure form is to give the City the information needed to identify potential conflicts of
interest for evaluation team members and other key personnel involved in the award of this contract.
The term "conflict of interest" refers to situations in which financial or other personal considerations may
adversely affect,or have the appearance of adversely affecting,an employee's professional judgment in exercising
any City duty or responsibility in administration, management, instruction, research, or other professional
activities.
Please check one of the following statements and attach additional documentation if necessary:
To the best of our knowledge,the undersigned firm has no potential conflict of interest due to any
other Cities,Counties, contracts,or property interest for this solicitation.
The undersigned firm, by attachment to this form, submits information, which may be a potential
conflict of interest due to other Cities,Counties,contracts,or property interest for this solicitation.
Acknowledged by:
Firm Name
Signature
Name and Title(Print or Type)
Date
I . I . 4
Preference shall be given to businesses with drug-free workplace programs. Whenever two or more proposals,which
are equal with respect to price, quality, and service, are received by the State or by any political subdivision for the
procurement of commodities or contractual services, a proposal received from a business that certifies that it has
implemented a drug-free workplace program shall be given preference in the award process. Established procedures
for processing tie bids will be followed if none of the tied vendors has a drug-free workplace program. In order to have
a drug-free workplace program,a business shall:
1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing,possession,or use
of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against
employees for violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-
free workplace,any available drug counselling,rehabilitation,and employee assistance programs,and the penalties
that may be imposed upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that are under contract a copy of
the statement specified in subsection(1).
4. In the statement specified in subsection(1),notify the employees that,as a condition of working on the commodities
or contractual services that are under wnttact,the employee will abide by the terms of the statement and will notify the
employer of any conviction of,or plea of guilty or nolo contender to,any violation of chapter 893 or of any controlled
substance law of the United States or any state for a violation occurring in the workplace no later than five(5)days
after such conviction.
5. Impose a sanction on,or require the satisfactory participation in a drug abuse assistance or rehabilitation program if
such is available in the employee's community,by any employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.
As the person authorized to sign the statement,I certify that this Firm complies fully with the above requirements.
THIS CERTIFICATION is submitted by the
(INDIVIDUAL'S NAME)
Of
(TITLE/POSITION WITH COMPANYNENDOR) (NAME OF COMPANYNENDOR)
who does hereby certify that said CompanyNendor has implemented a drug free workplace program which meets the
requirements of Section 287.087,Florida Statutes,which are identified in numbers(1)through(6)above.
SIGNATURE DATE
PUBLIC ENTITY CRIMES F
"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 bid on a contract to provide any goods or services to a public
entity; may not submit a bid on a contract with a public entity for the construction or repair of a
public building or public work; may not submit bids on leases or 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[F.S.] for CATEGORY TWO [$35,000.00] for a period
of 36 months from the date of being placed on the convicted vendor list."
Acknowledged by:
Firm Name
Signature
Name & Title (Print or Type)
Date
Page 31 of 46
CO r '.' ',I SAL 0 ' 11111P
"
The Proposer must give a detailed fee schedule that explains the cost for each contract year. This cost is
inclusive of all related expenses including contract administration, technical assistance to the City,
personnel training and certification, services for safety, travel, and associated actions necessary for the
services outlined in this RFP and Contract.**
CONTRACT TER ( OTAL ANNUAL FEE FOR WO
AS SPECIFIED IN THIS RFP
INITIAL CONTRACT TERM YEAR 1**
INITIAL CONTRACT TERM YEAR 2**
INITIAL CONTRACT TERM YEAR 3**
RENEWAL CONTRACT TERM YEAR 4**
RENEWAL CONTRACT TERM YEAR 5** I
TOTAL FEE FOR
ALL CONTRACT TERMS**
• Refer to the terms stated in Section 9.2 -8. Cost Proposal.
Acknowledged by:
Firm Name
Authorized Signature
Name& Title(Print or Type)
Date
Page 32 of 46
CONTRACT FOR CONSULTING/PROFESSIONAL SERVICES
This Contract is made as of this day of 2022, by and between the City of
Riviera Beach,a Municipal Corporation,hereinafter referred to as"CITY",whose address is 600 West
Blue Heron Boulevard,Riviera Beach,Palm Beach County,Florida,33404 and hereinafter referred to
as"CLAIMS ADMINISTRATOR".
In consideration of the mutual promises contained herein, the CITY and the CLAIM
ADMINISTRATOR agree as follows:
ARTICLE 1 - SERVICES
The CLAIM ADMINISTRATOR'S responsibility under this Contract is to provide professional claims
administration services as specifically set forth in the Scope of Work detailed in the"Scope of Work",
attached and incorporated hereto as Exhibit "A".
The CITY'S representative/liaison during the performance of this Contract shall be
Risk Manager, (email address)and telephone number, (561)000-0000.
The CLAIMS ADMINISTRATOR'S representative/liaison during the performance of this Contract
shall be
43TICLE =TERM OF AGREEMENT
Unless terminated earlier pursuant to Article 5 of this Contract, the term of this Contract shall
commence on ,and conclude on .The term of the Contract may,by mutual
agreement between the CITY and CLAIMS ADMINISTRATOR, be extended for two (2) additional
one(1)year periods and, if needed, 180 days beyond the expiration date of the renewal period.
Any renewal period shall be approved by an Amendment to this Contract executed by both parties.
ARTICLE 3 - FEES
See Exhibit B.
ARTICLE 4-TRUTH-IN-NEGOTIATION CERTIFICATE
Signature of this Contract by the CLAIM ADMINISTRATOR shall also act as the execution of a
truth-in-negotiation certificate certifying that the wage rates, over-head charges, and other costs used
to determine the compensation provided for in this Contract are accurate, complete and current as of
the date of the Contract and no higher than those charged the CLAIM ADMINISTRATOR'S most
favored customer for the same or substantially similar service.
The said rates and costs shall be adjusted to exclude any significant sums should the CITY determine
that the rates and costs were increased due to inaccurate, incomplete or noncurrent wage rates or due
to inaccurate representations of fees paid to outside CLAIM ADMINISTRATORS. The CITY shall
exercise its rights under this Article 4 within three(3)years following final payment.
Page 33 of 46
ARTICLE 5-TERMINATION
This Agreement may be cancelled with or without cause by CITY during the term hereof upon thirty
(30)calendar days' written notice to the other parties of its desire to terminate this Agreement. In the
event of such termination,CITY shall be entitled to a pro rata refund of any pre-paid amounts for any
services scheduled to be delivered after the effective date of such termination.
This Contract may be terminated by the CLAIM ADMINISTRATOR upon ninety (90) days' prior
written notice to the CITY in the event of substantial failure by the CITY to perform in accordance
with the terms of this Contract through no fault of the CLAIM ADMINISTRATOR.
Unless the CLAIM ADMINISTRATOR is in breach of this Contract,the CLAIM ADMINISTRATOR
shall be paid for services rendered to the CITY'S satisfaction through the date of termination. After
receipt of a Termination Notice, except as otherwise directed by the CITY, in writing, the CLAIM
ADMINISTRATOR shall,at the sole expense of the CLAIMS ADMINISTRATOR,provide the CITY
with digital media containing all of the CITY'S claim data. Such claim data will be made available
on a format generally importable into a commonly recognized database for claims administration
services.
ARTICLE 6 P .RSONN . .
The CLAIM ADMINISTRATOR represents that it has,or will secure at its own expense,all necessary
personnel required to perform the services under this Contract. Such personnel shall not be employees
of or have any contractual relationship with the CITY.
All of the services required herein under shall be performed by the CLAIM ADMINISTRATOR or
under its supervision, and all personnel engaged in performing the services shall be fully qualified
and, if required, authorized or permitted under state and local law to perform such services.
The CLAIM ADMINISTRATOR warrants that all services shall be performed by skilled and
competent personnel to the highest professional standards in the field.
All of the CLAIM ADMINISTRATOR'S personnel (and all Subcontractors), while on CITY
premises,will comply with all CITY requirements governing conduct, safety and security.
ARTICLE 7-SUBCONTRACTING
The CITY reserves the right to accept the use of a subcontractor or to reject the selection of a particular
subcontractor and to inspect all facilities of any subcontractors in order to make a determination as to
the capability of the subcontractor to perform properly under this Contract. The CLAIM
ADMINISTRATOR is encouraged to seek additional small business enterprises for participation in
subcontracting opportunities. If the CLAIM ADMINISTRATOR uses any subcontractors on this
project the following provisions of this Article shall apply:
If a subcontractor fails to perform or make progress, as required by this Contract, and it is necessary
to replace the subcontractor to complete the work in a timely fashion,the CLAIM ADMINISTRATOR
shall promptly do so, subject to acceptance of the new subcontractor by the CITY.
Page 34 of 46
ARTICLE 8-FEDERAL AND STA TF T A
The CITY is exempt from payment of Florida State Sales and Use Taxes. The CITY will sign an
exemption certificate submitted by the CLAIM ADMINISTRATOR. The CLAIM
ADMINISTRATOR shall not be exempted from paying sales tax to its suppliers for materials used to
fulfill contractual obligations with the CITY,nor is the CLAIM ADMINISTRATOR authorized to use
the CITY'S Tax Exemption Number in securing such materials.
The CLAIM ADMINISTRATOR shall be responsible for payment of its own and its share of its
employees'payroll,payroll taxes, and benefits with respect to this Contract.
ARTICLE 9 -AVAILABILITY OF FUNDS
The CITY'S performance and obligation to pay under this Contract for subsequent fiscal years are
contingent upon annual appropriations for its purpose by the CITY.
ARTICLE 10— INSUTRANCF,
See Exhibit C.
ARTICLE 11 -INDEMNIFICATION
CLAIM ADMINISTRATOR shall indemnify and hold harmless the CITY, its elected officials,
officers and employees, from all liabilities, damages, losses and costs (including, but not limited to,
reasonable attorneys' fees and court costs,whether such fees and costs are incurred in negotiations, at
the trial level or on appeal, or in the collection of attorneys' fees), to the extent caused by the
negligence, recklessness, or intentionally wrongful conduct of the firm's officers, employees, agents,
and other persons employed or utilized by the Proposer or qualified individual in the performance of,
or the failure to perform,the Agreement.
In the event of a claim, the CITY shall promptly notify the firm or qualified individual in writing by
prepaid certified mail (return receipt requested) or by delivery through any nationally recognized
courier service (such as Federal Express or UPS)which provides evidence of delivery, at the address
provided for receipt of Notice in the Agreement.
The CITY shall provide all available information and assistance that the firm or qualified individual
may reasonably require regarding any claim. This agreement for indemnification shall survive
termination or completion of the Agreement.
Nothing in this Agreement shall be deemed to affect the rights,privileges and immunities of the CITY
as set forth in Florida Statute § 768.28.
ARTICLE 1.2-SUCCESSORS AND ASSIGNS
The CITY and the CLAIM ADMINISTRATOR each binds itself and its partners, successors,
executors, administrators and assigns to the other party and to the partners, successors, executors,
administrators and assigns of such other party, in respect to all covenants of this Contract. Except as
above, neither the CITY nor the CLAIM ADMINISTRATOR shall assign, sublet, convey or transfer
its interest in this Contract without the prior written consent of the other.
Page 35 of 46
:ARTICLE 13 - REMEDIES
This Contract shall be governed by the laws of the State of Florida. Any legal action necessary to
enforce the Contract will be held in a court of competent jurisdiction located in Palm Beach County,
Florida. No remedy herein conferred upon any party is intended to be exclusive of any other remedy,
and each and every such remedy shall be cumulative and shall be in addition to every other remedy
given hereunder or now or hereafter existing at law or in equity,by statute or otherwise. No single or
partial exercise by any party of any right, power, or remedy hereunder shall preclude any other or
further exercise thereof.
No provision of this Contract is intended to,or shall be construed to,create any third party beneficiary
or to provide any rights to any person or entity not a party to this Contract, including but not limited
to any citizen or employees of the CITY and/or CLAIM ADMINISTRATOR.
ARTICLE 14-CONFLICT OF INTEREST
The CLAIM ADMINISTRATOR represents that it presently has no interest and shall acquire no
interest,either direct or indirect,which would conflict in any manner with the performance of services
required hereunder, as provided for in Chapter 112, Part HI, Florida Statutes, and the CITY Code of
Ethics. The CLAIM ADMINISTRATOR further represents that no person having any such conflict
of interest shall be employed for said performance of services.
The CLAIM ADMINISTRATOR shall promptly notify the CITY's representative, in writing, by
certified mail, of all potential conflicts of interest of any prospective business association, interest or
other circumstance which may influence or appear to influence the CLAIM ADMINISTRATOR'S
judgement or quality of services being provided hereunder. Such written notification shall identify
the prospective business association, interest or circumstance, the nature of work that the CLAIM
ADMINISTRATOR may undertake and request an opinion of the CITY as to whether the association,
interest or circumstance would, in the opinion of the CITY, constitute a conflict of interest if entered
into by the CLAIM ADMINISTRATOR. The CITY agrees to notify the CLAIM ADMINISTRATOR
of its opinion by certified mail within thirty (30) days of receipt of notification by the CLAIM
ADMINISTRATOR. If, in the opinion of the CITY, the prospective business association, interest or
circumstance would not constitute a conflict of interest by the CLAIM ADMINISTRATOR,the CITY
shall so state in the notification and the CLAIM ADMINISTRATOR shall, at its option, enter into
said association, interest or circumstance and it shall be deemed not in conflict of interest with respect
to services provided to the CITY by the CLAIM ADMINISTRATOR under the terms of this Contract.
ARTICLE 15-EXCUSABLE DELAYS
The CLAIM ADMINISTRATOR shall not be considered in default by reason of any failure in
performance if such failure arises out of causes reasonably beyond the control of the CLAIM
ADMINISTRATOR or its subcontractors and without their fault or negligence. Such causes include,
but are not limited to,acts of God,force majeure,natural or public health emergencies, labor disputes,
freight embargoes, and abnormally severe and unusual weather conditions.
Upon the CLAIM ADMINISTRATOR'S request,the CITY shall consider the facts and extent of any
failure to perform the work and, if the CLAIM ADMINISTRATOR'S failure to perform was without
it or its subcontractors fault or negligence, the Contract Schedule and/or any other affected provision
Page 36 of 46
37
of this Contract shall be revised accordingly,subject to the CITY'S rights to change,terminate,or stop
any or all of the work at any time.
ARTICLE 16-ARREARS
The CLAIM ADMINISTRATOR shall not pledge the CITY'S credit or make it a guarantor of payment
or surety for any contract,debt,obligation,judgement, lien,or any form of indebtedness. The CLAIM
ADMINISTRATOR further warrants and represents that it has no obligation or indebtedness that
would impair its ability to fulfill the terms of this Contract.
ARTICLE 17-DISCLOSURE AND OWNERSHIP OF DOCUMENTS
The CLAIM ADMINISTRATOR shall deliver to the CITY's representative for approval and
acceptance, and before being eligible for final payment of any amounts due, all documents and
materials prepared by and for the CITY under this Contract.
To the extent allowed by Chapter 119, Florida Statutes, all written and oral information not in the
public domain or not previously known,and all information and data obtained,developed,or supplied
by the CITY or at its expense will be kept confidential by the CLAIM ADMINISTRATOR and will
not be disclosed to any other party, directly or indirectly, without the CITY'S prior written consent
unless required by a lawful court order. All drawings, maps, sketches, programs, data base, reports
and other data developed, or purchased,under this Contract for or at the CITY'S expense shall be and
remain the CITY'S property and may be reproduced and reused at the discretion of the CITY.
All covenants, agreements,representations and warranties made herein, or otherwise made in writing
by any party pursuant hereto, including but not limited to any representations made herein relating to
disclosure or ownership of documents, shall survive the execution and delivery of this Contract and
the consummation of the transactions contemplated hereby.
Notwithstanding any other provision in this Contract, all documents, records, reports and any other
materials produced hereunder shall be subject to disclosure,inspection and audit,pursuant to the Palm
Beach County Office of the Inspector General, Palm Beach County Code, Sections 2-421 -2-440, as
amended.
ARTICLE 18-INDEPENDENT CONTRACTOR RELATIONSHIP
The CLAIM ADMINISTRATOR is, and shall be, in the performance of all work services and
activities under this Contract, an Independent Contractor, and not an employee, agent, or servant of
the CITY. All persons engaged in any of the work or services performed pursuant to this Contract
shall at all times, and in all places, be subject to the CLAIM ADMINISTRATOR'S sole direction,
supervision,and control. The CLAIM ADMINISTRATOR shall exercise control over the means and
manner in which it and its employees perform the work, and in all respects the CLAIM
ADMINISTRATOR'S relationship and the relationship of its employees to the CITY shall be that of
an Independent Contractor and not as employees or agents of the CITY.
The CLAIM ADMINISTRATOR does not have the power or authority to bind the CITY in any
promise,agreement or representation.
ARTICLE 19-CONTINGENT FEES
The CLAIM ADMINISTRATOR warrants that it has not employed or retained any company or
person,other than a bona fide employee working solely for the CLAIM ADMINISTRATOR to solicit
or secure this Contract and that it has not paid or agreed to pay any person, company, corporation,
individual, or firm, other than a bona fide employee working solely for the CLAIM
ADMINISTRATOR, any fee, commission, percentage, gift, or any other consideration contingent
upon or resulting from the award or making of this Contract.
ARTICLE 20 -ACCESS AND AUDITS
The CLAIM ADMINISTRATOR shall maintain adequate records to justify all charges,expenses,and
costs incurred in estimating and performing the work for at least five (5) years after completion or
termination of this Contract. The CITY shall have access to such books, records, and documents as
required in this section for the purpose of inspection or audit during normal business hours, at the
CLAIM ADMINISTRATOR'S place of business.
Palm Beach County has established the Office of the Inspector General in Palm Beach County Code,
Section 2-421 - 2-440, as may be amended. The Inspector General's authority includes but is not
limited to the power to review past, present and proposed city contracts, transactions, accounts and
records, to require the production of records, and to audit, investigate, monitor, and inspect the
activities of the CLAIM ADMINISTRATOR, its officers, agents, employees, and lobbyists in order
to ensure compliance with contract requirements and detect corruption and fraud.
Failure to cooperate with the Inspector General or interfering with or impeding any investigation shall
be in violation of Palm Beach County Code, Section 2-421 - 2-440, and punished pursuant to Section
125.69,Florida Statutes, in the same manner as a second degree misdemeanor.
ARTICLE 21 -NONDISCRIMINATION
The CITY is committed to assuring equal opportunity in the award of contracts and complies with all
laws prohibiting discrimination. CLAIM ADMINISTRATOR warrants and represents that throughout
the term of the Contract, including any renewals thereof, if applicable, all of its employees are treated
equally during employment without regard to race,color,religion,disability, sex,age,national origin,
ancestry, marital status, familial status, sexual orientation, gender identity or expression, or genetic
information. Failure to meet this requirement shall be considered default of the Contract.
ARTICLE 22-AUTHORITY TO PRACTICE
The CLAIM ADMINISTRATOR hereby represents and warrants that it has and will continue to
maintain all licenses and approvals required to conduct its business,and that it will at all times conduct
its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted
to the CITY's representative upon request.
ARTICLE 23 - SEVERABILITY
If any term or provision of this Contract, or the application thereof to any person or circumstances
shall,to any extent,be held invalid or unenforceable,the remainder of this Contract,or the application
of such terms or provision,to persons or circumstances other than those as to which it is held invalid
Page 38 of 46
or unenforceable, shall not be affected, and every other term and provision of this Contract shall be
deemed valid and enforceable to the extent permitted by law.
AR LE 24-PUBLIC ENTITY CRIMES
As provided in F.S. 287.132-133,by entering into this contract or performing any work in furtherance
hereof, the CLAIM ADMINISTRATOR certifies that it, its affiliates, suppliers, subcontractors and
CLAIM ADMINISTRATORs who will perform hereunder, have not been placed on the convicted
vendor list maintained by the State of Florida Department of Management Services within the 36
months immediately preceding the date hereof. This notice is required by F.S. 287.133(3)(a).
ARTICLE 25-MODIFICATIONS OF WORT{
The CITY reserves the right to make changes in Scope of Work, including alterations, reductions
therein or additions thereto. Upon receipt by the CLAIM ADMINISTRATOR of the CITY'S
notification of a contemplated change, the CLAIM ADMINISTRATOR shall, in writing: (1)provide
a detailed estimate for the increase or decrease in cost due to the contemplated change, (2)notify the
CITY of any estimated change in the completion date, and (3) advise the CITY if the contemplated
change shall affect the CLAIM ADMINISTRATOR'S ability to meet the completion dates or
schedules of this Contract.
If the CITY so instructs in writing, the CLAIM ADMINISTRATOR shall suspend work on that
portion of the Scope of Work affected by a contemplated change, pending the CITY'S decision to
proceed with the change.
If the CITY elects to make the change,the CITY shall initiate a Contract Amendment and the CLAIM
ADMINISTRATOR shall not commence work on any such change until such written amendment is
signed by the CLAIM ADMINISTRATOR and approved and executed by the City of Riviera Beach.
ARTICLE 26-NOTICE
All notices required in this Contract shall be sent by certified mail, return receipt requested, hand
delivery or other delivery service requiring signed acceptance. If sent to the CITY, notices shall be
addressed to:
(Name), Risk Manager
1481 W. 15th Street
Riviera Beach, FL 33404
With copy to:
Office of the City Attorney
1481 W. 15th Street
Riviera Beach, Florida 33404
If sent to the CLAIM ADMINISTRATOR,notices shall be addressed to:
Page 39 of 46
ARTICLE 27-ENTIRETY OF CONTRACTUAL AGREEMENT
The CITY and the CLAIM ADMINISTRATOR agree that this Contract sets forth the entire agreement
between the parties, and that there are no promises or understandings other than those stated herein.
None of the provisions, terms and conditions contained in this Contract may be added to, modified,
superseded or otherwise altered, except by written instrument executed by the parties hereto in
accordance with Article 25-Modifications of Work.
ARRTICLE 28-REGULATIONS: LICENSING REOUI] ,MENTS
The CLAIM ADMINISTRATOR shall comply with all laws, ordinances and regulations applicable
to the services contemplated herein, to include those applicable to conflict of interest and collusion.
CLAIM ADMINISTRATOR is presumed to be familiar with all federal, state and local laws,
ordinances, codes and regulations that may in any way affect the services offered.
ARTICLE 29-SCRUTINIZED COMPANIES
A. As provided in F.S. 287.135, by entering into this Contract or performing any work in
furtherance hereof, the CLAIM ADMINISTRATOR certifies that it, its affiliates,
suppliers, subcontractors and CLAIM ADMINISTRATORs who will perform
hereunder,have not been placed on the Scrutinized Companies that boycott Israel List,
or is engaged in a boycott of Israel, pursuant to F.S. 215.4725. Pursuant to F.S.
287.135(3)(b), if CLAIM ADMINISTRATOR is found to have been placed on the
Scrutinized Companies that Boycott Israel List or is engaged in a boycott of Israel,this
Contract may be terminated at the option of the CITY.
B. When contract value is greater than $1 million: As provided in F.S. 287.135, by
entering into this Contract or performing any work in furtherance hereof, the CLAIM
ADMINISTRATOR certifies that it, its affiliates, suppliers, subcontractors and
CLAIM ADMINISTRATORS who will perform hereunder, have not been placed on
the Scrutinized Companies With Activities in Sudan List or Scrutinized Companies
With Activities in The Iran Petroleum Energy Sector List created pursuant to F.S.
215.473 or is engaged in business operations in Cuba or Syria.
If the CITY determines,using credible information available to the public, that a false
certification has been submitted by CLAIM ADMINISTRATOR,this Contract may be
terminated and a civil penalty equal to the greater of$2 million or twice the amount of
this Contract shall be imposed, pursuant to F.S. 287.135. Said certification must also
be submitted at the time of Contract renewal, if applicable.
ARTICLE 30 - PUBLIC RECORDS
Notwithstanding anything contained herein, as provided under Section 119.0701, F.S., if the CLAIM
ADMINISTRATOR: (i) provides a service; and (ii) acts on behalf of the CITY as provided under
Section 119.011(2) F.S., the CLAIM ADMINISTRATOR shall comply with the requirements of
Section 119.0701, Florida Statutes, as it may be amended from time to time. The CLAIM
ADMINISTRATOR is specifically required to:
Page 40 of 46
A. Keep and maintain public records required by the CITY to perform services as provided
under this Contract.
B. Upon request from the CITY'S,provide the CITY with a copy of the requested records
or allow the records to be inspected or copied within a reasonable time at a cost that
does not exceed the cost provided in Chapter 119 or as otherwise provided by law. The
CLAIM ADMINISTRATOR further agrees that all fees,charges and expenses shall be
determined in accordance with Florida Statutes.
C. Ensure that public records that are exempt, or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law for the
duration of the contract term and following completion of the Contract, if the CLAIM
ADMINISTRATOR does not transfer the records to the CITY.
D. Upon completion of the Contract the CLAIM ADMINISTRATOR shall transfer, at no
cost to the CITY, all public records in possession of the CLAIM ADMINISTRATOR
unless notified by CITY'S representative/liaison, on behalf of the CITY'S Custodian
of Public Records,to keep and maintain public records required by the CITY to perform
the service. If the CLAIM ADMINISTRATOR transfers all public records to the CITY
upon completion of the Contract, the CLAIM ADMINISTRATOR shall destroy any
duplicate public records that are exempt, or confidential and exempt from public
records disclosure requirements. If the CLAIM ADMINISTRATOR keeps and
maintains public records upon completion of the Contract, the CLAIM
ADMINISTRATOR shall meet all applicable requirements for retaining public
records. All records stored electronically by the CLAIM ADMINISTRATOR must be
provided to CITY, upon request of the CITY'S Custodian of Public Records, in a
format that is compatible with the information technology systems of CITY, at no cost
to CITY.
Failure of the CLAIM ADMINISTRATOR to comply with the requirements of this article shall be a
material breach of this Contract. CITY shall have the right to exercise any and all remedies available
to it, including but not limited to, the right to terminate for cause. CLAIM ADMINISTRATOR
acknowledges that it has familiarized itself with the requirements of Chapter 119, F.S., and other
requirements of state law applicable to public records not specifically set forth herein.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF
CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE
PUBLIC RECORDS RELATING TO THIS CONTRACT,CONTACT THE CUSTODIAN OF
PUBLIC RECORDS OR DESIGNEE AT: CLAUDENE ROBINSON, CITY CLERK,
CROBINSON()RIVIERABEACH.ORG, 600 WEST BLUE HERON BLVD., RIVIERA BEACH,
FLORIDA 33404, 561-845-4090.
ARTICL 31 - COIjNTERPARTS
This Contract, including the exhibits referenced herein,may be executed in one or more counterparts,
all of which shall constitute collectively but one and the same Contract. The CITY may execute the
Contract through electronic or manual means. CLAIM ADMINISTRATOR shall execute by manual
means only,unless the CITY provides otherwise.
Page 41 of 46
ARTICLE 32 -E-VERIFY-EMPLOYMENT ELIGIBILITY
CLAIM ADMINISTRATOR warrants and represents that it is in compliance with section 448.095,
Florida Statutes, as may be amended, and that it: (1) is registered with the E-Verify System (E-
Verify.gov), and beginning January 1, 2021, uses the E-Verify System to electronically verify the
employment eligibility of all newly hired workers; and (2) has verified that all of CLAIM
ADMINISTRATOR's SUBCLAIM ADMINISTRATORs performing the duties and obligations of
this CONTRACT are registered with the E-Verify System,and beginning January 1,2021,use the E-
Verify System to electronically verify the employment eligibility of all newly hired workers.
CLAIM ADMINISTRATOR shall obtain from each of its SUBCLAIM ADMINISTRATORs an
affidavit stating that the SUBCLAIM ADMINISTRATOR does not employ, contract with, or
subcontract with an Unauthorized Alien, as that term is defined in section 448.095(1)(k), Florida
Statutes,as may be amended. CLAIM ADMINISTRATOR shall maintain a copy of any such affidavit
from a SUBCLAIM ADMINISTRATOR for, at a minimum, the duration of the subcontract and any
extension thereof. This provision shall not supersede any provision of this CONTRACT which
requires a longer retention period.
CITY shall terminate this CONTRACT if it has a good faith belief that CLAIM ADMINISTRATOR
has knowingly violated Section 448.09(1), Florida Statutes, as may be amended. If CITY has a good
faith belief that CLAIM ADMINISTRATOR's SUBCLAIM ADMINISTRATOR has knowingly
violated section 448.09(1), Florida Statutes, as may be amended, CITY shall notify CLAIM
ADMINISTRATOR to terminate its contract with the SUBCLAIM ADMINISTRATOR and CLAIM
ADMINISTRATOR shall immediately terminate its contract with the SUBCLAIM
ADMINISTRATOR. If CITY terminates this CONTRACT pursuant to the above, CLAIM
ADMINISTRATOR shall be barred from being awarded a future contract by CITY for a period of one
(1) year from the date on which this CONTRACT was terminated. In the event of such contract
termination, CLAIM ADMINISTRATOR shall also be liable for any additional costs incurred by
CITY as a result of the termination.
(Remainder of Page Intentionally Left Blank)
Page 42 of 46
WITNESSES: CLAIM ADMINISTRATOR:
Signature Company Name
Name(Type or Print) Signature
Signature Name(Type or Print)
(Name(Type or Print) Title
CITY OF RIVIERA BEACH,FLORIDA
ATTEST: Jonathan E.Evans,MPA,MBA
City Manager
Claudene Anthony, CMC
REVIEWED AS TO LEGAL SUFFICIENCY
DAWN S.WYNN,CITY ATTORNEY
Date
Page 43 of 46
EXHIBIT "A"
SCOPE OF WORK
(TBD)
EXHIBIT "B"
SCHEDULE OF PAYMENTS
(TBD)
Page 45 of 46
EXHIBIT "C"
INSURANCE REQUIREMENTS
CLAIMS ADMINISTRATOR shall provide, pay for and maintain in full force and affect at all times
during Contract insurance as set forth below: (This may be modified,as the City deems appropriate)
Type of Coverage AmounLaLCuragt
General Aggregate $2,000,000
Products/Completed Operations Aggregate $2,000,000
Personal and Advertising Injury $1,000,000
Each Occurrence $1,000,000 Annual Aggregate
Automobile(Body Injury and Property) $1,000,000 Each Occurrence
Worker's Compensation,as applicable $1,000,000 Per Accident
$1,000,000 Disease Each Employee
$1,000,000 Disease Policy Limit
Professional Liability Insurance $1,000,000 Per Occurrence/Annual Aggregate
Employee Dishonesty(Fidelity) $1,000,000 Each Occurrence
Cyber/Privacy Liability $1,000,000 Each Claim/Annual Aggregate CLAIMS
ADMINISTRATOR must maintain above insurance coverages in full force and effect,during
the life of this engagement. Certificates of liability insurance,satisfactory to the City,shall be furnished to
the City immediately upon commencement of any services, with complete copies of policies to be
furnished upon the City's request. Such certificates of insurance will provide the City with thirty(30)
days prior written notice of any cancellation or non-renewal.
The policies shall name the City as an additional insured,and proof of such coverage shall be furnished to the
City by way of an endorsement to same or a certificate of insurance no later than ten (10) days prior to
the provision of services under the awarded contract and upon renewal of each policy each year the
awarded contract remains in effect and for a period of one(1)year after the termination of the contract.
All such insurance must be with an insurance carrier approved and authorized to do business in the state of
Florida, and who must have a rating of no less than A VII by A.M. BEST RATING, or as mutually agreed
upon by the City and the successful Respondent. All such insurance policies may not be modified or
terminated without the express written authorization of the City. The insurance requirements set forth herein
may be modified by the City in its sole discretion in competitive negotiations.
Misrepresentation of any material fact, whether intentional or not, regarding the proposers insurance
coverage, policies or capabilities may be grounds for rejection of the proposal and rescission of any
resulting. All policies shall be endorsed to provide thirty (30) days prior written notice of
cancellation,non-renewal or reduction in coverage or limits to:
City of Riviera Beach
Attn: Risk Manager
1481 West 15th Street
Riviera Beach,FL 33404
Email:riskirivierabeach.ore
Page 46 of 46
3/3/26,4:28 PM Detail by Entity Name
DIVISION OF CORPORATIONS
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Department of State / Division of Corporations / Search Records / Search by Entity Name /
Detail by Entity Name
Florida Profit Corporation
PREFERRED GOVERNMENTAL CLAIM SOLUTIONS, INC.
Filing Information
Document Number P04000122261
FEI/EIN Number 20-1565528
Date Filed 08/24/2004
State FL
Status ACTIVE
Last Event NAME CHANGE AMENDMENT
Event Date Filed 11/19/2004
Event Effective Date NONE
Principal Address
2301 Maitland Center Parkway
Suite 450
Maitland, FL 32751
Changed: 02/21/2026
Mailing Address
PO Box 614004
Orlando, FL 32861
Changed: 02/21/2026
Bsgistered Agent Name &Address
CORPORATION SERVICE COMPANY
1201 HAYS STREET
TALLAHASSEE, FL 32301-2525
Name Changed: 09/18/2019
Address Changed: 09/18/2019
Officer/Director Detail
Name&Address
Title Director
https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDeta il?inquirytype=EntityName$directionType=ln itial&search NameOrder—PRE F ERR... 1/3
3/3/26,4:28 PM Detail by Entity Name
Patel, Dhara
701 B Street
Suite 1120
San Diego, CA 92101
Title Director
Heard, Michael
2301 Maitland Center Parkway
Suite 450
Maitland, FL 32751
Title President
Sepulveda, Kara
6240 Lake Osprey Drive
Sarasota, FL 34240
Title Director, Secretary, Treasurer
Kenneson, Paula
6240 Lake Osprey Drive
Sarasota, FL 34240
Title VP
Ruiz, Viviane
9588 Piccadilly Sky Way
Orlando, FL 32827
Annual Reports
Report Year Filed Date
2024 04/23/2024
2025 01/25/2025
2026 02/21/2026
Document Images
02/21/2026—ANN UAL BEFQBT View image In PDF format
91/25/2025—ANNUAL REPORT View image in PDF format
04/23/2024—ANNUAL REPORT View image in PDF format
04/09/2023—ANNUAL REPORT View image in PDF format
04/25/2022—ANNUAL REPORT View image in PDF format
04/24/2021—ANNUAL REPORT View image in PDF format
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1 RESOLUTION NUMBER 96-25
2
3 A Resolution of the City Council of the City of Riviera Beach, Palm Beach County,
4 Florida, authorizing the renewal for two additional one-year periods of the contract
5 with Preferred Governmental Claim Solutions, Inc. (PGCS) of Lake Mary, Florida,
6 for professional services related to Workers Compensation and Third-Party
7 Administration in the total amount of $274,254.00; authorizing the Director of
8 Finance and Administrative Services to make payments from Account No.
9 101152102-534000; and providing an effective date.
10
11 Whereas, the City of Riviera Beach awarded a professional services contract for
12 Workers' Compensation and Third Party Administration services to Preferred
13 Governmental Claim Solutions, Inc. (PGSC) through Bid No. 1072-22-3. The resulting
14 contract was executed on August 22,2022, for services through September 1, 2025; and
15
16 Whereas, included in the bid document was the option to renew for two
17 additional one-year periods. While both the City and PGCS intended for the contract to
18 offer the City the renewal options, the contract failed to specifically include the option
19 language; and
20
21 Whereas,the contractual language in Exhibit B of the contract allows the parties
22 to negotiate for years 4 and 5, while also specifying non-negotiated dollar amounts of
23 $135,100 for year 4 and $139,154 for year 5; and
24
25 Whereas, PGCS has provided the City with the required 30-day notice and has
26 submitted a formal request to exercise the Year 4 renewal option at the specified amount
27 of$135,100 for the period of August 17,2025,through September 1,2026; and
28
29 Whereas, the City can also accept a renewal option for Year 5 at the specified
30 amount of$139,154 for the period of September 1, 2026,to September 1, 2027; and
31
32 Whereas, this request is for approval of Year 4 and Year 5 renewals in the
33 amounts of$135,100 and $139,154 for a total of$274,254.
34
35 Now, therefore, be it resolved by the City Council of the City of Riviera
36 Beach,Palm Beach County, Florida as follows:
37
38 Section 1. The City Council hereby authorizes the Preferred Governmental
39 Claim Solutions, Inc. contract renewals for Year 4 and Year 5. A copy of the contract
40 information and Bid solicitation is attached hereto.
41
42 Section 2. The City Council hereby authorizes the payment of$135,100 for
43 Year 4 and$139,154 for Year 5 for a total of$274,254.
44
Resolution No. 96-25
Page 2 of 3
45 Section 3. Upon execution of two (2) original renewal agreements, one (1) fully
46 executed original shall be retained by the City Clerk for public record, and one fully
47 executed original shall be provided to Preferred Governmental Claim Solutions, Inc.
48
49 Section 4. This Resolution shall take effect immediately upon its passage and
50 approval by the City Council.
51
52
53 Passed and Adopted this 20 day of August ,2025.
54
55
Resolution No. 96-25
Page 3 of 3
56
57
58
59 APPROVED:
60
61
62 Dougl Lawson
63 Mayor
64
65 Attest:67 41/441-,
68 Debrah Hall
69 Acting City Clerk
70 Certified Municipal Clerk
71
72
73
74
75 MOTIONED BY: B. GUYTON
76
77 SECONDED BY: 1Z- MTT.T.RR-ANnvpcn Q
78
79 B. GUYTON: AY
80
81 K. MILLER-ANDERSON: _YE_
82
83 S. LANIER: _YE
84
85 G. SPIRITIS: AYE
86
87 F. DAVIS-PANIER: _
88
89
90 Rc iewe o Legal Sufficiency
91
92
93 n S.Wynn
94 City Attome
95 Q' )b145
96 Date: O /
Li 416
2301 Maitland Center Parkway,Suite 450
Maitland, Florida 32751
Claim Services
321-832-1400
July 18,2025
Stephen Gude, SHRM-CP, CEBS
Senior Human Resources Manager
Human Resources, Risk Management Division
City of Riviera Beach
1481 W 15th St.
Riviera Beach, FL,33404
Via:sgude@rivierabeach.org
Reference: Worker's Compensation and Liability Third Party Administrator(TPA) Services - PGCS
Dear Mr. Gude:
Please find the attached City of Rivera Beach agreement dated August 17, 2022 through September 1, 2025.
We would formally request to exercise the Renewal Option Year 4. In line with our contract.
August 17, 2025—September 1,2026
Year 4: $135,100
Respectfully submitted,
Viviane Ruiz
President, Workers' Compensation, Managed Care &Ancillary Services
viviane.ruizna.usis-toa.com
407.373.6240
Please execute below:
City of Riviera Beach
Sign: ^1X.4— Date: C/ 3 17-0?--C--- Reviewed as to egal Siff iency
Name: ��t ��` t���.._ Title: 1\101,4.4 a1--/
Da Wynn, , ,
Cit1yAttorney
Preferred Governmental Claim Solutions, Inc.(PGCS) Date: 2' ,
Sign: .fi ',)
0 Date: 7/18/2025
Name: Viviane Ruiz Title:President, Workers' Compensation,
Managed Care&Ancillary Services
Attachment: City of Rivera Beach Agreement
EXHIBIT B
PREFERRED GOVERNMENTAL CLAIM SOLUTIONS, INC. (PGCS) PROPOSAL
Piggyback Contract—Preferred Governmental Claims Solutions,Inc.(PGCS)COBB Contract#26-041 PB 10
Claim Services
Fee Proposal
New Claims Annual Monthly
Workers Compensation $39,000
Liability $78,000
Total $117,000 I $9,750
Workers' Compensation
Service PGCS Fee Monthly
Flat Fee
WC Claims Flat Fee $39,000* $3,250
Report Only Claims I Included
Medicare 111 Filing (per claim) I Included I
Claim Intake (per claim) I Included I
Final Claim Filing (per claim) I Included I
TCM (per hour) I$85 I
Medical Bill Review(per bill) $7.00 + 27% savings
(Nuplico chates)arge for
D
Mail EOB to Provider(per bill) I Included
Open Claims I No Charge
Liability
Service PGCS Fee Monthly
Flat Fee
Flat Fee $78,000 $6,500
GL Claims Flat Fee 'Need Full Loss Run I
Report Only Claims—No Charge I Included I
Other Ancillary Fees I PGCS Fee 1
Loss Control Services (per $165
hour)
Medical Bill Review $7.00 + 27% savings (per bill) (No charge for
Duplicates)
Telephonic Nurse Case $85
Management (per hour)
Subrogation 20% of Recovery
On Site Training (per hour) 11 per included per year
System Reports lIncluded
Claim Review Meetings I Included
Annual Stewardship Included
Meetings
Technical Conversion Fee $6,000
(ONE TIME Charge)—both
conversions
Annual Admin Fee (WC & $4,000
Liability Combined)
Compliance,
Technology, Data Trends,
Traininas.
Pricing and Service Overview
• Annual increase of CPI or 3.0%, whichever is less.
• Workers' Compensation (WC) Pricing: Based on estimated annual claim volume, averaging
approximately 30 Medical Only (MO) and 50 Lost Time (LT) claims per year. We reserve the
right to renegotiate if volume exceeds the average by over 20%.
• Liability Pricing: Determined by an average annual claim volume of approximately 100
reported claims. We reserve the right to renegotiate if volume exceeds the average by over
20%.
• Rebound Pro Integration: Available to support Return-to-Work (RTW) coordination.
• Medical Bill Review & Telephonic Case Management: These services are allocated directly
to the individual claim file and are not included in the monthly flat fee. No charges are
applied for duplicate medical bill submissions.
• Annual Fee: Does not include claim-specific costs allocated to individual files.
• Preferred Agreement: Auto PD and Property Claims are currently managed by PGCS under
an existing preferred vendor agreement and not included into this pricing proposal.
• Pricing is subject to review and potential renegotiation if annual claim volume fluctuates by
more than 20%.