COMPETITIVE SEALED PROPOSAL

Transcription

1 PROPOSAL INVITATION RFP No: Purchasing Services CITY OF WACO P. O. Box 2570 Waco, Texas Fax: City of Waco Purchasing Commodity/Service: COMPETITIVE SEALED PROPOSAL INVITATION COVER SHEET Third Party Administrator for Worker s Compensation Proposal Due/Closing Time: 2:00 P.M. CST, July 24, 2015 Proposal Opening Time: 2:01 P.M. CST, July 24, 2015 Proposal Opening Location: Purchasing Services Office 1415 North 4 th Street, Waco, Texas, For Information Contact: Mr. Jody Copp, Purchasing Services, Proposal packet and other supportive documents can be found at the City of Waco Purchasing website, Demandstar or the Electronic State Business Daily Firm: Signature of Person Authorized to Sign: Signor s Name and Title (print or type): Date: Fax: Telephone: Federal Tax I. D. Number: County of Business: Page 1 of 59

2 RFP NO TABLE OF CONTENTS Failure to provide all requested forms in a timely manner may result in the proposal being considered non-responsive and rejected. Pages that MUST be returned with the proposal are denoted with a *. Cover Sheet (Page 1) Table of Contents (Page 2) Advertisement for Proposals (Page 3) Instructions to Proposers (Page 4) Insurance, Bonding and Indemnification Requirements (Page 6) Award of Contract (Page 10) Elements of Contract (Page 10) Scope of Work (Page 11) Submission of Proposals (Page 22) Evaluation Procedures (Page 23) Terms and Conditions (Page 25) Proposal Document Section Business Entity Identification (Page 30) * Drug-Free Workplace Act Certification (Page 34) Minority/Women Owned Business (Page 35) Instructions for Conflict of Interest Questionnaire (Page 36) Conflict of Interest Questionnaire (Page 38) Disclosure of Relations with City Council Member, Officer or Employee of City of Waco (Page 39) Instructions for Completing Debarment, Suspension, Ineligibility and Voluntary Exclusion Certification (Page 40) Debarment, Suspension, Ineligibility and Voluntary Exclusion Certification (Page 41) Litigation Disclosure (Page 42) Texas Public Information Act (Page 43) Bid Protest Procedure (Page 44) Appendix A Proposer s Qualifications Questionnaire (Page 45) Appendix B Proposer s Scoop of Service Questionnaire (Page 49) Appendix C Proposer s Pricing/Fee Schedule Questionnaire (Page 56) Appendix D Statistical Data (Page 59) NOTE: As used in this document, the term bidder/proposer, vendor and contractor shall mean a person or entity submitting a response to this RFP. In some cases, as determined by context, the term bidder/proposer, vendor and contractor shall refer to the person or entity that submits a proposal and/or who is awarded the contract by the City. Page 2 of 59

3 ADVERTISEMENT FOR PROPOSALS PROPOSAL INVITATION RFP NO City of Waco (Owner) Sealed proposals for Third Party Administrator for Worker s Compensation for the City of Waco will be received by the CITY OF WACO in the office of Purchasing Services, 1415 North 4th Street, Waco, Texas, until 2:00 P.M. on July 24, 2015 and will be opened and publicly read at 2:01 P.M. in the office of Purchasing Services on the same day. The Buyer for this project is Mr. Jody Copp and he may be reached at or jodyc@wacotx.gov with questions. Mailing address is Purchasing Services, P.O. Box 2570, Waco, Texas, The owner reserves the right to waive any informality or to reject any and all proposals. No bidder/proposer may withdraw their proposal within 90 days after the actual date of the proposal opening. Page 3 of 59

4 INSTRUCTIONS TO PROPOSERS Tentative Schedule (This is a tentative schedule only and is subject to change) Deadline for Technical Questions: 5:00 P.M., July 15, 2015 RFP Responses Due: 2:00 P.M., July 24, 2015 Analysis of the Proposals and Interviews: No later than August 7, 2015 Notify proposers of award recommendation August 10, 2015 Recommendation to City Council/Award September 1, 2015 Effective Date of Contract October 1, 2015 Receipt and Opening of Proposals The CITY OF WACO, herein called the Owner, requests proposals on the form attached hereto, all blanks of which must be appropriately completed. Sealed proposals will be received in the office of Purchasing Services, 1415 North 4th Street, Waco, Texas, until 2:00 P.M. on July 24 and will be opened and publicly read at 2:01 P.M., in the Office of Purchasing Services on the same day. The envelope containing the proposal shall be plainly marked, Third Party Administrator for Worker s Compensation, RFP , 2:00 P.M., July 24, The Owner reserves the right to consider any proposal not prepared and submitted in accordance with the provisions hereof and may waive any informality and reject any or all proposals. Proposals received after the advertised closing time and date shall not be considered and will be refused and returned unopened to the bidder/proposer. No bidder/proposer may withdraw a proposal within 90 days after the date and time of the proposal opening. How To Package Your Proposal One (1), unbound, clearly marked Original and one (1) electronic version on standard CD-ROM in Adobe Acrobat format (PDF) of your proposal must be submitted: (1) inside a sealed envelope and (2) clearly marked on the outside with the RFP number, opening date and Third Party Administrator for Worker s Compensation. Proposals may be mailed or hand delivered to: Via US Mail: City of Waco Purchasing Services P.O. Box 2570 Waco, Texas ATTN: Mr. Jody Copp Note: Proposals must arrive in Purchasing to be date and time stamped before the closing date and time. Mail early to allow for delays in delivery. What is NOT Accepted Via Delivery Services: City of Waco Purchasing Services 1415 North 4 th Street Waco, Texas ATTN: Mr. Jody Copp Note: US Mail does NOT deliver to this street address A bid/proposal submitted by facsimile transmission (fax) or by electronic mail ( ) will NOT be accepted. A bid/proposal submitted or received after the deadline for submitting a bid/proposal (as stated above) will NOT be considered under any circumstances and will be returned unopened to the submitter. Page 4 of 59

5 Opened Proposal A Proposal may not be opened before the closing date for the purpose of changing or amending the proposal or to correct an error in the proposal terms or conditions. If the proposal is opened before the closing date by anyone other than the City, the proposal may be rejected in its entirety. Recycled Products Bidders/Proposers are encouraged to offer products that are produced with recycled materials, where appropriate, unless otherwise requested in the specifications. Authorized Signature A proposal must be manually signed by a person having authority to contractually bind the bidder/proposer. Any erasures or other changes must be initialed by the person authorized to sign the proposal, or by others who are able to show evidence of authority to execute or sign on behalf of the bidder/proposer. Addenda and Interpretations No interpretation of the meaning of the RFP documents will be made to any bidder/proposer orally. Every request for such interpretation should be in writing addressed to the contact person listed for this project, by to the contact person, by facsimile, or by mail to Purchasing Services, City of Waco, P. O. Box 2570, Waco, TX and to be given consideration must be received at least five days prior to the date fixed for the opening of proposals. If a deadline for technical questions is included in the timeline in this proposal package, that deadline will be adhered to instead of receiving questions up until five days prior to proposal opening. Any and all such interpretations and any supplemental instructions will be in the form of written addenda to the specifications which, if issued, will be advertised as required by law. Failure of any bidder/proposer to receive any such addendum or interpretation shall not relieve such bidder/proposer from any obligation under his proposal as submitted. All addenda so issued shall become part of the contract documents. Any non-written representations, explanations, or instructions given by City staff or City agents are not binding and do not form a part of, or alter in any way, the RFP, a written agreement pertinent to the RFP, or the awarding of the contract. Laws and Regulations The bidder/proposer s attention is directed to the fact that all applicable State laws, municipal ordinances, and the rules and regulations of all authorities having jurisdiction over the project shall apply to the contract throughout and they will be deemed to be included in the contract the same as though herein written out in full. Right to Accept or Reject The City reserves the right to accept or reject any or all proposals as a result of this RFP, to negotiate with all qualified sources, or to cancel in part or its entirety if found to be in the best interest of the City. The RFP does not commit the City to award a contract, issue a purchase order or pay any costs incurred in the preparation of a proposal in response to this RFP. Proposals may be held for ninety (90) days after opening without taking action. Page 5 of 59

6 City Council Approval Required The Waco City Council must approve the bidder/proposer selected to provide the service requested in this RFP. Each proposal should be submitted as completely and accurately as possible. Method of Award The contract will be awarded to the responsible offeror whose proposal is determined to be the most advantageous to the City considering the relative importance of the evaluation factors included in the RFP. Obligation of Bidder/Proposer At the time of the opening of proposals each bidder/proposer will be presumed to have read and to be thoroughly familiar with the RFP documents, including all addenda. The failure or omission of any bidder/proposer to examine any form, instrument or document shall in no way relieve any bidder/proposer from any obligation in respect to his proposal. Restrictions on Contact with City of Waco Staff or the Waco City Council Prospective proposers are advised that, from the date this RFP is issued until the award of any resultant contract, they are not permitted, except in public meetings, to contact City of Waco staff or members of the Waco City Council about ANY matter related to this solicitation. All questions must be sent to Mr. Jody Copp, preferably via . Insurance, Bonding and Indemnification Requirements a. Insurance: 1. Subject to the Selected Proposer s right to maintain reasonable deductibles in such amounts as are approved by the City, the Selected Proposer shall obtain and maintain in full force and effect for the duration of the services to be performed under the contract, and any extension hereof, at the Selected Proposer s sole expense, insurance coverage written on an occurrence basis, IN THE FOLLOWING TYPES AND AMOUNTS: Type Amount Workers' Compensation Statutory Employer s Liability $1,000,000/$1,000,000/$1,000,000 Comprehensive General Liability Including: Premises/Operations Independent Contractors Products/Completed Operations Personal & Advertising Injury Explosion, Collapse, Underground * Broad form property damage, to include fire legal liability * $1,000,000 per occurrence; $2,000,000General Aggregate, or its equivalent in Umbrella or Excess Liability Coverage Page 6 of 59

7 Business Automobile Liability * a. Owned/leased vehicles b. Non-owned vehicles c. Hired vehicles Professional Liability $500,000 $1,000,000 per occurrence or its equivalent on a combined single limit (CSL basis). Security and Privacy Liability * If applicable. $1,000,000 for Network Security & Privacy Security $500,000 sublimit for Crisis Management & Customer Notification. All insurance policies, except workers compensation and employer s liability, will name the City of Waco as an additional insured. For Workers Compensation and Employer s Liability the Contractor will provide and maintain this coverage and provide a waiver of subrogation in the favor of City of Waco. b. Term of Policy. The required coverage must remain in effect for a two (2) year period following the expiration of the contract with the City. c. Proof of Insurance Required. 1. Examination & Approval. Insurance policies shall be subject to the examination and approval of the City for their adequacy as to form and content, form of protection, and insurance company. 2. When to Submit. Within ten (10) days after execution of the contract and prior to the commencement of any work or services under this contract, the Selected Proposer shall furnish to the Risk Manager for City originals of completed certificates of insurance, policy endorsements, exclusions, and/or relevant extracts from the insurance policy, or copies of the policies, plainly and clearly evidencing such insurance. Thereafter new certificates, policy endorsements, exclusions, and/or relevant extracts from insurance policies, or policies shall be provided prior to the expiration date of any prior certificate, endorsement, or policy. 3. Insurers. The Selected Proposer shall maintain said insurance with insurance underwriters authorized to do business in the State of Texas and satisfactory to the City. 4. Additional Insured. Except for Workers Compensation and Employers Liability, the City, its elected officials, officers, servants, agents, volunteers and employees shall be named as additional insured. No officer or employee, other than the Risk Manager shall have authority to waive this requirement. 5. Other-Insurance Endorsement. Where the City is an additional insured shown on the policy, there shall be a provision or endorsement stating that any other insurance clause shall not apply to the City. 6. Agent Information. The certificate(s) must be completed by an agent authorized to bind the named underwriter(s) and their company to the coverage, limits, and termination provisions shown thereon, containing all required information referenced or indicated thereon. The original certificate(s) or form must have the agent s original signature, including the signer s company affiliation, title and phone number, and be mailed directly from the agent to the City. 7. Precondition to Performance & Basis for Termination. The City shall have no duty to pay or perform under the contract until such certificate(s), policy endorsements, exclusions, and/or relevant extracts from the insurance policy shall have been delivered to the City s risk Page 7 of 59

8 manager. The Selected Proposer understands that it is its sole responsibility to provide this necessary information to the City and that failure to timely comply with the requirements of this section shall be a cause for termination of this Agreement. If the City determines that it will deny payment, not perform, or terminate this contract because of the failure to provide certain information or documents, the City shall give the Selected Proposer notice of that determination and allow the Selected Proposer fifteen days to correct the deficiency. 8. Waiver of Subrogation. Workers compensation and employers liability policies will provide a waiver of subrogation in favor of the City. 9. Notice of Cancellation, Non-renewal, Material Change. When there is a cancellation, nonrenewal, or material change in coverage which is not made pursuant to a request by the City, the Selected Proposer shall notify the City of such and shall give such notices not less than thirty (30) days prior to the change, if the Selected Proposer knows of said change in advance, or ten (10) days notice after the change, if the Selected Proposer did not know of the change in advance. Such notice must be accompanied by a replacement certificate(s) of insurance, policy endorsements, exclusions, and/or relevant extracts from the insurance policy. d. INDEMNIFICATION: IF THE SELECTED PROPOSER FAILS TO PROVIDE SUCH INSURANCE NAMING CITY AS ADDITIONAL INSURED, THEN THE SELECTED PROPOSER AGREES TO ASSUME FULL RESPONSIBILITY AND LIABILITY FOR THE SERVICES RENDERED UNDER THE RESULTING AGREEMENT, AND HEREBY AGREES TO INDEMNIFY, PROTECT AND HOLD HARMLESS THE CITY, ITS EMPLOYEES, AGENTS AND SERVANTS, OF AND FROM ALL CLAIMS, DEMANDS, AND CAUSES OF ACTIONS OF EVERY KIND AND CHARACTER, INCLUDING THE COST OF DEFENSE THEREOF, FOR ANY INJURY TO, INCLUDING DEATH OF, PERSONS AND ANY LOSSES FOR DAMAGES TO PROPERTY CAUSED BY OR ALLEGED TO BE CAUSED, ARISING OUT OF, OR ALLEGED TO ARISE OUT OF, EITHER DIRECTLY OR INDIRECTLY OR IN CONNECTION WITH THE SERVICES TO BE RENDERED UNDER THE RESULTING CONTRACT, WHETHER OR NOT SAID CLAIMS, DEMANDS, CAUSES OF ACTIONS ARE CAUSED BY THE SOLE NEGLIGENCE OF THE CITY, ITS EMPLOYEES, AGENTS, OR SERVANTS, OR WHETHER IT WAS CAUSED BY CONCURRENT NEGLIGENCE OF THE CITY AND A PARTY TO THE RESULTING AGREEMENT, OR WHETHER IT WAS CAUSED BY CONCURRENT NEGLIGENCE OF THE CITY AND SOME OTHER THIRD PARTY. IF THE SELECTED PROPOSER PROVIDES THE APPROPRIATE INSURANCE NAMING CITY AS AN ADDITIONAL INSURED, THEN THIS SECTION SHALL NOT APPLY. THE SELECTED PROPOSER FURTHER AGREES TO WAIVE ANY AND ALL CLAIMS AND SUITS COVERED BY THIS INDEMNITY AGREEMENT AND AGREES THAT ANY INSURANCE CARRIER INVOLVED SHALL NOT BE ENTITLED TO SUBROGATION UNDER ANY CIRCUMSTANCES AGAINST THE CITY, IT OFFICERS, OFFICIALS, AND EMPLOYEES. e. If the services of the selected proposer include engineering or architectural services, the following indemnification shall apply to such engineering or architectural services: 1. INDEMNIFICATION: IF THE SELECTED PROPOSER FAILS TO PROVIDE INSURANCE IN ACCORDANCE WITH THE INSURANCE PROVISIONS OF THE RESULTING CONTRACT, THE SELECTED PROPOSER AGREES TO ASSUME FULL RESPONSIBILITY AND LIABILITY FOR THE WORK PERFORMED UNDER THE RESULTING CONTRACT AND HEREBY AGREES TO INDEMNIFY, HOLD HARMLESS, AND DEFEND THE CITY OF WACO, ITS OFFICERS, AND EMPLOYEES FROM ALL CLAIMS, DEMANDS, AND CAUSES OF ACTION OF Page 8 of 59

9 EVERY KIND AND CHARACTER ARISING FROM THE PERSONAL INJURY OR DEATH OF THE SELECTED PROPOSER OR AN OFFICER, AGENT, OR EMPLOYEE OF THE SELECTED PROPOSER CAUSED BY OR ALLEGED TO BE CAUSED BY, OR ARISING OUT OF OR ALLEGED TO ARISE OUT OF, AN ACT OF NEGLIGENCE OR INTENTIONAL TORT OF THE SELECTED PROPOSER OR AN OFFICER, AGENT, OR EMPLOYEE OF THE SELECTED PROPOSER IN CONNECTION WITH THE RESULTING CONTRACT OR THE ACTIVITIES TO BE PERFORMED THEREUNDER. THE SELECTED PROPOSER SHALL FURTHER INDEMNIFY AND HOLD HARMLESS THE CITY OF WACO, ITS OFFICERS, AND EMPLOYEES FROM ALL CLAIMS, DEMANDS, AND CAUSES OF ACTION OF EVERY KIND AND CHARACTER ARISING FROM THE ACTIONS OF THE SELECTED PROPOSER OR AGENTS OR EMPLOYEES OF THE SELECTED PROPOSER CAUSED BY OR ALLEGED TO BE CAUSED BY, OR ARISING OUT OF OR ALLEGED TO ARISE OUT OF, AN ACT OF NEGLIGENCE OR INTENTIONAL TORT OF THE SELECTED PROPOSER OR AN OFFICER, AGENT, OR EMPLOYEE OF THE SELECTED PROPOSER IN CONNECTION WITH THE RESULTING CONTRACT OR THE ACTIVITIES TO BE PERFORMED THEREUNDER. Page 9 of 59

10 1. AWARD BY CITY COUNCIL I. AWARD OF CONTRACT After negotiation with the top-ranked proposer and upon staff recommendation, the Waco City Council will make the final award of a contract for the services to be performed in accordance with this RFP. 2. RESERVATIONS BY CITY The City has the right to accept, reject, or cancel any and all proposals. In addition, the City expressly reserves the following: a. waive any defect, irregularity, or informality in any proposal or proposal procedure; b. extend the RFP closing time and date; c. reissue this RFP in a different form or context; d. procure any item by other allowable means; e. waive minor deviations from specifications, conditions, terms, or provisions of the RFP, if it is determined that waiver of the minor deviations improves or enhances the City s business interests under the RFP; AND/OR f. extend any contract when most advantageous to the City, as set forth in this RFP. 1. RFP AN INVITATION II. ELEMENTS OF CONTRACT This Request for Proposal is an invitation for companies to submit proposals. It is not a request for bid or a contract and has no legal binding effect upon the City. 2. PROPOSAL IS OFFER The proposal submitted by a proposer is an offer to contract with the City for the services requested in the RFP. 3. AWARD IS ACCEPTANCE The selection of a proposal or proposals, reflecting the agreements reached between the City and the proposer during the negotiation process, and award by the Waco City Council is acceptance on the part of the City, thereby resulting in a binding contract between the City and the selected proposer. 4. CONSIDERATION Consideration consists of the services to be performed under the contract awarded in exchange for compensation to be paid by the City to the selected proposer. 5. AGREEMENT; EXCEPTIONS a. Submission of a proposal indicates the proposer agrees to the terms, conditions, and other provisions contained in the RFP, unless the proposer clearly and specifically presents in its proposal any exceptions to the terms, conditions, and other provisions contained in the RFP. b. Exceptions presented in a proposal are not to be considered incorporated into the contract Page 10 of 59

11 between the City and the selected proposer unless and until the City agrees to accept such exceptions. c. The selected proposer must acknowledge and agree that the contract resulting from this RFP includes the terms, conditions, and other provisions contained in the RFP, the proposal selected (including any exceptions accepted by the City) which is acceptable to the City and is not in conflict or contravention of the RFP, and any other documents mutually agreed upon by the City and the selected proposer. d. No oral statement of any person shall modify or otherwise change or affect the terms, conditions, or specifications stated in the RFP or the resulting contract. 1. GENERAL INFORMATION III. SCOPE OF WORK a. A committee consisting of City of Waco staff and designees will evaluate submitted proposals. During the evaluation process, the Evaluation Committee and the City of Waco reserve the right, where it may serve the City of Waco s best interest, to request additional information or clarifications from proposers. b. The City of Waco reserves the right to retain all proposals submitted and to use any ideas in a proposal regardless of whether that proposal is selected. Submission of a proposal indicates acceptance by the proposer of the conditions contained in this request for proposals, unless clearly and specifically noted in the proposal submitted and confirmed in the contract between the City of Waco and the proposer selected. c. It is anticipated the selection of an Administrator will be completed by July 31, Following the notification of the selected Administrator, it is expected a contract will be negotiated between the parties by August 7, 2015, which will be sent to the City Council for approval. 2. NATURE OF SERVICES REQUIRED a. Introduction 1. The City of Waco (the City) is located in central Texas between Dallas and Austin. The City operates under a Council-Manager form of government and provides the following services as authorized by its Charter: public safety (police and fire), highways and streets, utilities, health and social services, parks, culture-recreation, public improvements, planning-zoning, and general administrative services. The number of City employees is approximately 1,500. The City operates a self-funded workers compensation program that is currently administrated by Tristar Risk Management Group. The current excess workers compensation insurance policy carries a Self-Insured Retention of $500,000 for non-sworn and $600,000 for sworn. 2. The City operates an Employee Health Clinic (EHS) with an occupational doctor in clinic 15 hours a week. There are 2 full time nurses on staff, 7:00am 4:30pm Monday through Friday. All non-emergency work related injuries report to EHS for initial treatment. If the doctor is not in clinic, the nurses triage the injury to determine if the employee needs to immediately be seen by a doctor. If the patient needs immediate treatment, they are referred to an outside clinic; if not, then an appointment is made with the doctor during clinic hours. 3. The City of Waco, Texas is soliciting proposals from organizations qualified to perform professional claims administration and risk management services for the City s self-funded Workers' Compensation Program. The selected vendor or vendors will provide services for existing and future workers compensation claims. We are seeking proposals preferably with flat fixed annual rates and three year flat fixed rates as an option. Page 11 of 59

12 4. The City may elect to select one or more providers for adjusting, medical bill review, loss control, and other services associated with the handling of workers compensation claims for an agreed to period beginning upon the authorization of the City Council. b. Scope of Work 1. The City is requesting proposals for a contract for Worker s Compensation Third Party Claim Administration Services, and associated services in accordance with the requirements specified herein and including all provisions set forth in the accompanying documentation. 2. City Responsibilities i The City shall handle incident-only reports, however, TPA must allow claim information to be entered into the database by City. ii The City shall provide the TPA detailed information related to each new claim and additional information as necessary throughout the life of the claim. iii The City shall forward claim reports and any available information about the claim to the TPA. iv The City shall assist the TPA in the investigation of a claim, make City staff available for assistance and for interviews, and give general direction as appropriate. 3. TPA Responsibilities i General (a) TPA shall aggressively manage all workers compensation claims presented by the City according to the professional standards of the Firm and the City s requirements, and to act as the City s representative in matters relating to the workers compensation laws of the state of Texas. A copy of the TPA s professional standards, including turnaround-time benchmarks, must accompany your proposal. (b) TPA shall make recommendations regarding the City s claims processes and procedures. (c) TPA shall cooperate completely with the City, City s Risk Consultant and adjusters/attorneys of the excess insurance carrier. TPA shall respond to inquiries within one business day. (d) TPA, at no additional cost to the City, shall provide dedicated claims handling staff licensed in the State of Texas to include at a minimum 1 indemnity/medical adjuster, a supervisor, and support staff. The support staff need not be dedicated but must be sufficient to address City claims volume and customer service standards. (e) TPA, at no additional cost to the City, agrees to collaborate with the City regarding language used in standard letters, filings, and documents. (f) TPA, at no additional cost to the City, agrees that the City shall have reasonable access to all claim files. Reasonable shall be deemed as within 2 hours of request. Moreover, the City requests the ability to have real time and immediate access to your web-based claims system. (g) TPA, at no additional cost to the City, agrees that the City shall have right, title, interest and ownership of all claim data, statistics, electronic media, and claim files including attendant managed care information assembled in the handling of the account. At the sole option of the City and upon ten (10) working days notice the TPA shall return such material to the City in a form agreeable to the City. (h) TPA, at no additional cost to the City, will meet with the City s risk manager at least quarterly to review the status and/or handling of all open claims and any other matters at the discretion of the City. An annual stewardship meeting will also be conducted. (i) TPA, at no additional cost to the City, must provide City employees (injured workers) access to claims staff. (j) TPA shall designate one individual as the primary contact on items not directly related Page 12 of 59

13 to specific claims. TPA shall ensure that secondary contacts are available in the event of the primary contact s absence. (k) TPA, at no additional cost to the City, shall provide access to and cooperate with independent claims and/or financial auditors retained by the City and information requested under the Texas Open Records Act. (l) TPA shall supply a list of all potential servicing personnel with a current resume of each designated adjuster(s) who will handle City claims. Any additional personnel to be involved in City claims handling at a later date should have a resume submitted for prior consultation with the City. Minimum qualifications for personnel handling City claims: Position Qualifications Account Manager Minimum of five years experience in workers Compensation, including public entity claims. Adjuster Workers Compensation Minimum of four years experience handling workers compensation claims, preferably for Texas public entities. (m) TPA shall provide access to Employee Benefits and Risk Management staff to TPA sponsored or hosted seminars and continuing education opportunities. ii Claims Handling (a) TPA shall review all DWC-1 s for compensability within 7 days of receipt and make the necessary filings attendant thereto. (b) Timely documenting of 3 point contact (injured worker, medical provider and City) within 48 hours on lost time claims and 72 hours on medical only claims. (c) Initiating weekly benefits within statutory time constraints. (d) Maintaining and documenting weekly contact with injured workers on active TIBS claims. In situations where contact is not made document the reason for lack of contact. TIBS should not be paid until off work status is verified with doctor and confirmed by City by filing the appropriate DWC form. (e) Maintaining and documenting regular contact with treating physicians. In situations where contact is not made document the reason for lack of contact. (f) Supervisor shall create a claim file workflow to ensure timely claim processing and handling. (g) Exhibit sound and timely file notes documentation practice. (h) Identifying, demonstrating and documenting medical management techniques such as procurement of treatment plans, disputing and/or questioning unrelated, unreasonable or unnecessary treatment protocols based on the reported injury, medical necessity and treatment guidelines. (i) Comply with statutory constraints regarding the state filings for administrative, medical and indemnity payments. (j) TPA shall, at its expense, provide Index Bureau checks on all indemnity files and medical only files with reserves of $ or above. (k) TPA shall cooperate with any medical cost containment, case management, risk management, investigations, law firm or any other organization designated by City. (l) TPA shall add no fees, charges, premiums in any amount to the actual cost to the TPA for subcontracted or vendor services. (m) For services sub-contracted out, TPA shall be the managing Administrator. TPA shall Page 13 of 59

14 disclose any financial arrangement referencing subcontractors and/or vendors for the related services sought herein. TPA s should highlight any internal profit centers established. (n) Medical Cost Containment services may be provided by the TPA or outsourced to a Medical Cost Containment provider. Proposer may submit up to two options with proposal; however, the Pricing/Fee schedule Other Services form must be submitted for each option. (o) Prescription benefit management (PBM) services may be provided by TPA or outsourced. Details should be provided in the Proposal Form. (p) TPA, at no additional cost to the City, shall pursue Designated Doctor (DD), Independent Medical Exam (IME) and/or Required Medical Exam (RME) routinely and provide a mechanism within the claim handling realm to furnish the examiner sufficient information upon which to base their medical opinion. Both parties shall establish mutually agreed upon procedures for accessing and assigning these services when applicable. (q) TPA shall pursue Peer Reviews judiciously, but routinely and provide a mechanism within the claim handling realm to furnish the reviewer sufficient information upon which to base their medical opinion. Both parties shall establish mutually agreed upon procedures for accessing and assigning these services when applicable. (r) Private Investigation, may be incorporated into the larger scope of claims management and cost containment strategies. However, any investigations of this nature must be done with the direct knowledge and prior approval of City. (s) TPA, at no additional cost to the City, shall assist City in identifying and reporting claims to the City s Excess Workers Compensation carriers as required by the carrier. TPA will also simultaneously notify City and/or designee of claims reported. (t) If an Adjuster is out for more than 10 consecutive days, proposer shall provide an acceptable substitute for the period of absence at no additional charge to the City. iii Financial Oversight (a) TPA, at no additional cost to the City, shall cooperate with the City in identifying duplicate and overpayments made by TPA. Where the reason for duplicate or overpayment is TPA s failure to act according to generally accepted standards, the TPA shall report to the City on a running monthly basis and make monthly arrangements to reconcile any such overpayments against anticipated fees. (b) TPA shall set reserves within a reasonable time after receipt taking into consideration the injury, medical information available, anticipated income benefit exposure and other allocated loss adjustment expenses applicable to the claims handling services. Once exposure is reasonably clear (within the first days of handling) TPA shall set reserve at what it considers the life of the file. Reserve changes after 60 days shall be accompanied by file note indicating what circumstance served to change the evaluation of the exposure from that of the day reserve. (c) TPA, at no additional cost to the City, shall provide periodic information to and cooperate with the City s actuarial service and/or loss forecasting evaluations. (d) TPA, at no additional cost to the City, shall identify, document and pursue contribution and subrogation as necessary within 30 days of receipt of claim. Any agreement to compromise a lien must be approved beforehand by the City. iv Information Management System (a) TPA, at no additional cost to the City, shall provide access to claim s system at City offices for no less than 6 users and provide the attendant training and support. (b) The access shall allow the creation of ad hoc reports as well as the standard package of Page 14 of 59

15 system reports. (c) TPA, at no additional cost to the City, shall make the necessary document filings and/or electronic submissions to satisfy the City, and any and all State and Federal mandates, requirements, or law. (d) Electronic Data Interface requirements, manual filings and intermediary filings on behalf of the City, referencing among other things, City status as Self Insured, DWC Austin Representative and 1099 s. (e) TPA will indemnify and protect the City against errors or omissions committed by the TPA. TPA agrees to hold the City harmless and to indemnify the City for all loss arising out of any claims alleging an error or omission with respect to the services performed by the TPA. v Transition/Implementation (a) TPA responding to this RFP agrees to handle all claims and related services going forward from 10/1/2015. TPA also agrees to include within its fee structure the handling of ALL claims dated before 10/1/2015. (b) If awarded this contract the TPA will become the manager of all open and closed claims controlled by the City. (c) TPA must also provide a transition plan to facilitate and coordinate the transitioning of this program. Such transition planning must be made and accepted by the City prior to its implementation. 4. Overview of Requirements i Administer workers compensation claims from cradle to grave, including but not limited to investigation, reserving and payment, and filing reports. With the approval of the risk manager or designee, arrange for IMEs, rehabilitation services and surveillance when such procedures may be constructive. The risk manager will have final approval for all outside vendors utilized, including but not limited to attorneys, IME examiners, vocational experts and case managers. 5. Mandatory Requirements i General (a) Provide a toll free telephone number for the City and claimants. (b) Work and telephone hours for all services shall be 8:00 a.m. 5:00 p.m.(ct), Monday through Friday with the exception of coordinated closures or holidays. (c) Provide on-call staff information for emergencies. This contact shall be available to City at all times, during non-business hours. (d) Claim load of each adjuster may not exceed the following limits: Workers Compensation, Indemnity No more than 50 Workers Compensation, Medical Only No more than 150 Workers Compensation, Combined Indemnity and Medical No more than 200 Only (e) Notification to all employees and providers of services of the change in workers' compensation administration by City. This notification shall include a statement indicating that all billing of City claims for all injuries subsequent to the Contract date should be submitted to the new administrator for processing. (f) Subject to periodic claims audits by internal City staff and/or an independent firm at the discretion of the City. ii Claim Processing (a) Files will be created and assigned within one working day from receipt of the initial Page 15 of 59

16 report. (b) Contact with claimant and City will be within two working days from receipt of initial report for all claims. (c) All indemnity files will contain reserve worksheets, which explain how the current reserves are calculated. A copy of the reserve worksheet will be placed in the file. Reserve worksheets are mandatory on any reportable claim, or request for authority. All indemnity files will contain a current action plan. (d) All file activity, including telephone conversations and/or personal meetings, and diary reviews will be immediately and clearly documented in the claim file Adjuster s Notes/notepad. This documentation will include a minimum of the individuals involved, dates, content of discussions, and the Adjuster s plan of action. It is the express understanding that if it is not documented, it did not happen. Immediately is defined as at the end of the above activities and maintained daily. (e) Specific direction on the investigation and handling of all indemnity claims will be established within three (3) working days of the initial report and clearly documented in the file notepad. (f) The Adjuster s basis for acceptance or denial of compensability will be clearly documented in the Adjuster s Notes/notepad. City of Waco Risk Management must be notified immediately upon the decision to deny a claim or treatment. The adjuster must contact the employee by phone to notify the employee about a denial of a claim or treatment. (g) Upon knowledge of catastrophic claim, notification will be made immediately via telephone to the City. These types of claims would include: fatality, amputations, serious burns, brain injury, and multiple injuries. Catastrophic claims will be handled by senior personnel. (h) Administrator shall maintain an imaged file for each reported claim, and old hard copy files that are re-opened shall be imaged. Each file shall contain all data pertinent to the claim. All files are the property of the City and not the Administrator. (i) Diaries will be established, monitored, and maintained, so that every open claim is reviewed, and claimant contact is made at least once every 30 days by the adjuster. Confirmation of every Adjuster s claim review and claimant contact must be documented in the claim file s Adjuster s Notes section/notepad. All notes will be maintained and addressed on the same business day or within 24 hours of receipt, with the exception of weekends. (j) A Supervisory file review will occur at least once every 30 days on all open indemnity claims, claims open for more than 60 days and 25% of all other claims, and will document the review of reserves, benefit management, medical and/or case management (telephonic or field), and the Adjuster s action plan. Supervisory claim reviews will be clearly documented in the claim file s Adjuster Notes (notepad) section, identifying the supervisor, comments, and or instructions to the Adjuster. Supervisor will also review all vendor reports authorizing surgical procedures. (k) Confirmation of review will be documented. (l) Prepare and maintain files necessary for legal defense of claims and/or litigation. (m) TPA or an outside agency approved by City will audit medical bills for causal relationship and reasonableness of charges. (n) All indemnity cases will be reported to the Index Bureau upon file creation, and a copy will be retained with the file, at no cost to City. (o) Medical only claims will be reviewed for possible closure no less frequently than every 30 days. Page 16 of 59

17 (p) All City of Waco locations participate in a return to work program. The City s Risk Manager will provide written bona-fide offers of transitional duty to the City employee, with a copy to the WC Adjuster. The Adjuster is responsible for documenting such offers in the Adjuster s Notes/notepad section of the electronic claim record, in addition to reporting on future activity relating to return to work, and subsequent status reports. (q) Adjuster can request a Peer Review, RME, or DD anytime however they must first consult with the Risk Manager and document in adjusters notes. (r) Adjustor will attend hearings, depositions, mediations, and other proceedings. The City will not pay expense to attend hearings. The expense must be included in your fee. (s) Administrator will aggressively pursue all possibilities of subrogation, excess insurance reimbursement, and third party liens. (t) Supervisory review of every open claim file should be clearly noted in the file notes/notepad at least once every 30 days. (u) The TPA will conduct quarterly internal audits, or quality control procedures, these audits will be continuously maintained in a central file set up specifically for internal audit results. (v) Claims adjuster will secure a DWC 69 (Maximum Medical Improvement form) on all claims except minimal first aid claims. (w) The City reserves the right to audit the Administrator and claim files for compliance with Texas administrative guidelines and other standards in this proposal. iii Reserving (a) Reserving will be estimated and maintained on the basis of most probable final cost. (b) Reserves will be established and reviewed every 30 days. (c) The basis for the initial reserve and any reserve revisions will be clearly documented for each file. (d) Reserve worksheets will be standardized among all City WC claim files, and will contain separate categories for indemnity, medical, and allocated expenses. Major subcategories of each shall be included. All worksheets must explain how current reserves were calculated. (e) With the exception of Medical Only claims, reserve worksheets will be completed for all initial and revised incurred loss estimates, and a copy sent to the Risk Manager. (f) Reserves will take into consideration the categories of indemnity, medical, rehabilitation, and allocated expenses, and all major sub-categories of each. (g) The Adjuster will advise the City immediately of any claim requiring an aggregate reserve of $25,000 or more, via , with documentation entered in the Adjuster s Notes/notepad. (h) On all claims reserved in excess of $25,000, periodic written reports, at least bimonthly, will be provided to City accompanied by any pertinent file materials. As an alternative, TPA shall have the ability to submit reports electronically through the IS. (i) Changes in reserves must be accompanied by a supervisor's approval and City approval for any increase over $2, iv Excess Reporting (a) The excess insurer will be reported to on the status of all files that meet the criteria of the policy provider(s). Such reporting will be conditioned upon City providing all necessary coverage and reporting criteria. v File Documentation (a) Thoroughly completed reserve analysis will be contained within all indemnity files. Page 17 of 59

18 (b) All file activity, including telephone conversations or personal meetings and diary reviews will be clearly documented to reflect the date, individuals involved, content of discussion and plan of action. (c) Specific direction on the investigation and handling of all indemnity and bodily injury cases will be established within one working day from receipt of the initial report and clearly evidenced within the file. (d) TPA's basis for acceptance or denial will be clearly documented. Prior to denial, the adjuster must discuss with the City for mutual agreement on the denial. (e) Copies of all correspondence from the TPA to/from other parties, including reports to the City's Risk Manager, or designee, and reports to excess carriers, will be documented in the file. vi Investigation and Case Management (a) Initial contact with indemnity claimant will be accomplished or attempted prior to the initial compensation unless the claimant has returned to work. (b) Audio recorded statements of the injured employee or claimant must be secured on all claims, to document accident facts, and affected body parts on all indemnity and major or questionable medical claims. Incident only claims do not require a recorded statement unless they subsequently result in medical treatment. (c) Claim profiles will be prepared on all claimants with two (2) or more prior workers' compensation indemnity claims. (d) Adjuster will actively work with medical professionals, employee, and City to enhance City's return to work program. (e) All contacts and attempts to make contact with claimants will be fully documented. (f) Claims adjuster will contact injured employees within a reasonable time prior to and following Surgeries and hospital stays. (g) Prior to all initial payments of temporary income benefits, unless a medical report has been received, the medical provider facility will be contacted to establish extent of injury, causal relationship to the alleged incident, and estimated return to work date. (h) On all questionable workers compensation cases, informative statements will be secured from the claimant, supervisor, witnesses, and any other pertinent parties, and City's Risk Management Department within three (3) working days of receipt of initial report, wherever possible. (i) Any workers' compensation claim to be controverted by TPA must be submitted in a caption report form to City for review. (j) Medical reports will be obtained as frequently as needed for verification of continuing indemnity payments. (k) Prior to each indemnity payment, TPA will confirm continued disability with City, provide status information, and discuss availability of modified duty and/or part time work. (l) The City pays supplemental salary to all employees, the City may elect to use a PLN-6 in lieu of TIBBS, and therefore the Administrator will need to complete the PLN-6. (m) Telephone or personal contact will be maintained with temporarily disabled employees and their Supervisor(s) or other City-designated person(s) at least weekly, to maintain rapport and to monitor medical progress, return to work status and modified duties. (n) Surveillance should be considered where length or extent of temporary disability is questioned. (o) Outside investigation services will be employed only where necessary and approved by City. Documentation of assignment will include specific reasons for referral. Direction and control will be exercised over the investigator's activities. Page 18 of 59

19 (p) Independent medical examinations will be scheduled with qualified City approved physicians in cases where treatment, length of disability or extent of permanent impairment assigned is in question. Appointment letters will attach copies of all medical reports, relevant information concerning the case, job information, and detailed description of opinions being sought. This will include coordination with the case manager. (q) Ensure personal delivery of any documentation needed in order for any RME to be completed, at no additional cost to City. (r) Pertinent past medical records will be secured and apportionment addressed in all cases, prior to final resolution of permanent partial disability, Impairment Income Benefits or Supplemental Income Benefits. (s) Vocational rehabilitation will be administered where approved by City. (t) Benefit payments will comply with maximum medical improvement and impairment/ supplemental income benefits of the Texas Department of Insurance Statutes. The TPA s workers' compensation manager will approve these payments and this information will be submitted to the risk manager, or designee, for review/comment in a timely manner. (u) Case Management will be assigned according to criteria established by the City and TPA, the cost will be charged to file. (v) Case Management costs will be tracked. On a quarterly basis, a report will be provided to City by TPA. vii Audits (a) Monthly DWC-3 Audits - for all new claims that in the previous month have indemnity payments initiated, or that was upgraded to an indemnity claim within the previous month, or that were flagged for potential lost time. Administrator shall conduct an audit for timely receipt for DWC-3. (b) Monthly Bill Review Service Quality Audit - is coordinated with Risk Management on bills chosen at random. This is a part of the Performance Measure Report. (c) SAS 70, Type II Audit - required at Administrator s own cost, conducted annually by a certified and licensed auditing firm with respect to internal controls for all contracted/subcontracted work pertaining to this proposal. The audit shall be conducted in accordance in accordance with the American Institute of Certified Public Accountants (AICPA) Statement on Auditing Standards Number 70-Reports on the Processing of Transactions by Service Organizations. The audit does not have to be specific to City of Waco but of the vendor s account service provider environment. Final audit reports shall be delivered to the City by December 1st of each year beginning An SAS Audit is an in depth audit of their internal claim control objectives and control activities. It is done at their expense but must be reported to us. (d) Annual Claims Administration Audit - The City may require an annual Claims Administration Audit. The City shall coordinate and advise the Administrator of the on-site audit to be performed by a qualified auditing firm. The Administrator shall allow ancillary serviced utilized in our program. The City audits will not be charged or incur any expenses for any work required of the TPA for this audit. viii Financial Procedures and Claim Payment (a) Workers Compensation payments will be made promptly and in accordance with the Workers' Compensation Statute. (b) Invoices submitted for the payment of vendor or subcontractor services will be paid if the services provided by the vendor or subcontractor have occurred within sixty (60) days prior to the invoice date. Any bills received over 60 days old will be reported to Page 19 of 59

20 the City for consideration. (c) A trust fund account will be established by the TPA and the City will make an initial deposit. The City will wire funds into the trust each month to reimburse claims made. (d) TPA will issue checks from a trust fund balance account funded by the City. Checks will be issued at least weekly with TPA providing a weekly check register and monthly invoice to the City for maintenance. (e) Any duplicate payments or overpayments made due to TPA s oversight or negligence shall be the responsibility of the TPA; TPA will reimburse City for same, within 30 days. In addition, TPA will provide City an overpayment report by type, reason, payee and by fiscal year on a quarterly and annual basis. (f) The Administrator shall pay compensation, medical expense, and allocated loss expense out of funds provided by the City and issue checks, drafts or other payments out of their office. (g) Monitor and collect all recoveries due the City. (h) Prepare and submit IRS form 1099 for all vendors and mail the forms to vendors. Proposer will prepare and submit IRS 1099 data electronically no later than January 15th of each year to City. (i) The Administrator shall provide adequate internal control procedures to protect the City from any type of financial loss. Payments of any type made solely in error by the Administrator shall be the responsibility of the Administrator. The Administrator shall reimburse the City for unrecovered payments that result solely from the Administrator s or a service partner s error or negligence. (j) The Administrators shall be responsible for any monetary fines and interest that becomes due as a result of non-compliance with Texas administrative and regulatory bodies if the duty was the responsibility of the Administrator or its subcontractors. The administrator shall not be held to this requirement when the fine arises solely from the City s error or delay. (k) The Administrator is responsible for any fines resulting from a Texas administrative office audit that finds evidence of noncompliance with a required standard. This responsibility shall continue throughout the life all claims or parts thereof managed by the Administrator, regardless of contractual relationship with the City. (l) The City shall disclose all DWC or other Texas Administrative audit activity that has occurred and /or pending. The Administrator shall implement any improvements named in the audit. The administrator shall accept the financial responsibility, if any, for the failure to improve in past audited areas and the lack of improvement causes fines to be brought forward and added to current fines in the same category: 1. As of the date of this document there are no outstanding audits or exposures. 2. As of the date of this document there are no notices of Texas administrative Administrator audits to be performed. 3. The City of Waco s performance based oversight results may be made available after the official results are released by the DWC. (m) The successful administrator shall submit a Business Continuity plan that shall detail how the administrator will recover and maintain critical operations in the event of business disruptions from system failures, natural occurrences, acts of man, or other events. ix Information System Requirements (a) Internet based claims system with real-time access 24 hours a day, 7 days a week to report claims, review all adjuster and supervisor claim notes, claim bills, generate loss runs or other pre-scheduled or ad hoc loss management/claim reports. Page 20 of 59

21 (b) Ability to export data into Microsoft products. (c) Provide IS technical support for questions, problems or development of customized reporting. (d) Import all prior loss data into a single database. (e) Imaging system to scan all documents received related to the claim. (f) Fully compliant with MMSEA Section 111 reporting requirements. Disclose any fees associated with this service, including the names of any third party used for this reporting. (g) Provide scheduled loss reports to be sent electronically to the City each month, each quarter and upon request. Sample reports must accompany your proposal. (h) Provide customized reports and interactive reporting capability (client-created). Sample reports must accompany your proposal. (i) Training in the use of the IS will be provided to City staff. Any fee for this should be included in the Pricing/Fee Schedule. (j) 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 TPA. TPA shall provide the City with computer media containing all claim data at termination of services. Such data shall be made available in a format generally importable into a commonly recognized database for claims administration services. x Reports (a) Bill Review Service Reports providing system reports monthly verifying transmissions of all medical bills are timely and accurately submitted to the appropriate Texas Administrative Office of the Division of Workers Compensation and reporting results of monthly required audits. (b) End of Month Reports that support the data included in the contract, Executive Summary, and Performance measures. Performance measures will be negotiated with the selected vendor. Additional criteria may be added to the reports, and shall be supported by the data. (c) End of Month Overpayment Report listing the injured employee name, claim number, type of indemnity payment error, reason for error, error date, and amount due, check number, recovery activity and reimbursement date. (d) Monthly DWC-1 Report listing all new claims in the previous month, including the date the DWC-1 was received; the date of knowledge by the City and whether this meets timely, criteria. (e) Monthly Financial Reports required by the City s Finance department. (f) Monthly Medical Bill Reports showing medical bill pending payment activity, duplicate/irregular payments, detail and summary reports by provider type, ANSI code, claimant and other specific reporting elements to be agreed upon. (g) Annual Actuary Data Report includes all data required by the actuary to produce an actuary report for the City. 3. CITY OF WACO CONTRACT CONTACT After award of contract, the firm s principal contact with the City of Waco will be the City Risk Manager or a designated representative, who will coordinate the assistance to be provided by the City of Waco to the firm. Page 21 of 59

22 1. PROPOSAL SUBMISSION IV. SUBMISSION & EVALUATION OF PROPOSALS a. The required contents and limitations for preparation of the technical proposal are described in this section. Failure to provide the requested information or adhere to any stated limitations may result in disqualification of the submitted proposal. b. Proposals are to contain the following: 1. Transmittal Letter and Proposer's Qualification Questionnaire i A Letter of Transmittal (a) A Letter of Transmittal signed by the individual or appropriate officer of the firm or corporation offering the proposal, which contains a statement that the information presented in the proposal is true and correct, and that the proposer acknowledges receipt of any addenda issued by the City of Waco to this RFP. 2. Description of Firm i Background and History (a) Describe the company, its age, organization, officers or partners, number of employees, type of work and operating policies which would affect this contract. State the number of years your organization has been continuously engaged in business. (b) Overview of the firm's qualifications to perform the work proposed. (c) Describe when and where the firm has performed similar or comparable services to what is requested by the City of Waco for Public entity clients. 3. Professional Qualifications i Resumes or background biographies should include experience at Firm and other work history (include years of experience in workers compensation, education, professional designations and/or licenses): (a) Account Manager (b) Claims Manager (c) Claims Adjustor ii List the professional/technical personnel who will be assigned to work on the account, identified as to his or her role in the account, the number of persons-hours each is expected to devote to each task and the project as a whole, and his/her qualifications to perform such tasks. iii The proposer should provide an organization chart for the account. Personnel resumes and biographic summaries that highlight relevant experience should be provided for all proposed personnel. There is a one page limitation on each biographic summary provided. iv In an effort to maintain transparency and a greater understanding of your organization please identify those services handled directly by your organization and those which are subcontracted to third parties. Within this discussion Respondent should disclose any relevant profit centers related to these services. v Discuss your firms mission and goals as related to customer service, growth and quality assurance. 4. Proposer's Previous Relevant Experience i TPA Services (a) List the dates, names, and locations of any cities or metropolitan areas where you are or where you have performed TPA Services. Please include the names and telephone numbers of former clients who could be contacted by the staff of the Evaluation Committee. Indicate if the services are currently being provided. Page 22 of 59

23 5. Implementation Plan i Description of Work to be Undertaken: Describe the proposed transition and support plan for assumption of TPA services on October 1, 2015 outlying major tasks and responsibilities, staff assigned, chronological time-line, and the estimated time required to complete. Proposals shall clearly distinguish the Proposer s duties and responsibilities and those of the City. Absence of this distinction shall mean the Proposer is assuming full responsibility for all tasks. 6. Professional Standards i Sample of Firm s professional claims standards and performance manual. 7. References i Include a list of local and Texas public entity references and a list that is representative of your clients. References will be contacted as part of the evaluation process. Include: (a) Name of agency (b) Contact name (c) Telephone number (d) Fax Number (e) address 8. Reporting Capabilities i Samples of scheduled, custom and ad hoc reports 9. Answers to the questions proposed - Attachment B 10. Additional Service Explanation (if any). Additional services pricing should be listed in the Pricing/Fee Schedule. 11. Pricing/Fee Schedule Attachment C i Provide a fixed cost per claim and/or a flat rate cost. ii Provide a not-to-exceed maximum annual fee for all claims. iii Quote a flat fee for handling of pending claims from the current Administrator iv All fees must be included in this schedule, a flat rate annual fee is preferred. 12. Exceptions i Please describe any exceptions to the terms and conditions of the Contract. Include any suggested alternatives. 2. EVALUATION PROCEDURES a. Review of Proposals 1. These are the minimum requirements for the selection procedure to determine the highest ranked and most responsible proposer. 2. The Evaluation Committee comprised of staff from the City of Waco and the City s Risk consultant will rank the proposals based on a total of one hundred (100) points. After the proposals have been ranked, the Evaluation Committee may interview the top three or four candidates, if deemed necessary. The Evaluation Committee will then select the highest ranked and most responsible proposer. The factors below will be used in the ranking / scoring process and are not in any particular order. b. Evaluation Criteria of Proposals 1. Proposals will be evaluated on a 100-point scale using the following criteria. i Economic evaluation of the proposed Pricing/Fee Schedule (Maximum points 20) (a) General understanding of the project. (b) Clarity and brevity of response. ii Responsiveness to the Request for Proposal. (Maximum points 30) (a) Requested information included and thoroughness of response. Page 23 of 59

24 (b) Understanding and acceptance of the scope and services. (c) Acceptance of the RFP and Contract requirements. (d) Clarity and conciseness of the response. iii Claims System abilities. (Maximum Points - 20) (a) Ability to report and transmit information within the claims system. (b) Imagining system and the ability to send scanned documents to the claim. (c) Evaluation of the sample reports provided. iv Proposer s capability to provide the services requested. (Maximum Points 30) (a) Background of the proposer and support personnel, including professional qualifications. (b) Relevant experience of the Proposer. (c) References in the Texas public sector. (d) Specific experience with public entity clients, especially municipalities. (e) Other resources, including total number of employees, number and location of offices. 2. Oral Presentations and Demonstrations i If deemed necessary, the Evaluation Committee may require finalists to give oral presentations regarding their proposals, relevant experience, and perception of the scope of work after the Closing Date. During such presentations, the firms will have an opportunity to present their proposals and answer questions from the Evaluation Committee. After the Oral presentations, firms will be ranked by the committee on a scale using the following criteria: (a) Project management approach (Maximum points - 45) (b) Communication ability (Maximum points - 20) (c) IT system and capabilities. (Maximum points 35) 3. Evaluation of Sole Bidders i In the event that only one proposal is received in response to this request, the evaluation committee will review the proposal based upon the following criteria: (a) Does the firm provide the necessary background and expertise to perform the requested tasks? (b) Does the firm adequately understand the nature of the requested tasks? (c) Does the firm provide the necessary resources to sustain the project? ii If a majority of the committee members answers yes to each question, then the City will enter into negotiations with the firm. If a majority of the committee members answers no to any of these questions, the committee will provide a recommendation to reject the proposal. 4. Final Selection i Based on all information and review, including oral interviews (if conducted), the City Manager and/or Executive Staff (or designated individuals) shall establish the final ranking of the proposers. The City will attempt to negotiate a contract with the Consultant who is ranked first. In the event that negotiations are conducted with the highest scoring proposer and an agreement cannot be reached, the City Manager (or designated individuals) shall be notified. Efforts to negotiate a contract will then proceed with the proposer ranked second. This process will not require repeating the formal solicitation process and will be followed (with the next highest Proposer, then the next) until a satisfactory contract can be negotiated. The actual contract award will be made by the Waco City Council. The City will not be bound under any contract until the Waco City Council authorizes the City of Waco, City Manager, or his designee, to execute a contract. 5. Right to Reject Proposals i Submission of a proposal indicates acceptance by the firm of the conditions contained in Page 24 of 59

25 this request for proposal unless clearly and specifically noted in the proposal submitted and confirmed in the contract between the City of Waco and the firm selected. ii The City of Waco reserves the right without prejudice to reject any or all proposals. 1. RELEASE AND HOLD HARMLESS V. TERMS AND CONDITIONS a. INDEMNIFICATION 1. IF THE SELECTED PROPOSER FAILS TO PROVIDE SUCH INSURANCE NAMING CITY AS ADDITIONAL INSURED, THEN THE SELECTED PROPOSER AGREES TO ASSUME FULL RESPONSIBILITY AND LIABILITY FOR THE SERVICES RENDERED UNDER THE RESULTING AGREEMENT, AND HEREBY AGREES TO INDEMNIFY, PROTECT AND HOLD HARMLESS THE CITY, ITS EMPLOYEES, AGENTS AND SERVANTS, OF AND FROM ALL CLAIMS, DEMANDS, AND CAUSES OF ACTIONS OF EVERY KIND AND CHARACTER, INCLUDING THE COST OF DEFENSE THEREOF, FOR ANY INJURY TO, INCLUDING DEATH OF, PERSONS AND ANY LOSSES FOR DAMAGES TO PROPERTY CAUSED BY OR ALLEGED TO BE CAUSED, ARISING OUT OF, OR ALLEGED TO ARISE OUT OF, EITHER DIRECTLY OR INDIRECTLY OR IN CONNECTION WITH THE SERVICES TO BE RENDERED UNDER THE RESULTING CONTRACT, WHETHER OR NOT SAID CLAIMS, DEMANDS, CAUSES OF ACTIONS ARE CAUSED BY THE SOLE NEGLIGENCE OF THE CITY, ITS EMPLOYEES, AGENTS, OR SERVANTS, OR WHETHER IT WAS CAUSED BY CONCURRENT NEGLIGENCE OF THE CITY AND A PARTY TO THE RESULTING AGREEMENT, OR WHETHER IT WAS CAUSED BY CONCURRENT NEGLIGENCE OF THE CITY AND SOME OTHER THIRD PARTY. IF THE SELECTED PROPOSER PROVIDES THE APPROPRIATE INSURANCE NAMING CITY AS AN ADDITIONAL INSURED, THEN THIS SECTION SHALL NOT APPLY. THE SELECTED PROPOSER FURTHER AGREES TO WAIVE ANY AND ALL CLAIMS AND SUITS COVERED BY THIS INDEMNITY AGREEMENT AND AGREES THAT ANY INSURANCE CARRIER INVOLVED SHALL NOT BE ENTITLED TO SUBROGATION UNDER ANY CIRCUMSTANCES AGAINST THE CITY, IT OFFICERS, OFFICIALS, AND EMPLOYEES. 2. TAX CERTIFICATION; OFFSET OF OTHER DEBTS AGAINST CITY Selected proposer hereby certifies that it is not delinquent in the payment of taxes owed to the City and will pay any taxes owed to the City so that such taxes will not become delinquent. If this certification is subsequently determined to be false, such false certification shall constitute grounds for termination of the contract awarded under this RFP, at the option of City. Furthermore, Selected proposer agrees the City is entitled to counterclaim and offset against any debt, claim, demand, or account owed by the City to the selected proposer, pursuant to the awarded contract, for any debt, claim, demand, or account owed to the City, including other than the taxes mentioned above. The City may withhold from payment under the awarded contract an amount equal to the total amount of debts, claims, accounts, or demands including taxes owed to the City by the selected proposer. The City may apply the amount withheld to the debts and taxes owed to the City by the selected proposer until said debts are paid in full. No assignment or Page 25 of 59

26 transfer of such debt, claim, demand or account after the said taxes or debts are due shall affect the right of the City to offset the taxes and the debt against the same. 3. FORCE MAJEURE a. In the event performance by the selected proposer of its obligations under this contract shall be interrupted or delayed by or as a consequence of a fire, flood, severe weather, or other act of God, war, insurrection, civil disturbance, or act of state, the selected proposer shall be excused from such performance for the period of time such occurrence shall have lasted or such period as is reasonably necessary to rebuild or take other action necessary to resume performance. The period of time reasonably necessary to rebuild or take other action necessary to resume performance shall be as determined by the agreement of the parties, which agreement shall be negotiated and arrived at in good faith. b. Vendor shall notify the RFP Administrator of any matter covered above, the occurrence of which interferes or threatens to interfere with the performance of any of its obligations under the contract. Upon such notice, the selected proposer and the City shall consult and cooperate as to measures which may be taken to overcome the interference or as to alternative measures which may be undertaken by the parties with a view to the continued performance of the contract. 4. INDEPENDENT CONTRACTOR The selected proposer will be an independent contractor under the contract. Services provided by the selected proposer shall be by the employees or authorized subcontractors of the selected proposer and subject to supervision by the selected proposer, and not as officers, employees or agents of the City. Selected proposer will be required and agrees to comply with all state and federal employment laws as well as all other federal, state and local laws, rules and regulations affecting the performance of all obligations taken herein. 5. NO JOINT ENTERPRISE/JOINT VENTURE It is not the intent of this RFP or the contract to be awarded to create a joint enterprise or joint venture. 6. SUSTAINED DAMAGES In the event the City terminates the awarded contract for breach or any other reason, the selected proposer shall not be relieved of liability to the City for damages sustained by the City by reason of any breach of the contract by the selected proposer or otherwise, and the City may withhold any payments to the selected proposer for the purpose of an offset until such time as the amount of damages due the City from the selected proposer can be determined. 7. CONFIDENTIALITY OF DOCUMENTS a. ALL PROPOSALS SUBMITTED WILL BE SUBJECT TO THE TEXAS PUBLIC INFORMATION ACT. b. In the event a request for public information is filed with the City which involves a proposer s proprietary information submitted to the City in a proposal, the proposer affected by such public information request will be notified by the City of the request in order to give the affected proposer an opportunity to provide correspondence to the Attorney General as to why such Page 26 of 59

27 information should not be released. The proposer must clearly mark each page of the proposal that contains proprietary information which the proposer believes should not be disclosed in response to a request for public information. 8. SUBCONTRACTING PROPOSAL If subcontracting with another company or individual is proposed, that fact, along with providing the same information for the subcontractor that is required to be provided by the proposer under this RFP, must be provided and clearly identified in the proposal. Following the award of the contract, no additional subcontracting will be permitted without the express prior written consent of the City. 9. MISCELLANEOUS a. There is no expressed or implied obligation for the City to reimburse proposers for any expenses incurred in preparing proposals to respond to this RFP. b. During the evaluation process, the City reserves the right, where it may serve the City s best interest, to request additional information or clarifications from proposers, or to allow corrections of errors or omissions. c. The City reserves the right to retain all proposals submitted and to use any ideas in a proposal regardless of whether or not that proposal is selected. d. Each proposal shall state that it is valid for a period of ninety (90) days from the date of opening of the proposal by the City. 10. NON-NEGOTIABLE TERMS a. THE FOLLOWING TERMS OR CONDITIONS ARE NOT NEGOTIABLE: 1. Unfunded Liability i The City will not incur a debt or obligation to pay selected proposer any amounts the City does not have the current funds available to pay, unless the contract includes a provision for the City to appropriate funding for the debt or obligation. 2. Indemnification i The City will not agree to indemnify selected proposer or any third party unless the City decides on its own to set aside funds to fund the indemnification. 3. Advance Payments i The City will not make advance payments to a selected proposer or any third party pursuant to this RFP or resulting contract. 4. Gift of Public Property i The City will not agree to any terms or conditions that cause the City to lend its credit or grant public money or anything of value to the selected proposer. 5. Procurement Laws i The City will not agree to any terms or conditions that cause the City to violate any federal, Texas, or local procurement laws, including its own charter. 6. Limitation of Liability i The City will not agree to allow the selected proposer to limit its liability for breach or default of contract to the contract amount or to the amount the City has paid up to the time of the breach or default. 7. Attorney s fees; Legal Costs i The City will not agree to pay the selected proposer s attorney s fees or other legal costs Page 27 of 59

28 under any circumstances. 8. Venue; Applicable Law i This RFP and any resulting contract will be governed and construed according to the laws of the State of Texas. The terms and conditions of the contract awarded pursuant to the RFP are fully performable in McLennan County, Texas and venue for any dispute regarding contract shall be in McLennan County, Texas. Page 28 of 59

29 PROPOSAL DOCUMENT SECTION Page 29 of 59

30 Business Entity Identification To identify the appropriate person to execute documents, please fill in this form: Full Legal Name of Business Entity: Doing Business As (assumed name): Main Contact Person: Registered Office Address: Mailing Address: Business Phone #: Fax #: Address: DUNS Number: Check the appropriate box to designate the type of business entity & complete the information below. Is entity: Sole Proprietorship Corporation Professional Corporation General Partnership Limited Partnership Limited Liability Partnership Limited Liability Company Other Date Business Started: Professional Limited Liability Company State Where Started: Depending on the type of business entity, the business will have owners, corporate officers, corporate directors, partners, managers, members, etc. Complete the information below. To provide information on more than one person or entity for boxes 1 to 5, please use back of page, blank page, or another copy of this form. 1 Name of Primary Officer, Partner, Owner, Manager, Member, Director 2 Position or title with business entity 3 Address (if different from above) 4 Who is authorized to execute contracts and other documents? 5 What is the title or position of the person listed in #4? 6 Please provide a document (resolution, bylaw, agreement, etc.) that states the person identified in #4 has authority to execute contracts or execute affidavit. In signing this form, I acknowledge that I have read the above and state that the information contained therein is true and correct. Signature: Date: Print Name: Print Title: Form 06/16/2015 Business Entity Identification Complete and Return with Bid/Proposal/Qualifications Page 30 of 59