HomeMy WebLinkAboutCC Resolution 7990 (Workers Comp Claims Administration)RESOLUTION NO. 7990
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
SAN RAFAEL AUTHORIZING THE SIGNING OF A CONTRACT,
LEASE OR AGREEMENT
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, a contract, lease or agreement
with Self -Insurers Service, Inc., to function as the City's Workers
Compensation Claims Administrator from July 1, 1989 through June 30,
1990.
I, JEANNE M. LEONCINI, Clerk of the City of San Rafael,
hereby certify that the foregoing resolution was duly and regularly
introduced and adopted at a regular meeting of the Council of said
City on MONDAY , the 19TH day of JUNE
1989, by the following vote, to wit:
AYES: COUNCILMEMBERS: Boro, Breiner, Frugoli, Thayer & Mayor Mulryan
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: None
JEAINEONCINI, City Clerk
rUl R 160" 1 N A
799a
I R, .. T
SELF I SURER,,S
SE ICE
A ROLLINS BURDICK HUNTER CORP.
SELF•INSURERS SERVICE. INC 2620 AUGUSTINE DRIVE SANTA CLARA, CALIFORNIA 95054 408-727-9515
SERVICE AGREEMENT
This Service Agreement is entered into this 1st day of July,
1989 by and between the City of San Rafael hereinafter called
the "Client" and Self Insurers Service, Inc., hereinafter called
"Self Insurers Service" and is as follows:
I. GENERAL STATEMENT
Client wishes to retain the services of Self Insurers
Service for administration of their Workers Compensation
Claims Program.
Self 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 07-01-89 through 06-30-90 except
as amended or canceled as hereinafter provided.
III. SERVICES TO BE PROVIDED BY SELF INSURERS SERVICE
Self Insurers Service shall provide the following
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.B)
C. Prepare and file all claim reports in accordance with
establishes procedures and state guidelines.
D. Maintain a separate claim file on each reported claim;
each file shall be available for review by the Client ar
any reasonable time during regular business hours. Self
Insurers Service will retain closed files for twe (2)
years following which the closed files will be returneci
to the Client at the client'E sole expense. Sel=
Insurers Service will do all within its scope ana
authority to ensure safe delivery.
t 'A r
SELF
E SEURVIC�E �
NATURE OF REPORT LS1 FREQUENCY
(1) Loss Experience Report Monthly
(2) Loss Experience Summary Monthly
E. Provide computerized standardized loss reports disclosing
pertinent claims data as follows.
The Client may request, from time -to -time, Self Insurers
Service to provide additional information, analysis,
reports and services. If so requested, Self Insurers
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 the
processing of qualified claims or losses. Self Insurers
Service, Inc. also agrees to provide the following for
contract year 89/90:
-Six claims status reviews
-Five training days to be spent either training
the Client's personnel or consulting with •Client's,
personnel.
Any subsequent such service by Self Insurers Service
shall be deemed an additional service to be inboiced to
and paid immediately by the Client according to the
prevailing time and expense charges of Self Insurers
Service.
J. Self Insurers Service will provide excess or reinsurer
notification as provided for, and as agreed to, in
Attached Addendum #1 to this contract.
r o r
SELF Efn/KE R`
IV. CLIENT'S OBLIGATIONS
The Client agrees to:
A. Pay Self Insurers 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 (10) 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
checks. 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 Insurers Service has no duty nor obligation to fund
claim payments or Allocated Loss Expense payments with
its own funds.
f • �
SELSERVKE �
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 Client 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
alternative dispute resolution costs, 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 $—n 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 practicble all claims, incidents,
losses, claim reports and all other claim correspondence
to Self Insurers Service.
V PROCEDURES UPON EXPIRATION AND NON RENEWAL
Ninety (90) days 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 of the receipt of the proposed new
Service Agreement its desire to continue forward under
the proposed n-ew Service Agreement.
SELF INSURER�
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 director
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
Agreement, 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, officers, employees, parents, subsidiaries and
affiliates from and against any and all claims, loss,
liability, costs, damages, expenses, and attorney's fees
incurred by Client as the direct or indirect result of
any misconduct, error or omission of the Self Insurers
SELF it
Service, 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 Agreement, provided that said claims, loss,
liability costs, dames and attorney's fees have not been
directly caused by any misconduct, error or omission 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 or 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.
L. 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 amendment 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 1s understood and agreed that Self Insurers Service is
engaged to perform 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
interest therein may be assigned by Self Insurers
Service, Inc. without the prior written consult of the
Client.
F
SELF INS_URE[�S
SERVICE
FI. This Service Agreement in all respects shall be governed
by and construed in accordance with the laws of the State -
of California.
I. The Client and Self Insurers Service shall not
discriminate against any employee or applicant for
employment because of race, religion, color, sex or
national origin.
J. Any notice required to be given under this Service
Agreement shall be sent by Certified Mail -Return Receipt
requested, only, to the following as respects Self
Insurers Service:
Managing, Director/Officer Vice President
Self Insurers, Service, Inc. ANLL/OR Self Insurers Service
One Illinois Center 2620 Augustine Dr.
111 East, WacKer Drive Santa Clara, Ca 95054
Ste 2x14
Chicago, Illinois 60601
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 Rafael,
California on the day and date first above written..
SELF INSURERS SERVICE, INC.
BY:
Its Duly Authorized Agent
City of Sand RafaelT]
Its Duly Authorized --Agent
Lawrence E. Mulryan, Mayor
ATTEST:
J n`e,M. Leoncini City Clerk
SELFEf1�5UKE [�S
SERVICE
ADDENDUM X31
NOTICE TO EXCESS OR REINSURER CARRIERS
If so requested by the client, in writing, Self Insurers
Service agrees to notify, on a timely 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 those persons
with 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 —7
LAWRENCE E. MULRYPi
Title MAYOR
CITY OF SAN RAFAEL
i
SELF INSURERS
SERV
ADDENDUM #2
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 $250 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.
[ ] (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. SIS
will distribute 1099 copies to the respect-ive
parties.
[ ] (3) Client hereby directs SIS not to include our
company's data on the magnetic tape filed with
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 AVENUE. P.O. BOX 60. SAN RAFAE + CA 94915-00F0
Contact: SUZANNE GOLT, ASSISTANT TO THE CITY MANAGER
Phone No. : (415) 485-3072
Federal Tax I.D. No . 946000424 {
-`
Signature:,, --.C- �— -c
LAWRENCE E. MULRYAN
Title: MAYOR
'SELF i NSIJRERS
SERVICE
ADDENDUM #3
1099 Miscellaneous Tax Form
Processing for 1989
Client hereby agrees that SIS will have no obligation to
produce 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 6Q, SAN RAFAEL, CA 94915-0060
Phone: (415) 485-3072
Contact: SUZANNE GOLT, ASSISTANT TO THE CITY MANAGER
S i g n a t u r e -,Lc-- L-,�-
'LAWRLNUL L. MULRYAN '
Title: MAYOR
1
SELF INSURERS
SERVICE
ADDENDUM #4
POWER OF ATTORNEY
Know all men by these presents, that the undersigned does hereby
make, constitute, and appoint Self Insurers Service, Inc.; 111
East Wacker 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.
i
Name LAWRENCE E. MULRYAN
MAYOR
Title
ACKNOWLEDGEMENT
State of rAI Ti:nPNTA
County of MARIN
Before me a Notory Public in and for said County personally
appeared LAWRENCE E. MULRYAN, Mayor , who acknowledged the signing of
the foregoing 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.
NOTARY PUD -10 - CALIGNIA
MARR COUNTY i
My Comm. Expires Ncw. 29, 1991 ?
�^�.-.r. _-,.-�•,- �--i-.r... .Ma
16L: 5;; F.:_., i -O. L. 5Q, Sen Rafael, CA 94915.0060.-gr
Q
ry Put1 L
NOVEMBER 29, 1991
My Commission Expires-
SELF INSURERS
SERVICE
ADDENDUM X35
COMPUTER ACCESS
Self Insurers Service will provide the Client with a PC
communications software package to access our LINX claim
database. The software is licensed by ROLM. The client agrees
to pay $500.00 above the stated contract price for this software
package. The Client is obligated to adhere to ROLM'S licensing
agreement. Self Insurers Service does not provide the computer
hardware for the Client.
Signedc��'ts �-cr
' LAWKENCE E.
Title: MAYOR
CITY OF SAN
L - � �'r�c�•-pct-�
MULKYAN
RAFAEL