HomeMy WebLinkAbout2009-005 Contract - Beecher Carlson Insurance
Contract for Risk Mana ernent Advisor
CITY OF
ASHLAND
20 East Main Street
Ashland, Oregon 97520
Telephone: 541/488-6002
Fax: 541/488-5311
CONSULTANT: Beecher Carlson Insurance Agency, LLC
CONTACT: Jim Cox, Senior Vice President/Branch Mgr
ADDRESS: 707 Murphy Road, Medford, OR 97504
TELEPHONE: 541-772-1111
DATE AGREEMENT PREPARED: 12/03/2008 FAX: 541-772-3785
BEGINNING DATE: January 2,2009 COMPLETION DATE: January 1,2012
COMPENSATION: The flat fee for 2009 will be $16,500 inclusive of all services outlined in their proposal, subject to a 3%
annual escalation factor. 2010 $16,995, 2011 $17,505
SERVICES TO BE PROVIDED: Risk Management Advisor to provide comprehensive insurance services and
advice/support to the City of Ashland Risk Management Team. An addition to the annual flat fee, a commission may be
paid to Beecher Carlson for coordination and negotiation services with a third party on unique coverage required by the
Cit .
ADDITIONAL TERMS: The agreement "Agency Compensation by Consulting Fee" submitted by Beecher Carlson is
hereby incorporated into the City's contract. Payments for consulting services will be made annually beginning January
2, 2009. Section 5 has been deleted. Section 10 b has been chan ed to sixt 60 da s.
FINDINGS:
Pursuant to AMC 2.52.040E and AMC 2.52.060, after reasonable inquiry and evaluation, the undersigned Department
Head finds and determines that: (1) the services to be acquired are personal services; (2) the City does not have
adequate personnel nor resources to perform the services; (3) the statement of work represents the department's plan for
utilization of such personal services; (4) the undersigned consultant has specialized experience, education, training and
capability sufficient to perform the quality, quantity and type of work requested in the scope of work within the time and
financial constraints provided; (5) the consultant's proposal will best serve the needs of the City; and (6) the
compensation negotiated herein is fair and reasonable.
NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONSULTANT AGREE as
follows:
1 . Findings I Recitations. The findings and recitations set forth above are true and correct and are incorporated herein
by this reference.
2. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described
above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance
of such service.
3. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel
assigned to the work required under this contract are fully qualified to perform the service to which they will be
assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of
Oregon, are so registered, licensed and bonded.
4. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated
above and complete the service by the completion date indicated above.
5. Compensation: City shall pay Consultant for service performed, including costs and expenses, the sum specified
above. Once work commences, invoices shall be prepared and submitted by the tenth of the month for work
completed in the prior month. Payments shall be made within 30 days of the date of the invoice. Should the contract
be prematurely terminated, payments will be made for work completed and accepted to date of termination.
6. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of
City.
7. Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract.
8. Living Wage Requirements: If the amount of this contract is $18,088 or more, Consultant is required to comply with
chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in this chapter, to all employees
performing work under this contract and to any Subcontractor who performs 500/0 or more of the service work under
this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where
it will be seen by all employees.
9. Indemnification: Consultant agrees to defend, indemnify and save City, its officers, employees and agents harmless
from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from
injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of
whatsoever nature arising out of or incident to the performance of this contract by Consultant (including but not
limited to, Consultant's em 10 ees, a ents, and others desi nated b Consultant to erform work or services
Contract for Risk Management Advisor, 12/03/2008, Page 1 of 9
attendant to this contract). Consultant shall not be held responsible for any losses, expenses, claims, subrogations,
actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
10. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. Citv's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
c. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Consultant, or at such later date as may be established by City under any of the following
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Consultant to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Consultant may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Consultant's performance of each and every obligation and duty under
this contract. City by written notice to Consultant of default or breach may at any time terminate
the whole or any part of this contract if Consultant fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obliaation/Liabilitvof Parties. Termination or modification of this contract pursuant to subsections a, b, or
c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such
termination or modification. However, upon receiving a notice of termination (regardless whether such notice is
given pursuant to subsections a, b, c or d of this section, Consultant shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Consultant shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Consultant for work performed prior to
the termination date if such work was performed in accordance with the Contract.
11. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City.
Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide
workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to
this contract. Consultant is a subject employer that will comply with ORS 656.017.
12. Assignment and Subcontracts: Consultant shall not assign this contract or subcontract any portion of the work
without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be
void. Consultant shall be fully responsible for the acts or omissions of any assigns or Subcontractors and of all
persons employed by them, and the approval by City of any assignment or subcontract shall not create any
contractual relation between the assignee or subcontractor and City.
13. Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default
of any covenant, warranty, certification, or obligation it owes under the Contract; its ORF status pursuant to the ORF
Rules or loses any license, certificate or certification that is required to perform the Services or to qualify as a ORF if
consultant has qualified as a ORF for this agreement; institutes an action for relief in bankruptcy or has instituted
against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business
on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or
delegate duties under, the Contract.
14. Insurance. Consultant shall at its own expense provide the following insurance:
a. Worker's Comoensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. Professional Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1.000.000, $2,000,000 or Not Applicable for each claim, incident or occurrence. This is to
cover damages caused by error, omission or negligent acts related to the professional services to be provided
under this contract.
c. General Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, 1 000000, $2,000,000 or Not A licable for each occurrence for Bodil In"ur and Pro ert
Contract for Risk Management Advisor, 12/03/2008, Page 2 of 9
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
d. Automobile Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1.000.000, or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
e. Notice of cancellation or chanae. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coverage(s) without 30 days' written notice from the Consultant or its insurer(s) to
the City.
f. Additional Insured/Certificates of Insurance. Consultant shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Consultant's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Consultant shall furnish acceptable insurance certificates prior to commencing work
under this contract. The certificate will specify all of the parties who are Additional Insureds. Insuring companies
or entities are subject to the City's acceptance. If requested, complete copies of insurance policies; trust
agreements, etc. shall be provided to the City. The Consultant shall be financially responsible for all pertinent
deductibles, self-insured retentions and/or self-insurance.
15. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, lithe claim") between the City (and/or any other or department of the State of Oregon) and
the Consultant that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Consultant, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
16. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONSULTANT, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
17. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Consultant
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Consultant, with no further
liability to Consultant:.
Certifica .on. Con It t shall si n the certification attached hereto as Exhibit A and herein incor orated b reference.
CON ~, I._ CITY OF ASHLAND:
BY ,A~ BY ~
Signature
ft17:,r;: c.,.. ,41 /f-.t;, r;~Z~'.N~
Print Name
TITLE
DATE
I~ ell
DATE
CONTRACT AWARD AND FINDINGS DETERMINED BY:
By: ~ J-..-- d 'tJ /'
FederallD#
City Department Head
Approved as to form
by Legal:
ACCOUNT # 7 'P-t1/ tfJ 9 ~ t' t:J C/ ~ tf?
(For City purposes only)
PURCHASE ORDER # C ~ '1 ~ ~
Date:
*Completed W9 form must be submitted with contract
Contract for Risk Management Advisor, 12/03/2008, Page 3 of 9
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EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be
issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from
backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS
has notified it that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
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 checked four or more of the following
criteria:
x
x
~
J\
~
(1) I carry out the labor or services at a location separate from my residence or is in a
specific portion of my residence, set aside as the location of the business.
(2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
(3) Telephone listing is used for the business separate from the personal residence listing.
(4) Labor or services are performed only pursuant to written contracts.
(5) Labor or services are performed for two or more different persons within a period of one
year.
(6) I assume financial responsibility for defective workmanship or for service not provided
as evidenced by the ownership of performance bonds, warranties, errors and omission
insurance or liability insurance relating to the labor or services to be provided.
I
Contract for Risk Management Advisor, 12/03/2008, Page 4 of 9
Fo~ W-g
Request for Taxpayer
Identification Number and Certification
Give fonn to the
requester. Do not
send to the IRS.
Check appropriate box: 0 Individual/Sole proprietor 0 Corporation 0 Partnership
Kl Limited liability company, Enter the tax classification (D=disregarded entity, C=corporation, P=partnership) .... __ _ ____
o Other (6&& !n6tructionS) ...
Address (number, street, and apt. or suite no,)
707 Mur h Road
City, state, and ZIP code
Medford, OR 97504-8425
(Rev. October 2007)
Department of the Treasury
Internal Revenue Service
Name (as shown on your income tax retum)
C\i
II)
OJ
<0
a.
c:
o
III III
~.~
~g
1:~
-c,s
0..0
:E
o
III
9i
II)
~
BC Holdih s
Business name, if different from above
Beecher Carlson Insurance A ency LLC
List account nU1'lber(s) here (optional)
Taxpayer Identification Number (TIN)
D Exempt
payee
Requester's name and address (optiona~
Enter your TIN in the appropriate box. The TIN provided must match the name given on Une 1 to avoid
backup withholding. For individuals, this is your social security number (SSN), However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3, For other entities, it is
your employer identification number (EIN), If you do not have a number, see How to get a TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter,
I Social 88! num~r
or
Employer identification nunber
81 : 0669367
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am SUbject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3, I am a U,S, citizen or other U.S. person (defined below),
Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return_ For real estate transactions. item 2 does not apply.
For mortgage interest paid. acquisition or abandonment of secured property. cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
prOVide your correct TIN, See the instructions on page 4,
Sign
Here
Signa1ure of
u.S. person ~
~~ 12 c
General Instruction
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use Form W-9 only if you are a U,S. person (including a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income from
a U,S. trade or business is not subject to the withholding tax on
foreign partners' share of effectively connected income,
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
Contract for Risk Management Advisor, 12/03/2008, Page 5 of 9
Date ~
lLr--l.'{-o~;)
Deftnltlon of a U.S. person. For federal tax purposes, you are
considered a U,S, person if you are:
. An individual who is a U.S. citizen or U.S. resident alien,
. A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
. An estate (other than a foreign estate), or
. A domestic trust (as defined in Regulations section
301,7701-7),
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners' share of income
from such business. Further, in certain cases where a Form W-9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United states is in the
following cases:
. The U,S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W-9 (Rev. 10-2007)
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AGENCY COMPENSATION BY
CONSULTING FEE
PREPARED FOR
City of Ashland
PREPARED BY
'Y'h#
j
BEECHER,/il'CARLSON
," Insurance Agency, LLC
Formerly J B ~K RISK SERVICES, LLC
220 t-NV 2nd Ave Ste 800
Portland OR 97209
(503)222-1831 Phone
(503)274-0323 Fax
November 24, 2008
STANDARDS AND ETHICS
We know that your selection of us as your broker is a statement of your trust in us to "Do the right thing, Every
time. Period." We are committed to the highest standards of legal and ethical business conduct. The foundation
of this is our Code of Ethics, but many of our standards go beyond legal requirements. This is not something that
our employees are simply trained on once a year.,. we put them to use daily on your behalf.
How do we do this? It is really not that hard. We place the interest of our clients ahead of all other interests. We
> make a diligent effort to learn your needs, business objectives, and circumstances before offering products and
services. We take all steps possible to determine the accuracy of information and data used to support our
requests for services. We disclose to you the relevant facts, considerations, costs, and risks necessary for an
informed decision on your part, We maintain the highest levels of professionalism by requiring our employees to
meet high standards of professional ethics, to act with honesty, integrity, fairness, diligence, and skill in all that
they do. We ensure our employees maintain the required licenses and continually keep their skills updated via
continuing education each year.
Our Compliance Committee meets regularly to set policy, analyze data, perform audits, and review work product
to ensure high standards are met. The committee works closely with the DeBS and other regulatory agencies.
Our automated systems distribute compliance related policies annually and require employees to sign off on each
policy and complete a test showing their understanding of our standards and expectations.
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CONSULTING FEE CONTRACT
General
Beecher Carlson Insurance Agency LLC (hereinafter Consultant) in consideration for providing services shall
receive a fee directly from City of Ashland (hereinafter Client). This contract is not an Agent of Record letter, an
authorization letter, or a proposal of services.
Contract Period
This contract shall be in effect for the period of January 1, 2009 to January 1, 2012. This contract shall remain in
effect during this contract period unless 60 (sixty) days written notice of termination is given by either party to the
other.
Fee Amount
Client agrees to compensate Consultant in the amount of $51,000. If combining Property/Casualty and
Employee Benefit services under one fee, please indicate allocation between both services:
$51,000 Property & Casualty $ Employee Benefits
If multi-year contract, fee schedule as follows:
2009-2010 Term $16,500 Amount
201 0-2011 Term $16,995 Amount
2011-2012 Term $17,505 Amount
[8J 3% Escalation Clause included on multi-year contracts,
Payment Terms
The Fee Amount shall be paid directly to Consultant by Client in equal payments. The payments shall be made:
[8J Annually, beginning January 1, 2009 or
o Other , beginning
jb
AGENCY COMPENSATION BY CONSULTING FEE
2
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Scope of Services
The fee shall be in consideration for the following insurance services
0 Employee Benefit Program
0 401 (k) Administration 0 Medical
0 AD&D D Medical Accident
0 COBRA Administration 0 Pharmacy Mgr/Prescription Drug
,0 Dental 0 Section 125/FSA Administration
D Employee Assistance Program D Short-Term Disability
D Life 0 Special Risk
0 Long Term Care 0 Travel Accident
D Long Term Disability D Vision
0 Other D
rzl Property and Casualty Insurance Program
0 Aviation ~ Inland Marine
rzl Boiler & Machinery 0 International/Foreign
0 Builders Risk/Course of Construction ~ Liquor Liability
rzl Commercial AutolTrucking/Garage 0 Ocean Marine
rzl Commercial Property ~ Pollution Liability
C8J Crime ~ Professional Liability
C8J Directors & Officers Liability IZl Special Events
C8J Earthquake/DIC D Surety/Bond
C8J Employment Practices Liability ~ Umbrella/Excess Liability
C8J Fiduciary Liability IZl Watercraft
0 Flood D Workers Compensation
D Foreign D Excess Workers Compensation
C8J General Liability 0 Wrap Ups/Special Projects
0 Hull/Protection & Indemnity 0 Other
This contract does not alter, void, terminate, or rescind any agreement that may be in effect between Client and
Consultant for insurance needs not marked in this Scope of Services section.
Additional Comments:
AGENCY COMPENSATION BY CONSULTING FEE
3
Services- Employee Benefits
Consultant will provide the following marked services under the terms of this contract.
o Determine employee benefit plan objectives and goals
o Annual Service Calendar
o Comprehensive review and evaluation of benefit program including plan design, contract provisions,
funding methcx:ls, and cost analysis
o Brokering plans, including request for proposal (RFP) and proposal analysis report
, . ,
o Premium rate and fee negotiations
o Underwrite carrier renewal rating
o Project benefit plan costs including claims, administrative expenses, and reserve liabilities
o Develop budget and COBRA rates for self-insured plans
o Routine claim experience reporting
o Annual benefit plan review including cost comparisons and retention
o Assist in collective bargaining negotiations
o Organize and assist with employee enrollment meetings
o Assist in the creation of open enrollment presentation materials
o Verify and process contracts, amendments, and statement of plan benefits
o Assistance with government compliance requirements, including ERISA reporting and disclosure
o Daily assistance with administrative problems (claims disputes, billings, etc.)
o Annual Report
o Other
AGENCY COMPENSATION BY CONSULTING FEE
4
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Services- Property and Casualtv
Consultant will provide the following marked services under the terms of this contract.
~ Comprehensive review and evaluation of property and casualty insurance program
o Daily maintenance and service of property and casualty insurance program (coverage modifications, audit
disputes, premium billings, etc,).
~ Aggressive marketing and premium negotiation
~ Annual Service Calendar
o Other
Risk Management:
~ Safety Committees - implemention and training
~ Claim Review - Workers' Compensation
~ Claim Review - Property and Liability
~ Ergonomic assessment and training
~ Review Drug and Alcohol Safety Program
C8J Review, develop, and assist in Emergency Procedures
~ Employment Practices consultative services
o Development of an Employment Handbook
~ Fleet Management
~ MyWave internet connection
~ Provide safety tools as needed
~ Site Inspection (annual)
o Other
Sianatures
City of Ashland by
~ ~- ~~
Client Signature
l;Mt(JW ~ ~ 74/YW:5~
Client Name and Title
~""N S~
h~~ ])/~t:.P<-
Beecher Carlson Insurance Agency LLC by
I4CK-'- MifSTYtOA1L- Vp
f3 /~ II " ( (\ n", tf A Co' ~
//0;
Date
/z-frZ/ZOOfj
,
Date
i 1..-2.'L-o ~
Date
State Law requires contracts to be signed prior to the contract effective date.
AGENCY COMPENSATION BY CONSULTING FEE
5
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/VYYY)
12/1/2008
PRODUCER (678)539-4800 FAX: (678)539-4890 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Beecher Carlson Atlanta ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
- HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
20002 Summit Blvd. AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 900
Atlanta GA 30319 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Grea t Northern Ins. Co.
Beecher Carlson Holdings Inc INSURER B: Federal Insurance Co.
2002 Summit Boulevard INSURER C: Lloyds of London
Suites 900 & 925 INSURER D:
Atlanta GA 30319 INSURER E:
rn\l~"'A,.....r-
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L POLICY EFFECTIVE P8~I.fJI~~~t'J!gN LIMITS
I TR IN~Rn TYPE OF INSURANCE POLICY NUMBER DA TEIMM/DDIYY)
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
- ~~~~~~J9E~~~J~~nce )
X COMMERCIAL GENERAL LIABILITY $ 1,000,000
A I CLAIMS MADE ~ OCCUR 3586-05-49 07/17/2008 07/17/2009 MED EXP (Anv one oerson) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Included
~ nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f-- (Ea accident) $
f-- ANY AUTO
f-- ALL OWNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
f---- HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
f----
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000
~ OCCUR D CLAIMS MADE AGGREGATE $ 10,000,000
$
B ~ DEDUCTIBLE 7985-59-93 07/17/2008 07/17/2009 $
RETENTION $ $
B WORKERS COMPENSATION AND 7172-76-02 07/17/2008 07/17/2009 I WC STATU-, I IOTH-
X TORY LIMITS ER
EMPLOYERS' LIABILITY 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E,L, EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under $ 1,000,000
SPECIAL PROVISIONS below E,L, DISEASE - POLICY LIMIT
C OTHER E&O B0146LDUSA0801021 11/15/2008 11/15/2009 $10,000,000
Each Claim/Agg
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Ashland, Oregon, and its elected officials, officers and employees are included as Additional Insureds.
10 Day Notice of Cancellation for Non-Payment of Premium. Subject to Policy Limits, Terms Conditions and Exclusions.
CERTIFICATE HOLDER
The City of Ashland
20 East Main Street
Ashland, OR 97520
CANCELLA TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE r'I7 I L"'t - .. I . /1,
Robert Hessel/BEVEBU ~~
ACORD 25 (2001108)
@ ACORD CORPORATION 1988
1t.J~n?1; ''''''0\ "O~
P,=,no 1 "f?
ADDITIONAL NAMED INSUREDS
Name (First Name & Other Named Insureds
Beecher Carlson Insurance Agency of Mass Inc.
Beecher Carlson Insurance Agency of Ohio Inc.
Beecher Carlson Insurance Agency of Texas, Inc.
Beecher Carlson Insurance Agency, LLC
Riskcap, Inc.
Riskcap Management, LLC
Riskcap Cayman, Ltd
Riskcap of Colorado, Inc.
Sawyer Foster Insurance Services LLC
Beecher Carlson Management, Ltd
Beecher Carlson Brokerage, Ltd
Thomas R. Jones, Inc., dba T. R. Jones & Company
and Kraft Insurance Agency
T. R. Jones & Company of Broward, LLC
On Point Underwriting, Inc.
Alliance Insurance Group
Tribal Nation Insurance Services, LLC
r~'
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
/T'f,"l"'"\' R, rCQ'I-\" ~"'R
V, T t: i1Uc:
I
Page 1 / 1
DATE
1/2/2009
PO NUMBER
08745
VENDOR: 013898
BEECHER CARLSON INSURANCE
707 MURPHY ROAD
MEDFORD, OR 97504
SHIP TO: Ashland Finance Deartment
(541) 488-5300
20 E MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: ADMINISTRATIVE SERVICES
Contact: Lee Tuneberq
Confirming? No
Quantity Unit Description Unit Price Ext. Price
Risk Manaqement Advisor to provide 16,500.00
comprehensive insurance services to the
City of Ashland. Flat fee for the 1 st
year of the contract is $16,500.
Contract For Services
Date of aqreement: ,12/03/2008
Beqinninq date: January 2, 2009
Completion date: January 1,2012
Insurance required/On file
SUBTOTAL 16500.00
BILL TO: Account Payable - TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 16,500.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 720.03.00.00.6041 OC 16 500.00
~~~?
horized Signature
VENDOR COpy