HomeMy WebLinkAboutHR LWP Claims Administration AgreementEXHIBIT A
City of San Rafael
CLAIMS ADMINISTRATION AGREEMENT
THIS AGREEMENT is made as of May 1, 2018 by and between LWP Claims
Solutions, Inc., a California corporation located at 35 Miller Ave. # 214, Mill Valley,
CA. 94941 ("Claims Administrator"), and the City of San Rafael, a California
m u n i c i p a I corporation located at 1400 Fifth Avenue, San Rafael, CA 94901
("Client" or "City").
RECITALS
A. Client desires to contract with a third-party claims administrator to administer the
Client's Workers' Compensation Claims.
B. Client desires to retain a qualified firm to conduct the services described above.
C. Claims Administrator represents to Client that it is a firm composed of highly
trained professionals and is fully qualified to conduct the services described above and render
advice to Client in connection with said services.
D. The parties have negotiated upon the terms pursuant to which Claims
Administrator will provide such services and have reduced such terms to writing.
ARTICLE 1 -TERM
The term of this Agreement shall commence at 12:01 a.m. on the date first written
above and shall remain in effect for (3) years, or until this Agreement is terminated in
accordance with Article 9 below. This Agreement may be renewed for two successive one
(l}-year terms by mutual agreement of the parties no later than thirty (30) days before the
expiration of the prior term.
Notwithstanding the above, Claims Administrator agrees to begin accepting new
claims from Client starting on or about April 16, 2018 in an effort to effectuate a smooth
transition of services beginning May 1, 2018.
ARTICLE 2 -DEFINITIONS
As used in this Agreement, the following terms shall have the following
meanings:
2.1 "Allocated Loss Adjustment Expenses": All out-of-pocket expense items
pertainingto specific files within the Program, such as reasonable attorneys' fees, medical
fee review charges, expert witness fees, fees for independent medical examinations,
witnesses' travel expense, extraordinary travel expense incurred by Claims Administrator at
the express request of Client, court reporters' fees, transcript fees, the cost of obtaining public
records and other similar fees, costs or expenses associated with the investigation, negotiation,
settlement or defense of any claim or as required for investigation and pursuit of subrogation
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on behalf of Client. Allocated loss adjustment expenses shall be subject to and in conformance
with all applicable State statutes, laws and regulations.
2.2 "Claim": Any demand for the payment of money arising from an incident or
report of an incident occurring during the term of this Agreement within the Program which
alleges or results in injury, damage or loss, which could give rise to a demand for the payment
of money, in connection with coverage under the applicable Workers' Compensation statute.
ARTICLE 3 -SERVICES PROVIDED
Subject to all other terms and conditions of this Agreement, Claims Administrator shall provide
the following services:
3.1. Claim Adjustment: Review and conduct investigations of all claims reported to
Claims Administrator; recommend and perform claims-related services as authorized by Client;
attempt to settle claims within the discretionary settlement authority limit; and make
recommendations to Client concerning claims which exceed the discretionary settlement
authority limit. Administrator shall comply with specified requirements outlined as Addendum III,
which is attached hereto and incorporated herein.
3.2 Claim Payment: Pay Claim payments, medical expenses, Allocated Loss
Adjustment Expenses and Claim settlements within Claims Administrator's discretionary
settlement authority limit, or as otherwise authorized by the Client, from the Claims
Payment account funded by Client in accordance with Article 5 of this Agreement.
3.3. Risk Data Management: Collect, process, and store reports containing risk data on
Claims handled by Claims Administrator pursuant to this Agreement. Such reports shall be in a
format as mutually agreed by the parties hereto and shall be forwarded as directed by the Client.
ARTICLE 4 -DISCRETIONARY SETTLEMENT AUTHORITY LIMIT
4.1 Claims Administrator shall be entitled to settle Claims subject to a
discretionary settlement authority limit ("DSAL") to be mutually agreed upon during account
set up. This amount can then be revised at any time at the sole discretion of the City.
4.2 Claims Administrator shall have full discretion to adjust any Claim to a settlement
value which Claims Administrator determines, in its discretion, is equal to or less than the DSAL
without supervision or direction from Client. Such adjustment and settlement shall be binding
upon Client.
4.3 Claims Administrator shall thoroughly review and investigate any Claims, the
settlement value of which Claims Administrator determines to be in excess of its DSAL, and
shall make recommendations to Client regarding the final disposition of any such Claim. Client
is not bound by Claims Administrator's recommendations and shall determine, in its sole
discretion, the final settlement to be paid on such Claims.
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4.4 Upon prior written notice to Client, Claims Administrator shall have the right
to ·treat any Claim, the settlement value of which is within the DSAL, as requiring Client's
approval prior to final disposition, adjustment and/or settlement.
4.5 Notwithstanding Sections 4.1 and 4.2, above, Client shall have the right to
revoke the discretionary settlement authority granted in this Article with respect to any
individual Claim, and may require that such Claim receive Client's approval prior to final
disposition, provided that written notice of such revocation is given to Claims Administrator
prior to Claims Administrator making any formal commitment with respect to the disposition
of such Claim.
ARTICLE 5-CLAIMS FUNDING ACCOUNT
Client agrees to establish and maintain a claims funding account as described in
Addendum II, which is attached hereto and incorporated herein. Addendum II sets
forth the check signature authority of the Claims Administrator for the claims funding
account.
ARTICLE 6-PROPRIETARY AND CONFIDENTIAL RIGHTS
6.1 I n the course of the work performed under this Agreement, either party may
make known or furnish its proprietary and/or confidential information to the other party to
enable the completion and fulfillment of its obligations hereunder. Both parties specifically
agree to keep such proprietary and/or confidential information of the other party confidential
and not to disclose such information to any third party, either directly or indirectly, without
the priorwritten authorization of the other party.
For the purposes of this Agreement, "proprietary and/or confidential
information" shall mean all information which is known or maintained by either party, and
which relates to matters of the other including, but not limited to, trade secrets, research and
development activities, books and records, member/client information and lists, pricing
information, knowhow, data, marketing plans, strategies, new products forecasts, financial
statements, computer programs and equipment, software, designs, internal reports,
procedures and other documentation.
6.2 The restriction contained in Section 6.1 shall not apply to the extent that
such information:
(a) Becomes available to the public, either directly or indirectly,
from a source other than from the other party;
(b) Becomes available through software obtained by the other party from
a third party without breach of any of the confidentiality obligations set forth in this
Agreement; or
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(c) Becomes available in the public domain, or otherwise known to the
other party by virtue of information being developed independently by the other party.
(d) Information subject to disclosure by state or federal law, including
but not limited to the Public Records Act (Cal. Gov. Code section 6250 et seq.) or court
order.
ARTICLE 7-RELATIONSHIP OF PARTIES
7.1 Client and Claims Administrator are independent contractors in all respects, and
as such, neither party shall bind or attempt to bind the other without the other's prior consent
or as specifically set forth in this Agreement. Each party is responsible for the acts and
omissions of itself, its employees, and representatives. Each party shall indemnify and hold the
other party harmless from all liabilities, damages and costs, including reasonable attorneys'
fees, resulting from any act or omission made by itself, its employees, agents, and/or
representatives (but excluding acts or omissions of Claims Administrator as the agent or
representative of Client). In no event shall employees of one party be considered employees
of the other party.
7.2 With the prior written approval of Client, Claims Administrator may retain third-
party vendors ("Vendors"), including designated managed care services, investigative services
and lawyers, as appropriate, to perform claims-related services in connection with the
adjustment of any claim referred to Claims Administrator under this Agreement.
ARTICLE 8-COMPENSATION
Client shall compensate Claims Administrator for services rendered pursuant to this
Agreement in accordance with the Fee Schedule attached hereto and incorporated herein
as Addendum I.
ARTICLE 9-TERMINATION
9.1 This Agreement may be terminated by Client as follows:
(a) Upon 90 days' written notice to Claims Administratorfor any reason
(b) Upon 10 days' written notice in the event of a material breach of
this Agreement by Claims Administratorthat is not cured within thirty (30) days
after receipt of written notice of such breach.
(c) Immediately upon written notice to Claims Administrator in the event
of fraud, gross or willful misconduct by Claims Administrator, or the entry of any
insolvency, liquidation, conservation or rehabilitation order by a court against Claims
Administrator.
9.2 This Agreement may be terminated by Claims Administrator as follows:
(a) Upon 90 days' written notice to Client for any reason;
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(b) Upon 10 days' written notice to Client in the event of a material breach
in this Agreement by Client that is not cured within thirty (30) days after receipt of
written notice of such breach.
(c) Immediately upon written notice to Client in the event of fraud,
gross or willful misconduct by Client or the entry of any insolvency, liquidation,
conservation or rehabilitation order by a court against Client.
(d) Immediately upon written notice to Client in the event of
Client's unreasonable failure to fund the Claims Funding Account in a timely
manner.
9.3 In the event this Agreement is terminated pursuant to Section 9.1 (a) or
Section 9.2(a} above, Claims Administrator shall immediately return all claim files to Client,
unless Client elects to have Claims Administrator continue to assume responsibility for
handling such claims, for a fee agreed upon by Claims Administrator and Client. This
Agreement shall continue to apply to the extent needed for all obligations and liabilities
incurred by each party hereunder prior to such termination to be fully performed and
discharged by such parties. In the event this Agreement is terminated pursuant to any other
provisions of Sections 9.1 or 9.2, it shall terminate on a cut-off basis and Claims
Administrator shall have neither the right nor the obligation to continue to administer
Claims.
9.4 Upon termination of this Agreement, Client shall have the continuing right to
take immediate possession of all Claims files and other records relating to such Claims for
which Claims Administrator does not have any further obligations pursuant to this
Agreement. In the event Client takes over handling of any or all outstanding claims after
termination, Claims Administrator agrees to cooperate fully with Client and to instruct its
employees and agents to cooperate fully with Client in connection with Client's handling of
such claims. In conjunction with any termination of this Agreement, Claims Administrator
agrees to provide a data file, in a form suitable to Client, of all payment, reserve, medical and
all other pertinent Claim file information contained within the computer system of Claims
Administrator, its subsidiaries, data warehouse or any other off-site on on-site media
storage facility.
9.5 Within thirty (30) days after the effective date of the termination of this
Agreement, Claims Administrator shall furnish Client with a final reconciliation of Client's
funds in the Account, and any payment shown to be due will be made by the responsible
party within thirty (30) days of the date of such reconciliation.
ARTICLE 10 -AUDIT RIGHTS
Upon reasonable notice, Claims Administrator shall permit authorized employees
and representatives of Client (including, without limitation, Program Administrator) to
review the operations and claims handling of Claims Administrator, both at its places of
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business and in the field, in order to evaluate the quality and accuracy of Claims
Administrator's employees and operations.
ARTICLE 11 -INDEMNITY AND INSURANCE
11.1 Claims Administrator agrees to indemnify, defend and hold harmless Client
and its affiliates, directors, officers, attorneys, insurers, directors, agents and employees
from and against any and all liability, loss, damage or expense, including reasonable
attorneys' fees, incurred in connection with claims or demands for damages arising from or
caused by any negligence, recklessness, or willful misconduct of Claims Administrator or its
officers, agents, or employees, unless such act or omission was undertaken at the express
direction of Client.
11.2 Client agrees to indemnify, defend and hold harmless Claims Administrator
and its affiliates, directors, officers, attorneys, insurers, agents and employees from and
against any and all liability, loss, damage or expense, including reasonable attorneys' fees,
incurred in connection with claims or demands for damages arising from or caused by any
negligence, recklessness, or willful misconduct of Client or its officers, agents, or employees,
unless such act or omission was undertaken at the express direction of Claims
Administrator.
11.3 Claims Administrator shall, at all times while any obligation under this
Agreement remains to be performed by Claims Administrator, maintain in force and effect
such insurance as is normal and customary or otherwise required by law to fully protect
itself, its clients and Client including, as a minimum:
(a) Workers' Compensation Insurance, as required by the State of California,
with statutory limits, and employer's liability insurance with limits of no less than one million
dollars ($1,000,000) per accident for bodily injury or disease. Claims Administrator's worker's
compensation insurance shall be specifically endorsed to waive any right of subrogation
against Client;
(b) Commercial General Liability Insurance with limits of not less than $1
million per claim and $3 million in the aggregate, including, without limitation, contractual
liability and personal injury for libel, slander and assault, insuring Claims Administrator's
services under this Agreement and naming Client as additional insured (with any per
occurrence deductible not to exceed $50,000);
(c) The additional insured coverage under Claims Administrator's insurance
policies shall be primary with respect to any insurance or coverage maintained by Client and
shall not call upon Client's insurance or self-insurance coverage for any contribution. The
"primary and noncontributory" coverage in Claims Administrator's policies shall be at least as
broad as ISO form CG20 01 04 13.
(d) An Errors and Omissions policy providing coverage in the amount of
not less than $1,000,000, with a per occurrence deductible not to exceed $50,000; and,
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(e) A Fidelity bond or insurance providing coverage for all officers and
other employees of Claims Administrator (including "money and securities" coverage) in
the amount not less than $1 million, with a deductible not to exceed $50,000.
(f) Upon request of Client, Claims Administrator will provide certificates
of insurance evidencing the above minimum specified insurance coverages.
(g) Claims Administrator will notify Client in writing sixty days prior to
cancellation or reduction in the above insurance coverages.
(h) Except for professional liability insurance or worker's
compensation insurance, the insurance policies shall include, in their text or by
endorsement, coverage for contractual liability and personal injury.
(i) By execution of this Agreement, Claims Administrator hereby
grants to Client a waiver of any right to subrogation which any insurer of Claims
Administrator may acquire against Client by virtue of the payment of any loss under
such insurance. Claims Administrator agrees to obtain any endorsement that may be
necessary to effect this waiver of subrogation, but this provision applies regardless of
whether or not Client has received a waiver of subrogation endorsement from the
insurer.
(j) The insurance policies shall provide for a retroactive date of
placement coinciding with the effective date of this Agreement.
(k) It shall be a requirement under this Agreement that any available insurance
proceeds broader than or in excess of the specified minimum insurance coverage requirements
and/or limits shall be available to Client or any other additional insured party. Furthermore, the
requirements for coverage and limits shall be: (1) the minimum coverage and limits specified in
this Agreement; or (2) the broader coverage and maximum limits of coverage of any insurance
policy or proceeds available to the named insured; whichever is greater.
(I) Proof of Insurance. Claims Administrator shall provide to Client's City Attorney
all of the following: (1) Certificates of Insurance evidencing the insurance coverage required in
this Agreement; (2) a copy of the policy declaration page and/or endorsement page listing all
policy endorsements for the commercial general liability policy, and (3) excerpts of policy
language or specific endorsements evidencing the other insurance requirements set forth in this
Agreement. Client reserves the right to obtain a full certified copy of any insurance policy and
endorsements from Claims Administrator. Failure to exercise this right shall not constitute a
waiver of the right to exercise it later. The insurance shall be approved as to form and sufficiency
by the City Attorney.
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ARTICLE 12 -GENERAL PROVISIONS
12.1 This Agreement sets forth the entire understanding of the parties and
supersedes any prior agreement or understanding relating to the subject matter hereof.
No amendment of this Agreement shall be binding unless executed in writing by both
parties. No waiver of any provision of this Agreement shall be deemed a waiver of any
other provision or a continuing waiver. No waiver shall be binding unless executed in
writing by the party making the waiver.
12.2 Except as otherwise provided herein, this Agreement shall inure to the
benefit of and be binding upon the parties' permitted successors and assignees.
12.3 This Agreement shall be governed by and construed in accordance with
California law. If any provision of this Agreement is held by a court of competent jurisdiction
to be unenforceable in California, the balance of this Agreement shall remain in full force
and effect.
12.4 Each notice or other communication referred to in this Agreement shall be
given in writing by personal delivery, by a nationwide overnight service such as Federal
Express, or by United States first class mail, postage prepaid, at the designated address set
forth below or at such other address as such party, by notice to the other party, may
designate from time to time:
If to Client:
Stacey Peterson, Director of Human Resources
City of San Rafael
1400 Fifth Avenue
San Rafael, CA 94901
Telephone (415) 485-3069
If to Claims Administrator:
Judy Adlam, President & CEO
LWP Claims Solutions, Inc .
35 Miller Ave. # 214
Mill Valley, Ca. 94941
Telephone: (415) 384-0370
12.5 Neither party may assign its rights or responsibilities under this
Agreement without the prior written consent of the other party.
12.6 If a dispute arises under this Agreement, the substantially prevailing party
shall be entitled to reasonable attorneys' fees and costs.
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12.7 NONDISCRIMINATION
Claims Administrator shall not discriminate, in any way, against any person
on the basis of age, sex, race, color, religion, ancestry, national origin or disability in
connection with or related to the performance of its duties and obligations under this
Agreement.
12.8 COMPLIANCE WITH ALL LAWS
Claims Administrator shall observe and comply with all applicable federal,
state and local laws, ordinances, codes and regulations, in the performance of its duties and
obligations under this Agreement. Claims Administrator shall perform all services under this
Agreement in accordance with these laws, ordinances, codes and regulations. Claims
Administrator shall release, defend, indemnify and hold harmless Client, its officers, agents
and employees from any and all damages, liabilities, penalties, fines and all other
consequences from any noncompliance or violation of any laws, ordinances, codes or
regulations.
12.9 COSTS AND ATTORNEY'S FEES
The prevailing party in any action brought to enforce the terms and
conditions of this Agreement, or arising out of the performance of this Agreement, may
recover its reasonable costs (including claims administration) and attorney's fees expended
in connection with such action.
12.10 CITY BUSINESS LICENSE / OTHER TAXES
Claims Administrator shall obtain and maintain during the duration of this
Agreement, a CITY business license as required by the San Rafael Municipal Code. Claims
Administrator shall pay any and all state and federal taxes and any other applicable taxes.
Client shall not be required to pay for any work performed under this Agreement, until
Claims Administrator has provided Client with a completed Internal Revenue Service Form
W-9 (Request for Taxpayer Identification Number and Certification).
12.11 APPLICABLE LAW
The laws of the State of California shall govern this Agreement.
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IN WITNESS WHEREOF, the parties hereto, intending to be legally bound
hereby, have executed this Agreement on the day and year first above written.
LWP Claims Solutions, Inc. City of San Rafael
BY BY
TITLE President & CEO TITLE City Manager
DATE DATE
ATTEST
Lindsay Lara, City Clerk
PROVED AS TO FORM:
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ADDENDUM I
FEE SCHEDULE
1. In consideration of the services to be provided hereunder, Client agrees to pay
Claims Administrator service fees as follows:
Proposed Pricing
Flat Fee Annual - 1 Partially Dedicated Sr Examiner and 1 Partially Dedication FM/MO Examiner
Year 1
Year2
Year3
Year 4 (Optional)
Year 5 (Optional)
Services Included in Claims Administration Fee
Claims Administration
On-Line System Access
Loss Reporting
Access to Ad Hoc Reporting
On-Line 5020 Reporting
Preparation of SIP Reports
Claim Review Meetings
$172,000
$176,300
$180,708
$185,225
$189,856
Designated Account Manager
Litigation Management
Trust Accounting
Preparation and filing of 1099's
Reporting to Excess Carriers
Subrogation
Swat Team Claim Intake
Bill Review Fee
Standard Medical Bill Review Fee Schedule
Reductions
Inpatient hospital and Ambulatory Surgery
Center
PPO Reduction
Bills not subject to Fee Schedule
$8.00 per bill plus PPO Reduction
$300 per bill plus PPO Reduction
24% of Reduction below Fee Schedule
24% of Reduction
Should Hospitollnpotient and Ambulotory Surgery Center charges be less thon $300 the standard bill review fee
and PPO network discount shall apply.
Other Fees
RMIS Access
Transition Services
Data Intake
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No Charge
$5,000
EXHIBIT A
Claims Triage
Ebill
Index and OFAC Reporting (ISO Fee passed
through)
Bank Fees
Storage Fee
Optional Managed Care Programs
Case Management
Telephonic Case Management
Field Case Management
Utilization Review
Tier 1-Nurse Review
No Charge
$1 per bill (if submitted by provider
through clearinghouse)
$9.75 per report
Actual bank fees will be the responsibility
of the client
No Charge
$102 per hour
$108 per hour + incidentals (including
mileage, phone, tolls, parking, etc.)
$110 Flat Fee
Includes 3 medical request in a single review, set up, phane calls ta physician, email natices ta adjuster and
letters ta all parties including netwark providers. Fee applies ta reviews approved by nurse or escalated to
physician.
Tier 2 -Physician Review $235 plus nurse charge
Includes 3 medical request in a single review.
Pharmacy Review $385 plus nurse charge
Includes unlimited medical request in a single review.
PPO fee for savings below fee schedule and negotiations 24%
There is no separate charge for medical provider access to L WP's proprietary network. Percentage of savings
below fee schedule is the only charge.
I Medicare Reporting
I Investigation
Field Investigation
SIU related work
I Managed Care Provider Feeds
Applies to feeds which LWP does not already
maintain
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No Charge
$88 per hour
$98 per hour
$3,000
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I Other Charges
Liens Negotiated by LWP Staff 10% of savings achieved below fee
schedule
LWP makes every effort not to change pricing. Pricing guarantee for 18 months. Price subject to
increase thereafter with advance notice.
1. Services fees shall be paid no later than thirty (30) days after being submitted
to Client for payment along with full documentation of such fees.
2. Client agrees to reimburse Claims Administratorfor reasonable processing costs
and out-of-pocket expenses incurred by Claims Administrator in the performance of its
services hereunder. Such reimbursementshall be paid within thirty (30) days of receipt
of an invoice outlining and fully documenting such reasonable expenses. Costs not
outlined elsewhere in this contract require the prior written approval of Client as a
condition for reimbursement.
3. Any fees not paid within thirty (30) days shall be subject to interest at a rate of six
(6%) percent per annum.
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ADDENDUM II
CLAIMS FUNDING ACCOUNT
The Claims Funding Account (the "Account") shall be funded as follows:
Signature Authority
LWP has discretionary authority to name officers, directors or other management staff as
signers on this account.
Frequency and method of Funding
LWP will check funds weekly, and request total amounts paid reconciling to agreed upon
Claims Funding Account balance of $125,000. Special funds will be requested for any single
payment exceeding $20,000 the Claims Funding Account balance will be monitored and
adjusted by mutual agreement between LWP and Client, as needed, in the spirit of ensuring
that claim payments are made timely.
Credits and Recoveries
Any monies collected by Claims Administrator for subrogation, from second or special injury
funds, as reimbursements of paid claim expenses, excess insurance recoveries, or any other
type of recovery shall be applied to the claim file and promptly deposited by Claims
Administrator into the Claims Funding Account and reconciled to the agreed upon account
balance.
Misc. Provisions
None
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ADDENDUM III
SPECIAL HANDLING AND REPORTING REQUIREMENTS
<To Be Determined>
CONTRACT ROUTING FORM
INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below.
TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER:
Contracting Department: Human Resources
Project Manager: Stacey Peterson
Extension: 3069
Contractor Name: LWP Claims Solutions, Inc.
Contractor's Contact: Judy Adlam
Contact's Email: iadlam@lwpclaims.com
D FPPC: Check if Contractor/Consultant must file Form 700
Step RESPONSIBLE DESCRIPTION
DEPARTMENT
1 Project Manager a. Email PINS Introductory Notice to Contractor
b. Email contract (in Word) & attachments to City
Atty c/o Laraine.Gittens@cityofsanrafael.org
2 City Attorney a. Review, revise, and comment on draft agreement
and return to Project Manager
b. Confirm insurance requirements, create Job on
PINS, send PINS insurance notice to contractor
3 Project Manager Forward three (3) originals of final agreement to
contractor for their signature
4 Project Manager When necessary, * contractor-signed agreement
agendized for Council approval
·PSA> $20,000; or Purchase> $35,000; or
Public Works Contract> $125,000
Date of Council approval
PRINT CONTINUE ROUTING PROCESS WITH HARD COPY
5 Project Manager Forward signed original agreements to City
Attorney with printed copy of this routing form
6 City Attorney Review and approve hard copy of signed
agreement
7 City Attorney Review and approve insurance in PINS, and bonds
(for Public Works Contracts)
8 City Manager / Mayor Agreement executed by Council authorized official
9 City Clerk Attest signatures, retains original agreement and
forwards copies to Project Manager
COMPLETED
DATE
3/26/2018
3/8/2018
3/22/2018
ClIck here to
enter a date.
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