HomeMy WebLinkAbout2014-112 Contract - Tristar Risk Mgmt
TRISTAR-
RISK NIANAGINIFNT
March 1, 2014
Tina Gray
Human Resource Manager
City of Ashland
Human Resource Department
20 East Main Street
Ashland, OR 97520
Re: Contract for Workers' Compensation TPA Services
Dear Ms. Grey,
Please find enclosed two (2) original Contracts for Workers' Compensation Third Party
Administrative Services between the City of Ashland and TRISTAR, signed on behalf of
TRISTAR Risk Management. Once approved. please counter-sign both originals and return one
(1) fully executed Amendment to our office.
Should you have any questions regarding this Agreement, please feel 'free to contact us at the
number listed below.
1
Sincerely,
Nancy Henderson
Administration
Enclosures
100 0reangate #700, Long Beach, CA 90802 ! T:562-495-6600 F:562-432-8258 i mm.tristargroup.net
' Contract for Workers' Compensation TPA Services
C I T Y OF CONTRAC-l OR: Tristar Risk Management
ASHLAND
CONTACT: Jeff Stromberg. Director Sales & Client Services
20 East Main Street
Ashland. Oregon 97520 ADDRESS t Lincoln:. 10300 SW Greenburg Road. Suite 265.
Telephone: 5411488-6002 PO ianj. Oregon 97223
Fax: 5411488-5311
TEL.EPHO lE 503.245-7592 Ext. 3429
2:4TE AGRER4ENf PREPARED, Fa rua[y 2v 201,1 FAX 714-245-4714
BEGINNING DATE: March '1, 2014 f 4 i C OOP E ill DATE. f ebruarv ly. 20'16
I OMPENS.ATION: Per attached fee schedule attached as txn!tit C.
GOODS AND SERVICES TQ BE PROVIDED: ! tor'rers' Compensation Third :Party Administrative Services as
outlined in the 2010 RFP and the Consultant's proposal su`rnitted in response to the RFP
1
ADDITIONAL TERMS:
Soeciai Prdeurament p„rw~t; b t,ity t,o utc 1 en_February~ 18.-2-0-14
~ NOVti THEREFORE, pursuant to AMC 2.5D !196 and n`t~, r:Onsiderat;O.. Of the n usual crn:enarts contained h= evr
CITY AND CONTRACTOR AGREE as tc'Irnvs
I t. All Costs by Contractor: Contractor shall. provide alt goods es soecrtted above and shat! at its oevr, f+sk anc
j expense, perform any work described above and, ur.{ess cther:nse specified, furnish all labor. ed,u;pmeni and
I materials required for the proper performance of such work
( 2. Qualified Work: Contractor has represented, and by zmte,r:no into this contract flow represents. that any person-n&;
assigned to the work required.under this contract aria fri uual,ircd to perform the work to which they cei!! oe ass:gnes
I in a skilled and worker like manner and. if required to be registered. licensed or bonded by the State of Or=egon. arc
so registered, licensed and bonded Contractor must aisc rnaimain a current City busirness license
3. Completion Date: Contractor shalt provide all goods in accordance with the standards and specifications. no later
than the date indicated above. and start per,-arn-ring the work under this contract by ire beginning date ind;c2I.ad
above and complete the work by the completion; date rndics,.ec aGcve
4. Compensation: City shall pay Contractor for the specifies _loccs anu for any work performed, including cc-,!5 are'
expenses, the sum specified above. Payments shell be., wiede ti,m ~ 6 days of the date of the invoice Should Me
contract be prematurely terminated, payments vvol' boa mac:-. ?or •wor4, completed and accepted to dot+c of
tennrnation,
5. Ownership oP'Documents: All documents prepare;! by Gxdrac:p, c)ursuant to this contract shall be :he gropafer o'
City
I
6. Statutory Requirements: ORS 2798226 2%96.225- 2% 8 7.3G. 2-9n.235. ORS Chapter 244 and ORS E ;:.500 are
made part of this contract.
7. Living Wage Requirements: if contractor is prov:dime r;ices under this contract and the amount of this contract
i is $19,825 or more, Contractor is required to comply ,vith chapter ? 12 of the Ashland Municiper! Code by paying a
living vage, as defined in this chapter, to ail employees per`crrm;g work under this contract and to any subcontractor
who performs 56% or more of the work under this Ooolrsci f.d!11:8C:Qr is also required to post the noticr- attachat
hereto as Exhibit 8 predominantly in areas where 4 :rill fie se.Hv by all employees.
8. Indemnification; Contractor agrees to defend, indernai.` and sd:e City. Its officers, e;no!nyees and agents hay mess
from any and all losses. claims, actions. costs, expenses. ;udya-eot<_, subrogauons, or other damages resuitino from
i injury to any person (including injury resulting in ceetnl. c- damace lir.r_iud:ng loss or destn,^.tionj io prcoery. ci
t whatsoever nature arising out of or incident to the ni~rt:;rma= .ice o; this c:ontr)r by Contractor (including h:-;: m:;r :imltec
to, Contractors employees, agents, and Others desigriz ted by 'Contractor [o perform work or services atcencant to m
:
contract). Contractor shall not be held responsible for any inSSes, expenses. vaimB, subrog3[igrns. a~!b,.5. ^~)Sl
judgments, or other damages. directly, solerv and pro;:iira~etry caused by the rregtryerce of City.
9. Termination:
a. Mutual Consent This cont73.t n-nay b t•.......~a[cd e.::ny iitne by mutual consent of both pa'ues.
b. CiNs Convenience. This contract ma; c;_ 3_.. ;ina;er, at any time by C y upon 30 da,•'s' [:.Otice :n ,vnting
and delivered by certified mail or in perm
c. For Cause. City may terminate o: modriy thin cent act, u; whole or in pa - effective upon dzirve:,, o!
written ratice to Contractor, or at st:ch inter dose as n;a; lx~ :=s!ai,,rahed py City ender ally Of the f1,110
I conditions.
i If City Funding from feces.. state. county a'Ah2r sources is riot. obtained and con+:need a". i„,,
sufficient to allow _a the ucl', c> h=.in Irv[ d_qunn Ct of ernces
Con-cact for 'Oorkers: Compensation TPA Service; G6 ±2L'.;. v w i of
ii. It federal or state regulations of gtndeUr:es are n;odified. changed. or irtarpreied in ci a ,vay--
that the services are no longer alicvcable or appropriate for purchase under this cortract c'r are
no longer eligible for the fundire oripoecd fix payments authoriZed by this contract; Cr
iii. If any license or certificate requirec by la:, of regulation 11) be held by Contractor to provide'hi;
services requried by this ;.:ontrac' is for arty :ea on denied, :evoked. suspended, or not reaz read
d. For Default or Breach.
1. Either City or Contractor !Tay iernimate this Contra C: In the event of a oreach c; the : ^ird b^
the other. Prior to such terranaiior th- panq seeking termination shall give ;c the other par.;
tvrtter. notice of the breach arc intent lb iermina,e If the party commixing the breach ties no;
entirely cured the breach w:tcin 16 days o tie date of the notice, orwith:r. such ogler period t=
the part, giving the notice may autho i_e cr require, then the contract may be terrimm.ed at a^•y
{ time thereafter by 2 wn^an nc,rce of tr~rmrn_ von by the party giving notice.
j ii. Time is of the essence for Gontracror'r teen-or,nan-e of ..act; and every obligation and duty under
this Contract City by wrifter, +rourc n Contracmr of default or breach, may at any time term:natia
the whole or any part of this con !rar_t it Contraacr fails to provide services called ter by tats
contract within the time specif ed hercni pi ii'i any extension thereof.
ill The rights and remedies of City provided in this subsection idl are not excluswe ar;d are I.
addition to any ether rights at id remedies p -~t9ded by fates or under this contract .
e, ObrigationriLiabiiity of Parties. Te.minat,->n o. nrcditlcatior: of this contract. pursuant to subs ch::^~ a b.
c above shall be without prejudice to any obiigations ur Mbii!ties of either party already accrued prior to sc;oh
termination or modification. However, upon roc-o!:-:r,;- a raise ^f tarmana'.ion i regardless whether sn'h notice s
given pursuant t0 subsections a. b, c or;, of th!<_ Ccntr'a:lor s.`lall Imnnediately Cease ail ac'ivrlies !'^dcr
' this contract. unless cxpressiy directed ctriervr,';e City ii inxe notice of ternwia!ion. Further. upon termrna ri
Contactor shall deliver to City all contract documents. inf~lrm.attor, works-in-Progress acid ether r p_ ry -
or would be deliverables had the contract been com.P;etec. City shall pay. Contra, :or for '✓lork perf,rnied pncr tc
the termination date if such work was perforated in accordartce with the C'onirac; i
i 10. Independent Contractor Status: Contractor is nn in"ecerident Cerara-tgr and not an cmplct:ee of the Cny
i Contractor shall have.the complete resconsibilit.v for tfte performance= of this coniract.
! 11. Non-discrimination-Certification- The <indersigne l 7e-t!ri05 that the undefsipned Contractor has net dis:::mrnate I
against minority, women or emerging small businesses enterprises in obtaining any required subcontracts
Contactor further certifies that it shall act discriminate the m.•rard of such subcontracts, if any. -The Contactor
understands and acknowledges that it my oe disquaiifiaJ from piodir. g on this contract, including but not iirr,iie.7!1
City discovery of a misrepresentation or sham iecardi:%g a subcorrt:act or that the Bidder nas violated any .
requirement of ORS 275AA 10 or the arimi.•'ds.-:.r. rule; inph:mcntirni !he5tatute.
12. Asbestos Abatement License: If reouired under ORS :bar: 7 Pi, Contractor or Subcontractor shall possess an
1 asbestos abatement license.
13. Assignment and Subcontracts: Contractor shall not assign tics contract or subcontract any portion of the
;rgrk
! without the written consent of City, Any attempted assignment or subcontract without :vr itten consent of C1., sft)ail. be
f void. Contactor shall be fully responsible for the acts or cmisslorns of any assions or subcontractors and of all
personsemployed by them, and the approval by Cit; of onr assignment or :u5contract shall not create any
contractual relation between the assignee or subu:gtra;;t:x stir. City.
14. Useof Recyclable products: Contractor shall use r:,cyclable "Toduc's to the rnaxirium extent eccnornicR:K- ieas!",!e
in the performance of the contract work set forth in this aucun'ient
15. Default. The Contactor shall be in default of this a ireen-,art it Contractor cornmfts any material oreacn gr default dt
any covenant, warranty, certification. or obligation it pines under the Contact, if !t loses its QRF status pursuer: to
I the QRF Rules or loses any license, certificate or ,&-tif!cat;cr.:hat s recuired to pellorm the work or to gua0fo as z
QRF if Contractor has qualified as a QRF for tills arreemeni, institutes an action for relief to bankruptcy or has
instituted against it an action for insolvency makes a generai assionnient for the benc"a or rreditors, or ceases doing
! business on a regular basis of the type identified in ;IS ooiidatiors under the Cor,lr act, or attempts to assign rights :n,
or delegate duties under. the Contract
16. Insurance. Contractor shall at ile own expense pacvnde tin; fo'.Ivv:ing insurance:
a. Workers Compensation insurance :ompliance with ORS 556.017, which requires subject empto-,ers e ~ .
I provide Oregon workers' compensation coverage for all (heir subject •.vorkers
b. General Liability insurance witfi a gmbined sulgie !iati'.. or the eGuhreler.t v; not less than E.^•ar one
i 5200,000. $500.000, 51,000.000;-"-$2,000,OO b Nei Appfcabie for each occurrence for Bodily injury and Proner-t
Damage, It shall include 'contracO t-51Pify co'.•era;pe nor n,e :,demmrty provided under this contract,
c. Automobile Liability insurance with a combir:cd sir.ule limit, or :he ecuivalenL of not Jess than Enler ,ne
i -5?£ Si,000,000, or, !dot Appiicable !or each accident for Bodily Injury znd Property Cama;:e•
including coverage for owned. hired or non-ov.ned venldes. as applicable.
i d. Notice of cancellation nr chance Thera =_haii be nil c-; ,collation, material chance. rzdurticn of iiml's of
intern not to renew the insurance covet age(s i'.vrt';G;ii 0 da.,- - an, tin. nc[iae 'tom the G- ntr3c[o, or its Ensure:;;) :c '
the City.
Conlraerfor Workers' Compenseuon TPA Scrvires. FeviSr;c i)t-i:': i~,i;- --,3T Si
• e Additional Insured/Cer lficat s of Insure lc Cn lta i;'r steal name The City of Ashlane Oregon, a d its
I elected officials. officers and employees as .Adwtlo ,o; nsurt,cs on any insurance policies required he%e.t o,,; o
wilh respect to Contractor's services to be D:ekld d under t'h-s :;oniract. As evidence of the insurance ooveraCe-
required by 'his Contra+r . the Contractor sitar; fiurns!t acp.?t,ta':!e insurance certificates print to
coif n':encirg '.cor4:
under this contract. The contractor's insurance primary and not--contributory. The certificate will soeClfy a" at
parties who are Additional Insvreds insuring companies or enlies are suhjact to the City's accep:an-c if
requested. complete copies of insurance policies. trust agreemznis etc. shall be prrnaded to Ste City T^e
Contractor shall be financially responsible for ail pertinenl cado_tibl=_s. self insured retention, and!or serf-
insurance.
17 Governing Law; Jurisdiction; Venue This contra sila,! be• ;aver-ied and constrced in accordance with me !::c;_
I of the State of Oregon without resort to any junsrl;:;t!on Df la'ais, rubes or doctrines nny cla!rr, aChcn, 5'.'It 0;
proceeding icollectiveiv. "the clarr,"1 bemeen tr!c' arVy "!lilt;r , r CEpartmen', of tre, State Ot r)regcnj an-,
the Contractor that arises from or relates to tilt _•,o!'.Ir?^1 eI1:70 !i- 1.,n,.!Ch,L and co nd GGicd solely w o
Bx CI L'S 1~'21y t•C ih in
I the Circuit Court of Jackson County for `he v e c 'n r: ! owe e r i hF r!a m mus! be bro ,qtt I J re + t
forum, then it shall be brought and conducted o d r...:-.i~- .'f 1. ; Wl!h.a the U:'Ited StateS Dist riot ,..;.-f r r;
District of Oregon filed ,n Jackson County, 07egrn. C:onva's boy 111, signature herein of its author ze:6
representative, hereby consents to the in perscnant;:.!ns;:rcuon ::f sa:d averts In nu event shall this szction be
j construed as a waiver by City of any form of defense :n;mvn b . cased on the Eleven'h
, A rriendinerit tc' ;he Unfrc,
States Constitution. or otherwise, from any cialm or front pre jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CCNSTITUTL 7-HE ENTIRE- AGREEMENT BETV-1EEN THE
PARTIES, NO'vV.AIVER, CONSENT.. NIODlFiC.-.TICN OR CHANGE OF TERMS OF THIS CONTRA CT SHALL
BIND EITHER PARTY UNLESS IN :'VRITING AND SIGA!ED BOTH PARTIES. SUCH PJAIVER. CO':SENT.
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECT'VE ONLY IN T HE SPECIFIC INSTANCE :-`:D ri~c
THE SPECIFIC PURPOSE GIVEN. THERE ARE PIQ Ur:D£RST.r;NDINGS, AGREEMENTS. OR
REPRESENTATIONS. ORAL OR WRITTEN, NCT SPECIFIEOI HEREIN REG.ARDING'F?IS CONTPACT
CONTRACTOR, BY SIGNATURE OF ITS AUTHOR!' D F,EPFESENTA'FiVE. HEREBY A;;KNOV&EDGES T
HE/SHE HAS READ THIS CONTRACT. UNDERSTANDS 11 ;'.NU AGREES TO BE BOUND BY ITs TERAMiS AND
CONDITIONS.
! 19. Nona ppropriations Clause. Funds Available and Acthonzed: City ties sufficient binds :;urrently avai!ai:;e and
? authorized for expenditure to finance the costs jf !.his contract rr!irn the City's fiscal year budget. Contractor
I understands and agrees that City's payment of an'iCVn L•; ceder this contract a:Cributabie ir, :vorK performed aftzr
last day of the current fiscal year is conilrg i1 Oil V,l' o(. Gpn' ~r -.T Other expend tune author: c fficien c
City 0 the exercise of its reasonable edrr nst:'a t!i+£ Jr .r:.+i,c, cc,n,i rue to make payments under this „o tr4~,
I the event City has insufficient' ap`propriatlona, lirsaitat~;~ _'r I,rl~r.r ct~_rr.clt;,;re sa`!hnra;% mo- y:e!minatq than
,
contract without penalty or ! abikity to Cit eftel.tiv:: up ;j;7?i'.'e f sift en notiL'e i0 Conzi.3ftor. '.Vitt no :Ur'h is
liability to Contractor.
20. Prior Approval Required Provision. Approval by the Cif;' of 4 shi2n 1 Council or the Public Contracting Otf:car s
I required before any work may begin under this cwntrec!
i 21. Certification. Contractor shalt sign the certification attarfi,ac neierc as Exhibit A and nerein ,ncorpo*ler by
l _ reference
~Gontractor. Ci, o4 Ashland
1BY
- -Ir------Signatur- Depart,nent Head -
I Thomas J. le
Print Name - print Name
j President & CEO
Title Date
1 W-9 One copy o£ a bV-9 is to be submitted north
i the signed contract I-:::rte,;zr- (;!,-der Re _
k ti.
,
Contract for Workers' Compensation, TPA Saivice S. avts, r! U^I 11
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contraciol', under penalty of perjury, certifies that (a) the
number shaven on the attached W-U form is its correct iaxpave 1C for is m'a'ting for the number to be
issued to it and (b) Contractor is not subject to backup withholding because (i) it is exernm from
backup withholding or (ii) it has not been notified t)y the Irner nai Revenue Service (IRS) that is
subject to backup withholding as a result of a falure to report al interest or dividends, or !,iii! the IRS
has notified it that it is no longer subject to backup ithnoiding. Contractor further represents and
warrants to Citv that (a) it has the power and authertty to enter into and perform the work. (b the
Contract. when executed and delivered, shall be a ,afid qnd binding obligation of Contractor
enforceable in accordance with its terms, (r.) flxi murk under the Contract shall be performed in
accordance with the highest profess!r; na; 5tanC3l3r;i dad id) cr',ntrac'tor is qualified. pr;fessio,ta!ly
competent and duly licensed to peiicrin the v"urk.. C:r.ir,u'a;aor also cerGf,es under penalty of p----rpury
that its business is not in violation of arty Oregon tax ia.a nd !t is a corporation authorized to act cn
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents. and has c.hedr..ed four or more of the foiiwviria
criteria:
) 1 Cary out the labor or se-ices at a locafloi'I ;eparate fron^ my reslr P.ricc or is iri e
specific portion of my residence, set aside as the iocatiOn of the business.
(2) Commercial advertising or business cards or a trade association members' nip are
purchased for the business.
(3) Telephone listing is used for the business separate n'om the personal residence listing.
(4) Labor or services are performed only p irz>uant to vVritten contracts.
(5) Labor or services are performed for tVdo or i pro d,!f°rent persons within a period of on e
year.
(6) 1 assume financial responsibiiif; for defective 'vJorkmanship er for se.-Ace nai provided
as evidenced by the ownership of performance bonds, .warranties, errors and omission
insurance or liability insurance relating to., tha i<:bor cw services to be, provided
Contractor te'.
Contrail for L+too..er; ComOenseiion. TPA Ser:;ccs. stow::: Oi `~7:"•:!!7 1 ;4
WIN
EXHIBIT B
City of Ashland
I _
MR,; per hour ei#e¢tive June 30,-2013
Wa. i (Increases anitudily-everyJune 30 by the
Consil user Price index) j
, ; portion Of bus Ness o` their cafeteria plans {wcwdrae
empiovi i. tl c ~:~~.p'o fc )'iris childcare) benefits' - h=
ten cr J C I amours' of-wages by
flas rG•iF 'i.' In ,:':r i the E°lp!nyee
assi5lall:e for iii proted, or
r For all hours worked under a business ro:m the l ct r Note: "Emplofe dues
service contract beli their Ashland in excess of $19;825. include temporary or can-tine
employer and the City of employees hired for less fnan
Ashland if the contract If their empoyer is the City of 1040 hours in any hl
exceeds $19,825 or more. Ashland rxi dino the Parks month perk.. For mare
and Recreation Cepal details on applicabilit of !n.:s
For all hours worked in a
policy. please see Ashland
month if the employeespends n calc:.r;aiir:g tfte )ran:.vage. I0uDt6oU Code Seetinn
50' er more of the t
emplc>ya may <,cd we e value 3.: i. O2t7.
employee's time in that month of he Ith care, retiremant.
working on a project or 401! antl IRS eligible
Call the Ashland City Administrators office at 541-408-LNt)2 .r ::rite io the City Administrator. City
20 East plain Street, Ashland. OR 91520 or visit the city's wehs;te ai vn;'ri.ashland_yr.us.
Notice to Employers: This notice must be posted predoainartiy ir: areas where it can be seen by al!
employees. C I T Y Of
ASHLAND
Contract for Workers' Compenras:on TPA Sen'iacs
ExHIBIT C
FEE SCHEDULE
This Exhibit C shall be effective March 1, 2014 and it shall: i) apply to all Claims reported and all services
i provided on or after that date, and ii) remain in effect until the patties agree on new rates. I
The terms and conditions of the Contract apph unless and to the extent modified of supplemented by the
specific terms and conditions of this Exhibit C.
1. FLAT RATES PER CLAIM & ANNUAL RATE PER CLAIM
During the term of the Contract.
Claim Type Flat Rates Per Claim
Indemnity 51,053.25
Medical Only $166.30
Complex Medical Only.... _ $166.30
incident Only (zero value claims) Nocharge (rfC~enters claim into on-line system)
Incident Only (zero value claims) $35 cif Controctor enters claim into system)
After the expiration of the Contract:
Claim Type Annual Pate Per Claim
Indemnity $250.00
Medical Only No Charge
Complex Medical Only.. No Charge
Note: The Annual Rate Per Claim shall be assessed for each claim open as of the dote of expiration,
but only if the City elects to have Controctor continue to handle the open claims.
2. ANNUAL RMIS FEE
Annual Rate Per User
RMIS Fee 5500.00
3. FEE FOR CLAIM REviEws
Number of Annual Visits Fee Per Claim Review
At Contractor's service location:
Unlimited No Charge
At City's location:
First 2 visits No Charge
Each additional visit $750.00
4. MANAGED CARE FEES
Services Managed Care Fees
Bill Review:
Medical Bill Review.. $$.50 flat fee per bill
PPO Savings 25% of savings after medical bill review
raamzsa m etat :<7 c,h;bir C - cuo2
Nurse Case Management:
Telephonic Case Management $95.00 per hour
Field Case Management ..............................$105.00 per hour
Utilization Review:
In-Patient / Out-Patient... 595.00 per hour
5. OTHER FEES
Services (Ithei Fees
Central index Bureau $8.75 per repo(-,
MMSEA Reporting ..........................................................57.85
6. INCREASES
For subsequent year increases:
i) Per Claim Rates (Section 1): 'The greater of CPI Increase for the City domiciled area or 3.54x;
subject to negotiation resulting from unanticipated economic variances.
ii) All Other Fees (Sections 2, 4, and 5): No increase during the first year and up to 'two (2)
option years.
7. PAYMENT
Contractor shall issue invoices for:
i) The Flat Rates Per Claim: at the end of the month in MilCh the claim is reported to Contractor:
ill The Fee Per Claim Review (if any), Managed Care reel, and Other Pees. at the end of the month
in which they are incurred and/or assessed;
iii) The Annual RMIS Fee: as of the Beginning Date and every twelve (12) months thereafter as long
as Contractor is providing P,MIS services to City under this Contract; and
iv) The Annual Rate Per Claim ;if any): as of the first day after the expiration of the Contract and
every twelve (12) months thereafter as long as Contractor is providing services for those claims
that were open as of the expiration date.
Each such invoice is payable by City to Contractor in accordance with Section 4 of the Contract.
;HC]-t011i sIJC+W (3-]3-sI zxhibi!C n-g:2
FIRST ADDENDUM TO CONTRACT
This First Addendum to Contract ("First Addendum"), effective March 1, 2014 is incorporated into and
made part of that certain Contract for Workers' Compensation TPA Services effective M<nrch 1, 2014
("Contract"). by and between TRiSTAR Risk Management (hereinafter referred to as "Contractor" or
"Third Party Administrator") and the City of Ashland (hereinafter referred to as `City" or' "Self-
Insurer").
WHEREAS, the Oregon Insurance Division regulates written agreements between service companies or
third party administrators and self-insurers under Oregon Statutes Chapter 731; and
WHEREAS, the Oregon Statutes require that agreements entered into between self-insurers and sendce
companies be approved by the Director of the Workers Compensation Division and that such agreements
contain a provision granting the service contpam or third party administrator a power of attorney to act
for self-insurer in workers' compensation coverage and claims proceedings under ORS chapter 656: and
NOW.THEREFORE, in consideration of the covenants and agreements set forth herein and for other
good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Self-
Insurer and Third Party Administrator hereby agree as follows:
1. In accordance with Oregon Revised Statutes (ORS) Section 731.475(3)(b), Self-Insurer hereby grants
Third Party Administrator a power of attorney for the limited purpose of acting on behalf of the Self-
Insurer in workers' compensation coverage and claim proceedings under ORS chapter 656.
2. The specific terms and conditions for claims administrative, investigative and adjustment services are
memorialized in the Contract. Any services not allowed in Oregon will not be used and are not
considered pan of the Contract.
3. The Third Parrv Administrator shall retain and make available at its office located at I030o SW
Greenburg Rd.. #440, Portland, OR 97223 copies of the following records as required by Oregon
Administrative Rude 436-050-0120:
a. Records used and relied upon in processing claims; and
b. Complete records of all payments requested by Third Party Administrator to be made as a result
of any workers' compensation claim presented to the Self-Insurer and arising under Oregon
statutes.
4. All other terms and conditions of the Contract not modified by this First Addendum are hereby
ratified and affirmed.
IN WITNESS WHEREOF, the parties hereto have caused this First Addendum to be executed in
duplicate by their authorized representatives on the dates set forth below.
Ci"f Ashland TRISTAR Risk Man t
Print Name: ~Av^ t{1~N Prinl Nana; _.l-ItUnt Veale _
President & CEO
Title; Titlt'.
Date. 11? I I u Date:
CITY OF
ASHLAND
Council Communication
February 18, 2014, Business Meeting
Special Procurement for Worker's Compensation
Third Party Administrative Services
FROM
Tina Gray, Human Resources Manager, tina.gray aashland.or.us
SUMMARY
The existing three year contract with Tristar Risk Management/Human Resources for Worker's
Compensation Third Party Administrator Services expires February 28, 2014. Staff is seeking
approval of a "Contract-specific Special Procurement" to extend the contract with Tristar Risk
Management for an additional two years for a maximum term of five years. Due to the complex nature
of administering these types of claims, City staff recommends extending the existing contract with
Tristar Risk Management, rather than seeking a new provider at this time.
BACKGROUND AND POLICY IMPLICATIONS:
A Request for Proposal was processed in October of 2010 and a contract was awarded to Tristar Risk
Management in January of 2011 for a maximum term of three years. The current contract expires on
February 28, 2014.
The sourcing method referred to as a Special Procurement is the sourcing method used to seek an
exemption from a competitive solicitation process and in this instance, directly award a two-year
contract extension to Tristar Risk Management. Tristar has done an outstanding job for The City and
given the complexity of Worker's Compensation administration and the staff burden created by having
to bring a new third party administrator up to speed on City claims history, it is in the City's interest to
continue its contracted relationship with Tristar Risk Management.
AMC 2.50.090 Exemptions from Formal Competitive Selection Procedures
All Public Contracts shall be based upon Competitive Sealed Bidding (Invitation to Bid) or
Competitive Sealed Proposals (Request for Proposal) pursuant to ORS 279A - 279C and the Model
Rules except for the following:
G. Special Procurements - a public contract for a class special procurement, a contract specific
procurement or both, based upon a contracting procedure that differs from procedures
described in ORS 279B.055, 279B.060, 279B.065, 279B.070. The contracting approach may be
custom designed to meet the procurement needs.
1. Special procurements shall be awarded in accordance with ORS 279B.085 and all other
applicable provisions of law.
Pa¢e 1 oft
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CITY OF
ASHLAND
(Additional information: A Special Procurement is used for the purpose of seeking an exemption from
the competitive bid process, custom designing a contracting approach, or the direct selection or award
of a public contract or for a series of contracts.)
FISCAL IMPLICATIONS:
Tristar has proposed modest rate increases tied to the CPI as were included in the previous contract.
Claim Rates:
Current Indemnity rate: $1,017.66
Current Medical only rate: $160.68
Proposed Claim Rates:
Indemnity rate: $1,053.28 (3.5% increase in-line with expiring contract provision). Increase of $35.62
per claim.
Medical only rate: $166.30 (3.5% increase in-line with expiring contract provision). Increase of $5.62
per claim.
Based on 2013 new claim volumes of 2 reported IND claims and 17 reported MO claims, the fee
variance or additional cost is estimated at $166.78 for contract year 3-1-14 through 2-28-15.
Current Index Bureau fees: $6.50 per claim
Proposed Index Bureau fees: $8.75 per claim in-line with current business rates quoted to all
TRISTAR customers.
Based on 2013 new claim volumes of 19 total claims reported, the fee variance or additional cost is
estimated at $42.75 (19 x $2.25).
STAFF RECOMMENDATION AND REQUESTED ACTION:
Staff recommends that the "Contract-specific Special Procurement" be approved.
SUGGESTED MOTION:
The Council, acting as the Local Contract Review Board, moves to approve the Contract-specific
Special Procurement to extend the contract with Tristar Risk Management for Workers' Compensation
TPA Services for two years.
ATTACHMENTS:
Special Procurement Request for Approval Form
Paee 2 of 2
CITY OF
FORM #9 ASHLAND
SPECIAL PROCUREMENT
REQUEST FOR APPROVAL
To: City Council, Local Contract Review Board
From: Tina Gray
Date: February 18, 2014
Subject REQUEST FOR APPROVAL OF A SPECIAL PROCUREMENT
In accordance with ORS27913.085, this request for approval of a Special Procurement is being presented
to the City Council for approval. This written request for approval describes the proposed contracting
procedure and the goods or services or the class of goods or services to be acquired through the special
procurement and the circumstances that justify the use of a special procurement under the standards set
forth ORS 279B.085(4).
1. Requesting Department Name: Human Resources
2. Department Contact Name:_ Tina Gray
3. Type of Request: Class Special Procurement X Contract-specific Special Procurement
4. Time Period Requested: From March 1. 2014 To: February 28. 2016
5. Total Estimated Cost: Approximately $30,000 per year. (Actual cost is dependent on number of
claims received by the City 1
6. Short title of the Procurement: Workers' Compensation - Third Party Administrative Services
Supplies and/or Services or class of Supplies and/or Services to be acquired:
Claims examination services to include: Review of all new workers' compensation claims, processing
of claims with timely acceptance or denial based on applicable Oregon State Workers' Compensation
law, processing of payments to injured work and medical providers timely, providing administrative
maintenance of all claim files in accordance with legal standards, filing applicable reports with CMS
and other agencies on behalf of the City in a timely manner, and responding to inquiries and
corresponding with injured workers in a respectable manner.
7. Background and Proposed Contracting Procedure: Provide a description of what has been done
in the past and the proposed procedure. The Agency may, but is not required to, also include the
following types of documents: Notice/Advertising, Solicitation(s), Bid/Proposal Forms(s), Contract
Form(s), and any other documents or forms to be used in the proposed contracting procedure. Attach
additional sheets as needed.
Form #9 - Special Procurement- Request for Approval, Page 1 of 4, 2111/2014
Background: An RFP was processed in October 2010 and a successful contract was awarded to
Tristar Risk Management in January 2011 for a maximum term of three years The current and final
contract extension allowed under this RFP expires on February 28, 2014
Proposed procedure: Due to the complex nature administering these types of claims City staff is
recommending the existing contract with Tristar Risk Management be extended for an additional two
year term.
8. Justification for use of Special Procurement: Describe the circumstances that justify the use of a
Special Procurement. Attach relevant documentation.
The sourcing method referred to as a Special Procurement is the sourcing method used to seek an
exemption from a competitive solicitation process and in this instance directly award a contract to a
specific service provider.
9. Findings to Satisfy the Required Standards: This proposed special procurement:
X (a) will be unlikely to encourage favoritism in the awarding of public contracts or to
substantially diminish competition for public contracts because:
The initial contract was awarded as a result of a formal competitive process
(Please provide specific information that demonstrates how the proposed Special Procurement meets this requirement.); and
X (b)(i) will result in substantial cost savings to the contracting agency or to the public
because:
As a self-insured agency, the City pays all claim costs directly including the administrative costs to
manage claims. The last time the City moved from Health Future to TriStar, we did so because Health
Future was going out-of-business The Workers' Compensation TPA market has become less and less
profitable and thus resulted in fewer TPA's in our eographic area. TriStar is one of only a few
companies well-established on the west coast that is able to provide TPA services While the City of
Ashland is fortunate to have fairly low claim volume it makes us less desirable for companies to bid
on our business as a TPA. TriStar has extended modest rate increases because we are an existin
client. Moving our business would likely result in higher per claim cost Additionally, we would
incur the cost of nhvsically relocating hardcopy files and/or placing them in confidential storage and
transferring electronic files to a new vendor. We would incur additional costs of mailing letters to
applicable agencies, medical providers and injured workers
(Please provide the total estimate cost savings to be gained and the rationale for determining the cost savings); or
Form #9 - Special Procurement- Request for Approval, Page 2 of 4, 211112014
X (b)(ii) will otherwise substantially promote the public interest in a manner that could not
practicably be realized by complying with the requirements of ORS 279B.055, 279B.060, 279B.065,
or 27913.070, or any rules adopted thereunder because:
There is a substantial burden of moving the Administration of our files due to all of the agencies that a
TPA reports to on the City's behalf such as Medicare. TriStar has met our needs and worked hard to
manage claims effectively on the City's behalf Moving our administration to another vendor is time-
consuming and causes substantial stress to aninjured workers currently receiving time loss benefits
There is also added burden on City Finance staff to close out and establish new banking relationships
for TPA access for loss replenishment Staff is recommending we retain TriStar for another contract
period for the purpose of business continuity and efficient delivery of government services
(Please provide specific information that demonstrates how the proposed Special Procurement meets this requirement)
Form #9 - Special Procurement- Request for Approval, Page 3 of 4,2111/2014
Public Notice:
Pursuant to ORS 279B.085(5) and OAR 137-047-0285(2), a Contracting Agency shall give public .
notice of the Contract Review Authority's approval of a Special Procurement in the same manner as a
public notice of competitive sealed Bids under ORS 279B.055(4) and OAR 137-047-0300. The public
notice shall describe the Goods or Services or class of Goods or Services to be acquired through the
Special Procurement and shall give such public notice of the approval ofa Special Procurement at
least seven (7) Days before Award of the Contract.
After the Special Procurement has been approved by the City Council, the following public notice will
be posted on the City's website to allow for the seven (7) day protest period.
Date Public Notice first appeared on www.ashland.or.us - [February 19, 2014, if approved by
Council]
PUBLIC NOTICE
Approval of a Special Procurement
First date of publication: [February 19, 2014, if approved by Council]
A request for approval of a Special Procurement was presented to and approved by the
City Council, acting as the Local Contract Review Board, on [February 18, 2014, if
approved by Council].
This Contract- specific Special Procurement allows the existing 3 -year contract with
Tristar Risk Managementfor Workers' Compensation ThirdPartyAdministrative
Services to be extended for an additional two years. Due to the complex nature of the
claims process, staff has requested the existing contract be extended for an additional two
years. The term for this contract extension will begin on March 1, 2014 and expire on
February 28, 2016.
It has been determined based on written findings that the Special Procurement will be
unlikely to encourage favoritism in the awarding of public contracts or to substantially
diminish competition for public contracts, and result in substantial cost savings or
substantially promote the public interest in a manner that could not be realized by
complying with the requirements that are applicable in ORS 279B.055, 279B.060,
279B.065, or 279B.070.
An affected person may protest the request for approval of a Special Procurement in
accordance with ORS 279B.400 and OAR 137-047-0300. A written protest shall be
delivered to the following address: City of Ashland, Tina Gray, Human Resources, 20 E.
Main Street, Ashland, OR 97520. The seven (7) protest period will expire at 5:00pm on
[February 26, 2014, if posted on February 19, 2014].
This public notice is being published on the City's Internet World Wide Web site at least
seven days prior to the award of a public contract resulting from this request for approval
of a Special Procurement.
Form #9 - Special Procurement- Request for Approval, Page 4 of 4, 2/11/2014
TstCity of Ashland, Oregon - RFPs Page 2 of 3
to eight (8) pages. Consultant selection will be based upon
weighted criteria as cited in the request for proposal
document. Standard selection criteria include, but are not
limited to: experience, availability, schedule, and response
time.
Consultant selection is anticipated to result in the issuance of
a contract for financial services in the form provided in this
RFP. The City of Ashland reserves the right to reject any and
all proposals, to waive formalities or to accept any proposal
which appears to serve the best interest of the City of
Ashland.
Request Bid Packet
Purchasing Program
Posting Number: SPECIAL PROCUREMENT
Project Name: PUBLIC NOTICE
Opening Date: 2/24/2014
Opening Time: 4:48:00 PM
Due Date: 3/10/2014
Due Time: 5:OOPM
Description: PUBLIC NOTICE
Approval of a Special Procurement
First date of publication: February 20, 2014
A request for approval of a Special Procurement was
presented to and approved by the City Council, acting as the
Local Contract Review Board, on February 18, 2014.
This Contract- specific Special Procurement allows the
existing 3-year contract with Tristar Risk Management for
Workers' Compensation Third Party Administrative Services
to be extended for an additional two years. Due to the
complex nature of the claims process, staff has requested the
existing contract be extended for an additional two years.
The term for this contract extension will begin on March 1,
2014 and expire on February 28, 2016.
It has been determined based on written findings that the
Special Procurement will be unlikely to encourage favoritism
in the awarding of public contracts or to substantially diminish
competition for public contracts, and result in substantial cost
savings or substantially promote the public interest in a
manner that could not be realized by complying with the
requirements that are applicable in ORS 279B.055,
279B.060, 279B.065, or 27913.070.
http://ashland.or.us/RFP.asp?Print=True 3/3/2014
TstCity of Ashland, Oregon - RFPs Page 3 of 3
An affected person may protest the request for approval of a
Special Procurement in accordance with ORS 279B.400 and
OAR 137-047-0300. A written protest shall be delivered to
the following address: City of Ashland, Tina Gray, Human
Resources, 20 E. Main Street, Ashland, OR 97520. The
seven (7) protest period will expire at 5:00pm on February 27,
2014.
This public notice is being published on the City's Internet
World Wide Web site at least seven days prior to the award of
a public contract resulting from this request for approval of a
Special Procurement.
Request Bid Packet
http://ashland.or.us/RFP.asp?Print=True 3/3/2014
CIT 1/ RECO[? ER Page 1 / 1
CITY OF
ASHLAND DATE==,:; - °s ~ :PO NUMBER
20 E MAIN ST. 5/23/2014 12260
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 015885
TRISTAR RISK MANAGEMENT, CITIZENS BUSINE SHIP TO: City 488OFAShIand
ity -6002
TRM ITF CITY OF ASHLAND (5 20 E MAIN STREET
970 W. 190TH ASHLAND, OR 97520
TORRANC E, CA
90805
FOB Point: Req. No.:
Terms: Net Dept:
Req. Del. Date: Contact: Tina Gray
Special Inst: Confirming? NO
Quanti Umt~, -Descn Lon."3`. ".:UnitPrice~ Ext Price °
THIS ISAREVISED PURCHASE ORDER
TPA Services for Self-insured Workers' 200.000.00
Compensation Proqram, (Loss
replenishment and claims administration)
Special Procurement
Approved by Council 02/18/2014
Valid until February 29, 2016
Contract for Workers' Comp TPA Services
Beqinninq date: March 1, 2014
Completion date: February 29, 2014
BILL To: Account Payable SUBTOTAL 200, 000.00
TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-201 o ASHLAND, , O OR 97520 TOTAL 200,000.00
ASHL
Account Number -.;.Project' Number:'. Amount ~AccountNumber -`Project Number Amount
E 720.03.00.00.60714 200 000.00
Authori Signature VENDORCOPY
CORM#3 CITY OF
ASHLAND
REQUISITION Date of request: I~
Required date for delivery:
Vendor Name I6TfiR 6K MAN4645- I
Address, City, State, zip rl d'W enh r Slu e
Contact Name & Telephone Number v 0 2
Fax Number
Jr.
SOURCING METHOD Z~FStf71q
❑ Exempt from Competitive' Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or proposal attached
❑ Small Procurement Cooperative Procurement
Less than $5.000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
❑ Direct Award Date approved by Council: Contract#
❑ VerbalNVritten quote(s) or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract #
GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract
$5.000 to $100.000 ❑ Written quote or proposal attached Agency
❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract #
PERSONAL SERVICES Intergovernmental Agreement
,Q Special Procurement
$5,000 to 50$0305,000, ❑ Form #g, Request for Approval - ❑ Agency
❑ Less by direct appointment ❑ Written quote or proposal ad had Date original contract approved by Council:
❑ (3) Written proposals/wriften solicitation Date approved b Council: yr~y`F (Date)
El Form #4, Personal Services $5K to $75K Valid until: ail Date
Description of SERVICES Total Cost
TPA- 50-V1 c,6 fvg- 69~w- (Wu.2~,;b WMAV93'
l
MPVSRT ON
1 -N
14 FaW N rsffnnT CLAMS ADos rK (~J
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
'TOTAL COST
• Per attached quotelproposal
Project Number------ Account NumberaJQYDr~~~
Account Number Account Number
'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
IT Director Date Support-Yes/No
By signing this requion form, l certify hat the Cityn's public contracting requirements have been satisfied.
Employee: L 1 Department Head: I
arto or-greater than $5,000)
Department Manager/Supervisor: City Administrator: C--(E u! K--
--mss (EqudLto or greater than $25,000)
Funds appropriated for current fiscal year. /E / NO 16;~/
Finance Director- (Equal ro orgreater than 5,000) Date
Comments:
Form #3 - Requisition