HomeMy WebLinkAboutCC Resolution 8181 (Self Insurance Services)RESOLUTION NO. 8181
A RESOLUTION AUTHORIZING THE SIGNING OF A
CONTRACT, LEASE OR AGREEMENT
(SELF INSURANCE SERVICES)
THE CITY COUNCIL OF THE CITY OF SAN RAFAEL RESOLVES as follows:
The MAYOR and CITY CLERK are authorized to execute, on behalf
of the City of San Rafael, an extension of the contract, lease or
agreement with Self Insurers Service, Inc. 2620 Augustine Drive,
Suite 230, Santa Clara, California 95054, a copy of which is hereby
attached and by this reference made a part hereof.
I, JEANNE M. LEONCINI, Clerk of the City of San Rafael, herebv
certify that
the foregoing resolution was
duly and
regularly
introduced and
adopted at a REGULAR meeting of
the City
Council of
said City held
on MONDAY the FOURTH
day of
JUNE ,
19 90 , by the following vote, to wit:
AYES: COUNCILMEMBERS : Boro, Brei ner, Shippey, Thayer & Mayor Mul ryan
NOES: COUNCILMEMBERS: None
ABSENT: COUNCI LMEMBERS : None
JEANNE M. LEONCINI, City Clerk
BY:
RO'E LOLA NIFFEN, Depu y City Clerk
r-
EIRIN'K
A ROLLINS BURDICK HUNTER CORP.
SELF INSURERS SERVICE INC 2620 AUGUSTINE DRIVE SANTA CLARA CALIFORNIA 95054 408 • 727 • 9515
05/30/90
City of San Rafael
1400 Fifth Avenue
P.O. Box 151560
San Rafael, CA 94915-1560
Attention: Suzi Golt, Assistant City Manager
Dear Suzi:
This is to confirm our conversation of May 24, 1990 regarding extension
of the contract beyond the June 30, 1990 expiration date. Self Insurers
Service agrees to continue providing services under the current
contract conditions on a month to month basis at the current rate of
$4,910.00/mo., until the City of San Rafael completes, within a
reasonable time period, the RFP process.
Sincerely,
cre is arcus
CITY OF SAN RAFAEL:
Vice President/Western Region
LAWRENCE E. MULRYAN, Mayor
ATTEST:
JEANNE M. LEONCINI, City Clerk
CO --'Y
SEI_.r I SUREI'\,�)
SERVICE
A ROWNS BURDICK HUIJTcR CORP
SELr•IIJSJRERS SER;ICE INC 2620 AUGUSTINE DRIVE SANTA CLARA CALIFORNIA 95054 40E • 727 • 95'5
SERVICE AGREEMENT
�nlE: Servace Aareement is entered into th-s 1st cay Cf ;.rule',
198'' by and between Lhe C; ty of San Rafael he relriaf t I- ca11eC
the "Client" and Self Insurers Service, Inc., hereinafter cailec
"Self Insurers Service'' and is as follows:
I. GENERAL STATEMENT
Client wishes to retain the services of Self Insurers
Service for administration of their Workcr�7 Compensation
Claims Program.
:elf Insurers Service is willing and .=agrees to provide
such services on the terms and conditions, hereinafter
stated.
II. TERM
This Service Agreement shall be effective for a period of
twelve (12) months from 07-01-B9 through 06-30-90 e.<cept
as amended or canceled as hereinafter provided.
III. SERVICES TO BE PROVIDED BY SELF INSURERS SERVICE
Self Insurers Service shall provide the follc::i1:';
services to the Client:
A. Investigate, adjust and otherwise administer all reported
claims during the period of this contract.
B. Determine the compensibility, if any, and the settlement
thereof and cause all compensable claims to be paid,
according to a funding mechanism as hereinafter provided
in paragraph (IV.E)
C. Prepare and file all claim reports in accordance with
eetablishec procedures and state guidelines.
D. Maintain a separate claim file on each reported claim;
each file shall be available for review by the Client a..
any reasonable time during regular- business hours. Se1T
nsu:'ers er'vl E Wili retain: closec files fen twc ( 2
`fie.-. s fo_1ow_n `� wh_ciI the cicseed files L ill be _ :'il -d
LO the C I i a n at the cllent'S =•D!e e::PEI—).-.tee. E.
Insurer ; Service wiall within i`..= S C 0 e ani:
authority to ensure safe delivery.
9 C r-Np"NY'
SELF I 'SU1'.ER�S
SEWICE
NATURE OF REPORT Ls Z FREQUENCY
(1) Loss Experience Report Monthly
(2) Loss Experience Summary Monthly
E. Provide computerized standardized loss reports di_.clo�:zn,;
pertinent claims data as follows.
The Client may request, from time -to -time, Self Insurers
Service to provide additional information, analySlE,
r-eYorts and serviceS. If so requested, Self Insurer
Service will provide such additional Services within its
scope and authority. The Client agrees to pay for. Same
on an agreed and prepaid fee basis within ten (10) days
of receipt of invoice.
f-. Manage all claims litigation known to Self Insurers
Service with the Client's Selected outside legal counsel.
Litigation costs shall be deemed Allocated Loss Expense
as per paragraph (IV.B)
G. Establish appropriate reserves for each file.
H. Self Insurers Service agrees to undertake, investigate,
and pursue reasonable subrogation/recovery possibilities
on behalf of Client. Funds received from all
Subrogation/recovery collections shall be considered the
revenue of the Client. Expenses incurred in
Subrogation/recovery efforts shall be deemed Allocated
Loss Expense.
I. Self Insurers Service agrees to participate in an initial
orientation or subsequent programs for the Client's
personnel who are directly or indirectly involved in th,e
processing of qualified claims or losses. Self Insurers
Service, Inc. also agrees to provide the following for
contract year 89/90:
-S,- claims status reviews
ive training days to be Spent either training
th lient's personnel or consulting with -Client's
personnel.
Any subsequent such Service by Self Insurers Service
Shall be deemed an additional Service to be inbeiced to
and paid immediately by the Client according to the
prev_=iling time and expense charges of Self" Insurer_.
service.
J. Self In-urerS SerViCe krill provide exc_�ss or reinsurer
notification as provided for, and as agreed, to, in
Attacned Acdendum #1 to this contract.
SELF INS.URER.S
SERVICE
IV. CLIENT'S OBLIGATIONS
The Client agrees to:
A. Pay Self Insurer -s Service for services rendered as herein
provide, the Sum of $58,920.00 to be. billed in
equal quarterly installments. Each installment shall
be paid within ten (1C)) days of receipt of the invoice.
Installments remaining unpaid after fifteen (15) days
will accrue interest at the rate of 1.5% per month.
Client agrees to pay all collection expenses incurred
including attorney's fees. Notwithstanding any other
termination or cancellation privileges provided in this
Service Agreement and without' waiver of any other -
remedies, Self Insurers Service may cancel this Service
Agreement upon ten (10) days written notice -for non
payment of the service fee installment.
B. Pay all claims and Allocated Loss Expense or otherwise
make available on a timely basis adequate funds from
which claims and Allocated Loss Expense may be paid as
follows:
CLIENT CHECKING ACCOUNT FUNDING
Client agrees to pay for check stock ordered by Self
Insurers Service, Inc. as required.
Client agrees to update signature information on their
bank account as requested by Self Insurers Service.
Client agrees to monitor the level of funds* in their
account and agrees to maintain adequate funds to cover
3hecks. Any fees, costs expenses,- fines, penalties or
other similar matters resulting from inadequate funding
are the sole responsibility of the Client.
Client agrees to pay all bank charges.
Client agrees that Self Insurers. Service is not
responsible for any bank account reconciliations.
Self Ir purer Se—rvi.e has no duty nor obligation to funrij
Maim payments or Allocated Lose, Expense payments with
its own funds.
SELF INSURERS
SERVICE
C. Pay all Allocated Loss Expense according to the mechanism
provided; Allocated Loss Expense are defined as any cost
or expense incurred by Self Insurers Service on behalf of
the 01ient as the result of engaging the services of
firms or persons outside Self Insurers Service for wok in
connection with the investigation, adjustment, settlement
or defense of a claim. Allocated Loss Expense includes,
but is not limited to the following: subrogation costs
as applicable; rehabilitation; automobile or other
physical damage appraisal; all. court, arbitration, or
=lternative dispute resolution cots, fees, and expenses;
fees for service of process; fees to attorneys; the cost
of services for subrosa operations and detectives; fees
of independent adjusters or attorneys for investigation
or adjustment of claims; the cost of obtaining copies of
of any public records or the like; and the costs of
depositions and court reports or recorded statements.
D. Cooperate fully in the disposition of all claims.
E. Agree to establish a settlement limit authority 'to be
used at the discretion of Self Insurers Service in the
amount of $_.a__ per claim. Self Insurers Service's
failure to settle a claim within the discretionary
settlement authority limit will not subject Self Insurers
Service to any liability whatsoever in the event of.' an
adverse judgment or settlement against the Client in any
action based upon or related to a claim.
F. Report as soon as praetieble all claims, incidents,
losses, claim reports and all other claim correspondence
to Self Insurers Service.
V. PROCEDURES UPON EXPIRATION AND NON RENEWAL
N-inety (90) da=ys prior to the expiration' date of this
Service Agreement, Self Insurers Service shall propose to
Client, for Client's approval, a new Service Agreement.
The Client shall advise Self Insurers Service within
thirty ( 30 ) days o-4 the receipt of the prapc!se , net•:
Service Agreement its desire to continue forward under
the proposed new Service Agreement.
SELF INSURERS
SERVICE
VI. CANCELLATION
Prior to the expiration of this Service Agreement, this
Service Agreement may be canceled by either the Client. or
Self Insurers Service by giving to the other, in writing,
notice of the intention to cancel this Service Agreement
sixty (60) days prior to the actual date of cancellation.
Upon cancellation, Self Insurers Service will not be
required to provide any further services to the Client
except as mutually agreed by signed amendment to- this
Service Agreement. Self Insurers Service will return as
soon as practicable all open/pending and all retained
closed files to the Client at Client's sole expense and
risk.
VII. GENERAL CONDITIONS
A. The Client recognizes that Self Insurers Service is not
providing any legal advice with respect to its activities
hereunder- and it is further understood and agreed- that
Self Insurers Service will not perform, and Client will
not request performance of, any services which may
constitute the practice of law.
B. Indemnification: The Client agrees that it will defend,
indemnify, and hold harmless Self Insurers Service and
its directors, officers, employees, parents, subsidiaries
and affiliates from and against any and all claims, loss,
liability, costs, damages, expenses, and attorney's.fees
incurred by Self Insurers Service as the direct or
indirect result of any instruction, direction,
misconduct, error or omission of the Client, or any'of
its directors, officers, employees, parents subsidiaries
and affiliates taken in connection with the furtherance
or performance of any provision of this Service
A•:ireement, provided that said claims, loss, liability
costs, damages and attorney's fees have not been directly
caused by any misconduct, error or omission of" Self
Insures Service, its directors, officers, employees,
Parents, subsidiaries and affiliates.
Self" Insurers Service agrees that it will defend.
indemnify, and hold harmless the Client and its
directors, off_cers, emrloyees, parents, suhsidi=-iec and
effiiiates from and against anv anc. all claim lcss,
liapi:ity, costs, cama�ges, e.;penses, and aztorney"s fees
incurred by Client as the dirr=ct or inCirect result of
any misconduct, error or omission of the Self Insurers
SELF INSURER�
SERVICE
_,er-vice, or any of its directors, officers, employees,
parents, subsidiaries and affiliate. taken in connection
N'ith the furtherance or performance of any provision of
this Service Agreement, provided that said claims, loss,
liability costs, dames and attorney's fees have not been
directly caused by any misconduct, error or omis-sion of
the Client, its directors, officers, employees, parents
subsidiaries and affiliates.
C. If any legal action is brought by either Party hereto
against the other- for the enforcement of this Service
Agreement or because of an alleged dispute, breach,
default cr misrepresentation in connection with this
Service Agreement, the prevailing party shall be entitled
to recover reasonable attorney's fees, expense, and other
costs incurred in addition to any other relief to which
it may otherwise be entitled.
D. This Service Agreement together with all exhibits
represents the entire and exclusive terms, conditions,
and agreements of the parties relative.to this subject
matter and hereby supersedes any and all such former
Service Agreements. Such former Service Agreements ae
hereby declared terminated and of no further force and
effective upon the execution and delivery hereof. There
are no terms, conditions or agreements with respect
thereto, except as herein provided, and no amendman-, or
modification of this Service Agreement shall be effective
unless reduced to writing and executed by the parties.
Such modification or amendment shall be attached to, and
shall there upon become a part of, this Service
Agreement.
E. Headings herein are for convenience of reference only•and
shall not be considered in any interpretation of this
Service Agreement.
F. It is understood and agreed that Self Insurers Service is
engaged to per -form services under this Service Agreement
as agent of the Client.
G. In the event of an acquisition of Self Insurers Service,
Inc. by any other company, neither- this agreement nor any
Znt_=rest therein may be assigned by Self Insurers
Service, Inc. without the prior writ.en con -suit cf the
Client.
1
SELF Ir ISURER�
SERVICE
H. This Service Agreement in all re_.pecte sh,:all be q overned
by and construed In accordance with the laws of the State
of California.
I. The Client and Self Insurers Service sha11 not
discriminate against any employee or applicant for
employment because of race, religion, color, sex or
naticrial origin.
J. Any notice required to
Agreement shall be sent by
requested, only, to the
Insurers Service:
Managing Director/Officer
Self Insurers Service, Inc
One Illinois Center
].11 East WacKer Drive
Ste 2914 .
Chicago, Illinois 60601
be given under this Service
Certified Mail -Return Receipt
following as respects Self
Vice President
AND/OR Self Insurers Service
2620 Augustine Dr.
Santa Clara, Ca 95054
And as respects the Client, the person signing on behalf
of the Client or as specified below:
In witness whereof, the parties hereto have caused this
Service Agreement to be executed in San P,a=ae1,
California on the day and date first above written. -
SELF INSURERS SERVICE, INC.
BYE/, .J'//�..
C/�Zts Duly Authorized Agent
4tC'of SandRafaelT]
Its Duly Authorized gent
Lawrence E. Mulryan, Mayor
ATTEST:
JeVr6�e,M. Leoncini City C erk
SELF INSURE
f�S
SERVICE
ADDENDUM 91
NOTICE TO EXCESS OR REINSURER CARRIERS
If so requested by the client, in writing, Self Insurers
Service agrees to notify, on a tirrrely basis., Client,
Client's representative or excess insurers, as so
identified by Client, of all qualified claims or losses
with respect to which potential losses may exceed the
Client's retention. If so requested by the Client, in
writing, Self Insurers Service will provide these persons
�.,ith necessary information on the current status -of those
claims or losses. The Client is to provide, upon
inception of this contract, or as soon as practicable,
for all excess insurance: the name and address of all
excess carriers, policy numbers, policy limits and
aggregates and policy terms. Client is to immediately
provide Self Insurers Service notice of any changes,
whatsoever, that occur during the term of this contract.
Signed��.�'tC��t t,
LAWRENCE E. MULRYAN
Title MAYOR
CITY OF SAN RAFAEL
SELF INSURER�S
SERVICE
ADDE14DUM 92
1099 Miscellaneous Tax Form
Processing for 1989
Client hereby authorizes Self Insurers Service, Inc.. to
complete the 1989 1099 Tax Form processing for Client at an
initial set up fee of 1250 and $2.00 per 1099 form.
For this fee, SIS will produce 1099 forms, and distribute
appropriate copies to the respective parties.
Please select on of the following options:
( ) (1) Client hereby authorizes SIS to produce 1099
forms and to include our company's data on, the
magnetic tape produced for the Federal
Government which includes data on all clients
of SIS.
11
(2) Client hereby directs SIS not to include our
company's data on the magnetic tape filed with
the Federal Government. Client will provide
SIS with an executed Power of Attorney Form
which will allow SIS to produce a 1096 form to
be filed with the Federal Government.. Si^
will distribute 1099 copies to the respective
parties.
(3) Client hereby directs SIS not to include our
company's data on the magnetic tape filed.w,ith
the Federal Government. Client requests that
all 1099 copies, excluding recipient's copy,
be forwarded to Client for proper filing with
the appropriate federal and/or state agencies.
No other forms will be completed or filed by
SIS.
Name of Company: CITY OF SAN RAFAEL
Address: 1400 FIFTH AVEI�UE� P.0_BO,X6Q, SPAL-RAFAEI SCA.._9_49.1.5=0DB.Q_.—___
Contact: SUZANNE GOLT, ASSISTANT TO THE CITY MANAGER
Phone No.: jil5 485-3072
Federal Tax I . D . No. 946000424
LAWRENCE E. MULRYAN
Title: MAYOR
SELF INS_URER�S
SERVICE
ADDENDUM #3
1099 Miscel"laneouE:. Tar; Form
Processing for 1985
Client hereby agrees, that SIS will have no obligation to
pr-oduc;e 1099 and/or other related forms. However, should
the Client desire a tape transfer of the 1989 data there
will be a charge to produce this tape, which will be in
the format required by the Federal Government.
Name of Company: CITY OF SAN RAFAEL
Address: 1400 FIFTH AVENUE, P.O. BOX 60, SAN RAFAEL, CA 94915_0060 _
Phone: (415) 485-3072
Contact: SUZAN14E GOLT, ASSISTANT TO THE --Q DY ��ANAG.ER
s i g n a t u r e: ;�F C Lc,, ---c
-LAWKENCE E. MULRYAN '
Title: MAYOR
SELF INSURER
SERVICE
ADDENDUM tt4
POWER OF ATTORNEY
Know all men by these presents, that the undersigned does hereby
make, constitute, and appoint Self Insurers Service, Inc.; 111
East. Wlacker Drive; Suite 2914; Chicago, Illinois 60601 my true
and lawful attorney-in-fact for me and my name, place and stead,
to make and execute the federal 1096 form for payments processed
by Self Insurers Service on behalf of CITY OF SAN RAFAEL
and granting to my said attorney-in-fact full authority to do and
perform all and every act and thing whatsoever, requisite,
necessary and proper to be done in and about the premises as
fully and to all intents and purposes as the undersigned might or
could do with full power of substitution and revocation hereby
ratifying and confirming all that said attorney or his substitue
shall lawfully do or cause to be done by virtue thereof.
In witness whereof, the undersigned has caused his name to be
subscibed hereto this 3RD day of JULY, 1989.
Name LAWRENCE E. MULRYAN
MAYOR
Title
ACKNOWLEDGEMENT
State of r.Al TP=4TA
County of MARIN
Eefor-e me a Notory Public in and for said County personally
appeared LAWRENCE E. MULRYAN, Mayor , who acknowledged the signing of
the foregoin_ instrument and that Such signing is his free act
and deed, on behalf of the CITY OF SAN RAFAEL, a Municipal Corporation.
In testimony whereof, I have hereunto set my hand and affixed my
official seal this 3RD day of JULY 1989.
:0'. "v Public
NOVEMBER 29, 1991
:`ty Commission Expires
._•
SELF I SUIREIRS
SERVICE
ADDENDUM #S
COMPUTER ACCESS
Self Insurers service will provide the Client with a PC
communications software package to access our LINX claim
d-tabase. The software is licensed by ROLM. The client. agr-eeE
to pay $500.00 above the stated contract price for this soTtwarc-
package. The Client is obligated to adhere to ROLM'S licensing
agreement. Self In7-urers '-ervice does not provid-- the computer
hardware for the Client.
,
LAWRERC�E-M[JLRYA( _
Title: MAYOR
CITY OF SAN RAFAEL