844-Johns Eastern Co-Addendum V
"l ' '.: :\ '. ," ,_of
. ,
~ ''')
~
;
ADDENDUM NUMBER V TO
SERVICE CONTRACT FOR WORKERS' COMPENSATION
CLAIMS HANDLING
This is the fifth Addendum to the Agreement entered into between Johns Eastern Company, Inc.,
hereinafter referred to as the "Service Agent", and the City of Sanford, hereinafter referred to as the
"Employer", dated the 1 st day of October, 200 I.
This Addendum affects the remuneration to be paid by the Employer to the Service Agent for the
handling of exposures whose dates ofloss fall between October 1, 2006 and September 30, 2007.
5. Compensation for Service Agent
a. Fees for claims handling for the Employer for exposures whose dates of loss fall
between October i, 2006 and September 30, 2007 will be a minimum and
deposit of $15,000.00. This fee will be billed annually.
b. The above fee contemplates handling 50 workers' compensation exposures. If
the number of exposures exceeds 50, then the fees will be $305.00 per lost time
or medical only exposure. The minimum and deposits covers all claims
management/administration and data processing services. All years are subject
to audit.
c. Provider bill review/cost containment services will be $5.60 per bill and 30% of
all savings over and above Fee Schedule reductions.
6. Excess Reporting Obligation
Unless otherwise specified in this addendum, Service Agent agrees that reporting claims
to excess insurance carrier is the Service Agent's responsibility. It is the responsibility of
the Employer to provide accurate coverage information regarding any insurance policies
insuring claims covered by this contract. The information for all claim years that the
Service Agent is handling has been provided by the Employer. New insurance
information on renewal years will be made within 90 days of renewal date. Excess
information will include name and claims reporting address and phone number of all
carriers, policy number, effective dates, limits ofliability, deductibles, specific retentions
and loss funds. Actual policies will be provided. If this information is not made available
as outlined in this paragraph, Service Agent will not be responsible for any penalties,
interest, or reductions in excess rccoveries because of late reporting.
r;/;
~
.
All other terms and conditions of the original contract remain unchanged.
IN WITNESS WHEREOF, the parties have executed this Agreement effective for all
purposes as of October 1, 2006.
C. ESSES: .. /
~rg} ~,o~
CITY OF SANFORD
~---
JOHNS EASTERN COMPANY, INC.
tl ~ '
1.~ r/V-d-
Re;
. {} /; (J' '/; /'t:-7-+-I& ,; ,f~/1
u-' C1!7' ,t1/t'{'rT 0/ Q/'vLi! l{~>I/l)1 v;.( fl,t iJ/-c v i "-
- '-~ , t j U [I .t~~ .'~
() ..; I It. -J- /0, j 7-tr' ~ \- / y~ <:}?-,-l i {,
/4/irVlU- .~'v i?WW",J ' Lr v (~ 1./ ~
,-,-
_Jt\I1, / II /'
,/f-f1z;J"eO I J ,tie c?Vi r~ ( ~ A-tJ jJ 60 ~OitV/f -~
W iJt, Johh{ 'ftIJ~ Jzr &0,'1/ ,?~ftJdtJ''''~
~~ z) Lp~ a {iof V{t(~~, )
(~f1./s of tL C~:f N.fL o1/~v ~1!;!"/
(i f /t~ ,th()hJ ~tO I will Je c ~:/ v ~~~lC,
IVl/thlf. rt.[;/
deposit of $15,000.00. This fee will be billed annllall~.
ern Company, Inc.,
rdcrrcd to as the
rvice ;\~ent t,x the
;0, 2007.
;e dates of loss fall
IlIilllllm <Iud
b. The above fee contemplates handling 50 workers' Cl)mpellsation exposures. If
the number of exposures exceeds 50. then the fees will be $305.00 per losttirne
or medical only exposure. The minimum and deposits covers all claims
management/administration and data processing services. All years are subject
to audit
c. Provider bill review/cost containment services will be $5.60 per bill and 30% of
all savings over and above Fee Schedule reductions.
~- ~.! .-"'; '\ -f' ':-t f' ,.' ~, ~_-i
6. Excess Reportin!!. Obligation
Unless otherwise specified in this addendum, Service Agent agrees that reporting claims
to excess insurance carrier is the Service Agent's responsibility. It is the responsibility of
the Employer to provide accurate coverage information regarding any insurance policies
insuring claims covered by this contract. The information tor all claim years that the
Service Agent is handling has been provided by the Employer. Ne\\I insurance
information on renewal years will be made within 90 days of renewal date. Excess
information will include name and claims reporting address and phone number of all
carriers, policy number, effective dates, limits of liability, deductibles, specific retentions
and loss funds. Actual policies will be provided. If this inf()rmation is not made available
as outlined in this paragraph, Service Agent will not be responsible lor any penalties.
interest, or reductions in excess recoveries bcc:wse of late rep(lrting.
, ",. :;) CJ
/'1
o:~